Isolated Third Nerve Cranial Palsy: Complication of Brain Aneurysm

This case report highlights a critical and emergent condition, isolated third nerve cranial palsy due to a brain aneurysm. It emphasizes the importance of differential diagnosis and attentiveness to the physical exam in an emergency setting. The detailed progression from initial symptoms and misinterpretation to final diagnosis offers valuable insight into the dangers of overlooking critical diagnoses. A bilobed intracranial aneurysm arising from the internal carotid artery (ICA) caused symptoms in this patient that could have been attributed to a less malignant etiology, such as a complex migraine. Overlooking the urgency of the situation and missing the diagnosis could have had a grave and irreversible outcome.

Toll-like receptor 4 as a possible therapeutic target for delayed brain injuries after aneurysmal subarachnoid hemorrhage

Neuroinflammation is a well-recognized consequence of subarachnoid hemorrhage（SAH）, and Toll-like receptor（TLR） 4 may be an important therapeutic target for post-SAH neuroinflammation. Of the TLR family members, TLR4 is expressed in various cell types in the central nervous system, and is unique in that it can signal through both the myeloid differentiation primary-response protein 88-dependent and the toll receptor associated activator of interferon-dependent cascades to coordinate the maximal inflammatory response. TLR4 can be activated by many endogenous ligands having damage-associated molecular patterns including heme and fibrinogen at the rupture of an intracranial aneurysm, and the resultant inflammatory reaction and thereby tissue damages may furthermore activate TLR4. It is widely accepted that the excreted products of TLR4 signaling alter neuronal functions. Previous studies have focused on the pathway through nuclear factor（NF）-κΒ signaling among TLR4 signaling pathways as to the development of early brain injury（EBI） such as neuronal apoptosis and blood-brain barrier disruption, and cerebral vasospasm. However, many findings suggest that both pathways via NF-κΒ and mitogen-activated protein kinases may be involved in EBI and cerebral vasospasm development. To overcome EBI and cerebral vasospasm is important to improve outcomes after SAH, because both EBI and vasopasm are responsible for delayed brain injuries or delayed cerebral ischemia, the most important preventable cause of poor outcomes after SAH. Increasing evidence has shown that TLR4 signaling plays an important role in SAH-induced brain injuries. Better understanding of the roles of TLR4 signaling in SAH will facilitate development of new treatments.

Clinical application of retrograde cerebral perfusion for brain protection during the surgery of ascending aortic aneurysm:50 cases report

Objective To assess retrospectively the effects of different protective methods on brain in ascending aortic aneurysm surgery. Methods In 65 patients, aneurysm was dissected to the aortic arch or right arch. To protect brain, deep hypotermic circulatory arrest ( DHCA.) combined with retrograde cerebral perfusion ( RCP) June 2003 Vol11 No2 through the superior vena cava ( n = 50) and simple DHCA ( n = 15) were used during the procedure. Blood samples for lactic acid level from the jugular vein were compared in both groups at different plase, and perfusion blood distribution and oxygen content difference between the perfused and returned blood were measured in some RCP patients. Results The DHCA time was 35.9 ± 8 min (10. 0 - 63. 0 min) and DHCA+ RCP time was 45.5 ± 17. 2 min (16. 0 - 81. 0 min)The resuscitationtime was 7.1 ± 1.6 h (4.4 - 9.4H)in DHCA patients and 5.4±2.2h(2.0-9.0 h)in RCP patients. Operation death was 3/15 in the DHCA group and 1/50 in the RCP patients. Central nervous complication

Characterizing objective and self-report habitual physical activity and sedentary time in outpatients with an acquired brain injury

Outpatients with an acquired brain injury(ABI)experience physical,mental,and social deficits.ABI can be classified into two subgroups based on mechanism of injury:mild traumatic brain injury(mTBI;e.g.,concussion)and other ABI(e.g.,stroke,brain aneurysm,encephalitis).Our understanding of habitual activity levels within ABI populations is limited because they are often collected using self-report measures.The purpose of this study was to,1)describe the habitual activity levels of outpatients with ABI using objective and self-report monitoring,and 2)compare the activity levels of outpatients with mTBI vs.other ABI.Sixteen outpatients with other ABI(mean±standard deviation:[58±13]years,9 females)and 12 outpatients with mTBI([48±11]years,9 females)wore a thigh-worn activPAL 24 h/day(h/day)for 7-days.Outpatients with ABI averaged(6.0±2.3)h/day of upright time,(10.6±2.2)h/day of sedentary time,(5.6±2.7)h/day in prolonged sedentary bouts>1 h,(5960±3037)steps/day,and(11±13)minutes/day(min/day)of moderate-vigorous physical activity(MVPA).There were no differences between activPAL-derived upright,sedentary,prolonged sedentary time,and physical activity between the mTBI and other ABI groups(all,p>0.31).Outpatients with ABI overestimated their MVPA levels(t138 min/week)and underestimated sedentary time(-4.3 h/day)compared to self-report(all,p<0.001).Despite self-reporting high activity levels,outpatients with ABI objectively exhibit highly inactive and sedentary lifestyles.The habitual movement behaviours of our sample did not differ by mechanism of injury(i.e.,mTBI versus other ABI).Targeting reductions in objectively measured sedentary time are needed to progressively improve the habitual movement behaviours of outpatients with ABI.

Association of aneurysmatic subarachnoid hemorrhage rate with environmental changes or emotional bursts

Introduction In the present letter we share the results of an analysis of more than 140,000 non traumatic arterial subarachnoid hemorrhages whereas the majority of them is expected to be after aneurysm rupture,in which we investigate a possible correlation of climatic changes and emotional bursts as correlating factors for such a rupture.Methods We obtained the daily number of SAH from 2006 to 2018 for males and females from the German National statistics agency.The ICD codes provided to us were I60.1-I60.7,which are SAHs originating from intracranial arteries and excluding traumatic SAH and other not specified SAH.Results An increase of mean SAH per day could be seen in winter compared to summer and family events seemed to have a protective effect against aneurysmal SAH.Additionally 6.55 more women per day suffer an SAH compared to men.Conclusion There is a statistical significant higher risk of aneurysm ruptures in winter and in females,and a statistical lower number in Mother’s day.