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Review Article
Impact of Postsurgical Disconnection in Aggression Disorder Treatment, Latin American Single Center Experience: A Neuronal Connectomics Analysis
Issue:
Volume 9, Issue 1, June 2025
Pages:
1-9
Received:
14 January 2025
Accepted:
1 February 2025
Published:
20 February 2025
Abstract: Recent advancements in the study of human behavior, along with significant technological progress, have provided a more complete understanding of the neural circuits involved in aggressive responses to external stimuli. Notably, aggression as a voluntary behavior differs from reactive aggression in its neural connections and cerebral connectomics. Aggression is identified as part of a series of responses to stimuli that pose a potential threat to an individual’s physical integrity. By identifying the neural pathways involved in pathological aggression, we can modify this behavior by disrupting these pathways through functional neurosurgery. This study aims to demonstrate, through neuronal connectomics, the effects of postsurgical disconnection following functional neurosurgical procedures designed to treat aggression disorders. For many years, brain function was believed to result solely from the activity of specific cortical areas, which conditioned cognitive responses. However, recent advances in neurology, neuroimaging, neuropsychology, and neurosurgery have shifted our understanding of brain function, revealing a more complex network of connectivity. Despite we are now able to predict the location of primary cortical areas, patients may still experience unanticipated deficits in functions like judgment or memory after surgery. This suggests that traditionally silent regions of the brain may be more anatomically intricate and functionally redundant than previously understood. One of the significant advancements in neuroimaging is Diffusion Tensor Imaging (DTI), which has revolutionized psychiatric surgery, neuroendoscopy, and neuro-oncology. DTI enabled the formation of the Human Connectome Project (HCP), a large-scale initiative that provides detailed data on the brain's connectivity in healthy individuals. The most recent HCP findings have reclassified cortical regions previously described by Brodmann, based on functional connectivity, myelination, and cortical thickness. These advancements contribute to a much more detailed framework for studying brain function and its anatomical organization. This paper explores how these developments in connectomics and neuroimaging are being applied to the understanding and treatment of aggression disorders through functional neurosurgery.
Abstract: Recent advancements in the study of human behavior, along with significant technological progress, have provided a more complete understanding of the neural circuits involved in aggressive responses to external stimuli. Notably, aggression as a voluntary behavior differs from reactive aggression in its neural connections and cerebral connectomics. ...
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Case Report
A Rare Case of External Ear Arteriovenous Malformation Treated with Linac Based Radiosurgery
Issue:
Volume 9, Issue 1, June 2025
Pages:
10-16
Received:
30 January 2025
Accepted:
14 February 2025
Published:
24 February 2025
Abstract: Background: Arteriovenous malformation (AVM) is a congenital vascular anomaly in which there are abnormal connections between arteries and veins in the form of fistula or nidus without an intervening capillary bed. External ear AVMs can cause swelling, redness, bleeding, and pain. Timely diagnosis and treatment are crucial to prevent complications. According to literature, there are different techniques to treat auricular AVM which include surgical excision followed by ear reconstruction, sclerotherapy and embolization. Stereotactic radiosurgery (SRS) has an established role in treating intracranial AVM with excellent obliteration rates but limited literature exists on its efficacy in treating auricular AVM in terms of obliteration rates and cosmetic outcome. Case Presentation: We report a rare case of right external ear AVM which was post embolization and post excision followed by reconstruction but had persistent residual nidus in right pinna treated by stereotactic radiosurgery. He was treated to a dose of 21 Gy in 3 fractions at 7 Gy per fraction for 3 consecutive days. He had completed treatment without any complications. Follow up after 2 weeks of treatment, clinically, patient had redness, swelling and persistent pulsations but no episode of bleeding. At the six-month follow-up, redness, swelling, and pulsations had decreased. Follow up after 1 year post treatment, clinically, redness, swelling and pulsations were not present. Dynamic Brain MRI with angiography showed complete obliteration of residual AVM nidus in right pinna. Patient was satisfied with the cosmetic outcome. Conclusion: We conclude that stereotactic radiosurgery can be used as an effective treatment modality for auricular AVMs. In our case, radiosurgery provided an excellent control and obliteration of the nidus and good cosmetic result eliminating the need for surgical reconstruction at the site of the nidus.
Abstract: Background: Arteriovenous malformation (AVM) is a congenital vascular anomaly in which there are abnormal connections between arteries and veins in the form of fistula or nidus without an intervening capillary bed. External ear AVMs can cause swelling, redness, bleeding, and pain. Timely diagnosis and treatment are crucial to prevent complications....
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Case Report
Sustained Effect of Posteroventral Pallidotomy for X-Linked Dystonia Parkinsonism
Issue:
Volume 9, Issue 1, June 2025
Pages:
17-22
Received:
12 February 2025
Accepted:
24 February 2025
Published:
18 March 2025
Abstract: Background: X-linked dystonia parkinsonism (XDP, DYT3), a disease endemic to Panay Island in the Philippines, is a progressive adult-onset sex-linked neurodegenerative movement disorder with features of both dystonia and parkinsonism. Medical treatment and botulinum toxin injection (BTX) are of limited benefit. Deep brain stimulation (DBS) of the bilateral globus pallidus internus (GPi) is effective but is expensive and requires specialized equipment, training and after care. Posteroventral pallidotomy (PVP) is an older known ablative procedure which has successfully treated cervical and generalized dystonia, but has not been previously used for XDP. Case presentation: Two male adults with genetically-confirmed XDP, presented with progressive and severely disabling dystonias. The mean preoperative Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was 80.5. Both XDP patients underwent a unilateral posteroventral pallidotomy. In the first case, there was a 38.46% decrease in BFMDRS score at 2 weeks sustained to 41.66% decrease (compared to pre-op BFMDRS at 4 years post-surgery). In the second case, there was a 33.73% decrease in BFMDRS at 2 months post-op, and a decrease of 86.74% in BFMDRS score at 3 years post-surgery. Conclusion: While not as effective as bilateral pallidal DBS, the benefits of a unilateral PVP are still substantial and sustained while also being less costly and resource expensive.
Abstract: Background: X-linked dystonia parkinsonism (XDP, DYT3), a disease endemic to Panay Island in the Philippines, is a progressive adult-onset sex-linked neurodegenerative movement disorder with features of both dystonia and parkinsonism. Medical treatment and botulinum toxin injection (BTX) are of limited benefit. Deep brain stimulation (DBS) of the b...
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Case Report
Diagnostic Dilemma in the Management of a Cervical Spinal Cord Lesion: A Case Report of Neuromyelitis Optica Spectrum Disorder
Issue:
Volume 9, Issue 1, June 2025
Pages:
23-29
Received:
13 March 2025
Accepted:
24 March 2025
Published:
19 April 2025
DOI:
10.11648/j.ijn.20250901.14
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Abstract: Neuromyelitis Optica spectrum disorder is a condition in which antibodies are elaborated against aquaporin water channels in the end foot processes of astrocytes due to autoimmune dysregulation thereby initiating a cascade of neuroinflammatory events that culminates in astrocytic injury, dysfunctional axonal blebs and demyelination of the central nervous system neurons. Its cervical spine symptom may sometimes mimic a similar presentation of a cervical spine lesion, this is further underscored by its core clinical magnetic resonance image feature of longitudinally extensive transverse myelitis bearing radiologic similarities with an intramedullary spinal cord lesion thereby resonating the need to maintain a high index of suspicion when evaluating patients with either conditions. Laboratory elucidation of increased titers of aquaporin -4 immunoglobulin and seronegativity for oligoclonal bands is the diagnostic hallmark of the condition and helps differentiate it from similar conditions such as multiple sclerosis and myelin oligodendrocyte glycoprotein disorder. While the mainstay of treatment involves the use of steroids, immunosuppressive therapy and plasmapheresis, it is pertinent to highlight that surgery may have a potential benefit in patients with acute exacerbations of symptoms attributable to cervical spine compressive myelopathy due to the disease. We report a case of a 50-year-old female who had clinical features initially suspected to be a spinal cord lesion but eventually proven with laboratory parameters and histological analysis of resected tissue specimen to be in keeping with Neuromyelitis Optica spectrum disorder.
Abstract: Neuromyelitis Optica spectrum disorder is a condition in which antibodies are elaborated against aquaporin water channels in the end foot processes of astrocytes due to autoimmune dysregulation thereby initiating a cascade of neuroinflammatory events that culminates in astrocytic injury, dysfunctional axonal blebs and demyelination of the central n...
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Review Article
Parasitic Infestations of the Central Nervous System - A Review Article
Issue:
Volume 9, Issue 1, June 2025
Pages:
30-49
Received:
13 March 2025
Accepted:
24 March 2025
Published:
19 April 2025
DOI:
10.11648/j.ijn.20250901.15
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Views:
Abstract: Despite being associated with tropical regions of the world, parasitic infestations of the central nervous system have rapidly evolved over the years to involve previously non-endemic countries. This has been aided by transmigration of populations and ecological drifts, thereby creating health problems of immense socioeconomic implications. Pathophysiologic processes that accompany these infections involve the elaboration of leucocytes, macrophages and inflammatory cytokines leading to the denudation of the blood brain barrier with consequent vasogenic edema with increased intracranial pressure, These infestations manifest with various symptoms of neurologic importance which may include headaches, altered sensorium, and progressive neurologic deficits attributable to the mass effect of tissue necrosis caused by neuroinflammatory reaction to the presence of the parasites. This article attempts to survey the predisposing factors, clinical outcomes and complications of these infestations, while exploring the complex interplay between the clinical presentation, diagnostic modalities and interactions between humans and their environment which aid the proliferation of these parasites. It is imperative to highlight the importance of optimal clinical scrutiny and judgment in diagnosing these conditions while advocating for public health intervention strategies and collaborative research efforts to ameliorate the potential complications of these infestations which exert an extreme impact in the prognosis of affected patients with attendant neurologic sequelae.
Abstract: Despite being associated with tropical regions of the world, parasitic infestations of the central nervous system have rapidly evolved over the years to involve previously non-endemic countries. This has been aided by transmigration of populations and ecological drifts, thereby creating health problems of immense socioeconomic implications. Pathoph...
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,
José Miguel Ramos Delgado
