Volume Articles

MR imaging findings of germ cell tumors arising from the basal ganglia: focused on early imaging finding

So Mi Lee^1,2, In-One Kim¹

Germ cell tumor (GCT) arising in the basal ganglia or thalami is relatively uncommon. It occurs most commonly in boys during second decade of life. It is difficult to diagnose early stage GCTs in these regions because the images are not so typical and the symptom onset is insidious. However, early diagnosis of this tumor is important because of the high radiosensitivity and potential curability. Early stage GCTs originating from the basal ganglia or thalami appear as ill-defined small patchy lesions. They frequently present as hyperintense lesions compared with deep gray matter on T2-weighted image without cyst, mass effect, or prominent enhancement. Microhemorrhages can be accompanied infrequently. These tumors are mostly associated with ipsilateral hemiatrophy at the time of presentation. During tumor progression, tiny cysts develop at a relatively early stage, and intratumoral cyst, hemorrhage, and ipsilateral hemiatrophy gradually tend to be more pronounced. Ultimately, these become overt large mass with remarkable heterogenous enhancement, containing multiple cysts of various sizes and hemorrhage. This review aims to describe the serial MR imaging findings of the GCTs arising from basal ganglia or thalami, focusing on the early finding.

Neonatal Hypoxic-Ischemic Brain Injury: Apoptotic and Non-Apoptotic Cell Death

Qing Lu, Stephen M. Black

The neuronal cell death associated with perinatal asphyxia, or hypoxic-ischemic (HI) brain injury, plays an important role in neonatal mortality and neurodevelopment retardation. The types of cell death associated with HI in the brain have been classified as being either apoptotic or necrotic. Here we describe the recent discoveries of multiple non-apoptotic cell death pathways: necroptosis; ferroptosis; and autosis (autophagy). These new cell death pathways expand our understanding of the mechanisms underlying the cell death associated with perinatal asphyxia. By targeting specific regulators of these pathways, new therapies may be developed that could protect the neonatal brain from the HI mediated injury.

Cannabis and Autoimmunity - The Neurologic Perspective: A Brief Review

Katz D^1,2, Katz I^1,2, Shoenfeld Y^1,3*

Primary Intracranial Leiomyosarcoma - Case Report and Principles for Treatment

Homajoun Maslehaty^1*, Arya Nabavi², Hubertus Maximilian Mehdorn²

Biological Factors Influencing the Mice Forced Swim Test

Cong-Cong Qi^1,2, Yu-Qiang Ding¹, Jiang-Ning Zhou^2*

The forced swim test (FST), originally developed by Porsolt et al., is highly valuable for assessing the antidepressant-like effects of the majority of currently-available antidepressants. Lucki et al. modified some parameters of the traditional FST in order to facilitate the differentiation between serotonergic and noradrenergic classes of antidepressant drugs. In addition, the FST is one of the most commonly used models for assessing antidepressant-like behaviors in both rats and mice. Focus on the present neuroscience field, knockout and transgenic mice provide a tool for assessing the mechanisms of action of antidepressants, and the factors influencing these behavior in the FST should be taken into considerations. In this MiniReview, we reviewed several biological factors (e.g. strain, gender, age, susceptibility) that may in?uence mice behavior in the FST and attempt to describe those variables that should be considered when designing studies employing the FST.

Hyperhidrosis - an unknown widespread "silent" disorder

Alma Rystedt¹, Kerstin Brismar², Sten-Magnus Aquilonius³, Hans Naver⁴, Carl Swartling^1,5*

¹Hidrosis Clinic, Stockholm, Sweden
²Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
³Department of Neuroscience, Neurology, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
⁴Department of Internal Medicine, Neurology, Nyköping Hospital, Nyköping, Sweden
⁵Department of Medical Sciences, Dermatology and Venereology, Uppsala University, Uppsala, Sweden

Hyperhidrosis is a social, emotional and occupational disability which affects close to 3 % of the population. Patients with hyperhidrosis suffer an extremely negative impact on their quality of life on a par with being severely affected by psoriasis. Most of the sufferers have the primary genetic form of hyperhidrosis. Secondary hyperhidrosis can often be omitted based on anamnestic data, but sometimes further examinations must be performed.

Topical treatment (e.g. aluminium chloride) is the first choice for localised hyperhidrosis. Botulinum toxin, iontophoresis, microwave thermolysis (miraDry®), and/or systemic medications are indicated if topical treatment is insufficient or not applicable. Endoscopic Thoracic Sympathectomy (ETS) is no longer performed in Sweden due to the serious side effects profile. In countries where ETS still is performed, patients must be carefully selected and educated to fully understand the possibility of limited efficacy and the risks of complications including, but not limited to, compensatory sweating. This treatment should be the last option.

Examination- and treatment recommendations based on international guidelines and literature are presented in this review.

The Essential Tremor Rating Assessment Scale

Rodger J. Elble

The Essential Tremor Rating Assessment Scale was developed by the Tremor Research Group (www.tremorresearchgroup.org) to quantify essential tremor severity and its impact on activities of daily living. This scale requires only a pen and paper, and can be completed in about 10 minutes. Upper extremity action tremor is the main focus of this scale, but action tremor is also assessed in the head, face, voice, and lower limbs. The scale has excellent face validity, inter- and intra-rater reliability, and sensitivity to change. The activities of daily living section correlates strongly with the performance section, and this scale also correlates strongly with transducer measures of tremor and with the Fahn-Tolosa-Marín tremor rating scale. In the Fahn-Tolosa-Marín tremor rating scale, upper extremity tremor greater than 4 cm corresponds to a maximum rating of 4, while grade 4 tremor in the Essential Tremor Rating Assessment Scale corresponds to an amplitude greater than 20 cm. Therefore, the Essential Tremor Rating Assessment Scale is better suited for assessment of severe essential tremor.

Central nervous system toxicities of anti-cancer immune checkpoint blockade

Jonathan T. Blackmon¹, Toni Viator RN², Robert M. Conry^3*

Immune checkpoint inhibitors (CPIs) which unleash suppressed antitumor immune responses are revolutionizing the systemic treatment of cancer. Durable responses and prolongation of survival come at a price of frequent immune-related adverse events resulting from inflammation of normal tissues. Herein, we review serious central nervous system (CNS) toxicities of immune CPIs including ipilimumab, nivolumab, pembrolizumab and atezolizumab. Case reports of 20 patients with CPI-associated encephalitis, meningitis, or myelitis were reviewed as well as data from large scale registration trials. The overall incidence of serious immune-related CNS toxicities is approximately 0.4-1% with the potential for hundreds of cases annually in the United States. Patients suspected of having serious CPI-associated CNS toxicity should have a neurology consult, lumbar puncture, and MRI of the affected regions. If confirmed, the offending drug should be permanently discontinued and high dose intravenous steroids initiated, preferably with 500-1,000 mg of methylprednisolone daily. With timely diagnosis and appropriate management, the majority of patients experience complete neurologic recovery. As the array of indications for CPIs rapidly increases, it is imperative for clinicians to have a high index of suspicion for immune-related CNS toxicities.