Limbic system

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  • 文章类型: Case Reports
    此案例强调了及时识别和管理青少年NMDAR脑炎对于减轻潜在的长期后遗症的至关重要性。如果儿科患者出现疑似病毒性脑炎,必须通过脑脊液抗体测定排除自身免疫性病因,以指导适当的免疫抑制治疗,改善患者预后。
    自身免疫性脑炎,特别是涉及n-甲基-d-天冬氨酸受体(NMDAR),被认为是小儿急性脑病的罕见原因。以下病例是一名14岁女性,被诊断患有抗NMDAR脑炎,最初出现发烧,发作性抽搐,和失去知觉。她随后出现了右侧身体无力,表现性失语症,和视觉幻觉。临床检查显示突出的神经精神表现,如感觉改变,运动障碍,幻觉,和视觉障碍。在这种特殊情况下,Cerebello-Bulbar体征并不明显。她接受了病毒性脑炎的治疗,但没有改善。实验室检查显示脑脊液中存在NMDAR抗体,证实了自身免疫病因的诊断。患者在免疫抑制治疗后表现出显著的改善。
    UNASSIGNED: This case underscores the critical importance of timely recognition and management of NMDAR encephalitis in adolescents to mitigate potential long-term sequelae. If a pediatric patient presents with suspected viral encephalitis, autoimmune etiology must be excluded via cerebrospinal fluid antibody assay to guide appropriate immunosuppressive therapy, and improve patient outcomes.
    UNASSIGNED: Autoimmune encephalitis particularly involving the n-methyl-d-aspartate receptor (NMDAR) is recognized as a rare cause of acute encephalopathy in pediatric patients. The following case is of a 14-year-old female diagnosed with anti-NMDAR encephalitis who initially presented with fever, episodic convulsions, and loss of consciousness. She subsequently developed right-sided body weakness, expressive aphasia, and visual hallucinations. Clinical examination revealed prominent neuropsychiatric manifestations such as altered sensorium, motor deficits, hallucinations, and visual disturbances. Cerebello-bulbar signs were not appreciable in this particular case. She was treated for viral encephalitis but showed no improvement. Laboratory investigations revealed the presence of NMDAR antibodies in the cerebrospinal fluid confirming the diagnosis of autoimmune etiology. The patient demonstrated notable improvement following immunosuppressive treatment.
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  • 文章类型: Case Reports
    气味唤起生动而强烈的自传记忆被称为“普鲁斯特现象”,“描绘嗅觉的特殊性,比其他感官方式更有效地引发情感记忆。这种现象已在健康参与者以及杏仁核局灶性刺激和创伤后应激障碍(PTSD)后的癫痫手术前评估中得到了广泛描述。在这项研究中,我们提供了中风后右侧海马区令人厌恶的气味诱发的自传体记忆的首次描述,海马旁,和丘脑核。作为这种现象潜在的潜在神经特征,我们讨论了边缘电路的抑制和主要网络之间的通信受损,比如显著性,中央行政,和默认模式网络。
    Odors evoking vivid and intensely felt autobiographical memories are known as the \"Proust phenomenon,\" delineating the particularity of olfaction in being more effective with eliciting emotional memories than other sensory modalities. The phenomenon has been described extensively in healthy participants as well as in patients during pre-epilepsy surgery evaluation after focal stimulation of the amygdalae and post-traumatic stress disorder (PTSD). In this study, we provide the inaugural description of aversive odor-evoked autobiographical memories after stroke in the right hippocampal, parahippocampal, and thalamic nuclei. As potential underlying neural signatures of the phenomenon, we discuss the disinhibition of limbic circuits and impaired communication between the major networks, such as saliency, central executive, and default mode network.
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  • 文章类型: Journal Article
    背景:内侧颞叶癫痫中,仅有胶质增生(GO)和海马硬化(HS)是不同的组织病理学实体。这项研究探讨了在评估术前和术后记忆时,这种区别是否也存在于功能水平上。
    方法:使用回顾性匹配的病例对照研究设计,我们分析了49例GO患者和49例HS患者择期手术前后的言语和视觉记忆表现.
    结果:临床差异明显,癫痫发作年龄越晚(18±12vs12±9岁),术后无癫痫发作的患者越少(63%vs82%)。术前,群体和个体水平的数据表明,记忆障碍的频率较低,与HS相比,GO患者的严重程度较低且相对非特异性。术后,两组的言语记忆力都下降了,尤其是在左侧切除后,GO患者的损失更大。考虑地板效果,GO还与更显著的视觉记忆丧失有关,特别是在左切除后。
    结论:与HS相比,GO的特点是(1)癫痫发作较晚,(2)手术前不太明显和更多的非特异性记忆障碍,(3)手术效果较差,(4)术后记忆力下降更明显。总的来说,我们关于认知的结果提供了进一步的证据,证明GO和HS是不同的临床实体.海马的功能完整性在GO中表现得更高,术前记忆表现更好,术后记忆结果更差。术前患者咨询期间应考虑不同的风险收益比。
    BACKGROUND: Gliosis only (GO) and hippocampal sclerosis (HS) are distinct histopathological entities in mesial temporal lobe epilepsy. This study explores whether this distinction also exists on a functional level when evaluating pre- and postoperative memory.
    METHODS: Using a retrospective matched case-control study design, we analysed verbal and visual memory performance in 49 patients with GO and 49 patients with HS before and one year after elective surgery.
    RESULTS: Clinical differences were evident with a later age at seizure onset (18±12 vs 12±9 years) and fewer postoperative seizure-free patients in the GO group (63% vs 82%). Preoperatively, group and individual-level data demonstrated that memory impairments were less frequent, less severe and relatively non-specific in patients with GO compared with HS. Postoperatively, verbal memory declined in both groups, particularly after left-sided resections, with more significant losses in patients with GO. Factoring in floor effects, GO was also associated with more significant visual memory loss, particularly after left resections.
    CONCLUSIONS: Compared with HS, GO is characterised by (1) a later onset of epilepsy, (2) less pronounced and more non-specific memory impairments before surgery, (3) a less successful surgical outcome and (4) a more significant memory decline after surgery. Overall, our results regarding cognition provide further evidence that GO and HS are distinct clinical entities. Functional integrity of the hippocampus appears higher in GO, as indicated by a better preoperative memory performance and worse memory outcome after surgery. The different risk-benefit ratios should be considered during presurgical patient counselling.
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  • 文章类型: Case Reports
    背景:SARS-Cov-2感染是一种持续肆虐世界的流行病。它的并发症清单每天都在继续增长。
    方法:我们报告了一例因严重COVID-19感染而入院重症监护的年轻患者。
    结论:由于COVID-19疫情是全球性的大流行,已经报道了各种神经系统表现。另一方面,最近描述了与COVID-19相关的各种边缘叶脑炎病例,它们与炎症细胞因子大量释放的过度炎症综合征或继发性自身免疫反应有关。
    结论:重症COVID-19患者患边缘叶脑炎的风险更高。因此,监测COVID-19患者的神经系统事件非常重要。这使得可以快速开始适当的治疗并避免并发症。
    BACKGROUND: SARS Cov-2 infection is a pandemic that continues to ravage the world. The list of its complications continues to grow every day.
    METHODS: We report the case of a young patient admitted to intensive care for limbic encephalitis associated with severely COVID-19 infection.
    CONCLUSIONS: With the COVID-19 outbreak being a global pandemic, various neurological manifestations have been reported. On the other hand, diverse cases of limbic encephalitis related to COVID-19 have been recently described, they are related either to hyper inflammation syndrome with massive release of inflammatory cytokines or to secondary autoimmune response.
    CONCLUSIONS: Seriously ill COVID-19 patients are at a higher risk of limbic encephalitis. It is therefore important to monitor Neurological Events in COVID-19 patients. This makes it possible to start the appropriate treatments quickly and avoid complications.
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  • 文章类型: Case Reports
    中枢神经系统疾病是Takotsubo综合征的常见诱因。我们在此报告了与自身免疫性边缘叶脑炎相关的Takotsubo综合征的罕见病例。
    一名68岁的日本妇女带着不安的意识来到我们的急诊室。入院时,她表现出低氧血症.左心室造影显示左心室中部运动不能,左心室顶端和基底部分运动过度,并建立了中室Takotsubo综合征的诊断。然而,在意识障碍和Takotsubo综合征症状改善后,她哥哥去医院时注意到她的行为有问题。随后,我们在入院后1周咨询了神经内科.她的兄弟在意识障碍发作前几天透露了患者的异常行为史(例如错误地进入她建筑物的错误公寓或他人的汽车),暗示对地方的迷失方向。脑磁共振成像显示颞叶内侧信号增加,这在流体衰减反转恢复序列上最清楚地观察到;此外,脑脊液分析显示轻度淋巴细胞增多.最后,我们确定了与自身免疫性边缘叶脑炎相关的中室Takotsubo综合征的诊断。
    据推测,自主性边缘性脑病引起的边缘系统功能障碍与过度的交感神经刺激有关。这可能导致我们患者的Takotsubo综合征。
    Central nervous system diseases are common triggers of Takotsubo syndrome. We herein report a rare case of Takotsubo syndrome associated with autoimmune limbic encephalitis.
    A 68-year-old Japanese woman presented to our emergency room with disturbed consciousness. At admission, she showed hypoxemia. Left ventriculography showed akinesia in the middle part of the left ventricle and hyperkinesia in the apical and basal parts of the left ventricle, and the diagnosis of midventricular Takotsubo syndrome was established. However, after an improvement in disturbed consciousness and Takotsubo syndrome symptoms, her brother noticed something wrong with her behavior during his visit to the hospital. Subsequently, we consulted the neurology department 1 week after admission. Her brother revealed a history of abnormal behavior by the patient (such as mistaken entry in the wrong apartment in her building or in another person\'s car) a few days prior to the onset of disturbed consciousness, suggesting disorientation of place. Brain magnetic resonance imaging showed an increased signal in the medial aspect of the temporal lobes, which was most clearly observed on the fluid-attenuated inversion recovery sequence; additionally, a cerebrospinal fluid analysis revealed mild lymphocytic pleocytosis. Finally, we established a diagnosis of midventricular Takotsubo syndrome associated with autoimmune limbic encephalitis.
    It is presumed that the dysfunction of limbic system due to autonomic limbic encephalopathy is associated with exaggerated sympathetic stimulation. This likely resulted in Takotsubo syndrome in our patient.
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  • 文章类型: Case Reports
    Limbic-predominant age-related TDP-43 encephalopathy (LATE) is a recently established neurodegenerative disease entity. LATE neuropathological change (LATE-NC) is characterized by a TDP-43 proteinopathy that mainly involves the amygdala and medial temporal structures, with or without hippocampal sclerosis. LATE-NC is typically observed in individuals aged 80 years or older and manifests clinically as amnestic memory decline. Herein, we report a case of LATE diagnosed by brain autopsy in an 82-year-old male who had an 11-year history of memory impairment. Pathological examination revealed high Alzheimer disease neuropathological changes, as well as amygdala-predominant Lewy body pathology. In addition, immunohistochemistry for TDP-43 revealed neuronal and glial cytoplasmic inclusions in the dentate gyrus of the hippocampus, amygdala, and inferior temporal cortex. Increasing awareness of the newly defined entity LATE will enhance our understanding of the neurodegenerative processes that occur in the oldest individuals.
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  • 文章类型: Case Reports
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  • 文章类型: Journal Article
    注意缺陷/多动障碍(ADHD)是一种神经发育障碍,对儿童的健康有严重影响,尤其是在学术上,心理和关系层面。目前对该疾病的评估得到了临床评估和书面测试的支持。通常根据DSM-V标准进行明确的诊断。有很多关于多动症的研究正在进行,以确定该疾病的神经生理学基础并达到更客观的诊断。机器学习(ML)的出现为能够根据表型和神经影像学数据预测诊断的系统的开发开辟了广阔的前景。这就是几年前启动ADHD-200竞赛的原因。根据公开的ADHD-200系列,参与者在预测ADHD时以最佳的预测准确性被挑战.在目前的工作中,相反,我们提出了一种ML方法,该方法主要重视模型的解释力。这种方法旨在在性能需求和医疗诊断辅助系统预期的可解释性之间实现公平的权衡。我们将我们的方法应用于从ADHD-200集合中提取的数据样本,通过开发决策树,这些决策树因其可读性而受到重视。我们的分析表明边缘系统与疾病诊断的相关性。此外,在提供有意义的解释的同时,鉴于文献中报道的最新结果,所得到的决策树表现良好。
    Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that has heavy consequences on a child\'s wellbeing, especially in the academic, psychological and relational planes. The current evaluation of the disorder is supported by clinical assessment and written tests. A definitive diagnosis is usually made based on the DSM-V criteria. There is a lot of ongoing research on ADHD, in order to determine the neurophysiological basis of the disorder and to reach a more objective diagnosis. The advent of Machine Learning (ML) opens up promising prospects for the development of systems able to predict a diagnosis from phenotypic and neuroimaging data. This was the reason why the ADHD-200 contest was launched a few years ago. Based on the publicly available ADHD-200 collection, participants were challenged to predict ADHD with the best possible predictive accuracy. In the present work, we propose instead a ML methodology which primarily places importance on the explanatory power of a model. Such an approach is intended to achieve a fair trade-off between the needs of performance and interpretability expected from medical diagnosis aid systems. We applied our methodology on a data sample extracted from the ADHD-200 collection, through the development of decision trees which are valued for their readability. Our analysis indicates the relevance of the limbic system for the diagnosis of the disorder. Moreover, while providing explanations that make sense, the resulting decision tree performs favorably given the recent results reported in the literature.
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  • 文章类型: Case Reports
    BACKGROUND The fornix is a white matter tract bundle that acts as the major output of the hippocampus and is an important component of the Papez circuit. We present an instructive imaging case of sudden onset of persistent amnesia due to selective ischemic damage of the anterior fornix. CASE REPORT A 54-year-old Japanese male came to our attention for a sudden onset of retrograde amnesia, associated with severe anterograde amnesia. The brain magnetic resonance imaging demonstrated a bright diffusion restriction, which was associated with swollen fornices bilaterally. His symptoms gradually improved, but episodic memory impairment still persisted after 1 month. The coronal T1-weighted MPRAGE (magnetization-prepared rapid acquisition with gradient echo) sequence clearly showed disruption of the left anterior fornix. Diffusion tensor tracking showed decrease in the density of entire fiber tracts on the Papez circuit as well as location of the left fornix. CONCLUSIONS When dealing with sudden, persistent amnesia associated with small fornix infarction, it is prudent to consider the possibility of tract damage along with limbic system damage using MPRAGE sequence.
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  • 文章类型: Journal Article
    Injury to the thalamocortical tract (one in the Papez circuit) that leads to memory impairment following brain injury is very rare. In this study, we present a case of partial injury to the thalamocortical tract that causes memory impairment after concurrent thalamic and hippocampal infarct. A 20-year-old male complained of memory impairment 1 month after partial injury to the thalamocortical tract. Using a probabilistic diffusing tensor tractography, it was found that the right thalamocortical tract was thinner than the left thalamocortical tract. However, all other neural tracts including the fornix, cingulum, and mammillothalamic tract were intact on both hemispheres. Therefore, the memory impairment in this patient was considered as being due to thalamic infarct based on the observation that the fornix from hippocampal infarct was intact. This case suggests that the assessment of lesions in the neural tracts of the Papez circuit might be useful for understanding the mechanism of memory impairment following cerebral infarction.
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