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Ignacio Casas Parera – One of the best experts on this subject based on the ideXlab platform.

  • Neuromyelitis optica with high aquaporin-4 expression and positive serum aquaporin-4 autoantibodies
    Medicina, 2012
    Co-Authors: Alejandra Báez, Mariana Báez, Valeria Kuchkaryan, Adrián Schoijedman, Carlos Lozano, Ignacio Casas Parera

    Abstract:

    Disease-specific aquaporin-4 antibodies (NMO-IgG) are the main effector of lesions in neuromyelitis optica (NMO) patients. Brain MRI lesions are detected in 60% of them, with 8% (almost infants) at sites of high aquaporin-4 expression. Patient 1: A fifty-year-old male with loss of vision in the right eye. Empiric treatment with metilprednisolone 1g/d for 3 days was indicated. After 30 days he complained of generalized pain, and a right hemiparesis was evident. The patient received bolus of metilprednisolone 1g/d for 5 days plus IgG 400 mg/kg/d IV for 5 days. He recovered ambulation but persisted with pain and paroxysmal phenomena (Lhermitte). Visual Evoked Potentials (VEP): P100 left eye 123 ms, right eye without response. Brain MRI (FLAIR) showed hyperintensity in the right optic nerve, hypothalamus and Anterior White Commissure. Cervical MRI showed extensive spinal cord lesion to an extension of 5 vertebral bodies. Patient 2: A fifty-three-year-old female who referred decreased visual acuity in both eyes and paresthesia in lower limbs which subsided spontaneously. One month later the patient evolved with cuadriparesis and sphincter incontinence. No improvement was observed with bolus of metilprednisolone 1g/d for 5 day. VEP: P100 left eye 124 ms, right eye 128 ms. Brain MRI (FLAIR) disclosed hypothalamic and periaqueductal hyperintensity. Cervical MRI showed extensive spinal cord lesion to an extension of 7 vertebral bodies. NMO-IgG antibodies were positive in both patients (indirect immunofluorescence assay). NMO brain lesions at sites of high aquaporin-4 expression, once considered atypical for their topography and infrequency in adults, should be borne in mind when considering differential diagnosis.

  • Neuromielitis óptica con alta expresión de acuaporina-4 y anticuerpos anti-acuaporina-4 positivos en suero Neuromyelitis optica with high aquaporin-4 expression and positive serum aquaporin-4 autoantibodies
    Fundación Revista Medicina, 2012
    Co-Authors: Alejandra Báez, Mariana Báez, Valeria Kuchkaryan, Adrián Schoijedman, Carlos Lozano, Ignacio Casas Parera

    Abstract:

    La presencia de anticuerpos IgG en suero, con blanco en los canales de acuaporina-4, es específica de la neuromielitis óptica (NMO). El 60% de los pacientes con NMO presentan lesiones cerebrales en la resonancia magnética (RM); en un 8% (mayoría niños) estas lesiones se consideraron “atípicas”. Presentamos dos pacientes con NMO y lesiones en el SNC de alta expresión de acuaporina-4. Caso 1: varón de 50 años, que comenzó con pérdida de visión en ojo derecho (OD). Recibió tratamiento empírico con metilprednisolona 1 g/d x 3 días. Al mes presentó dolor generalizado y hemiparesia derecha; nuevamente recibió metilprednisolona 1 g/d x 5 días e IgG IV 400 mg/kg/d × 5 días. Recuperó la deambulación persistiendo el dolor y fenómenos paroxísticos en los 4 miembros. Potenciales evocados visuales: P100, ojo izquierdo (OI) 123 mseg. OD sin respuesta. La RM de cerebro (FLAIR) mostró hiperintensidad en nervio óptico derecho, hipotálamo y comisura blanca Anterior. RM cervical: lesión medular extensa (5 cuerpos vertebrales). Caso 2: mujer de 53 años, con disminución de la agudeza visual en ambos ojos y parestesias en miembros inferiores que remitieron espontáneamente. Evolucionó al mes con cuadriparesia e incontinencia esfinteriana. Recibió metilprednisolona 1 g/d x 5 días, sin mejoría. Potenciales evocados visuales: P100 OI 124 mseg. OD 128 mseg. RM cerebro: (FLAIR) hiperintensidad hipotalámica y periacueductal. RM cervical: lesión medular extensa (7 cuerpos vertebrales). Anticuerpos anti-acuaporina-4 positivos en ambos pacientes (inmunofluorescencia indirecta). Las lesiones consideradas “atípicas”, como aquí, en sitios con alta densidad de proteínas canales de agua AQP4 deberán considerarse para el diagnóstico diferencial.Disease-specific aquaporin-4 antibodies (NMO-IgG) are the main effector of lesions in neuromyelitis optica (NMO) patients. Brain MRI lesions are detected in 60% of them, with 8% (almost infants) at sites of high aquaporin-4 expression. Patient 1: A fifty-year-old male with loss of vision in the right eye. Empiric treatment with metilprednisolone 1g/d for 3 days was indicated. After 30 days he complained of generalized pain, and a right hemiparesis was evident. The patient received bolus of metilprednisolone 1g/d for 5 days plus IgG 400 mg/kg/d IV for 5 days. He recovered ambulation but persisted with pain and paroxysmal phenomena (Lhermitte). Visual Evoked Potentials (VEP): P100 left eye 123 ms, right eye without response. Brain MRI (FLAIR) showed hyperintensity in the right optic nerve, hypothalamus and Anterior White Commissure. Cervical MRI showed extensive spinal cord lesion to an extension of 5 vertebral bodies. Patient 2: A fifty-three-year-old female who referred decreased visual acuity in both eyes and paresthesia in lower limbs which subsided spontaneously. One month later the patient evolved with cuadriparesis and sphincter incontinence. No improvement was observed with bolus of metilprednisolone 1g/d for 5 day. VEP: P100 left eye 124 ms, right eye 128 ms. Brain MRI (FLAIR) disclosed hypothalamic and periaqueductal hyperintensity. Cervical MRI showed extensive spinal cord lesion to an extension of 7 vertebral bodies. NMO-IgG antibodies were positive in both patients (indirect immunofluorescence assay). NMO brain lesions at sites of high aquaporin-4 expression, once considered “atypical” for their topography and infrequency in adults, should be borne in mind when considering differential diagnosis

Sonu Gupta – One of the best experts on this subject based on the ideXlab platform.

  • neuroanatomy spinothalamic tract
    StatPearls, 2019
    Co-Authors: Mustafa Alchalabi, Sonu Gupta

    Abstract:

    The spinothalamic tract (STT) is a sensory tract that carries nociceptive, temperature, crude touch, and pressure from our skin to the somatosensory area of the thalamus. It is responsible for our quick withdraw reaction to a painful stimulus such as touching the stove burner. The spinothalamic tract is composed of two adjacent pathways: Anterior and lateral. The Anterior spinothalamic tract carries sensory input about crude touch. The lateral spinothalamic tract carries information about pain and temperature. These two divisions of the spinothalamic tract run next to each other indistinctly. Thus, they can be considered one pathway. The spinothalamic tract is part of the anterolateral system which also encompasses the spinoreticulothalamic tract (SRTT) and the spinotectal tract (SpTT). Three types of sensory fibers are associated with the spinothalamic tract: type III fibers, unmyelinated c-fibers, and myelinated A-delta fibers. Peripheral receptors associated with the spinothalamic tract pathway are nociceptors, thermal receptors, and thermal nociceptors. Nociceptors are associated with A-delta and type III fibers, which are small, lightly myelinated axons for the transmission of fast, sharp pain. Thermal receptors and thermal nociceptors are associated with A-delta and C fibers, which are small, unmyelinated axons that conduction the transmission of slow burning pain.[1][2] The pathway of the spinothalamic tract to the cerebral cortex starts with the dorsal root ganglions, which are composed of pseudounipolar neurons with peripheral (distal) and central (proximal) axonal process. These dorsal root ganglia lie adjacent to the spinal cord and represent the first-order neuron of the spinothalamic tract pathway. The axons of central process of the first-order neurons enter the spinal cord through the lateral dorsal root entry zone to enter the Lissauer tract and synapses with second-order neurons in the substantia gelatinosa, which is located in the grey matter of the spinal cord. The axons of the second-order neurons cross over the spinal cord to the opposite side two segments above the level of entry via the Anterior White Commissure, unlike the posterior medial lemniscus pathway which decussates in the brainstem. The decussating second-neuron fibers enter the anterolateral portion of the spinal cord and then enter the brainstem as the spinal lemniscus. The spinothalamic tract ascends in the ventrolateral aspect of the spinal White matter over the length of the spinal cord. The anterolateral system in the rostral medulla runs between the inferior olivary nucleus and the nucleus of the spinal trigeminal tract; whereas, in the pons and midbrain anterolateral system runs dorsolateral to the medial lemniscus. The spinothalamic tract of the anterolateral system terminates in the ventral posterolateral nucleus (VPL) of the thalamus, the third-order neurons of this pathway. From the thalamus, axons of VPL neurons project out of the thalamus laterally and course somatotopically through the internal capsule’s posterior limb of the and terminate in the postcentral gyrus primary somatosensory. In the spinal cord, the spinothalamic tract pathway has a certain somatotopic organization. The medial part of the track receives cervical input while the lateral part receives sacral input. Other pathways such as cortical spinal tract and posterior medial lemniscus pathway have a reversed somatotopy in comparison to the spinothalamic tract.[3][4][5][6]

  • “StatPearls” – Neuroanatomy, Spinothalamic Tract
    , 2019
    Co-Authors: Mustafa Al-chalabi, Sonu Gupta

    Abstract:

    The spinothalamic tract (STT) is a sensory tract that carries nociceptive, temperature, crude touch, and pressure from our skin to the somatosensory area of the thalamus. It is responsible for our quick withdraw reaction to a painful stimulus such as touching the stove burner. The spinothalamic tract is composed of two adjacent pathways: Anterior and lateral. The Anterior spinothalamic tract carries sensory input about crude touch. The lateral spinothalamic tract carries information about pain and temperature. These two divisions of the spinothalamic tract run next to each other indistinctly. Thus, they can be considered one pathway. The spinothalamic tract is part of the anterolateral system which also encompasses the spinoreticulothalamic tract (SRTT) and the spinotectal tract (SpTT). Three types of sensory fibers are associated with the spinothalamic tract: type III fibers, unmyelinated c-fibers, and myelinated A-delta fibers. Peripheral receptors associated with the spinothalamic tract pathway are nociceptors, thermal receptors, and thermal nociceptors. Nociceptors are associated with A-delta and type III fibers, which are small, lightly myelinated axons for the transmission of fast, sharp pain. Thermal receptors and thermal nociceptors are associated with A-delta and C fibers, which are small, unmyelinated axons that conduction the transmission of slow burning pain.[1][2] The pathway of the spinothalamic tract to the cerebral cortex starts with the dorsal root ganglions, which are composed of pseudounipolar neurons with peripheral (distal) and central (proximal) axonal process. These dorsal root ganglia lie adjacent to the spinal cord and represent the first-order neuron of the spinothalamic tract pathway. The axons of central process of the first-order neurons enter the spinal cord through the lateral dorsal root entry zone to enter the Lissauer tract and synapses with second-order neurons in the substantia gelatinosa, which is located in the grey matter of the spinal cord. The axons of the second-order neurons cross over the spinal cord to the opposite side two segments above the level of entry via the Anterior White Commissure, unlike the posterior medial lemniscus pathway which decussates in the brainstem. The decussating second-neuron fibers enter the anterolateral portion of the spinal cord and then enter the brainstem as the spinal lemniscus. The spinothalamic tract ascends in the ventrolateral aspect of the spinal White matter over the length of the spinal cord. The anterolateral system in the rostral medulla runs between the inferior olivary nucleus and the nucleus of the spinal trigeminal tract; whereas, in the pons and midbrain anterolateral system runs dorsolateral to the medial lemniscus. The spinothalamic tract of the anterolateral system terminates in the ventral posterolateral nucleus (VPL) of the thalamus, the third-order neurons of this pathway. From the thalamus, axons of VPL neurons project out of the thalamus laterally and course somatotopically through the internal capsule’s posterior limb of the and terminate in the postcentral gyrus primary somatosensory. In the spinal cord, the spinothalamic tract pathway has a certain somatotopic organization. The medial part of the track receives cervical input while the lateral part receives sacral input. Other pathways such as cortical spinal tract and posterior medial lemniscus pathway have a reversed somatotopy in comparison to the spinothalamic tract.[3][4][5][6]

  • Neuroanatomy, Spinothalamic Tract
    , 2019
    Co-Authors: Mustafa Al-chalabi, Sonu Gupta

    Abstract:

    The spinothalamic tract (STT) is a sensory tract that carries nociceptive, temperature, crude touch, and pressure from our skin to the somatosensory area of the thalamus. It is responsible for our quick withdraw reaction to a painful stimulus such as touching the stove burner. The spinothalamic tract is composed of two adjacent pathways: Anterior and lateral. The Anterior spinothalamic tract carries sensory input about crude touch. The lateral spinothalamic tract carries information about pain and temperature. These two divisions of the spinothalamic tract run next to each other indistinctly. Thus, they can be considered one pathway. The spinothalamic tract is part of the anterolateral system, which also encompasses the spinoreticulothalamic tract (SRTT) and the spinotectal tract (SpTT). Three types of sensory fibers are associated with the spinothalamic tract: type III fibers, unmyelinated c-fibers, and myelinated A-delta fibers. Peripheral receptors having associations with the spinothalamic tract pathway are nociceptors, thermal receptors, and thermal nociceptors. Nociceptors are associated with A-delta and type III fibers, which are small, lightly myelinated axons for the transmission of fast, sharp pain. Thermal receptors and thermal nociceptors are associated with A-delta and C fibers, which are small, unmyelinated axons that conduction the transmission of slow-burning pain.The pathway of the spinothalamic tract to the cerebral cortex starts with the dorsal root ganglions, which are composed of pseudounipolar neurons with the peripheral (distal) and central (proximal) axonal processes. These dorsal root ganglia lie adjacent to the spinal cord and represent the first-order neuron of the spinothalamic tract pathway. The axons of the central process of the first-order neurons enter the spinal cord through the lateral dorsal root entry zone to enter the Lissauer tract and synapses with second-order neurons in the substantia gelatinosa, located in the grey matter of the spinal cord. The axons of the second-order neurons cross over the spinal cord to the opposite side two segments above the level of entry via the Anterior White Commissure, unlike the posterior medial lemniscus pathway, which decussates in the brainstem. The decussating second-neuron fibers enter the anterolateral portion of the spinal cord and then enter the brainstem as the spinal lemniscus. The spinothalamic tract ascends in the ventrolateral aspect of the spinal White matter over the length of the spinal cord. The anterolateral system in the rostral medulla runs between the inferior olivary nucleus and the nucleus of the spinal trigeminal tract, whereas, in the pons and midbrain, the anterolateral system runs dorsolaterally to the medial lemniscus. The spinothalamic tract of the anterolateral system terminates in the ventral posterolateral nucleus (VPL) of the thalamus, the third-order neurons of this pathway. From the thalamus, axons of VPL neurons project out of the thalamus laterally and course somatotopically through the internal capsule’s posterior limb of the and terminate in the postcentral gyrus primary somatosensory. In the spinal cord, the spinothalamic tract pathway has a certain somatotopic organization. The medial part of the track receives cervical input while the lateral part receives sacral input. Other pathways, such as cortical spinal tract and posterior medial lemniscus pathway, have a reversed somatotopy in comparison to the spinothalamic tract.

Jack L Feldman – One of the best experts on this subject based on the ideXlab platform.

  • Decussation of bulbospinal respiratory axons at the level of the phrenic nuclei in adult rats : a possible substrate for the crossed phrenic phenomenon
    Experimental Neurology, 1991
    Co-Authors: Harry G. Goshgarian, Howard H. Ellenberger, Jack L Feldman

    Abstract:

    The axonal trajectories of inspiratory bulbospinal neurons were examined after deposition of the anterograde neuronal tracer phaseolus vulgaris leucoagglutinin (PHA-L) into the rostral ventral respiratory group in rats. At the level of the phrenic nucleus, PHA-L-labeled bulbospinal axons crossed the midline of the spinal cord in both the Anterior gray and the Anterior White Commissure. These spinally decussating neurons provide a possible anatomical substrate for the respiratory reflex known as the crossed phrenic phenomenon.