Hemorrhagic stroke is a common and severe neurological disorder and is associated with high rates of mortality and morbidity, especially for intracerebral hemorrhage (ICH). Increasing evidence demonstrates that oxidative stress responses participate in the pathophysiological processes of secondary brain injury (SBI) following ICH. The mechanisms involved in interoperable systems include endoplasmic reticulum (ER) stress, neuronal apoptosis and necrosis, inflammation, and autophagy. In this review, we summarized some promising advances in the field of oxidative stress and ICH, including contained animal and human investigations. We also discussed the role of oxidative stress, systemic oxidative stress responses, and some research of potential therapeutic options aimed at reducing oxidative stress to protect the neuronal function after ICH, focusing on the challenges of translation between preclinical and clinical studies, and potential post-ICH antioxidative therapeutic approaches.

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Intracerebral Hemorrhage, Oxidative Stress, and Antioxidant Therapy

A Review of the Management of Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Due to a multiplicity of causes provoking traumatic brain injury (TBI), TBI is a highly heterogeneous pathology, characterized by high mortality and disability rates. TBI is an acute neurodegenerative event, potentially and unpredictably evolving into sub-chronic and chronic neurodegenerative events, with transient or permanent neurologic, cognitive, and motor deficits, for which no valid standardized therapies are available. A vast body of literature demonstrates that TBI-induced oxidative/nitrosative stress is involved in the development of both acute and chronic neurodegenerative disorders. Cellular defenses against this phenomenon are largely dependent on low molecular weight antioxidants, most of which are consumed with diet or as nutraceutical supplements. A large number of studies have evaluated the efficacy of antioxidant administration to decrease TBI-associated damage in various animal TBI models and in a limited number of clinical trials. Points of weakness of preclinical studies are represented by the large variability in the TBI model adopted, in the antioxidant tested, in the timing, dosages, and routes of administration used, and in the variety of molecular and/or neurocognitive parameters evaluated. The analysis of the very few clinical studies does not allow strong conclusions to be drawn on the real effectiveness of antioxidant administration to TBI patients. Standardizing TBI models and different experimental conditions, as well as testing the efficacy of administration of a cocktail of antioxidants rather than only one, should be mandatory. According to some promising clinical results, it appears that sports-related concussion is probably the best type of TBI to test the benefits of antioxidant administration.

Antioxidant therapies in traumatic brain injury

Thromboembolic complications are a major cause of postoperative morbidity and mortality in the neurosurgical patient. Prophylaxis with lower extremity pneumatic compression boots (PCBs) reduces the incidence of lower extremity deep vein thrombosis (DVT) but has not been shown to affect the incidence of pulmonary embolism (PE). Prophylaxis with low-dose heparin has consistently reduced the incidence of both DVT and PE in studies on general surgical patients but has not been adopted for use in neurosurgery primarily for fear of causing catastrophic hemorrhage. We report on a series of 138 consecutive adult patients who underwent major neurosurgical procedures on a general neurosurgical service at our institution. Patients were treated with intraoperative PCBs and, starting on the morning of the first postoperative day, with a regimen of 5000 U of heparin administered subcutaneously twice daily. This treatment was continued until patients were fully ambulatory. PCBs were discontinued 24 hours after the first administration of heparin. None of the heparin-treated patients suffered postoperative hemorrhage. We compared this series with a control group of 473 adult patients who had previously undergone major neurosurgical procedures on the same neurosurgical service. These patients had been treated with intraoperative and postoperative PCBs alone. The control group had a 3.2% incidence of thromboembolic complications (15 of 473; eight DVT, seven PE). Prophylaxis with PCBs plus heparin significantly (P = 0.020) reduced the incidence of thromboembolic complications: no PCBs/heparin-treated patient exhibited clinical evidence of PE or DVT (0%, 0/138). We conclude that a combination of intraoperative PCBs and postoperative low-dose heparin is a safe and effective method by which to reduce thromboembolic complications in the neurosurgical patient.

Postoperative Low-Dose Heparin Decreases Thromboembolic Complications in Neurosurgical Patients

Background : Cerebral ischemia is as a result of insufficient cerebral blood flow for cerebral metabolic functions. Resveratrol is a natural phytoalex in that can be extracted from grape’s skin and had potent role in treating the cerebral ischemia. Apoptosis, a genetically programmed cellular event which occurs after ischemia and leads to biochemical and morphological changes in cells. There are some useful markers for apoptosis like Bcl-2, bax, and p53. The last reports, researchers verify the apoptosis with early markers like Annexin V. Methods : We preferred in this experimental study a model of global cerebral infarction which was induced by bilateral common carotid artery occlusion method. Rats were randomly divided into 4 groups : sham, ischemia-reperfusion (I/R), I/R plus 20 mg/kg resveratrol and I/R plus 40 mg/kg resveratrol. Statistical analysis was performed using Sigmastat 3.5 ve IBM SPSS Statistics 20. We considered a result significant when p<0.001. Results : After administration of resveratrol, Bcl-2 and Annexin levels were significantly increased ( p<0.001). Depending on the dose of resveratrol, Bcl2 levels increased, p53 levels decreased but Annexin V did not effected. P53 levels were significantly increased in ishemia group, so apoptosis is higher compared to other groups. Conclusion : In the acute period, Annexin V levels misleading us because the apoptotic cell counts could not reach a certain level. Therefore we should support our results with bcl-2 and p53.

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Neuroprotective Effect of Resveratrol on Acute Brain Ischemia Reperfusion Injury by Measuring Annexin V, p53, Bcl-2 Levels in Rats

Sphingomonas paucimobilis (S. paucimobilis) is a gram negative bacillus. It has existed in soil, drinking water and plants. It has been isolated from distilled water tanks, respirators, and hemodialysis devices at the hospital setting. Patients with chronic disorders or immune suppression may be susceptible to infections with it. This microorganism has also been reported to infect healthy persons. Both nosocomial and community-acquired infections have been reported. So far, a variety of infections have been reported, including sepsis, septic pulmonary embolism, septic arthritis, peritonitis, and endophthalmitis. Only 2 cases of meningitis have been reported so far in the literature. So far, no previous reports of culture proliferation have been reported in patients with external ventricular drains, as was the case in our patient. Therefore, our case is the first to have S. paucimobilis proliferation in cerebrospinal fluid culture during intensive care unit stay for an external ventricular drain.

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Sphingomonas Paucimobilis: A Rare Infectious Agent Found in Cerebrospinal Fluid.

Aim A pericallosal lipoma is a fat-containing lesion occurring in the interhemispheric fissure closely related to the corpus callosum, which is often abnormal. This is the most common location for an intracranial lipoma. In this study, we aim to report on the clinical and radiographic aspects of ten patients diagnosed with pericallosal lipomas. Material and methods A retrospective analysis of patients who presented to the neurology and neurosurgery outpatient clinics of Kayseri Training and Research Hospital between 2010 and 2014 revealed that 10 patients had the diagnosis of pericallosal lipoma. The clinical and magnetic resonance imaging data were obtained by reviewing their files. Results Ten patients with an average age of 35.8 years (11-80 years) were included in the study. The mean follow-up was 17 months (8-31 months). No neurological deficits related to the lesions were found during neurological examination in any of the patients. Four patients had tubulonodular lipomas while the other 6 presented with curvilinear lipomas. Four patients (40%) displayed a coexistent corpus callosum hypoplasia. In contrast to previous reports, 3 of these patients had a curvilinear lipoma while the remaining one had tubulonodular lipoma. Also, one of the patients displayed plaque lesions attributable to multiple sclerosis. During the follow-up period, no growth in the lipomas was recorded in any of the patients. No surgical intervention was performed as none of the patients displayed symptoms caused by the lipoma. Conclusion In this study, we found a stronger association of corpus callosum hypoplasia with posteriorly situated curvilinear lipomas. Our results are in disagreement with previous studies, which suggested corpus callosum anomalies were more often associated with anteriorly situated tubulonodular lipomas. Pericallosal lipomas are benign, self-limiting or slow-growing lesions that generally remain asymptomatic. These lesions occur in the midline and surround critical neurovascular structures. Therefore, surgical intervention should be avoided in asymptomatic cases.

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Pericallosal Lipomas: A Series of 10 Cases with Clinical and Radiological Features.

AIM Failed back surgery syndrome is observed in 15% of patients who have undergone surgery for lumbar disk hernia.Excess epidural fibrosis is the etiology in 24% of FBSS cases. This study was conducted with the belief that the antiproliferative effect of temozolomide can prevent epidural fibrosis. MATERIAL AND METHODS 8 rats (Group I) underwent laminectomy and were then administered saline while 6 rats (Group II) were administered temozolomide at a dose of 18 mg/kg/day for 5 days after the surgery to make up a total of 14 male Wistar rats used. The pathology preparations of subjects sacrificed at the end of week 6 were histopathologically examined with the Hematoxylin-Eosin stain and Trichrome stain. The pathology preparations were assessed with the analysis parameters and scale generated by He et al. The results were analyzed with the Chisquare test. RESULTS No significant difference was found between the two groups in terms of bone and cartilage regeneration, arachnoidal fibrosis, and inflammatory and fibroblast cell densities. Epidural fibrosis formation was significantly less and there was no grade III fibrosis in the Temozolomide group. This was found to be statistically significant (p=0.0302). No side effect of dural or intradural damage was observed. CONCLUSION Temozolomide was found to be effective in preventing epidural fibrosis. However, further research is required to determine its effectiveness in local applications and the appropriate dose range.

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The effect of temozolomide on the prevention of epidural fibrosis developing after lumbar laminectomy in rats.

Vertebral artery injury including thrombosis, arteriovenous fistula (AVF), pseudo-aneurysm and hemorrhage may be iatrogenic or due to penetrating or blunt trauma. Although mostly asymptomatic, vertebral artery injury may also present with vertebrobasilar insufficiency findings, cephalgia, radicular pain or myelopathy due to blockade of arterial flow, arterial steal phenomenon and venous hypertension. The gold standard for diagnosis is digital subtraction angiography (DSA). Doppler ultrasonography, magnetic resonance-angiography and computerized tomography-angiography are also helpful. Endovascular treatment is now used more commonly. We present a case with sharp bread knife injury of the vertebral artery that was also complicated with a vertebrojugular fistula and pseudo-aneurysm together with the diagnostic and management options and a review of the current literature.

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Vertebrojugular arteriovenous fistula and pseudoaneurysm formation due to penetrating vertebral artery injury: case report and review of the literature.

AIM To present the magnetic resonance imaging (MRI) characteristics and clinical features of 12 patients with quadrigeminal cistern lipoma. MATERIAL AND METHODS A series of 12 patients with quadrigeminal cistern lipoma were followed up between 2010 and 2013 at the Kayseri Training and Research Hospital's Department of Neurosurgery. MRI characteristics and clinical features of the 12 patients were evaluated. RESULTS A total of 12 patients were followed up. The mean age was 36.25 years (range 6 - 74 years). All patients' neurological findings were normal, except one patient had strabismus. MRI revealed a tubulonodular type lipoma in eleven patients and curvilinear type lipoma in one patient. Two patients (16.6%) had associated Chiari malformation type 1. Calcification was found only in two patients (16.6%). None of patients had a corpus callosum malformation or associated hydrocephalus. The mean follow-up period was 17.2 months (range 3-36 months) and no patient showed progression. CONCLUSION Intracranial lipomas are considered benign, slow-growing congenital malformations due to infiltration of adipocytes into the neural tissue and conservative management should therefore be preferred.

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Muhammet Bahadir Yilmaz

Papers

Sphingomonas Paucimobilis: A Rare Infectious Agent Found in Cerebrospinal Fluid.

Pericallosal Lipomas: A Series of 10 Cases with Clinical and Radiological Features.

The effect of temozolomide on the prevention of epidural fibrosis developing after lumbar laminectomy in rats.

Vertebrojugular arteriovenous fistula and pseudoaneurysm formation due to penetrating vertebral artery injury: case report and review of the literature.

Lipoma of the quadrigeminal cistern: report of 12 cases with clinical and radiological features.