Category Archives: Medicine

Intracranial vessels in traumatic brain injury

vesselsTraumatic brain injury (TBI) is a frequent cause of death and disability affecting millions of people every year worldwide. It is initiated by mechanical forces that cause sudden head motion. Such motion produces deformation of the brain and surrounding tissues and thus may result in axonal injury, contusion, or hematoma. The trauma launches a cascade of biochemical reactions often leading to ischemia, hypoxia, brain swelling, and edema. TBI may also induce damages of the cranial vasculature, with alterations of the blood vessel that put the neural tissue at risk. TBI can either cause vessel rupture and hemorrhage (bleeding), or a pathophysiological change of the vessel structure which is secondary associated with some kind of dysfunction. Hemorrhage is easy to recognize, commonly categorized according to its location as epidural (between the skull and the dura mater – associated with disruption of the middle meningeal vessels), subdural (between the dura mater and arachnoid membrane – usually concerning the bridging veins), or subarachnoidal (between arachnoid membrane and the pia mater). Intracerebral bleeding may also occur when the membranes surrounding the brain are impaired. In case of contusion, vascular damage and mechanical cortical damage can occurr at the same time. Even if bleeding is not present, function and microstructure of the injured vessels might be impaired. Vessel disruption and hemorrhage alter the cerebral blood flow, increase the intracranial pressure, affect the maintenance of the blood-brain barrier (exchange of nutrients and waste that occurs at the capillary level), and disrupt the CNS homeostasis by exposing the neural tissue to disregulated blood flow.

Understanding cerebrovascular injuries and the mechanisms behind them is crucial for diagnostics and treatment strategies. Monson et al. (in press) describe the current state of knowledge on the mechanics of cerebral vessels during head trauma and how they respond to the applied loads. They provide a summary of the experimental research focused on the loading conditions during the TBI. Experiments with physical models for instance show that there is significant relative motion between the brain and skull during the trauma. In the sagittal plane, this motion tends to be largest at the vertex and smallest at the brain base. Constraints at the base can lead to brain rotation which pushes the parietal cortex into the cranial bones, possibly causing of contusion and subdural hematoma. In general, it appears that rotation is more damaging than translation. Computer models represent another approach of the TBI research and provide accurate predictions of brain deformation for many loading scenarios. These models enable to estimate exterior loading conditions according to the internal deformation of tissues that are directly involved in injury. However, validation of these models is needed, as well as specific models focusing on blood vessels. The authors also provide a summary of what is known about cerebral vessel response to extreme deformations, passive physical properties, structural failure, and subfailure damage and dysfunction. In another article, Saad et al. (in press) describe various kinds of intracranial hemorrhage in biomedical imaging. Both macroscopic hematomas and microhemorrhages are described according to the distinctions based on intracranial compartments, and traumatic vs nontraumatic cases.

Stáňa Eisová

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Modelling brain-skull interface

Precise computational modelling of the brain-skull interface is necessary for the prediction, prevention and treatment of acquired brain-injuries. The brain-skull interface comprises complex layers including the osseous cranial tissues, meninges, sub-arachnoidal space and tissues, cerebrospinal fluid (CSF), pia mater and the gray and white cerebral matter. While the tissue properties of the brain-skull interface are known, there is no consensus on how these layers interact during head impact.  To generate computational models of the brain-skull interface with greater accuracy, knowing the boundary conditions or constraints is necessary. Previous experimental studies have relied on modelling the deformation of the brain-skull interface using neural density targets (NDTs) implanted into the cadaver brain, collecting information on tissue displacement during front and rear impact in motor vehicle crash-tests.

Wang et al. (2018) utilized computational bio-mechanics and finite element analysis (FEA), placing nodes in the 3D model in close approximation to the position of the experimental NDTs. Four hypotheses of the brain-skull interface were modeled, each approach placing different boundary conditions to model deformation during simulated head impact. All analyses were validated against previous experimental studies. Results showed that how the brain-skull interface was modeled appreciably affected the results. The 3D model showing the closest agreement with the experimental data, included all tissues of the brain-skull interface, allowed for displacement without separation of the skull and brain tissues, and strongly corresponded with known neuroanatomy. This 3D model indicated that non-linear stress-strain associations between brain and skull tissues best matched experimental results. Further, this 3D model could be closely predicted using an Ogden Hyperviscoelastic Constitutive model which did not over- or under-estimate deformations during head impact. The risks of over- and under-estimating head impact during motor vehicle accidents has implications for vehicle construction and prevention of serious brain trauma during accidents. Ultimately, a better understanding of the interaction between layers of the brain-skull interface can produce more accurate predictions of the likely impact during motor vehicle accidents and prevent violent head injury. Extrapolation of this research into paleoneurology could allow investigations into the structural interaction between the brain and braincase, testing if the resistence of brain-skull tissues during deformation evolved in human species as primary adaptations or secondary adjustments such as allometric responses.

 

Alannah Pearson


A History of Surgery

The Chirurgeon’s Apprentice is a popular blog on the website of medical historian Dr Lindsey Fitzharris who received her doctorate from University of Oxford in medical, technology and science history. Dr Fitzharris discusses the apt naming of the blog with the word ‘chirurgeon‘ the first historical reference to a practitioner of surgery. The website illuminates the often grisly but fascinating historical developments in Medicine and Surgery with focus on the Victorian era and the rapidly developing techniques and methods occurring in all scientific disciplines at this time.  Under the Knife is a well-researched and often darkly humorous video series delivered by Fitzharris where each episode details different aspects of the history of Surgery and Medicine. Dr Lindsey Fitzharris is also the author of a recent book The Butchering Art about the Victorian surgical pioneer Jospeh Lister and the development of antiseptic practices.

Alannah Pearson


Infections of the brain and meninges

 

infectionsIntracranial infections represent serious brain diseases that occur in various forms and often may be hard to recognize in their earlier stages. A fast diagnosis is crucial for an effective treatment. Various technique of CT and MRI imaging have been developed to distinguish the symptoms in the brain and its associated tissues (see for example Hsu 2010). Radiologists recognize several categories of infections according to the origin (e.g. congenital and neonatal), location (intra-axial, extra-axial), or characters. In general, infections of the brain parenchyma, meninges and ventricles can have bacterial, viral, fungal, or parasitic origins. Bacterial infections usually develop from early cerebritis (inflammation of the cerebrum) to formation of abscesses (accumulation of infectious material and microorganisms) within the cranium. Some bacteria have more specific effects. Streptococcus pneumonia and Neisseria meningitides are common cause of bacterial meningitis (inflammation of the meninges and the cerebrospinal fluid). Tuberculomas, abscesses and tuberculous meningitis indicate presence of Mycobacterium tuberculosis (TB). Frequent viral infections are Herpes Simplex Encephalopathy involving Herpes simplex virus 1 (HSV-1), or infections induced by Human Immunodeficiency Virus (HIV) leading to cerebral atrophy and white matter disease. Fungal infections usually generate abscesses filled with fungi. Cryptococcosis and fungal meningitis are frequent fungal infections in some specific geographical regions. Examples of parasites causing intracranial infections are Toxoplasma gondii, or Taenia solium causing cysticercosis, which also leads to acquired epilepsy (see Vaccha et al. 2016). Consequences of intracranial infections could be in some cases lethal, in other cases they can cause a severe damage. For instance, infections of meninges and cerebrospinal fluid leading to meningitis can further evolve into subdural (between the dura mater and the underlying arachnoid layers) and epidural (between the meninges and the bone) abscesses, hydrocephalus (excessive accumulation of fluid in the brain), ventriculitis (inflammation of the ventricles containing and circulating cerebrospinal fluid throughout the brain), and venous thrombosis. Brain infection can be extended into the bone tissue and cause cranial pathologies like osteomyelitis or mastoiditis. Sometimes the infections can even lead to bone fractures. The origin of brain infection is often associated with traumas, when the microorganism spread from the wound into the soft tissues of the endocranium.

Stáňa Eisová


Digital Anatomy Education Tools

Educational medical resources provided by IMAIOS include interactive atlases and tools. The human e-Anatomy atlas combines digital imaging and computational tools for all anatomical regions from the human brain , with 3D reconstruction and labeling of neuroanatomical features, extending to the human pelvic girdle with 3D reconstructions of bones and arteries. Subscription to these utilities is useful for healthcare professionals but is focused on educational institutions and lecturers with access available for students enrolled in courses. For educational purposes, the resource includes quiz templates for each anatomical region and a virtual environment with enjoyable but educational tools for human lower limb anatomy using the Ninja Lower Limb game. The inclusion of resources for Veterinary Medicine with the vet-Anatomy atlas in similar design as the Human e-Anatomy atlas. All these tools are accessible through computer access and common mobile and tablet platforms in multiple languages.

Alannah Pearson


Eye-brain spatial relationship

We have just published a new study on the spatial relationship between visual and endocranial structures in adult modern humans, chimpanzees, and fossil humans. The survey was conducted in collaboration with Michael Masters from Montana Tech (USA), who previously hypothesized that, in modern humans, the positioning of the orbits below the frontal lobes coupled with a reduced face could result in spatial conflict among ocular, cerebral, and craniofacial structures. This could lead to vision problems, such as myopia. In addition, another study evidenced that eye and orbit dimensions have a stronger correlation with the frontal lobes, rather than with the occipital lobes, indicating that the ocular structures can be more constrained by spatial (physical) than by functional (vision) relationships. In this study we used geometric morphometrics to investigate the longitudinal (antero-posterior) spatial relationships between orbito-ocular and endocranial structures. First, we addressed the the position of the eye relatively to the frontal and temporal cortex, on a sample of 63 modern humans’ MRIs. Second, we addressed the spatial relationship between orbital and endocranial structures on a CT sample comprising 30 modern humans, 3 chimpanzees, and 3 fossil humans (Bodo, Broken Hill 1, Gibraltar 1).

The results of the MRI analysis show that in adult modern humans the main pattern of shape variation deals with the antero-posterior position of the eye relative to the temporal lobes. Individuals which eyes are closer to the temporal lobes exhibit rounder frontal outline and antero-posterior shorter eyes, indicating a possible physical constraint associated with the spatial contiguity between the eye and the middle cranial fossa. A second pattern describes the supero-inferior position of the eye, relatively to the frontal lobe. Also in this case, proximity is apparently associated with slight changes in eye form. Individuals with larger volumes of the frontal and temporal lobes tend to have eyes located more posteriorly, closer to the temporal lobe, although with no apparent change in the shape of the eye. These results partially support Master’s hypothesis, suggesting reciprocal spatial patterns influencing brain and eye form.

When analyzing orbits and braincase through CT data, the main intra-specific variation among modern humans concerns the orientation of the orbit, not the position. Nonetheless, analyzing humans, apes, and fossil hominids all together, the main differences deal with the distance between orbits and braincase: they are separated in chimps, overlapped in modern humans, and in intermediate position in fossils. In this case, fossils belong to the hypodigm of Homo heidelbergensis. Modern humans are characterized by larger temporal lobes when compared with other living primates, and longer middle cranial fossa. The proximity with the eyeballs due to face reduction can stress further a morphogenetic spatial conflict between orbits and brain. Next step: 3D analyses, ontogenetic series, and vision impairment.

Sofia Pedro


Microgravity and sensorimotor function

Space missions can have adverse effects on astronauts, such as the already-mentioned vision deterioration and cognitive impairment. Spending a long time on space can also impact sensorimotor function. Koppelmans et al. have recently investigated the influence of microgravity environment on sensorimotor performance and brain structure. They conducted a longitudinal study with a group of male subjects remaining in a 6-degrees head down tilt bed rest (HDBR) position, an analog environment to study the effects of spaceflight microgravity, during 70 days. MR images were collected before, during, and after HDBR, to explore changes in gray matter (GM) volume, and functional mobility and postural equilibrium tests were conducted pre- and post-HDBR, to check sensorimotor performance. For control, they used data from other subjects who had completed the same measurements at four different times over 90 days for another study, not being exposed to HDBR. Relative to controls, the HDBR subjects showed widespread changes in GM volume, as the percent of brain volume, from pre- to the last assessment during HDBR. More specifically, GM volume increased in the posterior parietal region and decreased in the fronto-temporal regions, and these changes are strongly correlated. The sensorimotor performance was decreased in HDBR subjects from pre- to post-HDBR, as they needed more time to complete the test, while controls showed no difference in performance. Following the HDBR period, both GM volume and sensorimotor changes started to recover, though not totally 12 days later. Regarding the association between brain and behavior, researchers found that larger increases in GM volume in precuneus and pre- and postcentral gyri correlated with better balance performance, though not significantly after Bonferroni correction. They propose these changes in GM volume might reflect cortical plasticity as an adaptive response to alterations in somatosensory input caused by HDBR position. The observed patterns of GM change could also be explained by alterations in intracranial fluids distribution and pressure due to posture, though this hypothesis would need further examination. The authors conclude their findings match the sensorimotor deterioration observed in astronauts, but are also of interest for individuals who are temporarily or permanently confined to a bed and will probably experience the same GM and sensorimotor alterations.

Sofia Pedro


Cortical and scalp development

In a recent study, Tsuzuki and colleagues analysed the co-development of the brain and head surfaces during the first two years of life using a sample of 16 infant MRIs, aged from 3 to 22 months. First, they digitized a set of cortical landmarks defined by the major sulci. Then they determined the position of cranial landmarks according to the 10-10 system, a standard method to place electrodes for electroencephalography, using  nasion, inion, and the pre-auriculars as a reference. Besides analysing the spatial variability of the cortical and scalp landmarks with age, they compared the variability of the cortical landmarks to the 10-10 positions, in order to evaluate the validity of the scalp system as a reference for brain development. For that, they transferred a given cortical landmark to the head surface by expressing its position as a composition of vectors in reference to the midpoint between the two pre-auriculars and to the three neighbor 10-10 points. The scalp-transferred landmarks were then transformed to the scalp template of a 12-month-old infant and depicted in reference to the 10-10 system.

Age-related changes in the cortical landmarks were most obvious in the prefrontal and parietal regions. As the brain elongates, the frontal lobe shifts anteriorly and the precentral gyri widen. In addition, the intraparietal sulci and the posterior part of the left Sylvian fissure move forward, suggesting relative enlargement of the parietal region in the anterior direction. The same result was obtained by our team by analyzing cranial and brain landmarks in adults: larger brain size is associated with a relative forward position of the parietal lobe. The scalp showed relative anteroposterior elongation and lateral narrowing with growth. Regarding the contrast between the cortical landmarks and the 10-10 system, the authors observed that the variability in the position of the former was much smaller than the area defined by 10-10 landmarks, indicating this system can be useful to predict the underlying cortical structures. Hence, they conclude that the changes in brain shape during development are well described by cortical landmarks and that the relative scalp positioning based on the 10-10 system can adjust to preserve the correspondence between the scalp and the cortical surfaces.

 

Sofia Pedro


What the brain’s wiring looks like

The world’s most detailed scan of the brain’s internal wiring has been produced by scientists at Cardiff University. The MRI machine reveals the fibres which carry all the brain’s thought processes. It’s been done in Cardiff, Nottingham, Cambridge and Stockport, as well as London England and London Ontario. Doctors hope it will help increase understanding of a range of neurological disorders and could be used instead of invasive biopsies …

[keep on reading this article by Fergus Walsh on BBC News]


Cerebellum and Alzheimer

A perspective review on cerebellum and Alzheimer’s disease, coordinated by Heidi Jacobs

Jacobs H.I., Hopkins D.A., Mayrhofer H.C., Bruner E., van Leeuwen F.W., Raaijmakers W., Schmahmann J.D.
The cerebellum in Alzheimer’s disease: evaluating its role in cognitive decline.
Brain, 2017

[link]

(and here a post on cerebellum and paleoneurology …)