Unusual cause of a painless soft tissue mass of the scalp: a rare presentation of primary intracranial neuroendocrine neoplasm.

Incidental soft tissue lumps in the scalp are a common presenting complaint in clinical practice. However, they may signify more sinister underlying pathologies. Our report examines a 63-year-old man presenting with impaired co-ordination in his left hand following a 3-month history of a painless left retroauricular scalp lump.

DNA methylation-based profiling for paediatric CNS tumour diagnosis and treatment: a population-based study.

Background: Marked variation exists in the use of genomic data in tumour diagnosis, and optimal integration with conventional diagnostic technology remains uncertain despite several studies reporting improved diagnostic accuracy, selection for targeted treatments, and stratification for trials. Our aim was to assess the added value of molecular profiling in routine clinical practice and the impact on conventional and experimental treatments.

Methods: This population-based study assessed the diagnostic and clinical use of DNA methylation-based profiling in childhood CNS tumours using two large national cohorts in the UK.

Vascular cognitive impairment neuropathology guidelines (VCING): the contribution of cerebrovascular pathology to cognitive impairment.

There are no generally accepted protocols for post-mortem assessment in cases of suspected vascular cognitive impairment. Neuropathologists from seven UK centres have collaborated in the development of a set of vascular cognitive impairment neuropathology guidelines (VCING), representing a validated consensus approach to the post-mortem assessment and scoring of cerebrovascular disease in relation to vascular cognitive impairment. The development had three stages: (i) agreement on a sampling protocol and scoring criteria, through a series of Delphi method surveys; (ii) determination of inter-rater reliability for each type of pathology in each region sampled (Gwet's AC2 coefficient); and (iii) empirical testing and validation of the criteria, by blinded post-mortem assessment of brain tissue from 113 individuals (55 to 100 years) without significant neurodegenerative disease who had had formal cognitive assessments within 12 months of death.

Tuberculous cerebrovascular disease: a review.

Cerebrovascular complications of tuberculous meningitis are common, and may represent its most serious legacy. They present in clinically diverse ways, and continue to develop during the initial stages of treatment. Magnetic resonance imaging is the imaging modality of choice in detecting brain infarcts, typically revealing multiple or bilateral lesions in the territories of the middle cerebral artery perforating vessels.

Apolipoprotein E (APOE) and lipoprotein lipase (LPL) gene variants and carotid atherosclerotic lesions in the oldest old: a population-based autopsy study.

We investigated the association between histologically defined atherosclerotic lesions in the carotid arteries and the genetic variants of APOE and LPL in a population-based sample of Finns aged 85 or over. Post-mortem analysis of carotid arteries was performed in 240 subjects. Atherosclerotic lesions were categorized according to the modified American Heart Association criteria, and classified into four different categories: pathological intimal thickening (PIT), fibrous cap atheromas (FCA), calcified lesions (CL), and atherosclerotic burden (AB) (a combination of the other three categories).

CNS lupus: a study of 41 patients.

Background: CNS lupus is a serious but potentially treatable illness, which, though long recognized, may still present very difficult diagnostic challenges. We believed that further detailed study of patients with neuropsychiatric lupus would yield clinical information of practical value in improving both recognition and management of this difficult illness.

Methods: A retrospective case analysis of 41 patients with CNS systemic lupus erythematosus (CNS-SLE) was performed largely in the southwest of England and South Wales, covering the period 1990 to 2002.

Tuberculous encephalopathy: a reappraisal.

Forty years ago Dastur and Udani described a form of diffuse cerebral damage in tuberculosis, which they called tuberculous encephalopathy. Their pathological and clinical observations led them to propose an immune pathogenesis. Although there have been no convincing independently reported series, the entity is now established in the tuberculosis literature.

Basal ganglia calcification in BB/E rats with diabetes.

Human diabetes is associated with cognitive impairment and structural abnormalities in the brain such as cerebral atrophy. The aetiology of these abnormalities is not known. The BB/E rat is a well-established model of type 1 (insulin dependent) diabetes.

The role of the renin-angiotensin system in malignant vascular injury affecting the systemic and cerebral circulations.

Malignant hypertension is a rare but serious syndrome complicating 1% of essential hypertension and causing neurological, renal and cardiac complications. Despite improved anti-hypertensive medication, the incidence of this condition fails to decline. In the first part of this review, we discuss transgenic rat models of malignant hypertension, generated by over-expressing renin, to illustrate the role of the renin-angiotensin system in the development of systemic hypertensive vascular remodelling and hypertension.

Venous angioma of the facial nerve: a case report.

Background: Lower motor neurone type facial nerve palsy is a common condition that is very rarely caused by a neoplastic lesion.

Case Description: This case report describes a progressive facial palsy in a 62-year-old man because of a vascular tumor of the facial nerve. Histologic examination confirmed it to be a venous angioma.

Cerebrovascular responses to pathophysiological insult in diabetic rats.

Diabetes mellitus is associated with altered cerebrovascular responsiveness and this could contribute to the pathology of stroke in diabetic patients. In these studies, we used a model of haemorrhagic stroke (intrastriatal injection of 50 microl blood) to examine subacute perilesional perfusion and blood-brain barrier (BBB) integrity in spontaneously diabetic rats. Volumes of striatal oligaemia (blood flow < 35 ml 100 g(-1) min(-1)) were significantly increased (>300%) in diabetic rats with intrastriatal blood, compared to either non-diabetic rats with blood or control diabetic rats with striatal injection of silicon oil.

Hypertensive cerebral small vessel disease and stroke.

Lacunar infarcts and "hypertensive" primary intracerebral hemorrhages, collectively often referred to as hypertensive small vessel strokes, constitute about one third of all strokes. However, despite their public health importance, their etiopathogenesis remains ill-understood. Like all strokes, they are a heterogeneous entity, but the autopsy pathology evidence suggests that the majority are caused by a limited number of cerebral small vessel lesions.

Pathology of small vessel stroke.

Disease of small intracerebral vessels is widely assumed to be responsible for the majority of small, deep-seated (lacunar) infarcts and primary intracerebral haemorrhages. Our present, limited understanding of the pathogenesis of these stroke subtypes, which together constitute up to one-third of all strokes, is based on a limited number of detailed pathology studies, supported by clinical, risk factor and imaging data. Further progress using these traditional approaches has been prevented by a variety of largely technical obstacles.

The significance of intratumoural neurones and neuronal differentiation in diffuse gliomas: a case series.

We describe four patients, ranging from 26-40 years of age, who presented with seizures and large, poorly circumscribed cerebral tumours on magnetic resonance imaging. The resected tumours demonstrated a histopathology similar to low-grade glioma, but with admixed mature neurones. Immunohistochemistry demonstrated expression of putative neuronal antigens in the neuronal component as well as in tumour cells which did not show neuronal morphology.

Cerebral infarction in adult AIDS patients: observations from the Edinburgh HIV Autopsy Cohort.

Background And Purpose: Autopsy series of patients with AIDS have found a 4% to 29% prevalence of cerebral infarction. Little is known of the prevalence of cerebral infarction when not associated with non-HIV central nervous system (CNS) infection, lymphoma, or cardioembolic sources. Clinical correlation has seldom been available.

Stress-related primary intracerebral hemorrhage: autopsy clues to underlying mechanism.

Background: Research into the causes of small-vessel stroke has been hindered by technical constraints. Cases of intracerebral hemorrhage occurring in unusual clinical contexts suggest a causal role for sudden increases in blood pressure and/or cerebral blood flow.

Case Description: We describe a fatal primary thalamic/brain stem hemorrhage occurring in the context of sudden emotional upset.

What pathological components indicate carotid atheroma activity and can these be identified reliably using ultrasound?

Objective: The aim of this project was to determine whether histological features of 'active' plaque as described in the coronary circulation following acute myocardial infarction were similar in the carotid circulation, and whether these factors could be detected ultrasonically.

Method: Endarterectomy specimens were prospectively collected, and examined histologically and assessed by two observers for ulceration, inflammation, size of necrotic core, thickness of fibrous cap, haemorrhage and luminal thrombosis. Ultrasound of the plaque obtained preoperatively was similarly coded (blind to pathology) and compared with the pathology.

Dsyembryoplastic neuroepithelial tumour with discrete bilateral multifocality: further evidence for a germinal origin.

We report the case of a middle aged woman who developed refractory complex partial seizures in her early twenties. She had a right coloboma and neurological examination was normal. Neuropsychological assessments revealed mild impairments of non-verbal memory, and visuospatial and constructional difficulties.

Imaging features of leptomeningeal metastases.

Aims: To assess the range of appearances, and accuracy of various methods of diagnosing leptomeningeal metastases.

Materials And Methods: In a retrospective study, the notes and imaging of all patients with a radiological and/or CSF cytological diagnosis of leptomeningeal metastasis (LM) were identified, and assessed for the following: age and sex, primary tumour type, presenting symptoms, initial radiological and cytological diagnosis, radiological appearances and length of survival following diagnosis. Discordance between the CSF cytology and radiological diagnosis of LM was also noted.

Inverse relation between Braak stage and cerebrovascular pathology in Alzheimer predominant dementia.

The most common neuropathological substrates of dementia are Alzheimer's disease, cerebrovascular disease, and dementia with Lewy bodies. A preliminary, retrospective postmortem analysis was performed of the relative burden of each pathology in 25 patients with predominantly Alzheimer's disease-type dementia. Log linear modelling was used to assess the relations between ApoE genotype, Alzheimer's disease, and cerebrovascular disease pathology scores.

Neuropathologic characterization of a rodent model of closed head injury--addition of clinically relevant secondary insults does not significantly potentiate brain damage.

We have characterized the early brain pathology in Sprague-Dawley rats subjected to a modified Richmond impact acceleration model of closed head injury (CHI). This model was modified to produce maximal traumatic brain injury (TBI) in the absence of skull fracture, extracerebral or intracerebral hemorrhage, or brain contusion. We then used this model to assess the neuropathologic effects of superimposed secondary insults, which were designed to reflect a clinically relevant combination of hypotension and pyrexia.

Intracerebral haemorrhage and cerebral amyloid angiopathy: CT features with pathological correlation.

Aims: To review the computed tomography (CT) features of intracerebral haemorrhage pathologically proven to be associated with cerebral amyloid angiopathy in order to facilitate recognition of the presence of cerebral amyloid angiopathy in life.

Methods: We prospectively collected the clinical and brain imaging records of patients dying following an intracerebral haemorrhage who underwent a post-mortem examination and were found to have cerebral amyloid angiopathy. We reviewed the brain imaging to highlight features of the haemorrhage and of the rest of the brain common to these cases.

Evaluation of serum markers of neuronal damage following severe hypoglycaemia in adults with insulin-treated diabetes mellitus.

Background: Neurone-specific enolase (NSE) and protein S-100 (S-100) may be used as markers of acute neuronal damage in humans with neurological disorders.

Method: To evaluate their use following a single episode of severe hypoglycaemia (defined as an episode requiring external assistance to aid recovery), serum concentrations of NSE and S-100 were measured following hypoglycaemia which had not caused persistent neurological impairment in 16 patients with insulin-treated diabetes (the 'hypo' subjects), and in three diabetic patients who died following severe hypoglycaemia. The serum proteins were also measured in 10 subjects with insulin-treated diabetes who had not experienced an episode of severe hypoglycaemia within the preceding year (the 'control' subjects).