phenylephrine-hydrochloride and Brain-Diseases

The treatment of brain disorders is particularly challenging due to the presence of a variety of formidable obstacles to deliver drugs selectively and effectively to the brain. Blood-brain-barrier (BBB) constitutes the major obstacle to the uptake of drugs into the brain following systemic administration. Intranasal delivery offers a non-invasive and convenient method to bypass the BBB and delivery of therapeutics directly to the brain. The review discusses the potential of intranasal route to deliver drugs to the brain, the mechanisms and pathways of direct nose to brain drug transport, the various factors influencing transnasal drug absorption, the conventional and novel intranasal drug delivery systems, the various intranasal drug delivery techniques and devices, and examples of brain drug transport that have been feasible in treating various brain disorders. Moreover, products on the market, investigational drugs, and the author's perceptions about the prospect of intranasal delivery for treating brain disorders are also been discussed.

Topics: Administration, Intranasal; Animals; Brain; Brain Diseases; DNA; Drug Delivery Systems; Humans; Nasal Mucosa; Nose; Pharmaceutical Preparations; Proteins

We describe a newborn girl with a lethal sclerosing bone dysplasia leading to prenatal skeletal alterations and microcephaly, proptosis, hypoplastic nose and midface, small jaw, cleft palate, hypertrophied gums, intracranial calcifications, and generalized osteosclerosis. There is a remarkable similarity between our patient and six previously reported infants subsequently categorized as having a distinct entity: Raine syndrome. Autosomal recessive inheritance is postulated based on parental consanguinity in several of the previous cases and in our patient.

Topics: Brain Diseases; Calcinosis; Exophthalmos; Facies; Female; Genes, Recessive; Humans; Infant, Newborn; Nose; Osteosclerosis; Radiography; Syndrome

The Gorlin-Goltz syndrome is characterized by four primary symptoms: multiple nevoid basal cell epitheliomas that usually undergo malignant transformation; jaw keratocysts that show constant growth; skeletal anomalies; and intracranial calcifications. A myriad of additional findings may also be noted. Among the most frequent are: palmar and plantar pits, a characteristic flattened facies and broad nasal root, frontal and parietal bossing, mandibular prognathia, hypertelorism, strabismus, dystrophia of the canthi, and clefts of the lip, alveolus, and/or palate. In this study, we review the literature and our 25 cases of Gorlin-Goltz syndrome patients, questioning their incidence of cleft formations (8.5%) as compared to the general population (0.1%). It is our contention that all patients who present with an orofacial cleft warrant deeper investigation as to the presence of additional signs indicative of Gorlin-Goltz syndrome. The nevi turn malignant with time, and thus, early diagnosis, follow-up, and treatment are imperative.

Topics: Adult; Alveolar Process; Basal Cell Nevus Syndrome; Brain Diseases; Calcinosis; Cell Transformation, Neoplastic; Cleft Lip; Cleft Palate; Diagnosis, Differential; Eyelid Diseases; Face; Facies; Female; Follow-Up Studies; Foot Deformities; Frontal Bone; Hand Deformities; Humans; Hypertelorism; Incidence; Jaw Cysts; Male; Mouth Abnormalities; Nose; Parietal Bone; Prognathism; Strabismus

Topics: Brain Diseases; Emergencies; Humans; Neurosurgery; Nose; Nose Diseases; Nose Neoplasms

Nasal dermoid and sinus cysts (NDSC) are uncommon congenital anomalies that may have intracranial extension and can be associated with other anomalies. We identified 22 patients in a retrospective review of cases diagnosed with NDSC at our institution over the past 10 years. Nine (41 percent) had associated anomalies and ten (45 percent) had intracranial extension of the sinus. In half of the patients with intracranial extension, the sinus transversed either the cribriform plate or foramen cecum and attached to the dura; in the other half, the sinus extended to cysts within the falx or other brain structures. Of the patients with multiple anomalies, six (67 percent) had intracranial extension. Presurgical complications occurred in a total of eight patients (36 percent): two had meningitis, two had osteomyelitis, four had periorbital-nasal cellulitis, three had nasal abscess, and four had nose anomalies requiring rhinoplasty.

Topics: Abnormalities, Multiple; Brain Diseases; Child; Child, Preschool; Dermoid Cyst; Fistula; Humans; Infant; Infant, Newborn; Nose; Nose Diseases; Nose Neoplasms; Retrospective Studies; Washington

Endonasal endoscopic odontoidectomy (EEO) is an alternative to transoral surgery for symptomatic ventral compression of the anterior cervicomedullary junction (CMJ), allowing for earlier extubation and feeding. Because the procedure destabilizes the C1-2 ligamentous complex, posterior cervical fusion is often performed concomitantly. The authors' institutional experience was reviewed to describe the indications, outcomes, and complications in a large series of EEO surgical procedures in which EEO was combined with posterior decompression and fusion.. A consecutive, prospective series of patients who underwent EEO between 2011 and 2021 was studied. Demographic and outcome metrics, radiographic parameters, extent of ventral compression, extent of dens removal, and increase in CSF space ventral to the brainstem were measured on the preoperative and postoperative scans (first and most recent scans).. Forty-two patients (26.2% pediatric) underwent EEO: 78.6% had basilar invagination, and 76.2% had Chiari type I malformation. The mean ± SD age was 33.6 ± 3.0 years, with a mean follow-up of 32.3 ± 4.0 months. The majority of patients (95.2%) underwent posterior decompression and fusion immediately before EEO. Two patients underwent prior fusion. There were 7 intraoperative CSF leaks but no postoperative CSF leaks. The inferior limit of decompression fell between the nasoaxial and rhinopalatine lines. The mean ± SD vertical height of dens resection was 11.98 ± 0.45 mm, equivalent to a mean ± SD resection of 74.18% ± 2.56%. The mean increase in ventral CSF space immediately postoperatively was 1.68 ± 0.17 mm (p < 0.0001), which increased to 2.75 ± 0.23 mm (p < 0.0001) at the most recent follow-up (p < 0.0001). The median (range) length of stay was 5 (2-33) days. The median time to extubation was 0 (0-3) days. The median time to oral feeding (defined as, at minimum, toleration of a clear liquid diet) was 1 (0-3) day. Symptoms improved in 97.6% of patients. Complications were rare and mostly associated with the cervical fusion portion of the combined surgical procedures.. EEO is safe and effective for achieving anterior CMJ decompression and is often accompanied by posterior cervical stabilization. Ventral decompression improves over time. EEO should be considered for patients with appropriate indications.

Topics: Adult; Brain Diseases; Brain Stem; Child; Decompression, Surgical; Endoscopy; Humans; Magnetic Resonance Imaging; Nose; Odontoid Process; Treatment Outcome

The use of nucleic acids to treat various brain diseases could offer new therapeutic modalities, providing the nucleic acids may be effectively delivered to areas of the brain using non-toxic vectors. In this study, we present evidence that genes may be successfully delivered in a dose-dependent manner via the nose, primarily to the cerebral cortex using a 6-O-glycolchitosan (GC) formulation of plasmid DNA. Positively charged (zeta potential = +13 - + 25 mV) GC-DNA nanoparticles of 100-500 nm in diameter with favourable cell biocompatibility were shown to deliver the reporter Green Fluorescent Protein (GFP) plasmid to the U87MG cell line and the resulting protein expression was not significantly different from that obtained with Lipofectamine 2000. On intranasal delivery of GC-luciferase-plasmid nanoparticles to Balb/ C mice at 4 doses, ranging from 0.02 to 0.1 mg/ kg, luciferase activity was observed qualitatively in intact mouse brains, 48 h after intranasal, using the IV-VIS visualisation. In further confirmation of brain delivery, dose-dependent protein expression was quantified in multiple brain areas 48 h after dosing; with protein expression seen mainly in the cerebral cortex and striatum and following expression levels: cerebral cortex = olfactory bulb > striatum > brain stem > mid brain = cerebellum. No protein expression was observed in the liver and lungs of dosed animals. GC-DNA protein expression was not significantly different to that observed with Lipofectamine 2000. These results demonstrate that GC-DNA nanoparticles are able to deliver genes preferably to specific brain regions such as the cerebral cortex and striatum; offering the possibility of using genes to treat a range of neurological disorders using a non-invasive method of dosing.

Topics: Animals; Brain; Brain Diseases; Cerebral Cortex; Mice; Nose; Nucleic Acids

Children with encephalopathy are at increased risk of swallowing disorders with aspirations, food blockages, difficulties, and stress during meals. Serious consequences may result, such as recurrent lung infections and failure to thrive. The ENT or phoniatric examination includes the evaluation of food bolus management, possible drooling, and swallowing safety. This article explains the role of the ENT in the management of these children, with a description of the examinations to be carried out for a global evaluation of swallowing and aspirations and the treatments proposed for a better management of food intake by mouth and chronic drooling.. Les enfants avec encéphalopathie sont davantage à risque de présenter des troubles de la déglutition avec fausses routes, blocages alimentaires, difficultés et stress pendant les repas. Des conséquences graves peuvent en résulter, telles que des infections pulmonaires répétitives et un défaut de croissance staturo-pondérale. L’examen ORL ou phoniatrique comporte l’évaluation de la gestion du bol alimentaire, d’un éventuel bavage et de la sécurité de la déglutition. Cet article explique le rôle de l’ORL dans la prise en charge de ces enfants, avec une description des examens à effectuer pour une évaluation globale de la déglutition et des fausses routes ainsi que les traitements proposés pour une meilleure gestion de la prise alimentaire par la bouche et du bavage chronique.

Topics: Allergens; Brain Diseases; Child; Deglutition Disorders; Humans; Nose; Pharynx

A therapeutic strategy that can combat the multifaceted nature of neuroinflammation pathology was investigated. Thus, we fabricated PEG-PdLLA polymersomes and evaluated the efficacy in co-delivery of simvastatin (Sim, as a repurposed anti-inflammatory agent) with brain derived neurotrophic factor (BDNF, as an exogeneous trophic factor supplementation). Using LPS model of neuroinflammation, intranasal administration of combination drug-loaded polymersomes (containing both Sim and BDNF; Sim-BDNF-Ps) markedly down-regulated brain levels of cytokines compared to free drug and single-drug-loaded polymersomes. Further, Sim-BDNF-Ps effectively replenished brain level of BDNF that was depleted following neuroinflammation, resulting in a 2-fold BDNF increase versus untreated LPS control group. We found out that the efficiency of the combination drug-loaded polymersomes to suppress microglia activation in brain regions followed the order: frontal cortex > striatum > hippocampus. Our findings indicated that Sim-BDNF-Ps could effectively inhibit microglial-mediated inflammation as well as potentially resolve the neurotoxic microenvironment that is often associated with neuroinflammation.

Topics: Animals; Brain Diseases; Brain-Derived Neurotrophic Factor; Cell Line; Inflammation; Lipopolysaccharides; Mice; Mice, Inbred BALB C; Microglia; Nose; Simvastatin

本文报道1例内镜下斜坡入路脑干腹面胆脂瘤手术病例，该患者手术后随访半年，头痛症状消失，MRI提示胆脂瘤未复发。鼻内镜下蝶窦斜坡入路治疗脑干腹面胆脂瘤具有入路直接、视野良好、创伤小等优点，是安全有效的治疗方法。.

Topics: Brain Diseases; Brain Stem; Cholesteatoma; Endoscopy; Humans; Nose; Sphenoid Bone

The endoscopic endonasal approach has been well established for skull base surgery. However, there are only few studies pointing out nasal complaints after surgery. In this study, the authors evaluated postoperative nasal complaints and complications after mononostril endoscopic procedures.. All patients operated on parasellar and sellar pathologies at our department via an endoscopic mononostril transnasal transsphenoidal approach from January 2011 to May 2015 were analyzed. To assess specific postoperative nasal pathological conditions and complaints, a questionnaire was established. Applicable data of 79 patients with additional ENT follow-up could be included. Endpoints were the quantitative evaluation of complications and correlation of these data.. There was no vascular injury or worsening of visual function. Two patients had persisting CSF fistula and one of them meningitis. There was a significant decrease of nasal complaints during follow up after 2 years (p < 0.001). Further surgical treatment by ENT physician was necessary in 11.4%. Resurgery significantly increased the risk of postsurgical complaints (p < 0.005). The use of a tamponade significantly reduced the risk of postsurgical reduced nasal airflow (p = 0.026) and sinusitis (p = 0.002).. Endoscopic endonasal procedures to skull base lesions achieve high radicality with low complication rates. However, they induce temporary and permanent nasal complaints and complications. Thereby, resurgeries increase the risk of nasal complaints and the use of nasal tamponades might increase the sinonasal outcome. Further prospective studies are necessary to objectify the evaluation of postsurgical nasal complications.

Topics: Adult; Aged; Brain Diseases; Female; Humans; Male; Middle Aged; Neuroendoscopy; Nose; Postoperative Complications; Prospective Studies; Skull Base; Treatment Outcome

We report the case of a 69-year-old female who presented with a chronic nasal skin rash, new onset focal seizure, and a cerebral ring-enhancing lesion after a year of improper nasal irrigation. Despite aggressive and novel anti-amoebic treatment, she died as a result of a Balamuthia mandrillaris brain infection.

Topics: Aged; Balamuthia mandrillaris; Brain; Brain Diseases; Exanthema; Fatal Outcome; Female; Humans; Nasal Lavage; Nose; Sulfamethoxazole; Trimethoprim

Topics: Administration, Inhalation; Brain Diseases; Cocaine; Cocaine-Related Disorders; Facial Bones; Fatal Outcome; Female; Humans; Ischemia; Maxillary Sinus; Maxillary Sinusitis; Nose; Palate; Paranasal Sinuses; Recurrence; Young Adult

Topics: Adult; Brain Diseases; Endoscopy; Humans; Male; Middle Aged; Nasal Surgical Procedures; Nose; Paranasal Sinuses; Postoperative Complications

Topics: Brain; Brain Diseases; Cell Transplantation; Guided Tissue Regeneration; Humans; Mesenchymal Stem Cell Transplantation; Models, Biological; Nerve Regeneration; Nose; Olfactory Mucosa; Regenerative Medicine; Tropism; Wit and Humor as Topic

The authors reviewed their experience with endoscopic approaches to determine their safety and efficacy in the treatment of pediatric patients who harbor skull base lesions. Although they were interested in ascertaining outcomes after surgery as well as validating and defining indications and limitations of these approaches, the authors recognized that the follow-up duration was inadequate to assess long-term outcomes.. The authors conducted a retrospective review of all endoscopic procedures performed at their institution between January 2000 and September 2005. The procedures were categorized into a series of anatomical modular approaches. Twenty-five patients 18 years of age or younger were identified. The surgical goals were individualized and included gross-total resection, partial resection, biopsy, decompression of neural structures, and repair of a cerebrospinal fluid (CSF) leak. One patient required an open procedure in addition to the expanded endonasal approach for definitive therapy. No patient suffered a neurological deficit, vascular injury, or central nervous system infection. A CSF leak was the most common complication and occurred in two (8%) of the 25 patients.. In well-selected patients, the expanded endonasal approach represents a safe, effective, and minimally invasive technique for the treatment of skull base lesions in children. Incremental experience is needed for acquiring the skills with endoscopic techniques to progress to the more complex modular approaches.

Topics: Adolescent; Biopsy; Brain Diseases; Brain Neoplasms; Cerebrospinal Fluid Rhinorrhea; Child; Child, Preschool; Craniotomy; Decompression, Surgical; Endoscopy; Female; Follow-Up Studies; Humans; Male; Nose; Postoperative Complications; Retrospective Studies; Safety; Skull Base; Treatment Outcome

This study describes the use of a novel collagen-based dural substitute in endoscopic endonasal transsphenoidal surgery.. Operative records were reviewed for a 12-month period for all patients who underwent surgery by means of an endoscopic endonasal transsphenoidal approach since we began using TissuDura (Baxter, Vienna, Austria) collagen-only dural substitute in January 2004.. During the 12-month period evaluated, we performed an endoscopic endonasal transsphenoidal operation for a variety of pituitary lesions on 72 consecutive patients. Among these, 15 patients (20.8%) required the implant of the collagen foil. Nine patients (60%) presented an intraoperative CSF leak (3 small weeping of CSF and 6 larger leaks); in these cases, the TissuDura was used against the arachnoid membrane, followed by the other materials used for the repair. In 7 other subjects without any evidence of CSF escape, the collagen foil was used to protect and enforce the arachnoidal membrane descent into the sellar cavity to prevent its possible postoperative rupture and consequent CSF leak. Fibrin glue was used in all cases. A postoperative CSF leak with meningitis occurred in only 1 (6.7%) of the 15 subjects. The patient required a reoperation for CSF fistula repair and intravenous antibiotics.. Even if based on a relatively small patient series, our experience demonstrated that the use of TissuDura in transsphenoidal surgery is safe and biocompatible, as compared with other dural substitutes.

Topics: Animals; Biocompatible Materials; Brain Diseases; Collagen; Dura Mater; Endoscopy; Horses; Humans; Magnetic Resonance Imaging; Neurosurgical Procedures; Nose; Postoperative Complications; Sphenoid Bone; Surgical Mesh; Treatment Outcome

To understand the demographic as well as clinical characteristics, and outcomes of patients with rhinocerebral mucormycosis in Taiwan, we retrospectively analyzed patients with this disease admitted to Chang Gung Memorial Hospital-Kaohsiung from 1988 through 2000. The 21 patients included 8 men (28%) and 13 women (62%). The median age was 60 years (range, 34-82 years). Twenty patients (95%) had underlying diabetes mellitus. The most common clinical feature at admission was ocular lesions, followed by headache, nostril lesions, and consciousness disturbance. Fifteen (94%) of 16 patients who received combined surgical debridement and therapy with amphotericin B survived, while only 1 (20%) of the 5 patients who received amphotericin B alone survived (p=0.004). The diagnosis of rhinocerebral mucormycosis was delayed in 4 patients (19%). Of the 16 patients who survived, 1 (6%) had delayed diagnosis, while of the 5 patients who died, 3 (60%) had delayed diagnoses (p=0.028). This series disclosed a higher proportion of patients with rhinocerebral mucormycosis in Taiwan had underlying diabetes mellitus, and ocular lesions were more frequent than nostril lesions at the time of admission. These results highlight the importance of the timely initiation of a combination of aggressive surgical debridement and treatment with amphotericin B in patients with rhinocerebral mucormycosis. Considering the high rate of delayed diagnosis, improved clinician's awareness of mucormycosis is extremely important and is in urgent need in Taiwan.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Brain Diseases; Community Health Centers; Debridement; Diabetes Complications; Eye; Female; Fever; Headache; Humans; Male; Middle Aged; Mucormycosis; Nose; Nose Diseases; Retrospective Studies; Taiwan; Treatment Outcome; Unconsciousness

Topics: Brain Diseases; Cleft Palate; Craniofacial Dysostosis; Female; Foot Deformities, Congenital; Humans; Hypertelorism; Infant; Infant, Newborn; Joint Dislocations; Nose

Topics: Allergens; Bacteria; Brain Diseases; Drug Hypersensitivity; Dust; Humans; Hypothalamus; Methods; Nose; Syndrome

Topics: Brain Diseases; Cerebrospinal Fluid Rhinorrhea; Ethmoid Bone; Female; Fistula; Humans; Hydrocephalus; Intracranial Pressure; Male; Nasal Cavity; Nose; Skull

Topics: Age Factors; Anti-Bacterial Agents; Blood Pressure; Brain Diseases; Brain Edema; Central Venous Pressure; Cerebrospinal Fluid Rhinorrhea; Child; Child, Preschool; Craniofacial Dysostosis; Emphysema; Face; Humans; Infant; Infant, Newborn; Intracranial Pressure; Nose; Orbit; Osteotomy; Postoperative Complications; Respiratory Insufficiency; Skin Transplantation; Skull; Surgery, Plastic; Transplantation, Autologous; Urinary Catheterization

Topics: Adult; Brain Diseases; Brain Neoplasms; Electrodes; Epilepsy; Epilepsy, Tonic-Clonic; Ethmoid Sinus; Frontal Lobe; Humans; Male; Meningioma; Middle Aged; Nose; Wakefulness

Topics: Brain Diseases; Cerebral Ventricle Neoplasms; Cerebrospinal Fluid Rhinorrhea; Fistula; Humans; Hydrocephalus; Intracranial Pressure; Nose; Papilloma; Pneumoencephalography; Subarachnoid Space

Topics: Angiography; Brain Diseases; Cerebral Angiography; Cleft Palate; Congenital Abnormalities; Craniofacial Dysostosis; Holoprosencephaly; Humans; Infant; Limbic System; Nose; Nose Deformities, Acquired; Radiography

Topics: Brain; Brain Diseases; Cleft Lip; Cleft Palate; Congenital Abnormalities; Diagnosis; Embryology; Holoprosencephaly; Humans; Infant; Infant, Newborn; Microcephaly; Nose; Nose Deformities, Acquired; Orbit

Topics: Brain Diseases; Communicable Diseases; Humans; Mastoiditis; Neurologic Manifestations; Nose; Pharynx; Sinusitis; Suppuration

Topics: Brain Diseases; Cavernous Sinus; Humans; Mucormycosis; Nose; Ophthalmoplegia; Orbit; Paranasal Sinuses; Pathology; Thrombosis

Topics: Brain Diseases; Choanal Atresia; Congenital Abnormalities; Humans; Nose; Nose Deformities, Acquired

Topics: Asphyxia; Brain; Brain Diseases; Ear; Humans; Larynx; Nose; Suicide

Topics: Brain; Brain Diseases; Eye; Humans; Injections; Nose; Skull; Sulfanilamide; Sulfanilamides; Sulfonamides; Turbinates