Clin. Transl. Neurosci., Volume 2, Issue 1 (January 2018) – 18 articles

For most sighted people, looking into a mirror helps to consolidate a visual and spatial concept of the self. This concept connects both theoretically and substantively to other elements of identity. Similarly, observing the bodies of others plays a key role in social interaction between sighted individuals. These visual inputs offer cues to identity as perceived by other people as well as cues for responding to these attributes. Both the ability to observe bodies visually and the ability to respond psychosocially necessarily involve a variety of structures in the brain. Responses to these images were historically framed as lying outside the realm of neuroscientific inquiry. However, neurosociological inquiry has since evolved as a distinct field—one acknowledging that recognizing and acting upon visual cues is equally a sociological one and a neurological one. We apply a broader neurosociological model of embodiment to the specific context of limb transplantation. We do so using anecdotes and writings from practicing clinicians that illustrate ongoing debates about how people experience and adapt to life with transplanted hands. In the process, we call for more detailed exploration of the synergistic connections between sociological and neurological processes using concepts from dramaturgy. Full article

The Swiss Young Neurosurgeons Society (SYNS) comes to life in 2008, creating a community renowned for its unique spirit, a platform dedicated to lifelong teaching and learning. In 2008, a small group of Swiss residents found a cross-canton training platform to provide dedicated, affordable courses organized by residents to directly support their peers. After almost 10 years, SYNS thrives on its unique, familial spirit cultivating a direct contact with teachers as well as with their supporters. The society provides up to four annual training courses and serves as an open platform for residents to exchange experiences and to represent their members’ interests on a national and international level. Full article

We wish to highlight the political impact of neuroscientific societies as forums of cross-border communication from a historical point of view. We trace the efforts of Constantin von Monakow, a founder of Swiss Neurology, and Cornelis Winkler, one of the primary figures in the early years of Dutch neurology and psychiatry, to shape their medical fields in their countries of residence. The foundation of the International Brain Commission and the failing of its continuation after World War I is reflected by the struggle to constitute the Swiss Neurological Society and the Netherlands Society of Neurology and Psychiatry and to develop their specialties along with new scientific findings in brain research. How both neuroscientists, from politically neutral countries, set different focuses concerning future developments of their societies, as well as their specialties, raises important questions about the role of neurosciences in society and were discussed by neuroscientists between the wars: Von Monakow tried to emphasize the moral meaning of knowledge about the human brain, whereas Winkler was convinced that neurology should focus on scientific issues in the traditional way, without bringing moral or societal implications to the fore. The journal Swiss Archives of Neurology and Psychiatry, founded by Constantin von Monakow in 1917, represents a successful attempt to establish an organ of scientific communication against the background of challenging political circumstances. Full article

We present the multidisciplinary approach toward the diagnostic and treatment of patients with cognitive complaints adopted within the Leenaards Memory Centre at the University Hospital of Lausanne in Switzerland. Our strategy combines clinical evaluation using standardized neuropsychological, biological, imaging, and genetic biomarkers, together with an integrated approach to care of the patient and his/her caregiver(s) that takes into account the individual environmental and socioeconomic circumstances. Tightly integrated with the clinical process is a centralized electronic information system—called CLEMENS—that maintains a database of detailed records of assessment results, actions, care plans and biomarker and imaging data of consulting patients. The CLEMENS system provides the translational bridge between the clinical activity and its projection into and from clinical research, enabling the in-depth and multivariate evaluation of all clinically measured aspects. We discuss how research outcomes can feed back into the clinical activity, allowing for more accurate patient evaluation, diagnostic stratification, and care Full article

Blood biomarkers are increasingly beginning to play a role in the diagnosis, management, and prognostication of patients with acute ischemic stroke. While imaging biomarkers have played the largest role in determining acute therapies, blood-based biomarkers may have important contributions to make in settings where imaging is not readily available, or when making predictions about future complications and recurrent stroke. Though more research in large, diverse patient populations are needed before blood-based biomarkers become widely accepted for stroke management, preliminary reports suggest their value in several settings and the use of biomarkers is gaining traction. This article discusses the role of several selected readily available protein biomarkers in stroke diagnosis, acute management decisions, and prognosis. Protein biomarkers were primarily selected based on the fact that they have been evaluated in cohort studies and ideally that they have been validated by independent groups. Full article

Since almost 50 years L-Dopa is the gold standard for the treatment of patients with Parkinson’s disease (PD). For the first time, a specific chemical abnormality was found in a specific brain disorder. It has been shown that the striatal dopamine (DA) content is greatly reduced in PD patients. The substitution of DA by its precursor L-dopa greatly enhanced the quality of life of PD patients. Full article

Background: Anti-CD20 therapies are an emerging treatment strategy in multiple sclerosis (MS). Objective: Retrospective analysis of efficacy and safety in an MS cohort treated with rituximab (RTX) with identification of potential treatment response predictors. Methods: This retrospective study describes a monocentric cohort of 30 MS patients treated with RTX in a routine clinical setting. Patient characteristics, disease course, clinical and magnetic resonance imaging (MRI) treatment response markers, and laboratory assessments were analyzed. Logistic regression analysis corrected for demographic characteristics was used to identify treatment response predictors. Results: The RTX-treated cohort (mean age at RTX initiation 48 years (SD 14)) comprised patients with relapsing-remitting MS (n = 9), primary progressive MS (n = 11), and secondary progressive MS (n = 10). Two-thirds of patients had at least one MS medication prior to RTX; 27.6% of patients improved on the Expanded Disability Status Scale during RTX, whereas 72.4% of patients were stable or worsened. Based on this classification, we identified the presence of gadolinium enhancement in MRI before RTX as a predictor of response (odds ratio (OR) 12.2, confidence interval (CI) 1.02–144.55). After receiver operating characteristic curve definition of immunoglobulin (Ig) class cutoffs and creation of a sum score, the latter also predicted RTX response (OR 5.15, CI 1.21–21.88). Infectious complications were seen in three patients under RTX treatment. Conclusion: With the limitation of the retrospective approach and small sample size, this study confirms gadolinium enhancement before treatment initiation as a predictor of anti-CD20 response in MS. Lower Ig levels were associated with RTX response; however, these will have to be further investigated for a potential role for infectious complications. Full article

A 62-year-old female with a history of stroke due to cerebral arteriosclerosis suffered from recurrent fainting (<10 s) provoked by rapid head movements up to four times per month for at least two years. There was no evidence of new strokes in repeated MRI and no high-grade vertebral artery stenosis on catheter angiography. Electroencephalography and cardiovascular workup were normal. Because fainting was head-position triggered, carotid massage was performed, demonstrating transient sinus arrest and carotid sinus syndrome (CSS) was diagnosed. After pacemaker implantation, episodes disappeared. Based on this case we discuss the diagnostic approach and also potential pitfalls and limitations of CSS. Full article

Degeneration of the intervertebral disc – triggered by ageing, mechanical stress, traumatic injury, infection, inflammation and other factors – has a significant role in the development of low back pain. Back pain not only has a high prevalence, but also a major socio-economic impact. With the ageing population, its occurrence and costs are expected to grow even more in the future. Disc degeneration is characterized by matrix breakdown, loss in proteoglycans and thus water content, disc height loss and an increase in inflammatory molecules. The accumulation of cytokines, such as interleukin (IL)-1β, IL-8 or tumor necrosis factor (TNF)-α, together with age-related immune deficiency, leads to the so-called inflammaging – low-grade, chronic inflammation with a crucial role in pain development. Despite the relevance of these molecular processes, current therapies target symptoms, but not underlying causes. This review describes the biological and biomechanical changes that occur in a degenerated disc, discusses the connection between disc degeneration and inflammaging, highlights factors that enhance the inflammatory processes in disc pathologies and suggests future research avenues. Full article

A 90-year-old woman developed a severe stroke (National Institutes of Health Stroke Scale Score (NIHSS) 24) due to an occlusion of the left carotid T. Computed tomography 60 min after symptom onset showed a large area of tissue at risk with a relatively large area of reduced cerebral blood volume indicating a relative large infarct core. After successful reperfusion, she recovered very well with only residual facial asymmetry (NIHSS 1). Up to now, therapeutic decisions for intravenous thrombolysis and endovascular treatment were mainly based on these time windows, although it was well known that the individual time window may vary widely due to a large variability of the quality of collateral circulation. The recently presented results of the DAWN trial have demonstrated that patients can be successfully treated in a time window up to 24 h when selected by imaging and clinical criteria. The described case impressively demonstrates that this positive selection of patients beyond established treatment time windows does not implicate in reverse that patient selection for therapy within the established time windows can be based on the same imaging criteria. In conclusion, patient selection beyond the established time windows may be based on the available techniques, but imaging-based decisions against therapy in patients within the established time windows should be made only with extreme caution. Full article

A 45-year-old man presented to the neurotology clinic, suffering from recurrent attacks of vertigo associated with falls, of unknown origin. Pure tone audiometry revealed a profound right-sided and mild left-sided pantonal sensorineural hearing loss. Caloric videonystagmography showed marked canal paresis on the right side. Video-head impulse test, however, showed bilaterally normal gain. Cranial magnetic resonance imaging (MRI) was normal. No neurovascular compression was noted. We performed locally enhanced inner ear MRI (LEIM). LEIM revealed a marked dilation of the endolymphatic space of the right inner ear, that is, endolymphatic hydrops. In light of the history, clinical, functional and imaging results, therefore, the diagnosis of hydropic ear disease (Menière’s disease) with vestibular drop attacks could be established. This clinical image case illustrates the usefulness of inner ear imaging for the differential diagnosis of vertigo disorders, such as hydropic ear disease (Menière’s disease). Full article

Aquaporins (AQPs) are water channel molecules that allow the passage of water through the lipid bilayers of cell membranes. AQP1, AQP4 and AQP9 are expressed in the central nervous system and AQP4 is well known as the target of auto-antibodies in Devic’s neuromyelitis optica. The role of AQPs in facilitating water movements suggests a link with oedema formation and resolution in the brain. Furthermore, AQPs are also involved in process formation in glial cells with a close link to neuroinflammation. This mini-review gives an overview of what is currently known about the role of AQPs in different neurological disorders. Full article

Objectives: To identify new magnetic resonance imaging (MRI) patterns in patients with high-grade glioma treated with bevacizumab (Avastin^®). Methods: The retrospective study was approved by the institutional review board. An extended case series of 27 patients (19 men, 8 women) with age range of 22–76 years and an average age 52 years were studied by 1.5T/3T MRI (Siemens scanner Erlangen, Germany). Protocol included axial T1-wi spin echo (SE), axial T2-wi fast SE, three-dimensional fluid-attenuated inversion recovery (3D FLAIR), axial diffusion tensor imaging, axial T2-wi gradient echo (GE), dynamic-susceptibility contrast T2-perfusion, axial T1-wi post-gadolinium (Gd) (0.2 ml/kg of body weight) and 3D T1-wi (weighted) GE post-Gd. Evaluation comprised oedema or low-grade tumour infiltration using FLAIR sequences, perfusion using relative cerebral blood volume (rCBV) and enhancement using T1-wi post-medium contrast images. Results: At baseline, the study included 27 patients, of which 14 patients were excluded and 13 patients analysed. One patient under treatment showed persistent hyperperfusion, three mixed perfusion, six hypoperfusion and three normal perfusion. FLAIR sequences were used in oedema analysis. When treated, 10 patients showed decrease in perilesional oedema, 1 showed increase in perilesional oedema and 2 had stability in perilesionnal oedema. Lesion enhancement was analysed using axial T1-wi SE post-Gd images; 12 patients showed decrease and 1 patient showed stability in lesion enhancement. Conclusions: Bevacizumab (Avastin) alters the process of angiogenesis resulting in different perfusion patterns in patients with disease progression that must be known in order to avoid erroneous interpretation. Full article

While the physiology, histology and stem cell biology of smell are active fields of contemporary research, smell is probably the sense that physicians knew the least about prior to the 20th century. Joseph-Hippolyte Cloquet (1787–1840) was an anatomist who, in 1815, defended a singular doctoral thesis—On odours, the sense of olfaction and the olfactory organs—then went on to publish, in 1821, the first complete treatise on rhinology. In our biographical sketch, we focus on Cloquet’s significant contributions to olfactory anatomy and physiology. His realization that odours are chemical and molecular in nature led him to formulate an accurate functional theory of the olfactory mucosa. Following a historical introduction, we review contemporary literature on the anatomical–functional understanding of olfaction and propose a (possibly debatable) theory for the lexical deficits one encounters when trying to describe the sense of smell. Full article

In Switzerland, since 2011, a mandatory certification system for stroke units (SUs) and stroke centres has been successfully implemented. Detailed criteria for stroke centres and SUs focusing on leadership, specialized staff, infrastructure, diagnostic procedures, treatment procedures, monitoring, education, research and key data have been defined by the Swiss Federation of Clinical Neurosocieties Swiss Stroke Committee mainly based on recommendations of the Swiss Stroke Society and European Stroke Organisation. During the certifications procedures, a very close and fruitful cooperation between stroke centres and SUs and other hospitals in regional networks could be observed. Improvement in the infrastructure and the quality of stroke care has been achieved during the last years. Full article