Viral infections of the central nervous system (CNS) have been emerging and re-emerging worldwide, and the Australasia region has not been spared. Enterovirus A71 and enterovirus D68, both human enteroviruses, are likely to replace the soon-to-be eradicated poliovirus to cause global outbreaks associated with neurological disease. Although prevalent elsewhere, the newly emergent orthoflavivirus, Japanese encephalitis virus (genotype IV), caused human infections in Australia in 2021, and almost certainly will continue to do so because of spillovers from the natural animal host-vector life cycle endemic in the country. Another orthoflavivirus, Murray Valley encephalitis virus, has re-emerged in Australia. The Hendra henipavirus together with Nipah henipavirus are listed as high-risk pathogens by the World Health Organization because both can cause lethal encephalitis. The former remains a health threat in Australasia because bats may still be able to spread the infection to unvaccinated Australian horses and other animals acting as intermediate hosts, and thence to humans. The global COVID-19 pandemic, caused by the emerging severe acute respiratory syndrome coronavirus-2, a virus transmitted from animals to humans that was first described and first arose in China, is associated with acute and long-lasting CNS pathology. Fortunately, the pathology and pathogenesis of these important neurotropic viruses are now better understood, leading to better management protocols and prevention strategies. Pathologists are in a unique position to contribute to the diagnosis and advancement in our knowledge of infectious diseases. This review summarises some of the current knowledge about a few important emerging and re-emerging CNS infections in Australasia and beyond.
Matched MeSH terms: Central Nervous System/pathology; Central Nervous System/virology; Central Nervous System Viral Diseases/diagnosis; Central Nervous System Viral Diseases/epidemiology; Central Nervous System Viral Diseases/virology
Burkholderia pseudomallei affecting the central nervous system has been extensively reported in the literature. However, combined central nervous system and peripheral nervous system involvement in melioidosis has never been reported. We report a 66-year-old man with diabetes mellitus who was diagnosed to have central nervous system melioidosis and developed acute flaccid quadriplegia. Nerve conduction studies and anti-ganglioside antibodies were consistent with Guillain-Barre syndrome. This case report highlights the importance to recognise the possibility of Guillain Barre syndrome complicating central nervous system melioidosis and stresses the urgency of early consideration of this complication, as early immunomodulatory therapy may hasten neurological recovery.
Third ventricular cavernous angiomas are rare vascular malformations of the brain. We report an eight-year old boy with a rare third ventricular cavernous angioma that hemorrhaged presenting with symptoms of acute hydrocephalus. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) showed a heterogenous ill-defined, solid and cystic intraventricular mass in the third ventricle which was mildly enhanced with contrast and there was associated hydrocephalus. The mass was removed with success and follow up after two years revealed no neurological abnormalities.
Matched MeSH terms: Central Nervous System Neoplasms/diagnosis*; Central Nervous System Neoplasms/surgery; Hemangioma, Cavernous, Central Nervous System/diagnosis*; Hemangioma, Cavernous, Central Nervous System/surgery
Matched MeSH terms: Central Nervous System Neoplasms/pathology; Central Nervous System Neoplasms/physiopathology*; Tuberculosis, Central Nervous System/physiopathology*
Individuals with attention-deficit/hyperactivity disorder (ADHD) exhibit varied responses to pharmacological treatments (e.g. stimulants and non-stimulants). Accurately and promptly detecting treatment-related improvements, response failure, or deterioration poses significant challenges, as current monitoring primarily relies on subjective ratings. In this commentary, we critically evaluate the evidence supporting the use of QbTest for objectively monitoring ADHD treatment response in clinical practice. We also offer recommendations for future research, advocating for rigorous clinical trials and longitudinal studies to further explore the potential utilisation of QbTest and other tools for monitoring treatment responses in individuals with ADHD.
Matched MeSH terms: Central Nervous System Stimulants/pharmacology; Central Nervous System Stimulants/therapeutic use
Two cases of Hypomelanosis of Ito are described; presenting with depigmented whorl-like, zig-zag, bizzare cutaneous manifestations associated with central nervous system disorders.
Matched MeSH terms: Central Nervous System Diseases*
Illicit drugs are used to produce a sense of euphoria in the user. Like marijuana, kratom is a plant-based substance. The leaves of the Mitragyna speciosa tree were used to treat mild medical conditions in Thailand and Malaysia as a stimulant in low doses, and sedative and analgesic at high doses. Over recent years, kratom gained popularity as a recreational drug among younger individuals in Southeast Asia due to its availability as a cheap and easily assessable substance with euphoric effects. This trend has rapidly made its way to the West. Unlike marijuana, in the United States kratom's use as an inexpensive herbal recreational "supplement" is poorly popularized. However, emerging reports garnished from use as a recreational drug reveals a potential health hazard. Seizures and neurological consequences have been reported from kratom abuse. Complex pharmacokinetics place patients at further risk of side effects and drug interactions. Still, individuals can legally purchase kratom at stores and through online distributers in capsule form or as teas, powders, and extracts under the veil of a harmless herbal remedy. Without United States Food and Drug Administration oversight, kratom has a high potential for abuse and without regulatory control threatens public safety.
Matched MeSH terms: Central Nervous System Stimulants*
Naegleria fowleri is a protist pathogen that can cause lethal brain infection. Despite decades of research, the mortality rate related with primary amoebic meningoencephalitis owing to N. fowleri remains more than 90%. The amoebae pass through the nose to enter the central nervous system killing the host within days, making it one of the deadliest opportunistic parasites. Accordingly, we present an up to date review of the biology and pathogenesis of N. fowleri and discuss needs for future research against this fatal infection.
Matched MeSH terms: Central Nervous System Protozoal Infections/parasitology*
Primary angiitis of the central nervous system (PACNS) is a rare vasculitis restricted to the central nervous system without systemic involvement. Delay in diagnosis and treatment is common due to its non-specific symptoms and lack of non-invasive diagnostic tests. Myelopathy can occur in PACNS, during the clinical course of the illness, with or without cerebral symptoms. We describe here a 51 year-old ethnic Chinese woman who presented initially with paraparesis without cerebral symptoms. The diagnosis of PACNS was eventually made from brain biopsy when she subsequently developed cerebral involvement. Despite aggressive treatment, the patient developed progressive neurological deterioration and died. This patient demonstrates the rare occurrence of myelopathy as the sole initial presentation of PACNS.
Matched MeSH terms: Central Nervous System; Vasculitis, Central Nervous System
Brain infections due to Acanthamoeba spp., Balamuthia mandrillaris, and Naegleria fowleri often lead to death. Despite differences in the preferential sites of infection in the brain, the mode of delivery of drugs is often intravenous. Here, we discuss targeted therapeutic approach to affect parasite viability without affecting the host cells, with an eye to improve formulation of drugs and/or administration of drugs against brain-eating amoebae.
Matched MeSH terms: Central Nervous System Protozoal Infections/drug therapy*
Neuroblastoma is usually presented with abdominal distension. However, central nervous system manifestations of neuroblastoma are uncommon. In this case report, patient presented with uncommon presentation of neuroblastoma and the diagnostic dilemma.
Matched MeSH terms: Central Nervous System Neoplasms
Disaster is that which stimulates a pronounced effect on the one who experiences it. Not only does it result in a physical effect but also a significant psychological repercussion on the victim. The bulk of disaster management researches give too great an emphasis on the physical outlook such as property and health, relative to the psychological aftermath and its management aspect. This research has taken the qualitative approach through an extensive interview with five victims of the flash flood catastrophe in Kelantan to identify the sustained psychological effect as well as how the management of psychological support aspect can be of assistance for the victims. The acquisition of the research findings encompassed several themes namely sustained emotion theme, sustained psychological issue theme along with management of psychological victim aspect. The outcome of the resulting theme corroborated with the disaster management model via three stages namely, induction, identification and assessment, and finally, development and preservation.
Pathogenic free-living amoeba are known to cause a devastating infection of the central nervous system and are often referred to as "brain-eating amoebae". The mortality rate of more than 90% and free-living nature of these amoebae is a cause for concern. It is distressing that the mortality rate has remained the same over the past few decades, highlighting the lack of interest by the pharmaceutical industry. With the threat of global warming and increased outdoor activities of public, there is a need for renewed interest in identifying potential anti-amoebic compounds for successful prognosis. Here, we discuss the available chemotherapeutic options and opportunities for potential strategies in the treatment and diagnosis of these life-threatening infections.
Matched MeSH terms: Central Nervous System Diseases/diagnosis; Central Nervous System Diseases/drug therapy*; Central Nervous System Diseases/parasitology*
The advancements in microscopic techniques have stimulated great interest in the muscular and neural architectures of invertebrates, specifically using muscle and neural structures to infer phylogenetic relationships. Here, we provide the data on the development of the muscular and nervous systems during the larval development of stalked barnacle, Octolasmis angulata using the phalloidin F-actin and immunohistochemical labelling (e.g. acetylated α-tubulin and serotonin) and confocal laser scanning microscopy analysis. All naupliar stages shared the same muscle and neural architectures with only the discrepancy in size. The nauplii have a complex muscle arrangement in their feeding apparatus and naupliar appendages. Most naupliar muscles undergo histolyse during the cyprid metamorphosis. The cyprid muscles form beneath the head shield at the end of nauplius VI. The naupliar and cyprid central nervous systems exhibit the typical tripartite brain comprising the protocerebrum, deutocerebrum and tritocerebrum. The serotonin-like immunoreactivity is mainly found in the naupliar brain, mandibular ganglia, cyprid brain and posterior ganglia. Our study revealed that numerous muscle and neural architectures in the naupliar and cyprids have phylogenetic significance, but future studies on the myoanatomy and neuroanatomy of other barnacle species are necessary to determine the homology of these structures.
Matched MeSH terms: Hemangioma, Cavernous, Central Nervous System/complications; Hemangioma, Cavernous, Central Nervous System/pathology*; Hemangioma, Cavernous, Central Nervous System/surgery; Central Nervous System Cysts/pathology; Central Nervous System Cysts/surgery
Anglerfish from the genus Lophius are a globally important commercial fishery. The microsporidian Spraguea infects the nervous system of these fish resulting in the formation of large, visible parasitic xenomas. Lophius litulon from Japan were investigated to evaluate the intensity and distribution of Spraguea xenomas throughout the nervous system and to assess pathogenicity to the host and possible transmission routes of the parasite. Spraguea infections in L. litulon had a high prevalence; all fish over 403 mm in standard length being infected, with larger fish usually more heavily infected than smaller fish. Seventy percent of all fish examined had some gross visible sign of infection. The initial site of development is the supramedullary cells on the dorsal surface of the medulla oblongata, where all infected fish have parasitic xenomas. As the disease progresses, a number of secondary sites typically become infected such as the spinal, trigeminal and vagus nerves. Fish with infection in the vagus nerve bundles often have simultaneous sites of infection, in particular the spinal nerves and along the ventral nerve towards the urinary bladder. Advanced vagus nerve infections sometimes form xenomas adjacent to kidney tissue. Spraguea DNA was amplified from the contents of the urinary bladders of two fish, suggesting that microsporidian spores may be excreted in the urine. We conclude that supramedullary cells on the hindbrain are the primary site of infection, which is probably initiated at the cutaneous mucous glands where supramedullary cells are known to extend their peripheral axons. The prevalence of Spraguea infections in L. litulon was very high, and infections often extremely heavy; however, no associated pathogenicity was observed, and heavily infected fish were otherwise normal.
Matched MeSH terms: Central Nervous System Fungal Infections/microbiology; Central Nervous System Fungal Infections/epidemiology; Central Nervous System Fungal Infections/pathology; Central Nervous System Fungal Infections/veterinary*