Depression is a heterogeneous clinical syndrome prevalent in patients with Parkinson disease (PD) that remains incompletely understood. Further, the differences in biomarkers of depression in PD and in non-PD patients are unclear. The subcallosal cingulate cortex (SCC) and its connections have been implicated in the pathophysiology of major depressive disorder (MDD). Diffusion tensor imaging (DTI) provides a tool to quantify MDD-related structural abnormalities underlying depressive symptoms in PD. Diffusion-weighted magnetic resonance imaging data were collected from 31 patients with PD. Depression symptom severity was measured using the Beck Depression Inventory (BDI-II), and assessed using three subscales: dysphoric mood, loss of interest/pleasure, and somatic symptoms. Probabilistic tractography methods were used to quantify the SCC connectivity to target regions in cortico-limbic-striatal network (ventral striatum, medial prefrontal cortex [mPFC], dorsal anterior cingulate cortex, and uncinate fasciculus), while fractional anisotropy (FA) was calculated in predefined white matter regions of interest. DTI data were correlated with severity of depression across three domains. SCC-mPFC connectivity in the left hemisphere was positively correlated with severity of dysphoric mood (Benjamini-Hochberg adjusted p = .02). Region of interest-based analyses demonstrated a significant and distinct topographic association between FA and dysphoric mood, loss of interest/pleasure, and somatic symptom severity, although these findings did not maintain significance after applying the false discovery rate correction. Abnormal SCC connectivity underlies depressive symptoms in both PD and MDD, suggesting that interventions used for MDD should be explored in treating depressive symptoms in PD, particularly depression dominated by dysphoric mood.

BACKGROUND: Chiari (type I) malformations are typically congenital. Occasionally, however, tonsillar herniation can arise secondary to cerebrospinal fluid leakage, posterior fossa or intraventricular mass lesions, or other etiologies. We present the first-ever case of an intramedullary subependymoma at the cervicomedullary junction associated with vertebral bone abnormalities and an acquired secondary Chiari malformation. CASE DESCRIPTION: A 60-year-old woman presented with a 3-year history of occipital, tussive headaches. Preoperative imaging was negative for mass lesions but demonstrated a Chiari malformation. She was recommended posterior fossa decompression with tonsillar shrinkage. During surgery, an intramedullary mass was incidentally observed, obstructing the obex at the cervicomedullary junction. Histopathological analysis of the resected lesion revealed a diagnosis of subependymoma. CONCLUSION: Subependymomas can sometimes present a diagnostic challenge due to their subtle appearance in neuroimaging. Only rarely are such masses associated with an acquired Chiari malformation. No such case has previously been reported. We present a literature review on acquired Chiari malformations and discuss their management.

Background

Intradural extramedullary teratomas in the cervical or cervicomedullary region are rare in adults.

Case description

We report a symptomatic, mature teratoma at the cervicomedullary junction in a 52-year-old Hispanic female who also has a type I diastematomyelia in the thoracolumbar spine. The patient underwent surgical resection of the lesion with the resolution of presenting symptoms. Histopathology of the lesion revealed a mature cystic teratoma with pulmonary differentiation.

Conclusion

We discuss the case along with a review of pertinent literature and considerations with regard to the diagnosis, etiology, prognosis, and management of this unusual pathology.