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Cocaine consumption is associated with a variety of clinical manifestations. Though cocaine intranasal inhalation always determines nasal mucosal damages, extensive septum perforations, and midline destructions-known as cocaine-induced midline destructive lesions (CIMDL)-affect only a limited fraction of patients. CIMDL is viewed as a cocaine-associated autoimmune phenomenon in which the presence of atypical anti-neutrophil cytoplasmic antibody (ANCA) promotes and/or defines the disease phenotype. A 51-year-old man presented with an intracranial tumor-like lesion by its space-occupying effect. CT also revealed the destruction of the nasal septum and skull base. A diagnosis of CIMDL was made in light of the patient's history as well as findings of the physical and endoscopic examinations, imaging studies, and laboratory testing. There was no evidence of other pathologies. Histopathological results from cerebral biopsy led us to consider the intracranial pathology as an extension of the CIMDL. CIMDL is the result of a necrotizing inflammatory tissue response triggered by cocaine abuse in a subset of predisposed patients. The reported case is the first CIMDL consistent with brain extension mimicking a tumor-like lesion. While the presence of atypical ANCA seems to promote and/or define the disease phenotype, the specific role of these and other circulating autoantibodies needs further investigation., (© 2020 American Association of Neuropathologists, Inc. All rights reserved.)

Traumatic brain injury (TBI) is frequently followed by a variety of physical, emotional, and cognitive symptoms, which affect the patient's daily life, their social relations, and their work/educational status. In addition to function measures, health-related quality of life (HRQoL) has received increasing attention as an important outcome after TBI, as it may guide rehabilitation and evaluate treatment success. Here, we report on psychometric properties of a Spanish translation of the quality of life after brain injury (QoLIBRI) questionnaire, a disease-specific instrument to assess HRQoL in patients after TBI. Classical test theory, item response theory, and structural equation modeling were used to evaluate psychometric properties of the Spanish QoLIBRI translation in a convenience sample of N = 155 patients with TBI. A subset of n = 23 patients were tested twice with a test-retest interval of ≤2 weeks. Internal consistency and test-retest reliabilities were high (Cronbach's α: 0.78-0.96; ICCs: 0.81-0.96). Rasch analysis infit (range 0.52-1.20) and outfit indices (range 0.50-1.17) supported unidimensionality of subscales, whereas SEM analysis tended to support a correlated six-factor model (CFI = .88, RMSEA = .068, 95% confidence interval [.061, .075]). Results show favorable psychometric properties of the Spanish translation of the QoLIBRI, comparable to the international version. It is, thus, a useful instrument for clinicians and researchers assessing the impact of TBI on quality of life, the outcomes of rehabilitation, and may be included in epidemiological surveys.

The aim of the study was twofold. First, to study the relationship among apathy in the long term, initial clinical measures, and standard outcome scores after traumatic brain injury (TBI). Second, to describe white matter integrity correlates of apathy symptoms. Correlational study. Methods and Procedures: Correlation and Bayesian networks analyses were performed in a sample of 40 patients with moderate to severe TBI in order to identify the relationship among clinical variables, functionality, and apathy. A diffusion tensor imaging study was developed in 25 participants to describe correlations between fractional anisotropy (FA) measures and apathetic symptoms. Correlation analysis revealed associations between pairs of variables as apathy in the long term and functional score at discharge from hospital. Bayesian network illustrated the relevant role of axonal injury mediating the relationship between apathy and initial clinical variables. FA in the superior longitudinal fasciculus, the inferior longitudinal fasciculus, and the internal capsule were negatively correlated with apathy measures. Widespread brain areas showed positive correlations between FA and apathy. These results highlight the relevance of white matter integrity measures in initial assessment after TBI and its relationship with apathetic manifestations in the chronic phase. [ABSTRACT FROM AUTHOR]