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Background: Cerebrospinal fluid (CSF) shunting refers to the surgical drainage of excess CSF, which arises due to outflow obstruction or a reduction in absorption. Although rare, the dissemination of neoplastic cells along ventriculoperitoneal shunts is well documented, a gap in knowledge exists regarding differences in the direction of neoplastic dissemination along CSF shunts. The aim of this systematic review was to comparatively assess the nature of antegrade and retrograde metastatic spread along CSF shunts. Methodology: A dual systematic review in six major databases was conducted for articles until June 15, 2023, without language restrictions following PRISMA 2020 guidelines and the Cochrane Handbook for Interventional Systematic Reviews. The study focused on the metastasis of both CNS malignancy to extra-neural sites and the retrograde metastasis of extra-neural tumours to the CNS along CSF shunts. Inclusion criteria were case reports with patient characteristics and clinical outcomes. Data were extracted using a standardised table and qualitatively analysed. The JBI case report critical appraisal tool assessed reporting quality. Grey literature was not included. Results: A total of 106 reports of antegrade metastasis were identified representing 121 cases. Patients were most commonly children, with the primary tumour and shunt type being germinomas. Six reports detailing retrograde metastasis met our inclusion criteria with an overall high quality of reporting. All primary tumours were in the abdomen or pelvic cavity with treatment from metastasis depending on patient characteristics. Generally, the prognosis was poor, with one patient succumbing to peritonitis, four cases showing residual disease, and one patient receiving palliative care. Discussion and Conclusion: This updated systematic review noted similar demographic trends regarding the metastasis of CNS malignancy to extra-neural sites through CSF shunts reported by Xu et al. (2018); yet, due to data inaccessibility, updated statistics could not be inferred. Germinomas remained the most common tumour pathology, warranting increased vigilance in patients with germinomas and a CSF shunt. Moreover, this review identified that extra-neural malignancy retrograde CSF shunt metastasis is extremely rare. This study proposes standardised nomenclature for classifying metastasis through CSF shunts for easier clinical identification. [ABSTRACT FROM AUTHOR]

This comprehensive review explores the intricate relationship between white matter (WM) asymmetry in the brain and handedness, shedding light on the intricate neural substrates that underlie manual dominance. The human brain's WM tracts, which facilitate rapid interregional communication, have been subjected to extensive investigation in the context of handedness. Diverse WM pathways, including commissural and association fibers, as well as global WM, have been implicated, although findings have often been contradictory. Studies utilizing diffusion tensor imaging (DTI) to assess WM asymmetry have revealed intriguing patterns by measuring anisotropy. Anisotropy is a measure of uniformity of axon directionality and diameter in WM tracts and is a useful measure of connectivity. Notably, right-handed individuals have demonstrated greater anisotropy, in both hemispheres, particularly in regions like the inferior frontal gyrus. Conversely, leftward fractional anisotropy (FA) asymmetry has been observed in left-handed individuals. Sex and age have also been identified as influential factors. Age, for instance, exhibits a positive association with FA in various WM tracts. Research on the corpus callosum has indicated differences between handedness groups, with left-handed twins displaying unique callosal patterns. Furthermore, studies have explored the corticospinal tract (CST) and its potential link to handedness. While some findings suggest CST structural asymmetry plays a role, others remain inconclusive. In conclusion, the interplay between WM asymmetry and handedness remains a complex and multifaceted phenomenon, influenced by various factors, including sex and age. Understanding these neural intricacies promises valuable insights into the nature of manual dominance and its broader implications for brain function. [ABSTRACT FROM AUTHOR]

Phoenix dactylifera, commonly known as palm dates, is an inexpensive dietary staple in many countries. It is rich in many nutrients and bioactive chemicals, which are responsible for its health benefits. Folk medicine has suggested that P.dactylifera has potent anti-constipation effects. Although many studies have investigated its physiological mechanisms and phytochemistry against diseases like colon cancer, hypertension and diabetes mellitus, research unraveling this fruit's laxative properties is limited. Studies characterizing the phytochemical, micromolecular and macromolecular composition of Phoenix dactylifera revealed numerous compounds with anti-constipation properties. The flavonoid, phenol, dietary fiber and mineral content were identified as the likely protagonists collectively contributing to Phoenix dactylifera's laxative properties. [ABSTRACT FROM AUTHOR]

Introduction and aim. Literature documenting the occurrence and management of Gullain-Barre' syndrome GBS in glioblastoma multiforme patients following craniotomy is scarce. This study aims to systematically review relevant literature while outlining demographic factors, onset, and management of GBS following craniotomy for Glioblastoma multiforme (GBM). Material and methods. A systematic literature review was conducted in four major databases, following the PRISMA 2020 guidelines. Two cases of GBS following GBM resection were identified. An additional study discussing GBM leptomeningeal dissemination presenting as GBS was also included. Analysis of literature. Patients presented with symptoms unrelated to their tumour location consisting of proximal weakness in the lower extremities, distal paraesthesia and symmetrical areflexic paraparesis without loss of sensitivity. Lumbar puncture demonstrated albuminocytological dissociation, elevated CSF proteins. Cytopathology was unremarkable and gram stains and cultures were negative. Routine blood chemistry was also unremarkable. Decreased motor conduction velocities with prolongation and distal latency coupled with decreased motor recruitment without denervation in limb muscles was noted. Cerebrospinal MRI did not evidence tumour mass or leptomeningeal abnormalities. Plasmapheresis treatments significantly improved motor function and parasthesia, while a regiment of immunoglobulins resulted in a full recovery within two weeks. It is worth noting that leptomeningeal dissemination may present as GBS, as documented by Cooke et al. who started their patient empirically on intravenous immunoglobulin for suspected GBS, despite subsequent tests evidencing a diagnosis of fulminating leptomeningeal dissemination, since early treatment is crucial for full resolution of GBS. Conclusion. Despite being a rare occurrence, GBS should be considered in the differential for GBM who develop generalized acute-subacute progressive weakness which is inconsistent with their tumour location, particularly patients on immunosuppressive regiments. CSF cytological studies by lumbar puncture and cerebrospinal MRI with contrast are key in differentiating GBS from leptomeningeal dissemination in post-resection GBM patients. If CSF cytology and imaging investigations remain inconclusive, electrophysiological studies are not only warranted but necessary. Moreover, if GBS is suspected, the administration of appropriate treatments should be considered prior to establishing a firm diagnosis, as early intervention increases the chances of complete resolution. [ABSTRACT FROM AUTHOR]