The Role of the Periaqueductal Gray Matter in Lower Urinary Tract Function

Zare, Aryo; Jahanshahi, Ali; Rahnama’i, Mohammad-Sajjad; Schipper, Sandra; Koeveringe, Gommert van

doi:10.1007/s12035-018-1131-8

Cited by 40 publications

(42 citation statements)

References 140 publications

(193 reference statements)

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“…In addition, optogenetic studies revealed that vlPAG GABAergic neurons regulated non-REM and REM sleep (Weber et al, 2018). Other studies based on genetically engineered systems showed that activation of vlPAG GABAergic neurons delayed detrusor contraction and inhibited voiding (Zare et al, 2018). In contrast, PPT GABAergic neurons are mostly involved in gait and balance regulation, a function that is not identified in LPT GABAergic neurons.…”

Section: Discussionmentioning

confidence: 99%

Whole-Brain Neural Connectivity to Lateral Pontine Tegmentum GABAergic Neurons in Mice

et al. 2019

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The GABAergic neurons in the lateral pontine tegmentum (LPT) play key roles in the regulation of sleep and locomotion. The dysfunction of the LPT is related to neurological disorders such as rapid eye movement sleep behavior disorder and ocular flutter. However, the whole-brain neural connectivity to LPT GABAergic neurons remains poorly understood. Using virus-based, cell-type-specific, retrograde and anterograde tracing systems, we mapped the monosynaptic inputs and axonal projections of LPT GABAergic neurons in mice. We found that LPT GABAergic neurons received inputs mainly from the superior colliculus, substantia nigra pars reticulata, dorsal raphe nucleus (DR), lateral hypothalamic area (LHA), parasubthalamic nucleus, and periaqueductal gray (PAG), as well as the limbic system (e.g., central nucleus of the amygdala). Further immunofluorescence assays revealed that the inputs to LPT GABAergic neurons were colocalized with several markers associated with important neural functions, especially the sleep-wake cycle. Moreover, numerous LPT GABAergic neuronal varicosities were observed in the medial and midline part of the thalamus, the LHA, PAG, DR, and parabrachial nuclei. Interestingly, LPT GABAergic neurons formed reciprocal connections with areas related to sleep-wake and motor control, including the LHA, PAG, DR, parabrachial nuclei, and superior colliculus, only the LPT-DR connections were in an equally bidirectional manner. These results provide a structural framework to understand the underlying neural mechanisms of rapid eye movement sleep behavior disorder and disorders of saccades.

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Section: Discussionmentioning

confidence: 99%

Whole-Brain Neural Connectivity to Lateral Pontine Tegmentum GABAergic Neurons in Mice

et al. 2019

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“…Although not a watershed area, the PAG is a highly active metabolic brain region that may have suffered from the insult of low circulating oxygen levels in our patient. While best known for the inhibition of pain, the PAG has been implicated in micturition control, migraines, vertical ophthalmoplegia, and, in this case, our patient presenting with esotropia [7].…”

Section: Discussionmentioning

confidence: 99%

Iron-deficiency Anemia Causes an Ischemic Stroke in a Young Man

Fluss

Zguri

Rahme

et al. 2019

Cureus

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Iron deficiency anemia is an unusual etiology of ischemic stroke in the adult population. Only a few case reports exist describing this rare cause of cerebrovascular accident due to low circulating levels of oxygen. To the best of our knowledge, we believe we have described here the first patient presenting with an ischemic stroke secondary to severe anemia without an obvious source of blood loss, evidence of thrombus formation, or associated thrombocytosis. A 28-year-old man presented to our institution, complaining of severe fatigue and was admitted under the pretext of dizziness, blurred vision, esotropia, diffuse retinal hemorrhage, and Roth spots found in the left eye. Laboratory investigations reported a hemoglobin level of 1.12 g/dL (13.5-17.5 g/dl) and thrombocytopenia with a platelet count of 16,000/ µL (150,000-450,000). Concomitant magnetic resonance imaging (MRI) of the brain revealed a right 4 mm periaqueductal lesion. After several red blood cell transfusions, the patient hereafter underwent an improvement in his clinical symptoms. Given no past medical history of anemia or thrombocytopenia, an extensive workup was prompted, but only microcytic anemia likely due to iron deficiency was found. Regarding a stroke in the young adult population, a differential beyond atherosclerosis and hypertension must be considered. Coagulopathies, vasculitis, sickle cell anemia, cerebral venous thrombosis, cocaine abuse, and systemic hypoperfusion are less common, but well-documented, causes of ischemia. Although infrequently mentioned, we demonstrate here a real possibility of severe iron deficiency anemia causing ischemic stroke in the brainstem of a young man. While a thorough neurologic evaluation is not often considered in patients presenting with signs and symptoms of severe anemia, vigilance regarding focal neurologic deficits should prompt suspicion for ischemic stroke in patients with significantly low hemoglobin levels.

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“…Step 2C: If periaqueductal grey damaged patient likely to have stress incontinence [8]. Initiate psychology consult.…”

Section: Section 2: Clinical Management Strategy By Injury Typementioning

confidence: 99%