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Abstract Introduction Bilateral thalamic infarcts are rare presentations of stroke. They are the result of a complex combination of risk factors and a predisposing vessel distribution. The artery of Percheron, characterized by a single arterial trunk that irrigates both paramedian thalamic regions, can be occluded as a result of embolic diseases leading to bilateral paramedian thalamic infarcts. Clinical and image findings of this uncommon form of posterior circulation infarct are presented along with their anatomic and pathophysiologic correlates. Case presentation A 27-year-old Mexican man with no relevant medical history was admitted to hospital after he was found deeply stuporous. On admission, an urgent neuroimaging protocol for stroke, including magnetic resonance imaging and magnetic resonance imaging angiography, was performed. The scans revealed symmetric bilateral hyperintense paramedian thalamic lesions consistent with acute ischemic events. The posterior circulation was patent including the tip of the basilar artery and both posterior cerebral arteries, making the case compatible with occlusion of the artery of Percheron. Further evaluation with an aim to define the etiology revealed a patent foramen ovale as the cause of embolism. Conclusion Bilateral thalamic infarcts are unusual presentations of posterior circulation stroke; once they are diagnosed by an adequate neuroimaging protocol, a further evaluation to define the cause is necessary. Cardioembolism should always be considered in relatively young patients. A complete evaluation should be conducted by an interdisciplinary team including neurologists, cardiologists and neurosurgeons.

The domestic sewage treatment performance of an integrated anoxic-aerobic photobioreactor with biomass settling and recycling, coupled with anaerobic digestion of the produced bacterial-algal biomass and biogas upgrading in the photobioreactor was investigated. Hydraulic retention time in the photobioreactor initially was 4 days (stage I and II) and then reduced to 2.5 days (stage III). The integrated system supported high total organic carbon removals of 98.9 ± 1.1% regardless of the operational stage. A high total nitrogen removal of 90.8 ± 8.0% was recorded in the integrated system during the three operational stages, while total phosphorus removals accounted for 68.4 ± 20.1%, 68.3 ± 20.8% and 53.4 ± 25.0% in stages I, II and III, respectively. Biogas upgrading in the absorption column exhibited maximum removals of CO 2 and H 2 S of 74.7 ± 3.0% and 99.0 ± 2.8%, respectively. Biomass settling and recycling resulted in overall improvement of biomass settleability., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Human sacrifice became a common cultural trait during the advanced phases of Mesoamerican civilizations. This phenomenon, influenced by complex religious beliefs, included several practices such as decapitation, cranial deformation, and the use of human cranial bones for skull mask manufacturing. Archaeological evidence suggests that all of these practices required specialized knowledge of skull base and upper cervical anatomy. The authors conducted a systematic search for information on skull base anatomical and surgical knowledge among Mesoamerican civilizations. A detailed exposition of these results is presented, along with some interesting information extracted from historical documents and pictorial codices to provide a better understanding of skull base surgical practices among these cultures. Paleoforensic evidence from the Great Temple of Tenochtitlan indicates that Aztec priests used a specialized decapitation technique, based on a deep anatomical knowledge. Trophy skulls were submitted through a stepwise technique for skull mask fabrication, based on skull base anatomical landmarks. Understanding pre-Columbian Mesoamerican religions can only be realized by considering them in their own time and according to their own perspective. Several contributions to medical practice might have arisen from anatomical knowledge emerging from human sacrifice and decapitation techniques.

Background and Aims: Craniopharyngioma is a rare and mostly benign epithelial tumor of the central nervous system, mostly affecting children. Considering that most of the published series of craniopharyngioma are based on pediatric populations, studies in adults gain importance based mainly on the reduced number of cases and the possible differences emerging from a mostly different histological type. We undertook this study to establish the pattern of presentation, morphological features and specific characteristics of craniopharyngioma in an adult Mexican population, as well as discussing the long-term outcome and how it may be influenced by surgical, anatomic and clinical factors., Methods: A total of 153 adult patients (16 years or older) underwent transcranial and transsphenoidal surgery between January 1985 and December 2009, all with histological confirmation of craniopharyngioma. Hypothalamic involvement, surgical complications, rate of tumor resection and endocrinological outcome were evaluated., Results: Seventy nine males (51.6%) and 74 females (48.4%) were included. Mean age at diagnosis was 32.4 years (range: 16-77 years). Mean initial tumor volume was 28.44 mL (range: 0.18-100.44 mL). Partial or complete hypothalamic involvement (Samii Grades III, IV and V) was found in 90.2%. The overall rate of new endocrinopathies was 37.25% after surgery (95% CI = 33.9-41.2)., Conclusions: Gross total removal of craniopharyngiomas with large hypothalamic involvement was related to poor neuroendocrine outcome in adults. Partial removal should be indicated, associated with adjuvant therapy, in order to improve postoperative neuroendocrine status., (Copyright © 2012 IMSS. Published by Elsevier Inc. All rights reserved.)

Unlabelled: ACTH-secreting tumors represent 10% of functioning pituitary adenomas, and most of them are microadenomas. It is generally accepted that only half of these tumors are correctly identified with current magnetic resonance imaging (MRI) techniques. The objective of the paper is to report a method for detecting suspected ACTH-secreting pituitary tumors undetectable by conventional dynamic MRI using dynamic 3-Tesla MRI (3T MRI) and half-dose gadopentetate dimeglumine (0.05 mmol/Kg). Eight patients were included (5 men and 3 women) with a mean age of 29.12 years. Each of them had a confirmed diagnosis of Cushing disease and a negative dynamic MRI for microadenoma using full-dose gadopentetate dimeglumine. A second MRI was then performed using only half the usual dose of contrast material. Images from the second MRI where compared with the first study. Microadenomas were detected in 100% of the patients using a half dose of the contrast. All were recognized on the basis of the presence of a hypointense nodular lesion surrounded by normal contrast-enhanced tissue. Six patients were submitted to surgery, and the results were confirmed by immunohistochemistry in all of them. The remaining subject had a sinus sample catheterization coincident with the MRI results., Conclusion: A half dose of dynamic resonance imaging contrast material increases the sensitivity of MRI detection of ACTH-secreting pituitary tumors.