Difference between revisions of "Encrypted code: Hyperexcitability of the trigeminal system"

[[File:Recovery cycle.jpeg|left|frameless|300x300px]]

| autore = Gianni Frisardi

| autore2 = Giorgio Cruccu

| autore6 =  

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We have therefore reached the section of the Cognitive Neural Network' abbreviated to 'RNC' presented for the diagnosis of the case of our 'Mary Poppins' in the chapter 'Encrypted code: Ephaptic transmission' and which we will propose again as a diagnostic model to accustom the reader to the procedure , simple, intuitive but essential in clinical cases of complex diagnosis such as our patient 'Bruxer'. Our starting point, therefore, is the point of arrival of the phase preceding the 'RNC', ie the discriminatory phase of the contexts ('''<math>\tau</math>''' Coherence Demarcator). The low diagnostic weight derived from the neurological assertions <math>\Im_n\cup0,33

</math>, in fact, refers only to a modest difference in the amplitude of the jaw jerk. Also in this case the Cognitive Neural Network (CNN) can help us to focus the machine language code and decrypt it. We therefore follow the same procedure already described extensively in the chapter '[[Encrypted code: Ephaptic transmission - it|Encrypted code: Ephaptic transmission]]'  and we will have the following result:

<math>CNN=\sum ( </math> [https://pubmed.ncbi.nlm.nih.gov/?term=Bruxism+ Bruxism] (4398), [https://pubmed.ncbi.nlm.nih.gov/?term=Bruxism+AND+trigeminal+system+&ac=yes&cauthor_id=None&user_filter=&schema=none&page=1&whatsnew=None&show_snippets=on&format=summary&sort=relevance&sort_order=desc&size=10 trigeminal system] (29), [https://pubmed.ncbi.nlm.nih.gov/?term=Bruxism+AND+trigeminal+system+AND+abnormal+&ac=yes&cauthor_id=None&user_filter=&schema=none&page=1&whatsnew=None&show_snippets=on&format=summary&sort=relevance&sort_order=desc&size=10 abnormality] ( 5), [https://pubmed.ncbi.nlm.nih.gov/?term=Bruxism%20AND%20trigeminal%20system%20AND%20abnormal%20AND%20excitability excitability] ( 3)<math>\longrightarrow</math>The excitability of the trigeminal motor system in sleep bruxism: a transcranial magnetic stimulation and brainstem reflex study </blockquote>

*'''''<math>\tau</math>''' Coherence Demarcator:'' As we have previously described, the first step is an initialization command of the network analysis which derives, in fact, from a previous cognitive elaboration of the assertions in the dental context <math>\delta_n</math> and the neurological one <math>\gamma_n</math> to which the '  <math>\tau</math> Coherence Demarcator' has given an absolute weight effectively eliminating the dental context <math>\delta_n</math> from the process. From what emerges from the neurological statements <math>\gamma_n</math> the 'State' of the Trigeminal Nervous System appears relatively asymmetrical in amplitude for the jaw jerk, given an average of <math>\Im_n\cup0,33

</math>. This does not allow the initial purely neurologica<nowiki/>l command to be entered in the Pubmed database as was performed for the previous clinical case of Mary Poppins. The initialization command will therefore be '[https://pubmed.ncbi.nlm.nih.gov/?term=Bruxism+ Bruxism]' which will concern both data samples (dental and neurological).

{{Q2|Also in this clinical case it is clear that the term 'Bruxism' is only a conventional term in an ambiguous and vague verbal language while the term 'Hyperexcitability' is a decrypted machine language.}}

The recovery cycle of the Inhibitory Masseter Reflex (_rcMIR) was studied by generating pairs of stimuli with identical characteristics, delivered percutaneously with a bipolar electrical stimulator positioned on the patient's face in the area of the mental nerve. The stimulation was produced using square wave electrical impulses, capable of evoking a well-defined inhibitory reflex composed of two silent periods (SP), called SP1 and SP2, separated by an interval of recovery of the EMG "Interposed Activity" ( IA). The first stimulus (S1) was considered as a conditioning stimulus and the second (S2) as a test stimulus. The inter-stimulus interval between S1 and S2 was set at 150 ms.

*The S1 stimulus splits the acquisition into pre and post analysis and generates the SPs and the AI.

*The SP of S1 and S2 are determined automatically by the software which positions the markers on the first and last minimum value elaborated on the traces for the generation of SP1 and SP2, and contextually calculates their duration. The IA duration is calculated between the last minimum value of SP1 and the first minimum value of SP2.

! colspan="5" |Tabella 1

|-

for the recovery cycle of the Masseter Inhibitory Reflex ( rc MIR)

|

| colspan="2" |S1

|-

|'''EMG'''

|'''Markers'''

|'''Onset latency'''  

|-

|

|11

|1E

|12

|-

Right masseter muscle

|1B

|1F

|24

|

|1C

|-

|

|-

| colspan="5" |

|-

|

|-

|Ch2

Left masseter muscle

|2B

|2F

|-

|

| 2D

|91

|98

|}

</Center>{{Q2|The test showed a high speed of recovery of the synaptic responses of the trigeminal system, index of neuronal hyperexcitability. This led the clinician to urgently request an MRI of the brain to define the correct diagnosis.}}

MRI of the brain, using Turbo Spin Echo, Fluid Attenuated Inversion Recovery, and Gradient Echo sequences, was conducted before and after intravenous administration of contrast medium. Results showed the presence of a roundish area of approximately 1.5 cm in diameter located in the vicinity of the quadrigeminal cistern at the level of the pineal gland. There was also a slight dilation of the supratentorial ventricular system, which appeared in the axis and was most evident in the proximity of the temporal horns, with a periventricular rim with a transependymal fluid absorption phenomenon.<ref>Peter H Yang, Alison Almgren-Bell, Hongjie Gu, Anna V Dowling, Sangami Pugazenthi, Kimberly Mackey, Esther B Dupépé, Jennifer M Strahle. Etiology- and region-specific characteristics of transependymal cerebrospinal fluid flow. J Neurosurg Pediatr. 2022 Aug 12;1-11. doi: 10.3171/2022.7.PEDS2246. Online ahead of print.</ref> The signal characteristics of the formation suggested a provisional diagnosis of pineal cavernoma. (Figures 2 and 3)

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|+{{Q2|In honor of Prof. Albino Bricolo neurosurgeon who saved the life of our patient 'Bruxer'}}

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|[[File:Pineal cavernoma pre surgery 2.jpg|thumb|150x150px|Pre-surgical sagittal MR]]

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