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Letters   |    
Cavum Septi Pellucidi and Cavum Vergae With Increased Amyloid β Cortical Load in a 65-Year-Old Woman With Bipolar Disorder: Post-Mortem Neuropathological Observations
Alexandra Economou, Ph.D.; Shefali S. Ballal, M.D.; Khuram S. Kazmi, M.D.; Christos D. Katsetos, M.D., Ph.D., F.R.C.Path.
The Journal of Neuropsychiatry and Clinical Neurosciences 2014;26:E18-E22. doi:10.1176/appi.neuropsych.13070151
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The authors report no financial relationships with commercial interests.

Dr. Alexandra Economou is the recipient of an institutional grant from the National and Kapodistrian University of Athens for the study of neuropathologic correlates of cognitive and neuropsychiatric disorders (in collaboration with Dr. Christos D. Katsetos).

Dept. of Psychology, National and Kapodistrian University of Athens, Athens, Greece

Dept. of Pathology and Laboratory Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA

Dept. of Radiology (Neuroradiology), Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA

Dept. of Pathology and Laboratory Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA
Dept. of Pediatrics (Neurology), Drexel University College of Medicine, St. Christopher’s Hospital for Children, Philadelphia, PA

Send correspondence to Dr. Katsetos; e-mail: Christos.Katsetos@DrexelMed.edu

Copyright © 2014 by the American Psychiatric Association

Extract

To the Editor: A case of a cavum septi pellucidi (CSP) and cavum vergae (CV) discovered incidentally in a 65-year-old woman with history of bipolar disorder with suicidal ideations is reported. The decedent died as a result of acute anoxic-ischemic encephalopathy of unknown etiology (patient was found unresponsive on the street). A head CT scan performed on admission to the emergency room showed a cystic space within the septum pellucidum with significant caudal extension consistent with a CSP/CV (Figure 1A). The two cava were not separated (Figure 1A). The antero-posterior length measured on CT was 5.7 cm. A follow-up head CT performed 2 days after admission demonstrated, besides the cava (Figures 1B and 1C), hypodensities in the thalamic and lentiform nuclei bilaterally consistent with hypoxic/ischemic injury (Figure 1C). Neuropathological evaluation at autopsy revealed a large CSP (Figures 2A-2C and Figures 3A) extending caudally to become CSP/CV (Figures 2D, 3B, 4A, and 4B). There was moderate dilatation of the lateral ventricles but no evidence of fenestrations in the septal leaves, pointing against a communication between the septal cavum and the lateral ventricles (Figure 3A).

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FIGURE 1. Noncontrast Head CTs Depicting Cavum Septi Pellucidi and Cavum Vergae

Panel A is an axial image from a noncontrast head CT scan performed upon admission demonstrating a cavum septi pellucidi (CSP) and cavum vergae (CV), both depicted by arrows, which are in communication with one another. Panels B and C are coronal and axial images respectively from a follow up noncontrast head CT performed 2 days later, shortly prior to the patient’s demise. The CSP is partially visualized in both panels. There is moderate symmetrical dilatation of the lateral ventricles with rounding of the lateral ventricular angles. Panel C also demonstrates bilateral hypodensities in the thalamus and globus pallidus (asterisks) consistent with hypoxic-ischemic damage.

FIGURE 2. Post-mortem Brain Specimen Showing Large Cavum Septi Pellucidi and Cavum Vergae (CV) with Total Nonfusion of the Septal Leaves

The rostrocaudal extent of the septal cavum is shown at different coronal cuts of the brain [A‒D]. Areas of thalamic necrosis are demarcated with asterisks [C]. CV is depicted by arrow in the caudal most section at the coronal level of the atrium/trigone of the lateral ventricle [D]. Note moderate dilatation of the lateral ventricles with rounding of the lateral ventricular angles [A‒D].

FIGURE 3. Inverted Images of Gross Brain Sections with Anatomical Annotations

Panel A is a close up view of panel A in Figure 2 showing a large cavum septi pellucidi. Inverted images were used to better illustrate the intactness of the leaves of the septal cavum. There is lack of septal fenestrations. Panel B is a close up view of panel D in Figure 2 showing anatomical details of the cavum vergae including demonstration of one of the pillars of the fornix lateral to the cavum wall.

FIGURE 4. Low Power Views of Histological Sections

Panels A and B are low power views of histological sections from the region of the cavum vergae (asterisks) corresponding to panel B in Figure 3, immunostained with antibodies to myelin basic protein (MBP) for the delineation of myelinated fibers [A] and glial fibrillary acidic protein (GFAP) for the demarcation of glial fibers [B]. Note MBP and GFAP labeling in the wall of the cavum vergae confirming that the latter contains myelinated axons and glial fibers in a distribution similar to that in the nearby fornix. Note lack of MBP staining in the pineal gland and the choroid plexus. Expected focal GFAP labeling is noted in the pineal. Panels C and D demonstrate diffuse amyloid beta (Aβ) deposits of moderate density in the cerebral cortex (asterisk).

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