101
|
Keeratiratwattana A, Saraya AW, Prakkamakul S. Computed tomography and magnetic resonance imaging findings in central nervous system listeriosis. Neuroradiology 2024; 66:717-727. [PMID: 38436702 DOI: 10.1007/s00234-024-03313-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To describe the imaging findings and determine the incidence of a characteristic worm-like pattern along the white matter tracts in neurolisteriosis on CT/MRI. METHODS An IRB-approved retrospective study in 21 consecutive neurolisteriosis cases during January 2002-July 2020. At least one of the following is required: (1) Positive Listeria monocytogenes (LM) in blood with clinical signs of meningeal irritation and/or abnormal CSF profile, (2) positive LM in blood with signs of encephalitis, (3) positive LM in CSF, (4) positive LM from brain biopsy/aspiration. Six cases were excluded due to the lack of contrast-enhanced images, leaving a total of 15 cases for analysis (mean age 53.5 years ± 18.8 SD). The imaging studies were independently reviewed by two blinded readers. Demographic data, imaging findings, and incidence of the worm-like pattern were reported. The Cohen's kappa was used to calculate interrater reproducibility. RESULTS Of the 12 patients with relevant imaging findings, nine cases (75%) had parenchymal lesions (eight cases in supratentorial compartment and one case in infratentorial compartment), four cases (33.3%) had leptomeningeal enhancement and two cases (16.7%) had hydrocephalus. Brain abscesses were found in eight cases and nodules evocative of abscess in one case. Restricted diffusion in the central area and hemosiderin deposition were observed in all cases. The involvement of white matter tract in a worm-like pattern was demonstrated in eight of nine patients with parenchymal lesions (88.9%). CONCLUSION Abnormal findings in brain CT/MRI images are common in neurolisteriosis. The incidence of worm-like spread along the white matter tracts is high and may help diagnose suspicious patients.
Collapse
Affiliation(s)
- Aimpavee Keeratiratwattana
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
- Department of Radiology, King Chulalongkorn Memorial Hospital the Thai Red Cross Society, Bangkok, Thailand
| | - Abhinbhen W Saraya
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Thai Red Cross Emerging Infectious Diseases and Health Science Centre (TRC-EID-HS), King Chulalongkorn Memorial Hospital - The Thai Red Cross Society, Bangkok, Thailand
| | - Supada Prakkamakul
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.
- Department of Radiology, King Chulalongkorn Memorial Hospital the Thai Red Cross Society, Bangkok, Thailand.
| |
Collapse
|
102
|
Shojaei H, Mollahoseini R, Kargar-Soleimanabad S. Giant frontal sinus mucocele mimicked a primary brain tumor: A case report. Int J Surg Case Rep 2024; 118:109598. [PMID: 38564902 PMCID: PMC11002290 DOI: 10.1016/j.ijscr.2024.109598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Frontal sinus mucoceles commonly manifest with orbital complications. Intracranial complications, though rare, are significant in the differential diagnosis. Tumefactive and giant mucoceles can resemble intracranial tumors. CASE PRESENTATION We present the case of a 24-year-old male patient who initially presented to our institution after experiencing a single generalized tonic-clonic seizure. Initial imaging revealed large masses in both frontal lobes. Surgical intervention revealed mucoceles originating from the frontal and paranasal sinuses. DISCUSSION Mucoceles are often misdiagnosed due to the wide variety of symptoms they can present. In particular, the tumefactive type of mucoceles can present brain tumors both clinically and radiologically. CONCLUSION Mucoceles can manifest as tumefactive lesions, mimicking intracranial masses, and may present as perplexing neurological conditions.
Collapse
Affiliation(s)
- Hamidreza Shojaei
- Department of Neurosurgery, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
| | - Reza Mollahoseini
- Department of Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Kargar-Soleimanabad
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
| |
Collapse
|
103
|
Tokuyasu D, Suzuki S, Uzawa A, Nagane Y, Masuda M, Konno S, Kubota T, Samukawa M, Sugimoto T, Ishizuchi K, Oyama M, Yasuda M, Akamine H, Onishi Y, Suzuki Y, Kawaguchi N, Minami N, Kimura T, Takahashi MP, Murai H, Utsugisawa K. Real-world experience with eculizumab and switching to ravulizumab for generalized myasthenia gravis. Ann Clin Transl Neurol 2024; 11:1338-1346. [PMID: 38572524 DOI: 10.1002/acn3.52051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 03/01/2024] [Accepted: 03/10/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE Eculizumab and ravulizumab are complement protein C5 inhibitors, showing efficacy and tolerability for patients with anti-acetylcholine receptor-positive (AChR+) generalized myasthenia gravis (gMG) in phase 3 clinical trials and subsequent analyses. The purpose of the present study was to evaluate the clinical significance of eculizumab and switching to ravulizumab for refractory AChR+ gMG patients in the real-world experience. METHODS Among the database of Japan MG registry survey 2021, we studied AChR+ gMG patients who received eculizumab. We also evaluated these patients who switched from eculizumab to ravulizumab. Responder was defined as an improvement of at least 3 points in MG-ADL. We performed a questionnaire of preference between eculizumab and ravulizumab. RESULTS Among 1,106 patients with AChR+ gMG, 36 patients (3%) received eculizumab (female 78%, mean age 56.0 years). Eculizumab was preferentially used in severe and refractory MG patients. The duration of eculizumab treatment was 35 months on average. MG-ADL improved from 9.4 ± 4.9 to 5.9 ± 5.1, and 25 (70%) of the 36 gMG patients were responders. Postintervention status was markedly improved after the eculizumab treatment. Of 13 patients who did not continue eculizumab, 6 showed insufficiencies. Early onset MG was most effective. However, 15 patients switching from eculizumab to ravulizumab kept favorable response and tolerability. Questionnaire surveys showed preference for ravulizumab over eculizumab. INTERPRETATION Eculizumab and switching to ravulizumab showed to be effective for refractory AChR+ gMG patients in clinical settings.
Collapse
Affiliation(s)
- Daiki Tokuyasu
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Shigeaki Suzuki
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Akiyuki Uzawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuriko Nagane
- Department of Neurology, Hanamaki General Hospital, Hanamaki, Japan
| | - Masayuki Masuda
- Department of Neurology, Tokyo Medical University, Tokyo, Japan
| | - Shingo Konno
- Department of Neurology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Tomoya Kubota
- Department of Clinical Laboratory and Biomedical Sciences, Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Makoto Samukawa
- Department of Neurology, Kindai University Faculty of Medicine, Sayama, Japan
| | - Takamichi Sugimoto
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan
| | - Kei Ishizuchi
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Munenori Oyama
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Manato Yasuda
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroyuki Akamine
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yosuke Onishi
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasushi Suzuki
- Department of Neurology, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Naoki Kawaguchi
- Department of Neurology, Neurology Chiba Clinic, Chiba, Japan
| | - Naoya Minami
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Takashi Kimura
- Department of Neurology, Hyogo Medical University, Nishinomiya, Japan
| | - Masanori P Takahashi
- Department of Clinical Laboratory and Biomedical Sciences, Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroyuki Murai
- Department of Neurology, International University of Health and Welfare, Narita, Japan
| | | |
Collapse
|
104
|
Canakci H, Akbas MU, Arslan E, Tulaci KG, Yazici H. A Rare Laryngeal Foreign Body Case: Postcricoid Total Dental Prosthesis. Laryngoscope 2024; 134:2331-2334. [PMID: 37916852 DOI: 10.1002/lary.31151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 11/03/2023]
Abstract
In this case report, 60-year-old patient who aspirated total dental prosthesis into the postcricoid region was presented with patient's history, clinical findings, radiologic examinations and surgical treatment with comparison of literature data. To our literature knowledge, this is the first total dental prosthesis detected in postcricoid region. This was unusual because it did not cause any respiratory disorders such as laryngospasm and asphyxia, although it led to mucosal abrasions in a wide area of esophageus. Laryngoscope, 134:2331-2334, 2024.
Collapse
Affiliation(s)
- Hasan Canakci
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Balikesir University, Balıkesir, Turkey
| | - Mustafa U Akbas
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Balikesir University, Balıkesir, Turkey
| | - Erhan Arslan
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Balikesir University, Balıkesir, Turkey
| | - Kamil G Tulaci
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Balikesir University, Balıkesir, Turkey
| | - Hasmet Yazici
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Balikesir University, Balıkesir, Turkey
| |
Collapse
|
105
|
Chen J, Tian M, Shu X. Only anti-GM4 antibody positivity in a Chinese girl with overlapping MFS/GBS: a case report. Neurol Sci 2024; 45:2331-2335. [PMID: 38270731 PMCID: PMC11021322 DOI: 10.1007/s10072-024-07300-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/01/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS), as the most common cause of acute flaccid paralysis worldwide, is considered a part of a clinical spectrum in which discrete, complete, or incomplete forms of GBS and overlapping syndromes lie on the basis of their clinical features. The term overlapping Miller Fisher syndrome (MFS)/GBS is used when patients with MFS also suffer from progressive motor weakness of the limbs. Anti-ganglioside GQ1b has been specifically associated with MFS and ophthalmoplegia. CASE DESCRIPTION Here, we report a Chinese girl who was diagnosed with overlapping MFS/GBS showing acute flaccid paralysis of all four limbs, sensory symptoms, cranial nerve dysfunction, autonomic involvement, ophthalmoplegia, and ataxia. She had high serum and cerebrospinal fluid titres of monospecific anti-GM4 IgG antibody instead of anti-GQ1b antibody in the acute phase. CONCLUSION Anti-GM4 antibodies usually coexist with other antiganglioside antibodies, leading to missed diagnoses. The findings of the present study show that antibodies to ganglioside GM4 may in overlapping MFS/GBS as the lone immunological factors.
Collapse
Affiliation(s)
- Jing Chen
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, No. 143, Dalian Road, Zunyi, 563003, China
| | - Maoqiang Tian
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, No. 143, Dalian Road, Zunyi, 563003, China
| | - XiaoMei Shu
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, No. 143, Dalian Road, Zunyi, 563003, China.
| |
Collapse
|
106
|
Jain S, Sirekulam V, Kinthada S, Patel RB, Naik N, Jain S, Khan T, Gill H, Patel N, Nanjundappa A, Vala L, Siripuram C. Unveiling a Neurological Enigma: Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy (CADASIL) Presenting With Facial Palsy. Cureus 2024; 16:e60165. [PMID: 38868233 PMCID: PMC11167509 DOI: 10.7759/cureus.60165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 05/12/2024] [Indexed: 06/14/2024] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an uncommon genetic disorder that affects small blood vessels in the brain. It leads to neurological symptoms, disability-adjusted life years, and difficult emotional and physical situations for patients and their families. As unusual brain symptoms appear, it becomes important to understand the different clinical manifestations of CADASIL. Our case report and review examine several cases to demonstrate different presentations and management strategies of CADASIL. A 52-year-old male with a family history of strokes at a young age from his father and paternal grandfather presented to a neurology clinic for left facial droop and drooling. Brain magnetic resonance imaging showed extensive periventricular and subcortical white matter disease, including the external capsule and subcortical white matter of the temporal lobe. Findings were suggestive of small vessel vasculopathy. A cerebral angiogram showed that all large extra- and intracranial vessels were patent without evidence of aneurysm formation. There was no obvious evidence of beading of the distal intracranial vessels. Cerebrospinal fluid studies were normal. The NOTCH3 mutation was sent to test for CADASIL, which came back positive. The patient was started on aspirin (81 mg) and atorvastatin (20 mg) daily. The patient was counseled on the possibility of having an ischemic or hemorrhagic stroke. Aspirin and atorvastatin were continued, a neuropsychological evaluation was ordered, and CADASIL genetic counseling and testing were offered to him and his children. Over several years, patients developed several strokes and seizures due to infarcts. He also developed intraparenchymal hemorrhage complicated by dysphagia, requiring a feeding tube. Due to his severe physical debility, he was discharged to a nursing home for rehabilitation, where he did not improve with therapy and remained bedbound. He was discharged and sent home with his family. CADASIL can present as a diagnostic challenge due to its common presentation with migraines, transient ischemic attacks, and strokes, with or without risk factors. This unique presentation of CADASIL with facial palsy highlights the importance of emerging atypical presentations and the need for a detailed history of neuroimaging, family history, and personal history of neurovascular events. By accurately diagnosing the condition, patients and families can be counseled on the disease course and genetics. Management requires a multidisciplinary approach with neurology, genetic counseling, physical therapy, psychology, and psychiatry if depression or anxiety is present, with the aim of improving the patient's quality of life.
Collapse
Affiliation(s)
- Sakshi Jain
- Geriatrics, Hackensack University Medical Center, Hackensack, USA
| | | | | | | | - Nishthaben Naik
- Health and Family Welfare, Primary Health Center, Navsari, IND
| | - Shikha Jain
- Medicine, MVJ Medical College and Research Hospital, Bengaluru, IND
| | - Tanzina Khan
- Internal Medicine, Bangladesh Medical College, Dhaka, BGD
| | | | - Neel Patel
- Internal Medicine, GMERS Medical College Gotri, Vadodara, IND
| | | | | | | |
Collapse
|
107
|
Han B, Dai Y, Peng J, Yuan T, Yin Q, Yang L. Study on clinical features and factors related to long-term outcomes of antibody-negative autoimmune encephalitis. Ann Clin Transl Neurol 2024; 11:1325-1337. [PMID: 38644648 DOI: 10.1002/acn3.52049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/04/2024] [Accepted: 03/13/2024] [Indexed: 04/23/2024] Open
Abstract
OBJECTIVE To delineate the clinical characteristics of antibody-negative autoimmune encephalitis (AE) and to investigate factors associated with long-term outcomes among antibody-negative AE. METHODS Patients diagnosed with antibody-negative AE were recruited from January 2016 to December 2022 at the Second Xiangya Hospital of Central South University. The study assessed the long-term outcomes of antibody-negative AE using the modified Rankin scale (mRS) and the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). Predictors influencing long-term outcomes were subsequently analyzed. External validation of RAPID scores (refractory status epilepticus [RSE], age of onset ≥60 years, ANPRA [antibody-negative probable autoimmune encephalitis], infratentorial involvement, and delay of immunotherapy ≥1 month) was performed. RESULTS In total, 100 (47 females and 53 males) antibody-negative AE patients were enrolled in this study, with approximately 49 (49%) experiencing unfavorable long-term outcomes (mRS scores ≥3). Antibody-negative AE was subcategorized into ANPRA, autoimmune limbic encephalitis (LE), and acute disseminated encephalomyelitis (ADEM). Psychiatric symptoms were prevalent in LE and ANPRA subtypes, while weakness and gait instability/dystonia were predominant in the ADEM subtype. Higher peak CASE scores (odds ratio [OR] 1.846, 95% confidence interval [CI]: 1.163-2.930, p = 0.009) and initiating immunotherapy within 30 days (OR 0.210, 95% CI: 0.046-0.948, p = 0.042) were correlated with long-term outcomes. Receiver operating characteristic (ROC) analysis returned that the RAPID scores cutoff of 1.5 best discriminated the group with poor long-term outcomes (sensitivity 85.7%, specificity 56.9%). INTERPRETATION The ANPRA subtype exhibited poorer long-term outcomes compared to LE and ADEM subtypes, and early immunotherapy was crucial for improving long-term outcomes in antibody-negative AE. The use of RAPID scoring could aid in guiding clinical decision making.
Collapse
Affiliation(s)
- Binhong Han
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuwei Dai
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jian Peng
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tianxiang Yuan
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qing Yin
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Li Yang
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| |
Collapse
|
108
|
Quattrocchi S, Bonan L, Cirillo L, Avoni P, Di Stasi V, Rizzo G, Liguori R, Vacchiano V. Bibrachial amyotrophy as a rare manifestation of intraspinal fluid collection: a case report and systematic review. Neurol Sci 2024; 45:2279-2288. [PMID: 37968433 DOI: 10.1007/s10072-023-07170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/29/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION Intraspinal cerebrospinal fluid (CSF) collection has been reported as a rare cause of lower motor neuron (LMN) disorder. We report a case of bibrachial diplegia associated with intraspinal CSF collection and perform a systematic literature review. PATIENT AND METHODS A 52-year-old man developed a bibrachial amyotrophy over 6 years, confirmed by the presence of cervical subacute neurogenic changes at electromyography (EMG). Brain magnetic resonance imaging (MRI) revealed cerebral siderosis, while spine MRI showed a ventral longitudinal intraspinal fluid collection (VLISFC) from C2 to L2. No CSF leakage was localized at myelography; a conservative treatment was chosen. We searched for all published cases until 30th April 2023 and extrapolated data of 44 patients reported in 27 publications. RESULTS We observed a male predominance, a younger disease onset compared to amyotrophic lateral sclerosis, and a quite long disease duration, highlighting a slow disease progression. LMN signs were more frequently bilateral, mostly involving C5-C6 myotomes. Around 61% of patients presented additional symptoms, but only three referred to a history of headache. Accordingly, CSF opening pressure was mostly normal. Spinal MRI revealed the presence of VLISFC and in some cases myelomalacia. EMG patterns displayed both chronic and subacute neurogenic change in the cervical region. The disease course mainly depended on the treatment choice, which was mostly represented by a surgical approach when a specific dural defect was detected by imaging. CONCLUSION Bibrachial diplegia due to VLISFC can be a treatable cause of focal amyotrophy and presents some clinical and radiological "red flags" which cannot be missed by a clinical neurologist.
Collapse
Affiliation(s)
- Silvia Quattrocchi
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Luigi Bonan
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Luigi Cirillo
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Patrizia Avoni
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Vitantonio Di Stasi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Giovanni Rizzo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Rocco Liguori
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Veria Vacchiano
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy.
| |
Collapse
|
109
|
Yu E, Valdivia-Valdivia JM, Silva F, Lindholm P. Breath-Hold Diving Injuries - A Primer for Medical Providers. Curr Sports Med Rep 2024; 23:199-206. [PMID: 38709946 DOI: 10.1249/jsr.0000000000001168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
ABSTRACT Breath-hold divers, also known as freedivers, are at risk of specific injuries that are unique from those of surface swimmers and compressed air divers. Using peer-reviewed scientific research and expert opinion, we created a guide for medical providers managing breath-hold diving injuries in the field. Hypoxia induced by prolonged apnea and increased oxygen uptake can result in an impaired mental state that can manifest as involuntary movements or full loss of consciousness. Negative pressure barotrauma secondary to airspace collapse can lead to edema and/or hemorrhage. Positive pressure barotrauma secondary to overexpansion of airspaces can result in gas embolism or air entry into tissues and organs. Inert gas loading into tissues from prolonged deep dives or repetitive shallow dives with short surface intervals can lead to decompression sickness. Inert gas narcosis at depth is commonly described as an altered state similar to that experienced by compressed air divers. Asymptomatic cardiac arrhythmias are common during apnea, normally reversing shortly after normal ventilation resumes. The methods of glossopharyngeal breathing (insufflation and exsufflation) can add to the risk of pulmonary overinflation barotrauma or loss of consciousness from decreased cardiac preload. This guide also includes information for medical providers who are tasked with providing medical support at an organized breath-hold diving event with a list of suggested equipment to facilitate diagnosis and treatment outside of the hospital setting.
Collapse
Affiliation(s)
- Elaine Yu
- University of California San Diego, Department of Emergency Medicine; San Diego, CA
| | | | - Fernando Silva
- Kaiser Permanente Vacaville Medical Center, Department of Emergency Medicine; Vacaville, CA
| | - Peter Lindholm
- University of California San Diego, Department of Emergency Medicine; San Diego, CA
| |
Collapse
|
110
|
Matsumoto H, Ugawa Y. Central and Peripheral Motor Conduction Studies by Single-Pulse Magnetic Stimulation. J Clin Neurol 2024; 20:241-255. [PMID: 38713075 PMCID: PMC11076191 DOI: 10.3988/jcn.2023.0520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 05/08/2024] Open
Abstract
Single-pulse magnetic stimulation is the simplest type of transcranial magnetic stimulation (TMS). Muscle action potentials induced by applying TMS over the primary motor cortex are recorded with surface electromyography electrodes, and they are called motor-evoked potentials (MEPs). The amplitude and latency of MEPs are used for various analyses in clinical practice and research. The most commonly used parameter is the central motor conduction time (CMCT), which is measured using motor cortical and spinal nerve stimulation. In addition, stimulation at the foramen magnum or the conus medullaris can be combined with conventional CMCT measurements to evaluate various conduction parameters in the corticospinal tract more precisely, including the cortical-brainstem conduction time, brainstem-root conduction time, cortical-conus motor conduction time, and cauda equina conduction time. The cortical silent period is also a useful parameter for evaluating cortical excitability. Single-pulse magnetic stimulation is further used to analyze not only the central nervous system but also the peripheral nervous system, such as for detecting lesions in the proximal parts of peripheral nerves. In this review article we introduce four types of single-pulse magnetic stimulation-of the motor cortex, spinal nerve, foramen magnum, and conus medullaris-that are useful for the diagnosis, elucidation of pathophysiology, and evaluation of clinical conditions and therapeutic effects. Single-pulse magnetic stimulation is a clinically useful technique that all neurologists should learn.
Collapse
Affiliation(s)
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| |
Collapse
|
111
|
Liu A, Van Uum S, Lee D, Hammond RR, Ezzat S, Clemens KK. A Rare Prolactin-secreting Pituitary Carcinoma With Epidural and Thecal Metastases. JCEM CASE REPORTS 2024; 2:luae047. [PMID: 38660486 PMCID: PMC11040273 DOI: 10.1210/jcemcr/luae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Indexed: 04/26/2024]
Abstract
Pituitary carcinomas are rare but associated with significant morbidity and mortality. They remain challenging to diagnose and manage. In this case, we describe a 56-year-old man who presented with erectile dysfunction and binocular vertical diplopia. He had central hypogonadism, secondary adrenal insufficiency, and central hypothyroidism on biochemical testing. His serum prolactin was 1517 mcg/L (1517 ng/mL; reference range 4-15 mcg/L), and his sellar magnetic resonance imaging showed a 2.0 × 2.2 × 3.1 cm pituitary tumor. Pathology revealed a prolactin-secreting carcinoma. Despite treatment with a high-dose dopaminergic, 2 transsphenoidal resections, and 1 course of radiation, prolactin levels continued to rise. He developed metastases to the epidural space and thecal sac from the thoracic to sacral spine, for which he received 12 cycles of temozolomide chemotherapy with initial clinical and biochemical response. This was followed by disease escape and progression. We discuss the clinical and imaging features that warrant a high index of suspicion for pituitary carcinoma and review contemporary treatment.
Collapse
Affiliation(s)
- Anna Liu
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Stan Van Uum
- Center for Diabetes, Endocrinology and Metabolism, St. Joseph's Health Care London, London, ON N6A 4V2, Canada
- Department of Medicine, Division of Endocrinology and Metabolism, Western University, London, ON N6A 5W9, Canada
| | - Donald Lee
- Department of Medical Imaging, Western University, London, ON N6A 5A5, Canada
| | - Robert R Hammond
- Department of Pathology and Laboratory Medicine and Department of Clinical Neurological Sciences, Western University, London, ON N6A 5A5, Canada
| | - Shereen Ezzat
- Endocrine Oncology Site Group, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Kristin K Clemens
- Center for Diabetes, Endocrinology and Metabolism, St. Joseph's Health Care London, London, ON N6A 4V2, Canada
- Department of Medicine, Division of Endocrinology and Metabolism, Western University, London, ON N6A 5W9, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON N6G 2M1, Canada
- Lawson Health Research Institute, London, ON N6C 2R5, Canada
| |
Collapse
|
112
|
Nuñez IA, Crane A, Crozier I, Worwa G, Kuhn JH. Treatment of highly virulent mammarenavirus infections-status quo and future directions. Expert Opin Drug Discov 2024; 19:537-551. [PMID: 38606475 PMCID: PMC11069405 DOI: 10.1080/17460441.2024.2340494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/04/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Mammarenaviruses are negative-sense bisegmented enveloped RNA viruses that are endemic in Africa, the Americas, and Europe. Several are highly virulent, causing acute human diseases associated with high case fatality rates, and are considered to be significant with respect to public health impact or bioterrorism threat. AREAS COVERED This review summarizes the status quo of treatment development, starting with drugs that are in advanced stages of evaluation in early clinical trials, followed by promising candidate medical countermeasures emerging from bench analyses and investigational animal research. EXPERT OPINION Specific therapeutic treatments for diseases caused by mammarenaviruses remain limited to the off-label use of ribavirin and transfusion of convalescent sera. Progress in identifying novel candidate medical countermeasures against mammarenavirus infection has been slow in part because of the biosafety and biosecurity requirements. However, novel methodologies and tools have enabled increasingly efficient high-throughput molecular screens of regulatory-agency-approved small-molecule drugs and led to the identification of several compounds that could be repurposed for the treatment of infection with several mammarenaviruses. Unfortunately, most of them have not yet been evaluated in vivo. The most promising treatment under development is a monoclonal antibody cocktail that is protective against multiple lineages of the Lassa virus in nonhuman primate disease models.
Collapse
Affiliation(s)
- Ivette A. Nuñez
- Integrated Research Facility at Fort Detrick, Division of
Clinical Research, National Institute of Allergy and Infectious Diseases, National
Institutes of Health, Fort Detrick, Frederick, MD21702, USA
| | - Anya Crane
- Integrated Research Facility at Fort Detrick, Division of
Clinical Research, National Institute of Allergy and Infectious Diseases, National
Institutes of Health, Fort Detrick, Frederick, MD21702, USA
| | - Ian Crozier
- Clinical Monitoring Research Program Directorate, Frederick
National Laboratory for Cancer Research, Frederick, MD 21702, USA
| | - Gabriella Worwa
- Integrated Research Facility at Fort Detrick, Division of
Clinical Research, National Institute of Allergy and Infectious Diseases, National
Institutes of Health, Fort Detrick, Frederick, MD21702, USA
| | - Jens H. Kuhn
- Integrated Research Facility at Fort Detrick, Division of
Clinical Research, National Institute of Allergy and Infectious Diseases, National
Institutes of Health, Fort Detrick, Frederick, MD21702, USA
| |
Collapse
|
113
|
Kaoutzani L, Garcia KA, Rahimi SY. Carotid artery dissection and non-aneurysmal subarachnoid hemorrhage following carotid endarterectomy. J Surg Case Rep 2024; 2024:rjae331. [PMID: 38812575 PMCID: PMC11132871 DOI: 10.1093/jscr/rjae331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 05/02/2024] [Indexed: 05/31/2024] Open
Abstract
Stroke continues to be a major public health issue resulting in high mortality and severe long-term disability. Carotid endarterectomy (CEA) plays an important role in the prevention of ischemic stroke. Complications associated with CEA can be life threatening and prompt recognition is crucial. In this report, we present a patient who presented to the hospital with progressive headache, 2 weeks following CEA. He was neurologically intact and hypertensive. Non-contrast head computed tomography (CT) scan showed convexity subarachnoid hemorrhage (SAH). He was found to have a left internal carotid artery dissection. Patients who present to the hospital following CEA with headache and hypertension benefit from a non-contrast head CT scan. The presence of SAH can be a warning sign of cerebral hyperperfusion syndrome. Carotid artery dissection is also a disease entity that can occur in the post-operative period. Prompt recognition and treatment is crucial for the management of these disease entities.
Collapse
Affiliation(s)
- Lydia Kaoutzani
- Department of Neurosurgery, Wellstar Medical College of Georgia Health, 1120 15 Street, Augusta, GA 30912, United States
| | - Klepper Alfredo Garcia
- Department of Neurology, Wellstar Medical College of Georgia Health, 1120 15 Street, Augusta, GA 30912, United States
| | - Scott Y Rahimi
- Department of Neurosurgery, Wellstar Medical College of Georgia Health, 1120 15 Street, Augusta, GA 30912, United States
| |
Collapse
|
114
|
Delanty N, Mohanraj R, Shankar R, Wehner T, Stephen LJ, D'Souza W, Cappucci S, McMurray R, Sainz-Fuertes R, Villanueva V. Perampanel for the treatment of epilepsy with genetic aetiology: Real-world evidence from the PERMIT Extension study. Epilepsy Res 2024; 202:107339. [PMID: 38492461 DOI: 10.1016/j.eplepsyres.2024.107339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/14/2024] [Accepted: 02/29/2024] [Indexed: 03/18/2024]
Abstract
Genetic factors contribute to the aetiology of epilepsy in >50% of cases, and information on the use of antiseizure medications in people with specific aetiologies will help guide treatment decisions. The PERMIT Extension study pooled data from two real-world studies (PERMIT and PROVE) to investigate the effectiveness and safety/tolerability of perampanel (PER) when used to treat people with focal and generalised epilepsy in everyday clinical practice. This post-hoc analysis of PERMIT Extension explored the use of PER when used to treat individuals presumed to have epilepsy with a genetic aetiology. Assessments included retention rate (evaluated at 3, 6 and 12 months), effectiveness (responder and seizure freedom rates; evaluated at 3, 6, 12 months and the last visit [last observation carried forward) and tolerability (adverse events [AEs]). Of the 6822 people with epilepsy included in PERMIT Extension, 1012 were presumed to have a genetic aetiology. The most common genetic aetiologies were idiopathic generalised epilepsy (IGE; 58.2%), tuberous sclerosis (1.1%), Dravet syndrome (0.8%) and genetic epilepsy with febrile seizures plus (GEFS+; 0.5%). Retention rates at 3, 6 and 12 months in the total genetic aetiology population were 89.3%, 79.7% and 65.9%, respectively. In the total genetic aetiology population, responder rates at 12 months and the last visit were 74.8% and 68.3%, respectively, and corresponding seizure freedom rates were 48.9% and 46.5%, respectively. For the specific aetiology subgroups, responder rates at 12 months and the last visit were, respectively: 90.4% and 84.4% (IGE), 100% and 57.1% (tuberous sclerosis), 100% and 71.4% (Dravet syndrome), and 33.3% and 20.0% (GEFS+). Corresponding seizure freedom rates were, respectively: 73.1% and 64.6% (IGE), 33.3% and 22.2% (tuberous sclerosis), 20.0% and 28.6% (Dravet syndrome), and 0% and 0% (GEFS+). The incidence of AEs was 46.5% for the total genetic aetiology population, 48.8% for IGE, 27.3% for tuberous sclerosis, 62.5% for Dravet syndrome, and 20% for GEFS+. Tolerability findings were consistent with PER's known safety profile. PER was effective and generally well tolerated when used in individuals with a presumed genetic epilepsy aetiology in clinical practice. PER was effective across a wide range of genetic aetiologies.
Collapse
Affiliation(s)
- Norman Delanty
- Department of Neurology, Beaumont Hospital, Dublin, Ireland.
| | - Rajiv Mohanraj
- Greater Manchester Neurosciences Centre, Salford Royal Hospital, UK
| | | | - Tim Wehner
- National Hospital for Neurology and Neurosurgery, UCLH Foundation Trust, and Department of Clinical and Experimental Epilepsy, UCL, London, UK
| | - Linda J Stephen
- Epilepsy Unit, West Glasgow Ambulatory Care Hospital, Glasgow, Scotland, UK
| | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Victoria, Australia
| | | | | | | | - Vicente Villanueva
- Refractory Epilepsy Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| |
Collapse
|
115
|
Chalupczak N, Cole C, Lohala N. Marchiafava-Bignami Disease in a Patient With Polysubstance Use Disorder. Cureus 2024; 16:e59730. [PMID: 38841043 PMCID: PMC11151182 DOI: 10.7759/cureus.59730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Marchiafava-Bignami disease (MBD) is a rare demyelinating disease associated with chronic alcohol use and/or malnutrition leading to vitamin deficiency. Clinical presentation is diverse and can range from mild neurological deficits of dysarthria and confusion to severe symptoms such as coma or even death. Diagnosis is made using imaging modalities including magnetic resonance imaging (MRI) and computed tomography (CT) with the rise in technological advances placing MRI as the most sensitive and specific imaging technology for diagnosis. Classic MBD imaging demonstrates demyelination and necrotic damage of the corpus callosum. While MBD is a well-documented neurologic complication of chronic alcoholism, its occurrence and presentation in the context of concurrent polysubstance abuse remain underexplored. We outline the case of a 27-year-old male with polysubstance use disorder presenting with subacute neurological deterioration and demyelination of the splenium of the corpus callosum.
Collapse
Affiliation(s)
- Natalia Chalupczak
- Chicago Medical School, Rosalind Franklin University of Medicine and Sciences, North Chicago, USA
| | - Connor Cole
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| | - Nita Lohala
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| |
Collapse
|
116
|
Yang Q, Lai C, Meng C, Chang Q, Wei N, Wang J. Clinical features and visual prognosis of very late-onset neuromyelitis optica spectrum disorder-related optic neuritis. Neurol Sci 2024; 45:2191-2197. [PMID: 37982973 DOI: 10.1007/s10072-023-07187-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 11/03/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Very late-onset neuromyelitis optica spectrum disorder-related optic neuritis is limited to a few case reports. OBJECTIVE To investigate the clinical features and visual prognosis of very late-onset neuromyelitis optica spectrum disorder-related optic neuritis. METHODS This study evaluated 22 patients with first-onset optic neuritis and fulfilled the 2015 diagnosis criteria for neuromyelitis optica spectrum disorders. RESULTS The mean age at optic neuritis onset was 73.91 ± 4.71 (range: 70-82) years with a female predominance (81.8%; ratio: 4.5:1). Antinuclear antibody seropositivity and seronegativity were identified in 12 (55.5%) and 10 (45.5%) patients, respectively. Severe visual loss persisted in 19 (19/42, 45.3%) eyes at the last follow-up. Although patients with antinuclear antibody seropositivity had a significantly higher frequency of attacks (P = 0.015), but they had a longer median time to reach severe visual loss (37 vs. 26 months; log-rank test, P = 0.023). Multivariate logistic regression analysis revealed antinuclear antibody seropositivity (hazard ratio = 4.849, 95% confidence interval: 1.309-17.965, P = 0.018) as a good predictor of visual acuity improvement. CONCLUSION Patients with very late-onset neuromyelitis optica spectrum disorder-related optic neuritis may develop severe optic neuritis, and those with antinuclear antibody seronegativity have a similar clinical presentation but worse outcome than those with seropositivity.
Collapse
Affiliation(s)
- Qinglin Yang
- Department of Neurology of Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Chuntao Lai
- Department of Neurology of Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chao Meng
- Department of Neurology of Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qinglin Chang
- Department of Radiology of Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Na Wei
- Department of Neurology of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiawei Wang
- Department of Neurology of Beijing Tongren Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
117
|
Ebong IL, Delgado A, Aranda SS, Shonibare OO, Aryal S, Karki B, Acosta K. Idiopathic Intracranial Hypertension in an Adolescent With Recent Human Immunodeficiency Virus (HIV) Diagnosis: A Challenging Etiological Dilemma. Cureus 2024; 16:e60001. [PMID: 38854218 PMCID: PMC11162352 DOI: 10.7759/cureus.60001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
Idiopathic intracranial hypertension (IIH) or benign intracranial hypertension affects the neuro-ophthalmological system and leads to elevated intracranial pressure. Elevated opening pressure during lumbar puncture is diagnostic of IIH. Here in, we present an interesting case of a 15-year-old girl, recently immigrated and with a high BMI, presenting with recurrent fever, abdominal issues, weight loss, and other symptoms, leading to a diagnosis of pelvic inflammatory disease (PID) and HIV infection. After treatment with antibiotics (doxycycline) and antiretroviral therapy, she developed IIH, manifesting as sudden-onset headache and vision problems. MRI and lumbar puncture confirmed the diagnosis. She responded well to acetazolamide and was discharged with continued medication and follow-up appointments. This case underscores the complexity of IIH development, especially in the setting of acute HIV infection and antibiotic treatment, highlighting the need for a comprehensive diagnostic approach and multidisciplinary management.
Collapse
Affiliation(s)
- Imoh L Ebong
- Department of Pediatrics, NYC Health+Hospitals/Woodhull Medical Center, New York, USA
| | - Arleen Delgado
- Department of Pediatrics, NYC Health+Hospitals/Woodhull Medical Center, New York, USA
| | - Sofia S Aranda
- Department of Pediatrics, NYC Health+Hospitals/Woodhull Medical Center, New York, USA
| | - Olufunto O Shonibare
- Department of Pediatrics, NYC Health+Hospitals/Woodhull Medical Center, New York, USA
| | - Saman Aryal
- Department of Pediatrics, NYC Health+Hospitals/Woodhull Medical Center, New York, USA
| | - Bijaya Karki
- Department of Pediatrics, NYC Health+Hospitals/Woodhull Medical Center, New York, USA
| | - Katiusca Acosta
- Department of Pediatrics, NYC Health+Hospitals/Woodhull Medical Center, New York, USA
| |
Collapse
|
118
|
Hussain MS, Moglad E, Afzal M, Sharma S, Gupta G, Sivaprasad GV, Deorari M, Almalki WH, Kazmi I, Alzarea SI, Shahwan M, Pant K, Ali H, Singh SK, Dua K, Subramaniyan V. Autophagy-associated non-coding RNAs: Unraveling their impact on Parkinson's disease pathogenesis. CNS Neurosci Ther 2024; 30:e14763. [PMID: 38790149 PMCID: PMC11126788 DOI: 10.1111/cns.14763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/18/2024] [Accepted: 04/28/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a degenerative neurological condition marked by the gradual loss of dopaminergic neurons in the substantia nigra pars compacta. The precise etiology of PD remains unclear, but emerging evidence suggests a significant role for disrupted autophagy-a crucial cellular process for maintaining protein and organelle integrity. METHODS This review focuses on the role of non-coding RNAs (ncRNAs) in modulating autophagy in PD. We conducted a comprehensive review of recent studies to explore how ncRNAs influence autophagy and contribute to PD pathophysiology. Special attention was given to the examination of ncRNAs' regulatory impacts in various PD models and patient samples. RESULTS Findings reveal that ncRNAs are pivotal in regulating key processes associated with PD progression, including autophagy, α-synuclein aggregation, mitochondrial dysfunction, and neuroinflammation. Dysregulation of specific ncRNAs appears to be closely linked to these pathogenic processes. CONCLUSION ncRNAs hold significant therapeutic potential for addressing autophagy-related mechanisms in PD. The review highlights innovative therapeutic strategies targeting autophagy-related ncRNAs and discusses the challenges and prospective directions for developing ncRNA-based therapies in clinical practice. The insights from this study underline the importance of ncRNAs in the molecular landscape of PD and their potential in novel treatment approaches.
Collapse
Affiliation(s)
- Md Sadique Hussain
- School of Pharmaceutical SciencesJaipur National UniversityJaipurRajasthanIndia
| | - Ehssan Moglad
- Department of Pharmaceutics, College of PharmacyPrince Sattam Bin Abdulaziz UniversityAl KharjSaudi Arabia
| | - Muhammad Afzal
- Department of Pharmaceutical Sciences, Pharmacy ProgramBatterjee Medical CollegeJeddahSaudi Arabia
| | - Shilpa Sharma
- Chandigarh Pharmacy College, Chandigarh Group of CollegesMohaliPunjabIndia
| | - Gaurav Gupta
- Centre of Medical and Bio‐allied Health Sciences ResearchAjman UniversityAjmanUnited Arab Emirates
- Chitkara College of PharmacyChitkara UniversityRajpuraPunjabIndia
| | - G. V. Sivaprasad
- Department of Basic Science & HumanitiesRaghu Engineering CollegeVisakhapatnamIndia
| | - Mahamedha Deorari
- Uttaranchal Institute of Pharmaceutical SciencesUttaranchal UniversityDehradunIndia
| | - Waleed Hassan Almalki
- Department of Pharmacology, College of PharmacyUmm Al‐Qura UniversityMakkahSaudi Arabia
| | - Imran Kazmi
- Department of Biochemistry, Faculty of ScienceKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Sami I. Alzarea
- Department of Pharmacology, College of PharmacyJouf UniversitySakakaAl‐JoufSaudi Arabia
| | - Moyad Shahwan
- Centre of Medical and Bio‐allied Health Sciences ResearchAjman UniversityAjmanUnited Arab Emirates
- Department of Clinical Sciences, College of Pharmacy and Health SciencesAjman UniversityAjmanUnited Arab Emirates
| | - Kumud Pant
- Graphic Era (Deemed to be University)DehradunIndia
- Graphic Era Hill UniversityDehradunIndia
| | - Haider Ali
- Centre for Global Health Research, Saveetha Medical College, Saveetha Institute of Medical and Technical SciencesSaveetha UniversityChennaiIndia
- Department of PharmacologyKyrgyz State Medical CollegeBishkekKyrgyzstan
| | - Sachin Kumar Singh
- School of Pharmaceutical SciencesLovely Professional UniversityPhagwaraPunjabIndia
- Faculty of Health, Australian Research Centre in Complementary and Integrative MedicineUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Kamal Dua
- Faculty of Health, Australian Research Centre in Complementary and Integrative MedicineUniversity of Technology SydneyUltimoNew South WalesAustralia
- Discipline of Pharmacy, Graduate School of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
- Uttaranchal Institute of Pharmaceutical SciencesUttaranchal UniversityDehradunIndia
| | - Vetriselvan Subramaniyan
- Pharmacology Unit, Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwaySelangor Darul EhsanMalaysia
| |
Collapse
|
119
|
AlEssa A, AlSahli A, AlJared T. Evidence of pial synagiosis through ventriculoperitoneal shunt entry site in a patient who manifested Moyamoya syndrome later in childhood: A case report and historical perspective. Childs Nerv Syst 2024; 40:1613-1616. [PMID: 38180509 PMCID: PMC11026288 DOI: 10.1007/s00381-023-06263-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024]
Abstract
The term Moyamoya , or "puff of smoke" in Japanese , was first used in 1969 by Suzuki and Takaku to describe the classical appearance of collateral blood vessels in response to progressive vascular stenosis of distal internal carotid artery (ICA). Such condition may result in various clinical presentations ranging from strokes to developmental delays. In order to cease the progression of such stenotic vasculopathy, several means of revascularization have been developed over the years. In this paper we present a case of a two-year-old girl with history of myelomeningocele repair and ventriculoperitoneal shunt insertion followed by manifestation of Moyamoya syndrome later in childhood as an evidence of revascularization through a burr hole. To our knowledge, this paper is the first of its kind to report such findings in one patient. Moreover, this paper provides a historical perspective on the development of different types of revascularization techniques.
Collapse
Affiliation(s)
- Awn AlEssa
- Neurosurgery Department, King Abdullah Specialized Children Hospital, Riyadh, Saudi Arabia
| | - Alaa AlSahli
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Tariq AlJared
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
120
|
Akhtar U, Naeem H, Fida S, Wahab QMF. Incidental Finding of Atrial Myxoma in a Patient Presenting With Transient Ischemic Attack (TIA): A Case Report. Cureus 2024; 16:e61082. [PMID: 38919224 PMCID: PMC11196853 DOI: 10.7759/cureus.61082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2024] [Indexed: 06/27/2024] Open
Abstract
Atrial myxomas are benign primary cardiac tumors. They can present with nonspecific symptoms, ranging from constitutional symptoms and embolic phenomena such as transient ischemic attacks (TIAs) or strokes to sudden cardiac death. Early diagnosis may be a challenge due to the nonspecific presentation of atrial myxoma. A high degree of suspicion is needed in patients with TIA having no known cardiovascular risk factors. Although benign, if left untreated, it can lead to serious complications ranging from embolic phenomena and obstructive symptoms to sudden cardiac death. An echocardiogram is of fundamental importance in diagnosing atrial myxoma, and surgical resection is the ultimate treatment of choice. Here, we discuss a case of TIA as the initial presentation of atrial myxoma.
Collapse
Affiliation(s)
- Ujala Akhtar
- Cardiac Surgery, Rehman Medical Institue, Peshawar, PAK
| | - Hamid Naeem
- Cardiac Surgery, Rehman Medical Institute, Peshawar, PAK
| | - Sanam Fida
- Cardiac Surgery, Rehman Medical Institute, Peshawar, PAK
| | | |
Collapse
|
121
|
Vinciguerra A, Turri-Zanoni M, Ferrari M, Mattavelli D, Giorgianni A, Fazio E, Pierro FD, Rampinelli V, Gazzini L, Verillaud B, Schreiber A, Calabrese L, Bignami M, Battaglia P, Nicolai P, Castelnuovo P, Herman P. Endovascular coils extrusion after internal carotid artery occlusion: From management to follow-up. Int Forum Allergy Rhinol 2024. [PMID: 38690609 DOI: 10.1002/alr.23357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/05/2024] [Accepted: 04/12/2024] [Indexed: 05/02/2024]
Abstract
KEY POINTS ICA coil extrusion (ICA-CE) occurs most frequently in the nasopharyngeal/sinonasal site. Evaluating the ICA coils stability, through an angiography, is of primary importance. ICA-CE management needs to be decided based on the patient's symptoms and general status.
Collapse
Affiliation(s)
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Marco Ferrari
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Davide Mattavelli
- Department of Medical and Surgical Specialties, Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Giorgianni
- Department of Neuroradiology, ASST Sette Laghi, Circolo Hospital, Varese, Italy
| | - Enrico Fazio
- Department of Otorhinolaryngology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medizinischen Privatuniversität (PMU), Bolzano-Bozen, Italy
| | - Francesco Di Pierro
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Vittorio Rampinelli
- Department of Medical and Surgical Specialties, Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Luca Gazzini
- Department of Otorhinolaryngology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medizinischen Privatuniversität (PMU), Bolzano-Bozen, Italy
| | - Benjamin Verillaud
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
| | - Alberto Schreiber
- Department of Medical and Surgical Specialties, Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Luca Calabrese
- Department of Otorhinolaryngology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medizinischen Privatuniversität (PMU), Bolzano-Bozen, Italy
| | - Maurizio Bignami
- Department of Otolaryngology Head and Neck Surgery, ASST Lariana, Ospedale Sant'Anna, University of Insubria, Como, Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Philippe Herman
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
| |
Collapse
|
122
|
Pulluru Y, Koohsari S, Bayoumi A, Aladawi M, Najdawi Z, Elfil M. Seizures due to pyridoxine deficiency in Parkinson's disease. Seizure 2024; 118:132-136. [PMID: 38703598 DOI: 10.1016/j.seizure.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/09/2024] [Accepted: 04/28/2024] [Indexed: 05/06/2024] Open
Abstract
Parkinson's disease (PD) is a complex neurodegenerative disorder characterized not only by its hallmark motor symptoms but also by a myriad of non-motor manifestations, including cognitive decline, autonomic manifestations, and gastrointestinal disturbances. Amidst these, a lesser-known but critical aspect is the increased risk of functional deficiency of pyridoxine (vitamin B6) in patients with PD, which is linked to an increased risk of seizures. This review investigates the intersection of PD, new-onset seizures, and pyridoxine deficiency, aiming to elucidate the significance of these associations and their contributions to the neurologic burden in PD. Case reports documenting the occurrence of seizures in patients with PD, particularly in the context of high-dose dopaminergic therapy and the subsequent revelation of pyridoxine deficiency were included. These cases, which often featured extensive workups revealing unremarkable findings aside from pyridoxine deficiency, underscore the multifaceted nature of PD and its treatment-related complications. The findings in these case reports suggest that dietary insufficiencies, gastrointestinal dysfunctions, and drug-nutrient interactions may eventually precipitate pyridoxine deficiency, which in turn may lead to seizures by disrupting GABAergic neurotransmission. This sheds the light on the need for increased clinical awareness and routine monitoring of pyridoxine levels in patients with PD, especially those undergoing significant therapeutic adjustments or exhibiting comorbidities that might interfere with their dietary intake such as gastrointestinal manifestations or depression. Such proactive measures could potentially mitigate the impact of this complication in patients with PD, ultimately enhancing patient care and quality of life.
Collapse
Affiliation(s)
- Yashwanth Pulluru
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sheida Koohsari
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ahmed Bayoumi
- Department of Neurology, McGovern Medical School, UTHealth, Houston, TX, USA
| | - Mohammad Aladawi
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Zaid Najdawi
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mohamed Elfil
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.
| |
Collapse
|
123
|
Monkman R, Monfregola M, Waibel C, Scheidegger P. Sweet syndrome with peripheral neuropathy in a patient with metastatic clear cell renal cell carcinoma. BMJ Case Rep 2024; 17:e254824. [PMID: 38684355 PMCID: PMC11146386 DOI: 10.1136/bcr-2023-254824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2024] [Indexed: 05/02/2024] Open
Abstract
A female patient in her 70s with a newly diagnosed clear cell renal cell carcinoma (ccRCC) with osseous metastasis presented with sudden onset erythematous painful blistering skin lesions on the dorsum of both hands, with associated intermittent fever episodes. Blood tests showed elevated inflammatory marker levels (C reactive protein 257.8 mg/dL, leucocytes 17.79×10⁹/L, with 94% neutrophils). Histologically, there was predominately neutrophil dermal infiltrate without leucocytoclastic vasculitis. The diagnostic criteria of Sweet syndrome were fulfilled. A week later, the patient developed abrupt left-hand palsy, which was confirmed as a medial and ulnar sensorimotor axonal peripheral neuropathy of paraneoplastic origin. The patient was prescribed a course of oral high-dose steroids, which significantly improved the skin lesions. The peripheral nerve palsy improved after 3 months. This case describes the two very rare concurrent paraneoplastic manifestations of ccRCC occurring simultaneously, which have been rarely reported.
Collapse
Affiliation(s)
- Rebecca Monkman
- Department of Internal Medicine, Cantonal hospital Baden, Baden, Switzerland
| | - Meng Monfregola
- Department of Internal Medicine, Cantonal hospital Baden, Baden, Switzerland
| | - Christine Waibel
- Department of Oncology, Cantonal hospital Baden, Baden, Switzerland
| | | |
Collapse
|
124
|
Eden CO, Alkhalaileh DS, Pettersson DR, Hunter AJ, Arastu AH. Clinical and neuroradiographic features of fentanyl inhalation-induced leukoencephalopathy. BMJ Case Rep 2024; 17:e258395. [PMID: 38684340 PMCID: PMC11103052 DOI: 10.1136/bcr-2023-258395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 05/02/2024] Open
Abstract
A man in his late 40s with no known past medical history was unresponsive for an unknown period of time. Crushed pills and white residue were found on a nearby table. On presentation he was obtunded and unresponsive to verbal commands but withdrawing to painful stimuli. The initial urine drug screen was negative, but a urine fentanyl screen was subsequently positive with a level of 137.3 ng/mL. MRI of the brain showed reduced diffusivity and fluid attenuated inversion recovery (FLAIR) hyperintensity symmetrically in the bilateral supratentorial white matter, cerebellum and globus pallidus. Alternative diagnoses such as infection were considered, but ultimately the history and workup led to a diagnosis of fentanyl-induced leukoencephalopathy. Three days after admission the patient became able to track, respond to voice and follow basic one-step commands. The patient does not recall the mechanism of inhalation. While there are case reports of heroin-induced leukoencephalopathy following inhaled heroin use and many routes of fentanyl, this is the first reported case of a similar phenomenon due to fentanyl inhalation.
Collapse
Affiliation(s)
- Christopher O Eden
- Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Duna S Alkhalaileh
- Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - David R Pettersson
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Alan J Hunter
- Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Asad H Arastu
- Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
125
|
Tan KS, Pandian JD, Liu L, Toyoda K, Leung TWH, Uchiyama S, Kuroda S, Suwanwela NC, Aaron S, Chang HM, Venketasubramanian N. Stroke in Asia. Cerebrovasc Dis Extra 2024; 14:58-75. [PMID: 38657577 PMCID: PMC11250668 DOI: 10.1159/000538928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/08/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND There is a significant burden of stroke in Asia. Asia has the largest population in the world in 2023, estimated at 4.7 billion. Approximately 9.5-10.6 million strokes will be anticipated annually in the backdrop of a diverse group of well-developed and less developed countries with large disparities in stroke care resources. In addition, Asian countries are in varying phases of epidemiological transition. SUMMARY In this review, we examined recent epidemiological features of ischaemic stroke and intracerebral haemorrhage in Asia with recent developments in hyperacute stroke reperfusion therapy and technical improvements in intracerebral haemorrhage. The article also discussed the spectrum of cerebrovascular diseases in Asia, which include intracranial atherosclerosis, intracerebral haemorrhage, infective aetiologies of stroke, moyamoya disease, vascular dissection, radiation vasculopathy, and cerebral venous thrombosis. KEY MESSAGES The review of selected literature and recent updates calls for attention to the different requirements for resources within Asia and highlights the breadth of cerebrovascular diseases still requiring further research and more effective therapies.
Collapse
Affiliation(s)
- Kay Sin Tan
- Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | - Thomas Wai Hon Leung
- Department of Medicine and Therapeutics, Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - Shinichiro Uchiyama
- Centre for Brain and Cerebral Vessels, Sanno Medical Centre, International University of Health and Welfare, Tokyo, Japan
| | - Sathoshi Kuroda
- Department of Neurosurgery, Toyama University, Toyama, Japan
| | - Nijasri C. Suwanwela
- Chulalongkorn Stroke Centre, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sanjith Aaron
- Department of Medicine, Christian Medical College, Vellore, India
| | - Hui Meng Chang
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
| | | |
Collapse
|
126
|
Karakasis P, Nasoufidou A, Sagris M, Fragakis N, Tsioufis K. Vascular Alterations Following COVID-19 Infection: A Comprehensive Literature Review. Life (Basel) 2024; 14:545. [PMID: 38792566 PMCID: PMC11122535 DOI: 10.3390/life14050545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
SARS-CoV-2, the causative agent of the ongoing COVID-19 pandemic, has revealed a broader impact beyond the respiratory system, predominantly affecting the vascular system with various adverse manifestations. The infection induces endothelial dysfunction and immune system dysregulation, creating an inflammatory and hypercoagulable state. It affects both microvasculature and macrovasculature, leading to thromboembolic events, cardiovascular manifestations, impaired arterial stiffness, cerebrovascular complications, and nephropathy, as well as retinopathy-frequently observed in cases of severe illness. Evidence suggests that SARS-CoV-2 infection may result in persistent effects on the vascular system, identified as long-term COVID-19. This is characterized by prolonged inflammation, endotheliopathy, and an increased risk of vascular complications. Various imaging modalities, histopathological studies, and diagnostic tools such as video capillaroscopy and magnetic resonance imaging have been employed to visualize vascular alterations. This review aims to comprehensively summarize the evidence concerning short and long-term vascular alterations following COVID-19 infection, investigating their impact on patients' prognosis, and providing an overview of preventive strategies to mitigate associated vascular complications.
Collapse
Affiliation(s)
- Paschalis Karakasis
- Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece; (P.K.); (A.N.); (N.F.)
| | - Athina Nasoufidou
- Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece; (P.K.); (A.N.); (N.F.)
| | - Marios Sagris
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital, 11527 Athens, Greece;
| | - Nikolaos Fragakis
- Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece; (P.K.); (A.N.); (N.F.)
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital, 11527 Athens, Greece;
| |
Collapse
|
127
|
Loureiro Fialho G, Miotto R, Tatsch Cavagnollo M, Murilo Melo H, Wolf P, Walz R, Lin K. The epileptic heart: Cardiac comorbidities and complications of epilepsy. Atrial and ventricular structure and function by echocardiography in individuals with epilepsy - From clinical implications to individualized assessment. Epilepsy Behav Rep 2024; 26:100668. [PMID: 38699061 PMCID: PMC11063386 DOI: 10.1016/j.ebr.2024.100668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 05/05/2024] Open
Abstract
Epilepsy is an increasing global neurological health issue. Recently, epidemiological and mechanistic studies have raised concern about cardiac involvement in individuals with epilepsy. This has resulted in the "epileptic heart" concept. Epidemiological data linking epilepsy to cardiovascular disease indicate an increased risk for ventricular and atrial arrhythmias, myocardial infarction, heart failure, and sudden death among individuals with epilepsy. Pathways of this interaction comprise increased prevalence of traditional cardiac risk factors, genetic abnormalities, altered brain circuitry with autonomic imbalance, and antiseizure medications with enzyme-inducing and ionic channel-blocking proprieties. Pathophysiological findings in the atria and ventricles of patients with epilepsy are discussed. Echocardiographic findings and future applications of this tool are reviewed. A risk stratification model and future studies on cardiac risk assessment in individuals with epilepsy are proposed.
Collapse
Affiliation(s)
- Guilherme Loureiro Fialho
- Cardiology Division, Department of Internal Medicine, University Hospital (HU) Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Applied Neuroscience, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Ramsés Miotto
- Cardiology Division, Department of Internal Medicine, University Hospital (HU) Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Márcia Tatsch Cavagnollo
- Neurology Division, Department of Internal Medicine, University Hospital, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Hiago Murilo Melo
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Applied Neuroscience, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Peter Wolf
- Danish Epilepsy Centre, Dianalund, Denmark
| | - Roger Walz
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Applied Neuroscience, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Neurology Division, Department of Internal Medicine, University Hospital, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Epilepsy Surgery of Santa Catarina (CEPESC), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Katia Lin
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Applied Neuroscience, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Neurology Division, Department of Internal Medicine, University Hospital, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Epilepsy Surgery of Santa Catarina (CEPESC), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| |
Collapse
|
128
|
John DS, Kankara SR, Palasamudram Kumaran S, Hussain AS. Clinicoradiological features of probable chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) syndrome. BMJ Case Rep 2024; 17:e258067. [PMID: 38627057 PMCID: PMC11029188 DOI: 10.1136/bcr-2023-258067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a recently described chronic inflammatory central nervous system disease. This case report describes a young female patient presenting with weakness in bilateral upper and lower limbs and tinnitus for 2 months. A neurological examination revealed signs of brainstem and cerebellar involvement. MRI brain showed characteristic features of CLIPPERS, with punctate and nodular enhancement in the pons and cerebellum. Differential diagnoses were systematically considered and excluded. The patient showed significant clinical and radiological improvement with steroid therapy. No clinical or radiological red flags occurred during the follow-up. This case underscores the critical role of integrating clinical and radiological findings to effectively diagnose and manage CLIPPERS. It emphasises the importance of ruling out alternative diagnoses through a thorough evaluation.
Collapse
Affiliation(s)
- Deepa Susan John
- Department of Radiology, St John's Medical College Hospital, Bangalore, Karnataka, India
| | - Shreyas Reddy Kankara
- Department of Radiology, St John's Medical College Hospital, Bangalore, Karnataka, India
| | | | - Adnan Sarfaraz Hussain
- Department of Radiology, St John's Medical College Hospital, Bangalore, Karnataka, India
| |
Collapse
|
129
|
Songtanin B, Chaisrimaneepan N, Mendóza R, Nugent K. Burden, Outcome, and Comorbidities of Extrahepatic Manifestations in Hepatitis B Virus Infections. Viruses 2024; 16:618. [PMID: 38675959 PMCID: PMC11055091 DOI: 10.3390/v16040618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/11/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Hepatitis B virus (HBV) infections affect approximately 296 million people around the world, and the prevalence of any past or present HBV infection during the years 2015-2018 was as high as 4.3%. Acute HBV infection often presents with nonspecific symptoms and is usually self-limited, but 5% of patients can have persistent infections leading to chronic HBV infection and the risk of turning into chronic HBV infection is significantly higher in babies with vertical transmission (95%). Patients with chronic HBV infection are usually asymptomatic, but 15 to 40% of chronic HBV carriers develop cirrhosis and/or hepatocellular carcinoma. In addition to liver-related disorders, HBV is also associated with several extrahepatic complications, including glomerulonephritis, cryoglobulinemia, neurologic disorders, psychological manifestations, polyarthritis, and dermatologic disorders. Making the diagnosis of HBV can be challenging since patients with chronic infections can remain symptom-free for decades before developing cirrhosis or hepatocellular carcinoma, and patients with acute HBV infection may have only mild, nonspecific symptoms. Therefore, understanding how this virus causes extrahepatic complications can help clinicians consider this possibility in patients with diverse symptom presentations. The pathophysiology of these extrahepatic disorders likely involves immune-related tissue injury following immune complex formation and inflammatory cascades. In some cases, direct viral infection of extrahepatic tissue may cause a clinical syndrome. Currently, the American Association for the Study of Liver Diseases recommends treatment of chronic HBV infections with interferon therapy and/or nucleos(t)ide analogs, and this treatment has been reported to improve some extrahepatic disorders in some patients with chronic HBV infection. These extrahepatic complications have a significant role in disease outcomes and increase medical costs, morbidity, and mortality. Therefore, understanding the frequency and pathogenesis of these extrahepatic complications provides important information for both specialists and nonspecialists and may help clinicians identify patients at an earlier stage of their infection.
Collapse
Affiliation(s)
- Busara Songtanin
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA (K.N.)
| | | | | | | |
Collapse
|
130
|
Ko S, Yamasaki R, Okui T, Shiraishi W, Watanabe M, Hashimoto Y, Kobayakawa Y, Kusunoki S, Kira JI, Isobe N. A nationwide survey of facial onset sensory and motor neuronopathy in Japan. J Neurol Sci 2024; 459:122957. [PMID: 38520939 DOI: 10.1016/j.jns.2024.122957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 02/15/2024] [Accepted: 03/10/2024] [Indexed: 03/25/2024]
Abstract
The epidemiology and etiology of facial onset sensory and motor neuronopathy (FOSMN), a rare syndrome that initiates with facial sensory disturbances followed by bulbar symptoms, remain unknown. To estimate the prevalence of FOSMN in Japan and establish the characteristics of this disease, we conducted a nationwide epidemiological survey. In the primary survey, we received answers from 604 facilities (49.8%), leading to an estimated number of 35.8 (95% confidential interval: 21.5-50.2) FOSMN cases in Japan. The secondary survey collected detailed clinical and laboratory data from 21 cases. Decreased or absent corneal and pharyngeal reflexes were present in over 85% of the cases. Electrophysiological analyses detected blink reflex test abnormalities in 94.1% of the examined cases. Immunotherapy was administered in 81% of cases and all patients received intravenous immunoglobulin. Among them, 35.3% were judged to have temporary beneficial effects evaluated by the physicians in charge. Immunotherapy tended to be effective in the early stage of disease. The spreading pattern of motor and sensory symptoms differed between cases and the characteristics of the motor-dominant and sensory-dominant cases were distinct. Cases with motor-dominant progression appeared to mimic amyotrophic lateral sclerosis. This is the first nationwide epidemiological survey of FOSMN in Japan. The clinical course of FOSMN is highly variable and motor-dominant cases developed a more severe condition than other types of cases. Because clinical interventions tend to be effective in the early phase of the disease, an early diagnosis is desirable.
Collapse
Affiliation(s)
- Senri Ko
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Ryo Yamasaki
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
| | - Tasuku Okui
- Medical Information Center, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Wataru Shiraishi
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; Department of Neurology, Kokura Memorial Hospital, Kitakyushu 802-8555, Japan
| | - Mitsuru Watanabe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yu Hashimoto
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; Department of Neurology, Kochi Medical School, Kochi University, Nankoku 783-8505, Japan
| | - Yuko Kobayakawa
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Susumu Kusunoki
- Department of Neurology, Kindai University Faculty of Medicine, Osakasayama 589-8511, Japan; Japan Community Health care Organization Headquarters, Tokyo 108-8593, Japan
| | - Jun-Ichi Kira
- Translational Neuroscience Research Center, Graduate School of Medicine, and School of Pharmacy at Fukuoka, International University of Health and Welfare, Okawa, 831-8501, Japan; Department of Neurology, Brain and Nerve Center, Fukuoka Central Hospital, International University of Health and Welfare, Fukuoka 810-0022, Japan
| | - Noriko Isobe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| |
Collapse
|
131
|
Liu Y, Tang Y, Zhang H, Chen H, Luo Q, Liu J. Duchenne muscular dystrophy caused by a deletion (c.5021del) in exon 35 of the DMD gene: A case report and review of the literature. Heliyon 2024; 10:e28677. [PMID: 38586344 PMCID: PMC10998125 DOI: 10.1016/j.heliyon.2024.e28677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 03/14/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024] Open
Abstract
Duchenne muscular dystrophy (DMD MIM#310200) is a degenerative muscle disease caused by mutations in the dystrophin gene located on Xp21.2. The clinical features encompass muscle weakness and markedly elevated serum creatine kinase levels. An 8-year-old Chinese boy was diagnosed with Duchenne muscular dystrophy (DMD). Whole exome gene sequencing was conducted and the Sanger method was used to validate sequencing. A deletion (c.5021del) in exon 35 of the dystrophin gene was identified, which was predicted to generate a frameshift mutation and create an early termination codon (p.Leu1674CysfsTer47). It has a pathogenic effect against dystrophin in the muscle cell membrane of the patient. As such, prednisone treatment at a dose of 0.75 mg/kg.d was administered. After one month, a notable reduction in fall frequency was observed. Our new finding will expand the pathogenic mutation spectrum causing DMD.
Collapse
Affiliation(s)
- Yue Liu
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Province Engineering Technology Research Center of Molecular Diagnosis of Clinical Diseases, Luzhou, China
- Molecular Diagnosis of Clinical Diseases Key Laboratory of Luzhou, Luzhou, China
| | - Yanhui Tang
- Department of Pediatric, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hui Zhang
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Province Engineering Technology Research Center of Molecular Diagnosis of Clinical Diseases, Luzhou, China
- Molecular Diagnosis of Clinical Diseases Key Laboratory of Luzhou, Luzhou, China
| | - Hongying Chen
- Department of Pediatric, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qing Luo
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Province Engineering Technology Research Center of Molecular Diagnosis of Clinical Diseases, Luzhou, China
- Molecular Diagnosis of Clinical Diseases Key Laboratory of Luzhou, Luzhou, China
| | - Jinbo Liu
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Province Engineering Technology Research Center of Molecular Diagnosis of Clinical Diseases, Luzhou, China
- Molecular Diagnosis of Clinical Diseases Key Laboratory of Luzhou, Luzhou, China
| |
Collapse
|
132
|
Terrani KF, Madura C, Rogers S, Avellino AM. Appearance of intracranial cottonoids on intraoperative magnetic resonance imaging. Neuroradiol J 2024:19714009241247466. [PMID: 38613446 DOI: 10.1177/19714009241247466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2024] Open
Abstract
To our knowledge, this is a unique report of intraoperative magnetic resonance imaging (iMRI) of an intracranial cottonoid. The current literature describes images of cottonoids as a post-operative finding in the setting of an unintentionally retained foreign body; however, the iMRI images we present are important as the use of iMRI in the resection of complex tumors and epilepsy foci increases. This series of images was obtained during a craniotomy for tumor resection of a patient with dysembryoplastic neuroepithelial tumor. To determine both the degree of tumor resection and the amount of residual tumor, cottonoids were left in our patient's resection cavity and underwent iMRI. The ability to distinguish cottonoids in these images is important for intraoperative localization of resection margins and to prevent the retention of cottonoids.
Collapse
Affiliation(s)
| | - Casey Madura
- Department of Pediatric Neurosurgery, Helen DeVos Children's Hospital, Spectrum Health, USA
| | - Samuel Rogers
- Department of Medical Imaging, University of Arizona Tucson College of Medicine, USA
| | - Anthony M Avellino
- College of Medicine, The University of Arizona, USA
- Department of Neurosurgery, Banner University Medical Center, USA
| |
Collapse
|
133
|
Wong B, Ismail Z, Watt J, Holroyd-Leduc J, Goodarzi Z. Barriers and facilitators to care for agitation and/or aggression among persons living with dementia in long-term care. BMC Geriatr 2024; 24:330. [PMID: 38600482 PMCID: PMC11008022 DOI: 10.1186/s12877-024-04919-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Agitation and/or aggression affect up to 60% of persons living with dementia in long-term care (LTC). It can be treated via non-pharmacological and pharmacological interventions, but the former are underused in clinical practice. In the literature, there is currently a lack of understanding of the challenges to caring for agitation and/or aggression among persons living with dementia in LTC. This study assesses what barriers and facilitators across the spectrum of care exist for agitation and/or aggression among people with dementia in LTC across stakeholder groups. METHODS This was a qualitative study that used semi-structured interviews among persons involved in the care and/or planning of care for people with dementia in LTC. Participants were recruited via purposive and snowball sampling, with the assistance of four owner-operator models. Interviews were guided by the Theoretical Domains Framework and transcribed and analyzed using Framework Analysis. RESULTS Eighteen interviews were conducted across 5 stakeholder groups. Key identified barriers were a lack of agitation and/or aggression diagnostic measures, limited training for managing agitation and/or aggression in LTC, an overuse of physical and chemical restraints, and an underuse of non-pharmacological interventions. Facilitators included using an interdisciplinary team to deliver care and having competent and trained healthcare providers to administer non-pharmacological interventions. CONCLUSIONS This study advances care for persons living with dementia in LTC by drawing attention to unique and systemic barriers present across local and national Canadian LTC facilities. Findings will support future implementation research endeavours to eliminate these identified barriers across the spectrum of care, thus improving care outcomes among people with dementia in LTC.
Collapse
Affiliation(s)
- Britney Wong
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Jennifer Watt
- Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Zahra Goodarzi
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
134
|
Ji X, Zhu J, Li L, Yang X, Zhou S, Cao L. Anti-sulfatide antibody-related Guillain-Barré syndrome presenting with overlapping syndromes or severe pyramidal tract damage: a case report and literature review. Front Neurol 2024; 15:1360164. [PMID: 38654738 PMCID: PMC11035893 DOI: 10.3389/fneur.2024.1360164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/07/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Anti-sulfatide antibodies are key biomarkers for the diagnosis of Guillain-Barré syndrome (GBS). However, case reports on anti-sulfatide antibody-related GBS are rare, particularly for atypical cases. Case description case 1 A 63 years-old man presented with limb numbness and diplopia persisting for 2 weeks, with marked deterioration over the previous 4 days. His medical history included cerebral infarction, diabetes, and coronary atherosclerotic cardiomyopathy. Physical examination revealed limited movement in his left eye and diminished sensation in his extremities. Initial treatments included antiplatelet agents, cholesterol-lowering drugs, hypoglycemic agents, and medications to improve cerebral circulation. Despite this, his condition worsened, resulting in bilateral facial paralysis, delirium, ataxia, and decreased lower limb muscle strength. Treatment with intravenous high-dose immunoglobulin and dexamethasone resulted in gradual improvement. A 1 month follow-up revealed significant neurological sequelae. Case description case 2 A 53 years-old woman was admitted for adenomyosis and subsequently experienced sudden limb weakness, numbness, and pain that progressively worsened, presenting with diminished sensation and muscle strength in all limbs. High-dose intravenous immunoglobulin, vitamin B1, and mecobalamin were administered. At the 1 month follow-up, the patient still experienced limb numbness and difficulty walking. In both patients, albuminocytologic dissociation was found on cerebrospinal fluid (CSF) analysis, positive anti-sulfatide antibodies were detected in the CSF, and electromyography indicated peripheral nerve damage. Conclusion Anti-sulfatide antibody-related GBS can present with Miller-Fisher syndrome, brainstem encephalitis, or a combination of the two, along with severe pyramidal tract damage and residual neurological sequelae, thereby expanding the clinical profile of this GBS subtype. Anti-sulfatide antibodies are a crucial diagnostic biomarker. Further exploration of the pathophysiological mechanisms is necessary for precise treatment and improved prognosis.
Collapse
Affiliation(s)
- Xiaotian Ji
- Department of Neurology, Sanya People’s Hospital, Sanya, China
| | - Jiaqian Zhu
- School of Medicine, Shenzhen University, Shenzhen, China
- Department of Neurology, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Lujiang Li
- Department of Neurology, Shenzhen Second People’s Hospital, Shenzhen, China
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xiaodan Yang
- Department of Neurology, Shenzhen Second People’s Hospital, Shenzhen, China
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Shaolong Zhou
- Department of Neurology, Sanya People’s Hospital, Sanya, China
| | - Liming Cao
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Hunan Provincial Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha, China
| |
Collapse
|
135
|
Nguyen H, Schubert KE, Pohling C, Chang E, Yamamoto V, Zeng Y, Nie Y, Van Buskirk S, Schulte RW, Patel CB. Impact of glioma peritumoral edema, tumor size, and tumor location on alternating electric fields (AEF) therapy in realistic 3D rat glioma models: a computational study. Phys Med Biol 2024; 69:085015. [PMID: 38417178 DOI: 10.1088/1361-6560/ad2e6c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/28/2024] [Indexed: 03/01/2024]
Abstract
Objective.Alternating electric fields (AEF) therapy is a treatment modality for patients with glioblastoma. Tumor characteristics such as size, location, and extent of peritumoral edema may affect the AEF strength and distribution. We evaluated the sensitivity of the AEFs in a realistic 3D rat glioma model with respect to these properties.Approach.The electric properties of the peritumoral edema were varied based on calculated and literature-reported values. Models with different tumor composition, size, and location were created. The resulting AEFs were evaluated in 3D rat glioma models.Main results.In all cases, a pair of 5 mm diameter electrodes induced an average field strength >1 V cm-1. The simulation results showed that a negative relationship between edema conductivity and field strength was found. As the tumor core size was increased, the average field strength increased while the fraction of the shell achieving >1.5 V cm-1decreased. Increasing peritumoral edema thickness decreased the shell's mean field strength. Compared to rostrally/caudally, shifting the tumor location laterally/medially and ventrally (with respect to the electrodes) caused higher deviation in field strength.Significance.This study identifies tumor properties that are key drivers influencing AEF strength and distribution. The findings might be potential preclinical implications.
Collapse
Affiliation(s)
- Ha Nguyen
- Baylor University, Waco, TX, 76706, United States of America
| | | | - Christoph Pohling
- Loma Linda University, Loma Linda, CA, 92350, United States of America
| | - Edwin Chang
- Stanford University, Stanford, CA, 94305, United States of America
| | - Vicky Yamamoto
- University of Southern California-Keck School of Medicine, Los Angeles, CA, 90033, United States of America
| | - Yuping Zeng
- University of Delaware, Newark, DE, 19716, United States of America
| | - Ying Nie
- Loma Linda University, Loma Linda, CA, 92350, United States of America
| | - Samuel Van Buskirk
- University of Texas at San Antonio, San Antonio, TX, 78249, United States of America
| | | | - Chirag B Patel
- The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, United States of America
- The University of Texas MD Anderson UTHealth Graduate School of Biomedical Sciences at Houston, Houston, TX, 77030, United States of America
| |
Collapse
|
136
|
Cleaver J, Jeffery K, Klenerman P, Lim M, Handunnetthi L, Irani SR, Handel A. The immunobiology of herpes simplex virus encephalitis and post-viral autoimmunity. Brain 2024; 147:1130-1148. [PMID: 38092513 PMCID: PMC10994539 DOI: 10.1093/brain/awad419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/25/2023] [Accepted: 11/27/2023] [Indexed: 04/06/2024] Open
Abstract
Herpes simplex virus encephalitis (HSE) is the leading cause of non-epidemic encephalitis in the developed world and, despite antiviral therapy, mortality and morbidity is high. The emergence of post-HSE autoimmune encephalitis reveals a new immunological paradigm in autoantibody-mediated disease. A reductionist evaluation of the immunobiological mechanisms in HSE is crucial to dissect the origins of post-viral autoimmunity and supply rational approaches to the selection of immunotherapeutics. Herein, we review the latest evidence behind the phenotypic progression and underlying immunobiology of HSE including the cytokine/chemokine environment, the role of pathogen-recognition receptors, T- and B-cell immunity and relevant inborn errors of immunity. Second, we provide a contemporary review of published patients with post-HSE autoimmune encephalitis from a combined cohort of 110 patients. Third, we integrate novel mechanisms of autoimmunization in deep cervical lymph nodes to explore hypotheses around post-HSE autoimmune encephalitis and challenge these against mechanisms of molecular mimicry and others. Finally, we explore translational concepts where neuroglial surface autoantibodies have been observed with other neuroinfectious diseases and those that generate brain damage including traumatic brain injury, ischaemic stroke and neurodegenerative disease. Overall, the clinical and immunological landscape of HSE is an important and evolving field, from which precision immunotherapeutics could soon emerge.
Collapse
Affiliation(s)
- Jonathan Cleaver
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, OX3 9DU, UK
| | - Katie Jeffery
- Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Paul Klenerman
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, OX1 3SY, UK
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Ming Lim
- Children’s Neurosciences, Evelina London Children’s Hospital at Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 7EH, UK
- Department Women and Children’s Health, School of Life Course Sciences, King’s College London, London, WC2R 2LS, UK
| | - Lahiru Handunnetthi
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, OX3 9DU, UK
| | - Adam Handel
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, OX3 9DU, UK
| |
Collapse
|
137
|
Scutelnic A, van de Munckhof A, Miraclin AT, Aaron S, Hameed S, Wasay M, Grosu O, Krzywicka K, Sánchez van Kammen M, Lindgren E, Moreira T, Acampora R, Negro A, Karapanayiotides T, Yaghi S, Revert A, Cuadrado Godia E, Garcia-Madrona S, La Spina P, Grillo F, Giammello F, Nguyen TN, Abdalkader M, Buture A, Sofia Cotelli M, Raposo N, Tsivgoulis G, Candelaresi P, Ciacciarelli A, Mbroh J, Batenkova T, Scoppettuolo P, Zedde M, Pascarella R, Antonenko K, Kristoffersen ES, Kremer Hovinga JA, Jood K, Aguiar de Sousa D, Poli S, Tatlisumak T, Putaala J, Coutinho JM, Ferro JM, Arnold M, Heldner MR. Characteristics and outcomes of cerebral venous thrombosis associated with COVID-19. Eur Stroke J 2024:23969873241241885. [PMID: 38572798 DOI: 10.1177/23969873241241885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Previous reports and meta-analyses derived from small case series reported a mortality rate of up to 40% in patients with coronavirus disease 2019 associated cerebral venous thrombosis (COVID-CVT). We assessed the clinical characteristics and outcomes in an international cohort of patients with COVID-CVT. PATIENTS AND METHODS This was a registry study of consecutive COVID-CVT patients diagnosed between March 2020 and March 2023. Data collected by the International Cerebral Venous Thrombosis Consortium from patients with CVT diagnosed between 2017 and 2018 served as a comparison. Outcome analyses were adjusted for age and sex. RESULTS We included 70 patients with COVID-CVT from 23 hospitals in 15 countries and 206 controls from 14 hospitals in 13 countries. The proportion of women was smaller in the COVID-CVT group (50% vs 68%, p < 0.01). A higher proportion of COVID-CVT patients presented with altered mental state (44% vs 25%, p < 0.01), the median thrombus load was higher in COVID-CVT patients (3 [IQR 2-4] vs 2 [1-3], p < 0.01) and the length of hospital stay was longer compared to controls (11 days [IQR 7-20] vs 8 [4-15], p = 0.02). In-hospital mortality did not differ (5/67 [7%, 95% CI 3-16] vs 7/206 [3%, 2-7], aOR 2.6 [95% CI 0.7-9]), nor did the frequency of functional independence after 6 months (modified Rankin Scale 0-2; 45/58 [78%, 95% CI 65-86] vs 161/185 [87%, 81-91], aOR 0.5 [95% CI 0.2-1.02]). CONCLUSION In contrast to previous studies, the in-hospital mortality rate and functional outcomes during follow-up did not differ between COVID-CVT patients and the pre-COVID-19 controls.
Collapse
Affiliation(s)
- Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anita van de Munckhof
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Angel T Miraclin
- Department of Neurosciences, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Sanjith Aaron
- Department of Neurosciences, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | | | | | - Oxana Grosu
- Institute of Neurology and Neurosurgery "Diomid Gherman," Chisinau, Republic of Moldova
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Mayte Sánchez van Kammen
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Tiago Moreira
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Roberto Acampora
- Department of Neurology and Stroke Unit, Ospedale del Mare Hospital, Naples, Italy
| | - Alberto Negro
- Department of Neurology and Stroke Unit, Ospedale del Mare Hospital, Naples, Italy
| | - Theodoros Karapanayiotides
- 2nd Department of Neurology, Aristotle University of Thessaloniki, School of Medicine, AHEPA University Hospital, Greece
| | - Shadi Yaghi
- Department of Neurology, Brown University, Providence, RI, USA
| | - Anna Revert
- Hospital del Mar, Faculty of Medicine and Life Sciences, Pompeu Fabra University Barcelona, Spain
| | - Elisa Cuadrado Godia
- Hospital del Mar, Faculty of Medicine and Life Sciences, Pompeu Fabra University Barcelona, Spain
| | | | - Paolino La Spina
- Translational Molecular Medicine and Surgery 36th Cycle, Department of BIOMORF, Stroke Unit, Department of Clinical and Experimental Medicine, University Hospital G. Martino, Messina, Italy
| | - Francesco Grillo
- Translational Molecular Medicine and Surgery 36th Cycle, Department of BIOMORF, Stroke Unit, Department of Clinical and Experimental Medicine, University Hospital G. Martino, Messina, Italy
| | - Fabrizio Giammello
- Translational Molecular Medicine and Surgery 36th Cycle, Department of BIOMORF, Stroke Unit, Department of Clinical and Experimental Medicine, University Hospital G. Martino, Messina, Italy
| | - Thanh N Nguyen
- Neurology, Boston Medical Center, MA, USA
- Radiology, Boston Medical Center, MA, USA
| | | | - Alina Buture
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Nicolas Raposo
- Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - Georgios Tsivgoulis
- Second Department of Neurology, National & Kapodistrian University of Athens, School of Medicine, "Attikon University Hospital", Athens, Greece
| | | | - Antonio Ciacciarelli
- Neurology Division, Santa Maria Goretti Hospital, Latina, Italy
- Department of Translation and Precision Medicine, Sapienza University of Rome, Italy
| | - Joshua Mbroh
- Department of Neurology & Stroke, University Hospital Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | | | - Pasquale Scoppettuolo
- Neurology Department, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rosario Pascarella
- Neuroradiology Unit, Azienda Unità Sanitaria-IRCCS di Reggio Emilia, Italy
| | - Kateryna Antonenko
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Johanna A Kremer Hovinga
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Diana Aguiar de Sousa
- Lisbon Central University Hospital and Faculdade de Medicina da Universidade de Lisboa, Portugal
| | - Sven Poli
- Department of Neurology & Stroke, University Hospital Tuebingen, Eberhard-Karls University, Tuebingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Jukka Putaala
- Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - José M Ferro
- Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
138
|
Phuyal S, Pokhrel B, Lamsal R, Mishra B, Nayak MK. Sequential mechanical thrombectomies in acute bilateral middle cerebral artery strokes: A case report and review of literature. J Neurosci Rural Pract 2024; 15:381-383. [PMID: 38746493 PMCID: PMC11090565 DOI: 10.25259/jnrp_26_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/09/2024] [Indexed: 05/16/2024] Open
Abstract
Simultaneous occlusion of both middle cerebral arteries (MCAs) is very rare and usually devastating. Few case reports are available in the literature where bilateral thrombectomy was done simultaneously to remove the clot. High NIH stroke scale with a low level of consciousness can be a clue for the diagnosis. Timely intervention is necessary to decrease morbidity and mortality in these patients. We also reviewed the existing literature where mechanical thrombectomies were done for bilateral MCA stroke in PubMed, Google Scholar, Cochrane, and Embase. Herein, we report a case of 47-year-old female having rheumatic heart disease presented with simultaneous bilateral MCAs occlusion, treated with mechanical thrombectomies successfully.
Collapse
Affiliation(s)
- Subash Phuyal
- Department of Neuroimaging, Interventional Neuroradiology, Kathmandu, Nepal
| | - Baburam Pokhrel
- Department of Neurology, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Ritesh Lamsal
- Department of Anaethesiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Biswamohan Mishra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj Kumar Nayak
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| |
Collapse
|
139
|
Rosenberg R, Thorpy MJ, Doghramji K, Morse AM. Brain fog in central disorders of hypersomnolence: a review. J Clin Sleep Med 2024; 20:643-651. [PMID: 38217475 PMCID: PMC10985301 DOI: 10.5664/jcsm.11014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 01/15/2024]
Abstract
Brain fog is an undefined term describing a cluster of symptoms related to fatigue and impaired memory, attention, and concentration. Brain fog or brain fog-like symptoms have been reported in central disorders of hypersomnolence and in a range of seemingly unrelated disorders, including coronavirus disease 2019, major depressive disorder, multiple sclerosis, lupus, and celiac disease. This narrative review summarizes current evidence and proposes a consensus definition for brain fog. Brain fog is prevalent in narcolepsy and idiopathic hypersomnia, with more than three-quarters of patients with either disorder reporting this symptom in a registry study; it has also been reported as particularly difficult to treat in idiopathic hypersomnia. Studies directly evaluating brain fog are rare; tools for evaluating this symptom cluster typically are patient reports, with few objective measures validated in any disorder. Evaluating brain fog is further complicated by confounding symptoms, such as excessive daytime sleepiness, which is a hallmark of hypersomnolence disorders. No treatments specifically address brain fog. The paucity of literature, assessment tools, and medications for brain fog highlights the need for research leading to better disambiguation and treatment. Until a clear consensus definition is established, we propose brain fog in hypersomnia disorders be defined as a cognitive dysfunction that may or may not be linked with excessive sleepiness, related to an underlying neuronal dysfunction, which reduces concentration and impairs information processing, leading to a complaint of lack of clarity of mental thinking and awareness. CITATION Rosenberg R, Thorpy MJ, Doghramji K, Morse AM. Brain fog in central disorders of hypersomnolence: a review. J Clin Sleep Med. 2024;20(4):643-651.
Collapse
Affiliation(s)
| | | | - Karl Doghramji
- Jefferson Sleep Disorders Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anne Marie Morse
- Department of Child Neurology and Sleep Medicine, Geisinger Medical Center, Janet Weis Children’s Hospital, Danville, Pennsylvania
| |
Collapse
|
140
|
Shiraishi W, Murata Y, Inamori Y, Matsuyoshi A, Nakazawa Y. Bilateral Phrenic Nerve Palsy Associated With Neuralgic Amyotrophy. Cureus 2024; 16:e58069. [PMID: 38738025 PMCID: PMC11088468 DOI: 10.7759/cureus.58069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Neuralgic amyotrophy (NA) is a multifocal inflammatory neuropathy accompanied by acute pain and muscle atrophy. NA commonly affects the upper extremities, but rarely affects the phrenic nerve. Here, we report a male with neck pain, orthopnea, difficulty sleeping in the supine position, and inability to slurp. His saturated oxygen level decreased from 97% to 86% in the supine position. His right shoulder showed muscle atrophy. Chest X-ray examination in the supine position and a nerve conduction study showed phrenic palsy. We diagnosed it as bilateral phrenic nerve palsy associated with NA. NA sometimes causes phrenic nerve palsy and may cause slurping difficulty.
Collapse
Affiliation(s)
- Wataru Shiraishi
- Neurology, Kokura Memorial Hospital, Kitakyushu, JPN
- Internal Medicine, Shiraishi Internal Medicine Clinic, Nogata, JPN
| | - Yuichi Murata
- Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, JPN
| | | | | | | |
Collapse
|
141
|
Raymond MJ, Ottinger A, Rowley MA, Bobian M, Dornhoffer J, Brennan E, Rizk HG. A Scoping Review of Otologic Manifestations of Hematologic Malignancies. Otol Neurotol 2024; 45:362-375. [PMID: 38437804 DOI: 10.1097/mao.0000000000004141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
OBJECTIVE To examine the otologic and neurotologic symptoms, physical examination findings, and imaging features secondary to hematologic malignancies. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, databases, including PubMed, Scopus, and CINAHL, were searched for articles including patients with otologic manifestations of leukemia, lymphoma and multiple myeloma. Data collected included patient and study demographics, specific hematologic malignancy, timing and classification of otologic symptoms, physical examination findings, imaging features and methods of diagnosis. Pooled descriptive analysis was performed. RESULTS Two hundred seventy-two articles, of which 255 (93.8%) were case reports and 17 (6.2%) were case series, reporting on 553 patients were identified. Otologic manifestations were reported on 307 patients with leukemia, 204 patients with lymphoma and 42 patients with multiple myeloma. Hearing loss and unilateral facial palsy were the most common presenting symptoms for 111 reported subjects with leukemia (n = 46, 41.4%; n = 43, 38.7%) and 90 with lymphoma (n = 38, 42.2%; n = 39, 43.3%). Hearing loss and otalgia were the most common presenting symptoms for 21 subjects with multiple myeloma (n = 10, 47.6%; n = 6, 28.6%). Hearing loss and unilateral facial palsy were the most common otologic symptoms indicative of relapse in subjects with leukemia (n = 14, 43.8%) and lymphoma (n = 5, 50%). CONCLUSION Hearing loss, facial palsy, and otalgia might be the first indication of a new diagnosis or relapse of leukemia, lymphoma, or multiple myeloma. Clinicians should have a heightened level of suspicion of malignant etiologies of otologic symptoms in patients with current or medical histories of these malignancies.
Collapse
Affiliation(s)
| | - Allie Ottinger
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - M Andrew Rowley
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Michael Bobian
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Jim Dornhoffer
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | | | - Habib G Rizk
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| |
Collapse
|
142
|
Rissardo JP, Vora NM, Tariq I, Batra V, Caprara ALF. Unraveling belly dancer's dyskinesia and other puzzling diagnostic contortions: A narrative literature review. Brain Circ 2024; 10:106-118. [PMID: 39036290 PMCID: PMC11259329 DOI: 10.4103/bc.bc_110_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 07/23/2024] Open
Abstract
Belly dancer's dyskinesia (BDD) is characterized by involuntary abdominal wall movements that are rhythmic, repetitive, and dyskinetic. The present study aims to review BDD's etiology, pathophysiology, and management. We searched six databases to locate existing reports on BDD published from 1990 to October 2023 in electronic form. A total of 47 articles containing 59 cases were found. The majority of the patients affected by BDD were female, accounting for 61.01% (36/59) of the cases. The mean and median ages were 49.8 (standard deviation: 21.85) and 52 years (range: 7-85), respectively. The BDD was unilateral in only 3.38% (2/59). The most commonly reported causes associated with BDD were 17 idiopathic, 11 drug-induced, 11 postsurgical procedures, 5 pregnancies, and 4 Vitamin B12 deficiencies. BDD is a diagnosis of exclusion, and other more common pathologies with similar presentation should be ruled out initially. Differential diagnostic reasoning should include diaphragmatic myoclonus, cardiac conditions, truncal dystonia, abdominal motor seizures, propriospinal myoclonus, and functional or psychiatric disorders.
Collapse
Affiliation(s)
| | - Nilofar Murtaza Vora
- Department of Medicine, Terna Speciality Hospital and Research Centre, Navi Mumbai, Maharashtra, India
| | - Irra Tariq
- Department of Medicine, United Medical and Dental College, Karachi, Pakistan
| | - Vanshika Batra
- Department of Medicine, SGT University, Gurugram, Haryana, India
| | | |
Collapse
|
143
|
Zhang Y, Wu C, Shi Q, Su M. Granulomatosis With Polyangiitis of Spinal Dura Presenting With "Bottle Brush Sign" on 18 F-FDG PET/CT. Clin Nucl Med 2024; 49:361-363. [PMID: 38350075 DOI: 10.1097/rlu.0000000000005113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
ABSTRACT A 72-year-old man with fever and weakness in both lower limbs underwent thoracolumbar MRI and 18 F-FDG PET/CT. The PET/CT scan revealed diffused FDG uptake along the spinal dura mater from T7 to S2 level like a "bottle brush." Pathologic examination after biopsy of spinal canal lesions manifested granulomatous inflammation. The blood test showed cytoplasmic antineutrophil cytoplasmic antibody (ANCA) and myeloperoxidase-ANCAs were positive, whereas the perinuclear ANCA was negative. Eventually, he was diagnosed with granulomatosis with polyangiitis.
Collapse
Affiliation(s)
- Yue Zhang
- From the Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Chunyan Wu
- Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Qinwen Shi
- From the Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Minggang Su
- From the Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan
| |
Collapse
|
144
|
Meylor J, Artunduaga DC, Mendoza M, Hooshmand SI, Obeidat AZ. Progressive multifocal leukoencephalopathy in patients with chronic kidney disease. Neurol Sci 2024; 45:1619-1624. [PMID: 37950135 DOI: 10.1007/s10072-023-07182-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
Progressive multifocal leukoencephalopathy (PML) is an opportunistic central nervous system infection caused by the human polyomavirus 2, leading to demyelination from oligodendrocyte death and rapid neurologic decline. Most commonly, PML affects patients in immunocompromised states. However, rare reports of PML in an immunocompetent host exist. Here, we report two cases of PML in older individuals with chronic kidney disease (CKD). CKD can ultimately lead to immune system dysfunction and place patients in a relatively immunosuppressed state. Testing for JC virus should remain a consideration for rapid, unexplained neurologic decline even without known immunocompromised status in the appropriate clinical setting.
Collapse
Affiliation(s)
- Jennifer Meylor
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Michael Mendoza
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sam I Hooshmand
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ahmed Z Obeidat
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Neurology, Division of Neuroimmunology and Multiple Sclerosis, The Medical College of Wisconsin, Hub of Collaborative Research, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| |
Collapse
|
145
|
Pichardo-Rojas PS, Marín-Castañeda LA, De Nigris Vasconcellos F, Flores-López SI, Coria-Medrano A, de Teresa López-Zepeda P, Sánchez-Serrano CD, Torres-Chávez MC, Escobar-López JM, Choque-Ayala LC, Jowah G, Rangel-Castilla L. Simultaneous Parkinsonism and Dementia as Initial Presentation of Intracranial Dural Arteriovenous Fistulas: A Systematic Review. World Neurosurg 2024; 184:e554-e576. [PMID: 38336210 DOI: 10.1016/j.wneu.2024.01.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Intracranial dural arteriovenous fistulas (IDAVFs) are abnormal vascular connections between dural arteries and various venous structures within the brain. IDAVFs, rarely present with parkinsonism and dementia concurrently, making this a unique and underexplored clinical scenario. To the best of our knowledge, this is the first systematic review to comprehensively analyze cases of IDAVFs manifesting as both parkinsonism and dementia. METHODS We assessed databases from inception to September 18, 2023. We identified studies describing patients with IDAVFs initially presenting with dementia or parkinsonism. Inclusion criteria encompassed case reports and case series, while excluding review articles, guidelines, technical notes, comments, conference abstracts, and editorials. RESULTS The systematic search resulted in the initial screening of 383 studies, with 33 articles meeting the inclusion criteria. Among these, 29 were case reports, often describing 3 or fewer patients. From the remaining 4 case series, data pertinent to patients presenting both parkinsonism and dementia were selectively extracted, yielding a total study population of 43 patients. The anatomical distribution of IDAVFs within this cohort was diverse, with the transverse and sigmoid sinuses being the most common locations. Although most of these patients received endovascular therapy, a few underwent microsurgical occlusion or combined surgical and endovascular treatment. CONCLUSIONS IDAVFs presenting with both parkinsonism and dementia represent a rare clinical entity. This systematic review provides valuable insights into the clinical characteristics, treatment options, and outcomes for such cases. However, additional research involving larger cohorts is essential to better comprehend the underlying mechanisms and establish standardized therapeutic guidelines.
Collapse
Affiliation(s)
- Pavel S Pichardo-Rojas
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas, USA.
| | | | - Fernando De Nigris Vasconcellos
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas, USA
| | - Shadia I Flores-López
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad en Ciencias de la Salud, Universidad Anáhuac México Campus Norte, Estado de México, Huixquilucan de Degollado, México
| | - Adrian Coria-Medrano
- Instituto de Neurobiología, Campus Universidad Nacional Autónoma de México-Juriquilla, Querétaro, México
| | | | - Claudia D Sánchez-Serrano
- Centro Universitario de Ciencias de la Salud, Guadalajara, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Mario C Torres-Chávez
- Facultad de Medicina, Universidad Autónoma de Baja California, Mexicali, Baja California, México
| | - Jesús M Escobar-López
- Escuela de Ciencias de la Salud, Universidad Del Valle de México, Ciudad de México, México
| | - Luz C Choque-Ayala
- Facultad de Medicina, Universidad Católica Boliviana San Pablo, Santa Cruz de la Sierra, Bolivia
| | - Gorbachev Jowah
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas, USA
| | | |
Collapse
|
146
|
Belay HD, Gebrewold MA, Ayele BA, Oda DM, Kelemu FT, Zewde YZ, Melkamu SK, Wuhib MZ, Gugssa SA, Mengesha AT, Metaferia GZ. Neurology Training and Medical Education in Resource-Limited Settings: Building and Growing the First Neurology Residency Program in East Africa. Semin Neurol 2024; 44:147-158. [PMID: 38631360 DOI: 10.1055/s-0044-1785539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
The burden of neurological disease disproportionately affects low- and middle-income countries, where the lowest number of neurologists are located. Building local training opportunities in resource-limited settings is a foundational step to enhancing the neurological workforce and improving access to neurological care in these regions. In this article, we describe the development and growth of the first neurology residency program in East Africa, which was established in 2006 at Zewditu Memorial Hospital and the Tikur Anbessa Specialized Hospital, Addis Ababa University, Ethiopia. We highlight the impact of the program on clinical care, research, collaborations between neurologists across Ethiopia, and ways to build educational opportunities and mentorship while faced with limited resources. The main challenges in starting the residency program included lack of faculty with neurological expertise, lack of a precedent for subspecialty training in our setting, as well as limited resources and space. The formation of sustainable international collaborations with clinicians at established institutions in high-income countries and neurological societies has been a major source of support in developing the initial infrastructure, curriculum and educational content, knowledge assessments, and mentored research projects. Local partnerships with related medical specialties, including internal medicine, critical care, neurological surgery, and psychiatry, were also instrumental in creating training opportunities. As the program continues to evolve, many challenges remain, including limited diagnostics, lack of access to advanced treatment modalities, lack of fellowship training opportunities in various neurological subspecialties, and insufficient training and experience in scientific writing. Despite these challenges, the residency program has persevered and its creation resulted in many positive changes: since its inception in 2006, we graduated 80 neurologists and the number of practicing neurologists in Ethiopia has increased from 5 to 78, our institution has evolved into a national referral center for neurology, graduates have published 61 articles in the past 3 years and contributed to international neurology research, and alumni of the program have grown the Association of Ethiopian Neurologists. Future directions include development of fellowship opportunities, creation of international rotations, and implementation of teleneurology to further strengthen neurological care across Ethiopia.
Collapse
Affiliation(s)
- Hanna D Belay
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Meron A Gebrewold
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Biniyam A Ayele
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dereje M Oda
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fikru T Kelemu
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yared Z Zewde
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Selam K Melkamu
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mehila Z Wuhib
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Seid A Gugssa
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abenet T Mengesha
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Guta Z Metaferia
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
147
|
Saad EA, Mukherjee T, Gandour G, Fatayerji N, Rammal A, Samuel P, Abdallah N, Ashok T. Cardiac myxomas: causes, presentations, diagnosis, and management. Ir J Med Sci 2024; 193:677-688. [PMID: 37737916 DOI: 10.1007/s11845-023-03531-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023]
Abstract
Cardiac myxomas (CM) are one of the most common benign tumors which are typical in adults with a yearly incidence of 0.5-1 case per million individuals. This review article includes discussions based on existing literature on the role of interleukin interactions in the pathophysiology of cardiac myxoma which can lead to embolic complications, aneurysms, and CNS involvement. The objective of this narrative review was to study the variable clinical presentations of cardiac myxoma, its detection and diagnosis involving multiple modalities like genetic and hematological testing, echocardiography, CT, and MRI, of which transoesophageal echocardiogram shows excellent precision with a 90% to 96% accuracy in diagnosing CM. Individuals with the Carney complex are prone to such neoplasia. Cardiac myxomas are challenging to diagnose due to the ambiguity of their differential with thrombi. Myxomas can also be diagnosed by tumor markers like interleukin-6 and endothelial growth factors. The management of CM includes surgical excision like median sternotomy and robotic minimally invasive surgery. The use of robotic surgery in CM increased from 1.8% in 2012 to 15.1% in 2018. Tumor recurrences are uncommon but can occur due to inadequate surgical resection.
Collapse
Affiliation(s)
- Elio Assaad Saad
- Faculty of Medicine and Medical Sciences, University of Balamand, Al Koura, Lebanon
| | - Tishya Mukherjee
- Faculty of Medicine, Nicolae Testemițanu State University of Medicine and Pharmacy, Chișinău, Moldova
| | - Georges Gandour
- Faculty of Medicine and Medical Sciences, University of Balamand, Al Koura, Lebanon
| | - Nora Fatayerji
- Faculty of Medicine and Medical Sciences, Poznan University of Medical Sciences, Poznan, Poland
| | - Aya Rammal
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Peter Samuel
- International Faculty of Medicine, Tbilisi State Medical University, Tbilisi, Georgia.
| | - Nicolas Abdallah
- Faculty of Medicine and Medical Sciences, University of Balamand, Al Koura, Lebanon
| | | |
Collapse
|
148
|
Peddareddygari LR, Grewal RP. A Patient With Charcot-Marie-Tooth Disease Type 4C (CMT4C) Presenting With Muscle Fasciculations and Motor Neuropathy. Cureus 2024; 16:e57550. [PMID: 38707135 PMCID: PMC11066706 DOI: 10.7759/cureus.57550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/07/2024] Open
Abstract
We report an unusual patient who, at age 47 years, had presented with complaints of muscle fasciculations. After neurological examination and electromyogram testing, he was diagnosed with motor neuropathy. Over the next 10 years, in addition to fasciculations, he developed numbness in his feet without any other symptoms. His current neurological examination at age 57 years was normal, except for mildly decreased light touch in the anterior portion of both feet. The nerve conduction studies performed repeatedly showed sensorimotor polyneuropathy with demyelination features. Blood tests, including anti-ganglioside antibodies, were normal. Genetic testing revealed two rare variants in trans in the SH3 domain and tetratricopeptide repeats 2gene, c.3413 G>A p.(S1138N) and c.3269 C>G p.(A1090G). Protein modeling suggests that these are disease-producing mutations and likely the cause of the neuropathy of our patient. Our study expands the clinical and genetic spectrum of patients with Charcot-Marie-Tooth disease type 4C.
Collapse
Affiliation(s)
| | - Raji P Grewal
- Neurosciences, Capital Health Institute for Neurosciences, Bordentown, USA
- Research and Development, Dynamic Biologics Inc., Monmouth Junction, USA
| |
Collapse
|
149
|
Hanna AF, Bolling D, Tadros M. From Wheelchair Bound to Working: A Case Study of Intravenous Ketamine Infusions in Treating Stiff Person Syndrome. Cureus 2024; 16:e59397. [PMID: 38817534 PMCID: PMC11139490 DOI: 10.7759/cureus.59397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Stiff Person Syndrome (SPS) is a rare autoimmune condition marked by extremely painful muscle spasms, stiffness, and rigidity throughout the body. Its rarity often translates to limited treatment options for patients and, occasionally, challenges in obtaining a definitive diagnosis. SPS also impacts patients' mental health, social and economic involvement, and overall quality of life. A 43-year-old man was initially being seen for lumbar radicular pain. A clinical diagnosis of SPS was made by a neurologist and confirmed by in-clinic follow-ups and anti-glutamic acid decarboxylase (anti-GAD) antibody testing. The Pain Management doctor agreed with this diagnosis and offered intravenous (IV) ketamine treatment, which he has found to positively impact the treatment of similar disorders. After an initial 10-day infusion, the patient reported improvement in pain and function. For almost two years, the patient received intravenous immunoglobulin (IVIg) and IV ketamine treatments to manage their condition and maintain pain control as well as quality of life. When the patient's symptoms began worsening after IVIg infusions, the decision to withdraw IVIg infusions and continue ketamine infusions was made. After discontinuing IVIg infusions, the patient reported improvement in function and pain level and continues to receive monthly two-day ketamine boosters. Outside of the infusions, the patient was able to discontinue the use of fentanyl patches and continued taking ketamine lozenges, oxycodone-acetaminophen, and dextromethorphan for at-home pain management. The patient's symptoms continue to be managed effectively with their current regimen, enabling their return to work and experiencing an enhanced quality of life. This case illustrates the potential benefits of IV ketamine treatment for patients with treatment-resistant SPS and similar neurologic and autoimmune disorders. Understanding and examining treatment alternatives for rare syndromes is crucial for achieving optimal patient outcomes. Additionally, documenting such cases offers valuable insights into the mechanism of ketamine, extending beyond these syndromes.
Collapse
Affiliation(s)
- Ashraf F Hanna
- Pain Management/Anesthesiology, Florida Spine Institute, Clearwater, USA
| | - Danielle Bolling
- Pain Management, University of South Florida (USF) Health Morsani College of Medicine, Tampa, USA
| | - Mariam Tadros
- Pain Management, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| |
Collapse
|
150
|
Erkalaycı C, Ramazanoğlu L, Gözke E. Symptomatic and asymptomatic pontine hyperintensities: are they central pontine myelinolysis? Case series. Ir J Med Sci 2024; 193:993-997. [PMID: 37831360 DOI: 10.1007/s11845-023-03538-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Abstract
The diagnosis of central pontine hyperintensities on cranial magnetic resonance imaging has wide-spectrum clinical entities, and the pro-type diagnosis of these is central pontine myelinolysis. The rapid changes in extracellular environment due to an imbalance of electrolytes or metabolic or toxic stress to the myelin sheath can cause demyelination of white matter tracts in pons, which is why this situation could have different etiologies than just rapid sodium changes. Central pontine myelinolysis can be presented with different clinical scenarios from asymptomatic to death. Here, we present eight patients who had central pontine hyperintensities on radiological imaging but showed various clinical symptoms and different etiologies. The etiologies of these cases are hypertriglyceridemia, alcohol consumption, antidepressant usage, immunocompromised situations, uncontrolled diabetes mellitus, liver and kidney failure, electrolyte changes, and adrenal insufficiency. We aimed to take attention with this case series to the fact that not only fast correction of hyponatremia is the cause of central pontine myelinolysis, but also different etiologies could play a role in this situation, and making the central pontine myelinolysis diagnosis considering different diagnosis is very important.
Collapse
Affiliation(s)
- Ceren Erkalaycı
- Department of Neurology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
| | - Leyla Ramazanoğlu
- Department of Neurology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Eren Gözke
- Department of Neurology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|