3101
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3102
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Fragile X-associated tremor/ataxia syndrome (FXTAS): pathology and mechanisms. Acta Neuropathol 2013; 126:1-19. [PMID: 23793382 DOI: 10.1007/s00401-013-1138-1] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 05/30/2013] [Indexed: 12/17/2022]
Abstract
Since its discovery in 2001, our understanding of fragile X-associated tremor/ataxia syndrome (FXTAS) has undergone a remarkable transformation. Initially characterized rather narrowly as an adult-onset movement disorder, the definition of FXTAS is broadening; moreover, the disorder is now recognized as only one facet of a much broader clinical pleiotropy among children and adults who carry premutation alleles of the FMR1 gene. Furthermore, the intranuclear inclusions of FXTAS, once thought to be a CNS-specific marker of the disorder, are now known to be widely distributed in multiple non-CNS tissues; this observation fundamentally changes our concept of the disease, and may provide the basis for understanding the diverse medical problems associated with the premutation. Recent work on the pathogenic mechanisms underlying FXTAS indicates that the origins of the late-onset neurodegenerative disorder actually lie in early development, raising the likelihood that all forms of clinical involvement among premutation carriers have a common underlying mechanistic basis. There has also been great progress in our understanding of the triggering event(s) in FXTAS pathogenesis, which is now thought to involve sequestration of one or more nuclear proteins involved with microRNA biogenesis. Moreover, there is mounting evidence that mitochondrial dysregulation contributes to the decreased cell function and loss of viability, evident in mice even during the neonatal period. Taken together, these recent findings offer hope for early interventions for FXTAS, well before the onset of overt disease, and for the treatment of other forms of clinical involvement among premutation carriers.
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3103
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Amaral TN, Peres FA, Lapa AT, Marques-Neto JF, Appenzeller S. Neurologic involvement in scleroderma: a systematic review. Semin Arthritis Rheum 2013; 43:335-47. [PMID: 23827688 DOI: 10.1016/j.semarthrit.2013.05.002] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 04/24/2013] [Accepted: 05/02/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To perform a systematic review of neurologic involvement in Systemic sclerosis (SSc) and Localized Scleroderma (LS), describing clinical features, neuroimaging, and treatment. METHODS We performed a literature search in PubMed using the following MeSH terms, scleroderma, systemic sclerosis, localized scleroderma, localized scleroderma "en coup de sabre", Parry-Romberg syndrome, cognitive impairment, memory, seizures, epilepsy, headache, depression, anxiety, mood disorders, Center for Epidemiologic Studies Depression (CES-D), SF-36, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Patient Health Questionnaire-9 (PHQ-9), neuropsychiatric, psychosis, neurologic involvement, neuropathy, peripheral nerves, cranial nerves, carpal tunnel syndrome, ulnar entrapment, tarsal tunnel syndrome, mononeuropathy, polyneuropathy, radiculopathy, myelopathy, autonomic nervous system, nervous system, electroencephalography (EEG), electromyography (EMG), magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA). Patients with other connective tissue disease knowingly responsible for nervous system involvement were excluded from the analyses. RESULTS A total of 182 case reports/studies addressing SSc and 50 referring to LS were identified. SSc patients totalized 9506, while data on 224 LS patients were available. In LS, seizures (41.58%) and headache (18.81%) predominated. Nonetheless, descriptions of varied cranial nerve involvement and hemiparesis were made. Central nervous system involvement in SSc was characterized by headache (23.73%), seizures (13.56%) and cognitive impairment (8.47%). Depression and anxiety were frequently observed (73.15% and 23.95%, respectively). Myopathy (51.8%), trigeminal neuropathy (16.52%), peripheral sensorimotor polyneuropathy (14.25%), and carpal tunnel syndrome (6.56%) were the most frequent peripheral nervous system involvement in SSc. Autonomic neuropathy involving cardiovascular and gastrointestinal systems was regularly described. Treatment of nervous system involvement, on the other hand, varied in a case-to-case basis. However, corticosteroids and cyclophosphamide were usually prescribed in severe cases. CONCLUSIONS Previously considered a rare event, nervous system involvement in scleroderma has been increasingly recognized. Seizures and headache are the most reported features in LS en coup de sabre, while peripheral and autonomic nervous systems involvement predominate in SSc. Moreover, recently, reports have frequently documented white matter lesions in asymptomatic SSc patients, suggesting smaller branches and perforating arteries involvement.
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Affiliation(s)
- Tiago Nardi Amaral
- Rheumatology Division, Faculty of Medical Science, State University of Campinas, Campinas, Brazil; Rheumatology Lab, Faculty of Medical Science, State University of Campinas, Campinas, Brazil
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3104
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Hirsch HH, Kardas P, Kranz D, Leboeuf C. The human JC polyomavirus (JCPyV): virological background and clinical implications. APMIS 2013; 121:685-727. [PMID: 23781977 DOI: 10.1111/apm.12128] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 04/29/2013] [Indexed: 02/06/2023]
Abstract
JC polyomavirus (JCPyV) was the first of now 12 PyVs detected in humans, when in 1964, PyV particles were revealed by electron microscopy in progressive multifocal leukoencephalopathy (PML) tissues. JCPyV infection is common in 35-70% of the general population, and the virus thereafter persists in the renourinary tract. One third of healthy adults asymptomatically shed JCPyV at approximately 50,000 copies/mL urine. PML is rare having an incidence of <0.3 per 100,000 person years in the general population. This increased to 2.4 per 1000 person years in HIV-AIDS patients without combination antiretroviral therapy (cART). Recently, PML emerged in multiple sclerosis patients treated with natalizumab to 2.13 cases per 1000 patients. Natalizumab blocks α4-integrin-dependent lymphocyte homing to the brain suggesting that not the overall cellular immunodeficiency but local failure of brain immune surveillance is a pivotal factor for PML. Recovering JCPyV-specific immune control, e.g., by starting cART or discontinuing natalizumab, significantly improves PML survival, but is challenged by the immune reconstitution inflammatory syndrome. Important steps of PML pathogenesis are undefined, and antiviral therapies are lacking. New clues might come from molecular and functional profiling of JCPyV and PML pathology and comparison with other replicative pathologies such as granule cell neuronopathy and (meningo-)encephalitis, and non-replicative JCPyV pathology possibly contributing to some malignancies. Given the increasing number of immunologically vulnerable patients, a critical reappraisal of JCPyV infection, replication and disease seems warranted.
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Affiliation(s)
- Hans H Hirsch
- Transplantation & Clinical Virology, Department Biomedicine (Haus Petersplatz), University of Basel, Basel, Switzerland.
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3105
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Akins PT, Axelrod YK, Ji C, Ciporen JN, Arshad ST, Hawk MW, Guppy KH. Cerebral venous sinus thrombosis complicated by subdural hematomas: Case series and literature review. Surg Neurol Int 2013; 4:85. [PMID: 23869285 PMCID: PMC3709281 DOI: 10.4103/2152-7806.113651] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/13/2013] [Indexed: 12/02/2022] Open
Abstract
Background: Cerebral venous sinus thrombosis (CVST) can cause elevated intracranial pressure, hemorrhagic venous infarct, and cortical subarachnoid hemorrhage. We present a case series and literature review to illustrate that CVST can also present with subdural hematoma (SDH). Case Description: Chart review was completed on a retrospective case series of CVST with spontaneous SDH. We also conducted a literature search. Over a 6 year interval, three patients with CVST and SDH were admitted to the neurointensive care unit. A 38-year-old woman had both SDH and a hemorrhagic venous infarct associated with a transverse sinus thrombosis. She was managed conservatively with long-term anticoagulation. A 68-year-old woman presented with an acute SDH requiring craniotomy and a thrombosed cortical vein was noted intraoperatively. Computed tomography venography showed thrombosis of the superior sagittal sinus. She had polycythemia vera with the V617 Jak2 gene mutation and was managed with aspirin and hydroxyurea. A 60-year-old male had recurrence of a spontaneous convexity SDH requiring reoperation. Neuroimaging identified ipsilateral transverse sinus thrombosis with retrograde flow into the opposite sinus. Manometry demonstrated elevated venous pressures and these normalized after thrombectomy. Angiography performed after endovascular treatment demonstrated a normal venous drainage pattern. There have been limited reports of SDH complicating CVST in the literature. Conclusion: This case series and literature review demonstrates that CVST can also present with spontaneous SDH with or without associated venous infarctions. Treatment must be individualized. This is the first published description of endovascular thrombectomy for recurrent symptomatic SDH due to CVST.
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Affiliation(s)
- Paul T Akins
- Department of Neurosurgery, Permanente Medical Group, Kaiser Sacramento Medical Center, Sacramento, CA 95825
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3106
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Riancho J, Delgado-Alvarado M, Sedano MJ, Polo JM, Berciano J. Herpes simplex encephalitis: clinical presentation, neurological sequelae and new prognostic factors. Ten years of experience. Neurol Sci 2013; 34:1879-81. [DOI: 10.1007/s10072-013-1475-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 06/11/2013] [Indexed: 10/26/2022]
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3107
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Bilateral paramedian thalamic infarction initially presenting as a convulsive seizure. Case Rep Neurol Med 2013; 2013:704952. [PMID: 23762679 PMCID: PMC3677012 DOI: 10.1155/2013/704952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 05/14/2013] [Indexed: 11/17/2022] Open
Abstract
Bithalamic infarctions initially presenting as a convulsive seizure are rarely reported and, to our best knowledge, have never been reported in China. Here, we present a patient with convulsive seizure at the onset of bilateral paramedian thalamic infarction. The diffusion-weighted imaging revealed that the infarct area is supplied by Percheron artery. Associated with the relationship between seizure and centrencephalic system and reticular formation as previously reported, we suggest that seizure could be the onset symptom of paramedian thalamic infarction. Physicians should recognize this condition, because both seizure control and early ischemic stroke management are required.
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3108
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Girgin NK, İşçimen R, Yılmaz E, Kahveci ŞF, Kutlay O. Guillain-Barré Syndrome and Human Immunodeficiency Virus. Turk J Anaesthesiol Reanim 2013; 42:100-2. [PMID: 27366399 DOI: 10.5152/tjar.2013.51] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 01/15/2013] [Indexed: 11/22/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute disease characterised by symmetrical muscle weakness, loss of sensation and reflex. There is usually a viral infection at the beginning of the disease. Here, we report a GBS case which did not respond to any treatment strategy at first and was diagnosed as Human Immunodeficiency Virus positive (HIV+) during the search for the aetiology. A 32-year-old male patient who presented to a medical centre with symptoms of gait disturbance and arm and leg numbness was found to have albuminocytologic dissociation upon cerebrospinal fluid examination. After the diagnosis of GBS, immunoglobulin G (IVIG) therapy (400 mg kg(-1) day(-1) 5 days) was started as a standard therapy. This therapy was repeated due to a lack of improvement of symptoms. During this therapy, the patient was sent to our clinic with symptoms of respiratory failure and tetraplegia. He was conscious, cooperative, haemodynamically stable and his arterial blood gas analyses were: pH: 7.28, PaO2: 74.4 mmHg, PCO2: 63.8 mmHg. He was intubated, mechanically ventilated and underwent plasmapheresis. After the investigation of aetiology, HIV(+), CD4/CD8: 0.17, absolute CD4: 71 cells mL(-1) were detected and antiretroviral therapy was started. The patient died from multiple organ failure due to sepsis on day 35. In conclusion, HIV infection should be kept in mind in GBS patients, especially those not responding to routine treatment. As a result, not only could the patient receive early and adequate treatment, but also HIV infection transmission would be avoided.
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Affiliation(s)
- Nermin Kelebek Girgin
- Department of Anaesthesiology and Reanimation, Intensive Care Unit, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Remzi İşçimen
- Department of Anaesthesiology and Reanimation, Intensive Care Unit, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Emel Yılmaz
- Department of Infectious Disease and Microbiology, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Ş Ferda Kahveci
- Department of Anaesthesiology and Reanimation, Intensive Care Unit, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Oya Kutlay
- Private Medicabil Hospital, Bursa, Turkey
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3109
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Marquart C, Strauss C, Alfieri A. Eight-and-a-half syndrome combined with an ipsilateral vertical gaze palsy: A pathophysiological explanation. Clin Neurol Neurosurg 2013; 115:767-9. [DOI: 10.1016/j.clineuro.2012.06.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 06/29/2012] [Accepted: 06/30/2012] [Indexed: 11/29/2022]
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3110
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Thrombosis in the Pulmonary Vein Stump After Left Upper Lobectomy as a Possible Cause of Cerebral Infarction. Ann Thorac Surg 2013; 95:1924-8. [DOI: 10.1016/j.athoracsur.2013.03.005] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 02/25/2013] [Accepted: 03/01/2013] [Indexed: 11/22/2022]
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3111
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Abstract
Recognizing stiff person syndrome is clinically important. It is uncommon, characterized by body stiffness associated with painful muscle spasms, and varies in location and severity. It is subdivided into stiff trunk versus stiff limb presentation, and as a progressive encephalomyelitis. Stiff person-type syndrome also reflects a paraneoplastic picture. Most patients demonstrate exaggerated lumbar lordosis. Roughly 60% of patients have antiglutamic acid decarboxylase antibodies in the blood and the cerebrospinal fluid. The differential diagnosis includes many severe conditions. There are reports of response to muscle relaxants, immunosuppressants, intravenous gamma globulin, plasma exchange, a number of anticonvulsants, and botulinum toxin.
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Affiliation(s)
- Giuseppe Ciccotto
- Department of Neurology, Tulane University School of Medicine, 1430 Tulane Avenue 8065, New Orleans, LA 70112, USA
| | - Maike Blaya
- Department of Neurology, Tulane University School of Medicine, 1430 Tulane Avenue 8065, New Orleans, LA 70112, USA
| | - Roger E Kelley
- Department of Neurology, Tulane University School of Medicine, 1430 Tulane Avenue 8065, New Orleans, LA 70112, USA.
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3112
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Collongues N, Labouret P, Speeg C, de Seze J. A case of recurrent facial pain associated with a Pourfour du Petit syndrome: a new entity? Headache 2013; 54:373-7. [PMID: 23700978 DOI: 10.1111/head.12137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2013] [Indexed: 11/28/2022]
Abstract
We report the case of a 38-year-old woman with a history of migraine who experienced an association of recurrent unilateral facial pain and Pourfour du Petit syndrome. The episodes occurred for between a few seconds and up to 3 minutes up to 6 times a day mimicking short-lasting unilateral neuralgiform headaches with cranial autonomic symptoms. No lesional cause was found and the use of topiramate led to a nearly complete disappearance of the episodes. This new entity raises the question of a novel autonomic dysfunction in short-lasting unilateral neuralgiform headaches with cranial autonomic symptoms or an unexpected presentation of migraine.
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Affiliation(s)
- Nicolas Collongues
- Department of Neurology, Hôpital Universitaire de Strasbourg, Strasbourg, France
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3113
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Alexander M, Patil AKB, Mathew V, Sivadasan A, Chacko G, Mani SE. Recurrent craniospinal subarachnoid hemorrhage in cerebral amyloid angiopathy. Ann Indian Acad Neurol 2013; 16:97-9. [PMID: 23661974 PMCID: PMC3644794 DOI: 10.4103/0972-2327.107712] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 03/08/2012] [Accepted: 04/15/2012] [Indexed: 11/08/2022] Open
Abstract
Cerebral amyloid angiopathy (CAA) usually manifests as cerebral hemorrhage, especially as nontraumatic hemorrhages in normotensive elderly patients. Other manifestations are subarachnoid (SAH), subdural, intraventricular hemorrhage (IVH) and superficial hemosiderosis. A 52-year-old hypertensive woman presented with recurrent neurological deficits over a period of 2 years. Her serial brain magnetic resonance imaging and computed tomography scans showed recurrent SAH hemorrhage, and also intracerebral, IVH and spinal hemorrhage, with superficial siderosis. Cerebral angiograms were normal. Right frontal lobe biopsy showed features of CAA. CAA can present with unexplained recurrent SAH hemorrhage, and may be the initial and prominent finding in the course of disease in addition to superficial cortical siderosis and intracerebal and spinal hemorrhages.
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Affiliation(s)
- Mathew Alexander
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India ; Department of Neurology, Christian Medical College, Vellore, Tamil Nadu, India
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3114
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Sumathipala DS, Abeysekera GS, Jayasekara RW, Tallaksen CME, Dissanayake VHW. Autosomal dominant hereditary ataxia in Sri Lanka. BMC Neurol 2013; 13:39. [PMID: 23634774 PMCID: PMC3667103 DOI: 10.1186/1471-2377-13-39] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 04/25/2013] [Indexed: 01/22/2023] Open
Abstract
Background Spinocerebellar ataxias (SCA) are a group of hereditary neurodegenerative disorders. Prevalence of SCA subtypes differ worldwide. Autosomal dominant ataxias are the commonest types of inherited ataxias seen in Sri Lanka. The aim of the study is to determine the genetic etiology of patients with autosomal dominant ataxia in Sri Lanka and to describe the clinical features of each genetic subtype. Methods Thirty four patients with autosomal dominant ataxia were recruited. For every patient the following was done: recording of clinical details and genotyping for SCA 1, 2, 3, 6, 7, 8, 12, and 17. Results Sixty one per cent of the subjects were identified as SCA1. One subject had SCA2, 12 remain unidentified. Mean age at onset was 34.8 ± 10years for SCA1 and 32.7 ± 9.8 for non SCA1. 76% of SCA1 patients and 50% of non SCA1 were using walking aids. Quantification of symptoms and signs were similar in the SCA1 and non SCA1 groups. Clinical depression was evidenced in 68.4% of SCA1 and 75% non SCA-1 patients. Mean CAG repeat length in SCA1 patients was 52.0 ± 3.8, with greater anticipation seen with paternal inheritance. Conclusion SCA1 was the predominant subtype and showed similar phenotype to previous reports. However, disease severity was higher and depression more prevalent in this population than previously described.
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Affiliation(s)
- Dulika S Sumathipala
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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3115
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Shah GN, Rubbelke TS, Hendin J, Nguyen H, Waheed A, Shoemaker JD, Sly WS. Targeted mutagenesis of mitochondrial carbonic anhydrases VA and VB implicates both enzymes in ammonia detoxification and glucose metabolism. Proc Natl Acad Sci U S A 2013; 110:7423-8. [PMID: 23589845 PMCID: PMC3645511 DOI: 10.1073/pnas.1305805110] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Prior studies with carbonic anhydrase (CA) inhibitors implicated mitochondrial CA in ureagenesis and gluconeogenesis. Subsequent studies identified two mitochondrial CAs. To distinguish the contribution of each enzyme, we studied the effects of targeted disruption of the murine CA genes, called Car5A and Car5B. The Car5A mutation had several deleterious consequences. Car5A null mice were smaller than wild-type littermates and bred poorly. However, on sodium-potassium citrate-supplemented water, they produced offspring in expected numbers. Their blood ammonia concentrations were markedly elevated, but their fasting blood sugars were normal. By contrast, Car5B null mice showed normal growth and normal blood ammonia levels. They too had normal fasting blood sugars. Car5A/B double-knockout (DKO) mice showed additional abnormalities. Impaired growth was more severe than for Car5A null mice. Hyperammonemia was even greater as well. Although fertile, DKO animals were produced in less-than-predicted numbers even when supplemented with sodium-potassium citrate in their drinking water. Survival after weaning was also reduced, especially for males. In addition, fasting blood glucose levels for DKO mice were significantly lower than for controls (153 ± 33 vs. 230 ± 24 mg/dL). The enhanced hyperammonemia and lower fasting blood sugar, which are both seen in the DKO mice, indicate that both Car5A and Car5B contribute to both ammonia detoxification (ureagenesis) and regulation of fasting blood sugar (gluconeogenesis). Car5A, which is expressed mainly in liver, clearly has the predominant role in ammonia detoxification. The contribution of Car5B to ureagenesis and gluconeogenesis was evident only on a Car5A null background.
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Affiliation(s)
| | - Timothy S. Rubbelke
- Edward A. Doisy Department of Biochemistry and Molecular Biology, Saint Louis University School of Medicine, St. Louis, MO 63104
| | - Joshua Hendin
- Edward A. Doisy Department of Biochemistry and Molecular Biology, Saint Louis University School of Medicine, St. Louis, MO 63104
| | - Hien Nguyen
- Edward A. Doisy Department of Biochemistry and Molecular Biology, Saint Louis University School of Medicine, St. Louis, MO 63104
| | - Abdul Waheed
- Edward A. Doisy Department of Biochemistry and Molecular Biology, Saint Louis University School of Medicine, St. Louis, MO 63104
| | - James D. Shoemaker
- Edward A. Doisy Department of Biochemistry and Molecular Biology, Saint Louis University School of Medicine, St. Louis, MO 63104
| | - William S. Sly
- Edward A. Doisy Department of Biochemistry and Molecular Biology, Saint Louis University School of Medicine, St. Louis, MO 63104
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3116
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Duning T, Deppe M, Brand E, Stypmann J, Becht C, Heidbreder A, Young P. Brainstem involvement as a cause of central sleep apnea: pattern of microstructural cerebral damage in patients with cerebral microangiopathy. PLoS One 2013; 8:e60304. [PMID: 23637744 PMCID: PMC3634049 DOI: 10.1371/journal.pone.0060304] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 02/25/2013] [Indexed: 12/22/2022] Open
Abstract
Background The exact underlying pathomechanism of central sleep apnea with Cheyne-Stokes respiration (CSA-CSR) is still unclear. Recent studies have demonstrated an association between cerebral white matter changes and CSA. A dysfunction of central respiratory control centers in the brainstem was suggested by some authors. Novel MR-imaging analysis tools now allow far more subtle assessment of microstructural cerebral changes. The aim of this study was to investigate whether and what severity of subtle structural cerebral changes could lead to CSA-CSR, and whether there is a specific pattern of neurodegenerative changes that cause CSR. Therefore, we examined patients with Fabry disease (FD), an inherited, lysosomal storage disease. White matter lesions are early and frequent findings in FD. Thus, FD can serve as a "model disease" of cerebral microangiopathy to study in more detail the impact of cerebral lesions on central sleep apnea. Patients and Methods Genetically proven FD patients (n = 23) and age-matched healthy controls (n = 44) underwent a cardio-respiratory polysomnography and brain MRI at 3.0 Tesla. We applied different MR-imaging techniques, ranging from semiquantitative measurement of white matter lesion (WML) volumes and automated calculation of brain tissue volumes to VBM of gray matter and voxel-based diffusion tensor imaging (DTI) analysis. Results In 5 of 23 Fabry patients (22%) CSA-CSR was detected. Voxel-based DTI analysis revealed widespread structural changes in FD patients when compared to the healthy controls. When calculated as a separate group, DTI changes of CSA-CSR patients were most prominent in the brainstem. Voxel-based regression analysis revealed a significant association between CSR severity and microstructural DTI changes within the brainstem. Conclusion Subtle microstructural changes in the brainstem might be a neuroanatomical correlate of CSA-CSR in patients at risk of WML. DTI is more sensitive and specific than conventional structural MRI and other advanced MR analyses tools in demonstrating these abnormalities.
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Affiliation(s)
- Thomas Duning
- Department of Neurology, University Hospital of Muenster, Muenster, Germany.
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3117
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Hirschvogel K, Matiasek K, Flatz K, Drögemüller M, Drögemüller C, Reiner B, Fischer A. Magnetic resonance imaging and genetic investigation of a case of Rottweiler leukoencephalomyelopathy. BMC Vet Res 2013; 9:57. [PMID: 23531239 PMCID: PMC3614464 DOI: 10.1186/1746-6148-9-57] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 03/14/2013] [Indexed: 11/12/2022] Open
Abstract
Background Leukoencephalomyelopathy is an inherited neurodegenerative disorder that affects the white matter of the spinal cord and brain and is known to occur in the Rottweiler breed. Due to the lack of a genetic test for this disorder, post mortem neuropathological examinations are required to confirm the diagnosis. Leukoencephalopathy with brain stem and spinal cord involvement and elevated lactate levels is a rare, autosomal recessive disorder in humans that was recently described to have clinical features and magnetic resonance imaging (MRI) findings that are similar to the histopathologic lesions that define leukoencephalomyelopathy in Rottweilers. Leukoencephalopathy with brain stem and spinal cord involvement is caused by mutations in the DARS2 gene, which encodes a mitochondrial aspartyl-tRNA synthetase. The objective of this case report is to present the results of MRI and candidate gene analysis of a case of Rottweiler leukoencephalomyelopathy to investigate the hypothesis that leukoencephalomyelopathy in Rottweilers could serve as an animal model of human leukoencephalopathy with brain stem and spinal cord involvement. Case presentation A two-and-a-half-year-old male purebred Rottweiler was evaluated for generalised progressive ataxia with hypermetria that was most evident in the thoracic limbs. MRI (T2-weighted) demonstrated well-circumscribed hyperintense signals within both lateral funiculi that extended from the level of the first to the sixth cervical vertebral body. A neurodegenerative disorder was suspected based on the progressive clinical course and MRI findings, and Rottweiler leukoencephalomyelopathy was subsequently confirmed via histopathology. The DARS2 gene was investigated as a causative candidate, but a sequence analysis failed to identify any disease-associated variants in the DNA sequence. Conclusion It was concluded that MRI may aid in the pre-mortem diagnosis of suspected cases of leukoencephalomyelopathy. Genes other than DARS2 may be involved in Rottweiler leukoencephalomyelopathy and may also be relevant in human leukoencephalopathy with brain stem and spinal cord involvement.
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Affiliation(s)
- Katrin Hirschvogel
- Department of Veterinary Clinical Sciences Ludwig-Maximilians-Universitaet, Neurology Service, Clinic of Small Animal Medicine, Munich, Germany
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3118
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Solomiichuk VO, Lebed VO, Drizhdov KI. Posttraumatic delayed subdural tension pneumocephalus. Surg Neurol Int 2013; 4:37. [PMID: 23607059 PMCID: PMC3622390 DOI: 10.4103/2152-7806.109537] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 03/05/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pneumocephalus is a complication of head injury in 3.9-9.7% of the cases, it also appears after supratentorial craniotomy in 100% of cases. The accumulation of intracranial air can be acute (<72 hours) or delayed (≥72 hours). When intracranial air causes intracranial hypertension and has a mass-effect with neurological deterioration, it is called tension pneumocephalus. CASE DESCRIPTION We represent a clinical case of a 75-year-old male patient with open penetrating head injury, complicated by tension pneumocephalus on the fifth day after trauma and underwent urgent surgical correction. Operation performed: Burr-hole placement in the right frontal region, evacuation of tension pneumocephalus. CONCLUSION Tension pneumocephalus is a life-threatening neurosurgical emergency case, which needs to undergo immediate surgical or conservative treatment.
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Affiliation(s)
| | - Vitaliy O. Lebed
- Neurosurgical Department, Yalta City Hospital, Yalta, Crimea, Ukraine
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Characteristics of Neurogenic Voiding Dysfunction in Cerebellar Stroke: A Cross-Sectional, Retrospective Video Urodynamic Study. THE CEREBELLUM 2013; 12:601-6. [DOI: 10.1007/s12311-013-0468-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Li M, Su W, Wang J, Pisani F, Frigeri A, Ma T. Detection of anti-aquaporin-4 autoantibodies in the sera of Chinese neuromyelitis optica patients. Neural Regen Res 2013; 8:708-13. [PMID: 25206717 PMCID: PMC4146080 DOI: 10.3969/j.issn.1673-5374.2013.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 11/15/2012] [Indexed: 11/23/2022] Open
Abstract
In this study, we recruited 10 neuromyelitis optica patients, two multiple sclerosis patients and two myelitis patients. Chinese hamster lung fibroblast (V79) cells transfected with a human aquaporin-4-mCherry fusion protein gene were used to detect anti-aquaporin-4 antibody in neuromyelitis optica patient sera by immunofluorescence. Anti-aquaporin-4 autoantibody was stably detected by immunofluorescence in neuromyelitis optica patient sera exclusively. The sensitivity of the assay for neuromyelitis optica was 90% and the specificity for neuromyelitis optica was 100%. The anti-aquaporin-4 antibody titers in sera were tested with serial dilutions until the signal disappeared. A positive correlation was detected between Expanded Disability Status Scale scores and serum anti-aquaporin-4 antibody titers. The anti-aquaporin-4 antibody assay is highly sensitive and specific in the sera of Chinese neuromyelitis optica patients. Detection of aquaporin-4 autoantibody is important for the diagnosis and treatment of neuromyelitis optica.
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Affiliation(s)
- Miao Li
- Membrane Channel Research Laboratory, Northeast Normal University, Changchun 130024, Jilin Province, China ; Department of Neurosurgery, China-Japan Union Hospital, Jilin University, Changchun 130033, Jilin Province, China
| | - Weiheng Su
- National Engineering Laboratory for AIDS Vaccine, College of Life Science, Jilin University, Changchun 130012, Jilin Province, China
| | - Jie Wang
- Department of Neurosurgery, China-Japan Union Hospital, Jilin University, Changchun 130033, Jilin Province, China
| | - Francesco Pisani
- Department of General and Environmental Physiology and Centre of Excellence in Comparative Genomics (CEGBA), University of Bari, I-70126 Bari, Italy
| | - Antonio Frigeri
- Department of General and Environmental Physiology and Centre of Excellence in Comparative Genomics (CEGBA), University of Bari, I-70126 Bari, Italy
| | - Tonghui Ma
- Membrane Channel Research Laboratory, Northeast Normal University, Changchun 130024, Jilin Province, China
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Moragas-Garrido M, Goudie C, Schmoll C, Madill S, Farrall A, Davenport R. Seizure, dysphasia, blindness and amnesia; what's the connection? Pract Neurol 2013; 13:331-4. [PMID: 23487826 DOI: 10.1136/practneurol-2012-000440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kanoto M, Toyoguchi Y, Hosoya T, Oda A, Sugai Y. Visualization of the trochlear nerve in the cistern with use of high-resolution turbo spin-echo multisection motion-sensitized driven equilibrium. AJNR Am J Neuroradiol 2013; 34:1434-7. [PMID: 23391840 DOI: 10.3174/ajnr.a3403] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The trochlear nerve is so thin that it is rarely observed with MR imaging. Therefore, we used high-resolution MSDE to reliably visualize the cisternal segments of the trochlear nerve. MATERIALS AND METHODS Participants were 10 healthy young adults (mean age, 24 years), and 20 trochlear nerves were examined. HR-MRC, BS-MRC, and HR-MSDE were performed. A neuroradiologist judged the visibility of the trochlear nerves as 1 of 4 grades ("Excellent," "Good," "Fair," and "Not") in each MR imaging sequence. The findings were then statistically analyzed with the χ(2) test. RESULTS Of all 20 trochlear nerves, 6 with HR-MRC, 13 with BS-MRC, and 18 with HR-MSDE were judged as "Excellent." CSF flow-related artifacts and vessels in the cistern and cerebellar tentorium in HR-MRC tended to prevent the neuroradiologists from identifying the trochlear nerve. Vessels in the cistern and cerebellar tentorium in BS-MRC also tended to prevent the neuroradiologists from identifying the trochlear nerve. Compared with other sequences, HR-MSDE visualized the trochlear nerve more often. The χ(2) test revealed statistically significant differences among the 3 MR imaging sequences (P < .01). The scan time of HR-MSDE was approximately 1.5-2.2 times longer than that of the other sequences. CONCLUSIONS HR-MSDE is able to clearly visualize the trochlear nerve and has the same or better ability to delineate the trochlear nerve compared with other MR imaging sequences, though its long scan time does not yet yield practical use.
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Affiliation(s)
- M Kanoto
- Department of Diagnostic Radiology, Yamagata University Faculty of Medicine, Yamagata, Japan.
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Kimmel RA, Doherty J, Slattery WH, Linthicum FH. Recurrent schwannoma postirradiation: histological review reveals mixed schwannoma and meningioma. Otolaryngol Head Neck Surg 2013; 148:886-8. [PMID: 23380761 DOI: 10.1177/0194599813475572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rachel A Kimmel
- House Research Institute, Eccles Temporal Bone Histopathology Laboratory, Los Angeles, California 90057, USA
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Sugiura Y, Nemoto E, Shinoda H, Nakamura N, Kaseda S. Surgery for lung adenocarcinoma with smokers' polycythemia: a case report. BMC Res Notes 2013; 6:38. [PMID: 23374961 PMCID: PMC3571947 DOI: 10.1186/1756-0500-6-38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 01/30/2013] [Indexed: 12/20/2022] Open
Abstract
Background Smoking is a cause of cancer and polycythemia. Therefore, surgeons who treat patients with cancer may also encounter patients with polycythemia. However, few cases of surgical patients with polycythemia have been reported; in particular, a surgical case involving smokers’ polycythemia has never been reported. We herein report a patient with lung cancer and smokers’ polycythemia who successfully underwent lobectomy with control of hematocrit based on a modified formula in the perioperative period. Case presentation A 67-year-old man underwent abdominoperineal resection for rectal carcinoma in June 2008. A ground glass opacity had been identified in the upper lobe of the right lung and was gradually enlarging. In March 2012, bronchoscopic cytology for investigation of the mass revealed non-small cell lung cancer, suggesting primary lung non-small cell carcinoma (T1bN0M0, Stage IA). When he was referred to our hospital for surgery, his complete blood count showed a red blood cell level of 6.50×106/μL, hemoglobin of 21.0 g/dL, and hematocrit of 60.1%. The hematologists’ diagnosis was secondary polycythemia due to heavy smoking (smokers’ polycythemia) because the white blood cell and platelet counts were within normal limits and the erythropoietin was not increased. We calculated the appropriate phlebotomy and infusion volumes based on a formula that we modified. After 550 g of blood was phlebotomized to reduce the hematocrit to approximately 55%, video-assisted right lung upper lobectomy with lymph node dissection was performed in April 2012. The hematocrit was maintained at <50% postoperatively, and the patient was uneventfully discharged on postoperative day 7. The predictive hematocrit and measured hematocrit were very closely approximated in this case. Conclusion We experienced a patient with smokers’ polycythemia who underwent right upper lobectomy for adenocarcinoma. The findings in this case report are meaningful for surgeons treating cancer patients because there are few reports discussing the perioperative care of surgical patients with polycythemia.
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Affiliation(s)
- Yasoo Sugiura
- National Hospital Organization, Kanagawa National Hospital, Pulmonary and Thoracic Surgery, 666-1 Ochiai, Hadano, Kanagawa, 257-8585, Japan.
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Figee M, Wielaard I, Mazaheri A, Denys D. Neurosurgical targets for compulsivity: what can we learn from acquired brain lesions? Neurosci Biobehav Rev 2013; 37:328-39. [PMID: 23313647 DOI: 10.1016/j.neubiorev.2013.01.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 12/03/2012] [Accepted: 01/03/2013] [Indexed: 11/18/2022]
Abstract
Treatment efficacy of deep brain stimulation (DBS) and other neurosurgical techniques in refractory obsessive-compulsive disorder (OCD) is greatly dependent on the targeting of relevant brain regions. Over the years, several case reports have been published on either the emergence or resolution of obsessive-compulsive symptoms due to neurological lesions. These reports can potentially serve as an important source of insight into the neuroanatomy of compulsivity and have implications for targets of DBS. For this purpose, we have reviewed all published case reports of patients with acquired or resolved obsessive-compulsive symptoms after brain lesions. We found a total of 37 case reports describing 71 patients with acquired and 6 with resolved obsessive-compulsive symptoms as a result of hemorrhaging, infarctions or removal of tumors. Behavioral symptoms following brain lesions consisted of typical obsessive-compulsive symptoms, but also symptoms within the compulsivity spectrum. These data suggests that lesions in the cortico-striato-thalamic circuit, parietal and temporal cortex, cerebellum and brainstem may induce compulsivity. Moreover, the resolution of obsessive-compulsive symptoms has been reported following lesions in the putamen, internal capsule and fronto-parietal lobe. These case reports provide strong evidence supporting the rationale for DBS in the ventral striatum and internal capsule for treatment of compulsivity and reveal the putamen and fronto-parietal cortex as promising new targets.
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Affiliation(s)
- Martijn Figee
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Liu GJ, Wang YF, Liu ZG, Liu JX, Ding L, Zhang LP, Wang ZJ, Luo J. A unilateral brachiocephalic vein thrombosis: cause of a rare, transient ischemic attack, a case report and review of the literature. Int J Neurosci 2013; 123:433-8. [PMID: 23286382 DOI: 10.3109/00207454.2012.762916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this report is to inform medical professionals of a case in which brachiocephalic vein thrombosis caused a transient ischemic attack (TIA). A brain computerized tomography (CT) scan, magnetic resonance imaging, digital subtraction angiography, head and lung CT angiography, jugular venography, cardiac color Doppler ultrasound scan, color Doppler ultrasound scan of the neck and lower vascular extremities and 24-hour, continuous electrocardiogram monitoring were performed. A 50-year-old male experienced a total of 31 onsets of weakness in the right side of his body, speech impairment and numbness in the right side of his body during a period of 20 days. Imaging results did not reveal evidence of a cerebral infarction. The potential of a TIA with an arterial origin and other causes were ruled out, and a left brachiocephalic vein thrombosis and left jugular vein congestion were discovered. Thus, the brachiocephalic vein thrombosis was considered to be the cause of the TIA. The patient received anticoagulant and antiplatelet aggregation treatment. On the following day after the termination of the TIA, a color Doppler ultrasound scan detected the opening of the jugular venous arch, but the blood flow that returned to the superior vena cava via the left brachiocephalic vein did not significantly increase. A brachiocephalic vein thrombosis can be the cause of a TIA. In addition to the anticoagulant and antiplatelet aggregation treatment, the opening of the collateral of veins, including that of the jugular venous arch, may play an important role in reducing venous congestion and in terminating TIAs.
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Affiliation(s)
- Guang Jian Liu
- Department of Neurology, Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan City, Hubei Province, China
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Kamran S, Howard S, Shinagare A, Krajewski K, Jagannathan J, Hornick J, Ramaiya N. Malignant peripheral nerve sheath tumors: Prognostic impact of rhabdomyoblastic differentiation (malignant triton tumors), neurofibromatosis 1 status and location. Eur J Surg Oncol 2013; 39:46-52. [DOI: 10.1016/j.ejso.2012.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 08/20/2012] [Accepted: 09/26/2012] [Indexed: 11/29/2022] Open
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Namekawa M, Nakamura Y, Nakano I. Cortical involvement in Marchiafava-Bignami disease can be a predictor of a poor prognosis: a case report and review of the literature. Intern Med 2013; 52:811-3. [PMID: 23545681 DOI: 10.2169/internalmedicine.52.9336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Marchiafava-Bignami disease (MBD) is a rare alcohol-associated disorder characterized by demyelination and necrosis of the corpus callosum. We herein present the case of a 56-year-old man with chronic alcoholism who was admitted to our hospital in a coma without focal or lateralizing neurological signs. MRI revealed a callosal lesion consistent with MBD and additional bifrontal linear cortical lesions. The callosal lesion completely disappeared with intravenous administration of high-dose multivitamins and corticosteroids, although the patient remained in a vegetative state. This case further supports the notion that cortical involvement in patients with MBD is a predictor of a poor prognosis.
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Ishikawa Y, Ikeda K, Murata K, Hirayama T, Takazawa T, Yanagihashi M, Kano O, Kawabe K, Takahashi Y, Iwasaki Y. Ophthalmoplegia and flaccid paraplegia in a patient with anti-NMDA receptor encephalitis: a case report and literature review. Intern Med 2013; 52:2811-5. [PMID: 24334591 DOI: 10.2169/internalmedicine.52.1065] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report the case of a 26-year-old woman with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis presenting with ophthalmoplegia and flaccid paraplegia. She developed disorientation and hallucination after fever and vomiting. Hypothermia, hypoventilation, hypertension, paralytic ileus and hyponatremia were present. Neurological examination showed mild consciousness disturbance and bilateral ophthalmoplegia on admission, flaccid paraplegia with leg areflexia on Day 4. Anti-NMDAR antibodies were detected in the serum and cerebrospinal fluid samples. Motor nerve conduction velocity was decreased in the tibial and peroneal nerves. F-wave amplitudes were reduced in the tibial nerve. MRI disclosed lesions in the callosal splenium, hippocampus and cerebral subarachnoid regions. In addition to various encephalitic symptoms, physicians should pay more attention to peripheral nerve damage in patients with anti-NMDAR encephalitis.
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Affiliation(s)
- Yuichi Ishikawa
- Department of Neurology, Toho University Omori Medical Center, Japan
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Himeno T, Takeshima S, Kubo S, Hara N, Takamatsu K, Kuriyama M. [Tension pneumocephalus complicated from bacterial meningitis - a report of case presenting "Mount Fuji sign" in brain CT]. Rinsho Shinkeigaku 2013; 53:478-481. [PMID: 23782828 DOI: 10.5692/clinicalneurol.53.478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A 39-year-old man was suffered from bacterial meningitis spread from sphenoid sinusitis. During the first several days of the hospitalization, his clinical and laboratory findings were improved by the antibiotics. But he developed impaired consciousness and paraparesis on the sixth hospital day. A CT scan of the brain revealed pneumocephalus with compression of frontal lobes and the widening of the interhemispheric space between the tips of the frontal lobes, which was known as "Mount Fuji sign". Tension pneumocephalus was diagnosed on the basis of the clinical symptoms and the characteristic CT findings. As the bacterial meningitis itself was improving, the surgical treatment was not performed, but the antibiotics therapy continued. He gradually recovered and discharged without any other complications. The mechanism of tension pneumocephalus could not be disclosed. However, it was speculated that tension pneumocephalus was formed due to combined conditions of following factors; the fistula formation between sphenoid sinus and subdural space, the reduced CSF pressure on lumbar puncture, and a ball-valve mechanism though the fistula. We would emphasize that "Mount Fuji sign"on CT or MRI was the important finding to diagnose tension pneumocephalus.
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Affiliation(s)
- Takahiro Himeno
- Department of Neurology, Brain Attack Center Ota Memorial Hospital
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Takagi M, Ozawa K, Yasuda H, Douke M, Hashimoto K, Hayashi Y, Inuzuka T, Hozumi I. Decreased bioelements content in the hair of patients with Fahr's disease (idiopathic bilateral calcification in the brain). Biol Trace Elem Res 2013; 151:9-13. [PMID: 23090713 DOI: 10.1007/s12011-012-9529-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 10/12/2012] [Indexed: 01/07/2023]
Abstract
The remarkable calcification of the basal ganglia and cerebellum has been traditionally called Fahr's disease, but this nomenclature is criticized for including heterogeneous diseases. To determine the pattern of some biological metals in the hair of patients with Fahr's disease, we investigated the levels of 24 bioelements in the hair of 28 patients (17 males and 11 females) with Fahr's disease and compared them with those of three age-, sex-, and living region-matched controls (84 controls in total). Interestingly, we found decreases in the levels of several bioelements [calcium (Ca), copper (Cu), iron (Fe), mercury (Hg), iodine (I), nickel (Ni), phosphate (P), lead (Pb), and selenium (Se)] in the hair of patients. This is in contrast to our previous finding of increases of Cu, Fe, zinc (Zn), and magnesium (Mg) in the cerebrospinal fluid (CSF) of patients. The decreased level of Cu in the hair was the most prominent and pathognomonic, while the increased level of Cu in the CSF had been found to be the most significant in patients. More significant correlations between two bioelements in the hair were recognized in patients than controls. Although Fahr's disease has been considered to be a heterogenous entity, the significant tendencies of several bioelements in the hair of patients in this study suggest metabolic disorders of bioelements, especially biometals, on the background. Some transporters, especially P transporter such as PiT2, of bioelements will be involved in the different distribution of bioelements in the body of patients.
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Affiliation(s)
- Mari Takagi
- Laboratory of Medical Therapeutics and Molecular Therapeutics, Gifu Pharmaceutical University, 1-25-4 Daigaku-Nishi, Gifu, Japan
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Abstract
Peripheral neuropathies are the most common neurological manifestations occurring in HIV-infected individuals. Distal symmetrical sensory neuropathy is the most common form encountered today and is one of the few that are specific to HIV infection or its treatment. The wide variety of other neuropathies is akin to the neuropathies seen in the general population and should be managed accordingly. In the pre-ART era, neuropathies were categorized according to the CD4 count and HIV viral load. In the early stages of HIV infection when CD4 count is high, the inflammatory demyelinating neuropathies predominate and in the late stages with the decline of CD4 count opportunistic infection-related neuropathies prevail. That scenario has changed with the present almost universal use of ART (antiretroviral therapy). Hence, HIV-associated peripheral neuropathies are better classified according to their clinical presentations: distal symmetrical polyneuropathy, acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), mononeuropathies, mononeuropathies multiplex and cranial neuropathies, autonomic neuropathy, lumbosacral polyradiculomyelopathy, and amyotrophic lateral sclerosis (ALS)-like motor neuropathy. Treated with ART, HIV-infected individuals are living longer and are at a higher risk of metabolic and age-related complications; moreover they are also prone to the potentially neurotoxic effects of ART. There are no epidemiological data regarding the incidence and prevalence of the peripheral neuropathies. In the pre-ART era, most data were from case reports, series of patients, and pooled autopsy data. At that time the histopathological evidence of neuropathies in autopsy series was almost 100%. In large prospective cohorts presently being evaluated, it has been found that 57% of HIV-infected individuals have distal symmetrical sensory neuropathy and 38% have neuropathic pain. It is now clear that distal symmetrical sensory neuropathy is caused predominantly by the ART's neurotoxic effect but may also be caused by the HIV itself. With a sizeable morbidity, the neuropathic pain caused by distal symmetrical sensory neuropathy is very difficult to manage; it is often necessary to change the ART regimen before deciding upon the putative role of HIV infection itself. If the change does not improve the pain, there are few options available; the most common drugs used for neuropathic pain are usually not effective. One is left with cannabis, which cannot be recommended as routine therapy, recombinant human nerve growth factor, which is unavailable, and topical capsaicin with its side-effects. Much has been done to and learned from HIV infection in humans; HIV-infected individuals, treated with ART, are now dying mostly from cardiovascular disease and non-AIDS-related cancers. It hence behooves us to find new approaches to mitigate the residual neurological morbidity that still impacts the quality of life of that population.
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Affiliation(s)
- Alberto Alain Gabbai
- Department of Neurology, UNIFESP-Escola Paulista de Medicina, São Paulo, Brazil.
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Zhao Y, Shen L, Ji HF. Osteoporosis risk and bone mineral density levels in patients with Parkinson's disease: a meta-analysis. Bone 2013; 52:498-505. [PMID: 23000281 DOI: 10.1016/j.bone.2012.09.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 08/20/2012] [Accepted: 09/11/2012] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) and osteoporosis are common diseases which affect a substantial portion of the elderly population. Accumulating evidence supports that PD patients have a high risk for osteoporosis in recent years. The purpose of the present study is to perform a meta-analysis on the risk of osteoporosis and bone mineral density (BMD) levels in PD patients. METHODS We searched all articles indexed in Medline, SciVerse Scopus and Cochrane Library published up to January 2012 concerning the association between PD and risk of osteoporosis or BMD levels. In total, 15 studies were included in the meta-analysis. RESULTS The results indicated that PD patients are at higher risk for osteoporosis (summary OR=1.18, 95% CI=[1.09, 1.27]) than healthy controls. The gender subgroup analysis suggested that PD male patients have a higher risk for osteoporosis than female patients (female patients: summary OR=1.16, 95% CI=[1.07, 1.26]; male patients: summary OR=2.44, 95% CI=[1.37, 4.34]). Further meta-analysis showed that PD patients have a lower hip, lumbar spine and femoral neck BMD than healthy controls. The gender subgroup analysis found a lower BMD in PD female patients than controls, while no obvious difference was observed in PD male patients and controls. CONCLUSIONS This meta-analysis suggested that PD patients are at higher risk for osteoporosis and have lower BMD levels than healthy controls overall.
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Affiliation(s)
- Yan Zhao
- Shandong Provincial Research Center for Bioinformatic Engineering and Technique, Shandong University of Technology, Zibo 255049, PR China
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Singh PM, Dehran M, Mohan VK, Trikha A, Kaur M. Analgesic efficacy and safety of medical therapy alone vs combined medical therapy and extraoral glossopharyngeal nerve block in glossopharyngeal neuralgia. PAIN MEDICINE 2012; 14:93-102. [PMID: 23279193 DOI: 10.1111/pme.12001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study is to compare medical therapy alone and medical therapy with add on extraoral glossopharyngeal nerve block in terms of analgesic efficacy and hemodynamic safety in patients with glossopharyngeal neuralgia (GPN). As GPN is a rare disease, our secondary targets were to review the demographic profile of the disease, clinical profile, and any associations with the disease. DESIGN This was a randomized, prospective, active-controlled, parallel group study conducted from 2007 to 2009 to determine the safety and efficacy of extraoral glossopharyngeal nerve block in GPN and compare it with pharmacological intervention. After institutional ethics committee approval and patient's consent, GPN patients were randomly allocated into two groups. Group A (N = 15) received standard medical therapy (gabapentin 300 mg, tramadol 50 mg TDS, methylcobalamin 500 μgm PO) and group B (N = 15) patients received extraoral glossopharyngeal nerve block together with standard medical therapy. Patients were analyzed for analgesic outcome using numerical pain scale (NPS) and brief pain inventory (BPI) assessing both analgesic effect and degree of interference in quality of life (QOL) during 3-month follow-up. They were also evaluated for any significant hemodynamic alterations. RESULTS Over the follow-up of 90 days, the mean NPS in group A decreased from 6 ± 2 to 3 ± 2 and in group B from 5 ± 1 to 2 ± 2. From the mean NPS scores, it can be interpreted that both the modalities were effective clinically in treating GPN. However, NPS scores were statistically similar by the end of 90 days. Improvement from baseline in BPI measurement of QOL (mood, interpersonal relationship, and emotion) was earlier in group B (1, 2, and 1 months, respectively) compared with group A (2, 3, and 2 months, respectively). However, there were no significant hemodynamic adverse outcomes after administration of the block. CONCLUSION This study found that patients in both the groups had significantly lower pain intensities, improved pain relief, and reduced pain interference with QOL, which was especially evident on fourth visit (2 months) after the initiation of treatment regimen. Both were safe and well tolerated. The study advocates rational polypharmacy approach (oral and block) in difficult to treat painful conditions. Further controlled trials are warranted to further define the impact of such a combination therapy.
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Affiliation(s)
- Preet M Singh
- Anaesthesia and Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
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Fukuda AM, Badaut J. Aquaporin 4: a player in cerebral edema and neuroinflammation. J Neuroinflammation 2012; 9:279. [PMID: 23270503 PMCID: PMC3552817 DOI: 10.1186/1742-2094-9-279] [Citation(s) in RCA: 158] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 12/07/2012] [Indexed: 02/07/2023] Open
Abstract
Neuroinflammation is a common pathological event observed in many different brain diseases, frequently associated with blood brain barrier (BBB) dysfunction and followed by cerebral edema. Neuroinflammation is characterized with microglia activation and astrogliosis, which is a hypertrophy of the astrocytes. Astrocytes express aquaporin 4, the water channel protein, involved in water homeostasis and edema formation. Aside from its function in water homeostasis, recent studies started to show possible interrelations between aquaporin 4 and neuroinflammation. In this review the roles of aquaporin 4 in neuroinflammation associated with BBB disruption and cerebral edema will be discussed with recent studies in the field.
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Affiliation(s)
- Andrew M Fukuda
- Department of Physiology, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA
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3137
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What does the CT angiography “spot sign” of intracerebral hemorrhage mean in modern neurosurgical settings with minimally invasive endoscopic techniques? Neurosurg Rev 2012; 36:341-8. [DOI: 10.1007/s10143-012-0437-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Revised: 04/28/2012] [Accepted: 10/03/2012] [Indexed: 01/19/2023]
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3138
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Engel EE, Brassesco MS, Valera ET, Nogueira-Barbosa MH, Yamashita MEDAS, Scrideli CA, Tone LG. Clinico-genetic aspects of a pediatric non-neurofibromatosis type 1 malignant triton tumor with loss of chromosome X. Pediatr Blood Cancer 2012; 59:1320-3. [PMID: 22610852 DOI: 10.1002/pbc.24197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 04/20/2012] [Indexed: 11/11/2022]
Abstract
Malignant triton tumor (MTT) is an aggressive peripheral nerve sheath tumor with rhabdomyoblastic differentiation. Less than 100 cases have been described, being mostly male children with type 1 neurofibromatosis. We report a 6-year-old female with MTT and no diagnostic criteria for neurofibromatosis type 1. Cytogenetic analysis showed a 46,X,-X[4]/46,XX[16] karyotype. She underwent a transfemoral amputation and chemotherapy and is free of disease 15 months after diagnosis. The few cytogenetic studies of MTT described in the literature have been inconclusive. Further cytogenetic analyses are needed to understand the role of chromosome X monosomy in the pathogenesis of this rare tumor.
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Affiliation(s)
- Edgard Eduard Engel
- Department of Orthopaedics and Traumatology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
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3139
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Multiple cerebral infarcts and intravascular central nervous system lymphoma: a rare but potentially treatable association. J Neurol Sci 2012; 325:183-5. [PMID: 23246010 DOI: 10.1016/j.jns.2012.10.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 09/06/2012] [Accepted: 10/17/2012] [Indexed: 11/23/2022]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare lymphoproliferative disorder characterized by massive intravascular growth of lymphoma cells with a predilection for the central nervous system (CNS). Diagnosis is generally delayed by variable clinical presentation and nonspecific laboratory findings. Brain biopsy is the gold standard diagnostic test. Prognosis is poor with a high mortality rate. We report a case of "in vivo" diagnosis of IVLBCL presenting with rapidly progressive encephalopathy secondary to multiple cerebral infarcts. This case highlights IVLBCL as a possible cause of unexplained multifocal and recurrent strokes. Earlier diagnosis and consequent earlier treatment may be associated with better prognosis.
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3140
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Brain abnormalities in neuromyelitis optica spectrum disorder. Mult Scler Int 2012; 2012:735486. [PMID: 23259063 PMCID: PMC3518965 DOI: 10.1155/2012/735486] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 11/02/2012] [Indexed: 12/17/2022] Open
Abstract
Neuromyelitis optica (NMO) is an idiopathic inflammatory syndrome of the central nervous system that is characterized by severe attacks of optic neuritis (ON) and myelitis. Until recently, NMO was considered a disease without brain involvement. However, since the discovery of NMO-IgG/antiaqaporin-4 antibody, the concept of NMO was broadened to NMO spectrum disorder (NMOSD), and brain lesions are commonly recognized. Furthermore, some patients present with brain symptoms as their first manifestation and develop recurrent brain symptoms without ON or myelitis. Brain lesions with characteristic locations and configurations can be helpful in the diagnosis of NMOSD. Due to the growing recognition of brain abnormalities in NMOSD, these have been included in the NMO and NMOSD diagnostic criteria or guidelines. Recent technical developments such as diffusion tensor imaging, MR spectroscopy, and voxel-based morphometry reveal new findings related to brain abnormalities in NMOSD that were not identified using conventional MRI. This paper focuses on the incidence and characteristics of the brain lesions found in NMOSD and the symptoms that they cause. Recent studies using advanced imaging techniques are also introduced.
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3141
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Isolated spasticity in sporadic Creutzfeldt-Jakob disease. J Neurol 2012; 260:654-5. [DOI: 10.1007/s00415-012-6746-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 11/01/2012] [Indexed: 10/27/2022]
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3142
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Togay Işıkay C, Kural AM, Erden İ. Cerebral Vein Thrombosis as an Exceptional Cause of Transient Ischemic Attack. J Stroke Cerebrovasc Dis 2012; 21:907.e9-12. [DOI: 10.1016/j.jstrokecerebrovasdis.2011.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 07/27/2011] [Accepted: 07/31/2011] [Indexed: 11/30/2022] Open
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3143
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Kai S, Wei J, Suojun Z, Peng P, Jie M, yuanxing W, Ting L. The concomitant occurrence of schwannoma and meningioma mimicking unilateral solitary cerebellopontine angle mass. Clin Neurol Neurosurg 2012; 114:1277-9. [DOI: 10.1016/j.clineuro.2012.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 02/22/2012] [Accepted: 03/02/2012] [Indexed: 11/16/2022]
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3144
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Chen MH, Cheng CA. Alcoholic ketoacidosis coincides with acute Marchiafava-Bignami disease. Am J Emerg Med 2012; 30:2087.e7-8. [DOI: 10.1016/j.ajem.2011.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 12/13/2011] [Indexed: 11/16/2022] Open
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3145
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Garcia AM, Egido JA, Simal P. Viral encephalitis and atherothrombotic stroke. BMJ Case Rep 2012; 2012:bcr.10.2011.5022. [PMID: 23125293 DOI: 10.1136/bcr.10.2011.5022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The clinical hallmark of viral encephalitis is an acute febrile illness, but stroke-like presentations have been rarely described. We report a patient who arrived at A&E with an acute right middle cerebral artery syndrome, without fever. Following thrombolytic treatment, clinical deficit almost disappeared and a critical ipsilateral carotid stenosis was identified. Stenting was implemented and 7 days later the patient started with high fever and reappearance of the initial deficit. Hyperperfusion syndrome and pneumonia were initially considered as the diagnosis but herpetic encephalitis (HE) was the final diagnosis. A very good response to antiviral treatment was achieved. We discuss whether the patient suffered from an unusual sudden stroke-like onset HE without encephalitic features or whether a stroke led to delayed HE.
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Affiliation(s)
- Ana Maria Garcia
- Stroke Unit, Department of Neurology, Hospital Clinico San Carlos, Madrid, Spain
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3146
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Hu J, Huang H, Zhang X, Li G, Liu Q, Wu M, Li G, Chen K, Shi S. Stent placement for treatment of long segment (≥80 mm) carotid artery stenosis in patients with Takayasu disease. J Vasc Interv Radiol 2012; 23:1473-7. [PMID: 23101920 DOI: 10.1016/j.jvir.2012.08.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 08/12/2012] [Accepted: 08/16/2012] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of carotid artery stent (CAS) placement for treatment of long segment stenosis in patients with Takayasu arteritis. MATERIALS AND METHODS Between January 2002 and February 2012, all patients with Takayasu arteritis found to have long segment (≥80 mm) carotid artery stenoses at a single institution were retrospectively analyzed. Five patients treated by CAS placement with either long or multiple self-expandable stents were included. All patients had focal neurologic symptoms, including three strokes and two transient ischemic attacks (TIAs). Six self-expanding stents were used in five patients. The mean follow-up period was 19.2 months (range, 6-30 mo); all patients had clinical evaluation, laboratory examination, and vascular imaging follow-up. RESULTS Improvement in clinical symptoms was shown after successful angioplasty. There were no perioperative or in-hospital deaths. Four patients exhibited persistent relief, and repeated angiography or computed tomography (CT) angiography showed normal flow. One patient stopped taking her medications after CAS placement and became symptomatic 8 months later as a result of a severe in-stent stenosis. CONCLUSIONS CAS placement was shown to be a feasible option for treating long segment (≥80 mm) stenosis of carotid arteries in patients with Takayasu arteritis with encouraging results.
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Affiliation(s)
- Jun Hu
- Department of Neurology, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China
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3147
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Kishi M, Sakakibara R, Yoshida T, Yamamoto M, Suzuki M, Kataoka M, Tsuyusaki Y, Tateno A, Tateno F. Visual Suppression is Impaired in Spinocerebellar Ataxia Type 6 but Preserved in Benign Paroxysmal Positional Vertigo. Diagnostics (Basel) 2012; 2:52-6. [PMID: 26859398 PMCID: PMC4665556 DOI: 10.3390/diagnostics2040052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 09/25/2012] [Accepted: 10/08/2012] [Indexed: 11/22/2022] Open
Abstract
Positional vertigo is a common neurologic emergency and mostly the etiology is peripheral. However, central diseases may mimic peripheral positional vertigo at their initial presentation. We here describe the results of a visual suppression test in six patients with spinocerebellar ataxia type 6 (SCA6), a central positional vertigo, and nine patients with benign paroxysmal positional vertigo (BPPV), the major peripheral positional vertigo. As a result, the visual suppression value of both diseases differed significantly; e.g., 22.5% in SCA6 and 64.3% in BPPV (p < 0.001). There was a positive correlation between the visual suppression value and disease duration, cerebellar atrophy, and CAG repeat length of SCA6 but they were not statistically significant. In conclusion, the present study showed for the first time that visual suppression is impaired in SCA6, a central positional vertigo, but preserved in BPPV, the major peripheral positional vertigo, by directly comparing both groups. The abnormality in the SCA6 group presumably reflects dysfunction in the central visual fixation pathway at the cerebellar flocculus and nodulus. This simple test might aid differential diagnosis of peripheral and central positional vertigo at the earlier stage of disease.
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Affiliation(s)
- Masahiko Kishi
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, 564-1 Shimoshizu, Sakura 285-8741, Japan.
| | - Ryuji Sakakibara
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, 564-1 Shimoshizu, Sakura 285-8741, Japan.
| | - Tomoe Yoshida
- Department of Otolaryngology, Sakura Medical Center, Toho University, Sakura 285-0841, Japan.
| | - Masahiko Yamamoto
- Department of Otolaryngology, Sakura Medical Center, Toho University, Sakura 285-0841, Japan.
| | - Mitsuya Suzuki
- Department of Otolaryngology, Sakura Medical Center, Toho University, Sakura 285-0841, Japan.
| | - Manabu Kataoka
- Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura 285-8741, Japan.
| | - Yohei Tsuyusaki
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, 564-1 Shimoshizu, Sakura 285-8741, Japan.
| | - Akihiko Tateno
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, 564-1 Shimoshizu, Sakura 285-8741, Japan.
| | - Fuyuki Tateno
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, 564-1 Shimoshizu, Sakura 285-8741, Japan.
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3148
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Amirjani N, Hudson AL, Butler JE, Gandevia SC. An algorithm for the safety of costal diaphragm electromyography derived from ultrasound. Muscle Nerve 2012; 46:856-60. [DOI: 10.1002/mus.23438] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2012] [Indexed: 11/11/2022]
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3149
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Boelmans K, Sedlacik J, Niehaus L, Jahn H, Münchau A. Recent advances in structural MRI in Parkinson’s disease and atypical parkinsonian syndromes. Neurodegener Dis Manag 2012. [DOI: 10.2217/nmt.12.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY In the past 2 years, technical developments in conventional and advanced MRI, such as ultra-high-field MRI or mapping of brain mineralization, has allowed novel insights into the nature of Parkinson’s disease (PD) and atypical parkinsonian syndromes, which may aid diagnostic accuracy and differential diagnosis. In addition, sophisticated post-processing analyses, such as morphometry- and surface-based classifications and automated whole-brain analyses, have become available; in PD, this has led to direct visualization of structural substantia nigra abnormalities, monitoring disease progression or screening for brain atrophy associated with dementia. Based on conventional MRI, new MRI rating scales have been established for progressive supranuclear palsy and multiple system atrophy and have been further assessed with a view to their diagnostic accuracy. Clinicopathological series of patients with tauopathies imply that correlations between clinical syndromes, imaging patterns and underlying histopathology are not always strong. Here, some of the issues related to conventional and advanced MRI for the diagnostic accuracy of PD and atypical parkinsonian syndromes are reviewed.
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Affiliation(s)
- Kai Boelmans
- Department of Psychiatry, Memory Clinic, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Jan Sedlacik
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ludwig Niehaus
- Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Holger Jahn
- Department of Psychiatry, Memory Clinic, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Alexander Münchau
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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3150
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