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Xiang J, Hong Z, Zhang Y, Chen J, Shen J, Zhu N. A rare case of daratumumab-associated encephalopathy in multiple myeloma. Immunotherapy 2024; 16:447-452. [PMID: 38440862 DOI: 10.2217/imt-2023-0321] [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] [Indexed: 03/06/2024] Open
Abstract
Aim: Daratumumab, a CD38 monoclonal antibody, has been widely used in patients with multiple myeloma. Although a variety of adverse events have been reported, consciousness impairment has not been reported yet. We report a case of encephalopathy associated with daratumumab. Case presentation: A 57-year-old male, diagnosed with relapsed multiple myeloma, was treated with daratumumab. He developed a loss of consciousness after the first administration. Cerebral spinal fluid and magnetic resonance imaging of the brain suggested encephalopathy. Conclusion: It is recommended to be aware of rare but life threatening side effects of daratumumab. We present a case of rare encephalopathy characterized by consciousness disorder associated with daratumumab, which was successfully resolved on prompt institution of steroids, although the mechanism was unknown.
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Affiliation(s)
- Jingjing Xiang
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310006, People's Republic of China
| | - Zirui Hong
- Department of Emergency, The First Affiliated Hospital Of Ningbo University, Ningbo, People's Republic of China
| | - Yu Zhang
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310006, People's Republic of China
| | - Junfa Chen
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310006, People's Republic of China
| | - Jianping Shen
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310006, People's Republic of China
| | - Ni Zhu
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310006, People's Republic of China
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2
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Chandrasekharan S, Jacob JE, Cherian A, Iype T. Exploring recurrence quantification analysis and fractal dimension algorithms for diagnosis of encephalopathy. Cogn Neurodyn 2024; 18:133-146. [PMID: 38406203 PMCID: PMC10881913 DOI: 10.1007/s11571-023-09929-z] [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: 10/20/2022] [Revised: 12/11/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023] Open
Abstract
Electroencephalography (EEG) is a crucial non-invasive medical tool for diagnosing neurological disorder called encephalopathy. There is a requirement for powerful signal processing algorithms as EEG patterns in encephalopathies are not specific to a particular etiology. As visual examination and linear methods of EEG analysis are not sufficient to get the subtle information regarding various neuro pathologies, non-linear analysis methods can be employed for exploring the dynamic, complex and chaotic nature of EEG signals. This work aims identifying and differentiating the patterns specific to cerebral dysfunctions associated with Encephalopathy using Recurrence Quantification Analysis and Fractal Dimension algorithms. This study analysed six RQA features, namely, recurrence rate, determinism, laminarity, diagonal length, diagonal entropy and trapping time and comparing them with fractal dimensions, namely, Higuchi's and Katz's fractal dimension. Fractal dimensions were found to be lower for encephalopathy cases showing decreased complexity when compared to that of normal healthy subjects. On the other hand, RQA features were found to be higher for encephalopathy cases indicating higher recurrence and more periodic patterns in EEGs of encephalopathy compared to that of normal healthy controls. The feature reduction was then performed using Principal Component Analysis and fed to three promising classifiers: SVM, Random Forest and Multi-layer Perceptron. The resultant system provides a practically realizable pipeline for the diagnosis of encephalopathy.
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Affiliation(s)
| | - Jisu Elsa Jacob
- Department of Electronics and Communication Engineering, Sree Chitra Thirunal College of Engineering, Thiruvananthapuram, 695018 Kerala India
| | - Ajith Cherian
- Department of Neurology, SCTIMST, Thiruvananthapuram, Kerala India
| | - Thomas Iype
- Department of Neurology, Government Medical College, Thiruvananthapuram, Kerala India
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3
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Kim SH, Kim H, Kim JB. Differences in functional network between focal onset nonconvulsive status epilepticus and toxic metabolic encephalopathy: application to machine learning models for differential diagnosis. Cogn Neurodyn 2023; 17:845-853. [PMID: 37522045 PMCID: PMC10374505 DOI: 10.1007/s11571-022-09877-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/19/2022] [Accepted: 08/19/2022] [Indexed: 11/29/2022] Open
Abstract
We aimed to compare network properties between focal-onset nonconvulsive status epilepticus (NCSE) and toxic/metabolic encephalopathy (TME) during periods of periodic discharge using graph theoretical analysis, and to evaluate the applicability of graph measures as markers for the differential diagnosis between focal-onset NCSE and TME, using machine learning algorithms. Electroencephalography (EEG) data from 50 focal-onset NCSE and 44 TMEs were analyzed. Epochs with nonictal periodic discharges were selected, and the coherence in each frequency band was analyzed. Graph theoretical analysis was performed to compare brain network properties between the groups. Eight different traditional machine learning methods were implemented to evaluate the utility of graph theoretical measures as input features to discriminate between the two conditions. The average degree (in delta, alpha, beta, and gamma bands), strength (in delta band), global efficiency (in delta and alpha bands), local efficiency (in delta band), clustering coefficient (in delta band), and transitivity (in delta band) were higher in TME than in NCSE. TME showed lower modularity (in delta band) and assortativity (in alpha, beta, and gamma bands) than NCSE. Machine learning algorithms based on EEG global graph measures classified NCSE and TME with high accuracy, and gradient boosting was the most accurate classification model with an area under the receiver operating characteristics curve of 0.904. Our findings on differences in network properties may provide novel insights that graph measures reflecting the network properties could be quantitative markers for the differential diagnosis between focal-onset NCSE and TME.
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Affiliation(s)
- Seong Hwan Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hayom Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jung Bin Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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4
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Kim KT, Kwon DH, Jeon JC, Kim IC, Park JA, Seo JG. A multicenter study of altered level of consciousness in the emergency room. Intern Emerg Med 2022; 17:2329-2337. [PMID: 36131181 DOI: 10.1007/s11739-022-03104-8] [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: 07/25/2022] [Accepted: 09/09/2022] [Indexed: 11/05/2022]
Abstract
New-onset altered level of consciousness (ALC) is a challenge in real-world clinical practice. Although its presentation is nonspecific and its etiology is intricate, the term ALC is frequently used in the emergency room (ER). This study aimed to clarify and classify the etiologies and outcomes of the ALC in the ER. We retrospectively investigated ALC patients in the ER of four tertiary referral centers from February 2018 to January 2020. The etiology of ALC was comprehensively analyzed by a consortium of university professors, board-certified clinicians in neurology, emergency medicine, or internal medicine. The time point to determine the etiology of ALC was at the time of discharge from the ER. A total of 315,526 patients who visited ER due to ALC were reviewed and found 7988 eligible patients, of which 4298 (53.8%) were male and 5282 (66.1%) were older than 60. The overall mortality was 13.5%. Except undetermined, the 9 etiologies (n = 7552) were categorized into extra- (n = 4768, 63.1%) or intracranial etiology (n = 2784, 36.9%). The most common etiology of ALC in the ER was metabolic cause (n = 1972, 24.7%), followed by systemic infection (n = 1378, 17.3%). The majority of ALC in the ER was derived from extracranial etiology. ALC in the ER is a neurological manifestation of diverse etiologies; not all can be confirmed in the ER. Not only neurological but also critical systemic illnesses should be considered to assess the protean manifestations of ALC in the ER.
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Affiliation(s)
- Keun Tae Kim
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
| | - Doo Hyuk Kwon
- Department of Neurology, Yeungnam University College of Medicine, Daegu, South Korea
| | - Jae Cheon Jeon
- Department of Emergency Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - In-Cheol Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - Jung A Park
- Department of Neurology, Daegu Catholic University School of Medicine, Daegu, South Korea
| | - Jong-Geun Seo
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, South Korea.
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5
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Characteristics of Obese Patients with Acute Hypercapnia Respiratory Failure Admitted in the Department of Pneumology: An Observational Study of a North African Population. SLEEP DISORDERS 2022; 2022:5398460. [PMID: 35223103 PMCID: PMC8872695 DOI: 10.1155/2022/5398460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 01/08/2022] [Accepted: 01/12/2022] [Indexed: 11/17/2022]
Abstract
Background. Acute hypercapnic respiratory failure (AHRF) is a common life-threatening event in patients with obesity hypoventilation syndrome (OHS). Objectives. To study the clinical pattern, noninvasive ventilatory support, as well as the short- and long-term outcomes of patients with OHS admitted in a ward because of AHRF. Methods. We conducted a retrospective cohort study including all adults with OHS
, admitted in a 90-bed-ward for AHRF. Results. A total of 44 patients were included. Fifteen (34.1%) and 29 (65.9%) patients were diagnosed with malignant OHS (mOHS) and nonmalignant OHS (non-mOHS), respectively, while 36 (81.8%) had coexisting obstructive sleep apnea hypopnea syndrome (OSAHS). Patients with mOHS had a significantly higher rate of heart failure (100% vs. 31%;
), chronic renal insufficiency (CRI) (73.3% vs. 41.4%;
), and dyslipidemia (66.7% vs. 34.5%;
) than those with non-mOHS. The mean forced vital capacity (FVC) in our patients was of
of the predicted value, lower than what is usually reported in stable patients with OHS. At hospital admission, more than two-thirds (
, 77.3%) were misdiagnosed as having asthma exacerbation (
, 4.9.1%), chronic obstructive pulmonary disease (COPD) exacerbation (
, 27.3%) and/or heart failure (
, 65.9%). Acute pulmonary oedema (ACPE) (
, 36.4%) and acute viral bronchitis (
, 27.3%) were the main identified causal factors, while no cause could be determined in 5 (11.4%) patients. Noninvasive positive pressure ventilation (NIPPV) using bilevel positive airway pressure (BIPAP) was very highly effective to treat AHRF, with only 2.27% of patients failing the modality. Median overall duration of ventilation was 9 hours per day (1.3–20) and was significantly longer in patients with mOHS than in those with non-mOHS (10 [6–18] vs. 8 [1.3–20], respectively;
). Forty two of the forty-three patients discharged alive were treated with BIPAP or continuous positive airway pressure (CPAP) in 26 and 16 patients, respectively. The probability of survival was 90% at 12 months, while the probability of readmission for a new episode of AHRF was 56% at 6 months and 22% at 12 months, respectively. Conclusion. AHRF in OHS patients is a life-threatening event which can be successfully and safely treated with BIPAP, with a low long-term mortality even in patients with mOHS.
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McLaine AS, Yaxley PE, Young AA, Cooper ES. Successful management of massive lamotrigine extended-release intoxication in a dog. Clin Case Rep 2021; 9:e05169. [PMID: 34963800 PMCID: PMC8677885 DOI: 10.1002/ccr3.5169] [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: 01/15/2021] [Revised: 10/14/2021] [Accepted: 11/03/2021] [Indexed: 11/12/2022] Open
Abstract
A 3-year-old spayed female Siberian Husky presented for evaluation following ingestion of approximately 429 mg/kg of lamotrigine extended-release. She demonstrated severe neurologic and cardiac signs and was treated with lipid emulsion, anticonvulsants, antiarrhythmics and aggressive decontamination and supportive care. She was successfully discharged from the hospital 5 days later.
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Affiliation(s)
- Alexis S. McLaine
- Department of Veterinary Clinical SciencesThe Ohio State UniversityColumbusOhioUSA
| | - Page E. Yaxley
- Department of Veterinary Clinical SciencesThe Ohio State UniversityColumbusOhioUSA
| | - Anda A. Young
- Department of Veterinary Clinical SciencesThe Ohio State UniversityColumbusOhioUSA
| | - Edward S. Cooper
- Department of Veterinary Clinical SciencesThe Ohio State UniversityColumbusOhioUSA
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7
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Ligtenstein S, Song J, Jin J, Sun H, Paixao L, Zafar S, Westover MB. Do Triphasic Waves and Nonconvulsive Status Epilepticus Arise From Similar Mechanisms? A Computational Model. J Clin Neurophysiol 2021; 38:366-375. [PMID: 34155185 PMCID: PMC8429048 DOI: 10.1097/wnp.0000000000000719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Triphasic waves arising in patients with toxic metabolic encephalopathy (TME) are often considered different from generalized periodic discharges (GPDs) in patients with generalized nonconvulsive status epilepticus (GNCSE). The primary objective of this study was to investigate whether a common mechanism can explain key aspects of both triphasic waves in TME and GPDs in GNCSE. METHOD A neural mass model was used for the simulation of EEG patterns in patients with acute hepatic encephalopathy, a common etiology of TME. Increased neuronal excitability and impaired synaptic transmission because of elevated ammonia levels in acute hepatic encephalopathy patients were used to explain how triphasic waves and GNCSE arise. The effect of gamma-aminobutyric acid-ergic drugs on epileptiform activity, simulated with a prolonged duration of the inhibitory postsynaptic potential, was also studied. RESULTS The simulations show that a model that includes increased neuronal excitability and impaired synaptic transmission can account for both the emergence of GPDs and GNCSE and their suppression by gamma-aminobutyric acid-ergic drugs. CONCLUSIONS The results of this study add to evidence from other studies calling into question the dichotomy between triphasic waves in TME and GPDs in GNCSE and support the hypothesis that all GPDs, including those arising in TME patients, occur via a common mechanism.
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Affiliation(s)
- Sophie Ligtenstein
- Department of Technical Medicine, Department of Applied Mathematics, University of Twente
| | | | - Jin Jin
- Department of Neurology, Massachusetts General Hospital, Boston MA
| | - Haoqi Sun
- Department of Neurology, Massachusetts General Hospital, Boston MA
| | - Luis Paixao
- Department of Neurology, Massachusetts General Hospital, Boston MA
| | - Sahar Zafar
- Department of Neurology, Massachusetts General Hospital, Boston MA
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8
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Badour M, Hammed A, Baqla S. Lethargy as an initial symptom of intussusception secondary to Meckel's diverticulum in a 2.5 year-old girl: Case report. Ann Med Surg (Lond) 2021; 68:102562. [PMID: 34377446 PMCID: PMC8329513 DOI: 10.1016/j.amsu.2021.102562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION and importance: Intussusception is one of the most common causes of acute abdomen and surgical morbidities in the childhood. In a paediatric presentation of intussusception due to Meckel's diverticulum there may be acute onset of abdominal pain, vomiting or painless red currant stools. However, Lethargy has been described as a rare presenting symptom. CASE PRESENTATION We present a case of 2,5 - year old female complained of acute alternation in consciousness followed by continuous vomiting two days later. CLINICAL DISCUSSION Her neurological examination showed a lethargic child, not reactive and hypotonic. Her past medical history was unremarkable. Abdominal ultrasonography was compatible with ileocolic intussusception. The necrotic bowel and diverticulum were resected, followed by anastomosis of the viable bowel segments. postoperatively the infant recovered dramatically. CONCLUSION Although lethargy is a rare presenting symptom of Intussusception, it should be kept as a differential diagnosis when a child presents with acute onset of drowsiness with or without abdominal symptoms.
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Affiliation(s)
- Maysaa Badour
- Pediatric University Hospital, Division of Neurology, Damascus, Syria
| | - Ali Hammed
- Tishreen University Hospital, Department of Neurosurgery, Lattakia, Syria
| | - Sameer Baqla
- Pediatric University Hospital, Division of Neurology, Damascus, Syria
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9
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Ma K, Ding X, Song Q, Han Z, Yao H, Ding J, Hu G. Lactate enhances Arc/arg3.1 expression through hydroxycarboxylic acid receptor 1-β-arrestin2 pathway in astrocytes. Neuropharmacology 2020; 171:108084. [PMID: 32294462 DOI: 10.1016/j.neuropharm.2020.108084] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 02/08/2023]
Abstract
In recent years, with the discovery and research of lactate-specific receptor HCAR1(hydroxycarboxylic acid receptor 1), lactate is not only as a product of Glycolysis in astrocytes, but also as a signaling molecule which has gradually received attention. Studies have found that lactate can be used as an intercellular signaling molecule involved in synaptic plasticity, and so that peripheral administration of lactate can produce antidepressant effects. Here, we focus on HCAR1 on the most widely distributed astrocytes in the brain, found and verified that lactate could cause Arc/arg3.1 protein overexpression in astrocytes through HCAR1. However, the expression of Arc/arg3.1 does not depend on the Gi protein pathway of HCAR1, and we found that lactate enhanced the expression of Arc/arg3.1 protein through the HCAR1-β-arrestin2 pathway. In summary, lactate acts on HCAR1 of astrocytes. It enhances the expression of MAPK-dependent Arc through β-arrestin2, thereby reducing the influx of calcium ions when astrocytes are exposed to glutamate damage, achieving the role of protecting astrocytes and indirectly enhancing the absorption of glutamate by astrocytes. These results also demonstrate that HCAR1 in the brain is a potential therapeutic target in an experimental in vitro model of glutamate damage, which is strongly associated with many neurodegenerative diseases.
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Affiliation(s)
- Kaiyang Ma
- Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Nanjing, China
| | - Xiao Ding
- Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Nanjing, China
| | - Qiqi Song
- Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Nanjing, China
| | - Zhitao Han
- Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Nanjing, China
| | - Hang Yao
- Jiangsu Key Laboratory of Neurodegeneration, Department of Pharmacology, Nanjing Medical University, Nanjing, China
| | - Jianhua Ding
- Jiangsu Key Laboratory of Neurodegeneration, Department of Pharmacology, Nanjing Medical University, Nanjing, China
| | - Gang Hu
- Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Nanjing, China; Jiangsu Key Laboratory of Neurodegeneration, Department of Pharmacology, Nanjing Medical University, Nanjing, China.
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10
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Hyperglycemia-Induced Aphasia Presenting with Seizure-like Brain Perfusion Findings on Single Photon Emission Computed Tomography. Dement Neurocogn Disord 2019; 18:69-72. [PMID: 31297137 PMCID: PMC6609532 DOI: 10.12779/dnd.2019.18.2.69] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/04/2019] [Accepted: 06/11/2019] [Indexed: 11/27/2022] Open
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11
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Dadlani R, Agrawal R. Fluctuating Hemiparesis as a Result of Traumatic Brain Injury-associated Hyponatremia. J Neurosci Rural Pract 2018; 9:445-446. [PMID: 30069115 PMCID: PMC6050759 DOI: 10.4103/jnrp.jnrp_560_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ravi Dadlani
- Department of Neurosurgery, Zulekha Hospital, Sharjah, UAE.,Department of Neurosurgery, MaxCure Hospitals, Hyderabad, Telangana, India
| | - Rahul Agrawal
- Department of General Medicine, MaxCure Hospitals, Hyderabad, Telangana, India
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12
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Abstract
OPINION STATEMENT Treatment of myoclonus requires an understanding of the physiopathology of the condition. The first step in treatment is to determine if there is an epileptic component to the myoclonus and treat accordingly. Secondly, a review of medications (e.g., opiates) and comorbidities (e.g., hepatic or renal failure) is required to establish the possibility of iatrogenic and reversible conditions. Once those are eliminated, delineation between cortical, cortico-subcortical, subcortical, brainstem, and spinal generators can determine the first-line treatment. Cortical myoclonus can be treated with levetiracetam, valproic acid, and clonazepam as first-line agents. Phenytoin and carbamazepine may paradoxically worsen myoclonus. Subcortical and brainstem myoclonus can be treated with clonazepam as a first-line agent, but levetiracetam and valproic acid can be tried as well. L-5-Hydroxytryptophan and sodium oxybate are agents used for refractory cases. Spinal myoclonus does not respond to anti-epileptic drugs, and clonazepam is a first-line agent. Botulinum toxin treatment can be useful for focal cases of spinal myoclonus. The etiology of propriospinal myoclonus is controversial, and a functional etiology is suspected in most cases. Treatment can include clonazepam, levetiracetam, baclofen, valproate, carbamazepine, and zonisamide. Functional myoclonus requires multimodal and multidisciplinary treatment that may include psychotropic drugs and physical and occupational therapy. Close collaboration between neurologists and psychiatrists is required for effective treatment. Finally, deep brain stimulation targeting the globus pallidus pars-interna bilaterally has been used in myoclonus-dystonia when pharmacological treatments have been exhausted.
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13
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Lu CX, Qiu T, Tong HS, Liu ZF, Su L, Cheng B. Peripheral T-lymphocyte and natural killer cell population imbalance is associated with septic encephalopathy in patients with severe sepsis. Exp Ther Med 2016; 11:1077-1084. [PMID: 26998040 DOI: 10.3892/etm.2016.3000] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 12/21/2015] [Indexed: 12/20/2022] Open
Abstract
Septic encephalopathy (SE) is a diffuse cerebral dysfunction resulting from a systemic inflammatory response, and is associated with an increased risk of mortality. The pathogenesis of SE is complex and multifactorial, but unregulated immune imbalance may be an important factor. The current retrospective study examined the clinical data of 86 patients with severe sepsis who were admitted to the Intensive Care Unit at Zhongshan Hospital, Xiamen University (Xiamen, China) from January, 2014 to January, 2015. The patients were assigned to SE and non-SE patient groups according to the presence or absence of SE. The proportion of T-lymphocyte subsets and natural killer (NK) cells in the immune cell population, representing the function of the immune system, were analyzed for their association with SE and compared with other clinical predictors and biomarkers. The incidence of SE in the patients was 39.5%, and this group demonstrated higher mortality rates (38 vs. 10% in non-SE patients; P=0.001). Univariate analysis revealed that the SE patients reported a lower percentage of cluster of differentiation 4+(CD4+) T-lymphocytes (51.67±7.12 vs. 60.72±3.70% in non-SE patients; P<0.01), a lower CD4+/cluster of differentiation 8+(CD8+) ratio (1.59±0.32 vs. 1.85±0.26% in non-SE patients; P<0.01) and a higher percentage of NK cells (11.80±1.44 vs. 9.19±2.36% in non-SE patients; P<0.01). Using a binary logistic regression model, the Acute Physiology and Chronic Health Evaluation II score and the percentage of CD4+ T-lymphocytes were demonstrated to be independently associated with SE (respectively, P=0.012 and OR, 4.763; P=0.005 and OR, 0.810). An area under the curve analysis of a receiver operating characteristic curve of the two indicators revealed that these were equally powerful measures in prediction of SE (Z=1.247, P>0.05). The present results confirm that SE leads to higher mortality in patients with severe sepsis, and demonstrate that immune imbalance is important in the development of SE. The proportion of CD4+ T-lymphocytes present were revealed in the current study to be a powerful predictor of SE in patients with severe sepsis.
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Affiliation(s)
- Cheng-Xiang Lu
- Department of Intensive Care Unit, Affiliated General Hospital of Guangzhou Military Command of Southern Medical University, Guangzhou, Guangdong 510515, P.R. China; Department of Intensive Care Unit, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361004, P.R. China
| | - Ting Qiu
- Department of Neurology, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361004, P.R. China
| | - Hua-Sheng Tong
- Department of Intensive Care Unit, General Hospital of Guangzhou Military Command, Guangzhou, Guangdong 510010, P.R. China
| | - Zhi-Feng Liu
- Department of Intensive Care Unit, General Hospital of Guangzhou Military Command, Guangzhou, Guangdong 510010, P.R. China
| | - Lei Su
- Department of Intensive Care Unit, Affiliated General Hospital of Guangzhou Military Command of Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Biao Cheng
- Department of Plastic Surgery, Affiliated General Hospital of Guangzhou Military Command of Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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14
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Abstract
Because coma has many causes, physicians must develop a structured, algorithmic approach to diagnose and treat reversible causes rapidly. The three main mechanisms of coma are structural brain lesions, diffuse neuronal dysfunction, and, rarely, psychiatric causes. The first priority is to stabilise the patient by treatment of life-threatening conditions, then to use the history, physical examination, and laboratory findings to identify structural causes and diagnose treatable disorders. Some patients have a clear diagnosis. In those who do not, the first decision is whether brain imaging is needed. Imaging should be done in post-traumatic coma or when structural brain lesions are probable or possible causes. Patients who do not undergo imaging should be reassessed regularly. If CT is non-diagnostic, a checklist should be used use to indicate whether advanced imaging is needed or evidence is present of a treatable poisoning or infection, seizures including non-convulsive status epilepticus, endocrinopathy, or thiamine deficiency.
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Affiliation(s)
- Jonathan A Edlow
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Rochester, MN, USA.
| | | | - Stephen J Traub
- Department of Emergency Medicine, Mayo Clinic, Scottsdale, AZ, USA
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15
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Day GS, Tang-Wai DF. When dementia progresses quickly: a practical approach to the diagnosis and management of rapidly progressive dementia. Neurodegener Dis Manag 2014; 4:41-56. [PMID: 24640978 DOI: 10.2217/nmt.13.75] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Making a diagnosis of rapidly progressive dementia requires practical adaptation of the skills used to assess patients with chronic causes of cognitive impairment. An expedited assessment, commensurate with the accelerated pace of the disease, is required to identify the cause of symptoms amidst a myriad of possibilities. Features upon history, physical examination and cognitive assessment that support specific diagnoses are reviewed, and a stratified approach to testing is presented. The use of readily-accessible investigations is prioritized, acknowledging the implications and applications of novel diagnostic tests. The coordinated use of clinical and laboratory measures are promoted as a means of facilitating rapid evaluation, with the ultimate goal of identifying patients with potentially reversible causes of rapidly progressive dementia.
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Affiliation(s)
- Gregory S Day
- University of Toronto, Division of Neurology, University Health Network Memory Clinic, Toronto Western Hospital, Toronto, ON, Canada
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Panda AK, Gopinath G, Maheswari S, Mehta VJ, Bhirud L. Hashimoto's encephalopathy masquerading as chronic meningitis- case of a middle-aged female with review of literature. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2014. [DOI: 10.7713/ijms.2013.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Stamelou M, Lai SC, Aggarwal A, Schneider SA, Houlden H, Yeh TH, Batla A, Lu CS, Bhatt M, Bhatia KP. Dystonic opisthotonus: a "red flag" for neurodegeneration with brain iron accumulation syndromes? Mov Disord 2013; 28:1325-9. [PMID: 23736975 PMCID: PMC4208296 DOI: 10.1002/mds.25490] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 03/11/2013] [Accepted: 04/01/2013] [Indexed: 01/06/2023] Open
Abstract
Back arching was reported in one of the very first patients with neurodegeneration with brain iron accumulation syndrome (NBIAs) published in 1936. However, recent reports have mainly focused on the genetic and imaging aspects of these disorders, and the phenotypic characterization of the dystonia has been lost. In evaluating patients with NBIAs in our centers, we have observed that action-induced dystonic opisthotonus is a common and characteristic feature of NBIAs. Here, we present a case series of patients with NBIAs presenting this feature demonstrated by videos. We suggest that dystonic opisthotonus could be a useful “red flag” for clinicians to suspect NBIAs, and we discuss the differential diagnosis of this feature. This would be particularly useful in identifying patients with NBIAs and no iron accumulation as yet on brain imaging (for example, as in phospholipase A2, group IV (cytosolic, calcium-independent) [PLA2G6]-related disorders), and it has management implications. © 2013 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Maria Stamelou
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, United Kingdom
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Michelagnoli G, Zamidei L, Consales G. Organ failure and central nervous system. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2013. [DOI: 10.1016/j.tacc.2013.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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