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Kim DK. Mid- and Late-Life Chronic Kidney Disease Is Associated with Parkinson's Disease, Not with an Increased Risk of Alzheimer's Disease. J Pers Med 2024; 14:597. [PMID: 38929818 PMCID: PMC11204683 DOI: 10.3390/jpm14060597] [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: 05/09/2024] [Revised: 05/26/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024] Open
Abstract
Chronic kidney disease (CKD) is strongly associated with dementia. However, its independent association with Alzheimer's or Parkinson's disease remains unclear. This study investigated the prospective association of patients with CKD aged ≥55 years with an increased risk of Alzheimer's or Parkinson's disease. We conducted a retrospective cohort analysis using a national cohort sample of approximately one million patients. Primary outcome indicators measured included incidence of all-cause dementia, Alzheimer's disease, and Parkinson's disease events using person-years at risk. The hazard ratio was adjusted using the Cox proportional hazards model. We included 952 patients without CKD and 476 with CKD over 55 years using propensity score matching. The CKD group exhibited higher incidences of all-cause dementia, Parkinson's disease, and Alzheimer's disease than the non-CKD group. Furthermore, the CKD group had an elevated risk of all-cause dementia and a significantly increased risk of Parkinson's disease, especially among older women. Notably, the risk of Parkinson's disease was higher within the first 3 years of CKD diagnosis. These findings emphasize the link between CKD in mid- and late-life individuals and a higher incidence of all-cause dementia and Parkinson's disease rather than Alzheimer's disease.
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Affiliation(s)
- Dong-Kyu Kim
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Hallym University College of Medicine, Chuncheon 24252, Republic of Korea; ; Tel.: +82-33-240-5180; Fax: +82-33-241-2909
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24252, Republic of Korea
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2
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Kwon MJ, Kim JK, Kim JH, Kim JH, Kim MJ, Kim NY, Choi HG, Kim ES. Exploring the Link between Chronic Kidney Disease and Parkinson's Disease: Insights from a Longitudinal Study Using a National Health Screening Cohort. Nutrients 2023; 15:3205. [PMID: 37513623 PMCID: PMC10385674 DOI: 10.3390/nu15143205] [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: 05/29/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Chronic kidney disease (CKD) and Parkinson's disease (PD) are common illnesses found in the geriatric population. A potential link between CKD and PD emergence has been hypothesized; however, existing conclusions are disputed. In this longitudinal research, we analyzed data acquired from the Korean National Health Insurance Service-Health Screening Cohort. The dataset comprised the health information of 16,559 individuals clinically diagnosed with CKD and 66,236 control subjects of comparable ages, all aged ≥40 years. These subjects participated in health examinations from 2002 to 2019. To assess the correlation between CKD and PD, we employed overlap-weighted Cox proportional hazard regression models. The unadjusted, crude hazard ratio for PD was greater in the CKD group than in the control group (crude hazard ration (HR) 1.20; 95% confidence interval (CI) = 1.04-1.39; p = 0.011). However, the Cox proportional hazard regression analysis, incorporating propensity score overlap weighting, revealed no significant discrepancy after considering confounding variables such as demographic factors, socio-economic status, lifestyle, and concurrent health conditions (adjusted HR (aHR), 1.09; 95% CI = 0.97-1.22; p = 0.147). Subgroup analyses showed a higher probability of PD development among certain CKD individuals, including those who resided in rural areas (aHR, 1.19; 95% CI = 1.03-1.37; p = 0.022), maintained a normal weight (aHR, 1.29; 95% CI = 1.08-1.56; p = 0.006), or had fasting blood glucose levels ≥100 mg/dL (aHR, 1.18; 95% CI = 1.00-1.39; p = 0.046). Therefore, these clinical or environmental factors may influence the incidence of PD in CKD patients. In conclusion, our results suggest that the general CKD population may not exhibit a greater propensity for PD than their non-CKD counterparts. However, this might be contingent upon specific lifestyle and comorbid conditions. Thus, certain lifestyle alterations could be crucial in mitigating the potential manifestation of PD in patients diagnosed with CKD.
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Affiliation(s)
- Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Jwa-Kyung Kim
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Joo-Hee Kim
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Min-Jeong Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Nan Young Kim
- Hallym Institute of Translational Genomics and Bioinformatics, Hallym University Medical Center, Anyang 14068, Republic of Korea
| | - Hyo Geun Choi
- Suseo Seoul E.N.T. Clinic and MD Analytics, 10, Bamgogae-ro 1-gil, Gangnam-gu, Seoul 06349, Republic of Korea
| | - Eun Soo Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
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Arora N, Mehdi Z, D’Cruz S, Sharma I. Orofacial Dyskinesia in Uremia in Polycystic Kidney Disease. J Emerg Trauma Shock 2023; 16:130-132. [PMID: 38025501 PMCID: PMC10661570 DOI: 10.4103/jets.jets_8_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/18/2023] [Accepted: 03/09/2023] [Indexed: 12/01/2023] Open
Abstract
Uremic encephalopathy presenting as involuntary movements of the orofacial region is important to recognize because of reversibility seen with resolution of azotaemia though residual neurological dysfunction might persist. Neuroimaging is important part of diagnosis with typical lesions involving basal ganglia seen mostly in diabetic patients. Our case highlights a patient with non-diabetic uremic encephalopathy with facial dyskinesia which is rare with a lesion in unilateral lentiform nucleus and small white matter hyperintensities. Resolution following dialysis pointed to uraemia as aetiology.
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Affiliation(s)
- Nidhi Arora
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Zainab Mehdi
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Sanjay D’Cruz
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Isha Sharma
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
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Sequeira M, Gama Lobo G, Ferro M, Brum M. Lentiform fork sign in uraemic striatopallidal syndrome. Pract Neurol 2023; 23:168-169. [PMID: 36572530 DOI: 10.1136/pn-2022-003610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Marta Sequeira
- Neurology Department, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - Gonçalo Gama Lobo
- Neuroradiology Department, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - Margarida Ferro
- Neurology Department, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - Marisa Brum
- Neurology Department, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
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Yap KH, Baharudin NH, Gafor AHA, Remli R, Lim SY, Zaidi WAW, Azmin S, Mukari SAM, Khalid RA, Ibrahim NM. Movement Disorders Resulting From Bilateral Basal Ganglia Lesions in End-Stage Kidney Disease: A Systematic Review. J Mov Disord 2022; 15:258-263. [PMID: 35614016 PMCID: PMC9536908 DOI: 10.14802/jmd.21185] [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: 12/15/2021] [Accepted: 02/19/2022] [Indexed: 12/02/2022] Open
Abstract
Objective The basal ganglia (BG) are susceptible to fluctuations in blood urea levels, sometimes resulting in movement disorders. We described patients with end-stage kidney disease (ESKD) presenting with movement disorders associated with bilateral BG lesions on imaging. Methods We report four patients and systematically reviewed all published cases of ESKD presenting with movement disorders and bilateral BG lesions (EBSCOhost and Ovid). Results Of the 72 patients identified, 55 (76.4%) were on regular dialysis. Parkinsonism was the most common movement disorder (n = 39; 54.2%), followed by chorea (n = 24; 33.3%). Diabetes mellitus (n = 51; 70.8%) and hypertension (n = 16; 22.2%) were the most common risk factors. Forty-three (59.7%) were of Asian ethnicity. Complete clinical resolution was reported in 17 (30.9%) patients, while 38 (69.1%) had incomplete clinical resolution with relapse. Complete radiological resolution occurred in 14 (34.1%) patients. Conclusion Movement disorders associated with BG lesions should be recognized as a rare and potentially reversible metabolic movement disorder in patients with ESKD.
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Affiliation(s)
- Kah Hui Yap
- Department of Medicine, UKM Medical Center, Kuala Lumpur, Malaysia
| | | | | | - Rabani Remli
- Department of Medicine, UKM Medical Center, Kuala Lumpur, Malaysia
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Shahrul Azmin
- Department of Medicine, UKM Medical Center, Kuala Lumpur, Malaysia
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Araújo NC, Suassuna JHR, Fernandes RDCL. Transcranial sonography depicts a larger substantia nigra echogenic area in renal transplant patients on calcineurin inhibitors than on rapamycin. BMC Nephrol 2022; 23:108. [PMID: 35300603 PMCID: PMC8931960 DOI: 10.1186/s12882-022-02741-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND After kidney transplantation neurologic manifestations may develop, including Parkinson's disease (PD). An enlarged substantia nigra (SN) by transcranial sonography has been recognized as a marker of PD. METHODS In renal transplant recipients (RTRs = 95) and controls (n = 20), measurement of mesencephalon, SN, third ventricle, spleen and carotid intima-media thickness (cIMT) and middle cerebral artery (MCA), kidney and spleen arteries Doppler resistive index (RI) were performed. RESULTS RTRs had larger SN, third ventricle and cIMT and higher renal RI than controls. The SN was larger in the CNIs group than in controls and rapamycin group, while the third ventricle was similar between patients but larger than in controls. In RTRs, SN showed a direct linear correlation with spleen and the third ventricle with age, cIMT and RI of the MCA, kidney and spleen. In CNIs group the SN correlated positively with age and cIMT, while the third ventricle reproduced RTRs correlations. Rapamycin group showed a direct linear relationship between the third ventricle and age and RI of the MCA, kidney and spleen; SN showed no correlations. CONCLUSION RTRs on CNIs present a larger SN area than on rapamycin, probably due to the antiproliferative effect of rapamycin. This finding might be relevant when interpreting TCS in RTRs.
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Affiliation(s)
- Nordeval Cavalcante Araújo
- Division of Nephrology, University of the State of Rio de Janeiro, Boulevard 28 de Setembro, 77 - Vila Isabel, Rio de Janeiro-RJ, 20551-030, Brazil.
| | - José Hermógenes Rocco Suassuna
- Division of Nephrology, University of the State of Rio de Janeiro, Boulevard 28 de Setembro, 77 - Vila Isabel, Rio de Janeiro-RJ, 20551-030, Brazil
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Hanazono A, Takahashi Y, Sanpei Y, Kamada S, Sugawara M. Focal brain lactate accumulation in metformin-induced encephalopathy without systemic lactic acidosis: A case report suggesting mitochondrial vulnerability in lentiform fork sign. eNeurologicalSci 2021; 25:100383. [PMID: 34917782 PMCID: PMC8645906 DOI: 10.1016/j.ensci.2021.100383] [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: 06/02/2021] [Revised: 11/24/2021] [Accepted: 11/28/2021] [Indexed: 01/27/2023] Open
Abstract
Metformin causes metabolic encephalopathy in some patients with end-stage chronic kidney disease, resulting in impaired consciousness and parkinsonism. This encephalopathy has a very characteristic magnetic resonance imaging feature in lentiform nuclei known as the “lentiform fork sign”. However, the mechanism is unknown. Here, we report a case of metformin-induced encephalopathy with a novel observation of lactate accumulation in the lentiform nuclei on magnetic resonance spectroscopy without systemic lactic acidosis. Since metformin is an inhibitor of mitochondrial complex-I, this focal brain lactate accumulation implies that a part of the pathogenesis of metformin-induced encephalopathy is the focal vulnerability of mitochondria to metformin in the lentiform nuclei. When metformin causes encephalopathy, not only testing for serum lactic acidosis and performing routine magnetic resonance imaging but also evaluation of brain lactate accumulation by magnetic resonance spectroscopy should be required to elucidate the etiology. Metformin-induced encephalopathy with lactate accumulation in lentiform fork sign was reported. Lentiform nuclei might be more vulnerable to metformin than other organs. This case suggested an etiology for the lentiform fork sign because metformin is a mitochondrial inhibitor.
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Affiliation(s)
- Akira Hanazono
- Akita University Graduate School of Medicine, Department of Neurology, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Yoshiko Takahashi
- Akita University Graduate School of Medicine, Department of Neurology, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Yui Sanpei
- Akita University Graduate School of Medicine, Department of Neurology, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Sachiko Kamada
- Akita University Graduate School of Medicine, Department of Neurology, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Masashiro Sugawara
- Akita University Graduate School of Medicine, Department of Neurology, 1-1-1 Hondo, Akita 010-8543, Japan
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Abstract
BACKGROUND Basal ganglia (BG) lesions are rarely reported in patients with uremia and may manifest by movement disorders. However, their exact incidence and pathogenesis have not been extensively studied. This study aimed to determine the frequency, types, risk variables (clinical, laboratory, and imaging), and manifestations of BG lesions with uremia and patients' neurologic outcomes. METHODS This observational study included 70 adults (mean age: 45.87 ± 3.36 years; duration of uremia: 5.5 ± 1.5 years). They underwent extensive evaluations (clinical, laboratory, and neuroimaging) and had prospectively evaluated clinically every 3 months for 2 years. Repeated magnetic resonance imaging (MRI) brains were done to patients with movement disorders and correlated with their neurologic outcomes. RESULTS BG lesions were found in 15 patients (21.4%) and 6 (8.6%) had movement disorders [Parkinsonism (n = 4), choreo-dystonia (n = 1) and dystonia (n = 1)] after the onset of uremia (mean = 10 months). There were no characteristic risk variables that distinguished patients with movement disorders from those without. Five developed movement disorders prior to the period of the study and one was de novo. The majority was females and had diabetes and higher frequencies of abnormal renal dysfunction, metabolic derangements, and white matter hyperintensities in MRIs. Movement disorders persisted in all patients despite the resolution of neuroimaging in three patients. CONCLUSIONS There is no clear threshold for renal failure to result in movement disorders due to BG lesions. The clinical outcome is variables depending on each patient's comorbidities and complications. Persistent neuronal damage (due to uremic toxins/metabolic/nutritional and ischemic/microvascular factors) has been suggested as the cause of poor neurologic outcomes.
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9
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Meléndez-Flores JD, Estrada-Bellmann I. Linking chronic kidney disease and Parkinson's disease: a literature review. Metab Brain Dis 2021; 36:1-12. [PMID: 32990929 DOI: 10.1007/s11011-020-00623-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
Chronic kidney disease (CKD) has been typically implicated in cardiovascular risk, considering the function the kidney has related to blood pressure, vitamin D, red blood cell metabolism, and electrolyte and acid-base regulation. However, neurological consequences are also attributed to this disease. Among these, recent large epidemiological studies have demonstrated an increased risk for Parkinson's disease (PD) in patients with CKD. Multiple studies have evaluated individually the association of blood pressure, vitamin D, and red blood cell dysmetabolism with PD, however, no study has reviewed the potential mechanisms related to these components in context of CKD and PD. In this review, we explored the association of CKD and PD and linked the components of the former to propose potential pathways explaining a future increased risk for PD, where renin-angiotensin system, oxidative stress, and inflammation have a main role. Potential preventive and therapeutic interventions based on these associations are also explored. More preclinical studies are needed to confirm the potential link of CKD conditions and future PD risk, whereas more interventional studies targeting this association are warranted to confirm their potential benefit in PD.
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Affiliation(s)
- Jesús D Meléndez-Flores
- Neurology Division, Internal Medicine Department, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, 64700, Monterrey, NL, Mexico
- Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Ingrid Estrada-Bellmann
- Neurology Division, Internal Medicine Department, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, 64700, Monterrey, NL, Mexico.
- Movement Disorders Clinic, Neurology Division, Internal Medicine Department, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico.
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Fricova D, Harsanyiova J, Kralova Trancikova A. Alpha-Synuclein in the Gastrointestinal Tract as a Potential Biomarker for Early Detection of Parkinson's Disease. Int J Mol Sci 2020; 21:E8666. [PMID: 33212934 PMCID: PMC7698349 DOI: 10.3390/ijms21228666] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 12/19/2022] Open
Abstract
The primary pathogenesis associated with Parkinson's disease (PD) occurs in peripheral tissues several years before the onset of typical motor symptoms. Early and reliable diagnosis of PD could provide new treatment options for PD patients and improve their quality of life. At present, however, diagnosis relies mainly on clinical symptoms, and definitive diagnosis is still based on postmortem pathological confirmation of dopaminergic neuronal degeneration. In addition, the similarity of the clinical, cognitive, and neuropathological features of PD with other neurodegenerative diseases calls for new biomarkers, suitable for differential diagnosis. Alpha-synuclein (α-Syn) is a potential PD biomarker, due to its close connection with the pathogenesis of the disease. Here we summarize the currently available information on the possible use of α-Syn as a biomarker of early stages of PD in gastrointestinal (GI) tissues, highlight its potential to distinguish PD and other neurodegenerative diseases, and suggest alternative methods (primarily developed for other tissue analysis) that could improve α-Syn detection procedures or diagnostic methods in general.
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Affiliation(s)
- Dominika Fricova
- Institute of Neuroimmunology, Slovak Academy of Sciences, 814 38 Bratislava, Slovakia;
| | - Jana Harsanyiova
- Department of Pathophysiology, Jessenius Faculty of Medicine in Martin, Comenius University, 814 99 Bratislava, Slovakia;
| | - Alzbeta Kralova Trancikova
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University, 814 99 Bratislava, Slovakia
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Lizarraga KJ, Chunga N, Yannuzzi NA, Flynn HW, Singer C, Lang AE. The retina as a window to the basal ganglia: Systematic review of the potential link between retinopathy and hyperkinetic disorders in diabetes. Parkinsonism Relat Disord 2020; 80:194-198. [PMID: 33069611 DOI: 10.1016/j.parkreldis.2020.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/15/2020] [Accepted: 10/12/2020] [Indexed: 12/18/2022]
Abstract
There is evidence that glycemic fluctuations trigger vascular-mediated dysfunction in both the retina and the striatopallidal regions in patients with diabetes. The latter is associated with a variety of hyperkinetic disorders that are rare but disabling and potentially preventable. We conducted a systematic review of the potential association between diabetic retinopathy and the risk and prognosis of hyperkinetic disorders in patients with diabetes. We identified a total of 461 articles and 147 were eligible for review. Nine out of 147 articles (6.12%) reported 13 patients with information on diabetic retinopathy. Glycemic fluctuations were present at onset in 10 patients (77%) and retinopathy was present in nine of them (69.23%). The degree of retinopathy was reported in four patients. Two had severe, bilateral proliferative retinopathy, one had moderate-to-severe non-proliferative retinopathy and one had non-proliferative retinopathy. In the nine patients with retinopathy, hyperkinesia persisted, required higher doses of dopamine receptor antagonists or deep brain stimulation. Retinopathy was absent in four cases (30.77%). In these patients, hyperkinesia resolved spontaneously or with lower doses of dopamine receptor antagonists. Diabetic retinopathy could be an indirect marker of striatopallidal microangiopathy in patients with diabetes. The severity of retinopathy may be associated with increased risk or worse prognosis for patients who develop hyperkinetic disorders of the diabetic striatopathy spectrum. Early detection of retinopathy could identify patients in which avoiding glycemic fluctuations may prevent the development of striatopathy and hyperkinetic disorders.
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Affiliation(s)
- Karlo J Lizarraga
- Motor Physiology and Neuromodulation Program, Division of Movement Disorders, Department of Neurology and Center for Health and Technology (CHeT), University of Rochester Medical Center, Rochester, NY, USA; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA; The Edmond J. Safra Program in Parkinson Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Division of Neurology, Department of Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | - Natalia Chunga
- Motor Physiology and Neuromodulation Program, Division of Movement Disorders, Department of Neurology and Center for Health and Technology (CHeT), University of Rochester Medical Center, Rochester, NY, USA
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, FL, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, FL, USA
| | - Carlos Singer
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anthony E Lang
- The Edmond J. Safra Program in Parkinson Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Division of Neurology, Department of Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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12
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Bhowmick SS, Lang AE. Movement Disorders and Renal Diseases. Mov Disord Clin Pract 2020; 7:763-779. [PMID: 33043074 DOI: 10.1002/mdc3.13005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 02/06/2023] Open
Abstract
Movement disorders often emerge from the interplay of complex pathophysiological processes involving the kidneys and the nervous system. Tremor, myoclonus, ataxia, chorea, and parkinsonism can occur in the context of renal dysfunction (azotemia and electrolyte abnormalities) or they can be part of complications of its management (dialysis and renal transplantation). On the other hand, myoglobinuria from rhabdomyolysis in status dystonicus and certain drugs used in the management of movement disorders can cause nephrotoxicity. Distinct from these well-recognized associations, it is important to appreciate that there are several inherited and acquired disorders in which movement abnormalities do not occur as a consequence of renal dysfunction or vice versa but are manifestations of common pathophysiological processes affecting the nervous system and the kidneys. These disorders are the emphasis of this review. Increasing awareness of these conditions among neurologists may help them to identify renal involvement earlier, take timely intervention by anticipating complications and focus on therapies targeting common mechanisms in addition to symptomatic management of movement disorders. Recognition of renal impairment in a patient with complex neurological presentation may narrow down the differentials and aid in reaching a definite diagnosis.
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Affiliation(s)
- Suvorit S Bhowmick
- Division of Neurology, Department of Medicine, Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital University Health Network Toronto Ontario Canada
| | - Anthony E Lang
- Division of Neurology, Department of Medicine, Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital University Health Network Toronto Ontario Canada
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13
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Henriques RN, Jespersen SN, Shemesh N. Correlation tensor magnetic resonance imaging. Neuroimage 2020; 211:116605. [DOI: 10.1016/j.neuroimage.2020.116605] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/23/2020] [Accepted: 02/02/2020] [Indexed: 12/17/2022] Open
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Metin KM, Ataç C, Şahin BE, Yoldaş TK. The Syndrome of Acute Bilateral Basal Ganglia Lesions in a Patient with Diabetes Mellitus and Uremia. Neurol India 2019; 67:1163-1165. [PMID: 31512672 DOI: 10.4103/0028-3886.266236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kubra Mehel Metin
- Clinic of Neurology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Ceyla Ataç
- Clinic of Neurology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Burç Esra Şahin
- Clinic of Neurology, Ahi Evran University Education and Research Hospital, Kırşehir, Turkey
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Nam GE, Kim NH, Han K, Choi KM, Chung HS, Kim JW, Han B, Cho SJ, Jung SJ, Yu JH, Park YG, Kim SM. Chronic renal dysfunction, proteinuria, and risk of Parkinson's disease in the elderly. Mov Disord 2019; 34:1184-1191. [PMID: 31021467 DOI: 10.1002/mds.27704] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/09/2019] [Accepted: 04/04/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The roles of chronic kidney disease and proteinuria in the development of Parkinson's disease have not been widely studied. The objective of this study was to examine the associations of chronic renal dysfunction and proteinuria with the risk of PD in older adults using cohort data of the whole South Korean population. METHODS We included 3,580,435 individuals aged ≥65 years who had undergone health checkups provided by the National Health Insurance Service of South Korea between 2009 and 2012 and were followed until 2015. Multivariable Cox proportional hazards regression models were performed. RESULTS During a mean follow-up of 5.2 ± 1.3 years, 30,813 individuals (0.86% of the total population) developed PD. Lower estimated glomerular filtration rate and a higher degree of proteinuria on a dipstick test were associated with higher incidence probability of PD (log-rank P < 0.001). In Cox regression models, chronic renal dysfunction graded by estimated glomerular filtration rate (mL/min/1.73 m2 ) was associated with increased risk of PD after adjusting for potential confounding variables; hazard ratio (95% confidence interval) was 1.13 (1.10-1.17) for estimated glomerular filtration rate 60-90, 1.36 (1.31-1.42) for estimated glomerular filtration rate 30-60, and 1.47 (1.32-1.63) for estimated glomerular filtration rate <30 (P for trend <0.001). Proteinuria ≥1+ was also associated with increased risk of PD development (hazard ratio, 1.12; 95% confidence interval, 1.06-1.18). Coexistence of chronic kidney disease and proteinuria showed an increased hazard ratio of 1.33 (95% confidence interval, 1.23-1.45) for PD occurrence. CONCLUSIONS Our findings suggest that chronic renal dysfunction and dipstick-positive proteinuria may be independent risk factors for the development of PD in older adults. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ga Eun Nam
- Department of Family Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hye Soo Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Jin Wook Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Byoungduck Han
- Department of Family Medicine, Korea University College of Medicine, Seoul, Republic of Korea.,Department of Family Medicine, Sahmyook Medical Center, Seoul, Republic of Korea
| | - Sung Jung Cho
- Department of Family Medicine, Korea University College of Medicine, Seoul, Republic of Korea.,Department of Family Medicine, Sahmyook Medical Center, Seoul, Republic of Korea
| | - Seung Jin Jung
- Department of Family Medicine, Korea University College of Medicine, Seoul, Republic of Korea.,Department of Family Medicine, Sahmyook Medical Center, Seoul, Republic of Korea
| | - Ji Hee Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yong Gyu Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seon Mee Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, Republic of Korea
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Unstable blood sugar levels as triggers for the syndrome of acute bilateral basal ganglia lesions in diabetic uremia: Two Taiwanese patients with unusual neuroimaging findings. eNeurologicalSci 2019; 14:85-88. [PMID: 30723812 PMCID: PMC6352294 DOI: 10.1016/j.ensci.2019.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 11/24/2022] Open
Abstract
The syndrome of acute bilateral basal ganglia lesions in diabetic uremia is uncommon and usually affects Asian patients. The underlying pathogenesis of this syndrome is not clear. We searched PUBMED using the keywords “bilateral basal ganglia”, “diabetic”, and “uremia”, and found a total of 34 cases from 1998 to 2016. In most cases, blood sugar levels were normal. Here we report two Taiwanese cases presenting with dyskinesias. In one case the syndrome was triggered by hyperglycemia, and in the other by severe hypoglycemia. Their neuroimaging findings were unusual as compared with previously reported cases, presenting as mixed hypo- and hyperintensity on T1-weighted magnetic resonance imaging. We think these new finding would shed some light on the underlying pathophysiology of this syndrome. For treatment, it is advisable to keep glucose levels as stable as possible in diabetic uremic patients to prevent this syndrome. A rapid correction of hyper- or hypoglycemia after the onset may help recovery. Syndrome of acute bilateral basal ganglia lesions in diabetic uremia presenting with dyskinesias. Hyperglycemia and hypoglycemia can trigger this syndrome. Mixed hypo- and hyperintensity on T1-weighted MRI.
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Hamed SA. Neurologic conditions and disorders of uremic syndrome of chronic kidney disease: presentations, causes, and treatment strategies. Expert Rev Clin Pharmacol 2019; 12:61-90. [PMID: 30501441 DOI: 10.1080/17512433.2019.1555468] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sherifa A. Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
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19
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Lizarraga KJ, Adams D, Post MJD, Skyler J, Singer C. Neurovascular uncoupling after rapid glycemic control as a trigger of the diabetic-uremic striatopallidal syndrome. Parkinsonism Relat Disord 2017; 39:89-90. [PMID: 28336348 DOI: 10.1016/j.parkreldis.2017.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 02/14/2017] [Accepted: 03/16/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Karlo J Lizarraga
- Department of Neurology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, 1120 N.W. 14th Street, Ste. 1383, Miami, FL 33136, USA.
| | - David Adams
- Department of Neurology, University of Miami School of Medicine/ Jackson Memorial Hospital, Miami, FL, USA
| | - M Judith D Post
- Department of Radiology, Section of Neuroradiology, University of Miami School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | - Jay Skyler
- Diabetes Research Institute, University of Miami School of Medicine, Miami, FL, USA
| | - Carlos Singer
- Department of Neurology, University of Miami School of Medicine/ Jackson Memorial Hospital, Miami, FL, USA
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20
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Mehta S, Kumar A, Takkar A, Goyal MK, Lal V. An unusual cause of reversible parkinsonism. Ann Indian Acad Neurol 2017; 20:82-83. [PMID: 28298854 PMCID: PMC5341280 DOI: 10.4103/0972-2327.194315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sahil Mehta
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amith Kumar
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aastha Takkar
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manoj Kumar Goyal
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Lal
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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21
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Neurological and imaging findings associated with acute reversible bilateral basal ganglia lesions in a non-diabetic hemodialysis patient. Neurol Sci 2016; 37:2013-2015. [PMID: 27421835 DOI: 10.1007/s10072-016-2671-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
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22
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Yoon JE, Kim JS, Park JH, Lee KB, Roh H, Park ST, Cho JW, Ahn MY. Uremic parkinsonism with atypical phenotypes and radiologic features. Metab Brain Dis 2016; 31:481-4. [PMID: 26631408 DOI: 10.1007/s11011-015-9774-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Abstract
Uremic encephalopathy with bilateral basal ganglia lesions has been reported as an acute neurometabolic disease which shows reversible clinical course and brain imaging features. The exact nature and pathophysiology have not been well established. We encountered two patients who showed a relapsing and aggravating course and an atypical phenotype including parkinsonism with paroxysmal dystonic head tremor and acute onset monoparesis of the lower extremity. They also showed unusual radiological findings which revealed combined lesions in the basal ganglia and cortex, persistent hemorrhagic transformation, and focal ischemic lesion in the internal capsule. Herein, we present the unusual phenomenology with atypical radiologic findings and suggest the possible multifactorial pathogenesis of uremic encephalopathy.
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Affiliation(s)
- Jee-Eun Yoon
- Department of Neurology, Soonchunhyang University School of Medicine, Soonchunhyang University Seoul Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul, 140-887, Republic of Korea
| | - Ji Sun Kim
- Department of Neurology, Soonchunhyang University School of Medicine, Soonchunhyang University Seoul Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul, 140-887, Republic of Korea.
| | - Jeong-Ho Park
- Department of Neurology, Soonchunhyang University School of Medicine, Soonchunhyang University Bucheon Hospital, Seoul, South Korea
| | - Kyung-Bok Lee
- Department of Neurology, Soonchunhyang University School of Medicine, Soonchunhyang University Seoul Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul, 140-887, Republic of Korea
| | - Hakjae Roh
- Department of Neurology, Soonchunhyang University School of Medicine, Soonchunhyang University Seoul Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul, 140-887, Republic of Korea
| | - Sung Tae Park
- Department of Radiology, Soonchunhyang University School of Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - Jin Whan Cho
- Department of Neurology, Sungkyunkwan University School of Medicine, Seoul,, South Korea
- Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Moo-young Ahn
- Department of Neurology, Soonchunhyang University School of Medicine, Soonchunhyang University Seoul Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul, 140-887, Republic of Korea.
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Decreased dopamine transporter and receptor ligand binding in Parkinsonism with diabetic uremic syndrome. Ann Nucl Med 2016; 30:320-4. [PMID: 26790869 DOI: 10.1007/s12149-015-1054-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022]
Abstract
Here, we describe the case of a 47-year-old man with bilateral striatal lesions with diabetic uremia. Following 4 years of hemodialysis, the patient experienced sudden onset of rigidity, bradykinesia, gait disorder, and postural instability. Symptoms were remediated 2 months later, and were no longer responsive to levodopa approximately 1 year after the onset. Brain magnetic resonance imaging (MRI) during the acute phase showed T 2-weighted high signal edematous lesions in the bilateral striatum, subsequently developing into vacuolated lesions. A positron emission tomography (PET) scan using ((11)C)-labeled 2-carbomethoxy-3-(4-fluorophenyl) tropane [((11)C) CFT] and ((11)C)-labeled raclopride [((11)C) RAC] revealed significant decreases bilaterally in pre- and postsynaptic functions of the dopaminergic neurons. When we experience a case with bilateral putaminal destruction resulting in Parkinsonism, examination of the function of doperminergic neurons and dopamine receptors using molecular imaging is useful to predict levodopa response and prognosis.
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24
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Park JW, Kim SU, Choi JY, Jung JM, Kwon DY, Park MH. Reversible parkinsonism with lentiform fork sign as an initial and dominant manifestation of uremic encephalopathy. J Neurol Sci 2015; 357:343-4. [DOI: 10.1016/j.jns.2015.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/31/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
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Abstract
Movement disorders, classically involving dysfunction of the basal ganglia commonly occur in neurodegenerative and structural brain disorders. At times, however, movement disorders can be the initial manifestation of a systemic disease. In this article we discuss the most common movement disorders which may present in infectious, autoimmune, paraneoplastic, metabolic and endocrine diseases. Management often has to be multidisciplinary involving primary care physicians, neurologists, allied health professionals including nurses, occupational therapists and less frequently neurosurgeons. Recognizing and treating the underlying systemic disease is important in order to improve the neurological symptoms.
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Affiliation(s)
- Werner Poewe
- Department of Neurology, Innsbruck Medical University, Anichstraße 35, Innsbruck A-6020, Austria.
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26
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Abstract
Parkinsonism associated with basal ganglia pathology represents a rare complication in uremia patients, characterized by acute hyperkinetic or hypokinetic extrapyramidal movement disorders. We herein present brain SPECT and MR findings of uremic patients with end-stage renal failure exhibiting parkinsonian symptoms. The bilateral basal ganglia exhibited decreased uptake on SPECT, and abnormal signals on MR, suggesting pathology.
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27
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Kim YJ, Kim SJ, Kim J, Kim MJ, Kim KJ, Yoon H, Kim SR, Chung SJ. Chorea due to diabetic hyperglycemia and uremia: distinct clinical and imaging features. Mov Disord 2015; 30:419-22. [PMID: 25649292 DOI: 10.1002/mds.26148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 12/15/2014] [Accepted: 12/21/2014] [Indexed: 11/06/2022] Open
Abstract
This study was undertaken to describe the clinical and imaging characteristics of patients with chorea associated with nonketotic hyperglycemia (C-NKH) in comparison with patients with chorea associated with uremia (C-URE). We retrospectively analyzed the clinical data of consecutive 10 C-NKH and five C-URE patients who were treated between January 1, 2001 and January 31, 2013. Women were more frequently affected by C-NKH (70% vs. 30%) and C-URE (80% vs. 20%) compared with men. The C-NKH patients demonstrated T1-hyperintense and inhomogeneous lesions in the basal ganglia, whereas C-URE patients demonstrated T2-hyperintense and homogeneous lesions in the basal ganglia. The mean time for chorea resolution after treatment was significantly shorter in C-NKH patients than in C-URE patients (4.4 ± 2.6 d vs. 73.8 ± 14.2 d, respectively; P = 0.005). The clinical and imaging features are remarkably different between C-NKH and C-URE patients, suggesting distinct pathogenic mechanisms.
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Affiliation(s)
- Young Jin Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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28
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Park JH, Kim HJ, Kim SM. Acute Chorea with Bilateral Basal Ganglia Lesions in Diabetic Uremia. Can J Neurol Sci 2014; 34:248-50. [PMID: 17598608 DOI: 10.1017/s0317167100006144] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Uremia is a syndrome of clinical and metabolic abnormalities, which develops in parallel with the deterioration of renal function. Uremic encephalopathy is one of many manifestations of acute or chronic renal failure. It is usually applied to patients with cortical involvement, such as confusion, seizure, tremor, myoclonus, or asterixis. Some cases of acute extrapyramidal movement disorders associated with bilateral basal ganglia lesions, especially parkinsonism have been reported in uremic patients. Here, we report a diabetic uremic patient who developed acute chorea associated with bilateral basal ganglia lesions.
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Mahajan PS, El Esnawi MA, Hussein SA, Al Maslamani NJ. Rare case of reversible acute symmetrical lesions of the bilateral Basal Ganglia associated with diabetic nephropathy and chronic renal failure. J Clin Imaging Sci 2014; 4:29. [PMID: 24991480 PMCID: PMC4078418 DOI: 10.4103/2156-7514.133264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 04/21/2014] [Indexed: 11/04/2022] Open
Abstract
Reversible acute symmetrical basal ganglial lesion on magnetic resonance imaging and/or computed tomography in cases of diabetic nephropathy and chronic renal failure exhibiting acute onset of movement abnormalities like chorea is a very rare entity. It has characteristic clinical and imaging features. Only 29 cases are described in the literature, including the current one. These cases are predominantly Asian patients from the Far East and only one Asian Indian patient has been described. We report the second Asian Indian case of this condition and describe its various clinical and imaging features. Our aim is to educate the clinicians and radiologists about this condition, so that more such cases can be detected.
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Affiliation(s)
- Parag Suresh Mahajan
- Department of Radiology, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Sheik Akbar Hussein
- Department of Radiology, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar
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Wang IK, Lin CL, Wu YY, Chou CY, Lin SY, Liu JH, Yen TH, Huang CC, Sung FC. Increased risk of Parkinson's disease in patients with end-stage renal disease: a retrospective cohort study. Neuroepidemiology 2014; 42:204-210. [PMID: 24751820 DOI: 10.1159/000358921] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 01/20/2014] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Studies on dyskinesia and Parkinson's syndrome associated with chronic kidney disease or end-stage renal disease (ESRD) have been mainly limited to case reports or case series studies. This population-based study investigated the risk of Parkinson's disease in patients with ESRD. METHODS From a universal insurance claims database of Taiwan, we established a cohort of 8,325 adults with newly diagnosed ESRD from 1997 to 2010 without a history of Parkinson's disease. A control cohort of 33,382 insured subjects without a history of kidney disease or Parkinson's disease was also selected, with frequency matched for age, sex and index date of the patients with ESRD. Both cohorts were followed up until the end of 2010. RESULTS The Parkinson's disease incidence was 1.55-fold higher in the cohort with ESRD than in the comparison cohort (48.8 vs. 31.7 per 10,000 person-years) with an adjusted hazard ratio of 1.73 (95% confidence interval, 1.39-2.15). Sex-specific and age-specific analysis showed a higher relative risk for women and younger patients with ESRD compared to the control cohort. CONCLUSIONS ESRD is significantly associated with an increased risk of Parkinson's disease. Close surveillance for Parkinson's disease should be considered for patients with ESRD.
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Affiliation(s)
- I-Kuan Wang
- Institute of Clinical Medical Science, China Medical University College of Medicine, Taichung, Taiwan
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Acar NP, Arsava EM, Gocmen R, Dericioglu N, Topcuoglu MA. Diabetic uremic syndrome studied with cerebral MR spectroscopy and CT perfusion. Metab Brain Dis 2013; 28:711-5. [PMID: 23959792 DOI: 10.1007/s11011-013-9427-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022]
Abstract
Diabetic uremic syndrome (DUS) is an increasingly reported acute neurometabolic cerebral disease with characteristic clinical and imaging features. Clinical spectrum includes a wide range of movement disorders such as acute parkinsonism. Imaging studies show reversible (with hemodialysis) bilateral lesions in the lenticular nuclei. DUS pathophysiology has not been entirely clarified yet. Our case study shows certainly that LN lesions are characterized with increased lactate peak with MR spectroscopy and decreased perfusion in computerized tomography perfusion along with increased diffusion with apparent diffusion coefficient (ADC) mapping in the subacute phase of the syndrome. Abnormalities were almost normalized quickly after metabolic control by hemodialysis. Together with reports indicating that a deficit of glucose use exacerbated with acute increase of uremic toxins in bilateral LN, observed changes (lactate peak and hypoperfusion) led us to state that a primary metabolic depression may cause this syndrome. Metabolic depression is probably due to uncompensated uremic toxin accumulation related mitochondrial supression and/or dysfunction. This definition fits well to the other elements of DUS such as ADC evolution and marked lesion regression. Our single case study is not supportive of other previously credited mechanisms such as microvascular dysfunction related focal ischemia or hypoperfusion, prolonged uremic toxin related histotoxic hypoxia, central pontine myelinolysis-like demyelination and posterior leukoencephalopathy spectrum disorder related vasogenic edema.
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Kuppachi S, Lwin L, Yoo J, Suneja M. Bilateral basal ganglia lesions in end-stage kidney disease presenting as acute chorea. Clin Kidney J 2013; 6:450-1. [PMID: 27293580 PMCID: PMC4898345 DOI: 10.1093/ckj/sft073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sarat Kuppachi
- Department of Medicine, Division of Nephrology and Hypertension , University of Iowa Hospital and Clinics , IA , USA
| | - Lin Lwin
- Department of Medicine, Division of Nephrology and Hypertension , Montefiore Medical Center , NY, USA
| | - Jinil Yoo
- Department of Medicine, Division of Nephrology and Hypertension , Montefiore Medical Center , NY, USA
| | - Manish Suneja
- Department of Medicine, Division of Nephrology and Hypertension , University of Iowa Hospital and Clinics , IA , USA
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Nishimura Y, Shibata K, Funaki T, Ito H, Ito E, Otsuka K. [A case of subacute parkinsonism presenting as bilateral basal ganglia legions by MRI in diabetic uremic syndrome]. Rinsho Shinkeigaku 2013; 53:217-23. [PMID: 23524602 DOI: 10.5692/clinicalneurol.53.217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 60-year-old male was admitted because he had developed tremulous movement in both upper and lower limbs and gait disturbance over the course of 3 months. He had been on continuous ambulatory peritoneal dialysis almost 1 year earlier due to end-stage diabetic nephropathy. A neurological examination revealed a mild disturbance of his consciousness, asterixis in the upper limbs, bilateral extensor plantar responses and parkinsonism, which were characterized by bradykinesia, akinesia, rigidity, and bilaterally tremors at rest. Cranial magnetic resonance imaging (MRI) revealed swollen bilateral basal ganglia legions, which appeared hyperintense on T2-weighted images. The patient was treated for metabolic acidosis and continued hemodialysis three times a week; however, the parkinsonism remained 1 year later. Follow-up MRI revealed decreased swelling of the basal ganglia, and the pattern of diffusion-weighted images and the apparent diffusion coefficient (ADC) map indicated vasogenic and cytotoxic edema in bilateral globus pallidus. The case was diagnosed as encephalopathy due to diabetic uremic syndrome, initially characterized by Wang et al. (2003). Only 17 cases with parkinsonism have been reported. Diabetic uremic syndrome is characterized by acute or subacute onset consciousness disturbance and movement disorders such as parkinsonism, chorea and the other extrapyramidal signs to various degrees related to bilateral lesions of the basal ganglia.
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Affiliation(s)
- Yoshiko Nishimura
- Tokyo Women's Medical University Medical Center East, Department of Medicine
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Abstract
AIMS Movement disorders are one of the central nervous system complications in uremic patients. Asterixis, multifocal myoclonus, and restless leg syndrome are well-documented in this category. Acute parkinsonism, however, is only reported in rare series with a small number of cases. In this study, we investigated the risk for parkinsonism during a 3-year follow-up period after a diagnosis of uremia. METHODS The Longitudinal Health Insurance Database in Taiwan was utilised. We identified a total of 2862 patients who had visited ambulatory care centers with a diagnosis of chronic renal failure between 1999 and 2001 as the study cohort. We further randomly selected 14,310 enrollees matched with the study cohort in terms of gender, age, and year of their index visit for comparison. Each patient was individually tracked for 3 years to identify the occurrence of parkinsonism. Stratified Cox proportional hazard regressions (stratified by age and gender) were performed for analyses. RESULTS We found the annual incidence rates of parkinsonism to be 1.2% and 0.6% in the uremic and non-uremic groups, respectively. Furthermore, uremic patients were more vulnerable to developing parkinsonism with a 1.81-fold higher risk [95%CI = (1.21-2.71)] than the non-uremic group after adjusting for diabetes mellitus, which did not augment the risk. CONCLUSIONS The importance of raising awareness regarding the early symptoms of parkinsonism among patients with uremia is tied to its early identification, with timely aggressive dialysis being able to apply to slow the progression of the disease and its symptoms. Further study is warranted to elucidate the pathophysiology of uremic parkinsonism.
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Affiliation(s)
- H-L Lin
- Department of Neurology, General Cathay Hospital, Sijhih Branch, Taipei, Taiwan
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35
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Generalized chorea in the syndrome of acute bilateral basal ganglia lesions in patients with diabetic uremia. J Clin Neurosci 2011; 18:1266-8. [DOI: 10.1016/j.jocn.2011.01.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 01/17/2011] [Accepted: 01/26/2011] [Indexed: 11/17/2022]
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36
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Kumar G, Goyal MK. Lentiform Fork sign: a unique MRI picture. Is metabolic acidosis responsible? Clin Neurol Neurosurg 2010; 112:805-12. [PMID: 20615611 DOI: 10.1016/j.clineuro.2010.06.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 05/01/2010] [Accepted: 06/10/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE Bilateral basal ganglia lesions are neither diagnostic nor pathognomonic of uremic encephalopathy (UE). Nonetheless, bilateral basal ganglia T2/FLAIR hyperintensities have been widely reported to be associated with UE. The aim of this study was to describe a unique neuroradiological sign seen on the MRI brain in UE, present a retrospective chart review of patients with UE over the past 10 years for evidence of similar MRI appearance, review literature for evidence of this sign, and generate a hypothesis to explain its pathophysiological basis. METHODS We describe a previously unreported and unique MRI picture, the Lentiform Fork sign, in a patient with UE. We conducted a focused retrospective chart review of patients with UE over the past 10 years, for evidence of similar MRI changes. We review literature (through PUBMED, OVID, and CENTRAL) for evidence of this sign and propose a hypothesis to explain the basis of this MRI sign. RESULTS We describe the Lentiform Fork sign in a patient with UE. Of our 21 retrospectively reviewed patients with UE who underwent MRI, only one had this sign. Literature review identified 22 patients with this sign who had various conditions, all associated with metabolic acidosis. Fourteen of these patients had documented evidence of severe metabolic acidosis. We propose the hypothesis that metabolic acidosis is the basis of this Lentiform Fork sign. CONCLUSION Lentiform Fork sign is a unique, previously unreported MRI picture that is seen not only in patients with UE but also in other conditions that result in metabolic acidosis, helping discriminate a specific etiology from the myriad of conditions that are lumped under the rubric of "basal ganglia hyperintensity." We propose the hypothesis that metabolic acidosis may be the key factor in the pathogenesis of this sign.
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Affiliation(s)
- Gyanendra Kumar
- Department of Neurology, University of Missouri-Healthcare, Columbia, MO, USA.
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Dicuonzo F, Di Fede R, Salvati A, Palma M, de Mari M, Baldassarre GD, Di Renzo B, Tortorella C. Acute extrapyramidal disorder with bilateral reversible basal ganglia lesions in a diabetic uremic patient: diffusion-weighted imaging and spectroscopy findings. J Neurol Sci 2010; 293:119-21. [PMID: 20381073 DOI: 10.1016/j.jns.2010.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Revised: 02/26/2010] [Accepted: 03/05/2010] [Indexed: 11/30/2022]
Abstract
Acute movement disorders associated with bilateral lesions in the basal ganglia are increasingly described in patients affected by diabetes and uremia. Pathophysiology has not been utterly understood yet, but it is likely to be multifactorial, with both ischemic/microvascular and metabolic/toxic factors determining the lesions and symptoms. We have studied a uremic diabetic patient who was admitted in emergency after presenting choreic movements, in which CT and MR, including diffusion-weighted imaging and spectroscopy, showed bilateral symmetric basal ganglia lesions with regression at follow-up. This is the first report in the literature describing spectroscopic findings in this condition.
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Affiliation(s)
- Franca Dicuonzo
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
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LI JORDANYZ, YONG TUCKY, SEBBEN RUBEN, KHOO EEWIN, DISNEY ALEXPS. Bilateral basal ganglia lesions in patients with end-stage diabetic nephropathy (Brief Communication). Nephrology (Carlton) 2008; 13:68-72. [DOI: 10.1111/j.1440-1797.2007.00838.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Acute bilateral basal ganglia lesions in diabetic uraemia: diffusion-weighted MRI. Neuroradiology 2007; 49:1009-13. [DOI: 10.1007/s00234-007-0299-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Accepted: 07/23/2007] [Indexed: 10/22/2022]
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Karaarslan E, Arslan A. Diffusion weighted MR imaging in non-infarct lesions of the brain. Eur J Radiol 2007; 65:402-16. [PMID: 17555903 DOI: 10.1016/j.ejrad.2007.04.023] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Revised: 02/06/2007] [Accepted: 04/24/2007] [Indexed: 11/21/2022]
Abstract
Diffusion weighted imaging (DWI) is a relatively new method in which the images are formed by the contrast produced by the random microscopic motion of water molecules in different tissues. Although DWI has been tried for different organ systems, it has been found its primary use in the central nervous system. The most widely used clinical application is in the detection of hyperacute infarcts and the differentiation of acute or subacute infarction from chronic infarction. Recently DWI has been applied to various other cerebral diseases. In this pictorial paper the authors demonstrated different DWI patterns of non-infarct lesions of the brain which are hyperintense in the diffusion trace image, such as infectious, neoplastic and demyelinating diseases, encephalopathies - including hypoxic-ischemic, hypertensive, eclamptic, toxic, metabolic and mitochondrial encephalopathies - leukodystrophies, vasculitis and vasculopathies, hemorrhage and trauma.
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Affiliation(s)
- E Karaarslan
- Department of Radiology, American Hospital, Sişli, Istanbul, Turkey.
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Maeno K, Nakanishi S, Kanda K, Shizukawa H, Tsuji S, Terae S, Ohkoshi R, Takeyama Y, Sakuta T, Matsumura K. Acute reversible parkinsonism in diabetic-uremic patients undergoing maintenance hemodialysis. ACTA ACUST UNITED AC 2007. [DOI: 10.4009/jsdt.40.919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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