1
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Atallah O, Almealawy YF, Alabide AS, Farooq M, Sanker V, Alrubaye SN, Darwazeh R, Awuah WA, Abdul-Rahman T, Muthana A, Saleh A, Wellington J, Badary A. Navigating the clinical landscape of artery of Percheron infarction: A systematic review. eNeurologicalSci 2024; 37:100521. [PMID: 39257866 PMCID: PMC11382010 DOI: 10.1016/j.ensci.2024.100521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 08/06/2024] [Accepted: 08/07/2024] [Indexed: 09/12/2024] Open
Abstract
Introduction Infarction of the artery of Percheron (AOP) is a rare vascular condition where a single arterial branch supplies blood to the thalamic and midbrain regions, leading to neurological deficits. The challenge lies in its often-delayed diagnosis due to its rarity and diverse clinical presentations, necessitating heightened awareness among clinicians for expedited diagnosis and appropriate therapeutic interventions. Materials and methods All relevant studies involving patients diagnosed with infarction of AOP were retrieved from PubMed, Google Scholar, Web of Science, and Scopus. Only human studies that were published in full English-language reports were included. Included in the search were the terms "Artery of Percheron," "infarction," "stroke," and "demarcation". Age, gender, presenting symptoms, treatment, recovery time, and outcome of patients with AOP infarction were all recorded. Results A systematic review was conducted on a total of 530 articles, out of which 130 articles met the specified requirements. The average age is 59, with men comprising 57.7% of the population. The symptoms reported were visual disturbance in 43.9% of cases and changed mental state in 77.2% of cases. Treatment options include conservative management (85.4%), thrombolysis (11.3%), and other approaches. The optimal age range for recovery is between 41 and 50 years old. Conclusion Our study on acute AOP infarction highlights male predominance, common comorbidities like hypertension and diabetes, and prevalent symptoms including visual disturbance and altered mental state. Early recognition is crucial, with thrombolytic therapy within the critical time window showing promising outcomes. These findings offer insights for enhanced clinical management of AOP infarction.
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Affiliation(s)
- Oday Atallah
- Departemnt of Neurosurgery, Hannover Medical School, Hannover, Germany
| | | | | | - Minaam Farooq
- Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore,Pakistan
| | - Vivek Sanker
- Department of Neurosurgery, Trivandrum Medical College, Kerala, India
| | | | - Rami Darwazeh
- Neurosurgery department, Prime Hospital, Dubai, United Arab Emirates
| | - Wireko Andrew Awuah
- University of Babylon, Hilla, Iraq
- Faculty of Medicine, Sumy State University, Sumy, Ukraine
| | | | - Ahmed Muthana
- College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Aalaa Saleh
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Jack Wellington
- Department of Neurosurgery, Branford TeachingHospital NHS Foundation Trust, Bradford, UK
| | - Amr Badary
- Departemnt of Neurosurgery, Klinikum Dessau, Dessau-Roßlau, Germany
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2
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Chong PLH, Garic D, Shen MD, Lundgaard I, Schwichtenberg AJ. Sleep, cerebrospinal fluid, and the glymphatic system: A systematic review. Sleep Med Rev 2022; 61:101572. [PMID: 34902819 PMCID: PMC8821419 DOI: 10.1016/j.smrv.2021.101572] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 10/14/2021] [Accepted: 11/10/2021] [Indexed: 02/03/2023]
Abstract
Current theories of the glymphatic system (GS) hypothesize that it relies on cerebrospinal fluid (CSF) circulation to disseminate growth factors and remove metabolic waste from the brain with increased CSF production and circulation during sleep; thereby, linking sleep disturbance with elements of CSF circulation and GS exchange. However, our growing knowledge of the relations between sleep, CSF, and the GS are plagued by variability in sleep and CSF measures across a wide array of pathologies. Hence, this review aims to summarize the dynamic relationships between sleep, CSF-, and GS-related features in samples of typically developing individuals and those with autoimmune/inflammatory, neurodegenerative, neurodevelopmental, sleep-related, neurotraumatic, neuropsychiatric, and skull atypicalities. One hundred and ninety articles (total n = 19,129 participants) were identified and reviewed for pathology, CSF circulation and related metrics, GS function, and sleep. Numerous associations were documented between sleep problems and CSF metabolite concentrations (e.g., amyloid-beta, orexin, tau proteins) and increased CSF volumes or pressure. However, these relations were not universal, with marked differences across pathologies. It is clear that elements of CSF circulation/composition and GS exchange represent pathways influenced by sleep; however, carefully designed studies and advances in GS measurement are needed to delineate the nuanced relationships.
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Affiliation(s)
| | - D. Garic
- University of North Carolina, Chapel Hill, NC
| | - M. D. Shen
- University of North Carolina, Chapel Hill, NC
| | - I. Lundgaard
- Department of Experimental Medicine Science, Lund University, Lund, Sweden,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
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3
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Saida IB, Saad HB, Zghidi M, Ennouri E, Ettoumi R, Boussarsar M. Artery of Percheron Stroke as an Unusual Cause of Hypersomnia: A Case Series and a Short Literature Review. Am J Mens Health 2021; 14:1557988320938946. [PMID: 32618485 PMCID: PMC7336829 DOI: 10.1177/1557988320938946] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The thalamus and the mesencephalon have a complex blood supply. The artery of
Percheron (AOP) is a rare anatomical variant. Occlusion of this artery may lead
to bithalamic stroke with or without midbrain involvement. Given its broad
spectrum of clinical features, AOP stroke is often misdiagnosed. Usually, it
manifests with the triad of vertical gaze palsy, memory impairment, and coma. In
this article, we report three cases of bilateral thalamic strokes whose clinical
presentations were dominated by a sudden onset of hypersomnia. We also reviewed
last 5 years’ publications related to the AOP strokes in males presenting
sleepiness or equivalent terms as a delayed complication. The AOP stroke may
present a diagnostic challenge for clinicians which should be considered in the
differential diagnosis of hypersomnia.
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Affiliation(s)
- Imen Ben Saida
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia.,Research Laboratory N° LR12SP09, Heart Failure, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Helmi Ben Saad
- Research Laboratory N° LR12SP09, Heart Failure, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia.,Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Maroua Zghidi
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia
| | - Emna Ennouri
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia
| | - Radhouane Ettoumi
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia.,Research Laboratory N° LR12SP09, Heart Failure, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Mohamed Boussarsar
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia.,Research Laboratory N° LR12SP09, Heart Failure, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
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4
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Berteotti C, Liguori C, Pace M. Dysregulation of the orexin/hypocretin system is not limited to narcolepsy but has far-reaching implications for neurological disorders. Eur J Neurosci 2020; 53:1136-1154. [PMID: 33290595 DOI: 10.1111/ejn.15077] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 12/23/2022]
Abstract
Neuropeptides orexin A and B (OX-A/B, also called hypocretin 1 and 2) are released selectively by a population of neurons which projects widely into the entire central nervous system but is localized in a restricted area of the tuberal region of the hypothalamus, caudal to the paraventricular nucleus. The OX system prominently targets brain structures involved in the regulation of wake-sleep state switching, and also orchestrates multiple physiological functions. The degeneration and dysregulation of the OX system promotes narcoleptic phenotypes both in humans and animals. Hence, this review begins with the already proven involvement of OX in narcolepsy, but it mainly discusses the new pre-clinical and clinical insights of the role of OX in three major neurological disorders characterized by sleep impairment which have been recently associated with OX dysfunction, such as Alzheimer's disease, stroke and Prader Willi syndrome, and have been emerged over the past 10 years to be strongly associated with the OX dysfunction and should be more considered in the future. In the light of the impairment of the OX system in these neurological disorders, it is conceivable to speculate that the integrity of the OX system is necessary for a healthy functioning body.
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Affiliation(s)
- Chiara Berteotti
- PRISM Lab, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Claudio Liguori
- Sleep Medicine Centre, Neurology Unit, University Hospital Tor Vergata, Rome, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Marta Pace
- Genetics and Epigenetics of Behaviour Laboratory, Istituto Italiano di Tecnologia, Genova, Italy
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5
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Tong DM, Liu GH, Wang YW, Gu HP, Wang Y, Bao JJ, Zhang X, Liu JL. The time course of acute Percheron artery ischemic coma on imaging: A retrospective cohort study. Brain Res Bull 2020; 165:298-304. [PMID: 33164843 DOI: 10.1016/j.brainresbull.2020.10.016] [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: 08/20/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022]
Abstract
We were to investigate the time course of lesions for awakening in acute Percheron artery ischemic coma (PAIC), which was previously unknown. Patients who had newly identified acute PAIC events in 2012-2015 and had not received thrombolytic therapy were enrolled retrospectively. The time course of lesions in PAIC was investigated by diffusion-weighted imaging (DWI). Ninety-three patients met the inclusion criteria, of whom 63 and 30 had transient PAIC and persistent PAIC, respectively. The time course of awakening events in persistent PAIC decreased over time, with large lesions in the bilateral paramedian thalamus/ rostral midbrain on DWI almost in all patients who was either plus or minus a "top of basilar artery" strokes. Whereas awakening events in transient PAIC increased over time, with small or lacunar lesions in the unilateral or bilateral thalamus/rostral midbrain about in 30.2 % cases, and the rest in naturally recanalization of infarcts or TIA. Lesion volumes were larger for persistent PAIC than for transient PAIC (median, 2.4 cm3 vs. 0.03 cm3, P < 0.0001). In Cox hazards ratio (HR) analysis, a lower GCS score was associated with mortality (HR, 5.5; 95 % confidence interval [CI],1.427-21.45). Multivaliate analysis shown that the predictors of higher risk of persistent PAIC were only increased NIHSS scores (HR,1.3; 95 % CI,1.109-1.640) and large lesions in bilateral thalamus/rostral midbrain (HR,15.0; 95 % CI,1.440-58.13). The time course of acute PAIC included transient and persistent. Most persistent PAIC was associated with large lesions in bilateral paramedian thalamus/ rostral midbrain, and with high mortality.
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Affiliation(s)
- Dao Ming Tong
- Department of Neurology, Affiliated Shuyang Hospital of Xuzhou Medical University, Jiangsu, China.
| | - Guo-Hong Liu
- Department of Radiology, Affiliated Shuyang Hospital of Xuzhou Medical University, Jiangsu, China
| | - Yuan-Wei Wang
- Department of Neurology, Affiliated Shuyang Hospital of Xuzhou Medical University, Jiangsu, China
| | - Han-Pei Gu
- Department of Neurology, Affiliated Shuyang Hospital of Xuzhou Medical University, Jiangsu, China
| | - Ying Wang
- Department of Neurology, Affiliated Shuyang Hospital of Xuzhou Medical University, Jiangsu, China
| | - Jun-Jie Bao
- Department of Neurology, Affiliated Shuyang Hospital of Xuzhou Medical University, Jiangsu, China
| | - Xian Zhang
- Department of Neurology, Affiliated Shuyang Hospital of Xuzhou Medical University, Jiangsu, China
| | - Jiu-Ling Liu
- Department of Neurology, Affiliated Shuyang Hospital of Xuzhou Medical University, Jiangsu, China
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6
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Matsubara T, Suzuki K, Kawasaki A, Miyamoto M, Okamura M, Kanbayashi T, Takekawa H, Nakamura T, Watanabe Y, Matsubara M, Hirata K. Sudden onset of sleep caused by hypothalamic infarction: a case report. BMC Neurol 2019; 19:182. [PMID: 31375081 PMCID: PMC6676520 DOI: 10.1186/s12883-019-1414-3] [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: 03/12/2019] [Accepted: 07/25/2019] [Indexed: 12/02/2022] Open
Abstract
Background Hypothalamic lesions, such as tumors and demyelinating diseases, reportedly cause abnormal sleepiness. However, stroke involving the hypothalamus has rarely been described. Here, we report a patient with infarction restricted to the hypothalamus who presented with sudden onset of sleep. Case presentation A 42-year-old woman with a history of migraine without aura presented with irresistible sleepiness and developed several episodes of sudden onset of sleep. Neurological examinations were unremarkable except for partial left Horner syndrome. Brain magnetic resonance imaging (MRI) revealed a high-intensity lesion restricted to the left hypothalamus on diffusion-weighted and fluid-attenuated inversion recovery MRI images. Cerebrospinal fluid (CSF) orexin-A levels obtained on hospital day 3 after her sleepiness had resolved were normal (337 pg/mL; normal > 200 pg/mL). Serum anti-nuclear and anti-aquaporin 4 (AQP4) antibodies and CSF myelin basic protein and oligoclonal band were negative. A small hypothalamic infarction was suspected, and the patient was treated with intravenous edaravone and argatroban, as well as oral clopidogrel. Three months later, there had been no clinical relapse, and the hypothalamic lesion had almost disappeared on follow-up MRI. No new lesion suggestive of demyelinating disease or tumor was observed. Conclusion Hypothalamic stroke should be considered a cause of sudden onset of sleep.
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Affiliation(s)
- Takeo Matsubara
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.
| | - Akiko Kawasaki
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Masayuki Miyamoto
- Department of Clinical Medicine for Nursing, Dokkyo Medical University School of Nursing, Tochigi, Japan
| | - Madoka Okamura
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Takashi Kanbayashi
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Hidehiro Takekawa
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.,Center of Medical Ultrasonics, Dokkyo Medical University Hospital, Tochigi, Japan.,Stroke Center, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Toshiki Nakamura
- Department of Neurology, Rehabilitation Amakusa Hospital, Saitama, Japan
| | - Yuji Watanabe
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Masanori Matsubara
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
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7
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Hamada Y, Takata T, Kawakita R, Kobara H, Okada M, Tamiya T, Kanbayashi T, Touge T, Deguchi K, Masaki T. Orexin secretion abnormality involved in excessive somnolence in CNS lymphoma without hypothalamic lesions. J Clin Neurosci 2019; 64:6-7. [PMID: 30962060 DOI: 10.1016/j.jocn.2019.03.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/29/2019] [Indexed: 11/19/2022]
Abstract
A 72-year-old woman developed excessive somnolence as one of the symptoms of diffuse large B-cell lymphoma in the central nervous system (CNS). Although somnolence might be caused by reduced orexin secretion associated with hypothalamic lesions, neither brain MRI nor 18F-fluorodeoxyglucose positron emission tomography identified hypothalamic lesions. However, the decreased cerebrospinal fluid (CSF) orexin levels recovered to near normal values with improvement of somnolence after chemotherapy. The alteration of CSF orexin levels suggested the involvement of potential hypothalamic lesions. Therefore, measurements of CSF orexin levels may be useful for understanding the pathological background of somnolence in CNS lymphoma without hypothalamic lesions.
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Affiliation(s)
- Yasuhiro Hamada
- Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Tadayuki Takata
- Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Rie Kawakita
- Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Masaki Okada
- Department of Neurosurgery, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Takashi Tamiya
- Department of Neurosurgery, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Takashi Kanbayashi
- Department of Neuropsychiatry, Akita University School of Medicine, 1-1-1 Hondo, Akita City, Akita 010-0000, Japan
| | - Tetsuo Touge
- Department of Health Sciences, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Kazushi Deguchi
- Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
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8
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Suzuki K, Miyamoto M, Miyamoto T, Matsubara T, Inoue Y, Iijima M, Mizuno S, Horie J, Hirata K, Shimizu T, Kanbayashi T. Cerebrospinal fluid orexin-A levels in systemic lupus erythematosus patients presenting with excessive daytime sleepiness. Lupus 2018; 27:1847-1853. [PMID: 29848165 DOI: 10.1177/0961203318778767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective Involvement of the hypothalamus is rare in patients with systemic lupus erythematosus (SLE). In this study, we measured cerebrospinal fluid (CSF) orexin-A levels in SLE patients with hypothalamic lesions to investigate whether the orexin system plays a role in SLE patients with hypothalamic lesions who present with excessive daytime sleepiness (EDS). Methods Orexin-A levels were measured in CSF from four patients with SLE who presented with hypothalamic lesions detected by MRI. Three patients underwent repeated CSF testing. All patients met the updated American College of Rheumatology revised criteria for SLE. Results Tests for serum anti-aquaporin-4 antibodies, CSF myelin basic protein and CSF oligoclonal bands were negative in all patients. All patients presented with EDS. Low to intermediate CSF orexin-A levels (92-180 pg/ml) were observed in three patients in the acute stage, two of whom (patients 1 and 2) underwent repeated testing and showed increased CSF orexin-A levels, reduced abnormal hypothalamic lesion intensities detected by MRI and EDS dissipation at follow-up. In contrast, CSF orexin-A levels were normal in one patient (patient 4) while in the acute stage and at follow-up, despite improvements in EDS and MRI findings. Patient 4 showed markedly increased CSF interleukin-6 levels (1130 pg/ml) and a slightly involved hypothalamus than the other patients. Conclusions Our findings suggest that the orexinergic system has a role in EDS in SLE patients with hypothalamic lesions. Furthermore, cytokine-mediated tissue damage might cause EDS without orexinergic involvement.
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Affiliation(s)
- K Suzuki
- 1 Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - M Miyamoto
- 2 Department of Clinical Medicine for Nursing, Dokkyo Medical University School of Nursing, Tochigi, Japan
| | - T Miyamoto
- 3 Department of Neurology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - T Matsubara
- 1 Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Y Inoue
- 4 Department of Neurology, Toyama Prefectural Rehabilitation Hospital and Support Center for Children with Disabilities, Toyama, Japan
| | - M Iijima
- 5 Department of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - S Mizuno
- 5 Department of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - J Horie
- 1 Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - K Hirata
- 1 Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - T Shimizu
- 6 Department of Neuropsychiatry, Akita University School of Medicine, Akita, Japan
- 7 International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - T Kanbayashi
- 6 Department of Neuropsychiatry, Akita University School of Medicine, Akita, Japan
- 7 International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
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9
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Oliveira GDP, Truzzi G, Lima FCB, Coelho FMS. A rare differential diagnosis of excessive daytime sleepiness - Artery of Percheron territory infarct. ACTA ACUST UNITED AC 2018; 11:25-27. [PMID: 29796197 PMCID: PMC5916572 DOI: 10.5935/1984-0063.20180006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Stroke is an example of neurological diseases that can commonly drives Excessive
Daytime Sleepiness (EDS). Extensive strokes with brain edema can leave a brain
herniation and coma. Other causes of EDS after stroke are strategic lesions at
Thalamus and brainstein. A 56-year-old man, right handed, with hypertension and
hypercholesterolemia was admitted at Emergency Room due to 5 days onset of EDS,
memory impairment, and left-sided weakness. A brain magnetic resonance imaging
showed paramedian thalamic hyperintensity with rostral midbrain hyperintensity
extending along the pial surface of the interpeduncular fossa. The artery of
Percheron (AP) is an unusual anatomical variation that originates from the
posterior cerebral artery and irrigates the paramedian regions of the thalamus
and part of the midbrain. It is important the clinical suspicions with detailed
drowsy patients history. Awareness of the clinical and neuroimaging features of
this stroke syndrome is essential for timely diagnosis and appropriate
management.
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Affiliation(s)
- Giuliano da Paz Oliveira
- Universidade Federal de São Paulo, Department of Neurology e Neurosurgery - São Paulo, SP, - Brazil.,Universidade Federal do Piauí, Campus Ministro Reis Velloso, Medicine Coordination - Parnaíba, PI, Brazil.,Universidade Federal de São Paulo, Department of Psychobiology - São Paulo, SP, Brazil
| | - Giselle Truzzi
- Universidade Federal de São Paulo, Department of Psychobiology - São Paulo, SP, Brazil
| | | | - Fernando Morgadinho Santos Coelho
- Universidade Federal de São Paulo, Department of Neurology e Neurosurgery - São Paulo, SP, - Brazil.,Universidade Federal de São Paulo, Department of Psychobiology - São Paulo, SP, Brazil
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10
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Wei TS, Hsu CS, Lee YC, Chang ST. Degeneration of paramedian nuclei in the thalamus induces Holmes tremor in a case of artery of Percheron infarction. Medicine (Baltimore) 2017; 96:e8633. [PMID: 29145285 PMCID: PMC5704830 DOI: 10.1097/md.0000000000008633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Holmes' tremor is an uncommon neurologic disorder following brain insults, and its pathogenesis is undefined. The interruption of the dento-rubro-thalamic tract and secondary deterioration of the nigrostriatal pathway are both required to initiate Holmes' tremor. We used nuclear medicine imaging tools to analyze a patient with concurrent infarction in different zones of each side of the thalamus. Finding whether the paramedian nuclear groups of the thalamus were injured was a decisive element for developing Holmes' tremor. PATIENT CONCERNS A 36-year-old woman was admitted to our department due to a bilateral paramedian thalamic infarction. Seven months after the stroke, a unilaterally involuntary trembling with irregularly wavering motions occurring in both her left hand and forearm. DIAGNOSIS Based on the distinct features of the unilateral coarse tremor and the locations of the lesions on the magnetic resonance imaging (MRI), the patient was diagnosed with bilateral paramedian thalamic infarction complicated with a unilateral Holmes' tremor. INTERVENTIONS The patient refused our recommendation of pharmacological treatment with levodopa and other dopamine agonists based on personal reasons and was only willing to accept physical and occupational training programs at our outpatient clinic. OUTCOMES We utilized serial anatomic and functional neuroimaging of the brain to survey the neurologic deficit. A brain magnetic resonance imaging showed unequal recovery on each side of the thalamus. The residual lesion appeared larger in the right-side thalamus and had gathered in the paramedian area. A brain perfusion single-photon emission computed tomography (SPECT) revealed that the post-stroke hypometabolic changes were not only in the right-side thalamus but also in the right basal ganglion, which was anatomically intact. Furthermore, the brain Technetium-99m-labeled tropanes as a dopamine transporter imaging agents scan ( Tc-TRODAT-1) displayed a secondary reduction of dopamine transporters in the right nigrostriatal pathway which had resulted from the damage on the paramedian nuclear groups of the right-side thalamus. LESSONS Based on the functional images, we illustrated that a retrograde degeneration originating from the thalamic paramedian nuclear groups, and extending forward along the direct innervating fibers of the mesothalamic pathway, played an essential role towards initiating Holmes' tremor.
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Affiliation(s)
| | | | - Yu-Chun Lee
- Department of Pediatrics and Child Health Care, Taichung Veterans General Hospital, Taichung
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Defense Medical Center, Taipei, Taiwan
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11
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Kang YJ, Tian G, Bazrafkan A, Farahabadi MH, Azadian M, Abbasi H, Shamaoun BE, Steward O, Akbari Y. Recovery from Coma Post-Cardiac Arrest Is Dependent on the Orexin Pathway. J Neurotrauma 2017; 34:2823-2832. [PMID: 28447885 DOI: 10.1089/neu.2016.4852] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cardiac arrest (CA) affects >550,000 people annually in the United States whereas 80-90% of survivors suffer from a comatose state. Arousal from coma is critical for recovery, but mechanisms of arousal are undefined. Orexin-A, a hypothalamic excitatory neuropeptide, has been linked to arousal deficits in various brain injuries. We investigated the orexinergic system's role in recovery from CA-related neurological impairments, including arousal deficits. Using an asphyxial CA and resuscitation model in rats, we examine neurological recovery post-resuscitation in conjunction with changes in orexin-A levels in cerebrospinal fluid (CSF) and orexin-expressing neurons. We also conduct pharmacological inhibition of orexin post-resuscitation. We show that recovery from neurological deficits begins between 4 and 24 h post-resuscitation, with additional recovery by 72 h post-resuscitation. Orexin-A levels in the CSF are lowest during periods of poorest arousal post-resuscitation (4 h) and recover to control levels by 24 h. Immunostaining revealed that the number of orexin-A immunoreactive neurons declined at 4 h post-resuscitation, but increased to near normal levels by 24 h. There were no significant changes in the number of neurons expressing melanin-concentrating hormone, another neuropeptide localized in similar hypothalamus regions. Last, administration of the dual orexin receptor antagonist, suvorexant, during the initial 24 h post-resuscitation, led to sustained neurological deficits. The orexin pathway is critical during early phases of neurological recovery post-CA. Blocking this early action leads to persistent neurological deficits. This is of considerable clinical interest given that suvorexant recently received U.S. Food and Drug Administration approval for insomnia treatment.
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Affiliation(s)
- Young-Jin Kang
- 1 Department of Neurology, School of Medicine, University of California , Irvine, California
| | - Guilian Tian
- 1 Department of Neurology, School of Medicine, University of California , Irvine, California
| | - Afsheen Bazrafkan
- 1 Department of Neurology, School of Medicine, University of California , Irvine, California
| | - Maryam H Farahabadi
- 1 Department of Neurology, School of Medicine, University of California , Irvine, California
| | - Matine Azadian
- 1 Department of Neurology, School of Medicine, University of California , Irvine, California
| | - Hamidreza Abbasi
- 1 Department of Neurology, School of Medicine, University of California , Irvine, California
| | - Brittany E Shamaoun
- 1 Department of Neurology, School of Medicine, University of California , Irvine, California
| | - Oswald Steward
- 2 Department of Anatomy & Neurobiology, School of Medicine, University of California , Irvine, California.,3 Reeve-Irvine Research Center, School of Medicine, University of California , Irvine, California
| | - Yama Akbari
- 1 Department of Neurology, School of Medicine, University of California , Irvine, California
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