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Agarwal A, Bathla G, Kanekar S. Imaging of Non-atherosclerotic Vasculopathies. J Clin Imaging Sci 2020; 10:62. [PMID: 33194304 PMCID: PMC7656038 DOI: 10.25259/jcis_91_2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/12/2020] [Indexed: 11/09/2022] Open
Abstract
Non-atherosclerotic vasculopathies (NAVs) may present with various neurological symptoms ranging from headache, stroke, visual symptoms, and various types of intracranial hemorrhage. NAVs result from different etiologies which include collagenopathies, immunological, hematological, and infection mechanisms, and other rarer unidentifiable or idiopathic causes. NAV etiologies account for about 10–15% and 20–25% of adult and pediatric stroke cases, respectively, and therefore, diagnosing the underlying cause of NAV becomes clinically very important. Clinical diagnosis of NAV is challenging because the clinical presentation is very non-specific and overlapping with various other central nervous system disorders. Before the advent of non-invasive techniques, making a diagnosis of non-atherosclerotic vasculopathy as a cause of the stroke was very challenging. Today with newer techniques such as high-resolution magnetic resonance (MR), MR and computed tomography perfusion, and angiogram, there are number of pointers which can give us a lead about the non-atherosclerotic causes. Imaging may provide the first lead to the clinician regarding the diagnosis or possible differential diagnosis so that the targeted and focused biomarkers (blood, cerebrospinal fluid, or/and in some cases biopsies) may be obtained to clinch the diagnoses. The purpose of the article is to enumerate the causes, clinical features, and illustrate the imaging findings of the various non-atherosclerotic vasculopathic disorders and discuss “pearls” to their diagnosis. In this article, we have also discussed the latest advances in vascular imaging and elaborated on few uncommon non-atherosclerotic vasculopathies. These are very relevant clinically in the day-to-day practice for the radiologist, neurologist, and the neurointerventionalist.
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Affiliation(s)
- Amit Agarwal
- Department of Radiology, University Texas Southwestern, Dallas, Texas
| | - Girish Bathla
- Department of Radiology, University of Iowa, Iowa City, Iowa
| | - Sangam Kanekar
- Department of Radiology, Penn State Health, Hershey, Pennsylvania, United States
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Ibrahim IK, Medani SH, El-Hameed MMA, Imam MH, Shaaban MMA. Tarsal tunnel syndrome in patients with rheumatoid arthritis, electrophysiological and ultrasound study. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2012.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Ibrahim Khalil Ibrahim
- Physical Medicine, Rheumatology and Rehabilitation , Faculty of Medicine , Alexandria University , Egypt
| | - Sameh Hafez Medani
- Diagnostic Radiology, Faculty of Medicine , Alexandria University , Egypt
| | | | - Mohamed Hassan Imam
- Physical Medicine, Rheumatology and Rehabilitation , Faculty of Medicine , Alexandria University , Egypt
| | - Mohamed Magdy Aly Shaaban
- Physical Medicine, Rheumatology and Rehabilitation , Faculty of Medicine , Alexandria University , Egypt
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Abstract
PURPOSE OF REVIEW Neurologic dysfunction is prevalent in patients with acute and chronic renal disease and may affect the central nervous system, peripheral nervous system, or both. Neurologic manifestations may result directly from the uremic state or as a consequence of renal replacement therapy. Early recognition of neurologic dysfunction may provide opportunities for intervention and reduced morbidity. RECENT FINDINGS Advances in the understanding of neurologic complications of renal disease and its treatments have led to more widespread recognition and earlier identification of encephalopathy syndromes such as cefepime neurotoxicity and posterior reversible encephalopathy syndrome (PRES), dramatic reductions in the incidence of dialysis disequilibrium syndrome and dialysis dementia, and improved survival in disorders such as von Hippel-Lindau disease and thrombotic thrombocytopenic purpura. SUMMARY This article summarizes the conditions that affect both the renal and the nervous systems, the effects of renal failure on the nervous system, and the neurologic complications of dialysis.
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Abstract
CLINICAL/METHODICAL ISSUE Vasculitis is a rare cause of diseases of the central nervous system (CNS). Vasculitis can be divided into primary and secondary forms, of which the vast majority can be manifested in various organ systems, including the CNS. Isolated vasculitis of the CNS is limited to the CNS and clinical neurological symptoms as with the other forms of vasculitis, are headaches, encephalopathy, focal deficits and seizures. A criterion of isolated CNS vasculitis is the clinical and laboratory diagnostic exclusion of other forms of vasculitis and the involvement of other organ systems. STANDARD RADIOLOGICAL METHODS Multiple leaps in the caliber of intracranial arteries in cerebral angiography and multiple, small contrast medium-enhanced lesions in magnetic resonance imaging (MRI) of the brain are typical findings, which, however, can also be found in other forms of vasculitis. PERFORMANCE The only way of proving meningitis is by a biopsy of the brain meninges and parenchyma. It is necessary to make as accurate a diagnosis as possible, especially in the context of therapeutic options of immunosuppression with steroids and cyclophosphamide. ACHIEVEMENTS Cerebral vasculitis is a rare entity but it is an important diagnosis to consider when the appropriate clinical symptoms are present. Thorough laboratory diagnostics and subsequent brain biopsy are necessary to confirm the diagnosis in order to then be able to initiate a specific treatment.
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Affiliation(s)
- W Reith
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland.
| | - C Kraus
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland
| | - N Harsch
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland
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de Jong HJI, Kingwell E, Shirani A, Cohen Tervaert JW, Hupperts R, Zhao Y, Zhu F, Evans C, van der Kop ML, Traboulsee A, Gustafson P, Petkau J, Marrie RA, Tremlett H. Evaluating the safety of β-interferons in MS: A series of nested case-control studies. Neurology 2017; 88:2310-2320. [PMID: 28500224 PMCID: PMC5567323 DOI: 10.1212/wnl.0000000000004037] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/21/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To examine the association between interferon-β (IFN-β) and potential adverse events using population-based health administrative data in British Columbia, Canada. METHODS Patients with relapsing-remitting multiple sclerosis (RRMS) who were registered at a British Columbia Multiple Sclerosis Clinic (1995-2004) were eligible for inclusion and were followed up until death, absence from British Columbia, exposure to a non-IFN-β disease-modifying drug, or December 31, 2008. Incidence rates were estimated for each potential adverse event (selected a priori and defined with ICD-9/10 diagnosis codes from physician and hospital claims). A nested case-control study was conducted to assess the odds of previous IFN-β exposure for each potential adverse event with at least 30 cases. Cases were matched by age (±5 years), sex, and year of cohort entry, with up to 20 randomly selected (by incidence density sampling) controls. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were estimated with conditional logistic regression adjusted for age at cohort entry. RESULTS Of the 2,485 eligible patients, 77.9% were women, and 1,031 were treated with IFN-β during follow-up. From the incidence analyses, 27 of the 47 potential adverse events had at least 30 cases. Patients with incident stroke (ORadj 1.83, 95% CI 1.16-2.89), migraine (ORadj 1.55, 95% CI 1.18-2.04), depression (ORadj 1.33, 95% CI 1.13-1.56), and hematologic abnormalities (ORadj 1.32, 95% CI 1.01-1.72) were more likely to have previous exposure to IFN-β than controls. CONCLUSIONS Among patients with RRMS, IFN-β was associated with a 1.8- and 1.6-fold increase in the risk of stroke and migraine and 1.3-fold increases in depression and hematologic abnormalities.
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Affiliation(s)
- Hilda J I de Jong
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Elaine Kingwell
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Afsaneh Shirani
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jan Willem Cohen Tervaert
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Raymond Hupperts
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Yinshan Zhao
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Feng Zhu
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Charity Evans
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Mia L van der Kop
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Anthony Traboulsee
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Paul Gustafson
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John Petkau
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Helen Tremlett
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
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Niu L, Wang L, Yin X, Li XF, Wang F. Role of magnetic resonance imaging in the diagnosis of primary central nervous system angiitis. Exp Ther Med 2017; 14:555-560. [PMID: 28672966 PMCID: PMC5488425 DOI: 10.3892/etm.2017.4572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 03/24/2017] [Indexed: 11/06/2022] Open
Abstract
The present study reported on the use of magnetic resonance imaging (MRI) in the diagnosis of primary angiitis of the central nervous system (PACNS). A total of 19 consecutive patients with a clinical diagnosis of PACNS confirmed by clinical follow-up were enrolled in the present study. All patients underwent unenhanced and enhanced MRI prior to and after steroids or steroids plus immunosuppressive therapy. At baseline, all patients showed lesions on MRI in the grey and white matter. Lesions presented as slightly hypointense on T1-weighted images (T1WI), slightly hyperintense on T2WI, hyperintense on fluid-attenuated inversion recovery, iso- or slightly hyperintense on diffusion-weighted images (DWI) and hyperintense on apparent diffusion coefficient (ADC) mapping. After contrast injection, the lesions showed patchy, cord-like or goral enhancement. Seven cases had unilateral lesions and the other 12 cases had bilateral lesions. On all sequences, indistinct margins characterised most of the lesions, and certain lesions were oedematous. Treatment with steroids or steroids plus immunosuppressive agents resulted in improvement or disappearance of symptoms, and seventeen patients had evidently improved according to MRI. In conclusion, PACNS has unique characteristics on MRI; DWI, ADC mapping and enhanced images are of great importance for the diagnosis and clinical management of early-stage PACNS.
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Affiliation(s)
- Lei Niu
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China.,Department of Radiology, Suqian City People's Hospital, Nanjing Drum Tower Hospital Group, Suqian, Jiangsu 223800, P.R. China
| | - Liwei Wang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Xiao-Feng Li
- Department of Diagnostic Radiology, University of Louisville, Louisville, KY 40202, USA
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
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Kulshreshtha D, Malhotra KP, Maurya PK, Singh AK, Thacker AK, Husain N. Nerve biopsy in Indian patients with mononeuropathy multiplex of undetermined etiology. Muscle Nerve 2016; 55:23-27. [DOI: 10.1002/mus.25179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 04/26/2016] [Accepted: 05/05/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Dinkar Kulshreshtha
- Department of Neurology Dr Ram Manohar Lohia Institute of Medical SciencesVibhuti KhandGomtinagar, Lucknow Uttar Pradesh226010 India
| | - Kiran Preet Malhotra
- Department of PathologyDr Ram Manohar Lohia Institute of Medical SciencesGomtinagar, Lucknow Uttar Pradesh India
| | - Pradeep Kumar Maurya
- Department of Neurology Dr Ram Manohar Lohia Institute of Medical SciencesVibhuti KhandGomtinagar, Lucknow Uttar Pradesh226010 India
| | - Ajai Kumar Singh
- Department of Neurology Dr Ram Manohar Lohia Institute of Medical SciencesVibhuti KhandGomtinagar, Lucknow Uttar Pradesh226010 India
| | - Anup Kumar Thacker
- Department of Neurology Dr Ram Manohar Lohia Institute of Medical SciencesVibhuti KhandGomtinagar, Lucknow Uttar Pradesh226010 India
| | - Nuzhat Husain
- Department of PathologyDr Ram Manohar Lohia Institute of Medical SciencesGomtinagar, Lucknow Uttar Pradesh India
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El-Moghazi Sultan H, El-Latef GA, El-Ghani HMA, El-Moez Heiba DA, Abdalla DM. Clinical and electrophysiological study of peripheral and central neuromuscular changes in connective tissue diseases in children. THE EGYPTIAN RHEUMATOLOGIST 2016; 38:233-239. [DOI: 10.1016/j.ejr.2015.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Magaki S, Gardner T, Khanlou N, Yong WH, Salamon N, Vinters HV. Brain biopsy in neurologic decline of unknown etiology. Hum Pathol 2015; 46:499-506. [PMID: 25661242 PMCID: PMC4380782 DOI: 10.1016/j.humpath.2014.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 12/11/2014] [Accepted: 12/18/2014] [Indexed: 11/21/2022]
Abstract
Brain biopsies have an uncertain role in the diagnosis of patients with dementia or neurologic decline of unknown etiology. They are often performed only after an exhaustive panel of less invasive tests and procedures have failed to provide a definitive diagnosis. The objective of this study was to evaluate the sensitivity of brain biopsies in this patient group through the retrospective analysis of 53 brain biopsies performed for neurologic disease of unknown etiology at a single tertiary care institution between December 2001 and December 2011. Patients with known nonlymphomatous neoplasms thought to be associated with the neurologic symptoms or with immunodeficiency were excluded from the study. Furthermore, the clinical presentation, imaging and laboratory tests were compared between diagnostic groups to identify factors more likely to yield a diagnosis. Sixty percent of the biopsies were diagnostic (32 of 53), with the most common histologic diagnosis of central nervous system lymphoma in 14 of 53 patients (26% of total) followed by infarct in four subjects (7.5%). A few patients were found to have rare and unsuspected diseases such as lymphomatosis cerebri, neurosarcoidosis and neuroaxonal leukodystrophy. Complications from biopsy were uncommon and included hemorrhage and infection with abscess formation at the biopsy site. These results suggest that brain biopsies may be useful in difficult cases in which less invasive measures have been unable to yield a definitive diagnosis.
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Affiliation(s)
- Shino Magaki
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, University of California, Los Angeles (UCLA) Medical Center, Los Angeles, CA 90095-1732, USA.
| | - Tracie Gardner
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, University of California, Los Angeles (UCLA) Medical Center, Los Angeles, CA 90095-1732, USA
| | - Negar Khanlou
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, University of California, Los Angeles (UCLA) Medical Center, Los Angeles, CA 90095-1732, USA
| | - William H Yong
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, University of California, Los Angeles (UCLA) Medical Center, Los Angeles, CA 90095-1732, USA
| | - Noriko Salamon
- Department of Radiological Sciences, University of California, Los Angeles (UCLA) Medical Center, Los Angeles, CA 90095-1732, USA
| | - Harry V Vinters
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, University of California, Los Angeles (UCLA) Medical Center, Los Angeles, CA 90095-1732, USA; Department of Neurology, University of California, Los Angeles (UCLA) Medical Center, Los Angeles, CA 90095-1732, USA; Brain Research Institute, David Geffen School of Medicine at University of California, Los Angeles (UCLA) Medical Center, Los Angeles, CA 90095-1732, USA
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Abstract
Rheumatologic diseases encompass autoimmune and inflammatory disorders of the joints and soft tissues that often involve multiple organ systems, including the central and peripheral nervous systems. Common features include constitutional symptoms, arthralgia and arthritis, myalgia, and sicca symptoms. Neurological manifestations may present in patients with preexisting rheumatologic diagnoses, occur concurrently with systemic signs and symptoms, or precede systemic manifestations by months to years. Rheumatic disorders presenting as neurological syndromes may pose diagnostic challenges. Advances in immunosuppressive treatment of rheumatologic disease have expanded the treatment armamentarium. However, serious neurotoxic effects have been reported with both old and newer agents. Familiarity with neurological manifestations of rheumatologic diseases, diagnosis, and potential nervous system consequences of treatment is important for rapid diagnosis and appropriate intervention. This article briefly reviews the diverse neurological manifestations and key clinical features of rheumatic disorders and the potential neurological complications of agents commonly used for treatment.
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Rafay MF, Sutcliffe TL, Shroff M, Hawkins C, Weiss S, Benseler SM, deVeber G. Primary Central Nervous System Angiitis in a 10-year-old Girl. Can J Neurol Sci 2014; 32:243-5. [PMID: 16018162 DOI: 10.1017/s0317167100004042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary angiitis of central nervous system (PACNS) is well reported, however its occurrence in the pediatric population is infrequent. We describe the clinical, neuroimaging and histopathological features of PACNS in a young girl.A ten year-old, previously healthy girl presented with a threeweek history of progressive left hemiparesis and facial weakness. Other findings included left hemineglect, impaired concentration and memory. She had no evidence of systemic disease. Head computed tomography (CT), with and without contrast, revealed no abnormalities. Magnetic resonance imaging (MRI) demonstrated multifocal, bilateral signal abnormalities within basal ganglia, thalami, right frontal cortex and subcortical white matter on T2 and FLAIR images. However, these areas did not show restricted diffusion on diffusion weighted imaging (DWI). Cerebral angiography revealed normal intracranial vessels (Figure 1). Neuroimaging, three weeks later,
showed progression of these abnormalities. The areas of abnormal signal showed heterogeneous and nodular enhancement on gadolinium enhanced T1 weighted images
(Figure 2). Rheumatologic, metabolic, prothrombotic and cerebral spinal fluid investigations were normal.
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Affiliation(s)
- Mubeen F Rafay
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
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12
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Abstract
The noninfectious, inflammatory vasculitides include giant cell arteritis, Takayasu disease, Churg-Strauss angiitis, Wegener disease, polyarteritis nodosa, microscopic polyangiitis, Buerger disease, amyloid-β-related angiitis, and isolated vasculitis of the central nervous system. While these disorders are relatively uncommon, they produce a variety of neurologic diseases including muscle disease, mononeuropathy multiplex, polyneuropathy, cranial nerve palsies, visual loss, seizures, an encephalopathy, venous thrombosis, ischemic stroke, and intracranial hemorrhage. The multisystem vasculitides often have stereotypical clinical findings that reflect disease of the kidney, sinuses, lungs, skin, joints, or cardiovascular system. These disorders also usually have abnormalities found on serologic testing. Isolated vasculitis of the central nervous system is more difficult to diagnose because the clinical and brain imaging findings are relatively nonspecific. Examination of the cerebrospinal fluid will demonstrate changes consistent with an inflammatory process. Arteriography often shows areas of segmental narrowing affecting multiple intracranial vessels and brain/meningeal biopsy may be required to establish the diagnosis. Management of patients with a multisystem vasculitis or isolated vasculitis of the central nervous system is centered on the administration of immunosuppressive agents. In many cases, corticosteroids remain the mainstay of medical treatment.
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Affiliation(s)
- Harold P Adams
- Division of Cerebrovascular Diseases, Department of Neurology, Carver College of Medicine, University of Iowa Health Care Stroke Center, University of Iowa, Iowa City, IA, USA.
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13
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14
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The destructive capacity of drug abuse: an overview exploring the harmful potential of drug abuse both to the individual and to society. ISRN ADDICTION 2013; 2013:450348. [PMID: 25938116 PMCID: PMC4392977 DOI: 10.1155/2013/450348] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 06/06/2013] [Indexed: 12/11/2022]
Abstract
From a public health perspective, substance abuse has long been a source of major concern, both for the individual's health and for wider society as a whole. The UK has the highest rates of recorded illegal drug misuse in the western world. In particular, it has comparatively high rates of heroin and crack cocaine use. Substances that are considered harmful are strictly regulated according to a classification system that takes into account the harms and risks of taking each drug (see the tables) (Nutt et al. (2007)). The adverse effects of drug abuse can be thought of in three parts that together determine the overall harm in taking it: (1) the direct physical harm of the substance to the individual user, (2) the tendency of the drug to induce dependence, and (3) the effect of abuse of the drug on families, communities, and society (Gable (2004, 1993)). In this report, we discuss published evidence relating to the harm of substance misuse and consider the neuropsychopharmacological mechanisms behind addiction in an attempt to gain an improved picture of the potential devastation that abuse of these substances may evoke.
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15
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Tkaczyk ER. Reversible Leukoencephalopathy—A Differential Diagnosis Beyond Posterior Reversible Encephalopathy Syndrome. Neuroophthalmology 2012. [DOI: 10.3109/01658107.2012.702293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Jarius S, Jacobi C, de Seze J, Zephir H, Paul F, Franciotta D, Rommer P, Mader S, Kleiter I, Reindl M, Akman-Demir G, Seifert-Held T, Kristoferitsch W, Melms A, Wandinger KP, Wildemann B. Frequency and syndrome specificity of antibodies to aquaporin-4 in neurological patients with rheumatic disorders. Mult Scler 2011; 17:1067-73. [DOI: 10.1177/1352458511403958] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: A new autoantibody (termed NMO-IgG, or AQP4-Ab) has recently been described in patients with neuromyelitis optica (NMO) and its formes frustes, longitudinally extensive transverse myelitis (LETM) and recurrent optic neuritis (rON). However, AQP4-Ab has been found also in patients with co-existing rheumatic diseases such as systemic lupus erythematosus (SLE) or Sjögren’s syndrome (SS), conditions which are characterized by broad, polyspecific B cell activation. Objectives: In this study, we aimed at evaluating the syndrome specificity and frequency of AQP4-Ab in patients with rheumatic diseases and neurological symptoms. Methods: For this purpose, serum samples from 109 neurological patients with established connective tissue disorders (CTD) ( n = 54), possible CTD ( n = 42), or vasculitis ( n = 13) were analysed for the presence of AQP4-Ab by a cell-based assay employing recombinant human AQP4. Results: AQP4-Ab was detectable in 31/40 (78%) patients with CTD and NMO spectrum disorders (median titre, 1:1000) but in none of the samples obtained from patients with CTD or vasculitis and neurological disorders other than NMO, LETM, or rON ( n = 69). Conclusion: The high syndrome specificity of the antibody for neuromyelitis optica spectrum disorders (NMOSDs) in patients with CTD supports the concept of AQP4-Ab being involved in the pathogenesis of these neurological conditions, and argues against AQP4-Ab simply being part of the polyclonal B cell activation generally associated with rheumatic diseases. Moreover, the finding that AQP4-Ab is present in patients with CTD and co-existing NMOSD with approximately the same frequency as in patients without CTD strengthens the case of CTD and AQP4-Ab positive NMOSD representing two co-existing yet distinct entities in the majority of patients.
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Affiliation(s)
- Sven Jarius
- Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Christian Jacobi
- Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Jerome de Seze
- Clinique Neurologique, CHU de Strasbourg, Strasbourg, France
| | - Helene Zephir
- Pôle Neurologique, Hôpital Roger Salengro, CHRU de Lille, Lille, France
- Laboratoire d’Immunologie, Université Lille Nord de France, Lille, France
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité – University Medicine Berlin, Berlin, Germany
| | - Diego Franciotta
- IRCCS, National Neurological Institute ‘C. Mondino’, Pavia, Italy
| | - Paulus Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Simone Mader
- Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Ingo Kleiter
- Department of Neurology, University Medical Centre Regensburg, Regensburg, Germany
| | - Markus Reindl
- Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | | | | | | | - Arthur Melms
- Department of Neurology, University of Tuebingen, Tuebingen, Germany
| | - Klaus-Peter Wandinger
- Institute for Experimental Immunology, affiliated to Euroimmun, Luebeck, Germany
- Institute for Neuroimmunology and Clinical MS Research, University Medical Center Eppendorf, Hamburg, Germany
| | - Brigitte Wildemann
- Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Heidelberg, Germany
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17
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De Tiège X, Van Bogaert P, Aeby A, Salmon I, Parpal H, Poppe AY, Maris C, Lanthier S. Primary angiitis of the central nervous system: neurologic deterioration despite treatment. Pediatrics 2011; 127:e1086-90. [PMID: 21402640 DOI: 10.1542/peds.2009-2729] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Primary angiitis of the central nervous system (PACNS) is an idiopathic vasculitis confined to the central nervous system. In children with PACNS, small-vessel (SV) involvement is characterized clinically by progressive neurologic symptoms, multifocal lesions on brain imaging, occasional pseudo-tumor presentation, and normal angiogram results in most patients. Small case series of patients with SV PACNS with short follow-up usually reveal favorable outcomes in children treated with immunosuppressive therapy. We report here the cases of 3 children with biopsy-confirmed SV PACNS and long-term follow-up who developed different patterns of neurologic deterioration despite immunosuppressive therapy. One patient had transient ischemic attacks shortly after initiation of corticosteroid treatment. Early ischemic events probably result from residual thrombogenicity or residual inflammation of recently affected vessels, which supports the use of antiplatelet agents and suggests potential benefits of stronger immunosuppressive therapy. In contrast, the other 2 patients had later neurologic deterioration after corticosteroid withdrawal, which suggests failure of initial immunosuppressant treatment and the need for stronger agents, longer treatment duration, or both. All patients responded to long-term treatment with corticosteroids combined with cytotoxic agents. This particular combination is probably indicated in many cases of SV PACNS, including those with neurologic deterioration that occurs during maintenance corticotherapy or after corticosteroid withdrawal. In 1 case, SV PACNS recurred several years after discontinuation of combination therapy. Long-term relapses may reflect intrinsic predispositions to SV PACNS rather than treatment failure. These cases highlight different chronological patterns of neurologic deterioration despite immunosuppressive therapy, which supports the relevance of monitoring clinical, laboratory, and radiologic responses to treatment and of long-term follow-up of patients with SV PACNS.
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Affiliation(s)
- Xavier De Tiège
- Department of Pediatric Neurology, Hôpital Erasme and Université Libre de Bruxelles, Brussels, Belgium
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18
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Nicolosi G, Donia MG, Tripi E, Rinollo C. Disturbo psichiatrico e LES: un grave crimine LES correlato. ITALIAN JOURNAL OF MEDICINE 2010. [DOI: 10.1016/j.itjm.2010.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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19
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White ML, Zhang Y. Primary angiitis of the central nervous system: apparent diffusion coefficient lesion analysis. Clin Imaging 2010; 34:1-6. [PMID: 20122512 DOI: 10.1016/j.clinimag.2009.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Accepted: 03/24/2009] [Indexed: 10/20/2022]
Abstract
Apparent diffusion coefficients (ADCs) of the brain lesions in primary angiitis of the central nervous system (PACNS) patients were analyzed in this study. The mean ADC ratios for acute/subacute phase lesions were significantly lower than that for chronic phase lesions. However, some acute/subacute phase lesions had elevated ADCs and these lesions disappeared overtime, implicating a nonischemic mechanism in PACNS.
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Affiliation(s)
- Matthew L White
- Department of Radiology, University of Nebraska Medical Center, Omaha, NE, USA.
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20
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Jacobi C, Lenhard T, Meyding-Lamadé U. [Vasculitis of the nervous system in infectious diseases]. DER NERVENARZT 2010; 81:172-80. [PMID: 20101491 DOI: 10.1007/s00115-009-2896-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Vasculitis and vasculopathies of the central and peripheral nervous system can be caused by infectious diseases. Vasculitis can lead to stenosis, occlusion and aneurysm formation of blood vessels which may result in stroke or cerebral haemorrhage. In cases of peripheral nervous system involvement mononeuritis multiplex and symmetric peripheral neuropathy are possible. The diagnosis is based on clinical presentation, serology, cerebrospinal fluid analysis and neuroradiologic examinations. In cases of peripheral neuropathy neurophysiologic examinations and biopsy of the sural nerve can lead to the diagnosis. A fast and efficient antimicrobial therapy is the most important treatment option. In cases of peripheral neuropathies short-term treatment with corticosteroids and plasma exchange may be helpful.
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Affiliation(s)
- C Jacobi
- Neurologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, Heidelberg, Germany.
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21
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Murakami M, Ikeda Y, Haraoka J. Cerebellar Infarction Caused by Primary Central Nervous System Angiitis of Childhood: Case Report. J Stroke Cerebrovasc Dis 2010; 19:77-80. [DOI: 10.1016/j.jstrokecerebrovasdis.2009.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Revised: 11/06/2007] [Accepted: 01/09/2008] [Indexed: 10/20/2022] Open
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22
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Abstract
Vascular dementia is a common cause of late-life cognitive decline. Vascular risk factors, transient ischemic attacks, silent and clinically evident strokes, and ischemic changes on brain imaging studies are all associated with the development of dementia. Prevention of vascular dementia involves treatment of risk factors and the same preventive measures used to avoid heart attacks and strokes. Other treatments for vascular dementia, although promising, remain unproved.
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23
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Immunomodulatory Therapies in Neurologic Critical Care. Neurocrit Care 2009; 12:132-43. [DOI: 10.1007/s12028-009-9274-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Accepted: 08/28/2009] [Indexed: 10/20/2022]
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24
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Solis OE, Mehta RI, Kalanithi S, Bordelon Y, Salamon N, Yong WH, Vinters HV. Primary angiitis of the CNS (PACNS) with predominant cranial neuropathy and spinal cord involvement. Neuropathology 2009; 30:267-72. [PMID: 19751245 DOI: 10.1111/j.1440-1789.2009.01055.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We describe a 70-year old man with a history of repeated epidural injections for chronic low back pain, presenting with headache, cranial nerve palsies and progressive myelopathy. Meningeal enhancement was initially seen in the posterior epidural space of the T(10)-T(12) spine on MRI. Extensive laboratory investigation showed normal or negative results except for persistent pleocytosis, elevated protein and absence of demonstrable microorganisms on CSF studies. Despite conventional and empirical treatments, the patient developed progressive neurological deterioration leading to death. Autopsy showed Primary angiitis of the CNS (PACNS) with predominant cranial neuropathy, spinal cord involvement and extensive myelomalacia.
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Affiliation(s)
- Orestes E Solis
- Department of Pathology and Laboratory Medicine, Section of Neuropathology, University of California, Los Angeles, California, USA.
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25
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Kluger N, Guilpain P, Varlet P, De Menthon M, Pagnoux C, Mouthon L, Guillevin L. Hématome frontal révélant une vascularite primitive du système nerveux central. Presse Med 2009; 38:844-6. [DOI: 10.1016/j.lpm.2008.09.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 09/15/2008] [Indexed: 11/30/2022] Open
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26
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Berlit P. Isolated angiitis of the CNS and bacterial endocarditis: similarities and differences. J Neurol 2009; 256:792-5. [PMID: 19363637 DOI: 10.1007/s00415-009-5018-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Revised: 12/09/2008] [Accepted: 12/17/2008] [Indexed: 11/25/2022]
Abstract
Both isolated angiitis of the central nervous system (IAN) and bacterial endocarditis (BE) may present with similar clinical and auxiliary findings. The differentiation is extremely important because of the different treatment regimens. We compared the findings of six patients with biopsy-proven IAN with the data of six patients with BE. Patients with IAN were younger (27-62 years) and presented with multiple strokes (n = 4), intracerebral hemorrhage (n = 1), epileptic seizures (n = 2), or encephalopathy (n = 1). All IAN patients had pathologic cerebrospinal fluid (CSF) findings (pleocytosis n = 5; protein elevation n = 4), and angiography revealed multilocular stenoses in two cases while digital subtraction angiography was normal in four. BE patients (32-77 years) presented multiple (n = 3) or single ischemic strokes (n = 2) or encephalopathy and headache (n = 2). While all patients showed inflammatory serum findings (C-reactive protein n = 6, leucocytosis n = 4), CSF-pleocytosis was present in two cases only. Angiography revealed a vasculitic pattern in two patients. The diagnosis of BE was established based on transesophageal echocardiography and blood cultures. Leptomeningeal and brain biopsies performed in two cases were normal. Both IAN and BE may present multiple strokes and encephalopathy. The frequency of a vasculitic pattern in angiography is similar in both conditions. While inflammatory serum findings are the rule in BE, pathologic CSF findings were present in all IAN patients. Transesophageal echocardiography and blood cultures should be performed in order to diagnose or exclude BE. Without brain biopsy, immunosuppressive therapy may be dangerous in suspected IAN.
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Affiliation(s)
- Peter Berlit
- Department of Neurology, Alfried Krupp Hospital, 21 Alfried Krupp Str, Essen 45133, Germany.
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27
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Sherlock Holmes in the ER (the case of red and the head). Surv Ophthalmol 2009; 54:128-34. [PMID: 19171214 DOI: 10.1016/j.survophthal.2008.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A 58-year-old woman presented with a problem with her peripheral vision. Computed tomography scan showed an occipital hemorrhagic stroke. She subsequently suffered gastrointestinal bleeding and at surgery biopsy of a portion of the middle colic artery aneurysm revealed changes consistent with polyarteritis nodosa.
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28
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Yin Z, Li X, Fang Y, Luo B, Zhang A. Primary angiitis of the central nervous system: report of eight cases from Southern China. Eur J Neurol 2009; 16:63-9. [DOI: 10.1111/j.1468-1331.2008.02344.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Refai D, Botros JA, Strom RG, Derdeyn CP, Sharma A, Zipfel GJ. Spontaneous isolated convexity subarachnoid hemorrhage: presentation, radiological findings, differential diagnosis, and clinical course. J Neurosurg 2008; 109:1034-41. [DOI: 10.3171/jns.2008.109.12.1034] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Object
The clinical characteristics and overall outcome in patients with spontaneous isolated convexity subarachnoid hemorrhage (SAH) are not well described in the literature. The purpose of this study was to examine the mode of presentation, common origins, radiographic findings, and clinical course in a large case series of such patients.
Methods
A retrospective single-center chart review of all patients in whom nontraumatic primary convexity SAH was diagnosed between 2002 and 2007 was performed. Twenty patients were identified and analyzed for presenting symptoms, radiological and laboratory findings, hospital course, and outcome.
Results
There were 15 women and 5 men in our series, and the mean age was 52 years (range 18–86 years). The most common presenting symptom was headache, with 15 patients experiencing it as a chief complaint. Other frequent manifestations included altered mental status (8 patients), focal neurological deficits (7), and seizure (4 patients). An underlying cause of the hemorrhage was identified in 13 cases, whereas the remainder went unresolved. Of the known causes, 5 were due to posterior reversible encephalopathy syndrome, 3 were caused by thrombocytopenia or anticoagulation, and the remainder were isolated cases of lupus vasculitis, drug-induced vasculopathy, postpartum cerebral angiopathy, hypertensive microangiopathy, and Call–Fleming syndrome. All patients with unknown disease origins had favorable outcomes, whereas 8 of 13 patients with an identifiable underlying disorder experienced favorable outcomes.
Conclusions
Spontaneous isolated convexity SAH is rarely caused by aneurysm rupture, has a distinct mode of presentation, and generally carries a more favorable prognosis than that of aneurysmal SAH.
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Affiliation(s)
| | | | | | - Colin P. Derdeyn
- 1Department of Neurosurgery,
- 2Mallinckrodt Institute of Radiology, and
- 3Department of Neurology, Washington University School of Medicine, Saint Louis, Missouri
| | | | - Gregory J. Zipfel
- 1Department of Neurosurgery,
- 3Department of Neurology, Washington University School of Medicine, Saint Louis, Missouri
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Abstract
In contrast with more common dementing conditions that typically develop over years, rapidly progressive dementias can develop subacutely over months, weeks, or even days and be quickly fatal. Because many rapidly progressive dementias are treatable, it is paramount to evaluate and diagnose these patients quickly. This review summarizes recent advances in the understanding of the major categories of RPD and outlines efficient approaches to the diagnosis of the various neurodegenerative, toxic-metabolic, infectious, autoimmune, neoplastic, and other conditions that may progress rapidly.
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Affiliation(s)
- Michael D Geschwind
- University of California San Francisco Memory & Aging Center, Department of Neurology, San Francisco, CA 94143-1207, USA.
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31
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Abstract
Central nervous system (CNS) vasculitis is a rare entity, especially when it occurs in isolation; it is seen more commonly as part of a multisystem vasculitis. Common presenting symptoms include persistent headache, encephalopathy, and multifocal signs. We discuss the case of a 68-year-old female who presented twice in 1 month with confusion and choreaform movements. Extensive workup was negative for a connective tissue disease or other conditions in the differential, including neurosarcoidosis, Creutzfeldt-Jakob disease, and neurosyphilis. The only significant findings were elevated erythrocyte sedimentation rate, inflammatory signs in the CNS, and diffuse slowing of the electroencephalogram. A presumptive diagnosis of isolated angiitis of the central nervous system (IACNS) was made and the patient was successfully treated with steroids. She recovered fully with no residual symptoms. The diagnosis of IACNS is often difficult given there are no definitive laboratory investigations or pathognomonic presentation. However, a series of signs, symptoms, and laboratory findings have been proposed that are helpful in making the diagnosis. To our knowledge, IACNS presenting primarily with delirium has not been previously reported in the literature. The diagnosis of IACNS is purely speculative for this case, as the gold standard for diagnosis, a leptomeningeal cortical biopsy, was not performed.
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32
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Abstract
Rapidly progressive dementias (RPDs) are neurologic conditions that develop subacutely over weeks to months or, rarely, acutely over days. In contrast to most dementing conditions that take years to progress to death, RPD quickly can be fatal. It is critical to evaluate patients who have RPD without delay, usually in a hospital setting, as they may have a treatable condition. This review discusses a differential diagnostic approach to RPD, emphasizing neurodegenerative, toxic and metabolic, infectious, autoimmune, neoplastic, and other conditions to consider.
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Affiliation(s)
- Michael D Geschwind
- Department of Neurology, Memory & Aging Center, University of California, San Francisco Medical Center, San Francisco, CA 94117, USA.
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Abstract
Since vasculitic neuropathy is treatable and potentially debilitating, clinicians should develop an approach to neuropathy that increases the likelihood of uncovering existing systemic or nonsystemic vasculitis. The presence of a connective tissue disease, systemic vasculitis, asymmetric or non--length-dependent axonal polyneuropathy, or multiple axonal mononeuropathies should heighten suspicion, but vasculitic neuropathy can also present as a distal symmetric polyneuropathy with or without other organ involvement. Electrodiagnostic testing utilizing extensive nerve conductions may be helpful in identifying features suggestive of vasculitic neuropathy and in selecting an abnormal nerve and muscle for biopsy confirmation. An array of laboratory tests may lead to identification of a systemic disorder that is either characterized by or predisposes to vasculitic neuropathy. The mainstays of treatment are corticosteroids and cyclophosphamide, but other drugs are used in specific conditions. With early diagnosis and careful monitoring of treatment regimens, the prognosis is usually good.
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Affiliation(s)
- David Lacomis
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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34
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Prasad K, Bhatia R. Rheumatoid neuropathy. INDIAN JOURNAL OF RHEUMATOLOGY 2007. [DOI: 10.1016/s0973-3698(10)60036-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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35
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Nagel MA, Forghani B, Mahalingam R, Wellish MC, Cohrs RJ, Russman AN, Katzan I, Lin R, Gardner CJ, Gilden DH. The value of detecting anti-VZV IgG antibody in CSF to diagnose VZV vasculopathy. Neurology 2007; 68:1069-73. [PMID: 17287447 DOI: 10.1212/01.wnl.0000258549.13334.16] [Citation(s) in RCA: 184] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Factors that may obscure the diagnosis of varicella zoster virus (VZV) vasculopathy include the absence of rash before TIAs or stroke as well as similar clinical features and imaging, angiographic, and CSF abnormalities to those of other vasculopathies. Diagnosis relies on virologic confirmation that detects VZV DNA, anti-VZV IgG antibody, or both in the CSF. METHODS We reviewed our current 14 cases of patients diagnosed with VZV vasculopathy based on combined clinical, imaging, angiographic, or CSF abnormalities. All CSFs must have been tested for VZV DNA by PCR and for anti-VZV IgG antibody by enzyme immunoassay and found to be positive for either or both. Of the 14 subjects, 8 had a history of recent zoster, whereas 6 had no history of zoster rash before developing vasculopathy. RESULTS All 14 subjects (100%) had anti-VZV IgG antibody in their CSF, whereas only 4 (28%) had VZV DNA. The detection of anti-VZV IgG antibody in CSF was a more sensitive indicator of VZV vasculopathy than detection of VZV DNA (p < 0.001). CONCLUSIONS In varicella zoster virus (VZV) vasculopathy, the diagnostic value of detecting anti-VZV IgG antibody in CSF is greater than that of detecting VZV DNA. Although a positive PCR for VZV DNA in CSF is helpful, a negative PCR does not exclude the diagnosis of VZV vasculopathy. Only when the CSF is negative for both VZV DNA and anti-VZV IgG antibody can the diagnosis of VZV vasculopathy be excluded.
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Affiliation(s)
- M A Nagel
- Department of Neurology, University of Colorado Health Sciences Center, Denver, CO 80262, USA
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36
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Abstract
The classification of vasculitis and the clinical features of vasculitic neuropathy are reviewed. Vasculitic neuropathy usually presents with painful mononeuropathies or an asymmetric polyneuropathy of acute or subacute onset. Neurologists should categorize vasculitic neuropathy in terms of clinical features (eg, systemic or non systemic) and in terms of histopathology (eg, nerve large arteriole vasculitis or nerve microvasculitis). Systemic vasculitis should be classified further into one of the primary and secondary forms. Steroids and cytotoxic agents have been the mainstay of therapy for most forms of vasculitic neuropathy. Dosing, potential side effects, and management recommendations of conventional therapies are provided.
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Affiliation(s)
- Ted M Burns
- Department of Neurology, University of Virginia, Charlottesville, VA 22908, USA
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Jaradeh SS. Neurological Manifestations of Vasculitis. Neurobiol Dis 2007. [DOI: 10.1016/b978-012088592-3/50084-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Aviv RI, Benseler SM, DeVeber G, Silverman ED, Tyrrell PN, Tsang LM, Armstrong D. Angiography of primary central nervous system angiitis of childhood: conventional angiography versus magnetic resonance angiography at presentation. AJNR Am J Neuroradiol 2007; 28:9-15. [PMID: 17213414 PMCID: PMC8134080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND PURPOSE To systematically analyze conventional angiographic (CA) features of children with primary central nervous system angiitis (cPACNS), to compare and correlate CA and MR angiography (MRA) lesion characteristics, and to define the sensitivity and specificity of MRA with CA as a reference standard. METHODS A retrospective, single-center cohort study of consecutive patients with cPACNS was performed. Patients with CA and MRA studies at diagnosis were included. Imaging studies were blindly reviewed by 2 neuroradiologists using a standard analysis protocol. CA and MRA studies were compared using nonparametric analysis. RESULTS Of 45 patients with MRA at diagnosis, there were 25 for whom CA and MRA studies were performed within 1 month of each other. These comprised the study group. The CA distribution of lesions was multifocal (76%) and proximal (86%) (P < .05) with a trend toward unilaterality (P = .06) with anterior circulation involvement (P = .08). The sensitivity and specificity of MRA for CA abnormality was 70% and 98%, respectively. There was no significant difference between MRA and CA for lesion detection or characterization (P = .87), and the modalities showed a fair correlation (kappa = 0.4). CONCLUSION Angiographic lesions are multifocal and occur proximally and unilaterally within the anterior circulation. There is no significant difference in the ability of MRA to detect and characterize lesions when compared with CA.
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Affiliation(s)
- R I Aviv
- Division of Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada.
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Wylie J, Campbell C, Pope J, Akikusa J, Laxer RM, Nicolle D. Convergence paralysis as a manifestation of polyarteritis nodosa. Can J Neurol Sci 2006; 33:423-5. [PMID: 17168172 DOI: 10.1017/s0317167100005424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Polyarteritis nodosa (PAN) is a rare, systemic necrotizing vasculitis of medium-sized arteries. The American College of Rheumatology criteria for the diagnosis of PAN includes at least three of: 1. weight loss < 4 kg, 2. livedo reticularis, 3. testicular pain or tenderness, 4. myalgias, weakness or leg tenderness, 5. mono-or polyneuropathy, 6. diastolic hypertension, 7. elevated blood creatinine or urea, 8. hepatitis B antigen or antibody in the serum, 9. aneurysms or occlusions of visceral arteries or 10. granulocytes on small or medium sized artery biopsy. Common sites of involvement include skin, joints, kidneys, gastrointestinal tract and peripheral nerves. Central nervous system involvement has been reported in up to 40% of cases; the usual manifestations are encephalopathy, focal deficits and seizures. Descriptions of PAN in the pediatric literature has been reported in fewer than 250 children.
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Affiliation(s)
- Jessica Wylie
- Department of Pediatrics, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
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40
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Bosche B, Dohmen C, Impekoven P, Zaro-Weber O, Weber OZ, Reske D, Rubbert A, Jacobs AH, Petereit HF. Stroke after initiation of interferon-beta treatment for relapsing-remitting disseminated white matter disease. Acta Neurol Scand 2006; 113:433-6. [PMID: 16674611 DOI: 10.1111/j.1600-0404.2006.00638.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Interferon-beta (INF-beta) is effective and used in reducing exacerbation frequency and disease progression in multiple sclerosis. In certain circumstances, INF-beta can lead to rare side effects. AIMS OF THE STUDY We report the case of a 34-year-old female patient satisfying the McDonald criteria of multiple sclerosis without showing typical pathologic changes in cerebrospinal fluid (CSF). After introduction of INF-beta treatment, she quickly developed further progression of her disseminated neurological symptoms and finally an ischemic cerebral infarction. METHODS Evaluation of the patient included arterial angiography, magnetic resonance and positron emission tomography, histopathological assessment as well as a broad spectrum of serum and CSF analysis. RESULTS All diagnostic evaluations and the clinical course revealed evidences for a primary angiitis of the CNS. We discuss the possible worsening due to inappropriate INF-beta treatment in cerebral angiitis promoting severe cerebrovascular insufficiency. CONCLUSION The authors suggest that all diagnostic multiple sclerosis criteria including typical CSF findings should be ascertained before INF-beta treatment is initiated.
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Affiliation(s)
- B Bosche
- Department of Neurology, University of Cologne, Germany.
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41
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Abstract
Autoimmune connective tissue diseases are common conditions that often present non-specifically. Clinicians in emergency departments and acute medical assessment units may face these patients. This article provides an overview for the non-specialist clinician on the acute manifestations that may occur in these patients.
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Affiliation(s)
- Ecaterina Bontas
- Internal Medicine Department, Saint Pantelimon Emergency Clinical Hospital, Bucharest, Romania
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42
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Abstract
BACKGROUND Young-onset dementia is best defined as dementia presenting at age less than 65 years. And, while cognitive impairment in the elderly is dominated by dementia of the Alzheimer type, young-onset dementia has a vast differential diagnosis. REVIEW SUMMARY This article reviews an extensive differential diagnosis for young-onset dementia by utilizing different clues in the historical records and laboratory findings to aid with diagnosis. Laboratory testing should be completed in at least 2 stages. In the first stage, referred to as the first "wave," we suggest more routine testing, particularly for treatable causes of dementia. The second "wave," which we also outline, emphasizes more esoteric testing that may require referral to a tertiary care medical facility. The manuscript is divided into 2 parts, with part 1 focusing on clues from the historical data, while part 2 focuses on laboratory abnormalities. CONCLUSION Unlike dementia presenting in the elderly, the differential diagnosis in young-onset dementia is vast. A thorough historical review of the symptoms, with special emphasis on the pattern of cognitive impairment, temporal profile of the disease, detailed family history, and extensive but coordinated laboratory and ancillary testing, may yield subtle clues to the diagnosis.
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Affiliation(s)
- Basil Ridha
- Dementia Research Center, Institute of Neurology and Neurosurgery, Queen Square, London, UK
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43
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Aviv RI, Benseler SM, Silverman ED, Tyrrell PN, Deveber G, Tsang LM, Armstrong D. MR imaging and angiography of primary CNS vasculitis of childhood. AJNR Am J Neuroradiol 2006; 27:192-9. [PMID: 16418382 PMCID: PMC7976078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND PURPOSE Primary angiitis of the central nervous system of childhood (cPACNS) is a rare and ill-defined disease. In the absence of a brain biopsy, the diagnosis is based on typical clinical and imaging abnormalities. The aim of this study was to analyze systematically the MR imaging and MR angiographic (MRA) abnormalities in a large cohort of children with cPACNS. METHODS We analyzed the MR imaging features of a single pediatric center cohort of 45 cPACNS patients. MR imaging studies were performed for all patients, and both MR imaging and MRA were performed for 42 patients, who formed the cohort for review of the presence and correlation of lesions. Proportions were calculated by using the Fisher exact test, and agreement between MR imaging and MRA was calculated by using the McNemar test. The sensitivity of each diagnostic technique was established. RESULTS The most-common pattern of parenchymal abnormality was multifocal, unilateral involvement, each in 42/45 patients (93%). The lateral lenticulostriate artery terrritory was affected in 56% of cases, with involvement of a supratentorial deep gray matter structure in 91%. No infratentorial lesion occurred in the absence of supratentorial abnormality. MRA was normal in 12/42 patients (28.6%). Among the abnormal studies, stenosis was detected on MRA in 83% and was "benign" in appearance in 73% of patients and "aggressive" in 16.7%. Involvement was proximal in 83% and distal in 27% of patients. Multiple ipsilateral lesions were seen in 63%. MR imaging was abnormal in every patient where MRA was abnormal. With the assumption of MR imaging as the gold standard, the sensitivity of MRA was 72%. The agreement between MR imaging and MRA for abnormality was significant (P = .04). CONCLUSION We have illustrated the MR imaging and MRA appearances of cPACNS in the largest cohort to date. Both parenchymal and vascular lesions were predominantly proximal, unilateral, and multifocal within the anterior circulation. There was good agreement between MR imaging and MRA for lesion location. MR imaging findings were abnormal in all cases at diagnosis, and this remains the most sensitive technique to the detection of vasculitis.
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Affiliation(s)
- R I Aviv
- Division of Neuroradiology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
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44
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Schaublin GA, Michet CJ, Dyck PJB, Burns TM. An update on the classification and treatment of vasculitic neuropathy. Lancet Neurol 2005; 4:853-65. [PMID: 16297843 DOI: 10.1016/s1474-4422(05)70249-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Vasculitic neuropathy usually presents with painful mononeuropathies or an asymmetric polyneuropathy of acute or subacute onset. The disorder should be classified as being systemic or non-systemic. Systemic vasculitis should be further classified into one of the primary and secondary forms. Although specific treatment regimens vary among neurologists, basic principles can be applied. Corticosteroids and cytotoxic drugs have been the mainstay of treatment for most forms of vasculitic neuropathy. Here we discuss dosing, potential side-effects, and management recommendations of conventional treatments. New treatments showing promise include intravenous immunoglobulin and biological agents and trials of the newest treatments are being reviewed. Future trials should compare commonly used treatment regimens and better establish the efficacy of newer, potentially safer, treatments.
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Affiliation(s)
- Greg A Schaublin
- Department of Neurology, University of Virginia Health Sciences, Charlottesville, VA 22908, USA
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Lukas C, Keyvani K, Börnke C. Primary angiitis of the central nervous system presenting with subacute and fatal course of disease: a case report. BMC Neurol 2005; 5:16. [PMID: 16162278 PMCID: PMC1236932 DOI: 10.1186/1471-2377-5-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Accepted: 09/14/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary angiitis of the central nervous system is an idiopathic disorder characterized by vasculitis within the dural confines. The clinical presentation shows a wide variation and the course and the duration of disease are heterogeneous. This rare but treatable disease provides a diagnostic challenge owing to the lack of pathognomonic tests and the necessity of a histological confirmation. CASE PRESENTATION A 28-year-old patient presenting with headache and fluctuating signs of encephalopathy was treated on the assumption of viral meningoencephalitis. The course of the disease led to his death 10 days after hospital admission. Postmortem examination revealed primary angiitis of the central nervous system. CONCLUSION Primary angiitis of the central nervous system should always be taken into consideration when suspected infectious inflammation of the central nervous system does not respond to treatment adequately. In order to confirm the diagnosis with the consequence of a modified therapy angiography and combined leptomeningeal and brain biopsy should be considered immediately.
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Affiliation(s)
- Carsten Lukas
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Kathy Keyvani
- Institute of Neuropathology, Westfälische Wilhelms-University, Domagkstr. 19, 48149 Münster, Germany
| | - Christian Börnke
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
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Spitzer C, Mull M, Rohde V, Kosinski CM. Non-traumatic cortical subarachnoid haemorrhage: diagnostic work-up and aetiological background. Neuroradiology 2005; 47:525-31. [PMID: 15971064 DOI: 10.1007/s00234-005-1384-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2005] [Accepted: 02/16/2005] [Indexed: 10/25/2022]
Abstract
Only 15% of all subarachnoid haemorrhages (SAHs) are not of aneurysmal origin. Among those, circumscribed SAHs along the cortical convexity are rare and have only been described in singular case reports so far. Here, we present a collection of 12 cases of SAH along the convexity, of non-traumatic origin. Over a period of 10 years, 12 cases of circumscribed SAH along the convexity were identified at our clinic. The clinical presentations, neuroradiological SAH characteristics, further diagnostic work-up to identify the underlying aetiologies, the therapy and clinical outcome were analysed. The patients' chief complaints were unspecific cephalgia, focal or generalised seizures and focal neurological deficits. Typical signs of basal SAH, such as nuchal rigidity, thunderclap-headache or alteration of consciousness, were rare. Magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) revealed different aetiologies, namely postpartal posterior encephalopathy (three), cerebral vasculitis (two), dural sinus thrombosis (two), cortical venous thrombosis (one), intracerebral abscesses (one) and cerebral cavernoma (one). Two cases remained unresolved. Treatment of the underlying disease and symptomatic medication led to good clinical outcome in almost all cases. On the basis of these findings, we demonstrate that the clinical presentation, localisation and aetiology of cortical SAH differ clearly from other SAHs. A diagnostic work-up with MRI and eventually DSA is essential. Mostly, the causative disease can be identified, and specific treatment allows a favourable outcome.
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Affiliation(s)
- C Spitzer
- Department of Neurology, University Hospital of RWTH Aachen, Germany
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Hocaoglu C, Tan M. Isolated angiitis of the central nervous system: a case presented with atypical psychiatric symptoms. Prog Neuropsychopharmacol Biol Psychiatry 2005; 29:627-31. [PMID: 15866368 DOI: 10.1016/j.pnpbp.2005.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2005] [Indexed: 10/25/2022]
Abstract
Isolated angiitis of the central nervous system (IACNS) is a rare form of angiitis limited to the central nervous system. The clinical finding of the combined series revealed that headache was the most common symptom within a combination of focal and diffuse neurological deficits. The case, a 28-year-old man, is presented; the clinical presentation and diagnostic difficulties are discussed. The patient's symptoms began with an obvious atypical depression. In spite of an antidepressive treatment, his symptoms continued to worsen with personality, mood changes and euphoria added to the clinical picture. Meanwhile after several transient ischemic attacks, 6 months later, he was admitted with neurological symptoms including headache, diplopia, and cerebellar ataxia. The radiological investigation was mimicked by primary brain lymphoma. The brain biopsy excluding of lymphoma revealed parenchymal hemorrhage with nonspecific degenerative changes. In systemic investigation, no underlying cause for vasculitis could be found. Neurological but not psychological deficits and radiological lesions of the patient improved with steroid therapy. Since we could not find features of systemic vasculitis, the patient's lesions responded to corticosteroid treatment and neuropathological investigation revealed no lymphoma, We concluded that the most probable diagnosis would be IACNS.
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Affiliation(s)
- Cicek Hocaoglu
- Department of Psychiatry, Karadeniz Technical University Medical School, Trabzon, Turkey.
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Koch M, den Dunnen W, Sie OG, De Keyser J. A fatal demyelinating illness in a young woman 10 weeks post partum. Lancet Neurol 2005; 4:129-34. [PMID: 15664545 DOI: 10.1016/s1474-4422(05)00994-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Marcus Koch
- Department of Neurology, Academisch Ziekenhuis Groningen, Groningen, Netherlands
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49
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Fourcade G, Lequellec A, Blard JM, Pagès M. Périartérite noueuse révélée par une artérite cérébrale. Rev Neurol (Paris) 2005; 161:323-5. [PMID: 15800454 DOI: 10.1016/s0035-3787(05)85039-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION We report a case of periarteritis nodosa revealed by a cerebral angiitis which recovered under treatment. OBSERVATION A 52-year-old patient suddenly presented with a left sensory syndrome and a fluctuating aphasia due to ischemia involving both parietal lobes. The diagnosis of periarteritis nodosa was based on the following criteria: severe loss of weight, renal insufficiency, hypertension, angiography suggesting an arteritis. Instead of an ileo-cecal perforation, the patient recovered under corticosteroid and immunosuppressive therapy. CONCLUSIONS Stroke in periarteritis nodosa may occur early be and associated with a good outcome.
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Affiliation(s)
- G Fourcade
- Service de Neurologie A et Maladies Neurovasculaires, CHU Gui-de-Chauliac, 80, avenue Fliche, 34295 Montpellier Cedex 5, France
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50
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Abstract
Cerebral vasculitides are infrequent in neurological practice but important for the differential diagnosis of multifocal CNS symptoms. The clinical presentation is typically a combination of chronic headache, multiple strokes and encephalopathy. In systemic vasculitis, a combination of CNS symptoms with inflammatory signs and with peripheral nervous system symptoms (painful multiplex polyneuropathy) or other organ manifestations (skin, joints, kidney, heart, lungs, eye) are frequent. In isolated CNS angiitis, CSF examinations are of particular value. Besides MRI, angiography, CSF and serum examinations, the verification of the diagnosis by biopsy is mandatory.
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Affiliation(s)
- P Berlit
- Klinik für Neurologie mit Klinischer Neurophysiologie, Alfried-Krupp-Krankenhaus, Essen.
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