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Henderson R, Lakshmanan R, McLaughlin A, Bangash O, Saha S, Carey-Smith R. A complicated Chiari type 1 malformation and holocord syrinx as a likely cause for heel pain. Childs Nerv Syst 2024; 40:997-1003. [PMID: 38302572 DOI: 10.1007/s00381-024-06299-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Chiari malformations are a rare group of rhomboencephalic abnormalities involving the brain, craniocervical junction and spine. They may manifest in a variety of clinical presentations which relate to the variable involvement of the cerebellum, brainstem, lower cranial nerves, spinal cord and altered CSF flow dynamics. METHOD We report an unusual case of incidental diagnosis of a type I Chiari malformation with secondary cystic cerebellar tonsillar encephalomalacia and holocord syrinx following investigation of a 5YO girl presenting with heel swelling related to progressive neuropathic osteoarthropathy of the posterior calcaneal body and apophysis. RESULT The child was treated with decompressive suboccipital craniectomy and C1 laminectomy and tonsillar resection. Cerebellar tonsillar gliosis and cystic degeneration were confirmed on histopathology. Referral for ongoing engagement with occupational and physical therapy. CONCLUSION Most type I Chiari malformations in the paediatric population are incidental and asymptomatic. Neurological symptoms are typically mild and relate to altered CSF flow dynamics; however, we present a complex case of type I Chiari malformation with an unusual constellation of associated complications.
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Affiliation(s)
- Robert Henderson
- Department of Radiology, Perth Children's Hospital, Perth, WA, Australia.
- University of Western Australia, Crawley, Perth, WA, Australia.
- Department of Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.
| | - Rahul Lakshmanan
- Department of Radiology, Perth Children's Hospital, Perth, WA, Australia
- Centre for Neuromuscular and Neurological Disorders (Perron Institute), University of Western Australia, Nedlands, WA, Australia
| | - Aden McLaughlin
- Department of Radiology, Perth Children's Hospital, Perth, WA, Australia
| | - Omar Bangash
- Department of Neurosurgery, Perth Children's Hospital, Perth, WA, Australia
| | - Snigdha Saha
- Department of Neurosurgery, Perth Children's Hospital, Perth, WA, Australia
| | - Richard Carey-Smith
- University of Western Australia, Crawley, Perth, WA, Australia
- Department of Orthopaedics, Perth Children's Hospital, Perth, WA, Australia
- Orthopaedic and Sports Medicine Centre, West Perth, WA, Australia
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2
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Tan HEI, Lakshmanan R, Warne R, Walwyn T, Roebuck D. Neuroimaging manifestations of paediatric histiocytoses. J Med Imaging Radiat Oncol 2023. [PMID: 37964685 DOI: 10.1111/1754-9485.13602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Abstract
Histiocytoses are rare multi-system disorders marked by abnormal histiocyte cell proliferation, affecting children with diverse clinical presentations. Classified into five groups in 2016, including Langerhans-related (L), cutaneous (C), malignant (M), Rosai-Dorfman disease (R) and haemophagocytic lymphohistiocytosis (H), newer entities such as ALK-positive histiocytosis have also emerged, heralding the era of molecular (sub)classification. Common entities include Langerhans cell histiocytosis (LCH), Erdheim-Chester disease (ECD), Rosai-Dorfman disease (RDD) and haemophagocytic lymphohistiocytosis (HLH). This pictorial essay aids radiologists in recognising and differentiating paediatric histiocytoses based on unique neuroimaging features.
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Affiliation(s)
- Hsern Ern Ivan Tan
- Department of Medical Imaging, Perth Children's Hospital, Perth, Western Australia, Australia
- Department of Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Rahul Lakshmanan
- Department of Medical Imaging, Perth Children's Hospital, Perth, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | - Richard Warne
- Department of Medical Imaging, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Thomas Walwyn
- University of Western Australia, Perth, Western Australia, Australia
- Department of Oncology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Derek Roebuck
- Department of Medical Imaging, Perth Children's Hospital, Perth, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
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3
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McLaughlin A, Lakshmanan R, Dyke J, Warne R, Saha S, Lind C, Bynevelt M. Diffuse paediatric cerebellar glioma: two identical imaging phenotypes of an extremely rare entity with disparate pathology. Childs Nerv Syst 2023; 39:857-861. [PMID: 36658366 DOI: 10.1007/s00381-023-05836-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 01/06/2023] [Indexed: 01/21/2023]
Abstract
Although the posterior fossa is a common location for paediatric brain tumours [1], diffuse glioma isolated to the cerebellum is an extremely rare imaging entity. Only two cases of isolated diffuse paediatric cerebellar glioma have been reported in the English language to the best of our knowledge [2, 3], and only one of these cases had a similar imaging phenotype to our cases [3]. Although somewhat similar to Lhermitte-Duclos (dysplastic gangliocytoma of the cerebellum), the appearances are distinct from other neoplastic entities of the paediatric posterior fossa. Clinical presentation and neurological examination findings are vital however to help differentiate other diffuse pathologies involving the cerebellum such as rhombencephalitis. Presented here are two diffuse cerebellar gliomas in children under the age of 3 with near identical imaging phenotypes demonstrating differing histological and molecular genetic profiles.
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Affiliation(s)
- Aden McLaughlin
- Department of Medical Imaging, Perth Children's Hospital, Nedlands, Perth, WA, 6009, Australia.
| | - Rahul Lakshmanan
- Department of Medical Imaging, Perth Children's Hospital, Nedlands, Perth, WA, 6009, Australia
| | - Jason Dyke
- PathWest Neuropathology, Royal Perth Hospital, Perth, WA, 6000, Australia
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, 6009, Australia
| | - Richard Warne
- Department of Medical Imaging, Perth Children's Hospital, Nedlands, Perth, WA, 6009, Australia
| | - Snigdha Saha
- Perth Children's Hospital Department of Neurosurgery, Nedlands, Perth, WA, 6009, Australia
| | - Christopher Lind
- Perth Children's Hospital Department of Neurosurgery, Nedlands, Perth, WA, 6009, Australia
| | - Michael Bynevelt
- Department of Medical Imaging, Perth Children's Hospital, Nedlands, Perth, WA, 6009, Australia
- Neurological Intervention and Imaging Service of Western Australia (NIISwa), Nedlands, Perth, WA, 6009, Australia
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4
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Kumar J, Lakshmanan R, Dyke JM, Lee S, Shipman P. Case report: congenital intraventricular meningioma demonstrated with fetal MRI. Childs Nerv Syst 2022; 38:191-194. [PMID: 33651158 DOI: 10.1007/s00381-021-05067-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 02/02/2021] [Indexed: 11/26/2022]
Abstract
Congenital intracranial meningiomas are rare lesions. We present a case of congenital intraventricular cystic meningioma, initially characterized with fetal MRI and confirmed postnatally with histopathology. To our knowledge, this is the first in vivo description of a congenital meningioma with fetal MRI. The fetal MRI was able to characterize the lesion as an atypical intraventricular mass which was separate from the choroid plexus, differentiating the mass from a choroid plexus neoplasm. An intraventricular location of the meningioma is more commonly described in pediatric than in adult patients. Meningioma should be considered in the differential for an intraventricular congenital lesion, and fetal MRI is advocated for lesion characterization.
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Affiliation(s)
- Jayant Kumar
- Department of Medical Imaging, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA, 6009, Australia.
| | - Rahul Lakshmanan
- Department of Medical Imaging, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA, 6009, Australia
| | - Jason M Dyke
- Department of Neuropathology, Pathwest, Royal Perth Hospital, Wellington Street, Perth, WA, 6000, Australia
| | - Sharon Lee
- Department of Neurosurgery, Perth Children's Hospital and Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA, 6009, Australia
| | - Peter Shipman
- Department of Medical Imaging, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA, 6009, Australia
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5
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Kusel K, Warne R, Lakshmanan R, Mason M, Bynevelt M, Shah S. Hirayama disease: the importance of flexion imaging. BJR Case Rep 2022; 8:20210105. [PMID: 35136641 PMCID: PMC8803229 DOI: 10.1259/bjrcr.20210105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/11/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022] Open
Abstract
Hirayama disease is a rare cervical myelopathy characterised by asymmetrical upper limb weakness and muscle atrophy in the forearm and hand. MRI of the cervical spine plays an essential role in diagnosis, however, the characteristic findings are often only seen when the patient is imaged with the neck in flexion. We present a case of a 15-year-old male who presented with left forearm and hand weakness with muscle wasting. An MRI of the cervical spine with the neck in a neutral position demonstrated atrophy of the spinal cord with intrinsic signal abnormality between C5 and C7. Further imaging with the patient’s neck in flexion demonstrated the hallmark features of Hirayama disease. There was anterior displacement of the thecal sac and spinal cord, and an enlarged, crescent-shaped dorsal epidural space which enhanced following i.v. gadolinium administration. The atrophic segment of cord contacted the posterior vertebral bodies when the neck was in full flexion. This case highlights the importance of imaging patients suspected of having this entity with the neck in full flexion in order to make a diagnosis.
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Affiliation(s)
- Kieran Kusel
- Department of Radiology, Perth Children’s Hospital, Nedlands, WA, Australia
| | - Richard Warne
- Department of Radiology, Perth Children’s Hospital, Nedlands, WA, Australia
| | - Rahul Lakshmanan
- Department of Radiology, Perth Children’s Hospital, Nedlands, WA, Australia
| | - Michael Mason
- Department of Radiology, Perth Children’s Hospital, Nedlands, WA, Australia
| | - Michael Bynevelt
- Neurological Intervention and Imaging Service of Western Australia, Perth Children’s Hospital, Nedlands, WA, Australia
| | - Snehal Shah
- Department of Neurology, Perth Children’s Hospital, Nedlands, WA, Australia
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6
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Parks R, Howard P, Zahit R, Kayani A, Lakshmanan R, Blake H, Winterbottom L, Jahan M, Cheung K. Short-term (6 months) impact of primary breast cancer treatment on functional status and quality of life of older women. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00405-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Kang A, Dickinson J, Kamien B, Azamov D, Lakshmanan R, Dyke J, Fabian V. Fetal dysplastic megalencephaly with angiomatosis and a pathogenic mtor mutation. Pathology 2021. [DOI: 10.1016/j.pathol.2021.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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8
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Bhattacharya D, Chhabda S, Lakshmanan R, Tan R, Warne R, Benenati M, Michalski A, Aquilina K, Jacques T, Hargrave D, Chang YC, Gains J, Mankad K. Spectrum of neuroimaging findings post-proton beam therapy in a large pediatric cohort. Childs Nerv Syst 2021; 37:435-446. [PMID: 32705327 DOI: 10.1007/s00381-020-04819-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 07/14/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Proton beam therapy (PBT) is now well established for the treatment of certain pediatric brain tumors. The intrinsic properties of PBT are known to reduce long-term negative effects of photon radiotherapy (PRT). To better understand the intracranial effects of PBT, we analyzed the longitudinal imaging changes in a cohort of children with brain tumors treated by PBT with clinical and radiotherapy dose correlations. MATERIALS AND METHODS Retrospective imaging review of 46 patients from our hospital with brain tumors treated by PBT. The imaging findings were correlated with clinical and dose parameters. RESULTS Imaging changes were assessed by reviewing serial magnetic resonance imaging (MRI) scans following PBT over a follow-up period ranging from 1 month to 7 years. Imaging changes were observed in 23 patients undergoing PBT and categorized as pseudoprogression (10 patients, 43%), white matter changes (6 patients, 23%), parenchymal atrophy (6 patients, 23%), and cerebral large vessel arteriopathy (5 patients, 25%). Three patients had more than one type of imaging change. Clinical symptoms attributable to PBT were observed in 13 (28%) patients. CONCLUSION In accordance with published literature, we found evidence of varied intracranial imaging changes in pediatric brain tumor patients treated with PBT. There was a higher incidence (10%) of large vessel cerebral arteriopathy in our cohort than previously described in the literature. Twenty-eight percent of patients had clinical sequelae as a result of these changes, particularly in the large vessel arteriopathy subgroup, arguing the need for angiographic and perfusion surveillance to pre-empt any morbidities and offer potential neuro-protection.
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Affiliation(s)
| | | | | | - Ronald Tan
- KK Women's and Children's Hospital, Singapore, Singapore
| | | | | | | | | | - Thomas Jacques
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | | | - Jenny Gains
- University College London Hospital, London, UK
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9
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Shah S, Khan N, Lakshmanan R, Lewis B, Nagarajan L. Biotinidase deficiency presenting as Neuromyelitis Optica Spectrum Disorder. Brain Dev 2020; 42:762-766. [PMID: 32741581 DOI: 10.1016/j.braindev.2020.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 11/17/2022]
Abstract
Biotinidase deficiency disorder is a rare inherited metabolic disorder with typical neurological manifestations of hypotonia, developmental delay, rashes, seizures, hearing and vision impairment. We present two cases with different and unusual clinical profiles, whose neuroimaging resembled Neuromyelitis Optica Spectrum Disorder. Case 1 was initially treated with immunomodulation with steroids and intravenous immunoglobulins, with partial improvement. However reinvestigation for worsening of symptoms showed more extensive changes on spine magnetic resonance imaging. Raised lactate and alanine levels on repeat cerebrospinal fluid testing resulted in further investigations that revealed a biotinidase deficiency. Case 2 presented mainly with respiratory symptoms: a barium swallow suggested bulbar dysfunction. Neuroimaging of brain and spine was similar to that in case 1 and the child was promptly investigated for and confirmed to have biotinidase deficiency. Both cases responded to biotin supplementation. It is important to be cognisant of atypical neurological presentations of biotinidase deficiency including those that mimic immune mediated neurodemyelination disorders, as biotinidase deficiency is potentially treatable.
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Affiliation(s)
- Snehal Shah
- Department of Neurology, Perth Children's Hospital, Nedlands, WA, Australia; School of Medicine , University of Western Australia, Perth, WA, Australia
| | - Najm Khan
- Department of Neurology, Perth Children's Hospital, Nedlands, WA, Australia
| | - Rahul Lakshmanan
- Department of Radiology, Perth Children's Hospital, Nedlands, WA, Australia
| | - Barry Lewis
- Department of Clinical Biochemistry, Path West, Nedlands, WA 6009, Australia
| | - Lakshmi Nagarajan
- Department of Neurology, Perth Children's Hospital, Nedlands, WA, Australia; School of Medicine , University of Western Australia, Perth, WA, Australia; Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia.
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10
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Agarwal A, Lakshmanan R, Devagnanam I, Bynevelt M. Multinodular and Vacuolating Neuronal Tumor of the Cerebrum: Does the Name Require Review? AJNR Am J Neuroradiol 2019; 40:E69-E70. [PMID: 31753835 DOI: 10.3174/ajnr.a6284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- A Agarwal
- Neurointervention and Imaging Services of Western Australia Sir Charles Gairdner Hospital Nedlands, Western Australia
| | - R Lakshmanan
- Princess Margaret Hospital Subiaco, Western Australia University College of London Foundation Trust National Hospital for Neurology and Neurosurgery, London London, UK
| | - I Devagnanam
- University College of London Foundation Trust National Hospital for Neurology and Neurosurgery, London London, UK
| | - M Bynevelt
- Neurointervention and Imaging Services of Western Australia Sir Charles Gairdner Hospital Nedlands, Western Australia Princess Margaret Hospital Subiaco, Western Australia
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11
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MacDonald A, Triplett J, Vijayan S, Bynevelt M, Lakshmanan R, Chemmanam T. 079 Glial fibrillary acidic protein (GFAP) astrocytopathy associated with cerebral micro-infarction and poor therapeutic response. J Neurol Psychiatry 2019. [DOI: 10.1136/jnnp-2019-anzan.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionGlial fibrillary acidic protein (GFAP) astrocytopathy is a lesser recognised immune-mediated meningo-encephalomyelitis, which is steroid responsive in the majority of cases. Neuroimaging is unique with a distinctive symmetric white matter perivascular linear and punctate enhancement pattern. We present a case with classical phenotype but delayed clinical response, and highlight the importance of early recognition and treatment.CaseA 59-year-old Caucasian female presented with a two month history of headache, gait disturbance, insomnia, agitation, disorientation and reduced oral intake. Examination revealed a high frequency upper limb tremor, hypertonicity and pathologically brisk reflexes with impaired cognitive function. MRI brain and spinal cord demonstrated high T2 signal and striking perivascular and punctate enhancement in supratentorial white matter, cervical and upper thoracic cord. CSF examination revealed lymphocytic pleocytosis and elevated protein. Brain biopsy demonstrated reduced GFAP expression, perivascular T-lymphocytic infiltrate, and recent white matter microinfarction. CSF and serum GFAP antibodies were positive.Motor deterioration accompanied progression to a stuporous state. High dose corticosteroids were commenced, followed by intravenous immunoglobulin and mycophenolate. While there was marked improvement of perivascular contrast enhancement on imaging, the patient continued to demonstrate prominent tremor, gait disturbance and behavioural issues 9 months following symptom onset.ConclusionsThe persistence of disability in this case is likely the result of axonal loss from the initial insult, reflected by the biopsy evidence of microinfarction. Awareness of the unique pattern on MRI and the clinical phenotype will aid in early recognition and prompt treatment of this condition, thus preventing the potential long term morbidity.
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12
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Affiliation(s)
- Julian Hermes
- From the Klinik für Radiologie und Neuroradiologie (J.H.), UKSH Campus Kiel, Germany; Lysholm Department of Neuroradiology (R.L.) and Department of Neurosurgery (L.W.), National Hospital for Neurology and Neurosurgery; and Brain Repair & Rehabilitation Department (I.D.), UCL Institute of Neurology, Queen Square, UK.
| | - Rahul Lakshmanan
- From the Klinik für Radiologie und Neuroradiologie (J.H.), UKSH Campus Kiel, Germany; Lysholm Department of Neuroradiology (R.L.) and Department of Neurosurgery (L.W.), National Hospital for Neurology and Neurosurgery; and Brain Repair & Rehabilitation Department (I.D.), UCL Institute of Neurology, Queen Square, UK
| | - Laurence Watkins
- From the Klinik für Radiologie und Neuroradiologie (J.H.), UKSH Campus Kiel, Germany; Lysholm Department of Neuroradiology (R.L.) and Department of Neurosurgery (L.W.), National Hospital for Neurology and Neurosurgery; and Brain Repair & Rehabilitation Department (I.D.), UCL Institute of Neurology, Queen Square, UK
| | - Indran Davagnanam
- From the Klinik für Radiologie und Neuroradiologie (J.H.), UKSH Campus Kiel, Germany; Lysholm Department of Neuroradiology (R.L.) and Department of Neurosurgery (L.W.), National Hospital for Neurology and Neurosurgery; and Brain Repair & Rehabilitation Department (I.D.), UCL Institute of Neurology, Queen Square, UK
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13
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Koohi N, Vickers DA, Lakshmanan R, Chandrashekar H, Werring DJ, Warren JD, Bamiou DE. Hearing Characteristics of Stroke Patients: Prevalence and Characteristics of Hearing Impairment and Auditory Processing Disorders in Stroke Patients. J Am Acad Audiol 2018; 28:491-505. [PMID: 28590894 DOI: 10.3766/jaaa.15139] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stroke survivors may suffer from a range of hearing impairments that may restrict their participation in postacute rehabilitation programs. Hearing impairment may have a significant impact on listening, linguistic skills, and overall communication of the affected stroke patient. However, no studies sought to systematically characterize auditory function of stroke patients in detail, to establish the different types of hearing impairments in this cohort of patients. Such information would be clinically useful in understanding and addressing the hearing needs of stroke survivors. PURPOSE The present study aimed to characterize and classify the hearing impairments, using a detailed audiological assessment test battery, in order to determine the level of clinical need and inform appropriate rehabilitation for this patient population. RESEARCH DESIGN A case-control study. STUDY SAMPLE Forty-two recruited stroke patients who were discharged from a stroke unit and 40 control participants matched for age. DATA COLLECTION AND ANALYSIS All participants underwent pure-tone audiometry and immittance measurements including acoustic reflex threshold, transient-evoked otoacoustic emissions, auditory-evoked brainstem response, and a central auditory processing assessment battery, performed in a single session. Hearing impairments were classified as peripheral hearing loss (cochlear and neural type), central auditory processing disorder (CAPD), and as a combination of CAPD and peripheral hearing loss. RESULTS Overall mean hearing thresholds were not significantly different between the control and stroke groups. The most common type of hearing impairment in stroke patients was the combination type, "peripheral and CAPD," in the 61- to 80-yr-old subgroup (in 55%), and auditory processing deficits in 18- to 60-yr-olds (in 40%), which were both significantly higher than in controls. CONCLUSIONS This is the first study to examine hearing function in detail in stroke patients. Given the importance of hearing for the efficiency of communication, it is essential to identify hearing impairments and differentiate peripheral and central deficits to define an appropriate intervention plan.
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Affiliation(s)
- Nehzat Koohi
- National Hospital for Neurology and Neurosurgery, London, UK.,UCL Ear Institute, University College London, London, UK
| | | | | | | | - David J Werring
- The Institute of Neurology, University College London, London, UK
| | - Jason D Warren
- The Institute of Neurology, University College London, London, UK
| | - Doris-Eva Bamiou
- National Hospital for Neurology and Neurosurgery, London, UK.,UCL Ear Institute, University College London, London, UK
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14
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Affiliation(s)
- Julian Schwarting
- From the Lysholm Department of Neuroradiology (J.S., R.L.), National Hospital for Neurology and Neurosurgery, Queen Square; and Brain Repair & Rehabilitation Department (I.D.), UCL Institute of Neurology, Queen Square, UK.
| | - Rahul Lakshmanan
- From the Lysholm Department of Neuroradiology (J.S., R.L.), National Hospital for Neurology and Neurosurgery, Queen Square; and Brain Repair & Rehabilitation Department (I.D.), UCL Institute of Neurology, Queen Square, UK
| | - Indran Davagnanam
- From the Lysholm Department of Neuroradiology (J.S., R.L.), National Hospital for Neurology and Neurosurgery, Queen Square; and Brain Repair & Rehabilitation Department (I.D.), UCL Institute of Neurology, Queen Square, UK
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15
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Hwang YT, Lakshmanan R, Davagnanam I, Thompson AGB, Lynch DS, Houlden H, Bajaj N, Eriksson SH, Bamiou DE, Warren JD. Brainstem phenotype of cathepsin A-related arteriopathy with strokes and leukoencephalopathy. Neurol Genet 2017; 3:e165. [PMID: 28702507 PMCID: PMC5499977 DOI: 10.1212/nxg.0000000000000165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/12/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Yun Tae Hwang
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Rahul Lakshmanan
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Indran Davagnanam
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Andrew G B Thompson
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - David S Lynch
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Henry Houlden
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Nin Bajaj
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Sofia H Eriksson
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Doris-Eva Bamiou
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Jason D Warren
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
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16
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Lynch DS, Zhang WJ, Lakshmanan R, Kinsella JA, Uzun GA, Karbay M, Tüfekçioglu Z, Hanagasi H, Burke G, Foulds N, Hammans SR, Bhattacharjee A, Wilson H, Adams M, Walker M, Nicoll JAR, Chataway J, Fox N, Davagnanam I, Phadke R, Houlden H. Analysis of Mutations in AARS2 in a Series of CSF1R-Negative Patients With Adult-Onset Leukoencephalopathy With Axonal Spheroids and Pigmented Glia. JAMA Neurol 2017; 73:1433-1439. [PMID: 27749956 DOI: 10.1001/jamaneurol.2016.2229] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP) is a frequent cause of adult-onset leukodystrophy known to be caused by autosomal dominant mutations in the CSF1R (colony-stimulating factor 1) gene. The discovery that CSF1R mutations cause ALSP led to more accurate prognosis and genetic counseling for these patients in addition to increased interest in microglia as a target in neurodegeneration. However, it has been known since the discovery of the CSF1R gene that there are patients with typical clinical and radiologic evidence of ALSP who do not carry pathogenic CSF1R mutations. These patients include those in whom the pathognomonic features of axonal spheroids and pigmented microglia have been found. Achieving a genetic diagnosis in these patients is important to our understanding of this disorder. Objective To genetically characterize a group of patients with typical features of ALSP who do not carry CSF1R mutations. Design, Settings, and Participants In this case series study, 5 patients from 4 families were identified with clinical, radiologic, or pathologic features of ALSP in whom CSF1R mutations had been excluded previously by sequencing. Data were collected between May 2014 and September 2015 and analyzed between September 2015 and February 2016. Main Outcomes and Measures Focused exome sequencing was used to identify candidate variants. Family studies, long-range polymerase chain reaction with cloning, and complementary DNA sequencing were used to confirm pathogenicity. Results Of these 5 patients, 4 were men (80%); mean age at onset of ALSP was 29 years (range, 15-44 years). Biallelic mutations in the alanyl-transfer (t)RNA synthetase 2 (AARS2) gene were found in all 5 patients. Frameshifting and splice site mutations were common, found in 4 of 5 patients, and sequencing of complementary DNA from affected patients confirmed that the variants were loss of function. All patients presented in adulthood with prominent cognitive, neuropsychiatric, and upper motor neuron signs. Magnetic resonance imaging in all patients demonstrated a symmetric leukoencephalopathy with punctate regions of restricted diffusion, typical of ALSP. In 1 patient, brain biopsy demonstrated axonal spheroids and pigmented microglia, which are the pathognomonic signs of ALSP. Conclusions and Relevance This work indicates that mutations in the tRNA synthetase AARS2 gene cause a recessive form of ALSP. The CSF1R and AARS2 proteins have different cellular functions but overlap in a final common pathway of neurodegeneration. This work points to novel targets for research and will lead to improved diagnostic rates in patients with adult-onset leukoencephalopathy.
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Affiliation(s)
- David S Lynch
- Department of Molecular Neuroscience, University College London Institute of Neurology, London, England2The Leonard Wolfson Experimental Neurology Centre, University College London Institute of Neurology, London, England
| | - Wei Jia Zhang
- Department of Molecular Neuroscience, University College London Institute of Neurology, London, England3Department of Neurology, Royal Free Hospital, London, England
| | - Rahul Lakshmanan
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, England
| | - Justin A Kinsella
- Dementia Research Centre, Department of Neurodegeneration, The National Hospital for Neurology and Neurosurgery, University College London Institute of Neurology, London, England6University College Dublin, Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - Günes Altiokka Uzun
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Merih Karbay
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep Tüfekçioglu
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hasmet Hanagasi
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Georgina Burke
- Department of Neurology, Queen Alexandra Hospital, Portsmouth, England9Wessex Neurological Centre, University Hospital Southampton, Southampton, England
| | - Nicola Foulds
- Wessex Clinical Genetics Services, Princess Anne Hospital, Academic Unit of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, England
| | - Simon R Hammans
- Department of Neurology, Queen Alexandra Hospital, Portsmouth, England
| | | | - Heather Wilson
- Department of Neurology, Royal Free Hospital, London, England
| | - Matthew Adams
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, England
| | - Mark Walker
- Clinical Neurosciences, Clinical & Experimental Sciences, University of Southampton, Department of Cellular Pathology, Southampton General Hospital, Southampton, England
| | - James A R Nicoll
- Clinical Neurosciences, Clinical & Experimental Sciences, University of Southampton, Department of Cellular Pathology, Southampton General Hospital, Southampton, England
| | - Jeremy Chataway
- Department of Neuroinflammation, University College London Institute of Neurology, London, England
| | - Nick Fox
- Dementia Research Centre, Department of Neurodegeneration, The National Hospital for Neurology and Neurosurgery, University College London Institute of Neurology, London, England
| | - Indran Davagnanam
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, England
| | - Rahul Phadke
- Division of Neuropathology and Department of Neurodegenerative Disease, The National Hospital for Neurology and Neurosurgery, University College London Institute of Neurology, London, England
| | - Henry Houlden
- Department of Molecular Neuroscience, University College London Institute of Neurology, London, England14Neurogenetics Laboratory, The National Hospital for Neurology and Neurosurgery, London, England
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17
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Lynch DS, Rodrigues Brandão de Paiva A, Zhang WJ, Bugiardini E, Freua F, Tavares Lucato L, Macedo-Souza LI, Lakshmanan R, Kinsella JA, Merwick A, Rossor AM, Bajaj N, Herron B, McMonagle P, Morrison PJ, Hughes D, Pittman A, Laurà M, Reilly MM, Warren JD, Mummery CJ, Schott JM, Adams M, Fox NC, Murphy E, Davagnanam I, Kok F, Chataway J, Houlden H. Clinical and genetic characterization of leukoencephalopathies in adults. Brain 2017; 140:1204-1211. [PMID: 28334938 PMCID: PMC5405235 DOI: 10.1093/brain/awx045] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/05/2017] [Accepted: 01/16/2017] [Indexed: 11/12/2022] Open
Abstract
Leukodystrophies and genetic leukoencephalopathies are a rare group of disorders leading to progressive degeneration of cerebral white matter. They are associated with a spectrum of clinical phenotypes dominated by dementia, psychiatric changes, movement disorders and upper motor neuron signs. Mutations in at least 60 genes can lead to leukoencephalopathy with often overlapping clinical and radiological presentations. For these reasons, patients with genetic leukoencephalopathies often endure a long diagnostic odyssey before receiving a definitive diagnosis or may receive no diagnosis at all. In this study, we used focused and whole exome sequencing to evaluate a cohort of undiagnosed adult patients referred to a specialist leukoencephalopathy service. In total, 100 patients were evaluated using focused exome sequencing of 6100 genes. We detected pathogenic or likely pathogenic variants in 26 cases. The most frequently mutated genes were NOTCH3, EIF2B5, AARS2 and CSF1R. We then carried out whole exome sequencing on the remaining negative cases including four family trios, but could not identify any further potentially disease-causing mutations, confirming the equivalence of focused and whole exome sequencing in the diagnosis of genetic leukoencephalopathies. Here we provide an overview of the clinical and genetic features of these disorders in adults.
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Affiliation(s)
- David S. Lynch
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
- 2 Leonard Wolfson Experimental Neurology Centre, UCL Institute of Neurology, London, UK
| | | | - Wei Jia Zhang
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Enrico Bugiardini
- 4 MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK
| | - Fernando Freua
- 3 Neurogenetics Unit, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Leandro Tavares Lucato
- 5 Instituto de Radiologia, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | | | - Rahul Lakshmanan
- 7 Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Justin A. Kinsella
- 8 Neurology Department, St. Vincent’s University Hospital and University College Dublin, Ireland
| | - Aine Merwick
- 9 Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- 10 Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Alexander M. Rossor
- 4 MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK
- 11 Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Nin Bajaj
- 12 Department of Neurology, Queens Medical Centre, Nottingham, UK
| | - Brian Herron
- 13 Department of Neuropathology, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - Paul McMonagle
- 14 Department of Neurology, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - Patrick J. Morrison
- 15 Centre for Cancer Research and Cell Biology, Queens University of Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - Deborah Hughes
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Alan Pittman
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Matilde Laurà
- 4 MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK
| | - Mary M Reilly
- 4 MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK
| | - Jason D Warren
- 16 Dementia Research Centre, UCL Institute of Neurology, London, UK
| | | | | | - Matthew Adams
- 7 Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Nick C. Fox
- 16 Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Elaine Murphy
- 9 Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Indran Davagnanam
- 7 Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Fernando Kok
- 3 Neurogenetics Unit, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Jeremy Chataway
- 17 Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Henry Houlden
- 1 Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
- 18 Neurogenetics Laboratory, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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18
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Lakshmanan R, Adams ME, Lynch DS, Kinsella JA, Phadke R, Schott JM, Murphy E, Rohrer JD, Chataway J, Houlden H, Fox NC, Davagnanam I. Redefining the phenotype of ALSP and AARS2 mutation-related leukodystrophy. Neurol Genet 2017; 3:e135. [PMID: 28243630 PMCID: PMC5312114 DOI: 10.1212/nxg.0000000000000135] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/04/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To provide an overview of the phenotype of 2 clinically, radiologically, and pathologically similar leukodystrophies, adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP) and alanyl-transfer RNA synthetase 2 mutation-related leukodystrophy (AARS2-L), and highlight key differentiating features. METHODS ALSP and AARS2-L cases were identified from the adult-onset leukodystrophy database at our institution. In addition, cases with imaging findings were identified from a literature review. The phenotypic features were determined by combining published cases with those from our database. RESULTS A combined total of 74 cases of ALSP and 10 cases of AARS2-L with neuroimaging data were identified. The mean age at onset was 42 years in ALSP and 26 years in AARS2-L. Cognitive and motor symptoms were the most common symptoms overall in both. Ovarian failure was exclusive to AARS2-L, present in all known female cases. Both ALSP and AARS2-L showed a confluent, asymmetric, predominantly frontoparietal, periventricular pattern of white matter disease with subcortical U-fiber sparing; pyramidal tract and corpus callosum involvement; and diffusion changes in the white matter which we have termed "deep white matter diffusion dots." Central atrophy and corpus callosal thinning were prominent in ALSP and disproportionately mild in AARS2-L when present. ALSP also occasionally showed ventricular abnormalities and calcifications in the frontal periventricular white matter, features not seen in AARS2-L. AARS2-L demonstrates white matter rarefaction which suppresses on fluid-attenuated inversion recovery MRI sequences, a feature not seen in ALSP. CONCLUSIONS ALSP and AARS2-L share similar clinical, imaging, and pathologic characteristics with key differentiating features that we have highlighted.
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Affiliation(s)
- Rahul Lakshmanan
- Lysholm Department of Neuroradiology (R.L., M.E.A., I.D.), the National Hospital for Neurology and Neurosurgery; Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology; the Leonard Wolfson Experimental Neurology Centre (D.S.L., J.A.K.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology; Dementia Research Centre (J.A.K., J.M.S., J.D.R., N.C.F.), Department of Neurodegeneration, UCL Institute of Neurology, UK; Department of Neurology (J.A.K.), St Vincent's University Hospital, University College Dublin, Ireland; Division of Neuropathology and Department of Neurodegenerative Disease (R.P.), Charles Dent Metabolic Unit (E.M.), Department of Neuroinflammation (J.C.), Neurogenetics Laboratory (H.H.), and Department of Brain Repair and Rehabilitation (I.D.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, UK
| | - Matthew E Adams
- Lysholm Department of Neuroradiology (R.L., M.E.A., I.D.), the National Hospital for Neurology and Neurosurgery; Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology; the Leonard Wolfson Experimental Neurology Centre (D.S.L., J.A.K.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology; Dementia Research Centre (J.A.K., J.M.S., J.D.R., N.C.F.), Department of Neurodegeneration, UCL Institute of Neurology, UK; Department of Neurology (J.A.K.), St Vincent's University Hospital, University College Dublin, Ireland; Division of Neuropathology and Department of Neurodegenerative Disease (R.P.), Charles Dent Metabolic Unit (E.M.), Department of Neuroinflammation (J.C.), Neurogenetics Laboratory (H.H.), and Department of Brain Repair and Rehabilitation (I.D.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, UK
| | - David S Lynch
- Lysholm Department of Neuroradiology (R.L., M.E.A., I.D.), the National Hospital for Neurology and Neurosurgery; Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology; the Leonard Wolfson Experimental Neurology Centre (D.S.L., J.A.K.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology; Dementia Research Centre (J.A.K., J.M.S., J.D.R., N.C.F.), Department of Neurodegeneration, UCL Institute of Neurology, UK; Department of Neurology (J.A.K.), St Vincent's University Hospital, University College Dublin, Ireland; Division of Neuropathology and Department of Neurodegenerative Disease (R.P.), Charles Dent Metabolic Unit (E.M.), Department of Neuroinflammation (J.C.), Neurogenetics Laboratory (H.H.), and Department of Brain Repair and Rehabilitation (I.D.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, UK
| | - Justin A Kinsella
- Lysholm Department of Neuroradiology (R.L., M.E.A., I.D.), the National Hospital for Neurology and Neurosurgery; Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology; the Leonard Wolfson Experimental Neurology Centre (D.S.L., J.A.K.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology; Dementia Research Centre (J.A.K., J.M.S., J.D.R., N.C.F.), Department of Neurodegeneration, UCL Institute of Neurology, UK; Department of Neurology (J.A.K.), St Vincent's University Hospital, University College Dublin, Ireland; Division of Neuropathology and Department of Neurodegenerative Disease (R.P.), Charles Dent Metabolic Unit (E.M.), Department of Neuroinflammation (J.C.), Neurogenetics Laboratory (H.H.), and Department of Brain Repair and Rehabilitation (I.D.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, UK
| | - Rahul Phadke
- Lysholm Department of Neuroradiology (R.L., M.E.A., I.D.), the National Hospital for Neurology and Neurosurgery; Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology; the Leonard Wolfson Experimental Neurology Centre (D.S.L., J.A.K.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology; Dementia Research Centre (J.A.K., J.M.S., J.D.R., N.C.F.), Department of Neurodegeneration, UCL Institute of Neurology, UK; Department of Neurology (J.A.K.), St Vincent's University Hospital, University College Dublin, Ireland; Division of Neuropathology and Department of Neurodegenerative Disease (R.P.), Charles Dent Metabolic Unit (E.M.), Department of Neuroinflammation (J.C.), Neurogenetics Laboratory (H.H.), and Department of Brain Repair and Rehabilitation (I.D.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, UK
| | - Jonathan M Schott
- Lysholm Department of Neuroradiology (R.L., M.E.A., I.D.), the National Hospital for Neurology and Neurosurgery; Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology; the Leonard Wolfson Experimental Neurology Centre (D.S.L., J.A.K.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology; Dementia Research Centre (J.A.K., J.M.S., J.D.R., N.C.F.), Department of Neurodegeneration, UCL Institute of Neurology, UK; Department of Neurology (J.A.K.), St Vincent's University Hospital, University College Dublin, Ireland; Division of Neuropathology and Department of Neurodegenerative Disease (R.P.), Charles Dent Metabolic Unit (E.M.), Department of Neuroinflammation (J.C.), Neurogenetics Laboratory (H.H.), and Department of Brain Repair and Rehabilitation (I.D.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, UK
| | - Elaine Murphy
- Lysholm Department of Neuroradiology (R.L., M.E.A., I.D.), the National Hospital for Neurology and Neurosurgery; Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology; the Leonard Wolfson Experimental Neurology Centre (D.S.L., J.A.K.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology; Dementia Research Centre (J.A.K., J.M.S., J.D.R., N.C.F.), Department of Neurodegeneration, UCL Institute of Neurology, UK; Department of Neurology (J.A.K.), St Vincent's University Hospital, University College Dublin, Ireland; Division of Neuropathology and Department of Neurodegenerative Disease (R.P.), Charles Dent Metabolic Unit (E.M.), Department of Neuroinflammation (J.C.), Neurogenetics Laboratory (H.H.), and Department of Brain Repair and Rehabilitation (I.D.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, UK
| | - Jonathan D Rohrer
- Lysholm Department of Neuroradiology (R.L., M.E.A., I.D.), the National Hospital for Neurology and Neurosurgery; Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology; the Leonard Wolfson Experimental Neurology Centre (D.S.L., J.A.K.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology; Dementia Research Centre (J.A.K., J.M.S., J.D.R., N.C.F.), Department of Neurodegeneration, UCL Institute of Neurology, UK; Department of Neurology (J.A.K.), St Vincent's University Hospital, University College Dublin, Ireland; Division of Neuropathology and Department of Neurodegenerative Disease (R.P.), Charles Dent Metabolic Unit (E.M.), Department of Neuroinflammation (J.C.), Neurogenetics Laboratory (H.H.), and Department of Brain Repair and Rehabilitation (I.D.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, UK
| | - Jeremy Chataway
- Lysholm Department of Neuroradiology (R.L., M.E.A., I.D.), the National Hospital for Neurology and Neurosurgery; Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology; the Leonard Wolfson Experimental Neurology Centre (D.S.L., J.A.K.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology; Dementia Research Centre (J.A.K., J.M.S., J.D.R., N.C.F.), Department of Neurodegeneration, UCL Institute of Neurology, UK; Department of Neurology (J.A.K.), St Vincent's University Hospital, University College Dublin, Ireland; Division of Neuropathology and Department of Neurodegenerative Disease (R.P.), Charles Dent Metabolic Unit (E.M.), Department of Neuroinflammation (J.C.), Neurogenetics Laboratory (H.H.), and Department of Brain Repair and Rehabilitation (I.D.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, UK
| | - Henry Houlden
- Lysholm Department of Neuroradiology (R.L., M.E.A., I.D.), the National Hospital for Neurology and Neurosurgery; Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology; the Leonard Wolfson Experimental Neurology Centre (D.S.L., J.A.K.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology; Dementia Research Centre (J.A.K., J.M.S., J.D.R., N.C.F.), Department of Neurodegeneration, UCL Institute of Neurology, UK; Department of Neurology (J.A.K.), St Vincent's University Hospital, University College Dublin, Ireland; Division of Neuropathology and Department of Neurodegenerative Disease (R.P.), Charles Dent Metabolic Unit (E.M.), Department of Neuroinflammation (J.C.), Neurogenetics Laboratory (H.H.), and Department of Brain Repair and Rehabilitation (I.D.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, UK
| | - Nick C Fox
- Lysholm Department of Neuroradiology (R.L., M.E.A., I.D.), the National Hospital for Neurology and Neurosurgery; Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology; the Leonard Wolfson Experimental Neurology Centre (D.S.L., J.A.K.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology; Dementia Research Centre (J.A.K., J.M.S., J.D.R., N.C.F.), Department of Neurodegeneration, UCL Institute of Neurology, UK; Department of Neurology (J.A.K.), St Vincent's University Hospital, University College Dublin, Ireland; Division of Neuropathology and Department of Neurodegenerative Disease (R.P.), Charles Dent Metabolic Unit (E.M.), Department of Neuroinflammation (J.C.), Neurogenetics Laboratory (H.H.), and Department of Brain Repair and Rehabilitation (I.D.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, UK
| | - Indran Davagnanam
- Lysholm Department of Neuroradiology (R.L., M.E.A., I.D.), the National Hospital for Neurology and Neurosurgery; Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology; the Leonard Wolfson Experimental Neurology Centre (D.S.L., J.A.K.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology; Dementia Research Centre (J.A.K., J.M.S., J.D.R., N.C.F.), Department of Neurodegeneration, UCL Institute of Neurology, UK; Department of Neurology (J.A.K.), St Vincent's University Hospital, University College Dublin, Ireland; Division of Neuropathology and Department of Neurodegenerative Disease (R.P.), Charles Dent Metabolic Unit (E.M.), Department of Neuroinflammation (J.C.), Neurogenetics Laboratory (H.H.), and Department of Brain Repair and Rehabilitation (I.D.), the National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, UK
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Parks R, Howard P, Hall L, Tang SW, Lakshmanan R, Winterbottom L, Morgan D, Porock D, Cox K, Cheung KL. Decision making in older women with primary operable breast cancer. J Geriatr Oncol 2013. [DOI: 10.1016/j.jgo.2013.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Parks⁎ R, Howard P, Tang SW, Hall L, Lakshmanan R, Winterbottom L, Morgan D, Cox K, Cheung KL. Assessment of changes of quality of life (QOL) following initial treatment of older women with primary operable breast cancer. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2012.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Parks RM, Hall L, Tang S, Lakshmanan R, Hurria A, Winterbottom L, Kennedy H, Morgan DAL, Porock D, Cox K, Cheung K. Evaluation of a cancer-specific comprehensive geriatric assessment (CGA) tool in older women with newly diagnosed primary breast cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lakshmanan R, Hyde Z, Jamrozik K, Hankey GJ, Norman PE. Population-based observational study of claudication in older men: the Health in Men Study. Med J Aust 2010; 192:641-5. [PMID: 20528717 DOI: 10.5694/j.1326-5377.2010.tb03663.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 02/11/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the prevalence of and risk factors for claudication and its association with subsequent cardiovascular events. DESIGN, SETTING AND PARTICIPANTS Observational cohort study of 12 203 Western Australian men aged 65 years and over, recruited from 1996 to 1999, and followed up from 2001 to 2004. MAIN OUTCOME MEASURES Prevalence of claudication and incidence of peripheral arterial disease (PAD); risk factors for claudication and its association with subsequent cardiovascular events. RESULTS The prevalence of claudication was 5.3% (638 of 11 970 men). At follow-up, after exclusion of 148 men with claudication at baseline and 76 with missing data at follow-up, the crude average annual incidence of new PAD (claudication or procedure for PAD) was 0.85% (95% CI, 0.72%-0.96%). The risk factors for prevalent claudication and incident PAD were similar, with age, smoking, hypertension, diabetes and history of cardiovascular disease dominating. Of the men with claudication at baseline, nearly half (47.5%; 303 of 638) were not taking aspirin. At follow-up, 42.5% (82 of 193) of the men with incident PAD were not taking aspirin. Claudication at baseline was associated with twice the risk of cardiovascular death (hazard ratio, 2.00; 95% CI, 1.52-2.64). There was a J-shaped relationship between aortic diameter, and both prevalent claudication and subsequent cardiovascular events. CONCLUSIONS Among older men, claudication is prevalent and is associated with factors that can still be modified in older age, including smoking, exercise and diet. Relatively few men with claudication or at risk of PAD use aspirin. Claudication is a significant predictor of cardiovascular outcome.
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Affiliation(s)
- Rahul Lakshmanan
- University of Western Australia, Fremantle Hospital, Fremantle, WA, Australia
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Lakshmanan R, Cheng A. Breast cancer presenting as axillary abscess and unilateral lymphedema. Breast Cancer Res 2009. [PMCID: PMC4284891 DOI: 10.1186/bcr2288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lakshmanan R, Clarke MJ, Putti TC. Diabetic fibrous mastopathy. Singapore Med J 2007; 48:579-81. [PMID: 17538761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Diabetic fibrous mastopathy is reported in a 37-year-old premenopausal woman. A known case of insulin-dependent diabetes mellitus, she presented with bilateral hard breast lumps, which were suggestive of malignancy on both ultrasonography and mammography. Fine-needle aspiration cytology and core biopsy showed fibrosis. An incisional biopsy further excluded malignancy and was conclusive for diabetic fibrous mastopathy.
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Affiliation(s)
- R Lakshmanan
- Department of General Surgery, Alexandra Hospital, Singapore.
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Lakshmanan R, Dalgaard P. Effects of high-pressure processing on Listeria monocytogenes, spoilage microflora and multiple compound quality indices in chilled cold-smoked salmon. J Appl Microbiol 2004; 96:398-408. [PMID: 14723701 DOI: 10.1046/j.1365-2672.2004.02164.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To evaluate the effect of high-pressure processing (HPP) on Listeria monocytogenes, microbial and chemical changes and shelf-life in chilled cold-smoked salmon (CSS). METHODS AND RESULTS First, challenge tests with L. monocytogenes were carried out using HPP of the product at 0.1 (control), 150, 200 and 250 MPa. Secondly, storage trials with the naturally contaminated product and HPP at 0.1 (control) and 200 MPa were realized. Shelf-life, microbial changes and chemical changes were determined and existing predictive models and multiple compound quality indices evaluated. HPP with 250 MPa did not inactivate L. monocytogenes but significant lag phases of 17 and 10 days were observed at ca 5 and 10 degrees C, respectively. HPP with 200 MPa had a marked effect on both colour and texture of CSS. CONCLUSIONS High-pressure processing was unable to prevent growth of L. monocytogenes or spoilage of chilled CSS. Existing mathematical models allowed growth rates of L. monocytogenes and shelf-life of samples without high-pressure treatments to be predicted. SIGNIFICANCE AND IMPACT OF THE STUDY High-pressure processing seems more appropriate for new types of salmon products than for a classical product like CSS where consumers expect specific quality attributes.
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Affiliation(s)
- R Lakshmanan
- Department of Bioscience, Food Quality Group, University of Strathclyde, Glasgow, UK
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Lakshmanan R, Moseley SK, Garza D, Sakowski J. Benchmarking graduate health administration programs: stakeholders' perceptions. J Health Adm Educ 2002; 19:417-55. [PMID: 11936769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The purpose of this study was to identify and compare among key stakeholders the factors in graduate health care administration education that are perceived to be important for ranking, or benchmarking, based on the opinions of those stakeholders, i.e., program directors, faculty, graduate students, and accrediting agency commissioners. We used an original survey to obtain stakeholders' perceptions and opinions about important process and outcome measures. We sent it to all ACEHSA-accredited graduate health care administration programs in the United States, Canada, and Puerto Rico; to full-time faculty members in each program; to three current graduate students in each program, and to all ACEHSA commissioners. We performed frequency of responses, Analysis of Variances (ANOVA) tests, and Dunnett T3 tests. A response rate of 32 percent (n = 156) was achieved for all stakeholders. A total of 67 percent of all respondents reported that benchmarking graduate health care administration programs was important. The study results revealed a significant difference between populations on the importance of evaluating certain process and outcome measures related to curriculum, research, student characteristics, and resources. However, most of the stakeholders reported that curriculum, faculty, and graduate student performance were the key quality indicators of a program. The results of this study provide preliminary information for health care administration programs to begin to develop an educational benchmarking effort.
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Affiliation(s)
- R Lakshmanan
- Program in Health Care Administration, Texas Woman's University-Houston, 77030 USA
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Lakshmanan R, Shakila R, Jeyasekaran G. Changes in the halophilic amine forming bacterial flora during salt-drying of sardines (Sardinella gibbosa). Food Res Int 2002. [DOI: 10.1016/s0963-9969(01)00154-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lakshmanan R, Venugopal V, Venketashvaran K, Bongirwar D. Bulk preservation of small pelagic fish by gamma irradiation: studies on a model storage system using Anchovies. Food Res Int 1999. [DOI: 10.1016/s0963-9969(99)00151-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lakshmanan R, Stephanopoulos G. Synthesis of operating procedures for complete chemical plants—II. A nonlinear planning methodology. Comput Chem Eng 1988. [DOI: 10.1016/0098-1354(88)87023-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lakshmanan R, Stephanopoulos G. Synthesis of operating procedures for complete chemical plants—I. Hierarchical, structured modelling for nonlinear planning. Comput Chem Eng 1988. [DOI: 10.1016/0098-1354(88)87022-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Study I investigated the effects of display type, amount of information presented, and display contrast on the visual mechanism during a visual search task. In the first phase, two subjects performed the visual task for four 3-h sessions. In the second phase, subjects were tested for two 6-h sessions. CRT usage for 3 h produced measurable visual fatigue in the eye movement and/or accommodation mechanism, as measured by increased durations to move from a near point and focus on a far point (and vice versa). Such visual fatigue was not present in the hard-copy visual search task. In a second study, subjects performed the visual task for two 4-h sessions. Two h of CRT usage produced measurable fatigue in the eye accommodation mechanism as well as an increased blink rate. Such visual fatigue was also present in the hard-copy task but to a lesser extent. In both studies, I-h breaks produced a marked reduction in visual fatigue indices.
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Lo SN, Marchildon L, Lakshmanan R, Garceau JJ. A kinetic model for continuous-flow stirred biological reactors. CAN J CHEM ENG 1978. [DOI: 10.1002/cjce.5450560410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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