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Li X, Bai J, Guo X, Mu Y, Di Z, Zhang G, Wang B, Zhang Y, Liu X, Shi Y, Lin S, Wu L, Bai Y, Liu X. Identifying New Subtypes of Multiple System Atrophy Using Cluster Analysis. J Parkinsons Dis 2024:JPD230344. [PMID: 38640168 DOI: 10.3233/jpd-230344] [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] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Background Multiple system atrophy (MSA) is a disease with diverse symptoms and the commonly used classifications, MSA-P and MSA-C, do not cover all the different symptoms seen in MSA patients. Additionally, these classifications do not provide information about how the disease progresses over time or the expected outcome for patients. Objective To explore clinical subtypes of MSA with a natural disease course through a data-driven approach to assist in the diagnosis and treatment of MSA. Methods We followed 122 cases of MSA collected from 3 hospitals for 3 years. Demographic characteristics, age of onset, clinical signs, scale assessment scores, and auxiliary examination were collected. Age at onset; time from onset to assisted ambulation; and UMSARS I, II, and IV, COMPASS-31, ICARS, and UPDRS III scores were selected as clustering elements. K-means, partitioning around medoids, and self-organizing maps were used to analyze the clusters. Results The results of all three clustering methods supported the classification of three MSA subtypes: The aggressive progression subtype (MSA-AP), characterized by mid-to-late onset, rapid progression and severe clinical symptoms; the typical subtype (MSA-T), characterized by mid-to-late onset, moderate progression and moderate severity of clinical symptoms; and the early-onset slow progression subtype (MSA-ESP), characterized by early-to-mid onset, slow progression and mild clinical symptoms. Conclusions We divided MSA into three subtypes and summarized the characteristics of each subtype. According to the clustering results, MSA patients were divided into three completely different types according to the severity of symptoms, the speed of disease progression, and the age of onset.
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Affiliation(s)
- Xiaobing Li
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Jing Bai
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Xin Guo
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Yaqian Mu
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Zhengli Di
- Department of Neurology, Xi'an Central Hospital, Xi'an, Shaanxi, China
| | - Gejuan Zhang
- Department of Neurology, Xi'an No. 3 Hospital, Xi'an, Shaanxi, China
| | - Bo Wang
- Department of Epidemiology, Air Force Medical University, School of Public Health, Xi'an, Shaanxi, China
| | - Yun Zhang
- Department of Neurology, Xi'an No. 9 Hospital, Xi'an, Shaanxi, China
| | - Xinyao Liu
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Yan Shi
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Shinuan Lin
- GYENNO Science Co., Ltd., Shenzhen, Guangdong, China
- HUST - GYENNO CNS, Intelligent Digital Medicine Technology Center, Wuhan, China
| | - Linyu Wu
- GYENNO Science Co., Ltd., Shenzhen, Guangdong, China
- HUST - GYENNO CNS, Intelligent Digital Medicine Technology Center, Wuhan, China
| | - Ya Bai
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Xuedong Liu
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
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VAN Brabander L, Huyghebaert L, Vermoere MS. CASE REPORT OF IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS: A CHALLENGING DIAGNOSIS. J Rehabil Med Clin Commun 2023; 6:11631. [PMID: 37927824 PMCID: PMC10622158 DOI: 10.2340/jrmcc.v6.11631] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/07/2023]
Abstract
Introduction This report concerns the case of a 70-year-old man with idiopathic normal pressure hydrocephalus (iNPH). The diagnosis in the current case took more than 2 years. iNPH is characterised by ventriculomegaly with a known triad of symptoms: gait disturbance, cognitive impairments and urinary incontinence. Although this is a difficult diagnosis and other conditions must be ruled out, several points in the process could lead to a correct diagnosis. The aim of the report is to identify several reasons why the diagnosis was delayed for such a long time, as well as lessons for the future. Case This patient developed several symptoms over time. First, he presented with depressive mood and altered behaviour. He later developed gait difficulties and, finally, urinary incontinence. Multiple consultations and examinations failed to provide an exact explanation for all his symptoms. After 2 years, a new doctor at the hospital started from scratch and recognised the iNPH triad, and the diagnosis was confirmed by the radiologist. Conclusion The diagnosis of iNPH is difficult, as symptoms may manifest over time. In this case, the delay of diagnosis exceeded estimations. A broader view through interdisciplinary consultation could provide new insights and lead to earlier diagnosis.
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Affiliation(s)
- Lina VAN Brabander
- Physical Medicine and Rehabilitation, AZ Glorieux, Ronse, Belgium
- Physical Medicine and Rehabilitation, UZ Brussel, Jette, Belgium
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Wuehr M, Eilles E, Lindner M, Grosch M, Beck R, Ziegler S, Zwergal A. Repetitive Low-Intensity Vestibular Noise Stimulation Partly Reverses Behavioral and Brain Activity Changes following Bilateral Vestibular Loss in Rats. Biomolecules 2023; 13:1580. [PMID: 38002261 PMCID: PMC10669117 DOI: 10.3390/biom13111580] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/18/2023] [Accepted: 10/22/2023] [Indexed: 11/26/2023] Open
Abstract
Low-intensity noisy galvanic vestibular stimulation (nGVS) can improve static and dynamic postural deficits in patients with bilateral vestibular loss (BVL). In this study, we aimed to explore the neurophysiological and neuroanatomical substrates underlying nGVS treatment effects in a rat model of BVL. Regional brain activation patterns and behavioral responses to a repeated 30 min nGVS treatment in comparison to sham stimulation were investigated by serial whole-brain 18F-FDG-PET measurements and quantitative locomotor assessments before and at nine consecutive time points up to 60 days after the chemical bilateral labyrinthectomy (BL). The 18F-FDG-PET revealed a broad nGVS-induced modulation on regional brain activation patterns encompassing biologically plausible brain networks in the brainstem, cerebellum, multisensory cortex, and basal ganglia during the entire observation period post-BL. nGVS broadly reversed brain activity adaptions occurring in the natural course post-BL. The parallel behavioral locomotor assessment demonstrated a beneficial treatment effect of nGVS on sensory-ataxic gait alterations, particularly in the early stage of post-BL recovery. Stimulation-induced locomotor improvements were finally linked to nGVS brain activity responses in the brainstem, hemispheric motor, and limbic networks. In conclusion, combined 18F-FDG-PET and locomotor analysis discloses the potential neurophysiological and neuroanatomical substrates that mediate previously observed therapeutic nGVS effects on postural deficits in patients with BVL.
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Affiliation(s)
- Max Wuehr
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, 81377 Munich, Germany; (M.W.); (E.E.); (M.L.); (M.G.); (R.B.)
| | - Eva Eilles
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, 81377 Munich, Germany; (M.W.); (E.E.); (M.L.); (M.G.); (R.B.)
| | - Magdalena Lindner
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, 81377 Munich, Germany; (M.W.); (E.E.); (M.L.); (M.G.); (R.B.)
| | - Maximilian Grosch
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, 81377 Munich, Germany; (M.W.); (E.E.); (M.L.); (M.G.); (R.B.)
| | - Roswitha Beck
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, 81377 Munich, Germany; (M.W.); (E.E.); (M.L.); (M.G.); (R.B.)
- Pharmaceutical Radiochemistry, TUM School of Natural Sciences, TU Munich, 85748 Garching, Germany
| | - Sibylle Ziegler
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, 81377 Munich, Germany;
| | - Andreas Zwergal
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, 81377 Munich, Germany; (M.W.); (E.E.); (M.L.); (M.G.); (R.B.)
- Department of Neurology, LMU University Hospital, LMU Munich, 81377 Munich, Germany
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Bonilha PÁAM, Cassarotti B, Nunes TEM, Teive HAG. Frontal ataxia: historical aspects and clinical definition. Arq Neuropsiquiatr 2023; 81:934-936. [PMID: 37899045 PMCID: PMC10631853 DOI: 10.1055/s-0043-1775886] [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] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/22/2023] [Indexed: 10/31/2023]
Abstract
Frontal ataxia, originally described by Bruns, is characterized by the presence of signs of frontal lobe dysfunction, such as perseveration, paratonia, frontal release signs, cognitive changes, and urinary difficulty, associated with imbalance, slow gait, broad-based, the presence of postural instability and falls, retropulsion, and bradykinesia in the lower limbs. The goal of the present study is to recall the historical aspects of this condition, to draw attention to the importance of this clinical finding for the differential diagnosis of ataxias and to review the main semiological differences between primary ataxias (frontal, cerebellar, and sensory ataxia).
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Affiliation(s)
- Patrícia Áurea Andreucci Martins Bonilha
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Unidade de Distúrbios do Movimento, Curitiba PR, Brazil.
| | - Beatriz Cassarotti
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Unidade de Distúrbios do Movimento, Curitiba PR, Brazil.
| | - Thabata Emanuelle Martins Nunes
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Unidade de Distúrbios do Movimento, Curitiba PR, Brazil.
| | - Hélio Afonso Ghizoni Teive
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Unidade de Distúrbios do Movimento, Curitiba PR, Brazil.
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Etter EJ, Trivitt SJ, Bosse BL, McWilliams A. Abnormal Presentation of Bartonella henselae Encephalopathy in a Pediatric Patient. Cureus 2023; 15:e43535. [PMID: 37719525 PMCID: PMC10500953 DOI: 10.7759/cureus.43535] [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] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Cat scratch disease (CSD) is a zoonotic infection caused by the transmission of gram-negative bacteria Bartonella henselae through a scratch or bite of a feline carrying B. henselae-infected fleas. CSD often presents clinically as a self-limited flu-like infection with painful regional lymphadenopathy appearing one to two weeks following initial transmission. However, a growing body of literature highlights abnormal presentations of Bartonella infections within the pediatric population. In this case report, we describe an atypical presentation of a B. henselae infection in an 11-year-old female with seizures, prolonged encephalopathy, agitation, and truncal instability. With an atypical presentation, a delay in diagnosis can result in potentially permanent organ damage, particularly as traditional empiric antibiotics fail to cover Bartonella infections. As such, proper treatment and complete resolution of symptoms require astute clinical recognition to make the correct diagnosis promptly.
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Affiliation(s)
- Emily J Etter
- Pediatrics, University of Nevada, Reno School of Medicine, Reno, USA
| | - Spencer J Trivitt
- Pediatrics, University of Nevada, Reno School of Medicine, Reno, USA
| | - Benjamin L Bosse
- Radiology, University of Nevada, Reno School of Medicine, Reno, USA
| | - Alison McWilliams
- Pediatrics, University of Nevada, Reno School of Medicine, Reno, USA
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Shah NS, Pathak J, Shah PC, Bharmal UF, Ansari MI. A Rare Case of Opsoclonus Myoclonus Ataxia Syndrome Post Viral Illness. Cureus 2023; 15:e40396. [PMID: 37456490 PMCID: PMC10345879 DOI: 10.7759/cureus.40396] [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] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Opsoclonus myoclonus ataxia syndrome (OMAS) is a rare inflammatory neurological disorder characterized by ocular, motor, behavioral, language, and sleep disturbances. It usually affects infants and young children but may affect adults. A 28-year-old male was brought to our emergency ward with complaints of involuntary spontaneous eye movements and jerky movements of limbs with imbalance while walking. He had a history of short febrile illness 10 days prior. His magnetic resonance imaging (MRI) of the brain, cerebrospinal fluid (CSF) analysis, and other routine investigations were normal. The patient was treated with injectable methylprednisolone (1 g) given for five days along with other supportive therapy. A significant reduction in the opsoclonus, myoclonus, and ataxia was seen on a six-month follow-up. OMAS should be identified early to avoid the use of inappropriate medications, and immunotherapy must be provided as early as possible in order to prevent irreversible neurological damage.
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Affiliation(s)
- Nauka S Shah
- Department of Medicine, Baroda Medical College, Maharaja Sayajirao (MS) University, Vadodara, IND
| | - Jaya Pathak
- Department of Internal Medicine, Baroda Medical College, Maharaja Sayajirao (MS) University, Vadodara, IND
| | - Purva C Shah
- Department of Internal Medicine, Baroda Medical College, Maharaja Sayajirao (MS) University, Vadodara, IND
| | - Ummayhany F Bharmal
- Department of Medicine, Baroda Medical College, Maharaja Sayajirao (MS) University, Vadodara, IND
| | - Maliha I Ansari
- Department of Internal Medicine, Pramukhswami Medical College, Anand, IND
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Usama M, Arora AKMS, Saleem F. Bulbar Dysfunction in Idiopathic Normal Pressure Hydrocephalus: A Case Report. Cureus 2023; 15:e34579. [PMID: 36883089 PMCID: PMC9985771 DOI: 10.7759/cureus.34579] [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] [Accepted: 02/02/2023] [Indexed: 02/05/2023] Open
Abstract
Normal pressure hydrocephalus (NPH) is a rare condition characterized by pathologically enlarged ventricles and a normal cerebrospinal fluid (CSF) opening pressure measured by lumbar puncture. NPH typically presents as a triad of cognitive decline, gait disturbance, and urinary incontinence. Rarely, NPH can present with bulbar involvement, particularly with difficulty swallowing. Here, we present a case of NPH in a 75-year-old man who presented with an episode of choking and a recent onset of swallowing difficulties with a three-month history of ataxia and progressive memory loss. His CT scan revealed ventriculomegaly, which was consistent with the clinical presentation of NPH and was further confirmed by a normal opening pressure on the CSF tap. Furthermore, ventriculoperitoneal shunts showed a marked improvement in patients' dysphagia and the classical triad of NPH symptoms. Through this case report, we want to highlight that NPH can present as a difficulty in swallowing.
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Affiliation(s)
- Muhammad Usama
- Neurology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, PAK
| | - Avneet Kaur Manjeet Singh Arora
- Public Health and Epidemiology, University of California, Berkeley, Berkeley, USA.,Internal Medicine, Mahatma Gandhi Mission Medical College and Hospital, Navi Mumbai, IND
| | - Faraz Saleem
- Internal Medicine, Akhtar Saeed Medical and Dental College, Lahore, PAK
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A. Castillo-Torres S, A. Soto-Rincón C, H. Gil-Valadez A, E. Chávez-Luévanos B, Góngora-Rivera F. A neglected symptom? Parietal gait lateropulsion as primary manifestation of acute is-chemic stroke. Rev Neurol 2023; 76:69-73. [PMID: 36631966 PMCID: PMC10364037 DOI: 10.33588/rn.7602.2021349] [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] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Gait disorders are commonly overlooked as a presenting manifestation of stroke and underrepresented in case series. We describe four cases of sudden-onset gait lateropulsion as primary manifestation of parietal lobe stroke. CASE REPORT Four patients presented after sudden-onset gait lateropulsion. On neurological examination, all patients had at least one cortical sensory deficit and wide-based gait with lateropulsion towards the side of the cortical deficit. Neuroimaging revealed a subacute parietal lobe stroke contralateral to the side of gait lateropulsion. In two patients we found bilateral lateropulsion with predominance towards the side of cortical deficit and increase of unsteadiness with eye closure (an apparent Romberg sign), with neuroimaging revealing bilateral parietal strokes (subacute contralateral and chronic ipsilateral to gait lateropulsion). CONCLUSION We report gait lateropulsion as a novel primary manifestation of acute stroke of the parietal lobe (parietal gait lateropulsion). Given its role as the destination of proprioceptive pathways, parietal strokes can result in gait lateropulsion, with bilateral lesions even mimicking sensory ataxia with bilateral lateropulsion and unsteadiness upon eye closure.
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Affiliation(s)
- Sergio A. Castillo-Torres
- Neurology Department. Hospital Universitario Dr. José Eleuterio González. Monterrey, MexicoNeurology DepartmentHospital Universitario Dr. José Eleuterio GonzálezMonterreyMexico
| | - Carlos A. Soto-Rincón
- Neurology Department. Hospital Universitario Dr. José Eleuterio González. Monterrey, MexicoNeurology DepartmentHospital Universitario Dr. José Eleuterio GonzálezMonterreyMexico
| | - Alfonso H. Gil-Valadez
- Neurology Department. Hospital Universitario Dr. José Eleuterio González. Monterrey, MexicoNeurology DepartmentHospital Universitario Dr. José Eleuterio GonzálezMonterreyMexico
| | - Beatriz E. Chávez-Luévanos
- Neurology Department. Hospital Universitario Dr. José Eleuterio González. Monterrey, MexicoNeurology DepartmentHospital Universitario Dr. José Eleuterio GonzálezMonterreyMexico
| | - Fernando Góngora-Rivera
- Neurovascular Care UnitNeurovascular Care UnitNeurovascular Care UnitMonterreyMexico
- Neurology Department. Hospital Universitario Dr. José Eleuterio González. Monterrey, MexicoNeurology DepartmentHospital Universitario Dr. José Eleuterio GonzálezMonterreyMexico
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Soma Y, Kubota S, Kadone H, Shimizu Y, Hada Y, Koda M, Sankai Y, Yamazaki M. Postoperative Acute-Phase Gait Training Using Hybrid Assistive Limb Improves Gait Ataxia in a Patient with Intradural Spinal Cord Compression Due to Spinal Tumors. Medicina (Kaunas) 2022; 58:medicina58121825. [PMID: 36557027 PMCID: PMC9782825 DOI: 10.3390/medicina58121825] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/29/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
Sensory ataxia due to posterior cord syndrome is a relevant, disabling condition in nontraumatic spinal cord dysfunction. Ataxic gait is a common symptom of sensory ataxia that restricts activities of daily living. A 70-year-old woman with severe sensory disturbance was diagnosed with intradural extramedullary spinal cord tumors found in the thoracic spine region (T8). Surgical management of the tumors was performed. The patient received gait training 20 days after surgery (postoperative acute phase) using a hybrid assistive limb (HAL). HAL is a wearable exoskeleton cyborg that provides real-time assistance to an individual for walking and limb movements through actuators mounted on the bilateral hip and knee joints. Walking ability was assessed using the 10 m walking test, which included evaluating walking speed, step length, and cadence in every session. To evaluate the immediate effects of HAL training, walking speed and step length were measured before and after the training in each session. During the 10 m walking test, gait kinematics and lower muscle activity were recorded using a motion capture system and wireless surface electromyography before the first session and after completion of all HAL sessions. After the HAL training sessions, improvement in the patient’s gait performance was observed in the gait joint angles and muscle activity of the lower limb. After 10 training sessions, we observed the following changes from baseline: walking speed (from 0.16 m/s to 0.3 m/s), step length (from 0.19 m to 0.37 m), and cadence (from 50.9 steps/min to 49.1 steps/min). The average standard deviations of the knee (from right, 7.31; left, 6.75; to right, 2.93; p < 0.01, left, 2.63; p < 0.01) and ankle joints (from right, 6.98; left, 5.40; to right, 2.39; p < 0.01, left, 2.18; p < 0.01) were significantly decreased. Additionally, walking speed and step length improved immediately after completing all the HAL training sessions. This suggests that HAL gait training might be a suitable physical rehabilitation program for patients with sensory ataxia causing dysfunctional movement of the lower limb.
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Affiliation(s)
- Yuichiro Soma
- Department of Rehabilitation Medicine, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan
| | - Shigeki Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan
- Correspondence: ; Tel.: +81-29-853-3219
| | - Hideki Kadone
- Center for Innovating Medicine and Engineering (CIME), University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan
| | - Yoshiyuki Sankai
- Faculty of Systems and Information Engineering, University of Tsukuba, Tsukuba 305-0006, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan
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Wijnia JW. A Clinician's View of Wernicke-Korsakoff Syndrome. J Clin Med 2022; 11. [PMID: 36431232 DOI: 10.3390/jcm11226755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/06/2022] [Accepted: 11/12/2022] [Indexed: 11/17/2022] Open
Abstract
The purpose of this article is to improve recognition and treatment of Wernicke-Korsakoff syndrome. It is well known that Korsakoff syndrome is a chronic amnesia resulting from unrecognized or undertreated Wernicke encephalopathy and is caused by thiamine (vitamin B1) deficiency. The clinical presentation of thiamine deficiency includes loss of appetite, dizziness, tachycardia, and urinary bladder retention. These symptoms can be attributed to anticholinergic autonomic dysfunction, as well as confusion or delirium, which is part of the classic triad of Wernicke encephalopathy. Severe concomitant infections including sepsis of unknown origin are common during the Wernicke phase. These infections can be prodromal signs of severe thiamine deficiency, as has been shown in select case descriptions which present infections and lactic acidosis. The clinical symptoms of Wernicke delirium commonly arise within a few days before or during hospitalization and may occur as part of a refeeding syndrome. Wernicke encephalopathy is mostly related to alcohol addiction, but can also occur in other conditions, such as bariatric surgery, hyperemesis gravidarum, and anorexia nervosa. Alcohol related Wernicke encephalopathy may be identified by the presence of a delirium in malnourished alcoholic patients who have trouble walking. The onset of non-alcohol-related Wernicke encephalopathy is often characterized by vomiting, weight loss, and symptoms such as visual complaints due to optic neuropathy in thiamine deficiency. Regarding thiamine therapy, patients with hypomagnesemia may fail to respond to thiamine. This may especially be the case in the context of alcohol withdrawal or in adverse side effects of proton pump inhibitors combined with diuretics. Clinician awareness of the clinical significance of Wernicke delirium, urinary bladder retention, comorbid infections, refeeding syndrome, and hypomagnesemia may contribute to the recognition and treatment of the Wernicke-Korsakoff syndrome.
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Bin Saqyan TM, Basunbul LI, Badahdah AA, Saleh YA, Filimban SS, Alwabari AA, Almutairi AA, Alanazi SR, Alghamdi AS, Aldadi BO, Alghamdi BA, Alzahrani SA, Alzahrani AR, Alghamdi OH, Alshammari M. Abdominal Pseudocyst: A Rare Complication of Ventriculoperitoneal Shunts. Cureus 2021; 13:e18956. [PMID: 34815902 PMCID: PMC8606019 DOI: 10.7759/cureus.18956] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/05/2022] Open
Abstract
We present the case of a 69-year-old man patient who was brought with a history of gait disturbances, memory impairment, and urinary incontinence with gradual worsening over the past six months. The patient underwent magnetic resonance imaging of the brain which demonstrated enlarged ventricles, widening of the Sylvian fissure, and narrow sulci at the vertex. Subsequently, the patient underwent a lumbar puncture which revealed a normal opening pressure with normal cerebrospinal fluid analysis. The diagnosis of normal pressure hydrocephalus was established. The patient underwent a ventriculoperitoneal shunt for the management of his symptoms. Three years after the placement of the shunt, the patient was brought to the emergency department with an expanding right-sided subcutaneous abdominal mass. A computed tomography scan of the abdomen showed the subcutaneous mass superficial to the right rectus muscle and was containing the coiled distal end of the shunt. Such findings were consistent with a subcutaneous cerebrospinal fluid pseudocyst. The mass was aspirated and the fluid analysis was in keeping with the cerebrospinal fluid characteristics. The fluid culture revealed no bacterial growth. The ventriculoperitoneal shunt was replaced with a minimally invasive technique.
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Affiliation(s)
- Turki M Bin Saqyan
- College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, SAU
| | | | | | - Yasir A Saleh
- College of Medicine, Umm Al Qura University, Mecca, SAU
| | | | | | | | | | | | | | | | | | | | | | - Malak Alshammari
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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Abstract
Wernicke encephalopathy (WE) is an acute reaction to thiamine deficiency, which presents with the classic triad of ocular findings, cerebellar dysfunction, and confusion. However, thiamine deficiency can also present with several neuropsychiatric signs and symptoms other than the classical triad. We report a patient who presented with catatonia as a presenting feature of WE. The objective of this report is to recognize the presentation of catatonia in WE. Some cases of WE are missed by physicians; therefore, a high index of suspicion and appropriate investigations depending on presentation and clinical condition can result in prompt diagnosis and early management.
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Affiliation(s)
- Saeed Ahmed
- Psychiatry and Behavioral Sciences, Nassau University Medical Center, East Meadow, USA.,Behavioral Health Sciences, Boston University School of Medicine, Boston, USA
| | - Tayo V Akadiri
- Anaesthesiology, Ocala Regional Medical Center, Ocala, USA
| | - Subhan Ata
- Internal Medicine, BronxCare Health System, New York, USA
| | - Shahana Ayub
- Psychiatry, Cornerstone Healthcare System, Newburgh, USA
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13
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Makino T, Takenaka S, Okamura G, Sakai Y, Yoshikawa H, Kaito T. Dorsal spinal cord herniation at the thoracolumbar junction presenting with scalloping of ossification of the ligamentum flavum: case report. J Neurosurg Spine 2019; 32:1-5. [PMID: 31628276 DOI: 10.3171/2019.8.spine19771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 08/02/2019] [Indexed: 11/06/2022]
Abstract
Dorsal spinal cord herniation is reportedly a rare condition. Here, the authors report an unusual case of dorsal spinal cord herniation at the thoracolumbar junction presenting with scalloping of ossification of the ligamentum flavum (OLF). A 75-year-old woman with a 2-year history of bilateral leg dysesthesia presented with progressive gait ataxia. Neurological examination showed bilateral patellar tendon hyperreflexia with loss of vibratory sensation and proprioception in her bilateral lower extremities. CT myelography revealed a posterior kink and dorsal herniation of the spinal cord at T11-12, with OLF between T10-11 and T12-L1. In addition, scalloping of the OLF was observed at T11-12 at the site of the herniated spinal cord. This scalloping was first noted 9 years previously and had been gradually progressing. The patient underwent surgical repair of the spinal cord herniation. Subsequently, her spinal cord herniation and vibratory sensation and proprioception in both legs partly improved, but gait ataxia remained unchanged. Dorsal spinal cord herniation reportedly occurs under conditions of vulnerability of the dorsal dura mater. In this case, acquired vulnerability of the dorsal dura mater owing to previous epidural catheter placement into the thoracolumbar space may have resulted in dorsal spinal cord herniation.
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14
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Meira AT, Arruda WO, Ono SE, Neto ADC, Raskin S, Camargo CHF, Teive HAG. Neuroradiological Findings in the Spinocerebellar Ataxias. Tremor Other Hyperkinet Mov (N Y) 2019; 9:tre-09-682. [PMID: 31632837 PMCID: PMC6765228 DOI: 10.7916/tohm.v0.682] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/02/2019] [Indexed: 01/19/2023]
Abstract
Background The spinocerebellar ataxias (SCAs) are a group of autosomal dominant degenerative diseases characterized by cerebellar ataxia. Classified according to gene discovery, specific features of the SCAs – clinical, laboratorial, and neuroradiological (NR) – can facilitate establishing the diagnosis. The purpose of this study was to review the particular NR abnormalities in the main SCAs. Methods We conducted a literature search on this topic. Results The main NR characteristics of brain imaging (magnetic resonance imaging or computerized tomography) in SCAs were: (1) pure cerebellar atrophy; (2) cerebellar atrophy with other findings (e.g., pontine, olivopontocerebellar, spinal, cortical, or subcortical atrophy; “hot cross bun sign”, and demyelinating lesions); (3) selective cerebellar atrophy; (4) no cerebellar atrophy. Discussion The main NR abnormalities in the commonest SCAs, are not pathognomonic of any specific genotype, but can be helpful in limiting the diagnostic options. We are progressing to a better understanding of the SCAs, not only genetically, but also pathologically; NR is helpful in the challenge of diagnosing the specific genotype of SCA.
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Affiliation(s)
- Alex Tiburtino Meira
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, BR
| | - Walter Oleschko Arruda
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, BR
| | | | - Arnolfo de Carvalho Neto
- DAPI, Diagnóstico Avançado por Imagem, Curitiba, BR.,Neurological Diseases Group, Graduate Program of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Curitiba, BR
| | - Salmo Raskin
- Genetika - Centro de aconselhamento e laboratório de genética, Curitiba, BR
| | - Carlos Henrique F Camargo
- Neurological Diseases Group, Graduate Program of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Curitiba, BR
| | - Hélio Afonso G Teive
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, BR.,Neurological Diseases Group, Graduate Program of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Curitiba, BR
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15
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Kroneberg D, Ewert S, Meyer AC, Kühn AA. Shorter pulse width reduces gait disturbances following deep brain stimulation for essential tremor. J Neurol Neurosurg Psychiatry 2019; 90:1046-1050. [PMID: 30765417 PMCID: PMC6820151 DOI: 10.1136/jnnp-2018-319427] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/12/2018] [Accepted: 01/04/2019] [Indexed: 12/02/2022]
Abstract
OBJECTIVE Gait disturbances are frequent side effects occurring during chronic thalamic deep brain stimulation (DBS) in patients with essential tremor (ET). Adapting stimulation settings to shorter pulse widths has been shown to reduce side effects of subthalamic DBS. Here, we assess how a reduction of pulse width changes gait performance of affected patients. METHODS Sensor-based gait assessment was performed to record spatiotemporal gait parameters in 10 healthy subjects (HS) and 7 patients with ET with gait disturbances following thalamic DBS. Patients were tested during standard DBS, after 72 hours of stimulation withdrawal and at least 30 days after adjusting DBS settings to a shorter pulse width of 40 µs (DBS40PW). RESULTS Patients with ET on standard DBS showed significantly higher variability of several spatiotemporal gait parameters compared with HS. Variability of stride length and range of motion of the shanks significantly decreased OFF DBS as compared with standard DBS. This improvement was maintained over 30 days with DBS40PW while providing effective tremor suppression in six out of seven patients. CONCLUSION Shorter pulse widths may reduce gait disturbances in patients with ET that are induced by DBS while preserving a level of tremor suppression equal to standard stimulation settings.
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Affiliation(s)
- Daniel Kroneberg
- Charité - Universitätsmedizin Berlin, Department of Neurology, Movement Disorder and Neuromodulation Unit, Berlin, Germany
| | - Siobhan Ewert
- Charité - Universitätsmedizin Berlin, Department of Neurology, Movement Disorder and Neuromodulation Unit, Berlin, Germany
| | - Anne-Christiane Meyer
- Charité - Universitätsmedizin Berlin, Department of Neurology, Movement Disorder and Neuromodulation Unit, Berlin, Germany
| | - Andrea A Kühn
- Charité - Universitätsmedizin Berlin, Department of Neurology, Movement Disorder and Neuromodulation Unit, Berlin, Germany .,Charité - Universitätsmedizin Berlin, NeuroCure Cluster of Excellence, Berlin, Germany
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16
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Peikert K, Gerber J, Winzer S, Schäfer J, Reichmann H, Hermann A. Palatal Tremor with Progressive Ataxia Secondary to A Dural Arteriovenous Fistula. Mov Disord Clin Pract 2019; 6:327-329. [PMID: 31061843 DOI: 10.1002/mdc3.12750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/23/2019] [Accepted: 02/12/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Kevin Peikert
- Department of Neurology University Hospital Carl Gustav Carus, Technische Universität Dresden 01307 Dresden Germany
| | - Johannes Gerber
- Department of Neuroradiology University Hospital Carl Gustav Carus, Technische Universität Dresden 01307 Dresden Germany
| | - Simon Winzer
- Department of Neurology University Hospital Carl Gustav Carus, Technische Universität Dresden 01307 Dresden Germany
| | - Jochen Schäfer
- Department of Neurology University Hospital Carl Gustav Carus, Technische Universität Dresden 01307 Dresden Germany
| | - Heinz Reichmann
- Department of Neurology University Hospital Carl Gustav Carus, Technische Universität Dresden 01307 Dresden Germany
| | - Andreas Hermann
- Department of Neurology University Hospital Carl Gustav Carus, Technische Universität Dresden 01307 Dresden Germany.,German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald 18147 Rostock Germany.,Translational Neurodegeneration Section "Albrecht-Kossel", Department of Neurology, and Center for Transdisciplinary Neurosciences Rostock (CTNR) University Medical Center Rostock, University of Rostock 18147 Rostock Germany
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17
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Abstract
Beyond the classic clinical description, recent studies have quantitatively evaluated gait and balance dysfunction in cerebellar ataxias by means of modern motion analysis systems. These systems have the aim of clearly and quantitatively describing the differences, with respect to healthy subjects, in kinematic, kinetic, and surface electromyography variables, establishing the basis for a rehabilitation strategy and assessing its efficacy. The main findings which characterize the gait pattern of cerebellar patients are: increased step width, reduced ankle joint range of motion with increased coactivation of the antagonist muscles, and increased stride-to-stride variability. Whereas the former is a compensatory strategy adopted by patients to keep the center of mass within the base of support, the latter indicates the inability of patients to maintain dynamic balance through a regular walking pattern and may reflect the primary deficit directly related to cerebellar dysfunction and the consequent lack of muscle coordination during walking. Moreover, during the course of the disease, with the progressive loss of walking autonomy, step length, and lower-limb joint range of motion are drastically reduced. As to the joint coordination defect, abnormal intralimb joint coordination during walking, in terms of both joint kinematics and interaction torques, has been reported in several studies. Furthermore, patients with cerebellar ataxia show a poor intersegmental coordination, with a chaotic coordinative behavior between trunk and hip, leading to increased upper-body oscillations that affect gait performance and stability, sustaining a vicious circle that transforms the upper body into a generator of perturbations. The use of motion analysis laboratories allows a deeper segmental and global characterization of walking impairment in these patients and can shed light on the nature of both the primary specific gait disorder and compensatory mechanisms. Such deeper understanding might reasonably represent a valid prerequisite for establishing better-targeted rehabilitation strategies.
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Affiliation(s)
- Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy.
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro, Rome, Italy
| | - Carlo Casali
- Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
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18
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Moskowitz AM, Belnap N, Siniard AL, Szelinger S, Claasen AM, Richholt RF, De Both M, Corneveaux JJ, Balak C, Piras IS, Russell M, Courtright AL, Rangasamy S, Ramsey K, Craig DW, Narayanan V, Huentelman MJ, Schrauwen I. A de novo missense mutation in ZMYND11 is associated with global developmental delay, seizures, and hypotonia. Cold Spring Harb Mol Case Stud 2016; 2:a000851. [PMID: 27626064 PMCID: PMC5002929 DOI: 10.1101/mcs.a000851] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Recently, mutations in the zinc finger MYND-type containing 11 (ZMYND11) gene were identified in patients with autism spectrum disorders, intellectual disability, aggression, and complex neuropsychiatric features, supporting that this gene is implicated in 10p15.3 microdeletion syndrome. We report a novel de novo variant in the ZMYND11 gene (p.Ser421Asn) in a patient with a complex neurodevelopmental phenotype. The patient is a 24-yr-old Caucasian/Filipino female with seizures, global developmental delay, sensorineural hearing loss, hypotonia, dysmorphic features, and other features including a happy disposition and ataxic gait similar to Angelman syndrome. In addition, this patient had uncommon features including eosinophilic esophagitis and multiple, severe allergies not described in similar ZMYND11 cases. This new case further supports the association of ZMYND11 with autistic-like phenotypes and suggests that ZMYND11 should be included in the list of potentially causative candidate genes in cases with complex neurodevelopmental phenotypes.
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Affiliation(s)
- Abby M Moskowitz
- Center for Rare Childhood Disorders and Neurogenomics Division Translational Genomics Research Institute, Phoenix, Arizona 85004, USA
| | - Newell Belnap
- Center for Rare Childhood Disorders and Neurogenomics Division Translational Genomics Research Institute, Phoenix, Arizona 85004, USA
| | - Ashley L Siniard
- Center for Rare Childhood Disorders and Neurogenomics Division Translational Genomics Research Institute, Phoenix, Arizona 85004, USA
| | - Szabolcs Szelinger
- Center for Rare Childhood Disorders and Neurogenomics Division Translational Genomics Research Institute, Phoenix, Arizona 85004, USA
| | - Ana M Claasen
- Center for Rare Childhood Disorders and Neurogenomics Division Translational Genomics Research Institute, Phoenix, Arizona 85004, USA
| | - Ryan F Richholt
- Center for Rare Childhood Disorders and Neurogenomics Division Translational Genomics Research Institute, Phoenix, Arizona 85004, USA
| | - Matt De Both
- Center for Rare Childhood Disorders and Neurogenomics Division Translational Genomics Research Institute, Phoenix, Arizona 85004, USA
| | - Jason J Corneveaux
- Center for Rare Childhood Disorders and Neurogenomics Division Translational Genomics Research Institute, Phoenix, Arizona 85004, USA
| | - Chris Balak
- Center for Rare Childhood Disorders and Neurogenomics Division Translational Genomics Research Institute, Phoenix, Arizona 85004, USA
| | - Ignazio S Piras
- Center for Rare Childhood Disorders and Neurogenomics Division Translational Genomics Research Institute, Phoenix, Arizona 85004, USA
| | - Megan Russell
- Center for Rare Childhood Disorders and Neurogenomics Division Translational Genomics Research Institute, Phoenix, Arizona 85004, USA
| | - Amanda L Courtright
- Center for Rare Childhood Disorders and Neurogenomics Division Translational Genomics Research Institute, Phoenix, Arizona 85004, USA
| | - Sampath Rangasamy
- Center for Rare Childhood Disorders and Neurogenomics Division Translational Genomics Research Institute, Phoenix, Arizona 85004, USA
| | - Keri Ramsey
- Center for Rare Childhood Disorders and Neurogenomics Division Translational Genomics Research Institute, Phoenix, Arizona 85004, USA
| | - David W Craig
- Center for Rare Childhood Disorders and Neurogenomics Division Translational Genomics Research Institute, Phoenix, Arizona 85004, USA
| | - Vinodh Narayanan
- Center for Rare Childhood Disorders and Neurogenomics Division Translational Genomics Research Institute, Phoenix, Arizona 85004, USA
| | - Matt J Huentelman
- Center for Rare Childhood Disorders and Neurogenomics Division Translational Genomics Research Institute, Phoenix, Arizona 85004, USA
| | - Isabelle Schrauwen
- Center for Rare Childhood Disorders and Neurogenomics Division Translational Genomics Research Institute, Phoenix, Arizona 85004, USA
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19
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Pierce SB, Gulsuner S, Stapleton GA, Walsh T, Lee MK, Mandell JB, Morales A, Klevit RE, King MC, Rogers RC. Infantile onset spinocerebellar ataxia caused by compound heterozygosity for Twinkle mutations and modeling of Twinkle mutations causing recessive disease. Cold Spring Harb Mol Case Stud 2016; 2:a001107. [PMID: 27551684 PMCID: PMC4990813 DOI: 10.1101/mcs.a001107] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Mutations in nuclear genes required for the replication and maintenance of mitochondrial DNA cause progressive multisystemic neuromuscular disorders with overlapping phenotypes. Biallelic mutations in C10orf2, encoding the Twinkle mitochondrial DNA helicase, lead to infantile-onset cerebellar ataxia (IOSCA), as well as milder and more severe phenotypes. We present a 13-year-old girl with ataxia, severe hearing loss, optic atrophy, peripheral neuropathy, and hypergonadotropic hypogonadism. Whole-exome sequencing revealed that the patient is compound heterozygous for previously unreported variants in the C10orf2 gene: a paternally inherited frameshift variant (c.333delT; p.L112Sfs*3) and a maternally inherited missense variant (c.904C>T; p.R302W). The identification of novel C10orf2 mutations extends the spectrum of mutations in the Twinkle helicase causing recessive disease, in particular the intermediate IOSCA phenotype. Structural modeling suggests that the p.R302W mutation and many other recessively inherited Twinkle mutations impact the position or interactions of the linker region, which is critical for the oligomeric ring structure and activity of the helicase. This study emphasizes the utility of whole-exome sequencing for the genetic diagnosis of a complex multisystemic disorder.
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Affiliation(s)
- Sarah B Pierce
- Department of Medicine (Medical Genetics), University of Washington, Seattle, Washington 98195, USA
| | - Suleyman Gulsuner
- Department of Medicine (Medical Genetics), University of Washington, Seattle, Washington 98195, USA
| | | | - Tom Walsh
- Department of Medicine (Medical Genetics), University of Washington, Seattle, Washington 98195, USA
| | - Ming K Lee
- Department of Medicine (Medical Genetics), University of Washington, Seattle, Washington 98195, USA
| | - Jessica B Mandell
- Department of Medicine (Medical Genetics), University of Washington, Seattle, Washington 98195, USA
| | - Augusto Morales
- Pediatric Neurology, Greenville Health System, Greenville, South Carolina 29615, USA
| | - Rachel E Klevit
- Department of Biochemistry, University of Washington, Seattle, Washington 98195, USA
| | - Mary-Claire King
- Department of Medicine (Medical Genetics), University of Washington, Seattle, Washington 98195, USA;; Department of Genome Sciences, University of Washington, Seattle, Washington 98195, USA
| | - R Curtis Rogers
- Greenwood Genetic Center, Greenville, South Carolina 29605, USA
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20
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Wright RL, Bevins JW, Pratt D, Sackley CM, Wing AM. Metronome Cueing of Walking Reduces Gait Variability after a Cerebellar Stroke. Front Neurol 2016; 7:84. [PMID: 27313563 PMCID: PMC4887482 DOI: 10.3389/fneur.2016.00084] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 05/16/2016] [Indexed: 11/13/2022] Open
Abstract
Cerebellar stroke typically results in increased variability during walking. Previous research has suggested that auditory cueing reduces excessive variability in conditions such as Parkinson's disease and post-stroke hemiparesis. The aim of this case report was to investigate whether the use of a metronome cue during walking could reduce excessive variability in gait parameters after a cerebellar stroke. An elderly female with a history of cerebellar stroke and recurrent falling undertook three standard gait trials and three gait trials with an auditory metronome. A Vicon system was used to collect 3-D marker trajectory data. The coefficient of variation was calculated for temporal and spatial gait parameters. SDs of the joint angles were calculated and used to give a measure of joint kinematic variability. Step time, stance time, and double support time variability were reduced with metronome cueing. Variability in the sagittal hip, knee, and ankle angles were reduced to normal values when walking to the metronome. In summary, metronome cueing resulted in a decrease in variability for step, stance, and double support times and joint kinematics. Further research is needed to establish whether a metronome may be useful in gait rehabilitation after cerebellar stroke and whether this leads to a decreased risk of falling.
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Affiliation(s)
- Rachel L Wright
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK; School of Psychology, University of Birmingham, Birmingham, UK
| | - Joseph W Bevins
- Institute of Sport and Exercise Science, University of Worcester , Worcester , UK
| | - David Pratt
- West Midlands Rehabilitation Centre, Birmingham Community Healthcare Trust , Birmingham , UK
| | | | - Alan M Wing
- School of Psychology, University of Birmingham , Birmingham , UK
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