Neurology International

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Open AccessArticle

Simultaneous Central Nervous System Complications of C. neoformans Infection

by Alejandra Gonzalez Duarte, Jesus Higera Calleja, Vicente Gijon-Mitre and Guillermo García Ramos

Neurol. Int. 2009, 1(1), e22; https://doi.org/10.4081/ni.2009.e22 - 29 Dec 2009

Cited by 3 | Viewed by 1

The most common neurological manifestation of Cryptococcus neoformans infection is meningitis. Other less common manifestations include parenchymal central nervous system (CNS) granulomatous disease, hydrocephalus and stroke. C. neoformans is often suspected in immunodepressed patients, but it can be easily overlooked in otherwise healthy [...] Read more.

The most common neurological manifestation of Cryptococcus neoformans infection is meningitis. Other less common manifestations include parenchymal central nervous system (CNS) granulomatous disease, hydrocephalus and stroke. C. neoformans is often suspected in immunodepressed patients, but it can be easily overlooked in otherwise healthy patients. This paper provides a detailed clinical description of a patient without immunosupression who developed multiple simultaneous neurological manifestations after the infection with C. neoformans. Full article

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Open AccessArticle

Granulomatous Hypophysitis by Mycobacterium Gordonae in a Non Hiv-Infected Patient

by Juan José Padilla-Martínez, Salvador González-Cornejo, Lucía Elizabeth Álvarez-Palazuelos, Jesús Alejandro Villagómez-Méndez, Erwin Chiquete, José Alfredo Domínguez-Rosales, Ismael Espejo-Plascencia, Esteban González-Díaz, José Rodrigo Torres-Baranda and José Luis Ruiz-Sandoval

Neurol. Int. 2009, 1(1), e18; https://doi.org/10.4081/ni.2009.e18 - 14 Dec 2009

Cited by 2 | Viewed by 1

Abstract

Lymphocytic or granulomatous hypophysitis is a rare entity with a difficult diagnosis. Our objective was to report a patient with non-tuberculous granulomatous hypophysitis. An HIV-negative 45-year old man with confusional state, subacute ophthalmoplegia, and clinical and laboratory findings of panhypopituitarism was seen in [...] Read more.

Lymphocytic or granulomatous hypophysitis is a rare entity with a difficult diagnosis. Our objective was to report a patient with non-tuberculous granulomatous hypophysitis. An HIV-negative 45-year old man with confusional state, subacute ophthalmoplegia, and clinical and laboratory findings of panhypopituitarism was seen in the emergency unit. A cranial MRI showed a sellar mass suggestive of hypophysitis. After an unsuccessful attempt with steroids and antituberculous drugs the patient died. Post-mortem histopathology revealed granulomatous lesions and restriction fragment length polymorphism analysis confirmed the presence of Mycobacterium gordonae’s DNA. In conclusion, we should consider granulomatous hypophysitis in the differential diagnosis of non-secreting hypophyseal tumors. The etiology of a pituitary granuloma by a non-tuberculous mycobacteria is best reached by histopathological techniques and molecular assays. The optimal therapy is yet to be established. Full article

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Open AccessArticle

Injuries in Epilepsy: A Review of Its Prevalence, Risk Factors, Type of Injuries and Prevention

by Rita Nguyen and José Tellez-Zenteno

Neurol. Int. 2009, 1(1), e20; https://doi.org/10.4081/ni.2009.e20 - 11 Dec 2009

Cited by 57 | Viewed by 1

Abstract

Currently, there is intense clinical research into various aspects of the medical risks relating to epilepsy, including total and cause-specific mortality, accidents and injuries in patients with epilepsy and mortality related with seizures. Seizures occurring in precarious situations and resulting in injuries are [...] Read more.

Currently, there is intense clinical research into various aspects of the medical risks relating to epilepsy, including total and cause-specific mortality, accidents and injuries in patients with epilepsy and mortality related with seizures. Seizures occurring in precarious situations and resulting in injuries are still an important concern for patients with epilepsy, their employers and their caregivers. Submersion injuries, motor vehicle accidents, burns, and head injuries are among the most feared epilepsy-related injuries. These concerns seem valid because the hallmark of epilepsy, episodic impairment of consciousness and motor control, may occur during interictal EEG epileptiform discharges, even in the absence of a clinical seizure. In addition, psychomotor comorbidity and side effects of antiepileptic drugs may contribute to the risk of injuries in patients with epilepsy. Published risk factors for injuries include the number of antiepileptic drugs, history of generalized seizures, and seizure frequency. In general, epidemiological information about incidence of injuries has been conflicting and sparse. In general, studies focusing on populations with more severe forms of epilepsy tend to report substantially higher risks of injuries than those involving less selected populations. On the other hand, studies based on non-selected populations of people with epilepsy have not shown an increased frequency of injuries in people with epilepsy compared with the general population. Some studies have shown that patients with epilepsy are more frequently admitted to the hospital following an injury. Possible explanations include: more cautious attitude of clinicians toward injuries occurring in the setting of seizures; hospitalization required because of seizures and not to the injuries themselves; and hospitalization driven by other issues, such as comorbidities, which are highly prevalent in patients with epilepsy. Potentially the high rate of hospitalizations could be related with the severity of the injury. This article reviews the best available epidemiological information about injuries, including incidence and risk factors. Also this article reviews information about specific types of injuries such as fractures, burns, concussions, dislocations, etc. Information about accidents in people with epilepsy is also discussed. Full article

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Open AccessArticle

Pupillary Responses to Single and Sinusoidal Light Stimuli in Diabetic Patients

by Wolfgang H. Zangemeister, Thilo Gronow and Ulrich Grzyska

Neurol. Int. 2009, 1(1), e19; https://doi.org/10.4081/ni.2009.e19 - 16 Nov 2009

Cited by 9 | Viewed by 1

Abstract

We examined effects of diabetes mellitus (DM) on the pupillary light reflex (PLR). Phasic pupillary response to a single light stimulus (200 ms) (pPLR) and to continuous sinusoidal stimuli with four different frequencies (0.1, 0.3, 0.7, 1.3Hz) (cPLR) were examined in 52 DM [...] Read more.

We examined effects of diabetes mellitus (DM) on the pupillary light reflex (PLR). Phasic pupillary response to a single light stimulus (200 ms) (pPLR) and to continuous sinusoidal stimuli with four different frequencies (0.1, 0.3, 0.7, 1.3Hz) (cPLR) were examined in 52 DM patients and 21 control subjects. We asked: does recording and frequency analysis of cPLR together with short time fourier [STFT] analysis of pPLR differentiate better between DM patients and normal subjects than pPLR only? Initial pupil diameter was significantly decreased in the DM group. For pPLR. maximal contraction velocity (Vmax), Vmax of redilation 1, reflex-amplitude and pPLR latency were significantly reduced in those patients who also showed signs of diabetic autonomic neuropathy (DNP). Tests of dynamic pupillary light reflex (cPLR) revealed that all DM patients had a significantly reduced gain at lower frequencies. Pupil phase lag was greater at 0.1 and 0.3Hz and smaller at 0.7 and 1.3 Hz in the DNP group (p<0.001). Comparison of single pPLR recordings of 5 DNP patients with 5 subjects using short time fast fourier (STFT) analysis revealed a characteristic change from low frequency content in healthy subjects to high frequency content in DNP patients. Significant changes in the PLR in DM can be found only when symptoms of autonomic neuropathy have been shown. Both sympathetic and the parasympathetic nervous systems are affected by diabetic autonomic neuropathy. Only recording of cPLR , together with STFT of pPLR can identify significant pathological deficits of pupillary control in single cases. Full article

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Open AccessArticle

Spontaneous Recanalization of the Basilar Artery with Conservative Management Months after Symptom Onset

by Joel M. Oster and Puja Aggarwal

Neurol. Int. 2009, 1(1), e17; https://doi.org/10.4081/ni.2009.e17 - 6 Nov 2009

Cited by 2 | Viewed by 1

Abstract

Basilar artery occlusion may be associated with a poor prognosis in the absence of recanalization. Choices in aggressive treatment for this potentially fatal condition vary from intra-arterial or intravenous thrombolysis, endovascular removal, or a combination of the two, with adjunct anti-coagulation therapy. These [...] Read more.

Basilar artery occlusion may be associated with a poor prognosis in the absence of recanalization. Choices in aggressive treatment for this potentially fatal condition vary from intra-arterial or intravenous thrombolysis, endovascular removal, or a combination of the two, with adjunct anti-coagulation therapy. These therapies have proven to be effective in recanalization, whereas conservative management with anti-coagulants alone has had more limited success in the literature. We report a case of basilar artery occlusion managed conservatively with unfractionated heparin, resulting in complete recanalization 3.5 months after symptom onset. Conservative management of basilar artery occlusion with unfractionated heparin was associated with complete recanalization long after symptom onset. Full article

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Open AccessArticle

Early Detachment of Neuromuscular Junction Proteins in Als Mice with Sodg93a Mutation

by Hisashi Narai, Yasuhiro Manabe, Makiko Nagai, Isao Nagano, Yasuyuki Ohta, Tetsuro Murakami, Yasushi Takehisa, Tatsushi Kamiya and Koji Abe

Neurol. Int. 2009, 1(1), e16; https://doi.org/10.4081/ni.2009.e16 - 6 Nov 2009

Cited by 29 | Viewed by 1

Abstract

The transgenic animals with mutant copper/zinc superoxide dismutase (SOD1) DNA develop paralytic motor neuron disease resembling human amyotrophic lateral sclerosis (ALS) patients and are commonly used as models for ALS. In the transgenic (Tg) mice with the G93A mutation of the human SOD1 [...] Read more.

The transgenic animals with mutant copper/zinc superoxide dismutase (SOD1) DNA develop paralytic motor neuron disease resembling human amyotrophic lateral sclerosis (ALS) patients and are commonly used as models for ALS. In the transgenic (Tg) mice with the G93A mutation of the human SOD1 gene (SOD1G93A mice), the loss of ventral root axons and the synapses between the muscles and the motor neurons suggested that the motor neuron degeneration might proceed in a dying-back degeneration pattern. To reveal the relationship between axonal degeneration and the progression of the muscle atrophy in the SOD1G93A mice, we investigated the status of the neuromuscular junction along the disease progression. As a presynaptic or postsynaptic marker of neuromuscular junction (NMJ), anti-synaptic vesicle protein 2 (anti-SV2) antibody and a-bungarotoxin (a-BuTX ) were chosen in this study and, as a marker of synaptic cleft, anti-agrin antibody was chosen in this study. In the immunohistochemistry of a-BuTX and anti-SV2 antibody, the percentages of double positive NMJs among a-BuTX single positive were decreased in Tg mice through time from ten weeks. The number of postsynaptic acethylcholine receptor (AChR) clusters did not decrease in Tg mice even at the end stage. Immunohistochemistry of a-BuTX and anti-agrin antibody revealed that the increase of immunopositive area of anti-agrin antibody around the muscle fiber in Tg mice from ten weeks of age. In this study, we revealed that the detachment of nerve terminals started at ten weeks in Tg mice. The levels of AChR did not change throughout 5-20 weeks of age in both groups of mice, and AChR remains clustering at NMJs, suggesting that the muscle abnormality is the result of detachment of nerve terminals. Full article

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Open AccessArticle

Mills’ Syndrome: A Case Report

by Fábio Henrique de Gobbi Porto, Marco Orsini, Marco Antônio Araújo Leite, José Moreira dos Santos, Soraia Pulier, Mariana Mello and Osvaldo J. M. Nascimento

Neurol. Int. 2009, 1(1), e15; https://doi.org/10.4081/ni.2009.e15 - 3 Nov 2009

Cited by 3 | Viewed by 1

Abstract

The syndrome of progressive, ascending or descending hemiplegia, with no significant sensory impairment was first describes by Mills in 1900, which several cases were reported later. However after diagnostic tests and image improvements, the number of reports has shortened. A possible explanation for [...] Read more.

The syndrome of progressive, ascending or descending hemiplegia, with no significant sensory impairment was first describes by Mills in 1900, which several cases were reported later. However after diagnostic tests and image improvements, the number of reports has shortened. A possible explanation for this shortage is the identification of other diseases that could mimic the clinical picture. Currently, the syndrome has an uncertain nosological status, since it was described based on clinical examination only. We can find this clinical presentation (Mills syndrome) in cases of amyotrophic lateral sclerosis (ALS), predominant upper motor neuron amyotrophic lateral sclerosis (UMN-ALS) and primary lateral sclerosis (PLS), besides its symptomatic (secondary) forms. We describe a case (initial presentation and one year follow-up) of progressive ascending hemiplegia with clinical isolated upper neuron signs and normal sensory examination, discussing its nosological status, electromyographic findings, differential diagnosis and prognosis. Full article

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Open AccessArticle

A Brainstem Anosognosia of Hemiparesis

by Kazuo Abe, Kiyoka Yamamoto and Yutaka Uchida

Neurol. Int. 2009, 1(1), e14; https://doi.org/10.4081/ni.2009.e14 - 16 Oct 2009

Viewed by 1

Abstract

A woman had anosognosia for hemiplegia as a manifestation of brainstem infarction. She had no mental or neuropsychological disturbances, and had involvement of the brainstem in the frontal/parietal-subcortical circuits to the right cerebral hemisphere. Brainstem lesions that disrupt frontal/parietal-subcortical areas may affect anosognosia [...] Read more.

A woman had anosognosia for hemiplegia as a manifestation of brainstem infarction. She had no mental or neuropsychological disturbances, and had involvement of the brainstem in the frontal/parietal-subcortical circuits to the right cerebral hemisphere. Brainstem lesions that disrupt frontal/parietal-subcortical areas may affect anosognosia for hemiplegia. Full article

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Open AccessArticle

Therapeutic Approaches to Cerebral Vasospasm Complicating Ruptured Aneurysm

by Mohamed Barbarawi, Sarah F. Smith, Mohamed Abu Jamous, Hazem Haboub, Qudsieh Suhair and Shboul Abdullah

Neurol. Int. 2009, 1(1), e13; https://doi.org/10.4081/ni.2009.e13 - 8 Oct 2009

Cited by 3 | Viewed by 1

Abstract

Cerebral vasospasm is a serious complication of ruptured aneurysm. In order to avoid short- and long-term effects of cerebral vasospasm, and as there is no single or optimal treatment modality employed, we have instituted a protocol for the prevention and treatment of vasospasm [...] Read more.

Cerebral vasospasm is a serious complication of ruptured aneurysm. In order to avoid short- and long-term effects of cerebral vasospasm, and as there is no single or optimal treatment modality employed, we have instituted a protocol for the prevention and treatment of vasospasm in patients suffering aneurysmal sub-arachnoid hemorrhage (SAH). We then reviewed the effectiveness of this protocol in reducing the mortality and morbidity rate in our institution. In this study we present a retrospective analysis of 52 cases. Between March 2004 and December 2008 52 patients were admitted to our service with aneurysmal SAH. All patients commenced nimodipine, magnesium sulphate (MgSO4) and triple H therapy. Patients with significant reduction in conscious level were intubated, ventilated and sedated. Intracranial pressure (ICP) monitoring was used for intubated patients. Sodium thiopental coma was induced for patients with refractory high ICP; angiography was performed for diagnosis and treatment. Balloon angioplasty was performed if considered necessary. Using this protocol, only 13 patients (25%) developed clinical vaso-spasm. Ten of them were given barbiturates to induce coma. Three patients underwent transluminal balloon angioplasty. Four out of 52 patients (7.7%) died from severe vasospasm, 3 patients (5.8%) became severely disabled, and 39 patients (75%) were discharged in a condition considered as either normal or near to their pre-hemorrhage status. Our results confirm that the aforementioned protocol for treatment of cerebral vasospasm is effective and can be used safely. Full article

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Open AccessArticle

The Follow-Up of Patients of Sixty-Five Years of Age and Younger with Acute Ischemic Stroke and Transient Ischemic Attacks, and Elevated D-Dimer Levels in Plasma

by Magnus Vrethem and Tomas Lindahl

Neurol. Int. 2009, 1(1), e11; https://doi.org/10.4081/ni.2009.e11 - 21 Sep 2009

Viewed by 1

Abstract

D-dimer levels in plasma, a degradation product of fibrin, have been shown to correlate with the severity of ischemic stroke. In order to investigate the outcome of patients with elevated D-dimer we have carried out a follow-up study of patients of 65 years [...] Read more.

D-dimer levels in plasma, a degradation product of fibrin, have been shown to correlate with the severity of ischemic stroke. In order to investigate the outcome of patients with elevated D-dimer we have carried out a follow-up study of patients of 65 years of age and younger with acute ischemic stroke or transient ischemic attacks (TIA) admitted to our stroke unit from 1991 to 1992. Twenty-two of the 57 patients had elevated D-dimer levels in the plasma. High levels were associated with cardioembolic stroke. On follow-up after a mean of 12 years, 15 patients had died and six patients had suffered another stroke or TIA (three of whom were dead). Ten patients had suffered other cardiovascular events and seven of them were dead. We concluded that high levels of D-dimer in acute ischemic stroke patients on admission were associated with cardioembolic stroke and might have prognostic value for the development of further cardio- or cerebrovascular events. Advanced age was found to be an independent risk factor. Full article

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Open AccessArticle

Hand Wasting in Calumny of Apelles

by Sanjay Sharma

Neurol. Int. 2009, 1(1), e12; https://doi.org/10.4081/ni.2009.e12 - 9 Sep 2009

Cited by 1 | Viewed by 1

Abstract

Renaissance painting from the early 15th to mid 16th centuries originated in the area of present-day Italy. Inspired by the works of ancient Greece and Rome, artist produced painting based on topographic observation and the idealistic body proportion. The most of the painting [...] Read more.

Renaissance painting from the early 15th to mid 16th centuries originated in the area of present-day Italy. Inspired by the works of ancient Greece and Rome, artist produced painting based on topographic observation and the idealistic body proportion. The most of the painting depicts human figure in perfect shape. Calumny of Apelles was painted by the Italian painter Sandro Botticelli. A dark male figure painted in center with bilateral symmetrical distal wasting of limbs and poor body frame. The unusual portrayal may also suggest use of live model suffering from lead toxicity and lead neuropathy. Full article

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Open AccessArticle

Effectiveness of Home Rehabilitation for Ischemic Stroke

by Pakaratee Chaiyawat, Kongkiat Kulkantrakorn and Paskorn Sritipsukho

Neurol. Int. 2009, 1(1), e10; https://doi.org/10.4081/ni.2009.e10 - 25 Aug 2009

Cited by 37 | Viewed by 1

Abstract

The objective of this study was to develop and examine the effectiveness of an individual home rehabilitation program for patients with ischemic stroke. This was a randomized controlled trial in 60 patients with recent middle cerebral artery infarction. After hospital discharge for acute [...] Read more.

The objective of this study was to develop and examine the effectiveness of an individual home rehabilitation program for patients with ischemic stroke. This was a randomized controlled trial in 60 patients with recent middle cerebral artery infarction. After hospital discharge for acute stroke care, they were randomly assigned to receive either a home rehabilitation program for three months (intervention group) or usual care (control group). We collected outcome data over three months after their discharge from the hospital. The Barthel Index (BI), the Modified Rankin Scale (MRS), the health-related quality-of-life index (EQ-5D), the Hospital Anxiety and Depression score (HADs), and the Thai Mental State Examination (TMSE) were used to analyze the outcomes. In the intervention group, all outcomes were significantly better (p<0.05) than in the control group, except in the case of TMSE. A favorable outcome, which was defined as minimal or no disability as measured by BI (score 95-100), was achieved by 93.33% of patients in the intervention group, and 90% had favorable scores (0 or 1) on the MRS. This showed a benefit in reducing disability, with two being the number of patients considered as needed-to-treat (NNT) (95% CI, 1.0-1.2). All dimensions of EQ-5D in the intervention group were significantly better for quality of life and generic health status than in the control group (p=0.001). Depression was found in one patient (3.33%) in the intervention group and in two patients (6.67%) in the control group. Dementia was found in three patients (10%) in the intervention group and in four patients (13.33%) in the control group. We concluded that an early home rehabilitation program for patients with ischemic stroke in the first three-month period provides significantly better outcomes in improving function, reducing disability, increasing quality of life, and reducing depression than a program of usual care does. Full article

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Open AccessArticle

Unusual Progression of Herpes Simplex Encephalitis with Basal Ganglia and Extensive white Matter Involvement

by Yoichi Ono, Yasuhiro Manabe, Hirotake Nishimura, Syoichiro Kono, Hisashi Narai, Nobuhiko Omori, Yoichiro Nanba and Koji Abe

Neurol. Int. 2009, 1(1), e9; https://doi.org/10.4081/ni.2009.e9 - 12 Aug 2009

Cited by 8 | Viewed by 1

Abstract

We report a 51-year old male with herpes simplex encephalitis (HSE) showing unusual progression and magnetic resonance (MR) findings. The initial neurological manifestation of intractable focal seizure with low-grade fever persisted for three days, and rapidly coma, myoclonic status, and respiratory failure with [...] Read more.

We report a 51-year old male with herpes simplex encephalitis (HSE) showing unusual progression and magnetic resonance (MR) findings. The initial neurological manifestation of intractable focal seizure with low-grade fever persisted for three days, and rapidly coma, myoclonic status, and respiratory failure with high-grade fever emerged thereafter. The polymerase chain reaction (PCR) result of cerebrospinal fluid (CSF) was positive for HSV-1 DNA. In the early stage, MR images (MRI) were normal. On subsequent MR diffusion-weighted (DW) and fluid-attenuated inversion recovery (FLAIR) images, high-intensity areas first appeared in the left frontal cortex, which was purely extra-temporal involvement, and extended into the basal ganglia, then the white matter, which are relatively spared in HSE. Antiviral therapy and immunosuppressive therapy did not suppress the progression of HSE, and finally severe cerebral edema developed into cerebral herniation, which required emergency decompressive craniectomy. Histological examination of a biopsy specimen of the white matter detected perivascular infiltration and destruction of basic structure, which confirmed non specific inflammatory change without obvious edema or demyelination. The present case shows both MR and pathological findings in the white matter in the acute stage of HSE. Full article

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Open AccessArticle

Stroke in Neurological Services in Italy

by Fabrizio Antonio De Falco, Maurizio A. Leone and Ettore Beghi

Neurol. Int. 2009, 1(1), e8; https://doi.org/10.4081/ni.2009.e8 - 11 Aug 2009

Cited by 1 | Viewed by 1

Abstract

o assess the stroke workload of Italian neurological services and to correlate it with indicators of each hospital’s emergency setting. A semi-structured questionnaire was sent to the 220 neurology units (NU) located in hospitals with an emergency room (ER) (155 responders, 71%). Stroke [...] Read more.

o assess the stroke workload of Italian neurological services and to correlate it with indicators of each hospital’s emergency setting. A semi-structured questionnaire was sent to the 220 neurology units (NU) located in hospitals with an emergency room (ER) (155 responders, 71%). Stroke was the most common discharge diagnosis (29%) (273 patients/year/NU on average) and condition requiring consultation in ER (28%). A stroke unit was available in 28% of NU, bedside monitors in 45%, a 24 hour/day and 7 day/week (24/7) CT scan in 90%, a 24/7-MRI in 32%, a 24/7 on-duty neurologist in 36%. The stroke workload was correlated only with the number of ER consultations per year, and marginally to the presence of stroke units and the number of monitored beds in the univariate, but not in the multivariate analysis. The stroke workload in Italian NU is very high, but is largely unrelated to their structural and functional characteristics, in contrast with the international indications requiring several essential criteria for the best hospital management of all stroke patients. Full article

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Open AccessArticle

Amyloid Myopathy: A Diagnostic Challenge

by Heli Tuomaala, Mikko Kärppä, Hannu Tuominen and Anne M. Remes

Neurol. Int. 2009, 1(1), e7; https://doi.org/10.4081/ni.2009.e7 - 3 Aug 2009

Cited by 14 | Viewed by 1

Abstract

Amyloid myopathy (AM) is a rare manifestation of primary systemic amyloidosis (AL). Like inflammatory myopathies, it presents with proximal muscle weakness and an increased creatine kinase level. We describe a case of AL with severe, rapidly progressive myopathy as the initial symptom. The [...] Read more.

Amyloid myopathy (AM) is a rare manifestation of primary systemic amyloidosis (AL). Like inflammatory myopathies, it presents with proximal muscle weakness and an increased creatine kinase level. We describe a case of AL with severe, rapidly progressive myopathy as the initial symptom. The clinical manifestation and muscle biopsy were suggestive of inclusion body myositis. AM was not suspected until amyloidosis was seen in the gastric mucosal biopsy. The muscle biopsy was then re-examined more specifically, and Congo red staining eventually showed vascular and interstitial amyloid accumulation, which led to a diagnosis of AM. The present case illustrates the fact that the clinical picture of AM can mimic that of inclusion body myositis. Full article

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Open AccessArticle

Cognitive Effects of Lamotrigine Versus Topiramate as Adjunctive Therapy in Older Adults with Epilepsy

by Steve S. Chung, Susan Kerls, Ann Hammer and Robert Kustra

Neurol. Int. 2009, 1(1), e6; https://doi.org/10.4081/ni.2009.e6 - 8 Jul 2009

Cited by 9 | Viewed by 1

Abstract

Older individuals may be more susceptible to cognitive side effects of antiepileptic drugs than are younger adults. This randomized, double-blind study compared the cognitive effects of lamotrigine (median maintenance dosage, 500.0 mg/d) and topiramate (median maintenance dosage, 300.0 mg/d) as adjunctive therapy for [...] Read more.

Older individuals may be more susceptible to cognitive side effects of antiepileptic drugs than are younger adults. This randomized, double-blind study compared the cognitive effects of lamotrigine (median maintenance dosage, 500.0 mg/d) and topiramate (median maintenance dosage, 300.0 mg/d) as adjunctive therapy for 16 weeks in patients ≥50 years of age. Fifty-one patients (lamotrigine, n=25; topiramate, n=26) were enrolled, and 28 patients (lamotrigine, n=15; topiramate, n=13) completed the study. In a combined analysis of all cognitive tests performed, no significant differences between treatment groups were noted. However, analyses of individual cognitive test results revealed that lamotrigine-treated patients had significantly better results on the Controlled Oral Word Association Test and the Symbol-Digit Modalities Test, whereas topiramate-treated patients had significantly more favorable results on the Digit Cancellation Test and the Rey Auditory-Verbal Learning Test. Larger studies are needed to further clarify the differences in the cognitive effects of lamotrigine and topiramate in older patients. Full article

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Open AccessArticle

Rehabilitation of the Upper Extremity and Basic Activities of Daily Living in the First Month after Ischemic Stroke: An International Cohort Comparison Study

by Cesar Minelli, Francisco A.A. Gondim, Amilton Antunes Barreira and Alexander W. Dromerick

Neurol. Int. 2009, 1(1), e4; https://doi.org/10.4081/ni.2009.e4 - 18 Jun 2009

Cited by 20 | Viewed by 1

Abstract

Inpatient rehabilitation has been traditionally employed in developed countries, while in developing countries, outpatient rehabilitation is the rule. The purpose of this study was to compare the patterns of recovery of upper extremity (UE) function, global impairment and independence in activities of daily [...] Read more.

Inpatient rehabilitation has been traditionally employed in developed countries, while in developing countries, outpatient rehabilitation is the rule. The purpose of this study was to compare the patterns of recovery of upper extremity (UE) function, global impairment and independence in activities of daily living (ADL) during the first month after ischaemic stroke in inpatient (United States) and outpatient (Brazil) rehabilitation settings. Design and Methods: This is a prospective cohort comparison study. Twenty patients from each country were selected using identical inclusion criteria. The study measures employed were the UE portion of the Fugl-Meyer scale, the Action Research Arm test, the National Institutes of Health Stroke Scale and Barthel Index. Changes from baseline to the end of treatment, efficiency and effectiveness of each treatment were compared. Results: Both populations exhibited significant improvement between the first and second evaluations in the four outcome scales (P <0.0001). There were no differences between the two rehabilitation settings on any of the four dependent measures (P>0.05). Conclusions: Substantially different treatment approaches after ischaemic stroke led to similar results in UE function, global impairment and ADL. Further studies in larger populations should be performed in order to confirm the present results. Full article

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Open AccessArticle

Assessment of Autonomic Nervous System Dysfunction in Multiple Sclerosis and Association with Clinical Disability

by Nilufer Kale, Setty Magana, Jale Agaoglu and Osman Tanik

Neurol. Int. 2009, 1(1), e5; https://doi.org/10.4081/ni.2009.e5 - 13 Jun 2009

Cited by 27 | Viewed by 1

Abstract

Recent studies have reported autonomic dysfunction (AD) in multiple sclerosis (MS), bladder and/or bowel dysfunction, orthostatic hypotension, and cardiac adaptation disorders have been observed in a wide range (15-80%). The primary aim of this study is to investigate the frequency and association of [...] Read more.

Recent studies have reported autonomic dysfunction (AD) in multiple sclerosis (MS), bladder and/or bowel dysfunction, orthostatic hypotension, and cardiac adaptation disorders have been observed in a wide range (15-80%). The primary aim of this study is to investigate the frequency and association of AD in MS patients, assessed by sympathetic skin reaction (SSR) and a symptoms questionnaire. The secondary aims of this study are to study the association of AD and disease disability assessed by expanded disability status scale (EDSS), as well as disease duration. Design and Methods: 100 clinically definite MS patients were evaluated for ANS dysfunction by use of an autonomic symptoms questionnaire and SSR testing. The relationship between these methods, AD and disease-related parameters, such as the expanded disability status scale (EDSS) and disease duration were all evaluated. Results: 65% of the patients presented with AD and 29% of these patients had abnormal SSR results. MS patients with high EDSS values (EDSS >4) and longer disease duration were more likely to have ANS dysfunction (p less than 0.0001). Conclusions. ANS dysfunction is not uncommon in CDMS patients and thus noninvasive investigations of AD are warranted to optimize AD evaluation and disease management. Full article

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Open AccessArticle

Focal Dystonia, Tremor and Myokymic Discharges Secondary to Electrical Injury

by Konstantina G. Yiannopoulou, Theodoros Avramidis, Roxani Divari and Alexandros Papadimitriou

Neurol. Int. 2009, 1(1), e2; https://doi.org/10.4081/ni.2009.e2 - 3 Jun 2009

Cited by 1 | Viewed by 1

Abstract

We describe the case of a male patient who developed electromyographically confirmed myokymia, dystonia and tremor and clinically confirmed focal dystonia and tremor, secondary to electrical injury. Dystonia is a rare complication of electrical injury. Myokymic discharges secondary to electrical injury are previously [...] Read more.

We describe the case of a male patient who developed electromyographically confirmed myokymia, dystonia and tremor and clinically confirmed focal dystonia and tremor, secondary to electrical injury. Dystonia is a rare complication of electrical injury. Myokymic discharges secondary to electrical injury are previously unreported. Dystonia and tremor EMG findings were present not only at the clinically affected muscles of the lower limb but also at the clinically unaffected upper limb muscles. This is the first case report to link myokymia as a secondary complication of an electrical injury. Full article

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Open AccessArticle

An Unusual Finding of Brain Magnetic Resonance Imaging in a Hypertensive Patient

by Harris A. Ngow, Wan Mohd Nowalid Wan Khairina and Bin Basri Hamidon

Neurol. Int. 2009, 1(1), e3; https://doi.org/10.4081/ni.2009.e3 - 22 May 2009

Cited by 1 | Viewed by 1

Abstract

Brain edema in patients with hypertensive encephalopathy frequently affects the parieto-occipital white matter. Hypertensive encephalopathy is thus included as a differential diagnosis in reversible posterior leukoencephalopathy syndrome. Diffuse white matter involvement rarely occurs. We report a 41-year old woman with hypertensive encephalopathy with [...] Read more.

Brain edema in patients with hypertensive encephalopathy frequently affects the parieto-occipital white matter. Hypertensive encephalopathy is thus included as a differential diagnosis in reversible posterior leukoencephalopathy syndrome. Diffuse white matter involvement rarely occurs. We report a 41-year old woman with hypertensive encephalopathy with diffuse and non-enhancing white matter hyper-intensities throughout the whole brain on magnetic resonance imaging (MRI). These hyperintensities spared the grey matter on T2-weighted and FLAIR sequence. These unusual finding on brain MRI was attributed to severe vasogenic cerebral edema resulting from accelerated hypertension. Full article

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Open AccessArticle

High Blood Pressure in Acute Ischemic Stroke And Clinical Outcome

by Yasuhiro Manabe, Syoichiro Kono, Tomotaka Tanaka, Hisashi Narai and Nobuhiko Omori

Neurol. Int. 2009, 1(1), e1; https://doi.org/10.4081/ni.2009.e1 - 8 Apr 2009

Cited by 14 | Viewed by 2

Abstract

This study aimed to evaluate the prognostic value of acute phase blood pressure in patients with acute ischemic stroke by determining whether or not it contributes to clinical outcome. We studied 515 consecutive patients admitted within the first 48 hours after the onset [...] Read more.

This study aimed to evaluate the prognostic value of acute phase blood pressure in patients with acute ischemic stroke by determining whether or not it contributes to clinical outcome. We studied 515 consecutive patients admitted within the first 48 hours after the onset of ischemic strokes, employing systolic and diastolic blood pressure measurements recorded within 36 hours after admission. High blood pressure was defined when the mean of at least 2 blood pressure measurements was ≥200 mmHg systolic and/or ≥110 mmHg diastolic at 6 to 24 hours after admission or ≥180 mmHg systolic and/or ≥105 mmHg diastolic at 24 to 36 hours after admission. The high blood pressure group was found to include 16% of the patients. Age, sex, diabetes mellitus, hypercholesterolemia, atrial fibrillation, ischemic heart disease, stroke history, carotid artery stenosis, leukoaraiosis, NIH Stroke Scale (NIHSS) on admission and mortality were not significantly correlated with either the high blood pressure or non-high blood pressure group. High blood pressure on admission was significantly associated with a past history of hypertension, kidney disease, the modified Rankin Scale (mRS) on discharge and the length of stay. On logistic regression analysis, with no previous history of hypertension, diabetes mellitus, atrial fibrillation, and kidney disease were independent risk factors associated with the presence of high blood pressure [odds ratio (OR), 1.85 (95% confidence interval (CI): 1.06-3.22), 1.89 (95% CI: 1.11-3.22), and 3.31 (95% CI: 1.36-8.04), respectively]. Multi-organ injury may be presented in acute stroke patients with high blood pressure. Patients with high blood pressure had a poor functional outcome after acute ischemic stroke. Full article

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Neurol. Int., Volume 1, Issue 1 (April 2009) – 21 articles

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