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Sample records for neurological symptoms evidence

  1. Transient Neurological Symptoms after Spinal Anesthesia

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    Zehra Hatipoglu

    2013-02-01

    Full Text Available Lidocaine has been used for more than 50 years for spinal anesthesia and has a remarkable safety record. In 1993, a new adverse effect, transient neurologic toxicity was described in patients recovering from spinal anesthesia with lidocaine. Transient neurological symptoms have been defined as pain in the lower extremities (buttocks, thighs and legs after an uncomplicated spinal anesthesia and after an initial full recovery during the immediate postoperative period (less than 24 h. The incidence of transient neurological symptoms reported in prospective, randomized trials varies from 4% to 37%. The etiology of transient neurological symptoms remains unkonwn. Despite the transient nature of this syndrome, it has proven to be difficult to treat effectively. Drug or some interventional therapy may be necessary. [Archives Medical Review Journal 2013; 22(1.000: 33-44

  2. [Neurological symptoms in children with intussusception].

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    Domínguez-Carral, J; Puertas-Martín, V; Carreras-Sáez, I; Maraña-Pérez, A I; Escobar-Delgado, T; García-Peñas, J J

    2014-05-01

    Intussusception is a potentially severe obstructive disease that occurs when a more proximal portion of bowel invaginates into a more distal part of the bowel. Patients with intussusception often present with a wide range of non-specific systemic symptoms, with less than one quarter presenting with the classic triad of vomiting, abdominal pain, and bloody stools. An acute change in level of consciousness could be the only clinical symptom of this disorder. To ascertain the frequency and nature of the neurological symptoms in children with intussusception, and to describe the characteristics of the patients presenting in this atypical way. We retrospectively reviewed the records of 351 children presenting with intussusception from 2000 to 2012. General epidemiological data, abdominal and neurological signs and symptoms, duration of symptoms and effectiveness of treatment, were analysed in all patients. Of the 351 patients studied, 15 (4.27%) had one or more neurological symptoms recorded at presentation, with lethargy being the most frequent (66.66%), followed by hypotonia, generalized weakness, paroxysmal events, and fluctuating consciousness. Sixty per cent of these fifteen patients showed isolated neurological symptomatology, and eleven of them (73.3%) needed a laparotomy to reduce the intussusception. Intussusception should be considered in the differential diagnosis in infants and young children presenting as a pediatric emergency with lethargy, hypotonia, generalized weakness, paroxysmal events and/or sudden changes in consciousness, even in the absence of the classical symptoms of intussusception. An early recognition of intussusception may improve the global prognosis and avoid ischaemic intestinal sequelae. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  3. Behavioural and psychiatric symptoms in cognitive neurology.

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    Robles Bayón, A; Gude Sampedro, F

    2017-03-01

    Behavioural and psychiatric symptoms (BPS) are frequent in neurological patients, contribute to disability, and decrease quality of life. We recorded BPS prevalence and type, as well as any associations with specific diagnoses, brain regions, and treatments, in consecutive outpatients examined in a cognitive neurology clinic. A retrospective analysis of 843 consecutive patients was performed, including a review of BPS, diagnosis, sensory impairment, lesion topography (neuroimaging), and treatment. The total sample was considered, and the cognitive impairment (CI) group (n=607) was compared to the non-CI group. BPS was present in 59.9% of the patients (61.3% in the CI group, 56.4% in the non-CI group). One BPS was present in 31.1%, two in 17.4%, and three or more in 11.4%. BPS, especially depression and anxiety, are more frequent in women than in men. Psychotic and behavioural symptoms predominate in subjects aged 65 and older, and anxiety in those younger than 65. Psychotic symptoms appear more often in patients with sensory impairment. Psychotic and behavioural symptoms are more prevalent in patients with degenerative dementia; depression and anxiety in those who suffer a psychiatric disease or adverse effects of substances; emotional lability in individuals with a metabolic or hormonal disorder; hypochondria in those with a pain syndrome; and irritability in subjects with chronic hypoxia. Behavioural symptoms are more frequent in patients with anomalies in the frontal or right temporal or parietal lobes, and antipsychotics constitute the first line of treatment. Leaving standard treatments aside, associations were observed between dysthymia and opioid analgesics, betahistine and statins, and between psychotic symptoms and levodopa, piracetam, and vasodilators. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Neurologic signs and symptoms frequently manifest in acute HIV infection.

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    Hellmuth, Joanna; Fletcher, James L K; Valcour, Victor; Kroon, Eugène; Ananworanich, Jintanat; Intasan, Jintana; Lerdlum, Sukalaya; Narvid, Jared; Pothisri, Mantana; Allen, Isabel; Krebs, Shelly J; Slike, Bonnie; Prueksakaew, Peeriya; Jagodzinski, Linda L; Puttamaswin, Suwanna; Phanuphak, Nittaya; Spudich, Serena

    2016-07-12

    To determine the incidence, timing, and severity of neurologic findings in acute HIV infection (pre-antibody seroconversion), as well as persistence with combination antiretroviral therapy (cART). Participants identified with acute HIV were enrolled, underwent structured neurologic evaluations, immediately initiated cART, and were followed with neurologic evaluations at 4 and 12 weeks. Concurrent brain MRIs and both viral and inflammatory markers in plasma and CSF were obtained. Median estimated HIV infection duration was 19 days (range 3-56) at study entry for the 139 participants evaluated. Seventy-three participants (53%) experienced one or more neurologic findings in the 12 weeks after diagnosis, with one developing a fulminant neurologic manifestation (Guillain-Barré syndrome). A total of 245 neurologic findings were noted, reflecting cognitive symptoms (33%), motor findings (34%), and neuropathy (11%). Nearly half of the neurologic findings (n = 121, 49%) occurred at diagnosis, prior to cART initiation, and most of these (n = 110, 90%) remitted concurrent with 1 month on treatment. Only 9% of neurologic findings (n = 22) persisted at 24 weeks on cART. Nearly all neurologic findings (n = 236, 96%) were categorized as mild in severity. No structural neuroimaging abnormalities were observed. Participants with neurologic findings had a higher mean plasma log10 HIV RNA at diagnosis compared to those without neurologic findings (5.9 vs 5.4; p = 0.006). Acute HIV infection is commonly associated with mild neurologic findings that largely remit while on treatment, and may be mediated by direct viral factors. Severe neurologic manifestations are infrequent in treated acute HIV. © 2016 American Academy of Neurology.

  5. Neurological symptoms among dental assistants: a cross-sectional study

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    Hollund BE

    2008-05-01

    Full Text Available Abstract Background Dental assistants help the dentist in preparing material for filling teeth. Amalgam was the filling material mostly commonly used in Norway before 1980, and declined to about 5% of all fillings in 2005. Amalgam is usually an alloy of silver, copper, tin and mercury. Copper amalgam, giving particularly high exposure to mercury was used in Norway until 1994. Metallic mercury is neurotoxic. Few studies of the health of dental assistants exist, despite their exposure to mercury. There are questions about the existence of possible chronic neurological symptoms today within this working group, due to this exposure. The aim of this study was to compare the occurrence of neurological symptoms among dental assistants likely to be exposed to mercury from work with dental filling material, compared to similar health personnel with no such exposure. Methods All dental assistants still at work and born before 1970 registered in the archives of a trade union in Hordaland county of Norway were invited to participate (response rate 68%, n = 41, as well as a similar number of randomly selected assistant nurses (response rate 87%, n = 64 in the same age group. The participants completed a self-administered, mailed questionnaire, with questions about demographic variables, life-style factors, musculoskeletal, neurological and psychosomatic symptoms (Euroquest. Results The dental assistants reported significant higher occurrence of neurological symptoms; psychosomatic symptoms, problems with memory, concentration, fatigue and sleep disturbance, but not for mood. This was found by analyses of variance, adjusting for age, education, alcohol consumption, smoking and personality traits. For each specific neurological symptom, adjusted logistic regression analyses were performed, showing that these symptoms were mainly from arms, hands, legs and balance organs. Conclusion There is a possibility that the higher occurrence of neurological symptoms

  6. Autism spectrum symptoms in children with neurological disorders

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    Ryland Hilde K

    2012-11-01

    Full Text Available Abstract Background The aims of the present study were to assess symptoms associated with an autism spectrum disorder (ASD in children with neurological disorders as reported by parents and teachers on the Autism Spectrum Screening Questionnaire (ASSQ, as well as the level of agreement between informants for each child. Methods The ASSQ was completed by parents and teachers of the 5781 children (11–13 years who participated in the second wave of the Bergen Child Study (BCS, an on-going longitudinal population-based study. Out of these children, 496 were reported to have a chronic illness, including 99 whom had a neurological disorder. The neurological disorder group included children both with and without intellectual disabilities. Results Children with neurological disorders obtained significantly higher parent and teacher reported ASSQ scores than did non-chronically ill children and those with other chronic illnesses (p Conclusions The ASSQ identifies a high rate of ASD symptoms in children with neurological disorders, and a large number of children screened in the positive range for ASD. Although a firm conclusion awaits further clinical studies, the present results suggest that health care professionals should be aware of potential ASD related problems in children with neurological disorders, and should consider inclusion of the ASSQ or similar screening instruments as part of their routine assessment of this group of children.

  7. Obsessive–Compulsive Symptoms in Neurologic Disease: A Review

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    M. S. George

    1992-01-01

    Full Text Available Obsessive–compulsive disorder (OCD is an increasingly recognized disorder with a prevalence of 2–3% (Robins et al., 1984. Once thought to be psychodynamic in origin, OCD is now generally recognized as having a neurobiological cause. Although the exact pathophysiology of OCD in its pure form remains unknown, there are numerous reports of obsessive–compulsive symptoms arising in the setting of known neurological disease. In this paper, we review the reported cases of obsessive–compulsive symptoms associated with neurologic diseases and outline the known facts about the underlying neurobiology of OCD. Finally, we synthesize these findings into a proposed theory of the pathophysiology of OCD, in both its pure form and when it accompanies other neurological illness.

  8. Acute Neurological Symptoms During Hypobaric Exposure: Consider Cerebral Air Embolism

    NARCIS (Netherlands)

    Weenink, Robert P.; Hollmann, Markus W.; van Hulst, Robert A.

    2012-01-01

    WEENINK RP, HOLLMANN MW, VAN HULST RA. Acute neurological symptoms during hypobaric exposure: consider cerebral air embolism. Aviat Space Environ Med 2012; 83:1084-91. Cerebral arterial gas embolism (CAGE) is well known as a complication of invasive medical procedures and as a risk in diving and

  9. Diagnosis and management of functional neurological symptoms: The Dutch experience

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    de Schipper, L.J.; Vermeulen, M; Eeckhout, A.M.; Foncke, E.M.J.

    2014-01-01

    Objectives Functional neurological symptoms (FNS) were considered as a psychiatric disorder at the beginning of the 20th century (conversion disorder). Psychiatrists performed diagnosis and treatment throughout most of the past century in the Netherlands, but in the latest decades patients were

  10. Diagnosis and management of functional neurological symptoms: The Dutch experience

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    de Schipper, Laura J.; Vermeulen, Marinus; Eeckhout, Augustinus M.; Foncke, Elisabeth M. J.

    2014-01-01

    Functional neurological symptoms (FNS) were considered as a psychiatric disorder at the beginning of the 20th century (conversion disorder). Psychiatrists performed diagnosis and treatment throughout most of the past century in the Netherlands, but in the latest decades patients were usually firstly

  11. Functional neurological symptoms modulate processing of emotionally salient stimuli.

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    Fiess, Johanna; Rockstroh, Brigitte; Schmidt, Roger; Wienbruch, Christian; Steffen, Astrid

    2016-12-01

    Dysfunctional emotion processing has been discussed as a contributing factor to functional neurological symptoms (FNS) in the context of conversion disorder, and refers to blunted recognition and the expression of one's own feelings. However, the emotion processing components characteristic for FNS and/or relevant for conversion remain to be specified. With this goal, the present study targeted the initial, automatic discrimination of emotionally salient stimuli. The magnetoencephalogram (MEG) was monitored in 21 patients with functional weakness and/or sensory disturbance subtypes of FNS and 21 healthy comparison participants (HC) while they passively watched 600 emotionally arousing, pleasant, unpleasant or neutral stimuli in a rapid serial visual presentation (RSVP) design. Neuromagnetic activity was analyzed 110-330ms following picture onset in source space for prior defined posterior and central regions of interest. As early as 110ms and across presentation interval, posterior neural activity modulation by picture category was similar in both groups, despite smaller initial (110-150ms) overall and posterior power in patients with FNS. The initial activity modulation by picture category was also evident in the left sensorimotor area in patients with FNS, but not significant in HC. Similar activity modulation by emotional picture category in patients with FNS and HC suggests that the fast, automatic detection of emotional salience is unchanged in patients with FNS, but involves an emotion-processing network spanning posterior and sensorimotor areas. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Reports of cases of renal tubular acidosis with neurologic symptomes

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    Ghafarpour M

    1996-07-01

    Full Text Available Proximal weakness specially in extremitas is a common neurologic symptom of patients, for which the physician should consider toxic, metabolic, infectious and paraneoblastic diseases affecting muscular system as well as primary myopathies. Osteomalacia is one of the most common considerations which is treatable but disabling as its natural course. Osteomalacia is the most often due to VITD or calcium deficiency but work up is necessary to find other primary defects that cause this disease. Renal tubular acidosis is one of these primary defects and osteomalacia secondary to it dose not respond to classic treatment of osteomalacia, so specific management is necessary. In this article we report six patients who have been referred to the clinic of neurology of Imam Khomeini Hospital since 1370 to 1374 with proximal weakness for whom RTA has been diagnosed

  13. Lyme neuroborreliosis in cases of non-specific neurological symptoms.

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    Roaldsnes, Erlend; Eikeland, Randi; Berild, Dag

    2017-01-01

    Analysis of cerebrospinal fluid is required in order to diagnose Lyme neuroborreliosis. We investigated the symptoms of patients in a highly endemic area who were referred for evaluation of possible Lyme neuroborreliosis, and explored whether cerebrospinal fluid analysis confirmed or ruled out the diagnosis. We reviewed the medical records of all patients who underwent lumbar puncture at Sørlandet Hospital Arendal in the period 1 January 2013 to 31 December 2013. A total of 140 patients were referred with suspected Lyme neuroborreliosis. Of these, 110 patients had non-specific neurological symptoms (e.g. fatigue, dizziness and headache), only one of whom received a diagnosis of possible Lyme neuroborreliosis. Thirty patients had symptoms typical of the condition (such as radiculitis or peripheral facial nerve palsy). Six of these were diagnosed with definite Lyme neuroborreliosis, and one with possible Lyme neuroborreliosis. None of those diagnosed with Lyme neuroborreliosis had had symptoms lasting more than six months. The probability of Lyme neuroborreliosis is low in the absence of typical symptoms of the condition, even when anti-Borrelia antibodies are detected in serum and especially when the symptoms are of long duration.

  14. 3. Neurological & Psychiatric Society of Zambia's Evidence-Based ...

    African Journals Online (AJOL)

    Esem

    ”. No evidence provided. Not evidence-based and impractical for a resource .... European Federation of. Neurological Sciences. Task Force[18]. Non-acute headache. EEG is not routinely indicated in the diagnostic evaluation of headache.

  15. Natural course and pathogenesis of transient focal neurologic symptoms during pregnancy.

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    Liberman, Anatoly; Karussis, Dimitrios; Ben-Hur, Tamir; Abramsky, Oded; Leker, Ronen R

    2008-02-01

    To determine the pathogenesis and course of transient focal neurologic symptoms in pregnant women and to identify prognostic variables that will enable targeted workup. Case-control series. Tertiary care university hospital. Pregnant patients with acute transient focal neurologic symptoms. Women with histories of migraine, recurrent thromboembolism, or cerebrovascular disease were excluded. Diffusion-weighted imaging (DWI), perfusion-weighted imaging, fluid-attenuated inversion recovery (FLAIR) imaging, gradient-recalled echo imaging, and magnetic resonance venography (MRV) and angiography to determine the presence of brain ischemia and venous thrombosis. Patients underwent echocardiography, duplex ultrasonography, and a battery of hypercoagulability tests and were followed up a mean of 12 months after the event. Twenty-eight controls and 14 patients were enrolled from 23 773 pregnancies. Mean age was 31.2 (range, 24-41) years and mean gestational age at symptom onset was 28 (range, 17-44) weeks. No controls reported transient focal neurologic symptoms, migraine aura, or headache. Presenting symptoms included dysphasia (6 patients) and hemisensory (5) and hemimotor (7) syndrome. In 4 patients, these symptoms were preceded by scintillating scotoma; in 9 patients, focal symptoms were followed by a first-ever, throbbing, migraine-like headache. Only 1 patient had evidence of frank infarction on magnetic resonance imaging (MRI); 2 patients had single, small, hyperintense bright foci on FLAIR imaging without accompanying lesions on DWI, and 11 patients had normal MRI and MRV results. Echocardiography, carotid duplex ultrasonography, and hypercoagulability results were negative in all patients. None of the patients had ischemic events and 4 (29%) developed migraines with aura headaches during follow-up. Focal neurologic symptoms in healthy pregnant women are frequently preceded by aural visual phenomena and can usually be attributed to a first-ever migraine attack

  16. Network localization of neurological symptoms from focal brain lesions.

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    Boes, Aaron D; Prasad, Sashank; Liu, Hesheng; Liu, Qi; Pascual-Leone, Alvaro; Caviness, Verne S; Fox, Michael D

    2015-10-01

    A traditional and widely used approach for linking neurological symptoms to specific brain regions involves identifying overlap in lesion location across patients with similar symptoms, termed lesion mapping. This approach is powerful and broadly applicable, but has limitations when symptoms do not localize to a single region or stem from dysfunction in regions connected to the lesion site rather than the site itself. A newer approach sensitive to such network effects involves functional neuroimaging of patients, but this requires specialized brain scans beyond routine clinical data, making it less versatile and difficult to apply when symptoms are rare or transient. In this article we show that the traditional approach to lesion mapping can be expanded to incorporate network effects into symptom localization without the need for specialized neuroimaging of patients. Our approach involves three steps: (i) transferring the three-dimensional volume of a brain lesion onto a reference brain; (ii) assessing the intrinsic functional connectivity of the lesion volume with the rest of the brain using normative connectome data; and (iii) overlapping lesion-associated networks to identify regions common to a clinical syndrome. We first tested our approach in peduncular hallucinosis, a syndrome of visual hallucinations following subcortical lesions long hypothesized to be due to network effects on extrastriate visual cortex. While the lesions themselves were heterogeneously distributed with little overlap in lesion location, 22 of 23 lesions were negatively correlated with extrastriate visual cortex. This network overlap was specific compared to other subcortical lesions (P network overlap in cortical areas previously implicated in symptom expression (P brain regions involved in symptom expression; and (ii) publically available human connectome data can be used to incorporate these network effects into traditional lesion mapping approaches. Because the current technique

  17. Atypical Craniosynostosis with Torticollis and Neurological Symptoms: A Rhombencephalosynapsis Sequence

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    Virve Koljonen

    2009-01-01

    Full Text Available Purpose. We describe a case of 3-year-old girl with rhombencephalosynapsis, a rare cerebellar anomaly. Patient. A 3-year-old girl was admitted to our hospital due to congenital torticollis and asymmetry of face, skull and trunk. Craniosynostosis was suspected due to abnormal head shape. 3D-CT revealed closure of the sagittal suture without scaphocephalic skull. Due to atypical craniosynostosis with neurological symptoms, brain-MRI was performed revealing rhombencephalosynapsis. Results. Our patient presented with atypical craniosynostosis and balance problems, not typical for scaphocephaly. Operative treatment for craniosynotosis was not carried out because the cause of the problems was the cerebellum instead of the brain. Conclusions. Therefore, we conclude that patients with atypical craniosynostosis should be examined with brain-MRI to exclude the intracranial malformations, which 3D-CT does not reveal. Without brain-MRI, decision (not to perform surgery could have been different.

  18. Cortical arousal in children and adolescents with functional neurological symptoms during the auditory oddball task

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    Kasia Kozlowska, MBBS., PhD. FRANZCP

    2017-01-01

    Conclusions: Our findings add to a growing literature indicating that a baseline state of high arousal may be a precondition for generating functional neurological symptoms, a finding that helps explain why a range of psychological and physiological stressors can trigger functional neurological symptoms in some patients. Interventions that target cortical arousal may be central to the treatment of paediatric patients with functional neurological symptom disorder.

  19. Prevalence and predictors of unexplained neurological symptoms in an academic neurology outpatient clinic--an observational study.

    NARCIS (Netherlands)

    Snijders, T.J.; Leeuw, H.F. de; Klumpers, U.M.H.; Kappelle, L.J.; Gijn, J. van

    2004-01-01

    OBJECTIVES: (a) To determine the prevalence of unexplained symptoms among newly referred patients in a Dutch academic outpatient clinic for general neurology; (b) To identify factors that can serve as characteristics and possibly as screening instruments for unexplained symptoms in this population.

  20. Clinical study of syringomyelia. Relation of neurological symptoms and imaging diagnosis

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    Ohga, Ritsu; Konishi, Yoshihiro; Higashi, Yasuto; Kawai, Kingo; Yasuda, Takeshi; Terao, Akira (Kawasaki Medical School, Kurashiki, Okayama (Japan))

    1988-12-01

    We discussed the relationship between neurological symptoms and the locations of syringes observed by CT and MRI (imaging diagnosis) in six cases of syringomyelia admitted to our department during the past five years. Neurological symptoms of the upper cervical and thoracic cords were found in six cases and five cases of them had symmetric distribution. Syringes were found in all cases by delayed CT (D-CT) and MRI. Five cases had laterality. The sites in the spinal cord exhibiting severe involvement of neurological symptoms corresponded with the sites of syringes in imaging diagnosis. The main asymmetric lesions of the syringes were located in the posterior horn. They indicated the relationship with the appearance of the neurological symptoms of the lesion. We compared with the width of the longitudinal level from neurological findings and imaging diagnosis. The rostral level of both corresponded in all cases, but the caudal level corresponded in only one case and neurological symptoms were broader than syringes in imaging diagnosis. It was difficult to identify small syringes when there was complicated scoliosis. The diagnosis of typical cases of syringomyelia is mainly based on such neurological symptoms as a bilateral segmental pattern of dissociated sensory impairment in the past, but imaging diagnosis has recently come to be regarded as very important. (J.P.N.).

  1. Recurrent takotsubo cardiomyopathy in the setting of transient neurological symptoms: a case report

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    Saeed Wajeeha

    2011-08-01

    Full Text Available Abstract Introduction First described in Japan, takotsubo cardiomyopathy is increasingly becoming recognized worldwide as a cause of sudden and reversible diminished left ventricular function characterized by left apical ballooning and hyperkinesis of the basal segments, often with symptoms mimicking a myocardial infarction. Associated with physical or emotional stress, its exact pathogenesis has not been established, though evidence supports a neurohumoral etiology. Additionally, recurrence of this condition is rare. In this report, we present a rare case of recurrent takotsubo cardiomyopathy in a post-menopausal woman who presented with transient neurological complaints on both occasions. Case presentation We present a rare case of a 76-year-old Caucasian woman with no history of congestive heart failure who presented to our emergency department twice with transient neurological complaints. On the first occasion, she was found to have transient aphasia which resolved within 24 hours, yet during that period she also developed symptoms of congestive heart failure and was noted to have a new, significantly depressed ejection fraction with apical akinesis and possible apical thrombus. One month after her presentation a repeat echocardiogram revealed complete resolution of all wall motion abnormalities and a return to baseline status. Seven months later she presented with ataxia, was diagnosed with vertebrobasilar insufficiency, and again developed symptoms and echocardiography findings similar to those of her first presentation. Once again, at her one-month follow-up examination, all wall motion abnormalities had completely resolved and her ejection fraction had returned to normal. Conclusion Though the exact etiology of takotsubo cardiomyopathy is unclear, a neurohumoral mechanism has been proposed. Recurrence of this disorder is rare, though it has been reported in patients with structural brain abnormalities. This report is the first to

  2. Anthropological neurology: symptoms and their meanings according to Joseph Prick (1909-1978)

    NARCIS (Netherlands)

    Meulen, B.C. ter; Dekkers, W.J.M.; Keyser, A.J.M.; Woerkom, T.C. van

    2011-01-01

    This article describes the life and work of the Dutch neurologist Joseph Prick (1909-1978) and his idea of an anthropological neurology. According to Prick, neurological symptoms should not only be explained from an underlying physico-chemical substrate but also be regarded as meaningful. We present

  3. Neurologic symptoms and neuropathologic antibodies in poultry workers exposed to Campylobacter jejuni.

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    Price, Lance B; Roess, Amira; Graham, Jay P; Baqar, Shahida; Vailes, Rocio; Sheikh, Kazim A; Silbergeld, Ellen

    2007-07-01

    To examine associations between occupational exposure to live poultry with Campylobacter exposure, Campylobacter-associated neurologic symptoms, and neuropathologic antibodies. Questionnaires, serum samples, and stool specimens were collected from 20 poultry workers and 40 community referents. Campylobacter exposure was evaluated by stool culture and serum antibodies; neurologic symptoms were assessed by questionnaire; and neuropathologic antibodies were measured by serum anti-glycolipid antibody concentrations. Poultry workers had significantly higher anti-Campylobacter immunoglobulin G titers compared with that of referents (P Campylobacter-associated neurologic symptoms; and male poultry workers had a higher point risk estimate for detectable neuropathologic anti-glycolipid immunoglobulin G titers (P = 0.07) compared with male referents. These data suggest that poultry workers are at elevated risk of Campylobacter exposure and may be at elevated risk for Campylobacter-associated neurologic sequelae.

  4. Household food insecurity and symptoms of neurologic disorder in Ethiopia: An observational analysis

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    Tessema Fasil

    2010-12-01

    Full Text Available Abstract Background Food insecurity (FI has been shown to be associated with poor health both in developing and developed countries. Little is known about the relation between FI and neurological disorder. We assessed the relation between FI and risk for neurologic symptoms in southwest Ethiopia. Methods Data about food security, gender, age, household assets, and self-reported neurologic symptoms were collected from a representative, community-based sample of adults (N = 900 in Jimma Zone, Ethiopia. We calculated univariate statistics and used bivariate chi-square tests and multivariate logistic regression models to assess the relation between FI and risk of neurologic symptoms including seizures, extremity weakness, extremity numbness, tremors/ataxia, aphasia, carpal tunnel syndrome, vision dysfunction, and spinal pain. Results In separate multivariate models by outcome and gender, adjusting for age and household socioeconomic status, severe FI was associated with higher odds of seizures, movement abnormalities, carpal tunnel, vision dysfunction, spinal pain, and comorbid disorders among women. Severe FI was associated with higher odds of seizures, extremity numbness, movement abnormalities, difficulty speaking, carpal tunnel, vision dysfunction, and comorbid disorders among men. Conclusion We found that FI was associated with symptoms of neurologic disorder. Given the cross-sectional nature of our study, the directionality of these associations is unclear. Future research should assess causal mechanisms relating FI to neurologic symptoms in sub-Saharan Africa.

  5. [Neurological symptoms and disability in HTLV-1 associated myelopathy].

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    Carod-Artal, F J; Mesquita, H Mourao; Ribeiro, L da Silveira

    2008-03-01

    The human T cell lymphotropic virus type I (HTLV-I) is a retrovirus that causes tropical spastic paraparesis/HTLV-I associated myelopathy (TSP/HAM). Objectives. To describe neurological characteristics and the severity of disability in a sample of patients with TSP/HAM. All TSP/HAM patients consecutively admitted during 2006 at the Brasilia Sarah Hospital, neurology outpatient clinic were included in the study. HTLV-I infected patient fulfilled criteria for serological positivity at both ELISA and western blot. Ashworth spasticity scale, Barthel index of activities of daily living, kurtzke functional systems and the Expanded Disability Status Scale (EDSS) were applied. All patients performed electrophysiological studies (evoked potentials, electromyogram) and brain/spinal cord magnetic resonance imaging (MRI). Forty two of 249 paraparetic patients (16.9%; 26 females; mean age: 49.8 years) were diagnosed as having TSP/HAM. Mean time of evolution was 11.2 years. Most common neurological syndrome was a chronic progressive spastic paraparesis with hyperreflexia, ankle clonus and bilateral Babinski sign (97.7 %). Other findings were proximal muscle atrophy in lower limbs (28.6 %) , ataxia (21.4%), and peripheral neuropathy (7.1%). Half of patients were wheel-chair restricted or had a domiciliary walk. EDSS median was 6 and Barthel index mean score was 65. Most common findings on spinal cord MRI were thoracic spinal cord atrophy (66.7%) and white matter hyper-intensity areas in cerebral subcortical (42.8 %) and spinal cord (21.4%) regions. TSP/HAM is a very disabilitating disorder. Peripheral neuropathy and ataxia are other syndromes that should be included in the spectrum of HTLV-I infection.

  6. Increased pediatric functional neurological symptom disorders after the Boston marathon bombings: a case series.

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    Guerriero, Réjean M; Pier, Danielle B; de Gusmão, Claudio M; Bernson-Leung, Miya E; Maski, Kiran P; Urion, David K; Waugh, Jeff L

    2014-11-01

    Functional neurological symptom disorders are frequently the basis for acute neurological consultation. In children, they are often precipitated by high-frequency everyday stressors. The extent to which a severe traumatic experience may also precipitate functional neurological abnormalities is unknown. For the 2-week period after the Boston Marathon bombings, we prospectively collected data on patients whose presentation suggested a functional neurological symptom disorder. We assessed clinical and demographic variables, duration of symptoms, extent of educational impact, and degree of connection to the Marathon bombing. We contacted all patients at 6 months after presentation to determine the outcome and accuracy of the diagnosis. In a parallel study, we reported a baseline of 2.6 functional neurological presentations per week in our emergency room. In the week after the Marathon bombings, this frequency tripled. Ninety-one percent of presentations were delayed by 1 week, with onset around the first school day after a city-wide lockdown. Seventy-three percent had a history of a prior psychiatric diagnosis. At the 6 months follow-up, no functional neurological symptom disorder diagnoses were overturned and no new organic diagnosis was made. Pediatric functional neurological symptom disorder may be precipitated by both casual and high-intensity stressors. The 3.4-fold increase in incidence after the Boston Marathon bombings and city-wide lockdown demonstrates the marked effect that a community-wide tragedy can have on the mental health of children. Care providers must be aware of functional neurological symptom disorders after stressful community events in vulnerable patient populations, particularly those with prior psychiatric diagnoses. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Evidence-based guideline update: Plasmapheresis in neurologic disorders

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    Cortese, I.; Chaudhry, V.; So, Y.T.; Cantor, F.; Cornblath, D.R.; Rae-Grant, A.

    2011-01-01

    Objective: To reassess the role of plasmapheresis in the treatment of neurologic disorders. Methods: We evaluated the available evidence based on a structured literature review for relevant articles from 1995 through September 2009. In addition, due to revision of the definitions of classification of evidence since the publication of the previous American Academy of Neurology assessment in 1996, the evidence cited in that manuscript was reviewed and reclassified. Results and Recommendations: Plasmapheresis is established as effective and should be offered in severe acute inflammatory demyelinating polyneuropathy (AIDP)/Guillain-Barré syndrome (GBS) and in the short-term management of chronic inflammatory demyelinating polyneuropathy (Class I studies, Level A). Plasmapheresis is established as ineffective and should not be offered for chronic or secondary progressive multiple sclerosis (MS) (Class I studies, Level A). Plasmapheresis is probably effective and should be considered for mild AIDP/GBS, as second-line treatment of steroid-resistant exacerbations in relapsing forms of MS, and for neuropathy associated with immunoglobulin A or immunoglobulin G gammopathy, based on at least one Class I or 2 Class II studies (Level B). Plasmapheresis is probably not effective and should not be considered for neuropathy associated with immunoglobulin M gammopathy, based on one Class I study (Level B). Plasmapheresis is possibly effective and may be considered for acute fulminant demyelinating CNS disease (Level C). There is insufficient evidence to support or refute the use of plasmapheresis for myasthenia gravis, pediatric autoimmune neuropsychiatric disorders associated with streptococcus infection, and Sydenham chorea (Class III evidence, Level U). PMID:21242498

  8. Neurological symptoms and syndromes in municipal transport drivers

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    Halina Sińczuk-Walczak

    2015-07-01

    Full Text Available Background: The way the municipal transport drivers perform their job contributes to varied burdens linked with the body posture at work, stress, shift work, vibration, noise and exposure to chemical agents. The aim of the study was to assess the condition of the nervous system (NS in municipal transport drivers. Material and Methods: The study covered 42 men, aged 43.4 years (standard deviation (SD: 8.3, employed as bus drivers in the municipal transport enterprise. The duration of employment was 11.8 years on average (SD: 8.6. The condition of the nervous system was assessed on the basis of clinical neurological examinations. Results: Chronic lumbosacral syndrome was found in 54.8% of the subjects. A significant relationship between the incidence of lumbosacral syndrome and the duration of employment (p = 0.032 was observed; significantly higher in drivers employed for 11–15 years (90.9% in comparison to the remaining groups. Nervous system functional disorders were niejedcharacterized by the increased emotional irritability (47.6%, sleep disorders manifested by excessive sleepiness (33.3% or insomnia (28.6% and headaches (3%, mostly tension headaches. Excessive daytime sleepiness was significantly age-dependent (p = 0.038. Conclusions: The evidenced NS disorders indicate the need to undertake preventive measures tailored for the occupational group of bus drivers. Med Pr 2015;66(3:333–341

  9. Neurological signs and late-life depressive symptoms in a community population: the ESPRIT study.

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    Soremekun, Mishael; Stewart, Robert; Portet, Florence; Artero, Sylvaine; Ancelin, Marie-Laure; Ritchie, Karen

    2010-07-01

    Depression in the elderly is common and often resistant to treatment. It has been suggested that late-life depression may be related to underlying neurobiological changes. However, these observations are derived from diverse clinical samples and as yet have not been confirmed in a more representative population study. Our aim was to investigate associations between neurological signs as markers of underlying brain dysfunction and caseness for depression in an elderly community sample, controlling for physical health and comorbid/past neurological disorders. A cross-sectional analysis of 2102 older people without dementia from the ESPRIT project. Depressive symptomatology was ascertained using the CES-D and abnormal neurological signs/comorbidity from a full neurological examination according to ICD-10 criteria. Pyramidal, extrapyramidal, cranial nerve and sensory deficit signs were significantly associated with case-level depressive symptoms. However, all odds ratios were close to null values in participants who did not have previous neurological disorder. We confirmed previous findings of an association between neurological signs and case-level depressive symptoms in late life. However, this association may simply reflect the impact of more severe comorbid neurological disorder. (c) 2009 John Wiley & Sons, Ltd.

  10. [Differential Diagnosis of Immune-Mediated Encephalopathies: "Neurological Symptoms of Diffuse Brain Damage": A New Concept].

    Science.gov (United States)

    Maki, Yoshimitsu; Takashima, Hiroshi

    2017-10-01

    In recent years, incidence of autoimmune encephalopathies has increased. The diagnosis of the severe form of autoimmune encephalopathy is not difficult; however, milder forms can be misdiagnosed as general encephalopathies. We often treat Hashimoto's encephalopathy, which has diverse clinical symptoms and is often misdiagnosed as a psychosomatic disease. We have found that the neurological findings and symptoms of patients with Hashimoto's encephalopathy are similar to those of psychogenic diseases, such as giveway weakness and atypical sensory disorder. To understand the mechanism underlying these symptoms, we propose a new concept: neurological symptoms of diffuse brain damage. This theory is based on the premise that etiologically, symptoms observed were caused by diffuse, spotty, and shaded brain damage due to autoimmune encephalopathies. We also found similar neurological conditions in patients with anti-ganglionic acetylcholine receptor antibody-related encephalopathy, encephalopathies that developed after injection of the cervical cancer vaccine, and encephalopathies associated with Stiff person syndrome. In conclusion, the clinical features of autoimmune encephalopathy include the "neurological symptoms of diffuse brain damage" as well as the presence of antibodies. We could diagnose autoimmune encephalopathy more easily, using this new diagnostic concept.

  11. Depressive symptoms in Parkinson’s disease and in non-neurological medical illnesses

    Science.gov (United States)

    Assogna, Francesca; Fagioli, Sabrina; Cravello, Luca; Meco, Giuseppe; Pierantozzi, Mariangela; Stefani, Alessandro; Imperiale, Francesca; Caltagirone, Carlo; Pontieri, Francesco E; Spalletta, Gianfranco

    2013-01-01

    Background Patients with neurological and non-neurological medical illnesses very often complain of depressive symptoms that are associated with cognitive and functional impairments. We compared the profile of depressive symptoms in Parkinson’s disease (PD) patients with that of control subjects (CS) suffering from non-neurological medical illnesses. Methods One-hundred PD patients and 100 CS were submitted to a structured clinical interview for identification of major depressive disorder (MDD) and minor depressive disorder (MIND), according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR), criteria. The Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory (BDI) were also administered to measure depression severity. Results When considering the whole groups, there were no differences in depressive symptom frequency between PD and CS apart from worthlessness/guilt, and changes in appetite reduced rates in PD. Further, total scores and psychic and somatic subscores of HDRS and BDI did not differ between PD and CS. After we separated PD and CS in those with MDD, MIND, and no depression (NODEP), comparing total scores and psychic/somatic subscores of HDRS and BDI, we found increased total depression severity in NODEP PD and reduced severity of the psychic symptoms of depression in MDD PD, with no differences in MIND. However, the severity of individual symptom frequency of depression was not different between PD and CS in MDD, MIND, and NODEP groups. Conclusion Although MDD and MIND phenomenology in PD may be very similar to that of CS with non-neurological medical illnesses, neurological symptoms of PD may worsen (or confound) depression severity in patients with no formal/structured DSM-IV-TR, diagnosis of depressive mood disorders. Thus, a thorough assessment of depression in PD should take into consideration the different impacts of neurological manifestations on MDD, MIND, and NODEP. PMID

  12. [Copper deficiency with pancytopenia, bradycardia and neurologic symptoms].

    Science.gov (United States)

    Miki, Hirokazu; Kuwayama, Yasuharu; Hara, Tomoko; Oaki, Keiji; Kanezaki, Yoshiko; Yoshida, Tomonori; Shintani, Yasumi; Miya, Keiko; Goto, Tetsuya

    2007-03-01

    A 48-year-old man was referred to our hospital in December, 2005 because of general fatigue, gait disturbance and bradycardia. He had a history of polysurgery due to recurrent ileus and had been treated with home total parenteral nutrition for the short-bowel syndrome since 2003. Clinical findings on admission included marked emaciation and severe weakness of the extremities. Pancytopenia was noted in the peripheral blood. The serum levels of copper and ceruloplasmin were 3 microg/dl and 3 mg/dl, respectively, while Vit. B12 and folate were within the normal range. The bone marrow demonstrated cytoplasmic vacuolation in the myeloid and megakaryocytic series, and sideroblastic changes. No evidence of hematologic malignancies was presented. The diagnosis was copper deficiency and the patient was treated with copper supplementation. Four weeks after copper therapy, the serum level of copper rose to 50 microg/dl and ceruloplasmin to 14 mg/dl. Significant improvements in the hematologic profile, ECG findings and weakness of extremities were noted. Although bicytopenia (anemia and neutropenia) is considered to be a feature of hematologic disorders caused by copper deficiency, the present case showed pancytopenia. The exact mechanism of the unusual association of thrombocytopenia and other abnormalities with copper deficiency remains to be elucidated.

  13. Anthropological neurology: symptoms and their meanings according to Joseph Prick (1909-1978).

    Science.gov (United States)

    ter Meulen, B C; Dekkers, W J M; Keyser, A; van Woerkom, T C A M

    2011-01-01

    This article describes the life and work of the Dutch neurologist Joseph Prick (1909-1978) and his idea of an anthropological neurology. According to Prick, neurological symptoms should not only be explained from an underlying physico-chemical substrate but also be regarded as meaningful. We present an outline of the historical and philosophical context of his ideas with a focus on the theory of the human body by the French philosopher Maurice Merleau-Ponty (1908-1961) and the concept of anthropology-based medicine developed by Frederik Buytendijk (1887-1974). We give an overview of anthropological neurology as a clinical practice and finally we discuss the value of Prick's approach for clinical neurology today.

  14. Neurological symptoms, evaluation and treatment in Danish patients with achondroplasia and hypochondroplasia

    DEFF Research Database (Denmark)

    Doherty, Mia Aagaard; Hertel, Niels Thomas; Hove, Hanne Buciek

    2017-01-01

    Aim To investigate the prevalence of neurological symptoms and the types of complications in a cohort of Danish patients with mutation verified achondroplasia and hypochondroplasia and compare the results with previously reported findings. Methods Retrospective descriptive study by chart review...... of patients followed in three outpatients clinics in the period 1997-2014. Forty-eight patients with achondroplasia and a median age of 9,5 years old and 20 patients with hypochondroplasia and a median age of 12 years old were enrolled. Neurological manifestations, epidemiological variables and clinical data...... for referral to an MRI scan or neurosurgery. Conclusion Through investigation of phenotypes and genotypes in patients with achondroplasia and hypochondroplasia we report the frequencies of neurological symptoms, foramen magnum stenosis, spinal cord compression and neurosurgery in Danish patients. Variation...

  15. Depressive symptoms in Parkinson’s disease and in non-neurological medical illnesses

    Directory of Open Access Journals (Sweden)

    Assogna F

    2013-03-01

    Full Text Available Francesca Assogna,1 Sabrina Fagioli,1 Luca Cravello,1 Giuseppe Meco,2 Mariangela Pierantozzi,3 Alessandro Stefani,3 Francesca Imperiale,2 Carlo Caltagirone,1,3 Francesco E Pontieri,4 Gianfranco Spalletta11I.R.C.C.S. Santa Lucia Foundation, Rome, Italy; 2Department of Neurology and Psychiatry (Parkinson’s Centre and Research Centre of Social Diseases (CIMS, University “Sapienza”, Rome, Italy; 3Department of Neuroscience, University “Tor Vergata”, Rome, Italy; 4Department of Neuroscience, Mental Health and Sensory Systems, University “Sapienza”, Movement Disorder Unit, Sant’Andrea Hospital, Rome, ItalyBackground: Patients with neurological and non-neurological medical illnesses very often complain of depressive symptoms that are associated with cognitive and functional impairments. We compared the profile of depressive symptoms in Parkinson’s disease (PD patients with that of control subjects (CS suffering from non-neurological medical illnesses.Methods: One-hundred PD patients and 100 CS were submitted to a structured clinical interview for identification of major depressive disorder (MDD and minor depressive disorder (MIND, according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR, criteria. The Hamilton Depression Rating Scale (HDRS and the Beck Depression Inventory (BDI were also administered to measure depression severity.Results: When considering the whole groups, there were no differences in depressive symptom frequency between PD and CS apart from worthlessness/guilt, and changes in appetite reduced rates in PD. Further, total scores and psychic and somatic subscores of HDRS and BDI did not differ between PD and CS. After we separated PD and CS in those with MDD, MIND, and no depression (NODEP, comparing total scores and psychic/somatic subscores of HDRS and BDI, we found increased total depression severity in NODEP PD and reduced severity of the psychic symptoms of

  16. Cannabinoid-based medicines for neurological disorders--clinical evidence.

    Science.gov (United States)

    Wright, Stephen

    2007-08-01

    Whereas the cannabis plant has a long history of medicinal use, it is only in recent years that a sufficient understanding of the pharmacology of the main plant constituents has allowed for a better understanding of the most rational therapeutic targets. The distribution of cannabinoid receptors, both within the nervous system and without, and the development of pharmacological tools to investigate their function has lead to a substantial increase in efforts to develop cannabinoids as therapeutic agents. Concomitant with these efforts, the understanding of the pharmacology of plant cannabinoids at receptor and other systems distinct from the cannabinoid receptors suggests that the therapeutic applications of plant-derived cannabinoids (and presumably their synthetic derivatives also) may be diverse. This review aims to discuss the clinical evidence investigating the use of medicines derived, directly or indirectly, from plant cannabinoids with special reference to neurological disorders. Published studies suggest that the oral administration of cannabinoids may not be the preferred route of administration and that plant extracts show greater evidence of efficacy than synthetic compounds. One of these, Sativex (GW Pharmaceuticals), was approved as a prescription medicine in Canada in 2005 and is currently under regulatory review in the EU.

  17. Prevalence of pulmonary arteriovenous malformations (PAVMs) and occurrence of neurological symptoms in patients with hereditary haemorrhagic telangiectasia (HHT)

    DEFF Research Database (Denmark)

    Kjeldsen, A D; Oxhøj, H; Andersen, P E

    2000-01-01

    Hereditary haemorrhagic telangiectasia (HHT) is a dominantly inherited disease. HHT is characterized by a wide variety of clinical manifestations, including pulmonary arteriovenous malformations (PAVMs) and neurological symptoms.......Hereditary haemorrhagic telangiectasia (HHT) is a dominantly inherited disease. HHT is characterized by a wide variety of clinical manifestations, including pulmonary arteriovenous malformations (PAVMs) and neurological symptoms....

  18. PRISM: a novel research tool to assess the prevalence of pseudobulbar affect symptoms across neurological conditions.

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    Benjamin Rix Brooks

    Full Text Available BACKGROUND: Pseudobulbar affect (PBA is a neurological condition characterized by involuntary, sudden, and frequent episodes of laughing and/or crying, which can be socially disabling. Although PBA occurs secondary to many neurological conditions, with an estimated United States (US prevalence of up to 2 million persons, it is thought to be under-recognized and undertreated. The PBA Registry Series (PRISM was established to provide additional PBA symptom prevalence data in a large, representative US sample of patients with neurological conditions known to be associated with PBA. METHODS: Participating clinicians were asked to enroll ≥20 consenting patients with any of 6 conditions: Alzheimer's disease (AD, amyotrophic lateral sclerosis (ALS, multiple sclerosis (MS, Parkinson's disease (PD, stroke, or traumatic brain injury (TBI. Patients (or their caregivers completed the Center for Neurologic Study-Lability Scale (CNS-LS and an 11-point scale measuring impact of the neurological condition on the patient's quality of life (QOL. Presence of PBA symptoms was defined as a CNS-LS score ≥13. Demographic data and current use of antidepressant or antipsychotic medications were also recorded. RESULTS: PRISM enrolled 5290 patients. More than one third of patients (n = 1944; 36.7% had a CNS-LS score ≥13, suggesting PBA symptoms. The mean (SD score measuring impact of neurological condition on QOL was significantly higher (worse in patients with CNS-LS ≥13 vs <13 (6.7 [2.5] vs. 4.7 [3.1], respectively; P<0.0001 two-sample t-test. A greater percentage of patients with CNS-LS ≥13 versus <13 were using antidepressant/antipsychotic medications (53.0% vs 35.4%, respectively; P<0.0001, chi-square test. CONCLUSIONS: Data from PRISM, the largest clinic-based study to assess PBA symptom prevalence, showed that PBA symptoms were common among patients with diverse neurological conditions. Higher CNS-LS scores were associated with impaired QOL and

  19. Brain magnetic resonance imaging screening is not useful for HIV-1-infected patients without neurological symptoms.

    Science.gov (United States)

    Nishijima, Takeshi; Gatanaga, Hiroyuki; Teruya, Katsuji; Tajima, Tsuyoshi; Kikuchi, Yoshimi; Hasuo, Kanehiro; Oka, Shinichi

    2014-10-01

    We investigated the diagnostic usefulness of brain magnetic resonance imaging (MRI) screening in HIV-1-infected patients without neurological symptoms in detecting intracranial diseases at early stages. In this retrospective analysis, the study patients were HIV-1-infected patients who underwent brain MRI scan in clinical practice between 2001 and 2013. We excluded patients with MRI for (1) follow-up examination for prediagnosed intracranial diseases, (2) cancer staging, (3) screening mycobacterium/bacteria/fungi disease proliferation in the brain, and (4) evaluation for meningitis/encephalitis. The study patients (n=485) were classified into two groups: those who underwent brain MRI scan without any neurological symptoms/signs (asymptomatic patients, n=158) and those who underwent MRI due to such symptoms (symptomatic patients, n=327). Asymptomatic patients had lower CD4 counts than symptomatic patients (median 78 versus 241/μl). Intracranial diseases were detected in three (2%) of the asymptomatic patients [two toxoplasmosis and one progressive multifocal leukoencephalopathy (PML)] compared to 58 (19%) of the symptomatic patients (the χ(2) test, pMRI screening for HIV-1-infected patients without neurological symptoms is of little value.

  20. Cognitive-analytical therapy for a patient with functional neurological symptom disorder-conversion disorder (psychogenic myopia: A case study

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    Hamid Nasiri

    2015-01-01

    Full Text Available Functional neurological symptom disorder commonly presents with symptoms and defects of sensory and motor functions. Therefore, it is often mistaken for a medical condition. It is well known that functional neurological symptom disorder more often caused by psychological factors. There are three main approaches namely analytical, cognitive and biological to manage conversion disorder. Any of such approaches can be applied through short-term treatment programs. In this case, study a 12-year-old boy with the diagnosed functional neurological symptom disorder (psychogenic myopia was put under a cognitive-analytical treatment. The outcome of this treatment modality was proved successful.

  1. B12 deficiency is common in infants and is accompanied by serious neurological symptoms.

    Science.gov (United States)

    Irevall, T; Axelsson, I; Naumburg, E

    2017-01-01

    Adverse neurological symptoms have been linked to vitamin B12 deficiency in infants. This explorative study described the clinical presentation associated with vitamin B12 deficiency in this age group. The study comprised infants who were born between 2004 and 2012 and were tested for vitamin B12 levels after they were admitted to a hospital with neurological symptoms at less than one year of age. Vitamin B12 deficiency was defined as low cobalamin in serum and/or increased homocysteine and/or increased methylmalonate. It was diagnosed according to the applicable International Classification of Diseases, 10th revision, and recorded as vitamin B12 deficiency in the medical records. All information was retrieved from medical records and compared to symptomatic infants with normal levels. Of the 121 infants tested, 35 had vitamin B12 deficiency and 86 had normal levels. Vitamin B12 deficiency was diagnosed at an average age of 1.7 months and was more common among boys. Seizures and apparent life-threatening events were the most common symptoms among infants with B12 deficiency compared to infants with normal levels. Vitamin B12 deficiency was more common in infants than we expected and presented with severe symptoms, such as seizures and apparent life-threatening events. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  2. Neurological symptoms and signs in HTLV-1 patients with overactive bladder syndrome

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    Davi Tanajura Costa

    2012-04-01

    Full Text Available OBJECTIVE: To compare neurological symptoms and signs in HTLV-1 asymptomatic carriers and HTLV-1 patients with overactive bladder (OB syndrome. METHODS: We studied 102 HTLV-1 positive individuals without HAM/TSP (HTLV-1 associated myelopathy/tropical spastic paraparesis divided into two groups according to the presence or absence of OB syndrome. Clinical interview, neurological exam and proviral load was performed in all patients. RESULTS AND CONCLUSIONS: Individuals with OB were more commonly female (84.3 vs. 60.8% of asymptomatics, p=0.01. The prevalence of neurological complaints was higher in OB group, especially hand or foot numbness and arm or leg weakness. There was no difference between the groups in neurological strength and reflexes. Weakness complaint remained strongly associated with OB in multivariate logistic regression analysis adjusting for sex and age [adjusted odds ratio and 95%CI 3.59 (1.45-8.88 in arms and 6.68 (2.63-16.93 in legs]. Proviral load was also different between the two groups with higher level on OB individuals.

  3. Case of herpes simplex encephalitis without neurologic symptoms. A comparison between CT scan and MRI

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    Kawabata, N.; Tanaka, T.; Hiramoto, N.; Takazuka, K.; Komatsu, T.

    1987-03-01

    The lack of neurologic symptoms is rare in herpes simplex encephalitis (HSE). A 42-year-old woman presented with psychiatric features alone, such as Korsakoff syndrome and abortive type Kluver-Bucy syndrome. The diagnosis of HSE was confirmed by serologically elevated antibody titer. The patient underwent both X-ray computed tomography and magnetic resonance imaging (MRI). X-ray computed tomography showed transient contrast enhancement and low density area confined to the lateral lobe. Magnetic resonance imaging revealed diffuse areas with a high MRI signal intensity. Considering that the lack of neurologic features, as seen in the present HSE patient, may sometimes rule out the possibility of parenchymal disease, imaging modalities, especially MRI, may be of value in the detection of lesions for HSE.

  4. Organophosphate intermediate syndrome with neurological complications of extrapyramidal symptoms in clinical practice

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    Mark B. Detweiler

    2014-01-01

    Full Text Available Organophosphates (OPs are ubiquitous in the world as domestic and industrial agricultural insecticides. Intentional poisoning as suicides attempts are clinical phenomena seen in emergency departments and clinics in agricultural areas. Intermediate syndrome with the neurological complication of extra pyramidal symptoms following acute OP ingestion may occur in pediatric and adult cases. While death is the most serious consequence of toxic OP doses, low levels of exposure and nonfatal doses may disrupt the neurobehavioral development of fetuses and children in addition to bring linked to testicular cancer and male and female infertility. These are disturbing. Chronic and acute toxicity from OPs are barriers to the health of our present and future generations. Symptoms and treatment of acute and chronic OP exposure are briefly referenced with inclusion of the intermediate syndrome. Suggestions for local and systemic reduction of the acute and long term consequences of OP ingestion are opined.

  5. Neurological symptoms associated with acute multifocal placoid pigment epitheliopathy: treatment dilemma and diagnostic issues.

    Science.gov (United States)

    Oleszczuk, Justyna D; Saeed, Muhammad Usman

    2015-05-01

    Acute multifocal placoid pigment epitheliopathy (AMPPE) is thought to be caused by vasculitis of the choroid. Central nervous system involvement is rare. We report a case of a 28-year-old male who developed blurred vision (6/12 OD, 6/24 OS). Past medical history involved non-specific viral meningitis treated with intravenous antibiotics and antivirals. Subsequently, the patient complained of recurrent headaches. Based on typical clinical findings and fluorescein angiogram, he was diagnosed with AMPPE. Visual disturbance resolved without any systemic treatment. Six months later, visual symptoms recurred and resolved spontaneously, but his headache continued. A few months later, the patient developed acute progressive neurological signs and symptoms necessitating inpatient admission. Lacunar infarcts in the CNS were found, which had not been noted in previous neuro-imaging studies. Cerebral vasculitis associated with AMPPE was diagnosed and treated with systemic steroids and immune suppression. Currently, the patient remains asymptomatic under joined care of an ophthalmologist and a neurologist.

  6. Cingulo-insular structural alterations associated with psychogenic symptoms, childhood abuse and PTSD in functional neurological disorders.

    Science.gov (United States)

    Perez, David L; Matin, Nassim; Barsky, Arthur; Costumero-Ramos, Victor; Makaretz, Sara J; Young, Sigrid S; Sepulcre, Jorge; LaFrance, W Curt; Keshavan, Matcheri S; Dickerson, Bradford C

    2017-06-01

    Adverse early-life events are predisposing factors for functional neurological disorder (FND) and post-traumatic stress disorder (PTSD). Cingulo-insular regions are implicated in the biology of both conditions and are sites of stress-mediated neuroplasticity. We hypothesised that functional neurological symptoms and the magnitude of childhood abuse would be associated with overlapping anterior cingulate cortex (ACC) and insular volumetric reductions, and that FND and PTSD symptoms would map onto distinct cingulo-insular areas. This within-group voxel-based morphometry study probes volumetric associations with self-report measures of functional neurological symptoms, adverse life events and PTSD symptoms in 23 mixed-gender FND patients. Separate secondary analyses were also performed in the subset of 18 women with FND to account for gender-specific effects. Across the entire cohort, there were no statistically significant volumetric associations with self-report measures of functional neurological symptom severity or childhood abuse. In women with FND, however, parallel inverse associations were observed between left anterior insular volume and functional neurological symptoms as measured by the Patient Health Questionnaire-15 and the Screening for Somatoform Symptoms Conversion Disorder subscale. Similar inverse relationships were also appreciated between childhood abuse burden and left anterior insular volume. Across all subjects, PTSD symptom severity was inversely associated with dorsal ACC volume, and the magnitude of lifetime adverse events was inversely associated with left hippocampal volume. This study reveals distinct cingulo-insular alterations for FND and PTSD symptoms and may advance our understanding of FND. Potential biological convergence between stress-related neuroplasticity, functional neurological symptoms and reduced insular volume was identified. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017

  7. Lower urinary tract symptoms associated with neurological conditions: Observations on a clinical sample of outpatients neurorehabilitation service

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    Fabrizio Torelli

    2015-07-01

    Full Text Available Objectives: The overall aims of this study were to investigate the lower urinary tract symptoms (LUTS associated with neurological conditions and their prevalence and impact on a clinical sample of outpatients of a neurorehabilitation service. Materials and methods: We reviewed the files of 132 patients treated in our neurorehabilitation service from December 2012 to December 2013. Patients were divided into several subgroups based on the neurological diagnosis: Multiple Sclerosis (MS, other demyelinating diseases, Peripheral Neuropathy, neurovascular disorders (ND, neoplastic disease, traumatic brain injury (TBI, Parkinson and Parkinsonism, spinal cord injuries (SCI. Urinary status was based on medical evaluations of history of LUTS, type, degree, onset and duration of symptoms. We tried to analyze prevalence, kind of disorder, timing of presentation (if before or after the neurological onset and eventual persistence of urological disorders (in the main group and in all subgroups. Results: At the time of admission to our rehabilitation service, LUTS were observed in 14 out of 132 cases (11%. A high proportion of these outpatients (64.2% presented bothersome urinary symptoms such as incontinence, frequency and urgency (storage LUTS. The most frequent symptom was urinary urge incontinence (42.8%. This symptom was found to be prevalent in the multiple sclerosis and neurovascular disorders. In 93% the urinary symptoms arose as a result of neurologic conditions and 78.5% did not present a complete recovery of urological symptoms in spite of improved selfreported functional activity limitations. None of these patients performed urological rehabilitation. Conclusions: Neurological disorders are a significant issue in rehabilitation services and it can lead to lower tract dysfunction, which causes LUTS. Storage symptoms are more common, especially urge incontinence. Current literature reports that a further optimization of the rehabilitation potential

  8. Decompression illness with hypovolemic shock and neurological failure symptoms after two risky dives: a case report.

    Science.gov (United States)

    Klapa, Sebastian; Meyne, Johannes; Kähler, Wataru; Tillmans, Frauke; Werr, Henning; Binder, Andreas; Koch, Andreas

    2017-03-01

    Hypovolemia is known to be a predisposing factor of decompression illness (DCI) while diving. The typical clinically impressive neurological symptoms of DCI may distract from other symptoms such as an incipient hypovolemic shock. We report the case of a 61-year-old male Caucasian, who presented with an increasing central and peripheral neural failure syndrome and massive hypovolemia after two risky dives. Computed tomography (CT) scans of the chest and Magnetic resonance imaging scans of the head revealed multiple cerebral and pulmonary thromboembolisms. Transesophageal echocardiography showed a patent foramen ovale (PFO). Furthermore, the patient displayed hypotension as well as prerenal acute kidney injury with elevated levels of creatinine and reduced renal clearance, indicating a hypovolemic shock. Early hyperbaric oxygen (HBO) therapy reduced the neurological deficits. After volume expansion of 11 liters of electrolyte solution (1000 mL/h) the cardiopulmonary and renal function normalized. Hypovolemia increases the risk of DCI during diving and that of hypovolemic shock. Early HBO therapy and fluid replacement is crucial for a favorable outcome. © 2017 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.

  9. Screening for primary creatine deficiencies in French patients with unexplained neurological symptoms

    Science.gov (United States)

    2012-01-01

    A population of patients with unexplained neurological symptoms from six major French university hospitals was screened over a 28-month period for primary creatine disorder (PCD). Urine guanidinoacetate (GAA) and creatine:creatinine ratios were measured in a cohort of 6,353 subjects to identify PCD patients and compile their clinical, 1H-MRS, biochemical and molecular data. Six GAMT [N-guanidinoacetatemethyltransferase (EC 2.1.1.2)] and 10 X-linked creatine transporter (SLC6A8) but no AGAT (GATM) [L-arginine/glycine amidinotransferase (EC 2.1.4.1)] deficient patients were identified in this manner. Three additional affected sibs were further identified after familial inquiry (1 brother with GAMT deficiency and 2 brothers with SLC6A8 deficiency in two different families). The prevalence of PCD in this population was 0.25% (0.09% and 0.16% for GAMT and SLC6A8 deficiencies, respectively). Seven new PCD-causing mutations were discovered (2 nonsense [c.577C > T and c.289C > T] and 1 splicing [c.391 + 15G > T] mutations for the GAMT gene and, 2 missense [c.1208C > A and c.926C > A], 1 frameshift [c.930delG] and 1 splicing [c.1393-1G > A] mutations for the SLC6A8 gene). No hot spot mutations were observed in these genes, as all the mutations were distributed throughout the entire gene sequences and were essentially patient/family specific. Approximately one fifth of the mutations of SLC6A8, but not GAMT, were attributed to neo-mutation, germinal or somatic mosaicism events. The only SLC6A8-deficient female patient in our series presented with the severe phenotype usually characterizing affected male patients, an observation in agreement with recent evidence that is in support of the fact that this X-linked disorder might be more frequent than expected in the female population with intellectual disability. PMID:23234264

  10. Imaging findings of paediatric oncology patients presenting with acute neurological symptoms

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    Chu, W.C.W. E-mail: winnie@med.cuhk.edu.hk; Lee, V.; Howard, R.G.; Roebuck, D.J.; Chik, K.W.; Li, C.K

    2003-08-01

    Paediatric oncology patients are prone to central nervous system (CNS) complications due to multiple factors including disorders of the blood cell counts (which include neutropenia, thrombocytopenia or hyperleukocytosis), immunosuppression, neurotoxicity of the treatment, CNS dysfunction due to failure of other organ systems, disease progression of the primary malignancy or metastases. Imaging plays an important role in the management of paediatric oncology patients presenting with acute neurological symptoms. This pictorial review is from our institutional experience on imaging children who are under the care of the Child Cancer Centre. The review consists of a spectrum of neurological complications in paediatric oncology patients. The complications can be classified as (1) cerebrovascular complications, (2) treatment-elated complications, (3) opportunistic infections and (4) tumoural involvement of the CNS. Computed tomography (CT) is the initial choice of investigation, which is easily available and helps to exclude major intracranial abnormality such as haemorrhage. If the CT is negative, magnetic resonance imaging (MRI) should be performed, which is more sensitive for detection of CNS lesions.

  11. A Woman with Treated Breast Cancer, Recent Neurological Symptoms and Xanthoderma

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    Vitorino Modesto dos Santos

    2013-03-01

    Full Text Available We describe a 69-year-old-woman with antecedent of breast cancer and recent transitory neurological symptoms. Physical examination showed yellow to orange skin pigmentation, more conspicuous on her palms and soles, while discoloration changes were absent in the eye and oral mucous membranes. Routine laboratory findings were not indicative of hemolytic anemia, liver or bile disorders, nephrotic syndrome, hypothyroidism or diabetes mellitus. We emphasize the role of her excessive ingestion of papaw and tomato. These foods are rich in carotenoids (β-carotene and lycopene, which are associated with pigmentation disorders. The skin discoloration improved in about two months after correction of the inadequate diet. Major concerns about differential diagnosis of yellow skin pigmentation are also highlighted.

  12. Occipital transcranial magnetic stimulation discriminates transient neurological symptoms of vascular origin from migraine aura without headache.

    Science.gov (United States)

    Naeije, Gilles; Fogang, Yannick; Ligot, Noémie; Mavroudakis, Nicolas

    2017-09-01

    The diagnosis of transient neurological attacks (TNA) relies on medical history. Transient ischemic attack is often considered until proven otherwise, because of lack of objective paraclinical tools that can help discriminate TIA from differential diagnoses such as migraine aura. This may lead to needless and potentially harmful stroke secondary prevention in many cases. This study aimed at determining the yield of occipital transcranial magnetic stimulation (oTMS) in discriminating TNA of vascular origin from migraine aura without headache (MAWH). Ten patients with acute TNA of vascular origin and ten patients with migraine aura without headache (MAWH), without prior history of migrainous headache, were prospectively included. TNA of vascular origin were considered for individuals presenting unilateral focal symptoms with full resolution within 24hours and positive diffusion weighted imaging (DWI+). For individuals with MAWH, diagnostic criteria were either ICHD-III beta or Fischer criteria for a first episode of MAWH. All participants underwent one session of oTMS. Induction and threshold of phosphene induction were recorded. In TNA of vascular origin, MRI disclosed cortical lesions in nine and one sub-cortical lesion. Phosphenes were induced in 9/10 subjects with MAWH with a mean threshold of 66% of the maximal intensity, whereas oTMS induced phosphenes in only one subject with TNA of vascular origin at a threshold of 85%. In this pilot study, oTMS was found to be an effective tool to discriminate between MAWH and transient neurological symptoms of vascular origin. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  13. Conversion Disorder, Functional Neurological Symptom Disorder, and Chronic Pain: Comorbidity, Assessment, and Treatment.

    Science.gov (United States)

    Tsui, Patricia; Deptula, Andrew; Yuan, Derek Y

    2017-06-01

    This paper examines the overlap of conversion disorder with chronic pain conditions, describes ways to assess for conversion disorder, and provides an overview of evidence-based treatments for conversion disorder and chronic pain, with a focus on conversion symptoms. Conversion disorder is a significant problem that warrants further study, given that there are not many well-established guidelines. Accurate and timely assessment should help move treatment in a more fruitful direction and avoid unnecessary medical interventions. Advances in neuroimaging may also help further our understanding of conversion disorder. Creating a supportive environment and a collaborative treatment relationship and improving understanding of conversion symptoms appear to help individuals diagnosed with conversion disorder engage in appropriate treatments. Novel uses of earlier treatments, such as hypnosis and psychodynamic approaches, could potentially be beneficial and require a more vigorous and systematic study. There are treatments that produce significant improvements in functioning and reduction of physical symptoms from conversion disorder even for very severe cases. Hypnotherapy, cognitive behavioral therapy, and inpatient multidisciplinary treatment with intensive physiotherapy for severe cases have the most evidence to support reduction of symptoms. Components of treatment for conversion disorder overlap with treatments for chronic pain and can be used together to produce therapeutic effects for both conditions. Treatment needs to be tailored for each individual's specific symptoms.

  14. Neurological Evidence Linguistic Processes Precede Perceptual Simulation in Conceptual Processing

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    Max eLouwerse

    2012-10-01

    Full Text Available There is increasing evidence from response time experiments that language statistics and perceptual simulations both play a role in conceptual processing. In an EEG experiment we compared neural activity in cortical regions commonly associated with linguistic processing and visual perceptual processing to determine to what extent symbolic and embodied accounts of cognition applied. Participants were asked to determine the semantic relationship of word pairs (e.g., sky – ground or to determine their iconic relationship (i.e., if the presentation of the pair matched their expected physical relationship. A linguistic bias was found towards the semantic judgment task and a perceptual bias was found towards the iconicity judgment task. More importantly, conceptual processing involved activation in brain regions associated with both linguistic and perceptual processes. When comparing the relative activation of linguistic cortical regions with perceptual cortical regions, the effect sizes for linguistic cortical regions were larger than those for the perceptual cortical regions early in a trial with the reverse being true later in a trial. These results map upon findings from other experimental literature and provide further evidence that processing of concept words relies both on language statistics and on perceptual simulations, whereby linguistic processes precede perceptual simulation processes.

  15. Genetics of neurological disorders.

    Science.gov (United States)

    Faghihi, Mohammad Ali; Mottagui-Tabar, Salim; Wahlestedt, Claes

    2004-05-01

    Neurological diseases are defined as an inappropriate function of the peripheral or central nervous system due to impaired electrical impulses throughout the brain and/or nervous system that may present with heterogeneous symptoms according to the parts of the system involved in these pathologic processes. Growing evidence on genetic components of neurological disease have been collected during recent years. Genetic studies have opened the way for understanding the underlying pathology of many neurological disorders. The outcome of current intense research into the genetics of neurological disorders will hopefully be the introduction of new diagnostic tools and the discovery of potential targets for new and more effective medications and preventive measures.

  16. Effect of neurological symptoms on the course and the healing of fractures of the mandible

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    Muhina N.M.

    2012-06-01

    Full Text Available

    Purpose: to study the dental status and neurological symptoms in patients with fractures of the mandible for improving diagnosis, predicting the course of reparative processes and the application of preventive measures of infam-matory complications. Material. We observed 132 patients with mandibular fractures of different location, the hospital received no later than 3 days after injury and comparison group, consisting of 15 healthy people. Dental status of patients included clinical examination: identifying reasons for injuries, complaints external examination of maxillofacial area. Assessment of pain that was observed in patients in the area of innervation of the trigeminal nerve, was carried out using a scale for measuring the intensity of pain and need for analgesics (Lantsev EA, AA Smirnov, 1990. Zone of hypesthesia and hyperesthesia were detected in patients in the study of the surface (pain, temperature and tactile and the deep sensitivity of the skin. State of the motor portion of the third branch of the trigeminal nerve was assessed by palpation of masticatory and temporal muscles, according to electromyographic, in the late periods of the presence of atrophy of the masticatory muscles on the affected side and disturbance trajectory of the mandible. In addition, elec-trophysiological examination included registration of trigeminal somatosensory evoked potentials. The study of pain sensitivity of the teeth was carried out using a digital tester to determine the viability of the pulp «Digitest». This study was conducted on the day of admission and on the 10th day of treatment. Results. Clinical and instrumental evaluation of patients with uncomplicated fractures of the mandibular nerve fber damage detected in 100 % of cases. In complicated fractures clinically identifed sensory disorders paresteticheskih signs of interest in the trigeminal nerve were found in 51.8 % of cases. In

  17. An evidence-based approach to clinical questions in the practice of equine neurology.

    Science.gov (United States)

    Van Biervliet, Jérôme

    2007-08-01

    The practice of equine neurology has special challenges posed by the size of the animal being examined. Many diagnostic procedures routinely used in small animal practice are unsafe when applied to the equine patient or unavailable to the equine practitioner. Therefore, astute observation is the mainstay of making a neuroanatomic diagnosis, and detailed evidence on the deficits present may be difficult to obtain. Because clinical observation can sometimes be ambiguous and somewhat subjective, it is even more important to approach equine neurology from an evidence-based point of view. Here, such an approach is outlined for the diagnosis of cervical vertebral compressive myelopathy (CVCM), one of the most common noninfectious causes of equine neurologic disease. This article is an attempt to summarize all aspects of making a diagnosis of CVCM on the basis of signalment, clinical examination, ancillary diagnostic tests, and pathologic examination. Each of these considerations has inherent limitations regarding diagnostic accuracy, which are discussed.

  18. Practice Parameter: treatment of nonmotor symptoms of Parkinson disease: report of the Quality Standards Subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Zesiewicz, T A; Sullivan, K L; Arnulf, I; Chaudhuri, K R; Morgan, J C; Gronseth, G S; Miyasaki, J; Iverson, D J; Weiner, W J

    2010-03-16

    Nonmotor symptoms (sleep dysfunction, sensory symptoms, autonomic dysfunction, mood disorders, and cognitive abnormalities) in Parkinson disease (PD) are a major cause of morbidity, yet are often underrecognized. This evidence-based practice parameter evaluates treatment options for the nonmotor symptoms of PD. Articles pertaining to cognitive and mood dysfunction in PD, as well as treatment of sialorrhea with botulinum toxin, were previously reviewed as part of American Academy of Neurology practice parameters and were not included here. A literature search of MEDLINE, EMBASE, and Science Citation Index was performed to identify clinical trials in patients with nonmotor symptoms of PD published between 1966 and August 2008. Articles were classified according to a 4-tiered level of evidence scheme and recommendations were based on the level of evidence. Sildenafil citrate (50 mg) may be considered to treat erectile dysfunction in patients with Parkinson disease (PD) (Level C). Macrogol (polyethylene glycol) may be considered to treat constipation in patients with PD (Level C). The use of levodopa/carbidopa probably decreases the frequency of spontaneous nighttime leg movements, and should be considered to treat periodic limb movements of sleep in patients with PD (Level B). There is insufficient evidence to support or refute specific treatments for urinary incontinence, orthostatic hypotension, and anxiety (Level U). Future research should include concerted and interdisciplinary efforts toward finding treatments for nonmotor symptoms of PD.

  19. Heavy cannabis use prior psychosis in schizophrenia: clinical, cognitive and neurological evidences for a new endophenotype?

    Science.gov (United States)

    Mallet, Jasmina; Ramoz, Nicolas; Le Strat, Yann; Gorwood, Philip; Dubertret, Caroline

    2017-02-11

    Cannabis use is associated with an increased risk of schizophrenia, and is considered to impact late neurodevelopment. Neurological soft signs (NSS) associated with schizophrenia are considered as markers of early neurodevelopmental impairment. Our study examines the association between heavy cannabis use before the onset of psychosis and clinical, neuropsychological and neurological symptoms, including NSS. In a cross-sectional study, we consecutively included 61 patients with schizophrenia (34 reporting heavy cannabis use before the onset of psychosis and 27 not reporting such use), in the setting of a University Hospital and a Medical Center. Symptoms assessment and substance use disorder were evaluated with the Diagnostic Interview for Genetic Studies. NSS were assessed with the Neurological Evaluation Scale. Psychopathology was assessed with the Positive and Negative Symptom Scale. All patients underwent a battery of neurocognitive tests evaluating attention, memory and executive functions domains. Patients with heavy cannabis use before the onset of psychosis showed significantly less NSS (p cannabis before the onset of schizophrenia. Patients with heavy cannabis use before the onset of schizophrenia may exhibit later neurodevelopmental impairment than those who do not report such use. Schizophrenia associated with heavy cannabis use could represent a specific phenotype.

  20. Injury mechanism of midfacial fractures in football causes in over 40% typical neurological symptoms of minor brain injuries.

    Science.gov (United States)

    Krutsch, Volker; Gesslein, Markus; Loose, Oliver; Weber, Johannes; Nerlich, Michael; Gaensslen, Axel; Bonkowsky, Viktor; Krutsch, Werner

    2017-02-08

    The injury mechanisms of midfacial fractures may be typical causes of concussion, but hardly any scientific data on midfacial injuries sustained in football are available. Head and brain trauma represent frequent injuries in athletes of different sports that require appropriate treatment by sports and trauma physicians. This study investigated the management of midfacial fractures in football and the association of such fractures with concomitant brain injury. In a prospective cohort study lasting 24 months (2012 to 2013), midfacial injuries of football players were analysed with regard to the injury mechanisms, first aid procedures on the field, treatment and return-to-play. To analyse concomitant and potentially overlooked minor brain injuries due to the trauma, we retrospectively investigated the neurological symptoms of the study population. The study included 132 football players (37 semi-professionals and 95 amateurs) with midfacial fractures. The main injury mechanisms were head-to-head and head-to-elbow trauma. The mean period of return-to-play after trauma was 33.5 days, which was significantly shortened if a protective face mask was worn (mean 10.4 days earlier, p = 0.0006). Semi-professional football players returned to play earlier (p = 0.009) and more often used protective face masks (p = 0.001). 55 players (41.6%) had neurological symptoms immediately after trauma as a possible sign of concomitant minor brain injury. 5 of 132 players with concussion had been hospitalised for 24 h, but no persistent neurological symptoms were detected. In football, midfacial fractures represent moderate-to-severe injuries with time away from sports of more than 4 weeks. Over 40% of athletes with a midfacial fracture showed concomitant neurological symptoms as a sign of minor brain injury. Therefore, sports physicians and other staff supervising athletes in daily practice should be aware of the presence of neurological symptoms. Level III.

  1. Complex neurological symptoms in bilateral thalamic stroke due to Percheron artery occlusion

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    Caruso P

    2016-12-01

    Full Text Available Paola Caruso, Paolo Manganotti, Rita Moretti Department of Clinical Neurology, University of Trieste, Trieste, Italy Abstract: The artery of Percheron is a rare anatomical variant where a single thalamic perforating artery arises from the proximal posterior cerebral artery (P1 segment between the basilar artery and the posterior communicating artery and supplies the rostral mesencephalon and both paramedian territories of the thalami. Almost one-third of human brains present this variant. Occlusion of the artery of Percheron mostly results in a bilateral medial thalamic infarction, which usually manifests with altered consciousness (including coma, vertical gaze paresis, and cognitive disturbance. The presentation is similar to the “top of the basilar syndrome”, and early recognition should be prompted. We describe the case of a young female with this vessel variant who experienced a bilateral thalamic stroke. Magnetic resonance angiography demonstrated bilateral thalamic infarcts and a truncated artery of Percheron. Occlusion of the vessel was presumably due to embolism from a patent foramen ovale. Thrombolysis was performed, with incomplete symptom remission, cognitive impairment, and persistence of speech disorders. Early recognition and treatment of posterior circulation strokes is mandatory, and further investigation for underlying stroke etiologies is needed. Keywords: thalamus vascularization, cognitive impairment, paramedian thalamus territory, speech disorder, vertical gaze palsy

  2. Evolution of substance use, neurological and psychiatric symptoms in schizophrenia and substance use disorder patients: a 12-week, pilot, case-control trial with quetiapine

    Directory of Open Access Journals (Sweden)

    Simon eZhornitsky

    2011-05-01

    Full Text Available Neurological and psychiatric symptoms are consequences of substance abuse in schizophrenia and non-schizophrenia patients. The present case-control study examined changes in substance abuse/dependence and neurological and psychiatric symptoms in substance abusers with (DD group, n=26 and without schizophrenia (SUD group, n=24 and in non-abusing schizophrenia patients (SCZ group, n=23 undergoing 12-week treatment with the atypical antipsychotic, quetiapine. Neurological and psychiatric symptoms were evaluated with the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia, the Extrapyramidal Symptoms Rating Scale and the Barnes Akathisia Rating Scale. At endpoint, DD and SCZ patients were receiving significantly higher doses of quetiapine (mean = 554mg/d and 478mg/d, respectively, relative to SUD patients (mean = 150mg/d. We found that SUD patients showed greater improvement in weekly dollars spent on alcohol and drugs and SUD severity, compared to DD patients. At endpoint, there was no significant difference in dollars spent, but DD patients still had a higher mean SUD severity. Interestingly, DD patients had significantly higher Parkinsonism and depression than SCZ patients at baseline and endpoint. On the other hand, we found that SUD patients had significantly more akathisia at baseline, improved more than SCZ patients and this was related to cannabis abuse/dependence. Finally, SUD patients improved more in PANSS positive scores than DD and SCZ patients. Taken together, our results provide evidence for increased vulnerability to the adverse effects of alcohol and drugs in schizophrenia patients. They also suggest that substance abuse/withdrawal may mimic some symptoms of schizophrenia. Future studies will need to determine the role quetiapine played in these improvements.

  3. Is Further Examination Necessary in Patients with Behcets Disease Without Any Neurological Signs or Symptoms?

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    Halit YAsAR

    2015-09-01

    Conclusion: Visually evoked potential examination may be used as a conductive method to detect the subclinical neurological pathologies in Behcets disease. The possible silent neurological involvement should be evaluated with further neuro-screening methods. [Dis Mol Med 2015; 3(3.000: 29-34

  4. The evidence for urodynamic investigation of patients with symptoms of urinary incontinence

    Science.gov (United States)

    2013-01-01

    Urodynamic studies are the gold standard to objectively diagnose dysfunction of the lower urinary tract. The widely available evidence for the clinical relevance is, however, fragmented. This article summarizes the published knowledge supporting the use of urodynamic studies in urinary incontinence in female, male and frail patients, as well as patients with relevant neurological disease. Five technological innovations are discussed briefly. Standard urodynamic cystometry can, on the basis of a solid body of evidence, objectively unveil the entire function of the lower urinary tract in all patients with urinary incontinence, regardless of the patients' perception of (ab-)normality of signs and or symptoms. PMID:23513180

  5. A case of neuro-Behcet's disease: comparison of neurological symptoms with PET, SPECT, and MRI findings

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    Kim, Jin Wook; An, Min; Kim, So Yon; Kim, Young Jung; Cho, Min Koo; Lee, Gwon Jun; Lim, Sang Mun; Hong, Sung Woon; Choi, Chang Woon [Korea Cancer Center, Seoul (Korea, Republic of)

    1998-08-01

    We describe a 27-year-old man who developed gait disturbance and dysarthria 2 years after the onset of cardinal symptoms of Behect's disease. Position emission tomography with {sup 18}F-fluorodeoxyglucose revealed severe hypometabolism in the cerebellum, in accordance with cerebellar symptoms and signs of the patients. However, single-photon emission tomography with {sup 99m}Tc-HMPAO and {sup 99m}Tc-ECD did not disclose significant perfusion abnormalities in the brain. Routine brain magnetic resonance imaging did not show signal abnormalities. The findings of imaging studies compared with neurological manifestations of the patient are discussed.

  6. Enterovirus 71-associated hand, foot and mouth diseases with neurologic symptoms, a university hospital experience in Korea, 2009

    Directory of Open Access Journals (Sweden)

    Hye Kyung Cho

    2010-05-01

    Full Text Available Purpose : Hand-foot-mouth disease (HFMD is a common viral illness in children, which is usually mild and self-limiting. However, in recent epidemics of HFMD in Asia, enterovirus 71 (EV71 has been recognized as a causative agent with severe neurological symptoms with or without cardiopulmonary involvement. HFMD was epidemic in Korea in the spring of 2009. Severe cases with complications including death have been reported. The clinical characteristics in children with neurologic manifestations of EV71 were studied in Ewha Womans University Mokdong Hospital. Methods : Examinations for EV71 were performed from the stools, respiratory secretion or CSF of children who presented neurologic symptoms associated with HFMD by realtime PCR. Clinical and radiologic data of the patients were collected and analyzed. Results : EV71 was isolated from the stool of 16 patients but not from respiratory secretion or CSF. Among the 16 patients, meningitis (n=10 was the most common manifestation, followed by Guillain-Barr&eacute; syndrome (n=3, meningoencephalitis (n=2, poliomyelitis-like paralytic disease (n=1, and myoclonus (n=1. Gene analysis showed that most of them were caused by EV71 subgenotype C4a, which was prevalent in China in 2008. Conclusion : Because EV71 causes severe complications and death in children, a surveillance system to predict upcoming outbreaks should be established and maintained and adequate public health measures are needed to control disease.

  7. The cerebro-morphological fingerprint of a progeroid syndrome: white matter changes correlate with neurological symptoms in xeroderma pigmentosum.

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    Jan Kassubek

    Full Text Available BACKGROUND: Xeroderma pigmentosum (XP is a rare autosomal recessive progeroid syndrome. It has recently been shown that the underlying DNA repair defect plays a central role in the aging process. In addition to skin symptoms, various premature neurological abnormalities have been reported. METHODOLOGY/PRINCIPAL FINDINGS: We present the clinical neurological phenotype in 14 XP patients (seven subtypes, in seven of these patients together with conventional and multiparametric advanced MRI data to assess the macrostructural and microstructural cerebral morphology in comparison to controls, including volumetric measurements, MR spectroscopy ((1H MRS, and diffusion tensor imaging (DTI. Clinical hallmarks were spinocerebellar ataxia, pyramidal tract signs, and mild cognitive deficits. DTI demonstrated significantly reduced WM directionality in all regions investigated, i.e. the thalamus, the corticospinal tracts and the dorsal corpus callosum. Single patients showed a marked relative hippocampal volume reduction, but the patients were not different from controls in the volumetric measurements of hippocampal and whole brain volumes at group level. However, (1H MRS demonstrated that the hippocampal formation was metabolically altered. CONCLUSIONS: The most prominent feature was the white matter affectation, as assessed by DTI, with volume and directionality reductions of the fiber projections involving both the craniocaudal fibers and the interhemispheric connections. These findings, although heterogeneous among the study sample, could be correlated with the clinico-neurological symptoms. The imaging findings support the position that myelin structures degrade prematurely in the brain of XP patients.

  8. The Cerebro-Morphological Fingerprint of a Progeroid Syndrome: White Matter Changes Correlate with Neurological Symptoms in Xeroderma Pigmentosum

    Science.gov (United States)

    Kassubek, Jan; Sperfeld, Anne-Dorte; Pinkhardt, Elmar H.; Unrath, Alexander; Müller, Hans-Peter; Scharffetter-Kochanek, Karin; Ludolph, Albert C.; Berneburg, Mark

    2012-01-01

    Background Xeroderma pigmentosum (XP) is a rare autosomal recessive progeroid syndrome. It has recently been shown that the underlying DNA repair defect plays a central role in the aging process. In addition to skin symptoms, various premature neurological abnormalities have been reported. Methodology/Principal Findings We present the clinical neurological phenotype in 14 XP patients (seven subtypes), in seven of these patients together with conventional and multiparametric advanced MRI data to assess the macrostructural and microstructural cerebral morphology in comparison to controls, including volumetric measurements, MR spectroscopy (1H MRS), and diffusion tensor imaging (DTI). Clinical hallmarks were spinocerebellar ataxia, pyramidal tract signs, and mild cognitive deficits. DTI demonstrated significantly reduced WM directionality in all regions investigated, i.e. the thalamus, the corticospinal tracts and the dorsal corpus callosum. Single patients showed a marked relative hippocampal volume reduction, but the patients were not different from controls in the volumetric measurements of hippocampal and whole brain volumes at group level. However, 1H MRS demonstrated that the hippocampal formation was metabolically altered. Conclusions The most prominent feature was the white matter affectation, as assessed by DTI, with volume and directionality reductions of the fiber projections involving both the craniocaudal fibers and the interhemispheric connections. These findings, although heterogeneous among the study sample, could be correlated with the clinico-neurological symptoms. The imaging findings support the position that myelin structures degrade prematurely in the brain of XP patients. PMID:22363517

  9. Individual features of autoimmune disoders in patients with arterial hypotension in structure of neurologic symptom complexes of organic lesion of the central nervous system

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    Елена Константиновна Зинченко

    2015-09-01

    Full Text Available This work deals with the special features of formation of individual clinical phenotype with an evident humoral sensitizing in patients with arterial hypotension in structure of neurologic symptom complexes of organic lesion of the central nervous system in accordance with the features of disorders of immune resistance and changes of the hormonal background.Materials and methods. There was carried out an examination of 201 patients: 89 with vegetative dysfunction, 50 in remote period of the closed craniocerebral trauma and 64 with cerebral arachnoiditis on the background of the chronic nidi of infection.45 examined persons with physiological arterial hypotension formed a control group. There were carried out clinical and neurological examinations, monitoring of arterial pressure, definition of the state of the primary, secondary immunity and hormonal background.Results. The main pathogenetic mechanisms in individual clinical phenotype with an evident humoral sensitizing that were formed on the background of the chronic infection are more connected with the humoral link of immunity (the high concentration of circulating immune complexes of the small values of molecular weight and peptides of the mean molecular weight, the growth of IgM content and form autoimmune disorders. This category can be related to the patients with irreversible functional states that complicates prescription of therapeutic measures.Conclusions. For patients with an evident humoral sensitizing it is reasonable to use desensitizing preparations, enterosorbents, plasmapheresis in the complex treatment. At persistent viral infection the use of specific antiviral immunoglobulins of IgG is recommended

  10. A somatic cell defect is associated with the onset of neurological symptoms in a lysosomal storage disease

    Science.gov (United States)

    Rodriguez-Gil, Jorge L.; Larson, Denise M.; Wassif, Christopher A.; Yanjanin, Nicole M.; Anderson, Stacie M.; Kirby, Martha R.; Trivedi, Niraj S.; Porter, Forbes D.; Pavan, William J.

    2013-01-01

    Mutations in individuals with the lysosomal storage disorder Niemann-Pick disease, type C1 (NPC1) are heterogeneous, not localized to specific protein domains, and not correlated to time of onset or disease severity. We demonstrate direct correlation of the time of neurological symptom onset with the severity of lysosomal defects in NPC1 patient-derived fibroblasts. This is a novel assay for NPC1 individuals that may be predictive of NPC1 disease progression and broadly applicable to other lysosomal disorders. PMID:23850077

  11. The impact of self-reported depressive symptoms on memory function in neurological outpatients.

    NARCIS (Netherlands)

    Kessels, R.P.C.; Ruis, C.; Kappelle, L.J.

    2007-01-01

    OBJECTIVES: To examine the effect of self-reported depressive symptoms on memory function in a non-psychiatric, non-litigation outpatient sample and to identify which memory tests may be most susceptible for depression-related decline. METHODS: Self-reported depressive symptoms were measured by the

  12. Transient neurologic symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics

    DEFF Research Database (Denmark)

    Zaric, Dusanka; Pace, Nathan Leon

    2009-01-01

    BACKGROUND: Spinal anaesthesia has been in use since 1898. During the last decade there has been an increase in the number of reports implicating lidocaine as a possible cause of temporary and permanent neurologic complications after spinal anaesthesia. Follow up of patients who received uncompli......BACKGROUND: Spinal anaesthesia has been in use since 1898. During the last decade there has been an increase in the number of reports implicating lidocaine as a possible cause of temporary and permanent neurologic complications after spinal anaesthesia. Follow up of patients who received...... complications after spinal anaesthesia with lidocaine compared to other local anaesthetics. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials Register (CENTRAL) (The Cochrane Library, Issue 4, 2008); MEDLINE (1966 to August 2008); EMBASE (1980 to week 35, 2008); LILACS (August 2008......); and handsearched the reference lists of trials and review articles. SELECTION CRITERIA: We included all randomized and quasi-randomized studies comparing the frequency of TNS and neurologic complications after spinal anaesthesia with lidocaine as compared to other local anaesthetics. DATA COLLECTION AND ANALYSIS...

  13. ‘Smoke in the air’: a rare cerebrovascular cause of neurological signs and symptoms in a young adult

    Directory of Open Access Journals (Sweden)

    Imtiaz Ismail

    2015-06-01

    Full Text Available Moyamoya disease is a rare neurological condition that affects children and adults of all ages. It is characterized by chronic, progressive stenosis of the circle of Willis that ultimately leads to the development of extensive collateral vessels. Presenting symptoms are usually due to cerebral ischemia or hemorrhage. The Japanese term moyamoya (meaning puffy or obscure was coined to describe the characteristic ‘smoke in the air’ appearance of these vessels on cerebral angiography. Moyamoya has the highest recorded incidence in Japan (0.28 per 100,000. In the west it is an extremely rare condition with an overall incidence of (0.086 per 100,000 in the Western United States. Etiology for the most part is unknown; however, genetic susceptibility related to RNF213 gene on chromosome 17q25.3 has been suggested. Moyamoya is being diagnosed more frequently in all races with varying clinical manifestations. Moyamoya disease is a rare progressive neurologic condition characterized by occlusion of the cerebral circulation with extensive collaterals recruitment in children and adults. Distinguished radiological findings confirm the diagnosis. Early recognition and swift institution of therapy is vital in order to minimize neurological deficits. We present the case of a 19-year-old African American female who presented with left-sided parastheia, weakness, and headache for 2 days duration.

  14. Evidence-based guideline update: Plasmapheresis in neurologic disorders: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Cortese, I; Chaudhry, V; So, Y T; Cantor, F; Cornblath, D R; Rae-Grant, A

    2011-01-18

    To reassess the role of plasmapheresis in the treatment of neurologic disorders. We evaluated the available evidence based on a structured literature review for relevant articles from 1995 through September 2009. In addition, due to revision of the definitions of classification of evidence since the publication of the previous American Academy of Neurology assessment in 1996, the evidence cited in that manuscript was reviewed and reclassified. Plasmapheresis is established as effective and should be offered in severe acute inflammatory demyelinating polyneuropathy (AIDP)/Guillain-Barré syndrome (GBS) and in the short-term management of chronic inflammatory demyelinating polyneuropathy (Class I studies, Level A). Plasmapheresis is established as ineffective and should not be offered for chronic or secondary progressive multiple sclerosis (MS) (Class I studies, Level A). Plasmapheresis is probably effective and should be considered for mild AIDP/GBS, as second-line treatment of steroid-resistant exacerbations in relapsing forms of MS, and for neuropathy associated with immunoglobulin A or immunoglobulin G gammopathy, based on at least one Class I or 2 Class II studies (Level B). Plasmapheresis is probably not effective and should not be considered for neuropathy associated with immunoglobulin M gammopathy, based on one Class I study (Level B). Plasmapheresis is possibly effective and may be considered for acute fulminant demyelinating CNS disease (Level C). There is insufficient evidence to support or refute the use of plasmapheresis for myasthenia gravis, pediatric autoimmune neuropsychiatric disorders associated with streptococcus infection, and Sydenham chorea (Class III evidence, Level U).

  15. Findings at brain MRI in children with dengue fever and neurological symptoms

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    Rastogi, Ruchi; Garg, Bhavya [Indraprastha Apollo Hospitals, Department of Radiodiagnosis, New Delhi (India)

    2016-01-15

    Dengue is a flavivirus of the genus arbovirus with four serotypes, from DEN 1 to DEN 4. There has been an increase in incidence of dengue infection in children in the tropics and subtropics. Dengue has a variable clinical presentation, with many patients being asymptomatic. Its clinical manifestations in children vary from fever and arthralgia to life-threatening dengue hemorrhagic fever and dengue shock syndrome. We describe MRI findings in children with neurological involvement including dengue encephalopathy, acute hypoxic injury and dengue encephalitis. Dengue encephalopathy is usually secondary to multisystem derangement such as shock, hepatitis, coagulopathy and concurrent bacterial infection and is relatively common. Dengue encephalitis from direct neuronal invasion is rare. Nonspecific changes are seen on brain MRI in dengue infection. Clinical and laboratory findings as well as outcome do not necessarily correspond with brain MRI findings. (orig.)

  16. Late-onset visceral presentation with cardiomyopathy and without neurological symptoms of adult Sanfilippo A syndrome

    NARCIS (Netherlands)

    Van Hove, JLK; Wevers, RA; Van Cleemput, J; Moerman, P; Sciot, R; Matthijs, G; Schollen, E; de Jong, JGN; Carey, WF; Muller, [No Value; Nicholls, C; Perkins, K; Hopwood, JJ

    2003-01-01

    Sanfilippo A syndrome, mucopolysaccharidosis type IIIA, is caused by a deficiency of heparan sulphamidase activity, and usually presents in childhood with neurodegeneration leading to death in teenage years. Visceral symptoms are limited to coarsening and diarrhea. We now describe an adult patient

  17. The heart in Friedreich ataxia: definition of cardiomyopathy, disease severity, and correlation with neurological symptoms.

    Science.gov (United States)

    Weidemann, Frank; Rummey, Christian; Bijnens, Bart; Störk, Stefan; Jasaityte, Ruta; Dhooge, Jan; Baltabaeva, Aigul; Sutherland, George; Schulz, Jörg B; Meier, Thomas

    2012-04-03

    This cross-sectional study provides a practical approach for the clinical assessment of Friedreich ataxia (FA) cardiomyopathy (FA-CM). A comprehensive cardiac assessment, including standard echocardiography, color Doppler myocardial imaging, cardiac magnetic resonance imaging, ECG, and exercise stress testing, was performed in 205 FA patients. To assess myocardial hypertrophy in FA-CM, the end-diastolic interventricular septal wall thickness (IVSTd) was found to be the best echocardiographic parameter compared with cardiac magnetic resonance imaging-determined left ventricular mass. With the use of this parameter, 4 groups of patients with FA-CM could be defined. Patients with normal values for IVSTd (31.7%) were classified as having no FA-CM. Patients with an IVSTd exceeding the predicted normal IVSTd were classified as having mild FA-CM (40%) if IVSTd exceeded the normal value by cardiomyopathy associated with FA based on echocardiographic IVSTd and ejection fraction data. Because no distinct interrelations between FA-CM and neurological status could be determined, regular follow-up of potential cardiac involvement in FA patients is essential in clinical practice.

  18. Diffuse large B-cell lymphoma presenting with neurolymphomatosis and intravascular lymphoma: a unique autopsy case with diverse neurological symptoms

    Directory of Open Access Journals (Sweden)

    Yamada Sohsuke

    2012-08-01

    Full Text Available Abstract A 78-year-old Japanese male noticed a difficulty in the beginning of standing up, followed by 7a progressive numbness of extremities with pain, Bell’s palsy, dysarthria, and difficulty in swallowing. A clinician had suspected cancer of unknown primary origin, accompanied by the diverse and elusive neurological symptoms, likely presenting as painful mononeuropathy simplex and cranial neuropathy. He developed dysbasia over weeks and died 1 month after the symptom onset. At autopsy, an ill-defined large and soft tumor mass in the right lobe of the liver with direct invasion into the right adrenal gland was observed. The left adrenal gland or right iliopsoas muscle was also involved. Microscopic findings showed a monotonous proliferation of medium-sized to large atypical lymphoid cells, which were diffusely positive for CD20 in immunohistochemistry, consistent with diffuse large B-cell lymphoma (DLBL. Furthermore, the lymphoma cells aggressively infiltrated endoneurial and subperineurial spaces not only in the peripheral nerves and plexuses, but partly in the spinal nerve roots, and intravascular spaces in various tissues. Therefore, systemic lymphoma (DLBL complicated with neurolymphomatosis (NL and intravascular lymphoma (IVL was diagnosed. Very early diagnosis and treatment are necessary for the NL patients with poor prognosis. Virtual slides The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5862472377020448.

  19. Diffuse large B-cell lymphoma presenting with neurolymphomatosis and intravascular lymphoma: a unique autopsy case with diverse neurological symptoms.

    Science.gov (United States)

    Yamada, Sohsuke; Tanimoto, Akihide; Nabeshima, Atsunori; Tasaki, Takashi; Wang, Ke-Yong; Kitada, Shohei; Noguchi, Hirotsugu; Sasaguri, Yasuyuki

    2012-08-13

    A 78-year-old Japanese male noticed a difficulty in the beginning of standing up, followed by 7a progressive numbness of extremities with pain, Bell's palsy, dysarthria, and difficulty in swallowing. A clinician had suspected cancer of unknown primary origin, accompanied by the diverse and elusive neurological symptoms, likely presenting as painful mononeuropathy simplex and cranial neuropathy. He developed dysbasia over weeks and died 1 month after the symptom onset. At autopsy, an ill-defined large and soft tumor mass in the right lobe of the liver with direct invasion into the right adrenal gland was observed. The left adrenal gland or right iliopsoas muscle was also involved. Microscopic findings showed a monotonous proliferation of medium-sized to large atypical lymphoid cells, which were diffusely positive for CD20 in immunohistochemistry, consistent with diffuse large B-cell lymphoma (DLBL). Furthermore, the lymphoma cells aggressively infiltrated endoneurial and subperineurial spaces not only in the peripheral nerves and plexuses, but partly in the spinal nerve roots, and intravascular spaces in various tissues. Therefore, systemic lymphoma (DLBL) complicated with neurolymphomatosis (NL) and intravascular lymphoma (IVL) was diagnosed. Very early diagnosis and treatment are necessary for the NL patients with poor prognosis. The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5862472377020448.

  20. Could cadmium be responsible for some of the neurological signs and symptoms of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

    Science.gov (United States)

    Pacini, Stefania; Fiore, Maria G; Magherini, Stefano; Morucci, Gabriele; Branca, Jacopo J V; Gulisano, Massimo; Ruggiero, Marco

    2012-09-01

    According to the World Health Organization, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a neurological disease characterized by widespread inflammation and multi-systemic neuropathology. Aetiology and pathogenesis are unknown, and several agents have been proposed as causative agents or as factors perpetuating the syndrome. Exposure to heavy metals, with particular reference to mercury and gold in dental amalgams, has been considered among the triggers of ME/CFS. Here we hypothesize that cadmium, a widespread occupational and environmental heavy metal pollutant, might be associated with some of the neurological findings described in ME/CFS. In fact, ME/CFS patients show a decrease of the volume of the gray matter in turn associated with objective reduction of physical activity. Cadmium induces neuronal death in cortical neurons through a combined mechanism of apoptosis and necrosis and it could then be hypothesized that cadmium-induced neuronal cell death is responsible for some of the effects of cadmium on the central nervous system, i.e. a decrease in attention level and memory in exposed humans as well as to a diminished ability for training and learning in rats, that are symptoms typical of ME/CFS. This hypothesis can be tested by measuring cadmium exposure in a cohort of ME/CFS patients compared with matched healthy controls, and by measuring gray matter volume in un-exposed healthy controls, exposed non-ME/CFS subjects, un-exposed ME/CFS patients and exposed ME/CFS patients. In addition, we hypothesize that cadmium exposure could be associated with reduced cerebral blood flow in ME/CFS patients because of the disruptive effects of cadmium on angiogenesis. In fact, cadmium inhibits angiogenesis and low global cerebral flow is associated with abnormal brain neuroimaging results and brain dysfunction in the form of reduced cognitive testing scores in ME/CFS patients. This hypothesis can be tested by measuring cerebral cortex blood flow in un

  1. Dysmyelination not demyelination causes neurological symptoms in preweaned mice in a murine model of Cockayne syndrome

    Science.gov (United States)

    Revet, Ingrid; Feeney, Luzviminda; Tang, Amy A.; Huang, Eric J.; Cleaver, James E.

    2012-01-01

    Cockayne syndrome (CS) is a rare autosomal recessive neurodegenerative disease that is associated with mutations in either of two transcription-coupled DNA repair genes, CSA or CSB. Mice with a targeted mutation in the Csb gene (Cs-bm/m) exhibit a milder phenotype compared with human patients with mutations in the orthologous CSB gene. Mice mutated in Csb were crossed with mice lacking Xpc (Xp-c−/−), the global genome repair gene, to enhance the pathological symptoms. These Cs-bm/m.Xp-c−/− mice were normal at birth but exhibited progressive failure to thrive, whole-body wasting, and ataxia and died at approximately postnatal day 21. Characterization of Cs-bm/m.Xp-c−/− brains at postnatal stages demonstrated widespread reduction of myelin basic protein (MBP) and myelin in the sensorimotor cortex, the stratum radiatum, the corpus callosum, and the anterior commissure. Quantification of individual axons by electron microscopy showed a reduction in both the number of myelinated axons and the average diameter of myelin surrounding the axons. There were no significant differences in proliferation or oligodendrocyte differentiation between Cs-bm/m.Xp-c−/− and Cs-bm/+.Xp-c−/− mice. Rather, Cs-bm/m.Xp-c−/− oligodendrocytes were unable to generate sufficient MBP or to maintain the proper myelination during early development. Csb is a multifunctional protein regulating both repair and the transcriptional response to reactive oxygen through its interaction with histone acetylase p300 and the hypoxia-inducible factor (HIF)1 pathway. On the basis of our results, combined with that of others, we suggest that in Csb the transcriptional response predominates during early development, whereas a neurodegenerative response associated with repair deficits predominates in later life. PMID:22393014

  2. Postoperative Dilatation of Superficial Temporal Artery Associated with Transient Neurologic Symptoms After Direct Bypass Surgery for Moyamoya Angiopathy.

    Science.gov (United States)

    Ishii, Daizo; Okazaki, Takahito; Matsushige, Toshinori; Shinagawa, Katsuhiro; Ichinose, Nobuhiko; Sakamoto, Shigeyuki; Kurisu, Kaoru

    2017-10-01

    In moyamoya angiopathy, transient neurologic symptoms (TNS) are occasionally observed after superficial temporal artery (STA)-middle cerebral artery direct bypass surgery. The purpose of this study was to investigate the correlation between TNS and postoperative magnetic resonance imaging as well as perform a perfusion study. We reviewed 52 hemispheres in 33 consecutive patients with moyamoya angiopathy. TNS were defined as reversible neurologic dysfunction without any apparent intracranial infarction or hemorrhage. All patients underwent magnetic resonance imaging and single-photon emission computed tomography before and within 5 days after surgery. Maximum diameter of STA on time-of-flight magnetic resonance angiography and the dilatation ratio of STA were calculated. The presence of signal changes on fluid-attenuated inversion recovery images and regional cerebral blood flow were also evaluated. TNS were observed in 13 of 52 (25%) cases 1-16 days after surgery. The mean preoperative STA dilatation, postoperative STA dilatation, and dilatation ratio of STA were 1.33 mm ± 0.27, 1.67 mm ± 0.30, and 29.31% ± 28.13%. Postoperative intraparenchymal cortical hyperintensity lesions and high-intensity signals in the cortex sulci (ivy sign) were detected in 24 (46.2%) cases and 29 (55.8%) cases, respectively. Univariate analyses demonstrated no association between TNS and postoperative signal change on fluid-attenuated inversion recovery images as well as cerebral blood flow. Only >1.5-fold dilatation of STA was significantly correlated with TNS (P dilatation was correlated with TNS after direct bypass surgery for moyamoya angiopathy. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Hibiscus sabdariffa increases hydroxocobalamin oral bioavailability and clinical efficacy in vitamin B12 deficiency with neurological symptoms.

    Science.gov (United States)

    Souirti, Zouhayr; Loukili, Mouna; Soudy, Imar D; Rtibi, Kaies; Özel, Aslihan; Limas-Nzouzi, Nicolas; El Ouezzani, Seloua; Eto, Bruno

    2016-12-01

    The aim of the study was to evaluate the bioavailability and clinical benefits of oral new formulation (HB12 ) of hydroxocobalamin (Hdrx) with Hibiscus sabdariffa (HS). First, in an observational study, a cohort of 30 vitamin B12 -deficient patients (vit B12 < 200 pg/mL) with neurological symptoms received oral fixed dose of Hdrx containing 15 mg Hdrx daily for 10 days followed by 15 mg monthly. Clinical benefits were evaluated on haematological and biochemical parameters, and neurological improvement at days 10 and 90 compared to day 0. To understand the mechanism, intestinal mucosa from mice were mounted in vitro in Ussing chambers to measure Hdrx Fluxes. In the clinical study, serum vitamin B12 level increased from 55.1 ± 36.9 to 1330 ± 335.5 pg/mL at day 10 and 431.0 ± 24.27 pg/mL at day 90, without overt adverse effects. In mice ileum, (i) intestinal bioavailability of Hdrx increased in dose-dependent manner with HB12 . The apparent permeability of Hdrx was Papp = 34.9 ± 4.6 × 10(-6) cm/s in the presence of 3 mg/mL (HB12 B) compared to the control Papp = 6.2 ± 0.7 × 10(-6) cm/s. (ii) Total transepithelial electrical conductance (Gt ) increased in dose-dependent manner with HB12 , Gt = 161.5 ± 10.8 mS/cm² with HB12 B (Hdrx 1 mg + HS 3 mg) compared to the control Hdrx, Gt = 28.7 ± 4.0 mS/cm². In conclusion, the clinical study suggests that injections are not required when Hdrx is given orally. Intestinal bioavailability of Hdrx increased in vitro when it was used concomitantly with HS. © 2016 Société Française de Pharmacologie et de Thérapeutique.

  4. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Giza, Christopher C; Kutcher, Jeffrey S; Ashwal, Stephen; Barth, Jeffrey; Getchius, Thomas S D; Gioia, Gerard A; Gronseth, Gary S; Guskiewicz, Kevin; Mandel, Steven; Manley, Geoffrey; McKeag, Douglas B; Thurman, David J; Zafonte, Ross

    2013-06-11

    To update the 1997 American Academy of Neurology (AAN) practice parameter regarding sports concussion, focusing on 4 questions: 1) What factors increase/decrease concussion risk? 2) What diagnostic tools identify those with concussion and those at increased risk for severe/prolonged early impairments, neurologic catastrophe, or chronic neurobehavioral impairment? 3) What clinical factors identify those at increased risk for severe/prolonged early postconcussion impairments, neurologic catastrophe, recurrent concussions, or chronic neurobehavioral impairment? 4) What interventions enhance recovery, reduce recurrent concussion risk, or diminish long-term sequelae? The complete guideline on which this summary is based is available as an online data supplement to this article. We systematically reviewed the literature from 1955 to June 2012 for pertinent evidence. We assessed evidence for quality and synthesized into conclusions using a modified Grading of Recommendations Assessment, Development and Evaluation process. We used a modified Delphi process to develop recommendations. Specific risk factors can increase or decrease concussion risk. Diagnostic tools to help identify individuals with concussion include graded symptom checklists, the Standardized Assessment of Concussion, neuropsychological assessments, and the Balance Error Scoring System. Ongoing clinical symptoms, concussion history, and younger age identify those at risk for postconcussion impairments. Risk factors for recurrent concussion include history of multiple concussions, particularly within 10 days after initial concussion. Risk factors for chronic neurobehavioral impairment include concussion exposure and APOE ε4 genotype. Data are insufficient to show that any intervention enhances recovery or diminishes long-term sequelae postconcussion. Practice recommendations are presented for preparticipation counseling, management of suspected concussion, and management of diagnosed concussion.

  5. Recent evidence for an expanded role of the kynurenine pathway of tryptophan metabolism in neurological diseases.

    Science.gov (United States)

    Lovelace, Michael D; Varney, Bianca; Sundaram, Gayathri; Lennon, Matthew J; Lim, Chai K; Jacobs, Kelly; Guillemin, Gilles J; Brew, Bruce J

    2017-01-01

    The kynurenine pathway (KP) of tryptophan metabolism has emerged in recent years as a key regulator of the production of both neuroprotective (e.g. kynurenic and picolinic acid, and the essential cofactor NAD+) and neurotoxic metabolites (e.g. quinolinic acid, 3-hydroxykynurenine). The balance between the production of the two types of metabolites is controlled by key rate-limiting enzymes such as indoleamine-2,3-dioxygenase (IDO-1), and in turn, molecular signals such as interferon-γ (IFN-γ), which activate the KP metabolism of tryptophan by this enzyme, as opposed to alternative pathways for serotonin and melatonin production. Dysregulated KP metabolism has been strongly associated with neurological diseases in recent years, and is the subject of increasing efforts to understand how the metabolites are causative of disease pathology. Concurrent with these endeavours are drug development initiatives to use inhibitors to block certain enzymes in the pathway, resulting in reduced levels of neurotoxic metabolites (e.g. quinolinic acid, an excitotoxin and N-Methyl-d-Aspartate (NMDA) receptor agonist), while in turn enhancing the bioavailability of the neuroprotective metabolites such as kynurenic acid. Neurodegenerative diseases often have a substantial autoimmune or inflammatory component; hence a greater understanding of how KP metabolites influence the inflammatory cascade is required. Additionally, challenges exist in diseases like multiple sclerosis (MS) and motor neurone disease (MND), which do not have reliable biomarkers. Clinical diagnosis can often be prolonged in order to exclude other diseases, and often diagnosis occurs at an advanced state of disease pathology, which does not allow a lengthy time for patient assessment and intervention therapies. This review considers the current evidence for involvement of the KP in several neurological diseases, in biomarkers of disease and also the parallels that exist in KP metabolism with what is known in other

  6. Strokes with minor symptoms: an exploratory analysis of the National Institute of Neurological Disorders and Stroke recombinant tissue plasminogen activator trials.

    Science.gov (United States)

    Khatri, Pooja; Kleindorfer, Dawn O; Yeatts, Sharon D; Saver, Jeffrey L; Levine, Steven R; Lyden, Patrick D; Moomaw, Charles J; Palesch, Yuko Y; Jauch, Edward C; Broderick, Joseph P

    2010-11-01

    The pivotal National Institute of Neurological Disorders and Stroke recombinant tissue plasminogen activator trials excluded patients with ischemic stroke with specific minor presentations or rapidly improving symptoms. The recombinant tissue plasminogen activator product label notes that its use for minor neurological deficit or rapidly improving stroke symptoms has not been evaluated. As a result, patients with low National Institutes of Health Stroke Scale scores are not commonly treated in clinical practice. We sought to further characterize the patients with minor stroke who were included in the National Institute of Neurological Disorders and Stroke trials. Minor strokes were defined as National Institutes of Health Stroke Scale score ≤ 5 at baseline for this retrospective analysis, because this subgroup is most commonly excluded from treatment in clinical practice and trials. Clinical stroke syndromes were defined based on prespecified National Institutes of Health Stroke Scale item score clusters. Clinical outcomes were reviewed generally and within these cluster subgroups. Only 58 cases had National Institutes of Health Stroke Scale scores of 0 to 5 in the National Institute of Neurological Disorders and Stroke trials (42 recombinant tissue plasminogen activator and 16 placebo), and 2971 patients were excluded from the trials due to "rapidly improving" or "minor symptoms" as the primary reason. No patients were enrolled with isolated motor symptoms, isolated facial droop, isolated ataxia, dysarthria, isolated sensory symptoms, or with only symptoms/signs not captured by the National Institutes of Health Stroke Scale score (ie, National Institutes of Health Stroke Scale=0). There were ≤ 3 patients with each of the other isolated deficits enrolled in the trial. The National Institute of Neurological Disorders and Stroke trials excluded a substantial number of strokes with minor presentations, those that were included were small in number, and conclusions

  7. Relationship between Urinary N-Desmethyl-Acetamiprid and Typical Symptoms including Neurological Findings: A Prevalence Case-Control Study.

    Directory of Open Access Journals (Sweden)

    Jemima Tiwaa Marfo

    Full Text Available Neonicotinoid insecticides are nicotinic acetylcholine receptor agonists used worldwide. Their environmental health effects including neurotoxicity are of concern. We previously determined a metabolite of acetamiprid, N-desmethyl-acetamiprid in the urine of a patient, who exhibited some typical symptoms including neurological findings. We sought to investigate the association between urinary N-desmethyl-acetamiprid and the symptoms by a prevalence case-control study. Spot urine samples were collected from 35 symptomatic patients of unknown origin and 50 non-symptomatic volunteers (non-symptomatic group, NSG, 4-87 year-old. Patients with recent memory loss, finger tremor, and more than five of six symptoms (headache, general fatigue, palpitation/chest pain, abdominal pain, muscle pain/weakness/spasm, and cough were in the typical symptomatic group (TSG, n = 19, 5-69 year-old; the rest were in the atypical symptomatic group (ASG, n = 16, 5-78 year-old. N-desmethyl-acetamiprid and six neonicotinoids in the urine were quantified by liquid chromatography-tandem mass spectrometry. The detection of N-desmethyl-acetamiprid was the most frequent and highest in TSG (47.4%, 6.0 ppb (frequency, maximum, followed by in ASG (12.5%, 4.4 ppb and in NSG (6.0%, 2.2 ppb, however acetamiprid was not detected. Thiamethoxam was detected in TSG (31.6%, 1.4 ppb, in ASG (6.3%, 1.9 ppb, but not in NSG. Nitenpyram was detected in TSG (10.5%, 1.2 ppb, in ASG (6.3%, not quantified and in NSG (2.0%, not quantified. Clothianidin was only detected in ASG (6.3%, not quantified, and in NSG (2.0%, 1.6 ppb. Thiacloprid was detected in ASG (6.3%, 0.1 ppb. The cases in TSG with detection of N-desmethyl-acetamiprid and thiamethoxam were aged 5 to 62 years and 13 to 62 years, respectively. Detection of N-desmethyl-acetamiprid was associated with increased prevalence of the symptoms (odds ratio: 14, 95% confidence interval: 3.5-57. Urinary N-desmethyl-acetamiprid can be used as a

  8. Impact of Elevated D-Dimer on Diagnosis of Acute Aortic Dissection With Isolated Neurological Symptoms in Ischemic Stroke.

    Science.gov (United States)

    Yoshimuta, Tsuyoshi; Yokoyama, Hiroyuki; Okajima, Toshiya; Tanaka, Hiroshi; Toyoda, Kazunori; Nagatsuka, Kazuyuki; Higashi, Masahiro; Hayashi, Kenshi; Kawashiri, Masa-aki; Yasuda, Satoshi; Yamagishi, Masakazu

    2015-01-01

    Plasma D-dimer is known to be a useful clinical marker of thrombogenic status, and D-dimer is used as a diagnostic marker for acute aortic dissection (AAD). Little is known, however, regarding the clinical value of D-dimer for diagnosis of asymptomatic AAD in patients with ischemic stroke. We investigated whether D-dimer could be used for early diagnosis of AAD with isolated neurological symptoms in ischemic stroke patients. We evaluated a total of 1,236 consecutive patients with symptomatic ischemic stroke without chest or back pain who underwent either head computed tomography or magnetic resonance imaging. D-dimer was measured within 24 h after onset. There were 9 patients with Stanford type A AAD and they had significantly higher D-dimer than the patients without AAD (mean, 46.47±54.48 μg/ml; range, 6.9-167.1 μg/ml vs. 2.33±3.58 μg/ml, 0.3-57.9 μg/ml, Psymptoms in ischemic stroke patients. Whole-body contrast-enhanced computed tomography should be performed in ischemic stroke patients who have high D-dimer.

  9. Histo- and immunopathological features of terminal AIDS. An autopsy case of a Japanese man with neurological signs as initial symptoms.

    Science.gov (United States)

    Miyayama, H; Takeya, M; Takahashi, K; Koito, A; Hattori, T; Takatsuki, K

    1988-10-01

    An autopsy case of a 37-year-old Japanese man, confirmed as an AIDS patient infected by an undetermined route of transmission, is presented. The initial symptoms of full-blown AIDS in this case were neurological, and the patient died of severe pneumonia 9 months after onset. The main histo- and immunopathological features were a marked depletion of helper-inducer T cells and dendritic reticulum cells in the lymphoid tissues, opportunistic infections, and some neuropathologic changes. Very few cells, possibly macrophages, immunoreactive with a monoclonal antibody (VAK-5) against HIV-gag protein P24 were found in the mediastinal lymph nodes. Numerous pathogens had induced opportunistic infections in many organs: severe and generalized cytomegalovirus infection, Pneumocystis carinii pneumonia, bronchopneumonia (possibly due to Pseudomonas aeruginosa), candidiasis in the tongue and oral cavity, and atypical mycobacteriosis in the pulmonic hilar lymph nodes. Vascular proliferation was found in the perinodal regions of some lymph nodes, but this was not neoplastic vascular proliferation compatible with that of localized Kaposi's sarcoma.

  10. Functional neurological disorders: imaging.

    Science.gov (United States)

    Voon, V

    2014-10-01

    Functional neurological disorders, also known as conversion disorder, are unexplained neurological symptoms. These symptoms are common and can be associated with significant consequences. This review covers the neuroimaging literature focusing on functional motor symptoms including motor functioning and upstream influences including self-monitoring and internal representations, voluntariness and arousal and trauma. Copyright © 2014. Published by Elsevier SAS.

  11. Evidence that psychopathology symptom networks have limited replicability.

    Science.gov (United States)

    Forbes, Miriam K; Wright, Aidan G C; Markon, Kristian E; Krueger, Robert F

    2017-10-01

    Network analysis is quickly gaining popularity in psychopathology research as a method that aims to reveal causal relationships among individual symptoms. To date, 4 main types of psychopathology networks have been proposed: (a) association networks, (b) regularized concentration networks, (c) relative importance networks, and (d) directed acyclic graphs. The authors examined the replicability of these analyses based on symptoms of major depression and generalized anxiety between and within 2 highly similar epidemiological samples (i.e., the National Comorbidity Survey-Replication [n = 9282] and the National Survey of Mental Health and Wellbeing [n = 8841]). Although association networks were stable, the 3 other types of network analysis (i.e., the conditional independence networks) had poor replicability between and within methods and samples. The detailed aspects of the models-such as the estimation of specific edges and the centrality of individual nodes-were particularly unstable. For example, 44% of the symptoms were estimated as the "most influential" on at least 1 centrality index across the 6 conditional independence networks in the full samples, and only 13-21% of the edges were consistently estimated across these networks. One of the likely reasons for the instability of the networks is the predominance of measurement error in the assessment of individual symptoms. The authors discuss the implications of these findings for the growing field of psychopathology network research, and conclude that novel results originating from psychopathology networks should be held to higher standards of evidence before they are ready for dissemination or implementation in the field. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  12. Psychometric Properties of a Generic, Patient-Centred Palliative Care Outcome Measure of Symptom Burden for People with Progressive Long Term Neurological Conditions

    Science.gov (United States)

    Gao, Wei; Crosby, Vincent; Wilcock, Andrew; Burman, Rachael; Silber, Eli; Hepgul, Nilay; Chaudhuri, K Ray; Higginson, Irene J.

    2016-01-01

    Background There is no standard palliative care outcome measure for people with progressive long term neurological conditions (LTNC). This study aims to determine the psychometric properties of a new 8-item palliative care outcome scale of symptom burden (IPOS Neuro-S8) in this population. Data and Methods Data were merged from a Phase II palliative care intervention study in multiple sclerosis (MS) and a longitudinal observational study in idiopathic Parkinson’s disease (IPD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). The IPOS Neuro-S8 was assessed for its data quality, score distribution, ceiling and floor effects, reliability, factor structure, convergent and discriminant validity, concurrent validity with generic (Palliative care Outcome Scale) and condition specific measures (Multiple Sclerosis Impact Scale; Non-motor Symptoms Questionnaire; Parkinson’s Disease Questionnaire), responsiveness and minimally clinically important difference. Results Of the 134 participants, MS patients had a mean Extended Disability Status Scale score 7.8 (SD = 1.0), patients with an IPD, MSA or PSP were in Hoehn & Yahr stage 3–5. The IPOS Neuro-S8 had high data quality (2% missing), mean score 8 (SD = 5; range 0–32), no ceiling effects, borderline floor effects, good internal consistency (Cronbach’s α = 0.7) and moderate test-retest reliability (intraclass coefficient = 0.6). The results supported a moderately correlated two-factor structure (Pearson’s r = 0.5). It was moderately correlated with generic and condition specific measures (Pearson’s r: 0.5–0.6). There was some evidence for discriminant validity in IPD, MSA and PSP (p = 0.020), and for good responsiveness and longitudinal construct validity. Conclusions IPOS Neuro-S8 shows acceptable to promising psychometric properties in common forms of progressive LTNCs. Future work needs to confirm these findings with larger samples and its usefulness in wider disease groups. PMID

  13. Aura and Other Neurologic Dysfunction in or with Migraine.

    Science.gov (United States)

    Kissoon, Narayan R; Cutrer, Fred Michael

    2017-07-01

    Migraine can present with a wide range of neurological symptoms. Based on currently available data, the symptoms of typical migraine aura are most likely related to cortical spreading depression (CSD), and evidence supports that CSD can lead to trigeminovascular activation resulting in the headache phase of migraine. An alternative diagnosis to migraine aura should be considered if migrainous headaches present with transient neurological symptoms that have features inconsistent with aura. © 2017 American Headache Society.

  14. The Role of Emotion in Decision-Making: Evidence from Neurological Patients with Orbitofrontal Damage

    Science.gov (United States)

    Bechara, Antoine

    2004-01-01

    Most theories of choice assume that decisions derive from an assessment of the future outcomes of various options and alternatives through some type of cost-benefit analyses. The influence of emotions on decision-making is largely ignored. The studies of decision-making in neurological patients who can no longer process emotional information…

  15. Genetic variation in the HN and SH genes of mumps viruses: a comparison of strains from mumps cases with and without neurological symptoms.

    Science.gov (United States)

    Cui, Aili; Brown, David W G; Xu, Wenbo; Jin, Li

    2013-01-01

    It is known that mumps virus (MuV) strains may vary in their neurovirulent capacity, and certain MuV strains may be highly neurotropic. In animal models and epidemiological studies, mutations at specific amino acids (aa) have been proposed to be associated with neurovirulence. To assess whether these genetic variations can be observed in clinical samples from patients and if they correlate with neurovirulence as determined by clinical symptoms, 39 mumps patients with or without neurological symptoms were investigated. Respiratory samples, oral fluids, throat swabs, and neurological and cerebrospinal fluid samples were tested by RT-PCR and products sequenced. Sequences of the entire small hydrophobic (SH) gene and the partial hemagglutinin-neuraminidase (HN) gene were compared. The results showed there was no significant difference between the samples of the two groups of patients at the aa sites in either the HN protein or the SH protein, which have previously been hypothesized to be associated with neurovirulence or antigenicity. The occurrence of neurological symptoms of mumps does not appear to be due to a single point mutation in either the HN or SH gene.

  16. Genetic variation in the HN and SH genes of mumps viruses: a comparison of strains from mumps cases with and without neurological symptoms.

    Directory of Open Access Journals (Sweden)

    Aili Cui

    Full Text Available BACKGROUND: It is known that mumps virus (MuV strains may vary in their neurovirulent capacity, and certain MuV strains may be highly neurotropic. In animal models and epidemiological studies, mutations at specific amino acids (aa have been proposed to be associated with neurovirulence. To assess whether these genetic variations can be observed in clinical samples from patients and if they correlate with neurovirulence as determined by clinical symptoms, 39 mumps patients with or without neurological symptoms were investigated. PRINCIPAL FINDINGS: Respiratory samples, oral fluids, throat swabs, and neurological and cerebrospinal fluid samples were tested by RT-PCR and products sequenced. Sequences of the entire small hydrophobic (SH gene and the partial hemagglutinin-neuraminidase (HN gene were compared. CONCLUSIONS: The results showed there was no significant difference between the samples of the two groups of patients at the aa sites in either the HN protein or the SH protein, which have previously been hypothesized to be associated with neurovirulence or antigenicity. The occurrence of neurological symptoms of mumps does not appear to be due to a single point mutation in either the HN or SH gene.

  17. Migraine- and dystonia-related disease-mutations of Na+/K+-ATPases: Relevance of behavioral studies in mice to disease symptoms and neurological manifestations in humans

    DEFF Research Database (Denmark)

    Bøttger, Pernille; Doganli, Canan; Lykke-Hartmann, Karin

    2012-01-01

    The two autosomal dominantly inherited neurological diseases: familial hemiplegic migraine type 2 (FHM2) and familial rapid-onset of dystonia-parkinsonism (Familial RDP) are caused by in vivo mutations of specific alpha subunits of the sodium–potassium pump (Na+/K+-ATPase). Intriguingly, patients...... patient symptoms and manifestations. Thus, it is interesting that mouse models targeting a specific -isoform cause different, although still comparable, phenotypes consistent with classical symptoms and other manifestations observed in FHM2 and RDP patients. This review highlights that use of mouse models...... with classical FHM2 and RDP symptoms additionally suffer from other manifestations, such as epilepsy/seizures and developmental disabilities. Recent studies of FHM2 and RDP mouse models provide valuable tools for dissecting the vital roles of the Na+/K+-ATPases, and we discuss their relevance to the complex...

  18. Evidence for a heritable unidimensional symptom factor underlying obsessionality.

    Science.gov (United States)

    Mathews, Carol A; Greenwood, Tiffany; Wessel, Jennifer; Azzam, Amin; Garrido, Helena; Chavira, Denise A; Chandavarkar, Uma; Bagnarello, Monica; Stein, Murray; Schork, Nicholas J

    2008-09-05

    The division of obsessive-compulsive symptoms (OCS) into specific factors is now widely accepted. However, the utility of these categories for genetic studies remains unclear, as studies examining their heritability have been inconsistent. Less attention has been paid to the possibility that clinically significant obsessionality is primarily determined by a "core" group of OCS that crosses the boundaries between symptom subgroups. The aim of this study is to determine whether such a core group exists, and to compare its heritability to that of the more traditionally derived symptom factors. We examined the properties and heritability of obsessive-compulsive symptoms in college students, medical students, and obsessive-compulsive disorder (OCD) families using the Leyton Obsessional Inventory. In each of the three samples, we identified a core group of symptoms that comprised a single unique construct and accounted for over 90% of the variation of the four more traditional symptom factors. This core construct was highly correlated with OCD in our families and had a heritability estimate of 0.19 when OCD was not included as a covariate and 0.49 when OCD was included as a covariate. In contrast, the four symptom factors were not heritable. There appears to be an underlying unidimensional component to obsessionality, both in non-clinical and clinical samples. This component, which is heritable, accounts for the majority of the variation of the more traditionally derived symptom factors in our sample, and is composed of OCS that are not specific to any of the symptom subgroups. 2007 Wiley-Liss, Inc.

  19. Quantitative MRI shows cerebral microstructural damage in hemolytic-uremic syndrome patients with severe neurological symptoms but no changes in conventional MRI

    Energy Technology Data Exchange (ETDEWEB)

    Weissenborn, Karin; Worthmann, Hans; Heeren, Meike [Hannover Medical School, Clinic for Neurology, Hannover (Germany); Bueltmann, Eva; Donnerstag, Frank; Giesemann, Anja M.; Goetz, Friedrich; Lanfermann, Heinrich; Ding, Xiao-Qi [Hannover Medical School, Institute of Diagnostic and Interventional Neuroradiology, Hannover (Germany); Kielstein, Jan; Schwarz, Anke [Hannover Medical School, Clinic for Nephrology and Hypertension, Hannover (Germany)

    2013-07-15

    Severe neurological symptoms in Shiga toxin-producing Escherichia coli infection associated hemolytic-uremic syndrome (STEC-HUS) are often accompanied by none or only mild alterations of cerebral magnetic resonance imaging (MRI). This study aims to analyze if quantitative MRI is able to reveal cerebral pathological alterations invisible for conventional MRI. In nine patients with STEC-HUS associated severe neurological symptoms but inconspicuous cerebral MRI findings maps of the parameters T2 relaxation time, relative proton density (PD), apparent diffusion coefficient (ADC), and fractional anisotropy (FA) were generated. Quantitative values of these parameters were measured at the basal ganglia, thalamus, and white matter of the frontal and parietal lobe and compared to those of nine age- and sex-matched controls. Significant T2 prolongation (p < 0.01) was found in the basal ganglia of all patients compared to controls. PD and ADC were not significantly altered. A significant reduction of FA in patients was seen at caput nuclei caudati (p < 0.01). Prolonged T2 relaxation time indicates cerebral microstructural damages in these patients despite their inconspicuous MRI findings. T2 relaxometry could be used as a complementary tool for the assessment of metabolic-toxic brain syndromes. (orig.)

  20. Psychiatric and neurological symptoms in patients with Niemann-Pick disease type C (NP-C): Findings from the International NPC Registry.

    Science.gov (United States)

    Bonnot, Olivier; Gama, Clarissa S; Mengel, Eugen; Pineda, Mercè; Vanier, Marie T; Watson, Louise; Watissée, Marie; Schwierin, Barbara; Patterson, Marc C

    2017-10-09

    Niemann-Pick disease type C (NP-C) is a rare inherited neurovisceral disease that should be recognised by psychiatrists as a possible underlying cause of psychiatric abnormalities. This study describes NP-C patients who had psychiatric manifestations at enrolment in the international NPC Registry, a unique multicentre, prospective, observational disease registry. Treating physicians' data entries describing psychiatric manifestations in NPC patients were coded and grouped by expert psychiatrists. Out of 386 NP-C patients included in the registry as of October 2015, psychiatric abnormalities were reported to be present in 34% (94/280) of those with available data. Forty-four patients were confirmed to have identifiable psychiatric manifestations, with text describing these psychiatric manifestations. In these 44 patients, the median (range) age at onset of psychiatric manifestations was 17.9 years (2.5-67.9; n = 15), while the median (range) age at NP-C diagnosis was 23.7 years (0.2-69.8; n = 34). Almost all patients (43/44; 98%) had an occurrence of ≥1 neurological manifestation at enrolment. These data show that substantial delays in diagnosis of NP-C are long among patients with psychiatric symptoms and, moreover, patients presenting with psychiatric features and at least one of cognitive impairment, neurological manifestations, and/or visceral symptoms should be screened for NP-C.

  1. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Wijdicks, Eelco F M; Varelas, Panayiotis N; Gronseth, Gary S; Greer, David M

    2010-06-08

    To provide an update of the 1995 American Academy of Neurology guideline with regard to the following questions: Are there patients who fulfill the clinical criteria of brain death who recover neurologic function? What is an adequate observation period to ensure that cessation of neurologic function is permanent? Are complex motor movements that falsely suggest retained brain function sometimes observed in brain death? What is the comparative safety of techniques for determining apnea? Are there new ancillary tests that accurately identify patients with brain death? A systematic literature search was conducted and included a review of MEDLINE and EMBASE from January 1996 to May 2009. Studies were limited to adults. In adults, there are no published reports of recovery of neurologic function after a diagnosis of brain death using the criteria reviewed in the 1995 American Academy of Neurology practice parameter. Complex-spontaneous motor movements and false-positive triggering of the ventilator may occur in patients who are brain dead. There is insufficient evidence to determine the minimally acceptable observation period to ensure that neurologic functions have ceased irreversibly. Apneic oxygenation diffusion to determine apnea is safe, but there is insufficient evidence to determine the comparative safety of techniques used for apnea testing. There is insufficient evidence to determine if newer ancillary tests accurately confirm the cessation of function of the entire brain.

  2. Negative symptoms of schizophrenia : Treatment options and evidence from neuroimaging

    NARCIS (Netherlands)

    de Lange, Jozarni

    2016-01-01

    This thesis focuses on studies to improve treatment options for patients who suffer from schizophrenia. Lack of initiative (apathy) and a reduced ability to experience pleasure is part of a syndrome, called “negative symptoms”, in these patients. These symptoms are related to severe impairments in

  3. One-Stage Correction Surgery of Scoliosis Associated With Syringomyelia: Is it Safe to Leave Untreated a Syrinx Without Neurological Symptom?

    Science.gov (United States)

    Wang, Guodong; Sun, Jianmin; Jiang, Zhensong; Cui, Xingang; Cui, Jiangchao

    2015-06-01

    Retrospective study. To investigate the safety to leave a syrinx untreated in 1-stage correction surgery of scoliosis associated with syringomyelia without progressive neurological symptom. The present protocol for patients with scoliosis secondary to syringomyelia advocated to treat the syrinx first because of the increased risk in correction surgery. However, in daily life, these patients could still do lateral bending, in which spinal cord distracted albeit without any neurological symptom occurred. Twenty-one consecutive patients with scoliosis associated with syringomyelia with or without Chiari malformation underwent surgery in our department from 2003 to 2010 were included in this study. Patients with progressive neural deficits were excluded. Every patient received detailed neurological and radiologic examination before the surgery, including whole spine films, lateral-bending and fulcrum-bending films, 3-dimensional computed tomography scan, and magnetic resonance imaging. All the patients underwent 1-stage correction surgery without treatment of syrinx. During the surgery, Spinal Cord Monitor (SCM) and wake-up test were used to prevent serious neurological complications. At follow-up, patients received neurological examination and whole spine x-ray films. There were 13 male and 8 female patients. Before the surgery, 3 patients complained wasting of the intrinsic muscles of hand, 1 complained numbness of left upper extremity, and 4 complained back pain. Negative abdomen reflex occurred on 12 of 21 patients. All the patients were single major curve, including 14 thoracic curves and 7 thoracolumbar curves. The mean preoperative Cobb angle of scoliosis was 68.05±20.1 degrees, on bending films was 39.48±21.56 degrees, postoperative was 23.19±14.14 degrees, at final follow-up was 25.76±14.46 degrees. The mean flexibility was 0.452±0.158, correction ratio was 0.685±0.140. During the operation, SCM showed motor evoked potential (MEP) loss transiently in 2

  4. Depression symptom dimensions as predictors of antidepressant treatment outcome: replicable evidence for interest-activity symptoms.

    Science.gov (United States)

    Uher, R; Perlis, R H; Henigsberg, N; Zobel, A; Rietschel, M; Mors, O; Hauser, J; Dernovsek, M Z; Souery, D; Bajs, M; Maier, W; Aitchison, K J; Farmer, A; McGuffin, P

    2012-05-01

    Symptom dimensions have not yet been comprehensively tested as predictors of the substantial heterogeneity in outcomes of antidepressant treatment in major depressive disorder. We tested nine symptom dimensions derived from a previously published factor analysis of depression rating scales as predictors of outcome in 811 adults with moderate to severe depression treated with flexibly dosed escitalopram or nortriptyline in Genome-based Therapeutic Drugs for Depression (GENDEP). The effects of symptom dimensions were tested in mixed-effect regression models that controlled for overall initial depression severity, age, sex and recruitment centre. Significant results were tested for replicability in 3637 adult out-patients with non-psychotic major depression treated with citalopram in level I of Sequenced Treatment Alternatives to Relieve Depression (STAR*D). The interest-activity symptom dimension (reflecting low interest, reduced activity, indecisiveness and lack of enjoyment) at baseline strongly predicted poor treatment outcome in GENDEP, irrespective of overall depression severity, antidepressant type and outcome measure used. The prediction of poor treatment outcome by the interest-activity dimension was robustly replicated in STAR*D, independent of a comprehensive list of baseline covariates. Loss of interest, diminished activity and inability to make decisions predict poor outcome of antidepressant treatment even after adjustment for overall depression severity and other clinical covariates. The prominence of such symptoms may require additional treatment strategies and should be accounted for in future investigations of antidepressant response.

  5. Language and thought are not the same thing: evidence from neuroimaging and neurological patients.

    Science.gov (United States)

    Fedorenko, Evelina; Varley, Rosemary

    2016-04-01

    Is thought possible without language? Individuals with global aphasia, who have almost no ability to understand or produce language, provide a powerful opportunity to find out. Surprisingly, despite their near-total loss of language, these individuals are nonetheless able to add and subtract, solve logic problems, think about another person's thoughts, appreciate music, and successfully navigate their environments. Further, neuroimaging studies show that healthy adults strongly engage the brain's language areas when they understand a sentence, but not when they perform other nonlinguistic tasks such as arithmetic, storing information in working memory, inhibiting prepotent responses, or listening to music. Together, these two complementary lines of evidence provide a clear answer: many aspects of thought engage distinct brain regions from, and do not depend on, language. © 2016 New York Academy of Sciences.

  6. Sports neurology topics in neurologic practice

    Science.gov (United States)

    Conidi, Francis X.; Drogan, Oksana; Giza, Christopher C.; Kutcher, Jeffery S.; Alessi, Anthony G.; Crutchfield, Kevin E.

    2014-01-01

    Summary We sought to assess neurologists' interest in sports neurology and learn about their experience in treating sports-related neurologic conditions. A survey was sent to a random sample of American Academy of Neurology members. A majority of members (77%) see at least some patients with sports-related neurologic issues. Concussion is the most common sports-related condition neurologists treat. More than half of survey participants (63%) did not receive any formal or informal training in sports neurology. At least two-thirds of respondents think it is very important to address the following issues: developing evidence-based return-to-play guidelines, identifying risk factors for long-term cognitive-behavioral sequelae, and developing objective diagnostic criteria for concussion. Our findings provide an up-to-date view of the subspecialty of sports neurology and identify areas for future research. PMID:24790800

  7. Gain-of-function SAMD9L mutations cause a syndrome of cytopenia, immunodeficiency, MDS, and neurological symptoms.

    Science.gov (United States)

    Tesi, Bianca; Davidsson, Josef; Voss, Matthias; Rahikkala, Elisa; Holmes, Tim D; Chiang, Samuel C C; Komulainen-Ebrahim, Jonna; Gorcenco, Sorina; Rundberg Nilsson, Alexandra; Ripperger, Tim; Kokkonen, Hannaleena; Bryder, David; Fioretos, Thoas; Henter, Jan-Inge; Möttönen, Merja; Niinimäki, Riitta; Nilsson, Lars; Pronk, Cornelis Jan; Puschmann, Andreas; Qian, Hong; Uusimaa, Johanna; Moilanen, Jukka; Tedgård, Ulf; Cammenga, Jörg; Bryceson, Yenan T

    2017-04-20

    Several monogenic causes of familial myelodysplastic syndrome (MDS) have recently been identified. We studied 2 families with cytopenia, predisposition to MDS with chromosome 7 aberrations, immunodeficiency, and progressive cerebellar dysfunction. Genetic studies uncovered heterozygous missense mutations in SAMD9L, a tumor suppressor gene located on chromosome arm 7q. Consistent with a gain-of-function effect, ectopic expression of the 2 identified SAMD9L mutants decreased cell proliferation relative to wild-type protein. Of the 10 individuals identified who were heterozygous for either SAMD9L mutation, 3 developed MDS upon loss of the mutated SAMD9L allele following intracellular infections associated with myeloid, B-, and natural killer (NK)-cell deficiency. Five other individuals, 3 with spontaneously resolved cytopenic episodes in infancy, harbored hematopoietic revertant mosaicism by uniparental disomy of 7q, with loss of the mutated allele or additional in cisSAMD9L truncating mutations. Examination of 1 individual indicated that somatic reversions were postnatally selected. Somatic mutations were tracked to CD34(+) hematopoietic progenitor cell populations, being further enriched in B and NK cells. Stimulation of these cell types with interferon (IFN)-α or IFN-γ induced SAMD9L expression. Clinically, revertant mosaicism was associated with milder disease, yet neurological manifestations persisted in 3 individuals. Two carriers also harbored a rare, in trans germ line SAMD9L missense loss-of-function variant, potentially counteracting the SAMD9L mutation. Our results demonstrate that gain-of-function mutations in the tumor suppressor SAMD9L cause cytopenia, immunodeficiency, variable neurological presentation, and predisposition to MDS with -7/del(7q), whereas hematopoietic revertant mosaicism commonly ameliorated clinical manifestations. The findings suggest a role for SAMD9L in regulating IFN-driven, demand-adapted hematopoiesis. © 2017 by The American

  8. A longitudinal study of differences in late- and early-onset geriatric depression: depressive symptoms and psychosocial, cognitive, and neurological functioning.

    Science.gov (United States)

    Sachs-Ericsson, Natalie; Corsentino, Elizabeth; Moxley, Jerad; Hames, Jennifer L; Rushing, Nicole C; Sawyer, Kathryn; Joiner, Thomas; Selby, Edward A; Zarit, Steven; Gotlib, Ian H; Steffens, David C

    2013-01-01

    Studies suggest early-onset depression (EOD) is associated with a more severe course of the depressive disorder, while late-onset depression (LOD) is associated with more cognitive and neuroimaging changes. This study examined if older adults with EOD, compared with those with LOD, would exhibit more severe symptoms of depression and, consistent with the glucocorticoid cascade hypothesis, have more hippocampal volume loss. A second goal was to determine if LOD, compared with EOD, would demonstrate more cognitive and neuroimaging changes. At regular intervals over a four-year period non-demented, older, depressed adults were assessed on the Mini-Mental Status Examination and the Montgomery-Asberg Depression Rating Scale. They were also assessed on magnetic resonance imaging. Compared with LOD, EOD had more depressive symptoms, more suicidal thoughts, and less social support. Growth curve analyses indicated that EOD demonstrated higher levels of residual depressive symptoms over time. The LOD group exhibited a greater decrement in cognitive scores. Contrary to the glucocorticoid cascade hypothesis, participants with EOD lost right hippocampal volume at a slower rate than did participants with LOD. Right cerebrum gray matter was initially smaller among participants with LOD. EOD is associated with greater severity of depressive illness. LOD is associated with more severe cognitive and neurological changes. These differences are relevant to understanding cognitive impairment in geriatric depression.

  9. Early carotid endarterectomy performed 2 to 5 days after the onset of neurologic symptoms leads to comparable results to carotid endarterectomy performed at later time points.

    Science.gov (United States)

    Avgerinos, Efthymios D; Farber, Alik; Abou Ali, Adham N; Rybin, Denis; Doros, Gheorghe; Eslami, Mohammad H

    2017-12-01

    Timing of carotid endarterectomy (CEA) after onset of neurologic symptoms remains controversial. We assessed the association of CEA timing with postoperative outcomes. The Vascular Study Group of New England (VSGNE) database (2003-2014) was queried to identify CEA performed for symptomatic carotid stenosis during the same hospitalization. Cases were divided into four groups based on the time from onset of neurologic symptoms to CEA: group I, <2 days; group II, 2 to 5 days; group III, ≥6 days; and group IV, same-day CEA. The χ2 test and t-test were used to compare demographics, medical history, modified Rankin scores, and outcomes (30-day postoperative death, stroke, myocardial infarction, and aggregate events [stroke/myocardial infarction]). Multivariable logistic regression was used to compare the association of time to surgery with outcomes while adjusting for confounding variables. Kaplan-Meier and Cox proportional hazards regression analyses were performed at 1 year to evaluate survival and stroke rates between the groups. There were 989 of 14,864 VSGNE CEA cases that fit the inclusion criteria. The frequency of cases was highest in group II (36.6%), followed by groups I (31.9%), III (18.9%), and IV (12.4%). Age, gender, and comorbidity compositions were similar between groups, although group III had the highest rates of diabetes mellitus, coronary artery disease, coronary artery bypass graft procedures, congestive heart failure, and American Society of Anesthesiologists class 4 and the highest modified Rankin score (P < .05). Stroke rates were highest in group I (7.3%; P = .016), whereas group III had the highest rate of discharges to nursing facilities (37.2%; P < .001); other adverse outcomes were comparable among groups. CEAs in group I had significantly increased adjusted odds of stroke; adverse outcomes of CEAs in groups II and III were comparable to those in group IV. Our results suggest that CEAs performed 2 to 5 days after a neurologic event

  10. Deep brain stimulation for obsessive-compulsive disorder: systematic review and evidence-based guideline sponsored by the American Society for Stereotactic and Functional Neurosurgery and the Congress of Neurological Surgeons (CNS) and endorsed by the CNS and American Association of Neurological Surgeons.

    Science.gov (United States)

    Hamani, Clement; Pilitsis, Julie; Rughani, Anand I; Rosenow, Joshua M; Patil, Parag G; Slavin, Konstantin S; Abosch, Aviva; Eskandar, Emad; Mitchell, Laura S; Kalkanis, Steven

    2014-10-01

    It is estimated that 40% to 60% of patients with obsessive-compulsive disorder (OCD) continue to experience symptoms despite adequate medical management. For this population of treatment-refractory patients, promising results have been reported with the use of deep brain stimulation (DBS). To conduct a systematic review of the literature and develop evidence-based guidelines on DBS for OCD. A systematic literature search was undertaken using the PubMed database for articles published between 1966 and October 2012 combining the following words: "deep brain stimulation and obsessive-compulsive disorder" or "electrical stimulation and obsessive-compulsive disorder." Of 353 articles, 7 were retrieved for full-text review and analysis. The quality of the articles was assigned to each study and the strength of recommendation graded according to the guidelines development methodology of the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Guidelines Committee. Of the 7 studies, 1 class I and 2 class II double-blind, randomized, controlled trials reported that bilateral DBS is more effective in improving OCD symptoms than sham treatment. Based on the data published in the literature, the following recommendations can be made: (1) There is Level I evidence, based on a single class I study, for the use of bilateral subthalamic nucleus DBS for the treatment of medically refractory OCD. (2) There is Level II evidence, based on a single class II study, for the use of bilateral nucleus accumbens DBS for the treatment of medically refractory OCD. (3) There is insufficient evidence to make a recommendation for the use of unilateral DBS for the treatment of medically refractory OCD.

  11. Cannabinoids for Symptom Management and Cancer Therapy: The Evidence.

    Science.gov (United States)

    Davis, Mellar P

    2016-07-01

    Cannabinoids bind not only to classical receptors (CB1 and CB2) but also to certain orphan receptors (GPR55 and GPR119), ion channels (transient receptor potential vanilloid), and peroxisome proliferator-activated receptors. Cannabinoids are known to modulate a multitude of monoamine receptors. Structurally, there are 3 groups of cannabinoids. Multiple studies, most of which are of moderate to low quality, demonstrate that tetrahydrocannabinol (THC) and oromucosal cannabinoid combinations of THC and cannabidiol (CBD) modestly reduce cancer pain. Dronabinol and nabilone are better antiemetics for chemotherapy-induced nausea and vomiting (CINV) than certain neuroleptics, but are not better than serotonin receptor antagonists in reducing delayed emesis, and cannabinoids have largely been superseded by neurokinin-1 receptor antagonists and olanzapine; both cannabinoids have been recommended for breakthrough nausea and vomiting among other antiemetics. Dronabinol is ineffective in ameliorating cancer anorexia but does improve associated cancer-related dysgeusia. Multiple cancers express cannabinoid receptors directly related to the degree of anaplasia and grade of tumor. Preclinical in vitro and in vivo studies suggest that cannabinoids may have anticancer activity. Paradoxically, cannabinoid receptor antagonists also have antitumor activity. There are few randomized smoked or vaporized cannabis trials in cancer on which to judge the benefits of these forms of cannabinoids on symptoms and the clinical course of cancer. Smoked cannabis has been found to contain Aspergillosis. Immunosuppressed patients should be advised of the risks of using "medical marijuana" in this regard. Copyright © 2016 by the National Comprehensive Cancer Network.

  12. Minor neurological dysfunction and behaviour in 9-year-old children born at term : evidence for sex dimorphism

    NARCIS (Netherlands)

    Kikkert, Hedwig K.; de Jong, Corina; van den Heuvel, Edwin R.; Hadders-Algra, Mijna

    2013-01-01

    Aim The aim of the study was to assess associations between minor neurological dysfunction (MND) and behaviour, with specific attention to sex differences. MethodThis was an observational cohort study in which 341 9-year-old children (177 male, 164 female) without perinatal risk were neurologically

  13. Chapter 38: American neurology.

    Science.gov (United States)

    Freemon, Frank R

    2010-01-01

    The great formative event in the history of North America, the Civil War of 1861 to 1865, was the stimulus for the development of clinical neurology and the neurosciences. The first neurological research center on the continent was the US Army hospital at Turner's Lane, Philadelphia, PA. Silas Weir Mitchell and his colleagues described causalgia (reflex sympathetic dystrophy), phantom limb sensation, and Horner's syndrome (before Horner). The medical leader of the Northern army was William Hammond. After the conclusion of hostilities, he began a huge clinical practice in New York City. In the United States, clinical neurology began in private practice, unlike Europe, where neurology began in institutions. Hammond's textbook, which first used the term athetosis, was used by a generation of physicians who encountered patients with neurological signs and symptoms. Early in the 20th century, neurological institutions were formed around universities; probably the most famous was the Montreal Neurological Institute founded by Wilder Penfield. The US federal government sponsored extensive research into the function and dysfunction of the nervous system through the Neurological Institute of Neurological Diseases and Blindness, later called the National Institute of Neurological Diseases and Stroke. The government officially classified the final 10 years of the 20th century as the Decade of the Brain and provided an even greater level of research funding.

  14. Evidence for ERP biomarkers of eating disorder symptoms in women.

    Science.gov (United States)

    Groves, Katie; Kennett, Steffan; Gillmeister, Helge

    2017-02-01

    Growing evidence suggests that the brain processes bodies distinctively from other stimuli, but little research has addressed whether visual body perception is modulated by the observer's thoughts and feelings about their own body. The present study thus investigated the relationship between body image and electrophysiological signatures of body perception, with the aim of identifying potential biomarkers of body image disturbances. Occipito-parietal (P1 and N1) and fronto-central (VPP) processing of body and non-body stimuli were assessed in 29 weight-restored eating disordered (ED) women and compared to 27 healthy controls. Rapid early visual processing was seen in the ED group, as the entire P1-N1 complex unfolded significantly earlier compared to controls. ED women also showed a gender-sensitive response to other women's bodies over N1 and VPP components. Such gender-sensitivity was not evident in controls. Moreover, ERP effects correlated with scores on the Eating Disorder Inventory-II (EDI-2), indicating a close link between the observers' ED symptomatology, including body image, and the visual analysis of human bodies during very early stages of cortical processing. The temporal dynamics of visual body perception may therefore serve as potential neural markers for the identification of ED symptomatology in 'at risk' populations. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. Neurological manifestaions among Sudanese patients with multiple ...

    African Journals Online (AJOL)

    The study demonstrated that the most common non- neurological symptoms was locomotor symptoms (24%) ,while the most common neurological symptoms were backache and neck pain .The most common neurological findings were cord compression (8%) followed by peripheral neuropathy (2%) and CVA (2%). 22% of ...

  16. Evidence-based guideline: treatment of tardive syndromes: report of the Guideline Development Subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Bhidayasiri, Roongroj; Fahn, Stanley; Weiner, William J; Gronseth, Gary S; Sullivan, Kelly L; Zesiewicz, Theresa A

    2013-07-30

    To make evidence-based recommendations regarding management of tardive syndromes (TDS), including tardive dyskinesias (TDD), by addressing 5 questions: 1) Is withdrawal of dopamine receptor blocking agents (DRBAs) an effective TDS treatment? 2) Does switching from typical to atypical DRBAs reduce TDS symptoms? 3) What is the efficacy of pharmacologic agents in treating TDS? 4) Do patients with TDS benefit from chemodenervation with botulinum toxin? 5) Do patients with TDS benefit from surgical therapy? PsycINFO, Ovid MEDLINE, EMBASE, Web of Science, and Cochrane were searched (1966-2011). Articles were classified according to a 4-tiered evidence-rating scheme; recommendations were tied to the evidence. Clonazepam probably improves TDD and ginkgo biloba probably improves TDS (both Level B); both should be considered as treatment. Risperidone may improve TDS but cannot be recommended as treatment because neuroleptics may cause TDS despite masking symptoms. Amantadine and tetrabenazine might be considered as TDS treatment (Level C). Diltiazem should not be considered as TDD treatment (Level B); galantamine and eicosapentaenoic acid may not be considered as treatment (Level C). Data are insufficient to support or refute use of acetazolamide, bromocriptine, thiamine, baclofen, vitamin E, vitamin B6, selegiline, clozapine, olanzapine, melatonin, nifedipine, fluperlapine, sulpiride, flupenthixol, thiopropazate, haloperidol, levetiracetam, quetiapine, ziprasidone, sertindole, aripiprazole, buspirone, yi-gan san, biperiden discontinuation, botulinum toxin type A, electroconvulsive therapy, α-methyldopa, reserpine, and pallidal deep brain stimulation as TDS treatments (Level U). Data are insufficient to support or refute TDS treatment by withdrawing causative agents or switching from typical to atypical DRBA (Level U).

  17. Anti-tumor immune response correlates with neurological symptoms in a dog with spontaneous astrocytoma treated by gene and vaccine therapy.

    Science.gov (United States)

    Pluhar, G Elizabeth; Grogan, Patrick T; Seiler, Charlie; Goulart, Michelle; Santacruz, Karen S; Carlson, Cathy; Chen, Wei; Olin, Mike R; Lowenstein, Pedro R; Castro, Maria G; Haines, Stephen J; Ohlfest, John R

    2010-04-26

    Gene therapy and vaccination have been tested in malignant glioma patients with modest, albeit encouraging results. The combination of these therapies has demonstrated synergistic efficacy in murine models but has not been reported in large animals. Gemistocytic astrocytoma (GemA) is a low-grade glioma that typically progresses to lethal malignancy despite conventional therapies. Until now there has been no useful animal model of GemA. Here we report the treatment of a dog with spontaneous GemA using the combination of surgery, intracavitary adenoviral interferon gamma (IFNgamma) gene transfer, and vaccination with glioma cell lysates mixed with CpG oligodeoxynucleotides. Surgical tumor debulking and delivery of Ad-IFNgamma into the resection cavity were performed. Autologous tumor cells grew slowly in culture, necessitating vaccination with allogeneic tumor lysate in four of the five vaccinations. Transient left-sided blindness and hemiparesis occurred following the fourth and fifth vaccinations. These neurological symptoms correlated with a peak in the levels of tumor-reactive IgG and CD8(+) T cells measured in the blood. All symptoms resolved and this dog remains tumor-free over 450 days following surgery. This case report preliminarily demonstrates the feasibility of treating dogs with spontaneous glioma using immune-based therapy and warrants further study using this therapeutic approach. Copyright 2010 Elsevier Ltd. All rights reserved.

  18. "That pulled the rug out from under my feet!" - adverse experiences and altered emotion processing in patients with functional neurological symptoms compared to healthy comparison subjects.

    Science.gov (United States)

    Steffen, Astrid; Fiess, Johanna; Schmidt, Roger; Rockstroh, Brigitte

    2015-06-24

    Medically unexplained movement or sensibility disorders, recently defined in DSM-5 as functional neurological symptoms (FNS), are still insufficiently understood. Stress and trauma have been addressed as relevant factors in FNS genesis. Altered emotion processing has been discussed. The present study screened different types and times of adverse experiences in childhood and adulthood in patients with FNS as well as in healthy individuals. The relationship between stress profile, aspects of emotion processing and symptom severity was examined, with the hypothesis that particularly emotional childhood adversities would have an impact on dysfunctional emotion processing as a mediator of FNS. Adverse childhood experiences (ACE), recent negative life events (LE), alexithymia, and emotion regulation style were assessed in 45 inpatients diagnosed with dissociative disorder expressing FNS, and in 45 healthy comparison subjects (HC). Patients reported more severe FNS, more (particularly emotional) ACE, and more LE than HC. FNS severity varied with emotional ACE and negative LE, and LE partially mediated the relation between ACE and FNS. Alexithymia and suppressive emotion regulation style were stronger in patients than HC, and alexithymia varied with FNS severity. Structural equation modeling verified partial mediation of the relationship between emotional ACE and FNS by alexithymia. Early, emotional and accumulating stress show a substantial impact on FNS-associated emotion processing, influencing FNS. Understanding this complex interplay of stress, emotion processing and the severity of FNS is relevant not only for theoretical models, but, as a consequence also inform diagnostic and therapeutic adjustments.

  19. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach.

    Science.gov (United States)

    Gibson, Peter R; Shepherd, Susan J

    2010-02-01

    Functional gastrointestinal symptoms are common and their management is often a difficult clinical problem. The link between food intake and symptom induction is recognized. This review aims to describe the evidence base for restricting rapidly fermentable, short-chain carbohydrates (FODMAPs) in controlling such symptoms. The nature of FODMAPs, their mode of action in symptom induction, results of clinical trials and the implementation of the diet are described. FODMAPs are widespread in the diet and comprise a monosaccharide (fructose), a disaccharide (lactose), oligosaccharides (fructans and galactans), and polyols. Their ingestion increases delivery of readily fermentable substrate and water to the distal small intestine and proximal colon, which are likely to induce luminal distension and induction of functional gut symptoms. The restriction of their intake globally (as opposed to individually) reduces functional gut symptoms, an effect that is durable and can be reversed by their reintroduction into the diet (as shown by a randomized placebo-controlled trial). The diet has a high compliance rate. However it requires expert delivery by a dietitian trained in the diet. Breath hydrogen tests are useful to identify individuals who can completely absorb a load of fructose and lactose so that dietary restriction can be less stringent. The low FODMAP diet provides an effective approach to the management of patients with functional gut symptoms. The evidence base is now sufficiently strong to recommend its widespread application.

  20. Evidence-based guideline update: medical treatment of infantile spasms. Report of the Guideline Development Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society.

    Science.gov (United States)

    Go, C Y; Mackay, M T; Weiss, S K; Stephens, D; Adams-Webber, T; Ashwal, S; Snead, O C

    2012-06-12

    To update the 2004 American Academy of Neurology/Child Neurology Society practice parameter on treatment of infantile spasms in children. MEDLINE and EMBASE were searched from 2002 to 2011 and searches of reference lists of retrieved articles were performed. Sixty-eight articles were selected for detailed review; 26 were included in the analysis. RECOMMENDATIONS were based on a 4-tiered classification scheme combining pre-2002 evidence and more recent evidence. There is insufficient evidence to determine whether other forms of corticosteroids are as effective as adrenocorticotropic hormone (ACTH) for short-term treatment of infantile spasms. However, low-dose ACTH is probably as effective as high-dose ACTH. ACTH is more effective than vigabatrin (VGB) for short-term treatment of children with infantile spasms (excluding those with tuberous sclerosis complex). There is insufficient evidence to show that other agents and combination therapy are effective for short-term treatment of infantile spasms. Short lag time to treatment leads to better long-term developmental outcome. Successful short-term treatment of cryptogenic infantile spasms with ACTH or prednisolone leads to better long-term developmental outcome than treatment with VGB. Low-dose ACTH should be considered for treatment of infantile spasms. ACTH or VGB may be useful for short-term treatment of infantile spasms, with ACTH considered preferentially over VGB. Hormonal therapy (ACTH or prednisolone) may be considered for use in preference to VGB in infants with cryptogenic infantile spasms, to possibly improve developmental outcome. A shorter lag time to treatment of infantile spasms with either hormonal therapy or VGB possibly improves long-term developmental outcomes.

  1. Efficacy of early administration of escitalopram on depressive and emotional symptoms and neurological dysfunction after stroke: a multicentre, double-blind, randomised, placebo-controlled study.

    Science.gov (United States)

    Kim, Jong S; Lee, Eun-Jae; Chang, Dae-Il; Park, Jong-Ho; Ahn, Seong Hwan; Cha, Jae-Kwan; Heo, Ji Hoe; Sohn, Sung-Il; Lee, Byung-Chul; Kim, Dong-Eog; Kim, Hahn Young; Kim, Seongheon; Kwon, Do-Young; Kim, Jei; Seo, Woo-Keun; Lee, Jun; Park, Sang-Won; Koh, Seong-Ho; Kim, Jin Young; Choi-Kwon, Smi

    2017-01-01

    Mood and emotional disturbances are common in patients with stroke, and adversely affect the clinical outcome. We aimed to evaluate the efficacy of early administration of escitalopram to reduce moderate or severe depressive symptoms and improve emotional and neurological dysfunction in patients with stroke. This was a placebo controlled, double-blind trial done at 17 centres in South Korea. Patients who had had an acute stroke within the past 21 days were randomly assigned in a 1:1 ratio to receive oral escitalopram (10 mg/day) or placebo for 3 months. Randomisation was done with permuted blocks stratified by centre, via a web-based system. The primary endpoint was the frequency of moderate or severe depressive symptoms (Montgomery-Åsberg Depression Rating Scale [MADRS] ≥16). Endpoints were assessed at 3 months after randomisation in the full analysis set (patients who took study medication and underwent assessment of primary endpoint after randomisation), in all patients who were enrolled and randomly assigned (intention to treat), and in all patients who completed the trial (per-protocol analysis). This trial is registered with ClinicalTrials.gov, number NCT01278498. Between Jan 27, 2011, and June 30, 2014, 478 patients were assigned to placebo (n=237) or escitalopram (n=241); 405 were included in the full analysis set (195 in the placebo group, 210 in the escitalopram group). The primary outcome did not differ by study group in the full analysis set (25 [13%] patients in the placebo group vs 27 [13%] in the escitalopram group; odds ratio [OR] 1·00, 95% CI 0·56-1·80; p>0·99) or in the intention-to-treat analysis (34 [14%] vs 35 [15%]; OR 1·01, 95% CI 0·61-1·69, p=0·96). The study medication was generally well tolerated; the most common adverse events were constipation (14 [6%] patients who received placebo vs 14 [6%] who received escitalopram), muscle pain (16 [7%] vs ten [4%]), and insomnia (12 [5%] vs 12 [5%]). Diarrhoea was more common in the

  2. Asthma symptoms and medication in the PIAMA birth cohort : Evidence for under and overtreatment

    NARCIS (Netherlands)

    Caudri, Daan; Wijga, Alet H.; Smit, Henriette A.; Koppelman, Gerard H.; Kerkhof, Marjan; Hoekstra, Maarten O.; Brunekreef, Bert; de Jongste, Johan C.

    2011-01-01

    Objective: Under and overtreatment of asthma may be a serious problem especially in young children, but the evidence is scarce and no longitudinal data are available. Our aim was to investigate whether inhaled medication use in young children was in agreement with asthma symptoms at the age of 2-8

  3. Splicing Regulation in Neurologic Disease

    National Research Council Canada - National Science Library

    Licatalosi, Donny D; Darnell, Robert B

    2006-01-01

    .... It is becoming evident that alternative splicing plays a particularly important role in neurologic disease, which is perhaps not surprising given the important role splicing plays in generating...

  4. Syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) in a patient with confusional symptoms, diffuse EEG abnormalities, and bilateral vasospasm in transcranial Doppler ultrasound: A case report and literature review.

    Science.gov (United States)

    Hidalgo de la Cruz, M; Domínguez Rubio, R; Luque Buzo, E; Díaz Otero, F; Vázquez Alén, P; Orcajo Rincón, J; Prieto Montalvo, J; Contreras Chicote, A; Grandas Pérez, F

    2017-04-17

    HaNDL syndrome (transient headache and neurological deficits with cerebrospinal fluid lymphocytosis) is characterised by one or more episodes of headache and transient neurological deficits associated with cerebrospinal fluid lymphocytosis. To date, few cases of HaNDL manifesting with confusional symptoms have been described. Likewise, very few patients with HaNDL and confusional symptoms have been evaluated with transcranial Doppler ultrasound (TCD). TCD data from patients with focal involvement reveal changes consistent with vasomotor alterations. We present the case of a 42-year-old man who experienced headache and confusional symptoms and displayed pleocytosis, diffuse slow activity on EEG, increased blood flow velocity in both middle cerebral arteries on TCD, and single-photon emission computed tomography (SPECT) findings suggestive of diffuse involvement, especially in the left hemisphere. To our knowledge, this is the first description of a patient with HaNDL, confusional symptoms, diffuse slow activity on EEG, and increased blood flow velocity in TCD. Our findings suggest a relationship between cerebral vasomotor changes and the pathophysiology of HaNDL. TCD may be a useful tool for early diagnosis of HaNDL. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Symptoms

    Science.gov (United States)

    ... an Allergic Reaction to Food Symptoms of an Allergic Reaction to Food Learn about the mild and severe ... the food to which you are allergic. An allergic reaction to food can affect the skin, the gastrointestinal ...

  6. Hypnosis as therapy for functional neurologic disorders.

    Science.gov (United States)

    Deeley, Q

    2016-01-01

    treatment approaches, such as cognitive-behavioral, rehabilitative, or psychodynamic therapy. Suggestions are generally symptom-focused (designed to resolve a symptom) or exploratory (using methods such as revivification or age regression to explore experiences associated with symptom onset). The evidence base is dominated by case studies and series, with a paucity of randomized controlled trials. Future evaluation studies should allow for the fact that suggestion with or without hypnosis is a component of broader treatment interventions adapted to a wide range of symptoms and presentations. An important role of the concept of suggestion in the management of functional neurologic symptoms is to raise awareness of how interactions with clinicians and wider clinical contexts can alter expectancies and beliefs of patients in ways that influence the onset, course, and remission of symptoms. © 2016 Elsevier B.V. All rights reserved.

  7. Neurological manifestations of snake bite in Sri Lanka.

    Directory of Open Access Journals (Sweden)

    Seneviratne U

    2002-10-01

    Full Text Available BACKGROUND AND AIMS: Snake bite is an important cause of mortality and morbidity in certain parts of Sri Lanka. This study was designed to determine the offending snakes, neurological manifestations, disease course, and outcome in neurotoxic envenomation. METHODS AND MATERIAL: Fifty six consecutive patients admitted with neurological manifestations following snake bite were studied prospectively. Data were obtained regarding the offending snakes, neurological symptoms, time taken for onset of symptoms, neurological signs, and time taken for recovery. RESULTS: The offending snake was Russell′s viper in 27(48.2%, common and Sri Lankan krait in 19(33.9%, cobra in 3(5.4%, and unidentified in 7(12.5%. Ptosis was the commonest neurological manifestation seen in 48(85.7% followed by ophthalmoplegia (75%, limb weakness (26.8%, respiratory failure (17.9%, palatal weakness (10.7%, neck muscle weakness (7.1%, and delayed sensory neuropathy (1.8%. Neurological symptoms were experienced usually within 6 hours after the bite. Following administration of antivenom, the signs of recovery became evident within a few hours to several days. The duration for complete recovery ranged from four hours to two weeks. CONCLUSIONS: Complete recovery of neuromuscular weakness was observed in all patients except for one who died with intracerebral haemorrhage shortly after admission.

  8. Complementary and alternative therapies for the management of menopause-related symptoms: a systematic evidence review.

    Science.gov (United States)

    Nedrow, Anne; Miller, Jill; Walker, Miranda; Nygren, Peggy; Huffman, Laurie Hoyt; Nelson, Heidi D

    2006-07-24

    Nearly half of adults in the United States use complementary and alternative therapies each year for a variety of reasons. These therapies are increasingly popular among women seeking alternatives to treatment with estrogen for managing menopausal symptoms. The objective of this review was to assess the effectiveness of complementary and alternative therapies in the management of menopausal symptoms. MEDLINE, PsychINFO, Cochrane Library database, MANTIS, and AMED. Full-text, English-language, randomized controlled trials and meta-analyses comparing a complementary or alternative therapy with placebo or control for treatment of menopausal symptoms. All eligible trials were reviewed, abstracted into evidence tables, and rated for quality. Seventy randomized controlled trials met inclusion criteria. Forty-eight studies of phytoestrogens and other biologically based agents showed mixed results. Smaller numbers of studies using mind-body, energy, manipulative, and body-based therapies and whole medical systems showed little benefit in treating menopausal symptoms. Although individual trials suggest benefits from certain therapies, data are insufficient to support the effectiveness of any complementary and alternative therapy in this review for the management of menopausal symptoms. Many of these potential therapies warrant further study in trials with rigorous scientific designs to determine benefit and safety.

  9. Reassessment: neuroimaging in the emergency patient presenting with seizure (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Harden, C L; Huff, J S; Schwartz, T H; Dubinsky, R M; Zimmerman, R D; Weinstein, S; Foltin, J C; Theodore, W H

    2007-10-30

    To reassess the value of neuroimaging of the emergency patient presenting with seizure as a screening procedure for providing information that will change acute management, and to reassess clinical and historical features associated with an abnormal neuroimaging study in these patients. A broad-based panel with topic expertise evaluated the available evidence based on a structured literature review using a Medline search from 1966 until November 2004. The 15 articles meeting criteria were Class II or III evidence since interpretation was not masked to the patient's clinical presentation; most were series including 22 to 875 patients. There is evidence that for adults with first seizure, cranial CT will change acute management in 9 to 17% of patients. CT in the emergency department for children presenting with first seizure will change acute management in approximately 3 to 8%. There is no clear difference between rates of abnormal emergent CT for patients with chronic seizures vs first. Children seizures have clinically relevant abnormalities on CT scans 50% of the time. Persons with AIDS and first seizure have high rates of abnormalities, and CNS toxoplasmosis is frequently found. Abnormal neurologic examination, predisposing history, or focal seizure onset are probably predictive of an abnormal CT study in this context. Immediate noncontrast CT is possibly useful for emergency patients presenting with seizure to guide appropriate acute management especially where there is an abnormal neurologic examination, predisposing history, or focal seizure onset.

  10. Minor neurological dysfunction and behaviour in 9-year-old children born at term: evidence for sex dimorphism.

    Science.gov (United States)

    Kikkert, Hedwig K; de Jong, Corina; van den Heuvel, Edwin R; Hadders-Algra, Mijna

    2013-11-01

    The aim of the study was to assess associations between minor neurological dysfunction (MND) and behaviour, with specific attention to sex differences. This was an observational cohort study in which 341 9-year-old children (177 male, 164 female) without perinatal risk were neurologically assessed, with attention to severity and type of MND. Eight domains of dysfunction were distinguished, including posture and muscle tone, fine manipulative ability and coordination. Severity of MND was based on the number of dysfunctional domains. Behaviour was assessed by parents and teachers using the Child Behavior Checklist and Teacher's Report Form (TRF); outcomes were internalizing and externalizing behaviour and total score of behavioural problems. Females with complex MND or dysfunctional posture and muscle tone had increased risk for externalizing behavioural problems (OR 4.52, 95% CI 1.01-20.2, and OR 4.05, 95% CI 1.06-15.5, respectively). In males, these associations were absent. However, males with simple MND had an increased risk for behavioural problems indicated by the total TRF-score (OR 7.52, 95% CI 1.36-41.4). In children without perinatal risk, associations between MND and behaviour are sex-specific. In females, dysfunction of complex neural networks, including the cerebellum, is associated with externalizing behaviour. In males, neurobehavioural relationships are limited, suggesting a larger role of psychosocial factors in the genesis of behavioural problems. © 2013 Mac Keith Press.

  11. Managing symptoms during cancer treatments: evaluating the implementation of evidence-informed remote support protocols

    Directory of Open Access Journals (Sweden)

    Stacey Dawn

    2012-11-01

    Full Text Available Abstract Background Management of cancer treatment-related symptoms is an important safety issue given that symptoms can become life-threatening and often occur when patients are at home. With funding from the Canadian Partnership Against Cancer, a pan-Canadian steering committee was established with representation from eight provinces to develop symptom protocols using a rigorous methodology (CAN-IMPLEMENT©. Each protocol is based on a systematic review of the literature to identify relevant clinical practice guidelines. Protocols were validated by cancer nurses from across Canada. The aim of this study is to build an effective and sustainable approach for implementing evidence-informed protocols for nurses to use when providing remote symptom assessment, triage, and guidance in self-management for patients experiencing symptoms while undergoing cancer treatments. Methods A prospective mixed-methods study design will be used. Guided by the Knowledge to Action Framework, the study will involve (a establishing an advisory knowledge user team in each of three targeted settings; (b assessing factors influencing nurses’ use of protocols using interviews/focus groups and a standardized survey instrument; (c adapting protocols for local use, ensuring fidelity of the content; (d selecting intervention strategies to overcome known barriers and implementing the protocols; (e conducting think-aloud usability testing; (f evaluating protocol use and outcomes by conducting an audit of 100 randomly selected charts at each of the three settings; and (g assessing satisfaction with remote support using symptom protocols and change in nurses’ barriers to use using survey instruments. The primary outcome is sustained use of the protocols, defined as use in 75% of the calls. Descriptive analysis will be conducted for the barriers, use of protocols, and chart audit outcomes. Content analysis will be conducted on interviews/focus groups and usability testing

  12. Neurology in Asia.

    Science.gov (United States)

    Tan, Chong-Tin

    2015-02-10

    Asia is important as it accounts for more than half of the world population. The majority of Asian countries fall into the middle income category. As for cultural traditions, Asia is highly varied, with many languages spoken. The pattern of neurologic diseases in Asia is largely similar to the West, with some disease features being specific to Asia. Whereas Asia constitutes 60% of the world's population, it contains only 20% of the world's neurologists. This disparity is particularly evident in South and South East Asia. As for neurologic care, it is highly variable depending on whether it is an urban or rural setting, the level of economic development, and the system of health care financing. To help remedy the shortage of neurologists, most counties with larger populations have established training programs in neurology. These programs are diverse, with many areas of concern. There are regional organizations serving as a vehicle for networking in neurology and various subspecialties, as well as an official journal (Neurology Asia). The Asian Epilepsy Academy, with its emphasis on workshops in various locations, EEG certification examination, and fellowships, may provide a template of effective regional networking for improving neurology care in the region. © 2015 American Academy of Neurology.

  13. Neurological complications in chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Ria Arnold

    2016-10-01

    Full Text Available Patients with chronic kidney disease (CKD are frequently afflicted with neurological complications. These complications can potentially affect both the central and peripheral nervous systems. Common neurological complications in CKD include stroke, cognitive dysfunction, encephalopathy, peripheral and autonomic neuropathies. These conditions have significant impact not only on patient morbidity but also on mortality risk through a variety of mechanisms. Understanding the pathophysiological mechanisms of these conditions can provide insights into effective management strategies for neurological complications. This review describes clinical management of neurological complications in CKD with reference to the contributing physiological and pathological derangements. Stroke, cognitive dysfunction and dementia share several pathological mechanisms that may contribute to vascular impairment and neurodegeneration. Cognitive dysfunction and dementia may be differentiated from encephalopathy which has similar contributing factors but presents in an acute and rapidly progressive manner and may be accompanied by tremor and asterixis. Recent evidence suggests that dietary potassium restriction may be a useful preventative measure for peripheral neuropathy. Management of painful neuropathic symptoms can be achieved by pharmacological means with careful dosing and side effect considerations for reduced renal function. Patients with autonomic neuropathy may respond to sildenafil for impotence. Neurological complications often become clinically apparent at end-stage disease, however early detection and management of these conditions in mild CKD may reduce their impact at later stages.

  14. Treatment resistant schizophrenia and neurological soft signs may converge on the same pathology: Evidence from explanatory analysis on clinical, psychopathological, and cognitive variables.

    Science.gov (United States)

    de Bartolomeis, Andrea; Prinzivalli, Emiliano; Callovini, Gemma; D'Ambrosio, Luigi; Altavilla, Benedetta; Avagliano, Camilla; Iasevoli, Felice

    2018-02-02

    Here, we investigated neurological soft signs (NSSs) in treatment resistant schizophrenia (TRS) vs treatment responder schizophrenia (SZ) patients. TRS is a severe condition, affecting approximately one-third of schizophrenia patients and representing a relevant clinical challenge. NSSs are neurological abnormalities reportedly described in schizophrenia patients and linked to dysregulated network connections. We explored the possibility that NSSs may be: i) more severe in TRS patients; ii) differentially associated to clinical/cognitive variables in TRS vs SZ; iii) predictive of having TRS. In addition, we evaluated whether diagnosis may mediate NSSs associations with the above-mentioned variables. Consecutive patients with schizophrenia diagnosis underwent stringent assessment for TRS diagnosis. Demographics and clinical variables were recorded. Psychopathology (by Positive and Negative Syndrome Scale, PANSS), cognitive performances, and NSSs (by Neurological Evaluation Scale, NES) were tested. TRS had higher scores than SZ patients in total NES score and in almost all NES subscales, even after correction for duration of illness and antipsychotic dose (ANCOVA, pvariables (above all: duration of disease and negative symptoms) in TRS but not in SZ patients. Two-way ANOVA showed NSS-x-diagnosis interaction in determining outcomes on multiple cognitive performances, but not in other clinical variables. However, simple main effect analysis detected a significant relationship between high severity NSSs and TRS diagnosis on multiple clinical and cognitive outcomes. Hierarchical regression analysis showed that diagnosis was among a discrete number of predictors yielding significant increases in variance explained on NES total, Sensory Integration and Other Signs subscales' scores. NSSs, together with antipsychotic dose and disease severity, were found to be significantly predictive of TRS diagnosis in a binary logistic regression model. These results suggest a stringent

  15. Adult neurology training during child neurology residency.

    Science.gov (United States)

    Schor, Nina F

    2012-08-21

    As it is currently configured, completion of child neurology residency requires performance of 12 months of training in adult neurology. Exploration of whether or not this duration of training in adult neurology is appropriate for what child neurology is today must take into account the initial reasons for this requirement and the goals of adult neurology training during child neurology residency.

  16. Evidence for shared genetic risk between ADHD symptoms and reduced mathematics ability: a twin study

    Science.gov (United States)

    Greven, Corina U.; Kovas, Yulia; Willcutt, Erik G.; Petrill, Stephen A.; Plomin, Robert

    2013-01-01

    Background Attention-deficit/hyperactivity disorder (ADHD) symptoms and mathematics ability are associated, but little is known about the genetic and environmental influences underlying this association. Methods Data came from more than 6,000 12-year-old twin pairs from the U.K. population-representative Twins Early Development Study. Parents rated each twin’s behaviour using a DSM-IV-based 18-item questionnaire of inattentive and hyperactive-impulsive ADHD symptoms. Mathematics tests based on the U.K. National Curriculum were completed by each twin. The twins also completed standardised tests of reading and general cognitive ability. Multivariate twin model fitting was applied. Results Inattentive and hyperactive-impulsive ADHD symptoms were highly heritable (67% and 73%, respectively). Mathematics ability was moderately heritable (46%). Mathematics ability and inattentiveness showed a significantly greater phenotypic correlation (rp=−0.26) and genetic correlation (rA=−0.41) than mathematics ability and hyperactivity-impulsivity (rp=−0.18; rA=−0.22). The genetic correlation between inattentiveness and mathematics ability was largely independent from hyperactivity-impulsivity, and was only partially accounted for by genetic influences related to reading and general cognitive ability. Conclusions Results revealed the novel finding that mathematics ability shows significantly stronger phenotypic and genetic associations with inattentiveness than with hyperactivity-impulsivity. Genetic associations between inattentiveness and mathematics ability could only partially be accounted for by hyperactivity-impulsivity, reading and general cognitive ability. Results suggest that mathematics ability is associated with ADHD symptoms largely because it shares genetic risk factors with inattentiveness, and provide further evidence for considering inattentiveness and hyperactivity-impulsivity separately. DNA markers for ADHD symptoms (especially inattentiveness) may also

  17. Evidence for shared genetic risk between ADHD symptoms and reduced mathematics ability: a twin study.

    Science.gov (United States)

    Greven, Corina U; Kovas, Yulia; Willcutt, Erik G; Petrill, Stephen A; Plomin, Robert

    2014-01-01

    Attention-deficit/hyperactivity disorder (ADHD) symptoms and mathematics ability are associated, but little is known about the genetic and environmental influences underlying this association. Data came from more than 6,000 twelve-year-old twin pairs from the UK population-representative Twins Early Development Study. Parents rated each twin's behaviour using a DSM-IV-based 18-item questionnaire of inattentive and hyperactive-impulsive ADHD symptoms. Mathematics tests based on the UK National Curriculum were completed by each twin. The twins also completed standardised tests of reading and general cognitive ability. Multivariate twin model fitting was applied. Inattentive and hyperactive-impulsive ADHD symptoms were highly heritable (67% and 73% respectively). Mathematics ability was moderately heritable (46%). Mathematics ability and inattentiveness showed a significantly greater phenotypic correlation (r(p) = -.26) and genetic correlation (r(A) = -.41) than mathematics ability and hyperactivity-impulsivity (r(p) = -.18; r(A) = -.22). The genetic correlation between inattentiveness and mathematics ability was largely independent from hyperactivity-impulsivity, and was only partially accounted for by genetic influences related to reading and general cognitive ability. Results revealed the novel finding that mathematics ability shows significantly stronger phenotypic and genetic associations with inattentiveness than with hyperactivity-impulsivity. Genetic associations between inattentiveness and mathematics ability could only partially be accounted for by hyperactivity-impulsivity, reading and general cognitive ability. Results suggest that mathematics ability is associated with ADHD symptoms largely because it shares genetic risk factors with inattentiveness, and provide further evidence for considering inattentiveness and hyperactivity-impulsivity separately. DNA markers for ADHD symptoms (especially inattentiveness) may also be candidate risk factors for

  18. Neurological aspects of eclampsia

    Directory of Open Access Journals (Sweden)

    Jovanović Dejana

    2003-01-01

    Full Text Available The difficult types of preeclampsia and eclampsia are presented with the neurological symptoms. The break of cerebral autoregulation mechanism plays the most important role in pathogenesis of cerebral vasospasm. Nevertheless eclampsia isn’t just an ordinary hypertensive encephalopathy because other pathogenic mechanisms are involved in its appearance. The main neuropathologic changes are multifocal vasogenic edema, perivascular multiple microinfarctions and petechial hemorrhages. Neurological clinical manifestations are convulsions, headache, visual disturbances and rarely other discrete focal neurological symptoms. Eclampsia is a high-risk factor for onset of hemorrhagic or ischemic stroke. This is a reason why neurological diagnostic tests are sometimes needed. The method of choice for evaluation of complicated eclampsia is computerized brain topography that shows multiple areas of hypodensity in occipitoparietal regions. These changes are focal vasogenic cerebral edema. For differential diagnosis of eclampsia and stroke other diagnostic methods can be used - fundoscopic exam, magnetic resonance brain imaging, cerebral angiography and cerebrospinal fluid exam. The therapy of eclampsia considers using of magnesium sulfate, antihypertensive, anticonvulsive and antiedematous drugs.

  19. Qualitative evidence of Ri specific IgG-synthesis in the cerebrospinal fluid from patients with paraneoplastic neurological syndromes.

    Science.gov (United States)

    Jarius, S; Stich, O; Rasiah, C; Voltz, R; Rauer, S

    2008-05-15

    The presence of Ri-specific oligoclonal IgG bands in the CSF was investigated in five patients with paraneoplastic anti-Ri associated neurological syndromes (PNS) and six controls. In 4/5 CSF samples reactivity of IgG bands with recombinant Ri antigen was found using isoelectrofocusing combined with affinity blotting; in one patient with absence of oligoclonal bands of total IgG in CSF Ri-specific oligoclonal bands were detected with the same sample, indicating a higher sensitivity of Ri-specific affinity blotting as compared to affinity blotting with anti-human IgG antibodies. Our results confirm previous studies demonstrating IgG synthesis against onconeuronal antigens by intrathecal B-cell clones in PNS and extend this observation to patients with anti-Ri syndrome. The pathogenic relevance of these antibodies, however, is further challenged by the finding that specific intrathecal IgG synthesis might not be a prerequisite of CNS involvement, because it was missed in one of our patients.

  20. Clinical study on the cardiac hemodynamics and the possibility of demonstration of the left intraatrial thrombi by echocardiography, angiocardiography and computed tomography and the neurological symptoms in patients with heart disorder and cerebral embolism

    Energy Technology Data Exchange (ETDEWEB)

    Nakajima, Kazuo

    1987-03-01

    In an attempt to elucidate risk factors for developing cerebral embolism (CE) in patients with heart disease, hemodynamic, sonographic or radiologic, and neurologic manifestations of heart disease developing into CE were retrospectively analyzed in 44 patients with CE and 122 patients with mitral valve disease (MVD). The most common underlying disease of CE was valve disease (50 %), followed by myocardial infarction, atrial fibrillation, and infectious endocarditis. In MVD patients, risk factors for CE were considered to be atrial fibrillation, mitral stenosis, and intraatrial thrombi. Combined use of various imaging modalities revealed the presence of intraatrial thrombi in 65 % of the CE patients. Cranial computed tomography showed hemorrhagic infarction in 22 %, and found the mid-arotic artery to be the commonest responsible region (81 %). The frequent initial neurologic symptom was hemiplegia. Half of the patients had disturbance of consciousness on admission. Prognosis was better in patients with MVD than those with the other types of heart disease. (Namekawa, K.). 117 refs.

  1. Hemangiosarcoma of the liver in workers of the PVC industry and other VC-induced diseases with angiologic-dermatologic, hepatologic, radiologic and neurologic symptoms

    Energy Technology Data Exchange (ETDEWEB)

    Halama, J.; Becker-Stone, S.; Halama, J.M.

    1985-01-01

    Occupational diseases resulting from exposure to vinyl chloride (VC) include angiosarcoma of the liver and other neoplasms. Among workers exposed to VC the authors have found capillary abnormalities in the extremities, with scleroderma and Raynaud syndrome, acro-osteolysis, neurological and psychiatric diseases and chromosome abnormalities, as well as abnormal liver metabolism and haematological findings.

  2. [Success of psychotherapy referral of a psychosomatic consultation service among neurologic inpatients].

    Science.gov (United States)

    Seibel, Ira; Imai, Tanya; Holzapfel, Christian; Husstedt, Ingo W; Heuft, Gereon; Schneider, Gudrun

    2009-01-01

    This study investigates the success of recommendations for psychotherapy given in a psychosomatic consultation service to neurological inpatients. In 2005, a subset of 401 (55.7 %) former neurologic inpatients from the initial sample of 720 who underwent psychosomatic consultation between 1999 and 2004 completed follow-up questionnaires to telephone interviews. 279 (69.6 %) participants stated that they had received a recommendation for in- or outpatient psychotherapy during the psychosomatic consultation. Of these, 152 (54.5 %) followed this recommendation. No differences in age, gender, familial status, initial symptoms, and diagnoses were detected between those who underwent psychotherapy and those who did not. Patients who underwent psychotherapy reported significant improvement of symptoms, less impairment, and less disability. A psychosomatic consultation may be a useful adjunct to neurological diagnostics in order to determine the correct diagnosis and therapy for patients with pseudo-neurological symptoms or evidence of psychological problems.

  3. Evidence of the Impact of Diet, Fluid Intake, Caffeine, Alcohol and Tobacco on Lower Urinary Tract Symptoms: A Systematic Review.

    Science.gov (United States)

    Bradley, Catherine S; Erickson, Bradley A; Messersmith, Emily E; Pelletier-Cameron, Anne; Lai, H Henry; Kreder, Karl J; Yang, Claire C; Merion, Robert M; Bavendam, Tamara G; Kirkali, Ziya

    2017-11-01

    Diet, fluid intake and caffeine, alcohol and tobacco use may have effects on lower urinary tract symptoms. Constructive changes in these modifiable nonurological factors are suggested to improve lower urinary tract symptoms. To better understand the relationship between nonurological factors and lower urinary tract symptoms, we performed a systematic literature review to examine, grade and summarize reported associations between lower urinary tract symptoms and diet, fluid intake and caffeine, tobacco and alcohol use. We performed PubMed® searches for eligible articles providing evidence on associations between 1 or more nonurological factors and lower urinary tract symptoms. A modified Oxford scale was used to grade the evidence. We reviewed 111 articles addressing diet (28 studies), fluid intake (21) and caffeine (21), alcohol (26) and tobacco use (44). The evidence grade was generally low (6% level 1, 24% level 2, 11% level 3 and 59% level 4). Fluid intake and caffeine use were associated with urinary frequency and urgency in men and women. Modest alcohol use was associated with decreased likelihood of benign prostatic hyperplasia diagnosis and reduced lower urinary tract symptoms in men. Associations between lower urinary tract symptoms and ingestion of certain foods and tobacco were inconsistent. Evidence of associations between lower urinary tract symptoms and diet, fluid intake and caffeine, alcohol and tobacco use is sparse and mostly observational. However, there is evidence of associations between increased fluid and caffeine intake and urinary frequency/urgency, and between modest alcohol intake and decreased benign prostatic hyperplasia diagnosis and lower urinary tract symptoms. Given the importance of these nonurological factors in daily life, and their perceived impact on lower urinary tract symptoms, higher quality evidence is needed. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All

  4. Evidence-based guideline: intravenous immunoglobulin in the treatment of neuromuscular disorders: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Patwa, H S; Chaudhry, V; Katzberg, H; Rae-Grant, A D; So, Y T

    2012-03-27

    To assess the evidence for the efficacy of IV immunoglobulin (IVIg) to treat neuromuscular disorders. The MEDLINE, Web of Science, and EMBASE databases were searched (1966-2009). Selected articles were rated according to the American Academy of Neurology's therapeutic classification of evidence scheme; recommendations were based on the evidence level. IVIg is as efficacious as plasmapheresis and should be offered for treating Guillain-Barré syndrome (GBS) in adults (Level A). IVIg is effective and should be offered in the long-term treatment of chronic inflammatory demyelinating polyneuropathy (Level A). IVIg is probably effective and should be considered for treating moderate to severe myasthenia gravis and multifocal motor neuropathy (Level B). IVIg is possibly effective and may be considered for treating nonresponsive dermatomyositis in adults and Lambert-Eaton myasthenic syndrome (Level C). Evidence is insufficient to support or refute use of IVIg in the treatment of immunoglobulin M paraprotein-associated neuropathy, inclusion body myositis, polymyositis, diabetic radiculoplexoneuropathy, or Miller Fisher syndrome, or in the routine treatment of postpolio syndrome or in children with GBS (Level U). IVIg combined with plasmapheresis should not be considered for treating GBS (Level B). More data are needed regarding IVIg efficacy as compared with other treatments/treatment combinations. Most studies concluded IVIg-related serious adverse effects were rare. Given the variable nature of these diseases, individualized treatments depending on patient need and physician judgment are important.

  5. Saw palmetto and lower urinary tract symptoms: what is the latest evidence?

    Science.gov (United States)

    Avins, Andrew L; Bent, Stephen

    2006-07-01

    The use of dietary supplements for treating a wide range of health conditions has grown rapidly in the United States. In the field of men's health, the most common dietary supplement used is an extract of the berry of the saw palmetto plant, with which men commonly self-medicate in order to treat lower urinary tract symptoms. Throughout the past two decades, substantial literature has emerged examining the biologic and clinical effects of saw palmetto extracts. Several lines of evidence suggest that saw palmetto may exert physiologic effects consistent with a beneficial clinical effect on the mechanisms of benign prostatic hyperplasia. Although most clinical studies tend to suggest a modest efficacy benefit of saw palmetto, more recent studies are less consistent and the precise clinical value of saw palmetto for treating lower urinary tract symptoms remains undefined. Overall, there appear to be few safety concerns with short-term use of this herbal medicine, although large-scale and longer-term safety studies have not been performed. Higher-quality studies are currently underway to better define the potential benefits and risks of plant-based extracts for treating symptoms related to benign prostatic hyperplasia.

  6. Assessment: Botulinum neurotoxin for the treatment of spasticity (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Simpson, D M; Gracies, J-M; Graham, H K; Miyasaki, J M; Naumann, M; Russman, B; Simpson, L L; So, Y

    2008-05-06

    To perform an evidence-based review of the safety and efficacy of botulinum neurotoxin (BoNT) in the treatment of adult and childhood spasticity. A literature search was performed including MEDLINE and Current Contents for therapeutic articles relevant to BoNT and spasticity. Authors reviewed, abstracted, and classified articles based on American Academy of Neurology criteria (Class I-IV). The highest quality literature available for the respective indications was as follows: adult spasticity (14 Class I studies); spastic equinus and adductor spasticity in pediatric cerebral palsy (six Class I studies). Botulinum neurotoxin should be offered as a treatment option for the treatment of spasticity in adults and children (Level A).

  7. Autoimmune Neurology of the Central Nervous System.

    Science.gov (United States)

    Tobin, W Oliver; Pittock, Sean J

    2017-06-01

    This article reviews the rapidly evolving spectrum of autoimmune neurologic disorders with a focus on those that involve the central nervous system, providing an understanding of how to approach the diagnostic workup of patients presenting with central nervous system symptoms or signs that could be immune mediated, either paraneoplastic or idiopathic, to guide therapeutic decision making. The past decade has seen a dramatic increase in the discovery of novel neural antibodies and their targets. Many commercial laboratories can now test for these antibodies, which serve as diagnostic markers of diverse neurologic disorders that occur on an autoimmune basis. Some are highly specific for certain cancer types, and the neural antibody profiles may help direct the physician's cancer search. The diagnosis of an autoimmune neurologic disorder is aided by the detection of an objective neurologic deficit (usually subacute in onset with a fluctuating course), the presence of a neural autoantibody, and improvement in the neurologic status after a course of immunotherapy. Neural autoantibodies should raise concern for a paraneoplastic etiology and may inform a targeted oncologic evaluation (eg, N-methyl-D-aspartate [NMDA] receptor antibodies are associated with teratoma, antineuronal nuclear antibody type 1 [ANNA-1, or anti-Hu] are associated with small cell lung cancer). MRI, EEG, functional imaging, videotaped evaluations, and neuropsychological evaluations provide objective evidence of neurologic dysfunction by which the success of immunotherapy may be measured. Most treatment information emanates from retrospective case series and expert opinion. Nonetheless, early intervention may allow reversal of deficits in many patients and prevention of future disability.

  8. Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Halperin, J J; Shapiro, E D; Logigian, E; Belman, A L; Dotevall, L; Wormser, G P; Krupp, L; Gronseth, G; Bever, C T

    2007-07-03

    To provide evidence-based recommendations on the treatment of nervous system Lyme disease and post-Lyme syndrome. Three questions were addressed: 1) Which antimicrobial agents are effective? 2) Are different regimens preferred for different manifestations of nervous system Lyme disease? 3) What duration of therapy is needed? The authors analyzed published studies (1983-2003) using a structured review process to classify the evidence related to the questions posed. The panel reviewed 353 abstracts which yielded 112 potentially relevant articles that were reviewed, from which 37 articles were identified that were included in the analysis. There are sufficient data to conclude that, in both adults and children, this nervous system infection responds well to penicillin, ceftriaxone, cefotaxime, and doxycycline (Level B recommendation). Although most studies have used parenteral regimens for neuroborreliosis, several European studies support use of oral doxycycline in adults with meningitis, cranial neuritis, and radiculitis (Level B), reserving parenteral regimens for patients with parenchymal CNS involvement, other severe neurologic symptomatology, or failure to respond to oral regimens. The number of children (> or =8 years of age) enrolled in rigorous studies of oral vs parenteral regimens has been smaller, making conclusions less statistically compelling. However, all available data indicate results are comparable to those observed in adults. In contrast, there is no compelling evidence that prolonged treatment with antibiotics has any beneficial effect in post-Lyme syndrome (Level A).

  9. Management of oral secretions in neurological disease.

    Science.gov (United States)

    McGeachan, Alexander J; Mcdermott, Christopher J

    2017-04-01

    Sialorrhoea is a common and problematic symptom that arises from a range of neurological conditions associated with bulbar or facial muscle dysfunction. Drooling can significantly affect quality of life due to both physical complications such as oral chapping, and psychological complications such as embarrassment and social isolation. Thicker, tenacious oral and pharyngeal secretions may result from the drying management approach to sialorrhoea. The management of sialorrhoea in neurological diseases depends on the underlying pathology and severity of symptoms. Interventions include anticholinergic drugs, salivary gland-targeted radiotherapy, salivary gland botulinum toxin and surgical approaches. The management of thick secretions involves mainly conservative measures such as pineapple juice as a lytic agent, cough assist, saline nebulisers and suctioning or mucolytic drugs like carbocisteine. Despite a current lack of evidence and variable practice, management of sialorrhoea should form a part of the multidisciplinary approach needed for long-term neurological conditions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. Evidence-based guideline: treatment of parenchymal neurocysticercosis: report of the Guideline Development Subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Baird, Ruth Ann; Wiebe, Sam; Zunt, Joseph R; Halperin, John J; Gronseth, Gary; Roos, Karen L

    2013-04-09

    To review the evidence base for different treatment strategies in intraparenchymal neurocysticercosis in adults and children. A literature search of Medline, EMBASE, LILACS, and the Cochrane Database from 1980 to 2008, updated in 2012, resulted in the identification of 10 Class I or Class II trials of cysticidal drugs administered with or without corticosteroids in the treatment of neurocysticercosis. The available data demonstrate that albendazole therapy, administered with or without corticosteroids, is probably effective in decreasing both long-term seizure frequency and the number of cysts demonstrable radiologically in adults and children with neurocysticercosis, and is well-tolerated. There is insufficient information to assess the efficacy of praziquantel. Albendazole plus either dexamethasone or prednisolone should be considered for adults and children with neurocysticercosis, both to decrease the number of active lesions on brain imaging studies (Level B) and to reduce long-term seizure frequency (Level B). The evidence is insufficient to support or refute the use of steroid treatment alone in patients with intraparenchymal neurocysticercosis (Level U).

  11. Palliative care and neurology

    Science.gov (United States)

    Boersma, Isabel; Miyasaki, Janis; Kutner, Jean

    2014-01-01

    Palliative care is an approach to the care of patients and families facing progressive and chronic illnesses that focuses on the relief of suffering due to physical symptoms, psychosocial issues, and spiritual distress. As neurologists care for patients with chronic, progressive, life-limiting, and disabling conditions, it is important that they understand and learn to apply the principles of palliative medicine. In this article, we aim to provide a practical starting point in palliative medicine for neurologists by answering the following questions: (1) What is palliative care and what is hospice care? (2) What are the palliative care needs of neurology patients? (3) Do neurology patients have unique palliative care needs? and (4) How can palliative care be integrated into neurology practice? We cover several fundamental palliative care skills relevant to neurologists, including communication of bad news, symptom assessment and management, advance care planning, caregiver assessment, and appropriate referral to hospice and other palliative care services. We conclude by suggesting areas for future educational efforts and research. PMID:24991027

  12. Side differences in cerebrovascular accidents after cardiac surgery: a statistical analysis of neurologic symptoms and possible implications for anatomic mechanisms of aortic particle embolization.

    Science.gov (United States)

    Boivie, Patrik; Edström, Cecilia; Engström, Karl Gunnar

    2005-03-01

    Aortic manipulation and particle embolization have been identified to cause cerebrovascular accidents in cardiac surgery. Recent data suggest that left-hemispheric cerebrovascular accident (right-sided symptoms) is more common, and this has been interpreted as being caused by aortic cannula stream jets. Our aim was to evaluate symptoms of cerebrovascular accident and side differences from a retrospective statistical analysis. During a 2-year period, 2641 consecutive cardiac surgery cases were analyzed. Patients positive for cerebrovascular accident were extracted from a database designed to monitor clinical symptoms. A protocol was used to confirm symptom data with the correct diagnosis in patient records. Patients were subdivided into 3 groups: control, immediate cerebrovascular accident, and delayed cerebrovascular accident. Among pooled patients, immediate and delayed cerebrovascular accidents were 3.0% and 0.9%, respectively. The expected predisposing factors behind immediate cerebrovascular accidents were significant, although the type of operation affected this search. Aortic quality was a strong predictor ( P cerebrovascular accident was unaffected by surgery group. Left-sided symptoms of immediate cerebrovascular accident were approximately twice as frequent ( P = .016) as on the contralateral side. This phenomenon was observed for pooled patients and for isolated coronary bypass procedures (n = 1882; P = .025). Immediate cerebrovascular accident and aortic calcifications are linked. The predominance of left-sided symptoms may suggest that aortic manipulation and anatomic mechanisms in the aortic arch are more likely to cause cerebrovascular accidents than effects from cannula stream jets.

  13. Cognition-related brain networks underpin the symptoms of unipolar depression: Evidence from a systematic review.

    Science.gov (United States)

    Rayner, Genevieve; Jackson, Graeme; Wilson, Sarah

    2016-02-01

    This systematic review sources the latest neuroimaging evidence for the role of cognition-related brain networks in depression, and relates their abnormal functioning to symptoms of the disorder. Using theoretically informed and rigorous inclusion criteria, we integrate findings from 59 functional neuroimaging studies of adults with unipolar depression using a narrative approach. Results demonstrate that two distinct neurocognitive networks, the autobiographic memory network (AMN) and the cognitive control network (CCN), are central to the symptomatology of depression. Specifically, hyperactivity of the introspective AMN is linked to pathological brooding, self-blame, rumination. Anticorrelated under-engagement of the CCN is associated with indecisiveness, negative automatic thoughts, poor concentration, distorted cognitive processing. Downstream effects of this imbalance include reduced regulation of networks linked to the vegetative and affective symptoms of depression. The configurations of these networks can change between individuals and over time, plausibly accounting for both the variable presentation of depressive disorders and their fluctuating course. Framing depression as a disorder of neurocognitive networks directly links neurobiology to psychiatric practice, aiding researchers and clinicians alike. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Summary of evidence-based guideline: complementary and alternative medicine in multiple sclerosis: report of the guideline development subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Yadav, Vijayshree; Bever, Christopher; Bowen, James; Bowling, Allen; Weinstock-Guttman, Bianca; Cameron, Michelle; Bourdette, Dennis; Gronseth, Gary S; Narayanaswami, Pushpa

    2014-03-25

    To develop evidence-based recommendations for complementary and alternative medicine (CAM) in multiple sclerosis (MS). We searched the literature (1970-March 2011; March 2011-September 2013 MEDLINE search), classified articles, and linked recommendations to evidence. Clinicians might offer oral cannabis extract for spasticity symptoms and pain (excluding central neuropathic pain) (Level A). Clinicians might offer tetrahydrocannabinol for spasticity symptoms and pain (excluding central neuropathic pain) (Level B). Clinicians should counsel patients that these agents are probably ineffective for objective spasticity (short-term)/tremor (Level B) and possibly effective for spasticity and pain (long-term) (Level C). Clinicians might offer Sativex oromucosal cannabinoid spray (nabiximols) for spasticity symptoms, pain, and urinary frequency (Level B). Clinicians should counsel patients that these agents are probably ineffective for objective spasticity/urinary incontinence (Level B). Clinicians might choose not to offer these agents for tremor (Level C). Clinicians might counsel patients that magnetic therapy is probably effective for fatigue and probably ineffective for depression (Level B); fish oil is probably ineffective for relapses, disability, fatigue, MRI lesions, and quality of life (QOL) (Level B); ginkgo biloba is ineffective for cognition (Level A) and possibly effective for fatigue (Level C); reflexology is possibly effective for paresthesia (Level C); Cari Loder regimen is possibly ineffective for disability, symptoms, depression, and fatigue (Level C); and bee sting therapy is possibly ineffective for relapses, disability, fatigue, lesion burden/volume, and health-related QOL (Level C). Cannabinoids may cause adverse effects. Clinicians should exercise caution regarding standardized vs nonstandardized cannabis extracts and overall CAM quality control/nonregulation. Safety/efficacy of other CAM/CAM interaction with MS disease-modifying therapies is unknown.

  15. Assessment: Botulinum neurotoxin for the treatment of movement disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Simpson, D M; Blitzer, A; Brashear, A; Comella, C; Dubinsky, R; Hallett, M; Jankovic, J; Karp, B; Ludlow, C L; Miyasaki, J M; Naumann, M; So, Y

    2008-05-06

    To perform an evidence-based review of the safety and efficacy of botulinum neurotoxin (BoNT) in the treatment of movement disorders. A literature search was performed including MEDLINE and Current Contents for therapeutic articles relevant to BoNT and selected movement disorders. Authors reviewed, abstracted, and classified articles based on American Academy of Neurology criteria (Class I-IV). The highest quality literature available for the respective indications was as follows: blepharospasm (two Class II studies); hemifacial spasm (one Class II and one Class III study); cervical dystonia (seven Class I studies); focal upper extremity dystonia (one Class I and three Class II studies); focal lower extremity dystonia (one Class II study); laryngeal dystonia (one Class I study); motor tics (one Class II study); and upper extremity essential tremor (two Class II studies). Botulinum neurotoxin should be offered as a treatment option for the treatment of cervical dystonia (Level A), may be offered for blepharospasm, focal upper extremity dystonia, adductor laryngeal dystonia, and upper extremity essential tremor (Level B), and may be considered for hemifacial spasm, focal lower limb dystonia, and motor tics (Level C). While clinicians' practice may suggest stronger recommendations in some of these indications, evidence-based conclusions are limited by the availability of data.

  16. Evidence-based guideline update: steroids and antivirals for Bell palsy: report of the Guideline Development Subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Gronseth, Gary S; Paduga, Remia

    2012-11-27

    To review evidence published since the 2001 American Academy of Neurology (AAN) practice parameter regarding the effectiveness, safety, and tolerability of steroids and antiviral agents for Bell palsy. We searched Medline and the Cochrane Database of Controlled Clinical Trials for studies published since January 2000 that compared facial functional outcomes in patients with Bell palsy receiving steroids/antivirals with patients not receiving these medications. We graded each study (Class I-IV) using the AAN therapeutic classification of evidence scheme. We compared the proportion of patients recovering facial function in the treated group with the proportion of patients recovering facial function in the control group. Nine studies published since June 2000 on patients with Bell palsy receiving steroids/antiviral agents were identified. Two of these studies were rated Class I because of high methodologic quality. For patients with new-onset Bell palsy, steroids are highly likely to be effective and should be offered to increase the probability of recovery of facial nerve function (2 Class I studies, Level A) (risk difference 12.8%-15%). For patients with new-onset Bell palsy, antiviral agents in combination with steroids do not increase the probability of facial functional recovery by >7%. Because of the possibility of a modest increase in recovery, patients might be offered antivirals (in addition to steroids) (Level C). Patients offered antivirals should be counseled that a benefit from antivirals has not been established, and, if there is a benefit, it is likely that it is modest at best.

  17. Neurological manifestations in Fabry's disease

    DEFF Research Database (Denmark)

    Møller, Anette Torvin; Jensen, Troels Staehelin

    2007-01-01

    . Neurological symptoms, such as burning sensations (occasionally accompanied by acroparesthesia) and stroke, are among the first to appear, and occur in both male and female patients. A delay in establishing the diagnosis of Fabry's disease can cause unnecessary problems, especially now that enzyme replacement...... treatment is available to prevent irreversible organ damage. Females with Fabry's disease who present with pain have often been ignored and misdiagnosed because of the disorder's X-linked inheritance. This Review will stress the importance of recognizing neurological symptoms for the diagnosis of Fabry...

  18. Symptom prevalence, severity and palliative care needs assessment using the Palliative Outcome Scale: a cross-sectional study of patients with Parkinson's disease and related neurological conditions.

    Science.gov (United States)

    Saleem, Tariq Z; Higginson, Irene J; Chaudhuri, K Ray; Martin, Anne; Burman, Rachel; Leigh, P Nigel

    2013-09-01

    Palliative care is rarely being offered to patients with Parkinson's disease. To assess symptom prevalence, severity and palliative care needs in advanced stages of Parkinsonism. A cross-sectional survey using a palliative care assessment tool, the Palliative Outcome Scale was administered to patients. Eight-two patients with a diagnosis of idiopathic Parkinson's disease, multiple systems atrophy or progressive supranuclear palsy were included in the study. Their mean age and disease stages 3-5 Hoehn and Yahr were 67 years and 4.1, respectively. Patients reported a mean of 10.7 (standard deviation = 3.9) physical symptoms. Over 80% had pain, fatigue, day time somnolence and problems with mobility. Other symptoms in 50%-80% included constipation, loss of bladder control, swallowing difficulties, drooling, breathlessness and sleep problems. Symptoms rated as causing severe problems were pain, fatigue, constipation and drooling. Assessment of mood revealed 70% of the patients felt anxiety and 60% had felt depressed. Eight-five per cent felt their families were anxious or worried about them. Thirty-eight per cent would have liked more information and 42% had practical problems that still needed to be addressed. There was a positive correlation between number of symptoms and disease severity (r = 0.39, p = 0.01). The total mean Palliative Outcome Scale score was 13.6 (standard deviation = 6.1), suggesting moderate palliative care needs. This is the first study to describe the care needs of people with Parkinson's disease using the Palliative Outcome Scale tool. The burden of symptoms and concerns was high in advanced stages of disease. It might be appropriate that people severely affected by these conditions should be considered for referral to specialist palliative care services.

  19. Sintomas neurológicos transitórios após raquianestesia Síntomas neurológicos transitorios después de raquianestesia Transient neurological symptoms after spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Pedro Paulo Tanaka

    2004-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Os sintomas neurológicos transitórios têm sido descritos em pacientes submetidos à raquianestesia sem outras complicações, após completa recuperação do bloqueio espinhal. Este estudo tem por objetivo apresentar uma revisão sobre o assunto. CONTEÚDO: São apresentados a história, incidência, possíveis etiologias, fatores de risco e tratamento dos sintomas neurológicos transitórios. CONCLUSÕES: A raquianestesia é bastante segura e a incidência destes sintomas é relativamente baixa, não justificando o abandono da técnica anestésica, bem como o uso da lidocaína.JUSTIFICATIVA Y OBJETIVOS: Los síntomas neurológicos transitorios han sido descritos en pacientes sometidos a raquianestesia sin más complicaciones, después de la completa recuperación del bloqueo espinal. Este estudio tiene por objetivo presentar una revisión sobre el asunto. CONTENIDO: Son presentados la historia, incidencia, posibles etiologías, factores de riesgo y tratamiento de los síntomas neurológicos transitorios. CONCLUSIONES: La raquianestesia es bastante segura y la incidencia de estos síntomas es relativamente baja, no justificando el abandono de la técnica anestésica, bien como el uso de la lidocaína.BACKGROUND AND OBJECTIVES: Transient neurological symptoms have been described in patients submitted to spinal anesthesia without other complications, after total spinal block recovery. This study aimed at reviewing this subject. CONTENTS: Transient neurological symptoms history, incidence, possible etiologies, risk factors and treatment are presented. CONCLUSIONS: Spinal anesthesia is a very safe procedure with a low incidence of these symptoms, not justifying abandoning the technique as well as lidocaine.

  20. Evidence-based guideline summary: Evaluation, diagnosis, and management of facioscapulohumeral muscular dystrophy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the Practice Issues Review Panel of the American Association of Neuromuscular & Electrodiagnostic Medicine.

    Science.gov (United States)

    Tawil, Rabi; Kissel, John T; Heatwole, Chad; Pandya, Shree; Gronseth, Gary; Benatar, Michael

    2015-07-28

    To develop recommendations for the evaluation, diagnosis, prognostication, and treatment of facioscapulohumeral muscular dystrophy (FSHD) from a systematic review and analysis of the evidence. Relevant articles were analyzed in accordance with the American Academy of Neurology classification of evidence schemes for diagnostic, prognostic, and treatment studies. Recommendations were linked to the strength of the evidence and other factors. Available genetic testing for FSHD type 1 is highly sensitive and specific. Although respiratory insufficiency occurs rarely in FSHD, patients with severe FSHD should have routine pulmonary function testing. Routine cardiac screening is not necessary in patients with FSHD without cardiac symptoms. Symptomatic retinal vascular disease is very rare in FSHD. Exudative retinopathy, however, is potentially preventable, and patients with large deletions should be screened through dilated indirect ophthalmoscopy. The prevalence of clinically relevant hearing loss is not clear. In clinical practice, patients with childhood-onset FSHD may have significant hearing loss. Because undetected hearing loss may impair language development, screening through audiometry is recommended for such patients. Musculoskeletal pain is common in FSHD and treating physicians should routinely inquire about pain. There is at present no effective pharmacologic intervention in FSHD. Available studies suggest that scapular fixation is safe and effective. Surgical scapular fixation might be cautiously offered to selected patients. Aerobic exercise in FSHD appears to be safe and potentially beneficial. On the basis of the evidence, patients with FSHD might be encouraged to engage in low-intensity aerobic exercises. © 2015 American Academy of Neurology.

  1. Neurologic manifestations of hypothyroidism in dogs.

    Science.gov (United States)

    Bertalan, Abigail; Kent, Marc; Glass, Eric

    2013-03-01

    Hypothyroidism is a common endocrine disease in dogs. A variety of clinicopathologic abnormalities may be present; however, neurologic deficits are rare. In some instances, neurologic deficits may be the sole manifestation of hypothyroidism. Consequent ly, the diagnosis and management of the neurologic disorders associated with hypothyroidism can be challenging. This article describes several neurologic manifestations of primary hypothyroidism in dogs; discusses the pathophysiology of hypothyroidism-induced neurologic disorders affecting the peripheral and central nervous systems; and reviews the evidence for the neurologic effects of hypothyroidism.

  2. Antenatal depressive symptoms among pregnant women: Evidence from a Southern Brazilian population-based cohort study.

    Science.gov (United States)

    Coll, Carolina de Vargas Nunes; da Silveira, Mariângela Freitas; Bassani, Diego Garcia; Netsi, Elena; Wehrmeister, Fernando César; Barros, Fernando César; Stein, Alan

    2017-02-01

    Antenatal depression (AD) is a major public health issue but evidence regarding its prevalence and associated factors in low and middle-income countries (LMICs) is limited. The aim of the study was to estimate the prevalence and identify risk factors for AD among Brazilian pregnant women. All women living in the urban area of the city of Pelotas, Southern Brazil, with confirmed pregnancy and estimated delivery date in the year 2015, were invited to take part. Eligible pregnant women were recruited from health services. Symptoms of antenatal depression were assessed using the Edinburgh Postnatal Depression Scale (EPDS) by face-to-face interviews. A cutoff-point of 13 or more was used to define probable AD. EPDS scores were available for 4130 women. The prevalence of AD was 16% (95%CI 14·9-17·1). After adjustment for potential confounders, the factors most strongly associated with higher EPDS scores were a previous history of depression (PR 2·81; 95%CI 2·44-3·25), high parity (PR 1·72; 95%CI 1·38-2·15 - ≥2 children vs. 1 child) and maternal education (PR 5·47; 95%CI 4·22-7·09 - 0-4 vs. ≥12 years of formal education). EPDS was administered through face-to-face interviews rather than questionnaires and some women may have felt uncomfortable reporting their symptoms leading to underreporting and consequently underestimation of the prevalence found. AD prevalence is substantially higher in Brazil than in high-income countries (HICs) but similar to other LMICs. Our study identified relevant risk factors that may be potential targets to plan interventions, particularly a history of depression. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

  3. Do inattention and hyperactivity symptoms equal scholastic impairment? Evidence from three European cohorts

    DEFF Research Database (Denmark)

    Rodriguez, Alina; Järvelin, Marjo-Riitta; Obel, Carsten

    2007-01-01

    children on inattention and hyperactivity symptoms and reported children's scholastic performance on basic skills. RESULTS: There was a significant association in all cohorts between core ADHD symptoms and scholastic impairment in reading, writing, and mathematics. Particularly, inattention was related...

  4. Renal and Neurologic Effects of Cadmium, Lead, Mercury, and Arsenic in Children: Evidence of Early Effects and Multiple Interactions at Environmental Exposure Levels

    Science.gov (United States)

    de Burbure, Claire; Buchet, Jean-Pierre; Leroyer, Ariane; Nisse, Catherine; Haguenoer, Jean-Marie; Mutti, Antonio; Smerhovský, Zdenek; Cikrt, Miroslav; Trzcinka-Ochocka, Malgorzata; Razniewska, Grazyna; Jakubowski, Marek; Bernard, Alfred

    2006-01-01

    Lead, cadmium, mercury, and arsenic are common environmental pollutants in industrialized countries, but their combined impact on children’s health is little known. We studied their effects on two main targets, the renal and dopaminergic systems, in > 800 children during a cross-sectional European survey. Control and exposed children were recruited from those living around historical nonferrous smelters in France, the Czech Republic, and Poland. Children provided blood and urine samples for the determination of the metals and sensitive renal or neurologic biomarkers. Serum concentrations of creatinine, cystatin C, and β2-microglobulin were negatively correlated with blood lead levels (PbB), suggesting an early renal hyperfiltration that averaged 7% in the upper quartile of PbB levels (> 55 μg/L; mean, 78.4 μg/L). The urinary excretion of retinol-binding protein, Clara cell protein, and N-acetyl-β-d-glucosaminidase was associated mainly with cadmium levels in blood or urine and with urinary mercury. All four metals influenced the dopaminergic markers serum prolactin and urinary homovanillic acid, with complex interactions brought to light. Heavy metals polluting the environment can cause subtle effects on children’s renal and dopaminergic systems without clear evidence of a threshold, which reinforces the need to control and regulate potential sources of contamination by heavy metals. PMID:16581550

  5. Neurologic complications of alcoholism.

    Science.gov (United States)

    Noble, James M; Weimer, Louis H

    2014-06-01

    This review serves as an overview of neurologic conditions associated with alcohol abuse or withdrawal, including epidemiology, clinical symptoms, diagnostic approach, and treatment. Frequent alcohol abuse and frank alcoholism are very common among adults in the United States. Although rates decline with each decade, as many as 10% of the elderly drink excessively. Given the ubiquitous nature of alcoholism in society, its complications have been clinically recognized for generations, with recent advances focusing on improved understanding of ethanol's biochemical targets and the pathophysiology of its complications. The chronic effects of alcohol abuse are myriad and include neurologic complications through both direct and indirect effects on the central and peripheral nervous systems. These disorders include several encephalopathic states related to alcohol intoxication, withdrawal, and related nutritional deficiencies; acute and chronic toxic and nutritional peripheral neuropathies; and myopathy. Although prevention of alcoholism and its neurologic complications is the optimal strategy, this article reviews the specific treatment algorithms for alcohol withdrawal and its related nutritional deficiency states.

  6. Neurological complications of underwater diving.

    Science.gov (United States)

    Rosińska, Justyna; Łukasik, Maria; Kozubski, Wojciech

    2015-01-01

    The diver's nervous system is extremely sensitive to high ambient pressure, which is the sum of atmospheric and hydrostatic pressure. Neurological complications associated with diving are a difficult diagnostic and therapeutic challenge. They occur in both commercial and recreational diving and are connected with increasing interest in the sport of diving. Hence it is very important to know the possible complications associated with this kind of sport. Complications of the nervous system may result from decompression sickness, pulmonary barotrauma associated with cerebral arterial air embolism (AGE), otic and sinus barotrauma, high pressure neurological syndrome (HPNS) and undesirable effect of gases used for breathing. The purpose of this review is to discuss the range of neurological symptoms that can occur during diving accidents and also the role of patent foramen ovale (PFO) and internal carotid artery (ICA) dissection in pathogenesis of stroke in divers. Copyright © 2014 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  7. Living with symptoms of attention deficit hyperactivity disorder in adulthood: a systematic review of qualitative evidence.

    Science.gov (United States)

    Bjerrum, Merete B; Pedersen, Preben U; Larsen, Palle

    2017-04-01

    Attention deficit hyperactivity disorder (ADHD) relates to four dimensions of behavior: inattentiveness, restlessness, impulsiveness and hyperactivity. Symptoms affect multiple areas of daily life such as academic performance and social functioning. Despite the negative effects of ADHD, people diagnosed with ADHD do not necessarily regard themselves as being impaired. However, it is unclear how adults with ADHD experience and manage their symptoms. To identify and synthesize the best available evidence on how adults experience living with ADHD. Adults with confirmed ADHD diagnosis. How adults with ADHD experience and manage the symptoms of ADHD and links between protective factors provided by relatives, friends, fellow students, mentors and colleagues. Studies based on qualitative data, including, but not limited to, designs within phenomenology, grounded theory, content analysis or ethnography. A three-step search strategy identified published and unpublished qualitative studies from 1990 to July 2015. Studies meeting the inclusion criteria were independently assessed by two reviewers using the standardized critical appraisal instrument from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). Data were extracted from 10 included studies using the JBI-QARI. Qualitative research findings were synthesized using the JBI-QARI. A total of 103 findings from 10 studies were aggregated into 16 categories that were meta-synthesized into four synthesized findings: "Adults are aware of being different from others and strive to be an integrated, accepted part of the community;" "Adults with ADHD are creative and inventive;" "Adults with ADHD develop coping strategies in striving for a healthy balance in life" and "For adults with ADHD, accomplishing and organizing tasks in everyday life is a challenge but it can also be rewarding." Adults with ADHD have problems stemming from ADHD symptoms in relation to interacting in social relationships

  8. A practical and evidence-based approach to common symptoms: a narrative review.

    Science.gov (United States)

    Kroenke, Kurt

    2014-10-21

    Physical symptoms account for more than half of all outpatient visits, yet the predominant disease-focused model of care is inadequate for many of these symptom-prompted encounters. Moreover, the amount of clinician training dedicated to understanding, evaluating, and managing common symptoms is disproportionally small relative to their prevalence, impairment, and health care costs. This narrative review regarding physical symptoms addresses 4 common epidemiologic questions: cause, diagnosis, prognosis, and therapy. Important findings include the following: First, at least one third of common symptoms do not have a clear-cut, disease-based explanation (5 studies in primary care, 1 in specialty clinics, and 2 in the general population). Second, the history and physical examination alone contribute 73% to 94% of the diagnostic information, with costly testing and procedures contributing much less (5 studies of multiple types of symptoms and 4 of specific symptoms). Third, physical and psychological symptoms commonly co-occur, making a dualistic approach impractical. Fourth, because most patients have multiple symptoms rather than a single symptom, focusing on 1 symptom and ignoring the others is unwise. Fifth, symptoms improve in weeks to several months in most patients but become chronic or recur in 20% to 25%. Sixth, serious causes that are not apparent after initial evaluation seldom emerge during long-term follow-up. Seventh, certain pharmacologic and behavioral treatments are effective across multiple types of symptoms. Eighth, measuring treatment response with valid scales can be helpful. Finally, communication has therapeutic value, including providing an explanation and probable prognosis without "normalizing" the symptom.

  9. Depressive Symptoms in Patients Referred to a Tertiary Lyme Center: High Prevalence in Those Without Evidence of Lyme Borreliosis.

    Science.gov (United States)

    Zomer, Tizza P; Vermeeren, Yolande M; Landman, Gijs W; Zwerink, Marlies; van Hees, Babette C; van Bemmel, Thomas; van Kooten, Barend

    2017-10-30

    Controversy exists whether mood disorders, such as depression, are associated with Lyme borreliosis (LB). The study objective was to assess prevalence of depressive symptoms in subgroups of patients referred to a tertiary Lyme center, to investigate whether depressive symptoms can be used in clinical practice to discriminate for LB. This cohort study included adult patients who visited a tertiary Lyme center between January 2008 and December 2014. Prior to medical consultation, serum samples were taken and the Beck Depression Inventory II was completed to assess depressive symptoms. Lyme diagnosis was retrospectively extracted from the patient's medical record. Patients were classified based on clinical LB and serology results. Prevalence of moderate/severe depressive symptoms was calculated. Using logistic regression, odds ratios with 95% confidence intervals (CIs) were calculated for moderate/severe depressive symptoms. In total, 1454 patients were included. Prevalence of moderate/severe depressive symptoms was lowest in patients with no clinical LB and positive serology (15.3%), higher in patients with clinical LB with positive and negative serology (19.3% and 20.9% respectively), and highest in patients with no clinical LB and negative serology (29.3%). The odds ratio for moderate/severe depressive symptoms in patients with LB and positive serology was 0.71 (95% CI, .50-1.03) compared to patients with no LB and negative serology. The prevalence of depressive symptoms was similar in patients with LB compared to patients with no evidence of infection. This suggests that depressive symptoms cannot be used to discriminate for LB in a tertiary Lyme center.

  10. Neurological manifestations of children with systemic lupus erythematosus.

    Science.gov (United States)

    Loh, W F; Hussain, I M; Soffiah, A; Lim, Y N

    2000-12-01

    In a cross-sectional study of 21 children with Systemic Lupus Erythematosus, 15 (71%) were found to have neuropsychiatric manifestations. The most common finding was generalised seizures (42.8%) followed by encephalopathy (19%) and hallucinations (19%). One child (4.76%) had hemichorea. In 3 children neurological manifestations were the first symptom of SLE. Computerised Axial Tomograms (CAT scans) showed cerebral atrophy in 7 of 12 scans available for review. Ten children had abnormal EEGs. Although none of the children had clinical evidence of a peripheral neuropathy, 8 had neurophysiological evidence of a neuropathy. One child died of intracranial haemorrhage. Six children had residual neuropsychiatric sequalae.

  11. Neurological Findings in Myeloproliferative Neoplasms

    Directory of Open Access Journals (Sweden)

    Semra Paydas

    2013-04-01

    Full Text Available Myeloproliferative neoplasms (MPN arise from genetic deficiencies at the level of pluripotent stem cells. Each of these neoplasms is a clonal stem cell disorder with specific phenotypic, genetic and clinical properties. Age is one of the most important factors in the development of symptoms and complications associated with MPNs.High white blood cell counts in chronic myelocytic leukemia also known as leukocytosis may lead to central nervous system findings. Tumors developing outside the bone marrow named as extramedullary myeloid tumors (EMMT could be detected at the initial diagnosis or during the prognosis of the disease, which may cause neurological symptoms due to pressure of leukemic cell mass on various tissues along with spinal cord. Central nervous system involvement and thrombocytopenic hemorrhage may lead to diverse neurological symptoms and findings.Transient ischemic attack and thrombotic stroke are the most common symptoms in polycythemia vera. Besides thrombosis and hemorrage, transformation to acute leukemia can cause neurological symptoms and findings. Transient ischemic attack, thrombotic stroke and specifically hemorrage can give rise to neurological symptoms similar to MPN in essential thrombocytosis.Extramedullary hematopoiesis refers to hematopoietic centers arise in organ/tissues other than bone marrow in myelofibrosis. Extramedullar hematopoietic centers may cause intracranial involvement, spinal cord compression, seizures and hydrocephalia. Though rare, extramedullary hematopoiesis can be detected in cranial/spinal meninges, paraspinal tissue and intracerebral regions. Extramedullary hematopoiesis has been reported in peripheral neurons, choroid plexus, pituitary, orbits, orbital and lacrimal fossa and in sphenoidal sinuses. [Cukurova Med J 2013; 38(2.000: 157-169

  12. Development of intracerebral hemorrhage in the short-term clinical course of a patient with microscopic polyangiitis without neurological symptoms at diagnosis: an autopsy case.

    Science.gov (United States)

    Miyawaki, Yoshia; Katsuyama, Takayuki; Sada, Ken-Ei; Taniguchi, Kohei; Kakio, Yuki; Wada, Jun

    2016-11-01

    A 77-year-old man with high-grade fever, progressive renal dysfunction, high serum level of C-reactive protein and positive serum myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) was diagnosed with microscopic polyangiitis with rapidly progressive glomerulonephritis, and remission induction treatment with glucocorticoids and intravenous cyclophosphamide was initiated. Although his general condition improved in a short time, intracerebral hemorrhage occurred 12 days after the initiation of treatment and emergent hematoma evacuation was performed. However, he passed away on day 14. Surprisingly, even though no clinical findings for any organs except for renal involvement was detected before his death, autopsy revealed necrotizing vasculitis affecting various systemic organs including kidney, pancreas, liver, myocardium in ventricle, adipose tissue of the left adrenal gland, small intestine, gallbladder, bronchus, prostate, testis and spleen. It is difficult to detect widespread vasculitis without clinical symptoms and signs in patients with ANCA-associated vasculitis. A whole body assessment tool is necessary to detect unexpected vital organ damage, including cerebral vessels.

  13. Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice -- an evidence-based international guide.

    Science.gov (United States)

    Hungin, A P S; Mulligan, C; Pot, B; Whorwell, P; Agréus, L; Fracasso, P; Lionis, C; Mendive, J; Philippart de Foy, J-M; Rubin, G; Winchester, C; de Wit, N

    2013-10-01

    Evidence suggests that the gut microbiota play an important role in gastrointestinal problems. To give clinicians a practical reference guide on the role of specified probiotics in managing particular lower gastrointestinal symptoms/problems by means of a systematic review-based consensus. Systematic literature searching identified randomised, placebo-controlled trials in adults; evidence for each symptom/problem was graded and statements developed (consensus process; 10-member panel). As results cannot be generalised between different probiotics, individual probiotics were identified for each statement. Thirty seven studies were included; mostly on irritable bowel syndrome [IBS; 19 studies; treatment responder rates: 18-80% (specific probiotics), 5-50% (placebo)] or antibiotic-associated diarrhoea (AAD; 10 studies). Statements with 100% agreement and 'high' evidence levels indicated that: (i) specific probiotics help reduce overall symptom burden and abdominal pain in some IBS patients; (ii) in patients receiving antibiotics/Helicobacter pylori eradication therapy, specified probiotics are helpful as adjuvants to prevent/reduce the duration/intensity of AAD; (iii) probiotics have favourable safety in patients in primary care. Items with 70-100% agreement and 'moderate' evidence were: (i) specific probiotics help relieve overall symptom burden in some patients with diarrhoea-predominant IBS, and reduce bloating/distension and improve bowel movement frequency/consistency in some IBS patients and (ii) with some probiotics, improved symptoms have led to improvement in quality of life. Specified probiotics can provide benefit in IBS and antibiotic-associated diarrhoea; relatively few studies in other indications suggested benefits warranting further research. This study provides practical guidance on which probiotic to select for a specific problem. © 2013 John Wiley & Sons Ltd.

  14. Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice – an evidence-based international guide

    Science.gov (United States)

    Hungin, A P S; Mulligan, C; Pot, B; Whorwell, P; Agréus, L; Fracasso, P; Lionis, C; Mendive, J; Philippart de Foy, J-M; Rubin, G; Winchester, C; Wit, N

    2013-01-01

    BackgroundEvidence suggests that the gut microbiota play an important role in gastrointestinal problems. AimTo give clinicians a practical reference guide on the role of specified probiotics in managing particular lower gastrointestinal symptoms/problems by means of a systematic review-based consensus. MethodsSystematic literature searching identified randomised, placebo-controlled trials in adults; evidence for each symptom/problem was graded and statements developed (consensus process; 10-member panel). As results cannot be generalised between different probiotics, individual probiotics were identified for each statement. ResultsThirty seven studies were included; mostly on irritable bowel syndrome [IBS; 19 studies; treatment responder rates: 18–80% (specific probiotics), 5–50% (placebo)] or antibiotic-associated diarrhoea (AAD; 10 studies). Statements with 100% agreement and ‘high’ evidence levels indicated that: (i) specific probiotics help reduce overall symptom burden and abdominal pain in some IBS patients; (ii) in patients receiving antibiotics/Helicobacter pylori eradication therapy, specified probiotics are helpful as adjuvants to prevent/reduce the duration/intensity of AAD; (iii) probiotics have favourable safety in patients in primary care. Items with 70–100% agreement and ‘moderate’ evidence were: (i) specific probiotics help relieve overall symptom burden in some patients with diarrhoea-predominant IBS, and reduce bloating/distension and improve bowel movement frequency/consistency in some IBS patients and (ii) with some probiotics, improved symptoms have led to improvement in quality of life. ConclusionsSpecified probiotics can provide benefit in IBS and antibiotic-associated diarrhoea; relatively few studies in other indications suggested benefits warranting further research. This study provides practical guidance on which probiotic to select for a specific problem. PMID:23981066

  15. Acupuncture application for neurological disorders.

    Science.gov (United States)

    Lee, Hyangsook; Park, Hi-Joon; Park, Jongbae; Kim, Mi-Ja; Hong, Meesuk; Yang, Jongsoo; Choi, Sunmi; Lee, Hyejung

    2007-01-01

    Acupuncture has been widely used for a range of neurological disorders. Despite its popularity, the evidence to support the use of acupuncture is contradictory. This review was designed to summarize and to evaluate the available evidence of acupuncture for neurological disorders. Most of the reviewed studies suffer from lack of methodological rigor. Owing to paucity and poor quality of the primary studies, no firm conclusion could be drawn on the use of acupuncture for epilepsy, Alzheimer's disease, Parkinson's disease, ataxic disorders, multiple sclerosis, amyotrophic lateral sclerosis and spinal cord injury. For stroke rehabilitation, the evidence from recent high-quality trials and previous systematic reviews is not convincing. More rigorous trials are warranted to establish acupuncture's role in neurological disorders.

  16. Advocacy in neurology

    National Research Council Canada - National Science Library

    Pauranik, Apoorva

    2008-01-01

    ...), launched the Neurological Alliance of Ireland, a nationwide coalition of patient advocacy groups and physicians and authored Standards of Care, the "blueprint" for the development of neurological...

  17. Endocannabinoid System in Neurological Disorders.

    Science.gov (United States)

    Ranieri, Roberta; Laezza, Chiara; Bifulco, Maurizio; Marasco, Daniela; Malfitano, Anna M

    2016-01-01

    Several studies support the evidence that the endocannabinoid system and cannabimimetic drugs might have therapeutic potential in numerous pathologies. These pathologies range from neurological disorders, atherosclerosis, stroke, cancer to obesity/metabolic syndrome and others. In this paper we review the endocannabinoid system signaling and its alteration in neurodegenerative disorders like multiple sclerosis, Alzheimer's disease, Parkinson's disease and Huntington's disease and discuss the main findings about the use of cannabinoids in the therapy of these pathologies. Despite different etiologies, neurodegenerative disorders exhibit similar mechanisms like neuro-inflammation, excitotoxicity, deregulation of intercellular communication, mitochondrial dysfunction and disruption of brain tissue homeostasis. Current treatments ameliorate the symptoms but are not curative. Interfering with the endocannabinoid signaling might be a valid therapeutic option in neuro-degeneration. To this aim, pharmacological intervention to modulate the endocannabinoid system and the use of natural and synthetic cannabimimetic drugs have been assessed. CB1 and CB2 receptor signaling contributes to the control of Ca2+ homeostasis, trophic support, mitochondrial activity, and inflammatory conditions. Several studies and patents suggest that the endocannabinoid system has neuro-protective properties and might be a target in neurodegenerative diseases.

  18. The Medical Home Model and Pediatric Asthma Symptom Severity: Evidence from a National Health Survey.

    Science.gov (United States)

    Rojanasarot, Sirikan; Carlson, Angeline M

    2017-08-14

    The objective was to investigate the association between receiving care under the medical home model and parental assessment of the severity of asthma symptoms. It was hypothesized that parents of children who received care under the medical home model reported less severe asthma symptoms compared with their counterparts, whose care did not meet the medical home criteria. Secondary analyses were conducted using cross-sectional data from the 2011-2012 National Survey of Children's Health. Children with asthma aged 0-17 years were included and classified as receiving care from the medical home if their care contained 5 components: a personal doctor, a usual source of sick care, family-centered care, no problems getting referrals, and effective care coordination. Ordinal logistic regression was used to examine the relationship between parent-rated severity of asthma symptoms (mild, moderate, and severe symptoms) and the medical home. Approximately 52% of 8229 children who reported having asthma received care from the medical home. Only 30.8% of children with severe asthma symptoms received care that met the medical home criteria, compared to 55.7% of children with mild symptoms. After accounting for confounding factors, obtaining care under the medical home model decreased the odds of parent-reported severe asthma symptoms by 31% (adjusted odds ratio 0.69; 95% CI, 0.56-0.85). Study results suggest that the medical home model can reduce parent-rated severity of asthma symptoms. The findings highlight the importance of providing medical home care to children with asthma to improve the outcomes that matter most to children and their families.

  19. Associations between infant negative affect and parent anxiety symptoms are bidirectional: Evidence from mothers and fathers

    Directory of Open Access Journals (Sweden)

    Rebecca J. Brooker

    2015-12-01

    Full Text Available Little is known about child-based effects on parents’ anxiety symptoms early in life despite the possibility that child characteristics may contribute to the quality of the early environment and children’s own long-term risk for psychological disorder. We examined bidirectional effects between parent anxiety symptoms and infant fear-based negative affect using a prospective adoption design. Infant fear-based negative affect and adoptive parent anxiety symptoms were assessed at child ages 9, 18, and 27 months. Birth parent negative affect was assessed at child age 18 months. More anxiety symptoms in adoptive parents at child age 9 months predicted more negative affect in infants 9 months later. More infant negative affect at child age 9 months predicted more anxiety symptoms in adoptive parents 18 months later. Patterns of results did not differ for adoptive mothers and adoptive fathers. Birth parent negative affect was unrelated to infant or adoptive parent measures. Consistent with expectations, associations between infant negative affect and rearing parents’ anxiety symptoms appear to be bidirectional. In addition to traditional parent-to-child effects, our results suggest that infants’ characteristics may contribute to parent qualities that are known to impact childhood outcomes.

  20. Microbiota and neurologic diseases: potential effects of probiotics.

    Science.gov (United States)

    Umbrello, Giulia; Esposito, Susanna

    2016-10-19

    The microbiota colonizing the gastrointestinal tract have been associated with both gastrointestinal and extra-gastrointestinal diseases. In recent years, considerable interest has been devoted to their role in the development of neurologic diseases, as many studies have described bidirectional communication between the central nervous system and the gut, the so-called "microbiota-gut-brain axis". Considering the ability of probiotics (i.e., live non-pathogenic microorganisms) to restore the normal microbial population and produce benefits for the host, their potential effects have been investigated in the context of neurologic diseases. The main aims of this review are to analyse the relationship between the gut microbiota and brain disorders and to evaluate the current evidence for the use of probiotics in the treatment and prevention of neurologic conditions. Overall, trials involving animal models and adults have reported encouraging results, suggesting that the administration of probiotic strains may exert some prophylactic and therapeutic effects in a wide range of neurologic conditions. Studies involving children have mainly focused on autism spectrum disorder and have shown that probiotics seem to improve neuro behavioural symptoms. However, the available data are incomplete and far from conclusive. The potential usefulness of probiotics in preventing or treating neurologic diseases is becoming a topic of great interest. However, deeper studies are needed to understand which formulation, dosage and timing might represent the optimal regimen for each specific neurologic disease and what populations can benefit. Moreover, future trials should also consider the tolerability and safety of probiotics in patients with neurologic diseases.

  1. Does Evidence-Based PTS Treatment Reduce PTS Symptoms and Suicide in Iraq and Afghanistan Veterans Seeking VA Care

    Science.gov (United States)

    2016-05-01

    AWARD NUMBER: W81XWH-15-1-0038 TITLE: Does Evidence-Based PTS Treatment Reduce PTS Symptoms and Suicide in Iraq and Afghanistan Veterans... Suicide in Iraq and Afghanistan Veterans Seeking VA Care? 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-15-1-0038 5c. PROGRAM ELEMENT NUMBER 6...cohort with two or more suicide screenings during the post-deployment period. 15. SUBJECT TERMS Key words or phrases identifying major concepts in

  2. Neuromarketing and consumer neuroscience: contributions to neurology.

    Science.gov (United States)

    Javor, Andrija; Koller, Monika; Lee, Nick; Chamberlain, Laura; Ransmayr, Gerhard

    2013-02-06

    'Neuromarketing' is a term that has often been used in the media in recent years. These public discussions have generally centered around potential ethical aspects and the public fear of negative consequences for society in general, and consumers in particular. However, positive contributions to the scientific discourse from developing a biological model that tries to explain context-situated human behavior such as consumption have often been neglected. We argue for a differentiated terminology, naming commercial applications of neuroscientific methods 'neuromarketing' and scientific ones 'consumer neuroscience'. While marketing scholars have eagerly integrated neuroscientific evidence into their theoretical framework, neurology has only recently started to draw its attention to the results of consumer neuroscience. In this paper we address key research topics of consumer neuroscience that we think are of interest for neurologists; namely the reward system, trust and ethical issues. We argue that there are overlapping research topics in neurology and consumer neuroscience where both sides can profit from collaboration. Further, neurologists joining the public discussion of ethical issues surrounding neuromarketing and consumer neuroscience could contribute standards and experience gained in clinical research. We identify the following areas where consumer neuroscience could contribute to the field of neurology:First, studies using game paradigms could help to gain further insights into the underlying pathophysiology of pathological gambling in Parkinson's disease, frontotemporal dementia, epilepsy, and Huntington's disease.Second, we identify compulsive buying as a common interest in neurology and consumer neuroscience. Paradigms commonly used in consumer neuroscience could be applied to patients suffering from Parkinson's disease and frontotemporal dementia to advance knowledge of this important behavioral symptom.Third, trust research in the medical context lacks

  3. Neuromarketing and consumer neuroscience: contributions to neurology

    Science.gov (United States)

    2013-01-01

    Background ‘Neuromarketing’ is a term that has often been used in the media in recent years. These public discussions have generally centered around potential ethical aspects and the public fear of negative consequences for society in general, and consumers in particular. However, positive contributions to the scientific discourse from developing a biological model that tries to explain context-situated human behavior such as consumption have often been neglected. We argue for a differentiated terminology, naming commercial applications of neuroscientific methods ‘neuromarketing’ and scientific ones ‘consumer neuroscience’. While marketing scholars have eagerly integrated neuroscientific evidence into their theoretical framework, neurology has only recently started to draw its attention to the results of consumer neuroscience. Discussion In this paper we address key research topics of consumer neuroscience that we think are of interest for neurologists; namely the reward system, trust and ethical issues. We argue that there are overlapping research topics in neurology and consumer neuroscience where both sides can profit from collaboration. Further, neurologists joining the public discussion of ethical issues surrounding neuromarketing and consumer neuroscience could contribute standards and experience gained in clinical research. Summary We identify the following areas where consumer neuroscience could contribute to the field of neurology: First, studies using game paradigms could help to gain further insights into the underlying pathophysiology of pathological gambling in Parkinson’s disease, frontotemporal dementia, epilepsy, and Huntington’s disease. Second, we identify compulsive buying as a common interest in neurology and consumer neuroscience. Paradigms commonly used in consumer neuroscience could be applied to patients suffering from Parkinson’s disease and frontotemporal dementia to advance knowledge of this important behavioral symptom

  4. Is there an association of vitamin B12 status with neurological function in older people? A systematic review.

    Science.gov (United States)

    Miles, Lisa M; Mills, Kerry; Clarke, Robert; Dangour, Alan D

    2015-08-28

    Low vitamin B12 status is common in older people; however, its public health significance in terms of neurological manifestations remains unclear. The present systematic review evaluated the association of vitamin B12 status with neurological function and clinically relevant neurological outcomes in adults aged 50+ years. A systematic search of nine bibliographic databases (up to March 2013) identified twelve published articles describing two longitudinal and ten cross-sectional analyses. The included study populations ranged in size (n 28-2287) and mean/median age (range 65-81 years). Studies reported various neurological outcomes: nerve function; clinically measured signs and symptoms of nerve function; self-reported neurological symptoms. Studies were assessed for risk of bias, and results were synthesised qualitatively. Among the general population groups of older people, one longitudinal study reported no association, and four of seven cross-sectional studies reported limited evidence of an association of vitamin B12 status with some, but not all, neurological outcomes. Among groups with clinical and/or biochemical evidence of low vitamin B12 status, one longitudinal study reported an association of vitamin B12 status with some, but not all, neurological outcomes and three cross-sectional analyses reported no association. Overall, there is limited evidence from observational studies to suggest an association of vitamin B12 status with neurological function in older people. The heterogeneity and quality of the evidence base preclude more definitive conclusions, and further high-quality research is needed to better inform understanding of public health significance in terms of neurological function of vitamin B12 status in older people.

  5. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Surgical Resection for the Treatment of Patients With Vestibular Schwannomas.

    Science.gov (United States)

    Hadjipanayis, Constantinos G; Carlson, Matthew L; Link, Michael J; Rayan, Tarek A; Parish, John; Atkins, Tyler; Asher, Anthony L; Dunn, Ian F; Corrales, C Eduardo; Van Gompel, Jamie J; Sughrue, Michael; Olson, Jeffrey J

    2017-12-20

    to either subspecialist working alone. Does a subtotal surgical resection of a VS followed by stereotactic radiosurgery (SRS) to the residual tumor provide comparable hearing and FN preservation to patients who undergo a complete surgical resection? There is insufficient evidence to support subtotal resection (STR) followed by SRS provides comparable hearing and FN preservation to patients who undergo a complete surgical resection. Does surgical resection of VS treat preoperative balance problems more effectively than SRS? There is insufficient evidence to support either surgical resection or SRS for treatment of preoperative balance problems. Does surgical resection of VS treat preoperative trigeminal neuralgia more effectively than SRS? Level 3: Surgical resection of VSs may be used to better relieve symptoms of trigeminal neuralgia than SRS. Is surgical resection of VSs more difficult (associated with higher facial neuropathies and STR rates) after initial treatment with SRS? Level 3: If microsurgical resection is necessary after SRS, it is recommended that patients be counseled that there is an increased likelihood of a STR and decreased FN function.  The full guideline can be found at: https://www.cns.org/guidelines/guidelines-management-patients-vestibular-schwannoma/chapter_8.

  6. Neurologic considerations in propionic acidemia.

    Science.gov (United States)

    Schreiber, John; Chapman, Kimberly A; Summar, Marshall L; Ah Mew, Nicholas; Sutton, V Reid; MacLeod, Erin; Stagni, Kathy; Ueda, Keiko; Franks, Jill; Island, Eddie; Matern, Dietrich; Peña, Loren; Smith, Brittany; Urv, Tiina; Venditti, Charles; Chakarapani, Anupam; Gropman, Andrea L

    2012-01-01

    Propionic acidemia (PA) is an organic acidemia which has a broad range of neurological complications, including developmental delay, intellectual disability, structural abnormalities, metabolic stroke-like episodes, seizures, optic neuropathy, and cranial nerve abnormalities. As the PA consensus conference hosted by Children's National Medical Center progressed from January 28 to 30, 2011, it became evident that neurological complications were common and a major component of morbidity, but the role of imaging and the basis for brain pathophysiology were unclear. This paper reviews the hypothesized pathophysiology, presentation and uses the best available evidence to suggest programs for treatment, imaging, and monitoring the neurological complications of PA. Copyright © 2011. Published by Elsevier Inc. All rights reserved.

  7. Neurological aspects of vibroacoustic disease.

    Science.gov (United States)

    Martinho Pimenta, A J; Castelo Branco, N A

    1999-03-01

    Mood and behavioral abnormalities are the most common early findings related to vibroacoustic disease (VAD). Other signs and symptoms have been observed in VAD patients. Brain MRI discloses small multifocal lesions in about 50% of subjects with more than 10 yr of occupational exposure to large pressure amplitude (> or = 90 dB SPL) and low frequency (< or = 500 Hz) (LPALF) noise. However, to date, there have been no studies globally integrating all the neurological, imaging and neurophysiological data of VAD patients. This is the main goal of this study. The 60 male Caucasians diagnosed with VAD were neurologically evaluated in extreme detail in order to systematically identify the most common and significant neurological disturbances in VAD. This population demonstrates cognitive changes (identified through psychological and neurophysiological studies (ERP P300)), vertigo and auditory changes, visual impairment, epilepsy, and cerebrovascular diseases. Neurological examination reveals pathological signs and reflexes, most commonly the palmo-mental reflex. A vascular pattern underlying the multifocal hyperintensities in T2 MR imaging, with predominant involvement of the small arteries of the white matter, is probably the visible organic substratum of the neurological picture. However, other pathophyisological mechanisms are involved in epileptic symptomatology.

  8. Evidence for shared genetic risk between ADHD symptoms and reduced mathematics ability: a twin study

    NARCIS (Netherlands)

    Greven, C.U.; Kovas, Y.; Willcutt, E.G.; Petrill, S.A.; Plomin, R.

    2014-01-01

    BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) symptoms and mathematics ability are associated, but little is known about the genetic and environmental influences underlying this association. METHODS: Data came from more than 6,000 twelve-year-old twin pairs from the UK

  9. Unlinking Negative Cognition and Symptoms of Depression: Evidence of a Specific Treatment Effect for Cognitive Therapy

    Science.gov (United States)

    Beevers, Christopher G.; Miller, Ivan W.

    2005-01-01

    In this study, the authors examined whether cognitive therapy alters the association between negative cognition and symptoms of depression. Participants were recruited during psychiatric hospitalization for depression. Following discharge, they were randomly assigned to 6 months of outpatient treatment. Treatment consisted of pharmacotherapy…

  10. Do inattention and hyperactivity symptoms equal scholastic impairment? evidence from three European cohorts

    Directory of Open Access Journals (Sweden)

    Henriksen Tine

    2007-11-01

    Full Text Available Abstract Background Attention Deficit/Hyperactivity Disorder (ADHD affects many children, adolescents, and adults and is associated with a number of impairments. Poor academic performance is related to ADHD in clinical samples. However, it is unclear to what extent core ADHD symptoms and scholastic impairment are related in non-referred school-aged children. Methods Data come from three population-based cohorts from Sweden, Denmark, and Finland, which are part of the Nordic Network on ADHD. The combined sample size was 13,087 children who were studied at ages 7–8 or 10–12 years. Teachers rated children on inattention and hyperactivity symptoms and reported children's scholastic performance on basic skills. Results There was a significant association in all cohorts between core ADHD symptoms and scholastic impairment in reading, writing, and mathematics. Particularly, inattention was related to a two to tenfold increase in scholastic impairment. Prevalence of hyperactivity symptoms was similar across the three cohorts, but inattention was lowest among children from the Finnish cohort, after stratification on living conditions. Conclusion These results extend previous reports of scholastic impairment among children with clinically diagnosed ADHD to non-referred population samples from three European countries. Surveillance policies should be implemented in school systems to catch children in need of behavioral or scholastic support early.

  11. Evidence for Shared Genetic Risk between ADHD Symptoms and Reduced Mathematics Ability: A Twin Study

    Science.gov (United States)

    Greven, Corina U.; Kovas, Yulia; Willcutt, Erik G.; Petrill, Stephen A.; Plomin, Robert

    2013-01-01

    Background: Attention-deficit/hyperactivity disorder (ADHD) symptoms and mathematics ability are associated, but little is known about the genetic and environmental influences underlying this association. Methods: Data came from more than 6,000 twelve-year-old twin pairs from the UK population-representative Twins Early Development Study. Parents…

  12. Attention Deficit Hyperactivity Disorder Symptoms and Low Educational Achievement: Evidence Supporting A Causal Hypothesis.

    Science.gov (United States)

    de Zeeuw, Eveline L; van Beijsterveldt, Catharina E M; Ehli, Erik A; de Geus, Eco J C; Boomsma, Dorret I

    2017-05-01

    Attention Deficit Hyperactivity Disorder (ADHD) and educational achievement are negatively associated in children. Here we test the hypothesis that there is a direct causal effect of ADHD on educational achievement. The causal effect is tested in a genetically sensitive design to exclude the possibility of confounding by a third factor (e.g. genetic pleiotropy) and by comparing educational achievement and secondary school career in children with ADHD who take or do not take methylphenidate. Data on ADHD symptoms, educational achievement and methylphenidate usage were available in a primary school sample of ~10,000 12-year-old twins from the Netherlands Twin Register. A substantial group also had longitudinal data at ages 7-12 years. ADHD symptoms were cross-sectionally and longitudinally, associated with lower educational achievement at age 12. More ADHD symptoms predicted a lower-level future secondary school career at age 14-16. In both the cross-sectional and longitudinal analyses, testing the direct causal effect of ADHD on educational achievement, while controlling for genetic and environmental factors, revealed an association between ADHD symptoms and educational achievement independent of genetic and environmental pleiotropy. These findings were confirmed in MZ twin intra-pair differences models, twins with more ADHD symptoms scored lower on educational achievement than their co-twins. Furthermore, children with ADHD medication, scored significantly higher on the educational achievement test than children with ADHD who did not use medication. Taken together, the results are consistent with a direct causal effect of ADHD on educational achievement.

  13. The effects of stress-tension on depression and anxiety symptoms: evidence from a novel twin modelling analysis.

    Science.gov (United States)

    Davey, C G; López-Solà, C; Bui, M; Hopper, J L; Pantelis, C; Fontenelle, L F; Harrison, B J

    2016-11-01

    Negative mood states are composed of symptoms of depression and anxiety, and by a third factor related to stress, tension and irritability. We sought to clarify the nature of the relationships between the factors by studying twin pairs. A total of 503 monozygotic twin pairs completed the Depression Anxiety Stress Scales (DASS), an instrument that assesses symptoms of depression, anxiety and stress-tension. We applied a recently developed twin regression methodology - Inference about Causation from Examination of FAmiliaL CONfounding (ICE FALCON) - to test for evidence consistent with the existence of 'causal' influences between the DASS factors. There was evidence consistent with the stress-tension factor having a causal influence on both the depression (p anxiety factors (p = 0.001), and for the depression factor having a causal influence on the anxiety factor (p stress-tension in the structure of negative mood states, and that interventions that target it may be particularly effective in reducing depression and anxiety symptoms.

  14. Neurology and literature 2.

    Science.gov (United States)

    Iniesta, I

    2014-05-01

    Good literary fiction has the potential to move us, extend our sense of life, transform our prospective views and help us in the face of adversity. A neurological disorder is likely to be the most challenging experience a human being may have to confront in a lifetime. As such, literary recreations of illnesses have a doubly powerful effect. Study the synergies between neurology and fictional literature with particular reference to narrative based medicine (NBM). Doctors establish boundaries between the normal and the abnormal. Taking a clinical history is an act of interpretation in which the doctor integrates the science of objective signs and measurable quantities with the art of subjective clinical judgment. The more discrepancy there is between the patient's experience with the illness and the doctor's interpretation of that disease, the less likely the doctor-patient interaction is to succeed. NBM contributes to a better discernment of the meanings, thus considering disease as a biographical event rather than just a natural fact. Drawing from their own experience with disease, writers of fiction provide universal insights through their narratives, whilst neuroscientists, like Cajal, have occasionally devoted their scientific knowledge to literary narratives. Furthermore, neurologists from Alzheimer to Oliver Sacks remind us of the essential value of NBM in the clinic. Integrating NBM (the narrative of patients) and the classic holistic approach to patients with our current paradigm of evidence based medicine represents a challenge as relevant to neurologists as keeping up with technological and scientific advances. Copyright © 2011 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  15. Neurology and neurologic practice in China.

    Science.gov (United States)

    Shi, Fu-Dong; Jia, Jian-Ping

    2011-11-29

    In the wake of dramatic economic success during the past 2 decades, the specialized field of neurology has undergone a significant transformation in China. With an increase in life expectancy, the problems of aging and cognition have grown. Lifestyle alterations have been associated with an epidemiologic transition both in the incidence and etiology of stroke. These changes, together with an array of social issues and institution of health care reform, are creating challenges for practicing neurologists throughout China. Notable problems include overcrowded, decrepit facilities, overloaded physician schedules, deteriorating physician-patient relationships, and an insufficient infrastructure to accommodate patients who need specialized neurologic care. Conversely, with the creation of large and sophisticated neurology centers in many cities across the country, tremendous opportunities exist. Developments in neurologic subspecialties enable delivery of high-quality care. Clinical and translational research based on large patient populations as well as highly sophisticated technologies are emerging in many neurologic centers and pharmaceutical companies. Child neurology and neurorehabilitation will be fast-developing subdisciplines. Given China's extensive population, the growth and progress of its neurology complex, and its ever-improving quality control, it is reasonable to anticipate that Chinese neurologists will contribute notably to unraveling the pathogenic factors causing neurologic diseases and to providing new therapeutic solutions.

  16. Evidence for disseminated Mycoplasma fermentans in New Jersey residents with antecedent tick attachment and subsequent musculoskeletal symptoms.

    Science.gov (United States)

    Eskow, Eugene; Adelson, Martin E; Rao, Raja-Venkitesh S; Mordechai, Eli

    2003-04-01

    Mycoplasma species are one of nature's most abundant groups of microbes. These bacteria inhabit a wide diversity of insect, plant, and animal species, including humans. Certain mycoplasma species have been identified in blood-sucking arthropods, including Ixodes ticks. Frequent human exposure to this genus of ticks led us to explore the possibility of tick-mediated transmission of these bacteria. We evaluated 7 residents of central New Jersey who developed fatigue, musculoskeletal symptoms, and cognitive disturbance after tick attachment. All 7 of these patients lacked both serological evidence and erythema migrans skin lesions characteristic of Lyme disease. We were able to amplify and quantitate Mycoplasma fermentans-specific DNA from their peripheral blood lymphocytes. After antimicrobial therapy, symptoms subsided, and M. fermentans DNA could no longer be detected in their blood specimens. These findings suggest that a subset of disseminated M. fermentans infections may be a vector-mediated process in humans and should be considered in patients with puzzling musculoskeletal presentations.

  17. Comorbidities in Neurology: Is Adenosine the Common Link?

    Science.gov (United States)

    Boison, Detlev; Aronica, Eleonora

    2015-01-01

    Comorbidities in Neurology represent a major conceptual and therapeutic challenge. For example, temporal lobe epilepsy (TLE) is a syndrome comprised of epileptic seizures and comorbid symptoms including memory and psychiatric impairment, depression, and sleep dysfunction. Similarly, Alzheimer’s disease (AD), Parkinson’s disease (PD), and Amyotrophic Lateral Sclerosis (ALS) are accompanied by various degrees of memory dysfunction. Patients with AD have an increased likelihood for seizures, whereas all four conditions share certain aspects of psychosis, depression, and sleep dysfunction. This remarkable overlap suggests common pathophysiological mechanisms, which include synaptic dysfunction and synaptotoxicity, as well as glial activation and astrogliosis. Astrogliosis is linked to synapse function via the tripartite synapse, but astrocytes also control the availability of gliotransmitters and adenosine. Here we will specifically focus on the ‘adenosine hypothesis of comorbidities’ implying that astrocyte activation, via overexpression of adenosine kinase (ADK), induces a deficiency in the homeostatic tone of adenosine. We present evidence from patient-derived samples showing astrogliosis and overexpression of ADK as common pathological hallmark of epilepsy, AD, PD, and ALS. We discuss a transgenic ‘comorbidity model’, in which brain-wide overexpression of ADK and resulting adenosine deficiency produces a comorbid spectrum of seizures, altered dopaminergic function, attentional impairment, and deficits in cognitive domains and sleep regulation. We conclude that dysfunction of adenosine signaling is common in neurological conditions, that adenosine dysfunction can explain comorbid phenotypes, and that therapeutic adenosine augmentation might be effective for the treatment of comorbid symptoms in multiple neurological conditions. PMID:25979489

  18. Evidence-based guideline summary: evaluation, diagnosis, and management of congenital muscular dystrophy: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the Practice Issues Review Panel of the American Association of Neuromuscular & Electrodiagnostic Medicine.

    Science.gov (United States)

    Kang, Peter B; Morrison, Leslie; Iannaccone, Susan T; Graham, Robert J; Bönnemann, Carsten G; Rutkowski, Anne; Hornyak, Joseph; Wang, Ching H; North, Kathryn; Oskoui, Maryam; Getchius, Thomas S D; Cox, Julie A; Hagen, Erin E; Gronseth, Gary; Griggs, Robert C

    2015-03-31

    To delineate optimal diagnostic and therapeutic approaches to congenital muscular dystrophy (CMD) through a systematic review and analysis of the currently available literature. Relevant, peer-reviewed research articles were identified using a literature search of the MEDLINE, EMBASE, and Scopus databases. Diagnostic and therapeutic data from these articles were extracted and analyzed in accordance with the American Academy of Neurology classification of evidence schemes for diagnostic, prognostic, and therapeutic studies. Recommendations were linked to the strength of the evidence, other related literature, and general principles of care. The geographic and ethnic backgrounds, clinical features, brain imaging studies, muscle imaging studies, and muscle biopsies of children with suspected CMD help predict subtype-specific diagnoses. Genetic testing can confirm some subtype-specific diagnoses, but not all causative genes for CMD have been described. Seizures and respiratory complications occur in specific subtypes. There is insufficient evidence to determine the efficacy of various treatment interventions to optimize respiratory, orthopedic, and nutritional outcomes, and more data are needed regarding complications. Multidisciplinary care by experienced teams is important for diagnosing and promoting the health of children with CMD. Accurate assessment of clinical presentations and genetic data will help in identifying the correct subtype-specific diagnosis in many cases. Multiorgan system complications occur frequently; surveillance and prompt interventions are likely to be beneficial for affected children. More research is needed to fill gaps in knowledge regarding this category of muscular dystrophies. © 2015 American Academy of Neurology.

  19. [Neurorehabilitation, neurology, rehabilitation medicine].

    Science.gov (United States)

    Urbán, Edina; Szél, István; Fáy, Veronika; Dénes, Zoltán; Lippai, Zoltán; Fazekas, Gábor

    2013-05-30

    We have read several publications of great authority on the neurological profession in the last two years in which were expressed assessments of the current situation combined with opinions about neurology and the necessity to reorganize neurological patient care. These articles took up the question of neurorehabilitation too. The authors, who on a daily basis, deal with the rehabilitation of people with disabilities as a consequence of neurological conditions, summarize some important definitions of rehabilitation medicine and the present system of neurological rehabilitation, as it is defined by the rehabilitation profession.

  20. Neurology at the bedside

    DEFF Research Database (Denmark)

    Kondziella, Daniel; Waldemar, Gunhild

    This updated and expanded new edition takes neurology trainees by the hand and guides them through the whole patient encounter - from an efficient neurological history and bedside examination through to differential diagnosis, diagnostic procedures and treatment. At each step the expert authors......, as have new chapters including neurogenetics, neurorehabilitation, neurocritical care and heuristic neurological reasoning. In addition, this second edition now includes more than 100 unique case histories. Neurology at the Bedside, Second Edition is written for neurologists in all stages of training....... Medical students, general practitioners and others with an interest in neurology will also find invaluable information here....

  1. Differences in parental bonding between schizophrenia and bipolar disorder: Evidence of prodromal symptoms?

    Science.gov (United States)

    Gomes, Fernando Grilo; Passos, Ives C; Krolow, Ana Carla; Reckziegel, Ramiro; Vasconcelos-Moreno, Mirela Paiva; Spanemberg, Lucas; Belmonte-de-Abreu, Paulo; Kapczinski, Flávio; Kauer-Sant'Anna, Marcia

    2015-07-01

    The Parental Bonding Instrument (PBI) examines parent-child bonds and attachment during the first 16 years. Our study aims to compare PBI scores between patients with schizophrenia and bipolar disorder (BD). We analyzed PBI scores in 59 patients with schizophrenia, 36 with BD and 52 healthy controls using ANCOVA, with age, gender and years of education as covariates. Bonferroni correction was used to adjust for multiple comparisons. PBI has maternal and paternal scores, each one with two domains: care and overprotection. In PBI maternal and paternal care domains, patients with schizophrenia showed significantly higher scores when compared with BD patients (pschizophrenia only showed significantly higher scores of PBI maternal care domain (p=0.037). BD patients showed significantly lower PBI care scores compared with healthy controls (maternal score: p=0.016; paternal score: pschizophrenia (p=0.004; p=0.021) and healthy controls (p=0.014; p=0.008); while no significant difference was observed between patients with schizophrenia and healthy controls. "P values" are according to Bonferroni correction. There are significant differences in the perception of attachment between schizophrenia and BD. This finding may shed some light to better understand the prodromal symptoms of each disorder. Copyright © 2015 Elsevier B.V. All rights reserved.

  2. Serenoa repens for Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia: Current Evidence and Its Clinical Implications in Naturopathic Medicine.

    Science.gov (United States)

    Ooi, Soo Liang; Pak, Sok Cheon

    2017-08-01

    Benign prostatic hyperplasia (BPH) commonly affects men above 40 years old. The progression of BPH is often accompanied with lower urinary tract symptoms (LUTS) that can significantly affect the quality of life of the patients. Serenoa repens (saw palmetto) is a popular herbal remedy indicated for LUTS/BPH. We reviewed the current research on the efficacy of S. repens on LUTS/BPH as a monotherapy as well as combination therapies. Non-systematic searches were performed in PubMed for human studies and systematic reviews on the topic. The latest evidence, based largely on the Cochrane review, suggests that S. repens is not superior to placebo in treating LUTS/BPH as a monotherapy, even at double and triple doses. Initial clinical trials on treatment of LUTS/BPH using S. repens with lycopene and selenium, as well as S. repens with Urtica Dioica, have shown positive results. S. repens is safe in its application. However, there is a high level of heterogeneity in the quality of S. repens products. We suggest that strong placebo effect, potentially influenced by positive patients' expectation on S. repens, shapes both the clinical practice outcomes and the findings of clinical trials. Hitherto, the totality of evidence continues to suggest that S. repens is a prudent therapeutic option as part of the naturopathic treatment for LUTS/BPH. The totality of evidence includes favorable patients' response from clinical experience, impact of placebo effect, early positive studies, subjective nature of symptom reporting, pharmacological properties of S. repens, and potential synergistic effects when combined with other therapies.

  3. Avoiding Misdiagnosis in Patients with Neurological Emergencies

    Science.gov (United States)

    Pope, Jennifer V.; Edlow, Jonathan A.

    2012-01-01

    Approximately 5% of patients presenting to emergency departments have neurological symptoms. The most common symptoms or diagnoses include headache, dizziness, back pain, weakness, and seizure disorder. Little is known about the actual misdiagnosis of these patients, which can have disastrous consequences for both the patients and the physicians. This paper reviews the existing literature about the misdiagnosis of neurological emergencies and analyzes the reason behind the misdiagnosis by specific presenting complaint. Our goal is to help emergency physicians and other providers reduce diagnostic error, understand how these errors are made, and improve patient care. PMID:22888439

  4. Focal neurological deficits

    Science.gov (United States)

    ... or head Electromyogram (EMG), nerve conduction velocities (NCV) MRI of the back, neck, or head Spinal tap Alternative Names Neurological deficits - focal Images Brain References Daroff RB, Jankovic ...

  5. Evidence Report: The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Marriott, James J; Miyasaki, Janis M; Gronseth, Gary; O'Connor, Paul W

    2010-05-04

    The chemotherapeutic agent mitoxantrone was approved for use in multiple sclerosis (MS) in 2000. After a review of all the available evidence, the original report of the Therapeutics and Technology Assessment Subcommittee in 2003 concluded that mitoxantrone probably reduced clinical attack rates, MRI activity, and disease progression. Subsequent reports of decreased systolic function, heart failure, and leukemia prompted the US Food and Drug Administration to institute a "black box" warning in 2005. This review was undertaken to examine the available literature on the efficacy and safety of mitoxantrone use in patients with MS since the initial report. Relevant articles were obtained through a review of the medical literature and the strength of the available evidence was graded according to the American Academy of Neurology evidence classification scheme. The accumulated Class III and IV evidence suggests an increased incidence of systolic dysfunction and therapy-related acute leukemia (TRAL) with mitoxantrone therapy. Systolic dysfunction occurs in approximately 12% of patients with MS treated with mitoxantrone, congestive heart failure occurs in approximately 0.4%, and leukemia occurs in approximately 0.8%. The number needed to harm is 8 for systolic dysfunction and 123 for TRAL. There is no new efficacy evidence that would change the recommendation from the previous report. The risk of systolic dysfunction and leukemia in patients treated with mitoxantrone is higher than suggested at the time of the previous report, although comprehensive postmarketing surveillance data are lacking.

  6. Is neuroradiological imaging sufficient for exclusion of intracranial hypertension in children? Intracranial hypertension syndrome without evident radiological symptoms.

    Science.gov (United States)

    Larysz, Dawid; Larysz, Patrycja; Klimczak, Andrzej; Mandera, Marek

    2010-01-01

    There are still many important questions about algorithms and clinical scenarios in the context of children with clinical intracranial hypertension symptoms (IHS) without radiological findings. Such conditions could appear in different clinical situations, including slit ventricle syndrome, overdrainage syndrome, normal volume hydrocephalus, or idiopathic intracranial hypertension. Many articles have defined specific treatment strategies for various forms of IHS, including ventriculoperitoneal shunting, medication for shunt-related migraine, steroids, and valve upgrades with antisiphoning devices or programmable systems. This study is an attempt to define the proper diagnostic procedures and treatment options for patients with various forms of IHS without evident neuroradiological findings. The authors discuss possible pathological mechanisms leading to IHS in the pediatric population. The authors present six children treated in their center. All of the children presented clinical manifestation of intracranial hypertension without evident neuroradiological findings in CT and/or MRI examinations. In three cases, the final diagnosis was slit ventricle syndrome; in two cases, normal volume hydrocephalus; in another case, idiopathic intracranial hypertension. The treatment options included short-term steroid (dexamethasone) administration and ventriculoperitoneal shunting using programmable systems. In one case of idiopathic intracranial hypertension, ICP monitoring was also performed. The authors discuss possible diagnostic and treatment strategies for the aforementioned cases. There are still many controversies about management of children with clinical symptoms of intracranial hypertension that are not confirmed in neuroimaging. It seems that our understanding of intracranial hypertension in the pediatric population is not nearly as sophisticated or complete as we might have imagined. Ventriculoperitoneal shunting with antisiphoning devices and/or short

  7. [Neurologic presentation in haemolytic-uraemic syndrome].

    Science.gov (United States)

    Roche-Martínez, A; Póo, P; Maristany-Cucurella, M; Jiménez-Llort, A; Camacho, J A; Campistol, J

    Haemolytic-uraemic syndrome (HUS) is characterized by microangiopathic hemolytic anaemia, thrombopenia and multiorganic aggression, specially renal, gastrointestinal and central nervous system disturbances. Sporadic in Spain (2/1,500,000 inhabitants), its clinical onset includes acute renal failure, hypertension and central nervous system symptoms (irritability, drowsiness, convulsions, cortical blindness, hemiparesia or coma), due to metabolic distress, hypertension or central nervous system microangiopathy. Few long-term outcome studies have been published. A retrospective analysis of a series of 58 patients with HUS between 1981 and 2006, is reported. Clinical onset, laboratory, electrophysiology, neuroimaging tests, and prognosis factors are reviewed, together with long-term clinical outcome. 22 children presented neurologic symptoms, seven had some neurological test; one patient died; in five some neurological sequelae persisted (hemiparesia, cognitive deficit, visual-perception deficit), the other 16 remaining asymptomatic. Neurological morbility is high in HUS (27% of the children with neurological symptoms), with a 1.7% mortality. Seizure at onset was not a poor prognosis factor in our group. No positive correlation can be established between neuroimaging and long-term outcome.

  8. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for the Diagnosis of Patients With Positional Plagiocephaly: The Role of Imaging.

    Science.gov (United States)

    Mazzola, Catherine; Baird, Lissa C; Bauer, David F; Beier, Alexandra; Durham, Susan; Klimo, Paul; Lin, Alexander Y; McClung-Smith, Catherine; Mitchell, Laura; Nikas, Dimitrios; Tamber, Mandeep S; Tyagi, Rachana; Flannery, Ann Marie

    2016-11-01

    No evidence-based guidelines exist for the imaging of patients with positional plagiocephaly. The objective of this systematic review and evidence-based guideline is to answer the question, Is imaging necessary for infants with positional plagiocephaly to make a diagnosis? The National Library of Medicine Medline database and the Cochrane Library were queried with the use of MeSH headings and key words relevant to imaging as a means to diagnose plagiocephaly. Abstracts were reviewed, and an evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III). A total of 42 full-text articles were selected for review. Of these, 10 were eliminated; thus, 32 full-text were manuscripts selected. There was no Class I evidence, but 2 Class II and 30 Class III studies were included. Three-dimensional cranial topographical imaging, ultrasound, skull x-rays, computed tomography, and magnetic resonance imaging were investigated. Clinical examination is most often sufficient to diagnose plagiocephaly (quality, Class III; strength, Level III). Within the limits of this systematic review, the evidence suggests that imaging is rarely necessary and should be reserved for cases in which the clinical examination is equivocal. Many of the imaging studies were not designed to address the diagnostic utility of the imaging modality, and authors were actually assessing the utility of the imaging in longitudinal follow-up, not initial diagnosis. For this reason, some of the studies reviewed were downgraded in Level of Evidence. When needed, 3-dimensional cranial topographical photo, skull x-rays, or ultrasound imaging is almost always sufficient for definitive diagnosis. Computed tomography scanning should not be used to diagnose plagiocephaly, but it may be necessary to rule out craniosynostosis. The full guidelines document can be located at https://www

  9. Guidelines: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for the Diagnosis of Patients With Positional Plagiocephaly: The Role of Imaging.

    Science.gov (United States)

    Mazzola, Catherine; Baird, Lissa C; Bauer, David F; Beier, Alexandra; Durham, Susan; Klimo, Paul; Lin, Alexander Y; McClung-Smith, Catherine; Mitchell, Laura; Nikas, Dimitrios; Tamber, Mandeep S; Tyagi, Rachana; Flannery, Ann Marie

    2016-11-01

    No evidence-based guidelines exist for the imaging of patients with positional plagiocephaly. The objective of this systematic review and evidence-based guideline is to answer the question, Is imaging necessary for infants with positional plagiocephaly to make a diagnosis? The National Library of Medicine Medline database and the Cochrane Library were queried with the use of MeSH headings and key words relevant to imaging as a means to diagnose plagiocephaly. Abstracts were reviewed, and an evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III). A total of 42 full-text articles were selected for review. Of these, 10 were eliminated; thus, 32 full-text were manuscripts selected. There was no Class I evidence, but 2 Class II and 30 Class III studies were included. Three-dimensional cranial topographical imaging, ultrasound, skull x-rays, computed tomography, and magnetic resonance imaging were investigated. Clinical examination is most often sufficient to diagnose plagiocephaly (quality, Class III; strength, Level III). Within the limits of this systematic review, the evidence suggests that imaging is rarely necessary and should be reserved for cases in which the clinical examination is equivocal. Many of the imaging studies were not designed to address the diagnostic utility of the imaging modality, and authors were actually assessing the utility of the imaging in longitudinal follow-up, not initial diagnosis. For this reason, some of the studies reviewed were downgraded in Level of Evidence. When needed, 3-dimensional cranial topographical photo, skull x-rays, or ultrasound imaging is almost always sufficient for definitive diagnosis. Computed tomography scanning should not be used to diagnose plagiocephaly, but it may be necessary to rule out craniosynostosis. The full guidelines document can be located at https://www

  10. Neurological Complications of AIDS

    Science.gov (United States)

    ... the National Library of Medicine’s MedlinePlus Living with HIV/AIDS × What research is being done? The National Institute of Neurological ... the National Library of Medicine’s MedlinePlus Living with HIV/AIDS See More About Research The National Institute of Neurological Disorders and Stroke ( ...

  11. Clinimetric properties of lower limb neurological impairment tests for children and young people with a neurological condition: A systematic review

    National Research Council Canada - National Science Library

    Ramona Clark; Melissa Locke; Bridget Hill; Cherie Wells; Andrea Bialocerkowski

    2017-01-01

    .... Objective To determine the clinimetric evidence underpinning neurological impairment tests currently used in paediatric rehabilitation to evaluate muscle strength, tactile sensitivity, and deep...

  12. Atypical Neurological Manifestations Of Hypokalemia

    Directory of Open Access Journals (Sweden)

    pal P K

    2004-01-01

    Full Text Available A part from the well-established syndrome of motor paralysis, hypokalemia may present with atypical neurological manifestations, which are not well documented in literature. Methods: We treated 30 patients of hypokalemia whose neurological manifestations improved after corrections of hypokalemia. A retrospective chart review of the clinical profile was done with emphasis on the evolution of symptoms and occurrence of unusual manifestations. Results: Twenty-eight patients had subacute quadriparesis with duration of symptoms varying from 10hrs to 7 days and two had slowly progressive quadriparesis. Fifty percent of patients had more than one attack of paralysis. Early asymmetric weakness (11, stiffness and abnormal posture of hands (7, predominant bibrachial weakness (4, distal paresthesias (4, hemiparesthesia (1, hyperreflexia(4, early severe weakness of neck muscles (3, chorea (1, trismus (1,and, retention of urine (1 were the unusual features observed. The means level of serum potassium on admission was 2.1+0.6mEq/L.and the serum creatine kinase was elevated in 14 out of 17 patients. All patients except two had complete recovery.

  13. Linking genes to neurological clinical practice: the genomic basis for neurorehabilitation.

    Science.gov (United States)

    Goldberg, Allon; Curtis, Catherine L; Kleim, Jeffrey A

    2015-01-01

    Large-scale genomics projects such as the Human Genome Project and the International HapMap Project promise significant advances in the ability to diagnose and treat many conditions, including those with a neurological basis. A major focus of research has emerged in the neurological sciences to elucidate the molecular and genetic basis of various neurological diseases. Indeed, genetic factors are implicated in susceptibility for many neurological disorders, with family history studies providing strong evidence of familial risk for conditions such as stroke, Parkinson's, Alzheimer's, and Huntington's diseases. Heritability studies also suggest a strong genetic contribution to the risk for neurological diseases. Genome-wide association studies are also uncovering novel genetic variants associated with neurological disorders. Whole-genome and exome sequencing are likely to provide novel insights into the genetic basis of neurological disorders. Genetic factors are similarly associated with clinical phenotypes such as symptom severity and progression as well as response to treatment. Specifically, disease progression and functional restoration depend, in part, on the capacity for neural plasticity within residual neural tissues. Furthermore, such plasticity may be influenced in part by the presence of polymorphisms in several genes known to orchestrate neural plasticity including brain-derived neurotrophic factor (BDNF) and Apolipoprotein E. (APOE). It is important for neurorehabilitation therapist practicing in the "genomic era" to be aware of the potential influence of genetic factors during clinical encounters, as advances in molecular sciences are revealing information of critical relevance to the clinical rehabilitation management of individuals with neurological conditions. Video Abstract available (See Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A88) for more insights from the authors.

  14. Reduced positive emotion and underarousal are uniquely associated with subclinical depression symptoms: Evidence from psychophysiology, self-report, and symptom clusters.

    Science.gov (United States)

    Benning, Stephen D; Ait Oumeziane, Belel

    2017-07-01

    Multiple models of aberrant emotional processing in depression have been advanced. However, it is unclear which of these models best applies to emotional disturbances in subclinical depressive symptoms. The current study employed a battery of psychophysiological measures and emotional ratings in a picture-viewing paradigm to examine whether the underarousal, low positive emotion, heightened negative emotion, or emotion context insensitivity model of emotional dysfunction in subclinical depressive symptoms received greatest support. Postauricular reflex and skin conductance response potentiation for pleasant minus neutral pictures (measuring low positive emotion), overall skin conductance magnitude and late positive potential (LPP) amplitude (measuring underarousal), and pleasant minus aversive valence ratings (measuring emotion context insensitivity) and aversive minus neutral arousal ratings (measuring heightened negative emotionality) were all negatively related to depressive symptomatology. Of these, postauricular reflex potentiation and overall LPP amplitude were incrementally associated with depressive symptoms over the other measures. Postauricular reflex potentiation, overall skin conductance magnitude, and aversive minus neutral arousal ratings were incrementally associated with depressive symptomatology after controlling for other symptoms of internalizing disorders. Though no model was unequivocally superior, the low positive emotion and underarousal models received the most support from physiological measures and symptom reports, with self-report data matching patterns consistent with the emotion context insensitivity model. © 2017 Society for Psychophysiological Research.

  15. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: FROM THE AMERICAN PHYSICAL THERAPY ASSOCIATION NEUROLOGY SECTION.

    Science.gov (United States)

    Hall, Courtney D; Herdman, Susan J; Whitney, Susan L; Cass, Stephen P; Clendaniel, Richard A; Fife, Terry D; Furman, Joseph M; Getchius, Thomas S D; Goebel, Joel A; Shepard, Neil T; Woodhouse, Sheelah N

    2016-04-01

    Uncompensated vestibular hypofunction results in postural instability, visual blurring with head movement, and subjective complaints of dizziness and/or imbalance. We sought to answer the question, "Is vestibular exercise effective at enhancing recovery of function in people with peripheral (unilateral or bilateral) vestibular hypofunction?" A systematic review of the literature was performed in 5 databases published after 1985 and 5 additional sources for relevant publications were searched. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case control series, and case series for human subjects, published in English. One hundred thirty-five articles were identified as relevant to this clinical practice guideline. Based on strong evidence and a preponderance of benefit over harm, clinicians should offer vestibular rehabilitation to persons with unilateral and bilateral vestibular hypofunction with impairments and functional limitations related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) as specific exercises for gaze stability. Based on moderate evidence, clinicians may offer specific exercise techniques to target identified impairments or functional limitations. Based on moderate evidence and in consideration of patient preference, clinicians may provide supervised vestibular rehabilitation. Based on expert opinion extrapolated from the evidence, clinicians may prescribe a minimum of 3 times per day for the performance of gaze stability exercises as 1 component of a home exercise program. Based on expert opinion extrapolated from the evidence (range of supervised visits: 2-38 weeks, mean = 10 weeks), clinicians may consider providing adequate supervised vestibular rehabilitation sessions for the patient to understand the goals of the program

  16. Neurological manifestations of snake bite in Sri Lanka.

    OpenAIRE

    Seneviratne U; Dissanayake S

    2002-01-01

    BACKGROUND AND AIMS: Snake bite is an important cause of mortality and morbidity in certain parts of Sri Lanka. This study was designed to determine the offending snakes, neurological manifestations, disease course, and outcome in neurotoxic envenomation. METHODS AND MATERIAL: Fifty six consecutive patients admitted with neurological manifestations following snake bite were studied prospectively. Data were obtained regarding the offending snakes, neurological symptoms, time taken for onset of...

  17. Evidence-based guideline: clinical evaluation and treatment of transverse myelitis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Scott, T F; Frohman, E M; De Seze, J; Gronseth, G S; Weinshenker, B G

    2011-12-13

    To assess the evidence for diagnostic tests and therapies for transverse myelitis (TM) and make evidence-based recommendations. A review of the published literature from 1966 to March 2009 was performed, with evidence-based classification of relevant articles. Level B recommendations: neuromyelitis optica (NMO)-immunoglobulin G (IgG) antibodies should be considered useful to determine TM cause in patients presenting with clinical acute complete transverse myelitis (ACTM) features. The presence of NMO-IgG antibodies (aquaporin-4-specific antibodies) should be considered useful in determining increased TM recurrence risk. Level C recommendations: in suspected TM, distinction between ACTM or acute partial transverse myelitis may be considered useful to determine TM etiology and risk for relapse (more common with APTM). Age and gender may be considered useful to determine etiology in patients presenting with TM syndrome, with spinal infarcts seen more often in older patients and more female than male patients having TM due to multiple sclerosis (MS). Brain MRI characteristics consistent with those of MS may be considered useful to predict conversion to MS after a first partial TM episode. Longer spinal lesions extending over >3 vertebral segments may be considered useful in determining NMO vs MS. CSF examination for cells and oligoclonal bands may be considered useful to determine the cause of the TM syndrome. Plasma exchange may be considered in patients with TM who fail to improve after corticosteroid treatment. Rituximab may be considered in patients with TM due to NMO to decrease the number of relapses. Level U recommendations: there is insufficient evidence to support or refute the efficacy of other TM therapies or the usefulness of ethnicity to determine the cause of a subacute myelopathy.

  18. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for the Management of Patients With Positional Plagiocephaly: The Role of Physical Therapy.

    Science.gov (United States)

    Baird, Lissa C; Klimo, Paul; Flannery, Ann Marie; Bauer, David F; Beier, Alexandra; Durham, Susan; Lin, Alexander Y; McClung-Smith, Catherine; Mitchell, Laura; Nikas, Dimitrios; Tamber, Mandeep S; Tyagi, Rachana; Mazzola, Catherine

    2016-11-01

    Evidence-based guidelines are not currently available for the treatment of positional plagiocephaly and, in particular, for the use of physical therapy for treatment. To answer the question: "does physical therapy provide effective treatment for positional plagiocephaly?" Treatment recommendations are created based on the available evidence. The PubMed and the Cochrane Library were queried using MeSH headings and key words relevant to the objective of this systematic review. Abstracts were reviewed, after which studies meeting the inclusion criteria were selected and graded according to their quality of evidence (Classes I-III). Evidentiary tables were constructed that summarized pertinent study results, and recommendations were made based on the quality of the literature (Levels I-III). Three studies met criteria for inclusion. Two randomized, controlled trials (Class I and Class II) and 1 prospective study assessing plagiocephaly as a secondary outcome measure (Class III) were included. Within the limits of this systematic review, physical therapy is significantly more effective than repositioning education as a treatment for positional plagiocephaly. There is no significant difference between physical therapy and a positioning pillow as a treatment for positional plagiocephaly. However, given the American Academy of Pediatrics' recommendation against soft pillows in cribs to ensure a safe sleeping environment for infants, physical therapy must be recommended over the use of a positioning pillow. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_4.

  19. Guidelines: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for the Management of Patients With Positional Plagiocephaly: The Role of Physical Therapy.

    Science.gov (United States)

    Baird, Lissa C; Klimo, Paul; Flannery, Ann Marie; Bauer, David F; Beier, Alexandra; Durham, Susan; Lin, Alexander Y; McClung-Smith, Catherine; Mitchell, Laura; Nikas, Dimitrios; Tamber, Mandeep S; Tyagi, Rachana; Mazzola, Catherine

    2016-11-01

    Evidence-based guidelines are not currently available for the treatment of positional plagiocephaly and, in particular, for the use of physical therapy for treatment. To answer the question: "does physical therapy provide effective treatment for positional plagiocephaly?" Treatment recommendations are created based on the available evidence. The PubMed and the Cochrane Library were queried using MeSH headings and key words relevant to the objective of this systematic review. Abstracts were reviewed, after which studies meeting the inclusion criteria were selected and graded according to their quality of evidence (Classes I-III). Evidentiary tables were constructed that summarized pertinent study results, and recommendations were made based on the quality of the literature (Levels I-III). Three studies met criteria for inclusion. Two randomized, controlled trials (Class I and Class II) and 1 prospective study assessing plagiocephaly as a secondary outcome measure (Class III) were included. Within the limits of this systematic review, physical therapy is significantly more effective than repositioning education as a treatment for positional plagiocephaly. There is no significant difference between physical therapy and a positioning pillow as a treatment for positional plagiocephaly. However, given the American Academy of Pediatrics' recommendation against soft pillows in cribs to ensure a safe sleeping environment for infants, physical therapy must be recommended over the use of a positioning pillow. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_4.

  20. Neurologic complications of vaccinations.

    Science.gov (United States)

    Miravalle, Augusto A; Schreiner, Teri

    2014-01-01

    This chapter reviews the most common neurologic disorders associated with common vaccines, evaluates the data linking the disorder with the vaccine, and discusses the potential mechanism of disease. A literature search was conducted in PubMed using a combination of the following terms: vaccines, vaccination, immunization, and neurologic complications. Data were also gathered from publications of the American Academy of Pediatrics Committee on Infectious Diseases, the World Health Organization, the US Centers for Disease Control and Prevention, and the Vaccine Adverse Event Reporting System. Neurologic complications of vaccination are rare. Many associations have been asserted without objective data to support a causal relationship. Rarely, patients with a neurologic complication will have a poor outcome. However, most patients recover fully from the neurologic complication. Vaccinations have altered the landscape of infectious disease. However, perception of risk associated with vaccinations has limited the success of disease eradication measures. Neurologic complications can be severe, and can provoke fear in potential vaccines. Evaluating whether there is causal link between neurologic disorders and vaccinations, not just temporal association, is critical to addressing public misperception of risk of vaccination. Among the vaccines available today, the cost-benefit analysis of vaccinations and complications strongly argues in favor of vaccination. © 2014 Elsevier B.V. All rights reserved.

  1. Cardiomyopathy in neurological disorders.

    Science.gov (United States)

    Finsterer, Josef; Stöllberger, Claudia; Wahbi, Karim

    2013-01-01

    According to the American Heart Association, cardiomyopathies are classified as primary (solely or predominantly confined to heart muscle), secondary (those showing pathological myocardial involvement as part of a neuromuscular disorder) and those in which cardiomyopathy is the first/predominant manifestation of a neuromuscular disorder. Cardiomyopathies may be further classified as hypertrophic cardiomyopathy, dilated cardiomyopathy, restrictive cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, or unclassified cardiomyopathy (noncompaction, Takotsubo-cardiomyopathy). This review focuses on secondary cardiomyopathies and those in which cardiomyopathy is the predominant manifestation of a myopathy. Any of them may cause neurological disease, and any of them may be a manifestation of a neurological disorder. Neurological disease most frequently caused by cardiomyopathies is ischemic stroke, followed by transitory ischemic attack, syncope, or vertigo. Neurological disease, which most frequently manifests with cardiomyopathies are the neuromuscular disorders. Most commonly associated with cardiomyopathies are muscular dystrophies, myofibrillar myopathies, congenital myopathies and metabolic myopathies. Management of neurological disease caused by cardiomyopathies is not at variance from the same neurological disorders due to other causes. Management of secondary cardiomyopathies is not different from that of cardiomyopathies due to other causes either. Patients with neuromuscular disorders require early cardiologic investigations and close follow-ups, patients with cardiomyopathies require neurological investigation and avoidance of muscle toxic medication if a neuromuscular disorder is diagnosed. Which patients with cardiomyopathy profit most from primary stroke prevention is unsolved and requires further investigations. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. Neurological Manifestations of Dural Sinus Thrombosis | Ali | Sudan ...

    African Journals Online (AJOL)

    ... head ache, neck pain and stiffness were the frequent neurological symptoms. Papilledema was the commonest neurological finding. Saggital sinus thrombosis was found to be the major radiological finding and great majority of patients showed remarkable improvement with treatment. Conclusion: Dural sinus thrombosis ...

  3. African Journal of Neurological Sciences - 2009 Vol. 28 No 1

    African Journals Online (AJOL)

    African Journal of Neurological Sciences. 2008 - Vol. 27, No 2. SUMMARY. Description. Neurological complications during Sjögren syndrome may occur between 8.5 and 70%. Peripheral nervous system (PNS) involvement is well known but data concerning central nervous system (CNS) symptoms are more uncommon.

  4. Neurology and international organizations.

    Science.gov (United States)

    Mateen, Farrah J

    2013-07-23

    A growing number of international stakeholders are engaged with neurologic diseases. This article provides a brief overview of important international stakeholders in the practice of neurology, including global disease-specific programs, United Nations agencies, governmental agencies with international influence, nongovernmental organizations, international professional organizations, large private donors, private-public partnerships, commercial interests, armed forces, and universities and colleges. The continued engagement of neurologists is essential for the growing number of international organizations that can and should incorporate neurologic disease into their global agendas.

  5. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Management of Patients With Positional Plagiocephaly: The Role of Repositioning.

    Science.gov (United States)

    Klimo, Paul; Lingo, Patrick Ryan; Baird, Lissa C; Bauer, David F; Beier, Alexandra; Durham, Susan; Lin, Alexander Y; McClung-Smith, Catherine; Mitchell, Laura; Nikas, Dimitrios; Tamber, Mandeep S; Tyagi, Rachana; Mazzola, Catherine; Flannery, Ann Marie

    2016-11-01

    Plagiocephaly, involving positional deformity of the calvarium in infants, is one of the most common reasons for pediatric neurosurgical consultation. To answer the question: "what is the evidence for the effectiveness of repositioning for positional plagiocephaly?" Treatment recommendations are provided based on the available evidence. The National Library of Medicine MEDLINE database and the Cochrane Library were queried using MeSH headings and key words relevant to repositioning as a means to treat plagiocephaly and brachycephaly. Abstracts were reviewed to identify which studies met the inclusion criteria. An evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III). There were 3 randomized trials (Class I), 1 prospective cohort study (Class II), and 6 retrospective cohort studies (Class III). Repositioning education was found to be equal to a repositioning device and inferior to a physical therapy program. Five of the 7 cohort studies comparing repositioning with a helmet reported helmets to be better and take less time. Within the limits of this systematic review, repositioning education is effective in affording some degree of correction in virtually all infants with positional plagiocephaly or brachycephaly. Most studies suggest that a molding helmet corrects asymmetry more rapidly and to a greater degree than repositioning education. In a Class I study, repositioning education was as effective as repositioning education in conjunction with a repositioning wrap/device. Another Class I study demonstrated that a bedding pillow was superior to physical therapy for some infants. However, in keeping with the American Academy of Pediatrics' warning against the use of soft positioning pillows in the sleeping environment, the Task Force recommends physical therapy over any positioning device. The full guidelines document can be

  6. Guidelines: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Management of Patients With Positional Plagiocephaly: The Role of Repositioning.

    Science.gov (United States)

    Klimo, Paul; Lingo, Patrick Ryan; Baird, Lissa C; Bauer, David F; Beier, Alexandra; Durham, Susan; Lin, Alexander Y; McClung-Smith, Catherine; Mitchell, Laura; Nikas, Dimitrios; Tamber, Mandeep S; Tyagi, Rachana; Mazzola, Catherine; Flannery, Ann Marie

    2016-11-01

    Plagiocephaly, involving positional deformity of the calvarium in infants, is one of the most common reasons for pediatric neurosurgical consultation. To answer the question: "what is the evidence for the effectiveness of repositioning for positional plagiocephaly?" Treatment recommendations are provided based on the available evidence. The National Library of Medicine MEDLINE database and the Cochrane Library were queried using MeSH headings and key words relevant to repositioning as a means to treat plagiocephaly and brachycephaly. Abstracts were reviewed to identify which studies met the inclusion criteria. An evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III). There were 3 randomized trials (Class I), 1 prospective cohort study (Class II), and 6 retrospective cohort studies (Class III). Repositioning education was found to be equal to a repositioning device and inferior to a physical therapy program. Five of the 7 cohort studies comparing repositioning with a helmet reported helmets to be better and take less time. Within the limits of this systematic review, repositioning education is effective in affording some degree of correction in virtually all infants with positional plagiocephaly or brachycephaly. Most studies suggest that a molding helmet corrects asymmetry more rapidly and to a greater degree than repositioning education. In a Class I study, repositioning education was as effective as repositioning education in conjunction with a repositioning wrap/device. Another Class I study demonstrated that a bedding pillow was superior to physical therapy for some infants. However, in keeping with the American Academy of Pediatrics' warning against the use of soft positioning pillows in the sleeping environment, the Task Force recommends physical therapy over any positioning device. The full guidelines document can be

  7. Screening for depressive symptoms in adolescents at school: New validity evidences on the short form of the Reynolds Depression Scale.

    Science.gov (United States)

    Ortuño-Sierra, Javier; Aritio-Solana, Rebeca; Inchausti, Félix; Chocarro de Luis, Edurne; Lucas Molina, Beatriz; Pérez de Albéniz, Alicia; Fonseca-Pedrero, Eduardo

    2017-01-01

    The main purpose of the present study was to assess the depressive symptomatology and to gather new validity evidences of the Reynolds Depression Scale-Short form (RADS-SF) in a representative sample of youths. The sample consisted of 2914 adolescents with a mean age of 15.85 years (SD = 1.68). We calculated the descriptive statistics and internal consistency of the RADS-SF scores. Also, confirmatory factor analyses (CFAs) at the item level and successive multigroup CFAs to test measurement invariance, were conducted. Latent mean differences across gender and educational level groups were estimated, and finally, we studied the sources of validity evidences with other external variables. The level of internal consistency of the RADS-SF Total score by means of Ordinal alpha was .89. Results from CFAs showed that the one-dimensional model displayed appropriate goodness of-fit indices with CFI value over .95, and RMSEA value under .08. In addition, the results support the strong measurement invariance of the RADS-SF scores across gender and age. When latent means were compared, statistically significant differences were found by gender and age. Females scored 0.347 over than males in Depression latent variable, whereas older adolescents scored 0.111 higher than the younger group. In addition, the RADS-SF score was associated with the RADS scores. The results suggest that the RADS-SF could be used as an efficient screening test to assess self-reported depressive symptoms in adolescents from the general population.

  8. Neurological Manifestations of Medical Child Abuse.

    Science.gov (United States)

    Doughty, Katharine; Rood, Corey; Patel, Anup; Thackeray, Jonathan D; Brink, Farah W

    2016-01-01

    Medical child abuse occurs when a child receives unnecessary and harmful, or potentially harmful, medical care at the instigation of a caretaker through exaggeration, falsification, or induction of symptoms of illness in a child. Neurological manifestations are common with this type of maltreatment. We sought to review common reported neurological manifestations that may alert the clinician to consider medical child abuse. In addition, the possible sequelae of this form of child maltreatment is discussed, as well as practice recommendations for establishing the diagnosis and stopping the abuse once it is identified. A review of the medical literature was conducted regarding the reported neurological presentations of this entity. Neurological manifestations of medical child abuse include false reports of apparent life-threatening events and seizures and reports of induction of symptoms from poisoning. Failure to correlate objective findings with subjective complaints may lead to unnecessary and potentially harmful testing or treatment. This form of child maltreatment puts a child at significant risk of long-term morbidity and mortality. A wide variety of neurological manifestations have been reported in cases of medical child abuse. It is important for the practicing neurologist to include medical child abuse on the differential diagnosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. [Neurological manifestations in atypical Kawasaki disease].

    Science.gov (United States)

    Martínez-Guzmán, Edgar; Gámez-González, Luisa Berenise; Rivas-Larrauri, Francisco; Sorcia-Ramírez, Giovanni; Yamazaki-Nakashimada, Marco

    2017-01-01

    Kawasaki disease (KD) is a type of systemic vasculitis of unknown etiology. Atypical Kawasaki disease is defined as that where there are signs and symptoms not corresponding to the classical criteria for this nosological entity. Children with atypical Kawasaki disease may present with acute abdominal symptoms, meningeal irritation, pneumonia or renal failure. We describe 4 children with ages ranging from 2 to 12 years who had atypical Kawasaki disease, with neurological and gastrointestinal symptoms as part of the systemic presentation of the disease. Treatment consisted of immunoglobulin and corticosteroids with good evolution. KD is a systemic vasculitis that can involve many territories. Atypical manifestations can mislead the clinician and delay diagnosis. Pediatricians and sub-specialists should be aware of these neurological manifestations in order to provide adequate and opportune treatment.

  10. Neurological abnormalities predict disability

    DEFF Research Database (Denmark)

    Poggesi, Anna; Gouw, Alida; van der Flier, Wiesje

    2014-01-01

    To investigate the role of neurological abnormalities and magnetic resonance imaging (MRI) lesions in predicting global functional decline in a cohort of initially independent-living elderly subjects. The Leukoaraiosis And DISability (LADIS) Study, involving 11 European centres, was primarily aimed...... at evaluating age-related white matter changes (ARWMC) as an independent predictor of the transition to disability (according to Instrumental Activities of Daily Living scale) or death in independent elderly subjects that were followed up for 3 years. At baseline, a standardized neurological examination.......0 years, 45 % males), 327 (51.7 %) presented at the initial visit with ≥1 neurological abnormality and 242 (38 %) reached the main study outcome. Cox regression analyses, adjusting for MRI features and other determinants of functional decline, showed that the baseline presence of any neurological...

  11. Neurological diseases and pain

    OpenAIRE

    Borsook, David

    2011-01-01

    Chronic pain is a frequent component of many neurological disorders, affecting 20–40% of patients for many primary neurological diseases. These diseases result from a wide range of pathophysiologies including traumatic injury to the central nervous system, neurodegeneration and neuroinflammation, and exploring the aetiology of pain in these disorders is an opportunity to achieve new insight into pain processing. Whether pain originates in the central or peripheral nervous system, it frequentl...

  12. Wikipedia and neurological disorders.

    Science.gov (United States)

    Brigo, Francesco; Igwe, Stanley C; Nardone, Raffaele; Lochner, Piergiorgio; Tezzon, Frediano; Otte, Willem M

    2015-07-01

    Our aim was to evaluate Wikipedia page visits in relation to the most common neurological disorders by determining which factors are related to peaks in Wikipedia searches for these conditions. Millions of people worldwide use the internet daily as a source of health information. Wikipedia is a popular free online encyclopedia used by patients and physicians to search for health-related information. The following Wikipedia articles were considered: Alzheimer's disease; Amyotrophic lateral sclerosis; Dementia; Epilepsy; Epileptic seizure; Migraine; Multiple sclerosis; Parkinson's disease; Stroke; Traumatic brain injury. We analyzed information regarding the total article views for 90 days and the rank of these articles among all those available in Wikipedia. We determined the highest search volume peaks to identify possible relation with online news headlines. No relation between incidence or prevalence of neurological disorders and the search volume for the related articles was found. Seven out of 10 neurological conditions showed relations in search volume peaks and news headlines. Six out of these seven peaks were related to news about famous people suffering from neurological disorders, especially those from showbusiness. Identification of discrepancies between disease burden and health seeking behavior on Wikipedia is useful in the planning of public health campaigns. Celebrities who publicly announce their neurological diagnosis might effectively promote awareness programs, increase public knowledge and reduce stigma related to diagnoses of neurological disorders. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Cervical spinal canal narrowing and cervical neurologi-cal injuries

    Directory of Open Access Journals (Sweden)

    ZHANG Ling

    2012-04-01

    Full Text Available 【Abstract】Cervical spinal canal narrowing can lead to injury of the spinal cord and neurological symptoms in-cluding neck pain, headache, weakness and parasthesisas. According to previous and recent clinical researches, we investigated the geometric parameters of normal cervical spinal canal including the sagittal and transverse diameters as well as Torg ratio. The mean sagittal diameter of cervical spinal canal at C 1 to C 7 ranges from 15.33 mm to 20.46 mm, the mean transverse diameter at the same levels ranges from 24.45 mm to 27.00 mm and the mean value of Torg ratio is 0.96. With respect to narrow cervical spinal canal, the following charaterstics are found: firstly, extension of the cervical spine results in statistically significant stenosis as compared with the flexed or neutral positions; secondly, females sustain cervical spinal canal narrowing more easily than males; finally, the consistent narrowest cervical canal level is at C 4 for all ethnicity, but there is a slight variation in the sagittal diameter of cervical spinal stenosis (≤14 mm in Whites, ≤ 12 mm in Japanese, ≤13.7 mm in Chinese. Narrow sagittal cervical canal diameter brings about an increased risk of neurological injuries in traumatic, degenerative and inflam-matory conditions and is related with extension of cervical spine, gender, as well as ethnicity. It is hoped that this re-view will be helpful in diagnosing spinal cord and neuro-logical injuries with the geometric parameters of cervical spine in the future. Key words: Spinal cord injuries; Spinal stenosis; Trauma, nervous system

  14. Neurological manifestations of calcific aortic stenosis

    Directory of Open Access Journals (Sweden)

    I. V. Egorov

    2014-01-01

    Full Text Available Despite being thoroughly studied, senile aortic stenosis (AS remains a disease that is frequently underestimated by Russian clinicians. Meanwhile, its manifestations can not only deteriorate quality of life in patients, but can also be poor prognostic signs. The most common sequels of this disease include heart failure and severe arrhythmias. However, there may be also rare, but no less dangerous complications: enteric bleeding associated with common dysembriogenetic backgrounds, infarctions of various organs, the basis for which is spontaneous calcium embolism, and consciousness loss episodes. The latter are manifestations of cardiocerebral syndrome. Apart from syncope, embolic stroke may develop within this syndrome. There is evidence that after syncope occurs, life expectancy averages 3 years. Global practice is elaborating approaches to the intracardiac calcification prevention based on the rapid development of new pathogenetic ideas on this disease. In particular, it is clear that valvular calcification is extraskeletal leaflet ossification rather than commonplace impregnation with calcium salts, i.e. the case in point is the reverse of osteoporosis. This is the basis for a new concept of drug prevention of both calcification and the latter-induced heart disease. But the view of senile AS remains more than conservative in Russia. The paper describes a clinical case of a rare complication as cerebral calcium embolism and discusses the nature of neurological symptoms of the disease, such as vertigo and syncope.

  15. The symptom burden of cancer: Evidence for a core set of cancer-related and treatment-related symptoms from the Eastern Cooperative Oncology Group Symptom Outcomes and Practice Patterns study.

    Science.gov (United States)

    Cleeland, Charles S; Zhao, Fengmin; Chang, Victor T; Sloan, Jeff A; O'Mara, Ann M; Gilman, Paul B; Weiss, Matthias; Mendoza, Tito R; Lee, Ju-Whei; Fisch, Michael J

    2013-12-15

    A set of common cancer-related and treatment-related symptoms has been proposed for quality of care assessment and clinical research. Using data from a large, multicenter, prospective study, the authors assessed the effects of disease site and stage on the percentages of patients rating these proposed symptoms as moderate to severe. The severity of 13 symptoms proposed to represent "core" oncology symptoms was rated by 3106 ambulatory patients with cancer of the breast, prostate, colon/rectum, or lung, regardless of disease stage or phase of care; 2801 patients (90%) repeated the assessment 4 to 5 weeks later. At the time of the initial assessment, approximately 33% of the patients reported ≥ 3 symptoms in the moderate-to-severe range; 11 of the 13 symptoms were rated as moderate to severe by at least 10% of all patients and 6 were rated as moderate to severe by at least 20% of those receiving active treatment. Fatigue/tiredness was the most severe symptom, followed by disturbed sleep, pain, dry mouth, and numbness/tingling. More patients with lung cancer and patients receiving active treatment reported moderate to severe symptoms. Percentages of symptomatic patients increased by disease stage, less adequate response to therapy, and declining Eastern Cooperative Oncology Group performance status. The percentages of patients reporting moderate to severe symptoms were stable across both assessments. The results of the current study support a core set of moderate to severe symptoms that are common across outpatients with solid tumors, that can guide consideration of progression-free survival as a trial outcome, and that should be considered in clinical care and in assessments of quality of care and treatment benefit. © 2013 American Cancer Society.

  16. Do psychological treatments reduce symptoms of post-traumatic stress disorder? Evidence update - Summary of a Cochrane Review

    OpenAIRE

    Effective Health Care Research Consortium

    2008-01-01

    Trauma focused cognitive behavioural therapy (TFCBT), eye movement desensitisation and reprocessing (EMDR), stress management, and group TFCBT reduce traumatic symptoms in post-traumatic stress disorder.

  17. Neurological manifestations as the initial presentation of acute myelogenous leukemia.

    Science.gov (United States)

    Maynor, M L

    1989-09-01

    This case report illustrates neurological deficits as an unusual presentation of acute myelogenous leukemia. Neurological deficits are rare early in this disease. Our patient presented with anorexia, malaise, headache, and multiple cranial nerve palsies. A high WBC count and abnormal peripheral smear led to the diagnosis of leukemia. This report demonstrates that, although rare, CNS symptoms may be the initial manifestation of leukemia. Blood dyscrasias should not be overlooked in patients with the acute onset of neurological symptoms. A complete blood count and differential should be obtained under those circumstances.

  18. Escalation to Major Depressive Disorder among adolescents with subthreshold depressive symptoms: evidence of distinct subgroups at risk.

    Science.gov (United States)

    Hill, Ryan M; Pettit, Jeremy W; Lewinsohn, Peter M; Seeley, John R; Klein, Daniel N

    2014-04-01

    The presence of subthreshold depressive symptoms (SubD) in adolescence is associated with high prospective risk of developing Major Depressive Disorder (MDD). Little is known about variables that predict escalation from SubD to MDD. This study used a longitudinal prospective design in a community sample of adolescents to identify combinations of risk factors that predicted escalation from SubD to MDD. Classification tree analysis was used to identify combinations of risk factors that improved the sensitivity and specificity of prediction of MDD onset among 424 adolescents with a lifetime history of SubD. Of the 424, 144 developed MDD during the follow-up period. Evidence for multiple subgroups was found: among adolescents with poor friend support, the highest risk of escalation was among participants with lifetime histories of an anxiety or substance use disorder. Among adolescents with high friend support, those reporting multiple major life events in the past year or with a history of an anxiety disorder were at highest risk of escalation. Study findings may not inform prevention efforts for individuals who first develop SubD during adulthood. This study did not examine the temporal ordering of predictors involved in escalation from SubD to MDD. Adolescents with a history of SubD were at highest risk of escalation to MDD in the presence of poor friend support and an anxiety or substance use disorder, or in the presence of better friend support, multiple major life events, and an anxiety disorder. Findings may inform case identification approaches for adolescent depression prevention programs. Copyright © 2014 Elsevier B.V. All rights reserved.

  19. [Neurology and literature].

    Science.gov (United States)

    Iniesta, I

    2010-10-01

    Literature complements medical literature in the academic and clinical development of neurologists. The present article explores the contributions of writers of fiction on neurology. Literary works of fiction with particular reference to neurology. A symbiosis between writers of fiction and doctors has been well recognised. From Shakespeare to Cervantes by way of Dickens and Cela to writer - physicians such as Anton Chekhov or António Lobo Antunes have contributed through their medically informed literature to the better understanding of neurology. Some writers like Dostoevsky, Machado de Assis and Margiad Evans have written about their own experiences with disease thus bringing new insights to medicine. Furthermore, some neurological disorders have been largely based on literary descriptions. For instance, Dostoevsky's epilepsy has been retrospectively analysed by famous neurologists including Freud, Alajouanine or Gastaut, whilst his writings and biography have prompted others like Waxman and Geschwind to describe typical behavioural changes in temporal lobe epilepsy, finding their source of inspiration in Dostoevsky. Likewise, Cirignotta et al have named an unusual type of seizure after the Russian novelist. Inspired by Lewis Carroll, Todd introduced the term Alice in Wonderland Syndrome to refer to visual distortions generally associated with migraine. Writers of fiction offer a humanised perception of disease by contributing new insights into the clinical history, informing about the subjective experience of the illness and helping to eradicate the stigma associated to neurological disorders.

  20. Suicide in Neurologic Illness.

    Science.gov (United States)

    Arciniegas, David B.; Anderson, C. Alan

    2002-11-01

    The risk of attempted or completed suicide is increased in patients with migraine with aura, epilepsy, stroke, multiple sclerosis, traumatic brain injury, and Huntington's disease. Contrary to the general perception that the risk of suicide among patients with Alzheimer's disease and other dementing conditions is low, several reports suggest that the risk of suicide in these patients increases relative to the general population. Some patients at risk for neurologic disorders are also at increased risk for suicide; in particular, the risk of suicide is increased among persons at risk for Huntington's disease, independent of the presence or absence of the Huntington's gene mutation. The risk of attempted or completed suicide in neurologic illness is strongly associated with depression, feelings of hopelessness or helplessness, and social isolation. Additional suicide risk factors in persons with neurologic illness include cognitive impairment, relatively younger age (under 60 years), moderate physical disability, recent onset or change in illness, a lack of future plans or perceived meaning in life, recent losses (personal, occupational, or financial), and prior history of psychiatric illness or suicidal behavior. Substance dependence, psychotic disorders, anxiety disorders, and some personality disorders (eg, borderline personality disorder) may also contribute to increased risk of suicide among persons with neurologic illnesses. Identification and aggressive treatment of psychiatric problems, especially depression, as well as reduction of modifiable suicide risk factors among patients with neurologic illness is needed to reduce the risk of attempted and completed suicide in this population.

  1. Neurologic manifestations of achondroplasia.

    Science.gov (United States)

    Hecht, Jacqueline T; Bodensteiner, John B; Butler, Ian J

    2014-01-01

    Achondroplasia is the best described and most common form of the congenital short-limbed dwarfing conditions. Achondroplasia is apparent at birth and has a birth prevalence of 1 in 20000-30000 live-born infants. Achondroplasia is inherited as an autosomal dominant condition, although 80% of cases occur sporadically as new events in their families. Achondroplasia is caused, in virtually all of the cases, by a G380R mutation in fibroblast growth factor receptor 3 (FGFR3). Patients with achondroplasia should be evaluated by a multidisciplinary team of clinicians including geneticists, neurologists, and orthopedists, since there are numerous bony and neurological complications. The most severe complication results from craniocervical stenosis and medullary and upper spinal cord compression, which can have devastating and even lethal sequelae during early childhood. In subsequent decades, including adolescence, spinal cord and nerve compression are more prominent. The neurological complications of achondroplasia have been recognized in adults for more than a century and are attributed to bony defects, connective tissue structures, or both. Similar neurological complications are now appreciated in infants, young children, and teenagers with achondroplasia. Defective connective tissue elements in achondroplasia frequently lead to ligamentous laxity, which can aggravate the complications associated with bony stenosis. Bony abnormalities are known to cause neurological morbidity and lead to a shortened lifespan. Neurological complications associated with achondroplasia are reviewed, including recommendations for the evaluation and management of these clinical problems. © 2014 Elsevier B.V. All rights reserved.

  2. Neurological complications in hyperemesis gravidarum.

    Science.gov (United States)

    Zara, Gabriella; Codemo, Valentina; Palmieri, Arianna; Schiff, Sami; Cagnin, Annachiara; Citton, Valentina; Manara, Renzo

    2012-02-01

    Hyperemesis gravidarum can impair correct absorption of an adequate amount of thiamine and can cause electrolyte imbalance. This study investigated the neurological complications in a pregnant woman with hyperemesis gravidarum. A 29-year-old pregnant woman was admitted for hyperemesis gravidarum. Besides undernutrition, a neurological examination disclosed weakness with hyporeflexia, ophthalmoparesis, multidirectional nystagmus and optic disks swelling; the patient became rapidly comatose. Brain MRI showed symmetric signal hyperintensity and swelling of periaqueductal area, hypothalamus and mammillary bodies, medial and posterior portions of the thalamus and columns of fornix, consistent with Wernicke encephalopathy (WE). Neurophysiological studies revealed an axonal sensory-motor polyneuropathy, likely due to thiamine deficiency or critical illness polyneuropathy. Sodium and potassium supplementation and parenteral thiamine were administered with improvement of consciousness state in a few days. WE evolved in Korsakoff syndrome. A repeat MRI showed a marked improvement of WE-related alterations and a new hyperintense lesion in the pons, suggestive of central pontine myelinolysis. No sign or symptom due to involvement of the pons was present.

  3. [Post-ischemia neurologic recovery].

    Science.gov (United States)

    Guiraud-Chaumeil, Bernard; Pariente, Jérémie; Albucher, Jean-François; Loubinoux, Isabelle; Chollet, François

    2002-01-01

    Stroke is one of the most common affliction of patients with neurological symptoms. Rehabilitation of stroke patients is a difficult task. Our knowledge on rehabilitation has recently improved with the emergence of data from new neuroimaging techniques. A prospective, double blind, cross over, placebo, controlled study on 8 patients with pure motor hemiparesia, is conducted to determine the influence of a single dose of fluoxetine on motor performance and cerebral activation of patients recovering from stroke. Each patient undergoes two functional magnetic resonance imaging (fMRI) examinations, one under fluoxetine and one under placebo. A single dose of fluoxetine is enough to modulate cerebral sensori-motor activation and significantly improves motor skills of the affected side. Further studies are required to investigate the effect of chronic administration of fluoxetine on motor function.

  4. Aphasia, Just a Neurological Disorder?

    Directory of Open Access Journals (Sweden)

    Mehmet Ozdemir

    2016-02-01

    Full Text Available Hashimoto%u2019s encephalopathy (HE is a rare disorder associated with autoimmune thyroiditis. Etiology of HE is not completely understood. High levels of serum antithyroid antibodies are seen in HE. Presentation with otoimmune thyroiditis, cognitive impairment, psychiatric and neurologic symptoms and absence of bacterial or viral enfections are characteristics of HE. HE is a steroid responsive encephalopathy. 60 years old male patient admitted to hospital with forget fulness continuing for 9 months and speech loss starting 2 days ago. Strong positivity of antithyroid antibodies increases the odds for HE. Thyroid function tests showed severe hypothyroidism. Electroencephalography and magnetic resonance imaging results were compatible with HE. HE is diagnosed with differantial diagnosis and exclusion of other reasons. This uncommon disorder is not recognised enough. High titres of serum antithyroid antiboides are always needed for diagnosis. Correct diagnosis requires awareness of wide range of cognitive and clinical presentations of HE.

  5. Maternal adiposity prior to pregnancy is associated with ADHD symptoms in offspring: evidence from three prospective pregnancy cohorts

    DEFF Research Database (Denmark)

    Rodriguez, A; Miettunen, J.; Henriksen, Tine Brink

    2007-01-01

    the Nordic Network on ADHD.Methods:Maternal pregnancy and delivery data were collected prospectively. Teachers rated inattention and hyperactivity symptoms in offspring. High scores were defined as at least one core symptom rated as 'severe' and two as 'present' (approximately 10% of children scored...... in this range). Logistic regression and latent class analyses were used to examine maternal pregnancy weight in relation to children's ADHD core symptoms.Results:Teacher rated 12 556 school-aged children. Gestational weight gain outside of the Institute of Medicine guidelines was not related to ADHD symptoms...... pre-pregnancy overweight or obesity and a high ADHD symptom score in offspring, ORs ranged between 1.37 (95% CI: 1.07, 1.75) and 1.89 (95% CI: 1.13, 3.15) adjusted for gestational age, birth weight, weight gain, pregnancy smoking, maternal age, maternal education, child gender, family structure...

  6. [Neurological sleep disorders].

    Science.gov (United States)

    Khatami, Ramin

    2014-11-01

    Neurological sleep disorders are common in the general population and may have a strong impact on quality of life. General practitioners play a key role in recognizing and managing sleep disorders in the general population. They should therefore be familiar with the most important neurological sleep disorders. This review provides a comprehensive overview of the most prevalent and important neurological sleep disorders, including Restless legs syndrome (with and without periodic limb movements in sleep), narcolepsy, NREM- and REM-sleep parasomnias and the complex relationship between sleep and epilepsies. Although narcolepsy is considered as a rare disease, recent discoveries in narcolepsy research provided insight in the function of brain circuitries involved in sleep wake regulation. REM sleep behavioral parasomnia (RBD) is increasingly recognized to represent an early manifestation of neurodegenerative disorders, in particular evolving synucleinopathies. Early diagnosis may thus open new perspectives for developing novel treatment options by targeting neuroprotective substances.

  7. The relationship between parental depressive symptoms and offspring psychopathology: evidence from a children-of-twins study and an adoption study.

    Science.gov (United States)

    McAdams, T A; Rijsdijk, F V; Neiderhiser, J M; Narusyte, J; Shaw, D S; Natsuaki, M N; Spotts, E L; Ganiban, J M; Reiss, David; Leve, L D; Lichtenstein, P; Eley, T C

    2015-01-01

    Parental depressive symptoms are associated with emotional and behavioural problems in offspring. However, genetically informative studies are needed to distinguish potential causal effects from genetic confounds, and longitudinal studies are required to distinguish parent-to-child effects from child-to-parent effects. We conducted cross-sectional analyses on a sample of Swedish twins and their adolescent offspring (n = 876 twin families), and longitudinal analyses on a US sample of children adopted at birth, their adoptive parents, and their birth mothers (n = 361 adoptive families). Depressive symptoms were measured in parents, and externalizing and internalizing problems measured in offspring. Structural equation models were fitted to the data. Results of model fitting suggest that associations between parental depressive symptoms and offspring internalizing and externalizing problems remain after accounting for genes shared between parent and child. Genetic transmission was not evident in the twin study but was evident in the adoption study. In the longitudinal adoption study child-to-parent effects were evident. We interpret the results as demonstrating that associations between parental depressive symptoms and offspring emotional and behavioural problems are not solely attributable to shared genes, and that bidirectional effects may be present in intergenerational associations.

  8. Evidence for prolonged and unique amenorrhea-related symptoms in women with premature ovarian failure/primary ovarian insufficiency.

    Science.gov (United States)

    Allshouse, Amanda A; Semple, Amy L; Santoro, Nanette F

    2015-02-01

    This study aims to describe premature ovarian failure (POF)/primary ovarian insufficiency (POI) symptoms experienced by women from a non-clinic-based sample of members of a POF/POI-specific support group. Two hundred ninety women were surveyed for 6 weeks. The survey included demographics, health history, and a validated menopause-related quality-of-life questionnaire. Symptom prevalence was described. One hundred sixty (55%) women aged 18 to 63 years (mean [SD], 39.3 [7.3] y) responded. Age at diagnosis ranged from 10 to 39 years (median [interquartile range], 30 [24-35] y). Most respondents were white (87%), college educated (76%), and employed full time (61%). Among women reporting a history of depression (43%), 26% reported that depression occurred more than 5 years before POF/POI diagnosis. Of 29 commonly assessed menopausal symptoms, women reported a mean (SD) of 14.7 (7.4) symptoms; symptom scores did not substantially decrease with time since diagnosis, and relationship with age at diagnosis was negligible. Other common symptoms included mood swings and mental fog (>75%); hair loss, dry eyes, cold intolerance, and joint clicking (>50%); tingling in limbs and low blood pressure (∼33%); hypothyroidism (17%); hypoglycemia (16%); and gluten allergies (10%). Ninety unique symptoms were written in as free text. Symptom checklists created for age-appropriate postmenopausal women do not adequately capture the scope of symptoms observed in this sample. Menopausal symptoms do not seem to diminish across time in women with POF/POI, in contrast to women with age-appropriate menopause. Depression is very commonly reported in this sample, with some women clearly experiencing depression well before their diagnosis of POF/POI. Hypothyroidism in this sample is more than three times the population mean.

  9. Evidence-based guideline: diagnostic accuracy of CSF 14-3-3 protein in sporadic Creutzfeldt-Jakob disease: report of the guideline development subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Muayqil, Taim; Gronseth, Gary; Camicioli, Richard

    2012-10-02

    To assess the available evidence for the diagnostic accuracy of CSF testing for protein 14-3-3 in patients with suspected sporadic Creutzfeldt-Jakob disease (sCJD). The authors performed a systematic review of the available literature from 1995 to January 1, 2011, to identify articles involving patients who were suspected of having sCJD and who had CSF analysis for protein 14-3-3. Studies were rated according to the American Academy of Neurology classification of evidence scheme for diagnostic studies, and recommendations were linked to the strength of the evidence. A pooled estimate of sensitivity and specificity was obtained for all studies rated Class II or higher. The question asked is "Does CSF 14-3-3 protein accurately identify Creutzfeldt-Jakob disease (CJD) in patients with sCJD?" The analysis was conducted on the basis of samples of 1,849 patients with suspected sCJD from 9 Class II studies. Assays for CSF 14-3-3 protein are probably moderately accurate in diagnosing sCJD: sensitivity 92% (95% confidence interval [CI] 89.8-93.6), specificity 80% (95% CI 77.4-83.0), likelihood ratio of 4.7, and negative likelihood ratio of 0.10. For patients who have rapidly progressive dementia and are strongly suspected of having sCJD and for whom diagnosis remains uncertain (pretest probability ∼20%-90%), clinicians should order CSF 14-3-3 assays to reduce the uncertainty of the diagnosis (Level B).

  10. The neurological disease ontology.

    Science.gov (United States)

    Jensen, Mark; Cox, Alexander P; Chaudhry, Naveed; Ng, Marcus; Sule, Donat; Duncan, William; Ray, Patrick; Weinstock-Guttman, Bianca; Smith, Barry; Ruttenberg, Alan; Szigeti, Kinga; Diehl, Alexander D

    2013-12-06

    We are developing the Neurological Disease Ontology (ND) to provide a framework to enable representation of aspects of neurological diseases that are relevant to their treatment and study. ND is a representational tool that addresses the need for unambiguous annotation, storage, and retrieval of data associated with the treatment and study of neurological diseases. ND is being developed in compliance with the Open Biomedical Ontology Foundry principles and builds upon the paradigm established by the Ontology for General Medical Science (OGMS) for the representation of entities in the domain of disease and medical practice. Initial applications of ND will include the annotation and analysis of large data sets and patient records for Alzheimer's disease, multiple sclerosis, and stroke. ND is implemented in OWL 2 and currently has more than 450 terms that refer to and describe various aspects of neurological diseases. ND directly imports the development version of OGMS, which uses BFO 2. Term development in ND has primarily extended the OGMS terms 'disease', 'diagnosis', 'disease course', and 'disorder'. We have imported and utilize over 700 classes from related ontology efforts including the Foundational Model of Anatomy, Ontology for Biomedical Investigations, and Protein Ontology. ND terms are annotated with ontology metadata such as a label (term name), term editors, textual definition, definition source, curation status, and alternative terms (synonyms). Many terms have logical definitions in addition to these annotations. Current development has focused on the establishment of the upper-level structure of the ND hierarchy, as well as on the representation of Alzheimer's disease, multiple sclerosis, and stroke. The ontology is available as a version-controlled file at http://code.google.com/p/neurological-disease-ontology along with a discussion list and an issue tracker. ND seeks to provide a formal foundation for the representation of clinical and research data

  11. Neurologic Diseases and Sleep.

    Science.gov (United States)

    Barone, Daniel A; Chokroverty, Sudansu

    2017-03-01

    Sleep disorders and neurologic illness are common and burdensome in their own right; when combined, they can have tremendous negative impact at an individual level as well as societally. The socioeconomic burden of sleep disorders and neurologic illness can be identified, but the real cost of these conditions lies far beyond the financial realm. There is an urgent need for comprehensive care and support systems to help with the burden of disease. Further research in improving patient outcomes in those who suffer with these conditions will help patients and their families, and society in general. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Neurologic Complications in Pregnancy.

    Science.gov (United States)

    Cuero, Mauricio Ruiz; Varelas, Panayiotis N

    2016-01-01

    Pregnant women are subject to the same complications as the general population, as well to specific neurologic complications associated with pregnancy, such as preeclampsia or eclampsia. The hormonal and physiologic changes during pregnancy lead to altered incidences of these complications, which usually present during the late period of pregnancy, labor, or the puerperium. In addition, the treatment of these conditions is different from that of nonpregnant women, because special attention is paid to avoid any abnormalities or death of the fetus. This article discusses the most common of these neurologic complications. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. The neurology literature 2016.

    Science.gov (United States)

    Khoujah, Danya; Chang, Wan-Tsu W; Abraham, Michael K

    2017-09-06

    Emergency neurology is a complex and rapidly changing field. Its evolution can be attributed in part to increased imaging options, debates about optimal treatment, and simply the growth of emergency medicine as a specialty. Every year, a number of articles published in emergency medicine or other specialty journals should become familiar to the emergency physician. This review summarizes neurology articles published in 2016, which the authors consider crucial to the practice of emergency medicine. The articles are categorized according to disease process, with the understanding that there can be significant overlap among articles. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Drinking pattern, abstention and problem drinking as risk factors for depressive symptoms: evidence from three urban Eastern European populations.

    Science.gov (United States)

    Bell, Steven; Britton, Annie; Kubinova, Ruzena; Malyutina, Sofia; Pajak, Andrzej; Nikitin, Yuri; Bobak, Martin

    2014-01-01

    To examine whether the frequency and amount of alcohol consumed in binge drinking sessions, total annual volume of alcohol consumed, problem drinking and abstaining from alcohol are associated with depressive symptoms in Eastern Europe. Cross-sectional data from a total of 24,381 participants from general population samples of the Czech Republic (N = 7,601), Russia (N = 6,908) and Poland (N = 9,872) aged 45-69 years in 2002-2005. Depressive symptoms were defined as ≥ 16 points on the Centre for Epidemiological Studies - Depression (CES-D) scale. Several alcohol related measures were derived using responses from the graduated frequency questionnaire. Binge drinking was defined at several sex-specific thresholds (ranging from 60+ to 140+ g of ethanol) and two frequencies (at least monthly or weekly). Total annual alcohol intake in grams was also extracted. Problem drinking was defined as ≥ 2 positive answers on the CAGE questionnaire. Problem drinking was consistently associated with approximately a 2-fold increase in odds of depressive symptoms across all countries and in both sexes. Abstaining from alcohol was typically associated with increased odds of depressive symptoms. Analyses separating lifelong abstainers and former drinkers in the Russian cohort revealed that this increased odds was driven by former drinkers. Amongst men, heavy frequent binge drinking was associated with increased odds of depressive symptoms in the Czech Republic and Poland. In women, heavy infrequent binge drinking was associated with increased odds of depressive symptoms in Russia and Poland. Only in Polish men was higher annual volume of alcohol intake associated with increased odds of depressive symptoms. Abstaining from alcohol and problem drinking were associated with increased odds of depressive symptoms in these Eastern European populations. Annual volume of alcohol intake as well as frequency and amount of alcohol consumed in a binge drinking session were less consistently

  15. Intervertebral Disc Characteristic on Progressive Neurological Deficit

    Directory of Open Access Journals (Sweden)

    Farid Yudoyono

    2017-09-01

    Full Text Available Objective: To examine the intervertebral disc characteristic on magnetic resonance imaging (MRI in lumbar herniated disc (LHD patients with progressive neurological deficit. Methods: Patients were collected retrospectively from Dr. Hasan Sadikin General Hospital Database from 2011–2013 with LHD, had neurological deficit such as radiculopathy and cauda equine syndrome for less than four weeks with a positive sign confirmed by neurological examination and confirmatory with MRI examination. Results: A total of 14 patients with lumbar herniated disc disease (10 males, 4 females suffered from progressive neurological deficit with an average age of (52.07±10.9 years old. Early disc height was 9.38±0.5 mm and progressive neurological deficit state disc height was 4.03±0.53 mm, which were significantly different statisticaly (p<0.01. Symptoms of radiculopathy were seen in 11 patients and cauda equine syndrome in three patients. Modic changes grade 1 was found in five patients, grade 2 in eight patients,grade 3 in one patient, Pfirmman grade 2 in eleven patients and grade 3 in three patients. Thecal sac compression 1/3 compression was seen in four patients and 2/3 compression in ten patients. Conclusions: Neurosurgeon should raise concerns on the characteristic changes of intervertebral disc in magnetic resonance imaging examination to avoid further neural injury in lumbar herniated disc patients.

  16. Dengue: a new challenge for neurology

    Directory of Open Access Journals (Sweden)

    Marzia Puccioni-Sohler

    2012-11-01

    Full Text Available Dengue infection is a leading cause of illness and death in tropical and subtropical regions of the world. Forty percent of the world’s population currently lives in these areas. The clinical picture resulting from dengue infection can range from relatively minor to catastrophic hemorrhagic fever. Recently, reports have increased of neurological manifestations. Neuropathogenesis seems to be related to direct nervous system viral invasion, autoimmune reaction, metabolic and hemorrhagic disturbance. Neurological manifestations include encephalitis, encephalopathy, meningitis, Guillain-Barré syndrome, myelitis, acute disseminated encephalomyelitis, polyneuropathy, mononeuropathy, and cerebromeningeal hemorrhage. The development of neurological symptoms in patients with positive Immunoglobulin M (IgM dengue serology suggests a means of diagnosing the neurological complications associated with dengue. Viral antigens, specific IgM antibodies, and the intrathecal synthesis of dengue antibodies have been successfully detected in cerebrospinal fluid. However, despite diagnostic advancements, the treatment of neurological dengue is problematic. The launch of a dengue vaccine is expected to be beneficial.

  17. Neurological Disorders in Adult Celiac Disease

    Directory of Open Access Journals (Sweden)

    Hugh J Freeman

    2008-01-01

    Full Text Available Celiac disease may initially present as a neurological disorder. Alternatively, celiac disease may be complicated by neurological changes. With impaired nutrient absorption, different deficiency syndromes may occur and these may be manifested clinically with neurological changes. However, in patients with deficiency syndromes, extensive involvement of the small intestine with celiac disease is often evident. There are a number of reports of celiac disease associated with neuropathy, ataxia, dementia and seizure disorder. In these reports, there is no clear relationship with nutrient deficiency and a precise mechanism for the neurological changes has not been defined. A small number of patients have been reported to have responded to vitamin E administration, but most do not. In some, gluten antibodies have also been described, especially in those with ataxia, but a consistent response to a gluten-free diet has not been defined. Screening for celiac disease should be considered in patients with unexplained neurological disorders, including ataxia and dementia. Further studies are needed, however, to determine if a gluten-free diet will lead to improvement in the associated neurological disorder.

  18. Neurological manifestations of dengue viral infection

    Directory of Open Access Journals (Sweden)

    Carod-Artal FJ

    2014-10-01

    Full Text Available Francisco Javier Carod-Artal1,21Neurology Department, Raigmore hospital, Inverness, UK; 2Universitat Internacional de Catalunya (UIC, Barcelona, Spain Abstract: Dengue is the most common mosquito-borne viral infection worldwide. There is increased evidence for dengue virus neurotropism, and neurological manifestations could make part of the clinical picture of dengue virus infection in at least 0.5%–7.4% of symptomatic cases. Neurological complications have been classified into dengue virus encephalopathy, dengue virus encephalitis, immune-mediated syndromes (acute disseminated encephalomyelitis, myelitis, Guillain–Barré syndrome, neuritis brachialis, acute cerebellitis, and others, neuromuscular complications (hypokalemic paralysis, transient benign muscle dysfunction and myositis, and dengue-associated stroke. Common neuro-ophthalmic complications are maculopathy and retinal vasculopathy. Pathogenic mechanisms include systemic complications and metabolic disturbances resulting in encephalopathy, direct effect of the virus provoking encephalitis, and postinfectious immune mechanisms causing immune-mediated syndromes. Dengue viruses should be considered as a cause of neurological disorders in endemic regions. Standardized case definitions for specific neurological complications are still needed. Keywords: encephalitis, encephalopathy, dengue fever, neurological complications

  19. Wikipedia and neurological disorders

    NARCIS (Netherlands)

    Brigo, Francesco; Igwe, Stanley C.; Nardone, Raffaele; Lochner, Piergiorgio; Tezzon, Frediano; Otte, WM

    2015-01-01

    Our aim was to evaluate Wikipedia page visits in relation to the most common neurological disorders by determining which factors are related to peaks in Wikipedia searches for these conditions. Millions of people worldwide use the internet daily as a source of health information. Wikipedia is a

  20. Astroglia in neurological diseases

    Czech Academy of Sciences Publication Activity Database

    Verkhratsky, Alexei; Rodríguez Arellano, Jose Julio; Parpura, V.

    2013-01-01

    Roč. 8, č. 2 (2013), s. 149-158 ISSN 1479-6708 R&D Projects: GA ČR(CZ) GAP304/11/0184; GA ČR GA309/09/1696 Institutional support: RVO:68378041 Keywords : amyotrophic lateral sclerosis * Alzheimer's disease * Alexander disease Subject RIV: FH - Neurology

  1. Post-Traumatic Stress Symptoms and Post-Traumatic Growth: Evidence from a Longitudinal Study following an Earthquake Disaster.

    Science.gov (United States)

    Chen, Jieling; Zhou, Xiao; Zeng, Min; Wu, Xinchun

    2015-01-01

    The current longitudinal study aims to examine the bidirectional relationship between post-traumatic stress symptoms (PTSS) and post-traumatic growth (PTG). One hundred twenty-two adults in the most severely affected area were investigated by self-report questionnaires at 12 months and 18 months after the Wenchuan Earthquake occurred in China. The autoregressive cross-lagged structure equation analysis revealed that PTG at 12 months post-earthquake could negatively predict PTSS at 18 months post-earthquake above and beyond PTSS stability, whereas PTSS at 12 months post-earthquake could not significantly predict subsequent PTG. Moreover, PTG at 12 months post-earthquake could predict fewer subsequent intrusions, numbing and hyper-arousal symptoms but not avoidance symptoms. Growth can play a role in reducing long-term post-traumatic stress symptoms, and the implication of a positive perspective in post-trauma circumstance is discussed.

  2. Homotypic versus heterotypic continuity of anxiety symptoms in young adolescents : Evidence for distinctions between DSM-IV subtypes

    NARCIS (Netherlands)

    Ferdinand, Robert F.; Dieleman, Gwen; Ormel, Johan; Verhulst, Frank C.

    Objective: to investigate homotypic and heterotypic longitudinal patterns of symptoms of separation anxiety disorder (SAD), generalized anxiety disorder (GAD), social phobia (SoPh), panic disorder (PD), and obsessive compulsive disorder (OCD) in young adolescents from the Dutch general population.

  3. Assessment of child neurology outpatients with headache, dizziness, and fainting.

    Science.gov (United States)

    Emiroğlu, Fatma Neslihan Inal; Kurul, Semra; Akay, Aynur; Miral, Süha; Dirik, Eray

    2004-05-01

    Neurologic symptoms such as headache, vertigo, dizziness, and fainting can create a diagnostic problem in pediatric neurology practice because they are also the most common presenting symptoms of psychiatric disorders. Children, especially adolescents, who are often admitted with such autonomic symptoms, are frequently misdiagnosed. In this study, we aimed to investigate the psychiatric morbidity and comorbidity rate in children and adolescents presenting with neurologic symptoms such as headache, vertigo, and syncope. We investigated 31 children who presented with these symptoms. All children were evaluated for their medical history and had a physical and neurologic examination. We attempted to rule out a possible organic etiology. All patients received a complete laboratory examination (blood count, electroencephalography), pediatric cardiology and otorhinolaryngology consultations, and a caloric test. All patients were assessed according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria. The majority of the patients (93.5%) received a psychiatric diagnosis according to the DSM-IV criteria. Most of these patients were adolescents and female. Psychosocial stressors such as academic problems, familial dysfunction, parental psychopathology, and child sexual abuse were associated with somatic symptoms. The results of this study demonstrated the importance of differential diagnosis and psychiatric comorbidity in a pediatric neurologic outpatient population. Treatment should be directed at biopsychosocial integrity, and a multidisciplinary treatment approach should be applied.

  4. Psychiatric symptoms and response quality to self-rated personality tests: Evidence from the PsyCoLaus study.

    Science.gov (United States)

    Dupuis, Marc; Meier, Emanuele; Rudaz, Dominique; Strippoli, Marie-Pierre F; Castelao, Enrique; Preisig, Martin; Capel, Roland; Vandeleur, Caroline L

    2017-06-01

    Despite the fact that research has demonstrated consistent associations between self-rated measures of personality dimensions and mental disorders, little has been undertaken to investigate the relation between psychiatric symptoms and response patterns to self-rated tests. The aim of this study was to investigate the association between psychiatric symptoms and response quality using indices from our functional method. A sample of 1,784 participants from a Swiss population-based cohort completed a personality inventory (NEO-FFI) and a symptom checklist of 90 items (SCL-90-R). Different indices of response quality were calculated based on the responses given to the NEO-FFI. Associations among the responses to indices of response quality, sociodemographic characteristics and the SCL-90-R dimensions were then established. Psychiatric symptoms were associated with several important differences in response quality, questioning subjects' ability to provide valid information using self-rated instruments. As suggested by authors, psychiatric symptoms seem associated with differences in personality scores. Nonetheless, our study shows that symptoms are also related to differences in terms of response patterns as sources of differences in personality scores. This could constitute a bias for clinical assessment. Future studies could still determine whether certain subpopulations of subjects are more unable to provide valid information to self-rated questionnaires than others. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  5. Influence of genetic factors on toluene diisocyanate-related symptoms: evidence from a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Rannug Agneta

    2008-04-01

    Full Text Available Abstract Background Toluene diisocyanate (TDI is a highly reactive compound used in the production of, e.g., polyurethane foams and paints. TDI is known to cause respiratory symptoms and diseases. Because TDI causes symptoms in only a fraction of exposed workers, genetic factors may play a key role in disease susceptibility. Methods Workers (N = 132 exposed to TDI and a non-exposed group (N = 114 were analyzed for genotype (metabolising genes: CYP1A1*2A, CYP1A1*2B, GSTM1*O, GSTM3*B, GSTP1 I105V, GSTP1 A114V, GSTT1*O, MPO -463, NAT1*3, *4, *10, *11, *14, *15, NAT2*5, *6, *7, SULT1A1 R213H; immune-related genes: CCL5 -403, HLA-DQB1*05, TNF -308, TNF -863 and symptoms of the eyes, upper and lower airways (based on structured interviews. Results For three polymorphisms: CYP1A1*2A, CYP1A1*2B, and TNF -308 there was a pattern consistent with interaction between genotype and TDI exposure status for the majority of symptoms investigated, although it did reach statistical significance only for some symptoms: among TDI-exposed workers, the CYP1A1 variant carriers had increased risk (CYP1A1*2A and eye symptoms: variant carriers OR 2.0 95% CI 0.68–6.1, p-value for interaction 0.048; CYP1A1*2B and wheeze: IV carriers OR = 12, 1.4–110, p-value for interaction 0.057. TDI-exposed individuals with TNF-308 A were protected against the majority of symptoms, but it did not reach statistical significance. In the non-exposed group, however, TNF -308 A carriers showed higher risk of the majority of symptoms (eye symptoms: variant carriers OR = 2.8, 1.1–7.1, p-value for interaction 0.12; dry cough OR = 2.2, 0.69–7.2, p-value for interaction 0.036. Individuals with SULT1A1 213H had reduced risk both in the exposed and non-exposed groups. Other polymorphisms, showed associations to certain symptoms: among TDI-exposed,NAT1*10 carriers had a higher risk of eye symptoms and CCL5 -403 AG+AA as well as HLA-DQB1 *05 carriers displayed increased risk of symptoms of the

  6. [Joseph Babinski's contribution to neurological symptomatology].

    Science.gov (United States)

    Furukawa, Tetsuo

    2014-11-01

    Joseph Babinski (1857-1932) was an excellent clinician. André Breton, a French poet, described Babinski's way of clinical examination in his Manifeste du surréalisme (1924), which vividly revealed Babinski's meticulous character. Babinski is well known by his eponymous Babinski reflex. Although some predecessors had described this phenomenon briefly, its meaning was interpreted by Babinski. His contribution to neurological symptomatology was not restricted to his plantar skin reflex, but also to other wide area. In this article, symptoms described by Babinski, i.e. plantar skin reflex, cerebellar symptoms including cerebellar asynergy, adiadochokinesis, dysmetria, cerebellar catalepsy, and rising sign, platysma sign, anosognosia are explained and are critically discussed.

  7. Management of vertigo: from evidence to clinical practice

    Directory of Open Access Journals (Sweden)

    Paola Gnerre

    2015-05-01

    Full Text Available Vertigo is a symptom, not a diagnosis and effective diagnosis and management begin with understanding what this symptom may represent. Thus the presence of postural insility includes a differential diagnosis for otologic, neurologic and other medical causes. The objective of this paper is to provide evidence-based recommendations for the proper management of vertigo by multi-parametric analysis of the guidelines available to date.

  8. Rare Neurological Manifestation of Celiac Disease

    Directory of Open Access Journals (Sweden)

    Uzma Rani

    2015-06-01

    Full Text Available Celiac disease (CD is an immune-mediated disease characterized by permanent gastrointestinal tract sensitivity to gluten in genetically predisposed individuals. It has varied clinical manifestations, ranging from gastrointestinal to extraintestinal, including neurological, skin, reproductive and psychiatric symptoms, which makes its diagnosis difficult and challenging. Known neurological manifestations of CD include epilepsy with or without occipital calcification, attention deficit hyperactivity disorder and ataxia, headache, neuropathies and behavior disorders. We present the case of a 14-year-old female with headaches and blurred vision for 1 year; she was noted to have papilledema on ophthalmic examination with increased cerebrospinal fluid opening pressure on lumber puncture and was diagnosed as a case of pseudotumor cerebri (PTC. Meanwhile her workup for chronic constipation revealed elevated tissue transglutaminase IgA and antiendomysial IgA antibodies. Upper gastrointestinal endoscopy with duodenal biopsy confirmed the diagnosis of CD. The patient was started on a gluten-free diet, leading to resolution of not only gastrointestinal symptoms but also to almost complete resolution of symptoms of PTC. This report describes the correlation of CD and PTC as its neurological manifestation.

  9. Symptom management in patients with lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.

    Science.gov (United States)

    Simoff, Michael J; Lally, Brian; Slade, Mark G; Goldberg, Wendy G; Lee, Pyng; Michaud, Gaetane C; Wahidi, Momen M; Chawla, Mohit

    2013-05-01

    Many patients with lung cancer will develop symptoms related to their disease process or the treatment they are receiving. These symptoms can be as debilitating as the disease progression itself. To many physicians these problems can be the most difficult to manage. A detailed review of the literature using strict methodologic review of article quality was used in the development of this article. MEDLINE literature reviews, in addition to Cochrane reviews and other databases, were used for this review. The resulting article lists were then reviewed by experts in each area for quality and finally interpreted for content. We have developed recommendations for the management of many of the symptom complexes that patients with lung cancer may experience: pain, dyspnea, airway obstruction, cough, bone metastasis, brain metastasis, spinal cord metastasis, superior vena cava syndrome, hemoptysis, tracheoesophageal fistula, pleural effusions, venous thromboembolic disease, depression, fatigue, anorexia, and insomnia. Some areas, such as dyspnea, are covered in considerable detail in previously created high-quality evidence-based guidelines and are identified as excellent sources of reference. The goal of this guideline is to provide the reader recommendations based on evidence supported by scientific study. Improved understanding and recognition of cancer-related symptoms can improve management strategies, patient compliance, and quality of life for all patients with lung cancer.

  10. Neurological manifestations of atypical celiac disease in childhood.

    Science.gov (United States)

    Sel, Çiğdem Genç; Aksoy, Erhan; Aksoy, Ayşe; Yüksel, Deniz; Özbay, Ferda

    2017-09-01

    Various typical and atypical neurological manifestations can be seen as the initial symptoms of celiac disease (CD). We suggest that gluten toxicity is the most suspicious triggering risk factor for probable pathophysiological pathways of neurological involvement in atypical CD. The medical charts of 117 patients diagnosed with atypical CD were retrieved from a tertiary center in Ankara, Turkey. Eight patients reported as having neurologic manifestations as initiating symptoms were evaluated in detail. The initial neurological manifestations of CD in our study included atypical absence, which was reported first in this study, generalized tonic-clonic seizures, complex partial seizures, severe axial hypotonia and down phenotype, multifocal leukoencephalopathy, mild optic neuritis, attention deficit hyperactivity disorder, and short duration headaches. Seizures mostly emphasizing atypical absence could be the initial presentation manifestation of CD, first described in this literature. Gluten toxicity could be one of the most powerful triggering factors for developing epilepsy in CD. Learning disorders such as attention deficit hyperactivity disorder, short duration headaches, mild optic neuritis, encephalopathy, and DS could also be the initial neurological manifestations of atypical CD. A gluten-restricted diet may improve neurological complaints, epileptic discharges, and neuropsychiatric symptoms. All we found may be a small part of the full range of neurological disorders of unknown origin related to CD. Clinical suspicion should be the rule for accurate diagnosis of the disease.

  11. Neurological manifestations of systemic lupus erythematosus: role of antiphospholipid antibodies.

    Science.gov (United States)

    Golstein, M; Meyer, O; Bourgeois, P; Palazzo, E; Nicaise, P; Labarre, C; Kahn, M F

    1993-01-01

    Antiphospholipid antibodies (APL) are associated with venous and arterial thrombosis in SLE patients. Various thrombotic and non-thrombotic neurological manifestations have been reported in SLE but whether or not they are related to the presence of APL antibodies remains uncertain. To assess the possible association between neurological involvement in SLE and APL antibodies, IgG anticardiolipin antibodies (IgG ACL) were looked for using an ELISA technique in 92 consecutive SLE patients seen over a one-year period. Other APL determinations included VDRL and lupus anticoagulant (LAC) testing using APTT and the diluted thromboplastin time. Twenty-four SLE patients presented with neurological manifestations (40 episodes): 15/24 (62.5%) were found positive for APL antibodies (11 VDRL, 8 LAC, 7 ACL antibodies) versus 22/68 patients (32%) without neurological symptoms (p < 0.01). APL antibodies antedated neurological symptoms in 13/16 cases. Neurological manifestations were subsequently divided into 3 groups: thrombotic (n = 14), psychosis and convulsions (n = 15), miscellaneous (n = 10). No correlation was found between APL antibodies and any of the 3 subgroups. Among patients with neurological SLE, APL antibodies were present in two with valvular heart disease, as well as in seven with a history of either deep vein thrombosis, livedo reticularis or miscarriage. Among 7 patients with thrombocytopenia and neurological symptoms, 6 had APL antibodies. These data suggest that APL syndrome is associated with neuro-ophthalmological manifestations of SLE regardless of whether or not the mechanism of neurological involvement is thrombotic. SLE patients with APL antibodies may be at risk for future neurological manifestations. However, it is still questionable that APL positivity has definite therapeutic consequences.

  12. Complementary and Integrative Medicine for Neurologic Conditions.

    Science.gov (United States)

    Wells, Rebecca Erwin; Baute, Vanessa; Wahbeh, Helané

    2017-09-01

    Although many neurologic conditions are common, cures are rare and conventional treatments are often limited. Many patients, therefore, turn to complementary and alternative medicine (CAM). The use of selected, evidence-based CAM therapies for the prevention and treatment of migraine, carpal tunnel syndrome, and dementia are presented. Evidence is growing many of modalities, including nutrition, exercise, mind-body medicine, supplements, and acupuncture. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Role of cardiorespiratory abnormalities, smoking and dive characteristics in the manifestations of neurological decompression illness.

    Science.gov (United States)

    Wilmshurst, P; Davidson, C; O'Connell, G; Byrne, C

    1994-03-01

    1. Blind analysis of contrast echocardiograms to detect intracardiac shunts, blind analysis of lung function tests for evidence of small airways disease, smoking history and dive characteristics were examined in an attempt to explain neurological symptoms that occurred within 5 min of surfacing from unprovocative dives. 2. Pulmonary abnormalities were significantly more frequent in those divers without intracardiac shunts (50%) than in those with shunts (0%). Smoking was more common in those divers without shunts (55% versus 15%), although this just failed to reach conventional significance levels. Divers without shunts experienced cerebral rather than spinal symptoms after significantly shallower dives with lower tissue nitrogen loads. Depths of dives, tissue nitrogen loads and clinical manifestations in those divers without shunts were similar to the findings in divers who had symptoms after rapid ascents. Despite conservative dive profiles, clinical manifestations in divers with shunts resembled those observed after missed decompression stops. 3. The findings suggest that occult lung disease, and probably smoking, increase the risk of neurological symptoms, even after unprovocative dives, and the similarity of the dive profiles and clinical manifestations to cases with rapid ascents suggest that pulmonary barotrauma and arterial gas embolism are responsible. In divers with intracardiac shunts the different dive profiles and clinical manifestations imply that there is another mechanism, involving different tissue and bubble nitrogen kinetics resulting in venous gas liberation and peripheral amplification in embolized tissues, rather than paradoxical embolism per se.

  14. The neurology of proverbs.

    Science.gov (United States)

    Van Lancker, D

    1990-01-01

    Although proverb tests are commonly used in the mental status examination surprisingly little is known about either normal comprehension or the interpretation of proverbial expressions. Current proverbs tests have conceptual and linguistic shortcomings, and few studies have been done to investigate the specific effects of neurological and psychiatric disorders on the interpretation of proverbs. Although frontal lobes have traditionally been impugned in patients who are "concrete", recent studies targeting deficient comprehension of non literal language (e.g. proverbs, idioms, speech formulas, and indirect requests) point to an important role of the right hemisphere (RH). Research describing responses of psychiatrically and neurologically classified groups to tests of proverb and idiom usage is needed to clarify details of aberrant processing of nonliteral meanings. Meanwhile, the proverb test, drawing on diverse cognitive skills, is a nonspecific but sensitive probe of mental status.

  15. The Neurology of Proverbs

    Directory of Open Access Journals (Sweden)

    Diana Van Lancker

    1990-01-01

    Full Text Available Although proverb tests are commonly used in the mental status examination surprisingly little is known about either normal comprehension or the interpretation of proverbial expressions. Current proverbs tests have conceptual and linguistic shortcomings, and few studies have been done to investigate the specific effects of neurological and psychiatric disorders on the interpretation of proverbs. Although frontal lobes have traditionally been impugned in patients who are “concrete”, recent studies targeting deficient comprehension of non literal language (e.g. proverbs, idioms, speech formulas, and indirect requests point to an important role of the right hemisphere (RH. Research describing responses of psychiatrically and neurologically classified groups to tests of proverb and idiom usage is needed to clarify details of aberrant processing of nonliteral meanings. Meanwhile, the proverb test, drawing on diverse cognitive skills, is a nonspecific but sensitive probe of mental status.

  16. Vaccination and neurological disorders

    Directory of Open Access Journals (Sweden)

    Anastasia Gkampeta

    2015-12-01

    Full Text Available Active immunization of children has been proven very effective in elimination of life threatening complications of many infectious diseases in developed countries. However, as vaccination-preventable infectious diseases and their complications have become rare, the interest focuses on immunization-related adverse reactions. Unfortunately, fear of vaccination-related adverse effects can led to decreased vaccination coverage and subsequent epidemics of infectious diseases. This review includes reports about possible side effects following vaccinations in children with neurological disorders and also published recommendations about vaccinating children with neurological disorders. From all international published data anyone can conclude that vaccines are safer than ever before, but the challenge remains to convey this message to society.

  17. [Vitamin D and neurology].

    Science.gov (United States)

    Thouvenot, Éric; Camu, William

    2013-10-01

    Vitamin D deficiency is associated with a higher risk of multiple sclerosis and also with a higher relapse rate as well as a higher number of MRI lesions. Elders with vitamin D deficiency have worse cognitive performance. Vitamin D deficiency is a risk factor for developing Alzheimer's disease. Ischemic stroke are more frequent and more severe in patients with low vitamin D levels. Carotid atherosclerosis is more frequent and more severe in patients with vitamin D deficiency. Vitamin D deficiency is associated with a higher risk and worse prognosis of Parkinson's disease. In the different neurological disorders discussed herein, gene polymorphisms that could alter vitamin D metabolism are also associated with a higher incidence or a worse disease prognosis. Despite the links between vitamin D deficiency and the risks of developing neurological disorders, there is, to date, no proof that supplementation could alter the course of these diseases. Copyright © 2013. Published by Elsevier Masson SAS.

  18. Neurological legal disability

    Directory of Open Access Journals (Sweden)

    Radhakrishna H

    2006-01-01

    Full Text Available Neurological disorders with a prolonged course, either remediable or otherwise are being seen increasingly in clinical practice and many such patients are young and are part of some organization or other wherein their services are needed if they were healthy and fit. The neurologists who are on the panel of these organizations are asked to certify whether these subjects are fit to work or how long they should be given leave. These certificates may be produced in the court of law and may be subjected to verification by another neurologist or a medical board. At present there are no standard guidelines in our country to effect such certification unlike in orthopedic specialty or in ophthalmology. The following is a beginning, based on which the neurologist can certify the neurological disability of such subjects and convey the same meaning to all neurologists across the country.

  19. Stem-cell therapy for neurologic diseases

    Directory of Open Access Journals (Sweden)

    Shilpa Sharma

    2015-01-01

    Full Text Available With the advent of research on stem cell therapy for various diseases, an important need was felt in the field of neurological diseases. While congenital lesion may not be amenable to stem cell therapy completely, there is a scope of partial improvement in the lesions and halt in further progression. Neuro degenerative lesions like Parkinson′s disease, multiple sclerosis and amyotrophic lateral sclerosis have shown improvement with stem cell therapy. This article reviews the available literature and summarizes the current evidence in the various neurologic diseases amenable to stem cell therapy, the plausible mechanism of action, ethical concerns with insights into the future of stem cell therapy.

  20. Acupuncture for Small Animal Neurologic Disorders.

    Science.gov (United States)

    Roynard, Patrick; Frank, Lauren; Xie, Huisheng; Fowler, Margaret

    2018-01-01

    Modern research on traditional Chinese veterinary medicine (TCVM), including herbal medicine and acupuncture, has made evident the role of the nervous system as a cornerstone in many of the mechanisms of action of TCVM. Laboratory models and clinical research available are supportive for the use of TCVM in the management of neurologic conditions in small animals, specifically in cases of intervertebral disk disease, other myelopathies, and painful conditions. This article is meant to help guide the use of TCVM for neurologic disorders in small animals, based on available information and recommendations from experienced TCVM practitioners. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Clinical perspectives on medical marijuana (cannabis) for neurologic disorders

    OpenAIRE

    Fife, Terry D.; Moawad, Heidi; Moschonas, Constantine; Shepard, Katie; Hammond, Nancy

    2015-01-01

    The American Academy of Neurology published an evidence-based systematic review of randomized controlled trials using marijuana (Cannabis sativa) or cannabinoids in neurologic disorders. Several cannabinoids showed effectiveness or probable effectiveness for spasticity, central pain, and painful spasms in multiple sclerosis. The review justifies insurance coverage for dronabinol and nabilone for these indications. Many insurance companies already cover these medications for other indications....

  2. The influence of causal connections between symptoms on the diagnosis of mental disorders: evidence from online and offline measures.

    Science.gov (United States)

    Flores, Amanda; Cobos, Pedro L; López, Francisco J; Godoy, Antonio; González-Martín, Estrella

    2014-09-01

    An experiment conducted with students and experienced clinicians demonstrated very fast and online causal reasoning in the diagnosis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders. The experiment also demonstrated that clinicians' causal reasoning is triggered by information that is directly related to the causal structure that explains the symptoms, such as their temporal sequence. The use of causal theories was measured through explicit, verbal diagnostic judgments and through the online registration of participants' reading times of clinical reports. To detect both online and offline causal reasoning, the consistency of clinical reports was manipulated. This manipulation was made by varying the temporal order in which different symptoms developed in hypothetical clients, and by providing explicit information about causal connections between symptoms. The temporal order of symptoms affected the clinicians' but not the students' reading times. However, offline diagnostic judgments in both groups were influenced by the consistency manipulation. Overall, our results suggest that clinicians engage in fast and online causal reasoning processes when dealing with diagnostic information concerning mental disorders, and that both clinicians and students engage in causal reasoning in diagnostic judgment tasks. PsycINFO Database Record (c) 2014 APA, all rights reserved.

  3. Homotypic versus heterotypic continuity of anxiety symptoms in young adolescents: Evidence for distinctions between DSM-IV subtypes

    NARCIS (Netherlands)

    R.F. Ferdinand (Robert); G.C. Dieleman (Gwen); J. Ormel (Johan Hans); F.C. Verhulst (Frank)

    2007-01-01

    textabstractObjective: to investigate homotypic and heterotypic longitudinal patterns of symptoms of separation anxiety disorder (SAD), generalized anxiety disorder (GAD), social phobia (SoPh), panic disorder (PD), and obsessive compulsive disorder (OCD) in young adolescents from the Dutch general

  4. Homotypic versus Heterotypic Continuity of Anxiety Symptoms in Young Adolescents: Evidence for Distinctions between DSM-IV Subtypes

    Science.gov (United States)

    Ferdinand, Robert F.; Dieleman, Gwen; Ormel, Johan; Verhulst, Frank C.

    2007-01-01

    Objective: To investigate homotypic and heterotypic longitudinal patterns of symptoms of separation anxiety disorder (SAD), generalized anxiety disorder (GAD), social phobia (SoPh), panic disorder (PD), and obsessive compulsive disorder (OCD) in young adolescents from the Dutch general population. Method: 2,067 individuals (51.4% girls) from a…

  5. The Neural Basis of Reversible Sentence Comprehension: Evidence from Voxel-Based Lesion Symptom Mapping in Aphasia

    Science.gov (United States)

    Thothathiri, Malathi; Kimberg, Daniel Y.; Schwartz, Myrna F.

    2012-01-01

    We explored the neural basis of reversible sentence comprehension in a large group of aphasic patients (n = 79). Voxel-based lesion symptom mapping revealed a significant association between damage in temporo-parietal cortex and impaired sentence comprehension. This association remained after we controlled for phonological working memory. We…

  6. Neurologic Complications of Celiac Disease

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2004-06-01

    Full Text Available Patients with celiac disease (CD [n=l 11] and controls (n=211 were questioned regarding neurologic disorders, their charts were reviewed, and they received neurologic evaluations, including brain imaging or EEG if indicated, in a study of neurologic complications of CD at Carmel Medical Center, Technion-Israel Institute of Technology, Haifa, Israel.

  7. African Journal of Neurological Sciences

    African Journals Online (AJOL)

    African Journal of Neurological Sciences (AJNS) is owned and controlled by the Pan African Association of Neurological Sciences (PAANS). The AJNS's aim is to publish scientific papers of any aspects of Neurological Sciences. AJNS is published quarterly. Articles submitted exclusively to the AJNS are accepted if neither ...

  8. A protocol for a systematic review of research on managing behavioural and psychological symptoms in dementia for community-dwelling older people: evidence mapping and syntheses.

    Science.gov (United States)

    Trivedi, Daksha; Goodman, Claire; Dickinson, Angela; Gage, Heather; McLaughlin, Jennifer; Manthorpe, Jill; Ashaye, Kunle; Iliffe, Steve

    2013-08-28

    Non-cognitive behavioural and psychological symptoms of dementia affect up to 90% of people with dementia during the disease course and result in distress, increased carer burden, high service utilization and unwanted moves to care homes. Research has focused on long-term settings and has not considered people with dementia living at home and at different stages of the disease trajectory. Our aim is to review systematically the evidence concerning non-pharmacological strategies to minimise behavioural and psychological symptoms in community-dwelling older people with dementia. Our approach is a two-stage co-design: a systematic mapping of the broad evidence around behavioural and psychological symptoms followed by an in-depth systematic review of studies of non-pharmacological interventions for behavioural and psychological symptoms from the perspective of their impact on community-dwelling older people with dementia and their carers. The review will include published literature involving a wide range of electronic databases using sensitive and comprehensive searches and lateral searching including checking citations.We will produce a descriptive map of the studies by design and by the focus of interventions and apply further inclusion criteria, developed in conjunction with lay experts, to select studies for an in-depth systematic review that will include independent quality assessment and detailed data extraction by two reviewers.The review process will be integrated with stakeholder meetings and a multidisciplinary expert advisory group to guide the review parameters and shape the research questions on the management of behavioural and psychological symptoms in people with dementia. Because studies are likely to be diverse in methodology and interventions, we will conduct a narrative synthesis of the in-depth systematic review. If appropriate, we will pool studies in a meta-analysis. We will explore review findings at both stages through focus groups and

  9. Neurology check list. 5. rev. and enl. ed.; Checkliste Neurologie

    Energy Technology Data Exchange (ETDEWEB)

    Grehl, Holger [Evangelisches und Johanniter Klinikum, Duisburg (Germany). Neurologische Klinik; Reinhardt, Frank

    2013-02-01

    The neurology check list covers the following issues, organized in four parts: Grey part - diagnostic fundamentals, therapeutic principles: clinical neurological examination, liquor puncture, specific laboratory diagnostics, neurophysical diagnostics, imaging techniques, therapeutic principles, legal aspects, neurological assessment. Green Part - leading syndromes and leading symptoms. Blue part - neurological disease appearance: pains in head and face, pain syndrome, congenital and development disturbances, liquor circulation disturbances, ZNS hemorrhages, tumors and neoplasm, paraneoplastic syndromes, inflammatory diseases of the nervous system, dementia diseases, metabolic and other encephalopathy, cerebellum diseases and system surmounting processes, movement degeneration, basal ganglion diseases, epilepsy, non-epileptic attacks, medulla diseases, brain nerve diseases, plexus lesions, radicular lesions, peripheric neuropathy, neuromuscular transfer disturbances, muscular diseases. Red part: neurological intensive medicine.

  10. Educational interventions in neurology: a comprehensive systematic review.

    Science.gov (United States)

    McColgan, P; McKeown, P P; Selai, C; Doherty-Allan, R; McCarron, M O

    2013-07-01

    A fear of neurology and neural sciences (neurophobia) may have clinical consequences. There is therefore a need to formulate an evidence-based approach to neurology education. A comprehensive systematic review of educational interventions in neurology was performed. BEI, Cochrane Library, Dialog Datastar, EBSCO Biomedical, EBSCO Psychology & Behavioral Sciences, EMBASE, ERIC, First Search, MDConsult, Medline, Proquest Medical Library and Web of Knowledge databases were searched for all published studies assessing interventions in neurology education among undergraduate students, junior medical doctors and residents up to and including July 2012. Two independent literature searches were performed for relevant studies, which were then classified for level of evidence using the Centre of Evidence-based Medicine criteria and four levels of Kirkpatrick educational outcomes. One systematic review, 16 randomized controlled trials (RCTs), nine non-randomized cohort/follow-up studies, 33 case series or historically controlled studies and three mechanism-based reasoning studies were identified. Educational interventions showed favourable evaluation or assessment outcomes in 15 of 16 (94%) RCTs. Very few studies measured subsequent clinical behaviour (two studies) and patient outcomes (one study). There is very little high quality evidence of demonstrably effective neurology education. However, RCTs are emerging, albeit without meeting comprehensive educational criteria. An improving evidence base in the quality of neurology education will be important to reduce neurophobia. © 2013 The Author(s) European Journal of Neurology © 2013 EFNS.

  11. Toward Establishing a Standard Symptom Set for Assessing Sluggish Cognitive Tempo in Children: Evidence From Teacher Ratings in a Community Sample.

    Science.gov (United States)

    Becker, Stephen P; Burns, G Leonard; Schmitt, Aidan P; Epstein, Jeffery N; Tamm, Leanne

    2017-06-01

    Despite increasing interest in sluggish cognitive tempo (SCT) in children, the field is stymied by the lack of a standard symptom set that can be used across studies. Without a standard symptom set, it is difficult to determine if differences across studies are due to methodological or sample differences, or simply the way SCT was measured. To move the field toward a standard symptom set, this study evaluates a teacher-report rating scale of SCT revised based on recent meta-analytic findings that identified optimal items for distinguishing SCT from attention-deficit/hyperactivity disorder inattention (ADHD-IN). Participants were 1,349 students (50.7% male) from grades 2 to 5. Teachers provided ratings of SCT, ADHD-IN, academic impairment, and social impairment. Exploratory structural equation modeling found 15 of the 16 SCT items to demonstrate excellent convergent validity and discriminant validity with ADHD-IN. The measurement properties of the SCT construct were also invariant across sex. SCT was uniquely associated with both academic and social impairment above and beyond ADHD-IN and sex. Although replication and extension is needed, the current study provides the strongest evidence to date of a possible standard symptom set that can be used across studies examining SCT in children.

  12. Neurological disorders in children with autism

    Directory of Open Access Journals (Sweden)

    N. N. Zavadenko

    2015-01-01

    Full Text Available During a clinical examination of children with autistic spectrum disorders, attention should be drawn to both their major clinical manifestations and neurological comorbidities. The paper considers the mechanisms of autism-induced neurological disorders, the spectrum of which may include manifestations, such as retarded and disharmonic early psychomotor development; the specific features of sensory perception/processing; rigidity and monotony of motor and psychic reactions; motor disinhibition and hyperexcitability; motor stereotypies; uncoordinated movements; developmental coordination disorders (dyspraxia; impaired expressive motor skills; speech and articulation disorders; tics; epilepsy. It describes the specific features of neurological symptoms in Asperger’s syndrome, particularly in semantic-pragmatic language disorders, higher incidence rates of hyperlexia, motor and vocal tics. The incidence rate of epilepsy in autistic spectrum disorders is emphasized to be greater than the average population one. At the same time, the risk of epilepsy is higher in mentally retarded patients with autism. Identification of neurological disorders is of great importance in determining the tactics of complex care for patients with autistic spectrum disorders. 

  13. The relationship between the First World War and neurology: 100 years of "Shell Shock".

    Science.gov (United States)

    Pedroso, José Luiz; Linden, Stefanie C; Barsottini, Orlando G; Maranhão, Péricles; Lees, Andrew J

    2017-05-01

    The First World War was a global war, beginning on 28 July 1914, until 11 November 1918. Soon after the beginning of the war, there was an "epidemic" of neurological conversion symptoms. Soldiers on both sides started to present in large numbers with neurological symptoms, such as dizziness, tremor, paraplegia, tinnitus, amnesia, weakness, headache and mutism of psychosomatic origin. This condition was known as shell shock, or "war neurosis". Because medically unexplained symptoms remain a major challenge, and considering the close relationship of symptoms described in shell shock with clinical neurology, we should study their history in order to improve future care.

  14. The relationship between the First World War and neurology: 100 years of “Shell Shock”

    Directory of Open Access Journals (Sweden)

    José Luiz Pedroso

    Full Text Available ABSTRACT The First World War was a global war, beginning on 28 July 1914, until 11 November 1918. Soon after the beginning of the war, there was an “epidemic” of neurological conversion symptoms. Soldiers on both sides started to present in large numbers with neurological symptoms, such as dizziness, tremor, paraplegia, tinnitus, amnesia, weakness, headache and mutism of psychosomatic origin. This condition was known as shell shock, or “war neurosis”. Because medically unexplained symptoms remain a major challenge, and considering the close relationship of symptoms described in shell shock with clinical neurology, we should study their history in order to improve future care.

  15. Post-Traumatic Stress Symptoms and Post-Traumatic Growth: Evidence from a Longitudinal Study following an Earthquake Disaster

    OpenAIRE

    Jieling Chen; Xiao Zhou; Min Zeng; Xinchun Wu

    2015-01-01

    Objective The current longitudinal study aims to examine the bidirectional relationship between post-traumatic stress symptoms (PTSS) and post-traumatic growth (PTG). Method One hundred twenty-two adults in the most severely affected area were investigated by self-report questionnaires at 12 months and 18 months after the Wenchuan Earthquake occurred in China. Results The autoregressive cross-lagged structure equation analysis revealed that PTG at 12 months post-earthquake could negatively pr...

  16. Stem Cell Therapy in Pediatric Neurological Disorders

    Directory of Open Access Journals (Sweden)

    Farnaz Torabian

    2015-06-01

    Full Text Available Pediatric neurological disorders including muscular dystrophy, cerebral palsy, and spinal cord injury are defined as a heterogenous group of diseases, of which some are known to be genetic. The two significant features represented for stem cells, leading to distinguish them from other cell types are addressed as below: they can renew themselves besides the ability to differentiate into cells with special function as their potency. Researches about the role of stem cells in repair of damaged tissues in different organs like myocardium, lung, wound healing, and others are developing. In addition, the use of stem cells in the treatment and improving symptoms of neurological diseases such as autism are known. Many epigenetic and immunological studies on effects of stem cells have been performed. The action of stem cells in tissue repair is a need for further studies. The role of these cells in the secretion of hormones and growth factors in the niche, induction of cell division and differentiation in local cells and differentiation of stem cells in damaged tissue is the samples of effects of tissue repair by stem cells.Cognitive disorders, epilepsy, speech and language disorders, primary sensory dysfunction, and behavioral challenges are symptoms of non-neuromotor dysfunction in half of pediatrics with CP. Occupational therapy, oral medications, and orthopedic surgery for supportive and rehabilitative approaches are part of Conventional remedy for cerebral palsy. This paper summarizes the clinical world wide experience about stem cell based therapeutic procedures for pediatric neurological disorders.

  17. Stem cell therapy in pediatric neurological disorders

    Directory of Open Access Journals (Sweden)

    Farnaz Torabian

    2015-06-01

    Full Text Available Pediatric neurological disorders including muscular dystrophy, cerebral palsy, and spinal cord injury are defined as a heterogenous group of diseases, of which some are known to be genetic. The two significant features represented for stem cells, leading to distinguish them from other cell types are addressed as below: they can renew themselves besides the ability to differentiate into cells with special function as their potency. Researches about the role of stem cells in repair of damaged tissues in different organs like myocardium, lung, wound healing, and others are developing. In addition, the use of stem cells in the treatment and improving symptoms of neurological diseases such as autism are known. Many epigenetic and immunological studies on effects of stem cells have been performed. The action of stem cells in tissue repair is a need for further studies. The role of these cells in the secretion of hormones and growth factors in the niche, induction of cell division and differentiation in local cells and differentiation of stem cells in damaged tissue is the samples of effects of tissue repair by stem cells.Cognitive disorders, epilepsy, speech and language disorders, primary sensory dysfunction, and behavioral challenges are symptoms of non-neuromotor dysfunction in half of pediatrics with CP. Occupational therapy, oral medications, and orthopedic surgery for supportive and rehabilitative approaches are part of Conventional remedy for cerebral palsy. This paper summarizes the clinical world wide experience about stem cell based therapeutic procedures for pediatric neurological disorders.

  18. [Neurologic manifestations in pediatric patients with AIDS].

    Science.gov (United States)

    Samudio-Domínguez, G; Dávila, G; Martínez-Aguilar, G; Santos-Preciado, J I

    1992-09-01

    Since the first cases of childhood AIDS were reported, the neurological involvement has been more frequently recognized. Several motor, intellectual and conductual changes as well as unexplained abnormalities have been described due to CNS infections. Findings have shown HIV to affect the CNS although it is unknown as to when the viral invasion actually occurs. This report describes the neurological manifestations found in pediatric patients with HIV infection at the Hospital Infantil de Mexico and their correlations with CT scans, EEGs, auditory evoked potentials, I.Q.s and postmortem findings. The medical records of 60 symptomatic HIV infected children, stages P0 to P2, are reviewed. Neurological abnormalities were found in 51 patients, 20 of which (39.2%) were due to perinatal infection with symptoms starting, on the average at 11 months 7 days (from the initial contact) taking into consideration in utero exposure. Nine cases (17.6%) were patients infected through transfusions with symptoms appearing on the average at 24 months 8 days; 2 cases (3.9%) were of unknown origin. The CT scans, EEGs and psychometric evaluations of the HIV infected patients correlated well with the clinical findings.

  19. Child Anxiety Symptoms Related to Longitudinal Cortisol Trajectories and Acute Stress Responses: Evidence of Developmental Stress Sensitization

    Science.gov (United States)

    Laurent, Heidemarie K.; Gilliam, Kathryn S.; Wright, Dorianne B.; Fisher, Philip A.

    2015-01-01

    Cross-sectional research suggests that individuals at risk for internalizing disorders show differential activation levels and/or dynamics of stress-sensitive physiological systems, possibly reflecting a process of stress sensitization. However, there is little longitudinal research to clarify how the development of these systems over time relates to activation during acute stress, and how aspects of such activation map onto internalizing symptoms. We investigated children’s (n=107) diurnal hypothalamic-pituitary-adrenal activity via salivary cortisol (morning and evening levels) across 29 assessments spanning 6+ years, and related longitudinal patterns to acute stress responses at the end of this period (age 9–10). Associations with child psychiatric symptoms at age 10 were also examined to determine internalizing risk profiles. Increasing morning cortisol levels across assessments predicted less of a cortisol decline following interpersonal stress at age 9, and higher cortisol levels during performance stress at age 10. These same profiles of high and/or sustained cortisol elevation during psychosocial stress were associated with child anxiety symptoms. Results suggest developmental sensitization to stress—reflected in rising morning cortisol and eventual hyperactivation during acute stress exposure—may distinguish children at risk for internalizing disorders. PMID:25688433

  20. Child anxiety symptoms related to longitudinal cortisol trajectories and acute stress responses: evidence of developmental stress sensitization.

    Science.gov (United States)

    Laurent, Heidemarie K; Gilliam, Kathryn S; Wright, Dorianne B; Fisher, Philip A

    2015-02-01

    Cross-sectional research suggests that individuals at risk for internalizing disorders show differential activation levels and/or dynamics of stress-sensitive physiological systems, possibly reflecting a process of stress sensitization. However, there is little longitudinal research to clarify how the development of these systems over time relates to activation during acute stress, and how aspects of such activation map onto internalizing symptoms. We investigated children's (n = 107) diurnal hypothalamic-pituitary-adrenal activity via salivary cortisol (morning and evening levels) across 29 assessments spanning 6+ years, and related longitudinal patterns to acute stress responses at the end of this period (age 9-10). Associations with child psychiatric symptoms at age 10 were also examined to determine internalizing risk profiles. Increasing morning cortisol levels across assessments predicted less of a cortisol decline following interpersonal stress at age 9, and higher cortisol levels during performance stress at age 10. These same profiles of high and/or sustained cortisol elevation during psychosocial stress were associated with child anxiety symptoms. Results suggest developmental sensitization to stress-reflected in rising morning cortisol and eventual hyperactivation during acute stress exposure-may distinguish children at risk for internalizing disorders. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  1. Neurological manifestations of cardiac myxoma: experience in a referral hospital.

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    Pérez Andreu, J; Parrilla, G; Arribas, J M; García-Villalba, B; Lucas, J J; Garcia Navarro, M; Marín, F; Gutierrez, F; Moreno, A

    2013-01-01

    Cardiac myxoma is an important but uncommon cause of stroke in younger patients. Few published case series analyse the frequency and clinical presentation of neurological complications in patients with myxoma. To list all neurological complications from cardiac myxoma recorded in our hospital in the past 28 years. We retrospectively reviewed the neurological manifestations of cardiac myxoma in patients treated in our hospital between December 1983 and March 2012. Of the 36 patients with cardiac myxoma, 8 (22%) presented neurological manifestations. Half were women and mean age of patients was 52.4 ± 11.6 years. Sudden-onset hemiparesis was the most frequent neurological symptom (63%). Established ischaemic stroke was the most common clinical manifestation (75%), followed by transient ischemic attack. The most commonly affected territory corresponded to the middle cerebral artery. Myxoma was diagnosed by echocardiography in all cases. Mean myxoma size was 4.1cm and most of the tumours (63%) had a polypoid surface. All tumours were successfully removed by surgery. There were no in-hospital deaths. Cardiac myxomas frequently present with neurological symptoms, especially ischaemic events (established stroke or transient ischaemic attack), in younger patients with no cardiovascular risk factors. The anterior circulation is more frequently affected, especially the middle cerebral artery. Echocardiography can facilitate prompt diagnosis and early treatment of the lesion. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  2. Neurological Respiratory Failure

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    Mohan Rudrappa

    2018-01-01

    Full Text Available West Nile virus infection in humans is mostly asymptomatic. Less than 1% of neuro-invasive cases show a fatality rate of around 10%. Acute flaccid paralysis of respiratory muscles leading to respiratory failure is the most common cause of death. Although the peripheral nervous system can be involved, isolated phrenic nerve palsy leading to respiratory failure is rare and described in only two cases in the English literature. We present another case of neurological respiratory failure due to West Nile virus-induced phrenic nerve palsy. Our case reiterates the rare, but lethal, consequences of West Nile virus infection, and the increase of its awareness among physicians.

  3. Neurological complications of chickenpox

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    Girija A

    2007-01-01

    Full Text Available Aim: To assess the neurological complications of chickenpox with prognosis. Background: The neurological complications occur in 0.03% of persons who get chickenpox. There is no universal vaccination against chicken pox in India. Most patients prefer alternate modalities of treatment. Hence these complications of chickenpox are likely to continue to occur. Study Design: A prospective study was conducted for 2 years (from March 2002 on the admitted cases with neurological complications after chickenpox (with rash or scar. Patients were investigated with CT/MRI, CSF study, EEG and nerve conduction studies and hematological workup. They were followed-up for 1 year and outcome assessed using modified Rankin scale. Results: The latency for the neurological complications was 4-32 days (mean: 16.32 days. There were 18 cases: 10 adults (64% and 8 children (36%. Cerebellar ataxia (normal CT/MRI was observed in 7 cases (32% (mean age: 6.85 years. One patient (6 years had acute right hemiparesis in the fifth week due to left capsular infarct. All these cases spontaneously recovered by 4 weeks. The age range of the adult patients was 13-47 years (mean: 27 years. The manifestations included cerebellar and pyramidal signs (n-4 with features of demyelination in MRI who recovered spontaneously or with methylprednisolone by 8 weeks. Patient with encephalitis recovered in 2 weeks with acyclovir. Guillain Barre syndrome of the demyelinating type (n-2 was treated with Intravenous immunoglobulin (IVIG and they had a slow recovery by a modified Rankin scale (mRs score of 3 and 2 at 6 months and 1 year, respectively. One case died after hemorrhage into the occipital infarct. There were two cases of asymmetrical neuropathy, one each of the seventh cranial and brachial neuritis. Conclusion: Spontaneous recovery occurs in post-chickenpox cerebellar ataxia. Rarely, serious complications can occur in adults. The demyelinating disorders, either of the central or peripheral

  4. Education Research: Neurology resident education

    Science.gov (United States)

    Mayans, David; Schneider, Logan; Adams, Nellie; Khawaja, Ayaz M.; Engstrom, John

    2016-01-01

    Objective: To survey US-trained graduating neurology residents who are American Academy of Neurology members, in an effort to trend perceived quality and completeness of graduate neurology education. Methods: An electronic survey was sent to all American Academy of Neurology members graduating from US neurology residency programs in the Spring of 2014. Results: Of 805 eligible respondents, 24% completed the survey. Ninety-three percent of adult neurology residents and 56% of child neurology residents reported plans to pursue fellowship training after residency. Respondents reported a desire for additional training in neurocritical care, neuro-oncology, neuromuscular diseases, botulinum toxin injection, and nerve blocks. There remains a clear deficit in business training of neurology residents, although there was notable improvement in knowledge of coding and office management compared to previous surveys. Discussion: Although there are still areas of perceived weakness in neurology training, graduating neurology residents feel generally well prepared for their chosen careers. However, most still pursue fellowship training for reasons that are little understood. In addition to certain subspecialties and procedures, practice management remains deficient in neurology training and is a point of future insecurity for most residents. Future curriculum changes should consider resident-reported gaps in knowledge, with careful consideration of improving business training. PMID:26976522

  5. Neurological aspects of grief.

    Science.gov (United States)

    Silva, Adriana C; de Oliveira Ribeiro, Natalia P; de Mello Schier, Alexandre R; Arias-Carrión, Oscar; Paes, Flavia; Nardi, Antonio E; Machado, Sergio; Pessoa, Tamires M

    2014-01-01

    Despite grief being a universal experience and the increased scientific attention paid to grief and bereavement in recent years, studies that seek to better understand the role of the neurological aspects of grief are still scarce. We found 5 studies that discussed the relationship between the neurological aspects of grief due to the death of a loved one. All studies showed an activation of common areas, i.e., the anterior cingulate cortex (ACC), posterior cingulate cortex (PCC), prefrontal cortex (PFC), insula and amygdala. These findings could indicate that there is a group of areas working together and responding to generate the symptomatology of grief. Because grief is a universal experience, it is essential that the necessary and effective support can be provided to those who experience the loss of someone considered important in their lives, and this requires understanding grief's manifestation, its differential diagnosis in reference to other clinical conditions, mainly psychiatric ones, and adequate forms of intervention and treatment when necessary. Proper understanding and support can help prevent the emergence of more serious health problems.

  6. Perceived factors influencing nurses' use of evidence-informed protocols for remote cancer treatment-related symptom management: A mixed methods study.

    Science.gov (United States)

    Stacey, Dawn; Carley, Meg; Ballantyne, Barbara; Skrutkowski, Myriam; Whynot, Angela

    2015-06-01

    To assess factors perceived to influence nurses' use of symptom protocols when providing remote management for oncology patients. A mixed methods descriptive study was guided by the Knowledge-to-Action Framework. In 2013, 8 focus groups and 7 interviews were conducted with 49 nurses or patients/family members in three ambulatory oncology programs within different provincial healthcare systems. Role-play with a protocol was used during nurse focus groups/interviews. Nurses who provided remote symptom support received a survey. Data was triangulated using thematic analysis guided by the Ottawa Model of Research Use. Over 90% of nurses provide telephone support during regular hours only. These symptom protocols were being used by 14% of nurses at one program. Nurses rated the protocols positively for content and format (>85%) but 20% indicated too complex. Protocol facilitators were systematic approach, comprehensive, and evidence-based. Protocol barriers were too long, not for symptom clusters, and inadequate space for documenting. To facilitate use, nurses need to enhance their knowledge (73%) and skills (58%), get access to resources, and obtain performance feedback. Nurse barriers included the learning curve, being unaware of protocols, and feeling tied to a script. Organizational barriers were communication challenges with patients, lack of electronic charting, and no clear direction to use them (54%). Several barriers and facilitators were perceived to influence the use of symptom protocols. Nurses and patients/family members identified similar factors. Interventions are needed to overcome barriers to nurses using the protocols such as education, clear organizational mandate, and integration with documentation. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  7. Gluten sensitivity and neurological manifestations

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    Agostino Berio

    2015-12-01

    Full Text Available The authors report on six cases of gluten-sensitivity, also defined non-celiac gluten sensitivity, characterized by abdominal features (diarrhea, bloating, pain, genetic positivity for predisposition to celiac disease (DQB1* 02 in all cases; DQA1*05 in three; DQA1*02 in two, DQB1*03 in two, negative anti-t-Transglutaminase antibodies, normal mucosa on biopsy in four cases, type 1 of Marsh in one case. The subjects presented frequent central nervous system (CNS symptoms: headache in three patients, somnolence in one, electroencephalogram aspecific alterations in three (in two of them with previous seizures, leptomeningeal cyst in one, intracranial calcification in one, cerebral gliosis in two. After a gluten-free diet, all intestinal and clinical CNS features remitted, but re-appeared after gluten reintroduction. On the basis of the neurological signs, the authors stress the relevance of immune innate system in the pathogenesis of these cases with possible subsequent evolution on immune adaptive system involvement.

  8. Hashimoto encephalopathy: Neurological and psychiatric perspective

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    Pavlović D.M.

    2009-01-01

    Full Text Available Hashimoto encephalopathy (HE is an autoimmune disease with neurological and neuropsychiatric manifestations and elevated titers of antithyroid antibodies in serum and cerebrospinal fluid. Patients are mostly women. Age varies from 8 to 86 years. Prevalence of HE is estimated to be 2.1/100,000. Neurological and/or psychiatric symptoms and signs constitute the clinical picture. The disease responds well to corticosteroid therapy, but sometimes other immunomodulatory therapies must be applied. Autoimmune mechanisms with antibodies against antigens in the brain cortex are suspected. The course of the disease can be acute, subacute, chronic, or relapsing/remitting. Some patients improve spontaneously, but a few died in spite of adequate therapy.

  9. Neurological manifestations of Chikungunya and Zika infections

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    Talys J. Pinheiro

    Full Text Available ABSTRACT The epidemics of Chikungunya virus (CHIKV and Zika virus (ZIKV infections have been considered the most important epidemiological occurrences in the Americas. The clinical picture of CHIKV infection is characterized by high fever, exanthema, myalgia, headaches, and arthralgia. Besides the typical clinical picture of CHIKV, atypical manifestations of neurological complications have been reported: meningo-encephalitis, meningoencephalo-myeloradiculitis, myeloradiculitis, myelitis, myeloneuropathy, Guillain-Barré syndrome and others. The diagnosis is based on clinical, epidemiological, and laboratory criteria. The most common symptoms of ZIKV infection are skin rash (mostly maculopapular, fever, arthralgia, myalgia, headache, and conjunctivitis. Some epidemics that have recently occurred in French Polynesia and Brazil, reported the most severe conditions, with involvement of the nervous system (Guillain-Barré syndrome, transverse myelitis, microcephaly and meningitis. The treatment for ZIKV and CHIKV infections are symptomatic and the management for neurological complications depends on the type of affliction. Intravenous immunoglobulin, plasmapheresis, and corticosteroid pulse therapy are options.

  10. Explanations for female excess psychosomatic symptoms in adolescence: evidence from a school-based cohort in the West of Scotland

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    West Patrick B

    2007-10-01

    Full Text Available Abstract Background By mid adolescence there is an excess in female physical and/or psychosomatic, as well as psychological morbidity. This paper examines the contribution of a range of factors (self-esteem, body image, gender-role orientation, body mass index, smoking and physical activity to explaining the female excess in three psychosomatic symptoms (headaches, stomach ache/sickness, and dizziness and depressive mood at age 15. Methods A cohort of 2,196 school pupils (analyses restricted to 2,005 with complete data surveyed at age 15. All measures were obtained via self-completion questionnaires, apart from body mass index, derived from measured height and weight. Analyses examined (a sex differences in each potential explanatory factor; (b their associations with the health measures; (c the effect of adjustment for these factors on sex differences in the health measures; and (d the existence of interactive effects between sex and the explanatory factors on the health measures Results Each potential explanatory factor was significantly differentiated by sex. Self-esteem, body image (represented by weight-related worries, smoking and physical activity were related to the health measures. These factors accounted for one third of the female excess in headaches and stomach problems, half the excess in dizziness and almost all that in respect of depressive mood. Self-esteem and body image were the factors most consistently related to health, and adjustment for these resulted in the largest reductions in the odds of a female excess in both the psychosomatic symptoms and depressive mood. Conclusion Adjustment for a range of potential psychosocial and behavioural factors largely explains (statistically excess female depressive mood. These factors also partially explain the female excess in certain psychosomatic symptoms.

  11. [Paraneoplastic neurological syndrome--definition and history].

    Science.gov (United States)

    Inuzuka, Takashi

    2010-04-01

    Paraneoplastic neurological syndrome (PNS) may affect any part of the nervous system and muscles. PNS is a rare disorder caused by the remote effects of cancer and is considered to be immune-mediated. Since the 1980s, several specific onco-neural antibodies and T-cell responses against onco-neural molecules have been reported, as shown in the historical review in this article. Immunoresponses to cancer are considered to cross-react with self-antigens in the nervous system or muscle. The presence of such onco-neural antibodies is a useful diagnostic marker for PNS and occult cancer. Despite sustained efforts to elucidate the effects of such antibodies on neuron, only a few onco-neural antibodies have been identified as primary effectors of neurological symptoms. However the absence of these antibodies does not exclude a PNS. In some instances, these antibodies can be detected in cancer patients without PNS. PNS diagnosis requires excluding many other complications of cancer and mimics of other neurological diseases as differential diagnoses. Recently, an international panel of experts provided useful diagnostic criteria for PNS. These criteria are based on well-characterized onco-neural antibodies and specific neurological syndromes. Probable cases of PNS are strongly advised to undergo early antitumor therapy and immunotherapy to prevent progressive neuronal death. As the symptoms of PNS often appear before the diagnosis of malignant cancer, repeated searches for occult cancer are recommended, if the tumor has not yet been found. Further studies are required to clarify the exact mechanisms underlying neuronal damage in PNS, which may lead to the development of more rational therapies and greater understanding of immunology in the nervous system.

  12. Disruptive technology disorder: A past, present, and future neurologic syndrome.

    Science.gov (United States)

    Weaver, Donald F

    2017-07-25

    Based upon an analysis of 6 major historical technological advances over the last 150 years, a new syndrome, disruptive technology disorder (DTD), is introduced. DTD describes the human health ailments that accompany the implementation of disruptive technologies. Elevator sickness, railway spine, and bicycle face are representative examples. Though the underlying causative disruptive technologies may differ, many neurologic symptoms (headache, dizziness, weakness) are common to multiple DTDs. Born of technology-driven societal change, DTDs manifest as a complex interplay between biological and psychological symptoms. © 2017 American Academy of Neurology.

  13. Cognitive style and depressive symptoms in elderly people - extending the empirical evidence for the cognitive vulnerability-stress hypothesis.

    Science.gov (United States)

    Meyer, Thomas D; Gudgeon, Emma; Thomas, Alan J; Collerton, Daniel

    2010-10-01

    Depression is common in older people and its identification and treatment has been highlighted as one of the major challenges in an ageing world. Poor physical and cognitive health, bereavement, and prior depression are important risk factors for depression in elderly people. Attributional or cognitive style has been identified as a risk factor for depression in children, adolescents and younger adults but its relevance for depression and mood in elderly people has not been investigated in the context of other risk factors. Sixty-four older adults from an 'extra care' living scheme (aged 59-97) were recruited for a 6-week prospective study to examine the relationships between cognitive style and depressive symptoms. Regression analyses revealed that, when other risk factors were controlled for, cognitive style and its interaction with stress predicted changes in depressive symptoms, therefore partially replicating prior research. Cognitive-stress-vulnerability models also apply to elderly populations, but may be rather predictive of changes in depression when facing lower levels of stress. Copyright 2010 Elsevier Ltd. All rights reserved.

  14. Dermatology referrals in a neurological set up

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    Deeptara Pathak Thapa

    2014-07-01

    Full Text Available Introduction: Dermatology is a specialty, which not only deals with dermatological problems with outpatient but also inpatients referrals. The importances of Dermatologist in hospital setting are rising due to changing condition of medical care. Since no peer-reviewed articles are available for dermatological problems in a neurological set up, we conducted this study to know about pattern of skin disorders in neurological patients. Material and Methods: The present study was a prospective study in a neurological setup, which included data from hospital dermatology consultation request forms over a period of one year. The data included demographic profile of the patient investigation where needed, neurological diagnosis and final dermatological diagnosis. The data was analyzed using SPSS. Results: A total of 285 patients who were requested for consultation were included in the study. Face was the commonest site of involvement (19.6%. Laboratory examination of referred patients revealed abnormal blood counts in 2% cases, renal function tests in 0.7% and urine in 0.4% cases. CT scan showed abnormal findings in 65.6% patients. The most common drug used in these patients was phenytoin (29.1%. The most common dermatological diagnosis was Infection and Infestation (34.7% followed by eczema (46.6%. Drug rash was seen in 3.9% cases. Out of which one had phenytoin induced Steven Johnson syndrome. Skin biopsy was done in 5 patients. Topicals was advised in 80%. Upon discharge 10% of inpatients didn’t require any follow-up. The patients who were followed up after 4 weeks, about 48% had their symptoms resolved with topicals and oral treatment as required. About 38% required more than two follow ups due to chronic course of the diseases. Conclusions: This present study discussed about various manifestations of skin disorders in a neurological set up and emphasizes the role of dermatologist in treating skin problems both in outpatient as well as inpatient

  15. Toward a Neurology of Loneliness

    Science.gov (United States)

    Cacioppo, Stephanie; Capitanio, John P.; Cacioppo, John T.

    2016-01-01

    Social isolation has been recognized as a major risk factor for morbidity and mortality in humans for more than a quarter century. The brain is the key organ of social connections and processes, however, and the same objective social relationship can be experienced as caring and protective or as exploitive and isolating. We review evidence that the perception of social isolation (i.e., loneliness) impacts brain and behavior and is a risk factor for broad-based morbidity and mortality. However, the causal role of loneliness on neural mechanisms and mortality is difficult to test conclusively in humans. Mechanistic animal studies provide a lens through which to evaluate the neurological effects of a member of a social species living chronically on the social perimeter. Experimental studies show that social isolation produces significant changes in brain structures and processes in adult social animals. These effects are not uniform across the brain or across species but instead are most evident in brain regions that reflect differences in the functional demands of solitary versus social living for a particular species. The human and animal literatures have developed independently, however, and significant gaps also exist. The current review underscores the importance of integrating human and animal research to delineate the mechanisms through which social relationships impact the brain, health, and well-being. PMID:25222636

  16. Primary care perceptions of neurology and neurology services.

    Science.gov (United States)

    Loftus, Angela M; Wade, Carrie; McCarron, Mark O

    2016-06-01

    Neurophobia (fear of neural sciences) and evaluation of independent sector contracts in neurology have seldom been examined among general practitioners (GPs). A questionnaire determined GPs' perceptions of neurology compared with other medical specialties. GP experiences of neurology services with independent sector companies and the local National Health Service (NHS) were compared. Areas of potential improvement in NHS neurology services were recorded from thematic analyses. Among 76 GPs neurology was perceived to be as interesting as other medical specialties. GPs reported less knowledge, more difficulty and less confidence in neurology compared with other medical specialties. There was a preference for a local NHS neurology service (pneurology services provided better patient satisfaction. GPs prefer local NHS neurology services to independent sector contracts. GPs' evaluations should inform commissioning of neurology services. Combating neurophobia should be an integral part of responsive commissioning. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  17. Music-based interventions in neurological rehabilitation.

    Science.gov (United States)

    Sihvonen, Aleksi J; Särkämö, Teppo; Leo, Vera; Tervaniemi, Mari; Altenmüller, Eckart; Soinila, Seppo

    2017-08-01

    During the past ten years, an increasing number of controlled studies have assessed the potential rehabilitative effects of music-based interventions, such as music listening, singing, or playing an instrument, in several neurological diseases. Although the number of studies and extent of available evidence is greatest in stroke and dementia, there is also evidence for the effects of music-based interventions on supporting cognition, motor function, or emotional wellbeing in people with Parkinson's disease, epilepsy, or multiple sclerosis. Music-based interventions can affect divergent functions such as motor performance, speech, or cognition in these patient groups. However, the psychological effects and neurobiological mechanisms underlying the effects of music interventions are likely to share common neural systems for reward, arousal, affect regulation, learning, and activity-driven plasticity. Although further controlled studies are needed to establish the efficacy of music in neurological recovery, music-based interventions are emerging as promising rehabilitation strategies. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Deja vu in neurology.

    Science.gov (United States)

    Wild, Edward

    2005-01-01

    The significance of deja vu is widely recognised in the context of temporal lobe epilepsy, and enquiry about deja vu is frequently made in the clinical assessment of patients with possible epilepsy. Deja vu has also been associated with several psychiatric disorders. The historical context of current understanding of deja vu is discussed. The literature reveals deja vu to be a common phenomenon consistent with normality. Several authors have suggested the existence of a "pathological" form of deja vu that differs, qualitatively or quantitatively, from "non-pathological" deja vu. The features of deja vu suggesting neurological or psychiatric pathology are discussed. Several neuroanatomical and psychological models of the deja vu experience are highlighted, implicating the perceptual, mnemonic and affective regions of the lateral temporal cortex, hippocampus and amygdala in the genesis of deja vu. A possible genetic basis for a neurochemical model of deja vu is discussed. Clinical approaches to the patient presenting with possible deja vu are proposed.

  19. Consciousness: A Neurological Perspective

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    Andrea E. Cavanna

    2011-01-01

    Full Text Available Consciousness is a state so essentially entwined with human experience, yet so difficult to conceptually define and measure. In this article, we explore how a bidimensional model of consciousness involving both level of arousal and subjective awareness of the contents of consciousness can be used to differentiate a range of healthy and altered conscious states. These include the different sleep stages of healthy individuals and the altered states of consciousness associated with neurological conditions such as epilepsy, vegetative state and coma. In particular, we discuss how arousal and awareness are positively correlated in normal physiological states with the exception of REM sleep, while a disturbance in this relationship is characteristic of vegetative state, minimally conscious state, complex partial seizures and sleepwalking.

  20. Neurology and diving.

    Science.gov (United States)

    Massey, E Wayne; Moon, Richard E

    2014-01-01

    Diving exposes a person to the combined effects of increased ambient pressure and immersion. The reduction in pressure when surfacing can precipitate decompression sickness (DCS), caused by bubble formation within tissues due to inert gas supersaturation. Arterial gas embolism (AGE) can also occur due to pulmonary barotrauma as a result of breath holding during ascent or gas trapping due to disease, causing lung hyperexpansion, rupture and direct entry of alveolar gas into the blood. Bubble disease due to either DCS or AGE is collectively known as decompression illness. Tissue and intravascular bubbles can induce a cascade of events resulting in CNS injury. Manifestations of decompression illness can vary in severity, from mild (paresthesias, joint pains, fatigue) to severe (vertigo, hearing loss, paraplegia, quadriplegia). Particularly as these conditions are uncommon, early recognition is essential to provide appropriate management, consisting of first aid oxygen, targeted fluid resuscitation and hyperbaric oxygen, which is the definitive treatment. Less common neurologic conditions that do not require hyperbaric oxygen include rupture of a labyrinthine window due to inadequate equalization of middle ear pressure during descent, which can precipitate vertigo and hearing loss. Sinus and middle ear overpressurization during ascent can compress the trigeminal and facial nerves respectively, causing temporary facial hypesthesia and lower motor neuron facial weakness. Some conditions preclude safe diving, such as seizure disorders, since a convulsion underwater is likely to be fatal. Preventive measures to reduce neurologic complications of diving include exclusion of individuals with specific medical conditions and safe diving procedures, particularly related to descent and ascent. © 2014 Elsevier B.V. All rights reserved.

  1. Aromatherapy and Aromatic Plants for the Treatment of Behavioural and Psychological Symptoms of Dementia in Patients with Alzheimer's Disease: Clinical Evidence and Possible Mechanisms

    Science.gov (United States)

    Scuteri, Damiana; Morrone, Luigi Antonio; Rombolà, Laura; Avato, Pina Rosa; Corasaniti, Maria Tiziana; Sakurada, Shinobu; Sakurada, Tsukasa

    2017-01-01

    The treatment of agitation and aggression, typical Behavioural and Psychological Symptoms of Dementia (BPSDs) of Alzheimer's Disease (AD), is one of the most complicated aspects of handling patients suffering from dementia. Currently, the management of these symptoms often associated with an increased pain perception, which notably reduces the patients' quality of life (QoL), relies on the employment of antipsychotic drugs. Unfortunately, the use of these pharmacological agents has some limits: in the long term, they do not result in being equally effective as in the first weeks of treatment and they present important side effects. Therefore, there is growing interest, supported by clinical evidence, in aromatherapy for the control of agitation, aggression, and psychotic symptoms. Some molecular mechanisms have been proposed to explain the behavioural effects of essential oils, as the whole phytocomplex or the single components, but important basic research effort is still needed. For this reason, rigorous preclinical studies are necessary in order to understand the pharmacological basis of aromatherapy in the treatment of BPSDs and to widen the cluster of effective essential oils in pharmacotherapeutic practice. PMID:28465709

  2. Aromatherapy and Aromatic Plants for the Treatment of Behavioural and Psychological Symptoms of Dementia in Patients with Alzheimer’s Disease: Clinical Evidence and Possible Mechanisms

    Directory of Open Access Journals (Sweden)

    Damiana Scuteri

    2017-01-01

    Full Text Available The treatment of agitation and aggression, typical Behavioural and Psychological Symptoms of Dementia (BPSDs of Alzheimer’s Disease (AD, is one of the most complicated aspects of handling patients suffering from dementia. Currently, the management of these symptoms often associated with an increased pain perception, which notably reduces the patients’ quality of life (QoL, relies on the employment of antipsychotic drugs. Unfortunately, the use of these pharmacological agents has some limits: in the long term, they do not result in being equally effective as in the first weeks of treatment and they present important side effects. Therefore, there is growing interest, supported by clinical evidence, in aromatherapy for the control of agitation, aggression, and psychotic symptoms. Some molecular mechanisms have been proposed to explain the behavioural effects of essential oils, as the whole phytocomplex or the single components, but important basic research effort is still needed. For this reason, rigorous preclinical studies are necessary in order to understand the pharmacological basis of aromatherapy in the treatment of BPSDs and to widen the cluster of effective essential oils in pharmacotherapeutic practice.

  3. Interactions among catechol-O-methyltransferase genotype, parenting, and sex predict children's internalizing symptoms and inhibitory control: Evidence for differential susceptibility.

    Science.gov (United States)

    Sulik, Michael J; Eisenberg, Nancy; Spinrad, Tracy L; Lemery-Chalfant, Kathryn; Swann, Gregory; Silva, Kassondra M; Reiser, Mark; Stover, Daryn A; Verrelli, Brian C

    2015-08-01

    We used sex, observed parenting quality at 18 months, and three variants of the catechol-O-methyltransferase gene (Val158Met [rs4680], intron1 [rs737865], and 3'-untranslated region [rs165599]) to predict mothers' reports of inhibitory and attentional control (assessed at 42, 54, 72, and 84 months) and internalizing symptoms (assessed at 24, 30, 42, 48, and 54 months) in a sample of 146 children (79 male). Although the pattern for all three variants was very similar, Val158Met explained more variance in both outcomes than did intron1, the 3'-untranslated region, or a haplotype that combined all three catechol-O-methyltransferase variants. In separate models, there were significant three-way interactions among each of the variants, parenting, and sex, predicting the intercepts of inhibitory control and internalizing symptoms. Results suggested that Val158Met indexes plasticity, although this effect was moderated by sex. Parenting was positively associated with inhibitory control for methionine-methionine boys and for valine-valine/valine-methionine girls, and was negatively associated with internalizing symptoms for methionine-methionine boys. Using the "regions of significance" technique, genetic differences in inhibitory control were found for children exposed to high-quality parenting, whereas genetic differences in internalizing were found for children exposed to low-quality parenting. These findings provide evidence in support of testing for differential susceptibility across multiple outcomes.

  4. History of neurologic examination books.

    Science.gov (United States)

    Boes, Christopher J

    2015-04-01

    The objective of this study was to create an annotated list of textbooks dedicated to teaching the neurologic examination. Monographs focused primarily on the complete neurologic examination published prior to 1960 were reviewed. This analysis was limited to books with the word "examination" in the title, with exceptions for the texts of Robert Wartenberg and Gordon Holmes. Ten manuals met the criteria. Works dedicated primarily to the neurologic examination without a major emphasis on disease description or treatment first appeared in the early 1900s. Georg Monrad-Krohn's "Blue Book of Neurology" ("Blue Bible") was the earliest success. These treatises served the important purpose of educating trainees on proper neurologic examination technique. They could make a reputation and be profitable for the author (Monrad-Krohn), highlight how neurology was practiced at individual institutions (McKendree, Denny-Brown, Holmes, DeJong, Mayo Clinic authors), and honor retiring mentors (Mayo Clinic authors).

  5. The ketogenic diet as a treatment paradigm for diverse neurological disorders.

    Science.gov (United States)

    Stafstrom, Carl E; Rho, Jong M

    2012-01-01

    Dietary and metabolic therapies have been attempted in a wide variety of neurological diseases, including epilepsy, headache, neurotrauma, Alzheimer disease, Parkinson disease, sleep disorders, brain cancer, autism, pain, and multiple sclerosis. The impetus for using various diets to treat - or at least ameliorate symptoms of - these disorders stems from both a lack of effectiveness of pharmacological therapies, and also the intrinsic appeal of implementing a more "natural" treatment. The enormous spectrum of pathophysiological mechanisms underlying the aforementioned diseases would suggest a degree of complexity that cannot be impacted universally by any single dietary treatment. Yet, it is conceivable that alterations in certain dietary constituents could affect the course and impact the outcome of these brain disorders. Further, it is possible that a final common neurometabolic pathway might be influenced by a variety of dietary interventions. The most notable example of a dietary treatment with proven efficacy against a neurological condition is the high-fat, low-carbohydrate ketogenic diet (KD) used in patients with medically intractable epilepsy. While the mechanisms through which the KD works remain unclear, there is now compelling evidence that its efficacy is likely related to the normalization of aberrant energy metabolism. The concept that many neurological conditions are linked pathophysiologically to energy dysregulation could well provide a common research and experimental therapeutics platform, from which the course of several neurological diseases could be favorably influenced by dietary means. Here we provide an overview of studies using the KD in a wide panoply of neurologic disorders in which neuroprotection is an essential component.

  6. THE KETOGENIC DIET AS A TREATMENT PARADIGM FOR DIVERSE NEUROLOGICAL DISORDERS

    Directory of Open Access Journals (Sweden)

    Jong Min Rho

    2012-04-01

    Full Text Available Dietary and metabolic therapies have been attempted in a wide variety of neurological diseases, including epilepsy, headache, neurotrauma, Alzheimer disease, Parkinson disease, sleep disorders, brain cancer, autism, pain, and multiple sclerosis. The impetus for using various diets to treat – or at least ameliorate symptoms of – these disorders stems from both a lack of effectiveness of pharmacological therapies, and also the intrinsic appeal of implementing a more natural treatment. The enormous spectrum of pathophysiological mechanisms underlying the aforementioned diseases would suggest a degree of complexity that cannot be impacted universally by any single dietary treatment. Yet, it is conceivable that alterations in certain dietary constituents could affect the course and impact the outcome of these brain disorders. Further, it is possible that a final common neurometabolic pathway might be influenced by a variety of dietary interventions. The most notable example of a dietary treatment with proven efficacy against a neurological condition is the high-fat, low-carbohydrate ketogenic diet (KD used in patients with medically intractable epilepsy. While the mechanisms through which the KD works remain unclear, there is now compelling evidence that its efficacy is likely related to the normalization of aberrant energy metabolism. The concept that many neurological conditions are linked pathophysiologically to energy dysregulation could well provide a common research and experimental therapeutics platform, from which the course of several neurological diseases could be favorably influenced by dietary means. Here we provide an overview of studies using the KD in a wide panoply of neurologic disorders in which neuroprotection is an essential component.

  7. Neurologic Intensive Care Unit Electrolyte Management.

    Science.gov (United States)

    Hutto, Craig; French, Mindy

    2017-06-01

    Dysnatremia is a common finding in the intensive care unit (ICU) and may be a predictor for mortality and poor clinical outcomes. Depending on the time of onset (ie, on admission vs later in the ICU stay), the incidence of dysnatremias in critically ill patients ranges from 6.9% to 15%, respectively. The symptoms of sodium derangement and their effect on brain physiology make early recognition and correction paramount in the neurologic ICU. Hyponatremia in brain injured patients can lead to life-threatening conditions such as seizures and may worsen cerebral edema and contribute to alterations in intracranial pressure. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Rumination as a mechanism linking stressful life events to symptoms of depression and anxiety: longitudinal evidence in early adolescents and adults.

    Science.gov (United States)

    Michl, Louisa C; McLaughlin, Katie A; Shepherd, Kathrine; Nolen-Hoeksema, Susan

    2013-05-01

    Rumination is a well-established risk factor for the onset of major depression and anxiety symptomatology in both adolescents and adults. Despite the robust associations between rumination and internalizing psychopathology, there is a dearth of research examining factors that might lead to a ruminative response style. In the current study, we examined whether social environmental experiences were associated with rumination. Specifically, we evaluated whether self-reported exposure to stressful life events predicted subsequent increases in rumination. We also investigated whether rumination served as a mechanism underlying the longitudinal association between self-reported stressful life events and internalizing symptoms. Self-reported stressful life events, rumination, and symptoms of depression and anxiety were assessed in 2 separate longitudinal samples. A sample of early adolescents (N = 1,065) was assessed at 3 time points spanning 7 months. A sample of adults (N = 1,132) was assessed at 2 time points spanning 12 months. In both samples, self-reported exposure to stressful life events was associated longitudinally with increased engagement in rumination. In addition, rumination mediated the longitudinal relationship between self-reported stressors and symptoms of anxiety in both samples and the relationship between self-reported life events and symptoms of depression in the adult sample. Identifying the psychological and neurobiological mechanisms that explain a greater propensity for rumination following stressors remains an important goal for future research. This study provides novel evidence for the role of stressful life events in shaping characteristic responses to distress, specifically engagement in rumination, highlighting potentially useful targets for interventions aimed at preventing the onset of depression and anxiety. © 2013 American Psychological Association

  9. Causal role for inverse reasoning on obsessive-compulsive symptoms: Preliminary evidence from a cognitive bias modification for interpretation bias study.

    Science.gov (United States)

    Wong, Shiu F; Grisham, Jessica R

    2017-12-01

    The inference-based approach (IBA) is a cognitive account of the genesis and maintenance of obsessive-compulsive disorder (OCD). According to the IBA, individuals with OCD are prone to using inverse reasoning, in which hypothetical causes form the basis of conclusions about reality. Several studies have provided preliminary support for an association between features of the IBA and OCD symptoms. However, there are currently no studies that have investigated the proposed causal relationship of inverse reasoning in OCD. In a non-clinical sample (N = 187), we used an interpretive cognitive bias procedure to train a bias towards using inverse reasoning (n = 64), healthy sensory-based reasoning (n = 65), or a control condition (n = 58). Participants were randomly allocated to these training conditions. This manipulation allowed us to assess whether, consistent with the IBA, inverse reasoning training increased compulsive-like behaviours and self-reported OCD symptoms. Results indicated that compared to a control condition, participants trained in inverse reasoning reported more OCD symptoms and were more avoidant of potentially contaminated objects. Moreover, change in inverse reasoning bias was a small but significant mediator of the relationship between training condition and behavioural avoidance. Conversely, training in a healthy (non-inverse) reasoning style did not have any effect on symptoms or behaviour relative to the control condition. As this study was conducted in a non-clinical sample, we were unable to generalise our findings to a clinical population. Findings generally support the IBA model by providing preliminary evidence of a causal role for inverse reasoning in OCD. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Neurological sequelae of bacterial meningitis.

    Science.gov (United States)

    Lucas, Marjolein J; Brouwer, Matthijs C; van de Beek, Diederik

    2016-07-01

    We reported on occurrence and impact of neurological sequelae after bacterial meningitis. We reviewed occurrence of neurological sequelae in children and adults after pneumococcal and meningococcal meningitis. Most frequently reported sequelae are focal neurological deficits, hearing loss, cognitive impairment and epilepsy. Adults with pneumococcal meningitis have the highest risk of developing focal neurological deficits, which are most commonly caused by cerebral infarction, but can also be due to cerebritis, subdural empyema, cerebral abscess or intracerebral bleeding. Focal deficits may improve during clinical course and even after discharge, but a proportion of patients will have persisting focal neurological deficits that often interfere in patient's daily life. Hearing loss occurs in a high proportion of patients with pneumococcal meningitis and has been associated with co-existing otitis. Children and adults recovering from bacterial meningitis without apparent neurological deficits are at risk for long-term cognitive deficits. Early identification of neurological sequelae is important for children to prevent additional developmental delay, and for adults to achieve successful return in society after the disease. Neurological sequelae occur in a substantial amount of patients following bacterial meningitis. Most frequently reported sequelae are focal neurological deficits, hearing loss, cognitive impairment and epilepsy. Copyright © 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  11. Perioperative Management of Neurological Conditions

    Directory of Open Access Journals (Sweden)

    Manjeet Singh Dhallu

    2017-06-01

    Full Text Available Perioperative care of the patients with neurological diseases can be challenging. Most important consideration is the management and understanding of pathophysiology of these disorders and evaluation of new neurological changes that occur perioperatively. Perioperative generally refers to 3 phases of surgery: preoperative, intraoperative, and postoperative. We have tried to address few commonly encountered neurological conditions in clinical practice, such as delirium, stroke, epilepsy, myasthenia gravis, and Parkinson disease. In this article, we emphasize on early diagnosis and management strategies of neurological disorders in the perioperative period to minimize morbidity and mortality of patients.

  12. Cannabinoids in neurology – Brazilian Academy of Neurology

    Directory of Open Access Journals (Sweden)

    Sonia M. D. Brucki

    2015-04-01

    Full Text Available The use of cannabidiol in some neurological conditions was allowed by Conselho Regional de Medicina de São Paulo and by Agência Nacional de Vigilância Sanitária (ANVISA. Specialists on behalf of Academia Brasileira de Neurologia prepared a critical statement about use of cannabidiol and other cannabis derivatives in neurological diseases.

  13. [Postpolio syndrome. Neurologic and psychiatric aspects].

    Science.gov (United States)

    Weber, M-A; Schönknecht, P; Pilz, J; Storch-Hagenlocher, B

    2004-04-01

    Postpolio syndrome is defined as a clinical syndrome of new pareses in individuals who had been affected by acute paralytic poliomyelitis years before. The objective of this study was to describe neurologic and psychiatric signs of the disease. We evaluated the clinical signs and treatment of 16 patients with postpolio syndrome. Possible symptoms of depression were evaluated by the Hamilton and Geriatric Depression Scales. Postpolio syndrome manifested at a median age of 57.5 years (range 25-73) in a median of 41 years (range 16-70 years) after acute poliomyelitis. Muscles already affected during acute poliomyelitis were affected in all patients with postpolio syndrome. Six of 16 patients (37.5%) developed paresis in muscles formerly not affected by acute poliomyelitis. In eight of 15 patients (53%), depressive episodes were recognized according to the ICD-10 criteria. Symptoms of depression should be recognized in patients with postpolio syndrome and incorporated in therapy based on physiotherapy.

  14. [Neurological interpretation of dreams] .

    Science.gov (United States)

    Pareja, J A; Gil-Nagel, A

    2000-10-01

    Cerebral cortical activity is constant throughout the entire human life, but substantially changes during the different phases of the sleep-wake cycle (wakefulness, non-REM sleep and REM sleep), as well as in relation to available information. In particular, perception of the environment is closely linked to the wake-state, while during sleep perception turns to the internal domain or endogenous cerebral activity. External and internal information are mutually exclusive. During wakefulness a neuronal mechanism allows attention to focus on the environment whereas endogenous cortical activity is ignored. The opposite process is provided during sleep. The function external attention-internal attention is coupled with the two modes of brain function during wakefulness and during sleep, providing two possible cortical status: thinking and dreaming. Several neurological processes may influence the declaration of the three states of being or may modify their orderly oscillation through the sleep-wake cycle. In addition, endogenous information and its perception (dreams) may be modified. Disturbances of dreaming may configurate in different general clinical scenarios: lack of dreaming, excess of dreaming (epic dreaming), paroxysmal dreaming (epileptic), nightmares, violent dreaming, daytime-dreaming (hallucinations), and lucid dreaming. Sensorial deprivation, as well as the emergence of internal perception may be the underlying mechanism of hallucinations. The probable isomorphism between hallucinations and dreaming is postulated, analyzed and discussed.

  15. Evidence-based guidelines for the treatment of lower urinary tract symptoms related to uncomplicated benign prostatic hyperplasia in Italy: updated summary from AURO.it

    Science.gov (United States)

    Casarico, Antonio; Fandella, Andrea; Galetti, Caterina; Hurle, Rodolfo; Mazzini, Elisa; Niro, Ciro; Perachino, Massimo; Sanseverino, Roberto; Pappagallo, Giovanni Luigi

    2012-01-01

    Background: The first Italian national guidelines were developed by the Italian Association of Urologists and published in 2007. Since then, a number of new drugs or classes of drugs have emerged for the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH), new data have emerged on medical therapy (monotherapies and combination therapies), new surgical techniques have come into practice, and our understanding of disease pathogenesis has increased. Consequently, a new update of the guidelines has become necessary. Methods: A structured literature review was conducted to identify relevant papers published between 1 August 2006 and 12 December 2010. Publications before or after this timeframe were considered only if they were recognised as important milestones in the field or if the literature search did not identify publications within this timeframe. The quality of evidence and strength of recommendations were determined according to the Grading of Recommendations Assessment, Development and Evaluation framework. Main findings: Decisions on therapeutic intervention should be based on the impact of symptoms on quality of life (QoL) rather than the severity of symptoms (International Prostate Symptom Score (IPSS) score). A threshold for intervention was therefore based on the IPSS Q8, with intervention recommended for patients with a score of at least 4. Several differences in clinical recommendations have emerged. For example, combination therapy with a 5α-reductase inhibitor plus α blocker is now the recommended option for the treatment of patients at risk of BPH progression. Other differences include the warning of potential worsening of cognitive disturbances with use of anticholinergics in older patients, the distinction between Serenoa repens preparations (according to the method of extraction), and the clearly defined threshold of prostate size for performing open surgery (>80 g). While the recommendations included in

  16. [Neurological disease and facial recognition].

    Science.gov (United States)

    Kawamura, Mitsuru; Sugimoto, Azusa; Kobayakawa, Mutsutaka; Tsuruya, Natsuko

    2012-07-01

    To discuss the neurological basis of facial recognition, we present our case reports of impaired recognition and a review of previous literature. First, we present a case of infarction and discuss prosopagnosia, which has had a large impact on face recognition research. From a study of patient symptoms, we assume that prosopagnosia may be caused by unilateral right occipitotemporal lesion and right cerebral dominance of facial recognition. Further, circumscribed lesion and degenerative disease may also cause progressive prosopagnosia. Apperceptive prosopagnosia is observed in patients with posterior cortical atrophy (PCA), pathologically considered as Alzheimer's disease, and associative prosopagnosia in frontotemporal lobar degeneration (FTLD). Second, we discuss face recognition as part of communication. Patients with Parkinson disease show social cognitive impairments, such as difficulty in facial expression recognition and deficits in theory of mind as detected by the reading the mind in the eyes test. Pathological and functional imaging studies indicate that social cognitive impairment in Parkinson disease is possibly related to damages in the amygdalae and surrounding limbic system. The social cognitive deficits can be observed in the early stages of Parkinson disease, and even in the prodromal stage, for example, patients with rapid eye movement (REM) sleep behavior disorder (RBD) show impairment in facial expression recognition. Further, patients with myotonic dystrophy type 1 (DM 1), which is a multisystem disease that mainly affects the muscles, show social cognitive impairment similar to that of Parkinson disease. Our previous study showed that facial expression recognition impairment of DM 1 patients is associated with lesion in the amygdalae and insulae. Our study results indicate that behaviors and personality traits in DM 1 patients, which are revealed by social cognitive impairment, are attributable to dysfunction of the limbic system.

  17. Breast Cancer Presents with a Paraneoplastic Neurologic Syndrome

    Directory of Open Access Journals (Sweden)

    Pedro Coelho Barata

    2012-11-01

    Full Text Available Background: Paraneoplastic neurologic syndromes (PNS pose quite an uncommon neurological complication, affecting less than 1% of patients with breast cancer. Nearly one third of these patients lack detectable onconeural antibodies (ONAs, and improvement in neurologic deficits with concomitant cancer treatments is achieved in less than 30% of cases. Case Presentation: A 42-year-old, premenopausal woman presented with facial paralysis on the central left side accompanied by a left tongue deviation, an upward vertical nystagmus, moderate spastic paraparesis, dystonic posturing of the left foot, lower limb hyperreflexia and bilateral extensor plantar reflex. After ruling out all other potential neurologic causes, PNS was suspected but no ONAs were found. A PET-CT scan detected increased metabolism in the right breast, as well as an ipsilateral thoracic interpectoral adenopathy. Core biopsy confirmed the presence of an infiltrating duct carcinoma. After breast surgery, the neurologic symptoms disappeared. One week later, the patient was readmitted to the hospital with a bilateral fatigable eyelid ptosis, and two weeks later, there was a noticeable improvement in eyelid ptosis, accompanied by a rapid and progressive development of lower spastic paraparesis. She started adjuvant treatment with chemotherapy with marked clinical and neurological improvement, and by the end of radiotherapy, there were no signs of neurologic impairment. Conclusion: This case study highlights the importance of a high level of vigilance for the detection of PNS, even when ONAs are not detected, as the rapid identification and treatment of the underlying tumor offers the best chance for a full recovery.

  18. Assessing obsessive compulsive symptoms and cognitions on the internet: evidence for the comparability of paper and Internet administration.

    Science.gov (United States)

    Coles, Meredith E; Cook, Laura M; Blake, Thomas R

    2007-09-01

    Administration of psychological questionnaires via the Internet has gained popularity in recent years and touts many advantages. However, before questionnaires that were originally developed as paper-and-pencil measures can be confidently administered over the Internet, it is necessary to document the equivalence of the paper and computer-generated versions [American Psychological Association. (1986). Guidelines for computer-based tests and interpretations. Washington, DC: American Psychological Association; Cohen, R.J., Swerdlik, M.E., & Smith, D.K. (1992). Psychological testing and assessment (2nd ed.). Mountain View, CA: Mayfield Publishing; Cronbach, L.J. (1990). Essentials in psychological testing (5th ed.). New York: Harper Collins; Meier, S. (1994). The chronic crisis in psychological measurement and assessment: A historical survey. San Diego: Academic Press; Schulenberg, S.E., & Yutrzenka, B.A. (2001). Equivalence of computerized and conventional versions of the Beck Depression Inventory- II (BDI-II). Current Psychology: Developmental, Learning, Personality, Social, 20, 216-230]. The current study tested this equivalence for the Obsessive Compulsive Inventory [Foa, E.B., Kozak, M.J., Salkovskis, P.M, Coles, M.E., & Amir, N. (1998). The validation of a new obsessive compulsive disorder scale: The obsessive-compulsive inventory. Psychological Assessment, 10(3), 206-214] and the Obsessive Beliefs Questionnaire-44 [Obsessive Compulsive Cognitions Working Group. (2005). Psychometric validation of the obsessive belief questionnaire and interpretation of intrusions inventory-Part 2: Factor analyses and testing of a brief version. Behaviour Research and Therapy, 43, 1527-1543] in an unselected student sample. Study results support the equivalence of these measures of obsessive compulsive disorder (OCD) symptoms and beliefs independent of administration method (paper versus secure project website). These findings create new opportunities for conducting OCD

  19. Insomnia in central neurologic diseases--occurrence and management

    DEFF Research Database (Denmark)

    Mayer, Geert; Jennum, Poul; Riemann, Dieter

    2011-01-01

    antidepressants may be an effective treatment for insomnia in stroke and Parkinson's disease (PD) patients. Melatonin and light treatment can stabilize the sleep-wake circadian rhythm and shorten sleep latency in dementias and PD. Cognitive behavioral therapy (CBT) can be effective in treating insomnia symptoms......The objective of this review is to highlight the impact of insomnia in central neurological disorders by providing information on its prevalence and give recommendations for diagnosis and treatment. Insomnia in neurological disorders is a frequent, but underestimated symptom. Its occurrence may...... the cause of insomnia must be clearly identified. First line treatment aims at the underlying neurologic disease. The few high quality treatment studies show that short term treatment with hypnotics may be recommended in most disorders after having ruled out high risk for adverse effects. Sedating...

  20. Interventional neurology: a reborn subspecialty.

    Science.gov (United States)

    Edgell, Randall C; Alshekhlee, Amer; Yavagal, Dileep R; Vora, Nirav; Cruz-Flores, Salvador

    2012-10-01

    Neurologists have a long history of involvement in cerebral angiography; however, the roots of neurologist involvement in therapeutic endovascular procedures have not been previously documented. As outlined in this article, it has taken the efforts of several early pioneers to lay the ground work for interventional neurology, a specialty that has become one of the fastest growing neurological subspecialties. The ground work, along with a great clinical need, has allowed the modern interventional neurologist to tackle some of the most intractable diseases, especially those affecting the cerebral vasculature. The institutionalization of interventional neurology as a subspecialty was first advocated in 1995 in an article entitled, "Interventional Neurology, a subspecialty whose time has come." The institutions created in the wake of this article have provided the framework that has allowed interventional neurology to transition from "a subspecialty whose time has come" to a subspecialty that is here to stay and thrive. Copyright © 2010 by the American Society of Neuroimaging.

  1. Neurologic Manifestations of Vitamin B Deficiency after Bariatric Surgery.

    Science.gov (United States)

    Punchai, Suriya; Hanipah, Zubaidah Nor; Meister, Katherine M; Schauer, Philip R; Brethauer, Stacy A; Aminian, Ali

    2017-08-01

    The aim of this study was to assess the incidence, clinical presentation, and outcomes of neurologic disorders secondary to vitamin B deficiencies following bariatric surgery. Patients at a single academic institution who underwent bariatric surgery and developed neurologic complications secondary to low levels of vitamins B1, B2, B6, and B12 between the years 2004 and 2015 were studied. In total, 47 (0.7%) bariatric surgical patients (Roux-en-Y gastric bypass n = 36, sleeve gastrectomy n = 9, and duodenal switch n = 2) developed neurologic manifestations secondary to vitamin B deficiencies. Eleven (23%) patients developed postoperative anatomical complications contributed to poor oral intake. Median duration to onset of neurologic manifestation following surgery was 12 months (IQR, 5-32). Vitamin deficiencies reported in the cohort included B1 (n = 30), B2 (n = 1), B6 (n = 12), and B12 (n = 12) deficiency. The most common manifestations were paresthesia (n = 31), muscle weakness (n = 15), abnormal gait (n = 11), and polyneuropathy (n = 7). Four patients were diagnosed with Wernicke-Korsakoff syndrome (WKS) which was developed after gastric bypass (n = 3) and sleeve gastrectomy (n = 1). Seven patients required readmission for management of severe vitamin B deficiencies. Overall, resolution of neurologic symptoms with nutritional interventions and pharmacotherapy was noted in 40 patients (85%). The WKS was not reversible, and all four patients had residual mild ataxia and nystagmus at the last follow-up time. Nutritional neurologic disorders secondary to vitamin B deficiency are relatively uncommon after bariatric surgery. While neurologic disorders are reversible in most patients (85%) with vitamin replacements, persistent residual neurologic symptoms are common in patients with WKS.

  2. Neurological manifestation of phenytoin toxicity, resulting from drug ...

    African Journals Online (AJOL)

    Phenytoin toxicity masquerading as deterioration of neurological symptoms caused by interaction with chloramphenicol is a very rare but real risk. To the authors' knowledge only one such case occurring in humans has been reported in the English literature. No case of clinical phenytoin toxicity occurring at less than ...

  3. Neurological soft signs as an endophenotype in an African ...

    African Journals Online (AJOL)

    Objective: The use of endophenotypes, such as neurological soft signs (NSS), is advocated as one possible method to elucidate the heterogeneity of schizophrenia. Exploring the associations between NSS and specific illness symptoms has revealed some trends, although results have been conflicting. To date, such ...

  4. Preputial calculus in a neurologically-impaired child.

    Science.gov (United States)

    Spataru, R I; Iozsa, D A; Ivanov, M

    2015-02-01

    Preputial calculi are rarely encountered in childhood. A 5-year-old boy with symptoms of chronic balanoposthitis. A preputial stone was documented and removed at circumcision. Uneventful postoperative recovery. In children, association between phimosis and neurologic impairment represent predisposing condition for preputial stone formation.

  5. Dumping syndrome: an unusual cause of severe hyperinsulinemic hypoglycemia in neurologically impaired children with gastrostomy.

    Science.gov (United States)

    Bizzarri, C; Cervoni, M; Crea, F; Cutrera, R; Schiavino, A; Schiaffini, R; Cappa, M

    2011-02-01

    This paper describes severe hyperinsulinemic hypoglycemia during bolus enteral feeding in two neurologically impaired children. Both children were affected by dysphagia with swallowing difficulties; caloric intake was inadequate. For these reasons, percutaneous endoscopic gastrostomy had been positioned during the first months of life. In one patient due to persisting vomiting, after a few months, a gastrojejunal tube (PEG-J) was inserted. Hypoglycemia was revealed by routine blood tests, without evidence of specific symptoms. Continuous subcutaneous glucose monitoring showed wide glucose excursions, ranging from hypoglycemia to hyperglycemia. Extremely high levels of insulin were detected at the time of hypoglycemia. A diagnosis of dumping syndrome (DS) was suspected in both children. In the child with PEG, the tip of the gastrostomy catheter was found to be lying in the bulbus duodeni. Once this had been pulled back, hypoglycemic episodes disappeared. The child with PEG-J needed continuous enteral feeding to reach a normal glucose balance. DS is a relatively common complication in children with gastrostomy, but extremely irregular glucose levels, ranging from hypoglycemia to hyperglycemia, and increased insulin secretion had not been previously demonstrated. The incidence of DS is probably underestimated in children receiving enteral feeding for neurological impairment. In these patients intensive monitoring of blood glucose levels should be performed to calibrate meals. Repeated underestimated hypoglycemic episodes could worsen neurological damage and cause a deterioration in clinical conditions.

  6. The Youth Anxiety Measure for DSM-5 (YAM-5): Development and First Psychometric Evidence of a New Scale for Assessing Anxiety Disorders Symptoms of Children and Adolescents.

    Science.gov (United States)

    Muris, Peter; Simon, Ellin; Lijphart, Hester; Bos, Arjan; Hale, William; Schmeitz, Kelly

    2017-02-01

    The Youth Anxiety Measure for DSM-5 (YAM-5) is a new self- and parent-report questionnaire to assess anxiety disorder symptoms in children and adolescents in terms of the contemporary classification system. International panels of childhood anxiety researchers and clinicians were used to construct a scale consisting of two parts: part one consists of 28 items and measures the major anxiety disorders including separation anxiety disorder, selective mutism, social anxiety disorder, panic disorder, and generalized anxiety disorder, whereas part two contains 22 items that focus on specific phobias and (given its overlap with situational phobias) agoraphobia. In general, the face validity of the new scale was good; most of its items were successfully linked to the intended anxiety disorders. Notable exceptions were the selective mutism items, which were frequently considered as symptoms of social anxiety disorder, and some specific phobia items especially of the natural environment, situational and other type, that were regularly assigned to an incorrect category. A preliminary investigation of the YAM-5 in non-clinical (N = 132) and clinically referred (N = 64) children and adolescents indicated that the measure was easy to complete by youngsters. In addition, support was found for the psychometric qualities of the measure: that is, the internal consistency was good for both parts, as well as for most of the subscales, the parent-child agreement appeared satisfactory, and there was also evidence for the validity of the scale. The YAM-5 holds promise as a tool for assessing anxiety disorder symptoms in children and adolescents.

  7. What research evidence is there for the use of art therapy in the management of symptoms in adults with cancer? A systematic review.

    Science.gov (United States)

    Wood, Michele J M; Molassiotis, Alexander; Payne, Sheila

    2011-02-01

    Common psychosocial difficulties experienced by cancer patients are fatigue, depression, anxiety, and existential and relational concerns. Art therapy is one intervention being developed to address these difficulties. The purpose of this research was to assess and synthesize the available research evidence for the use of art therapy in the management of symptoms in adults with cancer. A literature search of electronic databases, 'grey' literature, hand searching of key journals, and personal contacts was undertaken. Keywords searched were 'art therapy' and 'cancer' or 'neoplasm'. The inclusion criteria were: research studies of any design; adult cancer population; and art therapy intervention. There were no language or date restrictions. Data extraction occurred and quality appraisal was undertaken. Data were analyzed using narrative synthesis. Fourteen papers reporting 12 studies met the inclusion criteria. Symptoms investigated spanned emotional, physical, social and global functioning, and existential/spiritual concerns. Measures used were questionnaires, in-depth interviews, patients' artwork, therapists' narratives of sessions, and stress markers in salivary samples. No overall effect size was determined owing to heterogeneity of studies. Narrative synthesis of the studies shows art therapy is used at all stages of the cancer trajectory, most frequently by women, the most common cancer site in participants being breast. Art therapy is a psychotherapeutic approach that is being used by adults with cancer to manage a spectrum of treatment-related symptoms and facilitate the process of psychological readjustment to the loss, change, and uncertainty characteristic of cancer survivorship. Research in this area is still in its infancy. Copyright © 2010 John Wiley & Sons, Ltd.

  8. Phenotypic and Molecular Evidence Suggest That Decrements in Morning and Evening Energy Are Distinct But Related Symptoms

    Science.gov (United States)

    Aouizerat, Bradley E.; Dhruva, Anand; Paul, Steven M.; Cooper, Bruce A.; Kober, Kord M.; Miaskowski, Christine

    2015-01-01

    Context Little is known about energy levels in oncology patients and their family caregivers (FCs). Objectives This study sought to identify latent classes of participants, based on self-reported energy levels and to evaluate for differences in phenotypic and genotypic characteristics between these classes. Methods Energy subscale scores from the Lee Fatigue Scale were used to determine latent class membership. Morning and evening energy scores were obtained just prior to, during, and for four months following the completion of radiation therapy. Genetic associations were evaluated for fifteen pro- and anti-inflammatory cytokine genes. Results Two latent classes with distinct morning energy trajectories were identified. Participants who were younger, female, not married/partnered, Black, and had more comorbidities, and a lower functional status were more likely to be in the Low Morning Energy class. Two polymorphisms (IL2 rs1479923, NFKB1 rs4648110) were associated with morning energy latent class membership. Two latent classes with distinct evening energy trajectories were identified. Participants who were younger and male and who had more comorbidities, decreased body weight, and a lower functional status were more likely to be in the Moderate Evening Energy class. Five different polymorphisms (IL1R2 rs4141134, IL6 rs4719714, IL17A rs8193036, NFKB2 rs1056890, TNFA rs1800683) were associated with evening energy latent class membership. Conclusion This study provides preliminary evidence that decrements in morning and evening energy are associated with different phenotypic risk factors as well as cytokine gene variations. PMID:26031709

  9. Neurological examination in small animals

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    Viktor Paluš

    2014-03-01

    Full Text Available This clinical review about the neurological examination in small animals describes the basics about the first steps of investigation when dealing with neurological patients. The knowledge of how to perform the neurological examination is important however more important is how to correctly interpret these performed tests. A step-by-step approach is mandatory and examiners should master the order and the style of performing these tests. Neurological conditions can be sometimes very distressing for owners and for pets that might not be the most cooperating. The role of a veterinary surgeon, as a professional, is therefore to collect the most relevant history, to examine a patient in a professional manner and to give to owners an educated opinion about the further treatment and prognosis. However neurological examinations might look challenging for many. But it is only the clinical application of neuroanatomy and neurophysiology to an every-day situation for practicing veterinarians and it does not require any specific in-to-depth knowledge. This clinical review is aimed not only to provide the information on how to perform the neurological examination but it is also aimed to appeal on veterinarians to challenge their daily routine and to start practicing on neurologically normal patients. This is the best and only way to differentiate between the normal and abnormal in a real situation.

  10. Phenotypic and Molecular Evidence Suggests That Decrements in Morning and Evening Energy Are Distinct but Related Symptoms.

    Science.gov (United States)

    Aouizerat, Bradley E; Dhruva, Anand; Paul, Steven M; Cooper, Bruce A; Kober, Kord M; Miaskowski, Christine

    2015-11-01

    Little is known about energy levels in oncology patients and their family caregivers. This study sought to identify latent classes of participants, based on self-reported energy levels and evaluate for differences in phenotypic and genotypic characteristics between these classes. Energy subscale scores from the Lee Fatigue Scale were used to determine latent class membership. Morning and evening energy scores were obtained just before, during, and for four months after the completion of radiation therapy. Genetic associations were evaluated for 15 proinflammatory and anti-inflammatory cytokine genes. Two latent classes with distinct morning energy trajectories were identified. Participants who were younger, female, not married/partnered, black, and had more comorbidities, and a lower functional status were more likely to be in the low morning energy class. Two polymorphisms (IL2 rs1479923 and NFKB1 rs4648110) were associated with morning energy latent class membership. Two latent classes with distinct evening energy trajectories were identified. Participants who were younger and male and who had more comorbidities, decreased body weight, and a lower functional status were more likely to be in the moderate evening energy class. Five different polymorphisms (IL1R2 rs4141134, IL6 rs4719714, IL17A rs8193036, NFKB2 rs1056890, and TNFA rs1800683) were associated with evening energy latent class membership. This study provides preliminary evidence that decrements in morning and evening energy are associated with different phenotypic risk factors and cytokine gene variations. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  11. Opinion and Special Articles: Neurology education at US osteopathic medical schools.

    Science.gov (United States)

    Freedman, Daniel A; Albert, Dara V F

    2017-12-12

    Osteopathic medical schools have a longstanding tradition of training primary care physicians (PCP). Neurologic symptoms are common in the PCP's office and there is an undersupply of neurologists in the United States. It is therefore crucial for osteopathic medical students to have a strong foundation in clinical neurology. Despite the importance, a mere 6% of osteopathic medical schools have required neurology clerkships. Furthermore, exposure to neurology in medical school through required clerkships has been correlated with matching into neurology residency. As osteopathic medical schools continue to expand, it will become increasingly important to emphasize the American Academy Neurology's published guidelines for a core clerkship curriculum. Practicing neurologists should take an active role in encouraging osteopathic medical schools to adopt these guidelines. © 2017 American Academy of Neurology.

  12. Catheter-related epidural abscesses -- don't wait for neurological deficits.

    NARCIS (Netherlands)

    Royakkers, A.A.; Willigers, H.; Ven, A.J.A.M. van der; Wilmink, J.T.; Durieux, M.; Kleef, M. van

    2002-01-01

    Epidural abscess is a rare but serious complication of epidural anesthesia for peri- and postoperative analgesia. It is feared because of possible persistent neurological deficits. Epidural abscess presents mostly with a classic triad of symptoms: back pain, fever and variable neurological signs and

  13. Neurological Manifestations of Dengue Infection

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    Guo-Hong Li

    2017-10-01

    Full Text Available Dengue counts among the most commonly encountered arboviral diseases, representing the fastest spreading tropical illness in the world. It is prevalent in 128 countries, and each year >2.5 billion people are at risk of dengue virus infection worldwide. Neurological signs of dengue infection are increasingly reported. In this review, the main neurological complications of dengue virus infection, such as central nervous system (CNS, peripheral nervous system, and ophthalmic complications were discussed according to clinical features, treatment and possible pathogenesis. In addition, neurological complications in children were assessed due to their atypical clinical features. Finally, dengue infection and Japanese encephalitis were compared for pathogenesis and main clinical manifestations.

  14. Why neurology? Factors which influence career choice in neurology.

    Science.gov (United States)

    Albert, Dara V; Hoyle, Chad; Yin, Han; McCoyd, Matthew; Lukas, Rimas V

    2016-01-01

    To evaluate the factors which influence the decision to pursue a career in neurology. An anonymous survey was developed using a Likert scale to rate responses. The survey was sent to adult and child neurology faculty, residents and fellows, as well as medical students applying for neurology. Descriptive statistics were used to analyse the factors of influence. Respondents were subsequently categorized into pre-neurology trainees, neurology trainees, child neurologists and adult neurologists, and differences between the groups were analysed using Pearson's chi-square test. One hundred and thirty-three anonymous responses were received. The respondents were neurologists across all levels of training and practice. Across all respondents, the most common factor of high importance was intellectual content of specialty, challenging diagnostic problems, type of patient encountered and interest in helping people. Responses were similar across the groups; however, the earliest trainees cited interest in helping people as most important, while those in neurology training and beyond cite intellectual content of the specialty as most important. As trainees transition from their earliest levels of clinical experience into working as residents and faculty, there is a shift in the cited important factors. Lifestyle and financial factors seem to be the least motivating across all groups. Encouragement from peers, mentors, faculty and practicing physicians is considered high influences in a smaller number of neurologists. This may present an opportunity for practicing neurologists to make connections with medical students early in their education in an effort to encourage and mentor candidates.

  15. [Headache and functional symptoms].

    Science.gov (United States)

    Villate, Sebastián; Arroyo, José; Bessolo, Eduardo; Crespín, Fabiana

    2015-04-16

    Headaches are a common reason for visiting neurology clinics. They have their origin in a variety of causes and their specific diagnosis deteriorates as it overlaps with other chronic painful pathologies. Somatic functional syndromes are characterised by chronic painful conditions that have a negative effect on quality of life, and are accompanied by functional symptoms with no organic cause. The aim of this study is to evaluate the prevalence of functional symptoms in patients who visited due to headaches. The sample included all the patients who visited the walk-in neurology clinic because of headaches between March and September 2014. A semi-structured survey was carried out in order to evaluate obsessive personality traits, bruxism, gastrointestinal symptoms, anxiety, depression and sleep disorders. During the period under study, 125 patients visited due to headache. In all, 68.7% of patients with migraine presented functional symptoms and only 32.7% in the case of other headaches (p = 0.0001). Functional symptoms were prevalent in patients with headache, mainly in those with migraine.

  16. Neurological Diagnostic Tests and Procedures

    Science.gov (United States)

    ... of diagnostic imaging techniques and chemical and metabolic analyses to detect, manage, and treat neurological disease. Some ... performed in a doctor’s office or at a clinic. Fluoroscopy is a type of x-ray that ...

  17. Neurologic Complications of Smallpox Vaccination

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    J Gordon Millichap

    2003-06-01

    Full Text Available Smallpox and smallpox vaccination is reviewed from the Departments of Neurology, Yale University School of Medicine, New Haven, CT, and University of New Mexico School of Medicine, Albuquerque.

  18. Neurological Complications of Bariatric Surgery.

    Science.gov (United States)

    Goodman, Jerry Clay

    2015-12-01

    Obesity has attained pandemic proportions, and bariatric surgery is increasingly being employed resulting in turn to more neurological complications which must be recognized and managed. Neurological complications may result from mechanical or inflammatory mechanisms but primarily result from micro-nutritional deficiencies. Vitamin B12, thiamine, and copper constitute the most frequent deficiencies. Neurological complications may occur at reasonably predictable times after bariatric surgery and are associated with the type of surgery used. During the early post-operative period, compressive or stretch peripheral nerve injury, rhabdomyolysis, Wernicke's encephalopathy, and inflammatory polyradiculoneuropathy may occur. Late complications ensue after months to years and include combined system degeneration (vitamin B12 deficiency) and hypocupric myelopathy. Bariatric surgery patients require careful nutritional follow-up with routine monitoring of micronutrients at 6 weeks and 3, 6, and 12 months post-operatively and then annually after surgery and multivitamin supplementation for life. Sustained vigilance for common and rare neurological complications is essential.

  19. Neurologic disorder and criminal responsibility.

    Science.gov (United States)

    Yaffe, Gideon

    2013-01-01

    Sufferers from neurologic and psychiatric disorders are not uncommonly defendants in criminal trials. This chapter surveys a variety of different ways in which neurologic disorder bears on criminal responsibility. It discusses the way in which a neurologic disorder might bear on the questions of whether or not the defendant acted voluntarily; whether or not he or she was in the mental state that is required for guilt for the crime; and whether or not he or she is deserving of an insanity defense. The discussion demonstrates that a just determination of whether a sufferer from a neurologic disorder is diminished in his or her criminal responsibility for harmful conduct requires equal appreciation of the nature of the relevant disorder and its impact on behavior, on the one hand, and of the legal import of facts about the psychologic mechanisms through which behavior is generated, on the other. © 2013 Elsevier B.V. All rights reserved.

  20. Historical perspective of Indian neurology

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    Shrikant Mishra

    2013-01-01

    Full Text Available Objective: To chronicle the history of medicine and neurology in India with a focus on its establishment and evolution. Background: The history of neurology in India is divided into two periods: ancient and modern. The ancient period dates back to the mid-second millennium Before Christ (B.C. during the creation of the Ayurvedic Indian system of Medicine, which detailed descriptions of neurological disorders called Vata Vyadhi. The early 20 th century witnessed the birth of modern Indian medicine with the onset of formal physician training at the nation′s first allopathic medical colleges located in Madras (1835, Calcutta (1835 and Mumbai (1848. Prior to India′s independence from Britain in 1947, only 25 medical schools existed in the entire country. Today, there are over 355. In 1951, physicians across the field of neurology and neurosurgery united to create the Neurological Society of India (NSI. Four decades later in 1991, neurologists branched out to establish a separate organization called the Indian Academy of Neurology (IAN. Design/Methods: Information was gathered through literature review using PubMed, MD Consult, OVID, primary texts and research at various academic institutions in India. Results: Neurological disorders were first described in ancient India under Ayurveda. The transition to modern medicine occurred more recently through formal training at medical schools beginning in the 1930′s. Early pioneers and founders of the NSI (1951 include Dr. Jacob Chandy, Dr. B Ramamurthi, Dr. S. T. Narasimhan and Dr. Baldev Singh. Later, Dr. J. S. Chopra, a prominent neurologist and visionary, recognized the need for primary centers of collaboration and subsequently established the IAN (1991. The future of Neurology in India is growing rapidly. Currently, there are 1100 practicing neurologists and more than 150 post-graduate trainees who join the ranks every year. As the number of neurologists rises across India, there is an increase in

  1. Historical perspective of Indian neurology

    Science.gov (United States)

    Mishra, Shrikant; Trikamji, Bhavesh; Singh, Sandeep; Singh, Parampreet; Nair, Rajasekharan

    2013-01-01

    Objective: To chronicle the history of medicine and neurology in India with a focus on its establishment and evolution. Background: The history of neurology in India is divided into two periods: ancient and modern. The ancient period dates back to the mid-second millennium Before Christ (B.C.) during the creation of the Ayurvedic Indian system of Medicine, which detailed descriptions of neurological disorders called Vata Vyadhi. The early 20th century witnessed the birth of modern Indian medicine with the onset of formal physician training at the nation's first allopathic medical colleges located in Madras (1835), Calcutta (1835) and Mumbai (1848). Prior to India's independence from Britain in 1947, only 25 medical schools existed in the entire country. Today, there are over 355. In 1951, physicians across the field of neurology and neurosurgery united to create the Neurological Society of India (NSI). Four decades later in 1991, neurologists branched out to establish a separate organization called the Indian Academy of Neurology (IAN). Design/Methods: Information was gathered through literature review using PubMed, MD Consult, OVID, primary texts and research at various academic institutions in India. Results: Neurological disorders were first described in ancient India under Ayurveda. The transition to modern medicine occurred more recently through formal training at medical schools beginning in the 1930's. Early pioneers and founders of the NSI (1951) include Dr. Jacob Chandy, Dr. B Ramamurthi, Dr. S. T. Narasimhan and Dr. Baldev Singh. Later, Dr. J. S. Chopra, a prominent neurologist and visionary, recognized the need for primary centers of collaboration and subsequently established the IAN (1991). The future of Neurology in India is growing rapidly. Currently, there are 1100 practicing neurologists and more than 150 post-graduate trainees who join the ranks every year. As the number of neurologists rises across India, there is an increase in the amount of

  2. Neurologic Manifestations of Enterovirus 71 Infection in Korea.

    Science.gov (United States)

    Lee, Kyung Yeon; Lee, Myoung Sook; Kim, Dong Bin

    2016-04-01

    Enterovirus 71 frequently involves the central nervous system and may present with a variety of neurologic manifestations. Here, we aimed to describe the clinical features, magnetic resonance imaging (MRI) findings, and cerebrospinal fluid (CSF) profiles of patients presenting with neurologic complications of enterovirus 71 infection. We retrospectively reviewed the records of 31 pediatric patients hospitalized with acute neurologic manifestations accompanied by confirmed enterovirus 71 infection at Ulsan University Hospital between 2010 and 2014. The patients' mean age was 2.9 ± 5.5 years (range, 18 days to 12 years), and 80.6% of patients were less than 4 years old. Based on their clinical features, the patients were classified into 4 clinical groups: brainstem encephalitis (n = 21), meningitis (n = 7), encephalitis (n = 2), and acute flaccid paralysis (n = 1). The common neurologic symptoms included myoclonus (58.1%), lethargy (54.8%), irritability (54.8%), vomiting (48.4%), ataxia (38.7%), and tremor (35.5%). Twenty-five patients underwent an MRI scan; of these, 14 (56.0%) revealed the characteristic increased T2 signal intensity in the posterior region of the brainstem and bilateral cerebellar dentate nuclei. Twenty-six of 30 patients (86.7%) showed CSF pleocytosis. Thirty patients (96.8%) recovered completely without any neurologic deficits; one patient (3.2%) died due to pulmonary hemorrhage and shock. In the present study, brainstem encephalitis was the most common neurologic manifestation of enterovirus 71 infection. The characteristic clinical symptoms such as myoclonus, ataxia, and tremor in conjunction with CSF pleocytosis and brainstem lesions on MR images are pathognomonic for diagnosis of neurologic involvement by enterovirus 71 infection.

  3. NEUROLOGICAL DISORDERS IN PATIENTS WITH HYPERTENSION AND THEIR CORRECTION

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    N. V. Vakhnina

    2016-01-01

    Full Text Available Neurological disorders in hypertensive patients can be caused by both brain injury and concomitant diseases. The elucidation of the causes of neurological disorders and their effective treatment contribute to hypertensive patients’ better adherence to long-term antihypertensive therapy, which normalizes blood pressure (BP and reduces the risk of cerebral complications Objective: to study of the causes of neurological disorders in hypertensive patients and the efficiency of their correction using a new dispersible vinpocetine formulation (Cavinton® Comforte in combined therapy.Patients and methods. A total of 80 patients (men (20% and women (80%; mean age 63±12.3  years with neurological complaints in the presence of hypertension were examined. All the patients were diagnosed with dyscirculatory encephalopathy or chronic brain ischemia, whether they had vascular cognitive impairment. The examination of patients revealed that the neurological complaints were mainly due to concomitant diseases, such as migraine (12%, tension-type headache (66%, and the latter concurrent with migraine (4%.Results and  discussion. The  effective treatment of concomitant diseases in  combination with antihypertensive therapy contributed to normalization of BP and regression of complaints. The most pronounced effect was noted in 40 patients whose combination therapy included Vinpocetine (Cavinton® Comforte 10 mg thrice daily.Conclusion. The therapy resulted in the less severity of both the symptoms of cerebrovascular disease (vascular cognitive impairment and comorbid neurological disorders (headache, dizziness, etc..

  4. Neurologic complications of cerebral angiography in childhood moyamoya syndrome

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    Robertson, R.L.; Chavali, R.V.; Robson, C.D.; Barnes, P.D.; Burrows, P.E. [Department of Radiology, Children`s Hospital Medical Center, Boston, MA (United States); Eldredge, E.A. [Department of Anesthesia, Children`s Hospital Medical Center and Harvard Medical School, Boston, MA (United States); Scott, R.M. [Department of Neurosurgery, Children`s Hospital Medical Center and Harvard Medical School, Boston, MA (United States)

    1998-11-01

    Purpose. To determine the incidence of neurologic complications of cerebral angiography in children with moyamoya syndrome (MMS) as compared to children without MMS. Materials and methods. One-hundred-ninety consecutive cerebral angiograms obtained in 152 children were evaluated. Sixty of these angiograms were obtained in 40 children with MMS. Patients underwent neurologic evaluation prior to and after the procedure. For this study, a neurologic complication was defined as any new focal neurologic deficit or alteration in mental status occurring during the procedure or within the ensuing 24 hours. Results. There were 2 neurologic complications within 24 hours of angiography, one in the MMS group and one in the non-MMS group. One patient with MMS became mute following angiography. The symptom resolved within 12 hours. One patient without MMS being examined postoperatively for residual arteriovenous malformation developed intracranial hemorrhage requiring reexploration 12 hours after the angiogram. Using a two-tail Fisher`s exact test, there was no significant statistical difference in the ischemic (P = 0.3) or hemorrhagic (P = 1.0) complication rates between the group of patients with MMS and the non-MMS groups. Conclusion. The risk of a neurologic complication from cerebral angiography in children with MMS is low and not statistically different from the risk in children with other cerebrovascular disorders. (orig.) With 8 tabs., 37 refs.

  5. Evidence-based guideline summary: diagnosis and treatment of limb-girdle and distal dystrophies: report of the guideline development subcommittee of the American Academy of Neurology and the practice issues review panel of the American Association of Neuromuscular & Electrodiagnostic Medicine.

    Science.gov (United States)

    Narayanaswami, Pushpa; Weiss, Michael; Selcen, Duygu; David, William; Raynor, Elizabeth; Carter, Gregory; Wicklund, Matthew; Barohn, Richard J; Ensrud, Erik; Griggs, Robert C; Gronseth, Gary; Amato, Anthony A

    2014-10-14

    To review the current evidence and make practice recommendations regarding the diagnosis and treatment of limb-girdle muscular dystrophies (LGMDs). Systematic review and practice recommendation development using the American Academy of Neurology guideline development process. Most LGMDs are rare, with estimated prevalences ranging from 0.07 per 100,000 to 0.43 per 100,000. The frequency of some muscular dystrophies varies based on the ethnic background of the population studied. Some LGMD subtypes have distinguishing features, including pattern of muscle involvement, cardiac abnormalities, extramuscular involvement, and muscle biopsy findings. The few published therapeutic trials were not designed to establish clinical efficacy of any treatment. For patients with suspected muscular dystrophy, clinicians should use a clinical approach to guide genetic diagnosis based on clinical phenotype, inheritance pattern, and associated manifestations (Level B). Clinicians should refer newly diagnosed patients with an LGMD subtype and high risk of cardiac complications for cardiology evaluation even if they are asymptomatic from a cardiac standpoint (Level B). In patients with LGMD with a known high risk of respiratory failure, clinicians should obtain periodic pulmonary function testing (Level B). Clinicians should refer patients with muscular dystrophy to a clinic that has access to multiple specialties designed specifically to care for patients with neuromuscular disorders (Level B). Clinicians should not offer patients with LGMD gene therapy, myoblast transplantation, neutralizing antibody to myostatin, or growth hormone outside of a research study designed to determine efficacy and safety of the treatment (Level R). Detailed results and recommendations are available on the Neurology® Web site at Neurology.org. © 2014 American Academy of Neurology.

  6. Electrophysiological evidence of the time course of attentional bias in nonpatients reporting symptoms of depression with and without co-occurring anxiety

    Directory of Open Access Journals (Sweden)

    Sarah M. Sass

    2014-04-01

    Full Text Available Anxiety is characterized by attentional biases to threat, but findings are inconsistent for depression. To address this inconsistency, the present study systematically assessed the role of co-occurring anxiety in attentional bias in depression. In addition, the role of emotional valence, arousal, and gender was explored. Ninety-two nonpatients completed the Penn State Worry Questionnaire (PSWQ; Meyer et al., 1990; Molina & Borkovec, 1994 and portions of the Mood and Anxiety Symptom Questionnaire (MASQ; Watson, Clark, et al., 1995; Watson, Weber, et al., 1995. Individuals reporting high levels of depression and low levels of anxiety (depression only, high levels of depression and anxiety (combined, or low levels of both (control completed an emotion-word Stroop task during event-related brain potential (ERP recording. Pleasant and unpleasant words were matched on emotional arousal level. An attentional bias was not evident in the depression-only group. Women in the combined group had larger N200 amplitude for pleasant than unpleasant stimuli, and the combined group as a whole had larger right-lateralized P300 amplitude for pleasant than unpleasant stimuli, consistent with an early and later attentional bias that is specific to unpleasant valence in the combined group. Men in the control group had larger N200 amplitude for pleasant than unpleasant stimuli, consistent with an early attentional bias that is specific to pleasant valence. The present study indicates that the nature and time course of attention prompted by emotional valence and not arousal differentiates depression with and without anxiety, with some evidence of gender moderating early effects. Overall, results suggest that co-occurring anxiety is more important than previously acknowledged in demonstrating evidence of attentional biases in depression.

  7. Depression and immunity: Inflammation and depressive symptoms in multiple sclerosis

    Science.gov (United States)

    Gold, Stefan M.; Irwin, Michael R.

    2013-01-01

    An increasing body of evidence suggests that patients with major depressive disorder show alterations in immunological markers including increases in proinflammatory cytokine activity and inflammation. Animal models of a depression-like syndrome called sickness behavior have clearly shown that cytokines are implicated in the development of these symptoms. Inflammation of the CNS is a pathological hallmark of multiple sclerosis (MS). Patients affected by this disease also show a high incidence of depression. In light of accumulating evidence for cytokine-mediated sickness behavior from animal studies, it is possible that some aspects of depression and fatigue in multiple sclerosis may be linked to inflammatory markers. Here, we review the current knowledge in the field and illustrate how the sickness behavior model may be applied to investigate depressive symptoms in inflammatory neurological diseases such as multiple sclerosis. PMID:19389584

  8. [Can music therapy for patients with neurological disorders?].

    Science.gov (United States)

    Myskja, Audun

    2004-12-16

    Recent developments in brain research and in the field of music therapy have led to the development of music-based methods specifically aimed at relieving symptoms of Parkinson's disease and other neurologic disorders. Rhythmic auditory stimulation uses external rhythmic auditory cues from song, music or metronome to aid patients improving their walking functioning and has been shown to be effective both within sessions and as a result of training over time. Melodic intonation therapy and related vocal techniques can improve expressive dysphasia and aid rehabilitation of neurologic disorders, particularly Parkinson's disease, stroke and developmental disorders.

  9. The Still Enigmatic Syndrome of Transient Global Amnesia: Interactions Between Neurological and Psychopathological Factors.

    Science.gov (United States)

    Noël, Audrey; Quinette, Peggy; Hainselin, Mathieu; Dayan, Jacques; Viader, Fausto; Desgranges, Béatrice; Eustache, Francis

    2015-06-01

    Transient global amnesia (TGA) is a neurological syndrome that usually occurs in middle-aged or older people. It is characterized by the abrupt onset of profound anterograde amnesia, associated with more variable retrograde amnesia and repetitive questioning. The whole episode lasts no more than 24 h. Almost 60 years after its first descriptions, the etiology of TGA remains unknown. Until now, TGA has been described exclusively as a memory disorder, but there is a growing body of evidence to show that emotional and psychological factors (as anxious and depressive symptoms) are present at different times of TGA. Their role therefore needs to be clarified. First, these factors seem to play a part in triggering TGA, at least for a subgroup of patients, suggesting the existence of an emotional TGA subtype. Second, recent research shows that almost all the TGA patients displayed modifications of their emotional state during the episode, possibly linked to sudden memory loss. The level of depressive and anxious symptoms could even reach a pathological threshold in patients with the so-called "emotional TGA subtype". Third, the persistence of these depressive and anxious symptoms after the end of the episode could account for lasting memory disorders in some patients. Finally, the analysis of these emotional syndrome and emotional factors and the recent data in neuroimaging could allow us to gain a better understanding of the pathophysiological mechanisms behind TGA. The aim of this review was thus to discuss whether the anxious and depressive symptoms are causative, resultant or coincidental of TGA.

  10. Neurological manifestations of oculodentodigital dysplasia: a Cx43 channelopathy of the central nervous system?

    Directory of Open Access Journals (Sweden)

    Marijke eDe Bock

    2013-09-01

    Full Text Available The coordination of tissue function is mediated by gap junctions (GJs that enable direct cell-cell transfer of metabolic and electric signals. GJs are formed by connexins of which Cx43 is most widespread in the human body. In the brain, Cx43 GJs are mostly found in astroglia where they coordinate the propagation of Ca2+ waves, spatial K+ buffering and distribution of glucose. Beyond its role in direct intercellular communication, Cx43 also forms unapposed, non-junctional hemichannels in the plasma membrane of glial cells. These allow the passage of several neuro- and gliotransmitters that may, combined with downstream paracrine signaling, complement direct GJ communication among glial cells and sustain glial-neuronal signaling. Mutations in the GJA1 gene encoding Cx43 have been identified in a rare, mostly autosomal dominant syndrome called oculodentodigital dysplasia (ODDD. ODDD patients display a pleiotropic phenotype reflected by eye, hand, teeth and foot abnormalities, as well as craniofacial and bone malformations. Remarkably, neurological symptoms such as dysarthria, neurogenic bladder (manifested as urinary incontinence, spasticity or muscle weakness, ataxia, and epilepsy are other prominent features observed in ODDD patients. Over 10 mutations detected in patients diagnosed with neurological disorders are associated with altered functionality of Cx43 GJs/hemichannels, but the link between ODDD-related abnormal channel activities and neurologic phenotype is still elusive. Here, we present an overview on the nature of the mutants conveying structural and functional changes of Cx43 channels and discuss available evidence for aberrant Cx43 GJ and hemichannel function. In a final step, we examine the possibilities of how channel dysfunction may lead to some of the neurological manifestations of ODDD.

  11. Who Can Diagnose Parkinson's Disease First? Role of Pre-motor Symptoms.

    Science.gov (United States)

    Rodríguez-Violante, Mayela; Zerón-Martínez, Rosalía; Cervantes-Arriaga, Amin; Corona, Teresa

    2017-04-01

    In 1817, James Parkinson described the disease which bears his name. The disease was defined as a neurological syndrome characterized by tremor, rigidity, and slowness of movements. Almost one hundred years later, degeneration of neurons in the substantia nigra and low levels of dopamine were identified as the putative cause of the disease, thus the disease remained as a pure neurological disorder. In the late 1990s, non-motor symptoms of the disease began to gain interest because of their clinical relevance, as well as for their potential role in broadening the understanding of the pathophysiological mechanisms involved. In the last decade, focus has shifted to the pre-motor symptoms, those non-motor symptoms that present years before the motor onset of the disease. The main premotor symptoms include rapid eye movement sleep behavior disorder, hyposmia, constipation and depression. Subjects with these symptoms usually are not initially seen by a neurologist, and by the time they are consulted neuronal loss in the substantia nigra is over 50%. This review summarizes the overall relevance of non-motor symptoms, their frequency and their pathophysiological implications. Also, the importance of pre-motor symptoms, and the role of specialists other than neurologists in diagnosing subjects with Parkinson's disease is discussed. Two hundred years after the first description of the disease, it is now evident that Parkinson's disease is a systemic disease and a multispecialty team approach is mandatory. Copyright © 2017 IMSS. Published by Elsevier Inc. All rights reserved.

  12. Comparison of neurological health outcomes between two adolescent cohorts exposed to pesticides in Egypt.

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    Ahmed A Ismail

    Full Text Available Pesticide-exposed adolescents may have a higher risk of neurotoxic effects because of their developing brains and bodies. However, only a limited number of studies have addressed this risk among adolescents. The aim of this study was to compare neurological outcomes from two cohorts of Egyptian adolescents working as pesticide applicators. In 2005 and 2009, two cohorts of male adolescents working as pesticide applicators for the cotton crop were recruited from Menoufia Governorate, Egypt. The same application schedule and pesticides were used at both times, including both organophosphorus, and pyrethroid compounds. Participants in both cohorts completed three neurobehavioral tests, health and exposure questionnaires, and medical and neurological screening examinations. In addition, blood samples were collected to measure butyryl cholinesterase (BChE activity. Pesticide applicators in both cohorts reported more neurological symptoms and signs than non-applicators, particularly among participants in the 2005 cohort (OR ranged from 1.18 to 15.3. Except for one test (Trail Making B, there were no significant differences between either applicators or non-applicators of both cohorts on the neurobehavioral outcome measures (p > 0.05. The 2005 cohort showed greater inhibition of serum BChE activity than the 2009 cohort (p < 0.05. In addition, participants with depressed BChE activity showed more symptoms and signs than others without BChE depression (p < 0.05. Our study is the first to examine the consistency of health outcomes associated with pesticide exposure across two cohorts tested at different times from the same geographical region in rural Egypt. This similar pattern of findings across the two cohorts provides strong evidence of the health impact of exposure of adolescents to pesticides.

  13. Comparison of neurological health outcomes between two adolescent cohorts exposed to pesticides in Egypt

    Science.gov (United States)

    Bonner, Matthew R.; Hendy, Olfat; Abdel Rasoul, Gaafar; Wang, Kai; Olson, James R.; Rohlman, Diane S.

    2017-01-01

    Pesticide-exposed adolescents may have a higher risk of neurotoxic effects because of their developing brains and bodies. However, only a limited number of studies have addressed this risk among adolescents. The aim of this study was to compare neurological outcomes from two cohorts of Egyptian adolescents working as pesticide applicators. In 2005 and 2009, two cohorts of male adolescents working as pesticide applicators for the cotton crop were recruited from Menoufia Governorate, Egypt. The same application schedule and pesticides were used at both times, including both organophosphorus, and pyrethroid compounds. Participants in both cohorts completed three neurobehavioral tests, health and exposure questionnaires, and medical and neurological screening examinations. In addition, blood samples were collected to measure butyryl cholinesterase (BChE) activity. Pesticide applicators in both cohorts reported more neurological symptoms and signs than non-applicators, particularly among participants in the 2005 cohort (OR ranged from 1.18 to 15.3). Except for one test (Trail Making B), there were no significant differences between either applicators or non-applicators of both cohorts on the neurobehavioral outcome measures (p > 0.05). The 2005 cohort showed greater inhibition of serum BChE activity than the 2009 cohort (p < 0.05). In addition, participants with depressed BChE activity showed more symptoms and signs than others without BChE depression (p < 0.05). Our study is the first to examine the consistency of health outcomes associated with pesticide exposure across two cohorts tested at different times from the same geographical region in rural Egypt. This similar pattern of findings across the two cohorts provides strong evidence of the health impact of exposure of adolescents to pesticides. PMID:28231336

  14. Minocycline modulates neuroprotective effect of hesperidin against quinolinic acid induced Huntington's disease like symptoms in rats: behavioral, biochemical, cellular and histological evidences.

    Science.gov (United States)

    Kumar, Anil; Chaudhary, Tanya; Mishra, Jitendriya

    2013-11-15

    Emerging evidences indicate hesperidin, a citrus flavanone, attenuates neurodegenerative processes and related complications. Besides its anti-oxidant properties, the other probable mechanisms which underpin its neuroprotective potential are still not clear. In light of emerging role of flavonoids in modulating oxidative stress and neuro-inflammation, the study has been designed to explore the possible neuroprotective effect of hesperidin and its combination with minocycline (microglial inhibitor), against quinolinic acid (QA) induced Huntington's disease (HD) like symptoms in rats. Unilateral intrastriatal administration of QA (300 nmol/4 µl) significantly reduced body weight, impaired behavior (locomotor activity, beam balance and memory performance), caused oxidative damage (increased lipid peroxidation, nitrite concentration, depleted super oxide dismutase and reduced glutathione), demonstrated mitochondrial dysfunction (decreased Complex-I, II, III, and IV activities), increased striatal lesion volume and altered the levels of TNF-α, caspase-3 as well as BDNF expression, as compared to sham group. Meanwhile, chronic hesperidin (100mg/kg, p.o.) and minocycline (25mg/kg, p.o.) treatment for 21 days significantly attenuated the behavioral, biochemical and cellular alterations as compared to QA treated (control) animals, whereas hesperidin (50mg/kg, p.o.) treatment was found to be non-significant. However, treatment of hesperidin (50mg/kg) in combination with minocycline (25mg/kg) potentiated their neuroprotective effect, which was significant as compared to their effects per se in QA treated animals. Taken altogether, the results of the present study suggest a possible interplay of microglial modulation and anti-oxidant effect in neuroprotective potential of hesperidin against QA induced HD like symptoms in rats. © 2013 Published by Elsevier B.V.

  15. Neurologic Injury in Operatively Treated Acetabular Fractures.

    Science.gov (United States)

    Bogdan, Yelena; Tornetta, Paul; Jones, Clifford; Gilde, Alex K; Schemitsch, Emil; Vicente, Milena; Horwitz, Daniel; Sanders, David; Firoozabadi, Reza; Leighton, Ross; de Dios Robinson, Juan; Marcantonio, Andrew; Hamilton, Benjamin

    2015-10-01

    The purpose of this study is to evaluate a series of operatively treated acetabular fractures with neurologic injury and to track sensory and motor recovery. Operatively treated acetabular fractures with neurologic injury from 8 trauma centers were reviewed. Patients were followed for at least 6 months or to neurologic recovery. Functional outcome was documented at 3 months, 6 months, and final follow-up. Outcomes included motor and sensory recovery, brace use, development of chronic regional pain syndrome, and return to work. One hundred thirty-seven patients (101 males and 36 females), average age 42 (17-87) years, met the criteria. Mechanism of injury included MVC (67%), fall (11%), and other (22%). The most common fracture types were transverse + posterior wall (33%), posterior wall (23%), and both-column (23%). Deficits were identified as preoperative in 57%, iatrogenic in 19% (immediately after surgery), and those that developed postoperatively in 24%. A total of 187 nerve deficits associated with the following root levels were identified: 7 in L2-3, 18 in L4, 114 in L5, and 48 in S1. Full recovery occurred in 54 (29%), partial recovery in 69 (37%), and 64 (34%) had no recovery. Forty-three percent of S1 deficits and 29% of L5 deficits had no recovery. Fifty-five percent of iatrogenic injuries did not recover. Forty-eight patients wore a brace at the final follow-up, all for an L5 root level deficit. Although 60% (42/70) returned to work, chronic regional pain syndrome was seen to develop in 19% (18/94). Peripheral neurologic injury in operatively treated acetabular fractures occurs most commonly in the sciatic nerve distribution, with L5 root level deficits having only a 26% chance of full recovery. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  16. Neurological damage arising from intrapartum hypoxia/acidosis.

    Science.gov (United States)

    Rei, M; Ayres-de-Campos, D; Bernardes, J

    2016-01-01

    Complications occurring at any level of foetal oxygen supply will result in hypoxaemia, and this may ultimately lead to hypoxia/acidosis and neurological damage. Hypoxic-ischaemic encephalopathy (HIE) is the short-term neurological dysfunction caused by intrapartum hypoxia/acidosis, and this diagnosis requires the presence of a number of findings, including the confirmation of newborn metabolic acidosis, low Apgar scores, early imaging evidence of cerebral oedema and the appearance of clinical signs of neurological dysfunction in the first 48 h of life. Cerebral palsy (CP) consists of a heterogeneous group of nonprogressive movement and posture disorders, frequently accompanied by cognitive and sensory impairments, epilepsy, nutritional deficiencies and secondary musculoskeletal lesions. Although CP is the most common long-term neurological complication associated with intrapartum hypoxia/acidosis, >80% of cases are caused by other phenomena. Data on minor long-term neurological deficits are scarce, but they suggest that less serious intellectual and motor impairments may result from intrapartum hypoxia/acidosis. This chapter focuses on the existing evidence of neurological damage associated with poor foetal oxygenation during labour. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Advances in the management of MS symptoms: recently proposed clinical management algorithms.

    Science.gov (United States)

    Vermersch, Patrick

    2015-01-01

    Guidelines from both the German and Spanish Neurology Societies for managing patients with multiple sclerosis (MS) spasticity emphasize the importance of setting clear objectives and use evidence levels and grades to support their recommendations. Swedish guidelines for MS spasticity also reflect the need to establish treatment aims and recommend use of validated scales to measure symptom changes. Treatment of generalized MS spasticity, beyond physiotherapy, tends to begin with baclofen, tizanidine and/or diazepam, adding Sativex (THC:CBD) oromucosal spray for moderate-to-severe cases. The European Federation of Neurological Societies/European Academy of Neurology Taskforce on Spasticity in Multiple Sclerosis is currently reviewing the literature supporting the pharmacological treatment of MS spasticity and aims to publish recommendations in the near future to guide clinicians in their treatment choices.

  18. Neurological complications of kernicterus.

    Science.gov (United States)

    AlOtaibi, Suad F; Blaser, Susan; MacGregor, Daune L

    2005-08-01

    Prevention of bilirubin encephalopathy relies on the detection of newborns who are at risk of developing serious hyperbilirubinemia. The objective of this study was to reassess the clinical syndrome of kernicterus as neurodiagnostic studies have become more readily available and can be used to evaluate these infants. The study population was neonates born at term or near term admitted to The Hospital for Sick Children in Toronto, Ontario, Canada, between January 1990 and May 2000. During the study period, there were 9776 admissions (average number of admissions per year--888 infants). The inclusion criteria were that patients had total serum bilirubin levels of >400 micromol/L at the time of diagnosis and no evidence of hypoxic ischemic encephalopathy. Records were reviewed to establish neurodevelopment outcomes. Twelve neonates (nine males) were identified. Bilirubin levels at the time of diagnosis ranged from 405 to 825 micromol/L. Causes of these elevated levels included glucose-6-phosphate dehydrogenase deficiency (seven patients), dehydration (three patients), sepsis (one patient), and was undetermined in one patient. Abnormal visual evoked potentials were found in three of nine patients and abnormal brainstem auditory evoked potentials in seven of ten patients. Abnormal electroencephalograms were documented in five patients studied. Brain magnetic resonance imaging results were abnormal in three of four patients. Magnetic resonance imaging typically showed an increased signal in the posteromedial aspect of the globus pallidus and was, therefore, useful in the assessment of the structural changes of chronic bilirubin encephalopathy after kernicterus.

  19. Prediction and prognostication of neurological deterioration in patients with acute ICH

    DEFF Research Database (Denmark)

    Ovesen, Christian; Christensen, Anders Fogh; Havsteen, Inger

    2015-01-01

    OBJECTIVE: Patients with intracerebral haemorrhage (ICH) are at high risk of neurological deterioration (ND). We aimed at establishing predictors of early ND (END) as well as late ND (LND) and at exploring the impact of neurological stability during the first week on long-term prognosis. DESIGN: We...... conducted this study as a retrospective cohort study. ND was evaluated based on the consciousness and severity of neurological symptoms. ND during the first 24 h after admission was defined as early ND and from 24 h to 7 days as LND. Patients were followed up until February 2015. PARTICIPANTS: We included...... 300 patients with acute ICH (≤4.5 h from symptom onset) who were admitted to our institution from March 2009 to January 2015. SETTING: Section of Acute Neurology, Department of Neurology, Bispebjerg Hospital is a specialised referral centre receiving patients with acute stroke from the entire capital...

  20. Neurologic presentation of celiac disease.

    Science.gov (United States)

    Bushara, Khalafalla O

    2005-04-01

    Celiac disease (CD) long has been associated with neurologic and psychiatric disorders including cerebellar ataxia, peripheral neuropathy, epilepsy, dementia, and depression. Earlier reports mainly have documented the involvement of the nervous system as a complication of prediagnosed CD. However, more recent studies have emphasized that a wider spectrum of neurologic syndromes may be the presenting extraintestinal manifestation of gluten sensitivity with or without intestinal pathology. These include migraine, encephalopathy, chorea, brain stem dysfunction, myelopathy, mononeuritis multiplex, Guillain-Barre-like syndrome, and neuropathy with positive antiganglioside antibodies. The association between most neurologic syndromes described and gluten sensitivity remains to be confirmed by larger epidemiologic studies. It further has been suggested that gluten sensitivity (as evidenced by high antigliadin antibodies) is a common cause of neurologic syndromes (notably cerebellar ataxia) of otherwise unknown cause. Additional studies showed high prevalence of gluten sensitivity in genetic neurodegenerative disorders such as hereditary spinocerebellar ataxia and Huntington's disease. It remains unclear whether gluten sensitivity contributes to the pathogenesis of these disorders or whether it represents an epiphenomenon. Studies of gluten-free diet in patients with gluten sensitivity and neurologic syndromes have shown variable results. Diet trials also have been inconclusive in autism and schizophrenia, 2 diseases in which sensitivity to dietary gluten has been implicated. Further studies clearly are needed to assess the efficacy of gluten-free diet and to address the underlying mechanisms of nervous system pathology in gluten sensitivity.

  1. Acute and subacute symptoms among workers in the printing industry

    DEFF Research Database (Denmark)

    Bælum, Jesper; Andersen, I; Mølhave, Lars

    1982-01-01

    The study population comprised 52 male printers and 52 controls. Each person was interviewed about job history, general health, and work-related symptoms. Symptoms from eyes and airways, neurological symptoms, and general symptoms were recorded. A lung function test and a measurement of the sense...

  2. EFNS guidelines for the use of intravenous immunoglobulin in treatment of neurological diseases: EFNS task force on the use of intravenous immunoglobulin in treatment of neurological diseases

    NARCIS (Netherlands)

    Elovaara, I.; Apostolski, S.; van Doorn, P.; Gilhus, N. E.; Hietaharju, A.; Honkaniemi, J.; van Schaik, I. N.; Scolding, N.; Soelberg Sørensen, P.; Udd, B.

    2008-01-01

    Despite high-dose intravenous immunoglobulin (IVIG) is widely used in treatment of a number of immune-mediated neurological diseases, the consensus on its optimal use is insufficient. To define the evidence-based optimal use of IVIG in neurology, the recent papers of high relevance were reviewed and

  3. Milestone-compatible neurology resident assessments: A role for observable practice activities.

    Science.gov (United States)

    Jones, Lyell K; Dimberg, Elliot L; Boes, Christopher J; Eggers, Scott D Z; Dodick, David W; Cutsforth-Gregory, Jeremy K; Leep Hunderfund, Andrea N; Capobianco, David J

    2015-06-02

    Beginning in 2014, US neurology residency programs were required to report each trainee's educational progression within 29 neurology Milestone competency domains. Trainee assessment systems will need to be adapted to inform these requirements. The primary aims of this study were to validate neurology resident assessment content using observable practice activities (OPAs) and to develop assessment formats easily translated to the Neurology Milestones. A modified Delphi technique was used to establish consensus perceptions of importance of 73 neurology OPAs among neurology educators and trainees at 3 neurology residency programs. A content validity score (CVS) was derived for each neurology OPA, with scores ≥4.0 determined in advance to indicate sufficient content validity. The mean CVS for all OPAs was 4.4 (range 3.5-5.0). Fifty-seven (78%) OPAs had a CVS ≥4.0, leaving 16 (22%) below the pre-established threshold for content validity. Trainees assigned a higher importance to individual OPAs (mean CVS 4.6) compared to faculty (mean 4.4, p = 0.016), but the effect size was small (η(2) = 0.10). There was no demonstrated effect of length of education experience on perceived importance of neurology OPAs (p = 0.23). Two sample resident assessment formats were developed, one using neurology OPAs alone and another using a combination of neurology OPAs and the Neurology Milestones. This study provides neurology training programs with content validity evidence for items to include in resident assessments, and sample assessment formats that directly translate to the Neurology Milestones. Length of education experience has little effect on perceptions of neurology OPA importance. © 2015 American Academy of Neurology.

  4. Quality Metrics in Inpatient Neurology.

    Science.gov (United States)

    Dhand, Amar

    2015-12-01

    Quality of care in the context of inpatient neurology is the standard of performance by neurologists and the hospital system as measured against ideal models of care. There are growing regulatory pressures to define health care value through concrete quantifiable metrics linked to reimbursement. Theoretical models of quality acknowledge its multimodal character with quantitative and qualitative dimensions. For example, the Donabedian model distils quality as a phenomenon of three interconnected domains, structure-process-outcome, with each domain mutually influential. The actual measurement of quality may be implicit, as in peer review in morbidity and mortality rounds, or explicit, in which criteria are prespecified and systemized before assessment. As a practical contribution, in this article a set of candidate quality indicators for inpatient neurology based on an updated review of treatment guidelines is proposed. These quality indicators may serve as an initial blueprint for explicit quality metrics long overdue for inpatient neurology. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  5. [Child neurology and multimedia technology].

    Science.gov (United States)

    Nihei, Kenji

    2002-01-01

    Methods of computer technology (intelligent technology, IT), such as multimedia and virtual reality, are utilized more and more in all medical fields including child neurology. Advances in the digitalization of individual medical data and multi-media technology have enabled patients to be able to obtain their own medical data by small media and to receive medical treatment at any hospitals even if they are located in distance place. Changes from a doctor oriented to patients oriented medicine is anticipated. It is necessary to store medical data from birth to adulthood and to accumulate epidemiological data of rare diseases such as metabolic diseases or degenerative diseases especially in child neurology, which highly require tele medicine and telecare at home. Moreover, IT may improve in the QOL of patients with neurological diseases and of their families. Cooperation of medicine and engineering is therefore necessary. Results of our experiments on telemedicine, telecare and virtual reality are described.

  6. Late neurological complications after irradiation of malignant tumors of the testis

    DEFF Research Database (Denmark)

    Knap, Marianne; Bentzen, Søren M.; Overgaard, Jens

    2007-01-01

    To identify and describe late neurological complications in a Danish testis cancer cohort treated by radiotherapy. Clinical retrospective material of 94 consecutive patients with malignant testicular tumours treated at Aarhus County Hospital from 1964 to 1973. The irradiated dose in the paraaortic...... complications after irradiation. One developed symptoms 9 months after treatment, but in the six other cases we found a latency period between 10 and 20 years from radiotherapy until the initial neurological symptoms began. The clinical picture in all seven patients was dominated by muscle atrophy, flaccid...... and 13 patients with long-term gastrointestinal morbidity. Seven patients were identified with late neurological complications, and a clear dose-incidence relationship was shown. The latency period, from irradiation to the initial neurological symptoms began, ranged from 9 months to 20 years...

  7. Neurological soft signs, dissociation and alexithymia in patients with obsessive-compulsive disorder (OCD) and healthy subjects.

    Science.gov (United States)

    Tapancı, Zafer; Yıldırım, Abdullah; Boysan, Murat

    2017-11-21

    A body of evidence has supported that patients with obsessive-compulsive disorder (OCD) have increased rates of various neurological soft signs (NSS) compared to controls. Various lines of research has documented robust relationships between OCD and dissociative symptomatology. The study aimed to examine the associations between obsessive-compulsive symptoms, dissociative experiences alexithymia, and NSS. The study included thirty OCD patients and thirty healthy controls, matched for age, marital status, education, and income. The Neurological Evaluation Scale (NES), Padua Inventory-Revised (PI-R), Dissociative Experiences Scale (DES) and Toronto Alexithymia Scale (TAS-20) were administered. In comparison to healthy controls, patients with OCD had difficulty sequencing for complex motor acts and greater absorption/ imaginative involvement. Using latent class analysis, the study sample was classified into two homogenous subsets as mild NSS (n = 45) and severe NSS (n = 15). Majority of the participants who were grouped into severe NSS latent class were OCD patient (n = 14, 93.3%). Furthermore, those with severe NSS reported greater levels of alexithymia and more severe obsessive-compulsive symptoms, particularly precision. We concluded that relationships between OCD severity and NSS appear to be of crucial importance. Our data along with accumulated evidence suggest that OCD associated with pronounced NSS may represent a specific subtype of the disorder. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. The imaging features of neurologic complications of left atrial myxomas

    Energy Technology Data Exchange (ETDEWEB)

    Liao, Wei-Hua; Ramkalawan, Divya; Liu, Jian-Ling; Shi, Wei [Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, Hunan (China); Zee, Chi-Shing [Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033 (United States); Yang, Xiao-Su; Li, Guo-Liang; Li, Jing [Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, Hunan (China); Wang, Xiao-Yi, E-mail: cjr.wangxiaoyi@vip.163.com [Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, Hunan (China)

    2015-05-15

    Background: Neurologic complications may be the first symptoms of atrial myxomas. Understanding the imaging features of neurologic complications of atrial myxomas can be helpful for the prompt diagnosis. Objective: To identify neuroimaging features for patients with neurologic complications attributed to atrial myxoma. Methods: We retrospectively reviewed the medical records of 103 patients with pathologically confirmed atrial myxoma at Xiangya Hospital from January 2009 to January 2014. The neuroimaging data for patients with neurologic complications were analyzed. Results: Eight patients with atrial myxomas (7.77%) presented with neurologic manifestations, which constituted the initial symptoms for seven patients (87.5%). Neuroimaging showed five cases of cerebral infarctions and three cases of aneurysms. The main patterns of the infarctions were multiplicity (100.0%) and involvement of the middle cerebral artery territory (80.0%). The aneurysms were fusiform in shape, multiple in number (100.0%) and located in the distal middle cerebral artery (100.0%). More specifically, high-density in the vicinity of the aneurysms was observed on CT for two patients (66.7%), and homogenous enhancement surrounding the aneurysms was detected in the enhanced imaging for two patients (66.7%). Conclusion: Neurologic complications secondary to atrial myxoma consist of cerebral infarctions and aneurysms, which show certain characteristic features in neuroimaging. Echocardiography should be performed in patients with multiple cerebral infarctions, and multiple aneurysms, especially when aneurysms are distal in location. More importantly, greater attention should be paid to the imaging changes surrounding the aneurysms when myxomatous aneurysms are suspected and these are going to be the relevant features in our article.

  9. Neurological manifestation of colonic adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Uzair Chaudhary

    2012-04-01

    Full Text Available Paraneoplastic neurologic disorders are extremely rare in cancer patients and are most commonly associated with certain tumors, such as ovarian cancer, small cell lung cancer, and breast cancer. We report here a paraneoplastic neurological syndrome in a 53-year-old man with colonic adenocarcinoma with a solitary liver metastasis. His paraneoplastic syndrome was successfully treated by methylprednisolone and primary oncologic therapies including neoadjuvant chemotherapy and definitive surgery. This is also the first documented case of simultaneous manifestation of a sensory neuropathy and limbic encephalitis with colon cancer.

  10. Sleep disorders in neurological practice

    Directory of Open Access Journals (Sweden)

    Mikhail Guryevich Poluektov

    2012-01-01

    Full Text Available Sleep disorders are closely associated with both nervous system diseases and mental disorders; however, such patients prefer to seek just neurological advice. Insomnia is the most common complaint in routine clinical practice. It is characterized by different impairments in sleep and daytime awakening. Obstructive sleep apnea syndrome is less common, but more clinically important because of its negative impact on the cardiovascular and nervous systems. The common neurological disorders are restless legs syndrome and REM sleep behavior disorder, as well as narcolepsy, the major manifestations of which are impaired nocturnal sleep and daytime awakening.

  11. A consensus review on the development of palliative care for patients with chronic and progressive neurological disease

    NARCIS (Netherlands)

    Oliver, D. J.; Borasio, G. D.; Caraceni, A.; de Visser, M.; Grisold, W.; Lorenzl, S.; Veronese, S.; Voltz, R.

    2016-01-01

    The European Association of Palliative Care Taskforce, in collaboration with the Scientific Panel on Palliative Care in Neurology of the European Federation of Neurological Societies (now the European Academy of Neurology), aimed to undertake a review of the literature to establish an evidence-based

  12. Premenstrual symptoms.

    Science.gov (United States)

    1973-03-24

    Data is reviewed on premenstrual symptoms which have been related to high suicide and accident rates, employment absentee rates, poor academic performance and acute psychiatric problems. A recent study of healthy young women indicated that 39% had troublesome premenstrual symptoms, 54% passed clots in their menses, 70% had cyclical localized acneiform eruptions and only 17% failed to experience menstrual pain. Common menstrual disorders are classified as either dysmenorrhea or the premenstrual syndrome. Symptoms for the latter usually begin 2-12 days prior to menstruation and include nervous tension, irritability, anxiety, depression, bloated breasts and abdomen, swollen fingers and legs, headaches, dizziness, occasional hypersomia, excessive thirst and appetite. Some women may display an increased susceptibility to migraine, vasomotor rhinitis, asthma, urticaria and epilepsy. Symptoms are usually relieved with the onset of menses. While a definitive etiological theory remains to be substantiated, symptomatic relief has been reported with salt and water restriction and simple diuretics used 7 to 10 days premenstrually. Diazapam or chlordiazepoxide treatment is recommended before oral contraceptive therapy. The premenstrual syndrome may persist after menopause, is unaffected by parity, and sufferers score highly on neuroticism tests. Primary or spasmodic dysmenorrhea occurs in young women, tends to decline with age and parity and has no correlation with premenstrual symptoms or neuroticism. Spasmodic or colicky pain begins and is most severe on the first day of menstruation and may continue for 2-3 days. Treatment of dysmenorrhea with psychotropic drugs or narcotics is discouraged due to the risk of dependence and abuse. Temporary relief for disabling pain may be obtained with oral contraceptives containing synthetic estrogen and progestogen but the inherent risks should be acknowledged. Both disorders have been correlated to menstrual irregularity. Amenorrhea in

  13. Clinical perspectives on medical marijuana (cannabis) for neurologic disorders.

    Science.gov (United States)

    Fife, Terry D; Moawad, Heidi; Moschonas, Constantine; Shepard, Katie; Hammond, Nancy

    2015-08-01

    The American Academy of Neurology published an evidence-based systematic review of randomized controlled trials using marijuana (Cannabis sativa) or cannabinoids in neurologic disorders. Several cannabinoids showed effectiveness or probable effectiveness for spasticity, central pain, and painful spasms in multiple sclerosis. The review justifies insurance coverage for dronabinol and nabilone for these indications. Many insurance companies already cover these medications for other indications. It is unlikely that the review will alter coverage for herbal marijuana. Currently, no payers cover the costs of herbal medical marijuana because it is illegal under federal law and in most states. Cannabinoid preparations currently available by prescription may have a role in other neurologic conditions, but quality scientific evidence is lacking at this time.

  14. Glaucoma Symptoms

    Science.gov (United States)

    ... up You can help find a cure for glaucoma Give now Signs & Symptoms The most common types ... have completely different symptoms. Symptoms of Open-Angle Glaucoma Most people who develop open-angle glaucoma don’ ...

  15. Neurological Disorders in Medical Use of Cannabis: An Update.

    Science.gov (United States)

    Solimini, Renata; Rotolo, Maria Concetta; Pichini, Simona; Pacifici, Roberta

    2017-01-01

    Medical cannabis is increasingly used as a treatment or adjunct treatment with different levels of efficacy in several neurological disorders or related symptoms (such as multiple sclerosis, autism, Parkinson and Alzheimer disease, Tourette's syndrome, Huntington's disease, neuropathic pain, epilepsy, headache), as well as in other medical conditions (e.g. nausea and vomiting, glaucoma, appetite stimulation, cancer, inflammatory conditions, asthma). Nevertheless, a number of neurological adverse effects from use of medical cannabis on the short- and on the longterm have been reported, in addition to other adverse health events. It has been noticed that the use of medical cannabis can lead to a paradoxical effects depending on the amount of delta-9-tetrahydrocannabinol (THC) -like cannabinoids the preparation contain. Accordingly, some neurological disorders or symptoms (e.g. multiple sclerosis, seizures, epilepsy, headache) may be caused or exacerbated by the same treatment supposed to cure them. The current review presents an update of the neurological adverse effects resulting from the use of cannabis for medical purposes, highlighting the need to weigh the benefits and risks, when using cannabinoidbased treatments. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  16. Palliative care and neurology: time for a paradigm shift.

    Science.gov (United States)

    Boersma, Isabel; Miyasaki, Janis; Kutner, Jean; Kluger, Benzi

    2014-08-05

    Palliative care is an approach to the care of patients and families facing progressive and chronic illnesses that focuses on the relief of suffering due to physical symptoms, psychosocial issues, and spiritual distress. As neurologists care for patients with chronic, progressive, life-limiting, and disabling conditions, it is important that they understand and learn to apply the principles of palliative medicine. In this article, we aim to provide a practical starting point in palliative medicine for neurologists by answering the following questions: (1) What is palliative care and what is hospice care? (2) What are the palliative care needs of neurology patients? (3) Do neurology patients have unique palliative care needs? and (4) How can palliative care be integrated into neurology practice? We cover several fundamental palliative care skills relevant to neurologists, including communication of bad news, symptom assessment and management, advance care planning, caregiver assessment, and appropriate referral to hospice and other palliative care services. We conclude by suggesting areas for future educational efforts and research. © 2014 American Academy of Neurology.

  17. Neurological Adverse Effects after Radiation Therapy for Stage II Seminoma

    DEFF Research Database (Denmark)

    Ebbeskov Lauritsen, Liv; Meidahl Petersen, Peter; Daugaard, Gedske

    2012-01-01

    against the tumour bed) with a conventional fractionation of 2 Gy/day, 5 days per week. RT was applied as hockey-stick portals, also called L-fields. In 2 cases, the symptoms fully resolved. Therapeutic irradiation can cause significant injury to the peripheral nerves of the lumbosacral plexus and....../or to the spinal cord. RT is believed to produce plexus injury by both direct toxic effects and secondary microinfarction of the nerves, but the exact pathophysiology of RT-induced injury is unclear. Since reported studies of radiation-induced neurological adverse effects are limited, it is difficult to estimate...... their frequency and outcome. The treatment of neurological symptoms due to RT is symptomatic....

  18. Expanding the neurological examination using functional neurologic assessment: part II neurologic basis of applied kinesiology.

    Science.gov (United States)

    Schmitt, W H; Yanuck, S F

    1999-03-01

    Functional Neurologic Assessment and treatment methods common to the practice of applied kinesiology are presented. These methods are proposed to enhance neurological examination and treatment procedures toward more effective assessment and care of functional impairment. A neurologic model for these procedures is proposed. Manual assessment of muscular function is used to identify changes associated with facilitation and inhibition, in response to the introduction of sensory receptor-based stimuli. Muscle testing responses to sensory stimulation of known value are compared with usually predictable patterns based on known neuroanatomy and neurophysiology, guiding the clinician to an understanding of the functional status of the patient's nervous system. These assessment procedures are used in addition to other standard diagnostic measures to augment rather than replace the existing diagnostic armamentarium. The proper understanding of the neurophysiologic basis of muscle testing procedures will assist in the design of further investigations into applied kinesiology. Accordingly, the neurophysiologic basis and proposed mechanisms of these methods are reviewed.

  19. Edgar Allan Poe and neurology

    Directory of Open Access Journals (Sweden)

    Hélio Afonso Ghizoni Teive

    2014-06-01

    Full Text Available Edgar Allan Poe was one of the most celebrated writers of all time. He published several masterpieces, some of which include references to neurological diseases. Poe suffered from recurrent depression, suggesting a bipolar disorder, as well as alcohol and drug abuse, which in fact led to his death from complications related to alcoholism. Various hypotheses were put forward, including Wernicke's encephalopathy.

  20. Edgar Allan Poe and neurology.

    Science.gov (United States)

    Teive, Hélio Afonso Ghizoni; Paola, Luciano de; Munhoz, Renato Puppi

    2014-06-01

    Edgar Allan Poe was one of the most celebrated writers of all time. He published several masterpieces, some of which include references to neurological diseases. Poe suffered from recurrent depression, suggesting a bipolar disorder, as well as alcohol and drug abuse, which in fact led to his death from complications related to alcoholism. Various hypotheses were put forward, including Wernicke's encephalopathy.

  1. Proprioceptive reflexes and neurological disorders

    NARCIS (Netherlands)

    Schouten, A.C.

    2004-01-01

    Proprioceptive reflexes play an important role during the control of movement and posture. Disturbed modulation of proprioceptive reflexes is often suggested as the cause for the motoric features present in neurological disorders. In this thesis methods are developed and evaluated to quantify

  2. [Neurology in medieval regimina sanitatis].

    Science.gov (United States)

    de Frutos González, V; Guerrero Peral, A L

    2011-09-01

    In medical medieval literature some works about dietetics stand out. Dietetics, as a separate branch of medicine, includes not only food or drinks, but other environmental factors influencing on health. They are known as regimina sanitatis or salutis, and specially developed in the Christian west. They generally consisted of a balance between the Galenic "six non-natural things"; factors regulating health and its protection: environment, exercise, food, sleep, bowel movements and emotions. After reviewing the sources and defining the different stages of this genre, we have considered three of the most out-standing medieval regimina, the anonymous Regimen sanitatis salernitanum, Arnaldo de Vilanova's Regimen sanitatis ad regem aragonum and Bernardo de Gordon's Tractatus of conservatione vite humane. In them we review references to neurological disease. Though not independently considered, there is a significant presence of neurological diseases in the regimina. Dietetics measures are proposed to preserve memory, nerves, or hearing, as well as for the treatment of migraine, epilepsy, stroke or dizziness. Regimina are quiet representative among medical medieval literature, and they show medieval physicians vision of neurological diseases. Dietetics was considered useful to preserve health, and therapeutics was based on natural remedies. 2010 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  3. Education Research: Neurology training reassessed

    Science.gov (United States)

    Maas, Matthew B.; Coleman, Mary; Jozefowicz, Ralph; Engstrom, John

    2012-01-01

    Objective: To assess the strengths and weaknesses of neurology resident education using survey methodology. Methods: A 27-question survey was sent to all neurology residents completing residency training in the United States in 2011. Results: Of eligible respondents, 49.8% of residents returned the survey. Most residents believed previously instituted duty hour restrictions had a positive impact on resident quality of life without impacting patient care. Most residents rated their faculty and clinical didactics favorably. However, many residents reported suboptimal preparation in basic neuroscience and practice management issues. Most residents (71%) noted that the Residency In-service Training Examination (RITE) assisted in self-study. A minority of residents (14%) reported that the RITE scores were used for reasons other than self-study. The vast majority (86%) of residents will enter fellowship training following residency and were satisfied with the fellowship offers they received. Conclusions: Graduating residents had largely favorable neurology training experiences. Several common deficiencies include education in basic neuroscience and clinical practice management. Importantly, prior changes to duty hours did not negatively affect the resident perception of neurology residency training. PMID:23091077

  4. [Neurological soft signs in pervasive developmental disorders].

    Science.gov (United States)

    Halayem, S; Bouden, A; Halayem, M B; Tabbane, K; Amado, I; Krebs, M O

    2010-09-01

    Many studies have focused on specific motor signs in autism and Asperger's syndrome, but few has been published on the complete range of neurological soft signs (NSS) in children with pervasive developmental disorder (PDD). Scarce are the studies evaluating NSS in children suffering from PDD not otherwise specified (PDDNOS). This study compared performance of 11 autistic children (AD) and 10 children with PDDNOS, with controls matched on age, sex and cognitive performance on Krebs et al.'s NSS scale. Because of the duration of the assessments and specific difficulties encountered in managing some items, an adaptation of the scale had to be made during a pilot study with the agreement of the author. To be eligible, patients had to meet the following inclusion criteria: an age range of 6-16 years, a diagnosis of autistic disorder or PDDNOS based on the DSM IV criteria (American Psychiatric Association 1994). The autism diagnostic interview-revised (ADI-R) was used in order to confirm the diagnosis and to evaluate the association of the symptoms to the severity of the NSS. The childhood autism rating scale (CARS) was completed for the patients in order to evaluate symptoms at the time of the NSS examination. Cognitive ability was assessed with Raven's progressive matrices. Were excluded patients with: history of cerebral palsy, congenital anomaly of the central nervous system, epilepsy, known genetic syndrome, tuberous sclerosis, neurofibromatosis, antecedent of severe head trauma, Asperger's syndrome, obvious physical deformities or sensory deficits that would interfere with neurological assessment, deep mental retardation and recent or chronic substance use or abuse. Healthy controls shared the same exclusion criteria, with no personal history of neurological, psychiatric disorder or substance abuse, no family history of psychiatric disorder and normal or retardation in schooling. All study procedures were approved by the local Ethics Committee (Comité d

  5. International electives in neurology training

    Science.gov (United States)

    Lyons, Jennifer L.; Coleman, Mary E.; Engstrom, John W.

    2014-01-01

    Objective: To ascertain the current status of global health training and humanitarian relief opportunities in US and Canadian postgraduate neurology programs. Background: There is a growing interest among North American trainees to pursue medical electives in low- and middle-income countries. Such training opportunities provide many educational and humanitarian benefits but also pose several challenges related to organization, human resources, funding, and trainee and patient safety. The current support and engagement of neurology postgraduate training programs for trainees to pursue international rotations is unknown. Methods: A survey was distributed to all program directors in the United States and Canada (December 2012–February 2013) through the American Academy of Neurology to assess the training opportunities, institutional partnerships, and support available for international neurology electives. Results: Approximately half of responding programs (53%) allow residents to pursue global health–related electives, and 11% reported that at least 1 trainee participated in humanitarian relief during training (survey response rate 61%, 143/234 program directors). Canadian programs were more likely to allow residents to pursue international electives than US programs (10/11, 91% vs 65/129, 50%, p = 0.023). The number of trainees participating in international electives was low: 0%–9% of residents (55% of programs) and 10%–19% of residents (21% of programs). Lack of funding was the most commonly cited reason for residents not participating in global health electives. If funding was available, 93% of program directors stated there would be time for residents to participate. Most program directors (75%) were interested in further information on global health electives. Conclusions: In spite of high perceived interest, only half of US neurology training programs include international electives, mostly due to a reported lack of funding. By contrast, the majority

  6. Somatic Symptoms

    DEFF Research Database (Denmark)

    Eliasen, Marie; Kreiner, Svend; Ebstrup, Jeanette F

    2016-01-01

    A high number of somatic symptoms have been associated with poor health status and increased health care use. Previous studies focused on number of symptoms without considering the specific symptoms. The aim of the study was to investigate 1) the prevalence of 19 somatic symptoms, 2......) the associations between the symptoms, and 3) the associations between the somatic symptoms, self-perceived health and limitations due to physical health accounting for the co-occurrence of symptoms. Information on 19 somatic symptoms, self-perceived health and limitations due to physical health was achieved from.......9% of the respondents were bothered by one or more of the 19 somatic symptoms. The symptoms were associated in a complex structure. Still, recognisable patterns were identified within organ systems/body parts. When accounting for symptom co-occurrence; dizziness, pain in legs, respiratory distress and tiredness were...

  7. Assessment of neurological clinical management reasoning in medical students.

    Science.gov (United States)

    Lukas, Rimas V; Blood, Angela; Park, Yoon Soo; Brorson, James R

    2014-06-01

    In neurology education there is evidence that trainees may have greater ability in general localization and diagnosis than they do in treatment decisions, particularly with considering longer term care and supportive care. We hypothesized that medical students completing a neurology clerkship would exhibit greater skill at considering the acute diagnostic and therapeutic management than at considering supportive management measures. Data from 720 standardized patient encounters by 360 medical students completing a neurology clerkship being evaluated via an objective structured clinical examination were analyzed for skill in three components of clinical decision making: diagnostic evaluation, therapeutic intervention, and supportive intervention. Scores for all standardized patient encounters over the 2008-2012 interval revealed a significantly higher percentage of correct responses in both the diagnostic (mean [M]=62.6%, standard deviation [SD]=20.3%) and therapeutic (M=63.0%, SD=28.8%) categories in comparison to the supportive (M=31.8%, SD=45.2%) category. However, only scores in therapeutic and supportive treatment plans were found to be significant predictors of the USA National Board of Medical Examiners (NBME) clinical neurology subject examination scores; on average, a percent increase in therapeutic and support scores led to 5 and 2 point increases in NBME scores, respectively. We demonstrate empirical evidence of deficits in a specific component of clinical reasoning in medical students at the completion of a neurology clerkship. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Neurological AdverseEffects after Radiation Therapyfor Stage II Seminoma

    Directory of Open Access Journals (Sweden)

    Liv Ebbeskov Lauritsen

    2012-08-01

    Full Text Available We report 3 cases of patients with testicular cancer and stage II seminoma who developed neurological symptoms with bilateral leg weakness about 4 to 9 months after radiation therapy (RT. They all received RT to the para-aortic lymph nodes with a total dose of 40 Gy (36 Gy + 4 Gy as a boost against the tumour bed with a conventional fractionation of2 Gy/day, 5 days per week. RT was applied as hockey-stick portals, also called L-fields. In 2 cases, the symptoms fully resolved. Therapeutic irradiation can cause significant injury to the peripheral nerves of the lumbosacral plexus and/or to the spinal cord. RT is believed to produce plexus injury by both direct toxic effects and secondary microinfarction of the nerves, but the exact pathophysiology of RT-induced injury is unclear. Since reported studies of radiation-induced neurological adverse effects are limited, it is difficult to estimate their frequency and outcome. The treatment of neurological symptoms due to RT is symptomatic.

  9. Spasmodic dysphonia: description of the disease and associated neurologic disorders

    Directory of Open Access Journals (Sweden)

    Coelho, Marina Serrato

    2010-06-01

    Full Text Available Introduction: Spasmodic dysphonia (SD is a problem that affects speech and vocalization, one of the most devastating disorders of oral communication. It is characterized by vocal quality tensaestrangulada, harshly and / or interspersed with abrupt vocal attack and a great tension in the vocal tract. The etiology of spasmodic dysphonia is unclear. Some authors point to psychogenic causes, neurological or even unknown. Objective: To assess the prevalence of muscular dystonias and other neurological symptoms in patients with ED. Method: A retrospective study of 10 cases with diagnosis of ED for symptoms and neurological disorders associated. Results: There was a significant predominance of the disease in females (9:1. The average age of onset of symptoms was 32 years, ranging between 14 and 60 years. The mean disease duration was 10 years. Among the patients, 87.5% had a diagnosis of disorders of movement made by a neurologist, including orofacial dystonias (50%, essential tremor (50% and spastic paraparesis (12%. Conclusion: The presence of movement disorders followed almost all cases of spasmodic dysphonia. More studies are needed to clarify the pathophysiological basis of disease.

  10. Guided self-help interventions for mental health disorders in children with neurological conditions: study protocol for a pilot randomised controlled trial.

    Science.gov (United States)

    Bennett, Sophie; Heyman, Isobel; Coughtrey, Anna; Simmonds, Jess; Varadkar, Sophia; Stephenson, Terence; DeJong, Margaret; Shafran, Roz

    2016-11-04

    Rates of mental health disorders are significantly greater in children with physical illnesses than in physically well children. Children with neurological conditions, such as epilepsy, are known to have particularly high rates of mental health disorders. Despite this, mental health problems in children with neurological conditions have remained under-recognised and under-treated in clinical settings. Evidence-based guided self-help interventions are efficacious in reducing symptoms of mental health disorders in children, but their efficacy in reducing symptoms of common mental health disorders in children with neurological conditions has not been investigated. We aim to pilot a guided self-help intervention for the treatment of mental health disorders in children with neurological conditions. A pilot randomised controlled trial with 18 patients with neurological conditions and mental health disorders will be conducted. Participants attending specialist neurology clinics at a National UK Children's Hospital will be randomised to receive guided self-help for common mental health disorders or to a 12-week waiting list control. Participants in the treatment group will receive 10 sessions of guided self-help delivered over the telephone. The waiting list control group will receive the intervention after a waiting period of 12 weeks. The primary outcome measure is reduction in symptoms of mental health disorders. Exclusion criteria are limited to those at significant risk of harm to self or others, the presence of primary mental health disorder other than anxiety, depression or disruptive behaviour (e.g. psychosis, eating disorder, obsessive-compulsive disorder) or intellectual disability at a level meaning potential participants would be unable to access the intervention. The study has ethical approval from the Camden and Islington NHS Research Ethics Committee, registration number 14.LO.1353. Results will be disseminated to patients, the wider public, clinicians and

  11. [Application of psychophysics to neurology].

    Science.gov (United States)

    Koyama, Shinichi

    2008-04-01

    Although psychophysics has already been used in many neurological evaluations including the visual and hearing tests, the use of psychophysics has been limited to the evaluation of sensory disorders. In this review paper, however, the author introduced recent attempts to apply psychophysics to the evaluation of higher cognitive functions such as perception of scenes and facial expressions. Psychophysics was also used to measure visual hypersensitivity in a patient with migraine. The benefits of the use of psychophysics in neurological and neuropsychological settings would be as follows. (1) We can evaluate higher cognitive functions quantitatively. (2) We can measure performance both above and below the normal range by the same method. (3) We can use the same stimulus and task as other research areas such as neuroscience and neuroimaging, and compare results between research areas.

  12. Neurological diseases in famous painters.

    Science.gov (United States)

    Piechowski-Jozwiak, Bartlomiej; Bogousslavsky, Julien

    2013-01-01

    Visual art production involves multiple processes including basic motor skills, such as coordination of movements, visual-spatial processing, emotional output, sociocultural context, and creativity. Thus, the relationship between artistic output and brain diseases is particularly complex, and brain disorders may lead to impairment of artistic production in multiple domains. Neurological conditions may also occasionally modify artistic style and lead to surprisingly innovative features in people with an initial loss of creativity. This chapter focuses on anecdotal reports of various neurological disorders and their potential consequences on works produced by famous or well-established artists, including Carl Frederik Reutersward, Giorgio de Chirico, Krystyna Habura, Leo Schnug, Ignatius Brennan, and many others. © 2013 Elsevier B.V. All rights reserved.

  13. PET and SPECT in neurology

    Energy Technology Data Exchange (ETDEWEB)

    Dierckx, Rudi A.J.O. [Groningen University Medical Center (Netherlands). Dept. of Nuclear Medicine and Molecular Imaging; Ghent Univ. (Belgium). Dept. of Radiology and Nuclear Medicine; Vries, Erik F.J. de; Waarde, Aren van [Groningen University Medical Center (Netherlands). Dept. of Nuclear Medicine and Molecular Imaging; Otte, Andreas (ed.) [Univ. of Applied Sciences Offenburg (Germany). Faculty of Electrical Engineering and Information Technology

    2014-07-01

    PET and SPECT in Neurology highlights the combined expertise of renowned authors whose dedication to the investigation of neurological disorders through nuclear medicine technology has achieved international recognition. Classical neurodegenerative disorders are discussed as well as cerebrovascular disorders, brain tumors, epilepsy, head trauma, coma, sleeping disorders, and inflammatory and infectious diseases of the CNS. The latest results in nuclear brain imaging are detailed. Most chapters are written jointly by a clinical neurologist and a nuclear medicine specialist to ensure a multidisciplinary approach. This state-of-the-art compendium will be valuable to anybody in the field of neuroscience, from the neurologist and the radiologist/nuclear medicine specialist to the interested general practitioner and geriatrician. It is the second volume of a trilogy on PET and SPECT imaging in the neurosciences, the other volumes covering PET and SPECT in psychiatry and in neurobiological systems.

  14. Proust, neurology and Stendhal's syndrome.

    Science.gov (United States)

    Teive, Hélio A G; Munhoz, Renato P; Cardoso, Francisco

    2014-01-01

    Marcel Proust is one of the most important French writers of the 20th century. His relationship with medicine and with neurology is possibly linked to the fact that his asthma was considered to be a psychosomatic disease classified as neurasthenia. Stendhal's syndrome is a rare psychiatric syndrome characterized by anxiety and affective and thought disturbances when a person is exposed to a work of art. Here, the authors describe neurological aspects of Proust's work, particularly the occurrence of Stendhal's syndrome and syncope when he as well as one of the characters of In Search of Lost Time see Vermeer's View of Delft during a visit to a museum. © 2014 S. Karger AG, Basel.

  15. Depressive symptoms in neurodegenerative diseases

    Science.gov (United States)

    Baquero, Miquel; Martín, Nuria

    2015-01-01

    Depressive symptoms are very common in chronic conditions. This is true so for neurodegenerative diseases. A number of patients with cognitive decline and dementia due to Alzheimer’s disease and related conditions like Parkinson’s disease, Lewy body disease, vascular dementia, frontotemporal degeneration amongst other entities, experience depressive symptoms in greater or lesser grade at some point during the course of the illness. Depressive symptoms have a particular significance in neurological disorders, specially in neurodegenerative diseases, because brain, mind, behavior and mood relationship. A number of patients may develop depressive symptoms in early stages of the neurologic disease, occurring without clear presence of cognitive decline with only mild cognitive deterioration. Classically, depression constitutes a reliable diagnostic challenge in this setting. However, actually we can recognize and evaluate depressive, cognitive or motor symptoms of neurodegenerative disease in order to establish their clinical significance and to plan some therapeutic strategies. Depressive symptoms can appear also lately, when the neurodegenerative disease is fully developed. The presence of depression and other neuropsychiatric symptoms have a negative impact on the quality-of-life of patients and caregivers. Besides, patients with depressive symptoms also tend to further decrease function and reduce cognitive abilities and also uses to present more affected clinical status, compared with patients without depression. Depressive symptoms are treatable. Early detection of depressive symptoms is very important in patients with neurodegenerative disorders, in order to initiate the most adequate treatment. We review in this paper the main neurodegenerative diseases, focusing in depressive symptoms of each other entities and current recommendations of management and treatment. PMID:26301229

  16. [Deficiency, disability, neurology and cinema].

    Science.gov (United States)

    Collado-Vázquez, Susana; Cano de la Cuerda, Roberto; Jiménez-Antona, Carmen

    2010-12-16

    Cinema has been defined in many different ways, but most of them agree that it should be considered both a technique and an art. Although films often depict fantasy stories, in many cases they also reflect day-to-day realities. In its earliest days cinema was already attracted to the world of health and sickness, and frequently addressed topics like medical practice, how patients lived with their illnesses, bioethical issues, the relationship between physician and patient or research. To review the presence of neurological pathologies in the cinema with a view to identifying the main neurological disorders that have been portrayed in films. Likewise it also intends to describe the medical praxis that is employed, the relationship between physician and patient, how the experiences of the patient and the family are represented, the adaptation to social and occupational situations, and the intervention of other health care professionals related with neurological patients. Some of the most significant films that have addressed these topics were reviewed and it was seen that in some of them the illness is dealt with in a very true-to-life manner, whereas others tend to include a greater number of inaccuracies and a larger degree of fiction. Cinema has helped to shape certain ways of thinking about the health care professionals who work with neurological patients, the importance of support from the family and the social role, among other things. This confirms that resorting to cinematographic productions is a fruitful tool for stimulating a critical interest in the past and present of medical practice.

  17. Effectiveness of music-based interventions on motricity or cognitive functioning in neurological populations: a systematic review.

    Science.gov (United States)

    Moumdjian, Lousin; Sarkamo, Teppo; Leone, Carmela; Leman, Marc; Feys, Peter

    2017-06-01

    Motor and cognitive symptoms are frequent in persons with neurological disorders and often require extensive long-term rehabilitation. Recently, a variety of music-based interventions have been introduced into neurological rehabilitation as training tools. This review aims to 1) describe and define music-based intervention modalities and content which are applied in experimental studies; and 2) describe the effects of these interventions on motor and/or cognitive symptoms in the neurological population. The databases PubMed and Web of Science were searched. Cited references of included articles where screened for potential inclusion. A systematic literature search up to 20th of June 2016 was conducted to include controlled trials and cohort studies that have used music-based interventions for ≥3 weeks in the neurological population (in- and outpatients) targeting motor and/or cognitive symptoms. No limitations to publication date was set. EVIDENCE SYNTHESISː Nineteen articles comprising thirteen randomized controlled trials (total participants Nexp=241, Nctrl=269), four controlled trials (Nexp=59, Nctrl=53) and two cohort studies (N.=27) were included. Fourteen studies were conducted in stroke, three in Parkinson's disease, and two in multiple sclerosis population. Modalities of music-based interventions were clustered into four groups: instrument-based, listening-based, rhythm-based, and multicomponent-based music interventions. Overall, studies consistently showed that music-based interventions had similar or larger effects than conventional rehabilitation on upper limb function (N.=16; fine motricity, hand and arm capacity, finger and hand tapping velocity/variability), mobility (N.=7; gait parameters), and cognition (N.=4; verbal memory and focused attention). CONCLUSIONSː Variety of modalities using music-based interventions has been identified and grouped into four clusters. Effects of interventions demonstrate an improvement in the domains assessed

  18. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society.

    Science.gov (United States)

    Silberstein, S D; Holland, S; Freitag, F; Dodick, D W; Argoff, C; Ashman, E

    2012-04-24

    To provide updated evidence-based recommendations for the preventive treatment of migraine headache. The clinical question addressed was: What pharmacologic therapies are proven effective for migraine prevention? The authors analyzed published studies from June 1999 to May 2009 using a structured review process to classify the evidence relative to the efficacy of various medications available in the United States for migraine prevention. The author panel reviewed 284 abstracts, which ultimately yielded 29 Class I or Class II articles that are reviewed herein. Divalproex sodium, sodium valproate, topiramate, metoprolol, propranolol, and timolol are effective for migraine prevention and should be offered to patients with migraine to reduce migraine attack frequency and severity (Level A). Frovatriptan is effective for prevention of menstrual migraine (Level A). Lamotrigine is ineffective for migraine prevention (Level A).

  19. Prospects for neurology and psychiatry.

    Science.gov (United States)

    Cowan, W M; Kandel, E R

    2001-02-07

    Neurological and psychiatric illnesses are among the most common and most serious health problems in developed societies. The most promising advances in neurological and psychiatric diseases will require advances in neuroscience for their elucidation, prevention, and treatment. Technical advances have improved methods for identifying brain regions involved during various types of cognitive activity, for tracing connections between parts of the brain, for visualizing individual neurons in living brain preparations, for recording the activities of neurons, and for studying the activity of single-ion channels and the receptors for various neurotransmitters. The most significant advances in the past 20 years have come from the application to the nervous system of molecular genetics and molecular cell biology. Discovery of the monogenic disorder responsible for Huntington disease and understanding its pathogenesis can serve as a paradigm for unraveling the much more complex, polygenic disorders responsible for such psychiatric diseases as schizophrenia, manic depressive illness, and borderline personality disorder. Thus, a new degree of cooperation between neurology and psychiatry is likely to result, especially for the treatment of patients with illnesses such as autism, mental retardation, cognitive disorders associated with Alzheimer and Parkinson disease that overlap between the 2 disciplines.

  20. Neurologic deficits and arachnoiditis following neuroaxial anesthesia.

    Science.gov (United States)

    Aldrete, J A

    2003-01-01

    Of late, regional anesthesia has enjoyed unprecedented popularity; this increase in cases has brought a higher frequency of instances of neurological deficit and arachnoiditis that may appear as transient nerve root irritation, cauda equina, and conus medullaris syndromes, and later as radiculitis, clumped nerve roots, fibrosis, scarring dural sac deformities, pachymeningitis, pseudomeningocele, and syringomyelia, etc., all associated with arachnoiditis. Arachnoiditis may be caused by infections, myelograms (mostly from oil-based dyes), blood in the intrathecal space, neuroirritant, neurotoxic and/or neurolytic substances, surgical interventions in the spine, intrathecal corticosteroids, and trauma. Regarding regional anesthesia in the neuroaxis, arachnoiditis has resulted from epidural abscesses, traumatic punctures (blood), local anesthetics, detergents, antiseptics or other substances unintentionally injected into the spinal canal. Direct trauma to nerve roots or the spinal cord may be manifested as paraesthesia that has not been considered an injurious event; however, it usually implies dural penetration, as there are no nerve roots in the epidural space posteriorly. Sudden severe headache while or shortly after an epidural block using the loss of resistance to air approach usually suggests pneumocephalus from an intradural injection of air. Burning severe pain in the lower back and lower extremities, dysesthesia and numbness not following the usual dermatome distribution, along with bladder, bowel and/or sexual dysfunction, are the most common symptoms of direct trauma to the spinal cord. Such patients should be subjected to a neurological examination followed by an MRI of the effected area. Further spinal procedures are best avoided and the prompt administration of IV corticosteroids and NSAIDs need to be considered in the hope of preventing the inflammatory response from evolving into the proliferative phase of arachnoiditis.

  1. Functional Disorders in Neurology : Case Studies

    NARCIS (Netherlands)

    Stone, Jon; Hoeritzauer, Ingrid; Gelauff, Jeannette; Lehn, Alex; Gardiner, Paula; van Gils, Anne; Carson, Alan

    Functional, often called psychogenic, disorders are common in neurological practice. We illustrate clinical issues and highlight some recent research findings using six case studies of functional neurological disorders. We discuss dizziness as a functional disorder, describing the relatively new

  2. Clinical trials in neurology: design, conduct, analysis

    National Research Council Canada - National Science Library

    Ravina, Bernard

    2012-01-01

    .... Clinical Trials in Neurology aims to improve the efficiency of clinical trials and the development of interventions in order to enhance the development of new treatments for neurologic diseases...

  3. Head Impact Exposure and Neurologic Function of Youth Football Players.

    Science.gov (United States)

    Munce, Thayne A; Dorman, Jason C; Thompson, Paul A; Valentine, Verle D; Bergeron, Michael F

    2015-08-01

    Football players are subjected to repetitive impacts that may lead to brain injury and neurologic dysfunction. Knowledge about head impact exposure (HIE) and consequent neurologic function among youth football players is limited. This study aimed to measure and characterize HIE of youth football players throughout one season and explore associations between HIE and changes in selected clinical measures of neurologic function. Twenty-two youth football players (11-13 yr) wore helmets outfitted with a head impact telemetry (HIT) system to quantify head impact frequency, magnitude, duration, and location. Impact data were collected for each practice (27) and game (9) in a single season. Selected clinical measures of balance, oculomotor performance, reaction time, and self-reported symptoms were assessed before and after the season. The median individual head impacts per practice, per game, and throughout the entire season were 9, 12, and 252, respectively. Approximately 50% of all head impacts (6183) had a linear acceleration between 10g and 20g, but nearly 2% were greater than 80g. Overall, the head impact frequency distributions in this study population were similar in magnitude and location as in high school and collegiate football, but total impact frequency was lower. Individual changes in neurologic function were not associated with cumulative HIE. This study provides a novel examination of HIE and associations with short-term neurologic function in youth football and notably contributes to the limited HIE data currently available for this population. Whereas youth football players can experience remarkably similar head impact forces as high school players, cumulative subconcussive HIE throughout one youth football season may not be detrimental to short-term clinical measures of neurologic function.

  4. Astaxanthin as a Potential Neuroprotective Agent for Neurological Diseases

    Directory of Open Access Journals (Sweden)

    Haijian Wu

    2015-09-01

    Full Text Available Neurological diseases, which consist of acute injuries and chronic neurodegeneration, are the leading causes of human death and disability. However, the pathophysiology of these diseases have not been fully elucidated, and effective treatments are still lacking. Astaxanthin, a member of the xanthophyll group, is a red-orange carotenoid with unique cell membrane actions and diverse biological activities. More importantly, there is evidence demonstrating that astaxanthin confers neuroprotective effects in experimental models of acute injuries, chronic neurodegenerative disorders, and neurological diseases. The beneficial effects of astaxanthin are linked to its oxidative, anti-inflammatory, and anti-apoptotic characteristics. In this review, we will focus on the neuroprotective properties of astaxanthin and explore the underlying mechanisms in the setting of neurological diseases.

  5. Treatment of Alzheimer’s disease in Brazil: II. Behavioral and psychological symptoms of dementia

    Science.gov (United States)

    do Vale, Francisco de Assis Carvalho; Corrêa Neto, Ylmar; Bertolucci, Paulo Henrique Ferreira; Machado, João Carlos Barbosa; da Silva, Delson José; Allam, Nasser; Balthazar, Márcio Luiz Figueredo

    2011-01-01

    This article reports the recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology for the treatment of Alzheimer’s disease (AD) in Brazil, with special focus on behavioral and psychological symptoms of dementia (BPSD). It constitutes a revision and broadening of the 2005 guidelines based on a consensus involving researchers (physicians and non-physicians) in the field. The authors carried out a search of articles published since 2005 on the MEDLINE, LILACS and Cochrane Library databases. The search criteria were pharmacological and non-pharmacological treatment of the behavioral and psychological symptoms of AD. Studies retrieved were categorized into four classes, and evidence into four levels, based on the 2008 recommendations of the American Academy of Neurology. The recommendations on therapy are pertinent to the dementia phase of AD. Recommendations are proposed for the treatment of BPSD encompassing both pharmacological (including acetyl-cholinesterase inhibitors, memantine, neuroleptics, anti-depressives, benzodiazepines, anti-convulsants plus other drugs and substances) and non-pharmacological (including education-based interventions, physiotherapy, occupational therapy, music therapy, therapy using light, massage and art therapy) approaches. Recommendations for the treatment of cognitive disorders of AD symptoms are included in a separate article of this edition. PMID:29213743

  6. Treatment of Alzheimer's disease in Brazil: II. Behavioral and psychological symptoms of dementia

    Directory of Open Access Journals (Sweden)

    Francisco de Assis Carvalho do Vale

    Full Text Available Abstract This article reports the recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology for the treatment of Alzheimer's disease (AD in Brazil, with special focus on behavioral and psychological symptoms of dementia (BPSD. It constitutes a revision and broadening of the 2005 guidelines based on a consensus involving researchers (physicians and non-physicians in the field. The authors carried out a search of articles published since 2005 on the MEDLINE, LILACS and Cochrane Library databases. The search criteria were pharmacological and non-pharmacological treatment of the behavioral and psychological symptoms of AD. Studies retrieved were categorized into four classes, and evidence into four levels, based on the 2008 recommendations of the American Academy of Neurology. The recommendations on therapy are pertinent to the dementia phase of AD. Recommendations are proposed for the treatment of BPSD encompassing both pharmacological (including acetyl-cholinesterase inhibitors, memantine, neuroleptics, anti-depressives, benzodiazepines, anti-convulsants plus other drugs and substances and non-pharmacological (including education-based interventions, physiotherapy, occupational therapy, music therapy, therapy using light, massage and art therapy approaches. Recommendations for the treatment of cognitive disorders of AD symptoms are included in a separate article of this edition.

  7. Dysfunctional HCN ion channels in neurological diseases

    Directory of Open Access Journals (Sweden)

    Jacopo C. DiFrancesco

    2015-03-01

    Full Text Available Hyperpolarization-activated cyclic nucleotide-gated (HCN channels are expressed as four different isoforms (HCN1-4 in the heart and in the central and peripheral nervous systems. HCN channels are activated by membrane hyperpolarization at voltages close to resting membrane potentials and carry the hyperpolarization-activated current, dubbed If (funny current in heart and Ih in neurons. HCN channels contribute in several ways to neuronal activity and are responsible for many important cellular functions, including cellular excitability, generation and modulation of rhythmic activity, dendritic integration, transmission of synaptic potentials and plasticity phenomena. Because of their role, defective HCN channels are natural candidates in the search for potential causes of neurological disorders in humans. Several data, including growing evidence that some forms of epilepsy are associated with HCN mutations, support the notion of an involvement of dysfunctional HCN channels in different experimental models of the disease. Additionally, some anti-epileptic drugs are known to modify the activity of the Ih current. HCN channels are widely expressed in the peripheral nervous system and recent evidence has highlighted the importance of the HCN2 isoform in the transmission of pain. HCN channels are also present in the midbrain system, where they finely regulate the activity of dopaminergic neurons, and a potential role of these channels in the pathogenesis of Parkinson’s disease has recently emerged. The function of HCN channels is regulated by specific accessory proteins, which control the correct expression and modulation of the neuronal Ih current. Alteration of these proteins can severely interfere with the physiological channel function, potentially predisposing to pathological conditions. In this review we address the present knowledge of the association between HCN dysfunctions and neurological diseases, including clinical, genetic and

  8. Blog and Podcast Watch: Neurologic Emergencies

    Directory of Open Access Journals (Sweden)

    Andrew Grock

    2016-11-01

    Full Text Available Introduction: The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM based on the ongoing ALiEM Approved Instructional Resources (AIR and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of neurologic emergencies from the AIR series. Methods: The AIR series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Director’s (CORD annual testing schedule. For each module, relevant content is collected from the top 50 Social Media Index sites published within the previous 12 months, and scored by eight board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27-29 receive an honorable mention label, if the executive board agrees that the post is accurate and educationally valuable. Results: A total of 125 blog posts and podcasts were evaluated. Key educational pearls from the 14 AIR posts are summarized, and the 20 honorable mentions are listed. Conclusion: The WestJEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians with this installment focusing on neurologic emergencies.

  9. Diffusion-weighted imaging in chronic Behcet patients with and without neurological findings

    Energy Technology Data Exchange (ETDEWEB)

    Baysal, T.; Dogan, M.; Bulut, T.; Sarac, K. [Inonu University School of Medicine, Department of Radiology, Malatya (Turkey); Karlidag, R. [Inonu University School of Medicine, Department of Psychiatry, Malatya (Turkey); Ozisik, H.I. [Inonu University School of Medicine, Department of Neurology, Malatya (Turkey); Baysal, O. [Inonu University School of Medicine, Department of Physical Therapy and Rehabilitation, Malatya (Turkey)

    2005-06-01

    Our aim was to investigate whether neurological impairment in chronic Behcet's disease (BD) patients with normal appearing brain can be assessed by means of diffusion-weighted imaging (DWI). The averaged apparent diffusion coefficient (ADC) values were calculated in 22 different radiologically normal appearing brain regions in 32 patients with and without neurological findings and 20 control subjects. The ADC values in bilateral frontal, temporal and occipital normal appearing white matter were significantly higher in the patient groups compared with the control subjects (p<0.05). In these brain regions, DWI revealed differences in the ADC values between patients with neurological findings (including symptomatic and neuro-Behcet patients) and the asymptomatic patient group. The similarity of the ADC values of patients without symptoms to those of the control group allowed clear discrimination between patients with and without neurological findings. DWI may serve to assess subclinical neurological involvement in BD, even when structural changes are absent. (orig.)

  10. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society.

    Science.gov (United States)

    Holland, S; Silberstein, S D; Freitag, F; Dodick, D W; Argoff, C; Ashman, E

    2012-04-24

    To provide updated evidence-based recommendations for the preventive treatment of migraine headache. The clinical question addressed was: Are nonsteroidal anti-inflammatory drugs (NSAIDs) or other complementary treatments effective for migraine prevention? The authors analyzed published studies from June 1999 to May 2009 using a structured review process to classify the evidence relative to the efficacy of various medications for migraine prevention. The author panel reviewed 284 abstracts, which ultimately yielded 49 Class I or Class II articles on migraine prevention; of these 49, 15 were classified as involving nontraditional therapies, NSAIDs, and other complementary therapies that are reviewed herein. Petasites (butterbur) is effective for migraine prevention and should be offered to patients with migraine to reduce the frequency and severity of migraine attacks (Level A). Fenoprofen, ibuprofen, ketoprofen, naproxen, naproxen sodium, MIG-99 (feverfew), magnesium, riboflavin, and subcutaneous histamine are probably effective for migraine prevention (Level B). Treatments considered possibly effective are cyproheptadine, Co-Q10, estrogen, mefenamic acid, and flurbiprofen (Level C). Data are conflicting or inadequate to support or refute use of aspirin, indomethacin, omega-3, or hyperbaric oxygen for migraine prevention. Montelukast is established as probably ineffective for migraine prevention (Level B).

  11. Hypnosis as a model of functional neurologic disorders.

    Science.gov (United States)

    Deeley, Q

    2016-01-01

    In the 19th century it was recognized that neurologic symptoms could be caused by "morbid ideation" as well as organic lesions. The subsequent observation that hysteric (now called "functional") symptoms could be produced and removed by hypnotic suggestion led Charcot to hypothesize that suggestion mediated the effects of ideas on hysteric symptoms through as yet unknown effects on brain activity. The advent of neuroimaging 100 years later revealed strikingly similar neural correlates in experiments matching functional symptoms with clinical analogs created by suggestion. Integrative models of suggested and functional symptoms regard these alterations in brain function as the endpoint of a broader set of changes in information processing due to suggestion. These accounts consider that suggestions alter experience by mobilizing representations from memory systems, and altering causal attributions, during preconscious processing which alters the content of what is provided to our highly edited subjective version of the world. Hypnosis as a model for functional symptoms draws attention to how radical alterations in experience and behavior can conform to the content of mental representations through effects on cognition and brain function. Experimental study of functional symptoms and their suggested counterparts in hypnosis reveals the distinct and shared processes through which this can occur. © 2016 Elsevier B.V. All rights reserved.

  12. Effectiveness of music-based interventions on motricity or cognitive functioning in neurological populations: a systematic review.

    OpenAIRE

    Moumdjian, Lousin; Sarkamo, Teppo; Leone, Carmela; Leman, Marc; Feys, Peter

    2016-01-01

    INTRODUCTION: Motor and cognitive symptoms are frequent in persons with neurological disorders and often require extensive long-term rehabilitation. Recently, a variety of musicbased interventions have been introduced into neurological rehabilitation as training tools. AIM: This review aims to a) describe and define music-based intervention modalities and content which are applied in experimental studies, and b) describe the effects of these interventions on motor and/or cognitive symptoms...

  13. Work-family conflict as a mediator in the association between work stress and depressive symptoms: cross-sectional evidence from the German lidA-cohort study.

    Science.gov (United States)

    du Prel, Jean-Baptist; Peter, Richard

    2015-04-01

    The demographic change leads to a shrinking German work force. Depressive symptoms cause many days absent at work, loss of productivity and early retirement. Therefore, pathways for prevention of depressive symptoms are important for the maintenance of global competitiveness. We investigated the role of work-family conflict (WFC) in the well-known association between work stress and depressive symptoms. A total of 6,339 employees subject to social insurance, born in 1959 or 1965 and randomly drawn from 222 sample points in Germany participated in the first wave of the leben in der Arbeit-study. In the analysis, 5,906 study subjects working in full-time or part-time positions were included. Work stress was measured by effort-reward imbalance ratio, depressive symptoms by the applied Becks depression inventory (BDI-V) and WFC by items of the Copenhagen Psychosocial Questionnaire (COPSOQ)-scale. Multiple linear regression analysis adjusted for age, education, negative affectivity (PANAS), overcommitment and number of children was performed. Mediation was defined according to the criteria of Baron and Kenny. Work stress was significantly associated with depressive symptoms (BDI-V) in all full-time [ß1female = 6.61 (95 % CI 3.95-9.27); ß1male = 8.02 (95 % CI 5.94-10.09)] and female part-time employees [ß2female = 4.87 (95 % CI 2.16-7.59)]. When controlling for WFC effect, estimates became smaller in men and were even halved in women. WFC was also significantly associated with work stress and depressive symptoms: All criteria for partial mediation between work stress and depressiveness were fulfilled. Prevention of WFC may help to reduce days absent at work and early retirement due to work stress-related depressive symptoms in middle-aged women and men.

  14. Visual Loss from Choroidal Melanoma Mimicking Neurological Syndromes

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    Karim Hammamji

    2017-03-01

    Full Text Available Melanoma of the eye is rare, but can mimic a range of disorders. This report highlights 2 cases of choroidal melanoma with vision loss mimicking neurological diagnoses. The first patient is a 41-year-old white male with a known history of multiple sclerosis and a previous episode of optic neuritis in the right eye, who presented with a 6-month history of decreased vision in the same eye, and occasional photopsiae. He was treated with 2 courses of oral steroids for presumed recurrent optic neuritis. After a temporary improvement in his symptoms, his vision worsened, following which he had a head MRI, which revealed a solid intraocular mass. He was subsequently diagnosed with a choroidal melanoma for which he was treated successfully with ruthenium-106 plaque brachytherapy. The second patient is a 57-year-old female, who presented with a progressive cerebellar syndrome under investigation by the neurology service, as well as decreased vision in the right eye. Her visual acuity gradually deteriorated and her neurological assessment, which included a PET-CT, revealed uptake in the right eye. The diagnosis of a choroidal melanoma was made, and following conservative treatment with proton beam radiotherapy, she had an enucleation of the eye. Intraocular tumours can masquerade as many different entities. Unexplained unilateral visual loss, especially if it is atypical for a neurological syndrome, should prompt dilated fundoscopy and referral to an ophthalmologist.

  15. Subliminal unconscious conflict alpha power inhibits supraliminal conscious symptom experience

    Directory of Open Access Journals (Sweden)

    Howard eShevrin

    2013-09-01

    Full Text Available Our approach is based on a tri-partite method of integrating psychodynamic hypotheses, cognitive subliminal processes, and psychophysiological alpha power measures. We present ten social phobic subjects with three individually selected groups of words representing unconscious conflict, conscious symptom experience, and Osgood Semantic negative valence words used as a control word group. The unconscious conflict and conscious symptom words, presented subliminally and supraliminally, act as primes preceding the conscious symptom and control words presented as supraliminal targets. With alpha power as a marker of inhibitory brain activity, we show that unconscious conflict primes, only when presented subliminally, have a unique inhibitory effect on conscious symptom targets. This effect is absent when the unconscious conflict primes are presented supraliminally, or when the target is the control words. Unconscious conflict prime effects were found to correlate with a measure of repressiveness in a similar previous study (Shevrin et al., 1992, 1996. Conscious symptom primes have no inhibitory effect when presented subliminally. Inhibitory effects with conscious symptom primes are present, but only when the primes are supraliminal, and they did not correlate with repressiveness in a previous study (Shevrin, et al., 1992, 1996. We conclude that while the inhibition following supraliminal conscious symptom primes is due to conscious threat bias, the inhibition following subliminal unconscious conflict primes provides a neurological blueprint for dynamic repression: it is only activated subliminally by an individual’s unconscious conflict and has an inhibitory effect specific only to the conscious symptom. These novel findings constitute neuroscientific evidence for the psychoanalytic concepts of unconscious conflict and repression, while extending neuroscience theory and methods into the realm of personal, psychological meaning.

  16. Food insecurity, stressful life events and symptoms of anxiety and depression in east Africa: evidence from the Gilgel Gibe growth and development study.

    Science.gov (United States)

    Hadley, C; Tegegn, A; Tessema, F; Cowan, J A; Asefa, M; Galea, S

    2008-11-01

    Common mental disorders are a major contributor to the burden of disease in developing countries. An assessment was carried out of whether food insecurity and exposure to stressful life events, two common features of life in sub-Saharan Africa (SSA), are associated with symptoms of mental disorders among adults. The Gilgel Gibe Growth and Development Study (GGGDS) is an ongoing cohort study in rural Ethiopia. Participants of the GGGDS were randomly selected from households from a complete census of persons living in the area. The Hopkins Symptom Checklist and the Harvard Trauma Questionnaire were used to assess anxiety and depression and post-traumatic stress symptoms. Among 902 adult participants, food insecurity, stressful life events and symptoms of common mental disorders were highly prevalent. In separate multivariate models adjusting for potential confounders, food insecurity and stressful life events were independently associated with high symptoms of depression, anxiety and post-traumatic stress. Potentially modifiable stressors may influence variation in common mental disorders in Ethiopia, and SSA more generally. These findings suggest that the negative effects of food insecurity extend beyond nutritional outcomes and that interventions that promote food security may also positively influence adult mental health in the region.

  17. Estimating and communicating prognosis in advanced neurologic disease.

    Science.gov (United States)

    Holloway, Robert G; Gramling, Robert; Kelly, Adam G

    2013-02-19

    Prognosis can no longer be relegated behind diagnosis and therapy in high-quality neurologic care. High-stakes decisions that patients (or their surrogates) make often rest upon perceptions and beliefs about prognosis, many of which are poorly informed. The new science of prognostication--the estimating and communication "what to expect"--is in its infancy and the evidence base to support "best practices" is lacking. We propose a framework for formulating a prediction and communicating "what to expect" with patients, families, and surrogates in the context of common neurologic illnesses. Because neurologic disease affects function as much as survival, we specifically address 2 important prognostic questions: "How long?" and "How well?" We provide a summary of prognostic information and highlight key points when tailoring a prognosis for common neurologic diseases. We discuss the challenges of managing prognostic uncertainty, balancing hope and realism, and ways to effectively engage surrogate decision-makers. We also describe what is known about the nocebo effects and the self-fulfilling prophecy when communicating prognoses. There is an urgent need to establish research and educational priorities to build a credible evidence base to support best practices, improve communication skills, and optimize decision-making. Confronting the challenges of prognosis is necessary to fulfill the promise of delivering high-quality, patient-centered care.

  18. Neurological disorders in hypertensive patients

    Directory of Open Access Journals (Sweden)

    N. V. Vakhnina

    2015-01-01

    Full Text Available Hypertension is one of the most common vascular diseases. The brain as target organs in hypertension is damaged more often and earlier. Neurological complications due to hypertension are frequently hyperdiagnosed in Russian neurological practice. Thus, headache, dizziness, impaired recall of recent events, nocturnal sleep disorders, and many other complaints in a hypertensive patient are usually regarded as a manifestation of dyscirculatory encephalopathy. At the same time headaches (tension headache and migraine in hypertensive patients are predominantly primary; headache associated with dramatic marked elevations in blood pressure is encountered in only a small number of patients. The role of cerebrovascular diseases in the development of dizziness in hypertensive patients is also overestimated. The vast majority of cases, patients with this complaint are in fact identified to have benign paroxysmal postural vertigo, Mеniеre’s disease, vestibular neuronitis, or vestibular migraine. Psychogenic disorders or multisensory insufficiency are generally responsible for non-systemic vertigo in hypertensive patients. Chronic cerebral circulatory insufficiency may cause non-systemic vertigo as a subjective equivalent of postural instability.Cognitive impairments (CIs are the most common and earliest manifestation of cerebrovascular lesion in hypertension. In most cases, CIs in hypertension were vascular and associated with cerebrovascular lesion due to lacunar infarcts and leukoaraiosis. However, mixed CIs frequently occur when hypertensive patients are also found to have signs of a degenerative disease, most commonly in Alzheimer’s disease.

  19. [Oliver Sacks and literary neurology].

    Science.gov (United States)

    Guardiola, Elena; Banos, Josep E

    2014-03-16

    Popular medical literature attempts to discuss medical topics using a language that is, as far as possible, free of all medical jargon so as to make it more easily understandable by the general public. The very complexity of neurology makes it more difficult for the stories dealing with this specialty to be understood easily by an audience without any kind of medical training. This paper reviews the works written by Oliver Sacks involving the field of neurology aimed at the general public, and the main characteristics and the clinical situation discussed by the author are presented. Some biographical notes about Oliver Sacks are also included and the 11 books published by this author over the last 40 years are also analysed. In each case they are put into a historical context and the most outstanding aspects justifying what makes them an interesting read are commented on. In most cases, the genesis of the work is explained together with its most significant features. The works of Sacks contain a wide range of very interesting clinical situations that are usually explained by means of a language that is readily comprehensible to the general public. It also provides neurologists with a holistic view of different clinical situations, together with a discussion of their biographical, historical and developmental components.

  20. Neurologic and Functional Morbidity in Critically Ill Children With Bronchiolitis.

    Science.gov (United States)

    Shein, Steven L; Slain, Katherine N; Clayton, Jason A; McKee, Bryan; Rotta, Alexandre T; Wilson-Costello, Deanne

    2017-09-19

    Neurologic and functional morbidity occurs in ~30% of PICU survivors, and young children may be at particular risk. Bronchiolitis is a common indication for PICU admission among children less than 2 years old. Two single-center studies suggest that greater than 10-25% of critical bronchiolitis survivors have neurologic and functional morbidity but those estimates are 20 years old. We aimed to estimate the burden of neurologic and functional morbidity among more recent bronchiolitis patients using two large, multicenter databases. Analysis of the Pediatric Health Information System and the Virtual Pediatric databases. Forty-eight U.S. children's hospitals (Pediatric Health Information System) and 40 international (mostly United States) children's hospitals (Virtual Pediatric Systems). Previously healthy PICU patients less than 2 years old admitted with bronchiolitis between 2009 and 2015 who survived and did not require extracorporeal membrane oxygenation or cardiopulmonary resuscitation. None. Neurologic and functional morbidity was defined as a Pediatric Overall Performance Category greater than 1 at PICU discharge (Virtual Pediatric Systems subjects), or a subsequent hospital encounter involving developmental delay, feeding tubes, MRI of the brain, neurologist evaluation, or rehabilitation services (Pediatric Health Information System subjects). Among 3,751 Virtual Pediatric Systems subjects and 9,516 Pediatric Health Information System subjects, ~20% of patients received mechanical ventilation. Evidence of neurologic and functional morbidity was present at PICU discharge in 707 Virtual Pediatric Systems subjects (18.6%) and more chronically in 1,104 Pediatric Health Information System subjects (11.6%). In both cohorts, neurologic and functional morbidity was more common in subjects receiving mechanical ventilation (27.5% vs 16.5% in Virtual Pediatric Systems; 14.5% vs 11.1% in Pediatric Health Information System; both p < 0.001). In multivariate models also

  1. Fatigue and fatigability in neurologic illnesses

    Science.gov (United States)

    Krupp, Lauren B.; Enoka, Roger M.

    2013-01-01

    Fatigue is commonly reported in many neurologic illnesses, including multiple sclerosis, Parkinson disease, myasthenia gravis, traumatic brain injury, and stroke. Fatigue contributes substantially to decrements in quality of life and disability in these illnesses. Despite the clear impact of fatigue as a disabling symptom, our understanding of fatigue pathophysiology is limited and current treatment options rarely lead to meaningful improvements in fatigue. Progress continues to be hampered by issues related to terminology and assessment. In this article, we propose a unified taxonomy and a novel assessment approach to addressing distinct aspects of fatigue and fatigability in clinical and research settings. This taxonomy is based on our current knowledge of the pathophysiology and phenomenology of fatigue and fatigability. Application of our approach indicates that the assessment and reporting of fatigue can be clarified and improved by utilizing this taxonomy and creating measures to address distinct aspects of fatigue and fatigability. We review the strengths and weaknesses of several common measures of fatigue and suggest, based on our model, that many research questions may be better addressed by using multiple measures. We also provide examples of how to apply and validate the taxonomy and suggest directions for future research. PMID:23339207

  2. Neurology of widely embedded free will.

    Science.gov (United States)

    de Jong, Bauke M

    2011-01-01

    Free will is classically attributed to the prefrontal cortex. In clinical neurology, prefrontal lesions have consistently been shown to cause impairment of internally driven action and increased reflex-like behaviour. Recently, parietal contributions to both free selection at early stages of sensorimotor transformations and perception of specifically self-intended movements were demonstrated in the healthy brain. Such findings generated the concept that 'free will' is not a function restricted to the prefrontal cortex but is more widely embedded in the brain, indeed including the parietal cortex. In this paper, a systematic re-interpretation of parietal symptoms, such as apraxia and reduced sense of agency, is given with reference to the consequences of reduced freedom of selection at early stages of sensorimotor transformation. Failed selection between possible movement options is argued to represent an intrinsic characteristic of apraxia. Paradoxical response facilitation supports this view. Perception of self-intended movement corresponds with a sense of agency. Impaired parietal distinction between predicted and perceived movement sensations may thus equal a restricted repertoire for selection between possible movement options of which intention is attributed to either oneself, others or an alien hand. Sense of agency, and thus perception of free will, logically fits a model of the parietal cortex as a neuronal interface between the internal drive to reach a goal and a body scheme required to select possible effectors for motor preparation. Copyright © 2011 Elsevier Srl. All rights reserved.

  3. Male sexual dysfunction and infertility associated with neurological disorders

    DEFF Research Database (Denmark)

    Fode, Mikkel; Krogh-Jespersen, Sheila; Brackett, Nancy L

    2012-01-01

    always require assisted reproductive techniques including intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection. The method of choice depends largely on the number of motile sperm in the ejaculate.Asian Journal of Andrology advance online publication, 5...... is managed by medications to reverse the condition in mild cases and in bladder harvest of semen after ejaculation in more severe cases. Anejaculation might also be managed by medication in mild cases while assisted ejaculatory techniques including penile vibratory stimulation and electroejaculation are used......Normal sexual and reproductive functions depend largely on neurological mechanisms. Neurological defects in men can cause infertility through erectile dysfunction, ejaculatory dysfunction and semen abnormalities. Among the major conditions contributing to these symptoms are pelvic...

  4. Cardiac Dysrhythmias and Neurological Dysregulation: Manifestations of Profound Hypomagnesemia

    Directory of Open Access Journals (Sweden)

    Sagger Mawri

    2017-01-01

    Full Text Available Magnesium is the second most common intracellular cation and serves as an important metabolic cofactor to over 300 enzymatic reactions throughout the human body. Among its various roles, magnesium modulates calcium entry and release from sarcoplasmic reticulum and regulates ATP pumps in myocytes and neurons, thereby regulating cardiac and neuronal excitability. Therefore, deficiency of this essential mineral may result in serious cardiovascular and neurologic derangements. In this case, we present the clinical course of a 76-year-old woman who presented with marked cardiac and neurological signs and symptoms which developed as a result of severe hypomagnesemia. The patient promptly responded to magnesium replacement once the diagnosis was established. We herein discuss the clinical presentation, pathophysiology, diagnosis, and management of severe hypomagnesemia and emphasize the implications of magnesium deficiency in the cardiovascular and central nervous systems. Furthermore, this case highlights the importance of having high vigilance for hypomagnesemia in the appropriate clinical setting.

  5. Neurological melioidosis in Norway presenting with a cerebral abscess

    Directory of Open Access Journals (Sweden)

    Liv Hesstvedt

    2015-01-01

    Full Text Available Neurological melioidosis is a rare condition, as less than 30 cases have been reported in the last 50 years. We present a case of neurological melioidosis, presenting with a cerebral abscess in a returning traveler from an endemic area. While traveling in Cambodia on holiday, the patient was admitted to local hospital for pneumonia. Her condition improved after antimicrobial treatment, and she returned to Norway when discharged. The patient had several contacts with the health care system after returning to Norway, due to recurrent fever and deterioration. Short-term antimicrobial treatment was given with temporary improvement in her condition. Eventually she developed stroke-like symptoms, and a cerebral abscess was found. Cultures from the abscess were positive for Burkholderia pseudomallei and the treatment was adjusted accordingly.

  6. Lyme disease: neurology, neurobiology, and behavior.

    Science.gov (United States)

    Halperin, John J

    2014-05-01

    The Lyme disease controversy can be largely linked to the misconception that neurobehavioral effects of illness constitute evidence of nervous system infection. Appropriate differentiation between neuroborreliosis (nervous system Borrelia burgdorferi infection) and Lyme encephalopathy (altered nervous system function in individuals with systemic but not nervous system infection)-or encephalopathies of other etiologies-would lessen the controversy considerably, as the attribution of nonspecific symptoms to supposed ongoing central nervous system infection is a major factor perpetuating the debate. Epidemiologic considerations suggest that the entities referred to as "posttreatment Lyme disease" and "chronic Lyme disease" may not actually exist but rather reflect anchoring bias, linking common, nonspecific symptoms to an antecedent medical event. On the other hand, there are data suggesting possible mechanisms by which posttreatment Lyme disease could occur.

  7. Focal dystonia in musicians: Linking motor symptoms to somatosensory dysfunction

    Directory of Open Access Journals (Sweden)

    Juergen eKonczak

    2013-06-01

    Full Text Available Musician’s dystonia (MD is a neurological motor disorder characterized by involuntary contractions of those muscles involved in the play of a musical instrument. It is task-specific and initially only impairs the voluntary control of highly practiced musical motor skills. MD can lead to a severe decrement in a musician’s ability to perform. While the etiology and the neurological pathomechanism of the disease remain unknown, it is known that MD like others forms of focal dystonia is associated with somatosensory deficits, specifically a decreased precision of tactile and proprioceptive perception. The sensory component of the disease becomes also evident by the patients’ use sensory tricks such as touching dystonic muscles to alleviate motor symptoms. The central premise of this paper is that the motor symptoms of MD have a somatosensory origin and are not fully explained as a problem of motor execution. We outline how altered proprioceptive feedback ultimately leads to a loss of voluntary motor control and propose two scenarios that explain why sensory tricks are effective. Sensory tricks are effective, because the sensorimotor system either recruits neural resources normally involved in tactile-proprioceptive (sensory integration, or utilizes a fully functioning motor efference copy mechanism to align experienced with expected sensory feedback. We argue that an enhanced understanding of how a primary sensory deficit interacts with mechanisms of sensorimotor integration in musician’s dystonia provides helpful insights for the design of more effective behavioral therapies.

  8. EFNS guidelines for the use of intravenous immunoglobulin in treatment of neurological diseases: EFNS task force on the use of intravenous immunoglobulin in treatment of neurological diseases

    DEFF Research Database (Denmark)

    Elovaara, I.; Apostolski, S.; Doorn, P. van

    2008-01-01

    or third-line therapy in relapsing-remitting multiple sclerosis, if conventional immunomodulatory therapies are not tolerated (level B), and in relapses during pregnancy or post-partum period (good clinical practice point). IVIG seems to have a favourable effect also in paraneoplastic neurological diseases......Despite high-dose intravenous immunoglobulin (IVIG) is widely used in treatment of a number of immune-mediated neurological diseases, the consensus on its optimal use is insufficient. To define the evidence-based optimal use of IVIG in neurology, the recent papers of high relevance were reviewed...

  9. MRI and neurological findings in patients with spinal metastases

    Energy Technology Data Exchange (ETDEWEB)

    Switlyk, M.D.; Hole, K.H.; Knutstad, K. [Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norwegian Radium Hospital, Oslo (Norway)], E-mail: marta.switlyk@radiumhospitalet.no; Skjeldal, S.; Zaikova, O. [Department of Orthopedics, Oslo University Hospital, Norwegian Radium Hospital, Oslo (Norway); Hald, J.K. [Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo (Norway); Seierstad, T. [Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norwegian Radium Hospital, Oslo (Norway); Faculty of Health Sciences, Buskerud University College, Drammen (Norway)

    2012-12-15

    Background. Magnetic resonance imaging (MRI) is the recommended primary investigation method for metastatic spinal cord compression (MSCC). Initiating treatment before the development of motor deficits is essential to preserve neurological function. However, the relationship between MRI-assessed grades of spinal metastatic disease and neurological status has not been widely investigated. Purpose. To analyze the association between neurological function and MRI-based assessment of the extent of spinal metastases using two different grading systems. Material and Methods. A total of 284 patients admitted to our institution for initial radiotherapy or surgery for symptomatic spinal metastases were included in the study. Motor and sensory deficits were categorized according to the Frankel classification system. Pre-treatment MRI evaluations of the entire spine were scored for the extent of spinal metastases, presence and severity of spinal cord compression, and nerve root compression. Two MRI-based scales were used to evaluate the degree of cord compression and spinal canal narrowing and relate these findings to neurological function. Results. Of the patients included in the study, 28 were non-ambulatory, 49 were ambulatory with minor motor deficits, and 207 had normal motor function. Spinal cord compression was present in all patients with Frankel scores of B or C, 23 of 35 patients with a Frankel score of D (66%), and 48 of 152 patients with a Frankel score of E (32%). The percentage of patients with severe spinal canal narrowing increased with increasing Frankel grades. The grading according to the scales showed a significant association with the symptoms according to the Frankel scale (P < 0.001). Conclusion. In patients with neurological dysfunction, the presence and severity of impairment was associated with the epidural tumor burden. A significant number of patients had radiological spinal cord compression and normal motor function (occult MSCC)

  10. Broad autism spectrum and obsessive-compulsive symptoms in adults with the fragile X premutation.

    Science.gov (United States)

    Schneider, A; Johnston, C; Tassone, F; Sansone, S; Hagerman, R J; Ferrer, E; Rivera, S M; Hessl, D

    2016-08-01

    Clinical observations and a limited number of research studies provide evidence that the fragile X premutation may confer risk for autism, executive dysfunction, and psychopathology. The link to autism spectrum symptoms and social cognition deficits with the premutation remains uncertain, and thus was the focus of the present investigation. Our sample included 131 individuals, 42 men/22 women with the FMR1 premutation (mean age = 31.83 ± 8.59 years) with a normal neurological exam, and 48 men/19 women healthy age-matched controls (mean age = 29.48 ± 7.29 years). Individuals completed a comprehensive neuropsychological battery with additional assessments for social cognition, broad autism spectrum, and obsessive-compulsive (OC) symptoms. Premutation carriers self-reported higher rates of autism-related symptoms (Autism Quotient; p = .001). Among males only, premutation carriers showed more atypical social interaction (p obsessive-compulsive subtype in female premutation carriers.

  11. The Neurological Manifestations of H1N1 Influenza Infection; Diagnostic Challenges and Recommendations

    Directory of Open Access Journals (Sweden)

    Ali Akbar Asadi-Pooya

    2011-03-01

    Full Text Available Background: World Health Organization declared pandemic phase of human infection with novel influenza A (H1N1 in April 2009. There are very few reports about the neurological complications of H1N1 virus infection in the literature. Occasionally, these complications are severe and even fatal in some individuals. The aims of this study were to report neurological complaints and/or complications associated with H1N1 virus infection. Methods: The medical files of all patients with H1N1 influenza infection admitted to a specified hospital in the city of Shiraz, Iran from October through November 2009 were reviewed. More information about the patients were obtained by phone calls to the patients or their care givers. All patients had confirmed H1N1 virus infection with real-time PCR assay. Results: Fifty-five patients with H1N1 infection were studied. Twenty-three patients had neurological signs and/or symptoms. Mild neurological complaints may be reported in up to 42% of patients infected by H1N1 virus. Severe neurological complications occurred in 9% of the patients. The most common neurological manifestations were headache, numbness and paresthesia, drowsiness and coma. One patient had a Guillain-Barre syndrome-like illness, and died in a few days. Another patient had focal status epilepticus and encephalopathy. Conclusions: The H1N1 infection seems to have been quite mild with a self-limited course in much of the world, yet there appears to be a subset, which is severely affected. We recommend performing diagnostic tests for H1N1influenza virus in all patients with respiratory illness and neurological signs/symptoms. We also recommend initiating treatment with appropriate antiviral drugs as soon as possible in those with any significant neurological presentation accompanied with respiratory illness and flu-like symptoms

  12. Autoimmune neurological syndromes associated limbic encephalitis and paraneoplastic cerebellar degeneration.

    Science.gov (United States)

    Ayas, Zeynep Özözen; Kotan, Dilcan; Aras, Yeşim Güzey

    2016-10-06

    Autoimmune neurological syndrome is a group of disorders caused by cancer affecting nervous system by different immunological mechanisms. In this study, we aim to study the clinical symptoms, cerebrospinal fluid (CSF) findings, autoantibody tests, computed tomography (CT), magnetic resonance imaging (MRI) signs and treatment outcome of patients with autoimmune syndromes. In this study, 7 patients (4 male, 3 female) diagnosed with autoimmune neurological syndrome were retrospectively examined. Five of patients were diagnosed with limbic encephalitis, two of them were paraneoplastic cerebellar degeneration. Confusion and seizure were the most seen symptoms. Two patients had psychiatric disturbances (28,5%) followed by seizure. Headache was seen in 2 patients (% 28,5), disartria in 1 patient (% 14,2), and gait disorder in 2 patients (28,5%). The duration of symptoms was 46 (3-150) days on average. CSF abnormalities were detected in 2 patients. CT and MRI of the brain was available in all patients. Five patients had involvement of mesiotemporal region, two patients had diffuse cerebellar atrophy. One of patients had anti-GABAR B1 positivity. Tumors were detected in 2 patients while investigation for paraneoplasia screening. Remission is only possible with the detection and treatment of the malignancy. Early diagnosis and treatment are of paramount importance. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. Somatization and illness behaviour in a neurology ward.

    Science.gov (United States)

    Creed, F; Firth, D; Timol, M; Metcalfe, R; Pollock, S

    1990-01-01

    One hundred and thirty-three female patients admitted to a neurological ward were fully investigated for the presence of organic neurological disease, and assessed for psychiatric disorder and illness behaviour, using the Clinical Interview Schedule (CIS) and the Illness Behaviour Questionnaire (IBQ). The likelihood of the presenting symptoms being due to organic disease was expressed by the neurologists on a visual analogue scale and the psychiatrists used a similar technique to describe whether the symptoms could be the result of psychiatric disorder. Many patients either had clear organic disease or somatic presentation of psychiatric disorder 'somatization', but one-third fell between these two extremes and either had a complex mixture of the two types of illness or could not be accurately diagnosed. The IBQ scores were raised in those with psychiatric disorder but did not help to explain why some patients present to the neurologists with symptoms that are unexplained by either organic disease or psychiatric disorder. Close liaison between neurologists and psychiatrists increases the detection of psychiatric disorder but some patients would require long-term follow-up to understand the true nature of the underlying disorder.

  14. Neurology of foreign language aptitude

    Directory of Open Access Journals (Sweden)

    Adriana Biedroń

    2015-01-01

    Full Text Available This state-of-the art paper focuses on the poorly explored issue of foreign language aptitude, attempting to present the latest developments in this field and reconceptualizations of the construct from the perspective of neuroscience. In accordance with this goal, it first discusses general directions in neurolinguistic research on foreign language aptitude, starting with the earliest attempts to define the neurological substrate for talent, sources of difficulties in the neurolinguistic research on foreign language aptitude and modern research methods. This is followed by the discussion of the research on the phonology of foreign language aptitude with emphasis on functional and structural studies as well as their consequences for the knowledge of the concept. The subsequent section presents the studies which focus on lexical and morphosyntactic aspects of foreign language aptitude. The paper ends with a discussion of the limitations of contemporary research, the future directions of such research and selec ed methodological issues.

  15. Porphyria and its neurologic manifestations.

    Science.gov (United States)

    Tracy, Jennifer A; Dyck, P James B

    2014-01-01

    Porphyrias are rare disorders resulting from a defect in the heme biosynthetic pathway. They can produce significant disease of both the peripheral and central nervous systems, in addition to other organ systems, with acute intermittent porphyria, hereditary coproporphyria, and variegate porphyria as the subtypes associated with neurologic manifestations. The presence of a motor-predominant peripheral neuropathy (axonal predominant), accompanied by gastrointestinal distress and neuropsychiatric manifestations, should be a strong clue to the diagnosis of porphyria. Clinical confirmation can be made through evaluation of urine porphyrins during an exacerbation of disease. While hematin is helpful for acute treatment, long-term effective management requires avoidance of overstimulation of the cytochrome P450 pathway, as well as other risk factor control. © 2014 Elsevier B.V. All rights reserved.

  16. Is There Chronic Brain Damage in Retired NFL Players? Neuroradiology, Neuropsychology, and Neurology Examinations of 45 Retired Players

    Science.gov (United States)

    Casson, Ira R.; Viano, David C.; Haacke, E. Mark; Kou, Zhifeng; LeStrange, Danielle G.

    2014-01-01

    Background: Neuropathology and surveys of retired National Football League (NFL) players suggest that chronic brain damage is a frequent result of a career in football. There is limited information on the neurological statuses of living retired players. This study aimed to fill the gap in knowledge by conducting in-depth neurological examinations of 30- to 60-year-old retired NFL players. Hypothesis: In-depth neurological examinations of 30- to 60-year-old retired players are unlikely to detect objective clinical abnormalities in the majority of subjects. Study Design: A day-long medical examination was conducted on 45 retired NFL players, including state-of-the-art magnetic resonance imaging (MRI; susceptibility weighted imaging [SWI], diffusion tensor imaging [DTI]), comprehensive neuropsychological and neurological examinations, interviews, blood tests, and APOE (apolipoprotein E) genotyping. Level of Evidence: Level 3. Methods: Participants’ histories focused on neurological and depression symptoms, exposure to football, and other factors that could affect brain function. The neurological examination included Mini-Mental State Examination (MMSE) evaluation of cognitive function and a comprehensive search for signs of dysarthria, pyramidal system dysfunction, extrapyramidal system dysfunction, and cerebellar dysfunction. The Beck Depression Inventory (BDI) and Patient Health Questionnaire (PHQ) measured depression. Neuropsychological tests included pen-and-paper and ImPACT evaluation of cognitive function. Anatomical examination SWI and DTI MRI searched for brain injuries. The results were statistically analyzed for associations with markers of exposure to football and related factors, such as body mass index (BMI), ethanol use, and APOE4 status. Results: The retired players’ ages averaged 45.6 ± 8.9 years (range, 30-60 years), and they had 6.8 ± 3.2 years (maximum, 14 years) of NFL play. They reported 6.9 ± 6.2 concussions (maximum, 25) in the NFL. The

  17. [Frequency of hereditary neurologic diseases. A clinical study].

    Science.gov (United States)

    Leone, M; Baldini, S; Voltolin, G; Norat, M; Bottacchi, E

    1993-09-01

    The nervous system is affected in 30% of hereditary monogenic disorders and as many as 500 single-gene disorders display major neurologic symptoms. We have studied the frequency of hereditary neurological diseases to assess their importance in daily hospital activity. Only single-gene hereditary diseases with central or peripheral nervous system involvement were considered; thus chromosomal diseases and diseases with multifactorial etiology were excluded. We surveyed admission to in- and out-patient departments of Neurology, Pediatrics, and Dermatology of the Aosta Regional Hospital for the calendar years 1982-1991, collecting 229 cases, 95 women and 134 men. Out-patient departments held 126 patients, the others came from in-patient departments. Admission to the neurological in-patient department were 1.8% of total neurological admissions in the same period. Each diagnosis was assigned to the code number of the International Classification of Diseases (ICD-IX Revision, 1975). We found 33 different phenotypes. Most frequent diagnoses were: essential tremor (89 patients), hereditary sensory-motor neuropathy (HSMN) type I (28), Huntington's chorea (13), progressive muscular dystrophy limb-girdle type (8), neurofibromatosis type I (9), HSMN type II (9), spinocerebellar ataxia (9), hereditary spastic paraplegia (7), spinal muscular atrophy type IV (5), myotonic dystrophy (5), cerebellar ataxia (4), HSMN type III (4), spinal muscular atrophy type II and III (3), tuberous sclerosis (3). Essential tremor mostly affected persons in the over-50 age groups. On the contrary, the other neurologic monogenic diseases were diagnosed in all ages with the following age-group breakdown: 0-9, 11%; 10-19, 16%; 20-29, 15%; 30-39, 8%; 40-49, 11%; 50-59, 19%; 60-69, 14%, 70+, 7%. Consistently with the general rule, autosomic recessive diseases have the earliest onset and autosomic dominant ones the latest; HSMN, spinal muscular atrophy and Huntington's chorea were the disorders diagnosed

  18. Effects of a Psychological Internet Intervention in the Treatment of Mild to Moderate Depressive Symptoms: Results of the EVIDENT Study, a Randomized Controlled Trial.

    Science.gov (United States)

    Klein, Jan Philipp; Berger, Thomas; Schröder, Johanna; Späth, Christina; Meyer, Björn; Caspar, Franz; Lutz, Wolfgang; Arndt, Alice; Greiner, Wolfgang; Gräfe, Viola; Hautzinger, Martin; Fuhr, Kristina; Rose, Matthias; Nolte, Sandra; Löwe, Bernd; Anderssoni, Gerhard; Vettorazzi, Eik; Moritz, Steffen; Hohagen, Fritz

    Mild to moderate depressive symptoms are common but often remain unrecognized and treated inadequately. We hypothesized that an Internet intervention in addition to usual care is superior to care as usual alone (CAU) in the treatment of mild to moderate depressive symptoms in adults. This trial was controlled, randomized and assessor-blinded. Participants with mild to moderate depressive symptoms (Patient Health Questionnaire, PHQ-9, score 5-14) were recruited from clinical and non-clinical settings and randomized to either CAU or a 12-week Internet intervention (Deprexis) adjunctive to usual care. Outcomes were assessed at baseline, 3 months (post-assessment) and 6 months (follow-up). The primary outcome measure was self-rated depression severity (PHQ-9). The main analysis was based on the intention-to-treat principle and used linear mixed models. A total of 1,013 participants were randomized. Changes in PHQ-9 from baseline differed signixFB01;cantly between groups (t825 = 6.12, p effect of group). The post-assessment between-group effect size in favour of the intervention was d = 0.39 (95% CI: 0.13-0.64). It was stable at follow-up, with d = 0.32 (95% CI: 0.06-0.69). The rate of participants experiencing at least minimally clinically important PHQ-9 change at the post-assessment was higher in the intervention group (35.6 vs. 20.2%) with a number needed to treat of 7 (95% CI: 5-10). The Internet intervention examined in this trial was superior to CAU alone in reducing mild to moderate depressive symptoms. The magnitude of the effect is clinically important and has public health implications. © 2016 S. Karger AG, Basel.

  19. Association of urinary phenolic compounds, inflammatory bowel disease and chronic diarrheal symptoms: Evidence from the National Health and Nutrition Examination Survey.

    Science.gov (United States)

    de Silva, Punyanganie S; Yang, Xuan; Korzenik, Joshua R; Goldman, Rose H; Arheart, Kristopher L; Caban-Martinez, Alberto J

    2017-10-01

    Endocrine disruptors such as phenolic compounds and parabens may be involved in chronic non-infective disease. While products incorporating these compounds are extensively utilized in consumer and personal products, little is known about their effect on bowel health. Inflammatory bowel disease (IBD) - consisting of the diseases ulcerative colitis and Crohn's disease - and irritable bowel syndrome are common chronic non-infectious diarrheal diseases. Despite limited knowledge on the etiology of IBD, these diseases have increased prevalence in industrialized countries and cause significant impairment to quality of life. In the present study we examine relationships between urinary environmental phenolic compounds, chronic diarrhea and inflammatory bowel disease. Data was obtained from the 2005-2010 US National Health and Nutrition Examination Survey (NHANES) including demographics, lifestyle factors, self-reported health conditions, inflammatory markers and urinary phenolic chemical concentrations. Only participants with complete environmental phenols & parabens component were included in our analysis. Chronic diarrheal symptoms were determined by using the 2009-2010 NHANES questionnaire which included questions pertaining to bowel health. We utilized chronic bowel leakage symptoms as a surrogate marker for chronic diarrhea. The presence of IBD was also analyzed from 2009 to 2010 NHANES data, as a sub-analysis for arthropathy directly querying the presence or absence of IBD. Among the subset of 5218 American adults aged 20-80 years in the NHANES study period who completed environmental phenols & parabens component, 25.5% reported chronic diarrheal symptoms. Abnormal markers of inflammation were present in 2200 (42.2%) of respondents. For IBD, 19 individuals with arthropathy confirmed a diagnosis of ulcerative colitis, and 1 person confirmed a Crohn's diagnosis. After adjustment for demographics, inflammatory and subsample weighing; lower paraben levels were

  20. The good-old-days bias and post-concussion syndrome symptom reporting in a non-clinical sample.

    Science.gov (United States)

    Sullivan, Karen A; Edmed, Shannon L

    2012-01-01

    To investigate the good-old-days bias, a psychosocial factor associated with post-concussion syndrome (PCS). Repeated measures comparison of PCS symptoms reported 6 months prior (retrospectively) and currently. A non-clinical sample was used to determine if this bias is a general recall bias. Fifty-seven university students with no history of brain injury or neurological disease completed the British Columbia Post-concussion Symptom Inventory. Symptoms were reported on two occasions, spaced 1 week apart, commencing with current symptoms. Using PCS symptom frequency by severity product scores, there was no significant difference in the 13 PCS symptoms reported across occasions, nor the relevant summary score (p = 0.199). These data do not support the presence of a general recall bias. However, significant differences emerged when analysed using a simple count of the total number of endorsed symptoms (p = 0.002, d = 0.39, small-to-medium effect) or the sample percentage that endorsed each symptom (four symptoms were endorsed by fewer participants retrospectively than currently). There is only weak evidence of a general recall bias in this non-clinical sample. Further consideration of the methods used to study this bias and its role clinically is needed.

  1. Pediatric neurology of the dog and cat.

    Science.gov (United States)

    Lavely, James A

    2006-05-01

    The neurologic examination in the puppy or kitten can be a challenging experience. Understanding the development of behavior reflexes and movement in puppies and kittens enables us to overcome some of these challenges and to recognize the neurologically abnormal patient. Subsequently,we can identify the neuroanatomic localization and generate a differential diagnosis list. This article first reviews the pediatric neurologic examination and then discusses diseases unique to these individuals.

  2. Neurologic complications of polycythemia and their impact on therapy

    Energy Technology Data Exchange (ETDEWEB)

    Newton, L.K. (MD Anderson Cancer Center, Houston, TX (USA))

    1990-03-01

    Polycythemia vera, a clonal stem cell disorder, produces neurologic problems in 50-80% of patients. Some symptoms, such as headache and dizziness, are related to hyperviscosity, and respond immediately to reduction of cell counts. Others seem to result from an associated coagulopathy. Patients with polycythemia tend to develop both arterial and venous thrombosis and are prone to hemorrhages. Treatments for polycythemia include phlebotomy, chlorambucil supplemented with phlebotomy, and {sup 32}P plus phlebotomy. Whatever treatment is chosen, the aim of therapy should be to reduce the hematocrit to approximately 40-45%.37 references.

  3. Cauda Equina Compression in the Absence of Neurologic Signs.

    Science.gov (United States)

    Buzzell, Bethany; Sheets, Charles; Bagley, Carlos A

    2016-04-01

    The patient was a 45-year-old man with a 4-year history of chronic low back pain, intensifying insidiously over the previous 8 months. On physical examination, generalized, severe low back pain was increased with all motions, with no abnormal neurologic signs. The initial physical therapy diagnosis was nonspecific low back pain; however, when the patient reported worsening symptoms at 2-week follow-up, he was advised to complete his previously scheduled magnetic resonance imaging and physician follow-up before further physical therapy. Magnetic resonance imaging revealed a mass at L5 consistent with benign nerve sheath tumor.

  4. [Reconciliating neurology and psychiatry: The prototypical case of frontotemporal dementia].

    Science.gov (United States)

    Lagarde, J; Sarazin, M

    2017-10-01

    Frontotemporal degeneration (FTD) in its behavioral variant (bvFTD) is probably one of the conditions that best illustrates the links between psychiatry and neurology. It is indeed admitted that between a third and half of patients with this condition, especially in early-onset forms, receive an initial diagnosis of psychiatric disorder (depression, schizophrenia, bipolar disorder) and are then referred to a psychiatric ward. BvFTD can thus be considered a neurological disorder with a psychiatric presentation. Among psychiatric symptoms reported in this disease, psychotic symptoms (hallucinations, delusions, especially of persecution), which have long been underestimated in bvFTD and are not part of the current diagnostic criteria, are present in about 20% of cases and may be inaugural. They are particularly common in the genetic forms related to a mutation in the C9orf72 gene (up to 50%), and to a lesser extent in the GRN gene (up to 25%). C9orf72 gene mutation is often associated with a family history of dementia or motor neuron disease but also of psychiatric disorders. It has also been described in sporadic presentation forms. Sometimes, the moderate degree of brain atrophy on MRI described in patients carrying this mutation may complicate the differential diagnosis with late-onset psychiatric diseases. In the present article, we underline the importance of considering that psychiatric - especially psychotic - symptoms are not rare in bvFTD, which should lead to a revision of the diagnostic criteria of this disease by taking greater account of this fact. We also propose a diagnostic chart, based on concerted evaluation by neurologists and psychiatrists for cases of atypical psychiatric symptoms (late-onset or pharmacoresistant troubles) leading to consider the possibility of a neurological disorder, in order to shed a new light on these difficult clinical situations. In the field of research, bvFTD may constitute a model to explore the neural basis of certain

  5. Neurogenic lower urinary tract dysfunction: Clinical management recommendations of the Neurologic Incontinence committee of the fifth International Consultation on Incontinence 2013.

    Science.gov (United States)

    Drake, Marcus John; Apostolidis, Apostolos; Cocci, Andrea; Emmanuel, Anton; Gajewski, Jerzy B; Harrison, Simon C W; Heesakkers, John P F A; Lemack, Gary E; Madersbacher, Helmut; Panicker, Jalesh N; Radziszewski, Piotr; Sakakibara, Ryuji; Wyndaele, Jean Jacques

    2016-08-01

    Evidence-based guidelines for the management of neurological disease and lower urinary tract dysfunction have been produced by the International Consultations on Incontinence (ICI). These are comprehensive guidelines, and were developed to have world-wide relevance. To update clinical management of neurogenic bladder dysfunction from the recommendations of the fourth ICI, 2009. A series of evidence reviews and updates were performed by members of the working group. The resulting guidelines were presented at the 2012 meeting of the European Association of Urology for consultation, and consequently amended to deliver evidence-based conclusions and recommendations in 2013. The current review is a synthesis of the conclusions and recommendations, including the algorithms for initial and specialized management of neurogenic lower urinary tract dysfunction. The pathophysiology is categorized according to the nature of onset of neurological disease and the part(s) of the nervous system affected. Assessment requires clinical evaluation, general investigations, and specialized testing. Treatment primarily focuses on ensuring safety of the patient and optimizing quality of life. Symptom management covers conservative and interventional measures to aid urine storage and bladder emptying, along with containment of incontinence. A multidisciplinary approach to management is essential. The review offers a pragmatic review of management in the context of complex pathophysiology and varied evidence base. Neurourol. Urodynam. 35:657-665, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  6. Sleep Disorders in Childhood Neurological Diseases

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    Abdullah Tolaymat

    2017-09-01

    Full Text Available Sleep problems are frequently addressed as a primary or secondary concern during the visit to the pediatric neurology clinic. Sleep disorders can mimic other neurologic diseases (e.g., epilepsy and movement disorders, and this adds challenges to the diagnostic process. Sleep disorders can significantly affect the quality of life and functionality of children in general and those with comorbid neurological diseases in particular. Understanding the pathophysiology of sleep disorders, recognizing the implications of sleep disorder in children with neurologic diseases and behavioral difficulties, and early intervention continue to evolve resulting in better neurocognitive outcomes.

  7. Challenges in neurological practice in developing countries.

    Science.gov (United States)

    Pandey, Sanjay

    2012-01-01

    The burden of neurological illness is much higher in developing countries. Neurological disorders in these countries are mainly due to poverty and malnutrition. Spectrums of diseases are also different in comparison with developed countries. Lack of resources, ignorance, and overpopulation make it very difficult and challenging to tackle this problem. Majority of the patients are seen by general practitioners who have little knowledge about neurological illnesses. Most of the countries have very few or no neurologist. There is a greater need of taking neurological care at primary care level where majority of the patients struggle with epilepsy, stroke and neuroinfections.

  8. Neurologic long term outcome after drowning in children

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    Suominen Pertti K

    2012-08-01

    Full Text Available Abstract Drowning is a major source of mortality and morbidity in children worldwide. Neurocognitive outcome of children after drowning incidents cannot be accurately predicted in the early course of treatment. Therefore, aggressive out-of-hospital and in-hospital treatment is emphasized. There are "miracle" cases after long submersion times that have been reported in the medical literature, which mostly concern small children. However, many of the survivors will remain severely neurologically compromised after remarkably shorter submersion times and will consequently be a great burden to their family and society for the rest of their lives. The duration of submersion, the need of advanced life support at the site of the accident, the duration of cardiopulmonary resuscitation, whether spontaneous breathing and circulation are present on arrival at the emergency room are important factors related to survival with mild neurological deficits or intact function in drowned children. Data on long-term outcome are scarce. The used outcome measurement methods and the duration of follow-up have not been optimal in most of the existing studies. Proper neurological and neurophysiological examinations for drowned children are superior to outcome scales based chart reviews. There is evidence that gross neurological examination at the time of discharge from the hospital in young children does not reveal all the possible sequelae related to hypoxic brain injury and thus long-term follow-up of drowned resuscitated children is strongly recommended.

  9. Neurological aspects of HTLV-1 infection in Bahia: results from an 8-year cohort

    Directory of Open Access Journals (Sweden)

    Davi Tanajura

    2015-01-01

    Full Text Available HTLV-1 is the causal agent of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP, a disease observed in up to 5% of individuals infected with HTLV-1. However, infected individuals without the disease can present neurological complaints relating to sensory, motor or urinary manifestations. The aim of this study was to investigate the incidence of neurological manifestations among patients with HTLV-1. Method HTLV-1 patients in Salvador, Bahia, Brazil, were enrolled into a cohort study. Results Among 414 subjects, 76 had definite and 87 had possible or probable HAM/TSP at the baseline, whereas 251 subjects had no neurological signs or symptoms. Definite HAM/TSP developed in 5 patients (1.74%. The asymptomatic subjects were selected for analysis. The incidence rate expressed per 1,000 persons-year was calculated. It was 206 for hand numbness, 129 for nocturia and 126 for urinary urgency. In the neurological examination, leg hyperreflexia presented an average incidence rate of 76; leg paraparesis, 52; and Babinski sign, 36. Kaplan-Meyer curves categorized according to gender and proviral load showed that females and patients with proviral load of more than 100,000 copies per 106 peripheral blood mononuclear cells (PBMCs presented higher risk. Conclusion Development of neurological symptoms or signs occurred in up to 30% of asymptomatic subjects during 8 years of follow-up. Female gender and high proviral load were risk factors for neurological disease.

  10. A Sporadic Case of Fabry Disease Involving Repeated Fever, Psychiatric Symptoms, Headache, and Ischemic Stroke in an Adult Japanese Woman

    National Research Council Canada - National Science Library

    Sawada, Jun; Katayama, Takayuki; Kano, Kohei; Asanome, Asuka; Takahashi, Kae; Saito, Tsukasa; Chinda, Junko; Nakagawa, Naoki; Sato, Nobuyuki; Kimura, Takashi; Yahara, Osamu; Momosaki, Ken; Nakamura, Kimitoshi; Hasebe, Naoyuki

    2015-01-01

    Fabry disease can cause various neurological manifestations. We describe the case of a Japanese woman with Fabry disease who presented with ischemic stroke, aseptic meningitis, and psychiatric symptoms...

  11. Smoking, respiratory symptoms and likely asthma in young people: evidence from postal questionnaire surveys in the Wythenshawe Community Asthma Project (WYCAP

    Directory of Open Access Journals (Sweden)

    Linehan Mary

    2006-05-01

    Full Text Available Abstract Background Although it is recognised that smoking is a major risk factor for subjects with chronic obstructive pulmonary disease and is associated with respiratory symptoms, there is less agreement concerning the relationship between asthma and smoking. This study aims to examine the relationship between cigarette smoking and asthma prevalence. Method Data were used from two postal questionnaire surveys (1999 and 2001 in two general practice populations, using a respiratory questionnaire based on the ECRHQ and a generic quality of life questionnaire (EQ-5D. Only subjects less than 45 years old were included in the survey. An empirical definition of likely asthma was used based on respiratory questionnaire responses. Smoking was examined according to three categories, current smoker, ex smoker and never smoker. Results Almost 3500 subjects were included in the analyses. Current smokers had a higher prevalence of likely asthma compared to never smokers, odds ratio (OR 1.59 (95% confidence interval (CI 1.24 to 2.04. and also compared to ex smokers OR 1.79 (CI 1.25 to 2.56, but there was no difference between ex smokers and never smokers (OR 1.00 (0.75–1.35. Current smoking was also positively associated with all symptoms but not with a history of hayfever/eczema. Conclusion Although the positive association found between current smoking and obstructive airways disease is likely to be due to the effect of cigarettes on asthma, it could reflect an association with early COPD (GOLD stages 0 or 1. Smoking cessation has a beneficial effect on the prevalence of respiratory symptoms and is therefore of paramount importance among these young adults.

  12. Practice guideline summary: Treatment of restless legs syndrome in adults: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Winkelman, John W; Armstrong, Melissa J; Allen, Richard P; Chaudhuri, K Ray; Ondo, William; Trenkwalder, Claudia; Zee, Phyllis C; Gronseth, Gary S; Gloss, David; Zesiewicz, Theresa

    2016-12-13

    To make evidence-based recommendations regarding restless legs syndrome (RLS) management in adults. Articles were classified per the 2004 American Academy of Neurology evidence rating scheme. Recommendations were tied to evidence strength. In moderate to severe primary RLS, clinicians should consider prescribing medication to reduce RLS symptoms. Strong evidence supports pramipexole, rotigotine, cabergoline, and gabapentin enacarbil use (Level A); moderate evidence supports ropinirole, pregabalin, and IV ferric carboxymaltose use (Level B). Clinicians may consider prescribing levodopa (Level C). Few head-to-head comparisons exist to suggest agents preferentially. Cabergoline is rarely used (cardiac valvulopathy risks). Augmentation risks with dopaminergic agents should be considered. When treating periodic limb movements of sleep, clinicians should consider prescribing ropinirole (Level A) or pramipexole, rotigotine, cabergoline, or pregabalin (Level B). For subjective sleep measures, clinicians should consider prescribing cabergoline or gabapentin enacarbil (Level A), or ropinirole, pramipexole, ro