China
Africa
Explore chapters and articles related to this topic
Stroke and Transient Ischemic Attacks of the Brain and Eye
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
The risks of symptomatic ICH, particularly hemorrhagic transformation of the infarct, appear larger according to several prognostic factors, such as a high SEDAN score (blood Sugar, Early infarct signs, [hyper] Dense cerebral artery sign, Age, and NIHSS score). Leukoaraiosis also is associated with an increased risk of symptomatic ICH, but thrombolysis has a net clinical benefit in these patients and should not be withheld on the basis of this finding alone. Time from stroke onset is not a major determinant of the risk of fatal ICH with ALT.
Neuroanatomy: Age-related changes
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
White matter loss starts at a later stage in the aging brain but is more rapid than gray matter loss, and ultimately exceeds it (16). Myelin breakdown is an aspect of healthy aging, and this breakdown contributes to the loss of white matter volume in the elderly. White matter changes play a causal role in cognitive performance in aging, including mental speed, episodic memory function, executive and flexible cognition, and nonverbal problem solving. Thirty percent of subjects older than 60 years of age demonstrate white matter hyperintensities in the periventricular and subcortical regions on MR studies, and these lesions tend to increase with age (17). These white matter lesions, or leukoaraiosis, occur as a result of atrophic perivascular demyelination secondary to vascular insufficiency in the aged. The presence of white matter hyperintensities has been correlated with signs of cognitive decline (18,19). It has also been shown in recent studies to be a predictor of stroke (20). The identifiable risk factors for these lesions include diabetes, hypertension, decreased respiratory function, high cholesterol, and female gender (21).
The Neuropathology of Alzheimer’s Disease
Published in Zaven S. Khachaturian, Teresa S. Radebaugh, Alzheimer’s Disease, 2019
Suzanne S. Mirra, William R. Markesbery
Leukoaraiosis is a term used to describe the diffuse periventricular white matter alterations found on computerized tomography scan and magnetic resonance imaging in patients with AD and in intellectually normal elderly individuals. It has been suggested that these changes are ischemic in nature, resulting from hypoperfusion in the distal zone of penetrating blood vessels. Microscopically these zones show pallor, mild myelin loss, gliosis, ependymal breakdown, and hyalinization, fibrosis, and luminal narrowing of arterioles. The importance of these lesions in cognitive function is not known, especially in regard to vascular dementia, AD, and mixed forms of dementia.
Magnetic resonance imaging changes in Asian people living with HIV
Published in Infectious Diseases, 2021
Yusuke Yoshino, Ichiro Koga, Takatoshi Kitazawa, Hiroshi Oba, Shigeru Furui, Hiroshi Matsuda, Yasuo Ota
Imaging assessments of the elderly often reveals leukoaraiosis, which have been previously considered a benign accompaniment of aging. Leukoaraiosis is a radiological term used to describe WMHs observed as bright white appearances on T2 MRI scans. However, recent studies have reported a strong correlation of leukoaraiosis with ischaemic stroke, unfavourable course of acute ischaemic stroke, worse long-term outcomes, and cognitive disturbances [20]. Currently, leukoaraiosis is considered a cerebral small vessel disease. We found a significantly higher prevalence of leukoaraiosis in the PLWH than in the controls at younger ages. Watson et al. reported that PLWH aged > 60 years had a significantly higher WMH burden [10]. Another recent study reported that middle-aged (aged ≤ 45 years) male PLWH had a higher WMH burden, which was correlated with cognitive deficits, cardiovascular risk factors, and duration of suppressed CD4-positive T-lymphocyte counts [9]. This indicates that leukoaraiosis could be more prevalent in PLWH of all age groups than in HIV-negative individuals. Moreover, the early emergence of WMH could result in the occurrence of HAND, and WMHs could be a predictive marker of HAND. However, we did not observe a significant correlation of leukoaraiosis with the two neurocognitive scales used in this study. There is a need for long-term prospective observational studies to further assess these hypotheses.
Could hemogram parameters be predictors of dementia in elderly patients?
Published in The Aging Male, 2019
Numerous studies established the diagnostic significance of RDW in literature in inflammatory and vascular diseases [19,20]. Since inflammation promotes anisocytosis by interfering erythropoiesis in bone marrow [21], authors suggested that RDW elevates in inflammatory conditions [22]. Indeed, a positive correlation between inflammatory indices and RDW has been reported [23]. On the other hand, inflammation could play important role in subjects with leukoaraiosis. Umemura et al. [24] reported that endothelial and inflammatory markers were associated with vascular cerebral disease in subjects with type 2 diabetes mellitus. Similarly, Wright et al. [25] found that markers of inflammation were related with the degree of leukoaraiosis. Thus, RDW elevation reported in the present study in subjects with higher Fazekas’s score could be explained via inflammation.
Cotard's Syndrome Triggered by Fear in a Patient with Intellectual Disability: Causal or Casual Link?
Published in Issues in Mental Health Nursing, 2018
Fabrizio Sottile, Rosaria De Luca, Lilla Bonanno, Giuseppina Finzi, Carmela Casella, Rocco Salvatore Calabrò
A 46-year-old man came to our observation because his sister found him in a confusional state. The patient was affected by an idiopathic moderate mental retardation; he was mostly independent in performing the basic daily life activities, but lived with his sister. He attended a mental health outpatient clinic, and had a quite normal social life. About 2 months before his admission, the patient witnessed a theft attempt that caused an abnormal “state of fear.” Indeed, after about 2 weeks from the event, he started refusing food as he considered himself dead. His illness further progressed in a month and he developed muteness, total refusal to eat, and fecal and urinary incontinence. Subsequently, the patient was hospitalized in our Neurology Unit. At admission, general conditions showed a general state of malnutrition (hematochemical tests showed hemoglobin of 11 g/dL and hypoalbuminemia). At neurological examination, the patient had sad affect, mutism, rigidity in all the four limbs, and negativism; disperception was also evidenced. Magnetic resonance imaging examination revealed a mild to moderate leukoaraiosis. When general clinical conditions improved, the patient underwent a specific neuropsychological assessment. In particular, at the Wechsler Adult Intelligence Scale (WAIS), evaluating the intelligence quotient (IQ), he reported a score of 55; at the post-traumatic stress disorder (PTSD) his total score was 18 (indicating the absence of such disorder), whereas the Visual-Analogue Test for Anosognosia (VATam) score was 31 (demonstrating the presence of severe anosognosia).