China
Africa
Explore chapters and articles related to this topic
Autoimmune conditions
Published in Ibrahim Natalwala, Ammar Natalwala, E Glucksman, MCQs in Neurology and Neurosurgery for Medical Students, 2022
Ibrahim Natalwala, Ammar Natalwala, E Glucksman
After a successful recovery with the medication, several weeks later the patient returned to hospital, this time complaining of weakness in both legs. On clinical examination, it was found there was loss of sensation and he was incontinent. A repeat MRI scan showed another white matter lesion had developed. The clinical results demonstrated both dissemination in space and time as described by McDonald and colleagues;1 hence the diagnosis of MS was confirmed.
Ageing
Published in Henry J. Woodford, Essential Geriatrics, 2022
Changes seen in healthy older people compared to younger individuals include a generalised slowing of gait speed and a reduction in stride length, increased postural sway while standing still and a greater degree of deviation from the straight line when walking.59 There may be forward flexion of the upper body and reduced arm swing. Higher-level gait disorders are associated with frontal lobe dysfunction and may lead to periods of hesitation and freezing. In this situation, cerebral white matter lesions are typically seen on brain imaging. Capacity to perform exercise is reduced in older age. Cardiorespiratory fitness declines from our 40s onwards.73 This can be mitigated, but not avoided, by maintaining an optimal BMI, physical exercise and not smoking. Reaction times slow down, which increases the risk of injurious falls. Functional decline (assessed by walking speed, grip strength and timed chair rises [time to stand and sit five times]) is accelerated in the final years of life.74 This ‘terminal decline' starts four to ten years prior to death. There is heterogeneity between individuals in the degree of functional decline. Reduced motor function is associated with higher mortality.
CT, MRI, and NMR Spectroscopy in Alzheimer Disease*
Published in Robert E. Becker, Ezio Giacobini, Alzheimer Disease, 2020
Liane J. Leedom, Bruce L. Miller
Englund, Brun and Gustafson (1989) have carried out extensive studies on the prevalence, etiology, clinical significance and pathological and biochemical characteristics of white matter lesions. In addition, they examined the relationship of these lesions to AD. Microscopically the white matter changes include “partial loss of axons, myelin sheaths and oligodendroglial cells accompanied by a fibrohyaline arteriosclerosis” (Englund et al., 1989). The changes were moderate or severe in 20%, mild in 40% and absent in 40% of all AD cases. These authors called these lesions selective incomplete white- matter infarction and hypothesized that they were due to “regionally reduced cerebral perfusion due to a subcortical small vessel disease combined with systemic hypotension.”
Elevated sTREM2 and NFL levels in patients with sepsis associated encephalopathy
Published in International Journal of Neuroscience, 2023
Günseli Orhun, Figen Esen, Vuslat Yilmaz, Canan Ulusoy, Elif Şanlı, Elif Yıldırım, Hakan Gürvit, Perihan Ergin Özcan, Serra Sencer, Nerses Bebek, Erdem Tüzün
Detailed clinical and demographic features of SAE patients (8 men, 3 women; average age ± standard deviation, 50.3 ± 11.9) are listed in Table 1. All patients developed alterations in the level of consciousness and behavioral symptoms. The most common neurological symptom was delirium (9 patients). Other clinical presentations included coma in one patient and generalized tonic-clonic seizures in one patient. None of the patients had focal neurological deficits. Brain MRI was normal in 2 patients, showed white matter lesions in 6 patients and brain atrophy in 3 patients. EEG was performed in 6 patients revealing diffuse slow waves in all examinations. Days between the onset of sepsis and the development of acute encephalopathy ranged between 2 and 12 (7.5 ± 3.8) days. All patients underwent mechanical ventilation and sedation. During their follow-up, all patients developed septic shock (with an average duration of 7.0 ± 5.1 days). Two patients died after discharge and 5 patients were lost to follow-up.
Herpes Simplex Virus 2 Meningoencephalitis-Associated Bilateral Optic Neuritis and Radiculitis
Published in Neuro-Ophthalmology, 2020
William L. Conte, Faten El Ammar, Asadolah Movahedan, Hassan A. Shah, Jeffrey Nichols, Adil Javed
A 57-year-old white female with a history of IgM lymphoplasmacytic lymphoma in remission presented with 4 weeks of worsening malaise, mild bilateral blurred vision, confusion, and headaches. Her neurological exam was unremarkable for any motor or sensory impairments. MRI of the brain showed nonspecific white matter lesions. MRI of the orbits had significant motion artefact and within these confines, no overt optic nerve lesions or enhancement were found. A lumbar puncture was performed which revealed opening pressure of 24.5 cm H20 (although she was in a flexed position), WBC 142 (86% lymphocytes), protein 163 mg/dL, and glucose 32 mg/dL. Cytology and flow cytometry were negative for malignant cells. PCR was positive for HSV-2. Other infectious workup was negative. She was prescribed acyclovir 10 mg/kg every 8-h and acetazolamide 500 mg twice a day.
Atypical Perinuclear Anti-Neutrophil Cytoplasmic Antibodies in Ocular Inflammatory Diseases
Published in Ocular Immunology and Inflammation, 2019
Nazanin Ebrahimiadib, Lina Ma, Bobeck S. Modjtahedi, Samaneh Davoudi, Safa Rahmani, Sarah Syeda, Andrew Stephenson, Charles Stephen Foster
Al Hamdaoui et al. examined patients with inflammatory ophthalmic disease at Pitié-Salpétrière Hospital (Paris, France) to characterize the ocular manifestations of atypical P-ANCA and found that intermediate uveitis (with or without associated anterior uveitis) was the most common ocular finding followed by scleritis and optic neuritis. Peripheral retinal vasculitis was found in 68% of their patients with positive atypical ANCA. Anterior uveitis and scleritis were the most common ocular finding and peripheral retinal vasculitis was observed in only one (3%) case with atypical P-ANCA in our series. Al Hamdaoui et al. also reported that central nervous system (CNS) white matter lesions consistent with multiple sclerosis were a major finding14 which was also seen in one of our patients in the setting of scleritis. The presence of atypical P-ANCA may explain the optic neuritis in multiple sclerosis patients in Al Hamdaoui et al.’s study since P-ANCA autoantigens have been demonstrated in retinal ganglion cells.15,16 Other than multiple sclerosis, CNS vasculitis was observed in two cases of Al Hamdaoui study. Systemic vasculitis was present in one (3%) of our cases with positive atypical P-ANCA.