Sex differences in the relationship between obesity,C-reactive protein,physical activity,depression, sleep quality and fatigue in older adults

Fatigue is a serious health concern in the elderly. Sex differences exist in adiposity, systemic inflammation, physical activity/fitness and fatigue; however, the relations among these variables remain inadequately characterized impeding the development of fatigue prevention strategies. Measures of adiposity, C-reactive protein, physical activity, aerobic fitness, fatigue, sleep quality and depression were obtained from 127 community-dwelling older adults. Although similar in age (70 y) and BMI (28.0 kg/m²) women (n = 80) reported 63% greater fatigue than men (p = 0.04). Adiposity (r = 0.44), CRP (r = 0.29), physical activity (r = ?0.26) and fitness (r = ?0.41) were related to fatigue in women (all p < 0.05), but not in men. Depression was also related to fatigue in women (r = 0.37), and was the only variable related to fatigue in men (r = 0.42). In women, fatigue was independently explained (all p < 0.05) by CRP (6.6%), depression (6.3%), physical activity (5.8%), and adiposity (3.9%); however, in men, only depression explained variance in fatigue (12.0%). CRP was 40% higher and adiposity 12% higher in women reporting fatigue compared to those with no fatigue; no such differences existed in men. Obese women perceived a greater degree of fatigue than non-obese women, but this was not the case in men. Women report more fatigue than men which was independently associated with inflammation, depression, physical activity and adiposity, whereas in men the only independent predictor was depression. Strategies to prevent fatigue may differ in older women and men, especially with regard to inflammation, physical activity and adiposity.     

Association of stress coping strategies with Internet addiction in college students: The moderating effect of depression

BackgroundThis study examined the association between stress-related coping strategies and Internet addiction and the moderating effect of depression in a sample of Taiwanese college students.MethodA total of 500 college students (238 men and 262 women) participated in this study. Internet addiction was assessed using the Chen Internet Addiction Scale. Participants’ stress coping strategies and depressive symptoms were measured using the Coping Orientation to Problems Experienced and the Beck Depression Inventory-II, respectively. We used t and chi-square tests to examine differences in demographic characteristics, depression, and stress coping strategies between participants with and without Internet addiction. Significant variables were used in a logistic regression model to examine the association between stress coping strategies and Internet addiction and the moderating effect of depression on the association.ResultsResults indicated that use of restraint coping was negatively associated with Internet addiction (odds ratio [OR] = 0.886, 95% confidence interval [CI]: 0.802–0.977), whereas denial (OR = 1.177, 95% CI: 1.029–1.346) and mental disengagement (OR = 2.673, 95% CI: 1.499–4.767) were positively associated with Internet addiction. Depression had a moderating effect on the association between denial and Internet addiction (OR = 0.701, 95% CI: 0.530–0.927).ConclusionsStress coping strategies and depression are important factors to evaluate when developing intervention programs targeting college undergraduate students with Internet addiction.     

Salivary cortisol among American Indians with and without posttraumatic stress disorder (PTSD): Gender and alcohol influences

Disruptions in hypothalamic–pituitary–adrenal regulation and immunity have been associated with posttraumatic stress disorder (PTSD). We examined the association of PTSD with diurnal rhythms in salivary cortisol in a convenience sample from a population-based study of male and female American Indians. Subjects with and without PTSD were identified from American Indians living on/near a Northern Plains reservation as part of a larger study. Over two days diurnal saliva samples were collected by staff at the University of Colorado Denver Clinical Research Center at waking, 30 min after waking, before lunch, and before dinner. Generalized estimating equations linear regression models investigated the influence of PTSD on cortisol over time. The association of a lifetime diagnosis of PTSD with salivary cortisol level was assessed in subjects with complete data (PTSD: n = 27; no PTSD n = 32) for age, gender, and alcohol consumption in the past month. Subject mean age was 44 years, and 71% were women. When stratified by gender, women with a lifetime diagnosis of PTSD had significantly higher mean cortisol levels throughout the day than women without PTSD (p = 0.01); but there was no significant association between PTSD and cortisol levels in men (p = 0.36). The cortisol awakening response – the difference in cortisol levels from waking to 30 min after waking – was not associated with PTSD in men or women. A lifetime diagnosis of PTSD may influence diurnal cortisol among American Indian women. These effects were independent of influences of current alcohol use/abuse. The unexpected elevation in cortisol in American Indian women with a lifetime diagnosis of PTSD may reflect acute anxiety associated with experiencing a number of novel tests in a strange location (e.g., cardiac imaging, medical, dental exams, etc.), or concurrent depression.     

Gender differences in stimulated cytokine production following acute psychological stress

Emerging evidence suggests that acute psychological stress modulates inflammatory competence; however, not all findings are consistent. Gender is one factor that may impact magnitude of response. To explore this possibility, we examined the effects of acute mental stress on lipopolysaccharide-induced production of pro-inflammatory cytokines interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α among a relatively healthy sample of midlife men (n = 28) and women (n = 34). Blood samples for the assessment of cytokine production were drawn before, immediately after, and 30 min following subjects’ performance of an evaluative speech task. Relative to baseline evaluations, the speech stressor elicited a significant increase in stimulated production of all 3 pro-inflammatory cytokines, as measured 30 min following the end of the task. There were no gender differences in the magnitude of this effect. However, men showed a significant decrease in cytokine production from before to immediately following the stressor, whereas women showed no change across this period. Menopausal status partially accounted for these gender differences, with post-menopausal women displaying greater increases in IL-6 and TNF-α production from baseline-to-post-task when compared to men. These data provide further evidence that acute psychological stress primes the immune system to mount larger inflammatory responses and initial support for gender differences in the patterning of stress-related cytokine activity. In addition, this study presents novel evidence that post-menopausal women may be particularly susceptible to stress-related inflammatory responses. The possibility that this contributes to the increased risk of inflammatory disease observed among older women warrants investigation.     

Physical activity during the segmented school day in adolescents with and without autism spectrum disorders

The purpose of this study was to assess the intensity of physical activity (PA) that secondary school-aged students with autism spectrum disorders (ASD) and typically developing (TD) students exert during a school day, and to compare the percentages of students achieving the recommended guidelines between groups. The PA of 60 male students (ASD, n = 30; TD, n = 30) was recorded every 10 s for up to 5 school days by performing uniaxial accelerometry. The main results are listed as follows: (a) daily PA was significantly lower among the students with ASD than among the TD students; (b) students with ASD spent significantly lower proportion of their time in moderate PA than TD students did during physical education (PE), recess, and lunchtime; and (c) fewer students with ASD than TD students achieved the PA guidelines during the school day and PE time. Schools should increase PA opportunities across the school day.     

Prenatal maternal anxiety predicts reduced adaptive immunity in infants

Prenatal anxiety has been linked with altered immune function in offspring in animal studies, but the relevance for human health is unknown. We examined prenatal maternal anxiety as a predictor of adaptive immunity in infants at 2 and 6 months of age as part of a prospective longitudinal study. The humoral immune response to hepatitis B vaccine was assessed at 2 months (n = 80) and 6 months (n = 76) of age. Prenatal anxiety predicted lower hepatitis B antibody titers at 6 months of age independent of obstetric and socio-demographic covariates; the effects were limited to those infants who had not completed the 3-dose vaccine series (for transformed titer values, r = −.36, p < .05). Cell-mediated immune responses at 2 (n = 56) and 6 (n = 54) months of age were examined by ELISpot assays for interferon(IFN)-γ, interleukin(IL)-2, and IL-4 responder cell frequencies to three antigens: hepatitis B surface antigen, tetanus toxoid, and phytohaemagglutinin (PHA). Prenatal maternal anxiety was associated with reduced IFN-γ and increased IL-4 responder cell frequencies at 6 months of age, independent of obstetric and socio-demographic covariates. No effect of prenatal anxiety was found on adaptive immunity at 2 months of age. The findings provide the first demonstration in humans that prenatal anxiety alters adaptive immunity in the infant.     

Job satisfaction is associated with elevated natural killer cell immunity among healthy white-collar employees

Although the association of job satisfaction with health has been well documented, little is known about the biological mechanisms underlying this relationship. This study investigates the association of job satisfaction with cell-mediated immunity among Japanese white-collar daytime workers. A total of 306 healthy full-time employees (141 women and 165 men), aged 22–69 (mean 36) years, provided a blood sample for the measurement of circulating immune (natural killer (NK), B, and total T) cells and NK cell cytotoxicity (NKCC) and completed a questionnaire survey during April to June 2002. Job satisfaction was measured by a 4-item scale from the Japanese version of the generic job stress questionnaire with higher scores indicating greater satisfaction. Analyses were done separately for women and men using a hierarchical multiple linear regression model controlling for multiple confounders. The results revealed that greater job satisfaction was positively correlated with NKCC (β = .207; p = .029) and the number of NK (CD3^?CD56⁺) cells (β = .261; p = .008) in women. In men, job satisfaction was marginally correlated with NKCC (β = .165; p = .050) but was not correlated with the number of NK (CD3^?CD56⁺) cells (β = .142; p = .107). Job satisfaction did not correlate with numbers of T (CD3⁺CD56^?) and B (CD19⁺) cells in both women and men. Our findings suggest an independent association between job satisfaction and NK cells but the association seems to be stronger in women than in men. Although the results provide a support for the biological plausibility of the job satisfaction-health relationship, additional research is required to determine whether greater job satisfaction contributes to recovery/maintenance of NK cell immunity and host defense over time.     

Accelerometer-determined physical activity among elementary school-aged children with autism spectrum disorders in Taiwan

To examine age-related physical activity (PA) patterns between- and within-day in elementary school-aged children with autism spectrum disorders (ASD). PA was recorded every 5-s by uniaxial accelerometry in 35 children (grades 1–2, n = 13; grades 3–4, n = 13; grades 5–6, n = 9) for up to five weekdays and two weekend days. Younger children were more active during weekend days compared with weekdays, while the opposite was observed in older children. Age variation also exists in children's PA levels within a weekday, with this effect being most evident during recess and after school. Weekend days and free time within school days seem appropriate targets when promoting PA in older children with ASD.     

Implementation and effectiveness of integrated trauma and addiction treatment for incarcerated men

A controlled trial of Seeking Safety (SS) and Male-Trauma Recovery Empowerment Model (M-TREM) examined implementation and effectiveness of integrated group therapy for comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) on PTSD and mental health symptoms plus self-esteem and efficacy for incarcerated men. The study sample (n = 230) was male inmates 18 years or older who were primarily non-white, high school graduates or equivalents, had childhood trauma histories, committed violent crimes, had serious mental illnesses, and resided in a maximum security prison. Incarcerated men, who screened positive for PTSD and SUD, were assigned randomly (n = 142) or by preference (n = 88) to receive SS or M-TREM, with a waitlist group of (n = 93). Manualized interventions were group-administered for 14 weeks. Primary outcomes were PTSD and other mental health symptoms. Secondary outcomes were self-esteem, coping, and self-efficacy. SUD outcomes cannot be measured in a correctional setting. Implementation feasibility was exhibited by the ability to recruit, screen, assign, and retain participants. Effectiveness findings depended on sample, design, and method for analysis. Using a waitlist control group and no follow-up period, we found no aggregate effect of treatment on PTSD symptoms, although, when disaggregated, M-TREM was found to improve PTSD severity and SS improved general mental health symptoms and psychological functioning. Using intent-to-treat and completer analyses, no significant differences were found in the relative performance between SS and M-TREM on primary or secondary outcomes. When longitudinal data were maximized and modeled in ways that reflect the hierarchical nature of the data, we found that SS and M-TREM performed better than no treatment on PTSD severity and secondary outcomes, and that treatment benefits endured. Findings cautiously support implementing either Seeking Safety or M-TREM to treat incarcerated men with co-morbid PTSD and addiction problems.     

Cross-sectional assessment of diet quality in individuals with a lifetime history of attempted suicide

Increased evidence indicates an association between psychiatric disorders and dietary pattern. The objective of this study is to describe the differences in food consumption between suicide attempters and non-attempters. We analyzed the dietary information retrospectively collected from 6803 adults, aged 17 to 39 years, who also completed a mental disorder diagnostic interview as a part of the Third National Health and Nutrition Examination Survey, 1988–1994. The Healthy Eating Index score was used to measure the degree of compliance with the national diet guidelines. In men, attempters (n = 92) had a high odds of low consumption of vegetables (OR = 2.47, 95%CI = 1.19, 5.15). In women, attempters (n = 275) had a high odds of insufficient fruit consumption (OR = 2.36, 95%CI = 1.15, 4.85). For both men and women, the component scores for meat were lower in non-attempters compared with attempters. On a scale of zero (no serving) to 10 (meeting the serving recommendations), the scores were 6.74 (SE: 0.39) and 7.76 (0.10), respectively, for attempters and non-attempters among men, and 5.81 (0.33) and 6.43 (0.07), respectively, for attempters and non-attempters among women. It was further observed that female attempters ate significantly less fish and seafood. These results were obtained after adjustment for various factors, including the history of medical and psychiatric illnesses. The data suggest that fruits, vegetables and meat were significantly under-consumed in adults who had ever attempted suicide. The deleterious contribution of insufficient consumption of these foods to physical and psychiatric status in attempters merits investigation. In clinical practice, psychiatrists should pay more attention to what patients eat.     

Gender-based differences in oxidative stress parameters do not underlie the differences in mood disorders susceptibility between sexes

The present study aimed to determine whether any gender-related difference exists concerning oxidative stress parameters in a population of 231 subjects, and if these changes might be related to gender-associated differences in major depressive disorder (MDD) or bipolar disorder (BD) vulnerability. This is a case-control nested in a population-based study. The initial psychopathology screen was performed with the Mini-International Neuropsychiatric Interview and the diagnostic was further confirmed with the Structured Clinical Interview for DSM-IV. Blood samples were obtained after the interview and the oxidative stress parameters such as uric acid, advanced oxidation protein product (PCC) and lipid hydroperoxides (TBARS) were determined. Our results indicated a higher prevalence of MDD and BD in women when compared to men. In addition, significant gender differences were found in the levels of PCC (0.27 ± 0.27 vs. 0.40 ± 0.31 nmol CO/mg protein, men vs. women, respectively; P = 0.02) and uric acid (4.88 ± 1.39 mg/dL vs. 3.53 ± 1.02 mg/dL, men vs. women, respectively; P = 0.0001), but not in TBARS (0.013 ± 0.01 nmol/mg of protein vs. 0.017 ± 0.02 nmol/mg of protein, men vs. women respectively; P = 0.243). After sample stratification by gender, no association was found between oxidative stress parameters and clinical diagnosis of MDD and BD for women (P = 0.516 for PCC; P = 0.620 for TBARS P = 0.727 for uric acid) and men (P = 0.367 for PCC; P = 0.372 for TBARS P = 0.664 for uric acid). In this study, women seem more susceptible to oxidative stress than male. However, these gender-based differences do not seem to provide a biochemical basis for the epidemiologic differences in mood disorders susceptibility between sexes.     

Gender differences in the association of sleep apnea and inflammation

Over the last 15 years, many studies have established an association of sleep apnea with inflammation and metabolic aberrations. However, no controlled studies have examined potential gender effects in this association. We recruited 120 middle-aged, predominantly non-obese mild-to-moderate sleep apneics and controls (62 males, 58 females). All participants underwent a clinical history, physical examination, and 1-night 8-h polysomnography recording and provided a single fasting blood sample for assessment of interleukin-6 (IL-6), tumor necrosis factor receptor 1 (TNFR1), C-reactive protein (CRP), leptin, and adiponectin levels. Among non-sleep apneics, females had higher levels of TNFR1 (p = 0.01), CRP (p = 0.005), leptin (p < 0.001), and adiponectin (p < 0.001) compared to males, independent of age and body mass index. When analyzed separately by gender, sleep apneic men had elevated TNFR1 (p = 0.04), CRP (p = 0.06) and IL-6 (p = 0.11) relative to control men; in sleep apneic females, only CRP was elevated (p = 0.04). Furthermore, CRP was associated with apnea severity in a dose–response manner (p-linear = 0.04 in both genders) and was independently associated with comorbid hypertension in apnea (p-linear = 0.005 for women; p-linear = 0.09 for men). In conclusion, although women have naturally higher levels of inflammatory and metabolic markers than men, sleep apneic men appear to have a more severe inflammatory profile compared to women. Our findings suggest that these markers should be analyzed and interpreted separately in men and women, and that a single measure of plasma CRP appears to be a clinically-useful marker of apnea severity and comorbid cardiovascular morbidity.     

Higher CSF interleukin-6 and CSF interleukin-8 in current depression in older women. Results from a population-based sample

ObjectiveThe literature regarding cerebrospinal fluid (CSF) cytokines in geriatric depression is sparse. The aim of this study was to examine associations between CSF interleukin-6 (IL-6), interleukin-8 (IL-8) and depression in a population-based sample of older women who were followed for 17 years.Methods86 dementia-free women aged 70–84 years who participated in the Prospective Population Study of Women in Gothenburg, Sweden took part in a lumbar puncture in 1992–3. CSF IL-6 and CSF IL-8 were measured. Psychiatric symptoms were rated with the Comprehensive Psychopathological Rating Scale at baseline and at three subsequent face-to-face examinations. Depression (major or minor) was diagnosed in accordance with DSM-IV/DSM-IV research criteria.ResultsAt baseline, women with ongoing major (n = 10) or minor depression (n = 9) had higher levels of CSF IL-6 (p = 0.008) and CSF IL-8 (p = 0.007) compared with those without depression (n = 67). Higher CSF IL-8 was related to higher MADRS score (p = 0.003). New cases of depression were observed in 9 women during follow-ups. No associations between CSF cytokine levels and future depression could be shown in women without depression at baseline.ConclusionHigher levels of CSF IL-6 and IL-8 were associated with current depression in this population-based sample. CSF IL-6 and CSF IL-8 may play a role in depression in late life.     

Effect of exercise training on skeletal muscle cytokine expression in the elderly

Aging is associated with increased circulating pro-inflammatory and lower anti-inflammatory cytokines. Exercise training, in addition to improving muscle function, reduces these circulating pro-inflammatory cytokines. Yet, few studies have evaluated changes in the expression of cytokines within skeletal muscle after exercise training. The aim of the current study was to examine the expression of cytokines both at rest and following a bout of isokinetic exercise performed before and after 12 weeks of resistance exercise training in young (n = 8, 20.3 ± 0.8 yr) and elderly men (n = 8, 66.9 ± 1.6 yr). Protein expression of various cytokines was determined in muscle homogenates. The expression of MCP-1, IL-8 and IL-6 (which are traditionally classified as ‘pro-inflammatory’) increased substantially after acute exercise. By contrast, the expression of the anti-inflammatory cytokines IL-4, IL-10 and IL-13 increased only slightly (or not at all) after acute exercise. These responses were not significantly different between young and elderly men, either before or after 12 weeks of exercise training. However, compared with the young men, the expression of pro-inflammatory cytokines 2 h post exercise tended to be greater in the elderly men prior to training. Training attenuated this difference. These data suggest that the inflammatory response to unaccustomed exercise increases with age. Furthermore, regular exercise training may help to normalize this inflammatory response, which could have important implications for muscle regeneration and adaptation in the elderly.     

Évaluation du recours au programme de soins prévu par la loi du 5 juillet 2011

ObjectivesThe law of 5 July 2011 introduced the possibility of outpatient care without consent in the context of care programs (CP). Despite major ethical and legal issues and frequent recourse in France, few studies are available on the use of this mechanism. An in-depth review of practices involving a large sample of CP was essential. The main objective of this study was to look at their content, the clinical profile of the patients involved, and the progress of these CP.MethodsWe carried out a retrospective, observational study, including all the CP set up between January 1st, 2016 and December 31st, 2018 in the Sarthe department. Data strictly related to the CP (content, justification, duration, patient compliance, re-hospitalizations, etc.), and patient-related variables (socio-demographic characteristics, diagnosis, antecedents, etc.) were studied.ResultsWe studied 559 CP, 70 % of which (n = 391) in the context of “care by decision of the hospital director”, with a wide disparity of recourse by psychiatric sector. One third of the hospitalizations without consent ended with a CP. They involved men (68.5 %, n = 383), with a psychotic disorder (77.8 %, n = 435), with a history of hospitalization (90 %, n = 503), and with poor adherence to care (83.2 %, n = 465). Cannabis use accounted for 41.3 % (n = 231) of cases. Certificates initiating CP did not have a clear justification (34.6 %, n = 251) or state a goal of adherence to treatment (16.5 %, n = 120). The content of the different CP was homogeneous: 65.6% of medical consultations and 47.6 % with a nurse, 100 % mentioned treatment used. Their average duration was 3.4 months. Even though the CP were followed (69.9 %, n = 391), 52.8% (n = 295) ended with reintegration, mainly justified by symptomatic relapse (34.8 %, n = 147), and new CP were put in place almost systematically (90.6 %, n = 260). However, reintegrations were shorter than first-time admissions (26 vs. 95 days). When a decision was lifted (n = 174), it was based on the criteria of clinical stability (35.7 %, n = 120) and compliance with the CP (27.6 %, n = 93). Half of hospitalizations in “care at the decision of the State representative” ended with a CP. These CP were longer (4.5 months) and with a higher rate of reintegration (62.2 %) than for those in “care at the decision of the hospital director”. There was no significant difference of CP compliance according to the mode of psychiatric care.ConclusionsOur study allows a precise vision of patients concerned by CP: men with risk factors for psychiatric dangerousness, with a severe clinical profile. It also found a high rate of re-hospitalization despite good adherence with the CP which is in line with a device allowing the work of an alliance to care and interventions at the beginning of relapse. CP have poorly personalized content and are poorly justified by psychiatrists although it is a freedom-restricting measure, highlighting the need for increased awareness amongst psychiatrists of the legal framework of their practice regarding care without consent.     

Psychosocial well-being in Dutch adults with disorders of sex development

ObjectiveAtypical sex development is associated with psychosocial vulnerability. We investigated psychosocial well-being in individuals with disorders of sex development (DSD) and hypothesized that psychosocial well-being was related to degree of genital atypicality at birth.Methods120 male (n = 16) and female (n = 104) persons with DSD, aged 14–60 years, participated in a follow-up audit on psychosocial well-being. They were stratified in: women with 1) 46,XY and female genitalia, 2) 46,XY or 46,XX and atypical genitalia, and 3) men with 46,XY and atypical genitalia. We used the Illness Cognition Questionnaire (ICQ), Checklist Individual Strength (CIS8R), TNO-AZL Quality of Life questionnaire (TAAQOL), Adult Self-Report (ASR), and the Rosenberg Self-Esteem Scale (RSES).ResultsData were compared to reference groups. Participants generally were coping well with DSD (ICQ). Women with DSD reported elevated levels of fatigue (CIS8R) and slightly more attention and memory problems (TAAQOL, ASR). Women with atypical genitalia reported more emotional and behavioral problems. On the ASR Rule-breaking Behavior and Antisocial Personality scales, these women had similar scores as reference men. Women with DSD reported a higher self-esteem (RSES). No differences in psychosocial well-being were found between men with DSD and reference men.ConclusionIndividuals with DSD across all diagnostic groups generally reported a good psychosocial well-being. The results further suggest involvement of prenatal androgens in the development of personality traits related to assertiveness and egocentricity. We recommend that individuals with a DSD and their families are involved in decision-making processes and have access to multidisciplinary care.     

War and remembrance: Combat exposure in young adulthood and memory function sixty years later

ObjectiveIdentifying adaptive ways to cope with extreme stress is essential to promoting long-term health. Memory systems are highly sensitive to stress, and combat exposure during war has been shown to have deleterious effects on cognitive processes, such as memory, decades later. No studies have examined coping styles used by combat veterans and associations with later-life cognitive functioning. Defenses are coping mechanisms that manage difficult memories and feelings, with some more closely related to memory processes (e.g., suppression, repression). Utilizing a longitudinal database, we assessed how reliance on certain defense mechanisms after World War II combat exposure could affect cognitive health 60 years later.MethodData spanning 75 years were available on 71 men who had post-war assessment of combat exposure, defense mechanism ratings (ages 19–50), and late-life neuropsychological testing. Interaction models of combat exposure with defenses predicting late-life memory were examined.ResultsIn bivariate analyses, greater reliance on suppression correlated with worse memory performance (r = −0.30, p = .01), but greater reliance on repression did not. Greater reliance on suppression strengthened the link between combat exposure and worse memory in late life (R² = 0.24, p < .001). In contrast, greater reliance on repression attenuated the link between combat exposure and poorer late-life memory (R² = 0.19, p < .001).ConclusionsResults suggest that coping styles may affect the relationship between early-adult stress and late-life cognition. Findings highlight the importance of understanding how coping styles may impact cognitive functioning as people move through adult life.     

Syndrome de Susac : étude de cinq cas

IntroductionSusac syndrome is a rare microangiopathy, responsible for small cerebral, retinal and cochlear infarcts. The classic clinical triad includes multiple neurologic signs (from headaches to coma), retinal branch occlusions and sensorineural hearing loss.MethodsWe report a series of five patients with Susac syndrome followed in our department from 1997 to 2007.ResultsThere were four women and one man (mean age at onset: 35.2 years). Clinical symptoms at onset were neurological (n = 1), ophthalmological (n = 1), auditory (n = 1) and clinical triad (n = 2). Neurologic symptoms included encephalopathy (n = 2), headache (n = 5), transient ischemic attacks (n = 1). Brain MRI showed T2 lesions in the white and grey matter, corpus callosum and gadolinium-enhanced punctiform lesions. Cerebrospinal fluid contained an elevated protein level in three cases. Immunologic treatments (steroids [n = 4], cylophosphamid [n = 3], intravenous immunoglobulins [n = 5]) associated with aspirin and/or oral anticoagulants, despite early relapses (n = 2), led to dramatic clinical improvement (n = 5).ConclusionDue to its polymorphism the SS is difficult to diagnose when the clinical triad is lacking. In the absence of clinical trial and consensus treatment is empiric and based on supposed pathogenesis.