Paraneoplastic neuromyelitis optica spectrum disorders: a case series

Neurological Sciences - Aquaporin-4 antibody (AQP4-IgG) neuromyelitis optica spectrum disorders (NMOSD) are rare idiopathic autoimmune diseases, presenting with optic neuritis (ON), longitudinally...     

Donepezil for behavioural disorders associated with Lewy bodies: a case series

Dementia with Lewy bodies (DLB) has been associated with important behavioural disturbances, such as psychotic symptoms. Unfortunately, neuroleptic sensitivity in these patients limits effective pharmacological management of these symptoms. Seven patients, five male and two female (mean age 75.3+/-4.7 years, range 68-81), diagnosed with DLB were treated with the acetylcholinesterase inhibitor donepezil (5-10 mg once daily) to determine its effect on treating behavioural disorders. Although the intended length of treatment was a minimum of 8 weeks, only three patients completed 8 weeks of therapy, one patient completed 6 weeks, two patients completed 4 weeks and one patient was discontinued after 5 days. The primary outcome (behavioural disturbances) was measured prospectively by the Neuropsychiatric Inventory (NPI), while other outcomes included cognition (Mini-Mental State Examination (MMSE)) and Clinical Global Impression. Three of the seven subjects showed marked improvement in behaviour, with NPI scores dropping significantly over time. Donepezil therapy was discontinued prematurely in three of the cases due to insufficient response and/or adverse events. Overall, five of the seven patients were rated at least minimally improved in behavioural symptoms. Our experience with donepezil in this group of patients shows promise. Given the limited experience with this agent in treating behavioural disorders associated with DLB, further studies are warranted.     

Olanzapine in the treatment of pervasive developmental disorders: a case series analysis

Controlling the symptoms that are characteristic of patients with pervasive developmental disorders is often challenging. We report on the safety and efficacy of olanzapine in the treatment of 7 patients with pervasive developmental disorders. The patients were all male and ranged in age from 8 to 52 years. They received olanzapine doses of 5-10 mg/d along with their various other drug regimens. Patients were monitored and evaluated for a mean duration of 17.7 (range 12-26) months while on olanzapine therapy. Very few side effects were observed during treatment. All patients showed clinically significant improvement on the Clinical Global Impressions scale, as well as an improved score as measured by the Global Assessment of Functioning scale. Our observations support the use of long-term olanzapine therapy for symptom control in patients with pervasive developmental disorders.     

Smell and taste disorders in polyneuropathy: a prospective study of chemosensory disorders

Objective – The aim of the study was to assess the occurrence and the frequency of chemosensory dysfunction in patients with polyneuropathy (PNP). Methods – We performed a prospective observational study. Olfactory function was assessed using the standardized ‘Sniffin’ Sticks’ test to measure odor threshold for phenyl ethyl alcohol, odor discrimination, and odor identification. Gustatory function was assessed using the standardized ‘taste strips’ test. In addition, we assessed etiology, neurophysiology, and severity of the PNP, and the patients’ comorbidities and medication. Results – A total of 53 consecutive patients were enroled (15 women, 38 men; mean age 61 years); 27 of them (51%) exhibited olfactory dysfunction and 23 of them (43%) gustatory dysfunction. Patients with diabetic PNP had significantly lower taste scores than patients with inflammatory, genetic, or idiopathic PNP. In addition, odor identification was negatively correlated with PNP severity. Conclusion – The applied bedside tests are useful to detect chemosensory dysfunction in patients with PNP. Chemosensory dysfunction is quite frequent in these patients.     

Post-traumatic extrapyramidal syndrome: case report

We report the case of a young man with possible post-traumatic extrapyramidal syndrome. Some features of this case have a bearing on the controversy surrounding the existence of post-traumatic Parkinson disease.

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Sommario Si descrive il caso di un giovane paziente affetto da possibile sindrome extrapiramidale post traumatica. Alcune caratteristiche di questo caso rivestono una certa importanza nell'ambito della discussione concernente la possibile esistenza di un Parkinson post traumatico.

     

脑外伤后间变性星形少枝细胞瘤一例报告

患者 男,55岁,因间歇性右侧肢体麻木3月伴右侧肢体乏力10d入院.患者在7岁时从高处坠落,致左侧额骨凹陷性骨折,当时予以保守对症治疗,效果尚可.     

脑外伤后间变性星形少枝细胞瘤一例报告

患者 男,55岁,因间歇性右侧肢体麻木3月伴右侧肢体乏力10d入院.患者在7岁时从高处坠落,致左侧额骨凹陷性骨折,当时予以保守对症治疗,效果尚可.     

Lees' syndrome: a case series

We report a case series of dopamine dysregulation syndrome, previously known as hedonistic homeostatic dysregulation in patients with Parkinson's disease on dopamine replacement therapies, now designated as Lees' syndrome.     

Post-traumatic malignant glioma. Report of a case

Only a few cases reported in the literature fulfil the currently established criteria for accepting the traumatic origin of some intracranial tumors.A case of post-traumatic glioma is presented. Several years after sustaining a commotive left parietal trauma, our patient developed symptoms of intracranial tumor. Neuroimaging (CT and MRI) showed a large neoplasia in the left temporo-parietal-occipital region, and stereotactic biopsy revealed a mixed glioma in continuity with the scar resulting from the trauma.

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Sommario Solo pochi dei casi riportati nella letteratura scientifica soddisfano pienamente i criteri stabiliti per accettare l'origine post-traumatica di alcune neoplasie endocraniche. Presentiamo il caso di un paziente il quale, molti anni dopo aver subito un trauma cranico commotivo nella regione parietale sinistra, ha manifestato una sintomatologia compatibile con un processo espansivo endocranico. Le neuroimmagini (TC e RM) hanno mostrato una estesa neoplasia nella regione temporo-parieto-occipitale sinistra. Una biopsia stereotassica ha evidenziato un glioma misto in continuità diretta con la cicatrice del pregresso trauma.

     

Neuromyelitis optica spectrum disorders and systemic lupus erythematosus: A case series from a university center

Neuromyelitis optica spectrum disorders (NMOSD) are immune-mediated inflammatory diseases of the central nervous system (CNS), which preferentially affect the optic nerves and the spinal cord. Anti-aquaporin 4 antibody is a specific serological marker. Systemic lupus erythematosus (SLE) is a rheumatologic disease that may affect the CNS. There are several reports about the coexistence of NMOSD and autoimmune diseases, mainly those of rheumatologic origin. We describe three different cases in which SLE and NMOSD subsequently occurred, drawing attention to the clinical heterogeneity, the challenge and the importance of recognizing this possible association.     

Stroke in sports: a case series

Regular physical activity decreases vascular risk. However, vascular events, including stroke, can occur while practicing physical activities. Stroke associated with sports is a rare clinical entity, whose risk factors and mechanisms are not fully understood. We report a case series of sports-related stroke, from tertiary care institutions. From the stroke registries of two University Neurology services and Stroke Units we retrieved all cases of stroke which occurred in temporal association with the practice of sports. Investigators had to fill a simple case report form, describing the demographic, clinical characteristics of the patients and the sport associated with the stroke. We included ten patients aged between 27 and 65 years, 8 being male. Only three subjects had vascular risk factors. Trauma to the head and/or neck was reported in two patients only. Cervicocerebral arterial dissection was the main cause of stroke, occurring in six of the ten cases. No patient died, but three were left disabled (modified Rankin Scale 3–5). This case series confirms that stroke associated with sport is very rare. The majority of the victims did not have vascular risk factors. Dissection was the most common cause of sport-associated stroke. Strokes were often disabling.     

Posttraumatic obsessive-compulsive disorder: a case series

This report documents emerging posttraumatic obsessive-compulsive disorder in 13 Israeli military veterans diagnosed with both obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD), for whom the onset of OCD was clearly associated with the trauma. Data presented include four detailed case reports that delineate relations between symptomatology in the two disorders. Clinical and theoretical implications of these data are discussed.     

Post-traumatic stress disorder overcome by eye-movement desensitization: a case report.

Post-traumatic stress disorder is an exceptionally stressful syndrome that has been extremely difficult to treat. The prognosis was recently dramatically improved by the introduction of eye-movement desensitization. This paper reports, in substantial detail, a case that was precipitated by a rape 10 years earlier, describing its manifestations and various unsuccessful attempts to treat it; followed by a detailed exposition of the eventual, completely successful treatment by eye-movement desensitization.     

Late-onset obsessive-compulsive disorder: a case series

Obsessive-compulsive disorder (OCD) is a common and potentially disabling illness with onset usually in the second or third decade of life. Onset after age 50 is relatively rare and may be more likely to have an organic etiology. Out of an OCD patient population of over 1,000, the authors found 5 cases in which symptoms of OCD first developed late in life. Four of the 5 patients had intracerebral lesions in the frontal lobes and caudate nuclei, findings consistent with current theories about the pathogenesis of "idiopathic" OCD.