Progressive multifocal leukoencephalopathy 11 years after liver transplantation: a case report

Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection of the central nervous system caused by JC virus. Only ten cases of PML have been reported so far in liver transplant recipients. We present a case of liver posttransplantation PML with characteristic clinical and brain MRI findings, but with an atypical late onset, developed 11 years after transplantation and after single-drug, long-term (8 years), and low-dose (750 mg twice a day) immunosuppression with mycophenolate mofetil (MMF). This is the latest onset of PML associated to liver transplant reported. The present case should help physicians to be aware of PML after transplantation, even in the long term and even under low doses of immunosuppressants, especially MMF.     

Cognitive impairment in late life schizophrenia: a suitable case for treatment?

The benign side-effect profiles of the atypical antipsychotic drugs have earned them an important niche in old age psychiatry. Evidence for a specific improvement in cognitive function associated with the use of these drugs is inconsistent and the definitive studies are still awaited. If these drugs can improve cognitive function in elderly patients with schizophrenia and schizophrenia-like psychosis, then in terms of patient-years of effective treatment of cognition, this action may be more significant than the treatment of Alzheimer's disease with cholinergic therapies. © 1998 John Wiley & Sons, Ltd.     

Chronotypes in menstrual migraine: a case–control study

Migraine attacks have a seasonal, menstrual and circadian periodicity, suggesting a role of chronobiological mechanisms probably related to a hypothalamic involvement. The aim of the study was to evaluate the chronotypes in patients with menstrual migraine, a migraine sub-type with a cyclical recurrence compared to normal female. Ninety-three patients with ICHD-II diagnosis of pure menstrual migraine and menstrually-related migraine were recruited and compared to 85 age-matched healthy women. The Italian version of Morningness–Eveningness Questionnaire was administered to identify circadian preference of our participants. No differences were found regarding the distribution of chronotypes in patients with menstrual migraine and healthy controls. The study did not confirm the presence of a morning and evening preference among migraineurs as previously reported.

     

Low fetuin-A level in migraine: a case–control study

Migraine is a type of primary headache which is caused by the alterations in trigeminovascular system. Migraine attacks are associated with neurovascular inflammation of the cerebral and extracerebral vessels, but its pathophysiological mechanisms have not still been fully delineated. Also, migraine has been found to be associated with higher risks for various metabolic disorders. Thus, we aimed to investigate the matrix metalloproteinases (MMP), fetuin-A, ghrelin, and omentin levels which have important roles in metabolic disorders and inflammation, and to examine their relationship with migraine subtypes and attack frequency. Forty-nine migraine patients and 30 age- and sex-matched healthy control subjects were enrolled. Migraine diagnosis was confirmed according to the International Classification of Headache Disorders-II diagnostic criteria. Analyses of MMP9,MMP3, ghrelin, omentin, and fetuin-A were performed by the ELISA method. Fetuin-A, MMP-9, and MMP-3 levels were significantly lower in migraine than controls (p < 0.05). There were no significant differences between groups with respect to omentin and ghrelin (p > 0.05). In migraine patients, serum fetuin-A levels were positively correlated with MMP-9 and negatively correlated with MMP-3. MMP-3, MMP-9, fetuin-A, omentin and ghrelin levels did not correlate with age, disease duration, or frequency of migraine headache (p > 0.05). Migraine patients have lower fetuin-A, MMP-3 and MMP-9 levels than healthy individuals. Migraine patients have low fetuin-A levels, which may be related to the pathogenesis of migraine. The importance and impact of our findings on the pathogenesis, characteristics, and treatment of migraine needs to be investigated in further detailed studies.     

A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case–control study of 410 patients with 8 years post-operative follow-up

Pituitary adenomas are currently classified by histological, immunocytochemical and numerous ultrastructural characteristics lacking unequivocal prognostic correlations. We investigated the prognostic value of a new clinicopathological classification with grades based on invasion and proliferation. This retrospective multicentric case–control study comprised 410 patients who had surgery for a pituitary tumour with long-term follow-up. Using pituitary magnetic resonance imaging for diagnosis of cavernous or sphenoid sinus invasion, immunocytochemistry, markers of the cell cycle (Ki-67, mitoses) and p53, tumours were classified according to size (micro, macro and giant), type (PRL, GH, FSH/LH, ACTH and TSH) and grade (grade 1a: non-invasive, 1b: non-invasive and proliferative, 2a: invasive, 2b: invasive and proliferative, and 3: metastatic). The association between patient status at 8-year follow-up and age, sex, and classification was evaluated by two multivariate analyses assessing disease- or recurrence/progression-free status. At 8 years after surgery, 195 patients were disease-free (controls) and 215 patients were not (cases). In 125 of the cases the tumours had recurred or progressed. Analyses of disease-free and recurrence/progression-free status revealed the significant prognostic value (p < 0.001; p < 0.05) of age, tumour type, and grade across all tumour types and for each tumour type. Invasive and proliferative tumours (grade 2b) had a poor prognosis with an increased probability of tumour persistence or progression of 25- or 12-fold, respectively, as compared to non-invasive tumours (grade 1a). This new, easy to use clinicopathological classification of pituitary endocrine tumours has demonstrated its prognostic worth by strongly predicting the probability of post-operative complete remission or tumour progression and so could help clinicians choose the best post-operative therapy.     

Ectopic recurrence of a craniopharyngioma in a 15-year-old girl 9 years after surgery and conventional radiotherapy: case report

This 15-year-old girl was operated due to an ectopic recurrence of a craniopharyngioma along the previous surgical route. She presented with a sellar craniopharyngioma at the age of 4 years and underwent a right subfrontal craniotomy. Two and a half years later she had a local recurrence in the sella that was resected along the same surgical route. Postoperative cranial radiotherapy was administered with 50 Gy divided into 28 fractions. Nine years later, magnetic resonance imaging (MRI) revealed a local recurrence within the sella together with a supraorbital cystic mass. Both tumors were surgically removed. Microscopic examination revealed recurrence of an adamantinous craniopharyngioma at both localisations. Histopathological preparations showed a higher MIB-1 index at the simultaneous recurrences in the sella and in the frontal lobe and also an elevated focal p53 expression, compared to previous operations, suggesting a transformation to a more aggressive tumor. This is the first case report of ectopic recurrence in a child that had received conventional radiotherapy of 50 Gy to the sella. Careful intra-operative procedure is probably crucial for preventing ectopic recurrences. The future will reveal if the transsphenoidal surgical route will put an end to ectopic tumor recurrence in patients with a craniopharyngioma.     

Violent victimisation of psychiatric patients: a Swedish case–control study

Objectives  

To report the rate of violent victimisation of psychiatric patients 1 year before interview and to examine the relative rate in comparison to the general population.     

Gliosarcoma occurring 8 years after treatment for a medulloblastoma

Case report We present a rare case of a gliosarcoma occurring 8 years following treatment for a medulloblastoma. The patient was diagnosed with a medulloblastoma at the age of 13 years. We considered the possibility of a radiation-induced tumour and present evidence supporting this view. The second cerebral tumour was excised and confirmed to be a gliosarcoma. The tumour bed was re-irradiated with three-dimensional conformal radiotherapy (3DCRT). She remained well for 6 months, after which there was clinicoradiological progression.Conclusions During long-term follow-up of patients with medulloblastomas, the possibility of radiation-induced neoplasms must be borne in mind.     

Neurological diseases and risk of suicide attempt: a case–control study

Introduction

Neurological diseases have a profound impact on quality of life. We investigated the risk of suicide attempt in ten neurological diseases.

Methods

Case–control study. Cases were identified from the Danish Poison Information Centre database in the period 2006–2013. The prevalence of ten neurological diagnoses was compared with the prevalence in a randomly sampled age- and gender-matched control group.

Results

We identified 8974 cases of suicidal attempt and 89,740 controls. We found an association between suicide attempt in nine of ten neurological diseases and disease groups, including stroke [odds ratio (OR) 3.1, 95% confidence interval (CI) (2.8–3.6)], Huntington’s disease [OR 8.8, 95% CI (3.2–24.1)], amyotrophic lateral sclerosis [OR 5.0, 95% CI (1.7–14.6)], Parkinson’s disease [OR 2.9, 95% CI (1.8–4.6)], Alzheimer’s disease and other degenerative diseases [OR 4.8, 95% CI (3.1–7.5)], multiple sclerosis [OR 1.5, 95% CI (1.1–2.1)], epilepsy [OR 4.5, 95% CI (4.1–5.0)], hereditary and idiopathic neuropathy [OR 2.2, 95% CI (1.1–4.3)] and myasthenia gravis [OR 4.3, 95% CI (2.0–9.4)].

Conclusion

Nine out of ten chronic neurological diseases were associated with an increased risk of suicide attempt. These data must be considered for clinicians treating this vulnerable group of patients.

     

Risk factors for suicide in rural Italy: a case–control study

Purpose

Increased frequency of suicide in rural areas of Tuscany has been described since the 1970s. A case–control study was conducted in 2014 and 2015. The objective of this study was to identify major individual risk factors related to suicides in six rural districts of Tuscany.

Methods

Cases were identified as all 128 suicides occurred in six rural districts between 2009 and 2013. Controls (three for each case) were matched for age, sex, and general practice. Information was collected from GPs using a structured questionnaire. Univariate and multivariate analyses were carried out to investigate the association between individual risk factors and suicide.

Results

Informants for 91 cases of the 128 identified cases were successfully interviewed (response rate 71.1%). About 40.5–65.9% suicide cases and 11.4–20.0% of controls had some psychiatric pathology, accordingly to different definitions. Univariate conditional regression analysis showed that living in isolated houses (OR 2.48), living alone (OR 2.97), not being married (OR 2.63), low income (OR 2.73), psychiatric pathology (OR 9.70), psychotropic medication (OR 5.58), problems with relatives (OR 14.78), psychiatric family history (OR 5.67), and suicidal ideation (OR 15.61) were all risk factors. Practising religion (OR 0.27) was the only protective factor identified. Multivariate regression identified two independently and significantly associated variables namely, psychiatric pathology (OR 8.87) and living alone (OR 2.30).

Conclusions

Results of this study showed, similarly to recent research, that not all suicide events are the results of psychiatric pathology. Prevention strategies should, therefore, target both socio-economic and clinical risk factors.

     

Cognitive impairment and McArdle disease: Is there a link?

McArdle disease is caused by deficiency of myophosphorylase, the muscle isoform of glycogen phosphorylase. This isoform is also expressed in astrocytes, where it seems to have a key role in neural energy metabolism. Whereas in other glycogen storage diseases cognitive impairment has been rarely reported, it has not been previously observed in McArdle disease. Here we report the case of an Italian 55-year-old woman with McArdle disease and cognitive impairment with bilateral dysfunction of prefrontal and frontal cortex (shown by neuropsychological assessment and fluorodeoxyglucose PET). Further studies are needed to assess the prevalence of central neurological manifestations in this disease.