Brainstem auditory evoked potentials in patients with primary Sjögren’s syndrome without central nervous system involvement

Clinical Rheumatology - Primary Sjögren’s syndrome (pSS) is an autoimmune, multisystem exocrinopathy characterized by dysfunction of the exocrine glands. Central nervous system (CNS)...     

Retinal antigens are recognized by antibodies present in sera of patients with multiple sclerosis

Multiple sclerosis (MS) is frequently accompanied by visual symptoms including those related to retinal disorders. Since they may be a consequence of an autoimmune reaction, we examined whether sera of patients with diagnosed MS and changes in visual-evoked potentials contain antibodies against retinal antigens (retAgs). Immunoblot analysis revealed that MS sera recognized mainly a 46-kD antigen, a 41-kD antigen, retinal arrestin, to a smaller extent also 70-, 56-, 43-, and 36-kD proteins. Patients whose sera showed the highest reactivity with 41- and 46-kD antigens had deficiencies in visual acuity, visual fields, ophthalmoscopy, and electroretinograms. Our observation suggests that antibodies to these retAgs may play a role in the origin of ophthalmologic impairment in MS.     

The possible meaning of fractional anisotropy measurement of the cervical spinal cord in correct diagnosis of amyotrophic lateral sclerosis

Diagnosis of amyotrophic lateral sclerosis (ALS) is based on clinical criteria and electrophysiological tests (electromyography, and transcranial magnetic stimulation). In the search for ALS biomarkers, the role of imaging procedures is currently emphasized, especially modern MR techniques. MR procedures were performed on 15 ALS patients and a sex- and age-matched control group. The MR examinations were performed with a 1.5-T MR unit, and the protocol consisted of sagittal T1-weighed images, sagittal and axial T2-weighed images, and sagittal T2-weighed FAT SAT images followed by an axial diffusion tensor imaging (DTI) sequence of the cervical spinal cord. FA values in individual segments of the cervical spinal cord were decreased in the ALS group in comparison with the control group. After comparing FA values for anterior, posterior, and lateral corticospinal columns, the greatest difference was observed between the C2 and C5 segments. Spinal cord assessment with the use of FA measurements allows for confirmation of the motor pathways lesion in ALS patients. The method, together with clinical criteria, could be helpful in ALS diagnosis, assessment of clinical course, or even the effects of new drugs. The results also confirmed the theory of the generalized character of ALS.     

Sleep Disturbances and Cognitive Impairment in the Course of Type 2 Diabetes-A Possible Link

There is an increasing number of patients worldwide with sleep disturbances and diabetes. Various sleep disorders, including long or short sleep duration and poor sleep quality of numerous causes, may increase the risk of diabetes. Some symptoms of diabetes, such as painful peripheral neuropathy and nocturia, or associated other sleep disorders, such as sleep breathing disorders or sleep movement disorders, may influence sleep quality and quantity. Both sleep disorders and diabetes may lead to cognitive impairment. The risk of development of cognitive impairment in diabetic patients may be related to vascular and non-vascular and other factors, such as hypoglycemia, hyperglycemia, central insulin resistance, amyloid and tau deposits and other causes. Numerous sleep disorders, e.g., sleep apnea, restless legs syndrome, insomnia, and poor sleep quality are most likely are also associated with cognitive impairment. Adequate functioning of the system of clearance of the brain from toxic substances, such as amyloid β, i.e. glymphatic system, is related to undisturbed sleep and prevents cognitive impairment. In the case of coexistence, sleep disturbances and diabetes either independently lead to and/or mutually aggravate cognitive impairment.     

Neural conduction in workers after long-term exposure to mercury vapors]

36 workers exposed to mercury vapour intoxication were examined to estimate the abnormalities in peripheral nervous system. 18 workers showed on physical examination features of polyneuropathy and in this group 15 workers had on emg examination sensory polyneuropathy. Statistical analysis was performed to show correlations between polyneuropathy on emg and age, time of exposure to mercury vapour and urinary mercury level. No such correlations were demonstrated.     

Cortical and spinal evoked potentials in parkinsonism. Part I. Visual potentials evoked with a checkerboard pattern

In 21 patients with parkinsonism and 20 healthy controls visual potentials evoked with checker pattern used as an alternating stimulus were studied. The left and right eye were examined separately recording visual cortical responses in the central occipital area. The analysed elements included the latency of the first highest positive wave P100 and the amplitude of the P100/N120 complex. Prolongation of the mean latency of P100 was found in patients with parkinsonism, but it was not significant statistically. No differences were found of the P100/N120 amplitude in the group with parkinsonism in relation to healthy controls. In the patients with parkinsonian syndrome (mainly of atherosclerotic origin) the mean latency of the visual potentials was longer and the amplitude was lower than in cases of Parkinson's disease. Attention is called to the high variability of the visual evoked potentials related to the clinical state and origin of the disease (parkinsonian syndrome and Parkinson's disease).     

Cortical and spinal evoked potentials in parkinsonism. Part II. Somatosensory potentials evoked form the posterior tibial nerve

In 20 patients with parkinsonism somatosensory evoked potentials were studied. The posterior tibial nerves were stimulated successively at the medial ankle. The averaged responses were recorded at the level of the L2 vertebra, C2 vertebra and in the central parietal area (Cz/Pz). The obtained data were compared with similar values in a control group. The conduction velocity in the sensory fibres of the tibial nerves was normal in both groups. No significant differences were found also between the patients and the controls in the latency of the spinal lumbar and cervical potentials, and the spinal conduction time (L2-C2) was normal. In the patients with parkinsonism the cortical evoked response N35 was significantly prolonged. Differences were noted also in the time of central conduction (C2-cortex) between the patients and the controls, but they were not significant statistically. The effects of disturbed dopamine metabolism on the electro-physiological processes in the peripheral and the central nervous system are discussed.     

Antibodies to 46-kDa retinal antigen in a patient with breast carcinoma and cancer-associated retinopathy

Cancer-associated retinopathy (CAR) is a rare paraneoplastic syndrome usually associated with small-cell lung carcinoma and serum autoantibodies against recoverin. We report the breast cancer woman with visual impairments and electrophysiological abnormalities characteristic of CAR. Her serum contained high-titer antibodies against alpha-enolase but not against other retinal proteins. This suggests that anti-enolase antibodies could be responsible for the development of CAR symptoms.     

Interferon‐free therapy as the cause of white matter tracts and cerebral perfusion recovery in patients with chronic hepatitis C

The purpose of this study was to assess cerebral microstructural and perfusion changes in patients with chronic hepatitis C virus (HCV) infection before and after interferon‐free therapy, using advanced magnetic resonance (MR) techniques. Eleven HCV‐positive patients underwent diffusion tensor imaging (DTI) and perfusion‐weighted imaging (PWI) using a 1.5T MR unit, before and 24 weeks after completion of interferon‐free therapy. DTI fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained from 14 white matter tracts. PWI values of relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) were assessed from 8 areas, including basal ganglia, and cortical and white matter locations. In HCV‐positive patients therapy with ombitasvir, paritaprevir boosted with ritonavir and dasabuvir, with or without ribavirin, was scheduled. Cognitive tests were used to assess cognitive function. We found increased FA values after interferon‐free therapy compared to values obtained before treatment in HCV patients in almost all white matter tracts. We also observed elevated rCBV values in basal ganglia after therapy. There were significant correlations between improvement in the score of cognitive tests and increased FA values in both inferior fronto‐occipital fascicles and left posterior cingulum after treatment. Liver fibrosis regression in elastography, APRI and improvement in cognitive tests were observed. This is the first report of interferon‐free therapy as the cause of white matter tracts recovery as well as cerebral perfusion improvement in HCV‐infected patients, indicating better functioning of frontal lobes after interferon‐free treatment.     

The metabolic alterations within the normal appearing brain in patients with Hashimoto’s thyroiditis are correlated with hormonal changes

Hashimoto’s thyroiditis (HT) is the most common autoimmune disease in humans usually associated with subsequent hypothyroidism. The purpose of the study was to assess metabolic alterations within the normal appearing brain in subjects with HT using MR spectroscopy (MRS) and to correlate MRS measurements with hormonal concentrations. Fifty-five HT patients (mean age 43.5 yrs) and 30 healthy controls (mean age 42.5 yrs) were examined with the use of a 1.5 T MR scanner. There were no signs of central nervous system involvement in the studied group. The MRS examinations were performed using the single voxel method. The voxels were placed in the left parietal white matter (PWM) and the posterior cingulate gyrus (PCG). The NAA/Cr, Cho/Cr, and mI/Cr ratios were calculated. The correlations between metabolite ratios and hormonal concentrations (TSH, fT3, fT4) as well as anti-TG and anti-TPO levels were also assessed. We found significantly (p?<?0.05) decreased NAA/Cr ratios in PCG and PWM in HT subjects compared to the control group. There were no other significant differences in metabolite ratios. We observed significant positive correlations between the NAA/Cr ratio in PCG as well as the PWM and fT3 level. There was also a significant negative correlation between the Cho/Cr ratio in the PCG and fT4 level. MRS could be a sensitive biomarker capable of depicting early cerebral metabolic disturbances associated with HT. Our findings may indicate the reduction of neuronal activity within the normal appearing brain in patients with HT as well as suggesting that there is a possible biological association between thyroid dysfunction and cerebral metabolic changes.