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Neurology.
Lippincott Williams & Wilkins
Neurology.

Lippincott Williams & Wilkins

0028-3878

Neurology./Journal Neurology.
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    Can the Development of Mood and Anxiety Disorders During Pregnancy and the Postpartum Period Be Anticipated in Women With Epilepsy?

    Andres M. Kanner
    2页
    查看更多>>摘要：Depression and anxiety disorders are the 2 most frequent psychiatric comorbidities in epilepsy. Higher prevalence rates of symptoms of depression and anxiety have also been reported more frequently during pregnancy and the postpartum period in pregnant women with epilepsy (PWWE) than pregnant nonepileptic women. Using data from the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs study, and applying a robust methodology, Meador et al. compared the type and prevalence of mood and anxiety disorders during pregnancy and the postpartum periods among PWWE, nonpregnant WWE, and healthy pregnant women and the epilepsy and psychiatric variables associated with their occurrence, and they report their findings in this issue of Neurology?. They are the first investigators to demonstrate a pleomorphic manifestation of mood disorders in this setting: in some women, mood disorders present as a major depressive episode (MDE), in others, as subsyndromic depressive episodes. 4Although the prevalence of MDE did not differ among pregnant and nonpregnant WWE and healthy pregnant women, subsyndromic depressive episodes were identified more frequently among PWWE during pregnancy and the postpartum period.
      原文链接:
    • NSTL
    • Lippincott Williams & Wilkins

    Geography and Time CONCEPTION in Pregnancy-Associated Stroke

    Thanh G. PhanCheryl D. BushnellHenry Ma
    2页
    查看更多>>摘要：Given the differences in the pattern of stroke in women, recent effort devoted to the acute management and prevention of stroke in women, 1may lead to the development of targeted prevention strategies. While young women have a low risk of stroke, it is higher than that for men of the same age. The risk in women escalates after the age of 65 years. Overall, women have a higher lifetime risk of stroke, likely explained by their longer lifespan. Strokes in pregnancy are fortunately rare, but given that maternal death from stroke occurred in 7.7% of cases, any studies aiming to identify prevention strategies or acute treatment leading to reduce this mortality are needed. At present, reperfusion (thrombolysis and thrombectomy) trials have excluded pregnant patients, and as such clinicians often do not offer these therapies to them. Recent observational studies have shown that reperfusion therapy is relatively safe in pregnant patients. Pregnant women have the same benefit from reperfusion therapy as non-pregnant women and men. In this issue of Neurology?, Martin et al. publish a prospective population-based study of pregnancy-associated stroke conducted over a 9-year period. The CONCEPTION study enrolled women with no history of stroke before pregnancy from France and other French overseas territories. These regions are linked by the French National Health Insurance Information System database, which contains data from all public and private hospital admissions. Unlike administrative database studies which rely on International Classification of Diseases, Ninth or Tenth Revision coding alone, the authors had access to the discharge summaries to verify the stroke diagnoses. The prevalence of stroke among more than million pregnant women was 0.02%.
      原文链接:
    • NSTL
    • Lippincott Williams & Wilkins

    Preventing Neurodegeneration in Multiple Sclerosis Is Required From the Earliest Stages of the Disease

    Pablo VillosladaSara Llufriu
    2页
    查看更多>>摘要：The traditional clinical understanding of multiple sclerosis (MS) is that the early phase is dominated by acute inflammation leading to clinical relapses or new lesions visible on brain MRI (relapsing MS [RMS]). By contrast, the later stage is dominated by chronic compartmentalized inflammation and neurodegeneration (progressive MS [PMS]). Such a model has important therapeutic implications because it implies that relapse prevention is the main goal during the RMS phase. By contrast, the PMS stage will require new therapies targeting trapped inflammation, neuroprotection, or regeneration. However, this model has been challenged by the realization that MS is progressive from the onset in most cases, as revealed in patients with RMS showing progression independent of relapses (PIRAs). In addition, recent studies have shown that most brain and retinal atrophy happen in the first years of the disease, during the RMS phase. Thus, brain volume loss seems to follow a nonlinear trajectory, and certain areas, particularly in the deep gray matter and cortical areas, have a larger vulnerability to earlier volume loss. On-going inflammatory activity has been linked to accelerated concomitant atrophy rates in several clinical trials. Patients with radiologic activity or relapses have larger volume loss than stable patients, equivalent to those with PIRA. 6Indeed, the relationship between inflammatory activity and changes in the brain and retinal volume is stronger early in the disease but seems similar in active and stable patients later on. Still, neurodegeneration in the later stage (PMS) is smaller in magnitude although more visible clinically, ' ' when compensation mechanisms become exhausted. These new insights about the evolution of MS have significant implications for defining the best therapeutic strategy for people with MS.
      原文链接:
    • NSTL
    • Lippincott Williams & Wilkins

    Neuroimaging Biomarkers in a Patient With Probable Psychiatric-Onset Prodromal Dementia With Lewy Bodies

    Daniele UrsoValentina GnoniRoberto De BlasiAntonio Anastasia...
    4页
    查看更多>>摘要：Objectives Psychiatric-onset prodromal dementia with Lewy bodies (DLBs) is a recently proposed clinical entity characterized by psychiatric presentation that may predate clinical dementia by many years. It is not yet clear how to identify patients with prominent late-onset psychiatric symptoms who may have underlying Lewy body disease. In this article, we describe how neuroimaging can assist in the identification of this condition. Methods A 77-year-old man presented with late-onset psychosis. He underwent an extensive clinical and neuropsychological evaluation. These included brain MRI with arterial spin labeling (ASL) which quantifies perfusion. [~123I] FP-CIT SPECT and I-metaiodobenzylguanidine scintigraphy assessed striatal dopaminergic and cardiac adrenergic integrity, respectively. Results Clinical evaluation revealed a history of REM sleep behavior disorder and parkinsonism induced by antipsychotics. The patient's cognitive function was normal. Conventional MRI showed parieto-occipital atrophy, and posterior hypoperfusion was revealed by ASL-MRI. Of note, the "cingulate island sign" was present. [~123I]FP-CIT SPECT and I-metaiodobenzylguanidine endorsed the suspicion of α-synucleinopathy. The patient fulfils the recently proposed key features of psychiatric-onset prodromal DLB. Discussion Prodromal DLB is an emerging concept. Biomarkers have not been yet established. We propose that nuclear imaging and advanced MRI technics showing posterior hypoperfusion and the presence of the "cingulate island sign" could be promising biomarker candidates.
      原文链接:
    • NSTL
    • Lippincott Williams & Wilkins

    Pregnancy Fete Huntington's Pantoum

    Lealani Mae Y. Acosta
    2页
    查看更多>>摘要：A mother's excitement about welcoming a new child into the world is tempered by the fear that her Huntington disease genes will be passed on to the baby. Pregnancy fete: anticipation, Excitement, planning Counting the numbers Ten fingers, ten toes Excitement, planning Pink sheets, blue ties? Ten fingers, ten toes First movements: rolling, kicking Pink cheeks, blue eyes? Watching you grow First movements: rolling, kicking Flickering ultrasound pictures Watching you grow I cannot wait to hold you Flickering ultrasound pictures of your shape I cannot wait to hold you As parents, we wonder how we'll be You're shaped, your chromosomes from ours As parents, we wonder how will be each pair of your genes your chromosomes from ours I have Huntington's disease.
      原文链接:
    • NSTL
    • Lippincott Williams & Wilkins

    Child Neurology: Familial Hemophagocytic Lymphohistiocytosis Underlying Isolated CNS Inflammation

    Giorgia BucciolNele WillemynsBenjamin VerhaarenXavier Bossuyt...
    5页
    查看更多>>摘要：Encephalitis and encephalopathy in children represent a diagnostic challenge. We describe a patient with relapsing encephalitis in whom the differential diagnosis included acute disseminated encephalomyelitis, human herpesvirus 6 encephalitis, and hemophagocytic lymphohistiocytosis (HLH). Because of its rarity, HLH is often overlooked as a differential diagnosis in encephalitis, especially in the isolated CNS forms. As this case illustrates, inborn errors of immunity can underlie isolated encephalitis and should be included in the differential diagnosis of these presentations. Background Pediatric neuroinflammatory diseases represent a heterogeneous group of immune-mediated conditions affecting the CNS, including demyelinating diseases, autoimmune encephalopa-thies, autoinflammatory conditions, and neurodegenerative diseases. Among these falls acute disseminated encephalomyelitis (ADEM), an inflammatory, demyelinating condition usually affecting children and young adults days to weeks after an acute infection or vaccination. It is characterized by multifocal or diffuse gray and white matter damage and increased intensity lesions on T2/fluid-attenuated inversion recovery (FLAIR) MRI sequences. The hypothesized pathogenesis is immune-mediated white matter damage triggered by an acute infection, followed by a secondary autoimmune response, with lymphocyte and macrophage infiltration of perivascular regions. Viral encephalitis is one differential diagnosis in children presenting with symptoms compatible with ADEM. Human herpesvirus 6 (HHV-6) is a common cause of febrile seizures in children and can cause infectious encephalitis, more often in immunocom-promised patients. 3CNS manifestation of HHV-6 may or may not present with abnormal findings on MRI, and the imaging pattern is related to the immune status of the patient. Typical findings in the immunocompromised patient include hyperintense signal on the T2- and FLAIR-weighted sequences in the mesiotemporal regions, with or without diffusion restriction, and usually without enhancement. Nonimmunocompromised patients may present with a pattern of widespread T2 hyperintensities and areas of subcortical diffusion restriction. Of interest, HHV-6 infection has been described in association with ADEM and other forms of autoimmune encephalitis. CNS inflammation is also a common feature of hemophagocytic lymphohistiocytosis (HLH), a life-threatening systemic inflammatory disease due to a genetic (primary HLH) or acquired cause (secondary HLH), characterized by lymphocyte and macrophage activation and multiorgan infiltration. We here describe the diagnostic process and clinical course of a child with HLH presenting with 2 episodes of encephalitis and HHV-6 infection to highlight the importance of searching for underlying inborn errors of immunity (IEIs) in children presenting with various forms of encephalitis.
      原文链接:
    • NSTL
    • Lippincott Williams & Wilkins

    Pearls & Oy-sters: Postdural Puncture Headache, Cerebral Sinus Venous Thrombosis, and Reversible Cerebral Vasoconstriction Syndrome in the Peripartum Period

    Helene FenterPhilippe MaederPatrik MichelDavide Strambo...
    4页
    查看更多>>摘要：We report the case of a 34-year-old female patient complaining of headaches 1 day after childbirth, initially interpreted as postdural puncture headache (PDPH) and treated successfully with an epidural blood patch. Five days later, she presented with an acute proportional right sensorimotor hemisyndrome and a new-onset left-sided headache, attributed to a venous stroke from left-sided cerebral sinus venous thrombosis (CSVT). Simultaneously, we found radiologic signs of reversible cerebral vasoconstriction syndrome (RCVS), considered asymptomatic. We administered anticoagulant therapy to the patient, and she showed full motor recovery at 3-month clinical follow-up. PDPH, CSVT, and RCVS are well-known neurologic complications during the peripartum period. All 3 conditions present with headaches, and headache features may overlap, masking co-occurrence and making accurate diagnosis (differentiation) of these diseases difficult. Each disease can potentially lead to disabling deficits, but all respond to specific treatment. Knowledge of the causes of headaches in the peripartum period, their specific clinical characteristics, and potential complications helps to prioritize and interpret diagnostic tests to offer appropriate therapy.
      原文链接:
    • NSTL
    • Lippincott Williams & Wilkins

    Teaching NeuroImage: Horizontal Diplopia Due to Extraocular Muscle Metastasis

    Merve AtikDavid Nathan AbarbanelUgur Sener
    2页
    查看更多>>摘要：An 80-year-old woman with previously resected melanoma of the right thigh presented with acute binocular diplopia. Neurologic examination demonstrated inability to abduct the left eye with normal right eye adduction. Examination was otherwise normal. This presentation of left lateral rectus palsy can occur due to ischemic, inflammatory, autoimmune, compressive, or neoplastic etiologies. MRI orbits identified an enhancing left lateral rectus lesion consistent with extraocular muscle metastasis. MRI of the brain revealed multiple subcentimeter-enhancing lesions (Figure). Subsequent lymph node biopsy confirmed metastatic melanoma. Despite radiotherapy and BFRAF-targeted systemic therapy, rapid progression occurred, and the patient died 5 months after initial evaluation.
      原文链接:
    • NSTL
    • Lippincott Williams & Wilkins

    Teaching Video NeuroImage: Disabling Jaw Clonus in a Patient With Bulbar-Onset Amyotrophic Lateral Sclerosis Successfully Treated With Botulinum Toxin

    Miguel Oliveira SantosMiguel SchonAnabela ValadasMamede de Carvalho...
    1页
    查看更多>>摘要：Jaw clonus is a rare neurologic finding associated with supranuclear lesions of the trigeminal nerve. It is rare in amyotrophic lateral sclerosis (ALS). We describe a 63-year-old patient with ALS who presented with a disabling and sustained jaw clonus, reduced by mouth resting and elicited by mouth opening (Video 1). Association of baclofen (25 mg/3id), tizanidine (2 mg/id), and benzodiazepine treatments were ineffective. Onabotulinum toxin A injections were administered into the temporal (13 units) and masseter (25 units) muscles bilaterally. She experienced a complete relief of her symptom up to 4-5 months, with no side effects (Video 1). She confirmed improvement in quality of life.
      原文链接:
    • NSTL
    • Lippincott Williams & Wilkins

    Reader Response: Stroke Among SARS-CoV-2 Vaccine Recipients in Mexico: A Nationwide Descriptive Study

    Carol A. Taccetta
    1页
    查看更多>>摘要：This article presents a study of stroke occurrence among COVID-19 vaccine recipients in Mexico. It should be noted that a passive epidemiologic surveillance system cannot detect the incidence rate; therefore, a conclusion that "stroke remains an exceedingly rare event" is not justified. Multiple studies have demonstrated extreme underreporting in passive systems. In addition, by looking only at adverse events following immunization occurring within 30 days, one will miss many reports of strokes. Even vaccine-induced thrombotic thrombocytopenia is defined as occurring up to 42 days postvaccination.
      原文链接:
    • NSTL