Ivan Dimitrov, N. Deleva, B. Ivanov, Anelia D. Klissarova
Low education is commonly regarded as a risk factor for dementia, its role being confirmed in numerous studies. Some investigators, however, have reported only partial association between education and dementia, or no association at all. No studies on this topic have been performed in Bulgaria. The aim of our study was to assess whether prevalence of dementia varies among subgroups of Bulgarian citizens with different education degrees. Questions on the level of education, according to the national educational standards, were included in the screening interview of the first two-phase prevalence study of cognitive disturbances in the town of Varna, Bulgaria. We assessed the relationship between education and dementia, diagnosed according to DSM-IV criteria, as well as between education and neuropsychological test performance. While education affected MMSE scores, no statistically significant relationship with the diagnosis was found. Our results do not conform to the common conception stating that dementia prevalence is inversely related to the level of education. A larger study with a more uniform distribution of subjects according to education may be required in order to confirm these findings.
{"title":"Education Level Does Not Affect Prevalence of Dementia in a Bulgarian Population","authors":"Ivan Dimitrov, N. Deleva, B. Ivanov, Anelia D. Klissarova","doi":"10.5580/1895","DOIUrl":"https://doi.org/10.5580/1895","url":null,"abstract":"Low education is commonly regarded as a risk factor for dementia, its role being confirmed in numerous studies. Some investigators, however, have reported only partial association between education and dementia, or no association at all. No studies on this topic have been performed in Bulgaria. The aim of our study was to assess whether prevalence of dementia varies among subgroups of Bulgarian citizens with different education degrees. Questions on the level of education, according to the national educational standards, were included in the screening interview of the first two-phase prevalence study of cognitive disturbances in the town of Varna, Bulgaria. We assessed the relationship between education and dementia, diagnosed according to DSM-IV criteria, as well as between education and neuropsychological test performance. While education affected MMSE scores, no statistically significant relationship with the diagnosis was found. Our results do not conform to the common conception stating that dementia prevalence is inversely related to the level of education. A larger study with a more uniform distribution of subjects according to education may be required in order to confirm these findings.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132912253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Survival with good neurological recovery following cardiac arrest is poor. A number of recent studies have concluded that the use of induced hypothermia can improve survival and limit the level of neurological impairment following cardiac arrest. Objective: To audit survival and neurological recovery outcomes in patients treated with induced hypothermia within the Intensive Care Unit (ICU) following cardiac arrest.Design: A two year retrospective study.Method: Data from patient notes were extracted and analysed.Conclusion: The survival rate for patients presenting with a cardiac arrest and an initial rhythm of ventricular fibrillation (VF) is 62%, with 58% of patients surviving with good neurological recovery. Of those who were treated conservatively following a cardiac arrest with an initial rhythm of VF, 20% survived with good neurological recovery.
{"title":"Induced Hypothermia Following Cardiac Arrest And Subsequent Neurological Outcomes: An Audit","authors":"M. Sage, J. Wales, J. Cooper, I. White","doi":"10.5580/edb","DOIUrl":"https://doi.org/10.5580/edb","url":null,"abstract":"Background: Survival with good neurological recovery following cardiac arrest is poor. A number of recent studies have concluded that the use of induced hypothermia can improve survival and limit the level of neurological impairment following cardiac arrest. Objective: To audit survival and neurological recovery outcomes in patients treated with induced hypothermia within the Intensive Care Unit (ICU) following cardiac arrest.Design: A two year retrospective study.Method: Data from patient notes were extracted and analysed.Conclusion: The survival rate for patients presenting with a cardiac arrest and an initial rhythm of ventricular fibrillation (VF) is 62%, with 58% of patients surviving with good neurological recovery. Of those who were treated conservatively following a cardiac arrest with an initial rhythm of VF, 20% survived with good neurological recovery.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125544956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Kumar, S. Srivastava, Keshore, K. Chengappa, A. Sinha, R. Kant
Progressive neurodegenerative diseases like Huntington’s, Alzheimer’s disease, Down’s syndrome, Tay Sachs disease, spino cerebellar ataxia 2,kennedy disease, Dentatorubral – pallidoluysian atrophy and ALS have been gradually realized to be evolved from the common cellular and physiological pathways. The aim was to identify possible biases in the amino acid repeat patterns with respect to the repeats in other sequences responsible for neurodegenerative disorders, as this could be informative for specific constraints operating in the repetitive structures. Previous studies suggest the misfolding of the amyloid proteins as one of the most prominent causes. Our study reveals the critical role of proline and glycine conservation with Alanine, glycine, proline residue repeat polymorphism levels. Proline toxicities have been found involved in cardiac muscle disorder, neuro transmitter disorder, congestive heart failure and major depression found in most of the degenerative diseases worked on. We inspected the relative position 58 where proline conservation was seen in spino cerebellar ataxia 2 and Huntington giving rise to the common symptoms of the disease. Our study also suggests that Q repeats mostly fall in helical regions indicating responsible Proteins to be the surface proteins which cause different severe symptoms and effects. INTRODUCTION Neurological and psychiatric disorders taken together account for more chronic suffering than all other disorders combined.The sunset has been a prolonged one, as is usual in most neurodegenerative disorders, of which Huntington’s and Alzheimer's are the prototype. All have an insidious onset, progress slowly over years, and death is usually due to an intercurrent illness and not directly due to the disease itself. The diseases will rise with increasing longevity. Much of the burden is also borne by carriers and relatives. Brain parenchyma is supposed to be the layer in brain where the illicit protein deposits take place and give rise to different neurodegenerative disorders. Previous studies reveal the role of proteins like amyloid which are rich in beta sheets to be involved in the toxicity and lethality of the progression of the disease. Our study suggests role of the alpha helical residues in toxicity and lethality of the diseases which are also supported with the conservation of proline and glycine residues. Previous animal trials by beta sheet breaker residues may have failed because of the of proline conservation in the neurodegenerative studies. As per our study on proline repeats a suitable therapy for the treatment of the neurodegenerative disorders may be obtained. Prolinerich domain, along with a charged domain, is critical for PQE-1 protein function. Analysis of pqe-1 suggests that proteins exist that specifically protect neurons from the toxic effects of expanded polyQ disease proteins. Proline derivatives have affinity for the calcium channel alpha -2 delta subunit which is useful in the treatme
亨廷顿氏病、阿尔茨海默病、唐氏综合征、Tay Sachs病、脊髓小脑共济失调2、肯尼迪病、齿状脑-苍白球萎缩症、ALS等进行性神经退行性疾病逐渐被认识到是从共同的细胞和生理途径进化而来的。目的是确定氨基酸重复模式中可能存在的偏差，相对于负责神经退行性疾病的其他序列中的重复，因为这可能为重复结构中操作的特定限制提供信息。先前的研究表明淀粉样蛋白的错误折叠是最突出的原因之一。我们的研究揭示了脯氨酸和甘氨酸的保存与丙氨酸、甘氨酸、脯氨酸残基重复多态性水平的关系。脯氨酸毒性已被发现与心肌障碍、神经递质障碍、充血性心力衰竭和重度抑郁症有关，这些都是在大多数退行性疾病中发现的。我们检查了脯氨酸保存在脊髓小脑性共济失调2和亨廷顿引起疾病常见症状的相对位置58。我们的研究还表明，Q重复序列主要落在螺旋区域，这表明引起不同严重症状和影响的表面蛋白是负责蛋白。神经和精神疾病加在一起造成的慢性痛苦比所有其他疾病加起来还要多。像大多数神经退行性疾病一样，日落是一个漫长的过程，亨廷顿舞蹈症和阿尔茨海默氏症是这种疾病的原型。所有这些疾病的发病都是潜伏的，进展缓慢，而且死亡通常是由于疾病的并发性，而不是直接由于疾病本身。随着寿命的延长，这些疾病也会增多。大部分负担也由承运者和亲属承担。脑实质被认为是大脑中非法蛋白质沉积的地方，并引起不同的神经退行性疾病。先前的研究揭示了淀粉样蛋白等蛋白质的作用，它们富含β片，参与了疾病进展的毒性和致命性。我们的研究表明，α螺旋残基在疾病的毒性和致死率中起作用，这也与脯氨酸和甘氨酸残基的保存有关。由于脯氨酸在神经退行性研究中的保护作用，先前的动物试验可能会失败。根据我们对脯氨酸重复序列的研究，可能获得一种治疗神经退行性疾病的合适疗法。脯氨酸丰富结构域和带电结构域对PQE-1蛋白的功能至关重要。对pq -1的分析表明，存在特异性保护神经元免受扩展型多q疾病蛋白毒性作用的蛋白。脯氨酸衍生物对钙通道α -2 δ亚基具有亲和力，可用于治疗癫痫、专长、运动障碍、颅脑疾病、神经退行性疾病、抑郁、焦虑、恐慌、疼痛、纤维肌痛、关节炎、神经病理障碍、睡眠障碍、内脏疼痛障碍和胃肠道疾病。甘氨酸和脯氨酸残基经常出现在蛋白质的依次和环状结构中，被认为在折叠早期的链压实过程中起重要作用。在我们的研究中得到的蛋白质具有良好的脯氨酸重复组成和保守性，可以用于治疗方面。本研究中计算的蛋白质的计算机分析得出结论，与一些蛋白质相关，如titin, synapsin，利钠肽，β酪蛋白，导致不同的致命疾病，如心肌障碍，神经递质障碍，充血性心力衰竭，帕金森病，重度抑郁症等。脯氨酸和甘氨酸重复序列在神经退行性疾病中的关键作用2 / 4脯氨酸(P)和甘氨酸(G)残基的保守-我们发现脯氨酸和甘氨酸残基在所有神经退行性疾病模型中都是保守的。为了进行分析，我们使用了CLUSTAL W Boxshade(图1)和texshade(图2)，这给了我们脯氨酸和甘氨酸的保存模式。图1(绿色表示完全保存)
{"title":"Critical Role Of Proline And Glycine Conservation With Repeats In Neurodegenerative Disorders","authors":"A. Kumar, S. Srivastava, Keshore, K. Chengappa, A. Sinha, R. Kant","doi":"10.5580/3bd","DOIUrl":"https://doi.org/10.5580/3bd","url":null,"abstract":"Progressive neurodegenerative diseases like Huntington’s, Alzheimer’s disease, Down’s syndrome, Tay Sachs disease, spino cerebellar ataxia 2,kennedy disease, Dentatorubral – pallidoluysian atrophy and ALS have been gradually realized to be evolved from the common cellular and physiological pathways. The aim was to identify possible biases in the amino acid repeat patterns with respect to the repeats in other sequences responsible for neurodegenerative disorders, as this could be informative for specific constraints operating in the repetitive structures. Previous studies suggest the misfolding of the amyloid proteins as one of the most prominent causes. Our study reveals the critical role of proline and glycine conservation with Alanine, glycine, proline residue repeat polymorphism levels. Proline toxicities have been found involved in cardiac muscle disorder, neuro transmitter disorder, congestive heart failure and major depression found in most of the degenerative diseases worked on. We inspected the relative position 58 where proline conservation was seen in spino cerebellar ataxia 2 and Huntington giving rise to the common symptoms of the disease. Our study also suggests that Q repeats mostly fall in helical regions indicating responsible Proteins to be the surface proteins which cause different severe symptoms and effects. INTRODUCTION Neurological and psychiatric disorders taken together account for more chronic suffering than all other disorders combined.The sunset has been a prolonged one, as is usual in most neurodegenerative disorders, of which Huntington’s and Alzheimer's are the prototype. All have an insidious onset, progress slowly over years, and death is usually due to an intercurrent illness and not directly due to the disease itself. The diseases will rise with increasing longevity. Much of the burden is also borne by carriers and relatives. Brain parenchyma is supposed to be the layer in brain where the illicit protein deposits take place and give rise to different neurodegenerative disorders. Previous studies reveal the role of proteins like amyloid which are rich in beta sheets to be involved in the toxicity and lethality of the progression of the disease. Our study suggests role of the alpha helical residues in toxicity and lethality of the diseases which are also supported with the conservation of proline and glycine residues. Previous animal trials by beta sheet breaker residues may have failed because of the of proline conservation in the neurodegenerative studies. As per our study on proline repeats a suitable therapy for the treatment of the neurodegenerative disorders may be obtained. Prolinerich domain, along with a charged domain, is critical for PQE-1 protein function. Analysis of pqe-1 suggests that proteins exist that specifically protect neurons from the toxic effects of expanded polyQ disease proteins. Proline derivatives have affinity for the calcium channel alpha -2 delta subunit which is useful in the treatme","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116675809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The role of total and LDL-cholesterol as independent risk factors of ischemic stroke remains uncertain. The aim of this hospital based prospective observational study is to investigate the association between total and LDL cholesterol levels and ischaemic stroke in Emirates patients admitted to hospital between June 2007 and June 2009 with atherothrombotic stroke. One hundred and seventy one Emirati patients, 89 males and 82 females with acute ischemic stroke were diagnosed and investigated for risk factors, including hypertension, diabetes mellitus, cardiac diseases, cigarettes smoking and past history of transient ischemic attack (TIA) and past history of stroke. Exclusion criteria were patients with acute or chronic atrial fibrillation and patients receiving "statins". Brain CT scan, echocardiogram and carotid ultrasound were done on hospital admission. One hundred and twelve patients (65.5%) had hypercholesterolemia (total cholesterol level ≥ 5.2 mmole/L, LDL cholesterol ≥ 4.2 mmole/L). One hundred and thirty patients (76.0%) were hypertensive. Ninety patients (52.8%) were diabetic. Twenty two (12.9%) were heavy smokers. Fifty patients (29.2%) had past history of cardiac disease. Twenty eight patients (16.4%) had previous stroke Twelve patients (12%) had TIA. Out of the one hundred and twelve patients with hypercholesterolemia nine patients (5%) only had isolated hypercholesterolemia. The commonest risk factor associated with hypercholesterolemia is hypertension (78.8%). In conclusion, the results of this study do not support the association between isolated hypercholesterolemia and atherothrombotic stroke. Hypercholesterolemia is not an independent risk factor for ischaemic stroke but it can interact with other risk factors mainly hypertension to promote atherosclerosis.
{"title":"Total and LDL cholesterol as risk factors of ischemic stroke in Emirati patients","authors":"Z. Mirghani, T. Zein","doi":"10.5580/fa8","DOIUrl":"https://doi.org/10.5580/fa8","url":null,"abstract":"The role of total and LDL-cholesterol as independent risk factors of ischemic stroke remains uncertain. The aim of this hospital based prospective observational study is to investigate the association between total and LDL cholesterol levels and ischaemic stroke in Emirates patients admitted to hospital between June 2007 and June 2009 with atherothrombotic stroke. One hundred and seventy one Emirati patients, 89 males and 82 females with acute ischemic stroke were diagnosed and investigated for risk factors, including hypertension, diabetes mellitus, cardiac diseases, cigarettes smoking and past history of transient ischemic attack (TIA) and past history of stroke. Exclusion criteria were patients with acute or chronic atrial fibrillation and patients receiving \"statins\". Brain CT scan, echocardiogram and carotid ultrasound were done on hospital admission. One hundred and twelve patients (65.5%) had hypercholesterolemia (total cholesterol level ≥ 5.2 mmole/L, LDL cholesterol ≥ 4.2 mmole/L). One hundred and thirty patients (76.0%) were hypertensive. Ninety patients (52.8%) were diabetic. Twenty two (12.9%) were heavy smokers. Fifty patients (29.2%) had past history of cardiac disease. Twenty eight patients (16.4%) had previous stroke Twelve patients (12%) had TIA. Out of the one hundred and twelve patients with hypercholesterolemia nine patients (5%) only had isolated hypercholesterolemia. The commonest risk factor associated with hypercholesterolemia is hypertension (78.8%). In conclusion, the results of this study do not support the association between isolated hypercholesterolemia and atherothrombotic stroke. Hypercholesterolemia is not an independent risk factor for ischaemic stroke but it can interact with other risk factors mainly hypertension to promote atherosclerosis.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128367708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vertebral artery dissection is an important cause of brain stem stroke, especially in the young. Dissections of carotid and vertebral arteries in neck account for about 20% of strokes in young compared with 2.5% in the elderly. One patient of vertebral artery dissection after one class of chiropractor exercise is described in this case report. She didn’t have a direct severe neck trauma or concomitant risk factor like hypertension, connective tissue disease or migraine. Clinical symptomatology included occipito-nuchal pain, headache and brain stem dysfunction chiefly in the posterior inferior cerebellar artery (PICA) territory. MRA confirmed dissection with a predominant steno-occlusive picture. Cases of so called trivial neck movement/torsion related dissection have been described previously but have not received any major importance. Usually classified as 'spontaneous' or 'traumatic', there is a possible ambiguity in literature about appropriate terminology. We emphasize that a history of such subtle precipitating events be taken while diagnosing young patients with brain stem strokes, to recognize this clinical entity. Although mechanisms are not absolutely clear, yet there seems to be an important relationship between arterial dissection and neck movements or minor trauma.
{"title":"Vertebral Artery Dissection after Chiropractor Exercise: A Case Report","authors":"F. Aziz, S. Doddi, Chalapathy Narisety","doi":"10.5580/1bc3","DOIUrl":"https://doi.org/10.5580/1bc3","url":null,"abstract":"Vertebral artery dissection is an important cause of brain stem stroke, especially in the young. Dissections of carotid and vertebral arteries in neck account for about 20% of strokes in young compared with 2.5% in the elderly. One patient of vertebral artery dissection after one class of chiropractor exercise is described in this case report. She didn’t have a direct severe neck trauma or concomitant risk factor like hypertension, connective tissue disease or migraine. Clinical symptomatology included occipito-nuchal pain, headache and brain stem dysfunction chiefly in the posterior inferior cerebellar artery (PICA) territory. MRA confirmed dissection with a predominant steno-occlusive picture. Cases of so called trivial neck movement/torsion related dissection have been described previously but have not received any major importance. Usually classified as 'spontaneous' or 'traumatic', there is a possible ambiguity in literature about appropriate terminology. We emphasize that a history of such subtle precipitating events be taken while diagnosing young patients with brain stem strokes, to recognize this clinical entity. Although mechanisms are not absolutely clear, yet there seems to be an important relationship between arterial dissection and neck movements or minor trauma.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130546432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It is widely accepted that brain death (BD) is a clinical diagnosis, although ancillary tests are recommended when specific components of the clinical testing cannot reliably be evaluated. The therapeutic use of barbiturates in patients with severe intracranial hypertension or other forms of drug intoxication, hypothermia, and other metabolic disturbances, can prevent determination of BD by clinical criteria. We present a review here about the use of ancillary tests in BD confirmation. Confirmatory tests in BD can be divided in those proving absent cerebral blood flow (CBF) and those that demonstrate loss of bioelectrical activity. We recommend assessing circulatory arrest by transcranial Doppler (TCD), and neuronal function by a neurophysiologic test battery. If TCD fails to validate the absence of CBF, computer tomography angiography can be used to confirm BD diagnosis. It is widely accepted that brain death (BD) is a clinical diagnosis, and it is currently defined as a complete and irreversible loss of brain function. Confirmatory laboratory tests are recommended when specific components of the clinical testing cannot reliably be evaluated 1-3 In certain European, Central and South American, and Asian countries, law requires confirmatory tests. The diagnosis of BD in children and neonates is more complicated and ancillary tests are usually advocated. 6-12 According to Wijdicks, “a confirmatory test is needed for patients in whom specific components of clinical testing cannot be reliably evaluated.” An ideal confirmatory study for BD should be safe, extremely accurate and reliable, available, quick and inexpensive. Heran et al. also affirmed that an ideal confirmatory study for BD should be “readily available, rapid, safe, portable, non-invasive, inexpensive, independently sufficient to establish brain death, not susceptible to external/internal confounding factors”. The therapeutic use of barbiturates in patients with severe intracranial hypertension or other forms of drug intoxication, hypothermia, and other metabolic disturbances, can prevent determination of BD by clinical criteria. Confirmatory tests in BD can be divided in those proving absent cerebral blood flow (CBF) and those that demonstrate loss of bioelectrical activity. In fact, confirmatory tests that are widely accepted are conventional angiography and EEG. We review here when ancillary tests are recommended in BD confirmation. TESTS TO DEMONSTRATE ABSENT CEREBRAL BLOOD FLOW Several authors have defended that the only reliable test to prove irreversibility in BD is showing the complete absence of intracranial circulation. 1,3 During the 1950s and 1960s the phenomenon of 'cerebral circulatory arrest' (or 'blocked cerebral circulation') was repeatedly demonstrated. Bernat recently emphasized that “the most confident way to demonstrate that the global loss of clinical brain functions is irreversible is to show the complete absence of intracranial blood flow.” It is well established
{"title":"When Are Ancillary Tests Recommended In Brain Death Confirmation","authors":"C. Machado, Jesús Pérez, C. Scherle, J. Korein","doi":"10.5580/2714","DOIUrl":"https://doi.org/10.5580/2714","url":null,"abstract":"It is widely accepted that brain death (BD) is a clinical diagnosis, although ancillary tests are recommended when specific components of the clinical testing cannot reliably be evaluated. The therapeutic use of barbiturates in patients with severe intracranial hypertension or other forms of drug intoxication, hypothermia, and other metabolic disturbances, can prevent determination of BD by clinical criteria. We present a review here about the use of ancillary tests in BD confirmation. Confirmatory tests in BD can be divided in those proving absent cerebral blood flow (CBF) and those that demonstrate loss of bioelectrical activity. We recommend assessing circulatory arrest by transcranial Doppler (TCD), and neuronal function by a neurophysiologic test battery. If TCD fails to validate the absence of CBF, computer tomography angiography can be used to confirm BD diagnosis. It is widely accepted that brain death (BD) is a clinical diagnosis, and it is currently defined as a complete and irreversible loss of brain function. Confirmatory laboratory tests are recommended when specific components of the clinical testing cannot reliably be evaluated 1-3 In certain European, Central and South American, and Asian countries, law requires confirmatory tests. The diagnosis of BD in children and neonates is more complicated and ancillary tests are usually advocated. 6-12 According to Wijdicks, “a confirmatory test is needed for patients in whom specific components of clinical testing cannot be reliably evaluated.” An ideal confirmatory study for BD should be safe, extremely accurate and reliable, available, quick and inexpensive. Heran et al. also affirmed that an ideal confirmatory study for BD should be “readily available, rapid, safe, portable, non-invasive, inexpensive, independently sufficient to establish brain death, not susceptible to external/internal confounding factors”. The therapeutic use of barbiturates in patients with severe intracranial hypertension or other forms of drug intoxication, hypothermia, and other metabolic disturbances, can prevent determination of BD by clinical criteria. Confirmatory tests in BD can be divided in those proving absent cerebral blood flow (CBF) and those that demonstrate loss of bioelectrical activity. In fact, confirmatory tests that are widely accepted are conventional angiography and EEG. We review here when ancillary tests are recommended in BD confirmation. TESTS TO DEMONSTRATE ABSENT CEREBRAL BLOOD FLOW Several authors have defended that the only reliable test to prove irreversibility in BD is showing the complete absence of intracranial circulation. 1,3 During the 1950s and 1960s the phenomenon of 'cerebral circulatory arrest' (or 'blocked cerebral circulation') was repeatedly demonstrated. Bernat recently emphasized that “the most confident way to demonstrate that the global loss of clinical brain functions is irreversible is to show the complete absence of intracranial blood flow.” It is well established ","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"23 11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116183609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Avasarala, S. Chittur, Marcy L. Kuentzel, David Frank
Objective: To study if differences in gene expression in brain tissue among African-Americans (AA) and Caucasian Americans (CA) with multiple sclerosis (MS) exist. Understanding any genetic differences is critical for better understanding of MS and its outcomes.Methods: Microarray and microRNA methods were used in chronic brain lesions of AA and CA patients with MS.Results: We found marked downregulation in GM2A (5.2 vs. 2.07), GALC (4.48 vs. 2.66), EIF1AY (4.54 vs. 1.57) and carboxypeptidase D (3.72 vs. 1.79), genes among chronic lesions taken from AA and CA brains and validated using real-time qPCR techniques. A total of 1108 genes were down regulated, compared to 467 genes that were upregulated in chronic MS lesions, compared to normal appearing brain matter (ratio of 2:1); a similar comparison between AA and CA brains revealed a total of 611 down regulated vs. 192 upregulated genes (ratio of 3:1). Interpretation: Significant downregulation of GM2A, GALC, EIF1AY and carboxypeptidase D in the AA lesions as compared to CA cohort could have implications for MS.
目的:研究非裔美国人(AA)和白种人美国人(CA)多发性硬化症(MS)患者脑组织基因表达是否存在差异。了解任何遗传差异对于更好地理解多发性硬化症及其结果至关重要。方法:采用微阵列和microRNA方法对AA和CA ms患者的慢性脑病变进行检测。结果:我们在AA和CA脑慢性病变中发现GM2A (5.2 vs. 2.07)、GALC (4.48 vs. 2.66)、EIF1AY (4.54 vs. 1.57)和羧基肽酶D (3.72 vs. 1.79)基因显著下调，并使用实时定量pcr技术进行验证。与正常脑物质相比，慢性MS病变中共有1108个基因下调，而467个基因上调(比例为2:1);AA和CA大脑之间的类似比较显示，总共有611个下调基因和192个上调基因(比例为3:1)。解释:与CA队列相比，AA病变中GM2A、GALC、EIF1AY和羧基肽酶D的显著下调可能与MS有关。
{"title":"Microarray and miRNA analyses of brain lesions in African- American and Caucasians with multiple sclerosis","authors":"J. Avasarala, S. Chittur, Marcy L. Kuentzel, David Frank","doi":"10.5580/4d3","DOIUrl":"https://doi.org/10.5580/4d3","url":null,"abstract":"Objective: To study if differences in gene expression in brain tissue among African-Americans (AA) and Caucasian Americans (CA) with multiple sclerosis (MS) exist. Understanding any genetic differences is critical for better understanding of MS and its outcomes.Methods: Microarray and microRNA methods were used in chronic brain lesions of AA and CA patients with MS.Results: We found marked downregulation in GM2A (5.2 vs. 2.07), GALC (4.48 vs. 2.66), EIF1AY (4.54 vs. 1.57) and carboxypeptidase D (3.72 vs. 1.79), genes among chronic lesions taken from AA and CA brains and validated using real-time qPCR techniques. A total of 1108 genes were down regulated, compared to 467 genes that were upregulated in chronic MS lesions, compared to normal appearing brain matter (ratio of 2:1); a similar comparison between AA and CA brains revealed a total of 611 down regulated vs. 192 upregulated genes (ratio of 3:1). Interpretation: Significant downregulation of GM2A, GALC, EIF1AY and carboxypeptidase D in the AA lesions as compared to CA cohort could have implications for MS.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"118 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133916811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Ibañez-Valdés, Jc Moré-Rodriguez, H. Foyaca-Sibat
We report a case presenting progressive weakness of the limbs, paresthesia, disesthesias, and stiffness of the neck, radicular pain and vertigo. A multiplanar, multisequence MRI-spine showed a well defined dural based extra-medullary mass in the cranio cervical junction anteriorly with intense homogenous enhancement post contrast administration. The proximal cord is effaced and displaced antero-laterally to the left by this lesion. The right vertebral artery is encased by the mass. There is pathological cord hyperintensity extending from the inferior medulla to C2 vertebral body in keeping with compressive myelopathy. A tumor was partially removed and pathological study concluded as meningioma. We review the medical literature to update our current knowledge about this topic.
{"title":"Meningioma at the Craniocervical Junction.","authors":"L. Ibañez-Valdés, Jc Moré-Rodriguez, H. Foyaca-Sibat","doi":"10.5580/25db","DOIUrl":"https://doi.org/10.5580/25db","url":null,"abstract":"We report a case presenting progressive weakness of the limbs, paresthesia, disesthesias, and stiffness of the neck, radicular pain and vertigo. A multiplanar, multisequence MRI-spine showed a well defined dural based extra-medullary mass in the cranio cervical junction anteriorly with intense homogenous enhancement post contrast administration. The proximal cord is effaced and displaced antero-laterally to the left by this lesion. The right vertebral artery is encased by the mass. There is pathological cord hyperintensity extending from the inferior medulla to C2 vertebral body in keeping with compressive myelopathy. A tumor was partially removed and pathological study concluded as meningioma. We review the medical literature to update our current knowledge about this topic.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124060349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Ezeala-Adikaibe, I. Onwuekwe, S. Ekenze, J. Achor, J. Onwukwe
In the developing world an estimated 8 million (80%) are not receiving treatment. The management of epilepsy in Nigeria is primarily based on use of antiepileptic drugs. The direct cost of treatment is important in developing countries because economic factors are important determinants of clinical decision making as it affects the level of adherence to treatment in most patients. OBJECTIVES: The aim of this study was to estimate in financial terms, the direct health care costs of treating epilepsy per month of clinic attendance and to relate these costs with the individual patients monthly income. To identify the principal cost drivers and to estimate based on monthly costs the total cost per patient per year. METHODS. This is a cross sectional study conducted among outpatient attendees at the specialist neurology service provided in three tertiary hospitals in Enugu south east Nigeria from September 2008 to April 2010. RESULTS. A total of 120 patients were interviewed. The majority had secondary school education-62.3%; 24 (20%) had regular employment. The total direct medical cost/month was N461,820.00 (($3,947.2), the biggest contributor was drug cost N375,350.00($3208.10) or 81.3% of the cost burden. The total estimated direct cost/ year was N5,541,840.00 ($47,366.15) with a mean cost/ year of N46,182.00($394.70); 25% of those who worked spent more than 50% of their monthly income of seeking care for epilepsyCONCLUSION. Medication costs contributed the most to the direct costs of treating epilepsy. More than 25% of patients on regular income spend 50% or more of their income in the treatment of epilepsy. Efforts towards reducing the direct cost of treating epilepsy should be directed towards mitigating the cost of the medications, transportation and service charges through appropriate policy interventions.
{"title":"Estimated Direct Cost Of Treating Epilepsy Per Month In Southeast Nigeria.","authors":"B. Ezeala-Adikaibe, I. Onwuekwe, S. Ekenze, J. Achor, J. Onwukwe","doi":"10.5580/19eb","DOIUrl":"https://doi.org/10.5580/19eb","url":null,"abstract":"In the developing world an estimated 8 million (80%) are not receiving treatment. The management of epilepsy in Nigeria is primarily based on use of antiepileptic drugs. The direct cost of treatment is important in developing countries because economic factors are important determinants of clinical decision making as it affects the level of adherence to treatment in most patients. OBJECTIVES: The aim of this study was to estimate in financial terms, the direct health care costs of treating epilepsy per month of clinic attendance and to relate these costs with the individual patients monthly income. To identify the principal cost drivers and to estimate based on monthly costs the total cost per patient per year. METHODS. This is a cross sectional study conducted among outpatient attendees at the specialist neurology service provided in three tertiary hospitals in Enugu south east Nigeria from September 2008 to April 2010. RESULTS. A total of 120 patients were interviewed. The majority had secondary school education-62.3%; 24 (20%) had regular employment. The total direct medical cost/month was N461,820.00 (($3,947.2), the biggest contributor was drug cost N375,350.00($3208.10) or 81.3% of the cost burden. The total estimated direct cost/ year was N5,541,840.00 ($47,366.15) with a mean cost/ year of N46,182.00($394.70); 25% of those who worked spent more than 50% of their monthly income of seeking care for epilepsyCONCLUSION. Medication costs contributed the most to the direct costs of treating epilepsy. More than 25% of patients on regular income spend 50% or more of their income in the treatment of epilepsy. Efforts towards reducing the direct cost of treating epilepsy should be directed towards mitigating the cost of the medications, transportation and service charges through appropriate policy interventions.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121605221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Ezeala-Adikaibe, I. Onwuekwe, O. Ekenze, K. Madubuko, E. Ofoegbu
Background: Stroke is a growing noncommunicable disease in Africa. Though stroke accounts for a substantial number of medical and neurological admissions in Nigerian hospitals, the specific impact of stroke on women has not been well documented. Aim: This study examined the profile of risk factors in women diagnosed with stroke in South East Nigeria. Methodology: A retrospective study was done of all adult Nigerian women admitted with a diagnosis of stroke into the medical wards and casualty department of the University of Nigeria Teaching Hospital, Enugu, Nigeria. The period covered was from January 2006 to December 2008. The case notes were retrieved and appropriate data including biometrics and identified risk factors for stroke in the patients. Results: Hypertension was the commonest risk factor (49.6%), followed by age ≥ 65years (39.4%), diabetes mellitus (16.8%) and heart disease (9.2%). Morbid obesity, dyslipidaemia and HIV infection were also present in 13.2% of the patients.Conclusion: Stroke principally affects the middle aged Nigerian women, with increasing cases of stroke in the young. Despite the predominance of recognized risk factors for stroke, there is the need for clinicians to still consider under-recognized risk factors such as HIV infection.
{"title":"Stroke Risk Factor Profile In Nigerian African Women","authors":"B. Ezeala-Adikaibe, I. Onwuekwe, O. Ekenze, K. Madubuko, E. Ofoegbu","doi":"10.5580/6fe","DOIUrl":"https://doi.org/10.5580/6fe","url":null,"abstract":"Background: Stroke is a growing noncommunicable disease in Africa. Though stroke accounts for a substantial number of medical and neurological admissions in Nigerian hospitals, the specific impact of stroke on women has not been well documented. Aim: This study examined the profile of risk factors in women diagnosed with stroke in South East Nigeria. Methodology: A retrospective study was done of all adult Nigerian women admitted with a diagnosis of stroke into the medical wards and casualty department of the University of Nigeria Teaching Hospital, Enugu, Nigeria. The period covered was from January 2006 to December 2008. The case notes were retrieved and appropriate data including biometrics and identified risk factors for stroke in the patients. Results: Hypertension was the commonest risk factor (49.6%), followed by age ≥ 65years (39.4%), diabetes mellitus (16.8%) and heart disease (9.2%). Morbid obesity, dyslipidaemia and HIV infection were also present in 13.2% of the patients.Conclusion: Stroke principally affects the middle aged Nigerian women, with increasing cases of stroke in the young. Despite the predominance of recognized risk factors for stroke, there is the need for clinicians to still consider under-recognized risk factors such as HIV infection.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133779792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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