Background. It is known that alterations of the sleep-wake cycle are present from the early stages of hepatic encephalopathy (starting with grade I on the West Haven criteria). However, minimal hepatic encephalopathy (which is not included in the West Haven criteria) defines the earliest form of HE, with no obvious clinical manifestations, but with subtle alterations in cognitive domains such as attention, visuo-spatial perception, psychomotor speed and response inhibition. Aim. To determine if liver cirrhosis in otherwise asymptomatic individuals (without clinically manifest hepatic encephalopathy) is associated with an increased risk of altered sleep rhythm or excessive daytime sleepiness. Additionally, to determine if this risk is correlated with liver disease severity or other clinical and biological parameters Material and methods. Cross-sectional study involving 25 adult patients with liver cirrhosis. Patients were evaluated through a standard neurological examination and with the Epworth Sleepiness Scale. Liver disease severity was measured using the MELD and Child-Pugh scores. Blood ammonia levels were also measured. Results. Mean age of the patients was 50±12 years-old. There was a predominance of males (68%, n=17). Mean MELD score was 17±7 points. Mean Child-Pugh score was 8±2 points. Mean blood ammonia level was 34±17 μg/dL. Subjective daytime somnolence was reported by 24% of patients (n=6). Mean ESS score was 6±5 points. No correlation was noted between the ESS scores and liver disease severity as measured by the Child-Pugh and MELD scores. Only three patients (12%) scored over 10 points on the ESS (none of them obese) and were consequently diagnosed with excessive daytime sleepiness (EDS). This proportion falls into the accepted prevalence of EDS in the general population. Conclusions. In our study, liver cirrhosis was not associated with a higher prevalence of excessive daytime sleepiness than in the general population.
{"title":"Assessment of excessive daytime sleepiness in cirrhotic patients","authors":"I. Lupescu, S. Iacob, C. Pietrăreanu, L. Gheorghe","doi":"10.37897/rjn.2022.4.4","DOIUrl":"https://doi.org/10.37897/rjn.2022.4.4","url":null,"abstract":"Background. It is known that alterations of the sleep-wake cycle are present from the early stages of hepatic encephalopathy (starting with grade I on the West Haven criteria). However, minimal hepatic encephalopathy (which is not included in the West Haven criteria) defines the earliest form of HE, with no obvious clinical manifestations, but with subtle alterations in cognitive domains such as attention, visuo-spatial perception, psychomotor speed and response inhibition. Aim. To determine if liver cirrhosis in otherwise asymptomatic individuals (without clinically manifest hepatic encephalopathy) is associated with an increased risk of altered sleep rhythm or excessive daytime sleepiness. Additionally, to determine if this risk is correlated with liver disease severity or other clinical and biological parameters Material and methods. Cross-sectional study involving 25 adult patients with liver cirrhosis. Patients were evaluated through a standard neurological examination and with the Epworth Sleepiness Scale. Liver disease severity was measured using the MELD and Child-Pugh scores. Blood ammonia levels were also measured. Results. Mean age of the patients was 50±12 years-old. There was a predominance of males (68%, n=17). Mean MELD score was 17±7 points. Mean Child-Pugh score was 8±2 points. Mean blood ammonia level was 34±17 μg/dL. Subjective daytime somnolence was reported by 24% of patients (n=6). Mean ESS score was 6±5 points. No correlation was noted between the ESS scores and liver disease severity as measured by the Child-Pugh and MELD scores. Only three patients (12%) scored over 10 points on the ESS (none of them obese) and were consequently diagnosed with excessive daytime sleepiness (EDS). This proportion falls into the accepted prevalence of EDS in the general population. Conclusions. In our study, liver cirrhosis was not associated with a higher prevalence of excessive daytime sleepiness than in the general population.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44299617","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}
Objective. Migraine is a common type of primary headache disorder, distinguished by recurrent attacks of moderate to severe unilateral throbbing pain. The goal of this study is to analyze the epigenetic influences of diet and their effects on patients with migraine headaches. Materials and methods. 130 patients with migraine headaches were analyzed (13.7% male and 86.3% female). The subjects were divided into two groups; Group A patients subsequently followed an epigenetic diet enriched with 5 mg of folic acid. Group B patients didn’t follow any type of diet. Results. When analyzing the data before the start of the study, it was found that the average concentration of folic acid in Group A was 2.8+3.6 ng/ml, which was significantly lower than in Group B (p=0.003). The average level of homocysteine was significantly different in both groups (р=0.04). Furthermore, a significant decrease in the intensity and frequency of headache was found (р = 0.02; р = 0.04), and a decrease in the average level of anxiety according to the Hamilton Anxiety Scale was found (from 15.0+3.5 points to 9+2 points) (p=0.03). Conclusion. A significant effect from homocysteine and folic acid levels in migraine patients on headache severity and quality of life was observed.
{"title":"Influence of an epigenetic diet on migraine patients","authors":"O. Kopchak, Olena Hrytsenko","doi":"10.37897/rjn.2022.4.7","DOIUrl":"https://doi.org/10.37897/rjn.2022.4.7","url":null,"abstract":"Objective. Migraine is a common type of primary headache disorder, distinguished by recurrent attacks of moderate to severe unilateral throbbing pain. The goal of this study is to analyze the epigenetic influences of diet and their effects on patients with migraine headaches. Materials and methods. 130 patients with migraine headaches were analyzed (13.7% male and 86.3% female). The subjects were divided into two groups; Group A patients subsequently followed an epigenetic diet enriched with 5 mg of folic acid. Group B patients didn’t follow any type of diet. Results. When analyzing the data before the start of the study, it was found that the average concentration of folic acid in Group A was 2.8+3.6 ng/ml, which was significantly lower than in Group B (p=0.003). The average level of homocysteine was significantly different in both groups (р=0.04). Furthermore, a significant decrease in the intensity and frequency of headache was found (р = 0.02; р = 0.04), and a decrease in the average level of anxiety according to the Hamilton Anxiety Scale was found (from 15.0+3.5 points to 9+2 points) (p=0.03). Conclusion. A significant effect from homocysteine and folic acid levels in migraine patients on headache severity and quality of life was observed.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41589638","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}
Alina Ioana Nacu-Florescu, O. Schreiner, T. Schreiner
Multiple sclerosis (MS), the most common autoimmune neurological disease of young people, is a significant burden for the patient, significantly decreasing the quality of life. Besides motor deficits, sensory problems, and vision loss, in recent years, neurologists have focused also on the cognitive impairment related to this condition. The early detection of cognitive disturbances is currently an essential part of MS patients’ follow-ups, as any worsening suggests the inefficiency of the applied treatment and the need for a therapeutic switch. In this regard, this review aims to highlight the importance of cognitive screening tests in the periodical evaluation of MS patients. While in the first part, the most frequently used cognitive screening tests in Romania are presented in a detailed manner, in the second part of the article, the clinical impact of these tests is highlighted, based on the results of the most relevant randomized clinical trials published during the last 10 years. Finally, the authors suggest future research directions to improve cognitive screening testing in MS patients after exposing the limitations of currently used screening batteries.
{"title":"Screening tests for the evaluation of cognitive impairment in multiple sclerosis patients","authors":"Alina Ioana Nacu-Florescu, O. Schreiner, T. Schreiner","doi":"10.37897/rjn.2022.4.1","DOIUrl":"https://doi.org/10.37897/rjn.2022.4.1","url":null,"abstract":"Multiple sclerosis (MS), the most common autoimmune neurological disease of young people, is a significant burden for the patient, significantly decreasing the quality of life. Besides motor deficits, sensory problems, and vision loss, in recent years, neurologists have focused also on the cognitive impairment related to this condition. The early detection of cognitive disturbances is currently an essential part of MS patients’ follow-ups, as any worsening suggests the inefficiency of the applied treatment and the need for a therapeutic switch. In this regard, this review aims to highlight the importance of cognitive screening tests in the periodical evaluation of MS patients. While in the first part, the most frequently used cognitive screening tests in Romania are presented in a detailed manner, in the second part of the article, the clinical impact of these tests is highlighted, based on the results of the most relevant randomized clinical trials published during the last 10 years. Finally, the authors suggest future research directions to improve cognitive screening testing in MS patients after exposing the limitations of currently used screening batteries.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47586962","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}
G. Mega, Adriana Damayanti, C. Siswantoro, Irene Purnamawati
COVID-19, a pandemic caused by the SARS-CoV-2 infection, has many fatal complications related to neurological and cardiovascular events such as seizures and arrhythmia leading to cardiac arrest. The direct and indirect mechanisms of SARS-CoV-2 played a significant role to generate its clinical manifestation. Near-sudden unexpected death in epilepsy (SUDEP) is a reversal of cardiopulmonary arrest in an epileptic patient which is very dangerous if not treated well. Here we present a 27-year-old man with VF and near sudden unexpected death due to status epilepticus (SE) and COVID-19 infection that was successfully managed in a rural area emergency setting. Prompt treatment in the emergency room followed by supportive management is important for patient survival. This rare and complex case possibly happened and should be differentiated whether the cause is COVID-19 or SUDEP to establish definitive management though the supportive management is still the same. Prevention of COVID-19 complications and SUDEP should also be done to reduce morbimortality.
{"title":"A rare case of managing near sudden unexpected death in status epilepticus with COVID-19 infection in rural area: what is the possible cause?","authors":"G. Mega, Adriana Damayanti, C. Siswantoro, Irene Purnamawati","doi":"10.37897/rjn.2022.3.11","DOIUrl":"https://doi.org/10.37897/rjn.2022.3.11","url":null,"abstract":"COVID-19, a pandemic caused by the SARS-CoV-2 infection, has many fatal complications related to neurological and cardiovascular events such as seizures and arrhythmia leading to cardiac arrest. The direct and indirect mechanisms of SARS-CoV-2 played a significant role to generate its clinical manifestation. Near-sudden unexpected death in epilepsy (SUDEP) is a reversal of cardiopulmonary arrest in an epileptic patient which is very dangerous if not treated well. Here we present a 27-year-old man with VF and near sudden unexpected death due to status epilepticus (SE) and COVID-19 infection that was successfully managed in a rural area emergency setting. Prompt treatment in the emergency room followed by supportive management is important for patient survival. This rare and complex case possibly happened and should be differentiated whether the cause is COVID-19 or SUDEP to establish definitive management though the supportive management is still the same. Prevention of COVID-19 complications and SUDEP should also be done to reduce morbimortality.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44145834","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}
M. Elhidsi, Dyah Ayu Kusumoputri Buwono, Eka Musridharta, D. Soehardiman, P. Prasenohadi
Acute respiratory failure (ARF) is a life-threatening condition that often results from the acute onset of neuromuscular disease (NMD) and often coexists with other cardiorespiratory conditions. For more than two decades, existing studies have shown that non-invasive ventilation (NIV) is the main ventilatory support and provides a good clinical outcome in ARF with various conditions, but its use in NMD patients with ARF is still limited. In patients with ARF, NIV can be initiated in fully awake patients with hemodynamically stable, without upper airway obstruction, and airway secretions can be overcome. Furthermore, expiratory positive airway pressure (EPAP) and inspiratory positive airway pressure (IPAP) settings with backup rates are recommended. Additionally, some studies have reported that the application of NIV in NMD with ARF can also be beneficial as a weaning strategy. Hence, further studies need to be conducted to generate evidence regarding the role of NIV in NMD patients with ARF.
{"title":"Non-invasive ventilation in neuromuscular disease with acute respiratory failure: A narrative review","authors":"M. Elhidsi, Dyah Ayu Kusumoputri Buwono, Eka Musridharta, D. Soehardiman, P. Prasenohadi","doi":"10.37897/rjn.2022.3.4","DOIUrl":"https://doi.org/10.37897/rjn.2022.3.4","url":null,"abstract":"Acute respiratory failure (ARF) is a life-threatening condition that often results from the acute onset of neuromuscular disease (NMD) and often coexists with other cardiorespiratory conditions. For more than two decades, existing studies have shown that non-invasive ventilation (NIV) is the main ventilatory support and provides a good clinical outcome in ARF with various conditions, but its use in NMD patients with ARF is still limited. In patients with ARF, NIV can be initiated in fully awake patients with hemodynamically stable, without upper airway obstruction, and airway secretions can be overcome. Furthermore, expiratory positive airway pressure (EPAP) and inspiratory positive airway pressure (IPAP) settings with backup rates are recommended. Additionally, some studies have reported that the application of NIV in NMD with ARF can also be beneficial as a weaning strategy. Hence, further studies need to be conducted to generate evidence regarding the role of NIV in NMD patients with ARF.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41625534","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}
An 89 years-old female patient was brought in by the family for altered mental status and left-sided motor deficit. Medical history revealed high blood pressure for which the patient was receiving anti-hypertensive treatment. Upon examination, the patient presented altered mental status, dysarthria, dysphagia, left central facial palsy, ataxic tetraparesis with marked paralysis on the left side, bilateral Babinski signs, right-sided ophthalmoplegia with limitation of gaze in all directions, left-sided skew deviation, limited abduction and upgaze movements of the left eye, and bilateral ptosis (complete on the right side and incomplete on the left side). The clinical picture was thus compatible with a vertebrobasilar stroke. A possible diagnosis of Weber syndrome was suggested, given the left-sided hemiparesis and right-sided ophthalmoplegia. Both head CT and brain MRI confirmed this by demonstrating a right-sided thalamo-mesencephalic subacute ischemic stroke. No cardio-embolic source was identified on cardiac assessment. Consequently, the patient was discharged with antiplatelet therapy, statin and anti-hypertensive treatment. We provide a short review on Weber syndrome, emphasizing the correlations between the clinical pictures and imaging findings.
{"title":"Weber syndrome – clinical-imaging correlations","authors":"I. Lupescu, D. Anghel, A. Dulamea","doi":"10.37897/rjn.2022.3.9","DOIUrl":"https://doi.org/10.37897/rjn.2022.3.9","url":null,"abstract":"An 89 years-old female patient was brought in by the family for altered mental status and left-sided motor deficit. Medical history revealed high blood pressure for which the patient was receiving anti-hypertensive treatment. Upon examination, the patient presented altered mental status, dysarthria, dysphagia, left central facial palsy, ataxic tetraparesis with marked paralysis on the left side, bilateral Babinski signs, right-sided ophthalmoplegia with limitation of gaze in all directions, left-sided skew deviation, limited abduction and upgaze movements of the left eye, and bilateral ptosis (complete on the right side and incomplete on the left side). The clinical picture was thus compatible with a vertebrobasilar stroke. A possible diagnosis of Weber syndrome was suggested, given the left-sided hemiparesis and right-sided ophthalmoplegia. Both head CT and brain MRI confirmed this by demonstrating a right-sided thalamo-mesencephalic subacute ischemic stroke. No cardio-embolic source was identified on cardiac assessment. Consequently, the patient was discharged with antiplatelet therapy, statin and anti-hypertensive treatment. We provide a short review on Weber syndrome, emphasizing the correlations between the clinical pictures and imaging findings.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47827311","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}
Migraine is a neurological condition that is the third highest cause of disability in the population under 50 years old. The Increasing incidence of migraine will affect the quality of life and increase the financial burden on the patient. Vitamin D is one of the supplementation agents that is thought to be associated with headaches and has anti-inflammatory and antioxidant effects. There is an increasing prevalence of vitamin D deficiency in migraine patients but there is no consensus regarding the provision of vitamin D supplementation as a complementary therapy in migraine. This article aims to explain the role of vitamin D in the mechanism of headache, especially migraine, and vitamin D supplementation therapy as a complementary therapy in migraine. Vitamin D is thought to play a role in the pathogenesis of headache through several mechanisms, namely as an anti-inflammatory effect, regulates the immune system, reduces nitric oxide (NO) levels, suppresses prostaglandin synthesis, and is associated with changes in several neurotransmitters such as glutamine, noradrenaline, dopamine, and serotonin. Several studies have reported that vitamin D supplementation in patients with migraine can improve the frequency of headache attacks. Most migraine patients can experience vitamin D deficiency. Vitamin D supplementation is also thought to reduce the frequency of headache attacks in migraine patients. However, further research is still needed to confirm these results.
{"title":"The role of vitamin D in migraine, from mechanism to therapy: literature review","authors":"Igm Ardika Aryasa, I. M. Oka Adnyana","doi":"10.37897/rjn.2022.3.1","DOIUrl":"https://doi.org/10.37897/rjn.2022.3.1","url":null,"abstract":"Migraine is a neurological condition that is the third highest cause of disability in the population under 50 years old. The Increasing incidence of migraine will affect the quality of life and increase the financial burden on the patient. Vitamin D is one of the supplementation agents that is thought to be associated with headaches and has anti-inflammatory and antioxidant effects. There is an increasing prevalence of vitamin D deficiency in migraine patients but there is no consensus regarding the provision of vitamin D supplementation as a complementary therapy in migraine. This article aims to explain the role of vitamin D in the mechanism of headache, especially migraine, and vitamin D supplementation therapy as a complementary therapy in migraine. Vitamin D is thought to play a role in the pathogenesis of headache through several mechanisms, namely as an anti-inflammatory effect, regulates the immune system, reduces nitric oxide (NO) levels, suppresses prostaglandin synthesis, and is associated with changes in several neurotransmitters such as glutamine, noradrenaline, dopamine, and serotonin. Several studies have reported that vitamin D supplementation in patients with migraine can improve the frequency of headache attacks. Most migraine patients can experience vitamin D deficiency. Vitamin D supplementation is also thought to reduce the frequency of headache attacks in migraine patients. However, further research is still needed to confirm these results.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48543449","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}
Sravya Inumpudi, Maheedhar Reddy N, P. Hazeena, S. Shanmugam, S. Venkatasubramanian
Background. Idiopathic intracranial hypertension (IIH) also termed pseudotumor cerebri syndrome (PTCS). It mainly affects young overweight women of the reproductive age group. There is a scarcity of literature on IIH among the Indian population. Objective. To evaluate the clinical, demographic profile, laboratory parameters and outcomes of Idiopathic Intracranial hypertension (IIH) patients. Materials and method. The current study was a prospective observational study on 43 patients who were diagnosed as primary PTCS presenting to the neurology department of Sri Ramachandra Medical College and Research Institute from December 2019 to August 2021. Patients were assessed for BMI, papilledema, CSF manometry, MRI brain with MR venography was done. Co-guide software, V.1.03, was used for statistical analysis. Results. The mean age was 33.12 ± 12.29 years (ranged 14 to 55) in the study population. There were 5(11.63%) males and 38(88.37%) females. The mean BMI was 26.72 ± 3.56 kg/m2 (ranged from 17.40 to 34.20). The mean duration of headache was 28.41 ± 26.23 days (ranged 3 to 120) in the study population, and 39(90.69%) had papilledema. The mean CSF manometry was 29.6 ± 5.88(ranged from 16 to 42) cmH2O. Conclusion. In the Indian subcontinent, obesity may not be considered as a major risk factor in the causation of IIH.
{"title":"Profile of idiopathic intracranial hypertension in Indian population – A prospective study","authors":"Sravya Inumpudi, Maheedhar Reddy N, P. Hazeena, S. Shanmugam, S. Venkatasubramanian","doi":"10.37897/rjn.2022.3.12","DOIUrl":"https://doi.org/10.37897/rjn.2022.3.12","url":null,"abstract":"Background. Idiopathic intracranial hypertension (IIH) also termed pseudotumor cerebri syndrome (PTCS). It mainly affects young overweight women of the reproductive age group. There is a scarcity of literature on IIH among the Indian population. Objective. To evaluate the clinical, demographic profile, laboratory parameters and outcomes of Idiopathic Intracranial hypertension (IIH) patients. Materials and method. The current study was a prospective observational study on 43 patients who were diagnosed as primary PTCS presenting to the neurology department of Sri Ramachandra Medical College and Research Institute from December 2019 to August 2021. Patients were assessed for BMI, papilledema, CSF manometry, MRI brain with MR venography was done. Co-guide software, V.1.03, was used for statistical analysis. Results. The mean age was 33.12 ± 12.29 years (ranged 14 to 55) in the study population. There were 5(11.63%) males and 38(88.37%) females. The mean BMI was 26.72 ± 3.56 kg/m2 (ranged from 17.40 to 34.20). The mean duration of headache was 28.41 ± 26.23 days (ranged 3 to 120) in the study population, and 39(90.69%) had papilledema. The mean CSF manometry was 29.6 ± 5.88(ranged from 16 to 42) cmH2O. Conclusion. In the Indian subcontinent, obesity may not be considered as a major risk factor in the causation of IIH.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41593110","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. Stan, N. Gherghel, N. C. Drăghici, M. Tămaș, D. Muresanu
Sensory ganglionopathies (SG) are a rare but distinct clinical subgroup of peripheral neuropathies characterized by damage to dorsal root ganglia. Typical manifestations include early gait and limb ataxia, widespread diminished or absent deep tendon reflexes accompanied by Romberg sign and pseudo athetoid movements. The diagnosis of SG is valuable since it may prompt towards early recognition of an underlying malignancy or autoimmune disorder. We report the case of a female diagnosed with mixed connective tissue disease (MCTD) along with severe SG. To our knowledge, such disease association has not been reported yet. The pathophysiology in cases linked to MCTD is unclear and asks for further studies. Moreover, the important degree of disability associated with this condition highlights the need for effective therapies’ development.
{"title":"Severe sensory ganglionopathy as a manifestation of mixed connective tissue disease","authors":"A. Stan, N. Gherghel, N. C. Drăghici, M. Tămaș, D. Muresanu","doi":"10.37897/rjn.2022.3.10","DOIUrl":"https://doi.org/10.37897/rjn.2022.3.10","url":null,"abstract":"Sensory ganglionopathies (SG) are a rare but distinct clinical subgroup of peripheral neuropathies characterized by damage to dorsal root ganglia. Typical manifestations include early gait and limb ataxia, widespread diminished or absent deep tendon reflexes accompanied by Romberg sign and pseudo athetoid movements. The diagnosis of SG is valuable since it may prompt towards early recognition of an underlying malignancy or autoimmune disorder. We report the case of a female diagnosed with mixed connective tissue disease (MCTD) along with severe SG. To our knowledge, such disease association has not been reported yet. The pathophysiology in cases linked to MCTD is unclear and asks for further studies. Moreover, the important degree of disability associated with this condition highlights the need for effective therapies’ development.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49454279","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. The treatment of peripheral diabetic neuropathy is difficult to treat considering the pain is severe, long-lasting and does not respond to analgesics. Gabapentin has been recommended as the first line treatment for DPN but owing to cognitive dysfunction and other side effects the drug is discontinued. Recent studies suggest that oxcarbazepine; an antiepileptic drug has good-efficacy in management of DPN. This prospective, observational and comparative study was done to compare gabapentin and oxcarbazepine monotherapy in patient of DPN. Objectives. We assessed the efficacy of Oxcarbazepine monotherapy in terms of pain score, sleep score and quality of life and compared with gabapentin monotherapy. Methods. 100 patients with DPN or examinations suggesting DPN were divided into 2 groups to receive gabapentin 300-1200 mg/day or Oxcarbazepine 300-600mg/day. Assessment of pain scores, sleep score and quality of life were done at different duration during the course of therapy. Results. Out of total subject selected, the maximum (46%) subjects were between age group 60-90 years and the least effected were (24%) between age group 50-59 years. Male were more prevalent with 57% when compared to females with 43%. Improvement in Sleep was seen on using Group II with p value (0.0005). However, the correlation of Pain and Quality of life with the treatment shows p –value 0.24, 0.31 and 0.27 respectively showing non-significance. Conclusion. The sleep improved statistically correlated in patients with DPN, but not with quality of life and pain as the calculated p value was (p= 0.24, 0.31 and 0.27) respectively. Findings of this study suggest that oxcarbazepine can be used as an alternative treatment owing to its similar analgesic efficacy and improvement in sleep.
{"title":"Efficacy of Gabapentin vs Oxcarbazepine in terms of pain, sleep and quality of life in patients with diabetic peripheral neuropathy","authors":"Wadha Nawal Zaffer, Faiz Unnisa, Farath Unnisa, Ayesha Tahoora Fatima, Azmath Unnisa Begum, Mohammed Zoheb","doi":"10.37897/rjn.2022.3.8","DOIUrl":"https://doi.org/10.37897/rjn.2022.3.8","url":null,"abstract":"Background. The treatment of peripheral diabetic neuropathy is difficult to treat considering the pain is severe, long-lasting and does not respond to analgesics. Gabapentin has been recommended as the first line treatment for DPN but owing to cognitive dysfunction and other side effects the drug is discontinued. Recent studies suggest that oxcarbazepine; an antiepileptic drug has good-efficacy in management of DPN. This prospective, observational and comparative study was done to compare gabapentin and oxcarbazepine monotherapy in patient of DPN. Objectives. We assessed the efficacy of Oxcarbazepine monotherapy in terms of pain score, sleep score and quality of life and compared with gabapentin monotherapy. Methods. 100 patients with DPN or examinations suggesting DPN were divided into 2 groups to receive gabapentin 300-1200 mg/day or Oxcarbazepine 300-600mg/day. Assessment of pain scores, sleep score and quality of life were done at different duration during the course of therapy. Results. Out of total subject selected, the maximum (46%) subjects were between age group 60-90 years and the least effected were (24%) between age group 50-59 years. Male were more prevalent with 57% when compared to females with 43%. Improvement in Sleep was seen on using Group II with p value (0.0005). However, the correlation of Pain and Quality of life with the treatment shows p –value 0.24, 0.31 and 0.27 respectively showing non-significance. Conclusion. The sleep improved statistically correlated in patients with DPN, but not with quality of life and pain as the calculated p value was (p= 0.24, 0.31 and 0.27) respectively. Findings of this study suggest that oxcarbazepine can be used as an alternative treatment owing to its similar analgesic efficacy and improvement in sleep.","PeriodicalId":37662,"journal":{"name":"Romanian Journal of Neurology/ Revista Romana de Neurologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42644866","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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