Teaching Video NeuroImages: Upbeat and horizontal gaze-evoked nystagmus in bilateral medial medullary infarction
A 41-year-old man with progressive quadriparesis and generalized tingling sensation showed spontaneous upbeating nystagmus and horizontal gaze-evoked nystagmus (video at Neurology.org). The initial diffusion-weighted images showed an equivocal hyperintensity at midline of rostral medulla (upper row). Follow-up MRIs (lower row) showed characteristic heart appearance sign (figure). (Source: Neurology)
Source: Neurology - November 6, 2017 Category: Neurology Authors: Lee, E.-S., Sung, K.-B., Lee, T.-K. Tags: Clinical neurology examination, Nystagmus, All Cerebrovascular disease/Stroke, Infarction RESIDENT AND FELLOW SECTION Source Type: research
Teaching NeuroImages: Craniofacial fibrous dysplasia: Loss of vision after head trauma
A 24-year-old woman presented with blurred vision of her left eye 1 hour after a mild head trauma. Examination revealed left-sided exophthalmos and left side 20/40 vision with relative afferent pupillary defect. CT (figure 1) and MRI scan (figure 2) revealed ground-glass bone abnormalities involving the left frontal, orbital, and sphenoidal bones causing compression of the left optic nerve, all pathognomonic of fibrous dysplasia (FD). FD is a rare slowly progressive benign disorder where normal bone is replaced with abnormal fibrous tissue.1 IV methylprednisolone was given to treat supposed posttraumatic edema around the l...
Source: Neurology - November 6, 2017 Category: Neurology Authors: Sarihan, F., Kasius, K. M. Tags: CT, All Clinical Neurology, Optic nerve, Visual loss, Brain trauma RESIDENT AND FELLOW SECTION Source Type: research
Teaching NeuroImages: Sucking candy sign in Bell palsy
A 20-year-old woman presented with spontaneous onset of facial weakness. Examination revealed House-Brackmann grade IV1 right facial paresis and a contralaterally pigmented tongue (figure) from habitual sucking candy use. Contemporaneous taste loss on the anterior right tongue led her to keep the candy as far away from that area as possible—the posterior left tongue. (Source: Neurology)
Source: Neurology - November 6, 2017 Category: Neurology Authors: Armand, C. E., Robbins, M. S. Tags: Clinical neurology examination, Cranial neuropathy, All Education RESIDENT AND FELLOW SECTION Source Type: research
Clinical Reasoning: A patient with a history of encephalomyelitis and recurrent optic neuritis
A 4-year-old girl presented to an outside hospital after waking up with inability to stand or walk. She had a viral prodrome with fever for several days. Brain and spine MRIs revealed lesions in the left caudate, bilateral insular cortex, right thalamus, and right temporal cortex as well as longitudinally extensive cervical and thoracic cord lesions. Spinal fluid showed pleocytosis with 200 white blood cells (mixed neutrophils and lymphocytes), elevated CSF protein (103 mg/dL), and negative bacterial and viral cultures and PCR. Oligoclonal bands were negative. During the hospitalization, she developed encephalopathy and wa...
Source: Neurology - November 6, 2017 Category: Neurology Authors: Gutman, J. M., Levy, M., Galetta, S., Kister, I. Tags: All Pediatric, Optic neuritis; see Neuro-ophthalmology/Optic Nerve, Acute disseminated encephalomyelitis, Transverse myelitis RESIDENT AND FELLOW SECTION Source Type: research
Author response: Neuropsychiatric symptoms predict hypometabolism in preclinical Alzheimer disease
We thank Landin-Romero and Kumfor for the comments. Our regression techniques showed an association between neuropsychiatric inventory (NPI) scores and [18F]fluorodeoxyglucose (FDG) uptake in preclinical Alzheimer disease (AD).1 We did not find posterior cingulate cortex (PCC) hypermetabolism, but higher PCC-FDG uptake was found in patients with preclinical AD with higher NPI scores at baseline. We did not find hypermetabolism even when we contrasted the mean FDG uptake at the local maxima within the cluster. (Source: Neurology)
Source: Neurology - October 30, 2017 Category: Neurology Authors: Gauthier, S., Ng, K. P., Pascoal, T. A., Mathotaarachchi, S., Chung, C.-O., Benedetti, A. L., Shin, M., Kang, M. S., Li, X., Ba, M., Kandiah, N., Rosa-Neto, P. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Letter re: Neuropsychiatric symptoms predict hypometabolism in preclinical Alzheimer disease
Ng et al.1 reported that Neuropsychiatric Inventory (NPI) scores predict hypometabolism in the posterior cingulate cortex (PCC) in preclinical Alzheimer disease (AD) with PCC hypermetabolism at baseline preceding hypometabolism 2 years later. Early and progressive hypometabolism/atrophy of the PCC in AD is a well-established finding,2,3 but early hypermetabolism is more difficult to reconcile with current network-based models of neurodegeneration. Whether it is suitable to classify groups according to average metabolic changes in the same regions that emerge in subsequent analyses (e.g., orbitofrontal, PCC) is unclear. (Source: Neurology)
Source: Neurology - October 30, 2017 Category: Neurology Authors: Landin-Romero, R., Kumfor, F. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Author response: Trends in dementia prevalence, incidence, and survival rate in a Japanese community
We thank Dr. Grant for the comment on our article.1 According to the data on dietary supply from the Food and Agriculture Organization of the United Nations, the consumption of meat (from 7.6 to 33.7 kg/capita/y), animal fat (from 5 to 35 kg/capita/y), and energy from animal products (from 249 to 580 kcal/capita/d) increased from 1961 to 1985 in Japan.2 As Dr. Grant pointed out, the increasing consumption of animal products was highly correlated with data on the prevalence of Alzheimer disease (AD) in Japan with a lag of 25 years (correlation coefficient = 0.92).3 In addition, a multicountry ecologic study revealed that th...
Source: Neurology - October 30, 2017 Category: Neurology Authors: Ohara, T., Ninomiya, T. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Letter re: Trends in dementia prevalence, incidence, and survival rate in a Japanese community
I read with interest the article by Ohara et al.1 regarding trends in dementia prevalence, incidence, and survival rate in a Japanese community. The findings were similar to those reported in 2012 by Dodge et al.,2 in which Alzheimer disease (AD) rates for the elderly increased from 1% in 1985 to 7% in 2008. I explained that findings were due to the nutrition transition from the traditional Japanese diet to the Western diet, heavy in meat and other animal products, with a lag of 15–25 years.3 More recently, in a multicountry study, I found that dietary animal products other than milk were strongly correlated with AD ...
Source: Neurology - October 30, 2017 Category: Neurology Authors: Grant, W. B. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Editors' Note
: In "Trends in dementia prevalence, incidence, and survival rate in a Japanese community," the authors found an increase in Alzheimer disease (AD) prevalence in Japan between 1985 and 2012. Dr. Grant presents findings from other studies, supporting the explanation that the transition from a traditional Japanese diet to a westernized diet, replete with meat and other animal products, correlates to rising rates of AD and of cancers common in Western countries, with a lag time of several decades. (Source: Neurology)
Source: Neurology - October 30, 2017 Category: Neurology Authors: Alcauskas, M., Galetta, S. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Post viral upper and lower motor neuron injuries
A 20-year-old man presented with subacute dysarthria, along with bilateral facial and brachial palsy, after a febrile odynophagia. Initially brisk, his upper limb deep tendon reflexes decreased with muscle wasting concerning the C5-T1 myotomes. MRI showed bilateral prefrontal gyri and thalami lesions with anterior cervical spinal cord lesion (figures 1 and 2). Upper limb lower motor neuron involvement was confirmed by EMG. CSF analysis showed lymphocytic pleiocytosis, elevated protein, and normal glucose levels. Epstein-Barr virus (EBV) serology revealed acute infection with the presence of viral capsid antigen (VCA) ...
Source: Neurology - October 30, 2017 Category: Neurology Authors: De La Cruz, E., Metzger, A., Braquet, P., Gaillard, N., Taieb, G. Tags: Amyotrophic lateral sclerosis NEUROIMAGES Source Type: research
Neurolymphomatosis of the thoracic sympathetic chain
Neurolymphomatosis (NL) is defined as lymphomatous invasion of cranial or peripheral nerves by non-Hodgkin lymphoma (NHL). While most cases of NL are due to secondary dissemination from systemic or CNS sites, in rare cases it can be the primary manifestation of the malignancy.1–3 Early recognition of the disease and its precise neuroanatomic localization is critical for successful treatment. (Source: Neurology)
Source: Neurology - October 30, 2017 Category: Neurology Authors: Kaulen, L. D., Foss, F. M., Fulbright, R. K., Huttner, A., Baehring, J. M. Tags: PET, All Clinical Neurology, Hematologic, Nerve tumor, All Pain CLINICAL/SCIENTIFIC NOTES Source Type: research
Traumatic brain injury may not increase the risk of Alzheimer disease
Traumatic brain injury (TBI) commonly occurs in civilian and military populations. Some epidemiologic studies previously have associated TBI with an increased risk of Alzheimer disease (AD). Recent clinicopathologic and biomarker studies have failed to confirm the relationship of TBI to the development of AD dementia or pathologic changes, and suggest that other neurodegenerative processes might be linked to TBI. Additional studies are required to determine the long-term consequences of TBI. (Source: Neurology)
Source: Neurology - October 30, 2017 Category: Neurology Authors: Weiner, M. W., Crane, P. K., Montine, T. J., Bennett, D. A., Veitch, D. P. Tags: MRI, PET, Alzheimer's disease, Brain trauma, Assessment of cognitive disorders/dementia VIEWS & amp;amp; REVIEWS Source Type: research
Meta-analysis of pharmacogenetic interactions in amyotrophic lateral sclerosis clinical trials
Conclusions:
This study incorporated genetic data into past ALS trials to determine treatment effects in a genetic post hoc analysis. Our results suggest that we should reorient our strategies toward finding treatments for ALS, start focusing on genotype-targeted treatments, and standardize genotyping in order to optimize randomization and analysis for future clinical trials. (Source: Neurology)
Source: Neurology - October 30, 2017 Category: Neurology Authors: van Eijk, R. P. A., Jones, A. R., Sproviero, W., Shatunov, A., Shaw, P. J., Leigh, P. N., Young, C. A., Shaw, C. E., Mora, G., Mandrioli, J., Borghero, G., Volanti, P., Diekstra, F. P., van Rheenen, W., Verstraete, E., Eijkemans, M. J. C., Veldink, J. H., Tags: Amyotrophic lateral sclerosis, Clinical trials Systematic review/meta analysis, All Genetics ARTICLE Source Type: research
Prediction of work resumption and sustainability up to 1 year after mild traumatic brain injury
Conclusions:
RTW after mTBI is a gradual process, with varying levels of RTW throughout the first year after injury. Different predictors were relevant for short- vs long-term work resumption, with occupational factors influencing short-term RTW. However, for both short- and long-term RTW, posttraumatic complaints and signs of psychological distress early after injury were relevant predictors, allowing early identification of patients at risk for problematic work resumption. (Source: Neurology)
Source: Neurology - October 30, 2017 Category: Neurology Authors: de Koning, M. E., Scheenen, M. E., van der Horn, H. J., Timmerman, M. E., Hageman, G., Roks, G., Spikman, J. M., van der Naalt, J. Tags: Prognosis, Clinical trials Observational study (Cohort, Case control), Brain trauma ARTICLE Source Type: research
Effects of acute intermittent hypoxia on hand use after spinal cord trauma: A preliminary study
Conclusions:
This report suggests the need for further study of AIH as a plasticity "primer" for task-specific training in spinal cord injury rehabilitation. Important clinical questions remain concerning optimal AIH dosage, patient screening, safety, and effect persistence.
ClinicalTrials.gov identifier:
NCT01272336. (Source: Neurology)
Source: Neurology - October 30, 2017 Category: Neurology Authors: Trumbower, R. D., Hayes, H. B., Mitchell, G. S., Wolf, S. L., Stahl, V. A. Tags: Clinical trials Observational study (Cohort, Case control), All Rehabilitation, Spinal cord trauma, EMG, Motor Control ARTICLE Source Type: research
