Early cortical atrophy in REM sleep behavior disorder. / Atrofia cortical precoz en el trastorno de conducta del sueño REM.

INTRODUCTION: The presence of cortical atrophy (focal or diffuse) prior to the development of symptoms of cognitive impairment could predict the earliest cases of neurodegenerative disease in patients with REM sleep behavior disorder (RSBD). We reviewed the usefulness of cranial CT and MRI as early markers of cortical atrophy in patients with RSBD at our center. PATIENTS AND METHODS: Retrospective observational descriptive analysis of patients diagnosed with RSBD from October 2012 to October 2022. All with cranial CT or MRI, evaluated by a neuroradiologist. RESULTS: 54 patients were included, 21 women (38.88%), 33 men (61.12%), mean age at diagnosis of RSBD: 69.04±12.625 years. Of the 54 patients, 44 (81.48%) had imaging tests consistent with their age, and 10 had atrophy greater than expected for their age. Of the 54 patients, 21 (38.88%) with a diagnosis of neurodegenerative disease, 33 (61.12%) persist as idiopathic, almost all with more than 5years of evolution (range of 1 to 10years of evolution without diagnosis). Of the 10 (18.52%) patients with greater atrophy, all were diagnosed with neurodegenerative disease (8 in 1year, 2 in 8years). CONCLUSIONS: Almost half of our series have developed a neurodegenerative disease in the first 10years of evolution. The majority of them presented global cortical atrophy measured by the GCA scale in the first year of diagnosis, without other neurological symptoms. Patients who did not show cortical atrophy at diagnosis have not yet developed the neurodegenerative disease in 10years of evolution. In our experience, the absence of cortical atrophy on cranial MRI or CT (measured by scales such as GCA) at the diagnosis of RSBD seems to predict slower progression cases. These data should be corroborated with larger series.

Encephalopathy in severe SARS-CoV2 infection: Inflammatory or infectious?

Concerning the letter by Moriguchi et al., we describe our experience with a case of encephalopathy with and atypical damage on magnetic resonance imaging (MRI) in a patient with severe infection due to the SARS-CoV2 virus. A 56-year-old woman, without previous pathologies, developed cough, fever, and respiratory failure for five days, after returning from a 6-day trip to Venice. Chest radiography shows a large bilateral interstitial infiltrate. In the first 24 hours, she was admitted to the Intensive Care Unit (ICU) for severe respiratory failure and positive protein chain reaction-PCR in nasal exudate. She needed intubation for ten days. In the first 48 hours outside the ICU, she developed an acute confusional syndrome (hyperactive delirium). Neurological examination showed temporal-spatial disorientation and incoherent fluent speech. An electroencephalogram (EEG) showed generalized hypovoltaic activity. Cranial magnetic resonance imaging showed a bilateral and symmetrical increase in the supratentorial white matter's signal intensity, with a discrete thickening of both temporal lobes, with a slight increase in signal intensity and a sequence of normal diffusion. The lumbar puncture showed no changes (glucose 71 mg/dL, protein 30 mg/dL, 1 leukocyte). Within 72 hours of starting symptoms, she was neurologically asymptomatic. Our final diagnosis was an inflammatory encephalopathy related to a SARS-CoV2 infection.

Relationship Among Risk Score Systems and Coronary Atherosclerosis Determined by Multislice Computed Tomography.

BACKGROUND: Risk score systems (RSS) were designed to estimate the risk of cardiac events. Their ability to predict coronary atherosclerosis (CA) has not been established. HYPOTHESIS: Risk score systems can predict presence of CA in patients without typical symptoms or ischemia. Because design of each RSS is different, their predictive value could also differ. METHODS: A retrospective analysis was done on patients from a low-risk region referred for cardiac multislice computed tomography (MSCT). The sample included low- to intermediate-risk patients with nontypical chest pain and asymptomatic high-risk patients. Patients with documented ischemia were excluded. Three RSS were determined: Framingham Risk Score (FRS), Regicor (FRS calibrated for Spanish population), and Systematic Coronary Risk Evaluation (SCORE). Coronary arteries were investigated to determine calcium score and presence of protruding atheromas. RESULTS: We analyzed 582 patients (53.8% male; mean age 51 ± 11.5 years). Their mean estimated risk was intermediate: 15.6 ± 10.4 by FRS, 6.3 ± 4.3 by Regicor, and 3.9 ± 4.1 by SCORE. The MSCT showed no CA in 38.8%, nonobstructive plaques in 28.7%, and obstructive ones in 32.5%. The ability of the RSS to predict CA was not significantly different, with moderate diagnostic value (areas under ROC curves, 0.72-0.65). The prevalence of CA was high in low-risk patients: 40%, 47%, and 53% in FRS, Regicor, and SCORE low-risk patients, respectively. CONCLUSIONS: Risk score systems have only moderate diagnostic value to predict presence of CA, without significant differences among them. Coronary artery disease is highly prevalent in patients considered low risk.