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2.
Brain Behav ; 14(10): e70069, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39467102

RESUMO

INTRODUCTION: Patients with Parkinson's disease (PD) may benefit from deep brain stimulation (DBS). Perifocal brain edema sometimes occurs after DBS surgery, but it is transient and does not affect the final prognosis. Transient deterioration of cognitive function has been reported in patients with frontal edema in the first postoperative week. This study aimed to investigate the effect of Goreisan in preventing edematous changes after DBS and determine the influence of edema on cognition. METHODS: We included 29 patients with PD who underwent bilateral subthalamic nucleus (STN) DBS and who were divided into 2 groups: those using (11 patients) and those not using Goreisan (18 patients). At 1 week postoperatively, all patients underwent magnetic resonance imaging. We measured the volume of edema either in the frontal white matter or STN on fluid-attenuated inversion recovery (FLAIR) images. Finally, brain edema, motor function, and cognitive function were compared between the groups with and without Goreisan. RESULTS: In the FLAIR image 1 week postoperatively, the average postoperative frontal subcortical edema (FE) volume of the group with Goreisan was significantly lower than that without Goreisan (2249 ± 2186 mm3, 6261 ± 7213 mm3, respectively, p = 0.023). Multivariate analysis with age, preoperative Mini-Mental State Examination (MMSE) score, FE, and peri-STN edema (SE) as factors, and MMSE at 1 week postoperatively as the dependent variable showed that preoperative MMSE score and SE were significant as associated factors. CONCLUSIONS: FE after DBS surgery may be alleviated using Goreisan. SE and preoperative MMSE scores were associated with MMSE scores 1 week postoperatively. TRIAL REGISTRATION: Not applicable.


Assuntos
Estimulação Encefálica Profunda , Doença de Parkinson , Núcleo Subtalâmico , Humanos , Doença de Parkinson/terapia , Doença de Parkinson/fisiopatologia , Doença de Parkinson/diagnóstico por imagem , Estimulação Encefálica Profunda/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/etiologia , Imageamento por Ressonância Magnética , Período Perioperatório , Cognição/fisiologia
3.
J Neurol Sci ; 459: 122975, 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38527411

RESUMO

BACKGROUND: Strictly superficial cerebellar microbleeds and cerebellar superficial siderosis have been considered markers of advanced cerebral amyloid angiopathy (CAA), but there are few studies on cerebellar ischemic lesions in CAA. We investigated the presence of superficial small cerebellar infarct (SCI) ≤15 mm and its relation to magnetic resonance imaging (MRI) markers in patients with probable CAA. METHODS: Eighty patients with probable CAA were retrospectively evaluated. The presence of superficial SCIs was examined, along with cerebellar microbleeds and cerebellar superficial siderosis, using 3-T MRI. Lobar cerebral microbleeds, cortical superficial siderosis (cSS), enlargement of the perivascular space in the centrum semiovale, and white matter hyperintensity were assessed and the total CAA-small vessel disease (SVD) score was calculated. RESULTS: Nine of the 80 patients (11.3%) had a total of 16 superficial SCIs. By tentatively defining SCI <4 mm as cerebellar microinfarcts, 8 out of 16 (50%) superficial SCIs corresponded to cerebellar microinfarcts. The total CAA-SVD score was significantly higher in patients with superficial SCIs (p = 0.01). The prevalence of cSS (p = 0.018), cortical cerebral microinfarct (p = 0.034), and superficial cerebellar microbleeds (p = 0.006) was significantly higher in patients with superficial SCIs. The number of superficial cerebellar microbleeds was also significantly higher in patients with superficial SCIs (p = 0.001). CONCLUSIONS: Our results suggest that in patients with CAA, superficial SCIs (including microinfarcts) on MRI may indicate more severe, advanced-stage CAA. These preliminary findings should be verified by larger prospective studies in the future.


Assuntos
Angiopatia Amiloide Cerebral , Doenças de Pequenos Vasos Cerebrais , Siderose , Humanos , Estudos Retrospectivos , Hemorragia Cerebral/epidemiologia , Estudos Prospectivos , Angiopatia Amiloide Cerebral/complicações , Angiopatia Amiloide Cerebral/diagnóstico por imagem , Angiopatia Amiloide Cerebral/epidemiologia , Imageamento por Ressonância Magnética/métodos , Infarto
4.
Brain Behav ; 13(11): e3263, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37743594

RESUMO

PURPOSE: We have reported the relationship between low pulvinar nuclei (PN) intensity in susceptibility-weighted imaging and the appearance of visual hallucinations and cognitive function. The aim of the study was to examine the changes in the quantitative susceptibility mapping (QSM) in patients with Parkinson's disease (PD) who underwent deep brain stimulation (DBS) and verify whether the PN susceptibility value (SV) on QSM can predict visual hallucination and cognitive changes after DBS. METHODS: This study examined 24 patients with PD who underwent DBS along with QSM imaging on magnetic resonance imaging (MRI). All MRIs were performed within 3 months before surgery. The PN SV was further assessed based on the QSM. Then, associations were examined among cognitive changes, hallucination, and PN SV. The cognitive function of the patient was compared immediately before surgery and at 1 year postoperatively. RESULTS: Visual hallucinations were observed in seven patients during the follow-up period. The PN SV was ≥0.045 ppm in nine patients with PD, and six of them had visual hallucinations, whereas only one of 15 patients with PD with SV of <0.045 ppm had visual hallucinations (Fisher's exact test, p = .0037). CONCLUSIONS: The SV of >0.045 ppm at the PN in QSM in patients with PD may provide useful information suggesting visual hallucination and cognitive deterioration after DBS treatment.


Assuntos
Transtornos Cognitivos , Estimulação Encefálica Profunda , Doença de Parkinson , Pulvinar , Humanos , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/terapia , Doença de Parkinson/patologia , Estimulação Encefálica Profunda/efeitos adversos , Estimulação Encefálica Profunda/métodos , Pulvinar/patologia , Imageamento por Ressonância Magnética/métodos , Alucinações/diagnóstico por imagem , Alucinações/etiologia , Alucinações/terapia , Mapeamento Encefálico/métodos
5.
Intern Med ; 61(21): 3277-3279, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-35342141

RESUMO

Cortical superficial siderosis (cSS) is a rare condition that is regarded as a potential magnetic resonance marker of cerebral amyloid angiopathy (CAA). We describe the case of a 68-year-old man with cSS and Parkinson's disease (PD) who subsequently exhibited incidental microhemorrhages, which were only detected on magnetic resonance imaging (MRI), at one week after deep brain stimulation (DBS) surgery. cSS is now considered to be a significant risk factor for CAA and future bleeding. Therefore, because DBS surgery is invasive and may increase the risk of intracerebral hemorrhage, the procedure should be performed carefully when managing patients with PD and CAA.


Assuntos
Angiopatia Amiloide Cerebral , Estimulação Encefálica Profunda , Doença de Parkinson , Siderose , Masculino , Humanos , Idoso , Siderose/complicações , Siderose/diagnóstico por imagem , Siderose/terapia , Doença de Parkinson/complicações , Doença de Parkinson/terapia , Estimulação Encefálica Profunda/efeitos adversos , Angiopatia Amiloide Cerebral/complicações , Angiopatia Amiloide Cerebral/diagnóstico por imagem , Angiopatia Amiloide Cerebral/terapia , Hemorragia Cerebral , Imageamento por Ressonância Magnética
6.
Heliyon ; 8(2): e08900, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35265762

RESUMO

Background: Some patients with Parkinson's disease (PD) develop peri-lead brain edema after deep brain stimulation (DBS) surgery. The influence of edema on neurological function is not well characterized. We investigated the relationship of brain edema after DBS surgery with motor and cognitive function. Methods: Thirteen patients with PD (6 males and 7 females; mean age: 61.2 years) who underwent bilateral subthalamic nucleus (STN) DBS surgery were included. All patients underwent magnetic resonance imaging (MRI) examination on day 6 post-DBS surgery. The volume of edema was measured either in the frontal white matter or STN on fluid attenuated inversion recovery (FLAIR) images. We examined the relationship between these volumes and changes in cognitive and motor function. Results: Patients were divided into those with frontal subcortical edema (FE) ≥3,000 mm3 (FE + group; n = 7) and <3,000 mm3 (FE-group; n = 6). In the FE + group, the postoperative Mini-Mental State Examination score worsened by 2.4 points after one week compared with that immediately before surgery, while that in the FE-group worsened only by 0.2 points (p = 0.038). On comparing patients with peri-STN edema (SE) ≥1,000 mm3 (SE + group; n = 3) and those with SE < 1,000 mm3 (SE-group; n = 10) showed that frequency of DBS tuning in the early postoperative period of the SE + group was lesser than that in the SE-group. Conclusions: Development of FE after DBS surgery was related to transient cognitive decline. On the other hand, SE seemed associated with altered motor function and reduces the requirement for tuning in the initial period after DBS implantation.

7.
Rinsho Shinkeigaku ; 60(11): 768-772, 2020 Nov 27.
Artigo em Japonês | MEDLINE | ID: mdl-33115992

RESUMO

A 74-year-old man was administered nivolumab to treat recurrent squamous cell carcinoma of the lungs. He developed fatigue, redness on the front of his neck, muscle weakness, and difficulty in swallowing after receiving the third course of nivolumab. Physical and neurological examinations showed proximal limb muscle weakness, periorbital erythema, and erythema of the front of his neck as well as fingers. Laboratory investigations revealed elevated serum CK and aldolase levels, and he was diagnosed with dermatomyositis. We initiated steroid pulse therapy and intravenous immunoglobulin therapy; however, he died of advanced lung cancer. Immune checkpoint inhibitor-induced neuromuscular disease is increasingly being observed in clinical practice. We report a rare case of dermatomyositis with squamous cell carcinoma of the lungs secondary to nivolumab treatment.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Antineoplásicos Imunológicos/uso terapêutico , Carcinoma de Células Escamosas/tratamento farmacológico , Dermatomiosite/induzido quimicamente , Inibidores de Checkpoint Imunológico/efeitos adversos , Inibidores de Checkpoint Imunológico/uso terapêutico , Neoplasias Pulmonares/tratamento farmacológico , Nivolumabe/efeitos adversos , Nivolumabe/uso terapêutico , Idoso , Autoanticorpos , Dermatomiosite/diagnóstico , Dermatomiosite/terapia , Evolução Fatal , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Imunoterapia , Masculino , Metilprednisolona/administração & dosagem , Pulsoterapia , Tacrolimo/uso terapêutico , Fatores de Transcrição/imunologia
8.
Front Neurol ; 10: 1158, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31736863

RESUMO

Purpose: Deep brain stimulation (DBS) is an established therapy for Parkinson's disease (PD). However, deteriorating cognitive function after DBS is a considerable problem for affected patients. This study was undertaken to assess whether pulvinar findings in susceptibility-weighted imaging (SWI) can suggest cognitive worsening. Methods: We examined 21 patients with PD who underwent DBS along with SWI and neuromelanin-sensitive MR imaging (NMI). We further assessed pulvinar hypointensity based on the SWI findings and also the area of the substantia nigra (SN) pars compacta in NMI. We then examined associations among cognitive changes, pulvinar hypointensity, and SN area. The cognitive function of the patient immediately before surgery was compared with function at 1 year postoperatively. Results: Pulvinar hypointensity in SWI was found in 11 of 21 patients with PD at baseline. One year postoperatively, six of the 21 patients demonstrated a Mini-Mental State Examination score that was ≥3 points lower than the baseline score. We observed pulvinar hypointensity in SWI before DBS surgery in five of these six patients (p = 0.072). During the first postoperative year, six of 21 patients reported both transient or permanent hallucinations; we observed pulvinar hypointensity in these six patients, while 10 patients without pulvinar hypointensity had no hallucinations. Conclusion: Pulvinar hypointensity in SWI in patients with PD may provide information that is useful for suggesting cognitive deterioration after DBS treatment.

9.
Mol Clin Oncol ; 8(2): 292-295, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29435290

RESUMO

Palmar fasciitis and polyarthritis (PFPA) is an uncommon disorder clinically characterized by rapidly developing bilateral arthritis of the hands and fasciitis of the palms. This cancer-associated syndrome, primarily linked to ovarian cancer, has also been associated with multiple different malignancies. PFPA symptoms usually precede the detection of ovarian cancer. In all patients from case series and single case reports described, ovarian cancer is already present at an advanced stage. Therefore, the authors aimed to present a case and systematically review available evidence on the association between PFPA and ovarian cancer, as gynecological oncologists. Awareness and recognition of PFPA may allow for earlier diagnosis and treatment of an occult ovarian cancer. The commitment of the attending gynecologists to become familiar with and identify rare diseases may lead to the detection at an early and curative stage and potentially life-saving therapeutic interventions.

10.
Neurosci Lett ; 662: 158-161, 2018 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29031781

RESUMO

PURPOSE: Istradefylline is useful in treating the wearing-off state in Parkinson's disease (PD). We investigated the effectiveness of istradefylline (ISD) in improving arousal, sleep, and gait deficits in patients with PD. METHODS: We examined 14 patients with PD treated with ISD. We assessed the patients using the Unified Parkinson's Disease Rating Scale, Parkinson's Disease Questionnaire, Timed Up-and-Go test (TUG), Freezing of Gait Questionnaire (FOG-Q), Epworth Sleepiness Scale (ESS), and Parkinson's Disease Sleep Scale (PDSS) before and 1 month after ISD use. RESULTS: ESS scores were significantly lower 1 month after the start of ISD treatment (6.79±6.50) than before the intervention (8.14±6.15, Wilcoxon signed-rank test, p=0.0033). PDSS scores were not significantly different 1 month after beginning the treatment (112±23mm) when compared to those before the intervention (110±27mm, Wilcoxon signed-rank test, p=0.40). TUG scores were not changed after 1 month of ISD use (14.9±8.3s) when compared to those before the intervention (21.3±30.0s, Wilcoxon signed-rank test, p=0.59). Although these measures were not significantly affected by ISD treatment, some patients remarkably improved after the treatment. FOG-Q scores were significantly lower 1 month after the beginning of treatment (9.79±7.16) than those before the intervention (12.14±5.82, Wilcoxon signed-rank test, p=0.030). CONCLUSIONS: ISD may improve daytime sleepiness and FOG in patients with PD.


Assuntos
Antiparkinsonianos/uso terapêutico , Transtornos Neurológicos da Marcha/tratamento farmacológico , Doença de Parkinson/complicações , Purinas/uso terapêutico , Transtornos do Sono-Vigília/tratamento farmacológico , Antagonistas do Receptor A2 de Adenosina/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Feminino , Transtornos Neurológicos da Marcha/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Transtornos do Sono-Vigília/complicações , Resultado do Tratamento
11.
Neurosci Lett ; 633: 112-117, 2016 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-27619539

RESUMO

PURPOSE: Neuromelanin-sensitive MR imaging (NMI) is an increasingly powerful tool for the diagnosis of Parkinson's disease (PD). This study was undertaken to evaluate longitudinal changes on NMI in PD patients. METHODS: We examined longitudinal changes on NMI in 14 PD patients. The area and contrast ratio (CR) of the substantia nigra pars compacta (SNc) were comparatively analyzed. RESULTS: The total area and CR of the SNc upon follow-up NMI were significantly smaller than those on initial NMI (from 33.5±18.9 pixels and 6.35±2.86% to 21.5±16.7 pixels and 4.19±2.11%; Wilcoxon signed-rank test, p<0.001 and p=0.022, respectively). The area and CR of the dominant side SNc upon initial NMI were significantly greater than those on follow-up NMI (from 15.3±9.1 pixels and 6.5±2.7% to 7.9±8.5 pixels and 3.7±2.9%; Wilcoxon signed-rank test, p=0.002 and p=0.007, respectively). On a case-by-case basis, the area of the SNc invariably decreased upon follow-up NMI in all patients. We further demonstrated that the total area and CR of the SNc negatively correlated with disease duration (Pearson correlation coefficient, r=-0.63, p<0.001 and r=-0.41, p=0.031, respectively). In area analyses, our results demonstrated very high intraclass correlation coefficients for both intra- and inter-rater reliability. CONCLUSION: NMI is a useful and reliable tool for detecting neuropathological changes over time in PD patients.


Assuntos
Melaninas/metabolismo , Doença de Parkinson/metabolismo , Parte Compacta da Substância Negra/metabolismo , Idoso , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico , Doença de Parkinson/patologia , Parte Compacta da Substância Negra/patologia , Estudos Retrospectivos , Fatores de Tempo
12.
Neurologist ; 15(4): 220-2, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19590383

RESUMO

BACKGROUND: Juvenile muscular atrophy of the distal upper extremity (Hirayama disease) is a sporadic disorder, but very rarely occurs in a familial pattern. OBJECTIVE: To describe the clinical features of Hirayama disease in 2 brothers, especially the look-alike anatomic physiques and magnetic resonance imaging (MRI) findings. DESIGN: Case report. PATIENTS: Two physically look-alike young brothers with Hirayama disease. RESULTS: Clinical symptoms of the present brothers were consistent with those of sporadic cases. Their lanky physique, clinical features, and MRI findings looked alike to each other. CONCLUSIONS: The pathogenesis of familial Hirayama disease is not well understood. The present brothers looked alike in terms of their physical frame and clinical symptoms. These findings suggest that similar mechanical damage against the cervical spinal cord by look-alike anatomic frame of the neck could be an important factor of familial Hirayama disease in the present brothers.


Assuntos
Mãos/patologia , Músculo Esquelético/patologia , Atrofia Muscular/patologia , Irmãos , Adolescente , Fatores Etários , Idade de Início , Vértebras Cervicais/patologia , Progressão da Doença , Predisposição Genética para Doença/genética , Mãos/inervação , Mãos/fisiopatologia , Humanos , Padrões de Herança/genética , Imageamento por Ressonância Magnética , Masculino , Debilidade Muscular/genética , Debilidade Muscular/patologia , Debilidade Muscular/fisiopatologia , Músculo Esquelético/inervação , Músculo Esquelético/fisiopatologia , Atrofia Muscular/genética , Atrofia Muscular/fisiopatologia , Fenótipo , Somatotipos/genética , Medula Espinal/patologia , Medula Espinal/fisiopatologia , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/fisiopatologia , Adulto Jovem
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