Is Dysphagia in Older Patients with Parkinson's Disease Associated With Sarcopenia ?

BACKGROUND: Parkinson's Disease (PD) and sarcopenia share a number of common pathways, and they can potentially affect each other. OBJECTIVE: We aimed to investigate the relationship between dysphagia and sarcopenia in elderly patients with PD compared to healthy controls. METHODS: This case-control study was conducted on 54 elderly PD patients and age-, sex- and body mass index-matched 54 healthy elder persons. Demographic and disease characteristics such as disease duration, stage of disease and Unified Parkinson's disease rating scale were recorded. All subjects were assessed by 10- item Eating Assessment Tool, Gugging Swallowing Screen tests and flexible fiberoptic endoscopic evaluation of swallowing (FEES) as well as Mini nutritional test short form. Also, A simplified screening tool for assessing sarcopenia (SARC-F), five times sit-to-stand and gait speed tests as well as lumbar magnetic resonance imaging (MRI) cross-sectional area of psoas and paraspinal muscles were used for evaluation of sarcopenia. Patients were divided as «with normal swallowing¼ or «with dysphagia¼ according to the FEES results. Three groups were compared among themselves in terms of evaluation methods. RESULTS: Sarcopenia evaluation parameters were significantly higher in patient groups compared to the control group. Moreover, muscle measurements evaluated by MRI in patients with dysphagia are lower than both patients with normal swallowing and control group (p value between 0.001 and 0.011). CONCLUSIONS: Patients with PD have lower muscle mass compared to healthy controls, and the situation is more pronounced in dysphagic PD patients.

Can spinal cord injury patients show a worsening in ASIA impairment scale classification despite actually having neurological improvement? The limitation of ASIA Impairment Scale Classification.

BACKGROUND: In our clinical training program, which includes probable American Spinal Injury Association impairment scale (AIS) grade changes in the event of recovery, we have noticed some confounding results regarding the AIS grading in spinal cord injury (SCI) patient case examples who are expected to recover. We also observed an individual case that showed a conflict between AIS grade conversion and neurological changes in European Multicenter Study on Human Spinal Cord Injury study. STUDY DESIGN: The analysis of SCI case examples for the probable AIS grade changes in the event of recovery. OBJECTIVES: To demonstrate the possible problems with AIS classification in SCI cases involving presumed motor and sensory changes, and to clarify the possible causes of the inverse relationship between the motor/sensory changes and AIS conversion in certain conditions. SETTING: Ankara, Turkey. METHODS: We studied the case examples of reference from the 2011 revision of International Standards for the Neurological Classification of Spinal Cord Injury. RESULTS: We encountered the same unique problem of deteriorating AIS grades within the critical zones of conversion when presumed neurological improvement took place, and vice versa. CONCLUSION: When recovery occurs without observing any motor or sensory changes while taking only the AIS into account, it would be possible to make an incorrect conclusion. This is most likely an indication of a limitation of the AIS. To enlighten this paradox, the large amount of data in SCI databases should be reanalyzed.

Brucellar spondylitis: a rare cause of spinal cord compression.

STUDY DESIGN: A case report. OBJECTIVES: To present and discuss some of the difficulties in the diagnosis of brucellar spondylitis. SETTING: Ankara University, Ibni Sina Hospital, Turkey. METHODS: We report a patient with paraplegia, misdiagnosed as having a malignancy or tuberculosis who actually suffered from brucellar spondylitis. Diagnosis was established by her history and a compatible clinical picture together with a standard tube agglutination (Wright test) titer of > or =1/160 of antibodies for brucellosis. The patient was treated with oral doxycycline, rifampicin, and ciprofloxacin combination. RESULTS: At the end of the treatment, the blood Brucella Wright and anti-human globulin T titer levels decreased. Her lower limb weakness improved. She could walk, and climb stairs with the help of a cane. Urinary retention and fecal incontinence also resolved. CONCLUSION: Brucellosis is a systemic infection involving the musculoskeletal and nervous systems. Spondylitis frequently occurs in elderly patients. An early diagnosis of brucellar spondylitis can often be difficult. In endemic regions, as in the case of our country, brucellar spondylitis should always be considered in the differential diagnosis of older patients with back pain and constitutional symptoms. An early diagnosis will help to prevent the development of more severe complications such as spinal cord compression.

Butterfly vertebra: a case report.

Butterfly vertebra is a rare congenital anomaly associated with syndromes such as Pfeiffer, Jarcho-Levin, Crousen, Alagille. In the literature, only a few cases of butterfly vertebra have been reported as incidental finding. We described a 37-year-old male who had an L3 butterfly vertebra associated with an L4-L5 disc protrusion. Awareness of this anomaly is important for making correct diagnosis. Although this uncommon anomaly is considered to be usually asymptomatic, we suggest that it might increase the incidence of disc herniation, because the condition may alter the spinal biomechanics.