Experts' perspectives on the role of medical marijuana in oncology: A semistructured interview study.

BACKGROUND: Expansion of medical marijuana (MM) laws in the United States may offer oncology new therapeutic options. However, the scientific evidence for MM remains in infancy. This study qualitatively explored professional opinion around the role of MM in cancer care. METHODS: Semistructured interviews were administered to a sample of individuals with expertise at the interface of MM and oncology nationally. Key informant criteria included an oncologic clinical or research background and any of the following: publications, research, or lectures on cannabinoids or cancer symptoms; involvement in the development of MM dispensaries or legislation; and early adoption of state MM certification procedures. A gold standard, grounded, inductive approach was used to identify underlying themes. RESULTS: Participants (N = 15) were predominantly male, in their sixth decade, working in academic settings. Themes ranged from strong beliefs in marijuana's medical utility to reservations about this notion, with calls for expansion of the scientific evidence base and more stringent MM production standards. All participants cited nausea as an appropriate indication, and 13 of 15 pain. Over one-third believed MM to have a more attractive risk profile than opioids and benzodiazepines. CONCLUSIONS: Expert opinion was divided between convictions in marijuana's medicinal potential and guardedness in this assertion, with no participant refuting MM's utility outright. Emergent themes included that MM ameliorates cancer-related pain and nausea and is safer than certain conventional medications. Participants called for enhanced purity and production standards, and further research on MM's utility.

First Molecular Detection of Ramularia Leaf Spot (Ramularia collo-cygni) in Seeds and Leaves of Barley in Argentina.

The fungus Ramularia collo-cygni B. Sutton & J. M. Waller (Rcc) was identified as the causal agent of this emerging disease on barley (Hordeum vulgare L.) based on symptoms and signs on leaves and attributes of the fungus. The common name given to the disease was "necrotic sprinkling." This disease was found for the first time on barley in fields of Buenos Aires Province, Argentina, in 2001, with severities ranging from 60 to 100% (2). During the spring of 2012, the disease spread throughout most barley growing areas of the Pampean region, affecting almost all varieties of barley in the Buenos Aires, Entre Ríos, and Santa Fe provinces. The disease showed typical symptoms of small, brown spots on leaves, sheaths, and awns, and caused rapid loss of green leaf area and significant economic damage. The diagnosis of this disease is difficult by conventional techniques and has caused some confusion. In order to obtain appropriate information about the incidence of this pathogen in the most important barley growing region of Argentina, as well as to confirm its presence on seed, 39 seed samples containing 200 seeds each and eight leaf samples were analyzed using a real-time PCR diagnostic test (4). Thirty-five of the 37 seed samples had Rcc DNA levels above the minimum detection level (0.13 pg DNA). Ramularia has been described as a seedborne fungus previously (1) and seed infection could hasten the spread of the fungus to new geographically distinct areas. Moreover, leaf samples were microscopically assessed for conidophore presence and then ground for DNA extraction. Rcc DNA was detected by PCR in all eight leaf samples. To our knowledge, this is the first report about molecular detection of R. collo-cygni in barley seed of harvested samples from Argentina. Seeds infected/infested may also lead to new strains of the fungus arriving in barley fields and provide a source of inoculum for future epidemics (3). References: (1) N. D. Havis et al. FEMS Microbiol. Lett. 256:217, 2006. (2) M. Khier et al. Salpicado necrótico, nueva enfermedad de la cebada en Argentina causada por Ramularia collo-cygni. Page 47 in: Resúmenes XI Jornadas Fitosanitarias Argentinas, 26-29 June 2002, Río Cuarto, Córdoba, 2002. (3) P. Matusinsky et al. J. Plant Pathol. 3:679, 2011. (4) J. M. G. Taylor et al. Lett. Appl. Microbiol. 50:493, 2010.

Evaluation of indigenous bacterial strains for biocontrol of the frogeye leaf spot of soya bean caused by Cercospora sojina.

AIMS: Assessment of biological control of Cercospora sojina, causal agent of frogeye leaf spot (FLS) of soya bean, using three indigenous bacterial strains, BNM297 (Pseudomonas fluorescens), BNM340 and BNM122 (Bacillus amyloliquefaciens). METHODS AND RESULTS: From cultures of each bacterial strain, cell suspensions and cell-free supernatants were obtained and assayed to determine their antifungal activity against C. sojina. Both mycelial growth and spore germination in vitro were more strongly inhibited by bacterial cell suspensions than by cell-free supernatants. The Bacillus strains BNM122 and BNM340 inhibited the fungal growth to a similar degree (I ≈ 52-53%), while cells from P. fluorescens BNM297 caused a lesser reduction (I ≈ 32-34%) in the fungus colony diameter. The foliar application of the two Bacillus strains on soya bean seedlings, under greenhouse conditions, significantly reduced the disease severity with respect to control soya bean seedlings and those sprayed with BNM297. This last bacterial strain was not effective in controlling FLS in vivo. CONCLUSIONS: Our data demonstrate that the application of antagonistic bacteria may be a promising and environmentally friendly alternative to control the FLS of soya bean. SIGNIFICANCE AND IMPACT OF THE STUDY: To our knowledge, this is the first report of biological control of C. sojina by using native Bacillus strains.

First Report of Ascochyta rabiei Causing Ascochyta Blight of Chickpea in Argentina.

In November 2011, lesions similar to those reported for Ascochyta blight (1) were observed on Cicer arietinum L. (chickpea) plants growing in three commercial fields located at Río Primero and Río Segundo (Cordoba Province) and Lobería (Buenos Aires Province), Argentina. Disease incidence (percentage of plants affected) was 100% in all fields surveyed. Plants showed leaves, petioles, stems, and pods with brown lesions. Symptoms on leaves and pods were circular to oval (2 to 14 mm) while in the stems the lesions were elongated (2 to 30 mm). Seeds appeared small and shriveled with brown discoloration. Morphology of the fungi was examined on infected tissues. Numerous black pycnidia measuring 94.6 to 217.9 µm (145.9 ± 28.8 µm), arranged in concentric rings, were observed within of all the lesions. Conidia were predominantly aseptate, straight, hyaline with blunt ends, and measured 9.3 to 12.9 (11.3 ± 1.12) × 3.3 to 5.0 µm (4.2 ± 0.51). Morphological characteristics of the pathogen were similar to those described for Ascochyta rabiei (Pass.) Labrousse (teleomorph Didymella rabiei (Kovacheski) v. Arx (= Mycosphaerella rabiei Kovacheski)) (2). Fungus from infected leaf tissues was isolated on potato dextrose agar. Pathogenicity tests were conducted on seedlings of the susceptible cultivar by spraying leaves of each of 100 seedling plants with 10 ml of a conidial suspension (2 × 104 conidia/ml) of the isolated pathogen with a handheld atomizer. Plants were covered with plastic bags and placed in a growing chamber at 20 to 25°C for 3 days. The plastic bags were removed and the plants were maintained in high humidity at the same temperature. Noninoculated plants were used as controls. After 5 days, all inoculated plants showed typical symptoms. Foliar and stem lesions symptoms were similar to those originally observed in the field. Control plants remained healthy. Koch's postulates were fulfilled by isolating A. rabiei from inoculated plants. The colonies and the morphology of conidia were the same as those of the original isolates. To our knowledge, this is the first report of A. rabiei infecting chickpeas in Argentina. The outbreak of Ascochyta blight in Argentina is of concern because of its severity and the possibility that the pathogen was introduced on seed. This report underscores the need for further research on effective management programs for Ascochyta blight. References: (1) B. Bayaa and W. Chen. Compendium of Chickpea and Lentil Diseases and Pests The American Phytopathological Society, St. Paul, MN, 2011. (2) E. Punithalingam and P. Holliday. Page 337 in: CMI Descriptions of Pathogenic Fungi and Bacteria. CMI, Kew, Surrey, UK, 1972.

Feasibility and safety of long-term photodynamic therapy (PDT) in the palliative treatment of patients with hilar cholangiocarcinoma.

BACKGROUND AND AIM: PDT is an important palliative option for patients with unresectable extrahepatic cholangiocarcinoma (CC). However, the results published to date reported on studies with no more than 6 (mostly up to 4) PDT procedures. Furthermore, the clinical experience of PDT in combination with chemotherapy is limited. The purpose of this retrospective analysis was to evaluate the feasibility and safety of multiple (4 to 14) settings of PDT, combined with biliary drainage, and (in some cases) with chemotherapy. - METHODS: Ten patients with unresectable extrahepatic CC were treated with biliary stenting and at least 4 PDT procedures in our department between 10/2005 and 08/2010. - RESULTS: Ten patients (male/female = 5/5), mean age 68.8 years (range, 54 - 81 years) who received at least 4 PDT procedures were analyzed. All patients underwent endoscopic biliary drainage. Nine patients received metallic stents and one patient a plastic stent. In 4 patients (40%) bilateral metal stenting (JoStent SelfX®) was performed. The mean number of PDT sessions was 7.9 ± 3.9 (range: 4 - 14). Eight patients had elevated bilirubin levels with a mean bilirubin at admission of 9.9 ± 11.3 mg/dL, which had decreased to an average minimum of 1.2 ± 0.9 mg/dL after 3 months. No severe toxicity was noted. Two patients received concomitant chemotherapy (GEMCIS as 1st line, GEMOX plus cetuximab as 2nd line). The median overall survival has not been reached, whereas the estimated survival of all patients was 47.6 months, 95% CI 25.9 - 48.1. - CONCLUSION: Long-term PDT in patients with extrahepatic CC is feasible and effective and is accompanied - at least in this cohort- by a survival time of more than 2 years.

First Report of Sexual Reproduction by the Soybean Sudden Death Syndrome Pathogen Fusarium tucumaniae in Nature.

Of the four fusaria that have been shown to cause soybean sudden death syndrome (SDS), field surveys indicate that Fusarium tucumaniae is the most important and genetically diverse SDS pathogen in Argentina. Although none of the SDS fusaria have been shown to produce perithecia in nature, a heterothallic sexual cycle has been demonstrated for F. tucumaniae via laboratory crosses. Herein we report on the discovery of perithecia of F. tucumaniae on soybean in Argentina. Ascospores derived from these perithecia gave rise to colonies that produced sporodochial conidia diagnostic of F. tucumaniae. Sporodochial conidia were longer and narrower than those produced by the other SDS fusaria; these conidia also possessed a diagnostic acuate apical cell and a distinctly foot-shaped basal cell. Sixteen strains derived from single ascospores subjected to a validated multilocus genotyping assay (MLGT) for SDS species determination, together with 16 conidial isolates from two sites where teleomorphs were collected, independently confirmed the morphological identification as F. tucumaniae. This study represents the first authentic report of sexual reproduction by a soybean SDS pathogen in nature.

Severe Outbreaks of Soybean Frogeye Leaf Spot Caused by Cercospora sojina in the Pampean Region, Argentina.

Frogeye leaf spot of soybean (Glycine max (L.) Merr.) caused by Cercospora sojina Hara was reported to be severe from 1998 to 1999 in northwest Argentina (2). Although the disease was detected at low prevalence (5 to 25%), incidence, and severity in the Pampean Region from 2005 to 2008, no severe outbreaks have been recorded in the provinces of Córdoba, Santa Fe, and Buenos Aires. During the 2008-2009 growing season, disease spread rapidly throughout most soybean-growing areas of the Pampean Region. Disease was observed on almost all varieties of maturity group (MG) III, IV, and V. Symptoms on leaves were circular, reddish brown-to-gray spots (1 to 6 mm) and bordered by typical, narrow, reddish purple margins. Morphology of the fungi was examined on infected tissues. Conidiophores were light-to-dark brown, fasciculate, geniculate, and measured 110 to 203 µm long. Conidia were 1 to 9 septate, hyaline, elongate to fusiform, and measured 26 to 111 (47.3 ± 14.7) × 5.2 to 7.4 µm (6.1 ± 0.7). Pathogenicity tests were conducted on seedlings of a susceptible cultivar by spraying leaves of each of 80 plants at the V3 growth stage with 18 ml of a conidial suspension (3 × 104 conidia/ml) with a hand-held atomizer. Plants were covered with plastic bags and placed in a greenhouse at 28 to 30°C for 48 h. The plastic bags were removed and plants were maintained in high humidity at the same temperature. The same number of noninoculated plants was used as controls. After 10 to 12 days, all inoculated plants showed typical symptoms. Koch's postulates were fulfilled by isolating C. sojina from inoculated plants. Control plants remained healthy. Foliar lesions and morphological characteristics of the pathogen were consistent with C. sojina (1). Disease assessments were made for the middle and upper canopy from 15 arbitrarily collected plants. Soybean plants were in growth stages between R3 and R5 during the survey. Incidence (percentage of plants affected) and severity (percentage of leaf area affected with lesions) were visually estimated from each of the 30 soybean-production fields located in Monte Cristo, Alta Gracia, Jesús María, W. Escalante, Monte Buey, (10 fields, Córdoba Province), Venado Tuerto, Villa Cañás, Cristophersen, María Teresa, (12 fields, Santa Fe Province), Pergamino, Rojas, and Salto (8 fields, Buenos Aires Province). Incidence was 100% in all fields from Córdoba and Santa Fe. Incidence in Buenos Aires was 0 to 100%. Highest severity levels were quantified from fields in Córdoba (severity of 30 to 60%). Lesions also developed on stems and pods. In samples from Buenos Aires, severity levels were ≤10% in the eight soybean fields. Number of lesions per leaflet was recorded from central leaflets in samples from Monte Cristo, Alta Gracia, Venado Tuerto, and María Teresa with 20 to 55 typical lesions per leaflet. Since the disease was always more important in northwest Argentina, genetic resistance is more commonly available in varieties of MG VII to VIII, so most of the varieties of MG III, IV, and V frequently planted in Pampean Region are susceptible. This fact in combination with rainfall, warm temperatures, and high relative humidity in no-till fields during this summer have encouraged the severe outbreak of frogeye leaf spot, especially in the province of Córdoba and in some regions of Santa Fe. References: (1) D. V. Phillips. Page 20 in: Compendium of Soybean Diseases. 4th ed. The American Phytopathological Society. St. Paul, MN, 1999. (2) D. L. Ploper et al. Plant Dis. 85:801, 2001.

Morphologic and Pathometric Characterization of the Asian Soybean Rust (Phakopsora pachyrhizi) on Kudzu (Pueraria lobata) in Argentina.

Asian soybean rust (ASR) is a very important disease caused by Phakopsora pachyrhizi. The disease has emerged as a major threat to soybean production in South America since 2001. During the 2003-2004 growing season, P. pachyrhizi spread rapidly throughout most soybean-growing areas of northwestern and northeastern Argentina (1). One widespread naturalized host in the northeastern part of the country is kudzu (Pueraria lobata). Plants of severely infected kudzu were sampled during January 2005 in Cerro Azul (29°29'S Misiones Province) to quantify P. pachyrhizi infection and morphologically characterize the fungus in leaves. The number of lesions, uredinia per cm2, and uredinia per lesion were recorded from the undersides of 50 leaflets that were visually showing rust symptoms. The average number of lesions and uredinia per cm2 was 14 (4 to 22), and 24 (5 to 78), respectively. The number of uredinia per lesion was 3 (1 to 10). Twenty leaflets from the lower canopy averaged 55 (42 to 78) uredinia per cm2. The average size of urediniospores was 18.4 µm wide (12.5 to 22.5) and 22.7 µm long (17.5 to 26.3). Although important epidemics of ASR have not been registered on soybean crops in January (2) because of adverse conditions, the fungus was observed on kudzu plants. To our knowledge, this is the first report of morphologic and pathometric characterization of P. pachyrhizi on kudzu in Argentina. References: (1) M. A. Carmona et al Plant Dis. 89:109, 2005. (2) SINAVIMO, Sistema Nacional Argentino de Vigilancia y Monitoreo de plagas. Roya de la soja: Resultados de la campaña 2004-2005. On-line publication. SENASA, 2005.

Asian Soybean Rust: Incidence, Severity, and Morphological Characterization of Phakopsora pachyrhizi (Uredinia and Telia) in Argentina.

Asian soybean rust (ASR), caused by Phakopsora pachyrhizi, is the most destructive disease of soybean (Glycine max) in many areas of the world. ASR was first detected in Argentina during 2002 in a limited area in the northern region of the country (2). During the 2004 growing season, P. pachyrhizi spread rapidly throughout most soybean growing areas of northwestern and northeastern Argentina. ASR was also was found in some fields in Entre Ríos and Santa Fe provinces. In all areas, symptoms were expressed late in the 2004 season (growth stages R5.5 to R7) and yield losses were minimal. The objectives of this study were to quantify P. pachyrhizi infection in the canopy and morphologically characterize the fungus from fields where it had been previously detected by polymerase chain reaction (PCR) (3). Incidence (percentage of plants affected) and severity (percentage of leaf area affected, including chlorosis) were visually estimated for 10 plants arbitrarily collected (April 2004) from each of three fields located in Charata (Chacabuco), Chaco Province (Sample 1, collected in the R6 stage), La Paloma (Moreno), Santiago del Estero Province (Sample 2, stage R6 to R7), and Tolloche (Anta), Salta Province (Sample 3, stage R5.5). Disease assessments were made for the lower, middle, and upper canopy from 15 leaves per plant. The number of pustules per cm2 and uredinia per lesion were recorded from the undersides of central leaflets for each trifoliolate observed. Tissue sections were made to observe fructifications of P. pachyrhizi. Incidence of affected plants was 100% in all fields. Disease severity for Sample 1 was 45% (range 30 to 60%), 20% (10 to 30%), and 10% (5 to 20%) for the lower, middle, and upper canopy, respectively; for Sample 2: 60% (30 to 80%), 40% (25 to 50%), and 25% (15 to 40%) for the lower, middle, and upper canopy, respectively; and for Sample 3: 25% (10 to 50%), 15% (10 to 20%), and 10% (5 to 15%) for the lower, middle, and upper canopy, respectively. The number of pustules per cm2 for Sample 1 was 156/cm2 (range 88 to 200); Sample 2: 172/cm2 (128 to 232); and Sample 3: 120/cm2 (72 to 232). The number of uredinia per lesion for Sample 1 was 6 per lesion (range 1 to 15); Sample 2: 5.5 per lesion (1 to 13), and Sample 3: 2.8 per lesion (1 to 5). The two spore types that were commonly observed were urediniospores and teliospores. Telia were found on infected leaves mixed with uredinia in every sample. Urediniospores measured 16 to 22 µm (mean 18.5 µm) × 25 to 30 µm (mean 27 µm). Teliospores measured 8 to 11 µm (mean 9 µm) × 19 to 27 µm (mean 23.8 µm). Spores sizes are in the range described by Ono et al. (1). To our knowledge, this is the first report of epidemiological and morphological characterization of ASR in Argentina and the first report of the telial stage of P. pachyrhizi on soybean in South America. References: (1) Y. Ono et al. Mycol. Res. 96:825, 1992. (2) R. L. Rossi. Plant Dis 87:102, 2003. (3) SINAVIMO, Sistema Nacional Argentino de Vigilancia y Monitoreo de plagas. Roya de la soja: Resultados de la campaña 2003-2004. On-line publication. SENASA, 2004.

Water activity of Spanish intermediate-moisture meat products.

On the basis of considering foods with water activity from 0·600 to 0·910 to be intermediate-moisture foods (IMF), we determined the water activity, pH, and some chemical parameters for 70 samples from 17 different selected types of Spanish intermediate-moisture meat products. Even though the salt content is the main water-activity depressor, the sodium chloride molality in the overall amount of water of the product cannot be used to calculate the a(w) value of these types of meat products of intermediate moisture.

Cerebral thrombosis and vasculitis: an uncommon complication of ulcerative colitis.

Cerebral thrombotic disease is a rare and nearly always fatal complication of ulcerative colitis. It is associated with a necrotizing vasculitis. We report a fatal case with a confusing neurologic picture arising from this complication. Autopsy revealed necrosis and hemorrhages affecting both cortical grey and white matter. Microscopic examination showed thrombosis of small and medium size vessels associated with hemorrhages and a necrotizing angiitis. Ulcerations, hemorrhages, pseudopolyps, and cryptic abscesses were found in the rectosigmoid region of the colon compatible with active ulcerative colitis. A sudden neurologic deficit in a patient with ulcerative colitis should direct attention to the consideration of a cerebral thrombotic event and the possibility of an associated cerebral vasculitis. Diagnosis may be strongly suggested by MRI or arteriography, but it may require confirmation by biopsy of the brain parenchyma and leptomeninges. A hypercoagulable state has been associated with the thrombosis. Anticoagulation has yielded successful results in some patients with cerebral thrombosis but the risk of massive intracranial and gastrointestinal bleeding preclude to establish clear indications. Neurologic improvement has been obtained with the use of steroids and cyclophosphamide.

Metabolic characteristics of the deltoid muscle in patients with chronic obstructive pulmonary disease.

The purpose of this study was to analyse key enzyme activities of the deltoid muscle (DM) in chronic obstructive pulmonary disease (COPD) patients. The activities of one oxidative enzyme (citrate synthase (CS)), two glycolytic enzymes (lacatate dehydrogenase (LD); and phosphofructokinase (PFK)) and one enzyme related to the use of energy stores (creatine kinase (CK)) were determined in the DM of 10 patients with COPD and nine controls. Exercise capacity (cycloergometry) and the handgrip strength were also evaluated. Although exercise capacity was markedly reduced in COPD (57 +/- 20% predicted), their handgrip strength was relatively preserved (77 +/- 19% pred). The activity of LD was higher in the COPD patients (263.9 +/- 68.2 versus 184.4 +/- 46.5 mmol x min(-1) x g(-1), p<0.01), with a similar trend for CS (67.3 +/- 33.3 versus 46.0 +/- 17.4 mmol x min(-1) x g(-1), p = 0.07). Interestingly, the activity of the latter enzyme was significantly higher than controls if only severe COPD patients were considered (81.8 +/- 31.2 mmol x min(-1) x g(-1), p < 0.01). PFK and CK activities were similar for controls and COPD. Chronic obstructive patients show a preserved or even increased (severe disease) oxidative capacity in their deltoid muscle. This coexists with a greater capacity in the anaerobic part of the glycolysis. These findings are different to those previously observed in muscles of the lower limbs.

Aberrant development of hippocampal circuits and altered neural activity in netrin 1-deficient mice.

Diffusible factors, including netrins and semaphorins, are believed to be important cues for the formation of neural circuits in the forebrain. Here we have examined the role of netrin 1 in the development of hippocampal connections. We show that netrin 1 and its receptor, Dcc, are expressed in the developing fimbria and in projection neurons, respectively, and that netrin 1 promotes the outgrowth of hippocampal axons in vitro via DCC receptors. We also show that the hippocampus of netrin 1-deficient mice shows a misorientation of fiber tracts and pathfinding errors, as detected with antibodies against the surface proteins TAG-1, L1 and DCC. DiI injections show that hippocampal commissural axons do not cross the midline in these mutants. Instead, when axons approach the midline, they turn ventrally and form a massive aberrant projection to the ipsilateral septum. In addition, both the ipsilateral entorhino-hippocampal and the CA3-to-CA1 associational projections show an altered pattern of layer-specific termination in netrin 1-deficient mice. Finally, optical recordings with the Ca(2+) indicator Fura 2-AM show that spontaneous neuronal activity is reduced in the septum of netrin 1-mutant mice. We conclude that netrin 1 is required not only for the formation of crossed connections in the forebrain, but also for the appropriate layer-specific targeting of ipsilateral projections and for the control of normal levels of spontaneous neural activity.

[Periodontal disease in Noonan's syndrome]. / Enfermedad periodontal en el síndrome de Noonan.

Two cases of non-related patients suffering from Noonan syndrome with characteristic data of the syndrome, had clinical and radiological evidence of very advanced periodontal disease. This disease seems to be unjustified because of the patients age and the lack of irritating local factors or systemic illnesses. A review of the literature showed no evidence of the periodontal disease as part of the syndrome.

[Angelman's syndrome (happy puppet) in 2 siblings. A follow-up over 10 years]. / Síndrome de Angelman (happy puppet) en dos hermanos. Seguimiento durante diez años.

The Angelman syndrome or "happy puppet" syndrome is a disorder of severe mental retardation, seizure, paroxysms of laughter, absent speech, jerky movements and ataxic gait. We present two sibs, man and woman, with this disorder, fact that support the possible autosomal recessive inheritance as a cause of this pathology, which hereditary mechanism is still a controversial point. Besides, we can observe different expression, being the woman more severely affected than the man. To our knowledge, this is the first mexican family reported with this syndrome, and with a ten years follow up. Chromosomal studies, with high resolution technique, were normal, we did not find the 15 chromosomic deletion referred as a possible cause in some cases, that is why it is undeniable that genetic heterogeneity exists in this syndrome.

Cerebral thrombosis and vasculitis: an uncommon complication of ulcerative colitis

Cerebral thrombotic disease is a rare and nearly always fatal complication of ulcerative colitis. It is associated with a necrotizing vasculitis. We report a fatal case with a confusing neurologic picture arising from this complication. Autopsy revealed necrosis and hemorrhages affecting both cortical grey and white matter. Microscopic examination showed thrombosis of small and medium size vessels associated with hemorrhages and a necrotizing angiitis. Ulcerations, hemorrhages, pseudopolyps, and cryptic abscesses were found in the rectosigmoid region of the colon compatible with active ulcerative colitis. A sudden neurologic deficit in a patient with ulcerative colitis should direct attention to the consideration of a cerebral thrombotic event and the possibility of an associated cerebral vasculitis. Diagnosis may be strongly suggested by MRI or arteriography, but it may require confirmation by biopsy of the brain parenchyma and leptomeninges. A hypercoagulable state has been associated with the thrombosis. Anticoagulation has yielded successful results in some patients with cerebral thrombosis but the risk of massive intracranial and gastrointestinal bleeding preclude to establish clear indications. Neurologic improvement has been obtained with the use of steroids and cyclophosphamide