Dietary cholesterol, fats and risk of Parkinson's disease in the Singapore Chinese Health Study.

BACKGROUND: Prospective studies on lipids and risk of Parkinson's disease (PD) in Asian populations are sparse. This study prospectively examined the associations between dietary cholesterol and major fatty acids, and risk of PD among the Chinese in Singapore. METHODS: This study used data from the Singapore Chinese Health Study, a population-based prospective cohort of 63 257 men and women aged 45-74 years in Singapore enrolled in 1993-1998. Dietary intakes of cholesterol and fatty acids were derived from a validated semiquantitative food frequency questionnaire and the Singapore Food Composition Table. Incident PD cases were identified either through follow-up interviews or record linkage analysis with hospital discharge and PD outpatient registries. RESULTS: After an average of 14.6 years, 218 men and 193 women in the cohort developed PD. Dietary cholesterol was associated with statistically significantly lower risk of PD in a dose-dependent manner among men after adjustment for established risk factors for PD and intakes of major fatty acids. Compared to the lowest quartile, HR (95% CI) for the highest quartile was 0.53 (95% CI 0.33 to 0.84) (P for trend=0.006). Among women, dietary monounsaturated fatty acid was inversely associated with PD risk (P for trend=0.033). Compared to the lowest quartile, HR for the highest quartile was 0.44 (95% CI 0.22 to 0.88). There was no statistically significant association between dietary saturated, n-3 and n-6 fatty acids and PD risk. CONCLUSIONS: Higher intakes of cholesterol and monounsaturated fatty acids may reduce risk of PD in men and women, respectively.

The 2-Year Outcomes Comparison between Ischemic Stroke Patients with Intracranial Arterial Stenosis without Significant Extracranial Carotid Stenosis and Patients with Extracranial Carotid Stenosis.

OBJECTIVE: The risk of recurrent ischemic stroke and acute coronary syndrome increased in the large artery atherosclerotic subtype. The purpose of this study was to compare 2-year outcomes between the ischemic stroke patients with intracranial arterial stenosis without significant extracranial carotid stenosis and the patients with extracranial carotid stenosis. MATERIAL AND METHOD: This study prospectively compared 123 ischemic stroke patients: 71 patients with intracranial arterial stenosis without significant extracranial carotid stenosis and 52 patients with extracranial carotid stenosis. Neurologic and radiologic investigations were performed at the beginning of the study. All of them were treated as regular outpatients of the neurology unit with a mean follow-up of 24 months. Recurrent stroke, myocardial infarction, and death were recorded. RESULTS: Fifteen patients of the extracranial carotid stenosis group and eighteen patients ofthe intracranial arterial stenosis without significant extracranial carotid stenosis group developed recurrent stroke during follow-up (p = 0.40). Acute coronary syndrome occurred in eight patients of the extracranial carotid stenosis group and only one of the intracranial arterial stenosis without significant extracranial carotidstenosis group (p = 0.004). Causes of death were end stage cancers, stroke and related conditions, and acute coronary syndrome. The multivariate analysis showed that symptomatic extracranial carotid stenosis is an important risk factor of the acute coronary syndrome (p = 0.03, OR = 10.81, 95% CI 1.23-94.77). CONCLUSION: There was no significant difference of recurrent ischemic stroke and recurrent stroke between patients with intracranial arterial stenosis without extracranial carotid stenosis and patients with extracranial carotid stenosis. On the other hand, patients with extracranial carotid stenosis had more incidences of acute coronary syndrome significantly than patients with intracranial arterial stenosis.

Blepharoclonus: anatomical localization and etiological consideration..

Blepharoclonus refers to myoclonic rhythmic eyelid closure. This is an extremely rare abnormal movement of the eyelids. The symptom has an ill-defned anatomical localization and hypothesized etiologies are diverse. We describe a 42 year-old woman with known poorly controlled hypertension (HTN) who presented with a three-week history ofataxia, dysmetria, and uncontrolled eyelid twitching. The bilateral abnormal eyelid movement occurred during either eyelid closure or opening, and was compatible with blepharoclonus. MRI revealed multiple cerebral infarctions at red nucleus, dentate nucleus, and inferior olives. These foci are within Guillain-Mollaret's triangle. The ataxia and dysmetria gradually improved within three weeks. While the blepharoclonus improved, it persisted after one year offollow-up. Our conclusion was one of HTN leading to a lacunar infarct that manifested partially as blepharoclonus. Due to the neuroimaging findings and clinical course, we propose that blepharoclonus may be a variant ofpalatal myoclonus and may be considered as another lacunar syndrome.

Transverse Myelitis in Acute Hepatitis A Infection: The Rare Co-Occurrence of Hepatology and Neurology.

Transverse myelitis refers to the inflammatory process involving the spinal cord. Clinical features can be either acute or subacute onset that results in neurological deficits such as weakness and/or numbness of extremities as well as autonomic dysfunctions. While there are some etiologies related, a viral infection is common. However, the hepatitis A virus rarely causes myelitis. This report provides details of a hepatitis A infectious patient who developed myelitis as comorbidity. Although, the disability was initially severe, the patient successfully recovered with corticosteroid treatment.

Movement Disorders in Non-Wilsonian Hepatic Cirrhotic Patients: The Subgroup Analysis of Various Phenotypes and Associated Risk Factors.

OBJECTIVE: The aim of this subgroup analysis was to identify the risk factors associated with the development of various movement disorder phenotypes. METHODS: Eighty-three non-Wilsonian cirrhotic patients with abnormal movements were allocated into the following groups: intention tremor, bradykinesia, Parkinsonism, and abnormal ocular movements. These movement types were considered the primary outcomes as there was a sufficient sample size. Researchers took into consideration the gender, etiologies of cirrhosis, cirrhosis-related complications, hepatic encephalopathy, medical illness, and some neurological deficits as potential factors associated with these movement disorders. RESULTS: The male gender (p = 0.002) and alcoholic cirrhosis (p = 0.005) were significant factors for the prevalence of intention tremors. In bradykinesia, hepatic encephalopathy was highly statistically significant (p < 0.001), and females more commonly developed bradykinesia (p = 0.04). The Parkinsonism features in this study were confounded by hyperlipidemia (p = 0.04) and motor or sensory deficits (p = 0.02). Jerky pursuits and a horizontal nystagmus were detected. Jerky pursuits were significantly related to hepatic encephalopathy (p = 0.003) and bradykinesia, but there were no factors associated with the prevalence of nystagmus other than an intention tremor. CONCLUSIONS: The association of alcoholic cirrhosis with the development of intention tremor indicates that the persistent cerebellar malfunction in cirrhotic patients is due to alcohol toxicity. The slowness of finger tapping and jerky pursuit eye movements are significantly associated with hepatic encephalopathy. Thus, further studies are needed to evaluate the diagnostic value of these two signs for an early detection of mild hepatic encephalopathy.

Movement Disorders in Non-Wilsonian Cirrhotic Patients: A Report of the Prevalence and Risk Factors from a Study Done in a Medical School in an Agricultural-Based Community.

OBJECTIVE: Parkinsonism and other movement disorders have previously been reported in the acquired hepatocerebral degeneration associated with portosystemic shunting. However, there is no study to date about their prevalence as has been noted in general practice. METHODS: One hundred and forty-three patients with hepatic cirrhosis from the gastroenterology clinic and internal medicine wards were enrolled. Liver data included the diagnoses, etiologies, assessments of complications, and treatments for cirrhosis. Hepatic encephalopathy was classified with regard to the West Haven criteria for semi-quantitative grading for mental status. Neurological examination results and abnormal involuntary movements were recorded as primary outcomes. Neuro-radiology was used for the detection of severe brain lesions. RESULTS: Alcoholism was the most common cause of liver cirrhosis. Eighty-three patients (58%) presented with movement disorders. Asterixis was found in one of the cases. The most common movement disorder seen was an intentional tremor at 37.1%, which was followed by bradykinesia, Parkinsonism, and postural tremors at 29.4%, 10.5%, and 6.3%, respectively. The prevalence of movement disorders simultaneously increased with a high Child-Turcotte-Pugh score. The hepatic encephalopathy was grade 1 and 2. With the inclusion of age-range adjustments, we found that alcoholic cirrhosis and hepatic encephalopathy are statistically significant factors [p < 0.05, odds ratio (OR) = 6.41, 95% confidence interval (CI) 1.38-29.71 and p < 0.001, OR = 13.65, 95% CI 4.71-39.54] for the development of movement disorders in non-Wilsonian cirrhotic patients. CONCLUSIONS: Intentional tremor is a common abnormal movement. Alcoholic cirrhosis and hepatic encephalopathy are significant risk factors in the development of movement disorders in non-Wilsonian cirrhotic patients.