Low serum vitamin B12 in alzheimer’s patients as detected by a solid phase radioimmunoassay.

Objective: To determine the relationship between serum levels of vitamin B12 and folate in AD and other types of dementia in Thai patients. Methods: One hundred and eleven Thai subjects were classified into 3 groups: 32 AD patients, 43 non-AD dementia patients and 36 age-matched controls. Serum concentrations of vitamin B12 and folate were measured using a solid phase radioimmunoassay. Results: Serum vitamin B12 levels were found to be significantly lower in AD and non-AD dementia patients than in age-matched controls. There is a significant relationship between Mini-Mental State Examination score and vitamin B12 level in AD and non-AD dementia groups. However, there is no significant difference in serum folate in AD and non-AD dementia groups when compared to age-matched controls. Conclusion: These findings suggest the need for vitamin B12 supplementation in AD and non-AD dementia patients.

Prevalence of depression among epileptic patients at Phramongkutklao Hospital.

OBJECTIVES: To determine the prevalence of depression among epileptic patients in Phramongkutklao Hospital and to find the factors associated with depression. MATERIAL AND METHOD: One hundred and ten epileptic patients were enrolled and 60 patients met the inclusion criteria. These subjects were screened with Thai Geriatric Depressive Scale (TGDS) and were interviewed. Demographic data that effect depression were evaluated. RESULTS: During the 1-year study period, 60 of 110 patients diagnosed epilepsy were eligible. Prevalence of depression was 38.3%, which is similar to previous studies. Mild depression was found in 65.2% and moderate 34.8%, without severe depression. Comparing between male and female, there was no statistical significant difference (p = 0.75). The age group that compared between age equal or less than 25 years and more than 25 years had no statistical significant difference (p = 0.77). Other variables were not found to be significant risk factors of depression among epileptic patients including duration of seizures [equal or less than 5 and more than 5 per year (p = 0.43)], type of seizures [generalized tonic-clonic seizures and partial seizures (p = 0.69)], and number of antiepileptic drugs [monotherapy and polytherapy (p = 0.44)]. CONCLUSION: Prevalence of depression among epileptic patients was 38.3%, divided between mild (65.2%) and moderate (34.8%). There were no significant risk factors correlated with depression. Epileptic patients should be made aware of this and seek prompt treatment for depression.

Rapid detection of apolipoprotein E genotypes in Alzheimer's disease using polymerase chain reaction-single strand conformation polymorphism.

Apolipoprotein E (APOE) gene on chromosome 19q13.2 is encoded by three common alleles designated as epsilon2, epsilon3 and epsilon4. In Alzheimer's disease (AD) the epsilon4 allele is over-represented and is considered to be a major genetic risk factor. Several methods have been developed to determine APOE genotypes. Among them, polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) appears to be highly reliable. In this study, we improved the nonisotopic PCR-SSCP method for determining APOE genotypes in 42 cases of AD patients, 40 cases of non-AD dementia patients, and 49 cases of age-matched controls. DNA from the target sequence on APOE was amplified by PCR from peripheral blood genomic DNA. PCR products were electrophoresed in a non-denaturing polyacrylamide gel and visualized by silver staining. We found that the epsilon4 allele had a significantly high frequency of occurrence in AD patients (33.3%) compared with age-matched controls (13.3%) (chi(2) = 10.43, p = 0.001) and non-AD dementia (10%) (chi(2) = 13.02, p<0.001) whereas the epsilon3 allele was of high frequency in non-AD dementia (90%) compared with age-matched controls (85.7%) and AD patients (66.7%). APOE epsilon4 homozygotes were found only in AD groups. On the other hand, the epsilon2 allele was found only in an age-matched control. This study confirmed that the APOE psilon4 allele is a risk factor in Thai AD subjects and that the PCR-SSCP method is a rapid and useful means of detecting the APOE genotype in AD.

Dural sinus thrombosis in melioidosis: the first case report.

Melioidosis which is infection with Burkholderia pseudomallei, is an important cause of sepsis in India, southeast Asia and northern Australia. Mortality is high and treatment is problematic. Neurological melioidosis is unusual but meningoencephalitis, encephalomyelitis and brain microabscess can occur Dural sinus thrombosis is not an uncommon cerebrovascular disorder with various etiologies. Hypercoagulable state, pregnancy, dehydration, certain blood dyscrasia and contraceptive pills are common causes however meningitis and local head & neck infections may lead to this condition. Dural sinus thrombosis complicating septicemic melioidosis has never been reported. The authors report a 42-year-old Thai man suffering from septicemic melioidosis with dural sinus thrombosis. He had high fever, headache, left hemiparesis, focal seizure and increased intracranial pressure. Diabetes and mild alcoholic cirrhosis were diagnosed in this admission. CT scan, MRI brain and MRV revealed superior saggital sinus thrombosis with complicating venous infarction over right posterior parietal lobe. Hemoculture demonstrated Burkholderia pseudomallei and CSF was acellular Investigations for causes of dural sinus thrombosis were all negative. This patient gradually improved after treatment with ceftazidime, antiepileptic drug and heparin without clinical recurrence. Neuromelioidosis is a rare syndrome that may present as brain abscess, encephalitis or meningoencephalitis. The authors report dural sinus thrombosis associated with septicemic melioidosis. The authors' hypothesis of venous thrombosis in the presented case is sepsis induced hypercoagulable state. Physicians should be aware of cerebral venous thrombosis in case of suspicious melioidosis with neurological involvement. Prompt treatment with intravenous heparin and antibiotic is potentially effective.

Successful epidural blood patch treatment for spontaneous low cerebrospinal pressure headache with multiple leakages in lumbar spinal matter.

The authors reported a 54 year-old Italian woman with headache attributed to spontaneous low cerebrospinal pressure and normal brain magnetic resonance imaging. Lumbar puncture was done and opening pressure was not measurable. 99mTc radionuclide cysternography was used in diagnosis and demonstrated 3 lumbar leakages and early appearance of bladder activity. Epidural blood patch was performed. This option was safe and successful to treat this kind of headache without relapse of symptoms after 3 years follow-up.

Comparison between aspirin combined with dipyridamole versus aspirin alone within 48 hours after ischemic stroke event for prevention of recurrent stroke and improvement of neurological function: a preliminary study.

OBJECTIVES: To determine efficacy and tolerability of aspirin plus dipyridamole (combination) versus aspirin alone in acute intervention treatment after acute ischemic stoke among Thai patients. MATERIAL AND METHOD: This pilot study enrolled ischemic stroke patients within 48 hours and randomized to aspirin 300 mg/d or combination (aspirin 300 mg/d+ standard release dipyridamole 75 mg thrice a day) and followed up for 6 months. Endpoints were recurrent ischemic stroke, transient ischemic attack and vascular death. Side effects were recorded. National Institutes of Health Stroke Scale was assessed at entry and at 6 months period for determining neurological functions. RESULTS: Of 38 patients, mean age was 64.3 years. Male and female were 52.6% and 47.4% respectively. There were 18 patients in the aspirin group and 20 patients in the combination group. No patient developed end point events or no significant adverse event in both groups. The combination group showed more improvement in neurological function than the aspirin group (p-value 0.009). CONCLUSION: This pilot study showed equal efficacy and tolerability of the combination group and aspirin alone in acute intervention treatment for prevention of recurrent stroke or vascular death within 6 months.

Factors influencing MMSE-T score among Thai subjects.

OBJECTIVES: To explore association of variables influencing MMSE-Thai version (MMSE-T) score among Thai subjects. MATERIAL AND METHOD: 365 general non dementia Thai subjects of age 45-87 years were randomly recruited in Bangkok. All subjects were screened with MMSE-T and interviewed. Demographic factors that might affect the score of MMSE-T were collected. Relationship between demographic variables and MMSE-T score were evaluated. RESULTS: Of 365 subjects, mean MMSE-T score was 27.2 and ranged 17-30. There were 27 cases (7.44%) with MMSE-T score < or = 23. Subjects who had a score < or = 23, were 18 cases (27.69%) and 9 cases (3.01%) in education level less than bachelor degree and at least bachelor degree respectively (p value <0.001). By linear regression analysis, the factors significantly affected the lower score were age higher than 60 years (p=0.017) and education below bachelor degree (p<0.001). CONCLUSION: Factors including elderly and low education were negatively influenced on MMSE-T performance among Thai subjects.

Spinal cord compression and bilateral sensory neural hearing loss: an unusual manifestation of neurocysticercosis.

Neurocysticercosis is the most common parasitic infestation involving the central nervous system in tropical countries. Common presentations are seizure, meningitis and increased intracranial pressure. The authors report a case of a 52-year-old woman with racemose neurocysticercosis in the subarachnoid space at the cistern of the brain through the lumbar cistern. She presented with progressive paraparesis due to spinal cord compression and finally had progressive bilateral sensori-neural hearing loss. MRI brain and the whole spinal cord revealed numerous rim-enhancing cystic lesions at the basal cistern, prepontine cistern, bilateral cerebellopontine angle, internal acoustic canals, intramedullary lesion at the 5th cervical spinal level, lumbar cistern lesions and secondary syringomyelia at the thoracic spinal cord. The histopathologic examination confirmed cysticercosis. After treatment by albendazole and surgical removal, she still developed recurrent spinal compression at a higher level and obstructive hydrocephalus. Finally, she died from status epilepticus and septic shock.