RESUMEN
In about 10% of cases, tick-borne encephalitis (TBE) presents with additional myeloradiculitic features mimicking acute poliomyelitis, which can rarely appear as the sole symptom. We report on a 59-year-old man infected with TBE in Thuringia,Germany, who developed polyradiculitis with rapidly progressive, predominantly proximal tetraparesis and respiratory failure. We discuss the differential diagnosis and the epidemiological relevance in conjunction with a second typical case of TBE acquired in the same region and time period.
Asunto(s)
Encefalitis Transmitida por Garrapatas/diagnóstico , Polirradiculopatía/diagnóstico , Anticuerpos Antivirales/sangre , Especificidad de Anticuerpos/inmunología , Antígenos Virales/sangre , Terapia Combinada , Diagnóstico Diferencial , Progresión de la Enfermedad , Virus de la Encefalitis Transmitidos por Garrapatas/inmunología , Encefalitis Transmitida por Garrapatas/inmunología , Encefalitis Transmitida por Garrapatas/terapia , Humanos , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad , Examen Neurológico , Poliomielitis/diagnóstico , Polirradiculopatía/inmunología , Polirradiculopatía/terapiaRESUMEN
Iron may play an important role in the pathogenesis of Parkinson's disease (PD). Recent studies have shown that the iron-transporting glycoprotein lactoferrin (LF) and its receptor are increased in the substantia nigra (SN) in PD. We investigated whether plasma levels of LF are altered in dopa-responsive PD. Plasma LF was not different between patients with PD (n = 23; 306 +/- 116 [mean +/- standard deviation] ng/ml) and age- and sex-matched healthy control subjects (n = 15; 359 +/- 126 ng/ml ). However, LF was inversely correlated with PD severity (r = -0.68, P = 0.002), an association that remained significant after adjustment for treatment with levodopa, monoaminooxidase inhibitors, and dopa agonists (r = -0.53, P = 0.017). Plasma transferrin and ferritin levels were not different between groups and neither correlated with disease severity nor with LF levels. Together with the result of increased nigral lactoferrin, this finding is compatible with the hypothesis of an imbalance between LF levels in blood and SN in progressing PD. Larger and particularly longitudinal studies and measurements of LF in cerebrospinal fluid are warranted to further examine the role of LF in PD.
Asunto(s)
Lactoferrina/sangre , Enfermedad de Parkinson/sangre , Dopamina/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Sustancia Negra/metabolismo , Transferrina/metabolismoRESUMEN
BACKGROUND AND PURPOSE: Only a few clinical reports about the routine use of intravenous rt-PA for the treatment of acute ischemic stroke have been published. Wether the perfusion of the extracranial parts of the internal carotid artery influences the outcome of the patients is still unknown, because the two major studies about systemic thrombolytic therapy with rt-PA in stroke (ECASS and NINDS) did not formally assess the status of the extracranial vessels. METHODS: 56 Patients were treated with intravenous rt-PA within 6 h of acute ischemic stroke between January 1995 and May 1998. Before and within 24 h after the thrombolytic therapy usually a neurovascular diagnostic with extra- und transcranial Doppler-ultrasound or CT-angiography was performed. Occlusions of the intracranial parts of the internal carotid artery (Carotid-T) were excluded from thrombolytic therapy. The outcome was assessed using the Rankin-scale at least 3 month after the therapy. RESULTS: The average time from stroke onset to administration of treatment was 3.7 h.A parenchymal hemorrhage with clinical deterioration was found in four patients (7.1%). Eight patients died until the follow-up (14.3%), four within 14 days. 39 patients showed a clinical improvement. Outcome and recanalization rate of the medial cerebral artery was not influenced by stenoses or occlusions of the extracranial internal carotid artery. CONCLUSIONS: Routine intravenous use of rt-PA for acute ischemic stroke shows safety comparable to the results of the NINDS study even in 6 h time window. The outcome and recanalization rate depends not on the perfusion of the extracranial parts of the internal carotid artery.
Asunto(s)
Trombosis de las Arterias Carótidas/terapia , Infarto Cerebral/terapia , Terapia Trombolítica , Activador de Tejido Plasminógeno/administración & dosificación , Enfermedad Aguda , Trombosis de las Arterias Carótidas/diagnóstico , Arteria Carótida Interna , Infarto Cerebral/diagnóstico , Femenino , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Activador de Tejido Plasminógeno/efectos adversos , Resultado del TratamientoRESUMEN
Thrombolytic therapy in acute ischemic stroke is safe and effective in a defined subgroup of stroke patients. Until now, different fibrinolytic substances including urokinase, streptokinase and recombinant tissue plasminogen activator (rt-PA) have been tested regarding safety, efficacy, dosage and economic parameters in patients suffering from both carotid and basilar artery territory strokes. Recently, two large multicenter placebo-controlled intravenous rt-PA studies were published. The results show that thrombolysis of acute carotid territory strokes (European Cooperative Acute Stroke Study) and of strokes with a deficit measurable on the NIH Stroke Scale (National Institute of Neurological Disorders and Stroke rt-PA Stroke Study) improves clinical and economic outcome parameters in patients who were treated within 6 hours of the onset of symptoms and had that no signs of extended early infarction on the initial CT-scan. The occurrence of intracranial hemorrhages is more frequent after thombolytic therapy, but the majority of bleeding complications referred to petechial or more confluent hemorrhage limited to the infarcted tissue, without clinical deterioration. However, the identification of the appropriate patients is difficult and depends on the level of clinical and diagnostic experience. In vertebrobasilar artery territory stroke, local intraarterial thrombolysis with urokinase or streptokinase is performed in most cases. Thrombolytic treatment within twelve hours of the onset of symptoms was associated with significantly better results concerning both survival and neurological recovery.