Intracerebral Varicella Zoster Virus Vasculopathy in a Patient with Systemic Lupus Erythematosus and Imaging-Clinical Discordance.

BACKGROUND Varicella zoster virus (VZV) infection can increase the risk of cerebrovascular disease, involving small and large arteries, especially in immunosuppressed patients with ophthalmic division of the trigeminal nerve involvement. We present the case of a patient with intracerebral VZV vasculopathy without overt clinical manifestation but with abnormal imaging findings in the brain magnetic resonance (MR). CASE REPORT A 59-year-old woman with systemic lupus erythematosus (SLE), without other traditional cardiovascular risk factors, presented to the hospital due to headache, vertical diplopia, decreased of visual acuity of right eye, and disseminated varicella zoster virus (VZV) infection with predominant skin lesions distributed along the ophthalmic division of the right trigeminal nerve. Cerebrospinal fluid (CSF) testing revealed meningitis and positive polymerase chain reaction (PCR) for VZV, and a brain MRI scan showed a right occipital hemorrhagic lesion; thus, she was diagnosed with disseminated VZV infection with neurological involvement. She received intravenous acyclovir for 10 days. One month later, a physical examination was unremarkable and she was asymptomatic, but control brain MR angiography showed stenosis of the right internal carotid and the right middle cerebral artery, compatible with VZV vasculopathy. The PCR for VZV turned negative in CSF but the titers of anti-VZV IgG antibodies in CSF were high, and no increase of plasma autoimmune biomarkers were detected at any time in the course of the clinical evolution. CONCLUSIONS Discordance between imaging findings and clinical manifestations can appear in intracerebral VZV vasculopathy. A differential diagnosis is mandatory, especially if there is underlying immunosuppression.

Antiplatelet Therapy in a Patient with Coronary Artery Disease and Myelodysplastic Syndrome with Thrombocytopenia.

To date, there are no sufficient data to make firm recommendations on the treatment of patients with severe thrombocytopenia who require antiplatelet therapy after experiencing acute coronary syndrome. Therefore, we think that it is important to communicate the experience with individual cases. We report the case of a patient who presented with pericardial effusion causing cardiac tamponade. He had thrombocytopenia associated with myelodysplastic syndrome, and ten weeks before this admission, percutaneous transluminal coronary angioplasty with implantation of drug-eluting stents was performed for non-ST-segment elevation acute coronary syndrome. Platelets in myelodysplastic syndromes are dysfunctional, which exacerbates bleeding from thrombocytopenia, and the management of atherosclerotic cardiovascular disease in these patients is challenging.

Causes and factors related to dopamine agonist withdrawal in Parkinson's disease.

BACKGROUND: Although dopamine agonists (DAs) are useful in Parkinson's disease (PD), they are not frequently used in elderly patients due to adverse effects. However, there is a lack of evidence because few elderly PD patients are enrolled in clinical trials. AIMS OF THE STUDY: The aims of this study were to analyze the reasons of DA withdrawal (DAW) in a group of PD patients in clinical practice and to identify the related factors. Specifically, we studied the effect of age, comorbidity, and polypharmacy as potential risk factors for DAW. METHODS: A retrospective chart review of the follow-up (from May, 2012 to March, 2015) of a subgroup of PD patients receiving a DA (n = 68; 60.3% males, 69.3 ± 9.2 years old) from a cohort (n = 150) previously studied in detail in 2012 was used to identify predictive factors of DAW. RESULTS: The DAW percentage was 18.2% (12/66; follow-up of 690.2 ± 232.6 days). DAW causes were cognitive impairment (3), reduction therapy (3), hallucinations (2), dyskinesia (2), and excessive diurnal somnolence (2). Only a higher levodopa daily dose (HR 1.003; 95% CI 1.001-1.006; P = 0.044) was an independent predictor of DAW after adjustment for other explanatory variables. CONCLUSIONS: The frequency of DAW was low. Advanced age alone is not a contraindication to the administration of DAs.