RESUMEN
INTRODUCTION: Vascular calcifications, primarily in the aorta and its proximal branches, are commonly observed among subjects with impaired bone health. In this study, we sought to determine if a comparable association holds true for the calcifications in the intracranial internal carotid arteries (IICA), in general and also for particular calcification patterns. METHODS: A consecutive series of ischemic stroke patients were prospectively enrolled into the study, where computed tomography angiography source images were used to determine the presence and type of IICA calcifications, and dual-energy X-ray absorptiometry was used to determine the bone mineral density in the left femoral neck region. IICA calcifications were categorized as none, intimal, medial, and mixed types based on previously validated classification schemes. Their relationships with femoral bone T-scores were evaluated by bivariate and multivariate analyses. RESULTS: Femoral neck T-score was highest among patients without any vascular calcifications (n=65), when compared to the bone density measures among patients with any type of calcification (n=185) (p<0.001). After adjustment for age, gender, vascular risk factors, and serum biomarkers related to bone health, the T-score remained significantly associated only with the pattern of intimal calcification [OR 0.63 (0.42 - 0.95), p=0.028]. CONCLUSIONS: Our findings suggest that the intracranial vasculature, in particular the internal carotid arteries, is not immune to the interplay between suboptimal bone health and vascular calcifications. This association was most robust for an intimal type of IICA calcification pattern, while no such relationship could be demonstrated for other types of vascular calcifications.
RESUMEN
The awareness of the "Cerebellar Cognitive Affective Syndrome" (CCAS) as a clinical entity is emerging. The CCAS is characterized by impaired executive functions, linguistic skills, visuospatial cognition and personality change. Here we report a 56-year-old, male teacher who developed acute psychomotor retardation, low energy level, infrequent speech, and mild cognitive decline. Two months before admission, he was initially diagnosed as depression, and later misdiagnosed as encephalitis, which misled him to receive high-dose intravenous steroids and antimicrobial drugs. The Brain MRI revealed multiple posterior cerebellar infarcts predominantly at the lobules VII and VIII. The standard neuropsychological tests were unremarkable; however, the CCAS Scale confirmed the diagnosis. The treatment of depression and secondary prevention of stroke was conducted. In cases that present with features of cognitive and affective disorders but with mild voluntary motor or without typical cerebellar features, the role of posterior cerebellar and vermian pathologies should be considered. The CCAS Scale is an appropriate screening tool to detect these patients and provides a framework for evidence-based treatment.
