ABSTRACT
A 76-year-old man, diagnosed with chronic myeloid leukemia in 2010, had been on nilotinib for 7 years. He presented with right hemiparesis in September 2017. He had no history of hypertension, diabetes, hyperlipidemia, heart disease, or smoking. Brain MRI revealed a border-zone infarction of the left cerebral hemisphere and a rapidly progressing severe left internal carotid artery (ICA) stenosis. He was initiated on clopidogrel and bosutinib instead of nilotinib. He presented with right hemiparesis once again in December 2017. Brain MRI revealed the border-zone infarction of the left cerebral hemisphere and a more progressed, severe bilateral ICA stenosis. A carotid ultrasound demonstrated iso-intense and concentrically narrowed ICA on both sides. Carotid artery stenting of the left ICA was performed in February 2018, and clopidogrel was replaced by cilostazol to provide a drug-induced rush. Carotid artery stenting of the right ICA was performed in June 2018 and cervical angiogram demonstrated that there were no residual artery stenoses in the bilateral stent. In recent years, several case reports suggest that tyrosine kinase inhibitors (TKIs) are associated with progressive artery stenosis and cause cerebral infarction. Brain imaging tests should be conducted to evaluate arterial stenosis progression for patients with a history of taking TKI when an arterial vascular event occurs.
Subject(s)
Aniline Compounds/administration & dosage , Aniline Compounds/adverse effects , Cerebral Infarction/chemically induced , Enzyme Inhibitors/administration & dosage , Enzyme Inhibitors/adverse effects , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Nitriles/administration & dosage , Nitriles/adverse effects , Protein-Tyrosine Kinases/antagonists & inhibitors , Pyrimidines/administration & dosage , Pyrimidines/adverse effects , Quinolines/administration & dosage , Quinolines/adverse effects , Administration, Oral , Aged , Carotid Artery, Internal , Carotid Stenosis/chemically induced , Carotid Stenosis/surgery , Cerebral Infarction/diagnostic imaging , Clopidogrel/administration & dosage , Diffusion Magnetic Resonance Imaging , Humans , Male , Recurrence , StentsABSTRACT
BACKGROUND: Falls and fractures due to impaired balance in patients with Alzheimer's disease (AD) have an adverse effect on the clinical course of the disease. OBJECTIVE: To evaluate balance impairment in AD from the viewpoint of vestibular functional impairment. METHODS: The subjects were 12 patients with AD, 12 dementia-free elderly adults, and 12 younger adults. Vestibular function was assessed using a stepping test, caloric nystagmus, and a visual suppression (VS) test. RESULTS: The stepping test was abnormal in 9 of the 12 patients in the AD group. An abnormal stepping test was not associated with self-reported dizziness or tendency to fall. Significant VS abnormalities were present in the AD group. The suppression rate of VS was lower in AD patients with either a tendency to fall or constructional apraxia than in AD patients without either. The velocity of the rapid phase of caloric nystagmus before the VS test was similar in the AD group and the elderly control group. Significant abnormalities of both caloric nystagmus and VS were not present in either the elderly or the younger control groups. CONCLUSION: AD could involve impairments in the vestibular control of balance. The VS test is useful for assessing the tendency to fall in AD. Impairment of VS in AD might arise from cerebral vestibular cortex impairment rather than comorbid peripheral vestibular disorders.
Subject(s)
Alzheimer Disease/complications , Vestibular Diseases/etiology , Acoustic Stimulation , Age Factors , Aged , Aged, 80 and over , Alzheimer Disease/diagnostic imaging , Alzheimer Disease/drug therapy , Antipsychotic Agents/therapeutic use , Brain/diagnostic imaging , Brain/pathology , Female , Humans , Iofetamine/metabolism , Male , Nystagmus, Physiologic/physiology , Postural Balance , Psychiatric Status Rating Scales , Statistics, Nonparametric , Tomography, Emission-Computed, Single-Photon , Vestibular Diseases/diagnosis , Young AdultABSTRACT
A 38-year-old Japanese man with Nasu-Hakola disease (NHD) had repeated pathological fractures and frontal lobe symptoms which developed when he was 18 and 26 years old, respectively. Neuropsychological testing showed memory impairment, and in particular, visuo-spatial memory at the age of 35. Furthermore, single-photon emission computed tomography revealed precuneus hypoperfusion. The patient later suffered prolonged convulsive seizures, which left him in a persistent vegetative state. Genetic testing confirmed a heterozygous mutation in the DAP12 gene (a single-base deletion of 141 G in exon 3) specific to NHD. Precuneus dysfunction might contribute to characteristic memory impairment of NHD.
