Eosinophilic Granulomatosis With Polyangiitis Presentation After Nandrolone Withdrawal.

A 41-year-old man was admitted to the Emergency Department with bilateral numbness in lower extremities and left femoral palsy. He also reported constitutional symptoms, vomiting and non-bloody diarrhoea for the last several months. He had a previous history of eosinophilic asthma with erratic follow-up. During admission, eosinophil count was 66% of white blood cells. Sural nerve biopsy revealed vasculitis with eosinophilic infiltration. Further evaluations consisted of colonoscopy and nasal endoscopy that confirmed eosinophil infiltrates on colonic ulcers and nasal polypi. The patient was started on systemic corticosteroids and cyclophosphamide. Among his personal records, he had been taking nandrolone decanoate without medical prescription, and had withdrawn a few years before the first asthma exacerbation.

Plasma exchange in acute attacks of demyelinating diseases of the central nervous system: clinical outcomes and predictors of response.

BACKGROUND: Plasma exchange (PLEX) is a therapeutic option in the treatment of acute attacks of Demyelinating Diseases of the Central Nervous System (DDCNS). Factors related with PLEX response are not well established. METHODS: Descriptive and retrospective study. We included patients treated with PLEX for acute attacks of DDCNS between 2008 and 2017. We recorded demographics, clinical and treatment-related data, and Expanded Disability Status Scale (EDSS) score at admission, at discharge, and at 6 months. RESULTS: We included 64 patients. Forty-eight (75%) were female with a mean age of 48.28 ± 11.5 years. Half of our patients were diagnosed with multiple sclerosis. Clinical improvement was achieved in 51.6% at discharge and 62.5% at 6 months. The logistic regression model showed that EDSS score > 3 at admission (p = 0.04) and early clinical improvement with PLEX (p = 0.00) were predictors of good response to PLEX at discharge and at 6 months, respectively. No serious adverse effects were identified. CONCLUSIONS: PLEX is a safe and effective treatment for acute attacks of DDCNS. EDSS score at admission and early clinical improvement with PLEX were factors associated with good response to PLEX.

Deterioro cognitivo en el paciente muy anciano: estudio retrospectivo en una consulta de neurología / Cognitive impairment in very elderly patients: a retrospective study in a neurology service

Introducción. Una considerable proporción de pacientes muy ancianos con deterioro cognitivo son atendidos en las consultas generales de neurología, pero existen pocos estudios acerca de las características clínicas de estos pacientes. Objetivo. Describir los antecedentes y rasgos clínicos de los pacientes muy ancianos que acuden a consulta general de neurología por quejas o sospecha de deterioro cognitivo. Pacientes y métodos. Se estudio retrospectivamente a 336 pacientes (296 pacientes < 85 años frente a 40 pacientes ≥ 85 años) que habían sido remitidos en su mayoría desde la atención primaria. El rendimiento cognitivo se midió mediante el test minimental de Folstein, y la situación clínica global (cognitiva y funcional), mediante la escala de estatificación clínica de la demencia. Resultados. Los pacientes de más edad presentaban con mayor frecuencia deterioro cognitivo (alteración cognitiva leve o demencia), tanto en la primera visita como en la visita de seguimiento al cabo de un ano (p < 0,0005). No se encontraron diferencias en el tiempo desde el inicio de los síntomas (2,0 +/- 2,1 frente a 1,5 +/- 1,4 años), el tipo de síntomas ni la comorbilidad. La enfermedad de Alzheimer fue el diagnostico etiológico final más frecuente en los dos grupos de edad (82,4% frente a 75%; p > 0,05). Conclusiones. Los pacientes muy ancianos estudiados en la consulta de neurología presentan con mayor frecuencia deterioro cognitivo, a pesar de tener un tiempo de evolución y una sintomatología similares. Estos resultados podrían explicarse desde la hipótesis de la reserva cerebral y de la patología cerebral combinada

Introduction. A considerable proportion of very elderly patients with cognitive impairment are attended in the general neurology offices. There are few studies about the clinical characteristics of these patients. Aim. To describe the background and clinical features of very elderly patients who come to the general neurology clinic due to cognitive complaints or suspected cognitive impairment. Patients and methods. We retrospectively studied 336 patients (296 patients < 85 years vs. 40 patients ≥ 85 years of age) who had been mostly referred by primary care physicians. Cognitive performance was measured by the Mini-Mental State Examination and the overall (i.e., cognitive and functional) clinical situation was measured by the Clinical Dementia Rating scale. Results. Older patients had more frequently cognitive impairment (mild cognitive impairment or dementia), both at the first visit and at the one-year follow-up visit (p < 0.0005). No differences were found in symptom duration (2.0 +/- 2.1 vs. 1.5 +/- 1.4 years), type of symptoms, or comorbidity. Alzheimer's disease was the most frequent etiological diagnosis in both age groups (82.4% vs. 75.0%; p > 0.05). Conclusions. Very elderly patients studied in the neurology office have a higher risk of presenting cognitive impairment, despite being comparable in terms of symptoms and time of evolution. These results could be explained from the hypotheses of brain reserve and combined brain pathology