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1.
Neurol Sci ; 42(2): 479-489, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33409828

RESUMEN

OBJECTIVE: To describe the clinical, neurological, neuroimaging, and cerebrospinal fluid (CSF) findings associated with encephalopathy in patients admitted to a COVID-19 tertiary reference center. METHODS: We retrospectively reviewed records of consecutive patients with COVID-19 evaluated by a consulting neurology team from March 30, 2020 through May 15, 2020. RESULTS: Fifty-five patients with confirmed SARS-CoV-2 were included, 43 of whom showed encephalopathy, and were further divided into mild, moderate, and severe encephalopathy groups. Nineteen patients (44%) had undergone mechanical ventilation and received intravenous sedatives. Eleven (26%) patients were on dialysis. Laboratory markers of COVID-19 severity were very common in encephalopathy patients, but did not correlate with the severity of encephalopathy. Thirty-nine patients underwent neuroimaging studies, which showed mostly non-specific changes. One patient showed lesions possibly related to CNS demyelination. Four had suffered an acute stroke. SARS-CoV-2 was detected by RT-PCR in only one of 21 CSF samples. Two CSF samples showed elevated white blood cell count and all were negative for oligoclonal bands. In our case series, the severity of encephalopathy correlated with higher probability of death during hospitalization (OR = 5.5 for each increment in the degree of encephalopathy, from absent (0) to mild (1), moderate (2), or severe (3), p < 0.001). CONCLUSION: In our consecutive series with 43 encephalopathy cases, neuroimaging and CSF analysis did not support the role of direct viral CNS invasion or CNS inflammation as the cause of encephalopathy.


Asunto(s)
Encefalopatías/etiología , /complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Encefalopatías/líquido cefalorraquídeo , Encefalopatías/diagnóstico por imagen , Encefalopatías/inmunología , /terapia , Femenino , Mortalidad Hospitalaria , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Centros de Atención Terciaria
2.
Medicine (Baltimore) ; 99(36): e22052, 2020 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-32899066

RESUMEN

Reversible splenial lesion syndrome (RESLES) is a clinico-radiological entity that defines a reversible lesion in the splenium of the corpus callosum (SCC) on magnetic resonance imaging (MRI). The clinical and radiological characteristics of RESLES are poorly defined and most RESLES literature is in the form of case reports. We reviewed the clinical and radiological data from 11 RESLES patients in order to more clearly describe the characteristics of this disorder in adults.Patients included in this study were diagnosed with RESLES from May 2012 to March 2018. We collected clinical, imaging, and laboratory data of 11 adult patients from Neurology Department of the Affliated Yantai Yuhuangding Hospital of Qingdao University. After analyzing various clinico-radiological features and laboratory parameters, including serum sodium, pathogen testing, cerebrospinal fluid (CSF) studies, electroencephalography (EEG), and MRI findings, we made a diagnosis of RESLES based on the criteria proposed previously by Garcia-Monco et al.Of the 11 patients, 7 (63.63%) were male and 4 (36.36%) were female, ranging in age from 24 to 62 years with an average age of 31.48 ±â€Š11.47 years. Seven cases occurred in the months of winter and spring (December-March). The primary clinical symptoms were headache, seizure, disturbance of consciousness, mental abnormality, and dizziness. All 11 patients had lesions in the SCC and all the lesions disappeared or significantly improved on follow-up imaging that was done within a month of symptom resolution.We found 5 (45.45%) patients had a CSF opening pressure >180 mmH2O, in addition to elevated protein and(or) leukocytes levels in 3 (27.27%) patients. The serum sodium concentration in 6 (54.55%) patients was low (<137 mmol/L) and EEG showed nonspecific slowing in waves 4 (36.36%) patients.When we encounter clinical manifestations such as headache accompanied with mental symptoms, disturbance of consciousness or epilepsy, and brain MRI finds lesions of the corpus callosum, we should consider whether it is RESLES. In order to find out the possible cause of the disease, we should carefully inquire about the history of the disease, complete etiology examination, and CSF tests. Of course, it is one of the necessary conditions for the diagnosis that the lesions in the corpus callosum are obviously relieved or disappeared.


Asunto(s)
Encefalopatías/diagnóstico , Encefalopatías/terapia , Cuerpo Calloso/patología , Músculos Paraespinales/diagnóstico por imagen , Adulto , Encefalopatías/sangre , Encefalopatías/líquido cefalorraquídeo , Líquido Cefalorraquídeo/citología , Líquido Cefalorraquídeo/metabolismo , Líquido Cefalorraquídeo/fisiología , Presión del Líquido Cefalorraquídeo , Electroencefalografía/métodos , Femenino , Cefalea/tratamiento farmacológico , Cefalea/etiología , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Músculos Paraespinales/patología , Estudios Retrospectivos , Convulsiones/tratamiento farmacológico , Convulsiones/etiología , Sodio/sangre , Síndrome , Resultado del Tratamiento , Vértigo/tratamiento farmacológico , Vértigo/etiología
5.
Emerg Infect Dis ; 26(9): 2016-2021, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32487282

RESUMEN

There are few detailed investigations of neurologic complications in severe acute respiratory syndrome coronavirus 2 infection. We describe 3 patients with laboratory-confirmed coronavirus disease who had encephalopathy and encephalitis develop. Neuroimaging showed nonenhancing unilateral, bilateral, and midline changes not readily attributable to vascular causes. All 3 patients had increased cerebrospinal fluid (CSF) levels of anti-S1 IgM. One patient who died also had increased levels of anti-envelope protein IgM. CSF analysis also showed markedly increased levels of interleukin (IL)-6, IL-8, and IL-10, but severe acute respiratory syndrome coronavirus 2 was not identified in any CSF sample. These changes provide evidence of CSF periinfectious/postinfectious inflammatory changes during coronavirus disease with neurologic complications.


Asunto(s)
Betacoronavirus , Encefalopatías/virología , Infecciones por Coronavirus/complicaciones , Citocinas/líquido cefalorraquídeo , Encefalitis Viral/virología , Neumonía Viral/complicaciones , Adulto , Encefalopatías/líquido cefalorraquídeo , Infecciones por Coronavirus/líquido cefalorraquídeo , Infecciones por Coronavirus/virología , Encefalitis Viral/líquido cefalorraquídeo , Resultado Fatal , Femenino , Georgia , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/líquido cefalorraquídeo , Neumonía Viral/virología
6.
Biochimie ; 170: 36-48, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31857120

RESUMEN

The proximity of cerebrospinal fluid (CSF) with the brain, its permanent renewal and better availability for research than tissue biopsies, as well as ganglioside (GG) shedding from brain to CSF, impelled lately the development of protocols for the characterization of these glycoconjugates and discovery of central nervous system biomarkers expressed in CSF. Currently, the investigation of CSF gangliosides is focused on concentration measurements of the predominant classes and much less on their profiling and structural analysis. Since we have demonstrated recently the high performance of ion mobility separation mass spectrometry (IMS MS) for compositional and structural determination of human brain GGs, in the present study we have implemented for the first time IMS MS for the exploration of human CSF gangliosidome, in order to generate the first robust mass spectral database of CSF gangliosides. IMS MS separation and screening revealed 113 distinct GG species in CSF, having similar compositions to the species detected in human brain. In comparison with the brain tissue, we have discovered in CSF several components containing fatty acids with odd number of carbon atoms and/or short glycan chains. By tandem MS (MS/MS) we have further analyzed the structure of GD3(d18:1/18:0) and GD2(d18:1/18:0), two glycoforms exhibiting short carbohydrate chains found in CSF, but discovered and characterized previously in brain as well. According to the present results, human CSF and brain show a similar ganglioside pattern, a finding that might be useful in clinical research focused on discovery of ganglioside species associated to neurodegenerative diseases and brain tumors.


Asunto(s)
Biomarcadores/líquido cefalorraquídeo , Encefalopatías/diagnóstico , Encéfalo/metabolismo , Gangliósidos/líquido cefalorraquídeo , Espectrometría de Masa por Ionización de Electrospray/métodos , Adulto , Encefalopatías/líquido cefalorraquídeo , Humanos
7.
Artículo en Inglés | MEDLINE | ID: mdl-31202181

RESUMEN

Determination of ceftriaxone (CTRX) concentration in human cerebrospinal fluid (CSF) is required to clarify whether a high concentration of CTRX in CSF is associated with CTRX-induced encephalopathy (CIE). In our study, in order to perform an accurate analysis of CSF sample from CIE patient, we proposed HPLC with UV detection (HPLC-UV) using an octadecylsilica (ODS) column, a methanol and 10 mM phosphoric acid (25:75, v/v) mixture solution as a mobile phase, and a detection wavelength at 280 nm. The linear range was from 0.1 to 100 µg/mL (r = 0.999) in the present HPLC-UV. In the recovery tests using blank samples of human CSF and control serum spiked with CTRX, the recoveries of CTRX were >95.3%, and the RSD (n = 3) was <5.8%. We applied the proposed HPLC-UV system to determine CTRX in the CSF and serum samples obtained from a patient diagnosed as having CIE, and it was revealed that the CTRX concentrations in the CSF sample and the serum were 2.61 and 37.35 µg/mL, respectively. To the best of our knowledge, this is the first report describing the determination of CTRX concentration in a CSF sample obtained from a peritoneal dialysis patient diagnosed as having CIE.


Asunto(s)
Antibacterianos/líquido cefalorraquídeo , Encefalopatías/etiología , Ceftriaxona/líquido cefalorraquídeo , Cromatografía Líquida de Alta Presión/métodos , Adulto , Anciano , Antibacterianos/efectos adversos , Encefalopatías/líquido cefalorraquídeo , Encefalopatías/diagnóstico , Ceftriaxona/efectos adversos , Cromatografía Líquida de Alta Presión/instrumentación , Femenino , Humanos
8.
Am J Physiol Renal Physiol ; 317(2): F296-F302, 2019 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-31141401

RESUMEN

The accumulation of uremic solutes in kidney failure may impair mental function. The present study profiled the accumulation of uremic solutes in the cerebrospinal fluid (CSF) in acute renal failure. CSF and plasma ultrafiltrate were obtained from rats at 48 h after sham operation (control; n = 10) or bilateral nephrectomy (n = 10) and analyzed using an established metabolomic platform. Two hundred forty-eight solutes were identified as uremic based on their accumulation in the plasma ultrafiltrate of nephrectomized compared with control rats. CSF levels of 124 of these solutes were sufficient to allow calculation of CSF-to-plasma ultrafiltrate concentration ratios. Levels of many of the uremic solutes were normally lower in the CSF than in the plasma ultrafiltrate, indicating exclusion of these solutes from the brain. CSF levels of the great majority of the uremic solutes increased in renal failure. The increase in the CSF was, however, relatively less than in the plasma ultrafiltrate for most solutes. In particular, for the 31 uremic solutes with CSF-to-plasma ultrafiltrate ratios of <0.25 in control rats, the average CSF-to-plasma ultrafiltrate ratio decreased from 0.13 ± 0.07 in control rats to 0.09 ± 0.06 in nephrectomized rats, revealing sustained ability to exclude these solutes from the brain. In summary, levels of many uremic solutes are normally kept lower in the CSF than in the plasma ultrafiltrate by the action of the blood-brain and blood-CSF barriers. These barriers remain functional but cannot prevent accumulation of uremic solutes in the CSF when the kidneys fail.


Asunto(s)
Lesión Renal Aguda/líquido cefalorraquídeo , Encefalopatías/líquido cefalorraquídeo , Uremia/líquido cefalorraquídeo , Lesión Renal Aguda/sangre , Lesión Renal Aguda/complicaciones , Lesión Renal Aguda/fisiopatología , Animales , Biomarcadores/sangre , Barrera Hematoencefálica/metabolismo , Barrera Hematoencefálica/fisiopatología , Encefalopatías/sangre , Encefalopatías/etiología , Encefalopatías/fisiopatología , Cromatografía Líquida de Alta Presión , Modelos Animales de Enfermedad , Progresión de la Enfermedad , Riñón/metabolismo , Riñón/fisiopatología , Masculino , Metabolómica/métodos , Nefrectomía , Ratas Sprague-Dawley , Espectrometría de Masa por Ionización de Electrospray , Espectrometría de Masas en Tándem , Uremia/sangre , Uremia/etiología , Uremia/fisiopatología
9.
Vet Radiol Ultrasound ; 60(4): 390-399, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30887625

RESUMEN

Syringobulbia is a pathologic condition characterized by one or more fluid-filled cavities within the brainstem. This retrospective case series describes observations in eight dogs with syringobulbia diagnosed during MRI. All dogs were adult, small-breed dogs with concurrent syringomyelia and neurologic deficits localized to sites rostral to the spinal cord, which cannot be explained by syringomyelia (eg, six dogs had vestibular signs). On MRI, the fluid-filled cavities had signal intensity characteristics like cerebrospinal fluid, were in the medulla oblongata, and were solitary in each dog. Initially, the shape of the cavity was a slit in five dogs and bulbous in two dogs. Magnetic resonance imaging was repeated in five dogs (6-55 months of age). One dog had progression of syringobulbia from slit-like to bulbous, and four dogs had unchanged slit-like syringobulbia. One dog developed slit-like syringobulbia after cranioplasty. A variety of medical and surgical treatments were performed with improvement of some but not all clinical signs. One dog died following surgery due to cardiopulmonary failure and the other seven dogs were alive at least 1 year after the initial diagnosis, which was the least time of follow-up. One surviving dog developed a unilateral hypoglossal nerve deficit 2 months after the initial diagnosis and megaesophagus 14 months later. In conclusion, detecting a fluid-filled cavity in the medulla oblongata consistent with syringobulbia is possible in dogs undergoing MRI. The cavity is likely acquired, slit-like or bulbous, progressive, or static, and might be associated with breed size and neurologic signs localized to the medulla oblongata.


Asunto(s)
Encefalopatías/veterinaria , Enfermedades de los Perros/diagnóstico por imagen , Imagen por Resonancia Magnética/veterinaria , Bulbo Raquídeo/diagnóstico por imagen , Animales , Encefalopatías/líquido cefalorraquídeo , Encefalopatías/diagnóstico por imagen , Enfermedades de los Perros/líquido cefalorraquídeo , Perros , Resultado Fatal , Femenino , Masculino , Bulbo Raquídeo/patología , Estudios Retrospectivos , Resultado del Tratamiento
10.
Artículo en Inglés | MEDLINE | ID: mdl-30343110

RESUMEN

Dopamine (DA), a catecholamine neurotransmitter, is considered to be an important indicator for mental diseases detection in the clinic. In this study, a novel fluorescent sensing platform consisting of the ficin-H2O2-tyramine system for determining DA in cerebrospinal fluids (CSF) was established. The proposed method is based on the fact that ficin, a mimetic peroxidase, can catalyze H2O2 decomposition into OH radicals, which can oxidize non-fluorescent tyramine into fluorescent dityramine. When DA was introduced, DA can compete with tyramine for OH and resulting in the oxidation reaction of tyramine inhibited along with the fluorescence intensity of the system decreased, which provides a unique strategy for fluorescence detection of DA. Under optimal conditions, the fluorescence intensity decreased linearly with the DA level over a wide concentration range from 0.05 to 12.0 µM (R2 = 0.995) with a detection limit of 46 nM (3σ/k). More importantly, the proposed sensing approach exhibits high sensitivity, good selectivity and has been successfully applied to DA sensing in complex biological samples, which made it hold great potential for DA determination in chemical and biological analytical applications.


Asunto(s)
Encefalopatías/líquido cefalorraquídeo , Encéfalo/metabolismo , Dopamina/líquido cefalorraquídeo , Ficaína/metabolismo , Fluorescencia , Peroxidasa/metabolismo , Catálisis , Humanos , Límite de Detección , Oxidación-Reducción , Espectrometría de Fluorescencia
11.
Eur J Paediatr Neurol ; 23(1): 204-213, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30316638

RESUMEN

PURPOSE: Neurological complications of influenza cause significant disease in children. Central nervous system inflammation, the presumed mechanism of influenza-associated encephalopathy, is difficult to detect. Characteristics of children presenting with severe neurological complications of influenza, and potential biomarkers of influenza-associated encephalopathy are described. METHODS: A multi-center, retrospective case-series of children with influenza and neurological complications during 2017 was performed. Enrolled cases met criteria for influenza-associated encephalopathy or had status epilepticus. Functional outcome at discharge was compared between groups using the Modified Rankin Scale (mRS). RESULTS: There were 22 children with influenza studied of whom 11/22 had encephalopathy and 11/22 had status epilepticus. Only one child had a documented influenza immunization. The biomarker CSF neopterin was tested in 10/11 children with encephalopathy and was elevated in 8/10. MRI was performed in all children with encephalopathy and was abnormal in 8 (73%). Treatment of children with encephalopathy was with corticosteroids or intravenous immunoglobulin in 9/11 (82%). In all cases oseltamivir use was low (59%) while admission to the intensive care unit was frequent (14/22, 66%). Clinical outcome at discharge was moderate to severe disability (mRS score > 2) in the majority of children with encephalopathy (7/11, 64%), including one child who died. Children with status epilepticus recovered to near-baseline function in all cases. CONCLUSION: Raised CSF neopterin was present in most cases of encephalopathy, and along with diffusion restriction on MRI, is a useful diagnostic biomarker. Lack of seasonal influenza vaccination represents a missed opportunity to prevent illness in children, including severe neurological disease.


Asunto(s)
Biomarcadores/líquido cefalorraquídeo , Encefalopatías/líquido cefalorraquídeo , Encefalopatías/virología , Gripe Humana/complicaciones , Neopterin/líquido cefalorraquídeo , Adolescente , Encefalopatías/diagnóstico , Niño , Preescolar , Femenino , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Estudios Retrospectivos
12.
Mem Inst Oswaldo Cruz ; 114: e180450, 2018 Dec 10.
Artículo en Inglés | MEDLINE | ID: mdl-30540031

RESUMEN

BACKGROUND Amazon, the largest tropical forest of the world, has suffered from dengue outbreaks since 1998. Cerebrospinal fluid (CSF) of patients, from Amazonas state, suspected of central nervous system (CNS) viral infection was studied using molecular and immunological methods. OBJECTIVE To evaluate the importance of CSF investigation in patients with acute dengue virus (DENV) infection of CNS. METHODS CSF samples of 700 patients were analysed by reverse transcription polymerase chain reaction (RT-PCR) to detect the presence of dengue virus (DENV) RNA and by enzyme-linked immunosorbent assay (ELISA) to detect presence of DENV specific IgM. FINDINGS DENV infection was detected in 4.3% of the CSF samples; 85.7% (24/28) by DENV IgM and 14.3% (4/28) by viral RNA. DENV detected by viral RNA were to be found serotypes DENV-2 (three patients) and DENV-1 (one patient). The neurological diagnosis in patients CNS infection of DENV included encephalitis (10), meningoencephalitis (10), meningitis (6), acute myelitis (1), and encephalomyelitis (1). The majority (89.3%) had intrathecal inflammation: pleocytosis, hyperproteinorrachia and DENV IgM antibodies. Hypoglycorrhachia and/or high levels of lactate in CSF were found in 36% of the patients. Co-infection (CMV, HIV, EBV, and/or Mycobacterium tuberculosis) was observed in eight (28.6%) cases. CONCLUSIONS We found intense inflammatory CSF that is unusual in CNS disorders caused by dengue infection. It may be due co-infections or the immunogenetic background of the local Amerindian Brazilian population. CSF examination is an important diagnostic support tool for neurological dengue diagnosis.


Asunto(s)
Anticuerpos Antivirales/líquido cefalorraquídeo , Encefalopatías/virología , Líquido Cefalorraquídeo/virología , Dengue/diagnóstico , Inmunoglobulina M/líquido cefalorraquídeo , Adolescente , Adulto , Anciano , Encefalopatías/líquido cefalorraquídeo , Brasil , Niño , Preescolar , Dengue/líquido cefalorraquídeo , Enfermedades Endémicas , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Adulto Joven
15.
PLoS One ; 13(10): e0205501, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30379898

RESUMEN

Current laboratory testing of cerebrospinal fluid (CSF) does not consistently discriminate between different central nervous system (CNS) disease states. Rapidly distinguishing CNS infections from other brain and spinal cord disorders that share a similar clinical presentation is critical. New approaches focusing on aspects of disease biology, such as immune response profiles that can have stimulus-specific attributes, may be helpful. We undertook this preliminary proof-of-concept study using multiplex ELISA to measure CSF cytokine levels in various CNS disorders (infections, autoimmune/demyelinating diseases, lymphomas, and gliomas) to determine the potential utility of cytokine patterns in differentiating CNS infections from other CNS diseases. Both agglomerative hierarchical clustering and mixture discriminant analyses revealed grouping of CNS disease types based on cytokine expression. To further investigate the ability of CSF cytokine levels to distinguish various CNS disease states, non-parametric statistical analysis was performed. Mann-Whitney test analysis demonstrated that CNS infections are characterized by significantly higher CSF lP-10/CXCL10 levels than the pooled non-infectious CNS disorders (p = 0.0001). Within the infection group, elevated levels of MDC/CCL22 distinguished non-viral from viral infections (p = 0.0048). Each disease group of the non-infectious CNS disorders independently showed IP-10/CXCL10 levels that are significantly lower than the infection group [(autoimmune /demyelinating disorders (p = 0.0005), lymphomas (p = 0.0487), gliomas (p = 0.0294), and controls (p = 0.0001)]. Additionally, of the non-infectious diseases, gliomas can be distinguished from lymphomas by higher levels of GRO/CXCL1 (p = 0.0476), IL-7 (p = 0.0119), and IL-8 (p = 0.0460). Gliomas can also be distinguished from autoimmune/demyelinating disorders by higher levels of GRO/CXCL1 (p = 0.0044), IL-7 (p = 0.0035) and IL-8 (p = 0.0176). Elevated CSF levels of PDGF-AA distinguish lymphomas from autoimmune/demyelinating cases (p = 0.0130). Interrogation of the above comparisons using receiver operator characteristic analysis demonstrated area under the curve (AUC) values (ranging from 0.8636-1.0) that signify good to excellent utility as potential diagnostic discriminators. In conclusion, our work indicates that upon formal validation, measurement of CSF cytokine levels may have clinical utility in both identifying a CNS disorder as infectious in etiology and, furthermore, in distinguishing viral from non-viral CNS infections.


Asunto(s)
Encefalopatías/líquido cefalorraquídeo , Infecciones del Sistema Nervioso Central/líquido cefalorraquídeo , Citocinas/líquido cefalorraquídeo , Enfermedades de la Médula Espinal/líquido cefalorraquídeo , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/líquido cefalorraquídeo , Encefalopatías/etiología , Encefalopatías/inmunología , Infecciones del Sistema Nervioso Central/inmunología , Preescolar , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Curva ROC , Estudios Retrospectivos , Enfermedades de la Médula Espinal/etiología , Enfermedades de la Médula Espinal/inmunología , Adulto Joven
16.
J Neuroimmunol ; 323: 115-118, 2018 10 15.
Artículo en Inglés | MEDLINE | ID: mdl-30189384

RESUMEN

Although it remained controversial for a long time, central nervous system (CNS) involvement of graft-versus-host disease (GVHD) is now becoming recognized as a real nosological entity. Previous case reports have suggested heterogeneous clinical presentations and it is not excluded that the whole spectrum of manifestations has not yet been fully described. Here, we report the case of a 58-year-old man with chronic GVHD who developed a rapidly ingravescent encephalopathy. There was no evidence for CNS immune-mediated lesions on conventional imaging nor for cellular infiltration in the cerebrospinal fluid. Serum analyses revealed the presence of anti-neuronal antibodies directed against anti-contactin-associated protein 2 (anti-Caspr2), a protein associated with voltage-gated potassium neuronal channels. Functional imaging with 2-deoxy-2-[fluorine-18] fluoro- d-glucose integrated with computed tomography (18F-FDG PET-CT) demonstrated diffuse cortical and subcortical hypometabolism. The patient was treated with a combination of immunosuppressive agents (corticosteroids, cyclophosphamide and rituximab) and progressively recovered normal neurocognitive functions. Taken together, these data suggest that CNS-GVHD may manifest as a reversible antibody-mediated functional encephalopathy. This report suggests for the first time the interest of screening for anti-neuronal antibodies and functional imaging with brain 18F-FDG PET-CT in diagnosing this severe complication of allogeneic hematopoietic cell transplantation (alloHSCT).


Asunto(s)
Anticuerpos Anticitoplasma de Neutrófilos/líquido cefalorraquídeo , Encefalopatías/líquido cefalorraquídeo , Encefalopatías/diagnóstico por imagen , Enfermedad Injerto contra Huésped/líquido cefalorraquídeo , Enfermedad Injerto contra Huésped/diagnóstico por imagen , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Encefalopatías/etiología , Enfermedad Crónica , Enfermedad Injerto contra Huésped/etiología , Trasplante de Células Madre Hematopoyéticas/tendencias , Humanos , Masculino , Persona de Mediana Edad , Trasplante Homólogo/efectos adversos , Trasplante Homólogo/tendencias
17.
J Cell Mol Med ; 22(10): 5151-5154, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-30054982

RESUMEN

Given sex-related differences in brain disorders, it is of interest to study if there is a sex difference in the permeability of the blood-cerebrospinal fluid barrier (BCSFB) and the blood-brain barrier (BBB). The CSF/serum albumin ratio (QAlb ) is a standardized biomarker that evaluates the function of these barriers. In previous studies, contradictory results have been reported with respect to sex difference using this quotient, possibly because of small population sizes and heterogeneity with respect to ages. QAlb measurements in more than 20 000 patients between 1 and 90 years visiting our hospitals revealed a significant sex difference in all age groups also when excluding patients with pathologically high CSF albumin > 400 mg/L. Similar pattern was found in 335 healthy volunteers in similar age intervals. Although also other factors are likely important, our observation is consistent with lower integrity of the brain barriers in males. If the difference in QAlb is caused mainly by a difference in barrier function, this may require different drug doses and strategies for efficient central nervous system (CNS) delivery in males and females, as well as it may indicate differences in brain metabolism. Moreover, our study emphasizes that different reference values should be used both for different ages and sexes.


Asunto(s)
Albúminas/líquido cefalorraquídeo , Encefalopatías/sangre , Encefalopatías/líquido cefalorraquídeo , Albúmina Sérica , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Barrera Hematoencefálica , Encéfalo/metabolismo , Encéfalo/patología , Encefalopatías/epidemiología , Encefalopatías/patología , Sistema Nervioso Central/metabolismo , Sistema Nervioso Central/patología , Niño , Preescolar , Femenino , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Caracteres Sexuales , Adulto Joven
18.
J Neurotrauma ; 35(24): 2941-2946, 2018 12 15.
Artículo en Inglés | MEDLINE | ID: mdl-29993326

RESUMEN

Next to gray and white matter atrophy, cerebrospinal fluid (CSF) volume and ventricular dilation may be surrogate biomarkers for brain atrophy in spinal cord injury (SCI). We therefore aimed to track brain atrophy by means of CSF volume changes and ventricular enlargements over two years after SCI. Fifteen patients with SCI and 18 healthy controls underwent a series of T1-weighted scans during five time points over two years. Changes of CSF/intracranial volume (CSF/ICV) ratio, CSF volume, and ventricular enlargement rate over time were determined. Sample sizes with 80% power and 5% significance were calculated to detect a range of treatment effects for a two-armed trial. There was a significant cross-sectional increased CSF/ICV ratio in patients compared with controls at each time point (p < 0.02). The rate of CSF/ICV changes, however, was not significantly different between groups over time. CSF volume increased linearly over bilateral sensorimotor cortices (left: p = 0.002, right: p = 0.042) and in the supracerebellar space (p < 0.001) within two years. An acceleration of the enlargement within the third (p = 0.017) and the fourth (p = 0.006) ventricles was observed in patients over time. Sample size estimation for six-month trials with CSF volume requires 25 patients per treatment arm to detect a hypothetical treatment effect in terms of slowing of atrophy rate of 30%. This study shows that SCI-induced changes in CSF/ICV ratio and ventricular expansion rate provide additional information on the neurodegenerative processes after injury. The sensitivity to scoring treatment effects speaks to its potential to serve as a sensitive biomarker in addition to local atrophy measures.


Asunto(s)
Encefalopatías/patología , Encéfalo/patología , Ventrículos Cerebrales/patología , Líquido Cefalorraquídeo , Traumatismos de la Médula Espinal/patología , Adulto , Anciano , Atrofia , Encefalopatías/líquido cefalorraquídeo , Encefalopatías/etiología , Estudios Transversales , Femenino , Humanos , Estudios Longitudinales , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Degeneración Nerviosa/etiología , Degeneración Nerviosa/patología , Traumatismos de la Médula Espinal/complicaciones , Adulto Joven
19.
J Infect Chemother ; 24(11): 932-935, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-29752196

RESUMEN

Acute focal bacterial nephritis (AFBN) is a localized bacterial infection of the kidney presenting as an inflammatory mass, and some patients show deterioration of clinical condition with neurological symptoms. Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a syndrome that is characterized by biphasic seizures and impaired consciousness with reduced diffusion in the subcortical white matter on magnetic resonance imaging, typically observed between days 3 and 9 after clinical onset. Although AFBN sometimes causes neurological symptoms, no cases of AFBN with AESD have been reported, and no studies have presented the cytokine profiles of patients with a severe form of acute encephalopathy with AFBN. We report here a very rare case involving a 6-month-old boy who developed AFBN due to Enterococcus faecalis with both the clinical and radiological features of AESD. In our patient, serum interleukin (IL)-6, IL-10, and interferon (IFN)-γ levels markedly increased on admission, and on day 4, only IL-6 levels significantly increased in the cerebrospinal fluid (CSF). These results suggest that high serum cytokines are produced locally in response to AFBN and elevated IL-6 levels in CSF may have neuroprotective roles.


Asunto(s)
Encefalopatías/etiología , Enterococcus faecalis/aislamiento & purificación , Nefritis/microbiología , Convulsiones/etiología , Enfermedad Aguda , Encefalopatías/sangre , Encefalopatías/líquido cefalorraquídeo , Encefalopatías/diagnóstico por imagen , Citocinas/sangre , Citocinas/líquido cefalorraquídeo , Imagen de Difusión por Resonancia Magnética , Humanos , Lactante , Masculino , Nefritis/sangre , Nefritis/complicaciones , Nefritis/diagnóstico por imagen , Convulsiones/sangre , Convulsiones/líquido cefalorraquídeo , Convulsiones/diagnóstico por imagen , Ultrasonografía
20.
Diagn Interv Radiol ; 24(2): 108-112, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29757148

RESUMEN

PURPOSE: We aimed to present clinical and radiologic characteristics of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in children. METHODS: Eight children (5 boys and 3 girls; median age, 5.9 years; age range, 8 months to 14.1 years) diagnosed with MERS between September 2015 and June 2017 were included in the study. We reviewed the patient's data, including demographic characteristics, prodromal and neurologic symptoms, neurologic examination, magnetic resonance imaging and electroencephalography findings, laboratory findings, treatment, and prognosis. RESULTS: Prodromal symptoms were nausea and vomiting (n=6), diarrhea (n=6), and fever (n=3). Initial neurologic symptoms were seizures (n=4), delirious behavior (n=1), drowsiness (n=1), ataxia (n=1), transient blindness (n=2), abnormal speech (n=2), and headache (n=1). Two patients had a suspected infective agent: urinary tract infection caused by Escherichia coli and gastroenteritis caused by rotavirus. Seven patients had type I lesions, comprising characteristic symmetric ovoid (n=6) and band-shaped (n=1) T2-weighted hyperintense lesions at the spenium of corpus callosum, and one patient had type II lesion with additional symmetric posterior periventricular lesions. The lesions were isointense to mildly hypointense on T1-weighted imaging and did not show enhancement. All lesions displayed restricted diffusion. In all patients, neurologic symptoms completely normalized < 48 hours from the onset of symptoms without any sequelae. CONCLUSION: MERS has characteristic imaging features and favorable outcome.


Asunto(s)
Encefalopatías/complicaciones , Encéfalo/diagnóstico por imagen , Cuerpo Calloso/diagnóstico por imagen , Imagen de Difusión por Resonancia Magnética/métodos , Encefalitis/complicaciones , Músculos Paraespinales/diagnóstico por imagen , Adolescente , Encéfalo/patología , Encefalopatías/sangre , Encefalopatías/líquido cefalorraquídeo , Encefalopatías/patología , Niño , Preescolar , Cuerpo Calloso/patología , Electroencefalografía/métodos , Encefalitis/sangre , Encefalitis/líquido cefalorraquídeo , Encefalitis/patología , Femenino , Humanos , Lactante , Masculino , Músculos Paraespinales/patología , Pronóstico , Estudios Retrospectivos
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