Clinical Utility of Plantar Pressure Measurements as Screening in Patients With Parkinson Disease With and Without Freezing of Gait History.

OBJECTIVE: To test the feasibility of objective assessments using the TekScan MatScan pressure mat plantar pressure measurement as a time-effective screening service for Parkinson disease (PD) with and without freezing of gait (FOG) history. DESIGN: Prospective cross-sectional study. SETTING: Largest medical center in southern Taiwan. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Plantar pressure measurements including average peak pressure (PP), contact area (CA), and pressure-time integral (PTI) in static and dynamic conditions as well as clinical scores during off-medication states. PARTICIPANTS: A total of 103 patients with PD and 22 age- and sex-matched volunteers without PD (N=125). RESULTS: Plantar pressure assessment including PP, CA, and PTI on the total foot areas between participants with PD and controls without PD in the static conditions are similar. Patients with PD presented higher PTI on total foot areas as well as hallux, midfoot area, and medial and lateral heels during dynamic conditions than controls without PD. The PP, CA, and PTI during the static condition and CA during the dynamic condition on the hallux showed statistical significance between PD with and without FOG history. Stepwise logistic regression after controlling with age and body mass index showed only PTI on hallux (static conditions) was significantly associated with the presence of FOG. The receiver operating characteristic curve analysis in diagnostic accuracy for FOG in PTI was statistically significant (P=.002; area under the curve, 0.71). CONCLUSIONS: FOG screening using the TekScan MatScan pressure mat plantar pressure measurement could serve as a time-effective screening service at the outpatient clinic. Based on our study, PTI may be valuable in auxiliary diagnosis.

Genetics of Severe Cutaneous Adverse Reactions.

Severe cutaneous adverse reactions (SCARs) including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug rash with eosinophilia and systemic symptoms (DRESS) are T cells-mediated life-threatening immune reactions, most commonly induced by drug. The last decade has seen significant progress in SCARs research. Recent studies have unveiled the pathogenesis of SCARs involved in susceptible genes, including human leukocyte antigens (HLA) and drugs-T cell receptor (TCR) interaction that may trigger T cell activation with downstream immune signaling of cytokines/chemokines and specific cytotoxic proteins releases. Advances in identification of multiple genetic alleles associated with specific drugs related SCARS in different populations is an important breakthrough in recent years for prevention of SCARs. This article summarized the findings on genetic factors related to SJS/TEN, especially for HLA.

Predictors of poor outcomes in First-Event Ischemic Stroke as assessed by Magnetic Resonance Imaging.

PURPOSE: Stroke is the third most common cause of mortality worldwide and is a major cause of permanent disability. The purposed of the study was to better understand the risk factors for poor outcomes following ischemic stroke requiring treatment. METHODS: Three hundred seventy patients with first-event ischemic stroke were enrolled. Good outcomes was defined as a using the Modified Rankin Scale (MRS) score ≤3 without any cardiovascular event, while poor outcomes were any of the following end points: MRS >3 at 3 months, recurrent stroke or death. Prognostic variables for poor outcomes were analyzed based on a stepwise logistic regression model. RESULTS: Seventy-eight patients had poor outcomes (21%, 78/370), assessed at a minimum of six-month follow-up. Higher mean National Institutes of Health Stroke Scale (NIHSS) scores at presentation, presence of early neurologic deterioration (END) and higher mean high-sensitivity C-reactive protein (hs-CRP) levels were associated with poor outcomes at discharge. Furthermore, both NIHSS at presentation and the presence of END were associated with poor outcomes, assessed at a minimum of six-month follow-up. CONCLUSION: A higher mean initial NIHSS score implies not only severe neurologic deficits but also an increased risk of poor outcomes. Since END following ischemic stroke is frequently associated with poor outcomes, more attention should be directed to providing adequate treatment to patients in the acute stage, especially for high risk patients.

A clinical study of new cases of parenchymal neurosyphilis: has tabes dorsalis disappeared or been missed?

Tabes dorsalis (TD) was documented as the most common parenchymal neurosyphilis, but its incidence dramatically declined in the antibiotic era. Syphilis has resurged on the China mainland since the 1980s. In recent years, physicians have been reporting parenchymal neurosyphilis, and the overwhelming majority was general paresis, but this was not the case in the authors' hospital. To make clear the real situation of parenchymal neurosyphilis in the authors' hospital, a retrospective review was carried out of the records of patients during 2009-2012. Overrepresented clinical new cases of tabetic and paretic parenchymal neurosyphilis were collected. Clinical characteristics, neuroimaging, laboratory data, and responses to penicillin were analyzed in two groups. The efficiency of two current criteria based on CSF antibodies tests was inspected. In the 43 cases with positive serum rapid plasma reagin (RPR) and TPPA tests, 18 patients met the criteria of this study: 11 presented with symptoms of general paresis, and seven had typical presentations of TD. There were statistical differences in serum RPR titers, CSF RPR, white blood cell count, and TP between the paretic and tabetic groups. The response to penicillin was relatively poor in TD. The efficiency of two current criteria was lower in the diagnosis of TD. TD was not uncommon in our area. Its clinical features remained typical, but underdiagnosis with CSF-based criteria and a decreased response to penicillin were prominent issues.

Lesions more than cerebellum in a puerpera of acute cerebellitis: concurrent encephalitis, not a subtype of ADEM.

KEY CLINICAL MESSAGE: We report a puerpera who has acute-onset ataxia with fever, headache, convulsions, and altered mental status. She had a good response to antivirus treatment and low-dose steroid. Acute cerebellitis was the tentative diagnosis. But concurrent encephalitis was proposed with multiple lesions beyond cerebellum.