Neuromyelitis optica spectrum disorder coinciding with hematological immune disease: A case report.

INTRODUCTION: Recently defined consensus criteria for the diagnosis of neuromyelitis optica spectrum disorders (NMOSD) allow establishing the diagnosis in patients without elevated AQP4-Ab and optic nerve involvement. According to the new extended definition, NMOSD is closely associated with extensive spinal cord inflammation occurring in the course of systemic autoimmune diseases as sarcoidosis or lupus erythematodes. NMOSD occurring in the course of hematological disease have not yet been reported in the literature. CASE REPORT: A 38 year old male subsequently developed thrombocytopenia, hemolytic anemia and agranulocytosis over a 23 month period. Three months after an episode of agranulocytosis, he noticed ascending sensory disturbances and progressive weakness of his legs. Within two days, symptoms worsened to give almost complete paraplegia and loss of sensation below a midthoracic level. MRI revealed signal hyperintensity and edema in T2-weighted sequences reaching from the 2nd cervical to the 9th thoracic vertebral body. Two years later, he developed a second episode with lesions in the spinal cord and periventricular areas of brain stem and thalamus. CONCLUSION: The relapsing time course and the topographical pattern of central nervous system lesions restricted to axial brain structures and the spinal cord fulfill the criteria that have recently been defined for AQP4-Ab-negative NMO-spectrum disease. Systematic studies on the association of hematological autoimmune phenomena and spinal cord disease are needed to clarify whether this coincidence is just a casual phenomenon or whether it points to a yet undiscovered but perhaps therapeutically interesting link of immunological mechanisms affecting both organ systems.

[TDP-43 proteinopathies: ALS and frontotemporal dementias]. / TDP-43-Proteinopathien: ALS und Frontotemporale Demenzen.

Both, amyotrophic lateral sclerosis (ALS) and frontotemporal lobar degeneration with ubiquitin-positive inclusions (FTLD-U), and their combination (FTLD-U/MND) are principally sporadic diseases that are rarely familial. Cytoplasmic ubiquitinated proteinaceous inclusions in motor and extra-motor neurons are the pathological hallmark of all three forms. In 2006, the TAR DNA-binding protein of 43 kDa (TDP-43) was both identified as the key protein component of the ubiquitinated inclusions and recognised as the key protein of a spectrum of diseases that have since been consolidated as TDP-43 proteinopathies. TDP-43 as a nuclear protein contributes to the regulation of gene expression, and associated with neurodegeneration, it has been found to be truncated, hyperphosphorylated, and mislocalized. It is unclear whether the loss of the TDP-43's nuclear function or the gain of a toxic function outside its nucleus is disease causing. Since 2008, several TARDBP-mutations have been identified as leading to the autosomal-dominant familial ALS (ALS 10), although no TARDBP-mutations have yet to be linked to FTLD.

An association of migraine with hereditary haemorrhagic telangiectasia independently of pulmonary right-to-left shunts.

Hereditary haemorrhagic telangiectasia (HHT) is a genetic disorder characterized by epistaxis, telangiectasia and visceral vascular manifestations. It is associated with migraine with aura due to pulmonary arteriovenous malformations (pAVMs). The aim of the study was to evaluate headache prevalence in 106 consecutive HHT patients (67 female, 39 male, age 53.5 +/- 14.5 years) and age- and gender-matched controls. An extensive clinical work-up was performed and headache prevalence was determined. Lifetime prevalence of migraine was higher in HHT patients (39.6%) than in controls (19.8%) [P < 0.001, chi(2) = 12.17, odds ratio (OR) 3.0; 95% confidence interval 1.6 < OR < 5.7]. A positive association was confirmed between HHT patients with pAVMs and migraine with aura (38.5% vs. 10%). Furthermore, HHT patients without pAVMs had a higher prevalence of migraine without aura (11.5% vs. 26.3%; chi(2) = 11.85; d.f. = 2; P = 0.003). We speculate that pathophysiological mechanisms, including dysfunction of the transforming growth factor-beta pathways and resulting vascular changes, contribute to the higher prevalence of migraine without aura in HHT patients without pAVMs.

Sleep disordered breathing in medically stable patients with myasthenia gravis.

We investigate sleep and breathing in clinically stable myasthenia gravis (MG) patients and ask weather sleep disordered breathing (SDB) is causally linked with MG. Nineteen MG patients with a mean disease duration of 9.7 years underwent sleep studies in two consecutive nights. The primary outcome measure was the respiratory disturbance index (RDI) in terms of snoring and apneas/hypopneas. Further outcome measurements were total sleep time, sleep stage distribution and the number of arousals. A clinically relevant SDB in terms of obstructive sleep apnea (OSA) (defined as RDI > 10/h) was found in four patients. There were only a few central apneas (central apnea index: 0.19 +/- 0.4/h). We did not find a relationship between maximum inspiratory pressure and SDB (r = -0.03). There is no evidence for a causal relationship between medically stable MG and SDB in terms of OSA. The extent of respiratory muscle weakness failed to correlate with SDB. Furthermore, our study does not confirm the high occurrence of central respiratory events during sleep in patients with well-controlled MG.

Dementia of frontal lobe type in Kennedy's disease.

The pathomorphological correlate of Kennedy's disease (KD) is a degeneration of spinal and bulbar alpha-motor neurons. The disease is caused by a CAG repeat expansion in the first exon of the X-chromosomal androgene receptor gene. Contrary to the common belief that cognitive disorders in motor neuron diseases (MND) are either rare or only mild, there is now an increasing number of case reports on dementia in amyotrophic lateral sclerosis (ALS). In ALS, dementia of the frontal lobe type (frontotemporal dementia, FTD) seems to be the characteristic pattern. However, in KD cognitive dysfunction has not been studied systematically. Here we present a case with clinical characteristics of FTD in a patient with genetically confirmed KD. It remains speculative whether there is an association between KD and FTD comparable to a genetic linkage between ALS and FTD, which has been proposed in recent years. However, we suggest that cognitive dysfunction may be more common in KD than reported until today.

Point mutations of the p150 subunit of dynactin (DCTN1) gene in ALS.

The authors report mutation screening of the p150 subunit of dynactin (DCTN1) and the cytoplasmic dynein heavy chain (DNCHC1) genes in 250 patients with ALS and 150 unrelated control subjects. Heterozygous missense mutations of the DCTN1 gene were detected in one apparently sporadic case of ALS (T1249I), one individual with familial ALS (M571T), two patients with familial ALS, and two unaffected relatives in the same kindred (R785W). The allelic variants of the DCTN1 gene may represent a previously unknown genomic risk factor for ALS.

High rate of constitutional chromosomal rearrangements in apparently sporadic ALS.

Of 85 patients with ALS, the authors identified 3 patients with balanced translocations and 2 patients with pericentric inversions, all affecting distinct chromosomal loci. The high rate of constitutional aberrations (5.9%) suggests that ALS is, in part, associated with recombination-based rearrangements of genomic sequences.

Nested reverse transcriptase-polymerase chain reaction for the detection of group A rotaviruses.

Rotaviruses are important pathogens associated with diarrhoeal diseases in almost all species of mammals. In the present study, a nested reverse transcriptase-polymerase chain reaction (RT-PCR) for the detection of group A rotaviruses was developed, which is based on a target region in gene segment 6. Rotavirus strains of human, bovine, porcine, canine, feline, equine, and ovine origin were examined. Furthermore several faecal specimens, in which rotavirus had already been detected using other methods than PCR, were included in the study. A nested RT-PCR product was formed with all strains and faecal samples tested. The detection limit for virus-containing cell culture supernatant was 3 x 10(-2) [50% tissue culture infective dose (TCID50)] by RT-PCR and 3 x 10(-3) TCID50) by nested amplification. In order to examine the influence of the sample matrix on sensitivity, a rotavirus-negative faecal specimen was spiked with virus-containing cell culture suspension of the porcine rotavirus OSU. The detection limit of the present PCR procedure was approximately 1.6 x 10(2) TCID50 per g faeces and could be increased by one order of magnitude using nested PCR. The present method for detection and identification of group A rotaviruses represents a powerful diagnostic tool and was shown to be applicable to rotaviruses of different origin, including human sources.

Motor neuron cell death in a mouse model of FALS is not mediated by the p53 cell survival regulator.

Mutant Cu/Zn superoxide dismutase (SOD1) associated with familial amyotrophic lateral sclerosis (FALS) causes selective motor neuron loss through unknown mechanisms of cell damage. Damaged neurons frequently undergo apoptosis mediated by the p53 cell survival regulator. We therefore studied whether motor neuron disease (MND) in mice expressing the human SOD1 mutant G93A is dependent on p53 by crossing G93A mice with p53-knockout mice. Since p53-/- mice's life expectance is usually shorter (160+/-49 days, n=11) than the time at which the G93A mice die from MND (212+/-50 days, n=7), only a few of the G93A/p53-/- double transgenics were expected to live to experience MND. Nevertheless, four of the 22 G93A/p53-/- mice succumbed to MND after 160+/-28 days, as expected under these conditions of competing death risks if the absence of p53 fails to protect from MND. Thus, MND in mice expressing G93A does not require p53. This conclusion is supported by histology: pre-symptomatic G93A mice display disease-associated vacuoles within the dendrites of motor neurons regardless of p53 status.

[Use of a fast test to detect rotavirus in feces]. / Anwendung eines Schnelltests zum Nachweis von Rotaviren in Kotproben.

The commercially available immunoassay "OnSite Rotavirus" was used for the detection of animal rotaviruses in 113 faecal samples. The sensitivity of the test was 88% and the specificity 96% compared with reference methods (EIA, EM). This test would detect approximately 4.4 x 10(6) to 1.8 x 10(7) virus particles per ml. The presence of virus could be demonstrated in fresh faecal samples from cattle, horses and pigs within a few minutes. The rotaviruses of group A were identified independently of the virus serotype. Further results and additional problems of using this test kit are described.

Eye movement in amyotrophic lateral sclerosis: a longitudinal study.

Eye muscles and the sphincter muscles of the bowel and bladder were formerly thought to be spared in amyotrophic lateral sclerosis (ALS), a neurodegenerative disorder. As frequent subclinical impairment of the anal sphincter muscles in ALS has recently been reported, We suspected an earlier and more frequent, if subclinical, involvement of the oculomotor system than hitherto described. Starting in 1993, we repeatedly studied oculomotor involvement in eight patients with (ALS) using routine orthoptic examination techniques as well as electro-oculographic recordings of ocular movements. Three patients had consistently normal clinical examinations but progressive changes in electro-oculography (EOG). Three patients showed intermittent impairment of eye movements with normal EOG (one patient) or with progressive changes on EOG examination. In two patients, both clinical examination and EOG were progressively pathologic. These findings provide further evidence of early oculomotor involvement, e.g., prior to respiratory failure, in ALS than previously suspected. Since EOG changes seemed to be detectable in all but one patient, EOG changes may allow earlier, subclinical detection of impaired eye movement and thus reveal even an increased frequency of oculomotor impairment in ALS. Due to the heterogeneity of ALS the number of patients examined to settle finally the question of oculomotor involvement in ALS needs to be increased. Newly developed software will allow further interpretation and comparison of more data and, thus, should offer further help in detecting early changes.

[Disorders of eye movement in amyotrophic lateral sclerosis--report of 2 patients]. / Augenbewegunsstörungen bei Amyotropher Lateralsklerose--Bericht über zwei Patienten.

BACKGROUND: Amyotrophic lateral sclerosis (ALS), a neurodegenerative disorder of unknown origin, was thought to spare the extraocular muscles. Extraocular involvement has recently been reported to occur in the late stages of ALS following respiratory insufficiency. CASE REPORT: We report on two patients with ALS who were referred for screening of oculomotor impairment in ALS. Orthoptic examination in a 64-year-old woman with peripheral ALS revealed retraction of the upper eye lids as well as impaired abduction and upgaze in both eyes, developing prior to respiratory insufficiency. A 50-year-old man with bulbar ALS was found to have bilateral impairment of upgaze as well as a negative Bell's phenomenon. Horizontal pursuit was interrupted by compensatory saccades, vertical fixating saccades were slightly hypometric. These oculomotor changes were also seen prior to respiratory insufficiency. CONCLUSION: These findings provide further evidence of early oculomotor involvement in ALS, e.g. prior to respiratory failure and prior than previously suspected. Oculomotor impairment may occur in both the peripheral and the bulbar type of ALS.

Central nervous system alterations in a case of short-rib polydactyly syndrome, Majewski type.

The authors present a case of CNS abnormalities in a female newborn infant with Majewski syndrome. On examination the gyri were found to be normal, but there was narrowing of the corpus callosum and fornix, and dilated ventricles. A vermis hypoplasia and an arachnoid cyst were found between the cerebellar hemispheres. Cross-section of the cervical and thoracic segments revealed a flattened spinal cord in the sagittal section. There were reactive astrocytes and heterotopic ganglion cells in the white matter and isolated hypoxically damaged nerve-cells in the subiculum and nuclear masses of the brainstem. These findings are discussed with reference to the literature.