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1.
Life Sci ; 240: 117099, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31760098

RESUMO

Obviously, delivery of the medications to the brain is more difficult than other tissues due to the existence of a strong obstacle, which is called blood-brain barrier (BBB). Because of the lipophilic nature of this barrier, it would be a complex (and in many cases impossible) process to cross the medications with hydrophilic behavior from BBB and deliver them to the brain. Thus, novel intricate drug-carriers in nano scales have been recently developed and suitably applied for this purpose. One of the most important categories of these hydrophilic medications, are reactivators for acetyl cholinesterase (AChE) enzyme that facilitates the breakdown of acetylcholine (as a neurotransmitter). The AChE function is inhibited by organophosphorus (OP) nerve agents that are extremely used in military conflicts. In this review, the abilities of the nanosized drug delivery systems to perform as suitable vehicles for AChE reactivators are comprehensively discussed.


Assuntos
Encefalopatias/tratamento farmacológico , Encéfalo/efeitos dos fármacos , Reativadores da Colinesterase/administração & dosagem , Reativadores da Colinesterase/uso terapêutico , Sistemas de Liberação de Medicamentos , Animais , Barreira Hematoencefálica/efeitos dos fármacos , Portadores de Fármacos , Humanos , Nanoestruturas , Relação Estrutura-Atividade
2.
Medicine (Baltimore) ; 98(51): e18075, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860957

RESUMO

RATIONALE: Dyke-Davidoff-Masson syndrome (DDMS) is a rare syndrome commonly occurring in children and characterized by cerebral hemiatrophy, hypertrophy of the skull, epilepsy, and mental retardation. However, few have been reported in China, especially in teenagers. This case investigated its possible cause and explored a relative effective solution. PATIENT CONCERNS: A 24-year-old female came to department having experienced recurrent seizures for 12 years. DIAGNOSIS: DDMS was diagnosed from its manifestations, biochemistry indexes, and imaging (computed tomography angiography, magnetic resonance venography, and so on). INTERVENTIONS: Several drugs are used to treat the disease, including valproate, carbamazepine, topiramate, and ginkgo biloba extract. OUTCOMES: Under the medicine treatment of magnesium valproate with carbamazepine, the patient experienced partial seizures approximately once per month that lasted 30 to 60 seconds each without any complications observed during a follow-up period of 24 months. CONCLUSION: The imaging and clinical features of DDMS in this teenager were similar to those in classic infantile-onset cases. A potential cause of the disease could be brain trauma, which impaired the middle cerebral artery and reduced cerebral blood supply, leading to epilepsy and hemiatrophy. LESSONS: It was concluded early diagnosis and pharmacotherapy are the keys to preventing intellectual decline in DDMS patients. Moreover, the combination of magnesium valproate and carbamazepine could significantly reduce the frequency and duration of seizures, despite not eliminating them completely.


Assuntos
Encefalopatias/diagnóstico por imagem , Deficiência Intelectual/diagnóstico , Imagem por Ressonância Magnética/métodos , Convulsões/diagnóstico , Convulsões/tratamento farmacológico , Encefalopatias/tratamento farmacológico , Carbamazepina/uso terapêutico , China , Doença Crônica , Feminino , Humanos , Deficiência Intelectual/tratamento farmacológico , Prognóstico , Recidiva , Medição de Risco , Índice de Gravidade de Doença , Síndrome , Tomografia Computadorizada por Raios X/métodos , Ácido Valproico , Adulto Jovem
3.
Medicine (Baltimore) ; 98(44): e17794, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689856

RESUMO

RATIONALE: Bing-Neel syndrome (BNS) is a rare manifestation of Waldenström macroglobulinemia (WM) with <200 cases reported in the literature. Herein, we describe a case of newly diagnosed BNS treated with a novel therapeutic strategy. PATIENT CONCERNS: A 67-year-old woman diagnosed with asymptomatic WM 3 years ago presented with gradual vision deterioration the past 3 months. Ophthalmologic examination revealed bilateral reduction in visual acuity (7/10) and bilateral optic disc swelling which was more prominent in the left eye. DIAGNOSES: Brain imaging revealed bilateral swelling of optic nerves extending from the retina to the optic chiasm and swelling of the left optic tract. Patchy enhancement of optic nerves was also shown upon intravenous contrast administration. Flow cytometry of the cerebrospinal fluid (CSF) revealed the presence of κ-light chain restricted, monoclonal B-lymphocytes. CSF protein electrophoresis showed a monoclonal band in the gamma region and immunofixation was positive for immunoglobulin M and kappa light chain. Thus, the diagnosis of BNS was established. INTERVENTIONS: The patient was initially treated with intrathecal methotrexate and systemic chemotherapy. Following 2 intrathecal methotrexate infusions, CSF flow cytometry did not detect any cells, whereas the patient reported improvement in visual acuity. Therefore, we opted to start maintenance treatment with IV rituximab and per os ibrutinib. OUTCOMES: Following 1 year posttreatment initiation, visual problems have resolved completely and the patient remains on hematologic and imaging complete response. LESSONS: We propose a novel sequential chemoimmunotherapy approach for BNS treatment aiming both at rapid disease control and deep and durable remission with minimization of induced toxicity.


Assuntos
Encefalopatias/tratamento farmacológico , Imunoterapia/métodos , Quimioterapia de Indução/métodos , Neurite Óptica/tratamento farmacológico , Macroglobulinemia de Waldenstrom/tratamento farmacológico , Idoso , Encefalopatias/imunologia , Feminino , Humanos , Neurite Óptica/imunologia , Síndrome , Macroglobulinemia de Waldenstrom/imunologia
4.
Medicina (B Aires) ; 79 Suppl 3: 42-47, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31603843

RESUMO

Epileptic encephalopathies is a group of epileptic syndromes characterized by progressive cognitive impairment beyond the expected for the epilepsy activity. They are characterized by severe pharmaco-resistant epilepsy, severely abnormal electroencephalograms, early-age onset, neurocognitve impairment, variable phenotype and usually normal brain MRI. These syndromes are usually genetically determined. A correct and timely diagnosis could help and guide the medical counselling and the correct therapeutic approach improving the short, medium and long term outcomes. In this article we review the electroencephalographic and genetic findings along with the most recommended therapeutic options facilitating the clinical management. We include the following epileptic encephalopathy syndromes: Ohtahara, early myoclonic encephalopathy, epilepsy of infancy with migrating focal seizures, West, Dravet, non-progressive myoclonic status, Doose, Lennox-Gastaut, Landau-Kleffner and continuous spike-wave during sleep epilepsy.


Assuntos
Encefalopatias/genética , Epilepsias Mioclônicas/genética , Espasmos Infantis , Anticonvulsivantes/classificação , Anticonvulsivantes/uso terapêutico , Encefalopatias/classificação , Encefalopatias/diagnóstico , Encefalopatias/tratamento farmacológico , Eletroencefalografia , Epilepsias Mioclônicas/diagnóstico , Epilepsias Mioclônicas/tratamento farmacológico , Humanos , Síndrome
7.
Neuron ; 103(4): 563-581, 2019 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437453

RESUMO

Spike-timing-dependent synaptic plasticity (STDP) is a leading cellular model for behavioral learning and memory with rich computational properties. However, the relationship between the millisecond-precision spike timing required for STDP and the much slower timescales of behavioral learning is not well understood. Neuromodulation offers an attractive mechanism to connect these different timescales, and there is now strong experimental evidence that STDP is under neuromodulatory control by acetylcholine, monoamines, and other signaling molecules. Here, we review neuromodulation of STDP, the underlying mechanisms, functional implications, and possible involvement in brain disorders.


Assuntos
Plasticidade Neuronal/fisiologia , Neurotransmissores/fisiologia , Potenciais de Ação , Animais , Astrócitos/fisiologia , Comportamento/fisiologia , Encefalopatias/tratamento farmacológico , Encefalopatias/fisiopatologia , Mapeamento Encefálico , Humanos , Aprendizagem/fisiologia , Consolidação da Memória/fisiologia , Modelos Neurológicos , Terapia de Alvo Molecular , Doenças Neurodegenerativas/tratamento farmacológico , Doenças Neurodegenerativas/fisiopatologia , Transtornos do Neurodesenvolvimento/tratamento farmacológico , Transtornos do Neurodesenvolvimento/fisiopatologia , Neurônios/fisiologia , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Transtorno Obsessivo-Compulsivo/fisiopatologia , Terminações Pré-Sinápticas/fisiologia , Receptores de Neurotransmissores/fisiologia , Transdução de Sinais/fisiologia , Especificidade da Espécie , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/fisiopatologia , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/fisiopatologia , Fatores de Tempo
8.
Zhonghua Er Ke Za Zhi ; 57(7): 538-542, 2019 Jul 02.
Artigo em Chinês | MEDLINE | ID: mdl-31269554

RESUMO

Objective: To investigate the clinical manifestations, diagnosis, and treatment of H1N1 influenza A-associated encephalopathy (IAE) in children. Methods: The clinical manifestations, laboratory tests, cranial magnetic resonance imaging (MRI), electroencephalography (EEG) examinations and treatments of seven children with H1N1 IAE hospitalized in Guangzhou Women and Children's Medical Center from December 2018 to January 2019 were retrospectively analyzed. Results: Five of the seven children with H1N1 IAE were female. The age at admission was 4 years and 5 months (range 7 months-9 years). Neurological symptoms occurred simultaneously or early (0-3 days) after the flu-like symptom appeared. The main clinical manifestations of neurological symptoms were seizures (repeated seizures in five cases and status convulsion in two cases, including one case of unexpected fever and repeated seizures in a nine-year old girl) accompanied with altered consciousness (drowsiness in five cases and coma in two cases). Cranial MRI in three cases displayed multifocal lesions, mainly in the bilateral thalamus, brainstem and cerebellar hemisphere. MRI also showed reversible splenial lesion in the corpus callusumin in three cases. EEG tracings were characterized by diffuse slow wave activity in four cases, and status epilepticus was monitored in one case. All the 7 cases were treated with oral oseltamivir. Three cases were treated with pulsed methylprednisolone and intravenous immunoglobulin. One case was treated with intravenous immunoglobulin alone and all the patients received oral oseltamivir. All the patients survived, with three patients had minor neurological sequelae at discharge. Conclusions: The main clinical manifestations of H1N1 IAE are seizures and altered consciousness. Cranial MRI combined with EEG is helpful for early diagnosis. Intravenous immunoglobulin and (or) methylprednisolone should be considered for severe cases.


Assuntos
Encefalopatias/diagnóstico , Encefalopatias/tratamento farmacológico , Encéfalo/diagnóstico por imagem , Imunoglobulinas Intravenosas/administração & dosagem , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/diagnóstico , Influenza Humana/tratamento farmacológico , Oseltamivir/uso terapêutico , Encefalopatias/virologia , Criança , Pré-Escolar , Eletroencefalografia , Encefalite Viral/complicações , Encefalite Viral/diagnóstico por imagem , Encefalite Viral/virologia , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Vírus da Influenza A Subtipo H1N1/patogenicidade , Influenza Humana/complicações , Influenza Humana/virologia , Imagem por Ressonância Magnética , Masculino , Metilprednisolona , Estudos Retrospectivos , Resultado do Tratamento
9.
BMJ Case Rep ; 12(7)2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31270084

RESUMO

A 75-year-old female patient presented to the accident and emergency department following a collapse. She was treated for a saddle pulmonary embolism and underlying urinary tract infection. However, 48 hours later she was found to have reduced consciousness with no apparent cause (Glasgow Coma Scale of 8 out of 15). Subsequent blood results revealed a highammonia level. After reflection into her medical history, it was found that she had bladder exstrophy, which was managed with urinary diversion surgery as an infant, and her presentation was a rare complication of this operation.


Assuntos
Encefalopatias/diagnóstico , Encefalopatias/etiologia , Hiperamonemia/complicações , Hiperamonemia/diagnóstico , Infecções Urinárias/complicações , Infecções Urinárias/diagnóstico por imagem , Idoso , Antibacterianos/uso terapêutico , Encefalopatias/tratamento farmacológico , Ciprofloxacino/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Hiperamonemia/tratamento farmacológico , Tomografia Computadorizada por Raios X/métodos , Infecções Urinárias/tratamento farmacológico
10.
Medicina (B Aires) ; 79(3): 204-207, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31284256

RESUMO

Susac syndrome is a rare disorder caused by autoimmune-mediated occlusions of microvessels in the brain, retina and inner ear. These occlusions lead to a characteristic clinical triad of central nervous system dysfunction, visual disturbances and vestibule-cochlear deficits. The diagnosis is based on clinical manifestations and complementary studies, which demonstrate the involvement of three systems. There are different treatments that include various immunosuppressive drugs combinations such as corticosteroids, intravenous immunoglobulin, mycophenolate mofetil, among others. We present the case of a 26-year-old woman with left hearing loss, tinnitus and episodes of recurrent vertigo, four weeks after bilateral blurred vision, cerebellar ataxia and encephalopathy. Magnetic resonance imaging of the brain showed multiple rounded hyperintense lesions in t2 and fluid-attenuated inversion recovery (FLAIR), hypointense in t1, at the middle level of the corpus callosum, internal capsule, cerebellum and right middle cerebellar peduncle. The audiometry evidenced bilateral perceptual hearing loss, predominantly in the left ear. Angiography by optical coherence tomography showed obstruction in the deep layer retina arteries. The Susac syndrome was diagnosed and treatment started with methylprednisolone pulses therapy, intravenously 1000 mg/day for 5 days, followed by maintenance with mycophenolate, which completely reversed the encephalopathy, with persistence of mild ataxia and hearing loss. It is important to know the clinical triad characteristic and the complementary studies necessary to arrive at the diagnosis, since immunosuppressive treatment can often be delayed. Our case had an excellent response to corticosteroids.


Assuntos
Encefalopatias/diagnóstico por imagem , Encefalopatias/etiologia , Síndrome de Susac/complicações , Síndrome de Susac/diagnóstico por imagem , Vertigem/diagnóstico , Anti-Inflamatórios/uso terapêutico , Encefalopatias/tratamento farmacológico , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Metilprednisolona/uso terapêutico , Ácido Micofenólico/uso terapêutico , Fármacos Neuroprotetores , Prednisolona/uso terapêutico , Gravidez , Síndrome de Susac/tratamento farmacológico
11.
World Neurosurg ; 129: 497-502.e6, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31150865

RESUMO

BACKGROUND: Convection-enhanced delivery (CED) overcomes the blood-brain barrier to deliver therapy within the central nervous system. Our aim was to evaluate citation and other bibliometric characteristics of the 100 most-cited articles about CED to the brain to better understand the state of research efforts in the field. METHODS: Elsevier's Scopus database was searched for the 100 most-cited articles that focused on CED to the brain. Articles were dichotomized as either primarily basic science (BSc) or clinical (CL) articles. Various bibliometric parameters were summarized, and BSc and CL articles were compared. RESULTS: Of the 100 most-cited articles, 64 (64%) were BSc and 36 (36%) were CL. The most common indications reported were brain tumors (59%) and Parkinson disease (5%). Overall median values were as follows: citation count, 102 (range, 70-933); citation rate per year, 9.0 (range, 3.7-49.4); number of authors, 5 (range, 1-25); and publication year, 2006 (range, 1994-2015). Articles were published in a total of 48 different journals, and predominately originated in the United States (n = 78, 78%). BSc and CL articles were statistically comparable in terms of bibliometric parameters. CONCLUSIONS: In the 100 most-cited articles about CED to the brain, there were more BSc articles compared with CL articles; however, they were comparable with respect to the reported bibliometric parameters. Given that the peak year of publication of these articles was more than a decade ago, we anticipate that the field will shift toward more CL articles once effective therapies to be delivered via CED are discovered.


Assuntos
Bibliometria , Encefalopatias/tratamento farmacológico , Convecção , Sistemas de Liberação de Medicamentos/métodos , Animais , Humanos
12.
Epileptic Disord ; 21(S1): 76-81, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31172954

RESUMO

The major goal of therapy in patients with Encephalopathy related to Status Epilepticus during slow Sleep (ESES) is to prevent or reduce associated cognitive deficits. Whether or not the EEG pattern of ESES should be completely suppressed to improve cognition is unknown. In clinical practice, there are two major challenges: to establish the optimal treatment strategy in patients with ESES, and to identify the patients who will benefit most from therapy, including atypical cases. Here, we provide a comprehensive overview of the current literature on treatment efficacy in patients with ESES.


Assuntos
Encefalopatias/tratamento farmacológico , Transtornos Cognitivos/fisiopatologia , Sono/fisiologia , Estado Epiléptico/tratamento farmacológico , Encefalopatias/fisiopatologia , Criança , Eletroencefalografia/métodos , Humanos , Estado Epiléptico/fisiopatologia , Resultado do Tratamento
13.
World Neurosurg ; 129: 404-406, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31254691

RESUMO

Hydatid cyst is the larval form of the parasite Echinococcus. Echinococcus granulosus and less commonly Echinococcus multilocularis species cause the disease. Intracranial hydatid disease is relatively rare; the incidence is approximately 1%-2%. Intracranial hydatid cyst can be classified as primary and secondary. A primary cyst, the most common type, is always solitary. The treatment of hydatid cyst is surgical, and the aim of surgery is to remove the cyst without rupture to prevent recurrence or anaphylactic reaction. The Dowling technique (improved by Arana-Iniguez and San Julian) has been widely used for the excision. Albendazole and praziquantel are the medical treatment of choice. In recurrent cases or cases with rupture during surgery, medical therapy has been reported to be effective. Preoperative and postoperative albendazole may be considered to sterilize the cyst, decrease the chance of anaphylaxis, lower the tension in the cyst wall, and reduce the recurrence.


Assuntos
Encefalopatias/cirurgia , Equinococose/cirurgia , Albendazol/uso terapêutico , Anticestoides/uso terapêutico , Encefalopatias/complicações , Encefalopatias/tratamento farmacológico , Criança , Craniotomia/métodos , Equinococose/complicações , Equinococose/tratamento farmacológico , Feminino , Humanos , Paresia/etiologia
14.
J Vet Emerg Crit Care (San Antonio) ; 29(4): 431-438, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31218823

RESUMO

OBJECTIVE: To describe the clinical presentation, advanced imaging findings, and short- and long-term outcomes in dogs with intracranial empyema. DESIGN: Retrospective case series. ANIMALS: Client-owned dogs diagnosed with intracranial empyema. METHODS: Medical records from 2 referral hospitals were searched for dogs diagnosed with intracranial empyema. To be included in this study, dogs had to fulfill 1 or more of the following 3 inclusion criteria: a magnetic resonance imaging (MRI) scan with space occupying accumulation of extra-axial material suggestive of empyema, a cerebrospinal fluid analysis suggestive of empyema, or direct visualization of purulent material during intracranial surgery. RESULTS: Nine dogs with intracranial empyema were included, with a median age of 3.5 years (range: 4 mo-12.5 y). All presented as emergencies with 7 of the 9 dogs showing neurological abnormalities and 2 of the 9 with retrobulbar swelling and exophthalmos. Six had surgical intervention, 1 was medically managed, and the remaining 2 dogs were euthanized. Typical MRI findings included extra-axial, T1-weighted hypo- to isointense, T2-weighted hyperintense material compared to gray matter with varying degrees of contrast enhancement, with 6 of 8 showing evidence of contiguous infection from adjacent structures on MRI. For 7 dogs, ≥1 samples were sent for culture and sensitivity, with Enterococcus (surgical swab), Streptococcus pneumonia (from cerebral spinal fluid), and coagulase positive Staphylococcus (ear swab) being cultured. The median antimicrobial course length was 6 weeks (range: 2-28 wk). All dogs for which treatment was attempted survived to discharge, with a median hospitalization time of 7 days (range: 4-10 d). Four of the 7 are still alive at the time of writing (1 lost to follow-up; 2 euthanized for other reasons) with all 4 considered neurologically normal with a successful long-term outcome. CONCLUSION: Although intracranial empyema in dogs is a rare condition, excellent outcomes are possible in those cases treated appropriately.


Assuntos
Encefalopatias/veterinária , Doenças do Cão/diagnóstico por imagem , Empiema/veterinária , Animais , Antibacterianos/uso terapêutico , Encefalopatias/diagnóstico por imagem , Encefalopatias/tratamento farmacológico , Doenças do Cão/tratamento farmacológico , Cães , Empiema/diagnóstico por imagem , Empiema/tratamento farmacológico , Feminino , Imagem por Ressonância Magnética/veterinária , Masculino , Estudos Retrospectivos , Resultado do Tratamento
15.
Nutrients ; 11(6)2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31141890

RESUMO

Neurological, neurodegenerative, and psychiatric disorders represent a serious burden because of their increasing prevalence, risk of disability, and the lack of effective causal/disease-modifying treatments. There is a growing body of evidence indicating potentially favourable effects of carnosine, which is an over-the-counter food supplement, in peripheral tissues. Although most studies to date have focused on the role of carnosine in metabolic and cardiovascular disorders, the physiological presence of this di-peptide and its analogues in the brain together with their ability to cross the blood-brain barrier as well as evidence from in vitro, animal, and human studies suggest carnosine as a promising therapeutic target in brain disorders. In this review, we aim to provide a comprehensive overview of the role of carnosine in neurological, neurodevelopmental, neurodegenerative, and psychiatric disorders, summarizing current evidence from cell, animal, and human cross-sectional, longitudinal studies, and randomized controlled trials.


Assuntos
Encefalopatias/tratamento farmacológico , Encéfalo/efeitos dos fármacos , Carnosina/uso terapêutico , Cognição/efeitos dos fármacos , Suplementos Nutricionais , Fármacos Neuroprotetores/uso terapêutico , Animais , Encéfalo/metabolismo , Encéfalo/patologia , Encéfalo/fisiopatologia , Encefalopatias/metabolismo , Encefalopatias/fisiopatologia , Encefalopatias/psicologia , Carnosina/efeitos adversos , Suplementos Nutricionais/efeitos adversos , Humanos , Fármacos Neuroprotetores/efeitos adversos
16.
J Clin Neurosci ; 66: 156-164, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31088767

RESUMO

BACKGROUND: We studied patients with chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) associated with or without lymphoma and measured risk factors suggestive of an underlying lymphoma and follow-up outcomes. METHODS: CLIPPERS patients associated with or without lymphoma were included into this study. Clinical presentations were documented, risk factors suggestive of an underlying lymphoma were tested, and prognostic differences in terms of death were compared. RESULTS: Ten patients had a diagnosis of CLIPPERS associated with lymphoma, with 6 B-cell non-Hodgkin lymphoma, 2 T-cell non-Hodgkin lymphoma and 2 Hodgkin lymphoma. Using multivariate logistic analysis, the following 3 independent risk factors were found to be related to a final diagnosis of lymphoma: hyperreflexia (HR 16.56; 95% CI 1.03-265.29; p = 0.032), elevated protein in CSF (HR 11.59; 95% CI 1.24-108.39; p = 0.047), and recurrences between 2 months and 1 year after treatment (HR 29.27; 95% CI 2.09-409.58; p = 0.012). The model calibration was satisfactory (p = 0.392 with the Hosmer-Lemeshow test), and the discrimination power was good (area under the receiver operating characteristic curve 0.921; p < 0.001, 95% CI 0.826-1.000). Patients with CLIPPERS associated with lymphoma had higher mortality rate and lymphoma was a significant predictor of total mortality (HR 0.040; 95% CI 0.006-0.262; p = 0.001). CONCLUSIONS: Hyperreflexia, elevated protein in CSF and recurrences between 2 months and 1 year after treatment are risk factors suggesting an underlying lymphoma. Relapses during high-dose steroids maintenance therapy can be indicative of lymphoma, too. Patients having CLIPPERS associated with lymphoma have a worse prognosis than those without lymphoma.


Assuntos
Encefalopatias/diagnóstico , Linfoma/diagnóstico , Ponte/patologia , Adulto , Encefalopatias/tratamento farmacológico , Encefalopatias/etiologia , Feminino , Humanos , Inflamação , Linfoma/complicações , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ponte/diagnóstico por imagem , Esteroides/uso terapêutico
17.
Medicine (Baltimore) ; 98(15): e15139, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30985683

RESUMO

RATIONALE: The treatment of intracranial Acinetobacter baumannii infections is made difficult by multidrug-resistance poor drug penetration through the blood-brain barrier (BBB). Although tigecycline appears to be effective against A baumannii, it is only administered intravenously because it does not readily cross the BBB. The addition of intraventricular (IVT) or intrathecal infusions of tigecycline could revolutionize clinical therapy for intracranial A baumannii infections. However, there are few reports on the successful use of such treatments. PATIENT CONCERNS: We report the case of a 17-year-old male who presented with high fever and neck rigidity after intracranial drainage. DIAGNOSIS: Intracranial infection with extensively drug-resistant A baumannii after intracranial drainage. INTERVENTIONS: On the advice of a clinical pharmacist, the patient was administered intrathecal infusions of tigecycline after treatment failure with IVT tigecycline. OUTCOMES: The patient's body temperature returned to normal. Thereafter, the patient was in good clinical condition without signs of cerebrospinal fluid infection and tuberculosis. LESSONS: However, when central nervous system infections fail IVT tigecycline, clinicians should consider changing to intrathecal tigecycline infusions rather than raising the dose of IVT tigecycline. In addition, the co-administration of tigecycline with other drugs that can penetrate the BBB should not be ruled out.


Assuntos
Infecções por Acinetobacter/tratamento farmacológico , Acinetobacter baumannii , Antibacterianos/administração & dosagem , Encefalopatias/tratamento farmacológico , Infecções do Sistema Nervoso Central/tratamento farmacológico , Tigeciclina/administração & dosagem , Infecções por Acinetobacter/diagnóstico por imagem , Adolescente , Encefalopatias/diagnóstico por imagem , Infecções do Sistema Nervoso Central/diagnóstico por imagem , Farmacorresistência Bacteriana Múltipla , Humanos , Infusões Intraventriculares , Infusão Espinal , Masculino
18.
Nutrients ; 11(4)2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30979047

RESUMO

Unhealthy diet promotes progression of metabolic disorders and brain dysfunction with aging. Green tea extracts (GTEs) have various beneficial effects and alleviate metabolic disorders. GTEs have neuroprotective effects in rodent models, but their effects against brain dysfunction in models of aging fed unhealthy diets are still unclear. Here, we showed that GTEs attenuate high-fat (HF) diet-induced brain dysfunction in senescence-accelerated mouse prone-8 (SAMP8), a murine model of senescence. SAMP8 mice were fed a control diet, HF diet, or HF diet with 0.5% GTEs (HFGT) for four months. The HF diet reduced memory retention and induced amyloid ß1-42 accumulation, whereas GTEs attenuated these changes. In HF diet-fed mice, lipid oxidative stress, assessed by malondialdehyde levels, was increased. The levels of proteins that promote synaptic plasticity, such as brain-derived neurotrophic factor (BDNF) and postsynaptic density protein 95 (PSD95), were reduced. These alterations related to brain dysfunction were not observed in HFGT diet-fed mice. Overall, our data suggest that GTEs intake might attenuate brain dysfunction in HF diet-fed SAMP8 mice by protecting synaptic plasticity as well as via anti-oxidative effects. In conclusion, GTEs might ameliorate unhealthy diet-induced brain dysfunction that develops with aging.


Assuntos
Encefalopatias/tratamento farmacológico , Dieta Hiperlipídica/efeitos adversos , Fármacos Neuroprotetores , Extratos Vegetais/administração & dosagem , Chá , Envelhecimento , Peptídeos beta-Amiloides/análise , Animais , Encéfalo/patologia , Química Encefálica , Encefalopatias/etiologia , Encefalopatias/fisiopatologia , Fator Neurotrófico Derivado do Encéfalo/análise , Disfunção Cognitiva/tratamento farmacológico , Disfunção Cognitiva/etiologia , Proteína 4 Homóloga a Disks-Large/análise , Masculino , Memória , Camundongos , Plasticidade Neuronal , Tamanho do Órgão , Estresse Oxidativo/efeitos dos fármacos , Fitoterapia , Sinaptofisina/análise
19.
Fortschr Neurol Psychiatr ; 87(7): 355-360, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-30970386

RESUMO

Blepharospasm is a focal dystonia and a rare disease of the brain that causes involuntary spasms of the muscles responsible for eyelid closure. The diagnosis is made clinically and in unclear cases on the basis of results of electrophysiological tests. Therapy of choice consists of local injections with botulinum toxin that have to be repeated on a regular basis.


Assuntos
Blefarospasmo/tratamento farmacológico , Toxinas Botulínicas/uso terapêutico , Toxinas Botulínicas/administração & dosagem , Encefalopatias/tratamento farmacológico , Humanos
20.
Intern Med ; 58(13): 1947-1951, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-30918173

RESUMO

A 64-year-old man previously diagnosed with Waldenstrom's macroglobulinemia presented to our hospital with confusion. Magnetic resonance imaging (MRI) revealed diffuse meningeal enhancement. The patient was diagnosed with Bing-Neel syndrome (BNS) based on an elevated IgM index and the presence of monoclonal IgM protein, as detected by immunofixation electrophoresis of the cerebrospinal fluid. The patient underwent intrathecal and systemic chemotherapy but ultimately died of pneumonia. An autopsy revealed extensive meningeal and perivascular infiltration by malignant cells throughout the brain and spine. Thus, BNS may cause more extensive malignant infiltration into the central nervous system than is revealed by MRI.


Assuntos
Encefalopatias/tratamento farmacológico , Encefalopatias/patologia , Doenças Neurodegenerativas/diagnóstico , Doenças Neurodegenerativas/tratamento farmacológico , Doenças Neurodegenerativas/patologia , Macroglobulinemia de Waldenstrom/tratamento farmacológico , Macroglobulinemia de Waldenstrom/patologia , Autopsia , Encefalopatias/diagnóstico , Encefalopatias/mortalidade , Citarabina/uso terapêutico , Dexametasona/uso terapêutico , Evolução Fatal , Humanos , Imunossupressores/uso terapêutico , Imagem por Ressonância Magnética , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Doenças Neurodegenerativas/mortalidade , Radiografia , Macroglobulinemia de Waldenstrom/diagnóstico , Macroglobulinemia de Waldenstrom/mortalidade
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