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1.
Neuroophthalmology ; 45(6): 397-402, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34720271

RESUMO

Glioblastoma multiforme (GBM) is an aggressive glioma that is infrequently diagnosed in the paediatric population. GBM and other primary brain tumours have rarely been associated with paraneoplastic syndromes. We report an unusual case of an 8-year-old boy presenting with an inability to abduct his left eye and almost complete ophthalmoplegia of his right eye, prior to any radiological evidence of GBM. This is the first documented case of paediatric GBM presenting with bilateral asymmetric ophthalmoplegia.

2.
Can J Neurol Sci ; 43(5): 655-8, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27406422

RESUMO

Background Recent studies have strongly indicated the benefits of endovascular therapy for acute ischemic stroke, but what remains a continued debate is the role for general anaesthesia versus conscious sedation (CS) for such procedures. Retrospective studies have found poorer neurological outcomes in patients who underwent general anesthesia (GA); however, some have revealed worse baseline stroke severity in these patients. Methods This study is a retrospective cohort study aimed at comparing mortality and morbidity of GA versus CS in patients treated with endovascular intervention in acute ischemic stroke. Chi-square and t-test analyses were used. Results Patients in the GA (n=42) group were more likely to be deceased than those in the CS (n=67) group at hospital discharge, 3 months, and 6 months poststroke onset. Morbidity, as defined by modified Rankin Score, was significantly greater in the GA group at hospital discharge, and a similar trend was seen in morbidity at 3 months postdischarge. Conclusion General anesthesia for endovascular intervention in acute ischemic stroke was associated with increased mortality and poorer neurological incomes compared with conscious sedation. In our study, age, gender, history of hypertension, history of diabetes, and baseline National Institute of Health Stroke Scale were not significantly different between the groups. Although the need for a randomized, prospective study on this topic is clear, our study represents further corroboration of the safety and efficacy of conscious sedation in these procedures.


Assuntos
Anestesia Geral/métodos , Sedação Consciente/métodos , Procedimentos Endovasculares/métodos , Acidente Vascular Cerebral/cirurgia , Resultado do Tratamento , Isquemia Encefálica/complicações , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo
3.
Twin Res Hum Genet ; 15(5): 668-71, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22877833

RESUMO

The mothers of 603 pairs of 3- to 13-year-old twins in Korea completed the Emotionality, Activity, Sociability (EAS) Temperament Survey and the Strengths and Difficulties Questionnaire in reference to their twins. Principal factor analysis of the seven scales comprising these measures yielded a general factor on which all the scales had moderate to large loadings. Univariate behavioral genetic analyses showed that individual differences on this general factor could best be accounted for by additive genetic and non-shared environmental effects, with a heritability of 53%. The results strengthen the construct validity of the general factor of personality (GFP) by extracting this higher-order dimension from disparate measures, and have implications regarding social desirability criticisms applied to the GFP theory.


Assuntos
Emoções , Personalidade , Temperamento , Gêmeos Dizigóticos/psicologia , Gêmeos Monozigóticos/psicologia , Adolescente , Criança , Pré-Escolar , Coleta de Dados , Análise Fatorial , Feminino , Humanos , Individualidade , Masculino , Personalidade/genética , República da Coreia , Comportamento Social , Desejabilidade Social , Inquéritos e Questionários
4.
Neurol Clin Pract ; 11(2): e147-e151, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33842083

RESUMO

PURPOSE OF REVIEW: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the most critical public health challenge in recent history. In this report, we present a case of suspected acute hemorrhagic encephalitis with bilateral intracranial hemorrhages associated with coronavirus disease 2019 (COVID-19) infection. RECENT FINDINGS: A 48-year-old female COVID-19-positive patient developed acute changes in her neurologic status. A head CT with CT angiography demonstrated extensive bilateral parietal and occipital intraparenchymal hemorrhage with intraventricular extension and acute hydrocephalus. The patient was treated with an external ventricular drain, and a CSF sample was tested for SARS-CoV-2 but was found to be negative. SUMMARY: The underlying mechanism for developing acute hemorrhagic encephalitis in viral illnesses may be autoimmune in nature and warrants further investigation. The initial neurologic presentation of COVID-19-related hemorrhagic encephalitis is altered level of consciousness, which may prompt further neurologic examination and imaging to exclude this feature.

5.
Neurology ; 95(24): e3373-e3385, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-32934172

RESUMO

OBJECTIVES: To investigate the hypothesis that strokes occurring in patients with coronavirus disease 2019 (COVID-19) have distinctive features, we investigated stroke risk, clinical phenotypes, and outcomes in this population. METHODS: We performed a systematic search resulting in 10 studies reporting stroke frequency among patients with COVID-19, which were pooled with 1 unpublished series from Canada. We applied random-effects meta-analyses to estimate the proportion of stroke among COVID-19. We performed an additional systematic search for cases series of stroke in patients with COVID-19 (n = 125), and we pooled these data with 35 unpublished cases from Canada, the United States, and Iran. We analyzed clinical characteristics and in-hospital mortality stratified into age groups (<50, 50-70, >70 years). We applied cluster analyses to identify specific clinical phenotypes and their relationship with death. RESULTS: The proportions of patients with COVID-19 with stroke (1.8%, 95% confidence interval [CI] 0.9%-3.7%) and in-hospital mortality (34.4%, 95% CI 27.2%-42.4%) were exceedingly high. Mortality was 67% lower in patients <50 years of age relative to those >70 years of age (odds ratio [OR] 0.33, 95% CI 0.12-0.94, p = 0.039). Large vessel occlusion was twice as frequent (46.9%) as previously reported and was high across all age groups, even in the absence of risk factors or comorbid conditions. A clinical phenotype characterized by older age, a higher burden of comorbid conditions, and severe COVID-19 respiratory symptoms was associated with the highest in-hospital mortality (58.6%) and a 3 times higher risk of death than the rest of the cohort (OR 3.52, 95% CI 1.53-8.09, p = 0.003). CONCLUSIONS: Stroke is relatively frequent among patients with COVID-19 and has devastating consequences across all ages. The interplay of older age, comorbid conditions, and severity of COVID-19 respiratory symptoms is associated with an extremely elevated mortality.


Assuntos
COVID-19/mortalidade , COVID-19/fisiopatologia , Mortalidade Hospitalar/tendências , Fenótipo , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/fisiopatologia , Humanos , Mortalidade/tendências , Fatores de Risco
6.
Nutrients ; 10(6)2018 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-29914158

RESUMO

Metabolic products of the intestinal microbiome such as trimethylamine N-oxide (TMAO) that accumulate in renal failure (gut-derived uremic toxins, GDUTs) affect atherosclerosis and increase cardiovascular risk. We hypothesized that patients on a Mediterranean diet and those consuming lower amounts of dietary precursors would have lower levels of GDUTs. Patients attending vascular prevention clinics completed a Harvard Food Frequency Questionnaire (FFQ) and had plasma levels of TMAO, p-cresylsulfate, hippuric acid, indoxyl sulfate, p-cresyl glucuronide, phenyl acetyl glutamine, and phenyl sulfate measured by ultra-performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry. Carotid plaque burden was measured by ultrasound; CKD-Epi equations were used to estimate the glomerular filtration rate. In total, 276 patients completed the study. Even moderate renal function significantly increased plasma GDUTs, which were significantly associated with higher carotid plaque burden. There was no significant difference in plasma levels of any GDUT associated with a Mediterranean diet score or with intake of dietary precursors. In omnivorous patients with vascular disease, the intake of dietary precursors of intestinal metabolites or adherence to a Mediterranean diet did not change plasma GDUT. Approaches other than diet, such as probiotics and repopulation of the intestinal microbiome, may be required to mitigate the adverse effects of GDUTs.


Assuntos
Artérias Carótidas/patologia , Dieta Mediterrânea , Microbioma Gastrointestinal/efeitos dos fármacos , Intestinos/microbiologia , Rim/fisiologia , Placa Aterosclerótica/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Registros de Dieta , Feminino , Humanos , Mucosa Intestinal/metabolismo , Masculino , Pessoa de Meia-Idade
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