Cotard's Syndrome Triggered by Fear in a Patient with Intellectual Disability: Causal or Casual Link?

Cotard's syndrome is a neuropsychiatric disease characterized by a variety of nihilistic delusions, commonly associated with several psychotic and major affective disorders, and neurological diseases, including stroke, dementia, and mental retardation. A 39-year-old male with mental retardation developed Cotard's syndrome, following an important episode of fear. During admission to our neurological unit, the patient underwent an accurate assessment, including neuroradiological, clinical, and neuropsychological examinations. At the psychiatric evaluation, he presented nihilistic delusions, in which he negated the existence of his body parts and the existence of his family members. The neuropsychological assessment ruled out other possible causes of misidentification, including the post-traumatic stress disorder. Thus, since also organic causes of Cotard's syndrome were excluded, the correlation between fear and the syndrome has been postulated and the patient opportunely treated, using a multidisciplinary approach. Our case suggests that in predisposed individuals negative emotions, including fear, may lead to delusional syndromes.

Automatic Algorithm for Segmentation of Atherosclerotic Carotid Plaque.

BACKGROUND: Carotid atherosclerosis is one of the major causes of stroke. The determination of the intima-media thickness, the identification of carotid atherosclerotic plaque, and the classification of the different stenoses are considered as important parameters for the assessment of atherosclerotic diseases. The aim of this work is to segment the plaques and to allow a better comprehension of carotid atherosclerosis. METHODS: We considered 44 subjects, 22 with and 22 without the presence of plaques in the carotid axis, and we applied the snake algorithm. RESULTS: The resulting interclass correlation coefficients (ICCs) were significant for all 3 parameters (mean echogenicity: ICC1 = .78 [95%CI: .55-0.90]; perimeter: ICC2 = .81 [95%CI: .61-0.92]; area: ICC3 = .89 [95%CI: .75-0.95]). The diagnostic accuracy was 82%, with an appropriate cutoff value of 224.5, sensitivity of 79%, and specificity of 85%. CONCLUSIONS: In this study, we developed an automatic method to identify the carotid plaque. Our results showed that an automatic system of image segmentation could be used to identify, characterize, and measure atherosclerotic carotid plaques.

Cotard and Capgras syndrome after ischemic stroke.

Capgras and Cotard are delusional misidentification syndromes characterized by delusions about oneself, others, places, and objects. To date, there are few cases of comorbidity of both syndromes. We describe a case of aphasic stroke patient affected by cerebral ischemia localized in right temporoparietal region. The patient showed a typical clinical picture of delusional disorder attributable, through psychological assessment, to comorbidity of both Capgras and Cotard syndromes.

Assessment of sleep and obesity in adults and children: Observational study.

The sleep allows many psychological processes, such as immune system activity, body metabolism and hormonal balance, emotional and mental health, learning, mnemonic processes. The lack of sleep could undermine mental and physical purposes, causing an alteration in cognitive functions or metabolic disorders. In our study, we have examined the irregular sleep effects with the overweight and obesity risk in children and adults.The sample was composed of 199 subjects, of which 71 adults, (29 males and 42 females), and 128 children (73 males and 55 females). We have measured the weight and height with standard techniques; we also have measured the body mass index dividing the weight in kg with the height square expressed in meters (kg/m). Subjects were divided into underweight, normal weight, overweight, and obese. Were administered some questionnaires to measure the quantity and quality of sleep, and eating habits and individual consumption of food.Analysis of demographic variables not showed significant differences between male and female groups but highlighted a significant trend differences in normal-weight score. The clinical condition has a substantial impact on body mass index score and sleep hours were significant predictor on this.Quantity and quality sleep can also represent a risk factor of overweight and obesity, so sufficient sleep is a factor that influence a normal weight. Adults and children that sleep less, have an increase in obesity and overweight risk with dysfunctional eating behaviors, decreased physical activity, and metabolic changes.

Validation of a computer-aided diagnosis system for the automatic identification of carotid atherosclerosis.

Carotid atherosclerosis represents one of the most important causes of brain stroke. The degree of carotid stenosis is, up to now, considered one of the most important features for determining the risk of brain stroke. Ultrasound (US) is a non-invasive, relatively inexpensive, portable technique, which has an excellent temporal resolution. Computer-aided diagnosis (CAD) has become one of the major research fields in medical and diagnostic imaging. We studied US images of 44 patients, 22 patients with and 22 without carotid artery stenosis, by using US examination and applying a CAD system, an automatic prototype software to detect carotid plaques. We obtained 287 regions: 60 were classified as plaques, with an average signal echogenicity of 244.1 ± 20.0 and 227 were classified as non-plaques, with an average signal echogenicity of 193.8 ± 38.6 compared with the opinion of an expert neurologist (golden test). The receiver operating characteristic (ROC) analysis revealed a highly significant area under the ROC curve difference from 0.5 (null hypothesis) in the discrimination between plaques and non-plaques; the diagnostic accuracy was 89% (95% CI: 0.85-0.92), with an appropriate cut-off value of 236.8, sensitivity was 83% and specificity reached a value of 85%. The experimental results showed that the proposed method is feasible and has a good agreement with the expert neurologist. Without the need of any user-interaction, this method generates a detection out-put that may be useful in second opinion.

Fatigue in patients with multiple sclerosis: from movement preparation to motor execution.

BACKGROUND: The neural mechanisms underlying fatigue in multiple sclerosis (MS) are still poorly understood. Cortico-cortical and cortico-subcortical circuitry abnormalities may play a central role in its pathogenesis. Our previous studies suggest that central fatigue may be related to an impairment of volition drive during movement preparation. OBJECTIVE: We further explored the central mechanisms of fatigue at the premovement level in MS patients during a sustained motor task. METHODS: In MS patients with (MS-F) and without (MS-NF) fatigue and age-matched healthy controls, we evaluated the motor cortex excitability and the premovement facilitation (PMF) through transcranial magnetic stimulation before and after 5min of sequenced finger-tapping movements at a fixed frequency of 2Hz. RESULTS: In MS-F patients, the number of correct sequences performed and the ability to keep a fixed movement rate during the 5-min motor task were significantly decreased in comparison to the normal controls and MS-NF patients. Also, in MS-F patients, post-exercise PMF was significantly decreased. The PMF abnormalities were highly correlated with the performance decay. CONCLUSIONS: PMF may be considered as a kind of servo-mechanism which could play a crucial role during sustained motor task in order to prevent motor performance disruption and to avoid motor exhaustion.

Association between a genetic variant of type-1 cannabinoid receptor and inflammatory neurodegeneration in multiple sclerosis.

Genetic ablation of type-1 cannabinoid receptors (CB1Rs) exacerbates the neurodegenerative damage of experimental autoimmune encephalomyelitis, the rodent model of multiple sclerosis (MS). To address the role on CB1Rs in the pathophysiology of human MS, we first investigated the impact of AAT trinucleotide short tandem repeat polymorphism of CNR1 gene on CB1R cell expression, and secondly on the inflammatory neurodegeneration process responsible for irreversible disability in MS patients. We found that MS patients with long AAT repeats within the CNR1 gene (≥12 in both alleles) had more pronounced neuronal degeneration in response to inflammatory white matter damage both in the optic nerve and in the cortex. Optical Coherence Tomography (OCT), in fact, showed more severe alterations of the retinal nerve fiber layer (RNFL) thickness and of the macular volume (MV) after an episode of optic neuritis in MS patients carrying the long AAT genotype of CNR1. MS patients with long AAT repeats also had magnetic resonance imaging (MRI) evidence of increased gray matter damage in response to inflammatory lesions of the white matter, especially in areas with a major role in cognition. In parallel, visual abilities evaluated at the low contrast acuity test, and cognitive performances were negatively influenced by the long AAT CNR1 genotype in our sample of MS patients. Our results demonstrate the biological relevance of the (AAT)n CNR1 repeats in the inflammatory neurodegenerative damage of MS.