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Kalita J, Tripathi A, Jadhav M, Thakur RS, Patel DK. A Study of Dopaminergic Pathway in Neurologic Wilson Disease with Movement Disorder. Mol Neurobiol 2023; 60:3496-3506. [PMID: 36879138 DOI: 10.1007/s12035-023-03276-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/16/2023] [Indexed: 03/08/2023]
Abstract
Movement disorder (MD) is an important manifestation of neurologic Wilson disease (NWD), but there is a paucity of information on dopaminergic pathways. We evaluate dopamine and its receptors in patients with NWD and correlate the changes with MD and MRI changes. Twenty patients with NWD having MD were included. The severity of dystonia was assessed using BFM (Burke-Fahn-Marsden) score. The neurological severity of NWD was categorized as grades I to III based on the sum score of 5 neurological signs and activity of daily living. Dopamine concentration in plasma and CSF was measured using liquid chromatography-mass spectrometry, and D1 and D2 receptor expression at mRNA by reverse transcriptase polymerase chain reaction in patients and 20 matched controls. The median age of the patients was 15 years and 7 (35%) were females. Eighteen (90%) patients had dystonia and 2 (10%) had chorea. The CSF dopamine concentration (0.08 ± 0.02 vs 0.09 ± 0.017 pg/ml; p = 0.42) in the patients and controls was comparable, but D2 receptor expression was reduced in the patients (0.41 ± 0.13 vs 1.39 ± 1.04; p = 0.01). Plasma dopamine level correlated with BFM score (r = 0.592, p < 0.01) and D2 receptor expression with the severity of chorea (r = 0.447, p < 0.05). The neurological severity of WD correlated with plasma dopamine concentration (p = 0.006). Dopamine and its receptors were not related to MRI changes. The central nervous system dopaminergic pathway is not enhanced in NWD, which may be due to structural damage to the corpus striatum and/or substantia nigra.
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Affiliation(s)
- Jayantee Kalita
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, Uttar Pradesh, India.
| | - Abhilasha Tripathi
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, Uttar Pradesh, India
| | - Mahesh Jadhav
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, Uttar Pradesh, India
| | - Ravindra S Thakur
- CSIR, Indian Institute of Toxicology Research Institute, Lucknow, Uttar Pradesh, India
| | - Devendra K Patel
- CSIR, Indian Institute of Toxicology Research Institute, Lucknow, Uttar Pradesh, India
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Zhou D, Meng R, Li SJ, Ya JY, Ding JY, Shang SL, Ding YC, Ji XM. Advances in chronic cerebral circulation insufficiency. CNS Neurosci Ther 2017; 24:5-17. [PMID: 29143463 DOI: 10.1111/cns.12780] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 12/30/2022] Open
Abstract
Chronic cerebral circulation insufficiency (CCCI) may not be an independent disease; rather, it is a pervasive state of long-term cerebral blood flow insufficiency caused by a variety of etiologies, and considered to be associated with either occurrence or recurrence of ischemic stroke, vascular cognitive impairment, and development of vascular dementia, resulting in disability and mortality worldwide. This review summarizes the features and recent progress of CCCI, mainly focusing on epidemiology, experimental research, pathophysiology, etiology, clinical manifestations, imaging presentation, diagnosis, and potential therapeutic regimens. Some research directions are briefly discussed as well.
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Affiliation(s)
- Da Zhou
- Departments of Neurology and Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- Departments of Neurology and Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Si-Jie Li
- Departments of Neurology and Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Jing-Yuan Ya
- Departments of Neurology and Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jia-Yue Ding
- Departments of Neurology and Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shu-Ling Shang
- Departments of Neurology and Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yu-Chuan Ding
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xun-Ming Ji
- Departments of Neurology and Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
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Jeong H, Kim SK. Viral Encephalitis. JOURNAL OF NEUROCRITICAL CARE 2014. [DOI: 10.18700/jnc.2014.7.2.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Abstract
OBJECTIVES Japanese encephalitis (JE) is one of the commonest viral encephalitis especially prevalent in Southeast Asia. Estimated mortality rate of JE is approximately 30%, with survivors undergoing severe and irreversible neurological sequelae. Although central nervous system (CNS) inflammation is imminent upon JE infection, the pathways underlying the same have not yet been clearly elucidated. However, cytokines-tumor necrosis factor-alpha (TNF-alpha) and interlukin-2 (IL-2), are small secreted proteins, which mediate and regulate immunity. Therefore, we wanted to evaluate the role, if any, of these cytokines in the pathogenesis of JE. METHODS We measured the levels of TNF-alpha and IL-2 in the serum and cerebrospinal fluid (CSF) of patients suffering JE, using enzyme-linked immunosorbent assay (ELISA). RESULTS JE infection caused a remarkable increase (p<0.0001) in the levels of TNF-alpha in the serum and CSF, while IL-2 levels were unaffected. DISCUSSION These results show that TNF-alpha pathway is involved in JE infection-triggered neuroinflammation.
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Affiliation(s)
- G Nagesh Babu
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, UP 226014, India.
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Kalita J, Misra U, Pradhan P. Oromandibular dystonia in encephalitis. J Neurol Sci 2011; 304:107-10. [DOI: 10.1016/j.jns.2011.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 01/28/2011] [Accepted: 02/04/2011] [Indexed: 11/25/2022]
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Misra UK, Kumar S, Kalita J, Ahmad A, Khanna VK, Khan MY, Palit G. A study of motor activity and catecholamine levels in different brain regions following Japanese encephalitis virus infection in rats. Brain Res 2009; 1292:136-47. [PMID: 19631196 DOI: 10.1016/j.brainres.2009.07.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 07/07/2009] [Accepted: 07/09/2009] [Indexed: 11/16/2022]
Abstract
Japanese encephalitis (JE) is associated with a variety of movement disorders including transient form of pakinsonian features, dystonia and miscellaneous movement disorders. The neurotransmitters have important role in movement disorders. However their role in different brain regions in relation to behavioral activities in animal model of JE is not understood. The present study was aimed to investigate the behavioral parameters, the levels of catecholamine in brain regions--thalamus, midbrain, corpus striatum and frontal cortex on 0, 10 and 20 days post inoculation (dpi) with histopathological observations. Twelve day old Wistar strain rats were inoculated intracerebrally with a dose of 3 x 10(6) pfu of JE virus. Spontaneous locomotor activity (SLA) and grip strength were monitored. The levels of catecholamine were estimated using HPLC-ECD and histopathological changes were observed using haematoxylin and eosine staining. A significant decrease in SLA and grip strength was observed in JEV infected rats as compared to controls on 10 and 20 dpi. The levels of norepinephrine, dopamine, 3,4-dihydroxyphenylacetic acid, homovanillic acid, and serotonin were significantly decreased in all the brain regions studied with respect to controls. We did not find significant recovery in catecholamine levels and locomotor activities up to 20 dpi and any significant correlation between behavioral changes and neurotransmitter levels. However histopathological studies revealed mild reduction in degree of damage on 20 dpi. The present study demonstrates the involvement of different brain regions in altered locomotor activity which may be associated with reduction in catecholamine levels in rat model of JE.
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Affiliation(s)
- Usha Kant Misra
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareily Road, Lucknow-226014, U.P., India.
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Liao CH, Ling Z, Chou CH, Huang WS, Denq JC, Lin JC, Chen CY, Chang CJ, Peng GS. Involvement of nigrostriatal pathway in Japanese encephalitis with movement disorders: evidence from 99mTc-TRODAT-1 and 123I-IBZM SPECT imagings. Mol Imaging Biol 2009; 12:9-14. [PMID: 19548034 DOI: 10.1007/s11307-009-0244-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 02/03/2009] [Accepted: 03/03/2009] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate molecular evidence of nigrostriatal pathway involvement in Japanese encephalitis (JE) survivors with movement complications. METHODS Three JE patients were recruited. All had cranial magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) studies with (99m)Tc-TRODAT-1 and (123)I-IBZM. RESULTS Cranial MRI revealed involvement of bilateral thalami, substantia nigra, and medial temporal lobes in all three patients, but only case 1 had additional bilateral basal ganglia involvement. The (99m)Tc-TRODAT-1 SPECT for presynaptic dopamine transporter imaging disclosed asymmetrical decreases in bilateral striatal uptake in all three patients. However, the (123)I-IBZM SPECT imaging for postsynaptic D2 dopamine receptors (D2Rs) revealed inconsistent abnormalities including asymmetrical bilateral decreases (case 1), unilateral decrease (case 2), and bilateral increases (case 3) in striatal uptakes. CONCLUSION Data have suggested that presynaptic dopaminergic neurons in JE patients are more susceptible to JE virus than postsynaptic striatal neurons. The degree of movement impairment was more closely correlated to the degree of D2Rs disruption seen in (123)I-IBZM SPECT imaging.
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Affiliation(s)
- Chang-Hsu Liao
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Cheng-Kung Rd Section 2, Taipei, 114, Taiwan, Republic of China
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Lin CY, Changlia SP, Huang CK, Lin MSF, Yeh CH. Positive Tc-99m TRODAT findings in Japanese encephalitis. Clin Nucl Med 2007; 32:484-5. [PMID: 17515764 DOI: 10.1097/rlu.0b013e3180537814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Chun-Yi Lin
- Departments of Nuclear Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan, Republic of China
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Ono Y, Manabe Y, Sakai K, Hayashi Y, Abe K. Clonic perseveration in the subacute stage of Japanese encephalitis. J Neurol Sci 2006; 251:107-9. [PMID: 17097112 DOI: 10.1016/j.jns.2006.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Revised: 09/08/2006] [Accepted: 09/11/2006] [Indexed: 11/23/2022]
Abstract
We report a very rare case of Japanese encephalitis (JE) presenting with reversible stereotyped movement in the subacute stage. A 58-year-old woman presented with high fever, headache, nausea, vomiting, and consciousness disturbance. Cranial magnetic resonance imaging (MRI) of fluid attenuated inversion recovery (FLAIR) and T2-weighted image (WI) showed high intensity areas in the bilateral thalamus, caudate nucleus and hippocampus. She developed coma, convulsion, and ballism in the acute stage. One month after onset, she showed rhythmic, stereotyped, repetitive movements with hypoperfusion in the thalamus and frontal cortex on single photon emission computed tomography (SPECT). Three months later, her stereotyped movement improved accompanied by recovery of hypoperfusion in the thalamus and frontal cortex on SPECT. We speculated that her stereotyped movement was clonic perseveration due to frontal dysfunction induced by thalamofrontal disconnection.
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Affiliation(s)
- Y Ono
- Department of Neurology, National Hospital Organization, Okayama Medical Center, 1711-1 Tamasu, Okayama, Japan
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Leyssen P, Croes R, Rau P, Heiland S, Verbeken E, Sciot R, Paeshuyse J, Charlier N, De Clercq E, Meyding‐Lamadé U, Neyts J. Acute encephalitis, a poliomyelitis-like syndrome and neurological sequelae in a hamster model for flavivirus infections. Brain Pathol 2006; 13:279-90. [PMID: 12946018 PMCID: PMC8095928 DOI: 10.1111/j.1750-3639.2003.tb00028.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Infection of hamsters with the murine flavivirus Modoc results in (meningo)encephalitis, which is, during the acute phase, frequently associated with flaccid paralysis, as also observed in patients with West Nile virus encephalitis. Twenty percent of the hamsters that recover from the acute encephalitis develop life-long neurological sequelae, reminiscent of those observed, for example, in survivors of Japanese encephalitis. Magnetic resonance imaging and histology revealed severe lesions predominantly located in the olfactory-limbic system, both in hamsters with acute encephalitis as in survivors. Prominent pathology was also detected in the spinal cord of hamsters with paralysis. Modoc virus infections in hamsters provide a unique model for the study of encephalitis, a poliomyelitis-like syndrome and neurological sequelae following flavivirus infection.
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Affiliation(s)
- Pieter Leyssen
- Rega Institute for Medical Research, Katholieke Universiteit Leuven, Belgium
| | - Romaric Croes
- Department of Morphology and Molecular Pathology, Katholieke Universiteit Leuven, Belgium
| | - Philipp Rau
- Department of Neurology, University of Heidelberg, Germany
| | - Sabine Heiland
- Department of Neurology, University of Heidelberg, Germany
| | - Erik Verbeken
- Department of Morphology and Molecular Pathology, Katholieke Universiteit Leuven, Belgium
| | - Raphael Sciot
- Rega Institute for Medical Research, Katholieke Universiteit Leuven, Belgium
| | - Jan Paeshuyse
- Rega Institute for Medical Research, Katholieke Universiteit Leuven, Belgium
| | - Nathalie Charlier
- Rega Institute for Medical Research, Katholieke Universiteit Leuven, Belgium
| | - Erik De Clercq
- Rega Institute for Medical Research, Katholieke Universiteit Leuven, Belgium
| | | | - Johan Neyts
- Rega Institute for Medical Research, Katholieke Universiteit Leuven, Belgium
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12
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Misra UK, Kalita J, Pandey S, Khanna VK, Babu GN. Cerebrospinal fluid catecholamine levels in Japanese encephalitis patients with movement disorders. Neurochem Res 2006; 30:1075-8. [PMID: 16292498 DOI: 10.1007/s11064-005-7414-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2005] [Indexed: 10/25/2022]
Abstract
Norepinephrine and dopamine have important role in movement disorders but their role in movement disorders associated with Japanese encephalitis (JE) has not been evaluated. Therefore, in the present study, cerebrospinal fluid (CSF) catecholamine levels and its metabolites in JE patients with movement disorders were compared with those without JE. CSF was collected by lumbar puncture and analyzed by HPLC-ED. Norepinephrine, dopamine and homovanillic acid concentrations were significantly (P<0.005) lower in JE patients compared to control groups. Low levels of catecholamines in JE associated movement disorders compared to idiopathic Parkinson's disease and other extrapyramidal symptoms may be due to severe structural damage to thalamus, basal ganglia and brainstem in JE patients as revealed by MRI findings.
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Affiliation(s)
- U K Misra
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical sciences, RaeBarali Road, 226014, Lucknow, India
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13
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Abstract
The present review is aimed at providing practical assistance to the clinical neurologist in reaching a diagnosis, understanding the pathogenic mechanisms of movement disorders associated with systemic diseases, and determining appropriate therapy. Infectious disease by direct effect or as an acquired autoimmune neurological disease, stroke, hypoxia-ischemia, paraneoplastic syndromes, collagen disorders, endocrine, liver and kidney diseases that may cause hypokinetic or hyperkinetic abnormal movement are considered separately. The type and evolution of abnormal movement caused by systemic disease vary with age and underlying pathology. Therapy for abnormal movements should include a primary treatment for the systemic disease.
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Affiliation(s)
- Fernando Alarcón
- Department of Neurology, Eugenio Espejo Hospital, P.O. Box 17-07-9515, Quito, Ecuador.
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Tan MH, Lim E. Post-encephalitic segmental dystonia with apraxia of eyelid opening. Parkinsonism Relat Disord 2004; 10:173-5. [PMID: 15036173 DOI: 10.1016/j.parkreldis.2003.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2003] [Revised: 10/06/2003] [Accepted: 10/23/2003] [Indexed: 11/29/2022]
Abstract
We describe a 34 year old woman presenting with a 25 year history of segmental dystonia with apraxia of eyelid opening, orofacial and focal upper limb dystonia following an episode of meningoencephalitis. Post-encephalitic apraxia of eyelid opening has not been previously reported in the absence of parkinsonian features.
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Affiliation(s)
- Min-Han Tan
- Department of Medicine, Alexandra Hospital, 378 Alexandra Road, Singapore 159964, Singapore
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Ecker RD, Goerss SJ, Meyer FB, Cohen-Gadol AA, Britton JW, Levine JA. Vision of the future: initial experience with intraoperative real-time high-resolution dynamic infrared imaging. Technical note. J Neurosurg 2002; 97:1460-71. [PMID: 12507150 DOI: 10.3171/jns.2002.97.6.1460] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
High-resolution dynamic infrared (DIR) imaging provides intraoperative real-time physiological, anatomical, and pathological information; however, DIR imaging has rarely been used in neurosurgical patients. The authors report on their initial experience with intraoperative DIR imaging in 30 such patients. A novel, long-wave (8-10 microm), narrow-band, focal-plane-array infrared photodetector was incorporated into a camera system with a temperature resolution of 0.006 degrees C, providing 65,000 pixels/frame at a data acquisition rate of 200 frames/second. Intraoperative imaging of patients was performed before and after surgery. Infrared data were subsequently analyzed by examining absolute differences in cortical temperatures, changes in temperature over time, and infrared intensities at varying physiological frequencies. Dynamic infrared imaging was applied in a variety of neurosurgical cases. After resection of an arteriovenous malformation, there was postoperative hyperperfusion of the surrounding brain parenchyma, which was consistent with a loss of autoregulation. Bypass patency and increased perfusion of adjacent brain were documented during two of three extracranial-intracranial bypasses. In seven of nine patients with epilepsy the results of DIR imaging corresponded to seizure foci that had been electrocorticographically mapped preoperatively. Dynamic infrared imaging demonstrated the functional cortex in four of nine patients undergoing awake resection and cortical stimulation. Finally, DIR imaging exhibited the distinct thermal footprints of 14 of 16 brain tumors. Dynamic infrared imaging may prove to be a powerful adjunctive intraoperative diagnostic tool in the neurosurgical imaging armamentarium. Real-time assessment of cerebral vessel patency and cerebral perfusion are the most direct applications of this technology. Uses of this imaging modality in the localization of epileptic foci, identification of functional cortex during awake craniotomy, and determination of tumor border and intraoperative brain shift are avenues of inquiry that require further investigation.
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Affiliation(s)
- Robert D Ecker
- Department of Neurological Surgery, Mayo Clinic and Foundation, Rochester, Minnesota, USA
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Goethals I, Dierckx R, Van Laere K, Van De Wiele C, Signore A. The role of nuclear medicine imaging in routine assessment of infectious brain pathology. Nucl Med Commun 2002; 23:819-26. [PMID: 12195082 DOI: 10.1097/00006231-200209000-00001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
One of the leading causes of acute encephalopathy in children in the tropics is Japanese encephalitis (JE). Transmitted by the culex mosquito, this neurotropic virus predominately affects the thalamus, anterior horns of the spinal cord, cerebral cortex, and cerebellum. It mainly affects children <15 years and is mostly asymptomatic. The occasional symptomatic child typically presents with a neurological syndrome characterised by altered sensorium, seizures, and features of intracranial hypertension. Aetiological diagnosis is based on virus isolation or demonstration of virus specific antigen or antibodies in the cerebrospinal fluid/blood. Though no antiviral drug is available against JE, effective supportive management can improve the outcome. Control of JE involves efficient vector control and appropriate use of vaccines.
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Affiliation(s)
- S V Tiroumourougane
- Department of Paediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Abstract
Encephalitis has been reported to be a rare cause of severe dystonia. We describe five patients with markedly severe dystonia from Japanese encephalitis. These patients with markedly severe dystonia were seen during the past 8 years as a subgroup of 50 patients with Japanese encephalitis. The diagnosis of markedly severe dystonia was based on increasingly frequent episodes of generalized dystonia with bulbar, respiratory, or metabolic derangement or leading to exhaustion or pain. The diagnosis of JE was based on clinicoradiologic features and a fourfold increase of hemagglutination-inhibiting antibody titers in paired serum. The outcome of the patients was defined as a good, partial, or poor recovery on the basis of 1-year clinical status. All the patients were males, and their ages ranged from 6 to 19 years. Movement disorders appeared 1 to 3 weeks after the illness as the level of consciousness started improving. During the next 1 to 4 weeks, patients began to experience markedly severe dystonia. It was associated with marked axial dystonia resulting in opisthotonus and retrocollis in five patients, jaw-opening dystonia in two patients, teeth clenching in one patient, and oculogyric crisis and neck deviation in another patient. The attacks of markedly severe dystonia lasted for 2 to 30 minutes and occurred as many as 20 to 30 times daily. Other developments included fixed limb dystonia in one patient, severe spasticity and rigidity in five patients, and focal muscle wasting in one patient. These patients had only a modest improvement after treatment. Markedly severe dystonia abated by 2 to 6 months in all the patients who were followed up. Cranial magnetic resonance imaging showed bilateral thalamic involvement in all patients, brainstem involvement in three patients, and basal ganglia involvement in two patients. At the 3-month follow-up, all patients had a poor outcome. At 1 year, one patient had a complete recovery; one had a partial recovery; and two were bedridden. It can be concluded that markedly severe dystonia is an important and serious sequela of Japanese encephalitis and may occur as the result of thalamus, midbrain, or basal ganglia involvement in various combinations.
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Affiliation(s)
- J Kalita
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Nishikawa M, Matsubara T, Yoshitomi T, Ichiyama T, Hayashi T, Furukawa S. Abnormalities of brain perfusion in echovirus type 30 meningitis. J Neurol Sci 2000; 179:122-6. [PMID: 11054495 DOI: 10.1016/s0022-510x(00)00398-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
From May to August 1998 an epidemic of aseptic meningitis (AM) due to echovirus type 30 (E30) occurred in Yamaguchi prefecture, Japan. We performed single-photon emission-computed tomography (SPECT) to evaluate cerebral perfusion during the acute stage in 27 patients with AM due to E30. Moreover, we measured the cerebrospinal fluid (CSF) concentrations of soluble tumor necrosis factor receptor (sTNF-R) and interleukin-1 beta (IL-1beta) in all 27 patients, and the serum concentration of soluble E-selectin (sE-selectin) in 19 of the 27 patients, which is responsible for vasculitis, by means of a sandwich enzyme-linked immunosorbent assay. In 20 of the 27 (74.1%) children, SPECT imaging revealed localized cerebral hypoperfusion without abnormal focal neurological findings or symptoms. Follow-up SPECT after about 1 month revealed no abnormalities. The CSF concentrations of sTNF-R and IL-1beta, and the serum concentration of sE-selectin in the group with abnormal findings on SPECT were significantly higher than those in the group without abnormal findings on SPECT and the control subjects. Our results indicate that transient reduced regional blood flow is a frequent finding in children with AM due to E30 infection and that this abnormal finding may be induced by cerebral vasculitis.
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Affiliation(s)
- M Nishikawa
- Department of Pediatrics, Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube, 755-8505, Yamaguchi, Japan
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Wills B, Farrar J. Central nervous system infections in the tropics: diagnosis, treatment and prevention. Curr Opin Infect Dis 2000; 13:259-264. [PMID: 11964796 DOI: 10.1097/00001432-200006000-00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present review is a brief discussion of some of the important new developments that have been reported relating to bacterial and viral infections of the central nervous system. For many of these conditions, certain issues remain unresolved, including what is the best diagnostic approach, what is the optimum treatment and how best to prevent such conditions. The development of improved surveillance, more effective vaccines and a greater understanding of the pathophysiology of these diseases all offer great potential benefits. The hope is that these advances, when they come, will be affordable to those who need them most.
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Affiliation(s)
- Bridget Wills
- Wellcome Trust Clinical Research Unit, Centre for Tropical Diseases, Ho Chi Minh City, Viet Nam and Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, UK
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