1
|
Ruggeri M, Ricci M, Gerace C, Blundo C. Accelerated long-term forgetting: from subjective memory decline to a defined clinical entity. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2024:1-12. [PMID: 38363088 DOI: 10.1080/13825585.2024.2317924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
Subjective memory decline (SMD) might represent the preclinical phase of Alzheimer's disease (AD), and has been reported in epileptic amnesia associated with accelerated long-term forgetting (ALF). We investigated ALF in SMD subjects by means of RAVLT recall and recognition and ROCF recall after 1-week retention and compared with a control group. Two-way ANOVAs for RAVLT and ROCF were conducted, and stepwise regression analysis was administered considering EMQ and DASS-21 as factors. SMD subjects performed significantly worse than controls at 1-week delay on RAVLT recall and recognition, but not on ROCF, and not associated with depression or memory complaints. SMD patients showed ALF, which is usually associated with temporomesial dysfunctions, representing a cognitive marker to assess objectively memory problems in SMD, and to undisclose initial neurodegenerative disease involving temporal structures usually compromised in AD. Therefore, SMD might no longer be "subjective," but rather a specific and defined clinical entity.
Collapse
Affiliation(s)
- Massimiliano Ruggeri
- Unit for Cognitive Disorders and Dementia, Department of Neuroscience, San Camillo Forlanini Hospital, Rome, Italy
| | - Monica Ricci
- Unit for Cognitive Disorders and Dementia, Department of Neuroscience, San Camillo Forlanini Hospital, Rome, Italy
| | - Carmela Gerace
- Unit for Cognitive Disorders and Dementia, Department of Neuroscience, San Camillo Forlanini Hospital, Rome, Italy
| | - Carlo Blundo
- Unit for Cognitive Disorders and Dementia, Department of Neuroscience, San Camillo Forlanini Hospital, Rome, Italy
| |
Collapse
|
2
|
Ruggeri M, Ricci M, Pagliaro M, Gerace C. Anosmia predicts memory impairment in post-COVID-19 syndrome: results of a neuropsychological cohort study. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01670-2. [PMID: 37644214 DOI: 10.1007/s00406-023-01670-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
Recovered COVID-19 patients frequently suffer of cognitive disorders. Several etiopathogenetic mechanisms have been considered for the brain complications in COVID-19 but results are uncertain. Amongst them, an olfactory route to SARS-CoV-2 brain infection might explain cognitive and memory disturbances in post-COVID-19 patients, given the cooccurrence of anosmia and possible underlying limbic involvement. The aims of the study are to investigate cognition of patients with post-COVID-19 syndrome, and to find clinical factors predicting cognitive and memory impairments. 18 patients with post-COVID-19 syndrome underwent neuropsychological assessment and evaluation of clinical parameters. Stepwise regression analysis was used between clinical parameters as factors and cognitive global scores as dependent variables. Since only anosmia predicted memory performances, repeated measures ANOVA of memory scores was conducted between anosmic and non-anosmic patients. We found lack of association between clinical parameters and cognitive performances. Only anosmia was a good predictor for memory performances, with anosmic subjects showing a temporo-mesial amnesic profile. Our study shows novel findings of causal association between transient anosmia during COVID-19 and memory disorders with temporo-mesial dysfunction, probably sharing a common pathophysiological mechanism, and suggesting a possible SARS-CoV 2 infection of the limbic brain via the olfactory route. In contrast to previous studies, cognitive dysfunctions were not associated with respiratory distress, comorbidity, and depression.
Collapse
Affiliation(s)
- Massimiliano Ruggeri
- Cognitive Disorders and Dementia Unit, San Camillo Forlanini Hospital, C.ne Gianicolense 57, 00152, Rome, Italy.
- Rehabilitation Center C.A.R., Rome, Italy.
| | - Monica Ricci
- Cognitive Disorders and Dementia Unit, San Camillo Forlanini Hospital, C.ne Gianicolense 57, 00152, Rome, Italy
| | | | - Carmela Gerace
- Cognitive Disorders and Dementia Unit, San Camillo Forlanini Hospital, C.ne Gianicolense 57, 00152, Rome, Italy
| |
Collapse
|
3
|
Ricci M, Ruggeri M, Gnisci C, Pizzoni L, Gerace C, Blundo C. Improving Amnesia Diagnostic Accuracy with RAVLT Single Scores and Composite Indices: Italian Normative Data. Arch Clin Neuropsychol 2022; 37:1749-1764. [DOI: 10.1093/arclin/acac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
The Rey Auditory Verbal Learning Test (RAVLT) is a widely used verbal memory measure that provides scores for different aspects of memory. It involves repeated auditory presentation and recall of a 15-item word list (List A) followed by presentation and recall of a distractor list (List B) and then un-cued immediate and delayed recalls (at 15 min and 1 week) of List A as well as recognition testing. Aims of this study are to provide Italian normative data for certain RAVLT Scores and Composite Indices to improve the diagnostic accuracy of the test in clinical settings and to provide further evidence on how RAVLT can differentiate different amnesia profiles due to focal lesions.
Methods
We enrolled 440 healthy participants and RAVLT Single Scores and Composite Indices have been analyzed by means of multiple regression to verify the influence of age, education, and gender.
Results
We computed the best linear models with RAVLT Single Scores and Composite Indices, as dependent variables, and the most suitable transformation of independent variables. By reversing the signs of the regression coefficients, the adjustment factors for each level of age and, if needed, education and gender have been computed and the adjusted scores have been standardized into Equivalent Scores.
Conclusion
Using these standardized measures, we differentiate three profiles of amnesia due to selective hippocampal sclerosis with severe encoding deficit, fornix lesions with source memory problems, and temporal lobe epilepsy with consolidation failure.
Collapse
Affiliation(s)
- Monica Ricci
- Centre for Cognitive Disorders and Dementia (CDCD) , Neuroscience Departement, , Rome , Italy
- San Camillo-Forlanini Hospital , Neuroscience Departement, , Rome , Italy
| | - Massimiliano Ruggeri
- Centre for Cognitive Disorders and Dementia (CDCD) , Neuroscience Departement, , Rome , Italy
- San Camillo-Forlanini Hospital , Neuroscience Departement, , Rome , Italy
- CAR – Rehabilitation Centre , Rome , Italy
| | - Cristina Gnisci
- Centre for Cognitive Disorders and Dementia (CDCD) , Neuroscience Departement, , Rome , Italy
- San Camillo-Forlanini Hospital , Neuroscience Departement, , Rome , Italy
| | - Luca Pizzoni
- Centre for Cognitive Disorders and Dementia (CDCD) , Neuroscience Departement, , Rome , Italy
- San Camillo-Forlanini Hospital , Neuroscience Departement, , Rome , Italy
| | - Carmela Gerace
- Centre for Cognitive Disorders and Dementia (CDCD) , Neuroscience Departement, , Rome , Italy
- San Camillo-Forlanini Hospital , Neuroscience Departement, , Rome , Italy
| | - Carlo Blundo
- Centre for Cognitive Disorders and Dementia (CDCD) , Neuroscience Departement, , Rome , Italy
- San Camillo-Forlanini Hospital , Neuroscience Departement, , Rome , Italy
| |
Collapse
|
4
|
Prosperini L, Gentile M, Ricci M, Gerace C, Fabiano S, Stasolla A, Gasperini C, Cotroneo E. Dural Arteriovenous Fistula as a Reversible Cause of Progressive Parkinsonism and Dementia: A Case Report. Neurohospitalist 2022; 12:559-562. [DOI: 10.1177/19418744221098542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A dural arteriovenous fistula (DAVF) is an abnormal direct connection between an intracranial artery and the dural venous sinus. In rare cases, DAVF might show rapidly progressive dementia onset with extrapyramidal signs, often misdiagnosed as Parkinson disease or vascular parkinsonism and, therefore, pharmacological treatments are ineffective. Here, we report the case of 84-year-old man with rapidly progressive parkinsonism and dementia who was initially treated with levodopa without any improvement. Approximately 8 months following the symptom onset, a magnetic resonance (MR) imaging of the brain revealed bilateral and symmetrical hyperintensity of the white matter on both cerebral hemispheres on T2-weighted images. Three-dimensional and post-contrast T1-weighted images showed a subtentorial ovalar area with venous drainage alteration, and hypertrophic left occipital artery direct to venous sac. The angiography study confirmed a diagnosis of DAVF. Endovascular treatment by cook pressure technique successfully provided fistula obliteration. The patient rapidly recovered after the endovascular treatment, with restitutio ad integrum of cognitive functioning and resolution of extrapyramidal syndrome. Approximately 1 year after the endovascular treatment, a brain MR scan with angiogram-MR sequences showed almost complete disappearance of white matter alterations on both cerebral hemispheres, and normal visualization of venous system.
Collapse
Affiliation(s)
| | - Mara Gentile
- Neurology and Stroke Unit, San Eugenio Hospital, Rome, Italy
| | - Monica Ricci
- Neurology Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - Carmela Gerace
- Neurology Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | | | | | | | - Enrico Cotroneo
- Neuroradiology Unit, San Camillo-Forlanini Hospital, Rome, Italy
| |
Collapse
|
5
|
Ruggeri M, Ricci M, Gerace C, Blundo C. Late-onset obsessive-compulsive disorder as the initial manifestation of possible behavioural variant Alzheimer's disease. Cogn Neuropsychiatry 2022; 27:11-19. [PMID: 34713765 DOI: 10.1080/13546805.2021.1996342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION A late-onset obsessive-compulsive disorder (OCD) might be a challenging diagnostic issue because of the overlapping with the dementia conditions more related to frontal lobe pathology. We aim to describe and investigate how this condition might represent the isolated long-lasting symptomatology of a frontal Alzheimer's disease (AD). METHODS An elderly woman with normal cognitive status showed a subacute onset of OCD with contamination obsession and washing compulsion. We conducted neuropsychological assessments and neuroimaging examinations at the onset and at 3-years follow-up. RESULTS At 3-years follow-up, the patient developed cognitive deterioration, frontal behavioural disorders and improvement of OCD. Cognitive assessment showed impairments of executive functions, episodic memory, and constructional apraxia, according to the involvement of fronto-mesial, temporal and parietal regions at neuroimaging. A clinical diagnosis of possible behavioural variant AD was assigned. CONCLUSION A typical OCD might be the long-lasting initial manifestation of a possible behavioural variant AD due to dysfunctions of the anterior cingulate network.
Collapse
Affiliation(s)
- Massimiliano Ruggeri
- Unit of Cognitive Disorders and Dementia, Department of Neuroscience, San Camillo-Forlanini Hospital, Rome, Italy
| | - Monica Ricci
- Unit of Cognitive Disorders and Dementia, Department of Neuroscience, San Camillo-Forlanini Hospital, Rome, Italy
| | - Carmela Gerace
- Unit of Cognitive Disorders and Dementia, Department of Neuroscience, San Camillo-Forlanini Hospital, Rome, Italy
| | - Carlo Blundo
- Unit of Cognitive Disorders and Dementia, Department of Neuroscience, San Camillo-Forlanini Hospital, Rome, Italy
| |
Collapse
|
6
|
Ruggeri M, Ricci M, Gerace C, Blundo C. Accelerated long-term forgetting as a cognitive marker of subjective memory decline. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
7
|
Ricci M, Lispi L, Gerace C, Ruggeri M, Blundo C. Long-lasting memory no longer means forever: Relationship between accelerated long-term forgetting and autobiographical memory disorders amongst patients with temporal lobe epilepsy. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
8
|
Haggiag S, Prosperini L, Stasolla A, Gerace C, Tortorella C, Gasperini C. Ozone-induced encephalopathy: A novel iatrogenic entity. Eur J Neurol 2021; 28:2471-2478. [PMID: 33657263 DOI: 10.1111/ene.14793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Ozone-based treatments can be associated with central nervous system toxicity, which we have termed ozone-induced encephalopathy (OIE). A detailed description of its phenotype is lacking. METHODS Three cases with findings suggestive of OIE are presented, and the literature is reviewed. RESULTS Case 1 is a healthy 59-year-old man presenting with loss of consciousness, cortical blindness, restlessness, and anterograde amnesia immediately following a cervical ozone-therapy (OT) session for chronic neck pain. Brain magnetic resonance imaging (MRI) on admission was normal. A follow-up scan demonstrated a subtle increased T2 fluid-attenuated inversion recovery signal within the left cerebellum; an echocardiography showed a patent foramen ovale (PFO). Case 2 is a 56-year-old woman with history of migraine, PFO, and lumbar pain who presented with headache, bilateral visual impairment, motor dysphasia, and agitation. All her symptoms began immediately after lumbar OT. Her brain MRI was negative. Case 3 is a healthy 27-year-old man who complained of vertigo and mild blurred vision 5 min following a cervical ozone injection. His neurological examination and brain MRI were normal. All three patients had full recovery within 48 h. We found eight additional cases of OIE in the literature. CONCLUSIONS OIE should be considered in patients presenting with neurological symptoms in close relation to OT. OIE is likely a novel iatrogenic entity with a complex pathogenesis; it is probably underreported because it mimics other neurological conditions.
Collapse
Affiliation(s)
- Shalom Haggiag
- Neurology Department, San Camillo Forlanini Hospital, Rome, Italy
| | - Luca Prosperini
- Neurology Department, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Carmela Gerace
- Neurology Department, San Camillo Forlanini Hospital, Rome, Italy
| | - Carla Tortorella
- Neurology Department, San Camillo Forlanini Hospital, Rome, Italy
| | | |
Collapse
|
9
|
Ruggeri M, Biagioli C, Ricci M, Gerace C, Blundo C. Progressive aphasia, apraxia of speech and agraphia in corticobasal degeneration: A 12-case series clinical and neuropsychological descriptive study. Int J Lang Commun Disord 2020; 55:867-874. [PMID: 32725870 DOI: 10.1111/1460-6984.12559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/05/2020] [Accepted: 06/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite initial underreporting of language dysfunctions in corticobasal syndrome (CBS), aphasia is now recognized as a frequent feature of this disease. Aphasia in CBS seems clinically overlying to a non-fluent/agrammatic primary progressive aphasia (nfaPPA), which is also a clinical phenotype associated with corticobasal degeneration (CBD) pathology. However, the clinical features of aphasia in CBS still remain poorly delineated, resulting in misjudgements in the differential diagnosis from a PPA presentation of the disease. AIMS To investigate the language disorders of this syndrome, also through a systematic examination of recoding skills (reading, written spelling and repetition) and articulatory disturbances, which have been rarely examined in previous studies. METHODS & PROCEDURES We present a clinical and neuropsychological descriptive study of the language impairments in a case series of 12 aphasic patients with a clinical diagnosis of CBS. Language assessment was conducted by means of the Esame NeuroPsicologico dell'Afasia, a comprehensive Italian battery for language functions, the Token Test, and the Apraxia of Speech Rating Scale. OUTCOMES & RESULTS The language profile of the patients showed a severe expressive language disorder, characterized by non-fluent speech, apraxia of speech (AoS) with predominant stuttering-like dysfluencies, spatial/apraxic agraphia, lack of word-finding and defective sentence repetition. Severe limb apraxia, visual-spatial deficit and alien hand syndrome were also present. Neuroimaging showed bilateral left asymmetric atrophies and hypometabolism in the frontal premotor, parietal posterior and temporal areas. CONCLUSIONS & IMPLICATIONS These findings suggest that aphasia in CBS might present as a 'mixed PPA', instead of an nfaPPA as previously stated, showing a combination of features of the nfa and logopenic variants of the PPA, associated with AoS, stuttering and agraphia, which might be additional important cognitive markers for the clinical diagnosis of CBS and discriminating features of an nfaPPA presentation of a CBD. These results might also suggest specific intervention areas in the rehabilitation of patients with CBS. What this paper adds What is already known on the subject Language disorders in CBS patients usually present clinically overlying to an nfaPPA, which is also a clinical phenotype associated with CBD pathology, according to recent diagnostic criteria. However, the clinical features of aphasia in CBS still remain poorly delineated, and this raises difficulties and misjudgements for clinicians in the differential diagnosis from a PPA presentation of the disease. What this paper adds to existing knowledge This study shows that the language profile of our CBS patients was characterized by severe expressive language disorders, with non-fluent speech, apraxia of speech (AoS) with predominant stuttering-like dysfluencies, spatial/apraxic agraphia, lack of word-finding, and defective sentence repetition. These findings suggest that aphasia in CBS might present as a 'mixed PPA', rather than an nfaPPA as previously stated, showing a combination of features of the nfa and logopenic variants of the PPA associated with AoS, stuttering and agraphia. What are the potential or actual clinical implications of this work? These results suggest that AoS, stuttering and agraphia might be important additional cognitive markers for the clinical diagnosis of CBS, and discriminating features of an nfaPPA presentation of a CBD. The language disorders exhibited in the present study might also support speech and language therapists in targeting specific intervention areas in the rehabilitation of patients with CBS.
Collapse
Affiliation(s)
- Massimiliano Ruggeri
- Department of Neuroscience, San Camillo Forlanini Hospital, Rome, Italy
- Rehabilitation Center C.A.R., Neuropsychology Unit, Rome, Italy
| | - Clelia Biagioli
- Rehabilitation Center C.A.R., Neuropsychology Unit, Rome, Italy
| | - Monica Ricci
- Department of Neuroscience, San Camillo Forlanini Hospital, Rome, Italy
| | - Carmela Gerace
- Department of Neuroscience, San Camillo Forlanini Hospital, Rome, Italy
| | - Carlo Blundo
- Department of Neuroscience, San Camillo Forlanini Hospital, Rome, Italy
| |
Collapse
|
10
|
Corsi FM, Gerace C, Ricci M. Rotigotine effect in prolonged disturbance of consciousness. Brief report of two cases. Acta Biomed 2020; 91:132-133. [PMID: 32191667 PMCID: PMC7569577 DOI: 10.23750/abm.v91i1.7659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/23/2019] [Indexed: 11/23/2022]
Abstract
Two patients with post-coma reactivation deficiency who showed a “dramatic” response to rotigotine therapy are described. They had suffered from prolonged coma due to lesions in the mesencephalic ventral tegmental area. The authors believe that rotigotine effect in these cases could be due to restoration of dopaminergic transmission in medial frontal areas previously “de-afferented” from the lesions. Some comatous patients may experience a prolonged difficulty in recovering a normal state of consciousness. This phenomenon may be due to dysfunction of amynergic activating pathways connecting brainstem to the frontal cerebral cortex. In particular, dysfunction of dopaminergic pathways from the mesencephalon to the frontal cortical areas may be responsible for clinical pictures characterized by preserved alertness and total loss of interactions with the surrounding environment; the so called “waking coma” cases. (www.actabiomedica.it)
Collapse
Affiliation(s)
| | - Carmela Gerace
- Department of Neurosciences, Head and Neck Pathology - Neurology Unit. San Camillo - Forlanini Hospital, Roma, Italy.
| | - Monica Ricci
- Department of Neurosciences, Head and Neck Pathology - Neurology Unit. San Camillo - Forlanini Hospital, Roma, Italy.
| |
Collapse
|
11
|
Blundo C, Gerace C. Dopamine agonists can improve pure apathy associated with lesions of the prefrontal-basal ganglia functional system. Neurol Sci 2015; 36:1197-201. [PMID: 25876742 DOI: 10.1007/s10072-014-2061-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/29/2014] [Indexed: 11/30/2022]
Abstract
Apathy is a common neurobehavioral symptom of other syndromes or a syndrome per se which occurs in a variety of neuropsychiatric disorders. Apathy depends on disruption of emotional, cognitive, and behavioral functions. Six brain-damaged patients were assessed, including five patients with unilateral or bilateral focal lesions of the basal ganglia or the thalamus (showing apathy due to an auto-activation deficit) and one patient with bilateral lesions in the limbic temporomesial cortex associated with a form of emotional-affective apathy. A significant and persistent improvement of apathy was observed in all patients after treatment with dopamine agonists such as pramipexole, ropinirole, and rotigotine. These results confirm preliminary reports on the beneficial effects of dopamine agonist agents on apathy and suggest that this syndrome can be treatable in many cases.
Collapse
Affiliation(s)
- Carlo Blundo
- Department of Neuroscience, Azienda Ospedaliera S. Camillo-Forlanini, Circonvallazione Gianicolense 87, 00152, Rome, Italy,
| | | |
Collapse
|
12
|
Gerace C, Corsi FM, Blundo C. Rotigotine for apathy in limbic autoimmune encephalitis. J Neuropsychiatry Clin Neurosci 2014; 25:E42-3. [PMID: 24247887 DOI: 10.1176/appi.neuropsych.12100259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
13
|
|
14
|
Abstract
Isolated behavioural disturbances can mimic psychiatric diseases and delay diagnosis of acute brain disease. We reported the case of a patient with carotid dissection manifesting only with apathetic syndrome that was initially considered as a possible postpartum depression, causing a threatening diagnostic delay.
Collapse
Affiliation(s)
- Carmela Gerace
- Department of Neurology, Azienda Ospedaliera S.Camillo-Forlanini, Roma, Italy.
| | | | | |
Collapse
|
15
|
|
16
|
Affiliation(s)
- C Gerace
- Neuroscience Department, Azienda Ospedaliera S.Camillo-Forlanini, Rome, Italy.
| | | | | | | |
Collapse
|
17
|
Affiliation(s)
- C Gerace
- Neuroscience Department, S. Camillo Hospital, Rome, Italy.
| | | | | |
Collapse
|
18
|
Hasl DM, Ruiz OR, Baumert J, Gerace C, Matyas JA, Taylor PH, Kennedy GM. A prospective study of bile leaks after laparoscopic cholecystectomy. Surg Endosc 2001; 15:1299-300. [PMID: 11727137 DOI: 10.1007/s004640000379] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/1999] [Accepted: 10/25/2000] [Indexed: 11/25/2022]
Abstract
Since laparoscopic cholecystectomy rapidly became the gold standard, there is an increased morbidity of 1% to 3% for clinically significant bile leaks with this procedure, as compared with open cholecystectomy (<1%). The identification of subclinical bile leaks using cholescintigraphy occurs in the range from 31.4% to 40% after elective open cholecystectomy. At this writing, no studies exist that document the rate of subclinical bile leaks after elective laparoscopic cholecystectomy. In this study, 71 patients were evaluated using cholescintigraphy after elective laparoscopic cholecystectomy. This study represents the first prospective look at the rate of subclinical bile leaks after laparoscopic cholecystectomy in elective cases, and the findings show an overall incidence of 7.3%, as compared with historical reports of 30% to 44% for open cholecystectomy.
Collapse
Affiliation(s)
- D M Hasl
- Department of Surgery, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | | | | | | | | | | | | |
Collapse
|
19
|
Famularo G, Salvini P, Terranova A, Gerace C. Clinical errors in emergency medicine: experience at the emergency department of an Italian teaching hospital. Acad Emerg Med 2000; 7:1278-81. [PMID: 11073478 DOI: 10.1111/j.1553-2712.2000.tb00475.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The level of commitment in the analysis of clinical errors made in the emergency department (ED) is currently focused on organization and processes rather than on individual action. Four major cases of clinical errors made in the ED of a teaching hospital were investigated. Analysis suggested that the process of clinical decision making and the overreliance on the use of patterns during the cognitive process had a major role in causing the errors, rather than factors related to procedures or organization. It appears hard to design system changes and tactics to significantly reduce the probability of making errors associated with the cognitive process involved in clinical decision making. The authors have initiated a systematic analysis of errors made during the diagnostic workup in their ED, and the rate of clinically significant errors is tracked. A file is being created with the purpose to use it for teaching and orientation of all new staff.
Collapse
Affiliation(s)
- G Famularo
- Department of Emergency Medicine, San Camillo Hospital, Rome, Italy.
| | | | | | | |
Collapse
|
20
|
Tozzi V, Narciso P, Galgani S, Sette P, Balestra P, Gerace C, Pau FM, Pigorini F, Volpini V, Camporiondo MP. Effects of zidovudine in 30 patients with mild to end-stage AIDS dementia complex. AIDS 1993; 7:683-92. [PMID: 8318176 DOI: 10.1097/00002030-199305000-00012] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Zidovudine (ZDV) is an inhibitor of HIV replication that may have a beneficial effect on patients with AIDS dementia complex (ADC). However, little is known about the association between long-term ZDV treatment and severity of ADC, ZDV dose or clinical and laboratory response to therapy. DESIGN An open study on ZDV administration in 30 consecutive patients with ADC. SETTING An infectious diseases hospital. PATIENTS Thirty consecutive patients followed-up for 12 months. INTERVENTIONS Three oral ZDV doses were used: 1000 mg (nine patients), 750 mg (eight patients) and 500 mg (13 patients) per day, depending on haematological status. MAIN OUTCOME MEASURES Clinical and neurological examinations, neuropsychological evaluations, high-field brain magnetic resonance imaging (MRI) and 99mTc-HM-PAO single photon emission computerized tomography (SPECT). RESULTS A favourable clinical response, defined as reversal to a less severe ADC stage (Price and Brew's criteria), was observed after 1, 3, 6, 9 and 12 months in 15, 22, 25, 19 and 14 patients, respectively. Neither severity of ADC at entry nor ZDV dose correlated with response to treatment. Seven patients died during the 12-month follow-up. The only factor associated with longer survival was ADC severity at entry (12-month survival, 0.94 and 0.53, in patients in stages 1 or 2 and in stages 3 or 4, respectively; P < 0.01). After 6-12 months of ZDV treatment six patients who initially responded to therapy showed a relapse in initial ADC stage, and two patients a less severe neurological deterioration. Neuropsychological evaluations showed significant improvement in the Wisconsin Card-Sorting test (P = 0.006 for categories, P = 0.029 for perseverative errors), which is particularly sensitive to cognitive and frontal-lobe type functions. Brain MRI revealed a reduction of the extent of white matter lesions in six out of 13 patients, who also showed clinical improvement. SPECT scanning revealed a reduction in the extent of uptake defects concomitant with clinical response in nine out of 14 patients. CONCLUSIONS ZDV is effective in most patients with mild to end-stage ADC, although the benefit is sometimes only transient; several relapses and deaths occurred after the sixth month of treatment.
Collapse
Affiliation(s)
- V Tozzi
- Ospedale L. Spallanzani for Infectious Diseases, Rome, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Sinibaldi L, Gerace C, Meccia A. [Cerebrovascular manifestations while taking combined estrogens and progestins for contraceptive purposes. Clinical cases]. Riv Neurol 1991; 61:242-5. [PMID: 1813977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study concerns 20 patients with cerebrovascular disease in the course of oral contraception with estrogens/progestins. The assumption of oral contraceptives appears to be related to the cerebrovascular manifestations, which could be caused by alterations of the blood vessel walls or of the coagulative process induced by estrogens/progestins. The thrombogenic action of these substances could be enhanced by preexisting conditions such as protein C or protein S deficiency.
Collapse
Affiliation(s)
- L Sinibaldi
- Reparto di Neurologia, G.M. Lancisi, Ospedale S. Camillo, Roma
| | | | | |
Collapse
|