Cerebral amyloid angiopathy: clinical presentations and management challenges in the Australian context

Cerebral amyloid angiopathy (CAA) is a disease with several clinical manifestations. It is characterised by amyloid-beta deposition in cerebral blood vessels, making them prone to bleeding. The incidence of CAA increases with age and may be associated or co-exist with intraparenchymal neurodegenerative proteinopathies, which makes it an increasingly relevant condition for adult physicians in all areas of medical practice. The vast majority of cases of CAA are sporadic with a small minority of familial cases. CAA is asymptomatic in many older adults but increases the risk of fatal intracerebral or subarachnoid haemorrhage. We review the existing literature on CAA and summarise the key findings. We specifically explore clinical challenges relevant to CAA, particularly in diagnosis, management of intracranial haemorrhage and management of concurrent medical conditions.

Intravascular large B-cell lymphoma: representative cases and approach to diagnosis

Intravascular large B-cell lymphoma (ILBCL) is a subtype of non-Hodgkin's large B-cell lymphoma that is characterised by neoplastic lymphocyte proliferation within the lumen of small blood vessels, which may occur without an extracellular tumour mass or peripheral blood involvement. This report highlights some of the diagnostic issues for ILBCL, and how it can be approached. The two cases described below highlight two significantly different presentations, one with predominately neurological phenomena, and the other with fever of unknown origin for investigation. Both patients were managed with chemotherapy and intercalated intrathecal chemotherapy, with good clinical outcomes, without further evidence of clinical relapse. These cases along with a review of the literature highlight the key learning points in the difficulties in the diagnosis of this condition, and the appropriate use of random skin biopsy in patient suspected of having ILBCL, such as those with constitutional symptoms with otherwise negative malignancy screening, and unexplained neurological phenomena, especially if recurrent in nature.

Long-term mood, quality of life, and seizure freedom in intracranial EEG epilepsy surgery

OBJECTIVES

To determine the long-term outcomes in patients undergoing intracranial EEG (iEEG) evaluation for epilepsy surgery in terms of seizure freedom, mood, and quality of life at St. Vincent's Hospital, Melbourne.

METHODS

Patients who underwent iEEG between 1999 and 2016 were identified. Patients were retrospectively assessed between 2014 and 2017 by specialist clinic record review and telephone survey with standardized validated questionnaires for: 1) seizure freedom using the Engel classification; 2) Mood using the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E); 3) Quality-of-life outcomes using the QOLIE-10 questionnaire. Summary statistics and univariate analysis were performed to investigate variables for significance.

RESULTS

Seventy one patients underwent iEEG surgery: 49 Subdural, 14 Depths, 8 Combination with 62/68 (91.9%) of those still alive, available at last follow-up by telephone survey or medical record review (median of 8.2 years). The estimated epileptogenic zone was 62% temporal and 38% extra-temporal. At last follow-up, 69.4% (43/62) were Engel Class I and 30.6% (19/62) were Engel Class II-IV. Further, a depressive episode (NDDI-E > 15)was observed in 34% (16/47), while a 'better quality of life' (QOLIE-10 score < 25) was noted in 74% (31/42). Quality of life (p < 0.001) but not mood (p = 0.24) was associated with seizure freedom.

SIGNIFICANCE

Long-term seizure freedom can be observed in patients undergoing complex epilepsy surgery with iEEG evaluation and is associated with good quality of life.

Biological effects of the olive polyphenol, hydroxytyrosol: An extra view from genome-wide transcriptome analysis

Epidemiological and clinical studies have established the health benefits of the Mediterranean diet, an important component of which are olives and olive oil derived from the olive tree (Olea Europea). It is now well-established that not only the major fatty acid constituents, but also the minor phenolic components, in olives and olive oil have important health benefits. Emerging research over the past decade has highlighted the beneficial effects of a range of phenolic compounds from olives and olive oil, particularly for cardiovascular diseases, metabolic syndrome and inflammatory conditions. Mechanisms of action include potent antioxidant and anti-inflammatory effects. Further, accumulating evidence indicates the potential of the polyphenols and potent antioxidants, hydroxytyrosol and oleuropein in oncology. Numerous studies, both in vitro and in vivo, have demonstrated the anticancer effects of hydroxytyrosol which include chemopreventive and cell-specific cytotoxic and apoptotic effects. Indeed, the precise molecular mechanisms accounting for the antioxidant, anti-inflammatory and anticancer properties are now becoming clear and this is, at least in part, due to high through-put gene transcription profiling. Initially, we constructed phylogenetic trees to visualize the evolutionary relationship of members of the Oleaceae family and secondly, between plants producing hydroxytyrosol to make inferences of potential similarities or differences in their medicinal properties and to identify novel plant candidates for the treatment and prevention of disease. Furthermore, given the recent interest in hydroxytyrosol as a potential anticancer agent and chemopreventative we utilized transcriptome analysis in the erythroleukemic cell line K562, to investigate the effects of hydroxytyrosol on three gene pathways: the complement system, The Warburg effect and chromatin remodeling to ascertain relevant gene candidates in the prevention of cancer.