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Unger LW, Argeny S, Stift A, Yang Y, Karall A, Freilinger T, Müller C, Bergmann M, Stift J, Riss S. Mesenteric granulomas independently predict long-term risk of surgical recurrence in Crohn's disease. Colorectal Dis 2020; 22:170-177. [PMID: 31393663 PMCID: PMC7028106 DOI: 10.1111/codi.14814] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 07/26/2019] [Indexed: 12/16/2022]
Abstract
AIM The risk factors that predict surgical recurrence in Crohn's disease (CD) remain controversial. Postoperative anti-tumour necrosis factor (anti-TNF) therapy might lower recurrence rates whilst the presence of mesenteric granulomas has been postulated to increase the risk. We hypothesized that mesenteric granulomas indicate disease severity and might predict the risk of surgical recurrence, irrespective of immunosuppressive therapy. METHOD We performed a retrospective review of all consecutive patients undergoing operations for CD between January 2000 and December 2014 at a single tertiary referral centre and assessed the perioperative factors and histological findings at the time of surgery. Surgical recurrence rates and the immunosuppressive regimen were assessed through retrospective chart review and telephone interviews. RESULTS A total of 274 patients were eligible for analysis. Median follow-up was 8.54 (5.48-14.42) years. A total of 63 patients (23.0%) underwent surgery for recurrent CD after a median of 4.75 (2.10-7.96) years. In final histology, 35 (12.8%) patients had mesenteric granulomas. TNF inhibitors were administered postoperatively in 104 (38.0%) and thiopurines in 137 (50.0%) patients. In univariate analysis, only the presence of mesenteric granulomas [hazard ratio (HR) 1.95; 95% CI 1.05-3.62; P = 0.035] significantly increased the risk for recurrent surgery while postoperative anti-TNF (HR 0.85; 95% CI 0.49-1.50; P = 0.581) or thiopurine therapy (HR 1.03; 95% CI 0.61-1.73; P = 0.916) did not. In multivariate analysis, only the presence of mesenteric granulomas significantly influenced the risk of surgical recurrence (HR 1.94, 95% CI 1.04-3.60; P = 0.037). CONCLUSION Intestinal and mesenteric granulomas should be differentiated in pathology reports, because mesenteric, but not intestinal, granulomas may be associated with an increased risk of surgical recurrence.
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Affiliation(s)
- L. W. Unger
- Division of General SurgeryDepartment of SurgeryMedical University of ViennaViennaAustria
| | - S. Argeny
- Division of General SurgeryDepartment of SurgeryMedical University of ViennaViennaAustria
| | - A. Stift
- Division of General SurgeryDepartment of SurgeryMedical University of ViennaViennaAustria
| | - Y. Yang
- Division of General SurgeryDepartment of SurgeryMedical University of ViennaViennaAustria
| | - A. Karall
- Division of General SurgeryDepartment of SurgeryMedical University of ViennaViennaAustria
| | - T. Freilinger
- Division of General SurgeryDepartment of SurgeryMedical University of ViennaViennaAustria
| | - C. Müller
- Division of General SurgeryDepartment of SurgeryMedical University of ViennaViennaAustria
| | - M. Bergmann
- Division of General SurgeryDepartment of SurgeryMedical University of ViennaViennaAustria
| | - J. Stift
- Clinical Institute of PathologyMedical University of ViennaViennaAustria
| | - S. Riss
- Division of General SurgeryDepartment of SurgeryMedical University of ViennaViennaAustria
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Schubert V, Bender B, Kinzel M, Peters N, Freilinger T. A novel frameshift variant in the CADASIL gene NOTCH3: pathogenic or not? J Neurol 2018; 265:1338-1342. [PMID: 29600389 DOI: 10.1007/s00415-018-8844-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 12/28/2017] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) represents the most common monogenic cause of adult-onset ischemic stroke and vascular dementia. It is caused by heterozygous missense mutations in the NOTCH3 gene, encoding a transmembrane receptor protein on vascular smooth muscle cells. Classical CADASIL mutations affect conserved cysteine residues of the Notch3 protein. By contrast, the role of non-canonical genetic variation in NOTCH3, in particular of variants causing a hypomorphic Notch3 protein, is subject to an ongoing scientific debate. In this context, we here report a novel NOTCH3 frameshift variant in exon 18 (NM_000435.2: c.2853_2857delTCCCG), causing a frameshift and introducing a premature stop codon, which was detected in a 43-year-old woman and her father. Both carriers of the variant were carefully evaluated, including serial follow-up in the index. Neither clinical nor imaging features provided convincing evidence for a classical CADASIL phenotype, thus reinforcing the concept of hypomorphic NOTCH3 variants most likely not being causative for CADASIL. Our finding, which is discussed in the light of the published literature, has practical implications for interpreting results of NOTCH3 molecular genetic testing as well as patient counseling.
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Affiliation(s)
- V Schubert
- Zentrum für Neurologie, Hertie-Institut für Klinische Hirnforschung, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - B Bender
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - M Kinzel
- Medizinische Genetik, MedizinZentrum Lichtenberg, Berlin, Germany
| | - N Peters
- Neurologische Klinik, Universitätsspital Basel, Basel, Switzerland
| | - T Freilinger
- Zentrum für Neurologie, Hertie-Institut für Klinische Hirnforschung, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
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Affiliation(s)
- J Linn
- Department of Neuroradiology, Klinikum Grosshadern, Ludwig-Maximilians-Universität, Munich, Germany.
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Roeben B, Stirn S, Freilinger T. Testen Sie Ihr Fachwissen. Akt Neurol 2015. [DOI: 10.1055/s-0034-1387555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- B. Roeben
- Neurologie mit Schwerpunkt Neurodegenerative Erkrankungen, Universitätsklinik Tübingen
| | - S. Stirn
- Neurologie mit Schwerpunkt Epileptologie, Universitätsklinik Tübingen
| | - T. Freilinger
- Neurologie mit Schwerpunkt Epileptologie, Universitätsklinik Tübingen
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De Vries BL, Freilinger T, Anttila V, Malik R, Terwindt GM, Pozo-Rosich P, Winsvold B, Nyholt D, van Oosterhout WPJ, Artto V, Todt M, Hämäläinen E, Fernandez-Moralez J, Louter M, Kaunisto MA, Schoenen J, Raitakari O, Lehtimäki T, Ville-Pueyo M, Göbel H, Wichman E, Sintas C, Uitterlinden A, Hofman A, Rivadeneira F, Heinze A, Tronvik E, van Duin CM, Kaprio J, Cormand B, Wessman M, Frants RR, Meitinger T, Müller-Myhsok B, Zwart JA, Färkkilä M, Macaya A, Ferrari MD, Kubisch C, Palotie A, Dichgans M, van den Maagdenberg AMJ. Migraine without aura: genome-wide association analysis identifies several novel susceptibility. J Headache Pain 2013. [PMCID: PMC3620256 DOI: 10.1186/1129-2377-14-s1-p21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Grimm JM, Schindler A, Schwarz F, Cyran C, Dichgans M, Freilinger T, Reiser MF, Nikolaou K, Saam T. Identifikation von symptomatischen atherosklerotischen Karotisplaques: Vergleich zwischen CT Angiographie und Black-Blood 3T MRT. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311227] [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: 10/28/2022]
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Affiliation(s)
- T. Freilinger
- Neurologische Klinik und Poliklinik, Klinikum der Universität München
- Institut für Schlaganfall- und Demenzforschung, Klinikum der Universität München
| | - M. Dichgans
- Institut für Schlaganfall- und Demenzforschung, Klinikum der Universität München
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Strupp M, Kalla R, Claassen J, Adrion C, Mansmann U, Klopstock T, Freilinger T, Neugebauer H, Spiegel R, Dichgans M, Lehmann-Horn F, Jurkat-Rott K, Brandt T, Jen JC, Jahn K. A randomized trial of 4-aminopyridine in EA2 and related familial episodic ataxias. Neurology 2011; 77:269-75. [PMID: 21734179 DOI: 10.1212/wnl.0b013e318225ab07] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE The therapeutic effects of 4-aminopyridine (4AP) were investigated in a randomized, double-blind, crossover trial in 10 subjects with familial episodic ataxia with nystagmus. METHODS After randomization, placebo or 4AP (5 mg 3 times daily) was administered for 2 3-month-long treatment periods separated by a 1-month-long washout period. The primary outcome measure was the number of ataxia attacks per month; the secondary outcome measures were the attack duration and patient-reported quality of life (Vestibular Disorders Activities of Daily Living Scale [VDADL]). Nonparametric tests and a random-effects model were used for statistical analysis. RESULTS The diagnosis of episodic ataxia type 2 (EA2) was genetically confirmed in 7 subjects. Patients receiving placebo had a median monthly attack frequency of 6.50, whereas patients taking 4AP had a frequency of 1.65 (p = 0.03). Median monthly attack duration decreased from 13.65 hours with placebo to 4.45 hours with 4AP (p = 0.08). The VDADL score decreased from 6.00 to 1.50 (p = 0.02). 4AP was well-tolerated. CONCLUSIONS This controlled trial on EA2 and familial episodic ataxia with nystagmus demonstrated that 4AP decreases attack frequency and improves quality of life. LEVEL OF EVIDENCE This crossover study provides Class II evidence that 4AP decreases attack frequency and improves the patient-reported quality of life in patients with episodic ataxia and related familial ataxias.
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Affiliation(s)
- M Strupp
- Department of Neurology, Friedrich-Baur-Institute and IFB(LMU), University of Munich, Campus Grosshadern, Marchioninistr. 15, 81377 Munich, Germany.
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Grimm JM, Schindler A, Freilinger T, Cyran CC, Schmidt C, Dichgans M, Yuan C, Reiser MF, Nikolaou K, Saam T. Vergleich von symptomatischen und asymptomatischen atherosklerotischen Karotisplaques mittels Paralleler Bildgebung und hochauflösender 3T in vivo MRT. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279320] [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: 10/18/2022]
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Saam T, Freilinger T, Schindler A, Grimm J, Schmidt C, Bamberg F, Reiser MF, Dichgans M, Nikolaou K. Prävalenz vulnerabler Karotisplaques bei Patienten mit kryptogenem Schlaganfall: Eine in vivo MRT-Studie. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279364] [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: 10/18/2022]
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Freilinger T, Dimitriadis K, Nikolaou K, Reiser MF, Dichgans M, Saam T. Stroke while squeezing a pimple: traumatic rupture of a vulnerable carotid artery plaque. Neurology 2011; 76:305-6. [PMID: 21242501 DOI: 10.1212/wnl.0b013e3182074be8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- T Freilinger
- Neurologische Klinik und Poliklinik, Klinikum Großhadern der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 München, Germany.
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12
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Freilinger T, Saam T, Duering M, Dichgans M, Peters N. Internal Carotid Artery Dissection and Ischemic Cerebral Infarction in the Setting of Essential Thrombocythemia. Clin Appl Thromb Hemost 2010; 17:E138-40. [DOI: 10.1177/1076029610391651] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Cervical artery dissection (CAD) is an important etiology of stroke in young adults. Its etiology is incompletely understood. Here, we report a young woman who presented with acute ischemic stroke in the setting of internal carotid artery (ICA) dissection and essential thrombocythemia (ET). We present a review of previous cases with comorbidity of CAD and ET and discuss the pathophysiological implications of this co-occurrence. In particular, we speculate that ET may increase the susceptibility of cervical vessels to spontaneous dissection, for example, by disturbing the microcirculation within the vessel wall.
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Affiliation(s)
- T. Freilinger
- Department of Neurology, Ludwig-Maximilians-Universität, Klinikum Großhadern, Munich, Germany
- Institute for Stroke and Dementia Research, Ludwig-Maximilians-Universität, Munich, Germany
| | - T. Saam
- Department of Diagnostic Radiology, Ludwig-Maximilians-Universität, Klinikum Großhadern, Munich, Germany
| | - M. Duering
- Institute for Stroke and Dementia Research, Ludwig-Maximilians-Universität, Munich, Germany
| | - M. Dichgans
- Institute for Stroke and Dementia Research, Ludwig-Maximilians-Universität, Munich, Germany
| | - N. Peters
- Department of Neurology, Ludwig-Maximilians-Universität, Klinikum Großhadern, Munich, Germany
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Freilinger T, Ackl N, Ebert A, Schmidt C, Rautenstrauss B, Dichgans M, Danek A. A novel mutation in CACNA1A associated with hemiplegic migraine, cerebellar dysfunction and late-onset cognitive decline. J Neurol Sci 2010; 300:160-3. [PMID: 21035146 DOI: 10.1016/j.jns.2010.09.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 09/25/2010] [Accepted: 09/28/2010] [Indexed: 12/01/2022]
Abstract
Hemiplegic migraine (HM) is a rare and severe subtype of migraine with aura, characterized by some degree of hemiparesis and other aura symptoms. Mutations in three genes (CACNA1A, ATP1A2 and SCN1A) have been detected in familial and, more rarely, in sporadic cases. The disease can be complicated by permanent neurological deficits, the most frequent one being a cerebellar syndrome; in addition, mental retardation has been recognized as part of the phenotypic spectrum. Here, we report a Caucasian male with a novel CACNA1A mutation and an unusual clinical phenotype: the patient, who had had a history of only two HM attacks, sought medical advice at age 49 primarily because of increasing cognitive decline accompanied by cerebellar dysfunction. While common neurodegenerative causes were excluded, neuropsychological evaluation revealed a distinct profile of deficits of a subcortico-prefrontal type as previously reported in patients with cerebellar dysfunction. This suggests a possible causal link between cerebellar and cognitive disturbances in this patient; in addition to these pathophysiological aspects, we review of the role of the cerebellum in cognition.
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Affiliation(s)
- T Freilinger
- Department of Neurology, Klinikum Großhadern, Ludwig-Maximilians-Universität, Munich, Germany.
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14
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Freilinger T, Schmidt C, Duering M, Linn J, Straube A, Peters N. Reversible cerebral vasoconstriction syndrome associated with hormone therapy for intrauterine insemination. Cephalalgia 2010; 30:1127-32. [DOI: 10.1177/0333102409360675] [Citation(s) in RCA: 24] [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] [Indexed: 12/28/2022]
Abstract
Introduction: Reversible cerebral vasoconstriction syndrome (RCVS) comprises a heterogeneous group of acute neurological diseases which are characterized by thunderclap headache and evidence of reversible multifocal constriction of cerebral arteries. A number of precipitating factors have been described in the literature, including recent childbirth and use of vasoactive substances. Case description: Here we present the case of a female patient with RCVS which occurred in the setting of hormonal ovarian stimulation for intrauterine insemination. Discussion: This case possibly contributes to the understanding of the pathophysiological mechanisms underlying reversible cerebral vasoconstriction.
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Affiliation(s)
- T Freilinger
- Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - C Schmidt
- Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - M Duering
- Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - J Linn
- Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - A Straube
- Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - N Peters
- Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
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Zaki EA, Freilinger T, Klopstock T, Baldwin EE, Heisner KRU, Adams K, Dichgans M, Wagler S, Boles RG. Two common mitochondrial DNA polymorphisms are highly associated with migraine headache and cyclic vomiting syndrome. Cephalalgia 2009; 29:719-28. [PMID: 19220304 DOI: 10.1111/j.1468-2982.2008.01793.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Mitochondrial dysfunction is a hypothesized component in the multifactorial pathogenesis of migraine without aura (MoA, 'common migraine') and the related condition of cyclic vomiting syndrome (CVS). In this study, the entire mitochondrial genome was sequenced in 20 haplogroup-H CVS patients, a subject group studied because of greater genotypic and phenotypic homogeneity. Sequences were compared against haplogroup-H controls. Polymorphisms of interest were tested in 10 additional CVS subjects and in 112 haplogroup-H adults with MoA. The 16519C-->T polymorphism was found to be highly disease associated: 21/30 CVS subjects [70%, odds ratio (OR) 6.2] and 58/112 migraineurs (52%, OR 3.6) vs. 63/231 controls (27%). A second polymorphism, 3010G-->A, was found to be highly disease associated in those subjects with 16519T: 6/21 CVS subjects (29%, OR 17) and 15/58 migraineurs (26%, OR 15) vs. 1/63 controls (1.6%). Our data suggest that these polymorphisms constitute a substantial proportion of the genetic factor in migraine pathogenesis, and strengthen the hypothesis that there is a component of mitochondrial dysfunction in migraine.
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Affiliation(s)
- E A Zaki
- Division of Medical Genetics, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA
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Freilinger T, Bohe M, Wegener B, Müller-Myhsok B, Dichgans M, Knoblauch H. Expansion of the Phenotypic Spectrum of the CACNA1A T666M Mutation: A Family with Familial Hemiplegic Migraine Type 1, Cerebellar Atrophy and Mental Retardation. Cephalalgia 2008; 28:403-7. [DOI: 10.1111/j.1468-2982.2008.01540.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- T Freilinger
- Department of Neurology, Ludwig-Maximilians-Universität München, Klinikum Großhadern, Munich
| | - M Bohe
- Vivantes Klinikum am Urban, Department of Psychiatry and Psychotherapy, Berlin
| | - B Wegener
- Vivantes Klinikum am Urban, Department of Psychiatry and Psychotherapy, Berlin
| | | | - M Dichgans
- Department of Neurology, Ludwig-Maximilians-Universität München, Klinikum Großhadern, Munich
| | - H Knoblauch
- Vivantes Klinikum am Urban, Department of Psychiatry and Psychotherapy, Berlin
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de Vries B, Freilinger T, Vanmolkot KRJ, Koenderink JB, Stam AH, Terwindt GM, Babini E, van den Boogerd EH, van den Heuvel JJMW, Frants RR, Haan J, Pusch M, van den Maagdenberg AMJM, Ferrari MD, Dichgans M. Systematic analysis of three FHM genes in 39 sporadic patients with hemiplegic migraine. Neurology 2007; 69:2170-6. [PMID: 18056581 DOI: 10.1212/01.wnl.0000295670.01629.5a] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Familial (FHM) and sporadic (SHM) hemiplegic migraine are severe subtypes of migraine associated with transient hemiparesis. For FHM, three genes have been identified encoding subunits of a calcium channel (CACNA1A), a sodium-potassium pump (ATP1A2), and a sodium channel (SCN1A). Their role in SHM is unknown. Establishing a genetic basis for SHM may further the understanding of its pathophysiology and relationship with common types of migraine. It will also facilitate the often difficult differential diagnosis from other causes of transient hemiparesis. METHODS We systematically scanned 39 well-characterized patients with SHM without associated neurologic features for mutations in the three FHM genes. Functional assays were performed for all new sequence variants. RESULTS Sequence variants were identified in seven SHM patients: one CACNA1A mutation, five ATP1A2 mutations, and one SCN1A polymorphism. All six mutations caused functional changes in cellular assays. One SHM patient later changed to FHM because another family member developed FHM attacks. CONCLUSION We show that FHM genes are involved in at least a proportion of SHM patients without associated neurologic symptoms. Screening of ATP1A2 offers the highest likelihood of success. Because FHM gene mutations were also found in family members with "nonhemiplegic" typical migraine with and without aura, our findings reinforce the hypothesis that FHM, SHM, and "normal" migraine are part of a disease spectrum with shared pathogenetic mechanisms.
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Affiliation(s)
- B de Vries
- Departments of Human Genetics, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands
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Linn J, Herms J, Dichgans M, Brückmann H, Fesl G, Freilinger T, Wiesmann M. Subarachnoid hemosiderosis and superficial cortical hemosiderosis in cerebral amyloid angiopathy. AJNR Am J Neuroradiol 2007; 29:184-6. [PMID: 17947366 DOI: 10.3174/ajnr.a0783] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cerebral amyloid angiopathy (CAA) is an important cause of intracerebral hemorrhage. Its definite diagnosis still requires histopathologic demonstration of vascular amyloid. Thus, further improvement of noninvasive imaging methods would be desirable. Here we present 3 patients with histologically proved CAA, in which superficial cortical hemosiderosis and subarachnoid hemosiderosis were present in T2*-weighted MR images. Thus, we propose that these 2 findings might be valuable as noninvasive diagnostic markers for CAA.
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Affiliation(s)
- J Linn
- Department of Neuroradiology, University of Munich, Munich, Germany.
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Abstract
Despite several reports on symptomatic cluster-like headache, there is no clear explanation of how different lesions thought to be causative are related to cluster-like headache. On the basis of two additional cases of symptomatic cluster headache, we discuss the possibility that an acute imbalance of the autonomic nervous system, namely a net overactivity of the parasympathetic system, may be able to trigger these headache attacks in patients who probably have an additional individual predisposition to react with a cluster-like headache. Such an imbalance can be due to an increase in parasympathetic tone (e.g. stimulation of parasympathetic fibres) or to a reduction of the sympathetic tone (e.g. a lesion of the sympathetic fibres).
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Affiliation(s)
- A Straube
- Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians-University Munich, Germany.
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21
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Dichgans M, Gschwendtner A, Bevan S, Lichtner P, Ripke S, Müller-Myhsok B, Wichmann E, Markus H, Meitinger T, Freilinger T. Genetic variation in the lymphotoxin alpha pathway and the risk of ischaemic stroke. Akt Neurol 2007. [DOI: 10.1055/s-2007-987789] [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: 10/21/2022]
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Gschwendtner A, Ripke S, Freilinger T, Müller-Myhsok B, Meitinger T, Dichgans M. Sequence variation in the gene encoding soluble epoxide hydrolase (EPHX2) is associated with increased susceptibility to ischemic stroke in a central european population. Akt Neurol 2007. [DOI: 10.1055/s-2007-987777] [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: 10/21/2022]
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Peters N, Müller-Schunk S, Freilinger T, Düring M, Pfefferkorn T, Dichgans M. Ischaemic stroke of the cortical „hand knob“ area: pathomechanisms and clinical course. Akt Neurol 2007. [DOI: 10.1055/s-2007-987866] [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: 10/21/2022]
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Freilinger T, Bohe M, Wegener B, Dichgans M, Knoblauch H. Expansion of the phenotypic spectrum of the CACNA1A T666M mutation: a German family with FHM1, cerebellar atrophy and mental retardation. Akt Neurol 2007. [DOI: 10.1055/s-2007-987788] [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: 10/21/2022]
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Abstract
Twin and family studies provide evidence of a genetic component in migraine, in particular migraine with aura (MA). Familial hemiplegic migraine (FHM) is a rare monogenic subtype of MA for which three causative genes have been identified: CACNA1A (FHM1), ATP1A2 (FHM2), and SCN1A (FHM3). Mutations in these genes are also found in some patients with sporadic hemiplegic migraine. Linkage studies have identified several gene loci for the more common forms of migraine; however, identification of the respective causative genes is still pending. This review summarizes recent developments in the genetics of migraine and their implications for molecular genetic testing. We further discuss the roles of CACNA1A, ATP1A2, and SCN1A in the pathophysiology of cortical spreading depression, which is the likely correlate of migraine aura.
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Affiliation(s)
- T Freilinger
- Neurologische Klinik und Poliklinik, Klinikum Grosshadern der Ludwig-Maximilians-Universität München, Marchioninistrasse 23, 81377, München,
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Freilinger T, Popovici M, Tavraz N, Friedrich T, Dichgans M. Sporadic hemiplegic migraine associated with a novel mutation in ATP1A2. Akt Neurol 2006. [DOI: 10.1055/s-2006-953111] [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]
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Peters N, Freilinger T, Opherk C, Gschwendtner A, Pfefferkorn T, Dichgans M. Impaired L-arginine induced vasoreactivity suggests endothelial dysfunction in CADASIL. Akt Neurol 2005. [DOI: 10.1055/s-2005-919694] [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: 10/26/2022]
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Freilinger T, Eckstein G, Pusch M, van den Maagdenberg A, Strom T, Dichgans M. Klonierung eines dritten Gens für Familiäre Hemiplegische Migräne. Akt Neurol 2005. [DOI: 10.1055/s-2005-919243] [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: 10/26/2022]
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Abstract
BACKGROUND About 20% of patients with familial hemiplegic migraine (FHM) develop progressive cerebellar signs. Genetic studies have established an association with mutations in the CACNA1A gene. However, the mechanisms underlying cerebellar involvement are largely unknown. OBJECTIVE To use proton MR spectroscopy (1H-MRS) to investigate metabolic alterations in the cerebellum as well as cortical regions known to be involved in the propagation of migraine aura. METHODS Fifteen CACNA1A mutation carriers from three FHM families and 17 healthy control subjects were studied. Eleven patients had clinical signs of cerebellar involvement. LCModel fits were used to estimate absolute concentrations of N-acetyl aspartate (NAA), myo-inositol (mI), glutamate (Glu), choline-containing compounds, total creatine, and lactate in the superior cerebellar vermis (SCV), parietal cortex, and occipital cortex. To control for atrophy effects, automated image segmentation was performed using SPM99. The brain parenchyma fraction (BPF) was determined for all three regions. RESULTS Compared with controls, the brain parenchyma fraction (BPF), NAA, and Glu were significantly reduced and mI was significantly elevated in the SCV of patients with FHM. In contrast, no metabolite alterations were found in supratentorial regions. BPF and NAA in the SCV significantly correlated with cerebellar scores, in particular, gait ataxia. CONCLUSIONS The findings suggest that there is a regionally distinct neuronal impairment in the superior cerebellar vermis that exceeds macroscopic tissue loss. Correlations with clinical scores emphasize the functional relevance of localized atrophy (brain parenchyma fraction) and N-acetyl aspartate levels. These measures may be useful to monitor disease progression. The observed reduction in glutamate may in part reflect impaired glutamatergic neurotransmission.
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Affiliation(s)
- M Dichgans
- Department of Neurology, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany.
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Jurkat-Rott K, Freilinger T, Dreier JP, Herzog J, Göbel H, Petzold GC, Montagna P, Gasser T, Lehmann-Horn F, Dichgans M. Variability of familial hemiplegic migraine with novel A1A2 Na+/K+-ATPase variants. Neurology 2004; 62:1857-61. [PMID: 15159495 DOI: 10.1212/01.wnl.0000127310.11526.fd] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.9] [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: 12/14/2022] Open
Abstract
A1A2 Na+/K+-ATPase mutations cause familial hemiplegic migraine type 2 (FHM2). The authors identified three putative A1A2 mutations (D718N, R763H, P979L) and three that await validation (P796R, E902K, X1021R). Ten to 20% of FHM cases may be FHM2. A1A2 mutations have a penetrance of about 87%. D718N causes frequent, long-lasting HM, and P979L may cause recurrent coma. D718N and P979L may predispose to seizures and mental retardation. A1A2 does not play a major role in sporadic HM; only one variant, R383H, occurred in 1 of 24 cases.
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Affiliation(s)
- K Jurkat-Rott
- Department of Applied Physiology, Ulm University, Germany.
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Abstract
Patients with episodic ataxia type 2 (EA2) can often be successfully treated with acetazolamide. The authors report three patients with EA2 (two with proven mutations in the CACNA1A gene) whose attacks were prevented with the potassium channel blocker 4-aminopyridine (4-AP; 5 mg tid). Attacks recurred after treatment was stopped; subsequent treatment alleviated the symptoms (mean follow-up time 6 months). These effects might be due to an improvement of the impaired functioning of Purkinje cells.
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Affiliation(s)
- M Strupp
- Department of Neurology, University of Munich, Germany.
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Freilinger T, Eckstein G, Herzog J, Lorenz-Depiereux B, Huber S, Strom T, Dichgans M. Kartierung eines dritten Genlocus für familiäre hemiplegische Migräne. Akt Neurol 2004. [DOI: 10.1055/s-2004-833361] [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: 10/28/2022]
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