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Killam-Worrall L, Brand R, Castro JR, Patel DS, Huynh K, Lindley B, Torres BP. Baclofen and Tizanidine Adverse Effects Observed Among Community-Dwelling Adults Above the Age of 50 Years: A Systematic Review. Ann Pharmacother 2024; 58:523-532. [PMID: 37589096 DOI: 10.1177/10600280231193080] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE This review highlights adverse effects of baclofen and tizanidine in older community-dwelling adults. DATA SOURCES A literature search was conducted, including search terms of "adverse effect," "baclofen," "elderly," "falls," "fractures," and "tizanidine." Studies were included if they described community-dwelling adults aged 50 years and older who received oral baclofen or tizanidine. The Federal Drug Administration Adverse Event Reporting System (FAERS) data were compiled for adverse effect incidence. STUDY SELECTION AND DATA EXTRACTION The literature search was completed in July 2019 and updated in June 2023. Reviews performed by 2 independent reviewers yielded 15 records. FAERS identified 486 (baclofen) and 305 (tizanidine) adverse effects of interest. DATA SYNTHESIS Two retrospective cohort studies evaluating baclofen use in older adults showed increased hospitalizations for encephalopathy in chronic kidney disease (7.2% vs 0.1%) and end-stage renal disease (daily dose 20 mg or more; relative risk [RR] 19.8, 95% CI = [14.0-28.0]). Other articles were case reports; 10 articles reported dyskinesias, encephalopathy or disorientation, and drowsiness associated with baclofen, and 5 articles reported bradycardia and/or hypotension with tizanidine. The FAERS Public Dashboard revealed 12.1% and 28.7% overall incidence of adverse effects of interest, with a 27.8% and 29.2% incidence of falls for baclofen and tizanidine, respectively. Baclofen and tizanidine are associated with concerning adverse effects in older adults. Alternative agents should be considered, but, if necessary, providers should start at lower doses and increase slowly. CONCLUSIONS This review highlights the importance of using baclofen and tizanidine with caution in older adults.
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Affiliation(s)
- Lisa Killam-Worrall
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Sciences Center, Fort Worth, TX, USA
| | - Romana Brand
- Wise Regional Health System Emergency Department, Decatur, TX, USA
| | | | | | | | - Bryn Lindley
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Sciences Center, Fort Worth, TX, USA
| | - Brittany Palasik Torres
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Sciences Center, Fort Worth, TX, USA
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Kim JH, Kim T, Kim W, Kim SH, Hong YJ, Lim E, Bae DW, Noh SM, Lee J. The incidence and predictors of antibiotic-associated encephalopathy: a multicenter hospital-based study. Sci Rep 2024; 14:8747. [PMID: 38627483 PMCID: PMC11021399 DOI: 10.1038/s41598-024-59555-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/12/2024] [Indexed: 04/19/2024] Open
Abstract
This study aimed to evaluate the incidence and likelihood of antibiotic-associated encephalopathy (AAE), comparing rates among the classes of antibiotics in monotherapy or in combination therapy. We also investigated the associations between the incidence of AAE and the glomerular filtration rate (GFR) and electroencephalogram features. Consecutive admissions that used any kind of antibiotics to treat infectious diseases were identified from six hospitals. We classified antibiotics according to three distinct pathophysiologic mechanisms and clinical subtypes. We searched for the incidence of AAE as the primary outcome. A total of 97,433 admission cases among 56,038 patients was identified. Cases that received type 1 antibiotics had significantly more frequent AAE compared to those that received type 2 antibiotics (adjusted odds ratio [OR], 2.62; 95% confidence interval [CI] 1.15-5.95; P = 0.021). Combined use of type 1 + 2 antibiotics was associated with a significantly higher incidence of AAE compared to the use of type 2 antibiotics alone (adjusted OR, 3.44; 95% CI 1.49-7.93; P = 0.004). Groups with GFR < 60 mL/min/1.73 m2 had significantly higher incidence rates of AAE compared to those with GFRs ≥ 90 mL/min/1.73 m2 among cases that received type 1 + 2 antibiotics. Detection of spike-and-wave or sharp-and-wave patterns on electroencephalogram was significantly more common in the combination therapy group. Combination use of antibiotics was associated with a higher incidence of AAE compared to monotherapy. The incidence of AAE significantly increased as renal function decreased, and epileptiform discharges were more likely to be detected in cases receiving combined antibiotics.
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Affiliation(s)
- Jean Hee Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Taewon Kim
- Department of Neurology, Incheon St. Mary's Hospital, The Catholic University of Korea, #56 Dongsu-Ro, Bupyeong-Gu, Incheon, 21431, South Korea.
| | - Woojun Kim
- Department of Neurology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Seong-Hoon Kim
- Department of Neurology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Yun Jeong Hong
- Department of Neurology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Eunyae Lim
- Department of Neurology, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Dae Woong Bae
- Department of Neurology, St. Vincent's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Sang-Mi Noh
- Department of Neurology, St. Vincent's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jieun Lee
- Department of Neurology, Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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Affiliation(s)
- Takuya Suda
- Department of Nephrology and Rheumatology, Ishikawa Prefectural Central Hospital, Japan
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Xiang J, Hong Z, Zhang Y, Chen J, Shen J, Zhu N. A rare case of daratumumab-associated encephalopathy in multiple myeloma. Immunotherapy 2024; 16:447-452. [PMID: 38440862 DOI: 10.2217/imt-2023-0321] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Aim: Daratumumab, a CD38 monoclonal antibody, has been widely used in patients with multiple myeloma. Although a variety of adverse events have been reported, consciousness impairment has not been reported yet. We report a case of encephalopathy associated with daratumumab. Case presentation: A 57-year-old male, diagnosed with relapsed multiple myeloma, was treated with daratumumab. He developed a loss of consciousness after the first administration. Cerebral spinal fluid and magnetic resonance imaging of the brain suggested encephalopathy. Conclusion: It is recommended to be aware of rare but life threatening side effects of daratumumab. We present a case of rare encephalopathy characterized by consciousness disorder associated with daratumumab, which was successfully resolved on prompt institution of steroids, although the mechanism was unknown.
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Affiliation(s)
- Jingjing Xiang
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310006, People's Republic of China
| | - Zirui Hong
- Department of Emergency, The First Affiliated Hospital Of Ningbo University, Ningbo, People's Republic of China
| | - Yu Zhang
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310006, People's Republic of China
| | - Junfa Chen
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310006, People's Republic of China
| | - Jianping Shen
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310006, People's Republic of China
| | - Ni Zhu
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310006, People's Republic of China
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5
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Ruijter BJ, de Mooij MJ, Bruijnes JE, van Oosterhout WPJ, Kwa VIH. Neurological complications of excessive recreational nitrous oxide use: a case series based on a text mining algorithm. J Neurol 2024; 271:1267-1276. [PMID: 37914912 DOI: 10.1007/s00415-023-12061-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND The recreational use of nitrous oxide (N2O) has gained popularity over recent years. We present a case series of excessive N2O users with neurological complications. METHODS In this retrospective three-centre study, we used a text mining algorithm to search for patients who used N2O recreationally and visited a neurologist. RESULTS We identified 251 patients. The median duration of N2O use was 11 months (interquartile range [IQR], 3-24) and the median amount of N2O used per occasion 1.6 kg (IQR 0.5-4.0). Clinically, polyneuropathy (78%), myelopathy (41%), and encephalopathy (14%) were the most common diagnoses. An absolute vitamin B12 deficiency of < 150 pmol/L was found in 40% of cases. In 90%, at least one indicator of functional vitamin B12 status (vitamin B12, homocysteine, or methylmalonic acid) was abnormal. MRI showed signs of myelopathy in 30/55 (55%) of cases. In 28/44 (64%) of those who underwent electromyography, evidence of axonal polyneuropathy was found. Most (83%) patients were treated with vitamin B12 supplementation, and 23% were admitted to the hospital. Only 41% had follow-up for ≥ 30 days, and 79% of those showed partial or complete recovery. CONCLUSIONS In this case series of excessive N2O users, we describe a high prevalence of polyneuropathy, myelopathy, and encephalopathy. Stepwise testing for serum levels of vitamin B12, homocysteine, and methylmalonic acid may support the clinical diagnosis. Due to low sensitivity, MRI of the spinal cord and electromyography have limited value. Effective treatment should incorporate supplementation of vitamin B12 and strategies to prevent relapses in N2O use.
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Affiliation(s)
- B J Ruijter
- Department of Neurology, OLVG, Amsterdam, the Netherlands.
| | - M J de Mooij
- Department of Neurology, OLVG, Amsterdam, the Netherlands
| | - J E Bruijnes
- Department of Neurology, Zuyderland Medical Centre, Heerlen, the Netherlands
- Department of Neurology, Maastricht UMC+, Maastricht, the Netherlands
| | | | - V I H Kwa
- Department of Neurology, OLVG, Amsterdam, the Netherlands
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Zhu QM, Singh AK, Chang HER, Konka SA. Hyperammonemic encephalopathy induced by valproic acid. BMJ Case Rep 2024; 17:e257144. [PMID: 38350699 PMCID: PMC10868277 DOI: 10.1136/bcr-2023-257144] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Valproate (VPA) is broad-spectrum antiepileptic drug. Several adverse reactions including hepatotoxicity, fetal risk and pancreatitis are well known and labelled as boxed warnings in the USA. One adverse reaction that is less well known but clinically significant for its severe morbidity is hyperammonemic encephalopathy. We present a case of woman with hyperammonemic encephalopathy following the initiation of VPA therapy; she had a favourable outcome with discontinuation of the drug and prompt treatment with lactulose and L-carnitine.
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Affiliation(s)
- Qiuyu M Zhu
- Internal Medicine, Kaiser Permanente Mid-Atlantic States, Gaithersburg, Maryland, USA
| | - Amitosh K Singh
- Internal Medicine, Kaiser Permanente Mid-Atlantic States, Gaithersburg, Maryland, USA
| | - Huai-En Rachel Chang
- Internal Medicine, Kaiser Permanente Mid-Atlantic States, Gaithersburg, Maryland, USA
| | - Sandeep A Konka
- Hospital Medicine, Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
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7
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Takahashi K, Tomidokoro Y, Oda T. Metronidazole-induced encephalopathy after living donor liver transplantation. Transpl Infect Dis 2024; 26:e14240. [PMID: 38265157 DOI: 10.1111/tid.14240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024]
Affiliation(s)
- Kazuhiro Takahashi
- Department of Gastrointestinal and Hepatobiliary-Pancreatic Surgery, University of Tsukuba, Tsukuba, Japan
| | | | - Tatsuya Oda
- Department of Gastrointestinal and Hepatobiliary-Pancreatic Surgery, University of Tsukuba, Tsukuba, Japan
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Kollmar R, Biesel J. Contrast-Induced Encephalopathy. Dtsch Arztebl Int 2024; 121:24. [PMID: 38386943 PMCID: PMC10916767 DOI: 10.3238/arztebl.m2023.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Affiliation(s)
- Rainer Kollmar
- Klinik für Neurologie und Neurointensivmedizin, Klinikum Darmstadt GmbH,
| | - Julia Biesel
- Klinik für Neurologie und Neurointensivmedizin, Klinikum Darmstadt GmbH,
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Zarauskas A, Rodrigues B, Alvarez V. Ceftriaxone-induced encephalopathy in a patient with a normal renal function. BMJ Case Rep 2024; 17:e256934. [PMID: 38216159 PMCID: PMC10806959 DOI: 10.1136/bcr-2023-256934] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
Ceftriaxone-induced encephalopathy is an exceptionally rare adverse effect of this commonly used cephalosporin and is generally observed in patients undergoing haemodialysis or suffering from severe renal failure. We present a case of a fit woman in her mid-80s with a normal renal function who developed severe fluctuating neurological symptoms (aphasia, loss of contact, chorea-like tongue movements) while being treated with ceftriaxone for a urinary tract infection with bacteraemia. The symptoms began on day 4 of treatment and an adverse drug reaction was suspected on day 7, after exhaustive investigations failed to reveal another cause. A complete recovery was observed 3 days after discontinuing ceftriaxone. Our case highlights the need to consider the diagnosis of ceftriaxone encephalopathy, even if the traditional risk factors are lacking. In this article, we also provide a brief overview of the pathophysiology as well as a literature review concerning the subject.
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Affiliation(s)
- Audrius Zarauskas
- Internal Medicine, Hopital de Sion Centre Hospitalier du Valais Romand, Sion, Switzerland
| | - Bruno Rodrigues
- Internal Medicine, Hopital de Sion Centre Hospitalier du Valais Romand, Sion, Switzerland
| | - Vincent Alvarez
- Neurology, Hôpital de Sion Centre Hospitalier du Valais Romand, Sion, Switzerland
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10
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Kuzume D, Morimoto Y, Tsutsumi S, Yamasaki M, Hosomi N. [Clinical features of acyclovir encephalopathy without acute kidney injury]. Nihon Ronen Igakkai Zasshi 2024; 61:61-67. [PMID: 38583972 DOI: 10.3143/geriatrics.61.61] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Few reports have described acyclovir (ACV) encephalopathy without acute kidney injury (AKI). OBJECTIVE This study clarified the clinical features of ACV encephalopathy without AKI compared to that with AKI. METHODS Creatinine (Cre) levels were measured on admission. After admission, Cre was measured in a timely manner for the first seven hospital days. The minimum Cre level in these measurements was then determined. ACV encephalopathy was defined when two criteria were met: 1) neurological symptoms appeared after valacyclovir (VACV) administration, and 2) neurological symptoms improved after VACV discontinuation. AKI was defined when the Cre level on admission was >1.5 times higher than the minimum Cre level. The subjects were divided into AKI and non-AKI groups based on these findings. RESULTS Eighteen patients had ACV encephalopathy (5 males, mean age 81.3±5.5 years old). All patients were prescribed VACV 3,000 mg/day. The minimum Cre was 1.93±1.76 mg/dL. AKI occurred in 10 (56.6%) patients. VACV was discontinued in all patients, and emergency hemodialysis treatment was administered in 10 (55.6%) patients. All patients recovered. Compared to the AKI group, the non-AKI group had a lower history of taking a Ca-blocker (33.3% vs 80.0%, p=0.092), a lower rate of emergency dialysis (16.9% vs 70.0%, p=0.059) and a longer time to clinical improvement (3.67±1.86 vs 2.20±0.63 days, p=0.073). CONCLUSION ACV encephalopathy without AKI is characterized by a low rate of emergency dialysis, which may be linked to a prolonged duration of symptoms.
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11
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Ranjith S, Abeysundera H, Jeyaranjan H. Unusual case of sodium valproate-induced hyperammonaemia encephalopathy. BMJ Case Rep 2023; 16:e256796. [PMID: 38035682 PMCID: PMC10689361 DOI: 10.1136/bcr-2023-256796] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
There is limited information about sodium valproate-induced hyperammonaemia encephalopathy (VPAIHE). The aim of this case report is to provide medical practitioners with a greater awareness of the possible development of hyperammonaemia due to sodium valproate use and its associated complications.This paper describes a middle-aged man with a history of bipolar affective disorder who was admitted with a manic relapse secondary to medication non-compliance. His admission was complicated by an intensive care unit admission to manage medical compromise in the context of sodium VPAIHE.
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Affiliation(s)
- Shristhi Ranjith
- Psychiatry, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Hesitha Abeysundera
- Psychiatry, Gold Coast University Hospital, Southport, Queensland, Australia
- Griffith University School of Medicine and Dentistry, Southport, Queensland, Australia
| | - Hilary Jeyaranjan
- Psychiatry, Gold Coast University Hospital, Southport, Queensland, Australia
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Kumabe A, Kenzaka T. Levofloxacin-Associated Encephalopathy. Am J Ther 2023; 30:e549-e550. [PMID: 36848632 DOI: 10.1097/mjt.0000000000001615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Ayako Kumabe
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Internal Medicine, Toyooka Public Hospital, Toyooka, Japan
| | - Tsuneaki Kenzaka
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba, Japan
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Ordoño-Saiz MV, Púa-Torrejón RC, Justel-Rodríguez M, Arias-Vivas E, Heppe-Montero M, González-Alguacil E, Duat-Rodríguez A, Ruiz-Falcó-Rojas ML, García-Peñas JJ, Gutiérrez-Delicado E, Soto-Insuga V. Cerebral and cerebellar pseudoatrophy associated with valproic acid. Report of three pediatric cases. Rev Neurol 2023; 77:197-201. [PMID: 37807884 PMCID: PMC10831757 DOI: 10.33588/rn.7708.2023186] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Cerebral and cerebellar pseudoatrophy is a rare adverse effect of valproic acid (VPA) that we need to be aware of, due to its diagnostic and therapeutic implications. CASE REPORT We report three cases of children between 5 and 9 years old, with epilepsy and previous normal brain magnetic resonance imaging, who were taking the drug at correct doses. Pseudoatrophy manifests subacutely with symptoms and images of cerebral and/or cerebellar atrophy, reversible after drug withdrawal. DISCUSSION AND CONCLUSIONS This is a type of VPA-related encephalopathy, different from dose-dependent toxic encephalopathy, hyperammonaemic encephalopathy or encephalopathy related to liver failure. In children, it causes cognitive, motor, mood and behavioral deterioration, and may be accompanied by epileptic decompensation. Withdrawing the drug leads to complete clinical-radiological recovery, and reducing the dose leads to improvement.
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Affiliation(s)
- M V Ordoño-Saiz
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
| | - R C Púa-Torrejón
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
| | | | - E Arias-Vivas
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
| | - M Heppe-Montero
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
| | | | - A Duat-Rodríguez
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
| | | | - J J García-Peñas
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
| | | | - V Soto-Insuga
- Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España
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Fuga M, Tanaka T, Tachi R, Yamana S, Irie K, Kajiwara I, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y. Contrast Injection from an Intermediate Catheter Placed in an Intradural Artery is Associated with Contrast-Induced Encephalopathy following Neurointervention. AJNR Am J Neuroradiol 2023; 44:1057-1063. [PMID: 37536732 PMCID: PMC10494956 DOI: 10.3174/ajnr.a7944] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/22/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND PURPOSE Contrast-induced encephalopathy can result from neurotoxicity of contrast medium in the affected area. The development of intermediate catheters has allowed guidance of catheters to more distal arteries. This study focused on the association between contrast-induced encephalopathy and contrast injection from an intermediate catheter guided into a distal intradural artery during neurointervention for cerebral aneurysms. MATERIALS AND METHODS We retrospectively reviewed 420 consecutive aneurysms in 396 patients who underwent neurointervention for extracranial aneurysms and unruptured intracranial aneurysms at our institution from February 2012 to January 2023. Patients were divided into a group with contrast-induced encephalopathy and a group without. To identify risk factors for contrast-induced encephalopathy, we compared clinical, anatomic, and procedural factors between groups by multivariate logistic regression analysis and stepwise selection. RESULTS Among the 396 patients who underwent neurointervention for cerebral aneurysms, 14 (3.5%) developed contrast-induced encephalopathy. Compared with the group without contrast-induced encephalopathy, the group with contrast-induced encephalopathy showed significantly higher rates of patients on hemodialysis, previously treated aneurysms, intradural placement of a catheter for angiography, nonionic contrast medium, and flow-diversion procedures in univariate analyses. Stepwise multivariate logistic regression analysis revealed intradural placement of a catheter for angiography (OR = 40.4; 95% CI, 8.63-189) and previously treated aneurysms (OR = 8.20; 95% CI, 2.26-29.6) as independent predictors of contrast-induced encephalopathy. CONCLUSIONS Contrast injection from an intradural artery and retreatment of recurrent aneurysms were major risk factors for contrast-induced encephalopathy. Attention should be paid to the location of the intermediate catheter for angiography to avoid developing contrast-induced encephalopathy.
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Affiliation(s)
- M Fuga
- From the Department of Neurosurgery (M.F., T.T., R.T., S.Y., A.T., Y.H.), Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - T Tanaka
- From the Department of Neurosurgery (M.F., T.T., R.T., S.Y., A.T., Y.H.), Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
- Department of Neurosurgery (T.T., S.Y., T.I., Y.M.), Jikei University School of Medicine, Tokyo, Japan
| | - R Tachi
- From the Department of Neurosurgery (M.F., T.T., R.T., S.Y., A.T., Y.H.), Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - S Yamana
- From the Department of Neurosurgery (M.F., T.T., R.T., S.Y., A.T., Y.H.), Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
- Department of Neurosurgery (T.T., S.Y., T.I., Y.M.), Jikei University School of Medicine, Tokyo, Japan
| | - K Irie
- Department of Neurosurgery (K.I.), Japanese Red Cross Medical Center, Tokyo, Japan
| | - I Kajiwara
- Department of Neurosurgery (I.K.), National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan
| | - A Teshigawara
- From the Department of Neurosurgery (M.F., T.T., R.T., S.Y., A.T., Y.H.), Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - T Ishibashi
- Department of Neurosurgery (T.T., S.Y., T.I., Y.M.), Jikei University School of Medicine, Tokyo, Japan
| | - Y Hasegawa
- From the Department of Neurosurgery (M.F., T.T., R.T., S.Y., A.T., Y.H.), Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Y Murayama
- Department of Neurosurgery (T.T., S.Y., T.I., Y.M.), Jikei University School of Medicine, Tokyo, Japan
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Fujisawa H, Mitsui Y, Narukawa K, Shirasugi Y, Komaki S, Hao A, Matsumoto H, Takahashi T. Methotrexate-induced Subacute Encephalopathy That Showed No Abnormalities on Magnetic Resonance Imaging Soon after Symptom Appearance. Intern Med 2023; 62:2249-2252. [PMID: 36476551 PMCID: PMC10465289 DOI: 10.2169/internalmedicine.0855-22] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/27/2022] [Indexed: 12/12/2022] Open
Abstract
A 21-year-old woman was diagnosed with acute lymphoblastic leukemia. After the administration of intrathecal methotrexate (MTX), the patient experienced dysarthria and paralysis for one hour. Magnetic resonance imaging (MRI) performed one hour from the onset and just before symptoms disappeared revealed no abnormalities. The next day, the symptoms appeared again, and diffusion-weighed MRI revealed a high-intensity area in the left frontal lobe. The patient was diagnosed with MTX-induced encephalopathy. This case suggested that MRI performed as soon as symptoms appear might show normal findings in MTX-induced encephalopathy.
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Affiliation(s)
| | - Yurika Mitsui
- Division of Hematology, Mitsui Memorial Hospital, Japan
| | | | | | - Shogo Komaki
- Division of Neurology, Mitsui Memorial Hospital, Japan
| | - Akihito Hao
- Division of Neurology, Mitsui Memorial Hospital, Japan
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Loser V, Novy J, Beuchat I, Rossetti AO. Acute Valproate-Induced Encephalopathy in Status Epilepticus: A Registry-Based Assessment. CNS Drugs 2023; 37:725-731. [PMID: 37466895 PMCID: PMC10439035 DOI: 10.1007/s40263-023-01024-5] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Valproate-induced encephalopathy (VIE) affects between 0.1% and 2.5% of patients under long-term epilepsy treatment. Its frequency and characteristics in adults with status epilepticus (SE) is, however, unknown. OBJECTIVE The aim of this study was to characterize the frequency and the clinico-biological characteristics of VIE in adult SE patients. METHODS We reviewed all patients included in our institutional SE registry who were treated for an SE episode between November 2021 and February 2023 and identified 39 patients who received valproate for their SE treatment. Acute VIE was defined by worsening of consciousness having led to the discontinuation of valproate, and improvement of consciousness within 96 hours after discontinuation of valproate during acute hospital treatment. RESULTS Patients had a mean valproate intravenous loading dose of 34.5 mg/kg and a mean maintenance dose of 15.3 mg/kg/d (1078 mg/d). Four out of 29 patients with measured ammonium had hyperammonemia. We identified four (10%) patients fulfilling acute VIE criteria. Median time from administration of valproate to the occurrence of VIE, and to resolution of VIE after cessation of valproate treatment, was 2 days for each. Three of the four VIE patients had no associated hyperammonemia. Patients who developed VIE more frequently had a history of liver disease (p = 0.023), and tended to be younger, but other clinical variables did not differ significantly from patients without VIE, including valproate loading or maintenance doses, SE cause, duration or severity, other concomitant antiseizure medications (none received topiramate, phenobarbital, or primidone). CONCLUSION Pending larger studies, VIE in SE seems relatively frequent and difficult to foresee; clinical alertness to symptoms is mandatory, even without hyperammonemia, and valproate withdrawal should be considered in suspected cases.
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Affiliation(s)
- Valentin Loser
- Department of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Jan Novy
- Department of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Isabelle Beuchat
- Department of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Andrea O. Rossetti
- Department of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
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17
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Kong K, Chen A, Yang G, Gao R, Zhang S, Liu L, Chen X. After 3 months of medication balloon therapy, a patient who had contrast-induced encephalopathy recovered: A case report. Medicine (Baltimore) 2023; 102:e34392. [PMID: 37505152 PMCID: PMC10378961 DOI: 10.1097/md.0000000000034392] [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] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
RATIONALE Iodinated contrast agents are extensively employed in clinical settings, with allergic reactions and renal impairment being the most prevalent adverse events. Contrast-induced encephalopathy (CIE) can present with heterogeneous clinical features, making diagnosis challenging. Prior studies on CIE have primarily documented rapid recovery within several days. However, this paper describes a case of CIE in a patient whose clinical symptoms took 3 months to fully abate. PATIENT CONCERNS A female patient, aged 54 years, received drug-coated balloon therapy for stenosis in a branch of the anterior descending coronary artery. Unfortunately, the patient developed CIE, which initially manifested as visual disturbances and subsequently progressed to gastrointestinal and limb movement issues, as well as an altered mental status, all of which occurred within a 24-hour period during hospitalization. DIAGNOSES The patient was diagnosed with CIE after cerebral hemorrhage, and cerebral edema was ruled out based on the history of contrast medium administration and radiographic exams. INTERVENTIONS AND OUTCOMES Dexamethasone (10 mg/d), mannitol (100 mL/d), betahistine (500 mL), trazodone (25 mg), and hydration supplementation were given to treat CIE-related symptoms. Aspirin and clopidogrel were administered for the management of the cardiovascular ailment. The neurologist prescribed neurotrophic agents, namely, cytarabine and methylcobalamin, based on the cerebral magnetic resonance imaging findings. Despite the treatment, the patient's ocular symptoms, including blurry vision, diplopia, and impaired intraocular retraction, persisted. Furthermore, the patient's mental state was altered, and she continued to exhibit a depressive state during her 1-month follow-up visit. LESSONS CIE is a comparatively infrequent ailment, and its prompt identification and management are of paramount importance. Although the treatments for CIE are primarily symptomatic, it is crucial to acknowledge that the symptoms may not always subside quickly within a short duration. In conjunction with pharmacotherapy, counseling should be offered to address patients' mental health.
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Affiliation(s)
- Kaiyuan Kong
- College of Clinical Medicine, Jining Medical University, Jining, China
| | - Anyong Chen
- Department of Cardiology, Jining Key Laboratory for Diagnosis and Treatment of Cardiovascular Diseases, Affiliated Hospital of Jining Medical University, Jining, China
| | - Guoliang Yang
- Department of Cardiology, Jining Key Laboratory for Diagnosis and Treatment of Cardiovascular Diseases, Affiliated Hospital of Jining Medical University, Jining, China
| | - Ronghua Gao
- Department of Cardiology, Jining Key Laboratory for Diagnosis and Treatment of Cardiovascular Diseases, Affiliated Hospital of Jining Medical University, Jining, China
| | - Shaohui Zhang
- Department of Cardiology, Jining Key Laboratory for Diagnosis and Treatment of Cardiovascular Diseases, Affiliated Hospital of Jining Medical University, Jining, China
| | - Lixin Liu
- Department of Cardiology, Jining Key Laboratory for Diagnosis and Treatment of Cardiovascular Diseases, Affiliated Hospital of Jining Medical University, Jining, China
| | - Xueying Chen
- Department of Cardiology, Jining Key Laboratory for Diagnosis and Treatment of Cardiovascular Diseases, Affiliated Hospital of Jining Medical University, Jining, China
- Postdoctoral Mobile Station of Shandong University of Traditional Chinese Medicine, Jinan, China
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Milan Manani S, Mattiotti M, Marcello M, Virzì GM, Gnappi M, Marturano D, Tantillo I, Ronco C, Zanella M. Contrast-Induced Encephalopathy: A Rare Complication in a Patient on Peritoneal Dialysis with Several Risk Factors. Nephron Clin Pract 2023; 147:665-672. [PMID: 37442103 DOI: 10.1159/000531771] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Major adverse renal and cardiovascular events are reported for high-risk patients undergoing intra-arterial procedures, even if performed with iso-osmolar contrast media (CM). We report a case of contrast-induced encephalopathy (CIE) in a peritoneal dialysis (PD) patient, affected by diabetes, hypertension, and chronic heart failure. A 78-year-old PD patient (diuresis 1,000 mL) underwent a percutaneous angioplasty of the carotid. Immediately after the exam, he developed mental confusion and aphasia. Encephalic computed tomography scan and magnetic resonance imaging excluded ischemia or hemorrhage, but both showed cerebral edema; EEG showed right hemisphere abnormalities, sequelae of recent ischemia. Mannitol and steroids were administered to reduce edema, and additional PD exchange was performed with depurative aim. Within 2 days the patient completely recovered. CIE mimics severe neurological diseases, and it should be considered as differential diagnosis if symptoms come out soon after intra-arterial administration of CM, especially in high-risk patients. Our patient suffered from diabetes, chronic kidney disease, hypertension, chronic heart failure, which are possible contributing factors to the development of CIE. Moreover, this clinical scenario is noteworthy because the development in a patient who underwent PD had never been described before.
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Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV Foundation-International Renal Research Institute Foundation, Vicenza, Italy
| | - Maria Mattiotti
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV Foundation-International Renal Research Institute Foundation, Vicenza, Italy
| | - Matteo Marcello
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV Foundation-International Renal Research Institute Foundation, Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV Foundation-International Renal Research Institute Foundation, Vicenza, Italy
| | | | - Davide Marturano
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV Foundation-International Renal Research Institute Foundation, Vicenza, Italy
| | - Ilaria Tantillo
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV Foundation-International Renal Research Institute Foundation, Vicenza, Italy
| | - Claudio Ronco
- IRRIV Foundation-International Renal Research Institute Foundation, Vicenza, Italy
- DIMED, University of Padova, Padova, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
- IRRIV Foundation-International Renal Research Institute Foundation, Vicenza, Italy
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19
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Xavier CG, Kuo M, Desai R, Palis H, Regan G, Zhao B, Moe J, Scheuermeyer FX, Gan WQ, Sabeti S, Meilleur L, Buxton JA, Slaunwhite AK. Association between toxic drug events and encephalopathy in British Columbia, Canada: a cross-sectional analysis. Subst Abuse Treat Prev Policy 2023; 18:42. [PMID: 37420239 PMCID: PMC10329314 DOI: 10.1186/s13011-023-00544-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/03/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Encephalopathy can occur from a non-fatal toxic drug event (overdose) which results in a partial or complete loss of oxygen to the brain, or due to long-term substance use issues. It can be categorized as a non-traumatic acquired brain injury or toxic encephalopathy. In the context of the drug toxicity crisis in British Columbia (BC), Canada, measuring the co-occurrence of encephalopathy and drug toxicity is challenging due to lack of standardized screening. We aimed to estimate the prevalence of encephalopathy among people who experienced a toxic drug event and examine the association between toxic drug events and encephalopathy. METHODS Using a 20% random sample of BC residents from administrative health data, we conducted a cross-sectional analysis. Toxic drug events were identified using the BC Provincial Overdose Cohort definition and encephalopathy was identified using ICD codes from hospitalization, emergency department, and primary care records between January 1st 2015 and December 31st 2019. Unadjusted and adjusted log-binomial regression models were employed to estimate the risk of encephalopathy among people who had a toxic drug event compared to people who did not experience a toxic drug event. RESULTS Among people with encephalopathy, 14.6% (n = 54) had one or more drug toxicity events between 2015 and 2019. After adjusting for sex, age, and mental illness, people who experienced drug toxicity were 15.3 times (95% CI = 11.3, 20.7) more likely to have encephalopathy compared to people who did not experience a drug toxicity event. People who were 40 years and older, male, and had a mental illness were at increased risk of encephalopathy. CONCLUSIONS There is a need for collaboration between community members, health care providers, and key stakeholders to develop a standardized approach to define, screen, and detect neurocognitive injury related to drug toxicity.
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Affiliation(s)
- Chloé G Xavier
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
| | - Margot Kuo
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- Overdose Emergency Response Centre, Ministry of Mental Health and Addictions, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Roshni Desai
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Heather Palis
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
| | - Gemma Regan
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, Canada
- Woodward Instructional Resource Centre, Vancouver, BC, V6T 1Z3, Canada
| | - Bin Zhao
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Jessica Moe
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- Department of Emergency Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- Department of Emergency Medicine, Vancouver General Hospital, 899 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Frank X Scheuermeyer
- St Paul's Hospital and the Department of Emergency Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- Centre for Health Evaluation & Outcomes Sciences, St Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Wen Qi Gan
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Soha Sabeti
- Health Surveillance, First Nations Health Authority, 100 Park Royal S, West Vancouver, BC, V7T 1A2, Canada
| | - Louise Meilleur
- Health Surveillance, First Nations Health Authority, 100 Park Royal S, West Vancouver, BC, V7T 1A2, Canada
| | - Jane A Buxton
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Amanda K Slaunwhite
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada
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20
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Yu-E Y, Zhi-Qin L, Hui L, Zheng-Li D, Fang Z, Fang Y. Valproate-induced hyperammonemic encephalopathy treated by L-ornithine-L-aspartate: a case report. Clin Med (Lond) 2023; 23:271-274. [PMID: 38614785 DOI: 10.7861/clinmed.2023-0137] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 63-year-old man developed reduced consciousness and dysphagia progressively. Examination and parameters were normal, except for a Glasgow Coma Scale score of seven, and his grading on the swallow water test increased from grade 1 to grade 5. Brain imaging and blood tests were unexplainable except by high plasma ammonia. His past medical history included cerebral infarction, hypertension and epilepsy induced by cerebral hyperperfusion syndrome. He was rceiving antiepileptic treatment of continuously intravenously pumped sodium valproate of 64 mg/h for 4 days, which overlapped for 12 hours with taking 500 mg sustained release tablets. Sodium valproate was stopped; testing demonstrated normal plasma concentrations of sodium valproate and elevated concentrations of ammonia. Ornithine aspartate was administrated. The patient's level of responsiveness and ammonia levels gradually improved. The patient was also being treated with ceftriaxone sodium for a hypostatic pneumonia and with desmopressin for diabetes insipidus. There is an association between sodium valproate and hyperammonaemia and encephalopathy. Immediate recognition of the serious but uncommon adverse effects is essential. To our knowledge this is the first report of ornithine aspartate being used in this disorder.
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Affiliation(s)
- Yan Yu-E
- Xi'an Central Hospital, Medical College of Xi'an Jiao Tong University, Xi'an Shaanxi, China
| | - Liu Zhi-Qin
- Xi'an Central Hospital, Medical College of Xi'an Jiao Tong University, Xi'an Shaanxi, China
| | - Lei Hui
- Xi'an Central Hospital, Medical College of Xi'an Jiao Tong University, Xi'an Shaanxi, China
| | - Di Zheng-Li
- Xi'an Central Hospital, Medical College of Xi'an Jiao Tong University, Xi'an Shaanxi, China
| | - Zhang Fang
- Xi'an Central Hospital, Medical College of Xi'an Jiao Tong University, Xi'an Shaanxi, China
| | - Yong Fang
- Xi'an Central Hospital, Medical College of Xi'an Jiao Tong University, Xi'an Shaanxi, China.
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21
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Chiang MC, Tsai TY, Wang CJ. The Potential Benefits of Quercetin for Brain Health: A Review of Anti-Inflammatory and Neuroprotective Mechanisms. Int J Mol Sci 2023; 24:6328. [PMID: 37047299 PMCID: PMC10094159 DOI: 10.3390/ijms24076328] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Neuroinflammation is a critical factor in developing and progressing numerous brain diseases, including neurodegenerative diseases. Chronic or excessive neuroinflammation can lead to neurotoxicity, causing brain damage and contributing to the onset and progression of various brain diseases. Therefore, understanding neuroinflammation mechanisms and developing strategies to control them is crucial for treating brain diseases. Studies have shown that neuroinflammation plays a vital role in the progression of neurodegenerative diseases, such as Alzheimer's (AD) and Parkinson's (PD), and stroke. Additionally, the effects of PM2.5 pollution on the brain, including neuroinflammation and neurotoxicity, are well-documented. Quercetin is a flavonoid, a plant pigment in many fruits, vegetables, and grains. Quercetin has been studied for its potential health benefits, including its anti-inflammatory, antioxidant, and anti-cancer properties. Quercetin may also have a positive impact on immune function and allergy symptoms. In addition, quercetin has been shown to have anti-inflammatory and neuroprotective properties and can activate AMP-activated protein kinase (AMPK), a cellular energy sensor that modulates inflammation and oxidative stress. By reducing inflammation and protecting against neuroinflammatory toxicity, quercetin holds promise as a safe and effective adjunctive therapy for treating neurodegenerative diseases and other brain disorders. Understanding and controlling the mechanisms of NF-κB and NLRP3 inflammasome pathways are crucial for preventing and treating conditions, and quercetin may be a promising tool in this effort. This review article aims to discuss the role of neuroinflammation in the development and progression of various brain disorders, including neurodegenerative diseases and stroke, and the impact of PM2.5 pollution on the brain. The paper also highlights quercetin's potential health benefits and anti-inflammatory and neuroprotective properties.
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Affiliation(s)
- Ming-Chang Chiang
- Department of Life Science, College of Science and Engineering, Fu Jen Catholic University, New Taipei City 242062, Taiwan
| | - Tsung-Yu Tsai
- Department of Food Science, Fu Jen Catholic University, New Taipei City 242062, Taiwan
| | - Chieh-Ju Wang
- Department of Life Science, College of Science and Engineering, Fu Jen Catholic University, New Taipei City 242062, Taiwan
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22
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Huang YT, Sun CY, Chang CM, Lai CC. Metronidazole-induced encephalopathy: Uncommon cause of recurrent falling in a geriatric man. J Microbiol Immunol Infect 2023; 56:203-205. [PMID: 36210316 DOI: 10.1016/j.jmii.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/20/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Yi-Te Huang
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Yao Sun
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Chia-Ming Chang
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan
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23
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Usami Y, Munakata A, Takahashi S, Konno N, Imai Y, Okawara K, Hirosawa T, Aoki Y, Kashimura H, Nihei T. [A case of irreversible metronidazole encephalopathy during liver abscess treatment]. Nihon Shokakibyo Gakkai Zasshi 2023; 120:858-867. [PMID: 37821376 DOI: 10.11405/nisshoshi.120.858] [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: 10/13/2023]
Abstract
Metronidazole (MNZ) is a widely used drug for protozoan and anaerobic infections. The continuous use of MNZ causes various neurological symptoms, such as cerebellar ataxia, visual disturbance, vestibulocochlear symptoms, gait disturbance, dysarthria, and epileptic seizures of unknown cause, named MNZ-induced encephalopathy (MIE), in rare cases. MIE is a reversible disease that often improves within a few days of MNZ discontinuation, but irreversible neurological symptoms rarely remain. Herein, we report a case of MIE that developed during MNZ administration for a liver abscess, causing prolonged unconsciousness and death even after drug discontinuation. An 85-year-old female patient complained of fever, elevated liver enzymes, and a multifocal abscess in the right hepatic lobe, as seen on computed tomography. Percutaneous transhepatic abscess drainage and antibiotic therapy were initiated. The causative agent of the liver abscess could not be identified, thus meropenem was started, which demonstrated no inflammation improvement, thus oral MNZ was added. The inflammation recurred when MNZ was discontinued, and the patient continued taking MNZ. Vomiting, upper limb tremors, consciousness disturbance, and convulsions appeared on day 46 (total dose of MNZ 73.5mg), and the patient was hospitalized. T2-weighted, diffusion-weighted, and FLAIR head magnetic resonance imaging (MRI) revealed symmetrical abnormal high-signal areas in the cerebellar dentate nucleus, corpus callosum, cerebral white matter, and periventricular areas. MIE was diagnosed based on the patient's course and MRI images, and MNZ was discontinued. The patient continued to suffer from impaired consciousness and convulsions after MNZ discontinuation and died due to aspiration pneumonia. Suggestively, MIE development is related to long-term MNZ administration, poor nutrition, liver disease, underlying diseases (such as advanced cancer), and serious complications. A systematic review of MIE cases revealed that 4.8-5.9% of the patients demonstrated little improvement of symptoms after MNZ discontinuation, and some deaths were reported. Patients with poor prognosis were often suffering from impaired consciousness and convulsions. Furthermore, impaired consciousness was the most common residual symptom. Abnormal signals in characteristic areas, such as the dentate nucleus cerebri and corpus callosum, on head MRI are useful for MIE diagnosis, especially in patients with abnormal findings in the cerebral white matter, which is associated with a poor prognosis. We should pay close attention to the onset of MIE when MNZ is administered.
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Affiliation(s)
- Yoshie Usami
- Department of Gastroenterology, Mitosaiseikai General Hospital
| | - Akari Munakata
- Department of Gastroenterology, Mitosaiseikai General Hospital
| | | | - Naoaki Konno
- Department of Gastroenterology, Mitosaiseikai General Hospital
| | - Yushi Imai
- Department of Gastroenterology, Mitosaiseikai General Hospital
| | - Ken Okawara
- Department of Gastroenterology, Mitosaiseikai General Hospital
| | - Takuya Hirosawa
- Department of Gastroenterology, Mitosaiseikai General Hospital
| | - Yohei Aoki
- Department of Gastroenterology, Mitosaiseikai General Hospital
| | | | - Takeshi Nihei
- Department of Gastroenterology, Mitosaiseikai General Hospital
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24
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Wang H, Liu D. Retrospective case-control study on screening risk factors of antibiotic-associated encephalopathy in patients with chronic kidney disease. BMJ Open 2022; 12:e064995. [PMID: 36526324 PMCID: PMC9764618 DOI: 10.1136/bmjopen-2022-064995] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The renal excretion function of patients with chronic kidney disease (CKD) is reduced, and the nervous system toxic reactions of antibiotics are prone to occur. The purpose of this study is to screen out some risk factors for patients with CKD to suffer from antibiotic-associated encephalopathy (AAE). DESIGN A case-control study. SETTING A tertiary hospital in China. PARTICIPANTS The medical records of patients who were hospitalised for CKD and infectious diseases in our hospital from January 2010 to December 2019. All patients used antibiotics to treat infectious diseases during hospitalisation. All patients were divided into two groups according to whether they developed AAE during hospitalisation. The patients with CKD without AAE were selected as the control group (n=120), and the patients with CKD with AAE were regarded as the AAE group (n=102). INTERVENTIONS This study systematically analysed its clinical manifestations, laboratory examinations, prognosis, etc, and summarised the risk factors related to AAE in patients with CKD. PRIMARY OUTCOME Screening risk factors of AAE in patients with CKD. RESULTS Logistic regression analysis showed that coronary heart disease, as well as abnormal indicators of haemoglobin, albumin, uric acid and blood phosphorus were independent risk factors for patients with CKD with AAE (OR values were 4.137, 0.963, 0.849, 0.996 0.161, respectively, all p<0.05). The case fatality rate (Pearson χ2=7.524, p=0.006), rehospitalisation rate (Pearson χ2=6.187, p=0.013) and treatment costs (t=-8.44, p<0.001) in encephalopathy group are significantly higher than the control group. CONCLUSIONS Patients with CKD with AAE will increase the case fatality rate and cause poor prognosis. Coronary heart disease, as well as decreased levels of haemoglobin, albumin, uric acid, and blood phosphorus are independent risk factors for patients with CKD with AAE. Timely intervention of these risk factors may reduce the incidence of AAE and improve the prognosis.
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Affiliation(s)
- Hongling Wang
- Department of Nephrology and Rheumatology, Tianjin Third Central Hospital, Tianjin, China
| | - Daquan Liu
- Department of Anatomy and Histology, Tianjin Medical University, Tianjin, China
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Matas-García A, Téllez A, Fernández S, Salgado E, Castro P. Intranasal disulfiram-induced encephalopathy: clinical and neuroimage findings. Rev Neurol 2022; 75:357-360. [PMID: 36440748 PMCID: PMC10280740 DOI: 10.33588/rn.7511.2021415] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Disulfiram-induced-encephalopathy is a rare complication that has been well described in adults. Although it usually occurs in acute intoxication with high doses of disulfiram, late onset encephalopathy has also been reported. Some authors propose the inhibition of dopamine beta-hydroxylase mediated by toxic metabolites of disulfiram as the main responsible, but the exact mechanism remains unclear. The aim of this report was to describe the clinical and neuroimaging findings in an unusual case of acute encephalitis due to disulfiram toxicity associated to chronic intranasal consume. CASE REPORT A chronic alcoholic who referred snorted use of a very high dose of disulfiram without simultaneous alcohol intake developed an acute encephalopathy with a rapidly progressive respiratory failure. A characteristic neuroimage finding consisting in extensive bilateral symmetric involvement of both pallidal nuclei was described. Recovery and neurologic improvement were slow. Two months after the intoxication, the patient still had slight intentional tremor and a scheduled magnetic resonance imaging. showed evolution of symmetrical areas of cytotoxic edema to necrosis. CONCLUSION Disulfiram-induced neurotoxicity must be suspect during chronic therapy with disulfiram or after acute ingestion of high doses. Symptoms such as symmetric sensory and motor neuropathy, confusion, catatonia, parkinsonism, ataxia, choreoathetosis, seizures and encephalopathy should make us rule out this disorder. A brain imaging test should be performed in these patients since a characteristic involvement of both nuclei pallidus has been described, but it is not present in all patients.
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Affiliation(s)
| | - A Téllez
- Hospital Clínic de Barcelona, 08036 Barcelona, España
| | - S Fernández
- Hospital Clínic de Barcelona, 08036 Barcelona, España
| | - E Salgado
- Hospital Clínic de Barcelona, 08036 Barcelona, España
| | - P Castro
- Hospital Clínic de Barcelona, 08036 Barcelona, España
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刘 京, 陆 爱, 左 英, 吴 珺, 黄 志, 贾 月, 丁 明, 张 乐, 秦 炯. [Clinical characteristics and prognosis of seizures in 75 children with acute lymphoblastic leukemia]. Beijing Da Xue Xue Bao Yi Xue Ban 2022; 54:948-953. [PMID: 36241238 PMCID: PMC9568387 DOI: 10.19723/j.issn.1671-167x.2022.05.023] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To investigate the clinical characteristics, treatment, and prognosis of seizures in children with acute lymphoblastic leukemia (ALL) during chemotherapy. METHODS Children with ALL with seizures during chemotherapy admitted to the Department of Pediatrics, Peking University People's Hospital from January 2010 to March 2022 were retrospectively analyzed. Clinical data including the incidence of seizure, time at seizure onset, causes, management, and prognosis were collected retrospectively. RESULTS A total of 932 children with ALL were admitted during the study period, of whom, 75 (8%) were complicated with seizures during the period of chemotherapy. There were 40 males and 35 females, with a median age of 7.5 (1-17) years, and 43 cases (57.3%) occurred within the first 2 months of chemotherapy. The underlying diseases were reversible posterior encephalopathy syndrome (n=15), cerebral hemorrhage (n=10, one of whom was complicated with venous sinus thrombosis), intrathecal or systemic methotrexate administration (n=11), brain abscess (n=7, fungal infection in 3 cases, and bacterial in 4), viral encephalitis (n=2), febrile seizure (n=7), hyponatremia (n=7), hypocalcemia (n=2), and unknown cause (n=14). Sixty-four children underwent neuroimaging examination after seizure occurrence, of whom 37 (57.8%) were abnormal. The electroencephalograhpy (EEG) was performed in 44 cases and was abnormal in 24 (54.4%). Fifty-five patients remained in long-term remission with regular chemotherapy, 8 patients received hematopoietic stem cell transplantation, 9 died and 3 lost to follow-up. Symptomatic epilepsy was diagnosed in 18 cases (24%), and was well controlled in 16 with over 1 year of seizure-free. Whereas 2 cases were refractory to anti-seizure medications. CONCLUSION Seizures are relatively common in children with ALL, most commonly due to reversible posterior encephalopathy syndrome, methotrexate-related neurotoxicity, and cerebral hemorrhage. Seizures occurred within 2 months of chemotherapy in most cases. Neuroimaging and EEG should be performed as soon as possible after the first seizure onset to identify the etiology and to improve the treatment regimen. Some cases developed symptomatic epilepsy, with a satisfactory outcome of seizure remission mostly after concurrent antiseizure medication therapy.
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Affiliation(s)
- 京 刘
- 北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
| | - 爱东 陆
- 北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
| | - 英熹 左
- 北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
| | - 珺 吴
- 北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
- 北京大学首钢医院儿科, 北京 100144Department of Pediatrics, Peking University Shougang Hospital, Beijing 100144, China
| | - 志卓 黄
- 北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
| | - 月萍 贾
- 北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
| | - 明明 丁
- 北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
| | - 乐萍 张
- 北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
| | - 炯 秦
- 北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
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Klein L, Van Steenwinckel J, Fleiss B, Scheuer T, Bührer C, Faivre V, Lemoine S, Blugeon C, Schwendimann L, Csaba Z, Bokobza C, Vousden DA, Lerch JP, Vernon AC, Gressens P, Schmitz T. A unique cerebellar pattern of microglia activation in a mouse model of encephalopathy of prematurity. Glia 2022; 70:1699-1719. [PMID: 35579329 PMCID: PMC9545095 DOI: 10.1002/glia.24190] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 11/24/2022]
Abstract
Preterm infants often show pathologies of the cerebellum, which are associated with impaired motor performance, lower IQ and poor language skills at school ages. Using a mouse model of inflammation-induced encephalopathy of prematurity driven by systemic administration of pro-inflammatory IL-1β, we sought to uncover causes of cerebellar damage. In this model, IL-1β is administered between postnatal day (P) 1 to day 5, a timing equivalent to the last trimester for brain development in humans. Structural MRI analysis revealed that systemic IL-1β treatment induced specific reductions in gray and white matter volumes of the mouse cerebellar lobules I and II (5% false discovery rate [FDR]) from P15 onwards. Preceding these MRI-detectable cerebellar volume changes, we observed damage to oligodendroglia, with reduced proliferation of OLIG2+ cells at P10 and reduced levels of the myelin proteins myelin basic protein (MBP) and myelin-associated glycoprotein (MAG) at P10 and P15. Increased density of IBA1+ cerebellar microglia were observed both at P5 and P45, with evidence for increased microglial proliferation at P5 and P10. Comparison of the transcriptome of microglia isolated from P5 cerebellums and cerebrums revealed significant enrichment of pro-inflammatory markers in microglia from both regions, but cerebellar microglia displayed a unique type I interferon signaling dysregulation. Collectively, these data suggest that perinatal inflammation driven by systemic IL-1β leads to specific cerebellar volume deficits, which likely reflect oligodendrocyte pathology downstream of microglial activation. Further studies are now required to confirm the potential of protective strategies aimed at preventing sustained type I interferon signaling driven by cerebellar microglia as an important therapeutic target.
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Affiliation(s)
- Luisa Klein
- Department of NeonatologyCharité University Medicine BerlinBerlinGermany
| | | | - Bobbi Fleiss
- NeuroDiderot, InsermUniversité de ParisParisFrance
- School of Health and Biomedical SciencesRMIT UniversityMelbourneVictoriaAustralia
| | - Till Scheuer
- Department of NeonatologyCharité University Medicine BerlinBerlinGermany
| | - Christoph Bührer
- Department of NeonatologyCharité University Medicine BerlinBerlinGermany
| | | | - Sophie Lemoine
- Genomics Core Facility, Département de Biologie, École Normale Supérieure, Institut de Biologie de l'ENS (IBENS), CNRS, INSERMUniversité PSLParisFrance
| | - Corinne Blugeon
- Genomics Core Facility, Département de Biologie, École Normale Supérieure, Institut de Biologie de l'ENS (IBENS), CNRS, INSERMUniversité PSLParisFrance
| | | | - Zsolt Csaba
- NeuroDiderot, InsermUniversité de ParisParisFrance
| | | | - Dulcie A. Vousden
- Mouse Imaging CentreThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Jason P. Lerch
- Mouse Imaging CentreThe Hospital for Sick ChildrenTorontoOntarioCanada
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
- Wellcome Trust Centre for Integrative NeuroimagingUniversity of OxfordOxfordUK
| | - Anthony C. Vernon
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- MRC Centre for Neurodevelopmental DisordersKing's College LondonLondonUK
| | | | - Thomas Schmitz
- Department of NeonatologyCharité University Medicine BerlinBerlinGermany
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Maan G, Keitoku K, Kimura N, Sawada H, Pham A, Yeo J, Hagiya H, Nishimura Y. Cefepime-induced neurotoxicity: systematic review. J Antimicrob Chemother 2022; 77:2908-2921. [PMID: 35971666 DOI: 10.1093/jac/dkac271] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 04/18/2022] [Accepted: 06/24/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cefepime-induced neurotoxicity (CIN) has been well acknowledged among clinicians, although there are no clear diagnostic criteria or specific laboratory testing to help with its diagnosis. We aimed to summarize the existing evidence regarding CIN and provide future agendas for research. METHODS Following the PRISMA Extension for Scoping Reviews, we searched MEDLINE and Embase for all peer-reviewed articles using keywords including 'cefepime', 'neurotoxicity', 'encephalopathy' and 'seizure', from their inception to 20 January 2022. RESULTS We included 92 articles, including 23 observational studies and 69 cases from case reports and case series, in the systematic review. Among 119 patients with CIN, 23.5% were in the ICU at the time of diagnosis and nearly 90% of the cases showed renal dysfunction.Cefepime overdoses were described in 41%. The median latency period of developing CIN from cefepime initiation was 4 days, and about 12% developed CIN during empirical treatment. CIN patients commonly manifested altered mental status (93%), myoclonus (37%) and non-convulsive seizure epilepticus (28%). A serum cefepime trough level of >20 mg/L would put patients at risk for CIN. CIN-related symptoms were ameliorated in 97.5% by dose reduction or discontinuation of cefepime, with median time to improvement of 3 days. No CIN-associated deaths were reported. CONCLUSIONS This systematic review summarizes the current evidence and characteristics of CIN. In the current situation where there are no CIN diagnostic criteria and the drug monitoring platform is not routinely available, candidates for cefepime should be carefully selected. Also, based on these findings, it needs to be appropriately dosed to avoid the development of CIN.
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Affiliation(s)
- Gozun Maan
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, USA
| | - Koichi Keitoku
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, USA
| | - Nobuhiko Kimura
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, USA
| | - Haruki Sawada
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, USA
| | - Andrew Pham
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, USA
| | - Jihun Yeo
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, USA
| | - Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Yoshito Nishimura
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, USA
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
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Song LL, Yu JH, Hu XL, Li X. [A suspected case of delayed encephalopathy after acute hydrogen sulfide poisoning]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2022; 40:529-531. [PMID: 35915946 DOI: 10.3760/cma.j.cn121094-20220120-00035] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The main component of the gas in the fish storage tank is hydrogen sulfide. Hydrogen sulfide poisoning is a common occupational chemical poisoning among fishermen in summer, and acute hydrogen sulfide poisoning can manifest as toxic encephalopathy. This paper analyzes a patient with delayed encephalopathy suspected of acute hydrogen sulfide poisoning. The patient was unconscious for 18 days after waking up for 5 days after acute hydrogen sulfide poisoning. After waking up again, there were symptoms such as decreased limb muscle strength, ataxia, swallowing, dysarthria, and the clinical characteristics were significantly different from those of delayed encephalopathy caused by acute carbon monoxide poisoning, such as decreased cognitive function and damage to extrapyramidal system.
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Affiliation(s)
- L L Song
- Occupational Disease Department, the Affiliated Weihai Second Municipal Hospital of Qingdao University, Weihai 264200, China
| | - J H Yu
- Occupational Disease Department, the Affiliated Weihai Second Municipal Hospital of Qingdao University, Weihai 264200, China
| | - X L Hu
- Occupational Disease Department, the Affiliated Weihai Second Municipal Hospital of Qingdao University, Weihai 264200, China
| | - X Li
- Shandong First Medical University (Shandong Academy of Medical Sciences, Shandong Academy of Occupational Health and Occupational Medicine), Jinan 250062, China
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30
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Fernández-Rubio B, Luque-Márquez R, Gil-Navarro MV. Probable ertapenem-induced encephalopathy; case report and suggested alternatives for chronic prostatitis. Daru 2022; 30:159-163. [PMID: 35023080 PMCID: PMC9114266 DOI: 10.1007/s40199-021-00425-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/26/2021] [Indexed: 01/16/2023] Open
Abstract
Ertapenem is a carbapenem antibiotic usually reserved for complicated infections. Drug-induced neurotoxicity is a rare adverse reaction associated with ertapenem, and may be directly related to its chemical structure. We report a case of a 64-year-old male with a hematological history and chronic prostatitis that was admitted to hospital for gait instability, clumsiness, dysarthria and tremors. He started ertapenem intravenous 1 g once daily a week prior to admission. Creatinine clearance calculation by the Cockcroft-Gault method was 52 mL/min and total protein levels were low. Ertapenem's administration was discontinued and the patient's neurological symptoms improved dramatically just one day after. The result of the Naranjo Scale was six, suggesting a probable adverse drug reaction. We discussed if he could receive meropenem in case of severe infection such as septic shock. Considering the patient's medical history, the chemical structure of meropenem and the fact that there are almost no reported cases of neurotoxicity from this drug, we assume that meropenem could be used in case of severe infection in patients with history of neurotoxicity caused by ertapenem if no added risk factors are present, such as renal failure.
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Affiliation(s)
- Beatriz Fernández-Rubio
- Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío/CSIC, Instituto de Biomedicina de Sevilla (IBiS), 41009 Seville, Spain
| | - Rafael Luque-Márquez
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología Y Medicina Preventiva, Hospital Universitario Virgen del Rocío/CSIC, Instituto de Biomedicina de Sevilla (IBiS), 41009 Seville, Spain
| | - María-Victoria Gil-Navarro
- Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío/CSIC, Instituto de Biomedicina de Sevilla (IBiS), 41009 Seville, Spain
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Hui WF, Leung KKY, Au CC, Fung CW, Cheng FWT, Kan E, Hon KLE. Clinical Characteristics and Outcomes of Acute Childhood Encephalopathy in a Tertiary Pediatric Intensive Care Unit. Pediatr Emerg Care 2022; 38:115-120. [PMID: 35226619 DOI: 10.1097/pec.0000000000002571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Childhood encephalopathy comprises a wide range of etiologies with distinctive distribution in different age groups. We reviewed the pattern of encephalopathy admitted to the pediatric intensive care unit (PICU) of a tertiary children's hospital. METHODS We reviewed the medical records and reported the etiologies, clinical features, and outcomes of children with encephalopathy. RESULTS Twenty-four admissions to the PICU between April 2019 and May 2020 were reviewed. The median (interquartile range) age was 10.0 (14.7) years and 62.5% were boys. Confusion (66.7%) was the most common presentation. Adverse effects related to medications (33.3%) and metabolic disease (20.8%) were predominant causes of encephalopathies in our study cohort. Methotrexate was responsible for most of the medication-associated encephalopathy (37.5%), whereas Leigh syndrome, pyruvate dehydrogenase deficiency and Wernicke's encephalopathy accounted for those with metabolic disease. The median Glasgow Coma Scale (GCS) on admission was 12.5 (9.0). Antimicrobials (95.8%) and antiepileptic drugs (60.9%) were the most frequently given treatment. Children aged 2 years or younger were all boys (P = 0.022) and had a higher proportion of primary metabolic disease (P = 0.04). Intoxication or drug reaction only occurred in older children. The mortality was 8.3%, and over half of the survivors had residual neurological disability upon PICU discharge. Primary metabolic disease (P = 0.002), mechanical ventilation (P = 0.019), failure to regain GCS back to baseline level (P = 0.009), and abnormal cognitive function on admission (P = 0.03) were associated with cerebral function impairment on PICU discharge. CONCLUSIONS Primary metabolic encephalopathy was prevalent in younger children, whereas drug-induced toxic encephalopathy was common among older oncology patients. Survivors have significant neurologic morbidity. Failure to regain baseline GCS was a poor prognostic factor for neurological outcomes.
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Affiliation(s)
- Wun Fung Hui
- From the Department of Paediatrics and Adolescent Medicine
| | | | - Cheuk Chung Au
- From the Department of Paediatrics and Adolescent Medicine
| | | | | | - Elaine Kan
- Department of Radiology, The Hong Kong Children's Hospital, Kowloon, Hong Kong SAR
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Abstract
We present the case of a 55 year old who presented multiple times with altered conscious levels. He was often treated as being post-ictal, when in fact, he had Sodium Valproate induced hyperammonaemic encephalopathy. Sodium Valproate can frequently increase ammonia levels, and in some patient lead to hyperammonaemic encephalopathy.
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Affiliation(s)
| | - G Sharp
- Senior Clinical Pharmacist, East Surrey Hospital
| | - J Kimber
- Consultant Neurologist, East Surrey Hospital
| | - V Ziauddin
- Consultant in Acute and General Medicine, East Surrey Hospital
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Moynan D, Maqbool E, de Barra E. Antimicrobial neurotoxicity: an under-recognised cause of delirium. Acute Med 2022; 21:115-116. [PMID: 35681187 DOI: 10.52964/amja.0908] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Antimicrobial associated encephalopathy (AAE) is a well-documented, though under recognised, adverse event associated with antimicrobial use. Clinical manifestations of AAE are varied, ranging from myoclonus and seizure to an encephalopathy with cerebellar signs. The phenotypic presentation of the encephalopathy syndrome is, in general, governed by the antimicrobial in question. Given its apparent rarity in everyday clinical practice, awareness of AAE is crucial for physicians. We describe a reversible encephalopathy characterised by confusion, myoclonus and stupor in a 76 year old gentleman on antimicrobial therapy for a peri-rectal abscess.
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Affiliation(s)
- D Moynan
- Department of Infectious Diseases, Beaumont, Dublin
| | - E Maqbool
- Department of Geriatric and Stroke Medicine, Beaumont, Dublin
| | - E de Barra
- Department of Infectious Diseases, Beaumont, Dublin
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Abstract
OBJECTIVE To compare the efficacy of four therapeutic methods to modify gut microbiota dysbiosis and brain dysfunction in septic rats. METHODS Rats were treated with fecal microbiota transplantation, prebiotics, probiotics, and synbiotics after exposure to lipopolysaccharide. The diversity and composition of gut microbiota, electroencephalogram values, and the concentrations of TNF-α, IL-1β, and IL-6 in the cortex were analyzed. RESULTS Fecal microbiota transplantation was the most efficacious method to restore intestinal microbial diversity and exert the best corrective effects in modulating microbial composition in septic rats. More interestingly, fecal microbiota transplantation exerted the best protective effects in brain dysfunction in septic rats. CONCLUSION Among the four methods, fecal microbiota transplantation was the most useful method to modify the dysbiosis of intestinal microbiota and improve brain function in septic rats. These findings reveal the protective consequence of microbiota modification, and the findings suggest opportunities to improve brain function in sepsis.
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Affiliation(s)
- Suyan Li
- Department of Emergency, Hebei General Hospital, Shijiazhuang, Hebei, P. R. China
- Department of General Practice, Hebei General Hospital, Shijiazhuang, Hebei, P. R. China
| | - Hui Guo
- Department of Emergency, Hebei General Hospital, Shijiazhuang, Hebei, P. R. China
| | - Xin Xu
- Department of Emergency, Hebei General Hospital, Shijiazhuang, Hebei, P. R. China
| | - Ranliang Hua
- Department of Emergency, Hebei General Hospital, Shijiazhuang, Hebei, P. R. China
| | - Qian Zhao
- Department of Emergency, Hebei General Hospital, Shijiazhuang, Hebei, P. R. China
| | - Jian Li
- Department of Emergency, Hebei General Hospital, Shijiazhuang, Hebei, P. R. China
| | - Jian Lv
- Department of Emergency, Hebei General Hospital, Shijiazhuang, Hebei, P. R. China
| | - Jianguo Li
- Department of Emergency, Hebei General Hospital, Shijiazhuang, Hebei, P. R. China
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35
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Habrat B, Silczuk A, Klimkiewicz A. Manganese Encephalopathy Caused by Homemade Methcathinone (Ephedrone) Prevalence in Poland. Nutrients 2021; 13:nu13103496. [PMID: 34684497 PMCID: PMC8539983 DOI: 10.3390/nu13103496] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/24/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022] Open
Abstract
Manganese encephalopathy is a known disorder in occupational medicine. A serious phenomenon has been the emergence of manganese encephalopathy in intravenous users of homemade methcathinone (ephedrone). A short survey was developed for clinical environments dealing with people who use psychoactive substances. The data were obtained from 72 rehabilitation therapy centers. Surveys carried out in about a third of Polish centers dealing with providing medical assistance to people addicted to substances other than alcohol and tobacco have shown that over 4% of people treated there had symptoms of manganese encephalopathy, of which more than half are people in whom the probability of a clinical diagnosis of this disorder is significant. It has been shown that knowledge of manganese encephalopathy is none or minimal in more than 70% of the surveyed institutions. An urgent need for personnel training in this field was pointed out. Attention was paid to the importance of disseminating good review articles on new and dynamically developing problem phenomena.
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Affiliation(s)
- Bogusław Habrat
- Department of Prevention and Treatment of Addictions, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland; (B.H.); (A.S.)
| | - Andrzej Silczuk
- Department of Prevention and Treatment of Addictions, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland; (B.H.); (A.S.)
- Department of Public Health, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Anna Klimkiewicz
- Department of Psychiatry, Medical University of Warsaw, 02-091 Warsaw, Poland
- Correspondence:
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Rana I, Rieswijk L, Steinmaus C, Zhang L. Formaldehyde and Brain Disorders: A Meta-Analysis and Bioinformatics Approach. Neurotox Res 2021; 39:924-948. [PMID: 33400181 PMCID: PMC8102312 DOI: 10.1007/s12640-020-00320-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023]
Abstract
While there is significant investigation and investment in brain and neurodegenerative disease research, current understanding of the etiologies of illnesses like Alzheimer's disease (AD), Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS), and brain cancer remains limited. Environmental exposure to the pollutant formaldehyde, an emerging neurotoxin widely used in industry, is suspected to play a critical role in mediating these disorders, although findings are limited and inconsistent. Focusing on highly exposed groups, we performed a meta-analysis of human epidemiological studies of formaldehyde and neurodegenerative disease (N = 19) or brain tumors (N = 12). To assess the biological plausibility of observed associations, we then conducted a bioinformatics analysis using WikiPathways and the Comparative Toxicogenomics Database and identified candidate genes and pathways that may be related to these interactions. We reported the meta-relative risk (meta-RR) of ALS following high exposures to formaldehyde was increased by 78% (meta-RR = 1.78, 95% confidence interval, CI 1.20-2.65). Similarly, the meta-RR for brain cancer was increased by 71% (meta-RR = 1.71; 95% CI 1.07-2.73) among highly exposed individuals. Multiple sensitivity analyses did not reveal sources of heterogeneity or bias. Our bioinformatics analysis revealed that the oxidative stress genes superoxide dismutase (SOD1, SOD2) and the pro-inflammatory marker tumor necrosis factor (TNF) were identified as the top relevant genes, and the folate metabolism, vitamin B12 metabolism, and the ALS pathways were highly affected by formaldehyde and related to the most brain diseases of interest. Further inquiry revealed the two metabolic pathways are also intimately tied with the formaldehyde cycle. Overall, our bioinformatics analysis supports the link of formaldehyde exposure to ALS or brain tumor reported from our meta-analysis. This new multifactorial approach enabled us to both interrogate the robustness of the epidemiological data and identify genes and pathways that may be involved in these interactions, ultimately lending strong evidence and potential biological plausibility for the association between formaldehyde exposure and brain disease.
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Affiliation(s)
- Iemaan Rana
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Linda Rieswijk
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
- Institute of Data Science, Maastricht University, Maastricht, Netherlands
| | - Craig Steinmaus
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Luoping Zhang
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA.
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Kenzaka T, Sugimoto K, Goda K, Akita H. Acute kidney injury and acyclovir-associated encephalopathy after administration of valacyclovir in an elderly person with normal renal function: A case report and literature review. Medicine (Baltimore) 2021; 100:e26147. [PMID: 34032768 PMCID: PMC8154488 DOI: 10.1097/md.0000000000026147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/11/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Acyclovir (ACV)-associated encephalopathy is related to an increase in plasma levels of 9-carboxymethoxymethylguanine, an ACV metabolite, and is often reported in patients with renal dysfunction. We report a case of ACV-associated encephalopathy with rapid progression of renal dysfunction after oral administration of valacyclovir (VACV) and review literature of previous ACV-associated encephalopathy cases. PATIENT CONCERNS An 88-year-old man was diagnosed with herpes zoster. VACV (3000 mg/day) treatment was initiated. Serum creatinine (Cr) level was 0.80 mg/dL. However, irritability, memory impairment, and decreased responsiveness occurred after 3 days. The Cr level was 6.76 mg/dL on admission. DIAGNOSIS He was diagnosed with ACV-associated encephalopathy with acute kidney injury. INTERVENTIONS VACV was discontinued, hemodialysis was initiated on the day of admission, and then the signs and symptoms improved approximately 72 hours after the admission. CONCLUSION Worsening of renal function and encephalopathy should be a focus when using VACV or ACV, regardless of age and original renal function. Acute kidney injury and ACV-associated encephalopathy may particularly occur in the elderly even when renal function is normal. Therefore, regular monitoring of renal function and consciousness is necessary during VACV treatment.
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Affiliation(s)
- Tsuneaki Kenzaka
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuma Sugimoto
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba
| | - Ken Goda
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hozuka Akita
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba
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Uginet M, Stancu P, Bridel C, Serratrice J, Lalive PH, Coen M. [COVID-19-related acute encephalopathy: physiopathological hypothesis]. Rev Med Suisse 2021; 17:810-815. [PMID: 33908716] [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: 06/12/2023]
Abstract
Acute encephalopathy is one of the most frequent neurological complication in patients hospitalized for COVID-19. Electrolyte imbalance, drugs, and hypoxemia can all affect brain homeostasis, leading to acute cognitive dysfunction and direct implications of the SARS-CoV-2 are not completely understood. Neurological complications of SARS-CoV-2 infection are poorly understood: an inflammatory insult to the endothelium affecting the blood-brain barrier may explain the clinical presentation, but other hypotheses including direct viral damage or an immune-mediated reaction are also suggested. Among these various potential mechanisms, often combined, the controversy remains.
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Affiliation(s)
- Marjolaine Uginet
- Service de neurologie, Département des neurosciences cliniques, HUG et Faculté de médecine, 1211 Genève 14
| | - Patrick Stancu
- Service de neurologie, Département des neurosciences cliniques, HUG et Faculté de médecine, 1211 Genève 14
| | - Claire Bridel
- Service de neurologie, Département des neurosciences cliniques, HUG et Faculté de médecine, 1211 Genève 14
| | - Jacques Serratrice
- Service de médecine interne générale, Département de médecine, HUG, 1211 Genève 14
| | - Patrice H Lalive
- Service de neurologie, Département des neurosciences cliniques, HUG et Faculté de médecine, 1211 Genève 14
- Département diagnostique, médecine de laboratoire, HUG, 1211 Genève 14
- Département de pathologie et d'immunologie, Faculté de médecine, Université de Genève, 1211 Genève 4
| | - Matteo Coen
- Service de médecine interne générale, Département de médecine, HUG, 1211 Genève 14
- Unité de développement et recherche en éducation médicale (UDREM), Faculté de médecine, Université de Genève, 1211 Genève 4
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García-Pérez D, Parra-Serrano J, Panero I, Moreno LM, Campollo J, Alén JF. Transient cortical blindness secondary to contrast-induced encephalopathy following diagnostic cerebral angiography: report of 2 cases. Acta Neurol Belg 2021; 121:585-589. [PMID: 33123949 DOI: 10.1007/s13760-020-01532-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Daniel García-Pérez
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain.
| | - Javier Parra-Serrano
- Department of Neurology, University Hospital, 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - Irene Panero
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - Luis Miguel Moreno
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - Jorge Campollo
- Division of Neuroradiology, University Hospital, 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - José F Alén
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
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Kurpik M, Zalewski P, Kujawska M, Ewertowska M, Ignatowicz E, Cielecka-Piontek J, Jodynis-Liebert J. Can Cranberry Juice Protect against Rotenone-Induced Toxicity in Rats? Nutrients 2021; 13:nu13041050. [PMID: 33805023 PMCID: PMC8063919 DOI: 10.3390/nu13041050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/19/2021] [Accepted: 03/20/2021] [Indexed: 12/12/2022] Open
Abstract
The high polyphenols content of cranberry accounts for its strong antioxidant activity underlying the beneficial health effects of this fruit. Rotenone (ROT) is a specific inhibitor of mitochondrial complex I in the brain which leads to the generation of oxidative stress. To date, there are few data indicating that toxicity of ROT is not limited to the brain but can also affect other tissues. We aimed to examine whether ROT-induced oxidative stress could be counteracted by cranberry juice not only in the brain but also in the liver and kidney. Wistar rats were given the combined treatment with ROT and cranberry juice (CJ) for 35 days. Parameters of antioxidant status were determined in the organs. ROT enhanced lipid peroxidation solely in the brain. The increase in the DNA damage was noticed in all organs examined and in leukocytes. The beneficial effect of CJ on these parameters appeared only in the brain. Additionally, CJ decreased the activity of serum hepatic enzymes. The effect of CJ on antioxidant enzymes was not consistent, however, in some organs, CJ reversed changes evoked by ROT. Summing up, ROT can cause oxidative damage not only in the brain but also in other organs. CJ demonstrated a protective effect against ROT-induced toxicity.
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Affiliation(s)
- Monika Kurpik
- Department of Toxicology, Poznan University of Medical Sciences, Dojazd 30, 60-631 Poznań, Poland; (M.K.); (M.E.); (J.J.-L.)
| | - Przemysław Zalewski
- Department of Pharmacognosy, Poznan University of Medical Sciences, Święcickiego 4, 60-781 Poznań, Poland; (P.Z.); (J.C.-P.)
| | - Małgorzata Kujawska
- Department of Toxicology, Poznan University of Medical Sciences, Dojazd 30, 60-631 Poznań, Poland; (M.K.); (M.E.); (J.J.-L.)
- Correspondence: ; Tel.: +48-61-847-20-81 (ext. 156)
| | - Małgorzata Ewertowska
- Department of Toxicology, Poznan University of Medical Sciences, Dojazd 30, 60-631 Poznań, Poland; (M.K.); (M.E.); (J.J.-L.)
| | - Ewa Ignatowicz
- Department of Pharmaceutical Biochemistry, Poznan University of Medical Sciences, ul. Święcickiego 4, 60-781 Poznań, Poland;
| | - Judyta Cielecka-Piontek
- Department of Pharmacognosy, Poznan University of Medical Sciences, Święcickiego 4, 60-781 Poznań, Poland; (P.Z.); (J.C.-P.)
| | - Jadwiga Jodynis-Liebert
- Department of Toxicology, Poznan University of Medical Sciences, Dojazd 30, 60-631 Poznań, Poland; (M.K.); (M.E.); (J.J.-L.)
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Fox ER, Johnson-Arbor K, Mazer-Amirshahi M. Will There Ever be an Antidote for Drug Shortages? J Med Toxicol 2021; 17:321-322. [PMID: 33687652 DOI: 10.1007/s13181-021-00830-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 01/31/2021] [Accepted: 02/08/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Erin R Fox
- Department of Pharmacy Services, University of Utah Health, Salt Lake City, UT, USA
| | - Kelly Johnson-Arbor
- National Capital Poison Center, Washington, DC, USA
- MedStar Georgetown University Hospital, Washington, DC, USA
| | - Maryann Mazer-Amirshahi
- MedStar Georgetown University Hospital, Washington, DC, USA.
- Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC, USA.
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Affiliation(s)
- Sanjeev Khera
- Pediatrics, Army Hospital Research and Referral, New Delhi, India
| | - K P Shijith
- Radiodiagnosis, Army Hospital Research and Referral, New Delhi, India
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Jain R, Randev S, Kumar P, Guglani V. Acute Kidney Injury and Encephalopathy in a Child: Diethylene Glycol Poisoning. Indian J Pediatr 2021; 88:194-195. [PMID: 33175363 DOI: 10.1007/s12098-020-03557-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/22/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Reena Jain
- Department of Pediatrics, Government Medical College and Hospital, Sector 32, Chandigarh, 160036, India
| | - Shivani Randev
- Department of Pediatrics, Government Medical College and Hospital, Sector 32, Chandigarh, 160036, India.
| | - Pankaj Kumar
- Department of Pediatrics, Government Medical College and Hospital, Sector 32, Chandigarh, 160036, India
| | - Vishal Guglani
- Department of Pediatrics, Government Medical College and Hospital, Sector 32, Chandigarh, 160036, India
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Iversen IB, Mohr MS, Vestergaard JM, Stokholm ZA, Kolstad HA. Associations of Occupational Styrene Exposure With Risk of Encephalopathy and Unspecified Dementia: A Long-Term Follow-up Study of Workers in the Reinforced Plastics Industry. Am J Epidemiol 2021; 190:288-294. [PMID: 32803258 PMCID: PMC7850053 DOI: 10.1093/aje/kwaa170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 11/12/2022] Open
Abstract
Exposure to industrial solvents has been associated with encephalopathy. Styrene is a neurotoxic industrial solvent, and we investigated the long-term risk of encephalopathy and unspecified dementia following styrene exposure. We followed 72,465 workers in the reinforced plastics industry in Denmark (1977–2011) and identified incident cases of encephalopathy (n = 228) and unspecified dementia (n = 565) in national registers. Individual styrene exposure levels were modeled from information on occupation, measurements of work place styrene levels, product, process, and years of employment. Adjusted analyses were performed using a discrete survival function. A positive trend for encephalopathy (P < 0.01) and a negative trend for unspecified dementia (P = 0.03) were seen with cumulative styrene exposure accrued during the recent period of up to 15 years. For unspecified dementia and the combination of unspecified dementia and encephalopathy, a positive trend was indicated when applying a 30-year exposure lag (P = 0.13 and P = 0.07). The risk patterns seen following recent exposure probably reflect diagnostic criteria for encephalopathy requiring recent industrial solvent exposure and referral bias rather than association with styrene exposure, while the increasing risk observed for unspecified dementia and the combination of encephalopathy and unspecified dementia following distant exposure indicates an increased risk of dementia following styrene exposure with a long latency period.
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Affiliation(s)
- Inge Brosbøl Iversen
- Correspondence to Dr. Inge Brosbøl Iversen, Department of Occupational Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark (e-mail: )
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45
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Yao LD, Zhu XL, Yang RL, Zhang MM. Cardiorespiratory arrest after iso-osmolar iodinated contrast injection: A case report of contrast-induced encephalopathy following contrast-enhanced computed-tomography. Medicine (Baltimore) 2021; 100:e24035. [PMID: 33466150 PMCID: PMC7808532 DOI: 10.1097/md.0000000000024035] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 12/04/2020] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Contrast-induced encephalopathy (CIE) is a rare complication caused by administration of intravascular contrast media and characterized by acute reversible neurological disturbance. Most of the CIE cases are reported after arterial administration of contrast media such as during cerebral or coronary angiographies, yet only a few articles have reported CIE secondary to intravenous contrast. A case of CIE secondary to intravenous contrast administration is reported here. PATIENT CONCERNS A 68-year-old man was admitted to our hospital for contrast-enhanced chest computed-tomography (CT) examination due to suspected pulmonary nodules. After CT examination, the patient lost consciousness and experienced a cardiorespiratory arrest. An emergency plain brain CT was done immediately which showed abnormal cortical contrast enhancement and cerebral sulci hyperdensity. DIAGNOSES After excluding other differential diagnoses such as electrolytes imbalance, hypo/hyperglycemia, cardiogenic pathologies and other neurological emergencies such as cerebral hemorrhage, cerebral infarction, the final diagnosis of CIE was made. INTERVENTIONS The patient was admitted to the intensive care unit for further management. A series of supportive treatments were arranged. OUTCOMES Follow-up visits at the outpatient clinic showed no lasting neurological deficits. LESSONS CIE should be considered as 1 of the differential diagnoses for a patient with acute neurologic symptoms after iodinate contrast administration. Neuroradiological imaging examinations are essential to rule out other etiologies such as acute cerebral infarction or intracranial hemorrhage.
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Affiliation(s)
- Li-Ding Yao
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiu-Liang Zhu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Run-Lin Yang
- School of Medicine, University of Melbourne, Melbourne, Australia
| | - Min-Ming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Mesnil M, Defamie N, Naus C, Sarrouilhe D. Brain Disorders and Chemical Pollutants: A Gap Junction Link? Biomolecules 2020; 11:biom11010051. [PMID: 33396565 PMCID: PMC7824109 DOI: 10.3390/biom11010051] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 02/07/2023] Open
Abstract
The incidence of brain pathologies has increased during last decades. Better diagnosis (autism spectrum disorders) and longer life expectancy (Parkinson's disease, Alzheimer's disease) partly explain this increase, while emerging data suggest pollutant exposures as a possible but still underestimated cause of major brain disorders. Taking into account that the brain parenchyma is rich in gap junctions and that most pollutants inhibit their function; brain disorders might be the consequence of gap-junctional alterations due to long-term exposures to pollutants. In this article, this hypothesis is addressed through three complementary aspects: (1) the gap-junctional organization and connexin expression in brain parenchyma and their function; (2) the effect of major pollutants (pesticides, bisphenol A, phthalates, heavy metals, airborne particles, etc.) on gap-junctional and connexin functions; (3) a description of the major brain disorders categorized as neurodevelopmental (autism spectrum disorders, attention deficit hyperactivity disorders, epilepsy), neurobehavioral (migraines, major depressive disorders), neurodegenerative (Parkinson's and Alzheimer's diseases) and cancers (glioma), in which both connexin dysfunction and pollutant involvement have been described. Based on these different aspects, the possible involvement of pollutant-inhibited gap junctions in brain disorders is discussed for prenatal and postnatal exposures.
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Affiliation(s)
- Marc Mesnil
- Laboratoire STIM, ERL7003 CNRS-Université de Poitiers, 1 rue G. Bonnet–TSA 51 106, 86073 Poitiers, France; (M.M.); (N.D.)
| | - Norah Defamie
- Laboratoire STIM, ERL7003 CNRS-Université de Poitiers, 1 rue G. Bonnet–TSA 51 106, 86073 Poitiers, France; (M.M.); (N.D.)
| | - Christian Naus
- Faculty of Medicine, Department of Cellular & Physiological Sciences, Life Sciences Institute, University of British Columbia, 2350 Health Sciences Mall, Vancouver, BC V6T1Z3, Canada;
| | - Denis Sarrouilhe
- Laboratoire de Physiologie Humaine, Faculté de Médecine et Pharmacie, 6 rue de La Milétrie, bât D1, TSA 51115, 86073 Poitiers, France
- Correspondence: ; Tel.: +33-5-49-45-43-58
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Abstract
Objective Reversible splenial lesion syndrome (RESLES) is a clinical radiological syndrome characterized by a reversible lesion of the splenium of the corpus callosum with a decreased apparent diffusion coefficient (ADC) value. The clinical manifestations of RESLES are diverse. Methods Fifteen cases of adult RESLES patients (10 males and 5 females) were retrospectively selected from the radiology system using the key word "corpus callosum" at a university-affiliated tertiary care hospital between May 1, 2015 and December 31, 2019. The possible precipitating factors, clinicoradiological findings and modified Rankin Scale (mRS) on follow-up were then analyzed. Results The patient ages ranged from 22 to 53 years old. The mean age was 34 years old. The most common neurological symptoms included headache (3/15), dizziness (3/15), first onset of seizure (3/15), paroxysmal blurred vision (2/15), vertigo (2/15), amnesia (2/15), and confused consciousness without seizure (2/15), followed by drowsiness (1/15), paresthesia (1/15), dysmetria (1/15) and dysarthria (1/15). The precipitating factors included infection, seizure, anti-epileptic treatment with levetiracetam, carbamazepine, valproate, hyperglycemia, hypoglycemia, cerebral venous sinus thrombosis, and rabies vaccine injection prior to the onset of RESLES. All cases were carefully followed up and had excellent prognoses. Conclusion RESLES manifests as variety of symptoms with less specificity and precipitating factors. Paroxysmal blurred vision may be a relatively specific symptom of RESLES. Levetiracetam, carbamazepine or valproate could be the cause of RESLES, exposure to the rabies vaccine could be another predisposing factors for RESLES as well. RESLES type 1 was therefore found to be highly "reversible" with an excellent prognosis.
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Affiliation(s)
- Pei-Lin Lu
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, China
| | | | - Xu Zheng
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, China
| | - Xing-Yue Hu
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, China
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Yıldırım Z, Altunkaynak Y, Baybaş S. Delayed encephalopathy after carbon monoxide intoxication: case report. Acta Neurol Belg 2020; 120:1213-1214. [PMID: 31650423 DOI: 10.1007/s13760-019-01222-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 10/09/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Zerrin Yıldırım
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
- Department of Neurology, Bagcilar Education and Research Hospital, Istanbul, Turkey.
| | - Yavuz Altunkaynak
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Education And Research Hospital, Istanbul, Turkey
| | - Sevim Baybaş
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Education And Research Hospital, Istanbul, Turkey
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Bolden N, Posner KL, Domino KB, Auckley D, Benumof JL, Herway ST, Hillman D, Mincer SL, Overdyk F, Samuels DJ, Warner LL, Weingarten TN, Chung F. Postoperative Critical Events Associated With Obstructive Sleep Apnea: Results From the Society of Anesthesia and Sleep Medicine Obstructive Sleep Apnea Registry. Anesth Analg 2020; 131:1032-1041. [PMID: 32925320 PMCID: PMC7659468 DOI: 10.1213/ane.0000000000005005] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) patients are at increased risk for pulmonary and cardiovascular complications; perioperative mortality risk is unclear. This report analyzes cases submitted to the OSA Death and Near Miss Registry, focusing on factors associated with poor outcomes after an OSA-related event. We hypothesized that more severe outcomes would be associated with OSA severity, less intense monitoring, and higher cumulative opioid doses. METHODS Inclusion criteria were age ≥18 years, OSA diagnosed or suspected, event related to OSA, and event occurrence 1992 or later and <30 days postoperatively. Factors associated with death or brain damage versus other critical events were analyzed by tests of association and odds ratios (OR; 95% confidence intervals [CIs]). RESULTS Sixty-six cases met inclusion criteria with known OSA diagnosed in 55 (83%). Patients were middle aged (mean = 53, standard deviation [SD] = 15 years), American Society of Anesthesiologists (ASA) III (59%, n = 38), and obese (mean body mass index [BMI] = 38, SD = 9 kg/m); most had inpatient (80%, n = 51) and elective (90%, n = 56) procedures with general anesthesia (88%, n = 58). Most events occurred on the ward (56%, n = 37), and 14 (21%) occurred at home. Most events (76%, n = 50) occurred within 24 hours of anesthesia end. Ninety-seven percent (n = 64) received opioids within the 24 hours before the event, and two-thirds (41 of 62) also received sedatives. Positive airway pressure devices and/or supplemental oxygen were in use at the time of critical events in 7.5% and 52% of cases, respectively. Sixty-five percent (n = 43) of patients died or had brain damage; 35% (n = 23) experienced other critical events. Continuous central respiratory monitoring was in use for 3 of 43 (7%) of cases where death or brain damage resulted. Death or brain damage was (1) less common when the event was witnessed than unwitnessed (OR = 0.036; 95% CI, 0.007-0.181; P < .001); (2) less common with supplemental oxygen in place (OR = 0.227; 95% CI, 0.070-0.740; P = .011); (3) less common with respiratory monitoring versus no monitoring (OR = 0.109; 95% CI, 0.031-0.384; P < .001); and (4) more common in patients who received both opioids and sedatives than opioids alone (OR = 4.133; 95% CI, 1.348-12.672; P = .011). No evidence for an association was observed between outcomes and OSA severity or cumulative opioid dose. CONCLUSIONS Death and brain damage were more likely to occur with unwitnessed events, no supplemental oxygen, lack of respiratory monitoring, and coadministration of opioids and sedatives. It is important that efforts be directed at providing more effective monitoring for OSA patients following surgery, and clinicians consider the potentially dangerous effects of opioids and sedatives-especially when combined-when managing OSA patients postoperatively.
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Affiliation(s)
- Norman Bolden
- Department of Anesthesiology and Pain Management, MetroHealth Medical Center, Cleveland, OH, USA
| | - Karen L. Posner
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Karen B Domino
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Dennis Auckley
- Department of Pulmonary, Sleep, and Critical Care, MetroHealth Medical Center, Cleveland, OH, USA
| | - Jonathan L Benumof
- Department of Anesthesiology, University of California San Diego Medical Center, San Diego, CA, USA
| | - Seth T. Herway
- Department of Anesthesiology, Mountain West Anesthesia, St George UT, USA
| | - David Hillman
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, Western Australia.”
| | - Shawn L. Mincer
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Frank Overdyk
- Department of Anesthesiology, Roper St Francis Health System, Charleston, SC, USA
| | - David J. Samuels
- Department of Anesthesiology, Tampa General Hospital, Tampa, FL, USA
| | | | | | - Frances Chung
- Department of Anesthesia and Pain Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
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Ibáñez F, Ureña-Peralta JR, Costa-Alba P, Torres JL, Laso FJ, Marcos M, Guerri C, Pascual M. Circulating MicroRNAs in Extracellular Vesicles as Potential Biomarkers of Alcohol-Induced Neuroinflammation in Adolescence: Gender Differences. Int J Mol Sci 2020; 21:ijms21186730. [PMID: 32937997 PMCID: PMC7555060 DOI: 10.3390/ijms21186730] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/27/2020] [Accepted: 09/12/2020] [Indexed: 02/07/2023] Open
Abstract
Current studies evidence the role of miRNAs in extracellular vesicles (EVs) as key regulators of pathological processes, including neuroinflammation and neurodegeneration. As EVs can cross the blood–brain barrier, and EV miRNAs are very stable in peripheral circulation, we evaluated the potential gender differences in inflammatory-regulated miRNAs levels in human and murine plasma EVs derived from alcohol-intoxicated female and male adolescents, and whether these miRNAs could be used as biomarkers of neuroinflammation. We demonstrated that while alcohol intoxication lowers anti-inflammatory miRNA (mir-146a-5p, mir-21-5p, mir-182-5p) levels in plasma EVs from human and mice female adolescents, these EV miRNAs increased in males. In mice brain cortices, ethanol treatment lowers mir-146a-5p and mir-21-5p levels, while triggering a higher expression of inflammatory target genes (Traf6, Stat3, and Camk2a) in adolescent female mice. These results indicate, for the first time, that female and male adolescents differ as regards the ethanol effects associated with the inflammatory-related plasma miRNAs EVs profile, and suggest that female adolescents are more vulnerable than males to the inflammatory effects of binge alcohol drinking. These findings also support the view that circulating miRNAs in EVs could be useful biomarkers for screening ethanol-induced neuroinflammation and brain damage in adolescence.
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Affiliation(s)
- Francesc Ibáñez
- Department of Molecular and Cellular Pathology of Alcohol, Príncipe Felipe Research Center, 46012 Valencia, Spain; (F.I.); (J.R.U.-P.); (C.G.)
| | - Juan R. Ureña-Peralta
- Department of Molecular and Cellular Pathology of Alcohol, Príncipe Felipe Research Center, 46012 Valencia, Spain; (F.I.); (J.R.U.-P.); (C.G.)
| | - Pilar Costa-Alba
- Emergency Department, University Hospital of Salamanca-IBSAL, 37007 Salamanca, Spain;
| | - Jorge-Luis Torres
- Department of Internal Medicine, University Hospital of Salamanca, University of Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (J.-L.T.); (F.-J.L.); (M.M.)
| | - Francisco-Javier Laso
- Department of Internal Medicine, University Hospital of Salamanca, University of Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (J.-L.T.); (F.-J.L.); (M.M.)
| | - Miguel Marcos
- Department of Internal Medicine, University Hospital of Salamanca, University of Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (J.-L.T.); (F.-J.L.); (M.M.)
| | - Consuelo Guerri
- Department of Molecular and Cellular Pathology of Alcohol, Príncipe Felipe Research Center, 46012 Valencia, Spain; (F.I.); (J.R.U.-P.); (C.G.)
| | - María Pascual
- Department of Molecular and Cellular Pathology of Alcohol, Príncipe Felipe Research Center, 46012 Valencia, Spain; (F.I.); (J.R.U.-P.); (C.G.)
- Department of Physiology, School of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
- Correspondence: ; Tel.: +34-961-625-635; Fax: +34-963-864-642
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