Raphe Nuclei Echogenicity and Diameter of Third Ventricle in Schizophrenia Measured by Transcranial Sonography

Introduction

Serotonergic system hyperactivity at 5-HT2A receptors on glutamate neurons in the cerebral cortex is one of the pathways that is theoretically linked to psychosis. In addition to neurotransmitter dysfunction, volumetric studies have revealed the loss of cortical gray matter and ventricular enlargement in patients with schizophrenia, although there is no case-control research on patients with schizophrenia to evaluate echogenicity of raphe nuclei (RN) or diameter of the third ventricle (DTV). To address these issues, the present study assessed midbrain RN, as the main source of brain serotonin, and DTV, as an index of atrophy, by transcranial sonography (TCS) in a group of patients with schizophrenia.

Methods

Thirty patients with schizophrenia and 30 controls were assessed by TCS for RN echogenicity and DTV. TCS was done through a temporal bone window via a phased-array ultrasound using a 2.5 MHz transducer in a depth of 14-16 cm. RN echogenicity was assessed by a semi-quantitative visual scale and DTV was measured in the thalamic plane.

Results

Twenty-three patients (76.5%) and 15 controls (50 %) showed hypoechogenicity of RN, which was marginally significant (P=0.06). DTV was on average larger in the experimental group (0.388 cm vs 0.234 cm, P<0.001).

Conclusion

Increased DTV in patients with schizophrenia is consistent with previous neuroimaging findings. However, marginally lower echogenicity of midbrain RN on TCS in schizophrenia is a new finding that supports the serotonin hypothesis of schizophrenia.

Highlights

30 patients with schizophrenia and 30 controls were assessed by TCS for RN echogenicity and diameter of the third ventricle (DTV).23 patients (76.5%) and 15(50 %) controls showed hypoechogenicity of RN which was marginally significant (P=0.06)DTV was in average larger in the patient's group (0.388 cm vs 0.234 cm, P<0.001).Increased DTV in the patients with schizophrenia is consistent with previous neuroimaging findingsMarginally lower echogenicity of midbrain RN on TCS in schizophrenia is a new finding that supports the serotonin hypothesis of schizophrenia.

Plain Language Summary

Schizophrenia is a disabling psychiatric disorder. Various neurotransmitters have a role in the pathophysiology of schizophrenia including Serotonin and dopamine. This study assessed the echogenicity of raphe nuclei (RN), as the main source of brain serotonin, and the diameter of the third ventricle (DTV), as an index of atrophy, by transcranial sonography (TCS) method in 30 patients with schizophrenia and 30 healthy controls. Based on the results, 23 patients (76.5%) and 15 controls (50%) showed decreased echogenicity of RN. There was a significant difference between the two groups in terms of the echogenicity of RN. Moreover, the DTV diameter was significantly larger in patients compared to controls.

Posterior reversible encephalopathy syndrome in SARS‐CoV‐2 infection: A case report and review of literature

Consider PRES in SARS‐CoV‐2 infected patients who develop encephalopathy, seizures or impaired vision; especially if the disease is complicated by respiratory distress and need for mechanical ventilation.

Consider PRES in SARS‐CoV‐2 infected patients who develop encephalopathy, seizures or impaired vision; especially if the disease is complicated by respiratory distress and need for mechanical ventilation.

The Factors Associated With Olfactory Dysfunction in Patients with Multiple Sclerosis

Introduction:

An impaired sense of smell has a remarkable impact on the quality of life. It is seen in a variety of neurodegenerative diseases such as Parkinson disease. In this study, we assessed the olfactory function in patients with Multiple Sclerosis (MS) by Sniff Magnitude Test (SMT).

Methods:

A cross-sectional study was conducted on 48 patients with MS. A questionnaire, including demographic and clinical variables, was completed for each patient. The SMT was used for the evaluation of olfactory function.

Results:

Olfactory dysfunction was found in 14.6% of patients (8.3% hyposmia and 6.3% anosmia). Older age, longer disease duration, higher hospital admission rate, lower minimental status examination score, and secondary progressive course of MS were significantly related to olfactory dysfunction.

Conclusion:

Secondary progressive MS and markers of advanced disease toward neurodegenerative phase (including older age, longer disease duration, and lower cognitive function) can be associated with olfactory dysfunction in MS patients.

Description of combined ARHSP/JALS phenotype in some patients with SPG11 mutations

Background

SPG11 mutations can cause autosomal recessive hereditary spastic paraplegia (ARHSP) and juvenile amyotrophic lateral sclerosis (JALS). Because these diseases share some clinical presentations and both can be caused by SPG11 mutations, it was considered that definitive diagnosis may not be straight forward.

Methods

The DNAs of referred ARHSP and JALS patients were exome sequenced. Clinical data of patients with SPG11 mutations were gathered by interviews and neurological examinations including electrodiagnosis (EDX) and magnetic resonance imaging (MRI).

Results

Eight probands with SPG11 mutations were identified. Two mutations are novel. Among seven Iranian probands, six carried the p.Glu1026Argfs*4‐causing mutation. All eight patients had features known to be present in both ARHSP and JALS. Additionally and surprisingly, presence of both thin corpus callosum (TCC) on MRI and motor neuronopathy were also observed in seven patients. These presentations are, respectively, key suggestive features of ARHSP and JALS.

Conclusion

We suggest that rather than ARHSP or JALS, combined ARHSP/JALS is the appropriate description of seven patients studied. Criteria for ARHSP, JALS, and combined ARHSP/JALS designations among patients with SPG11 mutations are suggested. The importance of performing both EDX and MRI is emphasized. Initial screening for p.Glu1026Argfs*4 may facilitate SPG11 screenings in Iranian patients.

Reduced retinal nerve fiber layer (RNFL) thickness in ALS patients: a window to disease progression

OBJECTIVES

To assess RNFL thickness in ALS patients and compare it to healthy controls, and to detect possible correlations between RNFL thickness in ALS patients and disease severity and duration.

METHODS

Study population consisted of ALS patients and age- and sex-matched controls. We used the revised ALS functional rating scale (ALSFRS-R) as a measure of disease severity. RNFL thickness in the four quadrants were measured with a spectral domain OCT (Topcon 3D, 2015).

RESULTS

We evaluated 20 ALS patients (40 eyes) and 25 healthy matched controls. Average RNFL thickness in ALS patients was significantly reduced compared to controls (102.57 ± 13.46 compared to 97.11 ± 10.76, p 0.04). There was a significant positive correlation between the functional abilities of the patients based on the ALSFRS-R and average RNFL thickness and also RNFL thickness in most quadrants. A linear regression analysis proved that this correlation was independent of age. In ALS patients, RNFL thickness in the nasal quadrant of the left eyes was significantly reduced compared to the corresponding quadrant in the right eyes even after adjustment for multiplicity (85.80 ± 23.20 compared to 96.80 ± 16.96, p = 0.008).

CONCLUSION

RNFL thickness in ALS patients is reduced compared to healthy controls. OCT probably could serve as a marker of neurodegeneration and progression of the disease in ALS patients. RNFL thickness is different among the right and left eyes of ALS patients pointing to the fact that asymmetric CNS involvement in ALS is not confined to the motor system.

Palatal-Myoclonus as a Presentation of Hashimoto Encephalopathy: an interesting case report

OBJECTIVE

Hashimoto encephalopathy (HE) is known as a steroid- responsive encephalopathy associated with autoimmune thyroiditis or nonvascular inflammation-related autoimmune meningoencephalitis. The average age of onset of HE is approximately 50 years; and it is more common in women. The onset of HE may be acute or subacute. The course of most HE cases is relapsing and remitting, which is similar to that of vasculitis and stroke.

METHODS

In this article, we present a previously healthy 32 years old;veterinarian male with palatal myoclonus, as a rare presentation of this disorder, and review the neurologic aspects of hashimoto encephalitis.

RESULTS

The clinical presentation of HE is characterized by progressive cognitive decline tremor, transient aphasia, seizures, abnormal gait, sleep disorder and stroke-like episodes. Myoclonus, either generalized or multifocal, and tremor, often of the bilateral upper extremities, is the most frequently observed involuntary movements in HE.

CONCLUSION

The rapidly progressive cognitive dysfunction and encephalopathies observed.