Clinical Neuroscience

A young known case of multiple sclerosis was evaluated with chief complaint of gradually progressed left lower limb weakness over 3 weeks. Pathologic examination of a mass in brain magnetic resonance imaging confirmed the diagnosis of glioblastoma multiforme (GBM). Given the importance of the definite diagnosis of malignant glioma and its effect on patient’s management, GBM should be considered as a differential diagnosis in cases with coexisting mass like lesion and demyelinating plaques.

Multiple sclerosis (MS) is a chronic inflammatory disease, causing neuronal demyelination and axonal damage in the central nervous system. Symptoms of MS vary widely because of different grades of sensory, motor, and cognitive dysfunctions. Although headache as the initial symptom of MS is rare, it is a common comorbidity that affects most patients. However, it is unclear that the headache manifestation in newly diagnosed people with MS should be considered as an MS attack or merely a comorbid condition. We report the case of a 31-year-old woman with newly diagnosed MS who presented with exacerbation of headache episodes without any abnormal neurological exam findings. The headaches did not respond to nonsteroidal anti-inflammatory drugs and triptans. After administration of methylprednisolone, the headaches were significantly improved, and during 3 months of follow-up receiving glatiramer acetate, no episode of headache has occurred. This case demonstrates the possible relationship...

BackgroundA family history (FH) of alcohol dependence (AD) not only increases the risk for AD, but is also associated with an increased risk for mood and anxiety disorders. However, it is unknown how a FH of AD affects neural substrates in patients with mood and anxiety disorders. In this study we examined the effects of an alcoholic FH on cognitive and emotional functions in these patients using functional magnetic resonance imaging (fMRI).MethodIn a sample of non-alcoholic patients with depressive and/or anxiety disorders from the Netherlands Study of Depression and Anxiety (NESDA) neuroimaging study, patients with a first-degree FH of AD (FH + ; n = 31) were compared with patients without a FH (FH–; n = 77) on performance and brain activation during visuospatial planning and emotional word encoding. Results were compared with those of healthy controls (HCs) without a FH of AD (n = 31).ResultsFH+ patients performed slower during planning with increasing task load, coupled with str...

Little is known about the long-term acceptance and effects of cognitive and motor stimulation interventions (CMSI) in Alzheimer's disease (AD). To evaluate a replicable CMSI program for mild cognitive impairment (MCI) and mild-to-moderate AD persons. Eighty-four non-institutionalized subjects with AD were randomized to receive either CMSI, administered by a single care provider, or standard support. Cognition, activities of daily living (ADL), mood, and study partner's subjective burden were assessed by blinded raters. Data on institutionalization, psychiatric medications, and demise were collected by the study physicians. Random effects model and survival analyses were conducted, after 2 and 3 years of study. Three-year assessments could be performed by the physician in 85% and by the blinded rater in 66% of subjects. Significant benefits were observed in basic ADL at the 2- and 3-year assessments, whereas instrumental ADL showed benefits only up to the second year of inter...

Background and Importance: Neurenteric cysts (NCs) account for 0.7 to 1.3% of all spinal tumors and are most commonly present during the first three decades of life. Only two cases have been reported in individuals in their 7th and 8th decades of life. This study described a rare case of an NC in a septuagenarian (70 – 79 years of age) who presented with atypical features of the disease.
Case Presentation: A 77-year-old female patient presented with acute onset paraparesis. Magnetic resonance imaging revealed a 13.6 × 14.1 × 15.4 mm intradural extramedullary cystic lesion, which was anteriorly located at the C7-D1 level. It was T1 hypointense, T2 hyperintense, and showed faint contrast enhancement at the junction between the cyst and the spinal cord. At surgery, a cyst with a greyish-white thin wall was noted in the spinal canal, displacing the spinal cord posteriorly. The cyst wall was partially excised, and a small portion adhering to the spinal cord was left behind. The histopathology report was consistent with an NC. At the 2-week follow-up, the patient’s lower limb strength had improved.
Conclusion: Although rare, NCs can present in the seventh decade of life. Magnetic resonance imaging may reveal unusual findings, like T1 hypointensity and faint contrast enhancement of the cyst wall. In elderly patients, a portion of the cyst wall may be left behind if it adheres to the spinal cord to avoid the risk of neurological deterioration.

The effectiveness of action observation (AO) and motor imagery (MI) in high-quality studies with less risk of bias is rarely reported together. This systematic review evaluates the effectiveness of AO and MI on improving upper extremity function among people after stroke by combining evidence of studies with high methodological quality. Randomised controlled trials, with a score of 6 or above in the PEDro Scale, that examined the effects of AO or MI for people with stroke were selected. A narrative analysis and meta-analysis were conducted using the PRISMA guidelines. Ten randomised controlled trials from 11 articles met the inclusion criteria. The results of meta-analysis showed that AO had a small to moderate statistically significant effect on improving upper extremity motor function (standardized mean difference, SMD=0.34; confidence interval, CI=0.08, 0.59; P=0.35; I 2=0.00%) and no significant effect on MI (SMD=0.08; CI=-0.26, 0.42; P=0.65; I2=0.00%) when compared with the con...

The effectiveness of action observation (AO) and motor imagery (MI) in high-quality studies with less risk of bias is rarely reported together. This systematic review evaluates the effectiveness of AO and MI on improving upper extremity function among people after stroke by combining evidence of studies with high methodological quality. Randomised controlled trials, with a score of 6 or above in the PEDro Scale, that examined the effects of AO or MI for people with stroke were selected. A narrative analysis and meta-analysis were conducted using the PRISMA guidelines. Ten randomised controlled trials from 11 articles met the inclusion criteria. The results of meta-analysis showed that AO had a small to moderate statistically significant effect on improving upper extremity motor function (standardized mean difference, SMD=0.34; confidence interval, CI=0.08, 0.59; P=0.35; I 2=0.00%) and no significant effect on MI (SMD=0.08; CI=-0.26, 0.42; P=0.65; I2=0.00%) when compared with the con...

To provide an in-depth re-examination of assumed causes of tissue hypertrophy, port-wine stains, and the Sturge-Weber, Cobb, Klippel-Trénaunay, and related syndromes to support an alternative unifying pathophysiologic mechanism of venous dysplasia producing focal venous hypertension with attendant tissue responses; to provide proof of concept with new patient data; to propose a novel etiological hypothesis for the venous dysplasia in these syndromes and find supportive evidence. Data from 20 patients with port-wine stains and corneal pachymetry readings was collected prospectively by the author in an institutional referral-based practice. The literature was searched using MEDLINE, and articles and textbooks were obtained from the bibliographies of these publications. Newly obtained dermatologic, corneal pachymetry, fundus ophthalmoscopic, ocular and orbital venous Doppler ultrasonography, and magnetic resonance imaging findings in patients with the Sturge-Weber syndrome or isolated ...

Adequate intraoperative exposure of the brain is paramount to prevent unnecessary retraction of the brain parenchyma. Lesions in the anterior skull base, the middle fossa and even the upper part of the posterior fossa can be managed anterolaterally through the pterional approach, the orbitozygomatic approach and the transzygomatic approach. Although commonly discussed on a separate basis, these three procedures are here considered to belong in the same spectrum, which includes one, two or three step procedures depending on the case and the level of exposure required. Ten hemispheres were used to describe the surgical technique applied in a three-step anterolateral approach. The pterional approach provides adequate access to the frontal base and the Sylvian fissure, the circle of Willis and the optic nerves. Where access to the temporal base is needed, improved exposure can be afforded by sectioning the zygomatic arch and lowering the masseter muscle. The lateral orbital wall is sectioned to improve the vertical angle of approach and facilitate access to hypothalamic and posterior fossa lesions. The combination of three approaches into one procedure introduces a new perspective on this technique, one which makes them easier to understand and shows how craniotomy may be modified for optimal exposure, even while conducting the surgery.

This study aimed to demonstrate age-related and gender-related changes in diffusion tensor imaging (DTI) indices of deep grey matter (GM) nuclei of the normal human brain. DTI was performed on 142 subjects (age: 10-52 years). Regions of interest were placed on the caudate nucleus (CN), putamen, globus pallidus, frontal white matter (WM), occipital WM, anterior and posterior limb of internal capsule, genu of the corpus callosum and splenium in all participants. The quadratic regression model was used to describe age-related and gender-related changes in DTI indices for GM and WM. We observed increased fractional anisotropy (FA) values with age up to adulthood in GM, and a rise up to the third decade of life followed by a decrease in FA for WM. We observed higher FA values in males compared to females in CN and all WM regions. Decreased mean diffusivity with age was observed in GM and WM irrespective of gender. This normative data may be valuable in the diagnosis of neurodegenerative diseases.

Wernicke's encephalopathy (WE) is a potentially reversible disorder. It is often not considered in non-alcoholic patients unless MRI demonstrates lesions in the appropriate sites. However, specific MRI sequences only highlight some areas of abnormality and hence WE may not be considered unless a more complete study is performed and this is highlighted in the case described herein. The neuropathological basis for the imaging findings is also discussed.

tively, the spinal instrumentation precluded postoperative MRI to confirm resolution of the syrinx. Our patient's Marfan's syndrome, with ligamentous laxity, was responsible for the development of his BI and CM. Avoiding posterior fossa decompression in this instance provided maximal bone surface for osteointegration of the OC arthrodesis and minimized the potential for additional surgical morbidity. If the syrinx had not resolved, he would have required additional surgery to decompress the malformation, to drain the syrinx with a myelotomy, or both. We report a cervical syrinx that resolved in a patient with circumferential compression of the foramen magnum with ventral transoral decompression of the foramen magnum. Posterior OC occipitocervical fusion was performed without the need for posterior decompression of the CM.

Gerstmann's syndrome in patients with hydatid cyst has not been reported frequently, although many cerebral hydatid diseases have been detailed. Tsukamoto et al. (1) reported such a case in a patient who had a cysticercosis in his left angular gyrus. MRI showed a focal lesion situated subcortically in the left angular gyrus and reaching the superior posterior parietal lobe in a patient with Gerstmann's syndrome. Four symptoms of Gerstmann's syndrome are seen in left angular gyrus lesions in right-handed persons (2). Brain involvement is seen in 1 to 2% of all echinococcus granulosus infestations and the primary form is very rare (3,4). The diagnosis is established with serologic and imaging techniques (3). A round, cystic lesion is detected on the CT in cerebral hydatid disease (5-7). Cerebral hydatid cysts should be removed without rupture (4). However, only half of these cysts are removed unruptured (8). For this reason, all patients have to receive mebendazole therapy (3). Cases with a hydatid cyst first representing Gerstmann's syndrome have rarely been reported. We are reporting this case due to its rarity. CASE REPORT A 7-year-old boy was admitted to the psychiatry department with a history of headache, behavioral disturbances, mental regression, inability to perform skilful movement, counting and calculation disorders, and unawareness of his right side. Cranial computerized

To evaluate the diagnostic importance of event-related potential P300, the correlation between P300 and regional cerebral blood flow (rCBF) was investigated in various brain regions in patients with multiple cerebral infarction (16 cases), chronic alcoholism (11 cases) and Alzheimer's disease (5 cases) and in seven healthy people. Cognitive function was also evaluated by mini-mental state examination. P300 latency and rCBF was measured by recording of evoked potentials using an oddball paradigm and stable xenon computed tomographic scanning, respectively. A significant (P:0.05) negative correlation between P300 and rCBF was observed in the thalamus in patients with multiple cerebral infarction and chronic alcoholism. In addition, a significant (P:0.01) negative correlation between P300 latency and the mini-mental state examination score and positive correlation between rCBF in the thalamus and the mini-mental state examination score were observed. These findings suggest that P300 latency is associated with rCBF in the thalamus and cognitive function.

The objective of this study is to assess attention in recently diagnosed relapsing-remitting multiple sclerosis patients. Twenty-seven patients with early multiple sclerosis and low clinical disability scores (EDSS<2) and 27 sex-, age-, and education-matched healthy controls underwent attention assessment using the Attentional Network Test, a computerized task designed to measure efficiency independently in 3 attentional networks (Alerting, Orienting and Executive Control). MS patients had significantly less efficiency in the Alerting network (p = .006). In contrast, in the Orienting and Executive Control networks, they did not differ from controls. A significant interaction between Alerting and Executive Control was also found in the MS patients (p = .007). Early relapsing-remitting multiple sclerosis particularly affects the Alerting domain of attention, whereas the Orienting and Executive Control domains are not affected. (JINS, 2012, 18, 1–7)

Background Neutral lipid storage disease with myopathy (NLSD-M) is an autosomal recessive disease that manifests itself around the 3rd to 4th decade with chronic myopathy predominantly proximal in the shoulder girdle. Clinical myotonia is uncommon. We will report a rare case of association of pathogenic variants on PNPLA2 and CLCN1 genes with a mixed phenotype of NLSD-M and a subclinical form of Thomsen's congenital myotonia. Case presentation We describe a patient with chronic proximal myopathy, subtle clinical myotonia and electrical myotonia on electromyography (EMG). Serum laboratory analysis disclosure hyperCKemia (CK 1280 mg/dL). A blood smear analysis showed Jordan's anomaly, a hallmark of NLSD-M. A genetic panel was collected using next-generation sequencing (NGS) technique, which identified two pathogenic variants on genes supporting two different diagnosis: NLSD-M and Thomsen congenital myotonia, whose association has not been previously described. Conclusions Although uncommon, it is important to remember the possibility of association of pathogenic variants to explain a specific neuromuscular disease phenotype. The use of a range of complementary methods, including myopathy genetic panels, may be essential to diagnostic definition in such cases.

Questo lavoro esplora il campo delle neuroscienze computazionali e delle simulazioni cerebrali, con un focus sulle tecnologie emergenti, le applicazioni in ambito medico e le implicazioni etiche. Attraverso l'analisi delle neuroscienze, dell'intelligenza artificiale e delle biotecnologie, il documento esamina come i modelli matematici e le simulazioni possano migliorare la comprensione dei processi cognitivi, neurologici e comportamentali. Viene discusso l'uso di simulazioni cerebrali nella diagnosi e nel trattamento delle malattie neurologiche, con particolare attenzione a patologie come l'Alzheimer e il Parkinson. Inoltre, il lavoro affronta i rischi di abuso delle tecnologie, le sfide relative alla privacy e al controllo delle informazioni cerebrali, nonché le questioni morali e sociali legate all'utilizzo delle simulazioni cognitive. Infine, il paper considera le prospettive future di queste tecnologie, analizzando il loro impatto sulla medicina, sulla società e sull'etica scientifica.

Prior studies suggest a high incidence of leptomeningeal failure (LMF) in breast cancer metastatic to brain. This study examines breast cancer-specific variables affecting development of LMF and survival after Gamma-Knife Radiosurgery (GKS). Methods: Between 2000-2010, 149 (breast) and 658 other-histology patients were treated with GKS. Hormone/HER2, age, local/distant brain failure, prior craniotomy, and prior whole-brain radiotherapy (WBRT) were assessed. Median follow-up was 54 months (range, 0-106). Serial MRI determined local and distant-brain failure and LMF. Statistical analysis with categorical/continuous data comparisons were done with Fisher's-exact, Wilcoxon rank-sum, log-rank tests, and Cox-Proportional Hazard models. Results: Of 149 patients, 21 (14%) developed LMF (median time of 11.9 months). None of the following predicted for LMF: Her2-status (HR = 0.49, p = 0.16), hormone-receptor status (HR = 1.15, p = 0.79), prior craniotomy (HR = 1.58, p = 0.42), prior WBRT (HR = 1.36, p = 0.55). Non-significant factors between patients that did (n = 21) and did not (n = 106) develop LMF included neurologic death (p = 0.34) and median survival (8.6 vs 14.2 months, respectively). Breast patients who had distant-failure after GKS (65/149; 43.6%) were more likely to later develop LMF (HR 4.2, p = 0.005); including 15/65 (23%) patients who had distant-failure and developed LMF. Median time-to-death for patients experiencing LMF was 6.1 months (IQR 3.4-7.8) from onset of LMF. Median survival from LMF to death was much longer in breast (6.1 months) than in other (1.7 months) histologies Conclusion: Breast cancer patients had a longer survival after diagnosis of LMF versus other histologies. Neither ER/PR/HER2 status, nor prior surgery or prior WBRT predicted for development of LMF in breast patients.

Chemokines and their receptors are known to mediate inflammation and tissue damage in autoimmune disorders such as multiple sclerosis (MS). Multiple sclerosis is an inflammatory disease of the central nervous system, characterized by myelin damage and neurological complications. Monocyte chemoattractant protein-1 (MCP-1) interacts with the CC chemokine receptor 2 (CCR2) and plays a role in the migration of leukocytes into the central nervous system, thus contributing to the T cell-mediated pathogenesis of MS. Genomic DNA obtained from 58 MS patients and 72 healthy controls was tested for the MCP-1-2518 A > G and CCR2 Val64Ile polymorphisms using polymerase chain reaction-restriction fragment length polymorphism analysis. Neither the MCP-1-2518G (p = 0.43) nor the CCR2 64Ile (p = 0.52) variant contributed to the risk of MS in Tunisians.

Chemokines and their receptors are known to mediate inflammation and tissue damage in autoimmune disorders such as multiple sclerosis (MS). Multiple sclerosis is an inflammatory disease of the central nervous system, characterized by myelin damage and neurological complications. Monocyte chemoattractant protein-1 (MCP-1) interacts with the CC chemokine receptor 2 (CCR2) and plays a role in the migration of leukocytes into the central nervous system, thus contributing to the T cell-mediated pathogenesis of MS. Genomic DNA obtained from 58 MS patients and 72 healthy controls was tested for the MCP-1-2518 A > G and CCR2 Val64Ile polymorphisms using polymerase chain reaction-restriction fragment length polymorphism analysis. Neither the MCP-1-2518G (p = 0.43) nor the CCR2 64Ile (p = 0.52) variant contributed to the risk of MS in Tunisians.

In this article we propose a scientific approach to explain the fact that some near-death experiencers (NDErs) are able to recollect and verbalize real events occurring in the environment during the experience. Our model assigns a central place to priming, multiple declarative memory, and verbal modules. These biological mechanisms lead to the assimilation of multiple external cues, the consolidation in memory of matched primed environmental events, and the transformation and creation of logically struc tured functional engrams. Finally, the after-NDE behavioral and verbal in teractions between the experiencer and a community of observers are discussed, together with their results. Until now, near-death studies have been carried out along several approaches, some of which are incompatible. The emergence of neurobiological models strongly suggests that near-death studies have reached a stage allowing a systematic and rigorous organiza

We are pleased and grateful for the interest that our work has elicited in the preceding commentaries, and in the following pages we present pertinent responses. Our neurobiological "model" for near-death experiences (NDEs) was intended to be a preliminary work to be completed or modified by others, and may be considered a scientific hypothesis rather than a model. It fulfills the following criteria for scientific hypotheses: it is formally structured and not semantically empty, it is rooted in pre vious scientific knowledge, and it can be empirically tested by scien tific procedures (Bunge, 1979). This last condition deserves commentary. From the strict scientific point of view, NDEs could be provoked in some individuals in order to measure the different biochemical and electrical brain changes corre lated with them. However, accepted and sound ethical principles do not permit that. With the current use of noninvasive brain imaging sys tems, that impediment could be surmounted by the constant monitor

The thymus plays a critical role in establishing and maintaining the peripheral T-cell pool. It does so by providing a microenvironment within which T-cell precursors differentiate and undergo selection processes to create a functional population of major histocompatibility complex-restricted, self-tolerant T cells. These cells are central to adaptive immunity. Thymic T-cell development is influenced by locally produced soluble factors and cell-to-cell interactions, as well as by sympathetic noradrenergic and endocrine system signalling. Thymic lymphoid and non-lymphoid cells have been shown not only to express β- and α1- adrenoceptors (ARs), but also to synthesize catecholamines (CAs). Thus, it is suggested that CAs influence T-cell development via both neurocrine/endocrine and autocrine/paracrine action, and that they serve as immunotransmitters between thymocytes and nerves. CAs acting at multiple sites along the thymocyte developmental route affect T-cell generation not only num...

Data on the use in pregnancy of the new antiepileptic drugs (AED) are limited. We analysed data collected by the Australian Pregnancy Register to provide information on their relative teratogenicity. The database containing pregnancy outcomes from 1317 women with epilepsy (WWE) was examined for three widely used new AED in monotherapy in the first trimester-lamotrigine, levetiracetam and topiramate. This was compared with outcomes of pregnant WWE on monotherapy with three traditional AED, and with untreated women. The incidence of malformations associated with lamotrigine monotherapy was 12/ 231 (5.2%), with topiramate 1/31 (3.2%) and with levetiracetam 0/22 (0%). This compares with rates of 1/35 (2.9%) for phenytoin, 35/215 (16.3%) for valproate (VPA), 19/301 (6.3%) for carbamazepine and 6/ 116 (5.2%) for untreated women. There was no evidence of dose-dependent risks of foetal malformation, except with VPA monotherapy. We conclude that the new AED appear no more teratogenic than traditional drugs in monotherapy.

Objective: Weight loss is common in patients with Parkinson's disease (PD). It has been reported that low Body Mass Index (BMI) is associated with disease progression in these patients, but only a few data are available on the relationship between BMI and cognitive dysfunctions in PD patients. In the present study we systematically assessed the possible relationship between BMI index and specific cognitive defects. Method: We enrolled a prospective sample of 37 PD individuals and 30 healthy controls (HC) of similar age, sex, and education. The BMI was calculated in each participant, who underwent a neuropsychological assessment exploring the general cognitive skills, frontal/executive, visuo-spatial, visuo-constructional and memory abilities. Results: We showed that PD group had significant lower BMI value compared to HC group. In PD patients, the BMI was negatively correlated to disease duration and number of errors at the Stroop-Color Word Test, and positively to score on Frontal Assessment Battery (FAB). Moreover, a regression analysis revealed that, the BMI in PD patients was associated with disease duration and score on FAB. Conclusions: Our findings contribute to reveal that the relationship between height and weight is strongly related to frontal cognitive dysfunctions in PD patients.

study by Wasserstrom et al. 6 Median survival was 5.8 months after diagnosis with a range of 1-29 months. In 18 of the 90 patients, the disease was limited to the central nervous system and the median survival was 8 months with 4 patients surviving 1 year and 2 patients for 2 years. 6 Aggressive chemotherapy and/or radiotherapy therapy can result in necrotizing meningoencephalopathy. Although this is not common, it can occur usually 6 months later. 22 Nausea, vomiting, mental status changes and rarely seizures have also been described with high dose CSF methotrexate levels. In conclusion, we have illustrated a case of carcinomatous meningitis presenting in a previously healthy 45-year-old lady returning from a holiday in Bali. Whilst infectious diseases clearly predominate in the aetiology of meningitis, it is important to be aware of the non-infectious cause of this syndrome.

Patients with multiple sclerosis (MS) commonly suffer from fatigue, a multidimensional symptom with physical, cognitive and psychosocial components that can drastically alter the quality of life. Despite its debilitating nature, the current treatment options are limited by their modest efficacy and numerous side effects. Cognitive behavioral therapies (CBT) have been applied in MS patients and might be of help in relieving fatigue. This constitutes the main objective of the current review. Computerized databases (Medline/PubMed, Scopus) were consulted till January 2018, and a research was conducted according to PRISMA guidelines in order to identify original research articles published at any time in English and French languages on cognitive behavioral therapies and MS fatigue as a primary outcome. The following key terms were used: ('multiple sclerosis' OR 'MS') AND ('fatigue') AND ('cognitive behavioral therapy' OR 'CBT' OR 'cognitive th...

Introduction: This study examined the effects of administration of subcutaneous ȕHVWUDGLRO RQ 376'OLNH V\PSWRPV WKH HQKDQFHG FRQGLWLRQHG IHDU UHVSRQVH CFR) that induced by a single-prolonged stress (SPS) and shock in rats. Methods: Adult male Wistar rats were exposed to SPS procedure: restraint for 2 h, forced swim for 20 min, and ether anesthesia. Then the rats were placed in fear conditioning system and received 1 mA electric foot shock for 4 s. Following, VWUHVVHG UDWV LQMHFWHG ZLWK ȕHVWUDGLRO JNJ RU VHVDPH RLO)RU &)5 WHVWLQJ 24 h later animals were re-exposed to the shock chamber for 3-min without further shock application. Percent of freezing was scored. Following testing, the animals were anesthetized and their brains were removed for histological examination (cell count) of the hippocampus that stained with cresyl violet. Results: Our results indicated that rats who received electric shock after the SPS H[KLELWHG WKH &)5 ȕHVWUDGLRO VLJQL¿FDQWO\ UHGXFHG WKH &)5 LQ WKH 636 UDWV DV FRPSDUHG ZLWK FRQWURO UDWV 1R VLJQL¿FDQW GLIIHUHQFHV ZHUH IRXQG LQ FHOO FRXQW LQ different regions of the hippocampus between experimental groups. Discussion: 2XU ¿QGLQJV LQGLFDWHG WKDW ȕHVWUDGLRO DGPLQLVWUDWLRQ DIWHU 636 prevents the enhanced CFR in an animal model of PTSD, suggesting a possible UROH IRU ȕHVWUDGLRO LQ WKH SUHYHQWLRQ RI 376'

Guillain-Barré Syndrome (GBS) otherwise known as Acute Inflammatory Polyneuritis, characterized by acute progressive limb weakness and aretlexia, is the prototype of a post infectious autoimmune disease. Two-thirds of the cases of GBS emerge from viral or bacterial infection. In August 2006, a 20 year old man presented at ICU, BIRDEM Hospital with a history of brief icteric illness followed by progressive bilateral symmetrical hypotonic aretlexic muscular weakness, bilateral infra-nuclear facial palsy and bulbar weakness. Later on, he was diagnosed as a case of GBS and acute hepatitis E. Up till now, only three cases of GBS associated with hepatitis E have been reported in the medical literature world wide. This is probably the 4 th case to be reported.

The objective of the present retrospective study was analysis of clinical, radiological, and electrophysiological characteristics of the non-lesional late-onset epilepsy (NLLOE) in the elderly Japanese patients, and comparison of the seizure outcomes in this population with regard to presence of comorbid dementia. The study cohort comprised 89 consecutive patients with NLLOE aged ≥ 65 years. In 49 cases (55%), NLLOE manifested with a single type of seizure. Focal impaired awareness seizures (FIAS) were encountered most often (in 69 patients; 78%). Ten patients (11%) had a history of the status epilepticus. Comorbid dementia was diagnosed in 31 patients (35%). Localized or diffuse white matter hyperintensity was the most common imaging finding (66 cases). Epileptiform discharges in the temporal area represented the most frequent abnormality on interictal EEG (24 cases). Seizure-free status for ≥ 12 months was attained in 46 out of 64 patients (72%), who were followed for ≥ 12 months (range, 12 - 110 months), and 42 of them received monotherapy, mainly with levetiracetam (21 patients), carbamazepine (10 patients), or lacosamide (8 patients). In comparison to their counterparts, the rate of seizure-free status for ≥ 12 months was significantly lower in patients with comorbid dementia (81% vs. 52%; P = 0.0205). In conclusion, the NLLOE among Japanese patients aged ≥ 65 years has variable presenting characteristics, and comorbid dementia is diagnosed in one-third of cases. Seizure-free status for ≥ 12 months may be attained in more than two-thirds of treated patients, but comorbid dementia is associated with significantly worse response to antiseizure therapy.

Amnesia or loss of memory is the cardinal hallmark of Alzheimer's disease (AD), a progressive neurodegenerative disorder associated with ageing process. Although, AD had been discovered over a century ago, drugs which could cure or halt the progression of the disease are yet to see the light of the day. However, there has been a growing interest in the use of phytomedicines with multipronged mechanisms of action that could target various aspects of the pathologies of AD. Jobelyn (JB) is a potent antioxidant African polyherbal formulation with active components that have been acclaimed to show neuroprotection. This investigation was carried out to evaluate whether JB has anti-amnesic and antioxidant activities. The alteration of alternation behavior in the Y-maze paradigm was utilized as the test for memory function in mice. The effect of JB on acetylcholinesterase (AChE) activity, malondialdehyde (MDA) level and the concentrations of glutathione (GSH) in the frontal cortex and h...

Alzheimer's disease (AD) is a chronic, neurodegenaration resulting in progressive cognitive decline leading to dementia. Mild cognitive impairment (MCI) is also a clinical definition of cognitive decline without functional impairment. Receptor for advanced glycation end products (RAGE) is one of the neuronal membrane receptors that binds amyloid beta peptide (Ab) triggering Ab-related pathologic signalling mechanisms. Soluble RAGE (sRAGE) is the soluble isoform of RAGE and it collects peripheral Ab by acting as a sink, prevents both RAGE-AGE interaction and transfer of Ab into brain. In this study, an association was investigated in Turkish cohorts of patients with dementia with Alzheimer's Type (DAT) and MCI patients by measuring serum sRAGE levels and by genotyping G82S polymorphism and comparing them to healthy control (HC) subjects. Although the serum sRAGE levels showed a decreasing manner among the groups, these differences were not statistically significant (p = 0.2). This is the first study for Turkish population.

Carotid cavernous fistulae (CCF) are dangerous entities that may cause progressive cranial neuropathy, headache and blindness. Endovascular therapy for CCF is the treatment of choice and can be accomplished with minimal morbidity, but optimal treatment strategies vary according to CCF anatomy. We aimed to define a tailored endovascular treatment algorithm for CCF with a focus on traditional and aberrant venous anatomy. Retrospective cohort analysis of data for 57 patients (age range, 18-90 years, mean 53 years) with CCF (35 direct, 22 indirect) was performed. Treatment was transarterial (n = 31), transvenous (n = 18), combined (n = 2), or observation (n = 6). Non-conventional transvenous access (that is, via the facial vein, pterygoid plexus, or via direct puncture of the inferior ophthalmic or frontal vein) was employed in five patients. Mean follow-up period was 12 months. Radiographic cure rate in treated CCF was 96%. Forty-five patients presented with ophthalmic symptoms (chemosis, proptosis, eye pain); all resolved within 6 weeks of successful treatment. Forty-three patients presented with cranial nerve III, IV and/or VI palsy; complete recovery was seen in 54% and partial recovery in 18%. Five patients presented with blindness and five with declining visual acuity. No patient with blindness regained sight after treatment, but all five patients with declining vision recovered some visual acuity. The complication rate was 10.6% (one transient abducens nerve palsy, two symptomatic cerebral infarctions, and three groin hematomas). The permanent complication rate was 3.5%. Multimodal treatment of CCF, including non-traditional routes of transvenous access, results in excellent outcomes and low morbidity.