Dural arteriovenousfistula presenting as reversible dementia

DAVF is an abnormal connection between arteries and veins, where supply is mainly through branches arising from the external carotid artery. A 30 years old male had multiple episodes of seizures and progressive behavioral and cognitive decline, inattentionand disorientation to time, place and person, along with ptosis and ophthalmoplegia in the right eye. DSA provided a definitive diagnosis of hypervascular Dural AV fistula at the right transverse sigmoid junction with significant cortical venous hypertension. Through femoral access, both underwent transarterial embolization through the Middle Meningeal branch of the right external carotid artery using onyx, resulting in complete occlusion of fistula and resolution of venous hypertension. Post embolisation,cognitive function assessment revealed increased attention span and improved orientation with time,place and person. Thus, DAVF can be one of the rare but reversible causes of dementia. Early diagnosis and treatment may help to dramatically improve patients� clinical condition and minimize long-term disability

Normal-pressure hydrocephalus: A critical review / Hidrocefalia de pressão normal: uma revisão crítica

ABSTRACT. Normal-pressure hydrocephalus (NPH) is a potentially reversible syndrome characterized by enlarged cerebral ventricles (ventriculomegaly), cognitive impairment, gait apraxia and urinary incontinence. A critical review of the concept, pathophysiology, diagnosis, and treatment of both idiopathic and secondary NPH was conducted. We searched Medline and PubMed databases from January 2012 to December 2018 using the keywords "normal-pressure hydrocephalus" / "idiopathic normal-pressure hydrocephalus" / "secondary normal-pressure hydrocephalus" / "NPH" / "ventriculoperitoneal shunt". The initial search produced 341 hits. After careful selection, a total of 54 articles were chosen and additional relevant studies were included during the process of writing this article. NPH is an important cause of potentially reversible dementia, frequent falls and recurrent urinary infections in the elderly. The clinical and imaging features of NPH may be incomplete or nonspecific, posing a diagnostic challenge for medical doctors and often requiring expert assessment to minimize unsuccessful surgical treatments. Recent advances resulting from the use of non-invasive MRI methods for quantifying cerebral blood flow, in particular arterial spin-labeling (ASL), and the frequent association of NPH and obstructive sleep apnea (OSA), offer new avenues to understand and treat NPH.

RESUMO. A hidrocefalia de pressão normal (HPN) é uma síndrome potencialmente reversível marcada por ventrículos cerebrais alargados (ventriculomegalia), declínio cognitivo, apraxia da marcha e incontinência urinária. Revisar criticamente o conceito, a fisiopatologia, o diagnóstico e o tratamento da HPN idiopática e secundária. Os autores acessaram as bases de dados Medline e Pubmed entre janeiro de 2012 e dezembro de 2018, utilizando as palavras-chave "normal-pressure hydrocephalus" / "idiopathic normal-pressure hydrocephalus" / "secondary normal-pressure hydrocephalus" / "NPH" / "ventriculoperitoneal shunt". A busca inicial resultou em 341 artigos. Após cuidadosa seleção, 54 estudos foram escolhidos e pesquisas adicionais foram incluídas durante o processo de elaboração do manuscrito. A HPN é uma importante causa de demência potencialmente reversível, quedas frequentes e infecção urinária recorrente em idosos. As características clínicas e de imagem da HPN podem ser incompletas ou inespecíficas, de modo que este se torna um diagnóstico difícil para médicos. Não raro uma avaliação por especialista é necessária, visando minimizar tratamentos cirúrgicos ineficazes. Avanços recentes advindos do uso não invasivo de ressonância magnética para quantificação do fluxo sanguíneo cerebral, em particular arterial spin-labeling (ASL), assim como a usual associação entre HPN e apneia obstrutiva do sono representam novos meios de entender e de tratar a HPN.

Atenção psicossocial em um caso de Demência potencialmente reversível / Psychosocial Care in a potentially reversible case of Dementia / Atención psicosocial en un caso de Demencia potencialmente reversible

As síndromes demenciais têm múltiplas etiologias e, entre as causas de demências potencialmente reversíveis, está a depressão. Apresenta-se aqui um estudo de caso de paciente idoso diagnosticado com Demência por Corpos de Lewy e que, após tratamento multiprofissional, teve melhora da sua condição cognitiva e emocional, fazendo-se rever o diagnóstico inicial. Considerou-se que os sintomas demenciais iniciais estavam associados aos sintomas depressivos e o cuidado baseado na atenção psicossocial foi fundamental para as mudanças observadas.

Dementia syndromes have multiple etiologies and among the causes of potentially reversible dementias is depression. We present here a case study of an elderly patient diagnosed with Dementia by Lewy Bodies and who, after multiprofessional treatment, had an improvement in his cognitive and emotional condition, and the initial diagnosis was reviewed. Initial dementia symptoms were considered to be associated with depressive symptoms and care based on psychosocial care was central to the observed changes.

Los síndromes demenciales tienen múltiples etiologías y, entre las causas de demencias potencialmente reversibles, está la depresión. Se presenta aquí un estudio de caso de paciente mayor diagnosticado con Demencia por Cuerpos de Lewy y que, después del tratamiento multiprofesional, tuvo mejoría de su condición cognitiva y emocional, haciéndose revisar el diagnóstico inicial. Se consideró que los síntomas demenciales iniciales estaban asociados a los síntomas depresivos y el cuidado basado en la atención psicosocial fue fundamental para los cambios observados.

Demencia reversible por déficit de vitamina B12 en un adulto mayor / Reversible dementia caused by vitamin B12 deficiency in an older adult

Se presenta el caso de un paciente adulto mayor con antecedente de haber presentado úlcera gástrica hace 40 años, cuyos familiares observaron desde hace dos meses cambios en el comportamiento, los cuales incluyeron progresivamente desorientación, agitación psicomotriz, negativismo, delirio de persecución, lo que motivó ser traído al servicio de emergencia. Así mismo presentó palidez marcada y equimosis múltiple, por lo cual fue admitido posteriormente en nuestro servicio y diagnosticado de demencia reversible por anemia perniciosa. También se le detectó pancitopenia y cambios neurológicos. El paciente respondió favorablemente a la administración de vitamina B12.

This is the case of an elderly patient with a 40-year history of stomach ulcer, whose relatives perceived behavioral changes for the last two months. Those changes progressively included disorientation, psychomotor agitation, negativism and delirium of persecution, which caused him to be brought to the emergency room. He also showed marked pallor and multiple ecchymosis, due to which he was hospitalized in our service and diagnosed with reversible dementia caused by pernicious anemia. Pancytopenia and neurological changes were also found. The patient responded favorably to the administration of vitamin B12.

Reversible dementia due to neurocysticercosis: improvement of the racemose type with antihistamines / Demência reversível por neurocisticercose: melhora da forma racemosa com o uso de anti-histamínicos

Infection of the human central nervous system (CNS) by the larvae of Taenia solium, termed neurocysticercosis (NCC), is endemic in most developing countries, where it is a major cause of acquired seizures and other neurological morbidity, including neuropsychiatric symptoms. However, despite its frequent manifestation, some findings, such as cognitive impairment and dementia, remain poorly understood. Less commonly, NCC may affect the ventricular system and subarachnoid spaces and this form is known as extraparenchymal neurocysticercosis. A particular presentation of the subarachnoid form is called racemose cysticercosis, which has a progressive pattern, frequently leads to hydrocephalus and can be life-threatening. Here we review a case of the racemose variety of cysticercosis, complicated by hydrocephalus and reversible dementia, with remission of symptoms after derivation and that remained stable with use of dexchlorpheniramine. We discuss the challenges in diagnosis, imaging findings, treatment and follow-up of this disease.

A infecção do sistema nervoso central (SNC) pela larva da Taenia solium, intitulada neurocisticercose (NCC) é endêmica na maior parte dos países "em desenvolvimento", onde é a principal causa de convulsão adquirida, além de outras morbidades neurológicas, entre elas, sintomas neuropsiquiátricos. No entanto, apesar de manifestações neuropsiquiátricas serem frequentes, alguns achados, tais como comprometimento cognitivo e demência, continuam a ser mal compreendidos. Menos frequentemente, NCC pode afetar o sistema ventricular e espaços subaracnóideos e esta forma é conhecida como NCC extraparenquimatosa. Uma apresentação particular subaracnóidea, chamada cisticercose racemosa, é encontrada mais raramente, evolui de forma progressiva, associada a hidrocefalia e pode levar a morte. Neste artigo revisamos um caso da variedade racemosa de NCC, complicada com hidrocefalia e demência reversível que evoluiu com remissão dos sintomas após derivação ventricular e permaneceu estável com uso de dexclorfeniramina. Discutimos os desafios no diagnóstico, achados de imagem, tratamento e acompanhamento desta forma de doença.

Symptomatology of Dementia

Dementia can be defined as an acquired persistent impairment of intellectual func-tion with compromise in at least three of the mental activities such as language, memory, visuospatial skill, emotion or personality, and cognition. The purposes of diagnosing a dementia syndrome are to search systemically for various etiologies, to differentiate reversible or irreversible dementia, cortical or subcortical dementia, and degenerative or nondegenerative dementia, and to apply to patients neurocognitive rehabilitation or other specific trea-tment strategies. The evaluation of dementia includes neuropsychiatric history taking, neuropsychological assessment, neurologic examination, neuroimaging studies, and laboratory studies. It is impossible to evaluate dementic patients only with clinical signs, symptoms, and neuropsychiatric histories. But I will address specific neurologic or neuropsychiatric symptoms and signs of various dementias to und-erstand them as classification.

Correlation between exercise and psychiatric function in aged patients with circulatory disease / 体力科学

Senile patients with heart disease were evaluated in order to study the correlation between their mental and physical activities in daily life. Mental activity was classified using Hasegawa's dementia scale, and physical activity was measured by the number of steps per day recorded with a passimeter. It was found that;<BR>1) Hasegawa's dementia score was positively related to the number of steps.<BR>2) Hasegawa's dementia score was significantly increased after walking training for 1 year.<BR>Thus it is suggested that appropriate physical exercise is necessary for maintaining or increasing mental activity in aged patients with circulatory disease.