Posterior leukoencephalopathy syndrome: postpartum focal neurologic deficits: a report of three cases and review of the literature

Posterior reversible encephalopathy syndrome presents with a variety of neurologic features, which, although devastating at some point, are potentially reversible on prompt recognition and institution of appropriated treatment. We report the management of three cases occurring in the last 4 years in our tertiary university hospital

Neuropsychiatric lupus

Systemic lupus erythematosus [SLE] is a multisystem autoimmune disease. Involvement of the nervous system, either primary or secondary, is common in SLE, and 19 different neuropsychiatric clinical syndromes have been recognised in association with the disease. Several pathophysiological mechanisms have been implicated in the pathogenesis of neuropsychiatric SLE [NPSLE], including vasculopathy, autoantibodies, and cytokine-mediated tissue injury. Careful evaluation of the patient is required to rule out secondary causes before attributing the neurological symptoms to SLE. Treatment depends on the nature and severity of NPSLE syndrome

La mortalidad infantil en Valle de la Pascua: durante el Gomecismo: 1908-1935 / Infant mortality in Valle de la Pascua: during the Gomez era: 1908-1935

Un analisis de las partidas de defunción de 614 párvulos fallecidos en Valle de la Pascua, Estado Guárico, durante el período 1908-1935 reveló que el patrón de mortalidad infantil (0 a 11 meses de edad) fue un reflejo de las precarias condiciones socieconómicas y médico-sanitarias de la época. Dicho patrón, el cual asemejó al patrón del resto de Venezuela, se caracterizó por una elevada tasa de mortalidad, un alto índice de mortalidad por enfermedades infecciosas y una elevada mortalidad neonatal. también, la mortalidad infantil masculina exhibió una tendencia a la hipermortalidad como se ha revelado en estudios similares a nivel mundial. Por último, el estudio también reveló que un poco más del 20% de las defunciones fueron clasificadas como "mal definidas". Esto tal vez se debió a varios factores, entre ellos, la falta de un facultativo para atender al enfermo, la falta de recursos económicos por parte de los familiares del occioso para procurar asistencia médica y/o la negligencia de algunos facultativos al certificar la causa de muerte

An analysis of the death certificates for 614 infants who died in Valle de la Pascua, Guarico State, during the period 1908-1935, revealed that pattern of infant mortality (0 to 11 months of age) was a reflection of the precarious socio-economic and sanitary conditions of the time. This pattern, with resembled the pattern of the rest of Venezuela, was characterized by a high mortality rate high rate of mortality from infectious disease, and a high neonatal mortality. Also, the male infant mortality showed a tendency to hypermortality as found in similar studies worldwide. Finally, the study also revealed that just over 20% of the deaths were classified as "ill-defined". This was perhaps due to various factors, among them, the lack of a doctor to treat the sick child, the lack of financial resources by the deceased's family wihich prevented them from seeking medical assistence, and/or negligence on the part of some doctors when certitying the cause of death

Uma análise dos atestados de óbito de 614 crianças que morreram no Valle de la Pascua, estado Guárico durante o periodo 1908-1935 revelow que o padrâo de mortalidade infantil (0 a 11 meses de idade) foi un reflexo das más condiçôes socieconómicas e médico sanitarias da época. Esse padrâo que se assemelhou ao resto da Venezuela caracterizou-se por uma elevada taxa de mortalidade, alta taxa de mortalidade por doenças infecciosas e uma elevada mortalidade infantil. También na mortalidade masculina mostrou uma tendência de hipermortalidade como se revelou em estudios semelhantes em todo o mundo. Finalmente, o estudio también revelou que um pouco mais de vinte por cento mortes foram classificadas como "mal definidas". Isto talvez foi devido a varios fatores, incluindo, a falta de um médico para atender o doente, a falta de recursos económicos por parte dos familiares do falecido para procurar um medico e/ou negligência de alguns médicos encarregados de certificar a causa da morte

Advancement of methanol poisoning mechanism research / 法医学杂志

The methanol poisoning by oral intake or skin contact occurs occasionally, which may have serious consequences including blindness and/or death. Methanol and its metabolites, formaldehyde and formic acid, are associated with metabolic acidosis, visual dysfunction and neurological symptoms. At present, the mechanism of methanol poisoning primarily focuses on the cell hypoxia, the alteration of structure and biological activity induced by free radical and lactic acid. Meanwhile, methanol poisoning causes changes in the balance between the production of free radicals and antioxidant capacity and in the proteases-protease inhibitors system, which lead to a series of disturbances.

Doença de Wilson: apresentação clínica, diagnóstico e tratamento / Wilson's disease: clinical presentation, diagnosis and treatment

A doença de Wilson é um erro inato do metabolismo do cobre causado por uma mutação no gene ATP7B, responsável por seu transporte. É uma doença de herança autossômica recessiva, caracterizada pela deposição excessiva de cobre principalmente no fígado e no cérebro. Clinicamente, os pacientes apresentam manifestações hepáticas, neurológicas e psiquiátricas. O diagnóstico pode ser feito quando as seguintes características estiverem presentes: anéis de Kayser-Fleischer na córnea, diminuição dos níveis plasmáticos de ceruloplasmina e sintomas neurológicos típicos. A prevenção de danos permanentemente severos depende do reconhecimento e diagnóstico precoces pelo médico, seguidos de tratamento apropriado. A doença de Wilson pode ter prognóstico excelente, desqe que o tratamento seja feito durante toda a vida.

Wilson's disease is an inborn error of copper metabolismo caused by a mutation to the cooper-transporting gene ATP7B. This disease has an autosomal recessive mode of inheritance, and is characterized by excessive cooper deposition, predominantly in the liver and brain. Clinically, patients usually present hepatic, neurologic or psychiatric manifestations. The diagnosis can be done when these symptoms are present: Kayser-Fleischer rings, low serum ceruloplasmin levels and typical neurological symptoms. The prevention of severe permanente damage depends upon early recognition and diagnosis by the physician, followed by appropriate anticopper treatment. Wilson's disease it can have an excellent prognosis since that treatment either for all the life.

Cambios neurofisiológicos en el adulto mayor: sensibilidad y reflejos / Neurophysiological changes in the elderly: sensitivity and reflexes

Estudiar la prevalencia de algunos de los signos que se presentan en forma anormal con el envejecimiento del Sistema Nervioso por medio de la exploración de la sensibilidad y los reflejos. Se estudiaron la sensibilidades superficial y profunda y los reflejos osteotendinomusculares en 200 sujetos mayores de 65 años, sin enfermedades neurológicas, cardiovasculares o psiquiátricas, Se utilizó el estadístico Kappa interobservador para cada modalidad. Se clasificaron los hallazgos como normales, alterados y ausentes. Se aplicaron escalas para la sensibilidad y los reflejos y se realizó el cálculo estadístico por tablas de contingencia 2x2, chi cuadrado, con rango de confiabilidad de 95%. La edad fue 65-74 años en 73% y más de 75 en 27%. En sensibilidad térmica y posición segmentaría no hubo anormalidad, pero 37% tenían anormalidad en la discriminatoria. La estereognosia fue anormal en el 16,4% y 29,6 % de acuerdo a los grupos de edad respectivamente. La vibratoria mostróuna disminución de 4,54 hasta 6,96 seg., en miembros inferiores (p < -0,05) y diferencia significativa en los miembros inferiores. Hubo anormalidad para todos los reflejos osteotendinosos, mayor porcentaje en el patelar y aquiliano (21 y 44% respectivamente) y comparados entre si y el grupo de edad con diferencia estadísticamente significativa. Los resultados deben considerarse propios del envejecimiento

To study the prevalence of some abnormal neurologic signs of aging by exploring sensitivity and reflexes. We studied the superficial and deep sensitivity and the muscle stretch reflexes in a sample of 200 subjects older than 65 years without neurologic, cardiovascular or psychiatric disease.The kappa statistic was applied for each group of signs. We classified the findings in normal, abnormal and absent. A scale for sensitivity and reflexes was used. Statistic analysis was done by 2x2 tables of contingency and chi square with a CI of 95 %. The men aged 65 to74 years were 73% of the sample and older than 75 was 27% In thermic sensibility and segmental position there were no abnormalities. Discriminatory sensitivity was abnormeal in 37% stereognosis was abnormal in 16,4% and 29, 6% in the age groups respectively. Palesthesia was decreased by 4,54 to 6,96 seconds in the lower limbs (p 0,05 ) with a significant statistical difference. There were abnormalities in all the reflexes predominantly in the knee-jerk and ankle- jerk (21 and 44% respectively) and comparison with the age groups was statiscally significant. The prevalence of changes in sensitivity and muscle stretch reflexes in subjects more older than 65 years in this study ought to be considered part of the aging process

Neurological manifestations in organophosphorous toxicity.

Organophosphorous compounds are one of the efficient methods available for pest control. Because of its easy availability, the various preparations of organophosphorpus compounds cause significant morbidity and mortality to the human lives. In addition to producing pesticide related illness and death, Organophosphorous compounds produces different neurological manifestations as a sequelae to its toxicity. Four such neurological syndromes are discussed with their salient clinical features.

Mobilização do sistema nervoso: avaliação e tratamento / Mobilization nervous system: assessment and treatment

A mobilização do sistema nervoso é uma técnica que visa a restaurar o movimento e a elasticidade do sistema nervoso. Tem sido utilizada como método de avaliação e tratamento das mais diversas patologias que acometem o sistema nervoso e as estruturas por ele inervadas. Esta técnica é pouco conhecida, por isso pouco utilizada no tratamento de pacientes, devendo ser mais estudada para que seja aperfeiçoada e utilizada como técnica terapêutica. Este trabalho consiste em uma revisão bibliográfica, tendo por objetivo levantar as indicações e aplicações da mobilização do sistema nervoso como recurso diagnóstico e terapêutico

The mobilization nervous system is a technique aim at to recuperate the movement and the elasticity of the nervous system. Well like have been useful how method of assessment and treatment of several pathology attacks the nervous system and the structures unnerve for them. This technique a little known and a little utility in the treatment our patients, it’s must to be more study for to be improve and utility in the midecúbito dorsalle therapeutics. This work consists in a revision bibliography that have for objective to put the indications and application of mobilization nervous system like recourse diagnostic and therapeutic.

Frecuencias, características y mortalidad asociada a la enfermedad neurológica en la Unidad de Cuidados Intensivos Neonatales del Hospital Nacional Cayetano Heredia / Frequency, characteristics and mortality associated to neurological disorders at Neonatal Intensive Care Unit, Hospital Nacional Cayetano Heredia

Objetivo: determinar la frecuencia y las características de las enfermedades neurológicas en los recién nacidos atendidos en una unidad de cuidados intensivos neonatales. Material y métodos: estudio observacional, retrospectivo y descriptivo. Se incluyeron 450 recién nacidos atendidos en la Unidad de Cuidados Intensivos Neonatales del Hospital Nacional Cayetano Heredia (UCIN-HNCH) entre el 1 de enero de 2004 y el 31 de diciembre de 2005. Resultados: el 45,8 por ciento de los neonatos presentaron uno o más trastornos neurológicos, siendo la encefalopatía hipóxico-isquémica, la hemorragia intraventricular y las malformaciones del SNC los diagnósticos neurológicos más frecuentes. Se observó que la estancia hospitalaria mayor de un mes, la mortalidad y el peso menor de 1.500 g fueron significativamente mas frecuentes en el grupo con enfermedad neurológica. El 40,5 por ciento de los prematuros presentó una o más enfermedades neurológicas, siendo la hemorragia intraventricular la primera causa. El 53,8 por ciento de los bebes a término presentó una o más enfermedades neurológicas, la encefalopatía hipóxico-isquémica fue la más frecuente (21,2 por ciento). Conclusiones: demostramos una alta frecuencia de enfermedades neurológicas entre los recién nacidos atendidos en la unidad de cuidados intensivos de nuestro hospital. Consideramos necesario realizar estudios multicéntricos y prospectivos que nos permitan conocer la dimensión de la enfermedad neurológica neonatal, y plantear sus potenciales estrategias de solución.

Avaliação dos reflexos espinhais em cordeiros da raça Suffolk / Evaluation of spinal reflexes in Suffolk lambs

Fez-se a avaliação qualitativa e semiquantitativa dos reflexos espinhais em ovinos, utilizando-se 51 animais da raça Suffolk, machos e fêmeas, entre quatro e cinco meses de idade. Usaram-se os reflexos bilaterais dos membros torácicos, extensor carpo-radial, bicipital, tricipital e flexor, e pélvicos, isquiático, gastrocnêmio, patelar, tibial cranial e flexor, sendo zero indicativo de ausência de reflexo, 1= reflexo discreto e 2= reflexo evidente. Nos membros torácicos, as melhores respostas foram obtidas no flexor (99,0 por cento) e no extensor carpo-radial (87,3 por cento), seguidos de valores menos expressivos no bicipital (11,8 por cento) e no tricipital (2,0 por cento), com grau 2 de avaliação. Nos membros pélvicos, todos os ovinos produziram respostas em grau 2 para o reflexo flexor. Verificam-se também respostas evidentes nos reflexos patelar (98,0 por cento) e isquiático (81,4 por cento). Apenas 20,6 por cento dos animais apresentaram resposta evidente ao reflexo tibial cranial, e nenhum ovino respondeu ao reflexo gastrocnêmio de forma satisfatória.

This study was carried out to determine a qualitative and semiquantitative evaluation of the spinal reflexes in 51 both sexes, 4 to 5 months of age Suffolk lambs. Spinal reflexes were evaluated in the thoracic (extensor carpi reflex, biceps reflex, triceps reflex and flexor reflex) and pelvic (ischiatic reflex, gastrocnemius reflex, patellar reflex, cranial tibial reflex and flexor reflex) limbs, bilaterally. Reflexes were standardized, using a 2-point grading scale (0= absense, 1= mild reflex, 2= evident). Flexor reflex (99.0 percent) and extensor carpi reflex (87.3 percent) were the best reflexes elicited in thoracic limbs, while the least evident scores were found in biceps (11.8 percent) and triceps reflexes (2.0 percent) with grade 2. In pelvic limbs, all of the ovines showed a grade-2 flexor reflex. A high percentage of evident response in patellar (98.0 percent) and ischiatic (81.4 percent) reflexes were also observed. Only 20.6 percent of the animals showed evident response to the cranial tibial reflex but none had a satisfactory response to the gastrocnemius reflex.

Investigation of an outbreak of scrapie in Palestine

This study documents an outbreak of scrapie in adult sheep [East-Friesian Breed] in Palestine with high morbidity rate 21.5%. The clinical findings of the disease were abnormal behavior, ataxia, tremor, incoordination of locomotion pruritus, loss of wool, nibbling, recumbency and hyperaesthesia to noise, movement of touch. The clinical diagnosis is supported by histophatological lesions and immune-detection of prion proteins in central nervous system by immunohistochemistry using a reference specific staining monoclonal antibody RIDA Mab L42

Neuron to nerve terminals: aspects of neuropathology and toxicology

The nervous system is highly plastic. Its development and maturation is characterised by neuronal proliferation, specialisation and loss and the sorting of synaptic connectivity. Transmission (chemical and electrical), receptor and ion channel transcription and distribution all contribute to the emerging selectivity of action. Numerous factors – especially genetic and autoimmune – and extrinsic factors – synthetic and natural toxic chemicals – disrupt this process of development and maturation or interfere with the function and structure of the mature system. In this review, the response of the peripheral nervous system to such influences is discussed.

Neurobrucellosis and steroid therapy

Brucellosis is a relatively frequent disease in the Mediterranean and Middle East regions. We describe a young adult male presenting with a 6-month history of fever, headache, malaise, and mental dullness. CSF studies revealed lymphocytic pleocytosis with increased protein and low glucose. Serum and CSF analysis were strongly positive for brucella. He was prescribed ceftriaxone, doxycycline, rifampin, and co-trimoxazole, but two days later he developed quadriparesia with evidence of myelitis in cervical MRI for which he has received methyl prednisolone 500mg Iv for 5 days continued with prednisolone 50mg daily. His condition was improved significantly. This case is reported because of the importance of steroid therapy in brucellosis

Neurological manifestations of behcet's disease

To determine the prevalence, clinical manifestations, and laboratory features of Neuro-Behcet's disease. This prospective study was carried out in the Behcet's Research Clinic in Shiraz [south-west Iran] and included the patients referred from 1990-1999. The patients' clinical records, images, CSF analyses, and electrodiagnostic studies were reviewed. Eighteen [15 males and 3 females] out of 690 Behcet's patients [2.6%, 95% CI = 1.4-3.8%] were found to have neurological involvement. The mean +/- standard deviation age of these patients was 34.7 +/- 8.6 years. All fulfilled the criteria of the International Study Group of Behcet's Disease. Central nervous system involvement was more common than peripheral nervous system manifestations. Headache, weakness, tingling, and numbness were the most common symptoms. Hyperreflexia, upward plantar reflex, and somatosensory findings were the most frequent signs. Hemispheral and brainstem stroke-like syndromes and cerebral venous thrombosis were the major neurologic presentations. There were also cases of myelitic, pure meningoencephalitic, amyotrophic lateral sclerosis-like, multiple sclerosis-like, and Guillain Barre syndromes. Neuro-Behcet's disease must be considered in the differential diagnosis of stroke in young adults, chronic meningitis, intracranial hypertension, multiple sclerosis, myelopathies, and peripheral neuropathies

Role of diffusion-weighted MRI in neuro-behcet disease

We report the findings on serial diffusion-weighted MRI in a 29-year-old male with neuro-Beh‡et's disease. Initial T2-weighted and fluid-attenuated inversion recovery images showed a hyperintense lesion in the brain stem. The lesion showed slight hyperintensity on diffusion-weighted images with no evidence of diffusion restriction on apparent diffusion coefficient maps. A follow up study after 7 months showed complete resolution of the brain stem lesion. Our findings indicate that diffusion-weighted imaging is a useful tool to differentiate acute exacerbation of neuro-Behcet's disease from acute infarction, and therefore it helps in selecting the appropriate therapy

Neurological outcome after coronary artery bypass surgery

Neurological dysfunction is a common complication after cardiac surgery. Despite significant advances in cardiopulmonary bypass [CPB] technology, surgical techniques and anaesthetic management, central nervous system complications occur in a large number of patients undergoing surgery requiring CPB. The objective of this study was to determine neurocognitive status of the patients undergoing coronary artery bypass grafting [CABG] and to find any causative or associated factor. We evaluated 1000 consecutive patients undergoing primary isolated coronary artery bypass grafting [CABG] at a tertiary care cardiac institute from July 2000 to December 2001 to determine the neurological outcome after CABG and risk factors involved. The demographic and perioperative data were analyzed by X2 analysis. A history of diabetes, hypertension, increased age, preoperative neurological event, aortic atheromatous / calcific disease, bilateral carotid artery disease, intermittent aortic cross clamping and evidence of mural thrombi are all co-related with increased risk of neurological damage after CABG. When analyzed in a stepwise logistic regression model, diabetes mellitus, aortic disease increased age and mural thrombi carried a higher probability that the patient would have a postoperative neurological deficit. Conclusions: We conclude that although these factors are individually involved in the adverse neurological outcome after CABG but the combination of these factors greatly increases the risk of postoperative neurological consequences and only few of them are avoidable

Neurologic manifestations of acute gastroenteritis: a review of 45 patients in the intensive care setting

Acute gastroenteritis [AGE] is a serious disease and is one of the most important causes of early childhood mortality in developing countries. The neurologic manifestations can be propounded as primary symptoms of AGE. In order to determine the rate, clinical presentations, and outcome of patients with AGE who presented with neurologic manifestations and compare them with patients without neurologic symptoms, we reviewed the records of children 1 month to 14 years of age having AGE along with neurologic presentations, i.e. either convulsion or encephalopathy alone or together who had been admitted to the pediatric intensive care unit [PICU] of the Children's Hospital Medical Center [CHMS] from September 1996 till August 1998. Among all the patients admitted at that time, 7% [75 patients] had AGE, of which 60% [45 patients] had concomitant neurologic symptoms including 4% who had convulsion alone, 20% had encephalopathy alone, and 36% showed both of the symptoms. Of the patients who had AGE with neurologic symptoms, 36% initially presented with neurological manifestations without gastrointestinal symptoms. The duration of admission at PICU and the mortality rate among patients with AGE were significantly more in the patients with neurologic symptoms in comparison to those without neurologic symptoms. According to our findings, neurologic symptoms may be the first manifestation of AGE and are likely to increase the risk of mortality in AGE