ABSTRACT
BACKGROUND: The majority of patients with hepatitis C virus (HCV) infection suffer from disabling fatigue, cognitive dysfunction, and quality of life reduction. Meanwhile, there is increasing evidence that HCV infection can affect brain function. Recent studies have shown that fatigue and psychomotor slowing may resolve in patients with hepatitis C after treatment with ondansetron. This observation indicates alteration of serotonergic neurotransmission in HCV infected patients with chronic fatigue. METHODS: Data from 20 HCV infected patients who were referred to our clinic because of disabling fatigue and cognitive decline of unknown cause were analysed retrospectively. Patients had undergone a diagnostic programme, including clinical and psychometric examination, electroencephalogram (EEG), magnetic resonance imaging of the brain, cerebrospinal fluid analysis, and I-123-beta-CIT (2beta-carbomethoxy-3-beta-(4-[(123)I]iodophenyl)tropane) single photon emission computerised tomography (SPECT) studies of serotonin and dopamine transporter binding capacity. RESULTS: All patients had pathological results on the fatigue impact scale. Two thirds of patients showed pathological attention test results. EEG, magnetic resonance imaging, and cerebrospinal fluid analysis were normal. Pathological dopamine transporter binding was present in 12/20 (60%) patients and pathological serotonin transporter binding in 8/19 (50%) patients. Patients with normal SPECT results did not significantly differ from controls with regard to psychometric test results. Interestingly, patients with both decreased serotonin and dopamine transporter binding showed significantly impaired performance in most of the tests applied. Comorbidity that could have impaired cerebral function was excluded in all patients. CONCLUSION: Our findings indicate alteration of serotonergic and dopaminergic neurotransmission in HCV infected patients with chronic fatigue and cognitive impairment.
Subject(s)
Cognition Disorders/virology , Dopamine Plasma Membrane Transport Proteins/metabolism , Hepatitis C, Chronic/complications , Serotonin Plasma Membrane Transport Proteins/metabolism , Adult , Affect , Brain/diagnostic imaging , Brain/metabolism , Cognition Disorders/metabolism , Fatigue/metabolism , Fatigue/virology , Female , Hepatitis C, Chronic/metabolism , Hepatitis C, Chronic/psychology , Humans , Male , Middle Aged , Neuropsychological Tests , Psychometrics , Quality of Life , Retrospective Studies , Severity of Illness Index , Tomography, Emission-Computed, Single-PhotonABSTRACT
Cervical artery dissection (CAD) is being increasingly diagnosed due to improved neuroimaging methods. The mean age of patients with CAD is about 40 years, with a peak between 40 and 45 years of age. Proven data on the incidence of CAD in older patients are missing. Therefore, whether CAD should also be considered as a probable cause of cerebral ischemic events in the elderly was investigated. All consecutive patients referred to our clinic with a diagnosis of cerebral ischemia from January 1999 until June 2000 were thoroughly assessed for the presence of CAD. In addition, the records of all stroke patients treated in our department from January 1995 to December 1998 were analysed retrospectively for a diagnosis of CAD. A total of 34 patients (11 women) had suffered from internal carotid (n = 29) or vertebral artery (n = 5) dissection. Their mean (SD) age was 50.3 (14.6) years, with 32.4% being older than 60 years. Clinical presentation of CAD did not differ depending on the patients' age. The results show that CAD is a possible cause of cerebral ischemia in the elderly and thus has also to be considered in the diagnostic investigation in this patient group.
