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1.
Neurology ; 76(24): 2089-95, 2011 Jun 14.
Article in English | MEDLINE | ID: mdl-21670438

ABSTRACT

OBJECTIVE: To report the clinical phenotype and outcome of isolated paraneoplastic myelopathy. METHODS: We systematically reviewed clinical, serologic, and MRI data for 31 patients (20 female) who presented with an isolated myelopathy and coexisting cancer: carcinoma (lung, 9; breast, 7; kidney, 2; thyroid, 2; ovary/endometrium, 2), melanoma (2), or other cancer (3), or a paraneoplastic autoantibody with strong cancer association (amphiphysin-immunoglobulin G [IgG], 9; collapsin response-mediator protein 5-IgG, 9; Purkinje-cell cytoplasmic autoantibody type 1, 2; antineuronal nuclear autoantibody [ANNA]-1, 1; ANNA-3, 1). RESULTS: Of 31 patients who presented with a progressive myelopathy, symptom onset was subacute in 16 (52%). The median age was 62 years. CSF abnormalities included elevated protein (>45 mg/dL), 22; pleocytosis, 15; excess oligoclonal bands (normal <4), 7. MRI cord abnormalities identified in 20 patients were longitudinally extensive (>3 vertebral segments), 14; symmetric tract or gray matter-specific signal abnormality, 15 (enhancing in 13). Myelopathy preceded cancer diagnosis in 18 patients (median interval 12 months; range 2-44). After myelopathy onset, 26 patients underwent oncologic treatment, immunosuppressive treatment (median delay to commencing immunotherapy 9.5 months [range 1-54]), or both; only 8 improved (31%). At last neurologic evaluation (median interval after onset 17 months; range 1-165 months), 16 patients (52%) were wheelchair-dependent (median time from onset to wheelchair 9 months [range 1-21]). Ten patients died after a median of 38 months from symptom onset (range 7-152). CONCLUSION: Symmetric, longitudinally extensive tract or gray matter-specific changes on spinal MRI should raise suspicion for a paraneoplastic myelopathy. Resulting disability is often severe. Only a minority of patients improve with treatment.


Subject(s)
Paraneoplastic Syndromes, Nervous System/pathology , Paraneoplastic Syndromes, Nervous System/physiopathology , Spinal Cord Diseases/pathology , Spinal Cord Diseases/physiopathology , Spinal Cord/pathology , Adult , Aged , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Paraneoplastic Syndromes, Nervous System/therapy , Phenotype , Spinal Cord Diseases/therapy , Treatment Outcome
2.
AJNR Am J Neuroradiol ; 31(8): 1493-7, 2010 Sep.
Article in English | MEDLINE | ID: mdl-20395395

ABSTRACT

CNS WD is fatal if antibiotics are not begun early, but knowledge regarding the variety of presentations on MR imaging is limited. In order to more effectively recognize this entity on MR imaging, the Mayo Clinic medical records were reviewed for subjects diagnosed with CNS WD from 1992-2006 who had also undergone MR imaging of the neuraxis. Seven subjects were identified and their imaging findings were reviewed by the authors. Four of 7 had head MR imaging findings indicative of WD. Two subjects demonstrated high T2 signal within the corticospinal tracts. CNS WD may demonstrate high T2 signal with minimal enhancement and no restricted diffusion, primarily in the midline of the midbrain, hypothalamus, and mesial temporal lobes and occasionally the corticospinal tracts. MR imaging may also be normal. Radiologists should be aware of these presentations and be prepared to mention CNS WD as a diagnostic possibility since early antibiotic therapy may significantly impact morbidity and mortality.


Subject(s)
Brain/pathology , Magnetic Resonance Imaging , Whipple Disease/pathology , Adult , Female , Gadolinium , Humans , Hypothalamus/pathology , Mesencephalon/pathology , Middle Aged , Pyramidal Tracts/pathology , Retrospective Studies , Temporal Lobe/pathology
4.
J Neurol Sci ; 244(1-2): 77-87, 2006 May 15.
Article in English | MEDLINE | ID: mdl-16524595

ABSTRACT

Fifty-seven patients with biopsy-proven sarcoidosis causing limb neuropathy were reviewed in order to delineate the characteristic symptoms, impairments, disability, course, outcome and response to corticosteroid treatment of limb sarcoid neuropathy. Typically the neuropathy had a definite date of symptomatic onset. Prominent were positive neuropathic sensory symptoms (P-NSS), especially pain, overshadowing weakness and sensory loss. P-NSS were the main cause of disability. Almost always the pattern was asymmetric and not length-dependent (unlike distal polyneuropathy). We inferred (from kind and distribution of symptoms, signs and electrophysiologic and other test results) that the pathologic process was focal or multifocal, involving most classes of nerve fibers and variable levels of proximal to distal levels of roots and peripheral nerves. Additional features aiding in diagnosis were: systemic symptoms such as fatigue, malaise, arthralgia, fever and weight loss; involvement of multiple tissues (i.e. skin, lymph nodes and eye); the patterns of neuropathy; MRI features; and ultimately tissue diagnosis. Axonal degeneration predominated, although an acquired demyelinating process was observed in 3 patients. For most cases, the disease had a chronic, monophasic course. MRI studies done in later years of affected neural structures were helpful in identifying leptomeningeal thickening, hilar adenopathy; and enlargement and T2 enhancement of nerve roots, plexuses, and limb nerves. Corticosteroid treatment appeared to ameliorate symptoms more than impairments. Several variables were associated with neuropathic improvement: CSF pleocytosis, short duration between symptom onset and treatment, and a higher grade of disability at first evaluation-a possible rationale for future earlier diagnosis and treatment.


Subject(s)
Peripheral Nerves/physiopathology , Peripheral Nervous System Diseases/diagnosis , Peripheral Nervous System Diseases/physiopathology , Sarcoidosis/complications , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Aged, 80 and over , Axons/pathology , Demyelinating Diseases/etiology , Demyelinating Diseases/physiopathology , Disability Evaluation , Disease Progression , Early Diagnosis , Female , Humans , Male , Middle Aged , Neuralgia/etiology , Neuralgia/physiopathology , Peripheral Nerves/drug effects , Peripheral Nerves/pathology , Peripheral Nervous System Diseases/etiology , Prognosis , Retrospective Studies , Sensation Disorders/etiology , Sensation Disorders/physiopathology , Spinal Nerve Roots/pathology , Spinal Nerve Roots/physiopathology , Treatment Outcome , Wallerian Degeneration/etiology , Wallerian Degeneration/physiopathology
5.
Cephalalgia ; 24(10): 883-7, 2004 Oct.
Article in English | MEDLINE | ID: mdl-15377320

ABSTRACT

Two patients with cerebrospinal fluid (CSF) leak, one at the level of fourth thoracic spine and another with undetermined level of leak, presented with paradoxical postural headaches in that the headaches were present when in a horizontal position and resolved if the patients were upright. One patient improved spontaneously and the other responded to a targeted epidural blood patch. Paradoxical postural headache is yet another headache type that can be associated with CSF leak and CSF volume depletion. Its mechanism is uncertain, but it could be related to congestion and dilatation of cerebral venous sinuses and large veins.


Subject(s)
Headache/diagnosis , Subdural Effusion/diagnosis , Female , Headache/complications , Humans , Magnetic Resonance Imaging/methods , Middle Aged , Subdural Effusion/complications
6.
Neurology ; 62(7): 1177-82, 2004 Apr 13.
Article in English | MEDLINE | ID: mdl-15079019

ABSTRACT

OBJECTIVES: To describe the clinical features and coexisting serum autoantibodies in seven patients with encephalitis associated with autoantibodies to alpha-dendrotoxin-sensitive voltage-gated potassium channels (VGKCs), and to compare this disorder with other autoimmune encephalopathies. METHODS: Clinical information was obtained from a retrospective review of medical records and telephone interviews. All autoantibody testing was performed in a single laboratory. RESULTS: The seven patients were examined for subacute cognitive and behavioral changes. Seizures, usually temporal-onset complex partial type, were documented in six patients, and all seven patients had EEG abnormalities. None had symptoms or signs of neuromuscular hyperexcitability. One described hypersalivation. Four patients had additional autoantibody markers of neurologic autoimmunity (muscle acetylcholine receptor, striational, P/Q-type calcium channel, or GAD65), and two had thyroperoxidase antibodies. Two patients had a history of cancer: one had active prostate adenocarcinoma, and the second had a remote history of tongue carcinoma. Cranial MRI demonstrated mesial temporal lobe abnormalities in all patients. One patient improved spontaneously, and six were treated with IV methylprednisolone. Three improved remarkably with treatment. At follow-up evaluation, one had no cognitive deficits, four had mild persistent short-term memory dysfunction, and two had persistent disabling behavioral deficits. CONCLUSIONS: Voltage-gated potassium channel antibodies are a valuable serologic marker of a potentially reversible autoimmune encephalopathy. The neurologic manifestations of this disorder are indistinguishable from paraneoplastic limbic encephalitis but are distinct from Morvan syndrome and Hashimoto encephalopathy.


Subject(s)
Autoantibodies/blood , Autoimmune Diseases of the Nervous System/immunology , Limbic Encephalitis/immunology , Neurons/metabolism , Potassium Channels, Voltage-Gated/immunology , Adult , Aged , Amnesia, Anterograde/etiology , Autoimmune Diseases of the Nervous System/diagnosis , Autoimmune Diseases of the Nervous System/drug therapy , Biomarkers/blood , Diagnosis, Differential , Electroencephalography , Female , Follow-Up Studies , Glucocorticoids/therapeutic use , Humans , Limbic Encephalitis/diagnosis , Limbic Encephalitis/drug therapy , Magnetic Resonance Imaging , Male , Methylprednisolone/therapeutic use , Middle Aged , Paraneoplastic Polyneuropathy/diagnosis , Potassium Channels, Voltage-Gated/biosynthesis , Temporal Lobe/pathology
7.
Mayo Clin Proc ; 76(11): 1171-5, 2001 Nov.
Article in English | MEDLINE | ID: mdl-11702907

ABSTRACT

Progressive multifocal leukoencephalopathy (PML), a frequently fatal demyelinating disease caused by JC virus, occurs as an opportunistic infection in patients with acquired immunodeficiency syndrome. Curative therapy has been elusive, but recent reports suggest its improvement after institution of highly active antiretroviral therapy (HAART). We describe a case of PML that developed 6 months after the patient, a 55-year-old man, began to receive HAART. The PML progressed despite good virologic and immunologic response to HAART. Substantial symptomatic and radiographic improvement occurred after the addition of cidofovir to the treatment regimen. We reviewed the scientific literature on this rare occurrence of PML after institution of HAART and describe the patient characteristics, potential pathogenesis, and therapeutic options, including the successful use of cidofovir as an adjunctive agent.


Subject(s)
AIDS-Related Opportunistic Infections/drug therapy , Acquired Immunodeficiency Syndrome/drug therapy , Antiretroviral Therapy, Highly Active/adverse effects , Antiviral Agents/therapeutic use , Cytosine/analogs & derivatives , Cytosine/therapeutic use , Leukoencephalopathy, Progressive Multifocal/drug therapy , Organophosphonates , Organophosphorus Compounds/therapeutic use , AIDS-Related Opportunistic Infections/physiopathology , Cidofovir , Humans , Leukoencephalopathy, Progressive Multifocal/physiopathology , Male , Middle Aged , Treatment Outcome
8.
Neurology ; 57(4): 728-30, 2001 Aug 28.
Article in English | MEDLINE | ID: mdl-11524493

ABSTRACT

CSF 14-3-3 and neuron-specific enolase (NSE) proteins were quantitated from patients who had Creutzfeldt-Jakob disease (CJD) or other rapidly dementing disorders initially considered to be CJD. Thirty-one patients were diagnosed as having CJD among 152 studied. CSF 14-3-3 values more than 8 ng/mL correlated with CJD. CSF NSE values less than 30 ng/mL and 14-3-3 values less than 8 ng/mL made a diagnosis of CJD unlikely, but did not exclude it.


Subject(s)
Creutzfeldt-Jakob Syndrome/cerebrospinal fluid , Phosphopyruvate Hydratase/cerebrospinal fluid , Tyrosine 3-Monooxygenase/cerebrospinal fluid , 14-3-3 Proteins , Creutzfeldt-Jakob Syndrome/diagnosis , Creutzfeldt-Jakob Syndrome/enzymology , Humans , Retrospective Studies
9.
J Neurovirol ; 7(4): 386-90, 2001 Aug.
Article in English | MEDLINE | ID: mdl-11517422

ABSTRACT

This open label study determined the outcome of non-AIDS progressive multifocal leukoencephalopathy patients treated with a standard dose of intravenous cytosine arabinoside. Nineteen patients with PML proven by brain biopsy or spinal fluid polymerase chain reaction were treated with intravenous cytosine arabinoside 2 mg/kg per day for 5 days and followed for neurologic outcome by neurologic examination and MRI scanning. Seven of 19 PML patients treated with cytosine arabinoside intravenously improved neurologically. The range of follow-up for these patients was 2.0 to 4.5 years. All were left with neurologic deficits but were functionally improved, and 6 of 7 were able to independently carry out the activities of daily living. Twelve PML patients showed no evidence of response and died rapidly of their disease after treatment (range, 8 days to 6 months). All who survived their neurologic disease recovered from treatment-induced pancytopenia. Cytosine arabinoside given intravenously to non-AIDS PML patients in this small study was associated with a 36% chance of developing stabilization at 1 year. Treatment was associated with significant bone marrow toxicity. The improvement in MRI scan changes in those patients who responded took 6 weeks or longer.


Subject(s)
Antiviral Agents/administration & dosage , Cytarabine/administration & dosage , Leukoencephalopathy, Progressive Multifocal/drug therapy , Acquired Immunodeficiency Syndrome , Adult , Aged , Antiviral Agents/toxicity , Cytarabine/toxicity , Female , Follow-Up Studies , Humans , Injections, Intravenous , Leukoencephalopathy, Progressive Multifocal/pathology , Magnetic Resonance Imaging , Male , Middle Aged , Treatment Outcome
10.
Neurology ; 47(1): 277-8, 1996 Jul.
Article in English | MEDLINE | ID: mdl-8710096

ABSTRACT

Three weeks after an automobile accident, a 35-year-old man experienced left throat and neck pain, numbness of the left face and tongue, dysphagia, left arm pain and weakness, and left miosis. At age 27, he had suffered an aneurysmal subarachnoid hemorrhage. Angiography at that time had also demonstrated a fenestration of the left intracranial vertebral artery. At the time of the second presentation, angiography showed that one of the limbs of the fenestration had become occluded. Although the vast majority of intracranial arterial fenestrations are asymptomatic, occlusion of one of the limbs of a fenestration may be the cause of stroke.


Subject(s)
Arterial Occlusive Diseases/complications , Cerebrovascular Disorders/etiology , Wounds and Injuries/complications , Adult , Arterial Occlusive Diseases/diagnostic imaging , Cerebral Angiography , Cerebrovascular Circulation/physiology , Cerebrovascular Disorders/physiopathology , Humans , Male
11.
Microsc Res Tech ; 32(4): 302-11, 1995 Nov 01.
Article in English | MEDLINE | ID: mdl-8573780

ABSTRACT

Progressive multifocal leukoencephalopathy is an important viral opportunistic infection of oligodendrocytes leading to direct demyelination. Virus is likely disseminated to the brain via the blood. However, the timing of that dissemination with relationship to clinical disease is unknown. Important clues about viral pathogenesis have been learned by applying molecular in situ techniques to diseased brain. The oligodendrocyte is the primary target for JC virus infection, and its death is the primary reason for demyelination. Bizarre astrocytes show limited viral DNA replication but are abortively infected. Although lymphoid organs can be infected by JC virus, there is no definitive evidence that lymphoid cells carry virus into the brain at the time of immunosuppression. JC virus may be reactivated from a latent state in both the brain and in non-central nervous system (CNS) organs at the time of immunosuppression, leading to clinical disease. Future sensitive in situ studies will likely resolve controversies about pathogenesis.


Subject(s)
Brain/pathology , JC Virus , Leukoencephalopathy, Progressive Multifocal/pathology , Papillomavirus Infections/pathology , Tumor Virus Infections/pathology , Humans , Leukoencephalopathy, Progressive Multifocal/virology , Magnetic Resonance Imaging , Papillomavirus Infections/etiology , Tumor Virus Infections/etiology
13.
Mayo Clin Proc ; 69(6): 548-56, 1994 Jun.
Article in English | MEDLINE | ID: mdl-8189760

ABSTRACT

OBJECTIVE: To record long-term follow-up data on patients with chronic idiopathic meningitis. DESIGN: We retrospectively reviewed the outcome of 49 patients who were examined at the Mayo Clinic between 1978 and 1990. MATERIAL AND METHODS: For all patients, symptoms, signs, laboratory values, results of imaging studies, findings on biopsies, results of any empiric treatment, and results of autopsy, if applicable, were assessed. Some of these findings were stratified on the basis of good versus poor outcome of the patients and were analyzed statistically. RESULTS: Of the 49 patients who fulfilled the criteria for chronic idiopathic meningitis, 10 had a cause identified after repeated studies, brain biopsy, or autopsy (8 of these had a neoplasm). Of 21 brain biopsies, 5(24%) yielded a diagnosis. Follow-up of the 39 undiagnosed cases showed that 33 (85%) had a good outcome despite an often prolonged illness. Two patients (5%) died of the meningeal process. Of the eight patients treated empirically with antituberculous medications, none responded. Corticosteroid therapy was effective in 52% of the patients thus treated, but it did not influence the outcome. CONCLUSION: In this study, 85% of undiagnosed cases of chronic meningitis were benign. No clinical or laboratory findings predicted those patients who had a fatal outcome. In our study population, the most useful empiric therapy was corticosteroids rather than antituberculous medications.


Subject(s)
Meningitis , Adult , Aged , Chronic Disease , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Meningitis/diagnosis , Meningitis/drug therapy , Meningitis/etiology , Middle Aged , Prognosis , Retrospective Studies , Tomography, X-Ray Computed
14.
Mayo Clin Proc ; 68(9): 899-910, 1993 Sep.
Article in English | MEDLINE | ID: mdl-8396702

ABSTRACT

Biotinylated DNA:DNA in situ hybridization was used for determining the presence of JC virus in brain tissues of 67 patients thought to have progressive multifocal leukoencephalopathy. Sixty patients had acquired immunodeficiency syndrome (AIDS) or other illnesses that decreased the cell-mediated immunity. Two patients had no underlying disease, and five others had chronic illnesses not typically associated with reduced cell-mediated immunity. In situ hybridization with biotinylated probe provides specificity and ease of interpretation. The presence of virus can be correlated at the single-cell level with attendant pathologic changes in oligodendrocytes and astrocytes. Not only archival tissue but also tiny fragments of brain biopsy material can be evaluated successfully. Quantifying the technique suggests that the nucleus of a cell labeling for JC virus DNA averages 1,000 copies of replicating genome. Identification of an infected cell is pathologically significant even when only a few such cells are present in a biopsy specimen. Biotinylated DNA or RNA probes are equally effective in identifying infected cells. In situ hybridization will likely continue to be a useful adjunctive procedure for the evaluation of brain tissue from patients suspected of having progressive multifocal leukoencephalopathy.


Subject(s)
In Situ Hybridization , JC Virus/isolation & purification , Leukoencephalopathy, Progressive Multifocal/diagnosis , Adult , Aged , Brain/pathology , DNA Probes , DNA, Viral , Female , Humans , In Situ Hybridization/methods , Leukoencephalopathy, Progressive Multifocal/pathology , Male , Middle Aged , RNA Probes , RNA, Viral , Sensitivity and Specificity
15.
J Neurol ; 240(7): 391-406, 1993 Jul.
Article in English | MEDLINE | ID: mdl-8410079

ABSTRACT

We reviewed the clinical, radiographic, and pathologic features of 15 patients with the acquired immune deficiency syndrome (AIDS) and progressive multifocal leukoencephalopathy (PML). Brain tissue from 10 autopsy and 6 biopsy specimens was studied using: in situ hybridization (ISH) for JC virus (JCV), immunohistochemistry for human immunodeficiency virus (HIV) p24 antigen, and electron microscopy. Thirteen patients presented with focal neurologic deficits, while 2 presented with a rapid decline in mental status. PML was commonly the initial opportunistic infection of AIDS and produced hemiparesis, dementia, dysarthria, cerebellar abnormalities, and seizures. Magnetic resonance imaging was more sensitive than computed tomography in detecting lesions, and often showed multifocal areas of PML. CD4+ T-cell counts were uniformly low (mean 84/mm3), except in 1 patient who improved on 3'-azido-3'-deoxythymidine (AZT). PML involved the cerebral hemispheres, brain stem, cerebellum, and cervical spinal cord. The distribution of brain involvement was consistent with hematogenous dissemination of the virus. In 2 brain specimens, multiple HIV-type giant cells were present within the regions involved by PML. When co-infection by HIV and papovavirus was present, PML dominated the pathological picture. ISH for JCV showed virus in the nuclei of oligodendrocytes and astrocytes. Occasionally there was staining for JCV in the cytoplasm of glial cells and in the neuropil, the latter possibly a correlate of papovavirus spread between myelin sheaths, as seen by electron microscopy. ISH demonstrated more extensive foci of PML than did routine light microscopy.


Subject(s)
Acquired Immunodeficiency Syndrome/complications , Leukoencephalopathy, Progressive Multifocal/complications , Adult , Brain/diagnostic imaging , Brain/pathology , Female , Follow-Up Studies , Humans , Immunohistochemistry , In Situ Hybridization , Leukoencephalopathy, Progressive Multifocal/diagnostic imaging , Leukoencephalopathy, Progressive Multifocal/pathology , Magnetic Resonance Imaging , Male , Microscopy, Electron , Middle Aged , Retrospective Studies , Tomography, X-Ray Computed
16.
Mayo Clin Proc ; 68(7): 652-5, 1993 Jul.
Article in English | MEDLINE | ID: mdl-8350638

ABSTRACT

We reviewed the experience at the Mayo Clinic with neurologic complications related to herpes zoster in patients with systemic cancer. Aside from pain, the most common neurologic complication was zoster-associated meningoencephalitis, which occurred in 9 of 1,125 patients. In these nine patients, the most common underlying malignant lesions were chronic lymphocytic leukemia and lymphoma. All patients in whom meningoencephalitis developed had trigeminal zoster or disseminated zoster. The primary neurologic symptoms were headache, confusion, and somnolence. Nuchal rigidity and fever were uncommon. The response to treatment with acyclovir was generally favorable.


Subject(s)
Herpes Zoster/complications , Meningoencephalitis/complications , Neoplasms/complications , Adult , Aged , Female , Herpes Zoster/diagnosis , Humans , Leukemia/complications , Lymphoma/complications , Male , Meningoencephalitis/diagnosis , Middle Aged , Opportunistic Infections/diagnosis
17.
Eur J Clin Microbiol Infect Dis ; 11(3): 253-4, 1992 Mar.
Article in English | MEDLINE | ID: mdl-1317800

ABSTRACT

The polymerase chain reaction (PCR) was used to identify JC virus (JCV) in the cerebrospinal fluid of two patients with progressive multifocal leukoencephalopathy confirmed by brain biopsy. In addition, JCV viremia was demonstrated by PCR in one case. JCV detection in spinal fluid by PCR may be the first non-invasive technique available for the diagnostic confirmation of progressive multifocal leukoencephalopathy.


Subject(s)
JC Virus/isolation & purification , Leukoencephalopathy, Progressive Multifocal/cerebrospinal fluid , Tumor Virus Infections/cerebrospinal fluid , Viremia/microbiology , DNA, Viral/cerebrospinal fluid , Humans , Leukoencephalopathy, Progressive Multifocal/microbiology , Polymerase Chain Reaction , Tumor Virus Infections/microbiology
18.
Ann Neurol ; 30(1): 37-41, 1991 Jul.
Article in English | MEDLINE | ID: mdl-1929227

ABSTRACT

We retrospectively studied patients who had undergone orthotopic liver transplantation and who also had electroencephalography to determine whether epileptiform changes were associated with a poor neurological outcome. Study groups were 36 patients who died after transplantation (141 electroencephalograms) and underwent neuropathological examination, 11 who died (18 electroencephalograms) but did not have autopsy, and a third group of 34 (62 electroencephalograms) who remained alive. Epileptiform activity was seen in electroencephalograms of 14 of the patients who died (11 from the autopsy group) and in 2 of those who remained alive. All had multiple epileptiform abnormalities and clinical or subclinical seizures. The incidence of epileptiform activity after orthotopic liver transplantation was fivefold higher in the nonsurvivors. Serious cerebral structural changes were found in 10 of the 11 patients who underwent autopsy. Epileptiform activity in the electroencephalograms of patients who had undergone orthotopic liver transplantation indicates a poor prognosis. It should alert the clinician to investigate further for potentially treatable causes.


Subject(s)
Brain Diseases/etiology , Electroencephalography , Epilepsy/etiology , Liver Transplantation/adverse effects , Adolescent , Adult , Aged , Autopsy , Brain Diseases/mortality , Brain Diseases/physiopathology , Cerebral Hemorrhage/etiology , Cerebral Hemorrhage/physiopathology , Coma/etiology , Coma/mortality , Encephalitis/etiology , Encephalitis/physiopathology , Epilepsy/physiopathology , Female , Humans , Liver Transplantation/mortality , Male , Postoperative Complications , Prognosis , Treatment Outcome
19.
Mol Cell Probes ; 5(2): 125-8, 1991 Apr.
Article in English | MEDLINE | ID: mdl-1649395

ABSTRACT

Using polymerase chain reaction (PCR), we examined 108 urine specimens from 39 post transplant patients for polyomaviruses JC (JCV) and BK (BKV). Urine sediments were collected and subjected to 30 cycles of amplification. PCR products were resolved by agarose gel electrophoresis, transferred to nylon membranes by Southern blot, and hybridized with radiolabelled probes. Polyomavirus DNA was found in urine specimens from 17 out of 39 patients (44%). Both viruses were detected in specimens from nine patients, JCV alone in five, and BKV alone in three. In comparison, polyomavirus was detected in only five of 22 PCR positive specimens by shell vial cell culture assay. Our results show a high prevalence of polyomavirus shedding after transplantation and suggest a higher rate of JC viruria than previously reported.


Subject(s)
DNA, Viral/urine , Organ Transplantation , Polymerase Chain Reaction , Polyomavirus/genetics , Heart Transplantation , Humans , Liver Transplantation , Nucleic Acid Hybridization , Tumor Virus Infections/microbiology
20.
J Infect Dis ; 162(4): 858-61, 1990 Oct.
Article in English | MEDLINE | ID: mdl-2169500

ABSTRACT

Polymerase chain reaction (PCR) was used in the detection of JC virus (JCV) DNA in formalin-fixed, paraffin-embedded brain tissue sections from 24 patients with progressive multifocal leukoencephalopathy. Brain sections from normal autopsies (n = 17) and other neurologic conditions (n = 4) were used as controls. Specific amplified products were detected in 20 (83%) of 24 patients with progressive multifocal leukoencephalopathy. PCR did not amplify JCV or human beta-globin gene sequences in four patients with characteristic demyelinating lesions of progressive multifocal leukoencephalopathy that were positive for JCV by in situ hybridization or immunocytochemistry. PCR from biopsy sections resulted in more intense amplification signals than PCR from autopsy tissue. Normal brain sections from 17 autopsies were negative by PCR. Low-grade amplification of JCV was observed in one patient with herpes simplex virus encephalitis. PCR served as a more rapid test for confirmation of progressive multifocal leukoencephalopathy than in situ hybridization. However, PCR performance was altered by prolonged formalin fixation of tissue and undetermined inhibitors of the amplification reaction. Laboratories and clinicians should be aware of the difficulties encountered when using paraffin-embedded tissue for PCR.


Subject(s)
Brain/microbiology , DNA, Viral/analysis , JC Virus/genetics , Leukoencephalopathy, Progressive Multifocal/microbiology , Polyomavirus/genetics , Base Sequence , Blotting, Southern , DNA Probes , Electrophoresis, Polyacrylamide Gel , Humans , Molecular Sequence Data , Nucleic Acid Hybridization , Polymerase Chain Reaction
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