ABSTRACT
BACKGROUND AND PURPOSE: The purpose of this study was to describe typical ultrasonographic findings of vertebral arteries in patients affected by giant cell arteritis. METHODS: Color duplex sonography was used to asses the cervical arteries within 24 hours from stroke onset in 1237 patients. Vertebral arteritis was considered if concentric, homogeneous, and smooth hypoechogenic mural thickening (the so-called halo sign) was present in at least 1 cervical segment of the vertebral artery. If the patient showed such findings, an ultrasound examination of the temporal artery was also performed. Patients with probable giant cell arteritis were treated with high-dose intravenous methylprednisolone in association with antiplatelet therapy. Temporal artery biopsy was carried out by a vascular surgeon in the site targeted by the ultrasonographer. RESULTS: Five patients were diagnosed as having vertebral arteritis according to ultrasound criteria. All of them had initial neurological deficit due to infarctions affecting the vertebrobasilar territory. One patient died due to aspiration pneumonia, whereas the others were independent at discharge. All patients had a positive biopsy for giant cell arteritis. CONCLUSIONS: Vertebral artery involvement in giant cell arteritis may be suspected by color duplex sonography. This fact would allow a prompt diagnosis and treatment of this otherwise fatal disease. Because duplex ultrasonography is a usual test performed on patients with stroke, the recognition of the halo sign in vertebral arteries may be of crucial interest in selected cases.
Subject(s)
Giant Cell Arteritis/diagnostic imaging , Stroke/diagnostic imaging , Ultrasonography, Doppler, Duplex , Vertebral Artery/diagnostic imaging , Aged , Aged, 80 and over , Female , Humans , Male , Time Factors , Ultrasonography, Doppler, Duplex/methodsABSTRACT
Impaired olfaction is an early symptom of Parkinson's disease. The underlying neuropathology likely includes alpha-synucleinopathy in the olfactory bulb at an earlier stage (Braak's stage1) than pathology in the substantia nigra, which is not observed until stage 3. In this report, we investigated the distribution and cell types affected by alpha-synuclein in the olfactory bulb of transgenic mice (2-8 months of age) expressing the human A53T variant of alpha-synuclein. alpha-Synuclein immunostaining progressively affects interneurons and mitral cells. Double labeling studies demonstrate that dopaminergic cells are hardly involved, whereas glutamatergic- and calcium binding protein-positive cells are severely affected. This temporal evolution and the cell types expressing alpha-synuclein are reminiscent of idiopathic Parkinson's disease and support the usefulness of this model to address specific topics in the premotor phase of the disease.
Subject(s)
Neurons/metabolism , Olfactory Bulb/metabolism , Olfactory Bulb/pathology , Parkinson Disease/pathology , alpha-Synuclein/metabolism , Animals , Disease Models, Animal , Gene Expression Regulation/genetics , Humans , Mice , Mice, Transgenic , Mutation/genetics , Neurons/classification , Parkinson Disease/genetics , Parvalbumins/metabolism , Tyrosine 3-Monooxygenase/metabolism , Ubiquitins/metabolism , alpha-Synuclein/geneticsABSTRACT
Hyposmia is an early symptom of idiopathic Parkinson's disease but the pathological bases of such dysfunction are largely unknown. The distribution of alpha-synuclein, which forms Lewy bodies and Lewy neurites, and the types of neurons (based on their neurotransmitters) affected by alpha-synucleinopathy were investigated in the olfactory system in Parkinson's disease. Immunohistochemical distribution of alpha-synuclein and its co-localization with tyrosine hydroxylase, somatostatin, calbindin, calretinin, parvalbumin and substance P in the olfactory bulb, anterior olfactory nucleus, olfactory tubercle and piriform, periamygdaloid and rostral entorhinal cortices of idiopathic Parkinson's disease cases (n = 11) and age-matched controls (n = 11) were investigated. Lewy bodies and Lewy neurites were present in the olfactory bulb, particularly in mitral cells and in the inner plexiform layer. alpha-synuclein was particularly abundant in the different divisions of the anterior olfactory nucleus (bulbar, intrapeduncular, retrobulbar and cortical). In contrast, Lewy bodies and Lewy neurites were less abundant in the olfactory tubercle and olfactory cortices. In the olfactory bulb, anterior olfactory nucleus and olfactory cortices, cells affected by alpha-synucleinopathy rarely co-localized tyrosine hydroxylase or somatostatin, but they frequently co-localized calbindin, calretinin, parvalbumin and substance P. The present data provide evidence that alpha-synucleinopathy affects neurons along the olfactory pathway. Dopamine- and somatostatin-positive cells are rarely affected; whereas the cell types most vulnerable to neurodegeneration include glutamate- (mitral cells), calcium-binding protein- and substance P-positive cells. These results provide data on the distribution and cell types involved by alpha-synucleinopathy in the human olfactory system during Parkinson disease that may be useful for future clinical investigation.
Subject(s)
Calcium-Binding Proteins/metabolism , Cerebral Cortex/metabolism , Olfactory Bulb/metabolism , Parkinson Disease/metabolism , Substance P/metabolism , alpha-Synuclein/metabolism , Aged , Aged, 80 and over , Case-Control Studies , Cell Count , Cerebral Cortex/pathology , Female , Humans , Lewy Bodies/metabolism , Lewy Bodies/pathology , Male , Middle Aged , Neurites/metabolism , Neurites/pathology , Olfactory Bulb/pathology , Olfactory Pathways/metabolism , Olfactory Pathways/pathology , Parkinson Disease/pathologyABSTRACT
Introducción. Hace ya casi 200 años, James Parkinson describió con detalle la enfermedad que hoy lleva su nombre, centrándose no sólo en los trastornos motores sino también en los síntomas no motores que sufren estos pacientes. Desarrollo. Los síntomas no motores en enfermos parkinsonianos son prevalentes e interfieren en su calidad de vida. En los últimos años se ha intentado resolver el problema de su infradiagnóstico mediante cuestionarios y escalas. Asimismo, algunos de estos síntomas se postulan como predictores de la enfermedad y se plantea que individuos asintomáticos desde el punto de vista motor que sufran alguno de estos síntomas no motores podrían ser dianas de estrategias neuroprotectoras cuando se disponga de ellas. Conclusiones. Los síntomas no motores son frecuentes y tienen gran impacto en la calidad de vida de los enfermos parkinsonianos, por lo que es necesario reconocerlos y tratarlos. Su papel como predictores de la enfermedad a día de hoy aún no está aclarado (AU)
Introduction. Two hundred years ago James Parkinson accurately described the disease that bears his name today, focusing not only on motor aspects but also on non-motor symptoms suffered by these patients. Development. Non-motor symptoms are prevalent and decrease the quality of life of the patients with Parkinsons disease. In recent years, some non-motor scales have been developed to avoid the problem of underdiagnosis. Moreover, some of them have been proposed as clinical predictors for Parkinsons disease and it is has been suggested that individuals with any of these non-motor symptoms and without motor manifestations of the disease could be the aim for neuroprotective therapies when they become available. Conclusions. Non-motor symptoms are prevalent and have a great impact in the quality of life of patients. Therefore, it is important to detect and treat them. Their role as predictors of the disease is unclear yet (AU)
