Case of primary Sjogren's syndrome preceded by dystonia.

There are only six cases in literature that describe development of dystonia with Sjogren's syndrome (SS). We describe a case of a 43-year-old woman who presented with symptoms including movement disorder, sensory neurogenic bladder, sensory loss and neuropathic pain, migraine like headaches, musculoskeletal pain, Raynaud's phenomenon and dysautonomia. Symptoms started in 2000, with weakness that progressed to dystonia in 2003. Diagnostic work-up was inconclusive with negative inflammatory serologies, cerebrospinal fluid and MRI for many years. After patient developed sicca syndrome with dry eyes and mouth in 2009, her rheumatoid factor titre was elevated (550 IU/mL), erythrocyte sedimentation rate, anti-Sjogrens syndrome-related antigen A (anti-Ro/SSA) and anti-SSB/La: anti-Sjogrens syndrome-related antigen B (anti-La/SSB) became positive. Lip biopsy confirmed diagnosis of SS. She was diagnosed with primary SS with neurological involvement. Her symptoms responded well to intravenous methylprednisolone. Symptoms stabilised with trials of immune-suppressive therapy. This is a case that demonstrates the delay of diagnosing SS with preceding unique neurological association.

Lymphomatosis cerebri: diagnostic challenges and review of the literature.

Lymphomatosis cerebri (LC) is a rare variant of a primary central nervous system non-Hodgkin's lymphoma (PCNSL) characterised by diffuse infiltration of tumour cells throughout the brain parenchyma. We present a 68-year-old immunocompetent woman with headaches, dizziness, blurred vision, localised right leg weakness and rapidly progressive dementia. A brain MRI demonstrated diffuse T2 hyperintense white matter lesions that did not enhance with contrast. The clinical differential diagnosis of these lesions included metastatic disease, infectious or inflammatory process such as sarcoidosis, lymphoma, demyelinating disease and less likely vascular aetiology, such as vasculitis or ischaemic stroke. A right frontal stereotactic brain biopsy was non-diagnostic. The patient eventually died from aspiration pneumonia following a pneumonectomy for a primary lung adenocarcinoma. The diagnosis of LC was established on postmortem examination of the brain.

A case of neurosarcoidosis secondary to treatment of etanercept and review of the literature.

There are only three cases in the literature that describe development of neurosarcoidosis in a patient who is on tumour necrosis factor α inhibitors. We describe a case of a 33-year-old woman with a history of juvenile rheumatoid arthritis and refractory uveitis (with previous treatment trials of adalimumab, infliximab, mycophenolate, methotrexate) who had been stable for 2 years on etanercept. She was diagnosed with biopsy-proven systemic sarcoidosis with meningeal and parenchymal neurosarcoidosis. She was switched to infliximab and methotrexate, with clinical and imaging improvements. This is a case that demonstrates the difficulty of choosing tumour necrosis factor α (TNF-α) inhibitors when treating patients with multiple clinical autoimmune entities. It is also a case where a change in the mechanism of TNF-α inhibition pathway can still be used to treat refractory sarcoidoisis and rheumatoid arthritis. It is still unclear what the exact difference between the TNF-α blockers and their neurological complications is, and who the patients at risk of developing neurological complications are.

Morphine: axon regeneration, neuroprotection, neurotoxicity, tolerance, and neuropathic pain.

Opioids have been used medicinally for millennia for their potent effects on nociception. However, the past 20 years have led to important insights into the influences and mechanisms of opioid actions, which are more extensive than merely analgesia, including human synthesis of opioids, critical roles of opioids during development and following nerve injury, and actions of different opiate alkaloids and their receptors. Due to the vast literature on opioids, the scope of this review has been limited to opioid actions in maintaining neuron viability during development, promoting neurological function following nerve injuries, in inflammation, disease and against ischemia; alleviating neuropathic pain; raising and lowering cellular immunity; and mechanisms modifying morphine tolerance.

Visualization of six unique morphological subpopulations of adult frog dorsal root ganglion neurons at the light microscopic level.

Subpopulations of adult frog dorsal root ganglion (DRG) neurons respond to different physiological stimuli, and have unique biophysical and pharmacological properties. Two broad-based subpopulations of DRG neurons appear under phase optics, "large clear" and "small dark" neurons, while immunochemical and electrophysiological techniques allow identification of additional subpopulations. Nevertheless, most studies of DRG neurons involve randomly selected neurons. Under bright field illumination, we found dark and clear DRG neurons are distinctly different, with dark neurons composed of four subpopulations, each with unique numbers and distribution of bright rusty-colored cytoplasmic granules, and statistically significant difference in the soma diameter distribution. The clear neurons are granule-free, but the two subpopulations have statistically significant differences in soma size distributions. Thus, morphological criteria alone allow identification of six distinct subpopulations of DRG neurons in the light microscope, although further studies are required to determine whether they correspond to physiologically different subpopulations of sensory neurons.

Morphological characterization of six subpopulations of adult human DRG neurons at the light microscopic level.

Dorsal root ganglion (DRG) neurons are composed of physiologically distinct subpopulations, each responding to a different sensory stimulus. One can morphologically discriminate between two broad populations of adult rat and frog DRG neurons by their appearance under the light microscope. These groups are called large clear and small dark. However, additional subpopulations have not been identified by visual observation. Such identification requires application of immunochemistry or biophysical techniques. Although these are useful techniques, they do not allow the rapid discrimination of different neuron subpopulations, which would be useful for pharmacological studies on unique neuron subpopulations. Such experiments would be greatly facilitated if viable DRG neuron subpopulations could be identified based on their morphology at the light microscopic level. Just as for adult frog and rat DRG neurons, when adult human DRG neurons are observed under phase optics, two subpopulations can be seen, small dark and large light. However, under bright-field illumination, six distinct subpopulations can be distinguished based solely on morphological features. Five subpopulations contain rusty-colored cytoplasmic inclusions with different sized granules and differences in the size and density of the granule clusters, while one is granule-free. Analysis of the soma diameter distribution shows each of the six granule-containing and the non-granule-containing (clear) neuron subpopulations has a statistically significant difference in size distribution. We propose that neurons with different morphologies correspond to unique physiological subpopulations of DRG neurons. Experiments are underway using immunochemical techniques to determine whether neurons with the unique morphologies correspond with unique physiological functions.