Septic encephalopathy: relationship to serum and cerebrospinal fluid levels of adhesion molecules, lipid peroxides and S-100B protein.

Severe septic illness is often associated with cerebral manifestations such was disturbed consciousness and delirium. Little was known about its effect on the CNS. This is the first study in children that has assessed the direct mediators of brain inflammation and injury with sepsis. The serum and CSF concentrations of soluble intracellular adhesion molecule-1 (sICAM-1) (marker of endothelium-leukocyte interaction), nitric oxide (NO) and lipid peroxide (LPO) (markers for lipid peroxidation) and S-100B protein (marker of astrocytes activation and injury), were measured in 40 children with sepsis of whom 40% had moderate to severe septic encephalopathy. Serum from 25 normal children was used for comparison. Serum values of sICAM-1, NO, LPO and S100B were elevated in patients compared to controls. The greater elevation of the CSF:serum albumin ratio suggests loss of blood-brain barrier integrity. After normalising for CSF:serum albumin ratio, we demonstrated a significant intrathecal synthesis of NO, LPO and S100B. Patients with encephalopathy had elevated serum and CSF levels of sICAM-1, NO, LPO and S100B compared to sepsis only. This study indicates that the brain is vulnerable in children with sepsis. It also suggests that coordinated interactions between immune system, vascular endothelial cells, CNS barriers, astrocytes and brain lipid peroxides, may contribute to septic encephalopathy.

Cerebral cortical dysfunction in chronic obstructive pulmonary disease: role of transcranial magnetic stimulation.

SETTING: Chest and Neurology Departments, Assiut and Al-Azhar University Hospitals, Egypt. OBJECTIVES: To study a large population with respect to previous preliminary data, using transcranial magnetic stimulation (TMS) as a prognostic method for evaluation of cerebral cortical functions during acute exacerbation of chronic obstructive pulmonary disease (AE-COPD). DESIGN: In a case-control study, 41 patients with AE-COPD and 30 healthy controls were included. For all, TMS was used to assess corticospinal pathway function and cortical excitability. RESULTS: Patients demonstrated increased motor threshold (resting and active), central motor conduction time and increased cortical silent period. Significant correlation was identified between TMS parameters and pulmonary function tests (forced vital capacity, forced expiratory volume 1%, forced expiratory volume in one second) and arterial blood gases (pH, paO(2) and HCO(3)), serum chloride and potassium. CONCLUSION: These results indicate that the motor cortex is less excitable during AE-COPD. This is attributed to reduction of cortical excitability due to chronic hypoxaemia. Therefore, early detection of cerebral changes might be in accordance with the importance of early O(2) therapy in reducing morbidity and mechanical ventilation dependency in COPD. This opens discussion for future early therapeutic use of GABAergic and glutaminergic modulating drugs with oxygen to protect the brains of COPD patients.

Unusual presentations of neurocysticercosis.

INTRODUCTION: Neurocysticercosis (NCC) is the most common helminthic infection of the central nervous system. It is a major public health problem in developing countries, however, rarely reported in Saudi Arabia. As far as our knowledge, this is the first case report of NCC in Saudi Arabia. An increasing number of immigrants from endemic areas is the cause. CASE REPORTS: Here, we report three interesting cases of NCC in three adult females with very unusual clinical presentation. These include: (case 1) progressive spasticity of the four limbs with severe pseudobulbar manifestations, precipitancy of micturition, cognitive impairment and no eye involvement; (case 2) dystonic movement of right upper and lower limbs together with weight gain, lethargy, mental dullness and goitre; and (case 3) depressive manifestations together with disturbance of writing, mild deep sensory loss, limb-kinetic apraxia, lack of coordination and dystonia of the right upper limb. The clinical details and possible mechanisms for the uncommon presentations are discussed. CONCLUSION: NCC should be kept in mind and raise a high level of suspicion for unusual neurological manifestations in Saudian patients particularly as there has been increasing percentage of immigration from endemic areas during the last few years.

The reproductive conditions and lipid profile in females with epilepsy.

OBJECTIVE: To explore the reproductive conditions in women with epilepsy. METHODS: Eighty-eight women were included; 37.5% and 62.5% had generalized and partial epilepsies, respectively. Ovarian sonogram, reproductive hormone and lipid profiles were assessed. RESULTS: Compared with the control group and in accordance with our laboratory reference values, irregular menses and polycystic ovaries (PCO(s)) were reported in 70.5% and 39.8% versus 21.7% and 16.7% of controls. Abnormalities in leutinizing hormone (LH), follicle-stimulating hormone (FSH), LH-to-FSH ratio, testosterone (T) and prolactin (PRL) were identified. High values of FSH, LH and FSH-to-LH ratio were common with carbamazepine while that of T and PRL were common in untreated patients and with valproate. Low levels of high-density lipoprotein cholesterol was identified in approximately 59% but neither associated with duration and type of antiepileptic drugs nor patients' age, hormonal profile or PCO(s). Significant correlation was identified between menatrual irregularities, T, PRL, hormonal, lipid profile alterations, PCO(s) and seizure frequency but neither with epilepsy type nor focus. CONCLUSION: This is the first study in our country that aimed at evaluation of reproductive conditions in women with epilepsy. This study indicates that reproductive dysfunction is common, hence, characterization of seizure-associated neuroendocrine adverse effects is important while managing women particularly during choice of antiepileptic medications as initial step and during patients' follow-up.

Irreversible cochlear damage in myasthenia gravis -- otoacoustic emission analysis.

OBJECTIVE: Acetyl choline (ACh) is the main neurotransmitter of the efferent auditory system. This study is aimed to evaluate cochlear function in myasthenia gravis (MG), a neuromuscular transmission disorder caused by ACh receptor autoantibodies. METHODS: This prospective study included 16 myasthenic patients, tested audiologically twice, first after improvement from myasthenic crisis or acute oropharyngeal dysfunction (1 week from admission) and then 2 months later. We detected the effect of contralateral acoustic stimulation (CAS) on patients' transient and distortion product otoacoustic emissions (TEOAE and DPOAE). RESULTS: Compared with controls, patients reported significant reduction in overall echo response and amplitude of TEOAEs at 1-2 kHz and at 1-6 kHz of DPOAE with marked reduction at 5 kHz. In the control group, CAS produced amplitude reduction in TEOAEs and DPOAEs at 1-4 kHz. Utilizing masking effect, patients reported amplitude reduction in TEOAEs at 1.5-4 kHz while DPOAEs did not reach significant level except at 1.5 and 5 kHz. After 2 months, no changes were observed compared with early assessment. CONCLUSIONS: It is clear that disease progression is associated with irreversible cochlear damage. Lack of improvement in patients' emissions despite partial non-audiometric improvement in relation to receptors needs to be considered.

Role of some vasoactive mediators in patients with erectile dysfunction: their relationship with angiotensin-converting enzyme and growth hormone.

The imbalance between vasoconstrictors and vasodilators may play an important role in the pathogenesis of erectile dysfunction (ED). A total of 36 patients with ED, organogenic [diabetic (n=12) and nondiabetic (n=12)] and psychogenic (n=12) etiology, and 12 healthy adult men as controls were included. The levels of endothelin-1 (ET-1), growth hormone (GH), angiotensin-converting enzyme activity (ACE), nitric oxide (NO) and cyclic guanosine monophosphate (cGMP) were determined in the flaccid penis cavernosal blood of patients and in cubital blood of patients and controls. In psychogenic ED, systemic ACE activity was elevated compared to controls (P<0.05). In diabetic and nondiabetic ED patients, systemic levels of ET-1 (P<0.0001 for both) and ACE activity (P<0.01 and <0.05) were higher while GH (P<0.0001 and <0.001), NO (P<0.0001 for both) and cGMP (P<0.01 for both) levels were lower compared to controls. In diabetic patients, systemic and cavernosal ET-1 levels (P<0.0001 for both) and cavernosal ACE activity levels (P<0.05) were significantly elevated while systemic and cavernosal NO (P<0.0001 for both) and GH (<0.001 and <0.05) levels were declined compared to psychogenic. In nondiabetic patients, systemic and cavernosal ET-1 levels (P<0.0001 for both) were significantly elevated while systemic and cavernosal NO (P<0.0001 for both) and systemic GH levels (P<0.05) were declined compared to psychogenic. Systemic NO was positively correlated with GH in psychogenic (r=0.616, P<0.05), diabetic (r=0.583, P<0.05) and nondiabetic (r=0.615, P<0.05) patients and correlated positively with cGMP (r=0.605, P<0.05) but negatively with ACE activities (r=-0.585, P<0.05) in diabetic patients. In conclusion, plasma levels of ET-1, ACE activities are elevated and associated with reduction of GH, NO and cGMP levels in the systemic and cavernous blood of ED patients. This disturbance may indicate endothelial dysfunction that may hind at their significance in the pathophysiology of ED.