Clinical profile of patients with paraneoplastic neuromyelitis optica spectrum disorder and aquaporin-4 antibodies.

BACKGROUND: In a minority of patients with neuromyelitis optica spectrum disorder (NMOSD) and aquaporin-4 antibodies (AQP4-IgG), the disease has a paraneoplastic origin. It is unknown whether these patients have distinctive clinical features. OBJECTIVE: To report the clinical features of a series of patients with paraneoplastic NMOSD and AQP4-IgG and to review previously reported cases. METHODS: Retrospective analysis of clinical records of 156 patients with NMOSD and AQP4-IgG and review of previously reported patients with paraneoplastic NMOSD and AQP4-IgG. Paraneoplastic patients were defined as those with cancer identified within 2 years of the diagnosis of NMOSD. RESULTS: Five (3.2%) of 156 patients had paraneoplastic NMOSD, and 12 previously reported patients were identified. The most common tumors were adenocarcinoma of the lung (five patients) and breast (five). Compared with the 151 non-paraneoplastic NMOSD patients, the 17 (5 current cases and 12 previously reported) were older at symptom onset (median age = 55 (range: 17-87) vs 40 (range: 10-77) years; p = 0.006), more frequently male (29.4% vs 6.6%; p = 0.009), and presented with severe nausea and vomiting (41.2% vs 6.6%; p < 0.001). The frequency of longitudinal extensive transverse myelitis (LETM) as heralding symptom was similar in both groups, but patients with paraneoplastic NMOSD were older than those with non-paraneoplastic NMOSD (median age: 63 (range: 48-73) vs 43 (range: 14-74) years; p = 0.001). CONCLUSION: Patients, predominantly male, with NMOSD and AQP4-IgG should be investigated for an underlying cancer if they present with nausea and vomiting, or LETM after 45 years of age.

Continuous recording of blood pressure in cerebrovascular disease: when should it be done?

BACKGROUND AND OBJECTIVES: Ambulatory blood pressure (BP) monitoring has found some specific clinical indications in the treatment and control of hypertension (HT). As with other target organs exposed to vascular damage dependent on HT, ambulatory BP monitoring can be a useful tool in the prevention of cerebrovascular processes. METHOD: Review of published articles (Medline database) which have investigated the value of continuous recording of BP in cerebrovascular disease (CVD). RESULTS: Research on the BP patterns and its relationship with stroke has been carried out in subjects with no previous history of CVD (cohort studies and in patients with essential HT, differentiating between adults and elderly patients) and patients after a cerebral ischemic event. The study objectives are aimed at determining its prognostic value in the development of silent and symptomatic CVD, and its prognostic significance regarding functional recovery and the differences of the BP patterns according to the different stroke subtypes. CONCLUSIONS: BP monitoring is a useful technique with applications in the control and treatment of the pathological variations of BP in hypertensive patients, with and without a previous history of cerebral ischemia, and mainly in elderly patients, due to the deterioration of the cerebral circulation regulation mechanisms. Clinical research has confirmed the importance of factors related to the circadian rhythm of BP in the primary and secondary prevention of cerebrovascular processes.