ABSTRACT
Although the association between PFO and cryptogenic stroke is well shown in young adults, the causality is still unclear. The pathogenetic mechanism of ischemic stroke related to PFO is not entirely understood. Indeed, besides the well-known paradoxical embolism, formations of thrombi in situ, especially in the presence of ASA, a higher incidence of atrial fibrillation have been often observed. Cerebral sinus venous thrombosis may be due to local inflammation or to acquired or genetic thrombophilia including hyperhomocysteinemia. We report a case of a young man presenting with a cerebellar infarction probably secondary to a paradoxical brain-to-brain embolism, in which the only detectable embolic source was a cerebral vein thrombosis.
Subject(s)
Brain Stem Infarctions/diagnostic imaging , Cerebellum/diagnostic imaging , Cerebral Veins/diagnostic imaging , Foramen Ovale, Patent/diagnostic imaging , Intracranial Embolism/diagnostic imaging , Venous Thrombosis/diagnostic imaging , Adult , Brain Stem Infarctions/etiology , Foramen Ovale, Patent/complications , Humans , Intracranial Embolism/etiology , Male , Ultrasonography, Doppler, Transcranial/methods , Venous Thrombosis/complicationsABSTRACT
OBJECTIVE: To estimate prevalence of Parkinson's disease (PD) and other types of parkinsonism in the Aeolian Archipelago, Sicily. METHODS: We studied the frequency of PD and other types of parkinsonism in the Aeolian Archipelago (population 13,431). All potential cases were identified from available medical information sources. To ensure the completeness of the case-findings, a screening questionnaire was also mailed to residents aged 40 years and over. Subjects were considered prevalent if they fulfilled the SNES diagnostic criteria for PD, on prevalence day (January 1, 2001). RESULTS: We identified 17 patients with parkinsonism from medical sources, and 4 from mail-survey. Prevalence for all types of parkinsonism was 156.3/100,000 (95% CI 99.4-234.8). Fourteen subjects fulfilled diagnostic criteria for PD giving a crude prevalence of 104.2/100,000 (95% CI 59.4-170.7) and 422.5/100,000 in the population aged 60 years and over. CONCLUSIONS: Prevalence of all types of parkinsonism and PD found in the Aeolian Archipelago is lower than that previously reported in Sicily.
Subject(s)
Parkinson Disease/epidemiology , Parkinsonian Disorders/classification , Parkinsonian Disorders/epidemiology , Adult , Aged , Aged, 80 and over , Female , Health Surveys , Humans , Male , Middle Aged , Severity of Illness Index , Sicily/epidemiologyABSTRACT
A 76-year-old patient, since the age of 45, presented with frequent attacks often triggered by emotional stimuli and characterised by forward head drop and a fall to the ground without loss of consciousness. Clinically these episodes were misinterpreted as pseudoseizures and treated with clomipramine for more than 20 years. In spite of this chronic therapy, during the last year, the attacks presented with a daily recurrence and, moreover, after arbitrary clomipramine withdrawal, they increased in frequency until they became subcontinuous. Videopolygraphic analysis, multiple sleep latency test (MSLT) and human leukocyte antigen (HLA) association studies were suggestive of narcolepsy and the recurrent episodes, diagnosed as status cataplecticus, recovered after citalopram administration.
Subject(s)
Cataplexy/diagnosis , Diagnostic Errors , Syncope/diagnosis , Aged , Electroencephalography/methods , HLA-DQ Antigens/analysis , HLA-DQ beta-Chains , HLA-DR2 Antigen/analysis , Humans , Magnetic Resonance Imaging , Male , Recurrence , Syncope/physiopathologyABSTRACT
This study was performed to assess whether patients with Parkinson's disease (PD)develop cognitive and psychiatric impairments more frequently during therapy with continuous subcutaneous apomorphine infusion (CAI) compared to the standard oral treatment. Thirty consecutive PD patients with severe motor fluctuations were included. Of them, 12 patients received the CAI treatment, while the remaining 18 continued the treatment with oral dopaminergic drugs. The two groups were evaluated with neuropsychological,psychiatric and motor tests at baseline and after two years. The off-awake daily duration and the levodopa dosage were significantly reduced in the patients infused with apomorphine.In comparison with the baseline evaluation, the neuropsychiatric assessment did not change in either of groups at the follow-up, except for a significant improvement of mood in the CAI treated group.
Subject(s)
Apomorphine/therapeutic use , Cognition Disorders/complications , Depression/complications , Depression/psychology , Dopamine Agonists/therapeutic use , Parkinson Disease/complications , Parkinson Disease/drug therapy , Antiemetics/therapeutic use , Apomorphine/administration & dosage , Brain/physiopathology , Cognition Disorders/diagnosis , Depression/diagnosis , Domperidone/therapeutic use , Dopamine Agonists/administration & dosage , Drug Administration Schedule , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neuropsychological Tests , Parkinson Disease/psychology , Severity of Illness Index , Single-Blind Method , Surveys and QuestionnairesABSTRACT
Hereditary spastic paraplegias are neurodegenerative disorders characterized clinically by progressive spasticity of the lower limbs. They are inherited as autosomal dominant, autosomal recessive, and X-linked traits. Four Italian families with autosomal recessive pure spastic paraplegia are reported. We show evidence of linkage to the SPG5 locus on chromosome 8p and our data reduce the candidate interval for SPG5 to the11-cM interval spanned by D8S285 and D8S544. We also report the search for mutations in five genes located in the region and their exclusion as candidates for SPG5.
Subject(s)
Chromosomes, Human, Pair 8 , Lod Score , Paraplegia/genetics , Adult , Family Health , Female , Genes, Recessive , Genetic Markers , Humans , Italy , Male , Middle Aged , PedigreeABSTRACT
The aim of this study was to assess whether patients with Parkinson's disease (PD) develop cognitive and psychiatric complications more frequently during prolonged therapy with continuous apomorphine infusion compared with standard oral treatment. Thirty consecutive PD patients with severe motor fluctuations were included in the study. Twelve patients accepted the treatment with subcutaneous continuous apomorphine infusion, while the remaining 18 preferred to continue with oral dopaminergic therapy. The two groups were evaluated with neuropsychological, psychiatric, and motor tests at baseline and after 1 year. The off daily duration and the levodopa dosage were significantly reduced in infused patients. The neuropsychiatric assessment did not change in both groups compared with baseline, except for a significant improvement of mood in the apomorphine group.
Subject(s)
Apomorphine/adverse effects , Cognition Disorders/chemically induced , Dopamine Agonists/adverse effects , Parkinson Disease/complications , Aged , Apomorphine/therapeutic use , Dopamine Agonists/therapeutic use , Drug Administration Routes , Drug Administration Schedule , Humans , Levodopa/adverse effects , Longitudinal Studies , Middle Aged , Motor Activity , Neuropsychological Tests , Parkinson Disease/drug therapy , Psychiatric Status Rating ScalesABSTRACT
This study investigated the efficacy and safety of quetiapine versus clozapine in parkinsonian patients with dopaminergic psychosis. All patients fulfilling the inclusion criteria were randomly assigned to receive either quetiapine or clozapine. The duration of the trial was 12 weeks. The severity of psychosis was assessed using the BPRS and the Clinical Global Impression Scale-Severity subscale (CGI-S). The UPDRS III was used to monitor the progression of PD during the study period. Twenty patients, 10 on clozapine, and 10 on quetiapine, completed the study. The psychopathological state, as assessed by the BPRS and by the CGI-S, improved significantly ( p<0.001) from baseline in both treatment groups. No differences were found between clozapine and quetiapine at each assessment time. The UPDRS score decreased significantly ( p<0.05) in the clozapine group, while was almost unchanged in the quetiapine group.
Subject(s)
Antipsychotic Agents/pharmacology , Clozapine/pharmacology , Dibenzothiazepines/pharmacology , Dopamine Agonists/adverse effects , Parkinson Disease/drug therapy , Psychoses, Substance-Induced/drug therapy , Aged , Aged, 80 and over , Disease Progression , Dopamine Agonists/administration & dosage , Drug Administration Schedule , Female , Humans , Male , Middle Aged , Quetiapine FumarateABSTRACT
We describe four migraine patients who developed an ischemic stroke during their typical migraine attacks. Cerebral infarction as a possible complication of migraine without aura is discussed. We propose a review of the migraine stroke definition of the International Headache Society.
