Concurrent Transcatheter Aortic Valve Replacement and Leadless Pacemaker Implantation in a Patient With Aortic Stenosis and Tachycardia-Bradycardia Syndrome.

We present a patient with symptomatic severe aortic stenosis and atrial fibrillation complicated by tachycardia-bradycardia syndrome, deemed too high-risk for surgical valve replacement and referred for transcatheter aortic valve replacement. We show that concurrent implantation of a leadless pacemaker system can be performed successfully with minimal additional risk to the patient, and also, that it can be used to rapidly pace the ventricles to assist in balloon valvuloplasty and prosthetic aortic valve deployment.

Nous présentons le cas d'un patient ayant une sténose aortique symptomatique grave et une fibrillation auriculaire compliquée par un syndrome tachycardie-bradycardie, jugé comme présentant un risque trop élevé pour être candidat à un remplacement valvulaire chirurgical, et orienté pour subir un remplacement valvulaire aortique par cathéter. Nous démontrons que l'implantation concomitante d'un système de stimulateur cardiaque sans fil peut être réalisée avec succès tout en entraînant un risque additionnel minime pour le patient, et que celui-ci peut être utilisé pour stimuler rapidement les ventricules afin de faciliter la valvuloplastie par ballonnet et le déploiement de la prothèse valvulaire aortique.

Bayer-activities of daily living scale in mild and moderate dementia of the Alzheimer type.

The main purpose of this study is to examine the reliability of the Bayer-Activities of Daily Living (B-ADL) scale when used as a cognitive screening instrument for mild and moderate dementia of the Alzheimer type. This is a retrospective study of 66 patients with dementia. The B-ADL scale was completed by the caregiver or the family member at the first encounter. The internal consistency was found to be 0.94 for the 27 patients that completed all 25 questions in the scale. Significant correlation and receiver-operating characteristic curve analysis were found for the B-ADL total score and subscale 1 (tasks requiring short- and long-term memory) for Clinical Dementia Rating scale. Severity of dementia by the B-ADL scale is statistically similar but not the same as Mini-Mental State Examination. Our findings confirm that B-ADL scale is a valid indicator of the cognitive status of patients with Alzheimer's disease.

Akinetic mutism following stroke.

This is an appraisal of the varied clinical presentation and the neural substrate for akinetic mutism following stroke. The diagnosis is important as akinetic mutism is often misdiagnosed as depression, delirium and locked-in-syndrome. This is a descriptive study of eight selected patients with akinetic mutism following infarction/haemorrhage in different regions of the brain with characteristic syndromes. They involved the critical areas namely, the frontal (cingulate gyrus, supplementary motor area and dorso-lateral border zone), basal ganglia (caudate, putamen), the mesencephalon and thalamus. The disorders of speech and communication took different forms. The speech disorder included verbal inertia, hypophonia, perseveration, softened and at times slurred. The linguistic disturbances were fluent, non-fluent, anomia and transcortical (motor, mixed) aphasias. The findings were related to what is known about the neuroanatomic location of the lesions and the role of the frontal-subcortical circuitry in relation to behaviour. Akinetic mutism could be explained by damage to the frontal lobe and or interruption of the complex frontal subcortical circuits.

Slowly progressive aphasia with striatal involvement.

We have described four patients with slowly progressive aphasia with striatal involvement occurring at different stages in the course of the illness. There were two males and two females, and their ages ranged from 68 to 76 (mean: 72) years. The extrapyramidal signs included tremors, bradykinesia, rigidity, and focal dystonia, and one had weakness resembling stroke. There is a heterogeniety among patients with slowly progressive aphasia and the clinical features correspond to the functional anatomy of the areas involved rather than to the pathology.