Bilateral Hypertrophic Olivary Degeneration and Holmes Tremor without Palatal Tremor: An Unusual Association.

BACKGROUND: Lesions in the Guillain-Mollaret triangle or dentate-rubro-olivary pathway may lead to hypertrophic olivary degeneration (HOD), a secondary trans-synaptic degeneration of the inferior olivary nucleus. HOD is usually associated with palatal tremor and rarely with Holmes tremor. Bilateral HOD is a very unusual condition and very few cases are reported. CASE REPORT: We report here two cases of bilateral HOD after two different vascular lesions located at the decussation of superior cerebellar peduncles, thus impairing both central tegmental tracts and interrupting bilaterally the dentate-rubral-olivary pathway. Interestingly, both developed bilateral Holmes tremor but not palatal tremor. DISCUSSION: Lesions in some of the components in the Guillain-Mollaret triangle may develop Holmes tremor with HOD and without palatal tremor. Magnetic resonance imaging is an invaluable tool in these cases. Better understanding of the pathways in this loop is needed.

Hemichorea/Hemiballism Associated with Hyperglycemia: Report of 20 Cases.

BACKGROUND: Hemichorea/hemiballism associated with nonketotic hyperglycemia is a well-recognized syndrome, but few case series have been reported in the literature. CASE REPORT: We describe 20 patients with hemichorea/hemiballism associated with hyperglycemia (9 males and 11 females) with mean age of 67.8 years. Ten patients had a previous diagnosis of type 2 diabetes mellitus, and one had type 1 diabetes mellitus. Six of them had documentation of poor diabetic control over at least the last 3 months. Nine patients had new-onset hyperglycemia with a diagnosis of diabetes mellitus made after discharge. Seventeen patients had unilateral chorea/ballism, while three had bilateral chorea/ballism. Eighteen cases had striatal hyperdensities on computed tomography (CT) and/or hyperintense signals on magnetic resonance imaging (MRI). The putamen was affected in all cases, and the caudate nucleus was involved in nine. DISCUSSION: Hemichorea/hemiballism associated with nonketotic hyperglycemia can be the presenting sign of diabetes mellitus in almost half of cases or can occur after a few months of poor glycemic control in patients with diagnosed diabetes. This case series is one of the largest to date and adds valuable information about clinical and neuroimaging features that are comparable with published data but also emphasize the role of adequate diabetes mellitus control.

Reply #1 to: Glycemic Choreoballism.

In Response To: Lee D, Ahn TB. Glycemic choreoballism. Tremor Other Hyperkinet Mov. 2016; 6. doi: 10.7916/D8QJ7HNF Original Article: Cosentino C, Torres L, Nuñez Y, et al. Hemichorea/hemiballism associated with hyperglycemia: report of twenty cases. Tremor Other Hyperkinet Mov. 2016; 6. doi: 10.7916/D8DN454P.

Pan-American Consortium of Multiple System Atrophy (PANMSA). A Pan-American multicentre cohort study of multiple system atrophy.

BACKGROUND: Multiple system atrophy (MSA) is an adult-onset and rapidly progressive, neurodegenerative condition that presents with autonomic dysfunction, parkinsonism, cerebellar ataxia and corticospinal deficits. Clinical, demographic and epidemiological data from different regions have provided valuable information concerning the natural history of MSA. There are no published data of Multiple System Atrophy (MSA) in Latin American countries. OBJECTIVE: To describe clinical and epidemiological data of patients with "possible" MSA from seven referral movement disorders centers from Argentina, Chile, Mexico, Peru and United States. METHODS: We conducted a retrospective, observational, cross-sectional Pan-American multicentre cohort study of MSA. RESULTS: The sample was composed of 82 females and 77 men with the diagnosis of "possible" MSA with a mean age at onset of 65 ± 10 years. 67.29% of the individuals had a MSA-P variant with a mean age at onset of 61.47 ± 10.28 years, whereas the mean age at onset in the MSA-C patients was 57.44 ± 10.58 years. Interestingly, MSA-C-was more prevalent in Non-Caucasian (50-Mestizo and 2 Asian patients) than Caucasians (51.92% vs. 20.79%, p = 0.0001). Dysautonomic symptoms were present in 95.6% of the patients, parkinsonism in 85.5%, pyramidal signs in 25.8% and depression in 48.4% of the patients. CONCLUSIONS: Our epidemiological and clinical data appears to be similar to other Western international series, however, of note, the MSA-C phenotype was predominant in Non-Caucasians, more specifically the Mestizo population. This observation opens a new path to explore. Larger prospective epidemiologic studies in Latin America may provide valuable information concerning MSA in the region.

Frequency of non-motor symptoms in Peruvian patients with Parkinson's disease.

INTRODUCTION: Non-motor symptoms in Parkinson's disease are often not well recognized in clinical practice. Non-motor symptoms questionnaire (NMSQuest) is a simple instrument that allows patients or caregivers to report non-motor symptoms in a practical manner. OBJECTIVE: We attempted to determine the prevalence of non-motor symptoms in three hundred Parkinson's disease outpatients. RESULTS: The mean total non-motor symptoms was 12.41, ranging from 0 to 27 of a maximum of 30. At least one was present in 99.3% of patients. A progressive increase in mean total score was observed across each 5-year interval. Depression domain scored the most "positive" answers while urinary and anxiety /memory were secondly and thirdly most prevalent respectively. CONCLUSION: The large number of patients included in this study allowed evaluation of the occurrence of non-motor symptoms in early and advanced disease in addition to the relationship of these kinds of symptoms with progression of disease.

Frequency of non-motor symptoms in Peruvian patients with Parkinson's disease / Frecuencia de síntomas no motores en pacientes peruanos con enfermedad de Parkinson

Introduction: Non-motor symptoms in Parkinson's disease are often not well recognized in clinical practice. Non-motor symptoms questionnaire (NMSQuest) is a simple instrument that allows patients or caregivers to report non-motor symptoms in a practical manner. Objective: We attempted to determine the prevalence of non-motor symptoms in three hundred Parkinson's disease outpatients. Results: The mean total non-motor symptoms was 12.41, ranging from 0 to 27 of a maximum of 30. At least one was present in 99.3% of patients. A progressive increase in mean total score was observed across each 5-year interval. Depression domain scored the most “positive” answers while urinary and anxiety /memory were secondly and thirdly most prevalent respectively. Conclusion: The large number of patients included in this study allowed evaluation of the occurrence of non-motor symptoms in early and advanced disease in addition to the relationship of these kinds of symptoms with progression of disease. .

Introducción: Los síntomas no motores en la enfermedad de Parkinson son frecuentes y no bien reconocidos en la práctica clínica. El Cuestionario de Síntomas No Motores (NMSQ) es un instrumento simple que permite a los pacientes o cuidadores reportarlos de una manera práctica. Objetivo: Intentamos determinar la prevalencia de síntomas no motores en trescientos pacientes con enfermedad de Parkinson. Resultados: El promedio total de SNM fue de 12.41 con un rango de 0 a 27 de un máximo de 30. Al menos uno estaba presente en el 99,35 de los pacientes. Un incremento progresivo del score promedio total se observa lo largo de intervalos de 5 años. Los síntomas más frecuentes fueron depresión, incontinencia urinaria y ansiedad respectivamente. Conclusión: La gran cantidad de pacientes evaluados permitió la evaluación de los SNM en fases tempranas y avanzadas de la enfermedad y la relación de los mismos con la progresión de la enfermedad .

Intoxicación plúmbica crónica: una revisión de la problemática ambiental en el Perú / Chronic lead poisoning: a review of the environmental peruvian problem

La intoxicación plúmbica crónica por exposición ambiental constituye un problema de salud pública en Perú, Latinoamérica y a nivel mundial, por sus efectos en la calidad de vida de las personas, particularmente de los niños expuestos. En el presente artículo se realiza una revisión de la intoxicación plúmbica crónica y la problemática asociada en Perú. Se revisa las principales fuentes de exposición al plomo, su dinámica en el organismo, sus efectos por aparatos y sistemas, las manifestaciones clínicas, de laboratorio, tratamiento, así como estudios realizados por instituciones nacionales y extranjeras.

Chronic lead poisoning by environmental exposure has become a public health problem in Peru, Latin America and worldwide because of its effects on quality of life of people, particularly children. In this article we review chronic lead poisoning and related problems in Peru. We review the major sources of lead exposure, pharmacodynamics, and effects on organ systems, clinic and laboratory manifestations, treatment, and studies developed by national and international organizations.

Violencia psicológica contra la mujer por su pareja en el Perú, 2004-2007 / Intimate partner psychological violence against women in Peru, 2004-2007

Objetivo: Estimar la prevalencia de vida de violencia psicológica (VP) contra la mujer por parte de su pareja en el Perú entre los años 2004 a 2007, así como los factores demográficos y socioeconómicos asociados. Material y métodos: Estudio transversal, se empleó la base de datos de la Encuesta Nacional Demográfica y de Salud Familiar realizada por el Instituto Nacional de Estadística e Informática entre 2004 y 2007. El diseño fue estratificado, multietápico e independiente para cada departamento. La población objetivo fueron mujeres de 15 a 49 años que hayan tenido o tengan pareja. Del cuestionario aplicado, se analizaron las secciones de antecedentes y violencia doméstica. Se realizó un análisis descriptivo y se calculó el OR con intervalos de confianza al 95% para los factores potenciales de riesgo mediante análisis bivariable. Resultados: La muestra estuvo constituida por 13 724 mujeres con una edad media de 33.7±8.2 años. El 46.9% eran convivientes. El 38.5 % tenía instrucción primaria, 34.6% secundaria y 5.5% analfabeta. La prevalencia de vida de VP fue 74.1%. Comparadas con las casadas, aquellas separadas o divorciadas tenían cuatro veces el riesgo de haber sufrido VP (OR 4.08 IC95% 3.41û4.88). Aquellas con educación secundaria tuvieron 29% mayor riesgo de haber sufrido VP comparado las de educación superior. El consumo de alcohol por parte de la pareja estuvo asociado a VP, aumentando el riesgo en 66%. Los departamentos de la sierra central tuvieron una mayor prevalencia de VP. Conclusiones: El Perú tiene una de las más altas prevalencias de vida de VP contra la mujer por parte de su pareja. Los factores de riesgo asociados fueron el nivel educativo, estado civil, el consumo de alcohol por parte de la pareja y el antecedente de padre que haya maltratado a su madre.

Objective: To estimate the lifetime prevalence of psychological violence (PV) against women by an intimate partner in Peru from 2004 to 2007, and the associated demographic and socioeconomic factors. Methods: Cross-sectional study. We used the database of the National Health Survey conducted by the National Institute of Statistics and Informatics between 2004 and 2007. The design was stratified, multistage and independent for each region. The target population was women aged 15 to 49 who have or have had intimate partners. We analyzed the background and domestic violence sections from the questionnaire. We performed a descriptive analysis and calculated OR and 95% confidence intervals for potential risk factors by bivariate analysis. Results: The sample consisted of a total 13 724 women with a mean age of 33.7±8.2 years. 46.9% were living with a partner without marriage; 38.5% had only attended elementary school, 34.6% finished high school and 5.5% were illiterate. The lifetime prevalence of PV was 74.1%. Compared with married women, those separated or divorced had four times the risk of having suffered PV (OR 4.08; 95% CI 3.41-4.88). Those with only high school education had 29% higher risk of PV compared with those of higher education. Alcohol abuse by the male partner was associated with PV, increasing the risk by 66%. The central highlands region had a higher prevalence of PV. Conclusions: Peru has one of the highest life prevalences for PV against women by an intimate partner. The significant risk factors were educational level, marital status, alcohol abuse by the partner and history of a psychological violence between the parents of the victim.