Neurological manifestations related to Crohn's disease: a boon for the workforce.

The neurological manifestations of Crohn's disease and its prevalence are not well known. Here, we report five patients of confirmed Crohn's disease with different neurological presentations. The neurological presentations include anterior ischemic optic neuropathy, myelopathy, posterior reversible encephalopathy syndrome, chronic inflammatory demyelinating polyneuropathy, and chronic axonal sensory and motor polyneuropathy. These manifestations should be kept in mind in the assessment of Crohn's disease.

Brain perfusion imaging with voxel-based analysis in secondary progressive multiple sclerosis patients with a moderate to severe stage of disease: a boon for the workforce.

BACKGROUND: The present study was carried out to evaluate cerebral perfusion in multiple sclerosis (MS) patients with a moderate to severe stage of disease. Some patients underwent hyperbaric oxygen therapy (HBOT) and brain perfusion between before and after that was compared. METHODS: We retrospectively reviewed 25 secondary progressive (SP)-MS patients from the hospital database. Neurological disability evaluated by Expanded Disability Status Scale Score (EDSS). Brain perfusion was performed by (99 m) Tc-labeled bicisate (ECD) brain SPECT and the data were compared using statistical parametric mapping (SPM). In total, 16 patients underwent HBOT. Before HBOT and at the end of 20 sessions of oxygen treatment, 99mTc-ECD brain perfusion single photon emission computed tomography (SPECT) was performed again then the results were evaluated and compared. Brain perfusion was performed by (99 m) Tc-labeled bicisate (ECD) brain SPECT and the data were compared using statistical parametric mapping (SPM). RESULTS: A total of 25 SP-MS patients, 14 females (56 %) and 11 males (44 %) with a mean age of 38.92 ± 11.28 years included in the study. The mean disease duration was 8.70 ± 5.30 years. Of the 25 patients, 2 (8 %) had a normal SPECT and 23 (92 %) had abnormal brain perfusion SPECT studies. The study showed a significant association between severity of perfusion impairment with disease duration and also with EDSS (P <0.05). There was a significant improvement in pre- and post-treatment perfusion scans (P <0.05), but this did not demonstrate a significant improvement in the clinical subjective and objective evaluation of patients (P >0.05). CONCLUSIONS: This study depicted decreased cerebral perfusion in SP-MS patients with a moderate to severe disability score and its association with clinical parameters. Because of its accessibility, rather low price, practical ease, and being objective quantitative information, brain perfusion SPECT can be complementing to other diagnostic modalities such as MRI and clinical examinations in disease surveillance and monitoring. The literature on this important issue is extremely scarce, and follow up studies are required to assess these preliminary results.

Unusual neurologic manifestations of a patient with cyanotic congenital heart disease after phlebotomy.

Secondary erythrocytosis in cyanotic congenital heart disease (CCHD) is a compensatory response to chronic hypoxia which should be managed with caution. CCHD patients, who have compensated erythrocytosis but do not manifest significant neurologic symptoms, may experience secondary life-threatening complications such as stroke in case of inappropriate phlebotomy. This study reports a young man with CCHD who developed frequently repeated transient neurologic deficits with various presentations after one session of phlebotomy. The symptoms resolved a few days after the hematocrit (Hct) level returned to the prephlebotomy level.

Radiolabeled neurogenesis marker imaging: a revolution in the neurological diseases management?

A reduced rate of neurogenesis occurs in the adult brain of patients with neurological diseases, with the rate of new neuron proliferation not sufficient to replace neuron loss. Neurogenesis can be induced by several factors, including basic fibroblast growth factor, epidermal growth factor, and brain-derived neurotrophic factor. Neurogenesis determination is a valuable parameter for determining disease progression and monitoring various treatments. Currently, neurogenesis detection is possible by invasive methods, such as bromodeoxyuridine (BrdU) cell labeling and immunohistological analysis of immature neuron markers. However, these are not compatible with alive model examination. Neurogenesis detection by noninvasive methods, such as radiolabeling of specific antibodies and scintigraphy imaging, could shed light on immature neuronal markers. We propose that brain scintigraphy after radiolabeling of a specific antibody of an immature neuronal marker is a useful new modality for neurogenesis detection and that it would aid the management of neurological diseases.

Antiepileptic treatment is associated with bone loss: difference in drug type and region of interest.

UNLABELLED: The effects of antiepileptic drugs (AEDs) on bone mineral density (BMD) are well addressed, but data on children, especially concerning new antiepileptic medications, are scarce. This study aimed to reveal the impact of these drugs on the BMD of ambulatory patients with epilepsy. METHODS: BMD and detailed clinical information were obtained on 108 patients and 38 controls using dual-energy x-ray absorptiometry. The patients were categorized into 2 groups: enzyme-inducing AEDs (EIAEDs) and non-EIAEDs. Also, the patients were classified as being in either a monotherapy or a polytherapy group. All patients completed a 63-item questionnaire. In this study, the raw value of BMD, T score, and z score of the spine, neck of femur, total hip, and forearm were analyzed. RESULTS: Patients receiving AEDs showed diminished lumbar BMD, compared with controls (P < 0.05), regardless of the type of AED (EIAEDs or non-EIAEDs). In addition, there was a significant decrease in femoral neck BMD in patients receiving EIAEDs (0.922 ± 0.161, P < 0.05) but not in those treated with non-EIAEDs. Patients undergoing carbamazepine monotherapy (33 patients) showed diminished lumbar and femoral neck BMD, whereas those receiving valproate (22 patients) or undergoing polytherapy showed a BMD similar to that of controls in all studied regions of interest. There was no notable change in BMD in the Ward triangle, trochanter, or total hip in either the EIAED or the non-EIAED group. CONCLUSION: AED therapy, especially in patients on new-generation medication, is associated with low bone density. It is hoped that the presented data stressing several clinical and diagnostic points will stimulate a high index of suspicion to facilitate early diagnosis and preventive care.

Correlation of circulating omentin-1 with bone mineral density in multiple sclerosis: the crosstalk between bone and adipose tissue.

BACKGROUND: Patients with multiple sclerosis (MS) are at increased risk of osteoporosis and fractures. Adipose tissue-derived adipokines may play important roles in the osteoimmunology of MS. In order to determine whether omentin-1 and vaspin may be related to bone health in MS patients, we compared circulating levels of these recently identified adipokines, between MS patients and healthy controls. METHODS: A total of 35 ambulatory MS patients with relapsing-remitting courses were compared with 38 age- and sex-matched healthy controls. Bone mineral density (BMD) was determined for the lumbar spine (L2-L4) and the proximal femur using dual-energy x-ray absorptiometry. Circulating omentin-1, vaspin, osteocalcin, osteopontin, osteoprotegerin, the receptor activator of nuclear factor-κB ligand, matrix metalloproteinase 9, C-reactive protein and 25-hydroxy vitamin D levels were evaluated by highly specific enzyme-linked immunosorbent assay methods. RESULTS: There was no significant difference between the two groups regarding bone-related cytokines, adipocytokines, and the BMD measurements of patients with MS and the healthy controls. However, in multiple regression analysis, serum omentin-1 levels were positively correlated with BMD at the femoral neck (ß = 0.49, p = 0.016), total hip (ß = 0.42, p = 0.035), osteopontin (ß = 0.42, p = 0.030) and osteocalcin (ß = 0.53, p = 0.004) in MS patients. No correlations were found between vaspin, biochemical, and BMD measures in both groups. CONCLUSIONS: Elevated omentin-1 serum levels are correlated with BMD at the femoral neck and the serum levels of osteocalcin and osteopontin in MS patients. Therefore, there is crosstalk between adipose tissue and bone in MS.

Radiolabeled annexin V imaging: a useful technique for determining apoptosis in multiple sclerosis.

Multiple sclerosis (MS) is an inflammatory disease of the central nervous system (CNS) that involves myelin, oligodendrocytes and axons and culminates in consecutive neuronal death and progressive neurologic disability. Based on magnetic resonance imaging (MRI), neuroaxonal loss in MS results in brain atrophy and has a strong correlation with neurological disability. The newer MR imaging tools seem to be sensitive biomarkers for measuring the pathogenetic processes associated with disease activity and progression. However, they are unable to detect apoptosis in neurodegenerative diseases. Annexin V has a high affinity for phosphatidylserine (PS) that presents on the outer surface of the plasma membrane early on during the onset of apoptosis. Radiolabeled annexin V imaging may reveal the initiation and degree of neuronal apoptosis. We propose that radiolabeled annexin V imaging is a useful modality in determining apoptosis in MS and can assess and monitor the effectiveness of neuroprotective and immunomodulatory therapies on the clinical course of MS.

Brain single photon emission computed tomography with Tc-99m MIBI or Tc-99m ECD in comparison to MRI in multiple sclerosis.

PURPOSE: To evaluate whether or not brain single photon emission computed tomography (SPECT) with Tc-99m MIBI or Tc-99m ECD (ethyl cysteinate dimer) can detect any abnormality in patients with definite multiple sclerosis (MS). We then compared these values with the results of T1, T2, and fluid-attenuated inversion recovery in magnetic resonance imaging (MRI). MATERIALS AND METHODS: A total of 16 patients with proved MS were enrolled in the study, and the MRI with and without gadolinium contrast and also brain SPECT with Tc-99m MIBI (8 cases) or Tc-99m ECD (8 other cases) were performed. RESULTS: MRI studies was performed in 16 patients (13 women and 3 men, aged 16-38 years) and an average of 10.47, 3.7, 5.3, 1.7, and 0.9 lesions was found in respect in periventricular white matter, juxtacortical white matter, corpus callosum, cerebellar peduncles, and brainstem, whereas brain SPECT with Tc-99m MIBI or Tc-99m ECD detected no abnormality. In addition, 6 cases had some degree of contrast enhancement. CONCLUSIONS: It seems that brain SPECT with Tc-99m MIBI or Tc-99m ECD would not improve this insufficiency. The small sizes of some plaques, particularly in chronic atrophic form of lesions, and the possibility of deeper anatomic positions of plaques can explain to some extent why the MS lesions were impossible to delineate on brain scan, although additional studies are needed.

Diagnostic role of whole body bone scintigraphy in atypical skeletal tuberculosis resembling multiple metastases: a case report.

INTRODUCTION: Osseous tuberculosis can be present with unifocal or multifocal bony involvement. Although multifocal involvement of the skeletal system in areas where tuberculosis is endemic is not a rare presentation, its exact prevalence is not well known. A case of atypical skeletal tuberculosis mimicking multiple secondary metastases on radiologic and scintigraphic imaging is presented to emphasize the contribution of bone scintigraphy in the assessment of osseous tuberculosis in typical and atypical presentations. CASE PRESENTATION: A 73-year-old cachectic Asian man (Iranian) presented with a general feeling of being unwell and an acute loss of vision in his left eye accompanied by a severe headache. A Tc-99 m-methylene diphosphonate bone scan demonstrated multiple regions of intense activity in the appendicular and axial skeleton, suggesting metastatic involvement. Tumor markers (PSA, CA125, CA 19-9 and AFP) were within normal ranges. Based on clinical presentation and laboratory, radiological and scintigraphic findings, a presumptive diagnosis of tuberculosis was made. Quadruple antituberculous chemotherapy was consequently started and the patient later showed marked improvement. CONCLUSION: Scintigraphic bone scanning should be kept in mind when assessing bone pain in patients at a high risk of tuberculosis infection or reactivation. We present this unusual case of multifocal skeletal tuberculosis, and stress the related clinical and diagnostic points with the aim of stimulating a high index of suspicion that could facilitate early diagnosis and appropriate treatment.