Superficial siderosis of the central nervous system - treatment with steroids?

Steroids have been suggested as a therapeutic option for superficial siderosis of the central nervous system (SSCNS) without identifiable bleeding source. Longitudinal observational data of a patient with idiopathic SSCNS who was repeatedly treated with methylprednisolone over a course of 2 years are reported. The case history is critically discussed on the background of the sparse literature. In conclusion, if at all, there is only a limited and temporary, mostly subjective clinical response to steroids in SSCNS. Systematic studies of this medication in SSCNS do not seem warranted. Pathophysiological considerations hopefully may lead to more helpful medications for this chronic and debilitating disorder.

Neurologic manifestations of ulcerative colitis.

Ulcerative colitis (UC) has traditionally been considered to be an inflammatory disease limited to the colonic mucosa. However, since it has been shown that UC is frequently accompanied by various extraintestinal disorders, there is increasing evidence that UC may also manifest in the nervous system. The following review focuses particularly on these possible manifestations of UC, both in the peripheral (PNS), and in the central nervous system (CNS). A systematic literature search according to the MEDLINE database was performed for this purpose. Although a reliable differentiation may clinically not always be possible, three major pathogenic entities can be differentiated: (i) cerebrovascular disease as a consequence of thrombosis and thromboembolism; (ii) systemic and cerebral vasculitis; (iii) probably immune mediated neuropathy and cerebral demyelination. With the exception of thromboembolism and sensorineural hearing loss, evidence for a causal relationship relies merely on single case reports or retrospective case series. Considering the CNS-manifestations, similarities between UC-associated disorders of the white matter and acute disseminated encephalomyelitis (ADEM) are obvious. Epileptic seizures, unspecified encephalopathies and confusional states are most likely epiphenomena that have to be regarded symptomatic rather than as own entities. A prospective study on the neurologic aspects of UC would be very welcome.

Correlation of cognitive status, MRI- and SPECT-imaging in CADASIL patients.

Although there is evidence for correlations between disability and magnetic resonance imaging (MRI) total lesion volume in autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), the significance of structural MRI abnormalities for cognitive dysfunction remains controversial. We performed detailed neuropsychological testing, high resolution MRI, and Tc-99m-ethyl cysteinate-dimer SPECT in three CADASIL patients. MR-images were rated independently by two investigators for the presence of white matter lesions, lacunar infarcts, microbleeds, and ventricular enlargement. Cortical atrophy was quantified by the use of automatic morphometric assessment of the cortical thickness. In addition, laboratory and patients' history data were collected in order to assess the individual vascular risk factor profile. The differences in cognitive performance between the three patients are neither explained by structural-, or functional neuroimaging, nor by the patient-specific vascular risk factor profiles. The neuroradiologically least affected patient met criteria for dementia, whereas the most severely affected patient was in the best clinical and cognitive state. Conventional structural and functional neuroimaging is important for the diagnosis of CADASIL, but it is no sufficient surrogate marker for the associated cognitive decline. Detailed neuropsychological assessment seems to be more useful, particularly with respect to the implementation of reliable outcome parameters in possible therapeutic trials.

Clinical insights into paraneoplastic cerebellar degeneration.

Neuroimaging is usually unremarkable in paraneoplastic cerebellar degeneration (PCD), at least in the early stages of the disease. A patient with proven PCD is reported in whom it could be shown that cerebellar atrophy evolved very rapidly and was present in early imaging studies. Even with the use of the whole spectrum of modern diagnostic tools, the underlying malignancy can be difficult to diagnose. In addition to mammography, MRI is recommended in these cases and repeat FDG-PET may be necessary.

[Arterial hypertension and dementia]. / Arterielle Hypertonie und Demenz.

Arterial hypertension (AH) is considered to be an important risk factor for vascular cognitive impairment and probably for Alzheimer's disease, too. In the current review we provide an overview of the major prospective clinical trials on this issue. With respect to the inconsistent findings of these studies one must state that the interrelations between AH and dementia are still incompletely understood. Regarding therapy there thus is a simple rule: AH should be treated until normal blood pressure values are reached. As long as the hypothesis of a J-curve between blood pressure and cognitive dysfunction has not been disproved, overaggressive blood pressure lowering cannot be recommended. Regarding the aim of preventing dementia, there is no evidence for the superiority of a specific antihypertensive treatment regimen.

A new anti-neuronal antibody in a case of paraneoplastic limbic encephalitis associated with breast cancer.

Paraneoplastic neurological syndromes are rare remote effects of different types of cancer. Paraneoplastic limbic encephalitis is a specific syndrome, most often associated with small cell lung carcinoma. This report describes the case of a pure limbic encephalitis in association with breast cancer. An anti-neuronal antibody was found in the serum and CSF of the patient which has not been reported so far.

Intracerebral haemorrhage as a manifestation of Lyme neuroborreliosis?

Lyme Neuroborreliosis (LNB) has repeatedly been reported to cause cerebral vasculitis. However, there is no reliable information about the incidence of cerebral vessel affection. The majority of reports deal with ischaemic consequences, and there are a few reports of subarachnoid haemorrhage (SAH). We report a case of otherwise unexplained intracerebral haemorrhage (ICH) where clinical and laboratory tests have shown LNB. Late stage LNB might not only cause ischaemic, but haemorrhagic stroke as well.

[Cocaine-induced acute CNS diseases]. / Kokaininduzierte akute ZNS-Erkrankungen.

Drug-associated/-induced neurological complications are well known in the literature. Cocaine is of major interest due to its widespread use. On the basis of a case report, we discuss the broad spectrum of medical and, in particular, neurological complications. The risk of cerebrovascular damage and epileptic seizures is indicated. The pathophysiological mechanisms of cerebrovascular complications are not well understood.

An analysis of dental hygienist remuneration. Part III. From the results of the Ohio Dentist and Dental Hygiene Surveys.

The Division of Dental Hygiene of Ohio State University, working under a grant from the Ohio Dental Association, completed research defining the practice of dental hygiene in Ohio utilizing data gathered in the summer of 1991. This portion of the research focuses on the salaries and benefits earned by practicing Ohio dental hygienists. It also presents the salary and benefit levels which Ohio dentists believe to be reasonable for dental hygienist employees. The largest number of dental hygienists work 27 hours per week and are paid a straight salary averaging $15.86 per hour. The largest number of dentists believe that experienced, full-time dental hygienists should receive higher salaries and more benefits than part-time hygienists. They feel that $16-$21 per hour is a reasonable salary, and they most often provide reduced dental fees as a benefit.

Relationships between dental hygienists' career attitudes and their retention of practice. Part II. From the results of the Ohio Dentist and Dental Hygiene Surveys.

This article utilizes findings from the Ohio Dental Hygiene Survey and Ohio Dentist Survey to uncover what specific dental hygiene attitudes exist relative to employment and what factors have led to job termination and to re-entry. Ohio dental hygiene employees are most satisfied with patient relationships, co-worker relationships, and flexible working hours. The dental hygienists are least satisfied with fringe benefits, financial growth, and career creativity. Salary, benefits, nor career longevity were significant factors in determining satisfaction. Dental hygienists who were not working when surveyed, said they would consider returning to practice if a better salary were available, if they could find part-time work, if there were a good wage scale with benefits, or if their own financial need changed. Thirty-six percent of the non-practitioners said they would not ever consider returning to practice due to working conditions, establishment of a new career, or inadequate compensation. Dentist employers stated that they were satisfied or very satisfied with their dental hygienists' patient care and contribution to the practice.

Developmental biology of the common marmoset: proposal for a "postnatal staging".

The published knowledge on neurobiological, psychological, and ethological aspects of development in Callithrix jacchus is still limited. We have collected published and unpublished data from several Callithrix colonies and pooled information on criteria for developmental progress and maturation using a questionnaire sent to numerous experts in the field. The data suggest that developmental stages can be defined not only for the embryonic and fetal but also for the postnatal period. Based on multifactorial definitions, using criteria selected from maturational changes in the motor and visual systems and behavioral features, we propose to subdivide postnatal development of the common marmoset into seven periods ("stages").

The competitive NMDA antagonist CGP40.116 enhances L-dopa response in MPTP-treated marmosets.

Experiments in MPTP-treated non-human primates testing potential antiparkinsonian action have shown both, beneficial and adverse effects of gutamate receptor antagonists. To investigate this matter further, the novel competitive NMDA antagonist CGP40.116 was administered systemically to three adult MPTP-treated marmosets. When coadministered subcutaneously with a subthreshold dose of L-DOPA, 2 mg/kg, CGP40.116 25-250 micrograms/kg, increased locomotor activity. However, when administered alone, CGP40.116 had no effect on locomotor activity.

Spontaneous inclusion body hepatitis in young tamarins: I. Morphological study.

Over a period of 4 years approximately 60% of the new born and juvenile animals in a breeding colony of tamarins (Saguinus fuscicollis) died a sudden death. Histological examination at necropsy revealed interstitial hepatitis in 22 of the 30 young animals of the present study. The hepatocytes contained intranuclear inclusion bodies in 12 of the 22 cases. Upon ultrastructural examination, tubulovesicular structures and amorphous material were found in the nuclei. The endoplasmic reticulum had proliferated and was closely associated with undulating curved membranes. These morphological alterations resemble those reported in chimpanzees experimentally infected with NANB hepatitis viruses.