Posterior reversible encephalopathy syndrome in neuromyelitis optica spectrum disorders.

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is characterized by vasogenic subcortical edema without infarction. It has been associated with hypertensive crises and with immunosuppressive medications but not with neuromyelitis optica (NMO). METHODS: We reviewed the clinical and neuroimaging features of five NMO-immunoglobulin G (IgG) seropositive white women who experienced an episode of PRES and had a coexisting NMO spectrum disorder (NMOSD). We also tested for the aquaporin-4 (AQP4) water channel autoantibody (NMO-IgG) in 14 patients from an independently ascertained cohort of individuals with PRES. RESULTS: All five patients developed abrupt confusion and depressed consciousness consistent with PRES. The encephalopathy resolved completely within 7 days. Comorbid conditions or interventions recognized to be associated with PRES included orthostatic hypotension with supine hypertension, plasma exchange, IV immunoglobulin treatment, and high-dose IV methylprednisolone. Brain MRI studies revealed bilateral T2-weighted (T2W) hyperintense signal abnormalities, primarily in frontal, parieto-occipital, and cerebellar regions. Three patients had highly symmetric lesions and three had gadolinium-enhancing lesions. Follow-up neuroimaging revealed partial or complete disappearance of T2W hyperintensity or gadolinium-enhancing lesions in all five patients. Patients with PRES without NMOSD were uniformly NMO-IgG seronegative. CONCLUSIONS: Brain lesions in some patients with neuromyelitis optica spectrum disorder (NMOSD) may be accompanied by vasogenic edema and manifest as posterior reversible encephalopathy syndrome (PRES). Water flux impairment due to aquaporin-4 autoimmunity may predispose to PRES in patients with NMOSD who experience blood pressure fluctuations or who are treated with therapies that can cause rapid fluid shifts.

Mental retardation research methods in Latino communities.

The importance of understanding specific methods and strategies for conducting mental retardation research in Latino communities is discussed. Research methods used in the recruitment and analysis of a sample of 72 Puerto Rican mothers of a son or daughter with mental retardation are described. The emphasis is on the importance of involving the community in many aspects of the study in order to (a) ensure that the community benefits, (b) strengthen the scientific integrity of the study, and (c) facilitate sample recruitment.

Puerto Rican families caring for an adult with mental retardation: role of familism.

The role of familism (a cultural value including interdependence among nuclear and extended family members for support, loyalty, and solidarity) in caregiving was explored for Puerto Rican mothers with children with mental retardation living at home. Familism--defined here as direct caregiving provided by family members to the person with mental retardation, mothers' social support networks, and mothers' obligations to other family members--was hypothesized to account for variation in maternal well-being. Better maternal well-being was predicted by larger social support networks, greater satisfaction with social support, and more minor children living in the household. A troubling but not unexpected finding is that these mothers faced many socioeconomic challenges and were in poor health in addition to the challenges of parenting a child with mental retardation.