Magnetic Resonance Vessel Wall Imaging in Central Nervous System Vasculitides: A Case Series.

INTRODUCTION: We aim to report 3 cases of central nervous system (CNS) vasculitides, in which high-resolution magnetic resonance vessel wall imaging (HR-VWI) findings were instrumental in the diagnosis and management. CASE REPORT: Case 1: A 41-year-old obese, smoker female with arterial hypertension presented with recurrent transient ischemic attacks. Computed topography angiography demonstrated bilateral middle cerebral artery (MCA) stenosis. HR-VWI revealed uniform enhancement and thickening of the arterial wall, suggestive of MCA vasculitis. The patient reported chronic calf rash that was biopsied and revealed unspecified connective tissue disease. With immunomodulation, patient remained asymptomatic and 6-month surveillance HR-VWI showed improved MCA stenoses.Case 2: A 56-year-old male with herpes simplex virus 1 encephalitis was treated with antiviral therapy and improved clinically. Two months later, the brain magnetic resonance imaging revealed new temporo-parietal edema and distal MCA hyperintense vessels. HR-VWI showed MCA concentric smooth contrast enhancement, that was attributed to postinfectious vasculitis and had resolved on follow-up HR-VWI.Case 3: A 41-year-old male presented with 1-week of headache and encephalopathy. Brain magnetic resonance imaging revealed punctate multifocal acute ischemic infarcts and no contrast-enhancement. HR-VWI showed multifocal diffuse enhancement of distal cerebral vasculature. Patient subsequently developed branch retinal artery occlusion and hearing loss and was diagnosed with Susac syndrome. No recurrent symptoms were noted after immunotherapy initiation. CONCLUSIONS: In these 3 cases, HR-VWI identified distinctive vascular inflammatory changes, which were crucial to guide the etiological workup, positive diagnosis, surveillance neuroimaging, and targeted treatment. HR-VWI is an important diagnostic tool in CNS vasculitides, by providing nuanced information about arterial wall integrity and pathology.

Patients' and caregivers' experiences of the impact of Parkinson's disease on health status.

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disease that significantly affects patients' quality of life. The myriad complexities of the disease, including its nonmotor manifestations, are beginning to be more fully appreciated, particularly in regard to the emotional and social effects of PD. Considering that both motor and nonmotor manifestations of PD significantly influence the health outcomes and conditions of patients, and their health-related quality of life (HRQOL), we collected qualitative data from patients with PD, as well as caregivers of persons with PD having cognitive impairment, to assess their perceptions of the impact of PD on HRQOL. METHODS: We conducted eight focus groups and five one-on-one interviews in English and in Spanish between March 2007 and February 2008. Three of the focus groups were conducted with a total of 15 caregivers; the remaining focus groups and all interviews were conducted with 48 PD patients. Study participants were asked about the challenges that PD patients may experience, particularly pertaining to physical functioning, the impact of PD on their emotional status, and social functioning. RESULTS: Based on analysis of the transcripts, we identified seven overarching domains or themes that reflect patients' perspectives on living with PD, ie, physical functioning, social and role functioning, emotional impact, fears and uncertainty about the future, stigma and other feelings about PD, coping mechanisms, and benefits of having PD. CONCLUSION: We underscore the salient aspects regarding the physical effects of PD along with its nonphysical ramifications, offering perspectives into the experience of PD and suggestions on how PD patients and their caregivers may cope with the disease.

Optimizing algorithms to identify Parkinson's disease cases within an administrative database.

Patients assigned the diagnostic ICD-9-CM code for Parkinson's disease (PD) in an administrative database may not truly carry that diagnosis because of the various error sources. Improved ability to identify PD cases within databases may facilitate specific research goals. Experienced chart reviewers abstracted the working diagnosis of all 577 patients assigned diagnostic code 332.0 (PD) during 1 year at a VA Healthcare System. We then tested the ability of various algorithms making use of PD and non-PD diagnostic codes, specialty of clinics visited, and medication prescription data to predict the abstracted working diagnosis. Chart review determined 436 (75.6%) patients to be PD or Possibly PD, and 141 (24.4%) to be Not PD. Our tiered consensus algorithm preferentially used data from specialists over nonspecialists improved PPV to 83.2% (P = 0.003 vs. baseline). When presence of a PD prescription was an additional criterion, PPV increased further to 88.2% (P = 0.04 vs. without medication criterion), but sensitivity decreased from 87.4 to 77.1% (P = 0.0001). We demonstrate that algorithms provide better identification of PD cases than using a single occurrence of the diagnostic code for PD, and modifications of such algorithms can be tuned to maximize parameters that best meet the goals of a particular database query.