Delayed recovery from ataxic dementia following liposuction.

A 19-year-old student developed hypoventilation and cyanosis at the end of a cosmetic liposuction procedure. She was awake, but severely abulic, disoriented, and unable to stand and walk due to severe locomotor ataxia. Neuropsychological evaluation showed psychomotor slowness, and deficits in memory encoding and retrieval, and on executive, and visuospatial and visuoperceptual tests; oral comprehension and constructional praxis were spared. ¹H-MRS showed a reduction of NAA. A year later, her cognitive and neurological exam, and NAA returned to normal, and she resumed her normal life. The severity of the acute manifestations of hypoxic encephalopathy not always entail a poor prognosis.

Optic ataxia in a patient with HaNDL syndrome.

We present a woman in her 40s who arrived at the emergency room with hypertension and optic ataxia. Her medical history is only relevant for obesity. Her lumbar puncture revealed high intracranial pressure and lymphocytic pleocytosis, and her neuroimaging tests, including angiography and venography, were normal. The patient improved after a cerebrospinal fluid drainage with a lumbar puncture, and her clinical manifestations resolved in parallel to the lymphocytic pleocytosis.The patient was diagnosed with a syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis and fully recovered 21 days after her discharge.

Causas de ataxia aguda en un hospital de tercer nivel de complejidad / Causes of acute ataxia at a tertiary level hospital

La ataxia es una alteración de la coordinación motora voluntaria y del control postural. Es una entidad poco frecuente en la infancia, siendo la principal causa de ataxia aguda descripta en la bibliografía, de origen inmunológico (post infecciosa), seguida de las intoxicaciones. Para el diagnóstico es fundamental una anamnesis detallada, cronología de los síntomas, antecedentes infecciosos o de contacto con sustancias tóxicas y un examen neurológico completo. El objetivo de nuestro estudio fue analizar retrospectivamente la causa de ataxia aguda como signo neurológico predominante en pacientes que consultaron en el Hospital Juan P. Garrahan. Diseño: Se trata de un estudio descriptivo, observacional, retrospectivo y de corte transversal. Población: niños de 1 a 18 años, con o sin patología previa conocida, que consultaron al servicio de emergencias del hospital por ataxia entre enero de 2013 y octubre de 2018. Método: recolección y análisis de historias clínicas comprendidas en esa fecha, con alteración en la marcha como síntoma de consulta. Resultados: de un total de 237 pacientes, la causa más frecuente de ataxia aguda fue la inmunológica (incluyendo en este grupo a las postinfecciosas y a las no asociadas a infección). Conclusión: En nuestro hospital con tercer nivel de atención, la causa más frecuente de ataxia aguda fue la inmunológica. En segundo lugar, las intoxicaciones y, en tercer lugar, las enfermedades neurológicas. (AU)

Ataxia is a disorder of voluntary motor coordination and postural control, which is rare in childhood. The main cause of acute ataxia described in the literature is immune-mediated inflammation (postinfectious), followed by intoxication. A detailed anamnesis, chronology of symptoms, history of infection or contact with toxic substances, and a complete neurological examination are essential in the diagnostic work-up. The aim of our study was to retrospectively analyze the cause of acute ataxia as a predominant neurological sign in patients who consulted at Hospital Juan P. Garrahan. Study design: A descriptive, observational, retrospective, cross-sectional study was conducted. Study population: children aged 1 to 18 years, with or without known previous disease, who presented to the hospital emergency department for ataxia between January 2013 and October 2018. Method: collection and analysis of medical records from that period of patients with gait disturbance as the reason for consultation. Results: out of a total of 237 patients, the most frequent cause of acute ataxia was immune-mediated inflammation (both post-infectious and noninfectious). Conclusion: In our tertiary care hospital, the most frequent cause of acute ataxia was immune-mediated inflammation. The second most frequent cause was intoxication and the third neurological diseases (AU)

Safety and Outcomes of Dentate Nucleus Deep Brain Stimulation for Cerebellar Ataxia.

Cerebellar symptoms remain orphan of treatment options despite being prevalent and incapacitating. Investigate whether dentate nucleus deep brain stimulation (DN DBS) is safe and leads to improvements in cerebellar symptoms when compared to sham stimulation. This randomized double-blind crossover pilot trial enrolled five patients with spinocerebellar ataxia type 3 or post-lesion ataxia. Active or sham phases were randomly performed three months apart. The primary outcome was ataxia improvement as measured by the Scale for the Assessment and Rating of Ataxia (SARA) after the active compared to the sham period. Secondary outcome measures included safety and tolerability, the Fahn-Tolosa-Marin Tremor Rating Scale (FTMRS), quality of life measurements, and patients' global impression of change. The effects on ataxia were numerically better in four out of five patients after active versus sham stimulation. The composite SARA score did not change after comparing active to sham stimulation (8.6 ± 3.6 versus 10.1 ± 4.1; p = 0.223). The FTMRS showed significant improvement after active stimulation versus sham (18.0 ± 17.2 versus 22.2 ± 19.5; p = 0.039) as did patients' global impression of change (p = 0.038). The quality of life was not modified by stimulation (p = 0.337). DN DBS was well tolerated without serious adverse events. One patient had the electrode repositioned. DN DBS is a safe and well tolerated procedure that is effective in alleviating cerebellar tremor. In this small cohort of ataxic patients, DN DBS did not achieve statistical significance for ataxia improvement.

Teaching Video NeuroImages: Posterior Cortical Atrophy Presenting With Balint Syndrome.

We present the case of a 68-year-old woman who developed progressive visuospatial deficits in a period of 18 months, leading to the loss of her independence for activities of daily living. After examination, she showed signs of Balint syndrome with optic ataxia, oculomotor apraxia, and simultanagnosia without visual acuity impairment. After brain imaging showing severe bilateral parieto-occipital association cortex atrophy, a diagnosis of posterior cortical atrophy was made according to the 2017 International Consortium's criteria.

Spontaneous poisoning by Talisia esculenta in cattle / Intoxicação espontânea por Talisia esculenta em bovinos

Talisia esculenta, commonly known as pitombeira, is a tree which fruits are widely consumed by human beings in northeastern Brazil. The aim of this work is to describe the epidemiological, clinical and pathological aspects of two outbreaks of spontaneous poisoning by T. esculenta in cattle in the dry region of Pernambuco, northeastern Brazil. The cases occurred in the municipalities of São Bento do Una and Belo Jardim. From a total of 25 adult cattle, eight become sick after ingest T. esculenta leaves and fruits. Four cattle died until 72 hours after the first clinical signs; which consisted in ataxia, reluctance to walk, tottering, head tremors muscle spasms in the limbs, rigidity of the pelvic limbs with wide base stance position, ruminal atony and, when stressed, presented falls and remained in abnormal positions. Two cattle were necropsied; the only significant finding was the presence of partially digested leaves, barks and seeds of T. esculenta in ruminal contents. Microscopically no lesions were observed. There is no specific therapy for poisoning by T. esculenta leaves. Prophylaxis consists in preventing cattle from gaining access to pasture areas containing the plant.(AU)

Talisia esculenta, popularmente conhecida como pitombeira, é uma árvore cujos frutos são amplamente consumidos por seres humanos no nordeste do Brasil. O objetivo deste trabalho é descrever os aspectos epidemiológicos, clínicos e patológicos de dois surtos de intoxicação espontânea por T. esculenta em bovinos no Agreste de Pernambuco, Nordeste do Brasil. Os casos ocorreram nos municípios de São Bento do Una e Belo Jardim De um total de 25 bovinos adultos, oito adoeceram após consumirem as folhas e frutos de T. esculenta. Quatro morreram em até 72 horas após a observação dos primeiros sinais clínicos; que consistiam em ataxia, relutância em caminhar, andar cambaleante, tremores de cabeça, espasmos musculares nos membros, rigidez dos membros pélvicos com posição de ampla base, atonia ruminal e, quando excitados, apresentavam quedas e permaneciam em posições anormais. Dois bovinos foram necropsiados e o único achado significante foi a presença de folhas, cascas e sementes parcialmente digeridas de T. esculenta no conteúdo ruminal. Microscopicamente não foram observadas lesões. Não existe terapia específica para a intoxicação pelas folhas de T. esculenta. A profilaxia consiste em evitar que bovinos tenham acesso às áreas de pastagem contendo a planta.(AU)

Spontaneous poisoning by Talisia esculenta in cattle / Intoxicação espontânea por Talisia esculenta em bovinos

Talisia esculenta, commonly known as pitombeira, is a tree which fruits are widely consumed by human beings in northeastern Brazil. The aim of this work is to describe the epidemiological, clinical and pathological aspects of two outbreaks of spontaneous poisoning by T. esculenta in cattle in the dry region of Pernambuco, northeastern Brazil. The cases occurred in the municipalities of São Bento do Una and Belo Jardim. From a total of 25 adult cattle, eight become sick after ingest T. esculenta leaves and fruits. Four cattle died until 72 hours after the first clinical signs; which consisted in ataxia, reluctance to walk, tottering, head tremors muscle spasms in the limbs, rigidity of the pelvic limbs with wide base stance position, ruminal atony and, when stressed, presented falls and remained in abnormal positions. Two cattle were necropsied; the only significant finding was the presence of partially digested leaves, barks and seeds of T. esculenta in ruminal contents. Microscopically no lesions were observed. There is no specific therapy for poisoning by T. esculenta leaves. Prophylaxis consists in preventing cattle from gaining access to pasture areas containing the plant.(AU)

Talisia esculenta, popularmente conhecida como pitombeira, é uma árvore cujos frutos são amplamente consumidos por seres humanos no nordeste do Brasil. O objetivo deste trabalho é descrever os aspectos epidemiológicos, clínicos e patológicos de dois surtos de intoxicação espontânea por T. esculenta em bovinos no Agreste de Pernambuco, Nordeste do Brasil. Os casos ocorreram nos municípios de São Bento do Una e Belo Jardim De um total de 25 bovinos adultos, oito adoeceram após consumirem as folhas e frutos de T. esculenta. Quatro morreram em até 72 horas após a observação dos primeiros sinais clínicos; que consistiam em ataxia, relutância em caminhar, andar cambaleante, tremores de cabeça, espasmos musculares nos membros, rigidez dos membros pélvicos com posição de ampla base, atonia ruminal e, quando excitados, apresentavam quedas e permaneciam em posições anormais. Dois bovinos foram necropsiados e o único achado significante foi a presença de folhas, cascas e sementes parcialmente digeridas de T. esculenta no conteúdo ruminal. Microscopicamente não foram observadas lesões. Não existe terapia específica para a intoxicação pelas folhas de T. esculenta. A profilaxia consiste em evitar que bovinos tenham acesso às áreas de pastagem contendo a planta.(AU)

[GLUT-1 deficiency syndrome]. / Sindrome de deficiencia de GLUT-1.

TITLE: Sindrome de deficiencia de GLUT-1.

[Fragile X syndrome and other entities associated with the FMR1 gene: Study of 28 affected families]. / Fragilidad del X y otras entidades asociadas al gen FMR1: estudio de 28 familias afectadas.

The fragile X syndrome occurs due to an expansion of CGG trinucleotides, called full mutation, which is found at the Xq27.3 locus of the FMR1 gene. It is the most common cause of inherited intellectual disability. Associated with autistic spectrum disorders in one third of the patients, it affects males with higher prevalence. It also leads to hypermethylation of the gene promoter, silencing it and reducing the expression levels of FMRP, a protein involved in synaptic maturation and plasticity. A lower expansion causes primary ovarian failure syndrome as well as tremor and ataxia syndrome characterized by progressive cerebellar ataxia of late onset and intention tremor. In the present case-control study we analyze the segregation of mutations of the FMR1 gene in different families and the variability of expression that led to the genetic consultation.

El síndrome de fragilidad del cromosoma X es la causa de discapacidad intelectual heredable más frecuente. Asociado a trastornos del espectro autista en un tercio de los pacientes, afecta, con mayor prevalencia, a los varones. Se debe a una expansión de trinucleótidos CGG (citosina, guanina, guanina), llamada mutación completa en el locus Xq27.3 del gen FMR1, que conduce a la hipermetilación en el promotor del gen y reduce los niveles de expresión de FMRP, una proteína implicada en la maduración y plasticidad sináptica. Una expansión menor de CGG es la causa de insuficiencia ovárica primaria y del síndrome de temblor/ataxia asociado a X frágil, caracterizado por ataxia cerebelosa progresiva, de inicio tardío, y temblor de intención. En el presente estudio de serie de casos, se analiza la segregación de mutaciones del gen FMR1 en diferentes familias y la variabilidad de expresión clínica que llevó a la consulta genética.

Neurological syndrome in goats associated with Ipomoea trifida and Ipomoea carnea containing calystegines.

A disease characterized by ataxia, tremors and nystagmus had been observed in goats in Nicaragua. The main histologic lesions were loss and neuronal vacuolation of Purkinje cells and Wallerian-like degeneration mainly in the cerebellum, suggesting a glycoprotein storage disease. Ipomoea carnea and Ipomoea trifida found in the paddocks were negative for swainsonine, but contained calystegines at 0.02% and 0.06% suggesting that the disease was caused by these substances, which are competitive inhibitors of ß-glucosidase and α-galactosidase activities.

[Clinical features of 63 patients with ataxia]. / Características clínicas de 63 pacientes con ataxia.

BACKGROUND: Ataxia can be classified as genetic, sporadic or acquired. AIM: To report the clinical features of a group of patients with ataxia. MATERIAL AND METHODS: Review of medical records of patients consulting in a specialized center in movement disorders. Those records in which the diagnosis of "ataxia" or "ataxic syndrome" appeared, were selected for the review. RESULTS: Of 4,282 records surveyed, the diagnosis of ataxia appeared in 95. After eliminating repeated or incomplete records, 63 were reviewed. RESULTS: Ataxia was sporadic, genetic and acquired in 27, 22 and 14 patients, respectively. The mean age at presentation for genetic, acquired and sporadic ataxia was 24, 46 and 53 years respectively. All autosomal dominant ataxias were type 3 spinocerebellar ataxia (SCA). Friedrich's ataxia was the most common recessive form. Most sporadic forms of ataxia were multiple system atrophy with predominant cerebellar ataxia (MSA-C) subtype. CONCLUSIONS: Considering the heterogeneity of patients with ataxia, we propose a method to approach them.

Gluten and Neuroimmunology. Rare association with Myasthenia Gravis and Literature Review.

As the celiac disease (CD), the non-celiac gluten sensitivity (NCGS) has also been associated with several autoimmune manifestations. It is rarely associated with myasthenia gravis (MG). This paper shall introduce the case of a young female patient, initially presenting a peripheral neuropathy framework. During clinical and neurological follow-up, she began to present symptoms of various immune-mediated morbidities. Diseases related to gluten represent a clinical spectrum of manifestations with a trigger in common, the ingestion of gluten. CD is the most well-known and serious disease of the spectrum, also called gluten-sensitive enteropathy. The NCGS is diagnosed from clinical evidence of improvement in symptoms followed by a Gluten Free Diet (GFD) in patients without signs of enteropathy in duodenal biopsy. There are indications that, although rare, with a prevalence of 1 in 5000, myasthenia gravis (MG) may occur more often when CD is also present. Between 13 to 22% of the patients with MG have a second autoimmune disorder. However, it is often associated with dermatomyositis or polymyositis, lupus erythematosussystemic lupus erythematosus, Addison's disease, Guillain-Barré syndrome and juvenile rheumatoid arthritis. Thus, the symptoms of neuromuscular junction involvement may give a diagnostic evidence of this rare association.