Isolated abducens nerve palsy following lumbar puncture is a rare complication. In scientific literature, it has been mostly described after performing spinal anesthesia in anesthesiology literature ...rather than in neurological literature. Isolated abducens nerve palsy usually occurs from one to three weeks after performing lumbar puncture and it is important to connect it with this procedure and exclude other possible etiologies. The actual incidence of this complication is unknown. We describe a 32-year-old male patient who presented with unspecific headache attributed to cavernous malformation and two developmental venous anomalies. While searching for headache etiology, lumbar puncture was performed. Two days after lumbar puncture, the patient presented with isolated abducens palsy of the right eye. Our planned diagnostic evaluation included measuring intracranial pressure by noninvasive optic sheath nerve sonography and repeating brain magnetic resonance imaging. We also planned to treat the patient with epidural blood patch, which is usually successful when performed as soon as the diagnosis is established. Unfortunately, our patient refused diagnostic and therapeutic proposal, so it was impossible to know final outcome. In conclusion, we want to highlight these complications, especially to young doctors and specialists who might see it rarely.
Abstract The term neurologic symptom usually relates to the loss of motor or sensory functions; cognitive deficit is mostly unrecognized in patients with severe carotid stenosis. In large population ...studies carotid stenosis has been shown as independent risk factor for mild cognitive impairment (MCI) and it was not due to underlying vascular risk factors. The term MCI refers to a transitional stage between cognitive changes of normal aging and vascular dementia. At this stage, cognitive decline is not severe enough to constitute dementia, but also it is beyond the cognitive functioning deficit which is expected in normal aging. Carotid stenosis detected in population older than 65 is 75% for men and 62% for women, with prevalence of stenosis ≥ 50% in this population 7% for men and 5% for women. There are two possible underlying pathomorphological mechanisms of cognitive changes in patients with carotid disease — cerebral emboli and hypoperfusion with or without silent brain infarctions. In both cases loss of regional cerebral autoregulation can be recognized by means of neurosonology (transcranial Doppler ultrasonography). Most of the studies which evaluated cognitive functions before and after CEA/CAS have shown improvement or no changes in cognitive functions, but no deteriorations. There are still no clear recommendations about using CEA/CAS in treating cognitive deficit in otherwise asymptomatic patients. It is important to recognize cognitive changes as a symptom of carotid disease in order to follow up such patients and include cognitive deficit as one of the criteria in calculating perioperative risk and benefit from CEA/CAS.
Trigeminal neuralgia is one of the most common causes of facial pain. It implies
short lasting episodes of unilateral electric shock-like pain with abrupt onset and termination, in the
distribution ...of one or more divisions of the trigeminal nerve that are triggered by innocuous stimuli.
Most cases of trigeminal neuralgia are caused by compression of the trigeminal nerve root. Depending
on the etiology, trigeminal neuralgia can be classified as classic trigeminal neuralgia or painful trigeminal
neuropathy. It may be precipitated by some actions at trigger zones. The diagnosis of trigeminal
neuralgia is based on diagnostic criteria for classic trigeminal neuralgia, neuroimaging and
electrophysiologic trigeminal reflex testing. Treatment of classic trigeminal neuralgia for most patients
is pharmacological therapy, while surgical approach is reserved for patients that are refractory to medical
therapy and in cases of painful trigeminal neuropathy.
The concentration of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) in the blood is higher in patients with active multiple sclerosis (MS) compared to those with inactive disease. The ...concentration of IL-6 and TNF-α in the blood is higher in patients with Hashimoto's thyroiditis (HT) compared to those with a healthy thyroid. The aim of the study was to assess whether serum IL-6 and TNF-α levels correlated with saliva in patients with inactive MS and whether there was a difference in these groups of patients depending of thyroid status. We also examined the correlation of thyroid stimulating hormone (TSH) levels with thyroid status. The study included 54 patients in the inactive phase of MS. The level of cytokines in the blood was determined by chemiluminescence, and in saliva by ELISA. Blood and saliva IL-6 levels showed positive correlation, while blood and saliva TNF-α levels were not correlated. There was a significantly higher TSH level in patients with inactive MS with positive thyroid antibodies, without therapy, compared with those with negative antibodies.
This study compared the self-assessed health-related quality of life (HRQoL) and degree of depression between patients with chronic neuropathic nonodontogenic orofacial pain (NOFP) and healthy ...controls using the Short Form Survey (SF-36) health status questionnaire and Beck Depression Inventory II (BDI-II). This controlled cross-sectional study included 100 patients and 119 healthy controls. The diagnostic protocol recorded the following: 1) pain intensity using a visual analog scale for the time of examination and during the one-month prior; 2) evidence for neuropathic pain using the Leeds questionnaire for neuropathic signs and symptoms (LANSS); 3) emotional status using the BDI-II; and 4) HRQoL using the SF-36 questionnaire. The mean LANSS score was 17.18 in the patient group and 0.0 in the control group. The mean BDI-II score was 18.31 in the patient group and 5.87 in the control group. The SF-36 scores were shown with Mann-Whitney U testing to have statistically significant differences between the patient and healthy control groups in all categories. Vitality was the only SF-36 category in which the patient group scored higher than the control group. In conclusion, NOFP significantly reduces the self-reported HRQoL. NOFP is also related to the development of depression, but does not affect its severity. There is a significant correlation between depression and low quality of life in patients with NOFP.
The purpose of the study was to find differences in the parameters of the response to the blink reflex (BR) between patients with idiopathic trigeminal neuralgia (TN) and health volunteers. A ...prospective cohort study was conducted over 2 years. The TN-subgroup included 15 patients (mean age / SD 62.3 ± 10.7 years). Pain-free and healthy volunteers as a HV-subgroup (mean age / SD: 30.8 ± 8.1 years) were recruited from asymptomatic students of dental medicine. Diagnostic parameters were determined by measuring latency to the onset of the BR components from electric stimulation. The following branches of the trigeminal nerve were affected: maxillary branch only (26.7%), mandibular branch only (20%), combined: ophthalmic branch with maxillary branch (6.7%), and ophthalmic branch with mandibular branch (6.7%) respectively, combined maxillary and mandibular branch (26.7%) and affected all three branches (13.4%). The latencies of the BR, left and right side together, between subgroups were significantly higher for values R1 (homolateral early response), R2 (homolateral late response), R2c latency (contralaterally expressed response) in the TN-subgroup (p < 0.05). On the basis of the presence of R1c and R3 latencies and upon considering the abnormal findings of the BR, no statistically significant differences were found between the examined subgroups (p > 0.05). Blink-reflex parameters (R1, R2 and R2c) were significantly abnormal comparing TN-patients with healthy volunteers. The R3 component of the BR was related to noxious stimuli, likewise by innocuous stimuli.
Background
Different models that include clinical variables and blood markers have been investigated to predict acute ischemic stroke treatment course and recovery.
Aim
The aim of the study was to ...investigate associations between lipid levels, lifestyle factors, hemostatic (F5, F2, SERPINE1, F13A1, and FGB), and atherogenic (APOA5 and ACE) gene variants and acute ischemic stroke (AIS) severity.
Materials and methods
This study included 250 patients with AIS in which F5, F2, SERPINE1, F13A1, FGB, APOA5, and ACE genotypes were determined. Total cholesterol (TC), high-density cholesterol, low-density cholesterol, and triglycerides concentrations were measured within 24 h of the AIS onset. Examination of the neurological deficit was done using National Institutes of Health Stroke Scale/Score (NIHSS).
Results
APOA5 genotype TC + CC was more frequent (
P
= 0.026) in patients with the NIHSS score ≥ 21. Univariate regression analysis has shown that triglycerides (OR 0.55, 95% CI 0.34–0.91;
P
= 0.019), obesity (0.28, 95% CI 0.10–0.73;
P
= 0.010), age (OR 1.08, 95% CI 1.04–1.13;
P
< 0.001), and APOA5 genotype (TC + CC) (OR 2.40, 95% CI 1.10–5.25;
P
= 0.034) are significantly associated with a severe stroke. When all variables were included in model age (OR 1.06, 95% CI 1.01–1.11;
P
= 0.018), obesity (OR 0.25, 95% CI 0.08–0.77;
P
= 0.016) and APOA5 genotype (TC + CC) (OR 3.26, 95% CI 1.29–8.23;
P
= 0.012) remained significant for the risk of severe AIS.
Conclusion
APOA5 genotype (TC + CC), age, and obesity could be used as prognostic risk factors for a very severe stroke (NIHSS ≥ 21).
Apolipoprotein E (APOE) plays an important role in lipid metabolism and is a proven risk factor for development of dementia and other neurodegenerative diseases. The aim of the study was to determine ...the possible connection between particular APOE alleles, blood lipid profile and different types of epilepsy in children. Alleles of the APOE gene, blood cholesterol (total, high-density lipoprotein and low-density lipoprotein (LDL) cholesterol, and triglyceride levels were analyzed in blood samples of 111 children with epilepsy and 118 age- and sex-matched children without epilepsy. Distribution of APOE genotypes was the same in children of both groups. Significantly increased levels of total cholesterol and LDL cholesterol were found in control group (Z=3.49 and 3.52 respectively, p<0.01). No statistically significant difference was found between the genotypes of children with idiopathic and symptomatic epilepsy (χ
2
=1.96; df=2; p>0.05). There were statistically significant differences in the levels of total cholesterol (Z=2.09; p<0.05) and LDL cholesterol (Z=2.05; p<0.05) according to the type of epilepsy in favor of symptomatic epilepsy. The study confirmed that there was no connection between APOE and type of epilepsy in children and showed the children with epilepsy to have lower total cholesterol and LDL cholesterol levels. Interestingly, this also held true for children with idiopathic epilepsy compared to those with symptomatic condition.
Dental fear or dental phobia is caused by previous unpleasant dental experiences and pain. It can result in delaying or avoiding dental visits. Most often it leads to individuals avoiding visiting ...the dentist until physical pain completely impairs the quality of life.
Transcutaneous electrical nerve stimulation (TENS) is a method of pain relief involving the use of a mild electrical current. The main aim of this study was to examine whether the TENS device affects the reduction of anxiety and fear during dental procedures.
The study was conducted on a sample of 125 respondents, aged 9-14 years. Statistical significance of differences between pre- and post-treatment results on all applied measuring instruments was verified by the t-test for dependent samples. The calculation was performed for all respondents and individually for the three observed groups. The Children`s Fear Survey Schedule - Dental Subscale test was used to assess anxiety and fear.
The results on the CFSS-DS scale in all subjects did not differ statistically significantly before and after treatment (p > 0.05). The results on the CFSS-DS scale in subjects who received TENS were statistically significantly different before and after treatment (p < 0.01). The results on the CFSS-DS scale in subjects who received local anesthesia were statistically significantly different before and after treatment (p < 0.05).
The TENS device had an anxiolytic effect after the first visit.
•KFLC, especially KFLC index indicate diagnostic value for CIS and MS patients.•Along OCB, KFLC indicators could improve diagnostic and serve as a screening method.•OCB could be used in undefined ...cases only.•KFLC in patients who converted to MS is significantly higher.•With its predictive value, KFLC can contribute to early diagnosis and therapy.
The objective of the research was to evaluate diagnostic and predictive value for determination of KFLC in cerebrospinal fluid (CSF) compared to the qualitative procedure of OCB determination in patients with CIS who converted to MS during a two-year period.
KFLC, total immunoglobulin G (IgG), serum albumin and CSF albumin were determined with an immunonephelometric method in 151 patients with suspected MS who were admitted to the Neurology Clinic while CSF/serum quotients (QKFLC, QIgG and QAlb) and indexes were calculated with regards to albumin (QCSF/Qserum). Presence of OCBs was determined by isoelectric focusing with immunofixation. Based on their clinical, OCB and magnetic resonance imaging (MRI) findings, 50 patients were classified as other neurological disorder patients (OND), and 101 patients were classified as CIS, 50 of which converted to MS during the two-year period. ROC analysis, ROC curve comparisons and comparison of median KFLC parameters were used to find optimal cut-off with regards to CIS diagnosis and conversion to MS.
CSF KFLC median was 2,01 mg/L in MS group contrary to 0,68 mg/L and 0,17 mg/L in CIS and OND group, and KFLC index was 33,52 mg/L contrary to 9,68 mg/L and 3,71 mg/L (p < 0,0001). ROC analysis for accuracy of detection of intrathecal synthesis for QKFLC and KFLC index showed an AUC of 0,891 and 0,839 and the cut-off of 0,027 and 8,82, respectively (sensitivity 73,2% and 71,3%; specificity 96,0% and 98,0%; +PV 97,4% and 98,6%). The diagnostic accuracy of KFLC index for conversion from CIS to MS showed AUC of 0,840 and a cut-off of 9,092 (sensitivity 90,0%; specificity 73,3%; -PV 93,7%). Life age correlates significantly with serum KFLC (r = 0,34; p < 0,0001) and through aging process lower KFLC indexes can be expected, i.e. likelihood of false negative diagnoses.
KFLC index showed diagnostic value, although it is not more specific and more sensitive than OCB. Application of KFLC might serve as a screening method while OCB could be used in uninterpretted cases only. Patients who converted to MS have significantly higher KFLC which can contribute to an early diagnosis and prompt therapy with its predictive role.
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