European journal of neurology : the official journal of the European Federation of Neurological Societies
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Comparative Study
Changes in cerebral blood flow after acetazolamide: an experimental study comparing near-infrared spectroscopy and SPECT.
It is important to find a reliable and bedside method, which can estimate the cerebral blood flow (CBF) of patients in clinical settings. Estimation of CBF by calculating a blood flow index (BFI) using continuous wave near-infrared spectroscopy (CW-NIRS) and indocyanine green (ICG) as an i.v. tracer has been proposed to be a feasible and promising method. To validate if the BFI method can detect relative changes in CBF we compared data with the established method (133)Xenon single photon emission computer tomography ((133)Xe-SPECT). ⋯ The study shows that it is not possible to obtain reliable BFI data, which reflect changes in CBF after acetazolamide infusion, using the CW-NIRS and ICG method.
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Experimental studies suggest that deep brain stimulation (DBS) of the subthalamic nucleus (STN) induces impulsivity in patients with Parkinson's disease (PD). The purpose of this study was to assess various measures of impulse control in PD patients with STN DBS in comparison to patients receiving medical therapy. ⋯ Our data suggest that screening for impulsivity and ICDs should be performed prior to DBS, and that patients should be monitored for these problems during follow-up. Prospective trials are needed to confirm the findings of this exploratory study and to elucidate the reasons of a possible induction of impulsivity by STN DBS.
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Idiopathic inflammatory demyelinating disorders (IIDD) affect the central nervous system. In classical multiple sclerosis (CMS), brain, optic nerves [optic neuritis (ON)] and spinal cord [acute transverse myelitis (ATM)] are affected. In neuromyelitis optica (NMO), optic nerves and spinal cord are predominantly affected. NMO-IgG, an autoantibody targeting aquaporin-4, is a marker for NMO. We studied the frequency and clinical relevance of NMO-IgG seropositivity in IIDD patients. ⋯ Neuromyelitis optica -IgG facilitates diagnosis of NMO spectrum disorders. NMO-IgG seropositivity is associated with higher relapse rate in first 2 years.
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Overlooking a potential diagnosis of cauda equina syndrome (CES) can result in severe long-term neurologic deficits. There is a growing trend to order urgent magnetic resonance imaging (MRI) scans of the lumbar spine in any patient presenting with signs suspicious for CES. A substantial number of these MRI scans do not show cauda compression. The purpose of this study is to assess whether clinical characteristics can predict MRI-confirmed cauda compression. ⋯ In our series, urinary retention of more than 500 ml alone or in combination with two or more specific clinical characteristics were the most important predictors of MRI confirmed cauda compressions.