Journal of the neurological sciences
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Case Reports
Spontaneous spinal epidural hematoma: an urgent complication of adding clopidogrel to aspirin therapy.
We report a 56-year-old patient who had been taking antihypertensive medication in combination with prophylactic aspirin for 19 years who was diagnosed with stable angina with significant coronary artery stenosis on angiography. He was treated with drug-eluting coronary stent placement. Clopidogrel was added to the previous treatment regimen after stent placement. ⋯ The present case is interesting because it is the first case in spine which corresponds to the findings of MATCH study that bleeding tendency would be raised by dual antiplatelet treatment (aspirin+clopidogrel). With the popularity of antiplatelet medications, physicians should be aware of this critical side effect and provide urgent treatment. Furthermore, we should be cautious when we prescribe clopidogrel in addition to aspirin because it could cause bleeding complications like SSEH.
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The exact cause of amyotrophic lateral sclerosis (ALS) is unknown. Oxidative stress is one of the factors implicated in the etiology of ALS as well as in that of other neurodegenerative diseases. Uric acid is an important natural antioxidant that may reduce oxidative stress. The objective of this study was to prospectively determine the serum uric acid levels in ALS patients and allegedly healthy individuals and to correlate those values with measures of ALS disease progression among the patients. ⋯ ALS patients had lower serum uric acid levels than healthy individuals. The decreased uric acid levels were correlated to the rate of disease progression (ALSFRS-R decline), further demonstrating the possible role of oxidative stress in the induction and propagation of the disease.
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Despite the genetic heterogeneity reported in familial ALS (FALS), Cu/Zn superoxide-dismutase (SOD1) gene mutations are the most frequent cause of FALS, accounting for around 20% of familial cases (ALS1) and isolated sporadic cases. Some mutations are associated with a long survival time, while others are linked to a very rapid progression. Clinical-genetic characterization of ALS1 families is therefore important as it can provide information on the phenotype associated with a given mutation, the distribution of SOD1 mutations in different ethnic groups, and can clarify the genotype-phenotype correlation in patients with SOD1 gene mutations. ⋯ p.E22G is the ninth SOD1 gene mutation reported in Spain, and the third of these to be associated with long survival (the other two being p.G38R--previously G37R, and p.D77V--previously D76V). Our results emphasize the importance of genetic and clinical characterization of ALS1 families around the world for understanding the genotype-phenotype relationships of each SOD1 gene mutant and their relative frequency in different ethnic groups worldwide.
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Facioscapulohumeral muscular dystrophy (FSHD) is one of the most frequent forms of muscular dystrophy. The aims of this study were: 1) to evaluate the prevalence of sleep disordered breathing (SDB) in patients with FSHD; 2) to define the sleep-related respiratory patterns in FSHD patients with SDB; and 3) to find the clinical predictors of SDB. Fifty-one consecutive FSHD patients were enrolled, 23 women, mean age 45.7+/-12.3 years (range: 26-72). ⋯ The presence of SDB does not depend on the clinical severity of the disease. SDB is often asymptomatic, and no clinical or physical measure can reliably predict its occurrence. A screening of SDB should be included in the clinical assessment of FSHD.
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The purpose of the study is to investigate the embolic potential as well as ultrasonic characteristics of plaques in patients presenting with severe unilateral restenosis at least 1 year after carotid endarterectomy (CEA), compared with patients with severe unilateral primary carotid stenosis. ⋯ Carotid plaques in patients with severe unilateral carotid restenosis at least 1 year after surgery and in patients with primary lesions are similar in their embolic potential and ultrasonic characteristics.