Journal of the neurological sciences
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Comparative Study
Percutaneous endoscopic gastrostomy in amyotrophic lateral sclerosis: effect on survival.
Percutaneous endoscopic gastrostomy (PEG) is offered to amyotrophic lateral sclerosis (ALS) patients with severe dysphagia. Immediate benefits of PEG are adequate food intake and weight stabilization. However, the impact of PEG on survival is still uncertain. In this work we retrospectively evaluated the effect of PEG on survival in a cohort of ALS patients followed in a tertiary referral centre. ⋯ This study demonstrates that PEG improves survival in dysphagic ALS patients, with few side effects. The procedure is safe and applicable even to patients with impaired respiratory function. PEG remains a milestone in palliative care in dysphagic ALS patients.
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Case Reports
Motor and sensory conduction failure in overlap of Guillain-Barré and Miller Fisher syndrome: two simultaneous cases.
We report 2 patients diagnosed simultaneously with an overlap of Guillain-Barré syndrome (GBS) and Miller Fisher syndrome (MFS), who had anti-GT1a, anti-GQ1b, anti-GD1a and anti-GD1b antibodies. There was no identifiable specific preceding infection. Both patients presented with upper and lower limb paresthesias and severe weakness, bulbar and facial weakness, ophthalmoparesis and areflexia. ⋯ This phenomenon relates to rapidly resolving CBs possibly induced by the transitory and limited attack of antiganglioside antibodies at the axolemma of the nodes of Ranvier not progressing to axonal degeneration. These cases widen the range of GBS subtypes in which reversible conduction failure has been described, to include overlap syndromes with MFS. The factors determining the electrophysiology, as well as the rate, degree and quality of recovery in GBS subtypes remain uncertain at the present time.
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Comparative Study
Comparison of diffusion tensor imaging and voxel-based morphometry to detect white matter damage in Alzheimer's disease.
Regional atrophy of gray matter (GM) in Alzheimer's disease (AD) is well known; however, the relationship between macroscopic and microscopic changes of cerebral white matter (WM) is uncertain. The aim of this study was to investigate the pattern of GM, WM atrophy, and microscopic WM changes in the same individuals with AD. All subjects (10AD and 15 healthy controls [HC]) underwent a MRI scanning at 1.5 T, including a 3-dimensional volumetric scan and diffusion tensor imaging (DTI). ⋯ Unlike WM atrophy on VBM analysis, microscopic WM changes were shown in the medial frontal, orbitofrontal, splenium of the corpus callosum, and cingulum on DTI analysis with SPM. We demonstrated that the pattern of macroscopic WM atrophy was similar to GM atrophy, while microscopic WM changes had a different pattern and distribution. Our findings suggest that WM atrophy may preferentially reflect the secondary changes of GM atrophy, while microscopic WM changes start earlier in frontal areas before GM and WM atrophy can be detected macroscopically.
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Fatigue is highly prevalent in multiple sclerosis (MS). It appears to be multifactorial, with "primary" or disease-related factors involved, as well as "secondary" factors, including comorbidities. Sleep disturbances are frequent in MS as well, and often result from disease-related factors. ⋯ Data from neuroimaging studies and studies of molecular consequences of sleep disorders in the general population, with particular attention to sleep-disordered breathing (SDB), are briefly reviewed. Potential biologic interactions with MS are discussed in this context. We conclude that further studies of sleep disorders in MS are needed, to objectively establish their significance in this disease, and also to document any impact of treatment of sleep disorders on biologic and clinical outcomes such as fatigue.
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We present a case involving a 24-year-old woman who developed anterior spinal cord infarction with paraplegia but preserved posterior column sensation shortly after her first surfing lesson. The clinical presentation and magnetic resonance imaging findings were compatible with anterior cord infarction from T11 to conus medullaris. However, a thorough diagnostic workup revealed no predisposing factors of ischemia. ⋯ In this case report, we discuss the probable relationship between surfing and ischemic myelopathy. Non-traumatic myelopathy in surfing is a relatively new entity thought to occur in surfers while paddling their boards in a hyperextended position and perform the Valsalva maneuver while attempting to stand up on the boards, which may increase intra-spinal pressure. Increased awareness of this injury may make it possible to recognize its early symptoms and prevent further injury.