Journal of the neurological sciences
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Red cell distribution width (RDW) is a hematological parameter routinely obtained as part of the complete blood count. Recently, RDW has emerged as a potential independent predictor of clinical outcome in patients with established cardiovascular disease. However, little is known about the role of RDW as a prognosticator among persons with stroke, especially with regard to an incontrovertible endpoint like mortality. We assessed the association of RDW with stroke, and its effect on mortality among persons with stroke. ⋯ Elevated RDW is associated with stroke occurrence and strongly predicts both cardiovascular and all-cause deaths in persons with known stroke.
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Review Historical Article
The history of multiple sclerosis: the changing frame of the disease over the centuries.
For centuries, it was recognised that there was a condition characterised by episodic and progressive neurological deterioration, classified as 'paraplegia'. Some early cases of 'paraplegia' have been described in sufficient detail to recognise a condition resembling what we now call multiple sclerosis and these cast an interesting light on the approach to therapy before the disease had a name. Multiple sclerosis was differentiated and 'framed' as a separate identifiable entity by von Frerichs, Vulpian, Charcot and others in the mid-nineteenth century. ⋯ At the same time, attitudes of physicians towards management of people with multiple sclerosis changed. In the last fifty years, the major advances have been in basic research to elucidate the mechanisms and processes underlying the disease, the development of imaging techniques (MRI) and the development of immunomodulatory drugs which, for the first time, are altering the outcome of the disease. We have now entered the therapeutic era of multiple sclerosis, with continual major advances bringing hope and benefit to people with multiple sclerosis.
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Multiple sclerosis (MS) is characterised by focal areas that undergo cycles of demyelination and remyelination. Although conventional magnetic resonance imaging is very effective in localising areas of damage, these techniques are not pathology specific. A newer technique, T(2) relaxation, can separate water from brain into three compartments: (1) a long T(2) component (>2 s) arising from CSF, (2) an intermediate T(2) component (~80 ms) attributed to intra- and extra-cellular water and (3) a short T(2) component (~20 ms) assigned to water trapped in between the myelin bilayers (termed myelin water). ⋯ Two lesions showed low MWF in the core suggesting demyelination upon first appearance. At later time points, one lesion showed a decrease in volume of low MWF, reflecting remyelination whereas the volume of low MWF in the other lesion core remained constant. This work provides evidence that MWF and WC can monitor demyelination and remyelination in MS.
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The CACNA1A gene codes for the alpha(1A) pore-forming subunit of Ca(2+) voltage-gated Cav2.1 channels. CACNA1A mutations are responsible for Familial Hemiplegic Migraine (FHM) type 1, Episodic Ataxia (EA) type 2 and Spinocerebellar Ataxia type 6. The structure of the human gene includes, at present, 49 exons; however almost nothing is known about the 5' regulatory region, and there is now evidence suggesting the presence of additional exons at the 3' of the gene. ⋯ At the 3' end of the gene a new exon 48, followed by a strong poly-A signal, was identified as well as a new splice variant. The 5 bp insertion (g.38429_38430insCTTTT) in this exon was found in an EA patient. The two new regions can open the way for the study of human CACNA1A gene expression regulation and can be sites of mutations associated with FHM or EA phenotypes.
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Case Reports
Isolated facio-lingual hypoalgesia and weakness after a hemorrhagic infarct localized at the contralateral operculum.
Isolated facio-lingual hypoesthesia and weakness is rare. We describe a case of isolated facio-lingual hypoesthesia and weakness after a hemorrhagic infarct localized at the contralateral operculum. ⋯ Brain magnetic resonance imaging showed a subacute hemorrhagic infarct in the right frontal operculum, which spread slightly to the right temporo-parietal operculum. (123)IMP-SPECT showed hypoperfusion in the right fronto-temporo-parietal operculum, as detected by MRI, without apparent diaschisis within the brain. Neuroimaging findings for our patient suggested the involvement of the primary somatosensory-motor cortices (S1 and M1) and the secondary somatosensory cortex (S2), which receive trigemino-thalamo-cortical pathways.