- Sporadic NF2 Mosaic: Multiple spinal schwannomas presenting with severe, intractable pain following pregnancy. [Journal Article]
- INInterdiscip Neurosurg 2017; 10:142-145
- The aim of the present paper is to report undiagnosed sporadic neurofibromatosis type 2 presenting with symptomatic compressive spinal tumors following pregnancy. A 36-year-old woman experienced prog...
The aim of the present paper is to report undiagnosed sporadic neurofibromatosis type 2 presenting with symptomatic compressive spinal tumors following pregnancy. A 36-year-old woman experienced progressive, severe lumbar radicular pain in the second trimester of pregnancy which became intractable soon after delivery. Magnetic resonance imaging revealed a complex heterogeneous hypointense mass lesion around the conus. There were two small punctate lesions in the cauda equina suggestive of myxopapillary ependymoma with 'drop metastases.' The patient underwent surgical resection of two cystic compressive conus masses. Her low back pain improved after surgery. The masses were consistent with cystic/cellular schwannomas. An incidental finding was of a small, low-grade spinal ependymoma which lacked the characteristic histologic features of myxopapillary ependymoma. Multiple, large cystic schwannomas are not uncommon in schwannomatosis, however, the co-occurrence of low-grade ependymoma strongly suggests a clinical diagnosis of new, sporadic neurofibromatosis type 2. Although cranial nerve schwannomas (orbital, auditory) have been reported to enlarge during pregnancy, to our knowledge, this is the first report of multiple cystic/cellular schwannomas causing severe pain (due to conus compression) during and immediately after pregnancy.
- Distress tolerance: Associations with trauma and substance cue reactivity in low-income, inner-city adults with substance use disorders and posttraumatic stress. [Journal Article]
- PAPsychol Addict Behav 2018; 32(3):264-276
- Cue reactivity has great potential to advance our understanding of posttraumatic stress disorder (PTSD), substance use disorder (SUD), and PTSD/SUD comorbidity. The present investigation examined dis...
Cue reactivity has great potential to advance our understanding of posttraumatic stress disorder (PTSD), substance use disorder (SUD), and PTSD/SUD comorbidity. The present investigation examined distress tolerance (DT) with regard to trauma and substance cue reactivity. Participants included 58 low-income, inner-city adults (49.1% women; Mage = 45.73, SD = 10.00) with substance dependence and at least 4 symptoms of PTSD. A script-driven cue reactivity paradigm was utilized. Four DT measures were administered, including the Distress Tolerance Scale (DTS), Mirror-Tracing Persistence Task (MTPT), Breath-Holding Task (BH), and Paced Auditory Serial Addition Task (PASAT). Lower DT, as indexed by MTPT duration, was significantly predictive of greater levels of self-reported substance cravings/urges in response to trauma cues, above and beyond covariates. Lower DTS scores predicted lower levels of self-reported control/safety ratings in response to substance cues. None of the DT indices was significantly predictive of heart rate variability. Clinical and research implications are discussed. (PsycINFO Database Record
- Retrobulbar steatitis and meningitis/empyema secondary to right otitis media, right otitis interna and an inflammatory polyp in a cat. [Journal Article]
- OVOpen Vet J 2018; 8(2):144-148
- The purpose was to describe a case of retrobulbar steatitis and meningitis in a cat caused by otitis media, otitis interna and an inflammatory polyp in the middle ear. Investigations included ophthal...
The purpose was to describe a case of retrobulbar steatitis and meningitis in a cat caused by otitis media, otitis interna and an inflammatory polyp in the middle ear. Investigations included ophthalmic and neurological examinations, haematology and biochemistry, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis and aerobic, anaerobic bacterial and fungal culture of material from the middle ear. A 6-year-old female neutered domestic-short-haired cat presented with right-sided exophthalmos and resistance to retropulsion. Anisocoria, reduced corneal sensation and oculocephalic movements and low Schirmer tear test (STT1) were found. An MRI revealed the right external ear canal and tympanic bulla to be fluid filled with presence of a thickened contrast-enhancing mucosa. Contrast enhancement extended into the calvarium, as marked thickening and contrast enhancement of the pachymeninges, and further rostrally through the right orbital fissure into the orbit. The retrobulbar tissues were swollen, resulting in mild exophthalmos. Enrichment culture of material from the middle ear revealed Klebsiella pneumonia susceptible to marbofloxacin. The cat underwent a total ear canal ablation with removal of the cartilaginous cuff at the external auditory meatus and local debridement and curettage. A polypoid structure was removed from the middle ear. No bulla osteotomy was performed. Horner's syndrome was present immediately following surgery. The cat received a course of systemic dexamethasone (1mg/cat SID/3 weeks) tapered off and marbofloxacin (2mg/kg SID/2 weeks). Follow up at 120 days showed no recurrence of the symptoms. The Horner's syndrome and low STT1 had resolved and returned to normal values respectively. This case highlights the importance of MRI in the investigation of retrobulbar diseases. MRI is a useful tool for the evaluation of the extent of the lesion and the appearance of adjacent structures in which additional potentially life-threatening abnormalities, such as meningitis, can be seen.
- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- A seizure is a symptom that refers to episodic, excessive and disorderly neuronal activity in the brain. Traditionally seizures have been classified into partial and generalized. Partial seizure refe...
A seizure is a symptom that refers to episodic, excessive and disorderly neuronal activity in the brain. Traditionally seizures have been classified into partial and generalized. Partial seizure refers to abnormal neural activity localized to one area of the cerebral hemisphere and having a discernible focal or localized onset. When there is no associated impairment in consciousness, it is called simple partial seizure, and when it is associated with impairment in consciousness, it is called a complex partial seizure. When a partial seizure becomes generalized, it is referred to as a "partial seizure with secondary generalization." New terminology for a simple partial seizure is "focal onset aware seizure." Partial seizures are the most common type of seizures in patients with epilepsy. Complex partial seizures occur more often than simple partial seizures, although most complex partial seizures start as simple partial seizures. Patients with simple partial seizure remain awake and aware throughout the seizure, and some patients can even talk during the episode. It may be difficult to distinguish them from complex partial seizure in infants and patients with cognitive and speech difficulties, as impairment in consciousness can be difficult to assess in these patients. The term "aura" refers to signs and symptoms that occur with a seizure before consciousness is lost and for which memory is intact afterward. Auras that are not followed by seizure should be considered focal aware seizures or simple partial seizures. Depending on clinical signs, symptoms, and EEG localization, focal seizures can be further subdivided into four types: (1) focal motor seizures, (2) focal sensory seizures, (3) autonomic seizures, and (4) psychological seizures. Focal Motor Seizures Focal or partial motor seizure occurs due to an epileptogenic lesion on the contralateral frontal lobe. Motor symptoms constitute the primary clinical manifestation. Typically, consciousness is not impaired in seizures of discrete motor areas. They usually originate from the supplementary motor area and cause turning movements of head and neck to the opposite side and sometimes tonic contractions of the limbs and trunk on the same side. This may or may not be followed by generalized clonic movements. Subdivisions of ictal motor symptoms include elementary (tonic, clonic, dystonic, versive) and automatism (coordinated, repetitive motor activity like lip smacking, tapping, and swallowing). Another classification based on clinical symptomatology uses the terms like focal clonic, focal tonic, or versive seizures. Focal motor seizures are more common on the face, hands, and toes because these areas have disproportionately large cortical representation. The excitatory focus is usually around the rolandic (motor) cortex. If there are accompanying sensory symptoms, the focus may be on post-rolandic convolution. Temporal lobe origin seizures sometimes have head-turning movements on the same side followed by the forceful contraversive turning of the head and body. Clonic seizures refer to repeated, short contractions of various muscle groups characterized by twitching movements or rhythmic jerking that recur at regular intervals of less than 1 to 2 seconds. These seizures are brief, lasting less than 1 to 2 minutes. In focal clonic seizures, there is epileptic activation of a restricted area of the precentral gyrus. Tonic seizures refer to sustained contractions that last for more than 5 to 10 seconds and result in the posturing of the limbs and whole body. Focal tonic seizures refer to tonic contractions restricted to a part of the body on one side. Focal tonic seizures are attributed to activation of Brodmann area 6, particularly mesial frontal region. There may be some involvement of the premotor areas in some cases. Versive seizures consist of sustained, forceful, involuntary turning of head and eyes to one side due to tonic contraction of head and eye muscles. Usually, they are accompanied by loss of consciousness, but occasionally patients may be aware of the forced involuntary eye and head turning. The version can result from seizures originating from various locations and spreading to premotor cortex. Following convulsions with predominant focal motor symptoms, patients may have transient, functional, and localized paralysis of the affected limbs. This is known as Todd paralysis and can last minutes to hours, usually in proportion to the duration of the convulsion. This postepileptic paralysis occurs due to persistent focal dysfunction of the affected epileptogenic area and is the signature of a focal seizure. It has significant clinical value in lateralizing the hemisphere of seizure onset. Jacksonian march seizure Jacksonian march seizure starts with tonic contractions in one hand or on one side of the face or the muscles of one foot. This is followed by clonic movements in these parts and sometimes a series of clonic movements with increasing frequency that builds up to a tonic contraction. These movements may spread ("march") from the muscles affected to the other muscles on the same side of the body. In classic Jacksonian march, the seizure spreads from hand to arm to face and then down the leg ipsilaterally, or if it started in the foot, then seizure marches up the leg, down the arm, and then to the face. This typically happens over a short time (20 to 30 seconds). There can be other associated symptoms like automatism (lip smacking or tapping movements), hallucinations, muscle cramping, head-turning, etc. Symptoms are usually mild. These seizures rarely become generalized, and typically consciousness remains intact. Jacksonian march seizure can be mistaken for a transient ischemic attack, migraine, or other condition. Focal Somatosensory Seizures Sensory seizures present as numbness, tingling, crawling sensation, "pins and needles" feeling, and rarely, as pain or thermal sensations. They can be focal or can march to other ipsilateral body parts and usually have focus in or around post-rolandic convolution of the contralateral cerebral hemisphere. Visual seizures are rare but have localizing significance. Visual hallucinations and visual loss are typical of occipital lobe epilepsy but sometimes can occur with seizure foci in anteromedial temporal and occipitotemporal regions. Auditory hallucinations are a rare initial manifestation of seizure and have sometimes been noted with lesions in posterior temporal lobe on one side. Olfactory hallucinations often occur with a lesion in inferior and medial parts of the temporal lobe. Gustatory hallucinations can occur in temporal lobe disease with lesions in the insula and parietal operculum. Autonomic seizures Autonomic seizures manifest with predominantly altered autonomic function. Some common autonomic signs and symptoms include diaphoresis, shivering, piloerection, rising sensation in epigastrium, nausea, changes in blood pressure and heart rate (commonly tachycardia), and pupillary changes. Autonomic features are common in several nonepileptic conditions, making autonomic seizures harder to diagnose. Some specific epilepsy syndromes with prominent autonomic features include neonatal seizures, epilepsy of infancy with migrating focal seizures, Dravet syndrome, benign epilepsy with centrotemporal spikes, and early-onset benign occipital epilepsy. Psychological seizures Psychological seizures manifest with affective and cognitive symptoms like memory flashback, dream-like events, Deja Vu feeling, hallucinations, anxiety, agitation, and uncontrolled laughter or crying. They arise commonly from the temporal area rather than extratemporal.
- Cognitive Features of High-functioning Adults with Autism and Schizophrenia Spectrum Disorders. [Journal Article]
- TPTurk Psikiyatri Derg 2018; 29(1):1-10
- CONCLUSIONS: Comprehension abilities of educated adults with HFA could be higher than average in situations that do not involve social interaction. Tendency to perseveration in the presence of adequate concept formation ability may reflect the clinical symptoms of rigidity and repetitive behavior. In patients with higher levels of functioning and education, their diagnosis appears to be weakly associated with cognitive functioning. The potential roles of other variables, such as environmental factors, during development deserve further exploration in future studies.
- Natural history and clinical characteristics of 50 patients with Wolfram syndrome. [Journal Article]
- EEndocrine 2018 May 04
- CONCLUSIONS: The early presence of a non-autoimmune insulin dependent DM, should alert us of an "infrequent" diabetes syndrome. Wolfram's presumptive diagnosis could be established if juvenile-onset DM occurs concomitantly with OA, and this visual impairment is not attributable to diabetic retinopathy. Despite the long period of evolution of DM and altered values of HbA1c, the prevalence of microvascular complications in the sample are low.
- Dysregulation of auditory neuroplasticity in schizophrenia. [Journal Article]
- SRSchizophr Res 2018 Apr 24
- Schizophrenia is a complex brain syndrome characterized by an array of positive symptoms (delusions, hallucinations, disorganized speech), negative symptoms (alogia, apathy, avolition) and cognitive ...
Schizophrenia is a complex brain syndrome characterized by an array of positive symptoms (delusions, hallucinations, disorganized speech), negative symptoms (alogia, apathy, avolition) and cognitive impairments (memory, executive functions). Although investigations of the cognitive deficits in schizophrenia have primarily concentrated on disturbances affecting higher-order cognitive processes, there is an increasing realization that schizophrenia also affects early sensory processing, which might, in fact, play a significant role in the development of higher-order cognitive impairments. Recent evidence suggests that many of these early sensory processing impairments possibly arise from a dysregulation of plasticity regulators in schizophrenia, resulting in either reduced plasticity or excessive unregulated plasticity. The purpose of the present manuscript is to provide a concise overview of how the dysregulation of cortical plasticity mechanisms contributes to schizophrenia symptoms with an emphasis on auditory dysplasticity and to discuss its relevance for treatment outcomes. The idea that plasticity mechanisms are not constrained only within sensitive periods suggests that many functional properties of sensory neurons can be altered throughout the lifetime.
- A mania-related memory bias is associated with risk for relapse in bipolar disorder. [Journal Article]
- JAJ Affect Disord 2018 Aug 01; 235:557-564
- CONCLUSIONS: A mania-related memory bias emerged as a predictor of mania recurrence, specifically in an unstructured setting such as ST. Perhaps mania-related schemata are more salient or more easily activated in those at high risk for recurrence. Interventions targeting patients' insight into their internal states as potential indicators of prodromal manic symptoms could be the key to improve the outcome of psychological interventions in BD. Additional research in the role of cognitive factors in relapse prevention is warranted.
- Towards an objective test of chronic tinnitus: Properties of auditory cortical potentials evoked by silent gaps in tinnitus-like sounds. [Journal Article]
- HRHear Res 2018 Apr 17
- A common method designed to identify if an animal hears tinnitus assumes that tinnitus "fills-in" silent gaps in background sound. This phenomenon has not been reliably demonstrated in humans. One te...
A common method designed to identify if an animal hears tinnitus assumes that tinnitus "fills-in" silent gaps in background sound. This phenomenon has not been reliably demonstrated in humans. One test of the gap-filling hypothesis would be to determine if gap-evoked cortical potentials are absent or attenuated when measured within background sound matched to the tinnitus sensation. However the tinnitus sensation is usually of low intensity and of high frequency, and it is unknown if cortical responses can be measured with such "weak" stimulus properties. Therefore the aim of the present study was to test the plausibility of observing these responses in the EEG in humans without tinnitus. Twelve non-tinnitus participants heard narrowband noises centered at sound frequencies of 5 or 10 kHz at sensation levels of either 5, 15, or 30 dB. Silent gaps of 20 ms duration were randomly inserted into noise stimuli, and cortical potentials evoked by these gaps were measured by 64-channel EEG. Gap-evoked cortical responses were statistically identifiable in all conditions for all but one participant. Responses were not significantly different between noise frequencies or levels. Results suggest that cortical responses can be measured when evoked by gaps in sounds that mirror acoustic properties of tinnitus. This design can validate the animal model and be used as a tinnitus diagnosis test in humans.
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- The recency ratio as predictor of early MCI. [Journal Article]
- IPInt Psychogeriatr 2018 Apr 18; :1-6
- CONCLUSIONS: Rr is an emerging cognitive marker of cognitive decline.