Spontaneous intracerebral hemorrhage is a type of stroke associated with poor outcomes. Mortality is elevated, especially in the acute phase. From a pathophysiological point of view the bleeding must traverse differen...Spontaneous intracerebral hemorrhage is a type of stroke associated with poor outcomes. Mortality is elevated, especially in the acute phase. From a pathophysiological point of view the bleeding must traverse different stages dominated by the possibility of re-bleeding, edema, intracranial hypertension, inflammation and neurotoxicity due to blood degradation products, mainly hemoglobin and thrombin. Neurological deterioration and death are common in early hours, so it is a true neurologicalneurosurgical emergency. Time is brain so that action should be taken fast and accurately. The most significant prognostic factors are level of consciousness, location, volume and ventricular extension of the bleeding. Nihilism and early withdrawal of active therapy undoubtedly influence the final result. Although there are no proven therapeutic measures, treatment should be individualized and guided preferably by pathophysiology. The multidisciplinary teamwork is essential. Results of recently completed studies have birth to promising new strategies. For correct management it's important to establish an orderly and systematic strategy based on clinical stabilization, evaluation and establishment of prognosis, avoiding secondary insults and adoption of specific individualized therapies, including hemostatic therapy and intensive control of elevated blood pressure. Uncertainty continues regarding the role of surgery.展开更多
Abdominal epilepsy is often unrecognised as an epilepsy condition, particularly in adults. We present a rare adult patient who suffers daily episodes of abdominal pinching pain described lasting for 30 seconds, often ...Abdominal epilepsy is often unrecognised as an epilepsy condition, particularly in adults. We present a rare adult patient who suffers daily episodes of abdominal pinching pain described lasting for 30 seconds, often evolving to loss of consciousness. Scalp EEG-video monitoring showed interictal left temporal slowing and frequent left temporal epileptiform discharges. Three stereotypical complex partial seizures consistent with her habitual attacks were recorded. Two seizures showed a left temporal onset and whereas the third one appeared to start on the right temporal lobe. In patients with paroxysms of abdominal pain, nausea or vomiting, abdominal epilepsy should be considered after exclusion of the most common aetiologies for gastrointestinal conditions.展开更多
Intravenous immunoglobulin (IVIg) treatment improves mus- cle strength in Lambert-Eaton myasthenic syndrome (LEMS), butits specific mod e of action is unknown. We have delineated its mode of action on neuromuscular b ...Intravenous immunoglobulin (IVIg) treatment improves mus- cle strength in Lambert-Eaton myasthenic syndrome (LEMS), butits specific mod e of action is unknown. We have delineated its mode of action on neuromuscular b locking properties of LEMS IgG. The effect of sera and purified IgG from six pat ients with LEMS on evoked quantal release was investigated after direct applicat ion to the motor nerve terminal by the perfused macro-patch-clamp electrode in mouse hemidiaphragms. The effect of LEMS IgG was analyzed alone and after coinc ubation with different concentrations of IVIg or its Fab fragments. All LEMS ser a and purified LEMS IgG fractions taken before IVIg treatment inhibited evoked q uantal release in a dose-dependent manner. When LEMS IgG was coincubated with a therapeutic IVIg preparation, presynaptic inhibitory activity of LEMS IgG was d iminished in a dose-dependent fashion. Monovalent Fab fragments were as effecti ve in neutralizing the activity of LEMS IgG as whole IVIg. These direct neutrali zing effects of IVIg may explain its therapeutic efficacy.展开更多
Intracytoplasmic aggregation of α synuclein protein as Lewy bodies in the brainstem neurons is diagnostic for Parkinson s disease, whereas if this proc ess also occurs in the cortical neurons, it is considered p...Intracytoplasmic aggregation of α synuclein protein as Lewy bodies in the brainstem neurons is diagnostic for Parkinson s disease, whereas if this proc ess also occurs in the cortical neurons, it is considered pathognomonic for deme ntia with Lewy bodies. However, the link between α synuclein incorporation into inclusions, neuronal dysfunction, and clinical symptoms needs to be clarified. Another important issue of the pathogenetic puzzle is to understand where α synuclein pathology begins and how it progresses in the brain. To study this, we collected all cases from autopsy material (N = 904) that had α synuclein pa thology in the dorsal motor nucleus of vagus,substantia nigra, and/or basal fore brain nuclei. In this way, our study has a unique design because the selection o f material is entirely based on the presence of α synuclein pathology regard less of clinical phenotype. Retrospective clinical assessment then showed that o nly 32 (30% ) of 106 α synuclein positive cases were diagnosed with a neu rodegenerative disorder. The distribution or load of α synuclein pathology d id not permit a dependable postmortem diagnosis of extrapyramidal symptoms or co gnitive impairment. Some neurologically unimpaired cases had a reasonable burden of α synuclein pathology in both brainstem and cortical areas, suggesting t hat α synuclein positive structures are not definite markers of neuronal d ysfunction.展开更多
Aim: To assess depression severity among multiple sclerosis (MS) patients. Methods: Our survey was carried out among a sample of 598 MS patients (35.8% were males and 64.2% were females) from all different regions of ...Aim: To assess depression severity among multiple sclerosis (MS) patients. Methods: Our survey was carried out among a sample of 598 MS patients (35.8% were males and 64.2% were females) from all different regions of KSA. A self-administered questionnaire was used for data collection. The Chi-square test was applied to examine the association between demographic factors, depression severity and level of disability. Results: The mean age of patients at the time of diagnosis was 26.1 ± 7.9 years (range 15 to 60 years). The mean duration of the disease was 6.6 ± 4.8 years. More than quarter of patients (27.1%) were admitted during last year. Our results revealed that 9.7% of MS patients had a positive family history of MS, 27.8% of patients were also suffering from different chronic diseases. A large proportion of patients were receiving drugs for MS (e.g. interferon-β by 26.2% of patients). Among respondents, the majority (53.2%) were likely to have a mild level of disability and mild depression severity (30.8%), with a significant relationship between the level of disability and depression severity. Conclusion: Severity of depression is mostly mild among MS patients, while only some have severe depression. Depression severity is significantly related to the level of MS patients' disability. Early support of MS patients, especially newly diagnosed ones, is strongly advised in order to ensure a better quality of life. It is recommended to conduct a nationwide study to explore severity of depression among MS patients in Saudi Arabia.展开更多
文摘Spontaneous intracerebral hemorrhage is a type of stroke associated with poor outcomes. Mortality is elevated, especially in the acute phase. From a pathophysiological point of view the bleeding must traverse different stages dominated by the possibility of re-bleeding, edema, intracranial hypertension, inflammation and neurotoxicity due to blood degradation products, mainly hemoglobin and thrombin. Neurological deterioration and death are common in early hours, so it is a true neurologicalneurosurgical emergency. Time is brain so that action should be taken fast and accurately. The most significant prognostic factors are level of consciousness, location, volume and ventricular extension of the bleeding. Nihilism and early withdrawal of active therapy undoubtedly influence the final result. Although there are no proven therapeutic measures, treatment should be individualized and guided preferably by pathophysiology. The multidisciplinary teamwork is essential. Results of recently completed studies have birth to promising new strategies. For correct management it's important to establish an orderly and systematic strategy based on clinical stabilization, evaluation and establishment of prognosis, avoiding secondary insults and adoption of specific individualized therapies, including hemostatic therapy and intensive control of elevated blood pressure. Uncertainty continues regarding the role of surgery.
文摘Abdominal epilepsy is often unrecognised as an epilepsy condition, particularly in adults. We present a rare adult patient who suffers daily episodes of abdominal pinching pain described lasting for 30 seconds, often evolving to loss of consciousness. Scalp EEG-video monitoring showed interictal left temporal slowing and frequent left temporal epileptiform discharges. Three stereotypical complex partial seizures consistent with her habitual attacks were recorded. Two seizures showed a left temporal onset and whereas the third one appeared to start on the right temporal lobe. In patients with paroxysms of abdominal pain, nausea or vomiting, abdominal epilepsy should be considered after exclusion of the most common aetiologies for gastrointestinal conditions.
文摘Intravenous immunoglobulin (IVIg) treatment improves mus- cle strength in Lambert-Eaton myasthenic syndrome (LEMS), butits specific mod e of action is unknown. We have delineated its mode of action on neuromuscular b locking properties of LEMS IgG. The effect of sera and purified IgG from six pat ients with LEMS on evoked quantal release was investigated after direct applicat ion to the motor nerve terminal by the perfused macro-patch-clamp electrode in mouse hemidiaphragms. The effect of LEMS IgG was analyzed alone and after coinc ubation with different concentrations of IVIg or its Fab fragments. All LEMS ser a and purified LEMS IgG fractions taken before IVIg treatment inhibited evoked q uantal release in a dose-dependent manner. When LEMS IgG was coincubated with a therapeutic IVIg preparation, presynaptic inhibitory activity of LEMS IgG was d iminished in a dose-dependent fashion. Monovalent Fab fragments were as effecti ve in neutralizing the activity of LEMS IgG as whole IVIg. These direct neutrali zing effects of IVIg may explain its therapeutic efficacy.
文摘Intracytoplasmic aggregation of α synuclein protein as Lewy bodies in the brainstem neurons is diagnostic for Parkinson s disease, whereas if this proc ess also occurs in the cortical neurons, it is considered pathognomonic for deme ntia with Lewy bodies. However, the link between α synuclein incorporation into inclusions, neuronal dysfunction, and clinical symptoms needs to be clarified. Another important issue of the pathogenetic puzzle is to understand where α synuclein pathology begins and how it progresses in the brain. To study this, we collected all cases from autopsy material (N = 904) that had α synuclein pa thology in the dorsal motor nucleus of vagus,substantia nigra, and/or basal fore brain nuclei. In this way, our study has a unique design because the selection o f material is entirely based on the presence of α synuclein pathology regard less of clinical phenotype. Retrospective clinical assessment then showed that o nly 32 (30% ) of 106 α synuclein positive cases were diagnosed with a neu rodegenerative disorder. The distribution or load of α synuclein pathology d id not permit a dependable postmortem diagnosis of extrapyramidal symptoms or co gnitive impairment. Some neurologically unimpaired cases had a reasonable burden of α synuclein pathology in both brainstem and cortical areas, suggesting t hat α synuclein positive structures are not definite markers of neuronal d ysfunction.
文摘Aim: To assess depression severity among multiple sclerosis (MS) patients. Methods: Our survey was carried out among a sample of 598 MS patients (35.8% were males and 64.2% were females) from all different regions of KSA. A self-administered questionnaire was used for data collection. The Chi-square test was applied to examine the association between demographic factors, depression severity and level of disability. Results: The mean age of patients at the time of diagnosis was 26.1 ± 7.9 years (range 15 to 60 years). The mean duration of the disease was 6.6 ± 4.8 years. More than quarter of patients (27.1%) were admitted during last year. Our results revealed that 9.7% of MS patients had a positive family history of MS, 27.8% of patients were also suffering from different chronic diseases. A large proportion of patients were receiving drugs for MS (e.g. interferon-β by 26.2% of patients). Among respondents, the majority (53.2%) were likely to have a mild level of disability and mild depression severity (30.8%), with a significant relationship between the level of disability and depression severity. Conclusion: Severity of depression is mostly mild among MS patients, while only some have severe depression. Depression severity is significantly related to the level of MS patients' disability. Early support of MS patients, especially newly diagnosed ones, is strongly advised in order to ensure a better quality of life. It is recommended to conduct a nationwide study to explore severity of depression among MS patients in Saudi Arabia.
