scholarly journals Millard-Gubler Syndrome Associated with Cerebellar Ataxia in a Patient with Isolated Paramedian Pontine Infarction – A Rarely Observed Combination with a Benign Prognosis: A Case Report

2021 ◽  
pp. 239-245
Author(s):  
Biniyam A. Ayele ◽  
Yonas Tadesse ◽  
Betesaida Guta ◽  
Guta Zenebe
Keyword(s):  
Vitamin D ◽  
Cerebellar Ataxia ◽  
Facial Palsy ◽  
Nerve Palsy ◽  
Brain Mri ◽  
Serum Vitamin ◽  
Magnetic Resonance Imaging Examination ◽  
Pontine Infarction ◽  
History Of ◽  
Horizontal Nystagmus

Isolated pontine infarction accounts for 7% of all ischemic strokes. Millard-Gubler syndrome is a clinical syndrome which occurs following lesions involving the ventral portion of the caudal pons, resulting in classic clinical features such as ipsilateral abducens and facial nerve palsy and contralateral hemiparesis. We report the case of a 55-year-old male patient having presented to the Yehuleshet Specialty Clinic 6 years back with sudden-onset dysarthria and appendicular ataxia of 10 days duration. He reported having right hemibody weakness and blurred vision, which have significantly improved since then. He had a history of smoking of 30 pack-years. However, he quit smoking 8 years ago. There was no history of prior stroke, transient ischemic attack, diabetes, hypertension, head trauma, or dyslipidemia. On examination, he had horizontal left gaze palsy with horizontal nystagmus suggesting left-sided 6th cranial nerve palsy. He had mild left-sided facial palsy causing dysarthric speech. Right upper limb dysmetria was observed during examination; otherwise, motor, sensory, fundus, and gait examination results were normal. He had low serum vitamin D. Brain magnetic resonance imaging examination showed a 25 × 10 mm segmental lesion in the left median pons involving the basis pontis and tegmentum section. The lesion had T2 and T1 abnormal prolongation with no diffusion restriction, suggesting a subacute pontine infarct. The patient was managed with aspirin 325 mg, atorvastatin 80 mg, physical therapy, and vitamin D supplementation, and advised on behavioral risk factors. Six years after his isolated pontine infarction, the patient is fully recovered from dysarthria, facial palsy, hemiparesis, right-sided appendicular ataxia, and horizontal nystagmus, and the follow-up brain MRI showed radiological evidence of chronic paramedian pontine perforator infarction. Millard-Gubler syndrome may present with cerebellar ataxia if the paramedian pontine infarction area slightly extends laterally, affecting the middle cerebellar peduncles. Isolated pontine infarction may have a good prognosis if diagnosed and managed early.

Serum Vitamin D and Cingulate Cortex Thickness in Older Adults: Quantitative MRI of the Brain

2019 ◽  
Vol 16 (11) ◽  
pp. 1063-1071 ◽  
Author(s):  
Gonzague Foucault ◽  
Guillaume T Duval ◽  
Romain Simon ◽  
Olivier Beauchet ◽  
Mickael Dinomais ◽  
...  
Keyword(s):  
Older Adults ◽  
Vitamin D ◽  
Brain Mri ◽  
Serum Vitamin ◽  
Cingulate Cortex ◽  
Posterior Cingulate Cortex ◽  
Vitamin D Insufficiency ◽  
Anterior Cingulate ◽  
Posterior Cingulate ◽  
Significant Difference

Background: Vitamin D insufficiency is associated with brain changes, and cognitive and mobility declines in older adults. Method: Two hundred and fifteen Caucasian older community-dwellers (mean±SD, 72.1±5.5years; 40% female) received a blood test and brain MRI. The thickness of perigenual anterior cingulate cortex, midcingulate cortex and posterior cingulate cortex was measured using FreeSurfer from T1-weighted MR images. Age, gender, education, BMI, mean arterial pressure, comorbidities, use of vitamin D supplements or anti-vascular drugs, MMSE, GDS, IADL, serum calcium and vitamin B9 concentrations, creatinine clearance were used as covariables. Results: Participants with vitamin D insufficiency (n=80) had thinner total cingulate thickness than the others (24.6±1.9mm versus 25.3±1.4mm, P=0.001); a significant difference found for all 3 regions. Vitamin D insufficiency was cross-sectionally associated with a decreased total cingulate thickness (β=- 0.49, P=0.028). Serum 25OHD concentration correlated positively with the thickness of perigenual anterior (P=0.011), midcingulate (P=0.013) and posterior cingulate cortex (P=0.021). Conclusion: Vitamin D insufficiency was associated with thinner cingulate cortex in the studied sample of older adults. These findings provide insight into the pathophysiology of cognitive and mobility declines in older adults with vitamin D insufficiency.

scholarly journals Vitamin D Intoxication in An Elderly: A Case Report

2019 ◽  
Vol 3 (4) ◽  
pp. 147-149
Author(s):  
Sahil Singh ◽  
Prernika Mittal ◽  
Ajay Sharma
Keyword(s):  
Vitamin D ◽  
Serum Vitamin ◽  
High Serum ◽  
Intravenous Fluids ◽  
Serum Vitamin D ◽  
Replacement Surgery ◽  
Vitamin D Intoxication ◽  
History Of ◽  
Very High

Vitamin D is a very common prescribed drug for numerous indications. Due to scarce knowledge and poor awareness of the various formulations, preparations and dosages of Vitamin D, there are many chances of prescription errors, medication errors, product use issue and undesirable adverse drug reactions. We hereby detail case of 70-year-old ex-army gentleman reported to us with a history of lethargy, confusion, reduced appetite and gait imbalance since few days with a history of knee replacement surgery 2 years back. Medical history was not of much relevance before it was revealed that he was getting cholecalciferol injection with a strength of 600000 IU once a week for few months. He was detected to have very high serum vitamin D level and hypercalcemia. He was started on intravenous fluids, diuretics and glucocorticoids. In a few days, after effective treatment, the patient was discharged in a recovering stage and advised to stop intake calcium and vitamin D in any form. At his last follow up, after a few months of discharge, he had totally recovered.

Vitamin D, Sun Exposure, and Lymphoma Risk.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1783-1783
Author(s):  
Jennifer L. Kelly ◽  
Jonathan W. Friedberg ◽  
Laura M. Calvi ◽  
Edwin van Wijngaarden ◽  
Susan G. Fisher
Keyword(s):  
Vitamin D ◽  
New York State ◽  
Serum Vitamin ◽  
Sun Exposure ◽  
B Cell Lymphoma ◽  
Vitamin D Insufficiency ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
History Of ◽  
Lymphoma Risk

Abstract While a large number of exogenous and endogenous factors have been examined, the etiology of most lymphoma subtypes remains largely unknown. However, recent research suggests that sunlight exposure is associated with reduced lymphoma risk. As sunlight is our major source of vitamin D, it has been suggested that increases in serum vitamin D are responsible for this association. Extra-renal activation of vitamin D results in autocrine and paracrine effects including: maintaining regulation of cell cycle proliferation, apoptosis induction, and increased cell differentiation signaling. Animal and human studies investigating the association between vitamin D and other cancers have provided support for a protective effect of vitamin D related to malignancy. We conducted a case-control study in western New York State to test the hypothesis that a history of vitamin D insufficiency increases the risk of lymphoma. Between October 2005 and September 2007, we recruited 140 newly diagnosed and previously untreated lymphoma cases and 139 clinic-based controls. Cases and controls were recruited concurrently to account for seasonal variation in vitamin D, and a serum sample and self-administered survey were collected from each subject. Current serum 25(OH)D levels were measured by radioimmunoassay (Heartland Assays Inc., Ames, IA). We used multiple linear regression to obtain quantitative estimates of past (5–10 years ago) serum vitamin D concentrations based on survey data and measured current vitamin D levels. Subsequently, we evaluated the association between estimated past vitamin D insufficiency (25(OH)D < 30 ng/mL) and lymphoma risk with multiple logistic regression, controlling for the effects of age, gender, race, prior skin cancer diagnosis, known family history of lymphoma or other cancer, alcohol use, and BMI. Additionally, we examined the association between self-reported past sun exposure and lymphoma risk. The case population included 89 males (64%), 124 whites (89%), and median age was 60; the control population included 61 males (44%), 123 whites (88%), and median age was 52. Median time between case diagnosis and study participation was 21 days (5 month maximum). Cases presented predominantly with advanced stage (64% Stage III/IV) diffuse large B cell lymphoma (23%) and follicular lymphoma (32%) subtypes, and 30 (21%) cases had documented B symptoms. While serum vitamin D values ranged from 2.5 to 45.6 ng/mL, we were surprised to find that the majority of the study population (74%) was vitamin D insufficient. Those with past vitamin D insufficiency were found to have a slightly lower lymphoma risk (multivariate adjusted odds ratio (OR) = 0.68; 95% confidence interval (CI) = 0.38 – 1.23), but this result was not statistically significant. Self-reported past sunbathing (OR=0.30, 95% CI: 0.11–0.85) and past outdoor occupation (OR=0.49, 95% CI: 0.25–0.96) were statistically significantly associated with reduced lymphoma risk. This study fails to provide evidence to support an important role of vitamin D insufficiency in lymphoma etiology. However, we confirmed the previously reported decrease in lymphoma risk associated with measures of increased sun exposure, thereby supporting the validity of our study data. Moreover, our findings suggest that vitamin D insufficiency may not explain the observed association between sun and lymphoma. In light of both the high prevalence of vitamin D insufficiency and the known risk of excessive chronic sun exposure, further investigation of the risks of vitamin D insufficiency, as well as alternative pathways for the demonstrated inverse associations between sun exposure and lymphoma risk, is warranted.

scholarly journals ASSOCIATION BETWEEN MATERNAL SERUM VITAMIN D AND EARLY PREGNANCY SPONTANEOUS ABORTION IN IRAQI WOMEN

2018 ◽  
Vol 11 (2) ◽  
pp. 432
Author(s):  
Ashwaq Kadhim Mohammed ◽  
Vian Hussam Almansi Alqani
Keyword(s):  
Vitamin D ◽  
Spontaneous Abortion ◽  
Early Pregnancy ◽  
Pregnancy Loss ◽  
Strong Predictor ◽  
Serum Vitamin ◽  
Maternal Serum ◽  
Childbearing Age ◽  
Serum Vitamin D ◽  
History Of

Objective: This study was aimed to estimate the Vitamin D serum concentration in a cohort of women with a history of recurrent spontaneous abortion.Methods: The current cross-sectional study was conducted at Al-Diwaniya maternity and child teaching hospital, Al-Diwaniya province, Iraq. Data collection, lab work, and procedures related to the study extended from August 2016 to August 2017. The study enrolled 42 women of childbearing age who have a history of spontaneous early pregnancy loss. From each woman, a venous sample was obtained and sent to a lab to assess serum Vitamin D concentrations using standard routine biochemical methods.Results: Assessment of mean maternal serum Vitamin D concentration revealed that the mean was 21.48±11.82 (ng/ml) and the range was from 5 to 50 (ng/ml). The number of women with low serum Vitamin D (<20 ng/ml) was 25 (approximately 60%), the results also revealed a highly negative correlation was obtained between number of abortions and maternal serum Vitamin D (r=−0.717, p<0.001) and that the value or R2 was 0.514 which indicated that the level of Vitamin D alone can act as an independent predictor to explain 51.4% of spontaneous abortions in the participating women.Conclusion: Vitamin D level is a strong predictor of pregnancy loss in early pregnancy, and that correction of Vitamin D status among Iraqi pregnant ladies may substantially reduce the frequency of spontaneous abortion.

Association between serum vitamin D level and history of falls in elderly Japanese patients with rheumatoid arthritis

2015 ◽  
Vol 26 (3) ◽  
pp. 460-462 ◽  
Author(s):  
Kensuke Ochi ◽  
Takefumi Furuya ◽  
Katsunori Ikari ◽  
Atsuo Taniguchi ◽  
Hisashi Yamanaka ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Vitamin D ◽  
Serum Vitamin ◽  
Japanese Patients ◽  
Serum Vitamin D ◽  
History Of ◽  
Elderly Japanese ◽  
Elderly Japanese Patients ◽  
Falls In Elderly

scholarly journals Alternating Hemiplegia with Ipsilateral Supranuclear Facial Palsy and Abducens Nerve Palsy Caused by Pontine Infarction

2016 ◽  
Vol 55 (15) ◽  
pp. 2073-2075
Author(s):  
Shinichiro Maeshima ◽  
Tetsuya Tsunoda ◽  
Sayaka Okamoto ◽  
Yasunori Ozeki ◽  
Shigeru Sonoda
Keyword(s):  
Facial Palsy ◽  
Nerve Palsy ◽  
Abducens Nerve ◽  
Abducens Nerve Palsy ◽  
Pontine Infarction

scholarly journals Clinical and Genetic Study of Ataxia With Vitamin E Deficiency

2021 ◽  
Author(s):  
Linwei Zhang ◽  
Xiangfei Zhang ◽  
Pu Lv ◽  
Dantao Peng
Keyword(s):  
Vitamin E ◽  
Cerebellar Ataxia ◽  
Protein Function ◽  
Novel Mutation ◽  
Brain Mri ◽  
Serum Vitamin ◽  
Gene Mutations ◽  
Chinese Family ◽  
Vitamin E Deficiency ◽  
Progressive Cerebellar Ataxia

Abstract Background: Ataxia with Vitamin E deficiency (AVED) is a type of autosomal recessive cerebellar ataxia. The main clinical manifestation involves progressive cerebellar ataxia and movement disorders, α-tocopherol transfer protein(TTPA) gene mutations are responsible for this disease. Methods: A female patient from a consanguineous Chinese family underwent detailed physical and auxiliary examination. After exclusion of acquired causes of ataxia, Friedreich’s Ataxia, and common types of spinocerebellar ataxia, the patient was subjected to whole exome sequencing (WES) followed by confirmation of sequence variants using Sanger sequencing. Her asymptomatic parents and younger sister were genotyped for the variant. Results: This patient showed progressive cerebellar ataxia, dysarthria and dystonic tremor, her serum vitamin E concentration was remarkably decreased, brain MRI revealed no obvious cerebellum atrophy. Homozygous variant (c.473T>C, p.F158S) of TPPA gene were identified through WES. Bioinformatic analysis predicted F185S would be harmful to the protein function. After supplementation of vitamin E 400mg three times per day for two years, the patient’s symptom remained stabilization.Conclusions We identified an AVED patient caused by novel mutation in TTPA gene. Our findings widen the spectrum of TTPA gene mutations.

Anatomy and physiology of the facial nerve and aetiology of facial nerve palsy

2021 ◽  
pp. 963-968
Author(s):  
Onur Gilleard ◽  
Kalliroi Tzafetta
Keyword(s):  
Natural History ◽  
Facial Nerve ◽  
Facial Paralysis ◽  
Facial Palsy ◽  
Nerve Palsy ◽  
Social Consequences ◽  
Detailed Knowledge ◽  
Anatomy And Physiology ◽  
History Of ◽  
Facial Nerve Anatomy

Facial paralysis can have significant functional and social consequences and presents a challenging reconstructive problem for plastic surgeons. Detailed knowledge of facial nerve anatomy and an understanding of the natural history of the different conditions which result in facial palsy is a prerequisite for clinicians who are involved in the management of this devastating affliction.

scholarly journals Vitamin D and Skin Cancer: An Epidemiological, Patient-Centered Update and Review

Nutrients ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 4292
Author(s):  
Alejandro Martin-Gorgojo ◽  
Yolanda Gilaberte ◽  
Eduardo Nagore
Keyword(s):  
At Risk ◽  
Vitamin D ◽  
Skin Cancer ◽  
Serum Vitamin ◽  
Personal History ◽  
Current Evidence ◽  
Patient Centered ◽  
Serum Vitamin D ◽  
History Of ◽  
Practical Recommendations

Background: The current vitamin D deficiency epidemic is accompanied by an increase in endemic skin cancer. There are still multiple controversies. This review aims to give practical recommendations regarding vitamin D among people at risk or with a personal history of skin cancer. Methods: Narrative review including human research articles published between 2011 and 2021, elaborated bearing in mind an epidemiological, patient-centered approach. Results: Ultraviolet (UV) exposure (neither artificial nor natural) is not the ideal source to synthesize vitamin D. There is conflicting epidemiological evidence regarding vitamin D, non-melanoma skin cancer (NMSC), and cutaneous melanoma (CMM), confounded by the effect of sun exposure and other factors. Conclusions: Current evidence is controversial, and there are no widely applicable strategies. We propose three practical recommendations. Firstly, sun protection recommendations should be kept among people at risk or with a personal history of skin cancer. Secondly, vitamin D should preferably be sourced through diet. In patients with melanoma or at risk of cutaneous cancer, serum vitamin D checks are warranted to detect and avoid its insufficiency.

scholarly journals Association between Bone Metabolism and Vestibular Problems in the Modified Romberg Test: Data from the 2009–2010 Korean National Health and Nutrition Examination Survey

2020 ◽  
Vol 9 (8) ◽  
pp. 2415
Author(s):  
So Young Kim ◽  
Yang-Sun Cho ◽  
Ji-Soo Kim ◽  
Ja-Won Koo
Keyword(s):  
Vitamin D ◽  
Bone Metabolism ◽  
Serum Vitamin ◽  
Nutrition Examination Survey ◽  
Serum Vitamin D ◽  
Health And Nutrition ◽  
Vitamin D Levels ◽  
History Of ◽  
Post Menopause ◽  
Romberg Test

Osteoporosis contributes to the occurrence of falling and vestibular problems, particularly in elderly patients. This study aimed to investigate the association between bone metabolism with vestibular problems and falling. A total of 4054 participants of the Korean National Health and Nutrition Examination Survey (KNHANES) from 2009 to 2010 aged ≥50 years old were surveyed on their history of falling, vestibular problems evaluated by the modified Romberg test, variables involving bone metabolism, and serum levels of vitamin D and alkaline phosphatase. They also underwent dual energy X-ray absorptiometry. The crude (simple) and adjusted odd ratios (ORs) of variables involving bone metabolism for vestibular problems in the modified Romberg test and falling were analyzed using a logistic regression model. A subgroup analysis was performed according to sex and the presence of menopause in females. Vestibular problems in the modified Romberg test group but not the falling group were associated with decreased serum vitamin D levels (p < 0.001; odds ratio (OR) = 0.951; 95% confidence interval (CI), 0.926–0.976). In subgroup analysis according to sex, the post-menopause group showed a higher rate of vestibular problems in the modified Romberg test compared to the pre-menopause group (4.5% vs. 0.7%, p = 0.019). In the post-menopause group, osteoporosis was positively associated with vestibular problems in the modified Romberg test (p = 0.001, OR = 10.971, 95% CI = 2.650–45.414). On the other hand, a history of hormone replacement therapy was negatively related with vestibular problems in this subgroup (p = 0.035; OR = 0.473; 95% CI = 0.239–0.948). A decrease in serum vitamin D levels may impact the vestibular system through neural signaling or by osteoporotic changes of the otic capsule, as well as otolith particles. Decreased estrogen levels in postmenopausal women may make them more prone to osteoporotic changes, which were associated with vestibular problems in the modified Romberg test. Because this is a cross-sectional study, the causal relationship of bone metabolism with vestibular function needs to be investigated.

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