Dementia with non-convulsive seizures: a case report

Non-convulsive seizures (NCSs) are highly treatable, but appropriate management is usually delayed because of inaccurate diagnoses as a result of variable clinical presentations, including an altered mental state. It is difficult to detect NCSs in patients with dementia. We report a case of NCS superimposed on cognitive decline caused by Alzheimer’s dementia. The patient’s history was carefully recorded. An electroencephalogram was recorded with sphenoidal electrodes, which showed epileptiform discharges in the right mesial temporal lobe and focal, sharply contoured, slow wave activity in the left fronto-temporal area, suggesting an epileptic origin contributing to the patient’s cognitive decline. After treatment with antiepileptic drugs, the patient’s cognitive functioning gradually improved. An accurate diagnosis of NCS relies on performing a detailed inventory of a patient’s history, thorough physical and neurological examinations, and electroencephalogram recordings. In patients with cognitive decline, testing for NCS should always be included in the differential diagnosis of cognitive impairment, even in the case of dementia. Early administration of antiepileptic drug therapy is the mainstay treatment for reversing the condition and for preventing prolonged insults from neurological sequelae.

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Regional cerebral blood flow patterns of change following the own body image exposure in eating disorders: A longitudinal study

European Psychiatry ◽

10.1016/j.eurpsy.2008.11.004 ◽

2009 ◽

Vol 24 (5) ◽

pp. 275-281 ◽

Cited By ~ 11

Author(s):

Teresa Rodriguez-Cano ◽

Luis Beato-Fernandez ◽

Inmaculada Garcia-Vilches ◽

Ana Garcia-Vicente ◽

Victor Poblete-Garcia ◽

...

Keyword(s):

Body Image ◽

Blood Flow ◽

Cerebral Blood Flow ◽

Body Dissatisfaction ◽

Regional Cerebral Blood Flow ◽

Whole Body ◽

Regional Cerebral Blood ◽

Temporal Area ◽

The Right

AbstractObjectiveThe aim of the present study is to see if the changes in the regional cerebral blood flow (rCBF) experienced by restrictive anorexia nervosa (AR) and bulimia nervosa (BN) patients, following the exposure to their own body image, persist at follow-up.MethodsThree single photon emission computed tomography (SPECT) were performed on nine patients with a DSM-IV diagnosis of AR, 13 with BP, and 12 controls: at rest, following a neutral stimulus, and after exposure to their previously filmed whole body image. Body dissatisfaction was measured by means of the Body Dissatisfaction Questionnaire (BSQ). One year later the same assessment was repeated.ResultsFollowing the exposure to their own body image, BN showed an increase in body dissatisfaction, which was associated with the increase in the rCBF of the Right Temporal Area. Those changes persisted at follow-up.DiscussionMore specific long term therapies are needed for the treatment of the averse response showed by ED patients to their own body image exposure that is associated with the hyperactivation of the right temporal area when they are confronted with their whole body image.

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The Right Hemisphere Planum Temporale Supports Enhanced Visual Motion Detection Ability in Deaf People: Evidence from Cortical Thickness

Neural Plasticity ◽

10.1155/2016/7217630 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 23

Author(s):

Martha M. Shiell ◽

François Champoux ◽

Robert J. Zatorre

Keyword(s):

Cortical Thickness ◽

Motion Detection ◽

Visual Motion ◽

Right Hemisphere ◽

Deaf People ◽

Planum Temporale ◽

Detection Thresholds ◽

Temporal Area ◽

The Right ◽

Visual Motion Detection

After sensory loss, the deprived cortex can reorganize to process information from the remaining modalities, a phenomenon known as cross-modal reorganization. In blind people this cross-modal processing supports compensatory behavioural enhancements in the nondeprived modalities. Deaf people also show some compensatory visual enhancements, but a direct relationship between these abilities and cross-modally reorganized auditory cortex has only been established in an animal model, the congenitally deaf cat, and not in humans. Using T1-weighted magnetic resonance imaging, we measured cortical thickness in the planum temporale, Heschl’s gyrus and sulcus, the middle temporal area MT+, and the calcarine sulcus, in early-deaf persons. We tested for a correlation between this measure and visual motion detection thresholds, a visual function where deaf people show enhancements as compared to hearing. We found that the cortical thickness of a region in the right hemisphere planum temporale, typically an auditory region, was greater in deaf individuals with better visual motion detection thresholds. This same region has previously been implicated in functional imaging studies as important for functional reorganization. The structure-behaviour correlation observed here demonstrates this area’s involvement in compensatory vision and indicates an anatomical correlate, increased cortical thickness, of cross-modal plasticity.

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1223 Cholelithiasis and Choledocholithiasis with Migration of Stones into Right Psoas Muscle Cavity

British Journal of Surgery ◽

10.1093/bjs/znab259.362 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

J Hunter

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Psoas Muscle ◽

Magnetic Resonance Cholangiopancreatography ◽

Imaging Modalities ◽

Prior History ◽

Clinical Presentations ◽

Multiple Imaging ◽

The Right ◽

Psoas Major

Abstract Aim To highlight the importance of appropriate imaging modalities for abnormal clinical presentations. Method Xyo woman presented with severe right upper-quadrant pain to the emergency department. Prior history of colicky abdominal pain for 1 year, right-sided nephrectomy and hypertension. She stated that the current epsiode of pain was the worst so far, becoming more persistent, prompting her to call an ambulance. Cholecystitis was suspected, so a Computed Tomography abdomen/pelvis was performed. A dilated, inflamed gallbladder was noted in contact with the right psoas major, with what appeared to be an abscess in the right psoas major. Results A Magnetic Resonance Cholangiopancreatography was performed, which demonstrated that the aforementioned abscess was in fact a large cavity within the psoas major, containing up to 15 gallstones. Cholelithiasis was also seen, with common bile duct dilatation and evidence of a common bile duct stone. An Endoscopic Retrograde Cholangiopancreatography was performed, and X recovered well post-procedure with analgesia and antibiotics. Conclusions Acute cholecystitis/intra-abdominal gallstones may result in abscess/cavity formations and abnormal biliary clinical presentations. It is important therefore to fully investigate abnormal hepatobiliary imaging with multiple imaging modalities to allow for accurate diagnosis and appropriate further management of presentations.

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Effects of Electrical Stimulation in Tinnitus Patients: Conventional Versus High-Definition tDCS

Neurorehabilitation and Neural Repair ◽

10.1177/1545968318787916 ◽

2018 ◽

Vol 32 (8) ◽

pp. 714-723 ◽

Cited By ~ 12

Author(s):

Laure Jacquemin ◽

Giriraj Singh Shekhawat ◽

Paul Van de Heyning ◽

Griet Mertens ◽

Erik Fransen ◽

...

Keyword(s):

Electrical Stimulation ◽

Depression Scale ◽

Future Research ◽

Therapeutic Effects ◽

Long Term Effects ◽

High Definition ◽

Tinnitus Questionnaire ◽

Temporal Area ◽

Clinically Significant ◽

The Right

Background. Contradictory results have been reported for transcranial direct current stimulation (tDCS) as treatment for tinnitus. The recently developed high-definition tDCS (HD tDCS) uses smaller electrodes to limit the excitation to the desired brain areas. Objective. The current study consisted of a retrospective part and a prospective part, aiming to compare 2 tDCS electrode placements and to explore effects of HD tDCS by matched pairs analyses. Methods. Two groups of 39 patients received tDCS of the dorsolateral prefrontal cortex (DLPFC) or tDCS of the right supraorbital–left temporal area (RSO-LTA). Therapeutic effects were assessed with the tinnitus functional index (TFI), a visual analogue scale (VAS) for tinnitus loudness, and the hyperacusis questionnaire (HQ) filled out at 3 visits: pretherapy, posttherapy, and follow-up. With a new group of patients and in a similar way, the effects of HD tDCS of the right DLPFC were assessed, with the tinnitus questionnaire (TQ) and the hospital anxiety and depression scale (HADS) added. Results. TFI total scores improved significantly after both tDCS and HD tDCS (DLPFC: P < .01; RSO-LTA: P < .01; HD tDCS: P = .05). In 32% of the patients, we observed a clinically significant improvement in TFI. The 2 tDCS groups and the HD tDCS group showed no differences on the evolution of outcomes over time (TFI: P = .16; HQ: P = .85; VAS: P = .20). Conclusions. TDCS and HD tDCS resulted in a clinically significant improvement in TFI in 32% of the patients, with the 3 stimulation positions having similar results. Future research should focus on long-term effects of electrical stimulation.

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Acute Basilar Artery Occlusion Presenting With Convulsive Movements: A Systematic Review

Frontiers in Neurology ◽

10.3389/fneur.2021.803618 ◽

2022 ◽

Vol 12 ◽

Author(s):

Dan Zhang ◽

Yigang Chen ◽

Yonggang Hao ◽

Xingyue Hu ◽

Xudong He

Keyword(s):

Basilar Artery ◽

Reperfusion Therapy ◽

Artery Occlusion ◽

Acute Onset ◽

Basilar Artery Occlusion ◽

Institutional Review ◽

Initial Symptoms ◽

Convulsive Seizures ◽

The Right ◽

Vessel Dissection

Background and Purpose: Convulsive seizures related to posterior circulation stroke are considered rare. However, some patients with acute basilar artery occlusion (BAO) can present with convulsive movements. Misdiagnosed as seizures may delay the reperfusion therapy for acute BAO. In this study, we have summarized the clinical features and possible mechanisms of BAO presenting with convulsive movements.Methods: We performed an Institutional Review Board-approved institutional database query from 2015 to 2020 and a literature search of the online database PubMed. Clinical data were collected and analyzed.Results: In total, 14 patients with acute BAO presented with convulsions. There were 10 men and 4 women, with a mean age of 53 (range, 23–77) years. All of these patients had different degrees of impaired consciousness (100.0%, 14/14). Convulsive movements were the initial symptoms in 78.6% (11/14) of patients. Further, 64.3% (9/14) of patients presented with paralysis or cranial nerve abnormalities, and 85.7% (12/14) of patients were treated with reperfusion therapy (thrombolysis, 35.7% [5/14]; endovascular thrombectomy, 64.3% [9/14]). The BAO etiology and mechanism were related to embolism, vessel dissections, and severe stenosis of the right vertebral artery in 57.1% (8/14), 21.4% (3/14), and 7.1% (1/14) of patients, respectively; they were undefined in 14.3% (2/14) of patients. Moreover, 42.9% (6/14) of patients had a 90-day modified Rankin Scale score of 0–2, and the mortality rate was 21.4% (3/14).Conclusions: Acute BAO, especially that related to embolism or vessel dissection, may present with convulsive movements. Acute BAO is a devastating, but treatable disease if diagnosed in time. Considering the possibility of BAO is important when dealing with patients presenting with acute-onset convulsive movements. Prompt diagnosis and reperfusion therapy may help achieve a better prognosis.

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Are Artificial Intelligence (AI) And Machine Learning (ML) Having An Effective Role In Helping Humanity Address The New Coronavirus Pandemic?

WSEAS TRANSACTIONS ON BIOLOGY AND BIOMEDICINE ◽

10.37394/23208.2020.17.14 ◽

2020 ◽

Vol 17 ◽

Keyword(s):

Artificial Intelligence ◽

Machine Learning ◽

Disease Outbreaks ◽

Hospital Capacity ◽

Data Engineering ◽

Clinical Presentations ◽

The Face ◽

Effective Role ◽

Using Data ◽

The Right

COVID-19 has become a pandemic affecting the most of countries in the world. One of the most difficult decisions doctors face during the Covid-19 epidemic is determining which patients will stay in hospital, and which are safe to recover at home. In the face of overcrowded hospital capacity and an entirely new disease with little data-based evidence for diagnosis and treatment, the old rules for determining which patients should be admitted have proven ineffective. But machine learning can help make the right decision early, save lives and lower healthcare costs. So, there is therefore an urgent and imperative need to collect data describing clinical presentations, risks, epidemiology and outcomes. On the other side, artificial intelligence(AI) and machine learning(ML) are considered a strong firewall against outbreaks of diseases and epidemics due to its ability to quickly detect, examine and diagnose these diseases and epidemics.AI is being used as a tool to support the fight against the epidemic that swept the entire world since the beginning of 2020.. This paper presents the potential for using data engineering, ML and AI to confront the Coronavirus, predict the evolution of disease outbreaks, and conduct research in order to develop a vaccine or effective treatment that protects humanity from these deadly diseases.

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Region-Specific Neurovascular Decoupling Associated With Cognitive Decline in Parkinson’s Disease

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.770528 ◽

2021 ◽

Vol 13 ◽

Author(s):

Song’an Shang ◽

Hongying Zhang ◽

Yuan Feng ◽

Jingtao Wu ◽

Weiqiang Dou ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Cognitive Decline ◽

Cognitive Deficits ◽

Inferior Frontal Gyrus ◽

Neurovascular Coupling ◽

Angular Gyrus ◽

Visual Spatial ◽

The Right

Background: Cognitive deficits are prominent non-motor symptoms in Parkinson’s disease (PD) and have been shown to involve the neurovascular unit (NVU). However, there is a lack of sufficient neuroimaging research on the associated modulating mechanisms. The objective of this study was to identify the contribution of neurovascular decoupling to the pathogenesis of cognitive decline in PD.Methods: Regional homogeneity (ReHo), a measure of neuronal activity, and cerebral blood flow (CBF), a measure of vascular responses, were obtained from patients with PD with mild cognitive impairment (MCI) and normal cognition (NC) as well as matched healthy controls (HCs). Imaging metrics of neurovascular coupling (global and regional CBF-ReHo correlation coefficients and CBF-ReHo ratios) were compared among the groups.Results: Neurovascular coupling was impaired in patients with PD-MCI with a decreased global CBF-ReHo correlation coefficient relative to HC subjects (P < 0.05). Regional dysregulation was specific to the PD-MCI group and localized to the right middle frontal gyrus, right middle cingulate cortex, right middle occipital gyrus, right inferior parietal gyrus, right supramarginal gyrus, and right angular gyrus (P < 0.05). Compared with HC subjects, patients with PD-MCI showed higher CBF-ReHo ratios in the bilateral lingual gyri (LG), bilateral putamen, and left postcentral gyrus and lower CBF-ReHo ratios in the right superior temporal gyrus, bilateral middle temporal gyri, bilateral parahippocampal gyri, and right inferior frontal gyrus. Relative to the HC and PD-NC groups, the PD-MCI group showed an increased CBF-ReHo ratio in the left LG, which was correlated with poor visual–spatial performance (r = −0.36 and P = 0.014).Conclusion: The involvement of neurovascular decoupling in cognitive impairment in PD is regionally specific and most prominent in the visual–spatial cortices, which could potentially provide a complementary understanding of the pathophysiological mechanisms underlying cognitive deficits in PD.

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Subacute Cognitive Decline in an 86-Year-Old Woman With Prior Lobar Intracerebral Hemorrhage

10.1093/med/9780197583425.003.0062 ◽

2021 ◽

pp. 192-194

Author(s):

Stephen W. English ◽

James P. Klaas

Keyword(s):

Intracerebral Hemorrhage ◽

Cognitive Decline ◽

Temporal Lobe ◽

Cerebral Amyloid Angiopathy ◽

Mass Effect ◽

Amyloid Angiopathy ◽

Left Temporal Lobe ◽

Epileptiform Discharges ◽

Cerebral Amyloid ◽

T2 Hyperintensity

An 86-year-old woman with a history of hypertension, hyperlipidemia, coronary artery disease, and hypothyroidism sought care for subacute, progressive cognitive decline. Five months earlier, she was hospitalized for a small, left temporal, lobar, intracerebral hemorrhage with associated receptive aphasia. Over the next several months, she had a precipitous cognitive decline. She was prescribed memantine by her primary physician because of concern for dementia. One month before seeking care, she was found unconscious in her bathroom, which was believed to be an unwitnessed seizure. Brain magnetic resonance imaging 1 month before the current evaluation showed a prior, small, left temporal hemorrhage and diffuse lobar microhemorrhages on gradient echo imaging, focal leptomeningeal gadolinium enhancement in the left temporal lobe, and multifocal T2 hyperintensity with mass effect, maximal in the left temporal lobe. Electroencephalography showed multifocal, independent epileptiform discharges. She underwent open biopsy of the left temporal lobe, which indicated focal granulomatous inflammation causing vascular destruction, with β‎-amyloid plaques within the cortical and leptomeningeal vessels. The findings were consistent with a diagnosis of amyloid-β‎-related angiitis in the setting of severe cerebral amyloid angiopathy. Because of concern for subclinical seizures and epileptiform discharges on electroencephalography, the patient was started on levetiracetam without substantial change in her mental status. After the biopsy findings demonstrated inflammatory changes consistent with amyloid-β‎-related angiitis, she was started on intravenous methylprednisolone, followed by transition to prednisone. After 6 months of treatment, she had significant clinical and radiographic improvement. Follow-up magnetic resonance imaging at that time showed interval improvement in the T2 hyperintensity and mass effect in the left temporal lobe. She was again independent with her activities of daily living, and memantine was discontinued. Cerebral amyloid angiopathy encompasses a heterogeneous group of diseases characterized by amyloid-β‎ peptide deposition. The most common clinical manifestation of cerebral amyloid angiopathy is lobar intracerebral hemorrhage, which can be multifocal and recurrent but can also result in cerebral ischemia and ischemic leukoencephalopathy.

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Pyoderma gangraenosum – from the right diagnostic investigations to targeted therapy

Phlebologie ◽

10.12687/phleb2339-5-2016 ◽

2016 ◽

Vol 45 (05) ◽

pp. 333-340

Author(s):

F. Jockenhöfer ◽

J. Dissemond

Keyword(s):

Clinical Results ◽

Clinical Findings ◽

Pyoderma Gangraenosum ◽

The Metabolic Syndrome ◽

Potential Association ◽

Systemic Treatments ◽

Bowel Diseases ◽

Haematologic Neoplasms ◽

The Right ◽

Patient’S History

SummaryPyoderma gangrenosum (PG) is a rarely diagnosed neutrophilic skin disorder that still remains a diagnosis of exclusion. Therefore, the diagnosis has to be done in the synopsis of typical clinical findings, patient’s history and exclusion of relevant differential diagnoses. There are numerous references to relevant comorbidities from the metabolic syndrome, rheumatoid arthritis and inflammatory bowel diseases. Of particular importance is the potential association of PG with (haematologic) neoplasms. Treatment of PG includes topical and systemic immuno-modulating or immuno-suppressant therapies. Most important are for topical as well as systemic treatments are glucocorticoids. All other treatments represent an off-label-use. Especially Cyclosporine and TNF-α-inhibitors demonstrated very good and promising clinical results. Accompanying modern moist wound-therapy concepts avoiding painful dressings and an analgesic therapy are recommended.

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Personality Changes, Cognitive Decline, and Jerking Movements

10.1093/med/9780197583425.003.0024 ◽

2021 ◽

pp. 80-82

Author(s):

A. Sebastian Lopez Chiriboga

Keyword(s):

Cognitive Decline ◽

Oral Prednisone ◽

Clonic Seizure ◽

Substantial Improvement ◽

Fluid Analysis ◽

Epileptiform Discharges ◽

Abnormal Movements ◽

Positron Emission ◽

Personality Changes ◽

Fluid Attenuated Inversion Recovery

A 64-year-old man had development of abnormal movements characterized by grimacing of the left hemiface and posturing of the ipsilateral arm. He had a generalized tonic-clonic seizure, followed by cognitive decline requiring assistance for most activities of daily living. He was readmitted to the hospital for neurologic evaluation. His heart rate was 120 beats/min, he was afebrile. On neurologic examination, he had a Mini-Mental State Examination (MMSE) score of 16/30. The patient was oriented to person only, and he had multiple, frequent, left hemibody jerks during examination. Cerebrospinal fluid analysis indicated increased protein concentration but otherwise normal findings. Laboratory abnormalities included a serum sodium and antibodies to leucine-rich, glioma-inactivated protein 1. Electroencephalography revealed diffuse slowing and bilateral temporal lobe epileptiform discharges. Magnetic resonance imaging of the brain showed T2/fluid-attenuated inversion recovery hyperintensities in the bilateral hippocampi and amygdalae and gadolinium enhancement in the same regions. Brain 18F-fludeoxyglucose–positron emission tomography demonstrated hypermetabolism in the mesiotemporal lobes bilaterally. A diagnosis of limbic encephalitis associated with leucine-rich, glioma-inactivated protein 1-immunoglobulin G antibodies was. The unilateral facial and arm movements were consistent with faciobrachial dystonic seizures and are pathognomonic of the disorder. The patient’s seizure frequency did not improve with antiepileptic drug therapy. The patient was treated with intravenous methylprednisolone, followed by plasmapheresis. This resulted in substantial improvement of his cognitive dysfunction and decrease in the faciobrachial dystonic seizures frequency. Therapy was transitioned to oral prednisone and the patient was discharged from the hospital. This patient had classic features of leucine-rich, glioma-inactivated protein 1 antibody encephalitis: faciobrachial dystonic seizures, personality changes, subacute cognitive decline, hyponatremia, and improvement with immunotherapy.

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