scholarly journals Clinical Reasoning: Middle-aged Man With Progressive Gait Abnormalities

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012756
Author(s):  
Junyu Lin ◽  
Yanbing Hou ◽  
Huifang Shang
Keyword(s):  
Basal Ganglia ◽  
Ammonia Level ◽  
Dorsal Column ◽  
Spastic Paraplegia ◽  
Middle Aged ◽  
Current Case ◽  
Acquired Hepatocerebral Degeneration ◽  
History Of ◽  
Gait Abnormalities ◽  
Diagnostic Work

Progressive spastic paraplegia is the core symptom of hereditary spastic paraplegia (HSP), a group of monogenic disorder characterized pathologically by degeneration of the corticospinal tract and dorsal column and leading to irreversible neurologic deficits. However, acquired causes, such as structural, vascular, inflammatory, infectious, metabolic, toxic, neurodegenerative, and iatrogenic causes can also cause acquired spastic paraplegia. We describe a case of a middle-aged man presenting with progressive spastic paraplegia combined with ataxia and parkinsonism. No mutation of HSP genes was detected. After a comprehensive diagnostic work-up, hyperintensities in the bilateral basal ganglia, mesencephalon, pons, and cerebellum on T1-weighted images were found, which demonstrated hypointensity on susceptibility weighted imaging (SWI). Furthermore, an increased blood ammonia level and diffuse slow wave activity in electroencephalogram were detected. Combined with a 7-year history of hypertension and alcoholic liver cirrhosis and the history of Transjugular Intrahepatic Portosystemic Shunt (TIPS) operation two years prior to the symptom of spastic paraplegia, concurrent acquired hepatocerebral degeneration (AHD) and hepatic myelopathy (HM) was finally diagnosed. The current case provided a detailed diagnostic approach for progressive spastic paraplegias and an exhaustive differential diagnoses of basal ganglia deposits. The take-home message from this case was that acquired causes, especially curable causes should always be excluded first when dealing with patients with progressive spastic paraplegia.

Dysfunctional Eating Behaviour and Leptin in Middle-Aged Women: Role of Menopause and a History of Anorexia Nervosa

2021 ◽  
Author(s):  
Suzana Stojiljkovic-Drobnjak ◽  
Susanne Fischer ◽  
Myrtha Arnold ◽  
Wolfgang Langhans ◽  
Ulrike Kuebler ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Eating Behaviour ◽  
Middle Aged ◽  
History Of

Association of serum lipid profile and family history of coronary heart disease among middle aged Lithuanian adults

2018 ◽  
Vol 275 ◽  
pp. e215
Author(s):  
S. Kutkiene ◽  
Z. Petrulioniene ◽  
A. Laucevicius ◽  
U. Gargalskaite ◽  
A. Saulyte ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Family History ◽  
Lipid Profile ◽  
Serum Lipid ◽  
Serum Lipid Profile ◽  
Middle Aged ◽  
History Of

Basal ganglia echogenicity in preterm infants: A case series

2020 ◽  
pp. 1-5
Author(s):  
S. Harvey ◽  
S. Ryan ◽  
A. Tarrant ◽  
M. King ◽  
B. Hayes
Keyword(s):  
Basal Ganglia ◽  
Clinical Course ◽  
Case Series ◽  
Abnormal Development ◽  
Cranial Ultrasound ◽  
Perinatal Factors ◽  
Mri Brain ◽  
Developmental Progress ◽  
Cognitive Delay ◽  
History Of

BACKGROUND: Damage to the basal ganglia and thalamus (BGT) can be caused by multiple perinatal factors and may be associated with movement disorders, cognitive delay and visual difficulties. Changes in BGT structure, seen as echogenicity on ultrasound, are difficult to objectively quantify. The aetiology, clinical relevance and developmental outcomes of BGT echogenicity are poorly understood. We aimed to gain a better understanding of the natural history of BGT echogenicity in a preterm population. METHODS: Retrospective review of clinical course, neuroimaging and development in infants born <32weeks gestation over 5 years with evidence of BGT echogenicity. RESULTS: BGT echogenicity was reported in 18/650 infants (2.7%). Echogenicity appeared at a median of 8 days (2–45 days) and resolved on pre-discharge ultrasound in 50%. Thirteen infants had a term corrected MRI brain with abnormal BGT signal seen in 3 infants (23%). All 3 infants had persisting echogenicity on discharge ultrasound. No infant with echogenicity resolution on ultrasound had changes on term MRI. 14 infants had developmental progress available at 1 year corrected. Abnormal development was reported in four children of whom one had BGT changes on term MRI. Two children with persistent BGT changes but an otherwise normal MRI had reported normal neurodevelopment. CONCLUSION: BGT echogenicity is relatively common on routine ultrasound and resolves in the majority of infants by term corrected. This review suggests that at term corrected, normal cranial ultrasound may obviate the need for MRI where no other concerns exist. BGT echogenicity did not appear to independently influence neurodevelopment.

861 Vascular dementia presenting as rapidly progressive dementia secondary to zolpidem

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A335-A335
Author(s):  
Cameron Barber ◽  
Dylan Carroll ◽  
Bhavani Suryadevara
Keyword(s):  
Vascular Dementia ◽  
Microvascular Disease ◽  
Altered Mental Status ◽  
Progressive Dementia ◽  
Personality Changes ◽  
The Us ◽  
History Of ◽  
Gait Abnormalities ◽  
Scheduled Time ◽  
Chronic Use

Abstract Introduction Rapidly progressive dementia is a condition with a wide differential which remains difficult to accurately diagnose. The potential pathologies responsible include thyroid, vitamin, and electrolytes abnormalities, infectious, and malignant causes. Vascular dementia, however, typically has a slow and insidious presentation. Zolpidem (Ambien) is among the top 50 prescribed medications in the US. Report of case(s) An 84-year-old Caucasian male with a past medical history of insomnia, and sleep apnea who is noncompliant with CPAP presented after a fall associated with altered mental status. He has taken zolpidem 10 mg nightly for over six years. The patient and wife reported notable personality changes beginning six months prior, as well as four months of progressively worsening auditory and visual hallucinations. Additionally, the patient noted developing urinary incontinence, and worsening gait steadiness with recurrent falls. The patient then developed sleep-wake inversion during the three weeks prior to his fall, and an outpatient referral to neurology was subsequently sent for dementia evaluation. On the night prior to his presentation, the patient took his usual nighttime zolpidem at 22:00 and later fell and was unable to get up. Subsequent testing was negative for reversible causes of dementia and MRI Brain revealed only chronic microvascular disease. His zolpidem dose was decreased to 5 mg and scheduled earlier which resulted in the resolution of his hallucinations, gait abnormalities, and acute encephalopathy. Conclusion One month later, the patient presented to the hospital after a repeat fall secondary to taking his zolpidem at his previously scheduled time. Once more, his dosage was further decreased to 2.5 mg and scheduling earlier, resulting again, in the complete resolution of his symptoms. Zolpidem, has an increased potential for delirium in elderly patients and especially those with dementia. Chronic use of zolpidem with insidiously progressive vascular dementia led to a worsening delirium which resolved after adjustment of timing and reduction of zolpidem dosing. Support (if any):

Toluene-induced leukodystrophy from glue sniffing

2021 ◽  
pp. practneurol-2021-002942
Author(s):  
Yue Hui Lau ◽  
Ahmad Shahir Mawardi ◽  
Norzaini Rose Zain ◽  
Shanthi Viswanathan
Keyword(s):  
Basal Ganglia ◽  
Cognitive Decline ◽  
Early Recognition ◽  
Cerebellar Atrophy ◽  
Premature Mortality ◽  
History Of ◽  
The Brain

A 33-year-old man with a history of chronic toluene abuse through glue sniffing, developed tremors, cerebellar signs and cognitive decline. MR scan of the brain showed global cerebral and cerebellar atrophy with symmetrical T2-weighted hypointensities in the basal ganglia, thalami and midbrain. After stopping glue sniffing, his tremors, ataxia of gait, speech and cognition partially improved. Early recognition and intervention of toluene-induced leukodystrophy could prevent ongoing morbidity and premature mortality.

scholarly journals Parasitic hypereosinophilia in childhood: a diagnostic challenge

2018 ◽  
Vol 10 (1) ◽  
pp. 2018034
Author(s):  
Roberto Antonucci ◽  
Nadia Vacca ◽  
Giulia Boz ◽  
Cristian Locci ◽  
Rosanna Mannazzu ◽  
...  
Keyword(s):  
Eosinophil Count ◽  
Hypereosinophilic Syndrome ◽  
Igg Antibodies ◽  
Diagnostic Challenge ◽  
Etiological Diagnosis ◽  
Maximum Value ◽  
History Of ◽  
Diagnostic Work ◽  
Patient’S History ◽  
Work Up

Severe hypereosinophilia (HE) in children is rare, and its etiological diagnosis is challenging. We describe a case of a 30-month-old boy, living in a rural area, who was admitted to our Clinic with a 7-day history of fever and severe hypereosinophilia. A comprehensive diagnostic work-up could not identify the cause of this condition. On day 6, the rapidly increasing eosinophil count (maximum value of 56,000/mm3), the risk of developing hypereosinophilic syndrome, and the patient’s history prompted us to undertake an empiric treatment with albendazole.The eosinophil count progressively decreased following treatment. On day 13, clinical condition and hematological data were satisfactory, therefore the treatment was discontinued and the patient was discharged. Three months later, anti-nematode IgG antibodies were detected in patient serum, thus establishing the etiological diagnosis. In conclusion, an empiric anthelmintic treatment seems to be justified when parasitic hypereosinophilia is strongly suspected, and other causes have been excluded.

scholarly journals The middle-aged and elderly urban residents’ individual perceptions of PM2.5 pollution and its influencing factors in Wuxi, China

2019 ◽  
Author(s):  
Qi Chen ◽  
Jiayao Zhang ◽  
Yan Xu ◽  
Hong Sun ◽  
Zhen Ding
Keyword(s):  
Pulmonary Function ◽  
Respiratory Disease ◽  
Family Income ◽  
Middle Aged ◽  
Pm 2.5 ◽  
Average Family ◽  
Individual Perceptions ◽  
Individual Perception ◽  
Haze Pollution ◽  
History Of

Abstract Background PM 2.5 pollution has become a major public health concern in urban China. Understanding the residents’ individual perceptions toward haze pollution is critical for policymaking and risk communication. However, the perceptions of middle-aged and elderly residents, who particularly vulnerable to haze pollution, are poorly understood. Methods A cross-sectional study of 400 randomly sampled individuals (aged 40 to 90 years) was conducted in Wuxi, a typical PM 2.5 -polluted city. Each participant’s demographic and health information, individual perception and pulmonary function outcomes were collected to explore the relationship between personal characteristics and pulmonary function parameters and perception factors. Results We found that the mean values for controllability (4.99 ± 2.78) and dread of self-risk (6.90 ± 2.45) were the lowest and the highest values, respectively, in our study. Education and average family income were positively related with all individual perception factors, while age was negatively associated. A history of respiratory disease was positively associated with all individual perception factors except controllability . Significant positive associations were observed between PEF (coefficients ranged from 0.18 to 0.22) and FEF75% (coefficients ranged from 0.18 to 0.29) with a variety of individual perception factors. Conclusions There was a lack of concern and knowledge, weak self-protection consciousness and a strong dread of PM 2.5 pollution among the middle-aged and elderly residents in Wuxi. Their individual perceptions were associated with age, education levels, average family income, history of respiratory disease and pulmonary function outcomes. Our findings may help policymakers develop effective policies and communication strategies to mitigate the hazards of haze among older residents.

scholarly journals Clinical features and outcome of Covid-19 in individuals without Comorbidities. Do children have the advantage?

2021 ◽  
Vol 8 (2) ◽  
pp. 88-93
Author(s):  
Dr. Abhishek Kumar ◽  
◽  
Dr. Nilu Kumari ◽  
Dr. Ranjeet Kumar Singh ◽  
Dr. Alok Kumar ◽  
...  
Keyword(s):  
Severe Disease ◽  
Age Groups ◽  
Asymptomatic Infection ◽  
Healthy Individuals ◽  
Adult Group ◽  
Middle Aged ◽  
History Of ◽  
Adults And Children ◽  
The Mean ◽  
Respiratory Complaints

Objective: Information regarding clinical characteristics and the natural course of COVID-19amongst individuals without comorbidities is scarce. We therefore conducted a retrospectiveobservational study to decipher the disease profile in two different age groups, middle-aged (40-59years) and children (up to 12 years). Method: Study was conducted by reviewing the medicalrecords of all patients in the desired age groups and excluding all those with preexisting illness(called comorbidities). Result: A total of 154 and 27 patients were enrolled and studied in themiddle-aged adults and children group respectively. Males dominated in both groups with a sex ratioof 2.9 in adults and 1.7 in children. Most of the children (92.5%) had a history of exposure from aninfected family member, while in the adult group history of contact was present in 71.4% ofpatients.62.9% of children had an asymptomatic infection which was significantly higher than 22.8%in adults. Cough and fever were the most common symptoms in both age groups, but adults weremore likely to have respiratory complaints when compared with children.11 (7.1%) patients in theadult group had severe disease while in the children group none had severe disease. Similarly in theadult group 11 patients required ICU admission, but none in the children group. The mean durationof RTPCR positivity was similar in both groups. There was 1 (0.6%) expiry in the adult groupwhereas none in children. Conclusion: Healthy individuals in both middle-aged and children grouptend to have milder disease and both harbour the virus for the almost same duration but adults aremore symptomatic in comparison to children and hence children are more likely to be potentialasymptomatic carrier and transmitter of infection.

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