scholarly journals Limb Ataxia and a Slight Fever

2014 ◽  
Vol 103 (6) ◽  
pp. 1423-1428
Author(s):  
Mikihiro Kihara ◽  
Naoki Wada
Keyword(s):  
2019 ◽  
Author(s):  
Kazuya Taira ◽  
Taichi Murayama ◽  
Sumio Fujita ◽  
Mikiko Ito ◽  
Kei Kamide ◽  
...  

BACKGROUND Despite increasing opportunities for acquiring health information online, discussion of the specific words used in searches has been limited. OBJECTIVE The aim of this study was to clarify the medical information gap between medical professionals and the general public in Japan through health information–seeking activities on the internet. METHODS Search and posting data were analyzed from one of the most popular domestic search engines in Japan (Yahoo! JAPAN Search) and the most popular Japanese community question answering service (Yahoo! Chiebukuro). We compared the frequency of 100 clinical words appearing in the clinical case reports of medical professionals (clinical frequency) with their frequency in Yahoo! JAPAN Search (search frequency) logs and questions posted to Yahoo! Chiebukuro (question frequency). The Spearman correlation coefficient was used to quantify association patterns among the three information sources. Additionally, user information (gender and age) in the search frequency associated with each registered user was extracted. RESULTS Significant correlations were observed between clinical and search frequencies (<i>r</i>=0.29, <i>P</i>=.003), clinical and question frequencies (<i>r</i>=0.34, <i>P</i>=.001), and search and question frequencies (<i>r</i>=0.57, <i>P</i>&lt;.001). Low-frequency words in clinical frequency (eg, “hypothyroidism,” “ulcerative colitis”) highly ranked in search frequency. Similarly, “pain,” “slight fever,” and “numbness” were highly ranked only in question frequency. The weighted average of ages was 34.5 (SD 2.7) years, and the weighted average of gender (man –1, woman +1) was 0.1 (SD 0.1) in search frequency. Some words were specifically extracted from the search frequency of certain age groups, including “abdominal pain” (10-20 years), “plasma cells” and “inflammatory findings” (20-30 years), “DM” (diabetes mellitus; 30-40 years), “abnormal shadow” and “inflammatory findings” (40-50 years), “hypertension” and “abnormal shadow” (50-60 years), and “lung cancer” and “gastric cancer” (60-70 years). CONCLUSIONS Search and question frequencies showed similar tendencies, whereas search and clinical frequencies showed discrepancy. Low-clinical frequency words related to diseases such as “hypothyroidism” and “ulcerative colitis” had high search frequencies, whereas those related to symptoms such as “pain,” “slight fever,” and “numbness” had high question frequencies. Moreover, high search frequency words included designated intractable diseases such as “ulcerative colitis,” which has an incidence of less than 0.1% in the Japanese population. Therefore, it is generally worthwhile to pay attention not only to major diseases but also to minor diseases that users frequently seek information on, and more words will need to be analyzed in the future. Some characteristic words for certain age groups were observed (eg, 20-40 years: “cancer”; 40-60 years: diagnoses and diseases identified in health examinations; 60-70 years: diseases with late adulthood onset and “death”). Overall, this analysis demonstrates that medical professionals as information providers should be aware of clinical frequency, and medical information gaps between professionals and the general public should be bridged.


2019 ◽  
Vol 66 (3) ◽  
pp. 156-158 ◽  
Author(s):  
Naohiro Ohshita ◽  
Kaname Tsuji ◽  
Hiroaki Yoshida ◽  
Hiroki Shibata ◽  
Yoshiko Matsuda ◽  
...  

Dravet syndrome (DS) is a rare and severe form of epilepsy that begins in infancy. This is particularly burdensome because repeated epileptic seizures lead to cognitive decline. We describe the case of a 12-year-old girl who was diagnosed with DS and was scheduled to have gingival reduction around her mandibular molars. Despite the patient being intellectually disabled, she was able to cooperate somewhat during medical procedures, including intravenous cannulation. Under the assumption that the major problem with anesthesia for DS would be the regulation of body temperature–induced seizures, we used body temperature management equipment to maintain the patient's body temperature during the procedure. We opted for intravenous sedation and administered a total dose of 4.5 mg midazolam throughout the procedure. Anesthesia was completed within 1 hour and 20 minutes without any adverse events. To the best of our knowledge, no previous studies have documented the anesthetic management of DS. In this case, no adverse events occurred perioperatively. However, the patient's temperature rose to that which indicated a slight fever despite the use of a standard cooling technique.


2020 ◽  
Author(s):  
M. Hadjivassiliou ◽  
P. G. Sarrigiannis ◽  
P. D. Shanmugarajah ◽  
D. S. Sanders ◽  
R. A. Grünewald ◽  
...  

Abstract The objective of this study is to report the clinical characteristics and treatment of patients with progressive cerebellar ataxia associated with anti-GAD antibodies. We performed a retrospective review of all patients with anti-GAD ataxia managed at the Sheffield Ataxia Centre over the last 25 years. We identified 50 patients (62% females) with anti-GAD ataxia. The prevalence was 2.5% amongst 2000 patients with progressive ataxia of various causes. Mean age at onset was 55 and mean duration 8 years. Gaze-evoked nystagmus was present in 26%, cerebellar dysarthria in 26%, limb ataxia in 44% and gait ataxia in 100%. Nine patients (18%) had severe, 12 (24%) moderate and 29 (58%) mild ataxia. Ninety percent of patients had a history of additional autoimmune diseases. Family history of autoimmune diseases was seen in 52%. Baseline MR spectroscopy of the vermis was abnormal at presentation in 72%. Thirty-five patients (70%) had serological evidence of gluten sensitivity. All 35 went on gluten-free diet (GFD). Eighteen (51%) improved, 13 (37%) stabilised, 3 have started the GFD too recently to draw conclusions and one deteriorated. Mycophenolate was used in 16 patients, 7 (44%) improved, 2 stabilised, 6 have started the medication too recently to draw conclusions and one did not tolerate the drug. There is considerable overlap between anti-GAD ataxia and gluten ataxia. For those patients with both, strict GFD alone can be an effective treatment. Patients with anti-GAD ataxia and no gluten sensitivity respond well to immunosuppression.


2020 ◽  
Vol 101 (2) ◽  
pp. 121-125 ◽  
Author(s):  
A. V. Titov ◽  
O. E. Mozgovaya

The artery of Percheron originates from the right or left posterior cerebral artery and is one of the options for normal blood supply to the paramedian portions of the thalamus. Stroke in this area has specific MRI changes, the most informative ones in diffusion-weighted imaging mode. With the involvement of the midbrain, its pial surface can display an additional pathognomonic V-shaped sign in 67%. The clinical manifestations are non-specific. In some cases, there is a triad of symptoms, which is distinguished into paramedian thalamic syndrome (vertical gaze palsy, neuropsychological disorders, and depressed level of consciousness up to coma). The symptoms of a midbrain lesion as oculomotor nerve group diseases, contralateral hemiparesis, hemiataxia or hemianesthesia, in combination with a triad, develop a thalamopeduncular or mesencephalon thalamic syndrome. The paper presents a clinical case of a 59-year-old man who was hospitalized with acute unconsciousness, a Glasgow coma scale of 13 scores, and disorientation. A neurological examination revealed vertical gaze palsy and upper limb ataxia. Brain MRI revealed characteristic bithalamic paramedian stroke. After completing the treatment, the patient was discharged showing incomplete clinical recovery.


2015 ◽  
Vol 86 (11) ◽  
pp. e4.73-e4
Author(s):  
Anisha Doshi ◽  
Anis Haque ◽  
Muhammad Chowdhury ◽  
Kevin Boyd

A 69 year old retired lady presented with a 3 year history of progressive gait disturbance with unsteadiness and falls. Over the preceding year she had become recluse, failing to attend social gatherings and becoming anxious. She complained of lethargy and poor appetite and had lost weight. A witnessed generalised seizure led to admission. Examination revealed mixed pyramidal and extrapyramidal signs in the limbs with global hyperreflexia and upgoing plantars. There was upper limb ataxia with bilateral intention tremor and myoclonus. She was only obeying one stage commands.Investigations revealed elevated ESR and monoclonal IgM kappa band with paraprotein concentration 9.4 g/L. MRI whole axis revealed periventricular diffuse T2 and FLAIR signal change and prominence of the leptomeninges along the distal spinal cord, conus medullaris and cauda equina. Bone scan showed prominent uptake within both humeri. Bone marrow trephine biopsy indicated a low-grade B-cell lymphoproliferative disorder; lymphoplasmacytic lymphoma. Serial CSF analysis revealed lymphocytic pleocytosis with elevated protein of 4.47–6.25 g/L. CSF protein electrophoresis demonstrated the presence of an IgM paraprotein with monoclonal IgM kappa band on immunonofixation. CSF immunophenotyping confirmed the presence of clonal B–cells.We therefore present a rare case of Bing-Neel Syndrome, CNS manifestation of Wäldenstroms Macroglobulinaemia.


2008 ◽  
Vol 18 (6) ◽  
pp. 1364-1367 ◽  
Author(s):  
W. H. Bradley ◽  
P. R. Dottino ◽  
J. Rahaman

Paraneoplastic cerebellar degeneration (PCD) is a rare nonmetastatic complication of a carcinoma. It is typically mediated by antibodies generated against tumor antigens. These antigens are the same proteins as expressed on Purkinje cells within the cerebellum; immune activation in the central nervous system (CNS) results in the syndrome. A 56-year-old woman with stage IIIC serous ovarian carcinoma diagnosed 3 years prior developed progressive limb ataxia. Serum anti-Yo antibodies were positive, confirming the diagnosis of PCD. Treatment with plasmaphoresis, intravenous immune globulin, and immune modulation with corticosteroids and tacrolimus was unsuccessful. Although the syndrome can be debilitating and treatment options are limited, it may also be an example of a successful host immune response in certain cases.


2020 ◽  
Author(s):  
Cleo JLM Smeets ◽  
Kai Y Ma ◽  
Simon E Fisher ◽  
Dineke S Verbeek

Abstract Background Spinocerebellar ataxia type 23 (SCA23) is a late-onset neurodegenerative disorder characterized by slowly progressive gait and limb ataxia, for which there is no therapy available. It is caused by mutations in PDYN, which encodes the opioid precursor protein prodynorphin (PDYN). PDYN is processed into the opioid peptides α-neoendorphin, and dynorphins (Dyn) A and B; inhibitory neurotransmitters that function in pain signalling, stress-induced responses, and addiction. Mutations causing SCA23 mostly affect Dyn A, leading to loss of secondary structure and increased peptide stability. PDYNR212W mice express human PDYN containing the SCA23 p.R212W mutation. These mice show gait deficits and progressive loss of motor function from 3 months of age. The cerebella of PDYNR212W mice show climbing fibre (CF) deficits from 3 months of age and Purkinje cell (PC) loss from 12 months of age. A mouse model for SCA1 showed similar CF deficits, and a recent study found additional developmental abnormalities, namely hyperproliferation of stem cells leading to increased GABAergic interneuron connectivity and non-cell autonomous disruption of PC function. As SCA23 mice show a similar pathology to SCA1 mice in adulthood, we hypothesized that SCA23 may also follow SCA1 pathology during development. Methods In the present study, we examined the cerebella of PDYNR212W mice during cerebellar development, from 2 to 8 weeks of age, using immunohistochemistry, protein, and RNA analysis. Results We uncovered developmental deficits from 2 weeks of age, namely a reduced number of GABAergic synapses on PC soma in PDYNR212W mice, possibly leading to the observed delay in early phase CF elimination between 2 and 3 weeks of age. Furthermore, CFs did not reach terminal height leaving proximal PC dendrites open to be occupied by parallel fibres (PFs). The observed increase in vGlut1 protein -a marker for PF-PC synapses- indicates that PFs indeed take over CF territory and have increased connectivity with PCs. Additionally, we detected altered expression of several critical Ca2+ channel subunits, potentially contributing to altered Ca2+ transients in PDYNR212W cerebella. Conclusions These findings indicate that developmental abnormalities contribute to the SCA23 pathology and uncover a developmental role for PDYN in the cerebellum.


2021 ◽  
Vol 59 (3) ◽  
pp. 311-317
Author(s):  
Xiu-Min Han ◽  
Xue-Yong Zhang ◽  
Ying-Na Jian ◽  
Qing-Shan Tian

The present study reports a rare case of Taenia saginata infection, which was initially diagnosed as acute cholecystitis in a Tibetan patient at the Qinghai-Tibetan Plateau pastoral area, China. A 45-year-old female was initially diagnosed with acute cholecystitis at a hospital in China. She had a slight fever, weight loss and constipation and complained of pain in the upper abdomen and left back areas. Increase of monocyte, eosinophil and basophil levels were shown. Taenia sp. eggs were detected in a fecal examination. An adult tapeworm approximately 146 cm in length, whitish-yellow color, was collected from the patient after treatment with traditional Chinese medicine. The adult tapeworm had a scolex and proglottids with genital pores. The scolex was rectangular shape with 4 suckers and rostellum without hooklet. The cox1 gene sequence shared 99.5-99.8% homology with that of T. saginata from other regions in China. The patient was diagnosed finally infected with T. saginata by morphological and molecular charateristics.


1912 ◽  
Vol XIX (3) ◽  
pp. 561-567
Author(s):  
X. I. Protopopov

The history of the disease. Patient, student of the Faculty of Law of Kazan University, B, 22 years old. I applied to the clinic on January 21, 1911 with complaints of lack of movement in the wrist and fingers of the left hand, sensation of cold and onѣmeniya in the same hand up to half of the shoulder, inclusive. The patient tells the following about the beginning of his illness: on January 4, 1911, after standing for 1/2 hour on a sharp wooden railing with his left hand, just the outer side of his shoulder, he felt cold, he felt a chill in his hand and a feeling of chills; I wanted to straighten my jacket, but I could not, since the hand and fingers of my left hand did not function well enough. While standing, I did not feel anything and calmly talked to those around him (it happened in the people's house). Before dark alcohol did not drink and was completely healthy. Two days before that (January 1 and 2), the patient had a runny nose, cough and a slight fever, but he felt good.


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