Syndromes of Rapidly Progressive Cognitive Decline-Our Experience

ABSTRACT Background: Dementias are fairly slowly progressive degenerative diseases of brain for which treatment options are very less and carry a lot of burden on family and society. A small percentage of them are rapidly progressive and mostly carry a different course outcome. However, there are no definite criteria other than the time line for these patients. Aims: The aim of this was to identify and categorize the causes and course of rapidly progressive dementias seen in our center. Settings and Design: Patients who presented with rapid deterioration of cognitive functions within weeks to 1 year between 2011 and December 2016 were evaluated. Patients and Methods: All patients underwent all mandatory tests for dementia including brain imaging. Complete vasculitis workup, autoimmune encephalitis profile including Voltage Gated Potassium Channel, N-methyl-D-aspartic acid receptor, glutamic acid-decarboxylase, thyroid-peroxidase antibody, cerebrospinal fluid, and other special tests such as duodenal biopsy and paraneoplastic workup were done based on clinical indications. Results and Conclusions: Out of 144 patients 42 had immune-mediated encephalopathy, 18 had Creutzfeldt-Jakob disease, 3 had Vitamin B12 deficiency, 63 had infection with neurocysticercosis, 7 had tuberculosis, 2 had HIV, 1 had herpes simplex encephalitis, 1 had neurosyphilis, 1 Whipples disease, 1 had Subacute Sclerosing Panencephalitis, 1 had Mass lesion, 3 had Frontotemporal dementia, and 3 had small vessel disease. Good majority of these patients have infective and immune-mediated causes and less number belong to degenerative group. Therefore, caution is needed to look for treatable cause as it carries a different treatment options and outcome.

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Heidenhain variant sporadic Creutzfeldt-Jakob disease diagnosed as an autoimmune encephalitis due to a false-positive GAD autoantibody

BMJ Case Reports ◽

10.1136/bcr-2018-229018 ◽

2019 ◽

Vol 12 (5) ◽

pp. e229018

Author(s):

Nicolás Urriola ◽

Kavie Soosapilla ◽

Geoffrey Herkes ◽

Joseph Nogajski

Keyword(s):

Diffusion Weighted Imaging ◽

Autoimmune Encephalitis ◽

Visual Field Defects ◽

Acid Decarboxylase ◽

Gad Autoantibodies ◽

Diffusion Weighted ◽

Signal Abnormality ◽

Original Presentation ◽

Fluid Attenuated Inversion Recovery ◽

Jakob Disease

A 64-year-old man presented with a subacute history progressive visual field defects, illusions and misperceptions. An initial MRI brain revealed a right occipital signal abnormality on diffusion-weighted imaging (DWI) with serum glutamic acid decarboxylase (GAD) autoantibodies markedly elevated. A diagnosis of autoimmune encephalitis was made, with the patient being treated with intravenous immunoglobulin. One month after discharge, the patient represented with worsening frank and well-formed visual hallucinations, ataxia and progressive cognitive impairment. Progress MRI displayed characteristic T2 ribboning on diffusion weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences, along with periodic sharp wave complexes on electroencephalogram (EEG) and a raised CSF protein 14-3-3. Repeat serum, as well as cerebrospinal fluid (CSF), GAD antibodies were again markedly elevated as measured by ELISA (RSR, Cardiff, UK), although archival CSF from the original presentation as well as CSF from the second presentation had undetectable GAD autoantibodies as measured via radioimmunoassay (DIAsource, Ottignies-Louvain-la-Neuve, Belgium). Creutzfeldt-Jakob disease was confirmed at autopsy.

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Serum Thyroid Peroxidase Antibody Level and Incident Hypertension in Iranian Men: A Suggestion for the Role of Thyroid Autoimmunity

Endocrine Metabolic & Immune Disorders - Drug Targets ◽

10.2174/1871530320666200624163035 ◽

2020 ◽

Vol 20 (10) ◽

pp. 1711-1718

Author(s):

Maryam Tohidi ◽

Aidin Baghbani-Oskouei ◽

Atieh Amouzegar ◽

Ladan Mehran ◽

Fereidoun Azizi ◽

...

Keyword(s):

Total Population ◽

Thyroid Autoimmunity ◽

Elevated Serum ◽

Thyroid Peroxidase ◽

Incident Hypertension ◽

Natural Logarithm ◽

Hazard Ratios ◽

Thyroid Peroxidase Antibody ◽

Unit Increase

Background: Dysfunction of the thyroid gland has profound effects on the cardiovascular system. Objective: We aimed to explore the relation of serum thyroid peroxidase antibody (TPO-Ab), as a marker of thyroid autoimmunity with incident hypertension among a euthyroid population. Methods: A total of 3681 participants (1647 men) entered the study. Multivariate Cox proportional hazard models were conducted to estimate the association between TPO-Ab and incident hypertension. Results: The mean age (standard deviation) of the participants was 37.5 (12.8) years. During a median follow-up of 12.2 years, 511 men and 519 women developed hypertension. The multivariable hazard ratios (HRs) and related 95% confidence intervals (CIs) of 1-unit increase in natural logarithm (ln) of TPO-Ab for incident hypertension were 1.09 (1.00-1.19), 1.03 (0.97-1.10), and 1.05 (1.00-1.11) for men, women, and total population, respectively. Moreover, considering the TPO-Ab status as a categorical variable (i.e. TPO-Ab positive or TPO-Ab negative), the multivariate-adjusted HRs (95% CIs) of TPO-Ab positivity for incident hypertension, were 1.33 (0.95-1.85), 1.12 (0.86-1.45) and 1.19 (0.97- 1.46) for men, women, and total population, respectively. Conclusion: Elevated serum TPO-Ab level can contribute to the development of hypertension among euthyroid men during a long follow-up; suggesting a role for thyroid autoimmunity.

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Autoimmune Encephalitis versus Creutzfeldt-Jakob disease in a patient with typical Facio-brachial dystonic seizures: A case report with Diagnostic challenges

Brain, Behavior, & Immunity - Health ◽

10.1016/j.bbih.2021.100236 ◽

2021 ◽

Vol 13 ◽

pp. 100236

Author(s):

Vaibhav Seth ◽

Suman Kushwaha ◽

Ritu Verma ◽

Priyankkumar Mukeshbhai Patel ◽

R Kiran Gowda ◽

...

Keyword(s):

Case Report ◽

Autoimmune Encephalitis ◽

Jakob Disease

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Expression of Thyroid Peroxidase Antibody, Thyroglobulin Antibody, and Thyrotropin Receptor Antibody in Breast Cancer and Their Associations with Clinical Characteristics of Breast Cancer

Indian Journal of Surgery ◽

10.1007/s12262-021-02887-y ◽

2021 ◽

Author(s):

Xiaoyi Liu ◽

Zhengju Fu ◽

Hongmei Xu ◽

Kui Che ◽

Jingwei Chi ◽

...

Keyword(s):

Breast Cancer ◽

Clinical Characteristics ◽

Thyroid Peroxidase ◽

Thyrotropin Receptor ◽

Receptor Antibody ◽

Thyroid Peroxidase Antibody ◽

Thyroglobulin Antibody ◽

Thyrotropin Receptor Antibody

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Role of the Specialized Pro-resolving Mediator Resolvin D1 in Hashimotoʼs Thyroiditis

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/a-1345-0173 ◽

2021 ◽

Author(s):

Jing Song ◽

Rongxin Sun ◽

Yuanyuan Zhang ◽

Ying Fu ◽

Dong Zhao

Keyword(s):

Thyroid Autoimmunity ◽

Thyroid Stimulating Hormone ◽

Inflammatory Factors ◽

Thyroid Peroxidase ◽

Sensitivity Index ◽

Resolvin D1 ◽

Thyroid Peroxidase Antibody ◽

Thyroglobulin Antibody ◽

Inflammation Resolution

Abstract Objective Resolvins are produced by the catabolism of polyunsaturated fatty acids (PUFAs) and play vital roles in inflammation resolution. Resolvins have been associated with autoimmune disorders. This study aimed to measure the level of Resolvin D1 (RVD1) in the serum of Hashimoto's thyroiditis (HT) patients and healthy controls (HCs) and to further analyse its correlation with thyroid autoantibodies and inflammatory factors. Methods Sixty-three participants were recruited, namely, 30 untreated HT patients and 33 sex- and age-matched HCs. Serum RVD1 and inflammatory chemokine (MCP-1 and IP-10) levels were measured by ELISA according to the manufacturer’s protocol. Serum total T3 (TT3), TT4, free T3 (FT3), FT4, thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPOAb) and thyroid-stimulating hormone (TSH) levels were measured using an electrochemiluminescence immunoassay. Thyroid homeostasis parameters, including the thyroid secretory capacity (SPINA-GT), the total deiodinase activity (SPINA-GD), Jostel’s TSH index (TSHI) and the thyrotroph thyroid hormone sensitivity index (TTSI), were calculated. Results Serum RVD1 levels in HT patients (134.76, 85.35–201.36 pg/mL) were significantly lower than those in HCs (187.64, 131.01–326.85 pg/mL) (P=0.004). As the TPOAb level increased, the RVD1 level showed a decreasing trend (P for trend=0.002). Both multinomial and ordinal logistics analyses revealed that serum RVD1 levels were negatively correlated with TPOAb levels in the adjusted models. Moreover, RVD1 showed a negative correlation with the inflammatory chemokine IP-1 0 (r=–0.276, P=0.034), TSHI (r=–0.269, P=0.036) and TTSI (r=–0.277, P=0.031). Conclusions Thyroid autoimmunity may be associated with low levels of RVD1. Decreased RVD1 levels indicate impaired resolution of inflammation in HT patients.

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Treatment of Heparin-Induced Thrombocytopenia

Annals of Pharmacotherapy ◽

10.1345/aph.1a204 ◽

2002 ◽

Vol 36 (3) ◽

pp. 489-503 ◽

Cited By ~ 40

Author(s):

William E Dager ◽

Richard H White

Keyword(s):

Adverse Reaction ◽

Treatment Options ◽

Clinical Manifestations ◽

Low Molecular Weight ◽

National Library ◽

Severe Adverse Reaction ◽

Heparin Induced Thrombocytopenia ◽

Immune Mediated ◽

Study Selection ◽

Clinical Conditions

OBJECTIVE: To describe heparin-induced thrombocytopenia (HIT or HIT-2), an immune-mediated adverse reaction to heparin or low-molecular-weight heparin. Available treatment options and considerations in developing a therapy approach are discussed. DATA SOURCES: A search of the National Library of Medicine (1992–June 2001) was done to identify pertinent literature. Additional references were reviewed from selected articles. STUDY SELECTION: Articles related to laboratory recognition and treatment options of HIT, including the use of agents in selected clinical conditions, were reviewed and included. CONCLUSIONS: HIT is a rare but potentially severe adverse reaction to heparin that was, until recently, poorly understood and had limited treatment options. Recent advances describing the recognition and clinical manifestations of immune-mediated HIT, including recently available antithrombotic treatment options, have dramatically changed outcomes for patients having this syndrome.

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