Clinical signs, MRI features, and outcomes of two cats with thiamine deficiency secondary to diet change

AbstractObjectiveThiamine is an essential coenzyme for oxidative metabolisms; however, it is not synthesized in the human body, and the average thiamine storage capacity is approximately 18 days. Therefore, thiamine deficiency (TD) can occur in any condition of unbalanced nutrition. If TD is left untreated, it causes the neuropsychiatric disorder Wernicke encephalopathy (WE). Although WE is a medical emergency, it is sometimes overlooked because most patients with WE do not exhibit all of the typical symptoms, including delirium, ataxia, and ophthalmoplegia. If all of the typical clinical symptoms of WE are absent, diagnosis of TD or WE becomes more difficult.MethodFrom a series of cancer patients, we reported three patients who developed TD without the typical clinical symptoms of WE.ResultA 69-year-old woman with pancreatic body cancer receiving chemotherapy with paclitaxel and gemcitabine for six months. Her performance status (PS) was 1. A detailed interview revealed that she had appetite loss for six months. Another 69-year-old woman with ovarian cancer received nedaplatin; her PS was 0. A detailed interview revealed that she had appetite loss for three months. A 67-year-old woman with colon cancer receiving ramucirumab in combination with second-line fluorouracil with folinic acid and irinotecan. Her PS was 1. A detailed interview revealed that she had appetite loss for three weeks. None exhibited typical clinical signs of WE, but they developed appetite loss for six months, three months, and three weeks, respectively. The diagnosis of TD was supported by abnormally low serum thiamine levels.Significance of the resultsThis report emphasizes the possibility of TD in cancer patients even when patients do not develop typical clinical signs of WE. The presence of appetite loss for more than two weeks may aid in diagnosing TD. Patients receiving chemotherapy may be at greater risk for developing TD.

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1.5 Tesla Magnetic Resonance Imaging Features of Canine Intracranial Intra-axial Hematomas

Frontiers in Veterinary Science ◽

10.3389/fvets.2021.778320 ◽

2021 ◽

Vol 8 ◽

Author(s):

James Whitlock ◽

Andrew Holdsworth ◽

Carles Morales ◽

Laurent Garosi ◽

Inés Carrera

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Contrast Enhancement ◽

Clinical Signs ◽

Border Region ◽

Imaging Features ◽

Resonance Imaging ◽

Mri Findings ◽

Mri Features ◽

Mri Study

The differentiation of solitary intra-axial hematomas from hemorrhagic neoplasms based on their magnetic resonance imaging (MRI) features is challenging. The treatment and prognosis for these two disease entities are vastly different and distinction between them is often based on MRI findings alone. The aim of this study was to describe the 1.5 tesla MRI features of canine intra-axial hematomas and correlate these findings with the evolution of hemorrhages described in human brains. Retrospective evaluation of patient details, clinical signs, and MRI findings of dogs with intra-axial hematomas that were histopathologically confirmed or determined via repeat MRI study and/or resolution of neurological signs. Ten dogs met the inclusion criteria. All 10 hematoma lesions were determined to be 2–7 days in age. On MRI, all 10 hemorrhagic lesions were comprised of two distinct regions; a relatively thin T1-weighted (T1W), T2-weighted (T2W) and gradient echo (GRE) hypointense (9/10) peripheral border region and a large central region that was heterogenous but predominantly T1W, T2W and GRE hyperintense (8/10). The peripheral border region was complete in its integrity in all 10 cases on T2W and GRE sequences. Contrast enhancement was present in (6/10) hematoma lesions and was always peripheral in nature with no evidence of central enhancement associated with any of the lesions. An intra-axial hematoma should be suspected in solitary hemorrhagic space occupying lesions that have a complete hypointense peripheral rim, elicit a peripheral contrast enhancement pattern, and display the expected temporal pattern of hematoma evolution.

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Chinese patients with hereditary spastic paraplegias (HSPs): a protocol for a hospital-based cohort study

BMJ Open ◽

10.1136/bmjopen-2021-054011 ◽

2022 ◽

Vol 12 (1) ◽

pp. e054011

Author(s):

Yu-Sen Qiu ◽

Yi-Heng Zeng ◽

Ru-Ying Yuan ◽

Zhi-Xian Ye ◽

Jin Bi ◽

...

Keyword(s):

Cohort Study ◽

Disease Progression ◽

Molecular Mechanisms ◽

Cholesterol Metabolism ◽

Clinical Signs ◽

Clinical Manifestations ◽

Lower Limbs ◽

Chinese Patients ◽

Hereditary Spastic Paraplegias ◽

Mri Features

IntroductionHereditary spastic paraplegias (HSPs) are uncommon but not rare neurodegenerative diseases. More than 100 pathogenic genes and loci related to spastic paraplegia symptoms have been reported. HSPs have the same core clinical features, including progressive spasticity in the lower limbs, though HSPs are heterogeneous (eg, clinical signs, MRI features, gene mutation). The age of onset varies greatly, from infant to adulthood. In addition, the slow and variable rates of disease progression in patients with HSP represent a substantial challenge for informative assessment of therapeutic efficacy. To address this, we are undertaking a prospective cohort study to investigate genetic–clinical characteristics, find surrogates for monitoring disease progress and identify clinical readouts for treatment.Methods and analysisIn this case-control cohort study, we will enrol 200 patients with HSP and 200 healthy individuals in parallel. Participants will be continuously assessed for 3 years at 12-month intervals. Six aspects, including clinical signs, genetic spectrum, cognitive competence, MRI features, potential biochemical indicators and nerve electrophysiological factors, will be assessed in detail. This study will observe clinical manifestations and disease severity based on different molecular mechanisms, including oxidative stress, cholesterol metabolism and microtubule dynamics, all of which have been proposed as potential treatment targets or modalities. The analysis will also assess disease progression in different types of HSPs and cellular pathways with a longitudinal study using t tests and χ2 tests.Ethics and disseminationThe study was granted ethics committee approval by the first affiliated hospital of Fujian Medical University (MRCTA, ECFAH of FMU (2019)194) in 2019. Findings will be disseminated via presentations and peer-reviewed publications. Dissemination will target different audiences, including national stakeholders, researchers from different disciplines and the general public.Trial registration numberNCT04006418.

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Polioencephalomalacia of Dogs with Thiamine Deficiency

Veterinary Pathology ◽

10.1177/030098587701400202 ◽

1977 ◽

Vol 14 (2) ◽

pp. 103-112 ◽

Cited By ~ 25

Author(s):

D. H. Read ◽

R. D. Jolly ◽

M. R. Alley

Keyword(s):

Thiamine Deficiency ◽

Neurological Disease ◽

Thermal Destruction ◽

Spastic Paraparesis ◽

Clinical Signs ◽

Thiamine Hydrochloride ◽

Naturally Occurring ◽

Brainstem Nuclei ◽

Cooked Meat ◽

Dietary Deficiency

A naturally occurring neurological disease occurred in six dogs fed cooked meat. Clinical signs were anorexia, progressive spastic paraparesis, recumbency, convulsions and death. The disease was characterized by bilaterally symmetrical spongy change and necrosis of brainstem nuclei with a lesion distribution pattern similar to that in thiamine deficient foxes and cats. An associated thiamine deficiency was evidenced by decreased thiamine levels in the blood of one dog and in the food of another, and rapid remission of clinical signs in a dog given thiamine hydrochloride. Thermal destruction of thiamine through cooking of the foods probably caused the dietary deficiency.

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Comparison of contrast-enhanced MRI features of the (teno)synovium in the wrist of patients with juvenile idiopathic arthritis and pediatric controls

Rheumatology International ◽

10.1007/s00296-021-05041-9 ◽

2021 ◽

Author(s):

Jeffrey M. A. van der Krogt ◽

F. Verkuil ◽

E. Charlotte van Gulik ◽

Robert Hemke ◽

J. Merlijn van den Berg ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Clinical Signs ◽

Joint Inflammation ◽

Enhanced Mri ◽

Mri Features ◽

Contrast Enhanced ◽

Significant Difference ◽

Mri Scans ◽

Magnetic Resonance Imaging Mri ◽

Contrast Enhanced Mri

AbstractTo directly compare and describe the differences between juvenile idiopathic arthritis (JIA) patients and pediatric controls regarding features of the synovial and tenosynovial membrane on contrast-enhanced magnetic resonance imaging (MRI) of the wrist. T1-weighted contrast-enhanced MRI scans of 25 JIA patients with clinically active wrist arthritis and 25 children without a history of joint complaints nor any clinical signs of joint inflammation were evaluated by two readers blinded to clinical data. The synovium was scored at five anatomical sites based on thickening of the synovium (0–3 scale) and synovial enhancement (0–2 scale). Thickening and/or enhancement of the tenosynovium was scored at four anatomical sites using a 0–3 scale. Significantly higher scores for synovial thickening (median 4 vs. 1, p < 0.001) and synovial enhancement (median 4 vs. 1, p < 0.001) are found in the wrist of JIA patients as compared to controls. JIA patients experienced the highest synovial scores at the mid-/inter-carpal, 2nd –5th carpometacarpal, and radiocarpal joints. No significant difference in tenosynovial scores is found between both groups (median 0 vs. 0, p = 0.220). This study highlights the higher synovial thickening/enhancement scores on contrast-enhanced MRI of the wrist in JIA patients compared to pediatric controls. Tenosynovial thickening and/or enhancement was rarely present in both groups. In JIA patients, synovial thickening and enhancement were particularly present at three anatomical sites. These results substantially support rheumatologists and radiologists when navigating through MRI of the wrist in search for JIA disease activity.

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Clinical reasoning in feline vestibular syndrome: which presenting features are the most important?

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x20970869 ◽

2020 ◽

pp. 1098612X2097086

Author(s):

Nicholas J Grapes ◽

Frances E Taylor-Brown ◽

Holger A Volk ◽

Steven De Decker

Keyword(s):

Middle Ear ◽

Clinical Reasoning ◽

Thiamine Deficiency ◽

Clinical Presentation ◽

Clinical Signs ◽

Binary Logistic Regression ◽

Clinical Progression ◽

Feline Infectious Peritonitis ◽

Clinical Variables ◽

Regression Modelling

Objectives The aim of this study was to evaluate whether clinical variables from the history, clinical presentation, and physical and neurological examinations of cats with vestibular syndrome were statistically predictive of the underlying diagnosis. Methods In total, 174 cats presenting with vestibular syndrome between January 2010 and May 2019 were investigated. Univariate statistical analysis of clinical variables was performed and those statistically associated with a diagnosis were retained for multivariable binary logistic regression modelling. Results The seven most prevalent diagnoses represented 95% of vestibular presentations, which included: otitis media/interna (n = 48), idiopathic vestibular syndrome (n = 39), intracranial neoplasia (n = 24), middle ear polyp (n = 17), feline infectious peritonitis (n = 13), thiamine deficiency (n = 13) and intracranial empyema (n = 11). Idiopathic vestibular syndrome was commonly associated with non-purebred cats and had 17.8 times the odds of an improving clinical progression (95% confidence interval [CI] 1.3–250.0; P = 0.03). Intracranial neoplasia was associated with older age and chronic onset of clinical signs, and was significantly more likely to have a central vestibular neuroanatomical localisation (95% CI 8.5–344349142.0; P = 0.015) with postural deficits on neurological examination. Thiamine deficiency was more common in female cats, with 52.6 times the odds of a waxing and waning clinical progression (95% CI 1.2–1000; P = 0.038) and 6.8 times the odds of presenting with bilateral vestibular signs (95% CI 1.0–45.7; P = 0.047) and wide excursions of the head (95% CI 1.0–45.7; P = 0.047). Middle ear polyps were associated with 8.8 times the odds of presenting with Horner syndrome (95% CI 1.5–50.0; P = 0.015). Conclusions and relevance Although it may be difficult to identify the underlying diagnosis in cats with vestibular syndrome from the presenting features alone, there are instances in which discrete clinical features may help to guide clinical reasoning when evaluating cats with vestibular presentations.

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What are the clinical signs of thiamine deficiency in elderly patients?

Journal of General and Family Medicine ◽

10.1002/jgf2.479 ◽

2021 ◽

Author(s):

Hideki Onishi ◽

Mayumi Ishida

Keyword(s):

Elderly Patients ◽

Thiamine Deficiency ◽

Clinical Signs

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Author reply to what are the clinical signs of thiamine deficiency in elderly patients?

Journal of General and Family Medicine ◽

10.1002/jgf2.484 ◽

2021 ◽

Author(s):

Ryuichi Ohta ◽

Yoshinori Ryu ◽

Shuzo Hattori ◽

Chiaki Sano

Keyword(s):

Elderly Patients ◽

Thiamine Deficiency ◽

Clinical Signs ◽

Author Reply

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Diagnostic and Prognostic Value of Conventional Brain MRI in the Clinical Work-Up of Patients with Amyotrophic Lateral Sclerosis

Journal of Clinical Medicine ◽

10.3390/jcm9082538 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2538 ◽

Cited By ~ 1

Author(s):

Giovanni Rizzo ◽

Anna Marliani ◽

Stella Battaglia ◽

Luca Albini Riccioli ◽

Silvia De Pasqua ◽

...

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Predictive Value ◽

Brain Mri ◽

Clinical Signs ◽

Clinical Work ◽

3T Mri ◽

Mri Features ◽

Als Patients ◽

Work Up ◽

Lateral Sclerosis

Clinical signs of upper motor neuron (UMN) involvement are important in the diagnosis of amyotrophic lateral sclerosis (ALS) though are often difficult to analyze. Many studies using both qualitative and quantitative evaluations have reported abnormal Magnetic Resonance Imaging (MRI) findings at the level of the pyramidal pathway in patients with ALS. Although the most interesting results were obtained by quantitative studies using advanced MR techniques, the qualitative evaluation of MRI images remains the most-used in clinical practice. We evaluated the diagnostic and prognostic contribution of conventional 3T-MRI in the clinical work-up of ALS patients. Two neuroradiologists retrospectively assessed 3T-MRI data of 93 ALS patients and 89 controls. The features of interest were corticospinal tract (CST) T2/FLAIR hyperintensity, motor cortex (MC) T2*/SWI hypointensity, and selective MC atrophy. All MRI features were significantly more prevalent in ALS patients than in controls. The simultaneous presence of CST FLAIR hyperintensity and MC SWI hypointensity was associated with the highest diagnostic accuracy (sensitivity: 70%; specificity: 81%; positive predictive value, PPV: 90%; negative predictive value, NPV: 51%; accuracy: 73%) and a shorter survival (HR: 6.56, p = 0.002). Conventional 3T-MRI can be a feasible tool to detect specific qualitative changes based on UMN involvement and to support clinical diagnosis of ALS. Importantly, CST FLAIR hyperintensity and MC SWI hypointensity are predictors of shorter survival in ALS patients.

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