Progressive lacunar stroke presenting as cheiro-oral syndrome, dysarthria and hemiataxia

Context: Lacunar infarcts are small infarcts caused by occlusion of a single penetrating vessel, affecting mostly the basal ganglia, subcortical white matter and pons1. Around 20-30% of patients may progress symptoms over hours to days, and this presentation is associated with disability and poor prognosis2. Case report: A 70-year-old man with history of smoking, hypertension and a previous right occipital stroke reported right upper lip paresthesias since awakening. In 2-hours the right perioral region and his right hand were affected. After 3-hours he noted slurred speech. After 4-hours, imbalance was added to the previous symptoms. On admission, NIHSS was 4, mostly by previous left hemianopia, new right arm ataxia and cerebellar dysarthria. There were no weakness or sensory déficits. Brain MRI showed a subacute lacunar stroke in the left thalamus. Discussion: Thalamic lacunar strokes can present in a wide range of symptoms depending on the affected nuclei. The ventral posterior lateral nucleus (VPLn) and the ventral posterior medial nucleus (VPMn) carries sensory input from the contralateral body and face, respectively3. Cheiro-oral syndrome (COS) is considered a pure sensory thalamic lacunar syndrome with symptoms that affect the face, hand and/or foot, but may be accompanied by ipsilateral ataxia if the ventral lateral nucleus is also affected4 . Although classically associated with thalamic ischemic lesions, there are descriptions of hemorrhagic strokes5 and multiple different affected regions presenting as COS, including brainstem5 , internal capsule6 , operculum7 , cortex8 , corona radiata9 and thalamus10. Early recognition and diagnosis is essencial to institute adequate early treatment and secondary prophylaxis.

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Neuroimaging Insights Into Early Stages of HIV-Progressive Multifocal Leukoencephalopathy: A Case Report

Journal of Central Nervous System Disease ◽

10.1177/1179573520939339 ◽

2020 ◽

Vol 12 ◽

pp. 117957352093933

Author(s):

Natalia Gonzalez Caldito ◽

J Scott Loeb ◽

Darin T Okuda

Keyword(s):

Progressive Multifocal Leukoencephalopathy ◽

Early Recognition ◽

Brain Mri ◽

Disease Evolution ◽

Early Stages ◽

Mri Features ◽

Fluid Attenuated Inversion Recovery ◽

Magnetic Resonance Imaging Mri ◽

Punctate Pattern ◽

The Right

This report aims to enhance the understanding of early longitudinal neuroimaging features of progressive multifocal leukoencephalopathy (PML) in human immunodeficiency virus (HIV). Neuroimaging has become crucial in the diagnosis and early recognition of PML. Recognition of magnetic resonance imaging (MRI) features in the early stages of PML is paramount to avoid misdiagnosis and facilitate the delivery of treatments aimed at reducing disease progression. A 49-year-old white man with HIV presented with 4-month progressive left-sided weakness. Neurological examination revealed mild cognitive impairment, left-sided hemiparesis, and somatosense impairment to all modalities. Brain MRI revealed a punctate pattern with innumerable T2-FLAIR (fluid attenuated inversion recovery) hyperintensities in the cortex, brainstem, cerebellum, subcortical, and periventricular areas. Susceptibility-weighted imaging (SWI) revealed hypointensities involving subcortical U-fibers and cortical architecture. A comprehensive diagnostic evaluation was inconclusive. John Cunningham virus (JCV) PCR in cerebrospinal fluid (CSF) was indeterminate. He was started on antiretroviral therapy. Repeat brain MRI performed 1.5 months later, in the setting of further neurological decline, demonstrated progression of the T2-hyperintensities into a large confluent white matter lesion in the right frontoparietal lobe. Despite an indeterminate JCV PCR, the appearance and characteristic progression of the lesions in successive imaging in the setting of severe immunosuppression, with extensive negative infectious workup, was indicative of PML. This clinical experience illustrates unique neuroimaging features of HIV-PML in early stages and its progression over time. It especially highlights the relevance of the SWI sequence in the diagnosis and features observed with disease evolution. Short-term imaging follow-up may assist with the recognition of MRI features consistent with the biology of the infection.

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The effect of ablation of the olfactory pits on the development of the habenular nuclei in Rana pipiens

Development ◽

10.1242/dev.34.3.657 ◽

1975 ◽

Vol 34 (3) ◽

pp. 657-667

Author(s):

Byron K. Norris ◽

Victor B. Eichler

Keyword(s):

Rana Pipiens ◽

Cell Number ◽

Relative Volume ◽

Experimental Animals ◽

Medial Nucleus ◽

Cell Groups ◽

Early Embryonic Stage ◽

Single Nucleus ◽

The Right ◽

Lateral Nucleus

The habenular nuclei in the diencephalon of the frog, Rana pipiens, are asymmetrical structures: two discrete cell groups develop on the left side (as medial and lateral nuclei), while a single nucleus is formed on the right side. Experimental animals were subjected to bilateral removal of the olfactory pits at an early embryonic stage, and were maintained with normal control animals until metamorphosis was complete. The length, relative volume and cell number for each of the three nuclei were determined in the control and experimental animals at regular intervals during larval development. In the control animals, the left medial nucleus developed similarly to the right nucleus spatially and temporally; however, the left lateral nucleus was significantly different in its development in the three parameters measured. In the experimental animals the left medial and the right habenular nuclei were alone affected by the removal of the olfactory pits. The results provide experimental evidence that the right and left medial, but not the left lateral, habenular nuclei are centers receiving afferent olfactory fibers.

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Evaluation of 99mTc-Label led Vitamin K4 as an Agent for Testicular Imaging

Nuklearmedizin ◽

10.1055/s-0038-1629552 ◽

1991 ◽

Vol 30 (01) ◽

pp. 35-39 ◽

Cited By ~ 1

Author(s):

H. S. Durak ◽

M. Kitapgi ◽

B. E. Caner ◽

R. Senekowitsch ◽

M. T. Ercan

Keyword(s):

Soft Tissue ◽

Room Temperature ◽

Normal Subjects ◽

Left Testis ◽

Wide Range ◽

Activity Ratios ◽

The Right ◽

Radioactivity Levels

Vitamin K4 was labelled with 99mTc with an efficiency higher than 97%. The compound was stable up to 24 h at room temperature, and its biodistribution in NMRI mice indicated its in vivo stability. Blood radioactivity levels were high over a wide range. 10% of the injected activity remained in blood after 24 h. Excretion was mostly via kidneys. Only the liver and kidneys concentrated appreciable amounts of radioactivity. Testis/soft tissue ratios were 1.4 and 1.57 at 6 and 24 h, respectively. Testis/blood ratios were lower than 1. In vitro studies with mouse blood indicated that 33.9 ±9.6% of the radioactivity was associated with RBCs; it was washed out almost completely with saline. Protein binding was 28.7 ±6.3% as determined by TCA precipitation. Blood clearance of 99mTc-l<4 in normal subjects showed a slow decrease of radioactivity, reaching a plateau after 16 h at 20% of the injected activity. In scintigraphic images in men the testes could be well visualized. The right/left testis ratio was 1.08 ±0.13. Testis/soft tissue and testis/blood activity ratios were highest at 3 h. These ratios were higher than those obtained with pertechnetate at 20 min post injection.99mTc-l<4 appears to be a promising radiopharmaceutical for the scintigraphic visualization of testes.

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It is better an approximate answer to the right question than the exact answer to the wrong question : the case of the psychometric analysis of the ASQ:SE

10.31234/osf.io/a5tdf ◽

2020 ◽

Author(s):

Luis Anunciacao ◽

janet squires ◽

J. Landeira-Fernandez

Keyword(s):

Internal Structure ◽

Statistical Methods ◽

Principal Component ◽

Psychological Theory ◽

Published Data ◽

Multivariate Statistical ◽

Exact Answer ◽

Wide Range ◽

Ages And Stages Questionnaire ◽

The Right

One of the main activities in psychometrics is to analyze the internal structure of a test. Multivariate statistical methods, including Exploratory Factor analysis (EFA) and Principal Component Analysis (PCA) are frequently used to do this, but the growth of Network Analysis (NA) places this method as a promising candidate. The results obtained by these methods are of valuable interest, as they not only produce evidence to explore if the test is measuring its intended construct, but also to deal with the substantive theory that motivated the test development. However, these different statistical methods come up with different answers, providing the basis for different analytical and theoretical strategies when one needs to choose a solution. In this study, we took advantage of a large volume of published data (n = 22,331) obtained by the Ages and Stages Questionnaire Social-Emotional (ASQ:SE), and formed a subset of 500 children to present and discuss alternative psychometric solutions to its internal structure, and also to its subjacent theory. The analyses were based on a polychoric matrix, the number of factors to retain followed several well-known rules of thumb, and a wide range of exploratory methods was fitted to the data, including EFA, PCA, and NA. The statistical outcomes were divergent, varying from 1 to 6 domains, allowing a flexible interpretation of the results. We argue that the use of statistical methods in the absence of a well-grounded psychological theory has limited applications, despite its appeal. All data and codes are available at https://osf.io/z6gwv/.

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THE VALUE OF LOVE IN THE SYSTEM OF FORMATION OF THE PROFESSIONAL MATURITY OF THE EDUCATOR

EurasianUnionScientists ◽

10.31618/esu.2413-9335.2020.1.79.1032 ◽

2020 ◽

Vol 1 (10(79)) ◽

pp. 12-18

Author(s):

G. Bubyreva

Keyword(s):

Russian Federation ◽

The State ◽

Educational Process ◽

Wide Range ◽

The Family ◽

The Russian Federation ◽

The Government ◽

The Individual ◽

The Right

The existing legislation determines the education as "an integral and focused process of teaching and upbringing, which represents a socially important value and shall be implemented so as to meet the interests of the individual, the family, the society and the state". However, even in this part, the meaning of the notion ‘socially significant benefit is not specified and allows for a wide range of interpretation [2]. Yet the more inconcrete is the answer to the question – "who and how should determine the interests of the individual, the family and even the state?" The national doctrine of education in the Russian Federation, which determined the goals of teaching and upbringing, the ways to attain them by means of the state policy regulating the field of education, the target achievements of the development of the educational system for the period up to 2025, approved by the Decree of the Government of the Russian Federation of October 4, 2000 #751, was abrogated by the Decree of the Government of the Russian Federation of March 29, 2014 #245 [7]. The new doctrine has not been developed so far. The RAE Academician A.B. Khutorsky believes that the absence of the national doctrine of education presents a threat to national security and a violation of the right of citizens to quality education. Accordingly, the teacher has to solve the problem of achieving the harmony of interests of the individual, the family, the society and the government on their own, which, however, judging by the officially published results, is the task that exceeds the abilities of the participants of the educational process. The particular concern about the results of the patriotic upbringing served as a basis for the legislative initiative of the RF President V. V. Putin, who introduced the project of an amendment to the Law of RF "About Education of the Russian Federation" to the State Duma in 2020, regarding the quality of patriotic upbringing [3]. Patriotism, considered by the President of RF V. V. Putin as the only possible idea to unite the nation is "THE FEELING OF LOVE OF THE MOTHERLAND" and the readiness for every sacrifice and heroic deed for the sake of the interests of your Motherland. However, the practicing educators experience shortfalls in efficient methodologies of patriotic upbringing, which should let them bring up citizens, loving their Motherland more than themselves. The article is dedicated to solution to this problem based on the Value-sense paradigm of upbringing educational dynasty of the Kurbatovs [15].

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The Right to Bodily Integrity

10.1093/oso/9780190901516.003.0007 ◽

2018 ◽

Author(s):

Alison Brysk

Keyword(s):

Sexual Assault ◽

Sexual Violence ◽

Public Space ◽

Transitional Justice ◽

The United States ◽

Bodily Integrity ◽

Global Pattern ◽

Popular Resistance ◽

Wide Range ◽

The Right

In Chapter 7, we profile the global pattern of sexual violence. We will consider conflict rape and transitional justice response in Peru and Colombia, along with the plight of women displaced by conflict from Syria and Central America, and limited international policy response. State-sponsored sexual violence and popular resistance to reclaim public space will be chronicled in Egypt as well as Mexico. We will track intensifying public sexual assault amid social crisis in Turkey, South Africa, and India, which has been met by a wide range of public protest, legal reform, and policy change. For a contrasting experience of the privatization of sexual assault in developed democracies, we will trace campus, workplace, and military rape in the United States.

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Lying in Early Modern English Culture

10.1093/oso/9780198789468.001.0001 ◽

2017 ◽

Cited By ~ 4

Author(s):

Andrew Hadfield

Keyword(s):

Early Modern ◽

Cultural History ◽

Identity Politics ◽

Social Life ◽

Thomas More ◽

Early Modern English ◽

Wide Range ◽

Constant Feature ◽

The Right ◽

English Culture

Lying in Early Modern English Culture is a major study of ideas of truth and falsehood from the advent of the Reformation to the aftermath of the Gunpowder Plot. The period is characterized by panic and chaos when few had any idea how religious, cultural, and social life would develop after the traumatic division of Christendom. Many saw the need for a secular power to define the truth; others declared that their allegiances belonged elsewhere. Accordingly there was a constant battle between competing authorities for the right to declare what was the truth and so label opponents as liars. Issues of truth and lying were, therefore, a constant feature of everyday life, determining ideas of identity, politics, speech, sex, marriage, and social behaviour, as well as philosophy and religion. This book is a cultural history of truth and lying from the 1530s to the 1610s, showing how lying needs to be understood in practice and theory, concentrating on a series of particular events, which are read in terms of academic debates and more popular notions of lying. The book covers a wide range of material such as the trials of Anne Boleyn and Thomas More, the divorce of Frances Howard, and the murder of Anthony James by Annis and George Dell; works of literature such as Othello, The Faerie Queene, A Mirror for Magistrates, and The Unfortunate Traveller; works of popular culture such as the herring pamphlet of 1597; and major writings by Castiglione, Montaigne, Erasmus, Luther, and Tyndale.

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Tickets for the Inclusive Museum

The Oxford Handbook of Deaf Studies in Learning and Cognition ◽

10.1093/oxfordhb/9780190054045.013.23 ◽

2020 ◽

pp. 390-406

Author(s):

Magda Nikolaraizi ◽

Charikleia Kanari ◽

Marc Marschark

Keyword(s):

Hard Of Hearing ◽

Learning Experiences ◽

Learning Needs ◽

Participatory Learning ◽

Maximum Benefit ◽

Wide Range ◽

The Right ◽

Physical Features ◽

And Behavior

In recent years, museums of various kinds have broadened their mission and made systematic efforts to develop a dynamic role in learning by offering a wide range of less formal experiences for individuals with diverse characteristics, including individuals who are deaf or hard-of-hearing (DHH). Despite the worthwhile efforts, in the case of DHH individuals, museums frequently neglect to consider their unique communication, cognitive, cultural, and learning characteristics, thus limiting their access and opportunities for fully experiencing what museums have to offer. This chapter examines the potential for creating accessible museum environments and methods that reflect an understanding of the diverse communication, cognitive, cultural, and learning needs of DHH visitors, all of which enhance their access and participation in the museum activities. The role of the physical features of museum spaces for the access and behavior of DHH visitors is emphasized, together with attention to exhibition methods and the communication and cognitive challenges that need to be considered so DHH visitors can get the maximum benefit. The chapter emphasizes the right of individuals who are DHH to nonformal learning and analyzes how museums could become more accessible to DHH individuals by designing, from the beginning, participatory learning experiences that address their diverse needs.

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Gasperini Syndrome: A Case Report and Systematic Review and Proposing a New Definition

Case Reports in Neurology ◽

10.1159/000510845 ◽

2020 ◽

Vol 12 (3) ◽

pp. 433-439

Author(s):

Riwaj Bhagat ◽

Siddharth Narayanan ◽

Marwa Elnazeir ◽

Thong Diep Pham ◽

Robert Paul Friedland ◽

...

Keyword(s):

Systematic Review ◽

Brain Mri ◽

Cranial Nerves ◽

Clinical Manifestations ◽

The Other ◽

Neurological Deficits ◽

Brainstem Stroke ◽

Neurological Features ◽

The Right ◽

Core Features

Gasperini syndrome (GS), a rare brainstem syndrome, is featured by ipsilateral cranial nerves (CN) V–VIII dysfunction with contralateral hemibody hypoesthesia. While there have been 18 reported cases, the GS definition remains ambiguous. We report a new case and reviewed the clinical features of this syndrome from all published reports to propose a new definition. A 57-year-old man with acute brainstem stroke had right CN V–VIII and XII palsies, left body hypoesthesia and ataxia. Brain MRI showed an acute stroke in the right caudal pons and bilateral cerebellum. After a systematic review, we classified the clinical manifestations into core and associate features based on the frequencies of occurring neurological deficits. We propose that a definitive GS requires the presence of ipsilateral CN VI and VII palsies, plus one or more of the other three core features (ipsilateral CN V, VIII palsies and contralateral hemibody hemihypalgesia). Additionally, GS, similar to Wallenberg’s syndrome, represents a spectrum that can have other associated neurological features. The revised definition presented in this study may enlighten physicians with the immediate recognition of the syndrome and help improve clinical localization of the lesions and its management.

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Recurrence of Primary Breast Lymphoma Presenting as Bilateral Vitreoretinal Lymphoma

Ocular Oncology and Pathology ◽

10.1159/000515560 ◽

2021 ◽

pp. 1-5

Author(s):

Karishma Habbu ◽

Roshan George ◽

Miguel Materin

Keyword(s):

Brain Mri ◽

B Cell Lymphoma ◽

Intrathecal Chemotherapy ◽

Primary Breast Lymphoma ◽

Blurred Vision ◽

Breast Lymphoma ◽

Central Nervous System Penetration ◽

Vitreoretinal Lymphoma ◽

The Right ◽

Vitreous Biopsy

Purpose: This report describes a case of relapsed primary breast lymphoma (PBL) presenting as vitreoretinal lymphoma (VRL). Methods: We describe the clinical and hematopathologic findings in a patient with relapsed PBL involving the vitreous of both eyes. Results: A 59-year-old woman was treated for PBL with systemic and intrathecal chemotherapy 5 years prior to presentation. Three years later, she presented to an outside clinic with blurred vision in both eyes and bilateral vitritis. She was referred to our clinic with concern for ocular lymphoma. On presentation, the patient’s best-corrected visual acuity was 20/40 in the right eye and 20/25 in the left eye with 3+ vitreous cells in the right eye and 2+ vitreous cells in the left eye. Vitreous biopsy of the right eye revealed CD5-negative/CD10-negative B-cell lymphoma cells on flow cytometry. She had no evidence of disease on brain MRI, lumbar puncture, bone marrow biopsy, or full-body CT scans. She was treated with a regimen of rituximab, methotrexate, procarbazine, and vincristine for central nervous system penetration as well as multiple intraocular injections of methotrexate and rituximab with improvement in vision and ocular inflammation bilaterally. Conclusion: Relapsed PBL can present as bilateral VRL.

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