Rasmussen syndrome in a tropical environment: a study of six (6) observations

Background In sub-Saharan Africa, encephalitis of various etiologies is a major public health problem and Rasmussen syndrome is rarely diagnosed due to under-medicalization. The objective of this study is to describe the clinical and neuroradiological forms, especially since this affection is little known in sub-Saharan Africa as evidenced by the scarcity of publications. Results A retrospective, descriptive and analytical study of six (6) cases of Rasmussen syndrome, shows that it is an unrecognized disease in Africa. Men were more represented with a frequency of 67% with a young age. The clinical picture dominated by 100% seizures, mental deterioration and hemiparesis. The etiology is still questionable, probably autoimmune in our study. Conclusion Rasmussen syndrome accounts for 3% in 219 patients hospitalized for epileptic conditions. This study shows a clinical profile dominated by recurrent epileptic seizures refractory to the drugs Phenobarbital, Valproic Acid and Carbamazepine, the only antiepileptics available in the country. These results are valid for therapeutic and prognostic discussion.

Pathology, Power, and Patriarchy in The Autumn of the Patriarch and The General in His Labyrinth

In both of his political novels, The Autumn of the Patriarch (1975) and The General in His Labyrinth (1989), García Márquez employs similar themes and narrative strategies to portray very different protagonists. The Patriarch is a prototypical Latin American dictator, while Simón Bolívar is the hero of Latin American independence. The protagonists share numerous characteristics, such as illnesses that serve as metaphors for their loss of power (physical in the case of the General, mental in the case of the Patriarch), characterization through their numerous sexual encounters, their distaste for losing at games, and their control of national funds. The Patriarch’s pathology functions to underscore a psychological obsession with power, whose loss corresponds to the Patriarch’s mental deterioration and ultimate senility, while the General’s illness relies on traditional associations of consumption as representative of melancholy (as outlined by Sontag in Illness as Metaphor), thus romanticizing the figure of Bolívar. This essay examines how García Márquez employs similar tropes and novelistic elements to evolve very different portraits of his two protagonists: the Patriarch as a mythic figure who epitomizes evil and the abuse of power, and the General as a postmodern historical figure who combines his power obsession with other mitigating characteristics, such as the love of his continent and the dream of its unity. A contraposition of these two characters illustrates social psychological distinctions between the dominance and the functionalist perspectives of power, in addition to clarifying many of the ambiguities inherent in García Márquez’s portrait of Bolívar.

The Nell Dialogues

Nell M. came to her therapist with an unusual problem: She was disappointed that her metastatic breast cancer, with the promise of ending her life, was not progressing on her hoped-for schedule. She had hoped her death would prevent her from witnessing her spouse’s mental deterioration from Alzheimer’s disease. This is how Nell’s story began and proceeded for a period of 40 weeks of counseling meetings, including 12 recorded sessions. This book consists of 12 illness narratives created in the presence of her therapist. These dialogues explore the challenges of managing the physical and emotional demands of cancer, relationship issues with family and healthcare professionals, and disturbing, anxiety-provoking thoughts and the mourning that accompanies the end of life. Nell’s vibrant voice is a beacon throughout the narratives, sometimes sad, yet always hopeful for a good death. Her ability to navigate the difficult territory of mortal time and dying informs readers about how they might approach their own ending with grace and dignity.

A simple scoring system in COVID-19 patients with neurological manifestations

Background: Coronavirus disease 2019 (COVID-19) has affected a rapidly growing patient population worldwide. To effectively manage the disease, physicians need tests or methods that classify patients according to their risks. Our aim is to determine the importance of mean platelet volume (MPV), neutrophil-lymphocyte ratio (NLR), MPVNLR score (MPV×Neutrophil/lymphocyte) in predicting the clinical course and mortality in hospitalized COVID-19 patients with neurological manifestations. Methods: A total of 300 patients were enrolled in the study. MPV, NLR, MPVNLR score, CRP, D-dimer, IL-6, and procalcitonin tests were obtained for each patient. Results: MPV, NLR, MPVNLR score, IL-6, D-dimer, procalcitonin, and CRP in the non-survivor group were higher than the survivor group (p=0.001, p:0.001, p=0.001, p=0.001, p=0.001, p=0.027, and p=0.001, respectively). MPV, NLR, MPVNLR score, IL-6, D-dimer, procalcitonin and CRP were higher in patients with altered mental status (p=0.001, p=0.001, p=0.001, p=0.014, p=0.002, p=0.026, and p=0.001, respectively). Conclusion: High MPV, NLR, and MPVNLR scores may be simple markers to predict mortality and mental deterioration in COVID-19.

A review of the mechanisms underlying selected comorbidities in Alzheimer’s disease

Alzheimer's disease (AD) is a progressive neurodegenerative disorder of the central nervous system (CNS) leading to mental deterioration and devastation, and eventually a fatal outcome. AD affects mostly the elderly. AD is frequently accompanied by hypercholesterolemia, hypertension, atherosclerosis, and diabetes mellitus, and these are significant risk factors of AD. Other conditions triggered by the progression of AD include psychosis, sleep disorders, epilepsy, and depression. One important comorbidity is Down’s syndrome, which directly contributes to the severity and rapid progression of AD. The development of new therapeutic strategies for AD includes the repurposing of drugs currently used for the treatment of comorbidities. A better understanding of the influence of comorbidities on the pathogenesis of AD, and the medications used in its treatment, might allow better control of disease progression, and more effective pharmacotherapy. Graphic abstract

Frontal Hypoperfusion and the Effectiveness of Perampanel in Long-Lived Patient with Lafora Disease

We report a long-lived patient with Lafora disease (LD). A 34-year-old woman experienced onset of seizures at the age of 11 years. She was bedridden in her early twenties due to frequent generalized tonic-clonic seizures, myoclonus, and progressive mental deterioration. Her seizures occurred all the time despite administration of multiple anticonvulsants at high doses. At the age of 31, she started perampanel, which resulted in reduction of anticonvulsants after her visible myoclonus and convulsions disappeared. Brain magnetic resonance imaging showed marked cerebral and cerebellar atrophy, and single-photon emission computed tomography using N-isopropyl-p-[123I] iodoamphetamine (IMP-SPECT) revealed significant hypoperfusion of the frontal lobe and cerebellum. We identified a W219R homozygous mutation in exon 1 of the NHLRC1 gene. Because perampanel may not only control seizures but also prevent mental deterioration in LD, we propose that perampanel should be administered from the early stage of LD.

Neurological symptoms improved by hyperbaric oxygen therapy in a post-cardiac arrest patient due to carbon monoxide poisoning: a case report

Background: Carbon monoxide (CO) poisoning and cardiac arrest can cause neurological complications such as mental deterioration and movement disorders through ischemic brain injury. We report a case in which neurological sequelae after cardiac arrest caused by CO poisoning improved after hyperbaric oxygen (HBO2) therapy. Case report: A 43-year-old male visited the hospital with cardiac arrest due to CO poisoning. He developed neurological sequelae including mental deterioration and myoclonus after recovering spontaneous circulation. Anticonvulsant therapy was used after target temperature management but did not have a positive effect on neurological symptoms. However, after HBO2 therapy the patient’s neurological symptoms improved, and he was discharged a month later. Conclusion: HBO2 therapy may be considered when neurological sequelae persist after cardiac arrest due to CO poisoning.

From hybrids to new scaffolds: the latest medicinal chemistry goals in multi-target directed ligands for Alzheimer’s disease

: Alzheimer’s disease (AD) is a chronic, progressive, and fatal neurodegenerative disorder affecting cognition, behavior, and function, being one of the most common causes of mental deterioration in elderly people. Once thought as being just developed because of β amyloid depositions or neurofibrillary Tau tangles, during the last decades, numerous ADrelated targets have been established, the multifactorial nature of AD became evident. In this context, the one drug-one target paradigm has resulted to be inefficient in facing AD and other disorders with complex etiology, opening the field for the emergence of the multitarget approach. In this review, we highlight the recent advances within this area, emphasizing in hybridization tools of well-known chemical scaffolds endowed with pharmacological properties concerning AD, such as curcumin-, resveratrol-, chromone- and indole-. We focus mainly on well stablished and incipient AD therapeutic targets, AChE, BuChE, MAOs, β-amyloid deposition, 5-HT4 and Serotonin transporter, with the aim to shed light about new insights in the AD multitarget therapy.