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wake disturbances in mild traumatic brain injury patients
S272
19th World Congress of Neurology, Poster Abstracts / Journal of the Neurological Sciences 285 S1 (2009) S155–S339
the MLF in the medulla. To determine whether disruption of MLF in the medulla impairs formation of VEMP. Methods: We measured VEMP in fourteen patients with medial medullary infarction (MMI). VEMP was induced by a short tone burst and was recorded in contracting SCM while patients turned their heads forcefully to the contralateral side against resistance. Results: VEMP was abnormal in seven patients. Six of them showed absence (n = 2) or decreased amplitude (n = 4), and the remaining one exhibited delayed p13 latency of the ipsilesional VEMP. In patients with abnormal VEMP, the lesions usually extended to the dorsal tegmentum while those with normal VEMP usually showed restricted anteromedial lesions mainly involving the pyramids. Spontaneous nystagmus (4/7, 57.2%), gaze-evoked nystagmus (6/7, 85.7%), and OTR/SVV tilt (4/7, 57.2%) were frequently accompanied in the patients with abnormal VEMP. Conclusion: The abnormal VEMP in our patients with MMI supports that VEMP is mediated by MVST contained in MLF. The frequent association of abnormal VEMP and abnormal ocular motor findings also indicates that the lesions in the patients with abnormal VEMP involved the medullary tegmentum where MLF locates. PO20-WE-13 Unusual etiology of recurrent refractory paroxysmal vertigo: experience with 15 cases R. Rangel Guerra1 , A. Garcia de la Fuente2 . 1 Neurology, Hospital Universitario, Monterrey, Nuevo Leon, Mexico; 2 Hemodynamic Unit, Hospital Christus Muguerza, Monterrey, Nuevo Leon, Mexico Introduction: The most frequent type of vertigo is paroxysmal, positional vertigo (70–80% of all cases of vertigo). Objectives: To present to the neurological community a very unusual cause of paroxysmal and refractory type of vertigo, which has not been reported previously. Material and Methods: From March 2007 to December 2005, we collected 15 patients with recurrent, Refractory Paroxysmal vertigo (RRPV). 7 males and 8 females with median age of 28.7 year. All patients were evaluated clinically by a neurologist or ORL y neuro otological testing were performed in most of them. All were studied with MRI with MRV or Digital sustraction Panangiograpy. All subject showed Thrombosis of intracraneal sinuses and they were followed for several months. Results: All patients has Refractory Paroxysmal incapacitating Vertigo, not related to postural changes, and the DIX-HALLPIKE manouver was positive only in 4 cases. Cases 7 and 11 had abnormal prothrombotic factors. Magnetic Resonance Venography was performed is all patients and Digital Panangiography was realized in 6 cases. All patients received antiaggregants and 5 received warfarin. Superselective thrombolysis was performed in 3 cases and endovascular prothesis was applied in the affected vein. Vertigo disappeared in 100% of the cases. Conclusion: A very unusual etiology of RRPV, is presented, which has not been reported and we showed the excellent results obtained with the selected treatments. PO20-WE-14 Retrograde trans-synaptic retinal ganglion cell loss identified by optical coherence tomography (OCT) P. Jindahra1 , A. Petrie2 , G.T. Plant1 . 1 The National Hospital for Neurology and Neurosurgery, Moorfields Eye Hospital, London, United Kingdom; 2 Biostatistics Unit, UCL Eastman Dental Institute, London, United Kingdom Purpose: To study trans-synaptic degeneration in human visual pathway after injuries to retrogeniculate areas. Method: Forty-eight persons were recruited and divided into three groups. Two groups were patients with retrogeniculate lesions. In the first group, the occipital damage had occurred during childhood or in adult life whilst the lesions in the second group were congenital. Every patient had homonymous hemianopia and
neuroimaging showed occipital lobe damage. The third group had normal visual function. The thickness of the peripapillary retinal nerve fibre layer (RNT) was measured using OCT in both eyes of each subject. Results: The mean RNT in the eyes with temporal hemianopia (here called the “crossing-fibre defect” eyes) is 79.8 m (SD = 35.1 m) in the acquired and 72.7 m (SD = 33.2 m) in the congenital. The mean RNT in eyes with nasal hemianopia (here called the “non-crossing-fibre defect” eyes) is 83 m (SD = 29.5 m) in the acquired and 73.4 m (SD = 26 m) in the congenital. In the control group, the RNT measured 101.4 m (SD = 36.6 m) for the left eyes and 100.8 m (SD = 35.4 m) for the right eyes. In both crossing-fibre defect eyes and non-crossing-fibre defect eyes the mean RNT is significantly greater in the controls than in the hemianopia groups (P < 0.001). Conclusions: These data confirm that there is thinning of the RNT following both congenital and acquired lesions of the retrogeniculate visual pathway in humans, representing retinal ganglion cell loss in these patients. The data have also been analysed in 12 sectors around the optic disc: it has been shown that the RNT thinning follows the known trajectories of the crossing and noncrossing retinal ganglion cell axons approaching the disc.
PO21 – Sleep disorders PO21-WE-01 The prevalence of sleep/wake disturbances in mild traumatic brain injury patients P. Cuff1 , M. Russo2 , M. Stetz2 , T. Stetz2 . 1 Psychiatry, Tripler Army Medical Center, Honolulu, Hawaii, United States; 2 Psychology, Neurology, Tripler Army Medical Center, Honolulu, Hawaii, United States Introduction: Mild Traumatic Brain Injury (mTBI) is a diffuse process involving disruption of both neuronal synaptic circuitry and glial myelin maintenance, and for this reason patients typically struggle to keep their former activities of daily living due to the development of many behavioral symptoms. Mechanisms for sleep initiation and maintenance are distributed throughout the brain and brainstem, and require delicately coordinated neuronal interactions. Because traumatic brain injury disrupts components of this intricate network, we hypothesized a high occurrence of sleep/wake disturbances in patients with traumatic brain injury. Methods: 40 consecutive medical records of TBI patients were analyzed. Patients were classified as either having or not having a sleep problem. Sleep/wake disturbances were identified as a daytime dysfunction associated with not being able to fall sleep, feeling restless at night, having nightmares, awakening at night, early morning awakening, and having excessive daytime sleepiness. This data was then analyzed using the chi-square statistic to determine if sleep problems occurred at a greater than random rate. Results: The sample was composed mostly of males (n = 35) between the ages of 20 and 76 years old (mean 30.8, median 29). 25 were military service members. Preliminary analyses show that 39 of the 40 patients complained of sleep wake problems (c2 [1, N = 40] = 31.11, p < 0.001). Conclusion: We conclude that wake/sleep disfunction is highly associated with mTBI. We recommend that mTBI patients be carefully screened for excessive daytime sleepiness. Support: This research was performed with the approval of the TAMC Department of Clinical Investigations in accordance with Army Regulation 40–38 (conduct of clinical investigations). The views expressed are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.
19th World Congress of Neurology, Poster Abstracts / Journal of the Neurological Sciences 285 S1 (2009) S155–S339
the MLF in the medulla. To determine whether disruption of MLF in the medulla impairs formation of VEMP. Methods: We measured VEMP in fourteen patients with medial medullary infarction (MMI). VEMP was induced by a short tone burst and was recorded in contracting SCM while patients turned their heads forcefully to the contralateral side against resistance. Results: VEMP was abnormal in seven patients. Six of them showed absence (n = 2) or decreased amplitude (n = 4), and the remaining one exhibited delayed p13 latency of the ipsilesional VEMP. In patients with abnormal VEMP, the lesions usually extended to the dorsal tegmentum while those with normal VEMP usually showed restricted anteromedial lesions mainly involving the pyramids. Spontaneous nystagmus (4/7, 57.2%), gaze-evoked nystagmus (6/7, 85.7%), and OTR/SVV tilt (4/7, 57.2%) were frequently accompanied in the patients with abnormal VEMP. Conclusion: The abnormal VEMP in our patients with MMI supports that VEMP is mediated by MVST contained in MLF. The frequent association of abnormal VEMP and abnormal ocular motor findings also indicates that the lesions in the patients with abnormal VEMP involved the medullary tegmentum where MLF locates. PO20-WE-13 Unusual etiology of recurrent refractory paroxysmal vertigo: experience with 15 cases R. Rangel Guerra1 , A. Garcia de la Fuente2 . 1 Neurology, Hospital Universitario, Monterrey, Nuevo Leon, Mexico; 2 Hemodynamic Unit, Hospital Christus Muguerza, Monterrey, Nuevo Leon, Mexico Introduction: The most frequent type of vertigo is paroxysmal, positional vertigo (70–80% of all cases of vertigo). Objectives: To present to the neurological community a very unusual cause of paroxysmal and refractory type of vertigo, which has not been reported previously. Material and Methods: From March 2007 to December 2005, we collected 15 patients with recurrent, Refractory Paroxysmal vertigo (RRPV). 7 males and 8 females with median age of 28.7 year. All patients were evaluated clinically by a neurologist or ORL y neuro otological testing were performed in most of them. All were studied with MRI with MRV or Digital sustraction Panangiograpy. All subject showed Thrombosis of intracraneal sinuses and they were followed for several months. Results: All patients has Refractory Paroxysmal incapacitating Vertigo, not related to postural changes, and the DIX-HALLPIKE manouver was positive only in 4 cases. Cases 7 and 11 had abnormal prothrombotic factors. Magnetic Resonance Venography was performed is all patients and Digital Panangiography was realized in 6 cases. All patients received antiaggregants and 5 received warfarin. Superselective thrombolysis was performed in 3 cases and endovascular prothesis was applied in the affected vein. Vertigo disappeared in 100% of the cases. Conclusion: A very unusual etiology of RRPV, is presented, which has not been reported and we showed the excellent results obtained with the selected treatments. PO20-WE-14 Retrograde trans-synaptic retinal ganglion cell loss identified by optical coherence tomography (OCT) P. Jindahra1 , A. Petrie2 , G.T. Plant1 . 1 The National Hospital for Neurology and Neurosurgery, Moorfields Eye Hospital, London, United Kingdom; 2 Biostatistics Unit, UCL Eastman Dental Institute, London, United Kingdom Purpose: To study trans-synaptic degeneration in human visual pathway after injuries to retrogeniculate areas. Method: Forty-eight persons were recruited and divided into three groups. Two groups were patients with retrogeniculate lesions. In the first group, the occipital damage had occurred during childhood or in adult life whilst the lesions in the second group were congenital. Every patient had homonymous hemianopia and
neuroimaging showed occipital lobe damage. The third group had normal visual function. The thickness of the peripapillary retinal nerve fibre layer (RNT) was measured using OCT in both eyes of each subject. Results: The mean RNT in the eyes with temporal hemianopia (here called the “crossing-fibre defect” eyes) is 79.8 m (SD = 35.1 m) in the acquired and 72.7 m (SD = 33.2 m) in the congenital. The mean RNT in eyes with nasal hemianopia (here called the “non-crossing-fibre defect” eyes) is 83 m (SD = 29.5 m) in the acquired and 73.4 m (SD = 26 m) in the congenital. In the control group, the RNT measured 101.4 m (SD = 36.6 m) for the left eyes and 100.8 m (SD = 35.4 m) for the right eyes. In both crossing-fibre defect eyes and non-crossing-fibre defect eyes the mean RNT is significantly greater in the controls than in the hemianopia groups (P < 0.001). Conclusions: These data confirm that there is thinning of the RNT following both congenital and acquired lesions of the retrogeniculate visual pathway in humans, representing retinal ganglion cell loss in these patients. The data have also been analysed in 12 sectors around the optic disc: it has been shown that the RNT thinning follows the known trajectories of the crossing and noncrossing retinal ganglion cell axons approaching the disc.
PO21 – Sleep disorders PO21-WE-01 The prevalence of sleep/wake disturbances in mild traumatic brain injury patients P. Cuff1 , M. Russo2 , M. Stetz2 , T. Stetz2 . 1 Psychiatry, Tripler Army Medical Center, Honolulu, Hawaii, United States; 2 Psychology, Neurology, Tripler Army Medical Center, Honolulu, Hawaii, United States Introduction: Mild Traumatic Brain Injury (mTBI) is a diffuse process involving disruption of both neuronal synaptic circuitry and glial myelin maintenance, and for this reason patients typically struggle to keep their former activities of daily living due to the development of many behavioral symptoms. Mechanisms for sleep initiation and maintenance are distributed throughout the brain and brainstem, and require delicately coordinated neuronal interactions. Because traumatic brain injury disrupts components of this intricate network, we hypothesized a high occurrence of sleep/wake disturbances in patients with traumatic brain injury. Methods: 40 consecutive medical records of TBI patients were analyzed. Patients were classified as either having or not having a sleep problem. Sleep/wake disturbances were identified as a daytime dysfunction associated with not being able to fall sleep, feeling restless at night, having nightmares, awakening at night, early morning awakening, and having excessive daytime sleepiness. This data was then analyzed using the chi-square statistic to determine if sleep problems occurred at a greater than random rate. Results: The sample was composed mostly of males (n = 35) between the ages of 20 and 76 years old (mean 30.8, median 29). 25 were military service members. Preliminary analyses show that 39 of the 40 patients complained of sleep wake problems (c2 [1, N = 40] = 31.11, p < 0.001). Conclusion: We conclude that wake/sleep disfunction is highly associated with mTBI. We recommend that mTBI patients be carefully screened for excessive daytime sleepiness. Support: This research was performed with the approval of the TAMC Department of Clinical Investigations in accordance with Army Regulation 40–38 (conduct of clinical investigations). The views expressed are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.