- Email: [email protected]
5-27-02 Neurological damages in patients with systemic lupus erythematosus (SLE): A biochemical study
Legal Issues in Neurology
s310
Results: During the studies we had 67 patients - 52.23% of the male sex. Medical history of aterogenetic vascular disease and arterial hypertension in 71.4% and diabetes in 26.5%. Strokes were classified according to currently accepted, in general strokes belonged to the previous circuit 76.12% and posterior circuits 23.66% Clinical complications were labeled according to its origen; no complications were registered associated to the treatment. Mortality rate was 43.26%. The table shows other details which were studied. Conclusions: 1) The difficulty in handling these patients is determined by the high quantity of patients requiring mechanical breathing assistance (62.67%) and the clinical complications (49%) 2) It is our belief that the objective in these type of patients is to maintain an adequate cerebral perfusion which, we will probably acquire with the therapeutic scheme we purpose.
15-26-04
1 Hyperventilation restores cerebral blood flow autoregulation In patients with acute liver failure
G. Strauss,
B.A. Hansen,
G.M. Knudsen
‘, F.S. Larsen,
O.B. Paulson
5-27-02 0. Pascal,
koroienko
Neurological damages in patients with systemic lupus erythematosus (SLE): A biochemical study Rodica
Cerebral blood flow autoregulation is lost in patients with fulminant hepatic failure (FHF) whereas CO2 reactivity is preserved. In this study, we investigated whether autoregulation could be reestablished in patients with FHF by mechanical hyperventilation. Six consecutive patients with FHF coma grade 4 (median age 35, range 30-50 yrs) entered the study. Cerebral blood flow autoregulation was evaluated using transcranial Doppler sonography (TCD, Multidop X), assessed by continuous mean flow velocity (Vmsan) measurements in the middle cerebral artery during changes in mean arterial blood pressure (MAP), induced by norepinephrine infusion. The patients were subsequently hyperventilated for 15 min and cerebral autoregulation was reevaluated in the same MAP-range. Hyperventilation 3.1 (2.9-4.6) 103 (89-122)
53(x-78)
85(65-94) 59(4l?-70)
68(4s-107)'
110 (89-130) 60 (49-78)
Values are medians, ranges in brackets. ‘p < 0.05. with MAP in the baseline conIn all patients, V,,,, increased significantly dition, whereas hyperventilation restored autoregulation in four patients. In two patients, cerebral autoregulation was not completely restored, but hyperventicorrelation. These two patients had lation reduced the slope of the MAP-V,,,=” renal failure and were treated with intermittent hemcdialysis. It is concluded that hyperventilation reestablishes the cerebral autoregulation in FHF. Future studies must uncover whether this is due to a right-shift of the autoregulation curve in FHF.
27
Legal Issues in Neurology
5-27-01
Neurological complications after renal transplantation, a local experience
L. Jost Jr., L. Jest, M. Dtivalos, F. Manes, R. Leiguarda, M. Merello, M. Esteguy, M. Nogu&. Depaftment of Neuroiw Centro de Educacidn
MBdica e lnvestigaciones Argentina
Cllnicas
“01. Norberto
Quirno’;
universiu
We studied 97 patients with SLE, 66 females and 9 males with a mean age of 36.2 years. Symptoms of focal lesion of nervous system were diagnosed in 41.3% of them, which manifested with hemiparesis, sensitive disorders, epileptic syndrome, hyperkinesis, peripheral neuropathy. Serum lipid peroxide (LPO) levels, lysosomal enzymes (LE), superoxide dismutase (SOD) activity in peripheral blood erythrocytes, serum ANA were measured in all patients with SEL and 31 healthy controls. Compared to the controls, LPQ levels, LE were significantly increased in active SLE patients while SOD activity was decreased. A marked difference in LPO levels, LE and SOD activity was found between SLE patients with and without neurological impairments.
5-27-03
lntracerebral
Ayub L. Pattinama.
Indonesia,
Jakarta
Buenos Aires,
In a 27-year period, from a total number of 543 renal transplants, 40 patients developed neurological complications. Neurologic infections were the commonest: cryptoooccus meningitis (n = 5); viral encephalitis (n = 4); Chagas’ (American trypanosomiasis) encephalitis (n = 3); Lysteria meningitis (n = 2); HIV encephalitis (n = 1). Ctyptococcus meningitis occurred between 4 and 12 years after transplantation, and presented without meningeal signs and normal CSF in 1 of the patients. Chagas’ encephalitis was solely diagnosed by brain biopsy since neurological exam and CSF were non-contributory. Other complications were: seizure (n = 9); delirium (n = 4); stroke (n = 4); damage to the lateral femoral cutaneous nerve of the thigh (n = 3); CNS lymphoma (n = 2); and paraplegia due to epidural lipomatosis (n = 1). This complication occurred in a 15 year old boy after treatment with a total dose 27.5 gr of Prednisone over a 3 year period (mean daily dose of 0.4 mg/kg/day for the treatment of 6 episodes of rejection, and it resolved with a low caloly diet and progressive reduction of the prednisone dose.
endometriosis
Medical Facully Hospifal, Timur. Indonesia
Christian
University
of
Although endometriosis can occur very rarely in men receiving estrogen therapy and in postmenopause women, it is found almost exclusively in women of reproductive age. Very rarely, endometriosis is found distant from the pelvis, in such site as the brain. We reported one case with periodical neurologic deficits caused by intracerebral endometriosis.
5-27-04 PCOP (kPs) MAP (mmHg) Vmean WW
medical
‘. Dept.
Hepatolog)! Rigshospitalet, Univetsify Hospital Copenhagen, Denmark, ’ Dept. Neurology, Rigshospitalet, Univefsiiy Hospital Copenhagen, Denmark
Baseline 4.0 (M-4.9) 80 (6049)
Department of neurology, Republic of Moldova
Pascal.
2, Kishinau,
Kammant
Idiopathic hypertrophic pachymeningitis: An emerging inflammatory meningeal syndrome Phanthumchinda.
Chulalongkom
UniversiM
Department of Medicine, Bangkok, Thailand
Faculfy
of Medicine,
- Idiopathic hypertrophic pachymeningitis, a rare form of chronic non-specific inflammation of the dura, has been increasingly reported with the wide spread of CT scanning and MRI. These imaging techniques can demonstrate the abnormalities of the dura much more better than the previous techniques. - Five cases of idiopathic hypertrophic pachymeningitis were analyzed. Male to female ratio was 3:2. The age ranged from 23-70 years with an average of 40 years. The duration of clinical course ranged from 1 month to 7 years with an average of 37.4 months. The main clinical features were subacute, chronic or recurrent headache which had been observed in all cases. Four cases had associated mild leptomeningitis with mild lymphocytic and occasionally polymorphonuclear pleocytosis. Two cases had a clinical syndrome of polyneuritis cranialis (CN Ill, IV, VI, V, VIII) which had either spontaneous remission course or dramatically responded to corticosteroid. Two cases had a clinical syndrome of increased intracranial pressure and both of them had evidence of superior saggitial sinus involvement and cerebral parenchymal venous infarction and compression from the inflammed dura. All but one cases had an elevation of ESR which ranged from 65-120 mm/hr with an average of 100 mm/hr. Imaging with CT-scan and/or MRI revealed thickening enhanced tentorium cerebelli in all cases. Most of the tentorial involvement was unilateral or one-sided predominant which was corresponded to the side of headache. Two cases had inflammatory process extended to superior saggitial sinus. One of these two cases had straight sinus and another had transverse sinus involvement. One had the inflammation extended to cavernous sinus and dura of the clivus. All had dural and leptomeningeal biopsy which showed thickened-fibrotic dura with non-specific inflammation. Three cases were treated intermittently with high dosage of prednisolone 60 mg per day for 4-6 weeks in order to control the headache or polyneuritis cranialis. Two cases became steroid-dependent and had to used prednisolone 1O-l 5 mg per day for controlling their headache. The most common provisional diagnosis before referring to our insitution was giant cell arteritis. This may be due to the prominent presenting symptom of headache and high ESR in most of these cases. - Clinical cases of idiopathic hypertrophic pachymeningitis which involved cranial and craniocewical dura and could extend extracranially and manifested as pseudotumor of the orbit or involving the bone and manifested as extracranial soft tissue mass had been rarely reported before the advent of CT-scan and MRI. This extremely interesting clinical entity is now increasingly detected. The etiology and the efficacy of various treatments of this important disease are inconclusive and further study and observation are needed.
s310
Results: During the studies we had 67 patients - 52.23% of the male sex. Medical history of aterogenetic vascular disease and arterial hypertension in 71.4% and diabetes in 26.5%. Strokes were classified according to currently accepted, in general strokes belonged to the previous circuit 76.12% and posterior circuits 23.66% Clinical complications were labeled according to its origen; no complications were registered associated to the treatment. Mortality rate was 43.26%. The table shows other details which were studied. Conclusions: 1) The difficulty in handling these patients is determined by the high quantity of patients requiring mechanical breathing assistance (62.67%) and the clinical complications (49%) 2) It is our belief that the objective in these type of patients is to maintain an adequate cerebral perfusion which, we will probably acquire with the therapeutic scheme we purpose.
15-26-04
1 Hyperventilation restores cerebral blood flow autoregulation In patients with acute liver failure
G. Strauss,
B.A. Hansen,
G.M. Knudsen
‘, F.S. Larsen,
O.B. Paulson
5-27-02 0. Pascal,
koroienko
Neurological damages in patients with systemic lupus erythematosus (SLE): A biochemical study Rodica
Cerebral blood flow autoregulation is lost in patients with fulminant hepatic failure (FHF) whereas CO2 reactivity is preserved. In this study, we investigated whether autoregulation could be reestablished in patients with FHF by mechanical hyperventilation. Six consecutive patients with FHF coma grade 4 (median age 35, range 30-50 yrs) entered the study. Cerebral blood flow autoregulation was evaluated using transcranial Doppler sonography (TCD, Multidop X), assessed by continuous mean flow velocity (Vmsan) measurements in the middle cerebral artery during changes in mean arterial blood pressure (MAP), induced by norepinephrine infusion. The patients were subsequently hyperventilated for 15 min and cerebral autoregulation was reevaluated in the same MAP-range. Hyperventilation 3.1 (2.9-4.6) 103 (89-122)
53(x-78)
85(65-94) 59(4l?-70)
68(4s-107)'
110 (89-130) 60 (49-78)
Values are medians, ranges in brackets. ‘p < 0.05. with MAP in the baseline conIn all patients, V,,,, increased significantly dition, whereas hyperventilation restored autoregulation in four patients. In two patients, cerebral autoregulation was not completely restored, but hyperventicorrelation. These two patients had lation reduced the slope of the MAP-V,,,=” renal failure and were treated with intermittent hemcdialysis. It is concluded that hyperventilation reestablishes the cerebral autoregulation in FHF. Future studies must uncover whether this is due to a right-shift of the autoregulation curve in FHF.
27
Legal Issues in Neurology
5-27-01
Neurological complications after renal transplantation, a local experience
L. Jost Jr., L. Jest, M. Dtivalos, F. Manes, R. Leiguarda, M. Merello, M. Esteguy, M. Nogu&. Depaftment of Neuroiw Centro de Educacidn
MBdica e lnvestigaciones Argentina
Cllnicas
“01. Norberto
Quirno’;
universiu
We studied 97 patients with SLE, 66 females and 9 males with a mean age of 36.2 years. Symptoms of focal lesion of nervous system were diagnosed in 41.3% of them, which manifested with hemiparesis, sensitive disorders, epileptic syndrome, hyperkinesis, peripheral neuropathy. Serum lipid peroxide (LPO) levels, lysosomal enzymes (LE), superoxide dismutase (SOD) activity in peripheral blood erythrocytes, serum ANA were measured in all patients with SEL and 31 healthy controls. Compared to the controls, LPQ levels, LE were significantly increased in active SLE patients while SOD activity was decreased. A marked difference in LPO levels, LE and SOD activity was found between SLE patients with and without neurological impairments.
5-27-03
lntracerebral
Ayub L. Pattinama.
Indonesia,
Jakarta
Buenos Aires,
In a 27-year period, from a total number of 543 renal transplants, 40 patients developed neurological complications. Neurologic infections were the commonest: cryptoooccus meningitis (n = 5); viral encephalitis (n = 4); Chagas’ (American trypanosomiasis) encephalitis (n = 3); Lysteria meningitis (n = 2); HIV encephalitis (n = 1). Ctyptococcus meningitis occurred between 4 and 12 years after transplantation, and presented without meningeal signs and normal CSF in 1 of the patients. Chagas’ encephalitis was solely diagnosed by brain biopsy since neurological exam and CSF were non-contributory. Other complications were: seizure (n = 9); delirium (n = 4); stroke (n = 4); damage to the lateral femoral cutaneous nerve of the thigh (n = 3); CNS lymphoma (n = 2); and paraplegia due to epidural lipomatosis (n = 1). This complication occurred in a 15 year old boy after treatment with a total dose 27.5 gr of Prednisone over a 3 year period (mean daily dose of 0.4 mg/kg/day for the treatment of 6 episodes of rejection, and it resolved with a low caloly diet and progressive reduction of the prednisone dose.
endometriosis
Medical Facully Hospifal, Timur. Indonesia
Christian
University
of
Although endometriosis can occur very rarely in men receiving estrogen therapy and in postmenopause women, it is found almost exclusively in women of reproductive age. Very rarely, endometriosis is found distant from the pelvis, in such site as the brain. We reported one case with periodical neurologic deficits caused by intracerebral endometriosis.
5-27-04 PCOP (kPs) MAP (mmHg) Vmean WW
medical
‘. Dept.
Hepatolog)! Rigshospitalet, Univetsify Hospital Copenhagen, Denmark, ’ Dept. Neurology, Rigshospitalet, Univefsiiy Hospital Copenhagen, Denmark
Baseline 4.0 (M-4.9) 80 (6049)
Department of neurology, Republic of Moldova
Pascal.
2, Kishinau,
Kammant
Idiopathic hypertrophic pachymeningitis: An emerging inflammatory meningeal syndrome Phanthumchinda.
Chulalongkom
UniversiM
Department of Medicine, Bangkok, Thailand
Faculfy
of Medicine,
- Idiopathic hypertrophic pachymeningitis, a rare form of chronic non-specific inflammation of the dura, has been increasingly reported with the wide spread of CT scanning and MRI. These imaging techniques can demonstrate the abnormalities of the dura much more better than the previous techniques. - Five cases of idiopathic hypertrophic pachymeningitis were analyzed. Male to female ratio was 3:2. The age ranged from 23-70 years with an average of 40 years. The duration of clinical course ranged from 1 month to 7 years with an average of 37.4 months. The main clinical features were subacute, chronic or recurrent headache which had been observed in all cases. Four cases had associated mild leptomeningitis with mild lymphocytic and occasionally polymorphonuclear pleocytosis. Two cases had a clinical syndrome of polyneuritis cranialis (CN Ill, IV, VI, V, VIII) which had either spontaneous remission course or dramatically responded to corticosteroid. Two cases had a clinical syndrome of increased intracranial pressure and both of them had evidence of superior saggitial sinus involvement and cerebral parenchymal venous infarction and compression from the inflammed dura. All but one cases had an elevation of ESR which ranged from 65-120 mm/hr with an average of 100 mm/hr. Imaging with CT-scan and/or MRI revealed thickening enhanced tentorium cerebelli in all cases. Most of the tentorial involvement was unilateral or one-sided predominant which was corresponded to the side of headache. Two cases had inflammatory process extended to superior saggitial sinus. One of these two cases had straight sinus and another had transverse sinus involvement. One had the inflammation extended to cavernous sinus and dura of the clivus. All had dural and leptomeningeal biopsy which showed thickened-fibrotic dura with non-specific inflammation. Three cases were treated intermittently with high dosage of prednisolone 60 mg per day for 4-6 weeks in order to control the headache or polyneuritis cranialis. Two cases became steroid-dependent and had to used prednisolone 1O-l 5 mg per day for controlling their headache. The most common provisional diagnosis before referring to our insitution was giant cell arteritis. This may be due to the prominent presenting symptom of headache and high ESR in most of these cases. - Clinical cases of idiopathic hypertrophic pachymeningitis which involved cranial and craniocewical dura and could extend extracranially and manifested as pseudotumor of the orbit or involving the bone and manifested as extracranial soft tissue mass had been rarely reported before the advent of CT-scan and MRI. This extremely interesting clinical entity is now increasingly detected. The etiology and the efficacy of various treatments of this important disease are inconclusive and further study and observation are needed.