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Paralytic mydriasis in Bickerstaff brainstem encephalitis. Report of three cases
Abstracts / Autonomic Neuroscience: Basic and Clinical 177 (2013) 1–65
autonomic system. We investigated an association between new onset diabetes mellitus (NODM) after severe GBS. Methods: A cohort of patients in the Marketscan-database with claims of GBS were classified by the presence or absence of NODM. We defined NODM as a new claim of diabetes mellitus (DM) N90 days after the GBS claim. Variables suggesting severity of GBS were collected for analysis by univariate and multivariate methods. Results: 3282 patiens with GBS were included and of these 199 (6.1%) had NODM. Of the variables collected, older age (50.2 years vs 42.1 years, p b0.0001), longer hospital length of stay (14.3 vs 9.5, p = 0.005), tracheostomy (9.6% vs 4.3%, p = 0.007), cardiac arrhythmia (5% vs 1.2% p = 0.008) and discharge to a rehab facility or long term acute care hospital (25.6% vs 19.3%, p = 0.024) were associated with NODM. We allocated a point each to age N45 years, length of hospital stay N10 days, tracheostomy, arrhythmia and discharge to an acute or subacute rehabilitation facility to develop a scoring system for GBS severity. The total possible score was 5 points with higher scores reflecting increasing GBS severity. Using the total points, risk of NODM was stratified as low risk 0-1, moderate risk 2-3, high risk 4-5. The frequency of NODM in the low risk group was 4.9%, moderate risk 8.8% and high risk 15.5%. Conclusion: Amongst patients with GBS, features suggestive of severe disease are associated with new onset DM. This study is supported by the National center for Advancing Translational Sciences of the National Institutes of Health through Grant Number ULI TR000430. doi:10.1016/j.autneu.2013.05.110
Poster 14.15 Development of neuropeptide Y-mediated heart innervation P.M. Masliukov, A.I. Emanuilov, V.V. Konovalov (Yaroslavl State Medical Academy, Yaroslavl, Russia), T.A. Anikina, A.A. Zverev2, F.G. Sitdikov (Kazan (Volga Region) Federal University, Kazan, Russia) Neuropeptide Y (NPY) has been associated with numerous physiological processes, including feeding, memory, circadian rhythms, and regulation of blood pressure. A large number of adult mammalian autonomic neurons express NPY. However, there are only few works concerning the development of NPY-mediated innervation of the heart. In the current study, immunohistochemistry and tract tracing was used to label NPY in the neurons of autonomic ganglia that supply axons to the heart. Y1 and Y2 receptors (R) to NPY were also immunohistochemically identified in the heart. NPY (10- 10-10- 6М) was also applied to study contraction function on isolated atrial and ventricular stripes. Experiments were performed on rats of different ages (newborn, 7-day-old, 20-day-old, 30-day-old, 100-day-old, 180day-old). NPY-immunoreactive (IR) neurons were found in in the intramural parasympathetic ganglia and sympathetic stellate ganglia from the moment of birth. We observed that the percentage of NPYimmunoreactive neurons increased in the early postnatal development in the intramural ganglia during first 10 days and in the sympathetic stellate ganglion during first month of animals’ life. Y1RIR and Y2R-IR fibers were found in coronary arteries, arterioles and cardiac muscle cells. Density of IR fibers increased during first 10 days of life. NPY elicited negative contraction atrial and ventricular response in 7-day-old puppies but this effect was not observed in
53
older animals. In conclusion, there are developmental changes in the NPY-mediated heart innervation which become complete in rats at the end of the first month of life. This work was supported by RFBR grants (NN 12-04-00621, 1304-00059) and by The Ministry of education and science of Russian Federation (projects 8290, 8566, 8603). doi:10.1016/j.autneu.2013.05.111
Poster 14.16 Paralytic mydriasis in Bickerstaff brainstem encephalitis. Report of three cases Y. Hasegawa, K. Kawabata (Department of Neurology, Nagoya Daini Red Cross Hospital, Nagoya, Japan), N. Nakai (Department of Neurology, Toyota Memorial Hospital, Toyota, Japan), M. Tujimoto (Department of Neurology, Ngoya University Graduate School of Medicine, Nagoya, Japan), A. Takahashi (Department of Neurology, Nagoya Daini Red Cross Hospital, Nagoya, Japan) Bickerstaff brainstem encephalitis(BBE) is an immune-mediated syndrome of consciousness disturbance, cranial nerve symptoms/ signs, cerebellar ataxia and altered deep reflexes, preceded by a febrile illness. Simultaneous involvement of both brainstem and peripheral nerves has been reported. Here we report three BBE patients with paralytic mydriasis whose autonomic dysfunctions were analyzed. Case1: A 42-year-old woman acutely appeared dysarthria, quadriplegia, left-dominant cerebellar ataxia, complete extraocular muscle palsy and hyperreflexia in four limbs, following to fever, headache and diarrhea for several days. Case2: A 21-year-old woman had a history of rhinorrhea and cough for some days, then appeared drowsiness, limitation of eye movement to the left, limb ataxia and hyperreflexia. F wave occurrence of the median nerve was decreased. Case3: A 23-year-old man acutely suffered from numbness of hands and feet of acute onset, preceded by fever and diarrhea for some days. There were corectopia, pharyngoplegia, poor gag reflex, ataxia and hyperreflexia in the extremities. All cases were proven to have positive serum anti-GQ1b antibody. Pharmacological pupillomotor tests using 0.125% pilocarpine did not have much effect on the iridoplegia in case 1, but caused contraction in case 3. Intravenous administration of high dose methylprednisolone or γ-globulin certainly gave an improvement on the clinical manifestations including pupillomotor paralysis. In conclusion, paralytic mydriasis may occur in association with BBE, and is likely to be caused by some lesion of the pre- or post-ganglionic parasympathetic neuron or both. doi:10.1016/j.autneu.2013.05.112
Poster 14.18 Autonomic modulation of heart rate in women with fibromyalgia syndrome: Linear and nonlinear analysis A.R. Zamunér, M.A.A. Vera, I.L. Ribeiro (Federal University of São Carlos, Brazil), R.S. Zuttin (Federal University of São Carlos, Brazil), T.F. Salvini, E. Silva (Federal University of São Carlos, Brazil) Background: Studies suggest that autonomic dysfunction, common in patients with fibromyalgia syndrome (FMS), may play a central role in the pathogenesis of this disease. Thus, the heart rate variability (HRV) assessment has been used in order to identify abnormalities in the autonomic nervous system. Although the HRV is
autonomic system. We investigated an association between new onset diabetes mellitus (NODM) after severe GBS. Methods: A cohort of patients in the Marketscan-database with claims of GBS were classified by the presence or absence of NODM. We defined NODM as a new claim of diabetes mellitus (DM) N90 days after the GBS claim. Variables suggesting severity of GBS were collected for analysis by univariate and multivariate methods. Results: 3282 patiens with GBS were included and of these 199 (6.1%) had NODM. Of the variables collected, older age (50.2 years vs 42.1 years, p b0.0001), longer hospital length of stay (14.3 vs 9.5, p = 0.005), tracheostomy (9.6% vs 4.3%, p = 0.007), cardiac arrhythmia (5% vs 1.2% p = 0.008) and discharge to a rehab facility or long term acute care hospital (25.6% vs 19.3%, p = 0.024) were associated with NODM. We allocated a point each to age N45 years, length of hospital stay N10 days, tracheostomy, arrhythmia and discharge to an acute or subacute rehabilitation facility to develop a scoring system for GBS severity. The total possible score was 5 points with higher scores reflecting increasing GBS severity. Using the total points, risk of NODM was stratified as low risk 0-1, moderate risk 2-3, high risk 4-5. The frequency of NODM in the low risk group was 4.9%, moderate risk 8.8% and high risk 15.5%. Conclusion: Amongst patients with GBS, features suggestive of severe disease are associated with new onset DM. This study is supported by the National center for Advancing Translational Sciences of the National Institutes of Health through Grant Number ULI TR000430. doi:10.1016/j.autneu.2013.05.110
Poster 14.15 Development of neuropeptide Y-mediated heart innervation P.M. Masliukov, A.I. Emanuilov, V.V. Konovalov (Yaroslavl State Medical Academy, Yaroslavl, Russia), T.A. Anikina, A.A. Zverev2, F.G. Sitdikov (Kazan (Volga Region) Federal University, Kazan, Russia) Neuropeptide Y (NPY) has been associated with numerous physiological processes, including feeding, memory, circadian rhythms, and regulation of blood pressure. A large number of adult mammalian autonomic neurons express NPY. However, there are only few works concerning the development of NPY-mediated innervation of the heart. In the current study, immunohistochemistry and tract tracing was used to label NPY in the neurons of autonomic ganglia that supply axons to the heart. Y1 and Y2 receptors (R) to NPY were also immunohistochemically identified in the heart. NPY (10- 10-10- 6М) was also applied to study contraction function on isolated atrial and ventricular stripes. Experiments were performed on rats of different ages (newborn, 7-day-old, 20-day-old, 30-day-old, 100-day-old, 180day-old). NPY-immunoreactive (IR) neurons were found in in the intramural parasympathetic ganglia and sympathetic stellate ganglia from the moment of birth. We observed that the percentage of NPYimmunoreactive neurons increased in the early postnatal development in the intramural ganglia during first 10 days and in the sympathetic stellate ganglion during first month of animals’ life. Y1RIR and Y2R-IR fibers were found in coronary arteries, arterioles and cardiac muscle cells. Density of IR fibers increased during first 10 days of life. NPY elicited negative contraction atrial and ventricular response in 7-day-old puppies but this effect was not observed in
53
older animals. In conclusion, there are developmental changes in the NPY-mediated heart innervation which become complete in rats at the end of the first month of life. This work was supported by RFBR grants (NN 12-04-00621, 1304-00059) and by The Ministry of education and science of Russian Federation (projects 8290, 8566, 8603). doi:10.1016/j.autneu.2013.05.111
Poster 14.16 Paralytic mydriasis in Bickerstaff brainstem encephalitis. Report of three cases Y. Hasegawa, K. Kawabata (Department of Neurology, Nagoya Daini Red Cross Hospital, Nagoya, Japan), N. Nakai (Department of Neurology, Toyota Memorial Hospital, Toyota, Japan), M. Tujimoto (Department of Neurology, Ngoya University Graduate School of Medicine, Nagoya, Japan), A. Takahashi (Department of Neurology, Nagoya Daini Red Cross Hospital, Nagoya, Japan) Bickerstaff brainstem encephalitis(BBE) is an immune-mediated syndrome of consciousness disturbance, cranial nerve symptoms/ signs, cerebellar ataxia and altered deep reflexes, preceded by a febrile illness. Simultaneous involvement of both brainstem and peripheral nerves has been reported. Here we report three BBE patients with paralytic mydriasis whose autonomic dysfunctions were analyzed. Case1: A 42-year-old woman acutely appeared dysarthria, quadriplegia, left-dominant cerebellar ataxia, complete extraocular muscle palsy and hyperreflexia in four limbs, following to fever, headache and diarrhea for several days. Case2: A 21-year-old woman had a history of rhinorrhea and cough for some days, then appeared drowsiness, limitation of eye movement to the left, limb ataxia and hyperreflexia. F wave occurrence of the median nerve was decreased. Case3: A 23-year-old man acutely suffered from numbness of hands and feet of acute onset, preceded by fever and diarrhea for some days. There were corectopia, pharyngoplegia, poor gag reflex, ataxia and hyperreflexia in the extremities. All cases were proven to have positive serum anti-GQ1b antibody. Pharmacological pupillomotor tests using 0.125% pilocarpine did not have much effect on the iridoplegia in case 1, but caused contraction in case 3. Intravenous administration of high dose methylprednisolone or γ-globulin certainly gave an improvement on the clinical manifestations including pupillomotor paralysis. In conclusion, paralytic mydriasis may occur in association with BBE, and is likely to be caused by some lesion of the pre- or post-ganglionic parasympathetic neuron or both. doi:10.1016/j.autneu.2013.05.112
Poster 14.18 Autonomic modulation of heart rate in women with fibromyalgia syndrome: Linear and nonlinear analysis A.R. Zamunér, M.A.A. Vera, I.L. Ribeiro (Federal University of São Carlos, Brazil), R.S. Zuttin (Federal University of São Carlos, Brazil), T.F. Salvini, E. Silva (Federal University of São Carlos, Brazil) Background: Studies suggest that autonomic dysfunction, common in patients with fibromyalgia syndrome (FMS), may play a central role in the pathogenesis of this disease. Thus, the heart rate variability (HRV) assessment has been used in order to identify abnormalities in the autonomic nervous system. Although the HRV is