Backgro und: Sexual dysfunction in women with Parkinson's disease is poorly understood and research in this area is scarce. The objectives of this study were sexual function characterization in female Parkinson's disease patients, description of sexual dysfunctions, correlation with disease characteristics, and comparison with matched healthy controls. Methods: Social and demographic data from consecutive female patients with Parkinson's disease and matched healthy controls were collected. The following instruments were used: UPDRS, the Hoehn and Yahr scale, the Beck Depression Inventory-II, the Female Sexual Function Index, and the Sexual Dysfunction Inventory. The only exclusion criterion was cognitive deterioration precluding comprehension of the study scope and its instruments. Results: Of the 95 patients identified, 61 were included. Mean age was 66 years (range 40-89 years), and mean disease duration was seven years (range 1-18 years). Twenty-nine presented an akinetic-rigid syndrome, 25 tremoric disease, and, the remaining, a mixed type of disease. Mean "on" total/part III UPDRS scores were 46 6 15.0 and 31 6 8.9. Sexual dysfunction was present in 86.9% of patients and 79.0% of controls, according to the Female Sexual Function Index (p < .01), and in 57.4% of patients and 22.6% of controls, according to the Sexual Dysfunction Inventory (p < .001). Multivariate binary logistic regression identified age and depressive symptoms as positive predictors in the severity of sexual dysfunction. Disease duration, UPDRS part III score, Hoehn and Yahr stage, and antiparkinsonian medication did not show significant predictive value. Conclusions: Sexual dysfunction is more prevalent in women with Parkinson's disease than in controls and is predicted by older age and severity of depressive symptoms. V C 2016 International Parkinson and Movement Disorder Society
In multiple sclerosis (MS), ocular motor disturbances such as nystagmus or internuclear ophthalmoplegia are frequent and their pathophysiological processes are relatively well known. On the contrary, other rare and not so well studied manifestations such as isolated ocular motor nerve palsy may be observed and can represent a diagnostic challenge for the clinician as in the case we report. caseA 35-year-old woman was admitted in the emergency department complaining of double vision on right gaze of sudden onset lasting for three days. Additionally from the beginning of clinical onset she referred constant right periocular pain not related with ocular movements, which spontaneously reverted within 24 hours. She had no recent infectious or traumatic events and her personal and familiar medical history was otherwise unremarkable. On neurological examination showed a left isolated incomplete III cranial nerve (CN) palsy characterized by eyelid ptosis, limitation on adduction and supraversion of left eye, paresis of the four extraocular muscles confirmed by Hess screen and no pupillary dysfunction, either on light or accommodation. The remaining neurological examination, namely visual acuity, fundoscopy, other cranial nerves and long tracts systems were normal. Also, orbital murmurs, proptosis, quemosis or conjunctival hyperemia were not found. She was apyretic and normotensive. All the analytic work-up was within normal limits. It included hemogram, C-reactive protein, sedimentation rate, glycemia, lipid profile, thyroid function, infectious serologies (lyme disease, syphilis), immunologic study (antinuclear antibodies, anticardiolipin antibodies, anti-neutrophilic cytoplasmic antibodies, anti-double stranded antibodies, angiotensin-converting enzyme) and CSF cytochemistry studies. The MRI and the conventional angiography performed at 24 hours and at the fifth day after admission respectively were normal. A complete and spontaneous reversion of the III CN palsy occurred within three weeks.Regarding the clinical follow-up, one year and half afterwards she presented another deficit episode, now consisting of left eye blurred vision which had partially recovered without medication. Further, one month later she had numbness of the left lower limb. At that time, examination revealed low visual acuity in the left eye (1/10) with normal fundoscopy, bilateral pyramidal syndrome without motor deficits and a left D10 hyposthesic level. The MRI showed multiple small T2 and Flair hyperintense lesions located in the subcortical white matter on the high frontal convexity, interhemispheric cortex and left middle cerebellar peduncle, without disruption of the bloodbrain barrier (Fig 1). Left optic nerve was found to be thick although did not show signal abnormalities or gadolinium enhancement. The spinal cord MRI disclosed multiple intraspinal cord lesions in the transitions of C1-C2, C5-C6 and D9-D10 showing T2 hyperintensity and gadolinium enhancement (Fig 2). Oligoclonal bands were present in the CSF although not in the serum.Th...
Background: The "other Babinski sign" consists in the co-contraction of the orbicularis and frontalis muscles, causing an eyebrow elevation during ipsilateral eye closure. It cannot be voluntarily reproduced. Aims of the study: To determine the utility of this sign in the differential diagnosis of hyperkinetic facial disorders. Methods: The presence of the sign was assessed in consecutive patients with blepharospasm, primary hemifacial spasm or post-paralytic facial syndrome treated in a botulinum toxin outpatient clinic. Results: Of the 99 patients identified, 86 were included, 41 with blepharospasm (32 female, mean age 71 ± 11 years), 28 with hemifacial spasm (16 female, mean age 65 ± 12 years) and 17 with post-paralytic facial syndrome (14 female, mean age 50 ± 17 years). The sign was detected in 67.9% of the patients with hemifacial spasm, in 23.5% of the post-paralytic facial syndrome group and in none of the patients with blepharospasm, exhibiting a sensitivity of 51% and a specificity of 100% for the diagnosis of hemifacial spasm/post-paralytic facial syndrome and a specificity of 76% for hemifacial spasm, compared to post-paralytic facial syndrome. Conclusions: This sign is highly specific for the diagnosis of peripherally induced hyperkinetic facial disorders. Its assessment should integrate the routine examination of patients with abnormal facial movements.
RESUMONos doentes idosos há um risco elevado de medicação inapropriada e de efeitos adversos da polimedicação. Doente do sexo feminino, 68 anos, previamente autónoma, recorre ao Serviço de Urgência por suspeita de Acidente Vascular Cerebral. Segundo o marido, nos seis meses prévios à admissão, apresentou progressiva dependência funcional e períodos de desorientação. Por esse motivo, havia recorrido a consultas de diferentes especialidades, encontrando-se polimedicada, sendo impossível perceber a posologia administrada. Apresentava-se desatenta, desorientada, apráxica, com mioclonias e marcha atáxica. Durante o internamento, após suspensão de toda a medicação crónica, revelou melhoria gradual, apresentando, à data de alta, exame neurológico completamente normal. A iatrogenia medicamentosa como causa reversível para quadros demenciais deve ser equacionada. Todos os doentes, particularmente os idosos e seus cuidadores, deverão ser adequadamente informados acerca dos medicamentos prescritos e da respetiva posologia. A utilização do modelo biopsicossocial poderá evitar a polimedicação inapropriada e a iatrogenia. Palavras-chave: Demência/induzida quimicamente; Doença Iatrogénica; Perturbações Cognitivas; Polimedicação; Portugal. ABSTRACTIn the elderly there is a high risk of inappropriate medication and adverse effects of polypharmacy. A 68 year-old female patient resorted to the Emergency Room for suspected stroke. According to the husband, in the six months prior to admission, she became progressively disorientated and dependent. She had resorted to various appointments from different specialties and was polymedicated. It was impossible to clarify the exact dosage. On neurological examination she presented disturbance in attention and memory, disorientation, constructional apraxia, myoclonus and gait imbalance. After the suspension of all chronic medication, she showed gradual improvement. By the time of discharge, her neurological examination was completely normal. Iatrogenic effect of drugs as a cause of reversible dementia should be considered. All patients, particularly the elderly and their caregivers, should be suitably informed about the drugs that are prescribed and the dosages used. Using the biopsychosocial model could prevent inappropriate polypharmacy and iatrogeny. Keywords: Cognition Disorders; Dementia/chemically induced; Iatrogenic Disease; Polypharmacy. INTRODUÇÃOEm Portugal, a população residente com 65 anos ou mais ultrapassou, em 2011, os dois milhões.1 A este fenó-meno associa-se um aumento da prevalência e incidência de patologias características desta faixa etária, com necessidade de consultas regulares e polimedicação. Para superar o desafio do envelhecimento deve garantir-se que as pessoas se mantenham saudáveis, ativas e autónomas durante o máximo tempo possível. 2A demência caracteriza-se por défice cognitivo que inclui compromisso da memória e pelo menos um dos seguintes: afasia, apraxia, agnosia e/ou perturbação da capacidade executiva. Deve ser suficientemente severo para comprometer o...
Tardive dystonia occurs after exposure, over months to years, to antipsychotics and other drugs that block dopaminergic receptors. Anterocollis is a rare form of cervical dystonia which is usually disabling for the patient. Here, we present the case of a 61-year-old woman with Alzheimer’s dementia diagnosed eight years ago who was previously medicated with antipsychotics. Two years before admission, she was medicated with olanzapine. She presented to the emergency room with a sustained flexion posture of the neck that was difficult to feed. She had a marked and fixed anterocollis and severe akathisia. After the administration of propofol to perform computerized tomography, the abnormal posture disappeared. Subsequently, she was started on biperiden without improvement. One week later, olanzapine was suspended, and she was progressively started on propranolol, trihexyphenidyl, and tetrabenazine. Cervical posture improved, but two weeks later, she presented with a left laterocollis, which allowed feeding, and improvement of akathisia. We present a case of tardive dystonia supported by the beginning of dystonia five months after olanzapine administration and improvement after its suspension. The coexistence of degenerative pathology is a risk factor for dystonia, which often persists despite the suspension of the causative agent. Therefore, non-pharmacological treatment and approach with antipsychotics with a better profile of extrapyramidal effects should be preferred in patients with dementia.
Introdução. A Terapia de Restrição e Indução ao Movimento (TRIM) é uma técnica que consiste em incentivar o paciente a utilizar o membro superior parético nas suas atividades de vida diária (AVD), imobilizando o membro não acometido. Objetivo. Avaliar a utilização da TRIM na recuperação do membro superior afetado em pacientes pós-Acidente Vascular Cerebral (AVC). Método. Participaram do estudo pacientes com AVC na fase crônica, hemiparéticos, com mais de 18 anos e foram excluídos pacientes que apresentam outras patologias neurológicas, uso de neurotoxinas e alteração cognitiva que impossibilitasse a realização da técnica. Foram submetidos a duas sessões semanais de 50 minutos da TRIM por um período de 4 semanas. A fisioterapia consistiu na realização de exercícios voltados as AVD e atividades instrumentais de vida diária (AIVD). Resultados. Foram selecionados e recrutados 15 indivíduos, destes, 8 não finalizaram a intervenção. Na avaliação de recuperação da função motora dos membros superiores, mais da metade dos pacientes apresentaram melhora significante (p=0,008) na redução do grau de comprometimento motor. Nas atividades espontâneas de vida diária tiveram uma melhora na avaliação quantitativa e qualitativa. A redução do tônus foi percebida apenas em dois pacientes (14%). Conclusão. Os pacientes com AVC que realizaram TRIM apresentaram melhora na recuperação motora e nas atividades espontâneas de vida diária e do movimento do membro superior, na fase crônica. Já a espasticidade não apresentou diminuição significante, o que já era esperado.
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