Aim To determine the frequency and topographic distribution of cerebral microbleeds (CMBs) in dementia with Lewy bodies (DLB) in comparison to CMBs in Alzheimer disease dementia (AD). Methods Consecutive probable DLB (n= 23) patients who underwent 3-tesla T2* weighted gradient-recalled-echo MRI, and age and gender matched probable Alzheimer’s disease patients (n=46) were compared for the frequency and location of CMBs. Results The frequency of one or more CMBs was similar among patients with DLB (30%) and AD (24%). Highest densities of CMBs were found in the occipital lobes of patients with both DLB and AD. Patients with AD had greater densities of CMBs in the temporal lobes and deep or infratentorial regions compared to DLB (p<0.05) Conclusion CMBs are as common in patients with DLB as in patients with AD, with highest densities observed in the occipital lobes, suggesting common pathophysiologic mechanisms underlying CMBs in both diseases.
Autoimmune encephalitis may manifest as a typical limbic syndrome or with isolated syndromes such as atypical psychosis or refractory epilepsy. Psychotic, affective and behavioral disorders are frequently seen especially in Nmethyl-D-aspartate receptor (NMDAR) encephalitis putting autoimmunity to forefront as a potential cause of some psychiatric disorders [1,2]. Studies showing the relationship between cell surface antigens and first-episode schizophrenia or atypical psychosis have fueled interest to this hypothesis [2]. Moreover, post-herpes simplex virus (HSV) and post-varicella zoster virus (VZV) encephalitis with NMDAR antibody and remarkable response to immunotherapy have also been defined [3,4]. In parallel with these studies, we herein report a case presenting with psychosis attacks following systemic VZV infection and improving after immunotherapy.A 17-year-old male with no medical history of prior psychiatric problems was admitted by his family with sleeping difficulties, altered personality, aggression and self-talking. Four weeks ago, he was diagnosed with chickenpox based on typical skin rashes in the form of small blisters all over his body. About 7 days later, while his skin lesions were regressing, he started self-talking, having auditory and visual hallucinations and displaying violent behaviors. His psychomotor activity was increased, he was irritable and anxious. His judgement and insight were deteriorated and attention, impulse control and frustration tolerance were decreased. Neurological examination did not show any focal pathological findings. Routine blood and urine studies and cranial MRI performed upon admission were normal. EEG showed diffuse mild slowing with no epileptic discharges. CSF examination revealed no lymphocytes, normal protein and glucose levels. CSF PCR assays for viral pathogens (VZV, HSV1/2, CMV, HHV-6, enterovirus and EBV), CSF cultures for bacterial (including tuberculosis) and fungal pathogens and extensive panel for rheumatological-vasculitic disorders were negative. Serum VZV IgG was positive compatible with the chickenpox history. Serum and CSF samples were negative for antibodies against Hu, Yo, Ri, Ma2, CV2, amphiphysin, NMDAR, a-amino-hydroxy-methyl-isoxazolepropionic acid (AMPA) receptor, contactin-associated protein-like 2 (CASPR2), leucine-rich, glioma inactivated 1 (LGI1), gamma-amino butyric acid (GABA) B receptor and glutamic acid decarboxylase (GAD). Radioimmunoassays for detection of serum voltage-gated potassium channel complex (VGKC) and voltage-gated calcium channel (VGCC) antibodies were also negative. The patient gave no response to optimal dose of mood stabilizers and antipsychotic drugs. These medications did not cause any side effects (e.g., movement disorders), as well, however, the patient developed analgesic-resistant throbbing headache. Due to absence of evidence for any metabolic, toxic and & Erdem Tüzün
ÖzetBeyin omurilik sıvısı (BOS) lenfositozu ve geçici nörolojik bulguların eşlik ettiği baş ağrısı sendromu ('The syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis: HaNDL') nadir görülen, iyi seyirli, kendini sınırlayan ve az tanınan bir sendromdur. Zengin nörolojik semptomatolojisi ile morbidite ve mortaliteye yol açan çok sayıda hastalığı taklit edebilen bu sendrom için, klinik şüphe ile yapılan BOS incelemesi tanısal değer taşır. Etiyopatogenezi tam olarak bilinmese de, otoimmünite ön planda düşünülmektedir. Bu yazıda, ilk klinik prezentasyonu geçici iskemik atağı taklit eden, geçici ve tekrarlayıcı nörolojik bulgular gösteren epizodları ve normal BOS basıncına eşlik eden papilödem bulgusu ile bir HaNDL olgusu tartışıldı, sendromun tanımı, klinik tablo ve epidemiyolojisi, etiyopatogenezi, ayırıcı tanısı ve tedavisi literatür eşliğinde gözden geçirildi.Anahtar sözcükler: HaNDL, inme taklidi; intravenöz trombolitik tedavi; lenfositik pleositoz; otoimmün hastalık. SummaryThe syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL), is a rare, benign, self-limiting syndrome that is not well known. Cerebrospinal fluid examination (CSF) on clinical suspicion has diagnostic value for this syndrome, which has a rich neurological symptomatology that can mimic many diseases causing mortality and morbidity. Although the ethiopathogenesis of this syndrome is not fully known, autoimmunity is thought to be in the foreground. Described in this article is a HaNDL case that on first clinic presentation appeared to be a transient ischemic attack (TIA) with temporary but recurring neurological findings and normal CSF pressure accompanied by papilledema. Clinical features, epidemiology, ethiopathogenesis, differential diagnosis, and treatment of this syndrome are reviewed according to the literature.
Melatonin is an indoleamine often used in children and adolescents. Melatonin is considered to be an effective clinical management for dyssomnias, sleep disorders present in children with attention-deficit hyperactivity, autism spectrum disorders, developmental delays. Quickacting capsules, controlled-release (CR) capsules, sublingual tablets and liquid forms are available. Melatonin is generally very well-tolerated in children and adolescents. The pharmacology, therapeutic applications, and side effects of melatonin are discussed. Although stimulants have been used most frequently in ADHD treatment their long term effects did not investigate well. Methylphenidate which is the most frequently prescribed stimulant's long term side effects on growth-development, cardiovascular, psychiatric and neurological systems are very important 2 . Stimulant diversion or misuse in long term has growing up in recent years and lead important consequences on community health 3 . Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects (ADDUCE) consortium was established in 2012 and experts on ADHD, drug safety, neuropsychopharmacology and cardiology developed a programme which investigates the long term possible side effects of stimulants 2 . In this presentation, long term side effects of stimulants (methylphenidate) will be reviewed through the perspective of ADDUCE work group study results.
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