Central Nervous System Disturbances Research Articles

The association between hypoparathyroidism and cognitive impairment: a systematic review.

Hypocalcemia and low parathyroid hormone levels have been commonly suggested as factors able to induce central nervous system disturbances. However, evidences on the occurrence of cognitive impairment are limited or underestimated. The aim of this review is, therefore, to systematically summarize the available evidence concerning the occurrence of cognitive impairment among subjects suffering from idiopathic or secondary hypoparathyroidism. A systematic selection of the available literature was performed by searching the online databases PubMed, Scopus and Web of Knowledge. The present systematic review included sixteen case report articles and one cross-sectional controlled study. Case reports were the most representative literature sources and involved ten women and seven men. The presence of cognitive impairment was mostly discussed in association with idiopathic hypoparathyroidism (HPT); five articles described the occurrence of cognitive impairment following postsurgical HPT. The case-controlled study reported a significant presence of peculiar cognitive deficits (e.g. reduced inhibitory control, impairment in visuo-spatial functioning among, and psychomotor retardation) among HPT subjects compared to healthy controls, with serum total calcium and its product with phosphorus as independent predictors of neuropsychological dysfunctions. Even though mostly based on single case reports, the presence of neuropsychological dysfunctions in the context of HPT appears to be a consistent core finding.

Thyroid Storm in a Toddler Presenting as a Febrile Seizure

Although simple febrile seizures are relatively common and benign in toddlers, it is important to rule out any underlying critical disease that necessitates further intervention and treatment. Thyroid storm, the extreme manifestation of hyperthyroidism, is relatively rare and not often considered in the differential diagnosis of a febrile seizure despite its high mortality rate. Here, we report 1 of the youngest patients with thyroid storm, who initially presented with a febrile seizure. After reevaluation, the 2-year-9-month-old patient was discovered to have thyromegaly, which led to recognition that her persistent tachycardia and widened pulse pressure were likely signs of thyrotoxicosis. Laboratory results were consistent with primary hyperthyroidism due to Graves' disease. Thyroid storm was then diagnosed on the basis of clinical features including gastrointestinal and central nervous system disturbances. Treatment with methimazole, propranolol, hydrocortisone, and Lugol's iodine solution was used. This medication regimen was safe and effective with restoration of a euthyroid state after 2 months and no recurrence of seizures. Improved awareness of hyperthyroidism and thyroid storm can lead to prompt diagnosis and treatment of this endocrine emergency, thus reducing mortality and morbidity. Pediatricians should consider this diagnosis in children with febrile seizures and suggestive vital signs and physical examination findings.

Fentanyl - Based Cardiac Anesthesia Provides Higher Recovery Compared with Morphine in Elective CABG Surgery Patients

Background : High-dose opioid anesthesia during cardiac surgery has been the mainstay of cardiacanesthesia for decades due to its ability to preserve hemodynamic stability and attenuate hormonal andmetabolic response to surgical stress. The hypothesis of this study is that the use of fentanyl as part of abalanced anesthetic would lead to improved patient health status and recovery during the first 3 daysafter cardiac surgery with CPB compared with morphine. Quality of recovery was assessed using theQoR-40 questionnaire administered preoperatively and daily on postoperative days 1–3. Hemodynamicvariables, duration of tracheal intubation, organ morbidities, intensive care unit (ICU) and hospitallength of stay were evaluated. Methods: This comparative randomized double blind study was conducted in the department ofcardiothoracic vascular anaesthesia and critical care of Apollo Hospitals,Dhaka on 100 patientsundergoing elective CABG. Study period was (January-July), 2019. The study was approved by theinstitutional review board, and informed consent was obtained from all subjects. One hundred patientspresenting for elective CABG surgery, between the ages of 18 and 79, were enrolled in the study. Exclusioncriteria included (1) concurrent valvular surgery or the presence of valvular disease, (2) reoperativeprocedures, (3) unstable angina or elevated cardiac enzymes within 48 hours of surgery, (4) morphine orfentanyl allergy, (5) the need for an intra-aortic balloon pump or inotropic agents preoperatively, (6)psychiatric or central nervous system disturbances precluding completion of the QoR-40. Results: Compared with patients given morphine, those receiving fentanyl had higher global QoR-40scores on postoperative days 1 (174.8 vs 162.5, P 0.001), 2 (175 vs 166.1, P 0.001), and 3 (178.1 vs 167.3,P 0.001). Differences between the groups were observed in the QoR-40 dimensions of emotional state,physical comfort, and pain . Postoperative visual analog scale pain scores, use of pain medication in theICU and surgical ward, and postoperative febrile reactions were reduced significantly in the fentanylgroup . No differences between the groups were noted in duration of tracheal intubation,ICU and hospitallength of stay, or postoperativecomplications. Conclusion: Continuous intravenous infusions of fentanyl have been used to provide intraoperativeanalgesia also give good-to-excellent postoperative analgesia furthermore early extubation and the qualityof postoperative recovery in cardiac surgical patients can be enhanced when fentanyl is used as part of abalanced anesthetic. JBSA 2020; 33(1): 28-35

Patient with severe fever with thrombocytopenia syndrome virus infection and central nervous system disturbance in Dongyang, Zhejiang Province, China, 2017

BackgroundSevere fever with thrombocytopenia syndrome (SFTS) is an emerging hemorrhagic fever that was first described in China in 2011. We report a patient who died of Severe fever with thrombocytopenia syndrome virus (SFTSV) infection, with a rapidly progressive central nervous system (CNS) disturbance, in Dongyang, Zhejiang Province, China, in 2017.Case presentationA 64-year-old man was admitted to hospital after 4 days of fever. SFTSV was detected 1 day after the patient was admitted to hospital. The patient presented with CNS disturbance and died 4 days after admission. Detailed clinical and epidemiological investigations and laboratory tests were conducted. Reduced platelet, white blood cell, lymphocyte, and neutrophil counts, elevated lactate dehydrogenase, creatine kinase, aspartate aminotransferaseand alanine aminotransferase concentrations, and an increased activated partial thromboplastin time were observed. In a phylogenetic analysis, the isolate clustered close to a strain derived from South Korea.Conclusions: This is the first case of SFTSV infection with CNS disturbance in Dongyang, Zhejiang Province, China. The surveillance of suspected cases of SFTS is important in SFTSV endemic regions.

Vulnerable Populations Receiving Palliative Radiation in a Children’s Hospital: Reporting on the Underreported

Few studies have examined the use of palliative radiation therapy (RT) in the pediatric population. This single institution study is one of the largest series reported of palliative RT practice patterns prior to and within the last month of life with a focus on vulnerable and underserved pediatric patients. A retrospective chart review of patients treated from 2008-2017 identified patients treated with radiotherapy with palliative intent. Demographic, diagnosis, and treatment parameters were collected from the electronic medical records. Vital status was recorded at date of death or last follow-up. Vulnerable patients were defined as belonging to a minority, adolescent and young adult (AYA), special needs, or low income population. Of the 1092 patients treated with RT, 108 were identified as having received 227 treatments with palliative intent. Forty-five patients (42%) were female and 63 (58%) were male. The median age at the time of the first course of radiation was 11 years (range 0-25). Central nervous system (CNS) disturbance was the most common indication (n=50, 46%) followed by pain (n=44, 41%). Top primary diagnoses included CNS neoplasm (n=30, 37%), neuroblastoma (n=20, 19%), and rhabdomyosarcoma or other sarcoma (n=11, 10%). Forty-four percent were treated with anesthesia for at least one course of radiation. The median time from last course of RT to date of last follow-up was 3 months (range 0-105), and 25 patients (23%) received radiation in the last month of life. Eighty-two (76%) patients were deceased at time of review. The vulnerable constituted the overwhelming majority of the 108, only 13 (11.5%) were not. Patients were classified in the following individual categories: minority (n=90, 83.3%), AYA (n=34, 30%), special needs (n=10, 8.8%), or low income (n=70, 62%). Eight patients initially came seeking cancer treatment not available in Asia or Latin America. Latinos (n=66, 61%) were numerous and diverse, 12% were mixed race, and 18% had employer-based coverage. The most common vulnerable patients were Latin children from low income families (n=40, 35%). Obstacles to care included the immigration system, limited English, discrimination, cultural barriers, and poverty with job, transportation, and housing insecurity. Safety net and charitable organizations had scarce resources and rules intended to reduce fraud and abuse further limited access. Parents reported these challenges amplified the great psychological distress felt after the death of a child. This is the first report to document the vulnerable pediatric and AYA population receiving palliative radiation therapy at a large urban hospital. Almost a quarter of patients received treatment in the last month of life. Most commonly, a vulnerable child was Latinx from a low income family. Further investigation is needed to guide radiation oncologists on the delivery of optimal end-of-life care and address barriers to care in this population.

Neurotropic enteroviruses co-opt "fair-weather-friend" commensal gut microbiota to drive host infection and central nervous system disturbances.

Some neurotropic enteroviruses hijack Trojan horse/raft commensal gut bacteria to render devastating biomimicking cryptic attacks on human/animal hosts. Such virus-microbe interactions manipulate hosts' gut-brain axes with accompanying infection-cycle-optimizing central nervous system (CNS) disturbances, including severe neurodevelopmental, neuromotor, and neuropsychiatric conditions. Co-opted bacteria thus indirectly influence host health, development, behavior, and mind as possible "fair-weather-friend" symbionts, switching from commensal to context-dependent pathogen-like strategies benefiting gut-bacteria fitness.

Prevalence and outcome of hypoglycemia in children attending emergency pediatric unit of a specialist hospital in Nigeria

Background: Hypoglycemia is a common metabolic problem encountered in pediatric emergency admissions. The absence of clinical symptoms does not preclude the presence of hypoglycemia as presentation may vary from asymptomatic to central nervous system and cardiopulmonary disturbances. If untreated, hypoglycemia can result in permanent neurological damage or even death. Objectives: The objective of the study is to determine the prevalence, associated factors and outcome of hypoglycemia in pediatric emergency admissions at Ahmad Sani Yariman Bakura Specialist Hospital, Gusau, Nigeria. Materials and Methods: The study was a prospective cross-sectional study involving children aged 1 month–13 years. Blood glucose was determined at admission using Accu-Chek® Active Blood Glucose Meter, and hypoglycemia was defined as blood glucose levels

326. Malaria vs. Bacterial Meningitis in Children With Spinal Tap in the Luanda Children’s Hospital, Angola

BackgroundIn Sub-Saharan Africa, both malaria (M), and bacterial meningitis (BM) cause fever and central nervous system (CNS) disturbance. We studied their prevalence, characteristics, outcome, and risk factors for poor outcome to better understand the clinical impact of suspected CNS infection in children.MethodsWe conducted a prospective study in the Children’s Hospital (HPDB) in the capital of Angola which attends 300 new patients daily. Spinal tap (ST) was performed for children presenting with altered consciousness, convulsions, prostration, or meningism. The analysis included children aged 3 month to 15 years with confirmed discharge diagnosis in 2016–2017.ResultsOf 941 children, the diagnosis was M in 56% (525), BM in 12% (116), epilepsy/convulsions in 9% (88), and other infections in 6% (60). Of all children, 16% (150/941) died, 6% (45/733) had severe, 14% (93/655) any neurological sequelae, and 27% (243/897) either died or had neurological sequelae. In children with M, the corresponding figures were 7% (35/525), 1.5% (7/476), 4% (19/443), and 11% (54/514). In children with BM, the figures were 41% (47/116), 15% (8/54), 33% (11/33), and 55% (58/105), respectively. Comparing with M, children with BM were younger (median age (IQR) 28 (61) vs. 60 (68) months, P < 0.0001), had an underlying illness (23/97 vs. 19/374, P < 0.0001), like sickle-cell disease (18/96 vs. 9/372, P < 0.0001), longer duration of illness (4 (4) vs. 3 (3) days, P < 0.0001, dyspnea (70/119 vs. 210/463, P = 0.009), were dehydrated (36/113 vs. 67/441, P < 0.0001), or malnourished (38/115 vs. 75/447, P = 0.0001). Multivariate analysis revealed as independent risk factors for death or neurological sequelae age <12 months (OR 1.71, 95% CI 1.02–2.88, P < 0.0001), duration of illness >3 days (2.48, 1.68–3.64, P < 0.0001), malnutrition (1.92, 1.20–3.05, P = 0.006), and dehydration (1.92, 1.16–3.14, P = 0.01). When BM vs. M was included in the analysis, BM appeared as the most important risk factor (OR 8.06, 4.44–14.65, P < 0.0001) and age lost its significance.ConclusionIn suspected CNS infection, M was the final diagnosis of most children. However, BM caused more deaths and neurological sequelae. Amendable factors, such as delay in treatment, dehydration, and malnutrition, appeared as risk factors for poor outcome.Disclosures T. Pelkonen, sanofi pasteur: Investigator, Sanofi Paster funded this study. Paediatric Research Foundation, Helsinki, Finland: Grant Investigator, Grant recipient. Päivikki and Sakari Sohlberg Foundation, Helsinki, Finland: Grant Investigator, Grant recipient

Blood Lead Levels and Healthy Complaint in Printing Workers of Unipress Surabaya

Lead is found in the printing ink, it gets into the human body through skin absorption and ingestion. Blood lead level &gt; 10 μg/dL causes health disturbances. The purpose of this study was analyzed blood lead level and healthy complaints in printing worker of Unipress Surabaya. This research was observational analytic with cross sectional approach. The subject was printing production process employees and administration employees. Population of production process employees were 10 people and administration employees were 7 people. Whereas, sample of production process employees were 9 and administration employees were 6. The determination of the sampling used simple random sampling. Data analyzed with chi-square test and t-independent test. Blood lead level of production process employees have ± SD = 6.16 ± 0.37 μg/dl, whereas the blood lead level of administration employees have ± SD = 6.0±0.18 μg/dl. Based on the results by t-independent test (p = 0.371) which indicated there was no difference blood lead level of production process employees and administration employees. Based on the test results by chi-square (p = 0.005) which indicated there was difference in central nervous system disturbances of study group and control group. It is concluded that blood lead level in printing worker of Unipress Surabaya are normal. Though it can suggested to use gloves while working, increase hygiene and sanitation behavior, reducing smoking habit, as well as routine health check up to see the blood lead leve

F18. IS SCHIZOPHRENIA A MULTI-SYSTEM DISORDER? CONSIDERING NEUROLOGICAL, IMMUNE, CARDIOMETABOLIC, AND ENDOCRINE ALTERATIONS IN FIRST EPISODE PSYCHOSIS

BackgroundPeople with schizophrenia and related psychotic disorders show abnormalities in several organ systems in addition to the central nervous system (CNS). It is not yet known how the magnitude of disturbance in non-CNS systems compares with the magnitude of CNS disturbance in FEP. Here, we statistically compare effect sizes (ES) for non-CNS and CNS dysfunction in FEP, and consider whether schizophrenia is a multi-system disorder.MethodsPubmed was systematically searched from 1990 to May 2017 for meta-analyses examining non-CNS dysfunction in FEP, focusing on immune, cardiometabolic, and hypothalamic-pituitary-adrenal (HPA) systems. A parallel search was performed for meta-analyses examining representative CNS dysfunction in FEP, specifically neurophysiological, neurochemical and brain structural alterations. To statistically compare the magnitude of effect sizes (ES) between different CNS and non-CNS systems in FEP, data were extracted from case-control studies making up these meta-analyses, and meta-analyses repeated. For non-CNS parameters, random-effects meta-analyses were performed examining immune (cytokines, CRP, and lymphocytes), cardiometabolic (glucose/insulin and lipids), and HPA parameters (cortisol and prolactin). For CNS parameters, meta-analyses were performed examining brain structural, neurophysiological (Auditory P300 amplitude and latency, duration deviant mismatch negativity), and neurochemical parameters (N-acetylaspartic acid levels). Standardized mean differences between patient and control cohort parameters were used as the ES (Hedges adjusted g). As well as individual meta-analyses being run for each parameter as described, 6 separate sub-group meta-analyses were performed examining data for overall immune, cardiometabolic, HPA, brain structural, neurophysiological, and neurochemical systems. Sub-group summary effect size magnitudes were calculated by running a combined analysis of all studies assigned to a sub-group (e.g. to calculate the summary effect size magnitude for immune alterations, a single analysis was performed that combined IL-1b, sIL-2R, IL-6, TNFa, TGFb, CRP, and lymphocyte count data sets). Summary effect sizes for these 6 individual systems were statistically compared in a fixed effects model using a Wald-type test. This was also used to compare overall summary CNS and non-CNS effect sizes. Antipsychotic naïve sensitivity analyses were performed.ResultsData were extracted for 165 studies comprising a total sample size of 13,440. The summary effect size for immune alterations (g=1.19; CI:0.82–1.56) was significantly greater than brain structural (g=0.40;P<.001) and neurochemical alterations (g=0.43;P<.001), and no different from neurophysiological alterations (g=0.80; P=0.05). The summary effect size for HPA alterations (g=0.68; CI:0.32–1.04) was not significantly different from brain structural (P=.14), neurophysiological (P=.54), and neurochemical (P=.22) alterations. The summary effect size for cardiometabolic alterations (g=0.23; CI:0.15–0.31) was significantly lower than neurochemical (P=.04), neurophysiological (P<.001) and brain structural alterations (P=.001). The overall summary effect sizes for non-CNS (g=0.58; CI:0.44–0.72) and CNS (g=0.50; CI:0.44–0.56) alterations were not significantly different (P=.28).DiscussionThese data indicate that there are robust alterations in non-CNS systems in psychosis, and that these are broadly similar in magnitude to a range of CNS alterations, indicating that psychosis involves multiple organ systems to a comparable degree from onset. We consider three models that could account for these findings and discuss implications for future research and treatment.

1.23 A Pilot Resting State Functional Connectivity Study of the Kynurenine Pathway in Adolescents With Depression and Healthy Controls

The neuroimmunological kynurenine pathway (KP) has been hypothesized to play a role in depressive/anhedonic symptoms and related central nervous system disturbances. Indoleamine 2,3-dioxygenase (IDO) is the rate limiting enzyme which leads to neurotrophic [kynurenic acid (KA)] and neurotoxic [quinolinic acid (QUIN)] branches. In this pilot, we sought to examine associations between blood KP neuro-toxic/trophic measures and an anhedonia/depression associated network in youth with MDD and healthy controls (HC).

Role of antioxidant treatment on DNA and lipid damage in the brain of rats subjected to a chemically induced chronic model of tyrosinemia type II.

Tyrosine levels are abnormally elevated in tissues and body fluids of patients with inborn errors of tyrosine metabolism. Tyrosinemia type II, which is caused by tyrosine aminotransferase deficiency, provokes eyes, skin, and central nervous system disturbances in affected patients. However, the mechanisms of brain damage are still poorly known. Considering that studies have demonstrated that oxidative stress may contribute, along with other mechanisms, to the neurological dysfunction characteristic of hypertyrosinemia, in the present study we investigated the effects of antioxidant treatment (NAC and DFX) on DNA damage and oxidative stress markers induced by chronic administration of L-tyrosine in cerebral cortex, hippocampus, and striatum of rats. The results showed elevated levels of DNA migration, and thus DNA damage, after chronic administration of L-tyrosine in all the analyzed brain areas, and that the antioxidant treatment was able to prevent DNA damage in cerebral cortex and hippocampus. However, the co-administration of NAC plus DFX did not prevent the DNA damage in the striatum. Moreover, we found a significant increase in thiobarbituric acid-reactive substances (TBA-RS) and DCFH oxidation in cerebral cortex, as well as an increase in nitrate/nitrite levels in the hippocampus and striatum. Additionally, the antioxidant treatment was able to prevent the increase in TBA-RS levels and in nitrate/nitrite levels, but not the DCFH oxidation. In conclusion, our findings suggest that reactive oxygen and nitrogen species and oxidative stress can play a role in DNA damage in this disorder. Moreover, NAC/DFX supplementation to tyrosinemia type II patients may represent a new therapeutic approach and a possible adjuvant to the current treatment of this disease.

A Preliminary Study on Indoor Air Quality for the Development of Risk Assessment Methods for Central Nervous System Disturbances

The present study aimed to identify the air pollutants associated with central nervous system (CNS) disturbances through a survey of indoor air pollutants and manifestation of CNS diseases, and to establish a risk assessment method and risk management measures for CNS disturbances caused by these pollutants. A patient cohort consisting of patients suffering from CNS diseases was selected and a health risk assessment was performed for fine dust (PM2.5) and 17 heavy metals/ other elements in the indoor air of the residences of survey subjects. The study results showed statistically significant differences in fine dust concentrations according to the region in which the surveys were conducted.

Effect of Salvia miltiorrhiza root extract on brain acetylcholinesterase and butyrylcholinesterase activities, their mRNA levels and memory evaluation in rats

Salvia miltiorrhiza (Lamiaceae), one of the most important and popular plants of traditional medicine of Asia, is used for the prevention and treatment of cardiovascular diseases and in central nervous system disturbances. The main aim of this study was to assess the influence of subchronic (28-fold) administration of Salvia miltiorrhiza root extract (SE, 200mg/kg, p.o.) on behavioural activity and memory of rats and to evaluate the activities of cholinesterases (AChE and BuChE) and gene expression levels of AChE and BuChE as well as of beta-secretase (BACE1) in the hippocampus and frontal cortex in vivo. Huperzine A (HU, 0.5mg/kg b.w., p.o.) served as a positive control substance, whereas scopolamine (0.5mg/kg, i.p.) injection was used as a well-known model of memory impairment. The results showed that subchronic administration of SE led to an improvement of long-term memory of rats. Strong inhibition of AChE and BuChE mRNA transcription in the frontal cortex of rats treated with SE or HU was observed. The BACE1 transcript level was significantly decreased. AChE activity was statistically significantly inhibited in the frontal cortex and the hippocampus by SE (47% and 55%, respectively). Similar effects were observed in the case of HU. In summary, activity of SE provides evidence that the plant can be a source of drugs used in the treatment of Alzheimer disease.

Time-Dependent Lactate Production and Amino Acid Utilization in Cultured Astrocytes Under High Glucose Exposure.

Accumulating investigations have focused on the severity of central nervous system (CNS) complications in diabetic patients. The effects of the high glucose (HG) probably attribute to the metabolic disturbances in CNS. Astrocytes, with powerful ability of metabolic regulation, play crucial roles in physiological and pathological processes in CNS. Hence, an in-depth analysis as to metabolic alterations of astrocytes exposure to HG would facilitate to explore the underlying pathogenesis. In this study, the 1H NMR-based metabonomic approach was performed to characterize the metabolic variations of intracellular metabolites and corresponding culture media in a time-dependent manner. Our results revealed a significant elevation in lactate production and release. Four amino acids, leucine, isoleucine, methionine and tyrosine, were the most important metabolites for utilization. Also, profound disturbances of several metabolic pathways, including osmoregulation, energy metabolism, and cellular biosynthesis were observed. In that sense, the detailed information of astrocyte metabolism under HG exposure provides us a comprehensive understanding of the intrinsic metabolic disorders in CNS during hyperglycemia or diabetes.

THE LINK BETWEEN VITAMIN В12 DEFICIENCY, RISK OF CARDIOVASCULAR DISEASES AND AGING PROCESS

Disorder of formation of vitamin B 12 , which has a wide range of biological properties and is involved in the regulation of many important physiological functions, is the basis of a number of serious diseases. Usually internists consider that vitamin В 12 deficiency is associated with disturbances of hematopoiesis or central nervous system. However cobalamin deficiency also affects the state of the cardiovascular system. Its connections to the increased incidence of myocardial infarction, stroke, and congestive heart failure were found, as well as the elevated risk of restenosis after coronary artery bypass surgery. Besides, there are data that demonstrate an association between vitamin В 12 and telomere length (a marker of aging). This review presents the main reasons of cobalamin deficiency in the elderly, as well as an analysis of clinical studies that show the link between vitamin В 12 deficiency and the risk of cardio-vascular diseases and aging process.

Goldenhar Syndrome in a pediatric patient: a case report and review of literature

ABSTRACT Goldenhar Syndrome is a rare, generally sporadic condition, whose physical manifestations include asymmetric incomplete facial development, epibulbar dermoids, auricular malformations e auricular appendices, vertebral anomalies, central nervous system disturbances, ocular irregularities and visceral abnormalities. Its etiology is not fully understood, with its incidence ranging from 1:3500 to 1:5600 live births, and a gender ratio of 3:2 (male: female), presenting more frequently in children with congenital deafness. The purpose of this case report was to describe clinical presentation of Goldenhar syndrome in a five-year old male with no significant family history, where almost all of the classic signs of the condition were present. Considering its involvement in craniofacial structures, its rarity, and its wide spectrum of symptoms and associated systemic abnormalities, knowledge of this condition is paramount for the dental surgeon.

Clinically Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion without Central Nervous System Disturbances: A Case Report

Patients with clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) on the splenium of the corpus callosum (SCC) present with relatively mild central nervous system disturbances. A 41‐year‐old man was admitted with fever and headache and, his main symptoms were mild headache and fatigue. There were no neurological focal signs. Brain magnetic resonance imaging (MRI) showed abnormal signals in SCC. We report, for the first time, a MERS patient, detected on MRI, who did not present with central nervous system disturbances. Our experience suggests MERS should be considered as a differential diagnosis in patients with fever of unknown origin.

Enfermedades de la neurohipófisis: diabetes insípida y síndrome de secreción inadecuada de la hormona antidiurética

Diabetes InsipidusIs a clinical disorder defined by an hypotonic polyuria because of an incapacity to concentrate the urine. PathogenesisThe causes can be central, nephrogenic or dipsogenic. DiagnosisA careful anamnesis and the water deprivation test are the most important tools for a correct diagnostic. TreatmentFor central diabetes insispidus, desmopressin could be the treatment. For nephrogenic diabetes insipidus or dipsogenic, other considerations need to be considered. Syndrome of Inappropriate Antidiuretic Hormone SecretionIs the most important cause of hyponatremia in the clinical practice. PathogenesisMany causes have been described, but the most important to consider are tumors, pulmonary diseases, central nervous system disturbances and drugs. DiagnosisDiagnosis of exclusión is the key point, based on anamnesis, physicial examination and a correct differential diagnostic procedure. TreatmentTreatment of the hyponatremia depending on clinical severity and its duration; and the original cause, as a definitive treatment.

Oleic Acid and Cholinergic dysfunction in Down Syndrome Models of the Central Nervous System

Down syndrome (DS): or trisomy 21: is the most common autosomal aneuploidy and the leading genetic cause of intellectual disability. It is widely established that mental retardation is primarily a consequence of brain functioning and developmental abnormalities in neurogenesis. Some changes in the physical structure of the dendrites are a major cause of impaired synaptic plasticity of DS. The overexpression of the dual specificyty tyrsone phosphorylation-regulated kinase 1A (DYRK1A): located on chromosome 21: is involved in cellular plasticity and responsible for central nervous system disturbance in DS. Oleic acid is a neurotrophic factor that promotes neuronal differentiation and increases the levels of choline acetyltransferase (ChAT). Furthermore: it has recently been shown that it induces migration and formation of new synapses in euploid cells. However: remarkably oleic acid fails to reproduce the same effects in trisomic cells. Here we review the hypothesis that oleic acid-dependent synaptic plasticity may be dependent on the lipid environment. Thus: differences in membrane composition may be essential to understand why oleic acid promotes higher cell plasticity in euploid than in trisomic cells.