Neurological Causes Research Articles

Postural disorders of neurological genesis in elderly patients: pathogenesis and features of diagnostics (literature review)

Walking and balance disorders in elderly patients are the most common manifestations of various diseases of the nervous system. Balance imbalance is the leading cause of injuries in the elderly, leading to a limitation of both the patient’s ability to work and communication in the social environment, which in particular cases leads to a loss of independence, reducing the quality of life. Walking disorders are an important, difficult to resolve medical and social problem. The aim of the study was to identify the physiological and clinical aspects of age-related gait disorders with an emphasis on neurological pathogenetic causes. A detailed study of modern foreign medical literature and current international clinical guidelines was carried out with further systematization of the data obtained. Falls in the elderly are a common and major factor that threatens the independence of older people. The frequency of falls increases with age. Treatment for fall injuries does not always include identifying the cause of the fall. In the elderly, loss of balance is most commonly due to multiple causes, including impending threat to the homeostatic mechanisms that maintain postural stability combined with age-related impairments in balance, gait stability, and cardiovascular function. Gait disorders are a major cause of functional impairment and morbidity in the elderly. Most gait disorders in the elderly are multifactorial and have neurological components. In developed countries, there is a trend towards aging of the population: the percentage component of the elderly part of the population is growing. It is violations of balance, stability and walking, to a large extent, that lead to the inability of the patient to provide his quality of life at a satisfactory level on his own, to disability and failure in the workplace. Early diagnosis of gait disorders can prevent premature disability and limit the independence of elderly patients. It is important to note that a history of falls is a predictor of the risk of new falls.

Trastorno específico del lenguaje en Andalucía, España: prevalencia en función del subtipo y del género

IntroductionSpecific Language Impairment (SLI) is a significant impairment in language acquisition (−1.25 SD), resistant to intervention and not justified by physical, neurological, intellectual, sensory or social causes, requiring specialized intervention. There is little information on the prevalence of this group in Spain. ObjectivesThree objectives, to calculate the prevalence of SLI in general and subtypes globally and according to gender, to determine the ages of diagnosis of SLI and to know its distribution by provinces in Andalusia. Materials and methodsPrevalence: Reference population: 537,879 Primary School students. The prevalence is calculated by types, provinces and sex and homogeneity with hierarchical cluster is analyzed. Detection ages and SLI allocation in Andalusia: Reference population: 1,185,061 students. Frequencies and percentages of SLI are calculated by typology, province, age group and sex. Classification tree technique (CHAID method) is used. ResultsPrevalence: 8.27 per thousand (‰) in Andalusia (Spain). Screening ages. At age 8, 86.9%, mainly expressive SLI (E-SLI). Semantic-pragmatic disorder (SPD) is detected mainly from the age of 8 years. DistributionSex: 74% are boys. Age groups: 2.9% are between 3-6 years old, 32% between 6 and 8, 42% between 8 and 12 and 23% over 12. Typologies: expressive SLI (E-SLI): 56%, expressive-receptive SLI (ER-SLI): 33% and semantic-pragmatic disorder (SPD): 11%. ConclusionsSLI students, due to their specific characteristics and dimensions, should be considered in educational policies.

Pharyngolaryngeal semiology and prognostic factors in multiple system atrophy

IntroductionMultiple system atrophy (MSA) is a rare degenerative neurological disorder in adults. It induces parkinsonian and/or cerebellar syndrome associated with dysautonomia. Pharyngolaryngeal symptoms are common. Our aim is to describe the Pharyngolaryngeal semiology on one hand, and to ascertain whether the presence of these symptoms represents a prognostic factor for MSA on the other.MethodsThus, we carried out a retrospective, single-centre study, on a cohort receiving care at the centre of reference for MSA. The patients were referred for otorhinolaryngology assessment. The data was collected over the year 2020 with the help of computer software from the university hospital centre (UHC). Firstly, we described the Pharyngolaryngeal semiology specific to MSA by questioning patients, and by the results of nasofibroscopic examinations and swallowing tests. We then used multivariate analysis of variance to describe the prognostic factors of MSA progression (in UMSARS I and II points per month of progression) and survival (number of years between the first symptoms and death).ResultsThis study included a hundred and one patients and made it possible to define a Pharyngolaryngeal semiology profile of MSA, which is: a reduction in laryngeal mobility (primarily vocal cord abduction defects), abnormal movements (particularly at rest or when initiating a movement) and a defect in the protection mechanisms of the upper airways. The swallowing difficulties are moderate and the main mechanisms are delayed pharyngeal swallow and/or an oro-pharyngeal transport defect. In the multivariate analyses, the contributing factors are laryngeal anomalies, modification of solid food to fluid food and nutritional complication.ConclusionENT specialists should pay close attention to problems in the Pharyngolaryngeal dynamic and then consider a neurological cause. They can also itemize the clinical factors that could have a negative effect on the prognosis of the patient with MSA. Indeed, early detection makes it possible to provide care for respiratory and nutritional complications.

Impact of timing and dosing of four‐factor prothrombin complex concentrate administration on outcomes in warfarin‐associated intracranial hemorrhage

The objective of this study was to evaluate clinical outcomes associated with time to administration and dose of four-factor prothrombin complex concentrate (4F-PCC) in patients with ICH on warfarin. This was a single-center retrospective analysis of patients with ICH on warfarin who received 4F-PCC. The site of the study was a large, Level I trauma, academic medical center with a dedicated neurologic intensive care unit and an emergency department (ED) that has approximately 72,000 visits annually. Patients were included if they were ≥18 years of age, diagnosed with ICH, had an INR >1 due to warfarin use, and received both 4F-PCC and IV vitamin K for anticoagulation reversal. Exclusion criteria included patients who were less than 18 years of age, were not currently taking warfarin, had a bleeding site other than ICH, were pregnant or incarcerated, had an inadequate medical record, had a left ventricular assist device, had known liver disease with Child-Pugh Class C, received anticoagulation with heparin therapy within 24 h of anticoagulation reversal, or did not receive vitamin K within 24 h of hospital admission. Our primary outcome was a composite of hematoma expansion or death due to neurologic injury. Treatment groups were defined as receipt of 4F-PCC within 0-30, 31-60, 61-90, 91-120 min, or greater than 120 min. Hematoma expansion was defined as any increase in hematoma size as assessed by a radiologist via standard 6-h CT. Death due to neurologic injury was defined as death prior to a repeat CT being performed or documentation of a neurologic cause of death. Adequate INR reversal (INR ≤1.3 on repeat INR) vs. inadequate INR reversal and weight-based vs. fixed-dose 4F-PCC were also assessed. A total of 94 patients met the inclusion criteria. Forty-one patients (43.6%) met the composite endpoint, including 60% of the 31-60 min group, 47.6% of the 61-90 min group, 71.4% of the 91-120 min group, and 30.6% of the >120-min group. A significant difference in primary outcome occurred between the 91-120 min and >120-min groups (71.4% vs. 30.6%; p= 0.005), but this difference was not observed when accounting for disparities in Glasgow Coma Scale (GCS). Patients with adequate INR reversal were less likely to meet the primary endpoint than those with inadequate INR reversal (28.1% vs. 58.6%; p= 0.0059). There was less failure of anticoagulation reversal with weight-based dosing compared with fixed dosing (24.2% vs. 65.0%; p< 0.001). No difference in clinical outcomes among 4F-PCC dosing strategies or time windows to administration was observed in patients with GCS <15. Rates of repeat INR ≤1.3 were higher with weight-based dosing, suggesting investigation of populations in which fixed dosing may be inappropriate is warranted.

Historical Perspective and Medical Maladies of Alexander the Great.

Alexander the Great (356 BC - 323 BC) was only 20 years old when he was named the next King of Macedonia after his father was assassinated. The following 11 years witnessed the evolution of an outstanding leader who expanded his empire from Egypt to the Indian frontier. Despite successfully conquering much of the world, he was afflicted with a febrile illness at the age of 32, which he battled for a mere 11 days before perishing. It has been almost 2,400 years since his death, but the exact cause remains a mystery. Did he die of natural causes or at the hands of conspirators? Numerous papers have been written about the illnesses suffered by Alexander, with the current evidence revealing a healthy 32-year-old man who developed fever and acute abdominal pain with rapid deterioration of his general condition leading to death within a short duration. We analyze various theories and discuss possible etiologies that may have contributed to his tragic death. Information was gathered from primary and secondary sources found through searching multiple online academic databases and the University of Southern California (USC), University of California Los Angeles (UCLA), and Harvard libraries. Unreliable sources and the unavailability of Alexander’s body for autopsy make reaching a definitive diagnosis an impossible task; however, based on existing information, we presume that he most probably died of a neurological cause due to acute necrotizing pancreatitis and encephalopathy secondary to peritonitis. Other potential causes include fulminant hepatic failure, acute demyelinating neuropathy or Guillain Barre Syndrome, and arsenic poisoning.

Contemporary outcomes of cardiac surgery patients supported by the intra-aortic balloon pump.

OBJECTIVESAlthough the intra-aortic balloon pump (IABP) has been the most widely adopted temporary mechanical support device in cardiac surgical patients, its use has declined. The current study aimed to evaluate the occurrence and predictors of early mortality and complication rates in contemporary cardiac surgery patients supported by an IABP.METHODSA multicentre, retrospective analysis was performed of all consecutive cardiac surgical patients receiving perioperative balloon pump support in 8 centres between January 2010 to December 2019. The primary outcome was early mortality, and secondary outcomes were balloon-associated complications. A multivariable binary logistic regression model was applied to evaluate predictors of the primary outcome.RESULTSThe study cohort consisted of 2615 consecutive patients. The median age was 68 years [25th percentile 61, 75th percentile 75 years], with the majority being male (76.9%), and a mean calculated 30-day mortality risk of 10.0%. Early mortality was 12.7% (n = 333), due to cardiac causes (n = 266), neurological causes (=22), balloon-related causes (n = 5) and other causes (n = 40). A composite end point of all vascular complications occurred in 7.2% of patients, and leg ischaemia was observed in 1.3% of patients. The most important predictors of early mortality were peripheral vascular disease [odds ratio (OR) 1.63], postoperative dialysis requirement (OR 10.40) and vascular complications (OR 2.57).CONCLUSIONSThe use of the perioperative IABP proved to be safe and demonstrated relatively low complication rates, particularly for leg ischaemia. As such, we believe that specialists should not be held back to use this widely available treatment in high-risk cardiac surgical patients when indicated.

Facial Asymmetry: A Narrative Review of the Most Common Neurological Causes

Symmetry of the face is one of the most important features for the perception of attractiveness. Asymmetry of the face means that the right and left sides of the face are not identical. Subclinical facial asymmetry is very common in the general population. Most people have some slight facial asymmetry, and this is the normal biological situation in humans. Abnormalities from soft tissue, dental, and skeletal elements lead to facial asymmetry. Asymmetry has many causal factors, and its aetiology includes both congenital and acquired conditions. Neurological facial asymmetry is scarcely addressed in the dental literature. In this narrative review, we focus on the most common neurological causes of facial asymmetry. From a neurological point of view, facial asymmetry can result from disturbances of the cranial nerves, developmental disorders, or myopathies. In the broad range of differential diagnostics of facial asymmetry, neurological abnormalities should be taken into consideration. The treatment must be related to the underlying cause. Complete knowledge of the aetiological factors and the character of the asymmetry plays a crucial role in formulating a treatment plan.

Thyroid Storm Presenting with Isolated Acute Bulbar Myopathy: A Case Report and Literature Review

AbstractWhile proximal skeletal muscle myopathy is a frequently reported complication of thyrotoxicosis, acute bulbar thyrotoxic myopathy is rare especially in absence of other forms of myopathy. In this report, we present a case of 31 years old male presenting with thyrotoxicosis and aspiration pneumonia following weeks of experiencing dysphagia and hoarseness of voice. Labs confirmed Graves' disease and other causes of bulbar myopathy like Myasthenia gravis was ruled out. He was started on thyroid treatment and showed remarkable improvement of dysphagia over 15 days. Based on this, we conclude that isolated bulbar myopathy in hyperthyroidism should be considered in patients presenting with dysphagia and dysphonia in absence of other possible neurological causes.

Comparison of patient-demographics, causes, and costs of 90-day readmissions following primary total shoulder arthroplasty for glenohumeral osteoarthritis

IntroductionReadmissions following orthopaedic surgery are associated with worse outcomes and increased healthcare costs. Studies investigating trends, causes, and costs of readmissions following primary total shoulder arthroplasty (TSA) for the indication of glenohumeral osteoarthritis (OA) are limited. The objective was to compare: 1) patient-demographics of those readmitted and not readmitted within 90-days following primary TSA for OA; 2) causes of readmissions and 3) associated costs. MethodsA retrospective query from 2005 to 2014 was performed using a nationwide administrative claims database. The study group consisted of patients readmitted within 90-days following primary TSA for glenohumeral OA, whereas patients not readmitted served as controls. Causes of readmission were stratified into the following groups: cardiovascular, hematological, endocrine, gastrointestinal (GI), musculoskeletal (MSK), neoplastic, neurological, pulmonary, infectious, renal, and miscellaneous causes. Patient demographics were compared, in addition to the frequency of the causes of readmissions, and their associated costs. Chi-square analyses compared demographics between groups. Analysis of variance was utilized to determine differences in 90-day costs for the causes of readmission. A p-value less than 0.001 was significant. ResultsThe overall 90-day readmission rate was 2.4% (3432/143,878). Patients readmitted following primary TSA were more likely to be over the age of 75, female, and higher prevalence of comorbid conditions, including psychiatric and medical conditions. Readmitted patients had a higher overall comorbidity burden per mean Elixhauser-Comorbidity Index (ECI) scores (10 vs. 7,p < .0001). The leading cause of readmissions were due to MSK (17.34%), cardiac (16.28%), infectious (16.26%), and gastrointestinal (11.64%) etiologies. There were differences in the mean 90-day costs of care for the various causes of readmissions, with the leading cost of readmissions being cardiac causes ($10,913.70) and MSK ($10,590.50) etiologies. ConclusionPatients with greater comorbidities experienced increased incidence of readmission following TSA for glenohumeral OA. Cardiac and MSK etiologies were the primary cause of readmissions. Level of evidenceIII.

Etiologies of In-hospital cardiac arrest: A systematic review and meta-analysis

BackgroundEtiologies of in-hospital cardiac arrest (IHCA) in general wards may differ from etiologies of out-of-hospital cardiac arrest (OHCA) given the different clinical characteristics of these patient populations. An appreciation for the causes of IHCA may allow the clinician to appropriately target root causes of arrest. MethodsMEDLINE/PubMed, EMBASE, and Google Scholar were queried from inception until May 31, 2021. Studies reporting etiologies of IHCA were included. A random effects meta-analysis of extracted data was performed using Review Manager 5.4. ResultsOf 12,451 citations retrieved from the initial literature search, 9 were included in the meta-analysis. The most frequent etiologies of cardiac arrest were hypoxia (26.46%, 95% confidence interval [CI] 14.19–38.74%), acute coronary syndrome (ACS) (18.23%, 95% CI 13.91–22.55%), arrhythmias (14.95%, 95% CI 0–34.93%), hypovolemia (14.81%, 95% CI 6.98–22.65%), infection (14.36%, 95% CI 9.46–19.25%), and heart failure (12.64%, 95% CI 6.47–18.80%). Cardiac tamponade, electrolyte disturbances, pulmonary embolism, neurological causes, toxins, and pneumothorax were less frequent causes of IHCA. Initial rhythm was unshockable (pulseless electrical activity or asystole) in 69.83% of cases and shockable (ventricular tachycardia or ventricular fibrillation) in 21.75%. ConclusionThe most prevalent causes of IHCA among the general wards population are hypoxia, ACS, hypovolemia, arrythmias, infection, heart failure, three of which (arrhythmia, infection, heart failure) are not part of the traditional “H’s and T’s” of cardiac arrest. Other causes noted in the “H’s and T’s” of advanced cardiac life support do not appear to be important causes of IHCA.

Evaluation and Treatment of Urinary Incontinence in Women.

This review focuses on the diagnosis, evaluation, and treatment of urinary incontinence (UI). UI is a common diagnosis that is encountered among women in their lifetime. Stress, urge (overactive bladder), and overflow are the most commonly encountered types of incontinence, but anatomic and neurologic causes are important to rule out. There are many treatment options available for the management of UI, and most patients will benefit from conservative strategies including weight loss, timed voiding, fluid intake reduction, pelvic floor strengthening exercises, and medications. For those who do not achieve adequate improvement with conservative measures, surgical intervention can provide good symptom relief.

AETIOLOGIES AND PATHOPHYSIOLOGICAL BASIS OF MONOCULAR VISUAL AURA

Monocular visual aura is an atypical form of visual disturbance that could be indicative of many different underlying causes, originating in either the vascular or nervous system. The word aura is used to refer to migraine aura, but the description of scintillations, scotoma and blindness can also suggest many other aetiologies. There has been a varied use of terminology to describe these visual symptoms, such as monocular blindness, monocular visual loss, phosphenes. This narrative literature review aims to summarise the aetiologies of these monocular visual symptoms and their pathophysiologies. Relevant articles were sourced using databases PubMed and ScienceDirect, and from the bibliography of the articles. 17 articles were selected in total. Monocular visual symptoms were found to be a possible result of benign retinal migraine, as well as vascular and neurological causes. More research is still needed to understand the pathophysiological mechanisms underlying each of the aetiologies.

Study of clinical and etiological profile of new onset seizure in adults reporting to tertiary care centre, Mysore

Background: Overall incidence of seizure is found to be 0.2-0.6 per 1000 population per year. A first seizure mandates individual counselling about the risk of recurrence, the pros and cons of drug treatment. Seizures are usually a manifestation of an underlying pathology which may be genetic, structural or metabolic. Objectives of current study were to study the clinical profile of new onset seizures in adults (greater than 19 years) attending to tertiary care Centre, Mysore and to determine the etiology of new onset seizures in adults reporting to tertiary care centre, Mysore.Methods: All participants fulfilling the inclusion criteria were interviewed as per proforma. Participant’s demographic, social and medical details were recorded in proforma sheet and patients were subjected to neuroimaging studies, EEG and other necessary blood investigations. In all cases the seizure type is classified according to ILAE Classification 2017.Results: Among 100 cases evaluated for new onset, Majority of the patients were 41 to 60 years. Generalised seizures (95%) were more common than focal seizures.Among neurological etiological causes, vascular causes (34%) were most common. Most common Non-neurological cause for seizures was alcohol withdrawal (46.67%).Conclusions: If proper analysis of etiology is made, seizures can be treated accordingly thus reducing the morbidity and mortality associated with it. Primary care physicians play a pivotal role in identifying patients with adult onset seizures and should encourage these patients to undergo neuroimaging so as to arrive at an appropriate etiological diagnosis.

Epidemiology of multiple sclerosis in West bank of Palestine

BackgroundMultiple sclerosis (MS) is the most common demyelinating disease of the central nervous system, and the major neurologic cause of disability in young adults. Its incidence and prevalence vary significantly between different ethnic groups and geographical regions. It is thought that MS is more frequent as we go further from the equator. In Palestine, there is yet no published data concerning its incidence and prevalence. So, in this article, we aim to study the epidemiological and clinical characteristics of MS in the West Bank of Palestine. MethodsA retrospective observational study was conducted from year 2010 to 2019 among MS patients in West Bank. Demographic and clinical records of concerned patients were collected from the database of the Palestinian Ministry of Health. Age, sex, onset of symptoms, first symptom, year of diagnosis, family history, and smoking were noted. The crude 2019 prevalence and incidence rate were calculated. ResultsWe identified 1652 MS patients with 1074 (65.01%) females and 578 (34.99%) males. In 2010, the crude incidence rate was 1.96 cases per 100,000. Peaked in 2017 to 6.08, and then dropped unexpectedly in 2018 to 2.91 before it re-rose again to 3.54 in 2019. The incidence rates among females were higher than in males from 2010 to 2019. 802 and 730 patients were diagnosed at age groups (below 30) year and (30–45) year respectively, which comprises 92.74% of all patients. Males were slightly more affected at a later age group (30–45), whereas females were more affected at age group below 30. The most common symptom at disease onset was motor presentation (16.04%) followed by blurring of vision (15.74%). ConclusionThis is the first epidemiological study regarding MS disease in the West Bank of Palestine. Our results showed that crude incidence rate is increasing from 2010 to 2017. This is in part due to increasing awareness of the disease as well as the availability of diagnostic tools. Further researches will be necessary to closely monitor this increasing trend of the disease amongst Palestinian population in the coming future. Clinical features of the disease were similar to those described in the literature.

Clinical utility of a pediatric hand exoskeleton: identifying users, practicability, and acceptance, and recommendations for design improvement

BackgroundChildren and adolescents with upper limb impairments can experience limited bimanual performance reducing daily-life independence. We have developed a fully wearable pediatric hand exoskeleton (PEXO) to train or compensate for impaired hand function. In this study, we investigated its appropriateness, practicability, and acceptability.MethodsChildren and adolescents aged 6–18 years with functional limitations in at least one hand due to a neurological cause were selected for this cross-sectional evaluation. We characterized participants by various clinical tests and quantified bimanual performance with the Assisting Hand Assessment (AHA). We identified children whose AHA scaled score increased by ≥ 7 points when using the hand exoskeleton and determined clinical predictors to investigate appropriateness. The time needed to don each component and the number of technical issues were recorded to evaluate practicability. For acceptability, the experiences of the patients and the therapist with PEXO were evaluated. We further noted any adverse events.ResultsEleven children (median age 11.4 years) agreed to participate, but data was available for nine participants. The median AHA scaled score was higher with PEXO (68; IQR: 59.5–83) than without (55; IQR: 37.5–80.5; p = 0.035). The Box and Block test, the Selective Control of the Upper Extremity Scale, and finger extensor muscle strength could differentiate well between those participants who improved in AHA scaled scores by ≥ 7 points and those who did not (sensitivity and specificity varied between 0.75 and 1.00). The median times needed to don the back module, the glove, and the hand module were 62, 150, and 160 s, respectively, but all participants needed assistance. The most critical failures were the robustness of the transmission system, the electronics, and the attachment system. Acceptance was generally high, particularly in participants who improved bimanual performance with PEXO. Five participants experienced some pressure points. No adverse events occurred.ConclusionsPEXO is a safe exoskeleton that can improve bimanual hand performance in young patients with minimal hand function. PEXO receives high acceptance. We formulated recommendations to improve technical issues and the donning before such exoskeletons can be used under daily-life conditions for therapy or as an assistive device.Trial registration Not appropriate

Prosthetics and Physiotherapy Center Data Analysis, Sana’a, 2015-2017

Introduction: The International Society for Prosthetics and Orthotics and the World Health Organization (WHO) have estimated that people needing prostheses or orthotics and related services represent 0.5% of the population in developing countries; and 30 million people in Africa, Asia, and Latin America require an estimated 180 000 rehabilitation professionals. In Yemen, the need for prosthesis and physiotherapy is increasing especially current protracted conflict and war. An estimated 28500 people have been left disabled most as a result of a blast, mine, or gunshot after the war erupted. Furthermore, the burden of road traffic injuries in term of disability is high. The Prosthetics and physiotherapy center (PPC) is the only public center providing rehabilitation services in Sana’a. We analyzed PPC data to describe the pattern of attendees and most common causes for disability. Methods: The Soft copy data in excel format for Prosthetics and physiotherapy Center (PPC) for the period from January 1st, 2015 to December 31st, 2017 was used. For each attendant the following variables: demographic data including age, gender, location and cause, site of disability, and services provided were collected by the system. After the data was cleaned, categorized and translated to English, it was imported to epi info program 7.2 to be analyzed. Results: The number of attendees was higher in 2016 and 2017 compared to 2015: 37.3%%, 34.1 vs. 28.6. the median age was 28 years (range: 1-110), and males were more affected (61%). 84% of attendees were from Sana’a governorate. The first three causes for attendance were neurological (32.4%), musculoskeletal (25.4%) and injuries (13.8%). Regarding the neurological causes, the most common diagnoses were: disc prolapse (37.9%), ischemic stroke (21.3%) and Cerebral palsy (15.2%). The highest three causes of musculoskeletal causes were flat foot (29.4%), joint stiffness (23.6%) and, muscle spasm (14.9%). For injuries, War injuries (32.4%), undetermined injuries (18.3%) and car accidents (17.1%) were the most common causes. The most affected body pat was lower limbs (43.5%) and 81% of attendees were given Physiotherapy. Conclusion: The PPC witness increase in number of attendees after the conflict arisen with a male predominance where war injuries constitute around a third of injuries that was the third cause for disability. The two other most common causes were neurological and musculoskeletal causes of disability. PPC Data entry system must be re-visited and re-categorized for diagnosis and body part affected. Quality of data should be improved e.g., through taking proper history and examination. Training of data clerks is a perquisite. PPC Governorate branches should be connected through a network with PPC at the central level to give clearer nationwide picture about the problems of disability and rehabilitation needs.

Incidence, prevalence, and outcome of moderate to severe neurotrophic keratopathy in a German tertiary referral center from 2013 to 2017

BackgroundNeurotrophic keratopathy (NK) is an orphan disease, with an estimated prevalence of 1–5/10,000. No data regarding the incidence exists. The primary aim was to evaluate incidence and prevalence of NK at a tertiary referral center in Germany, and the secondary aim was to analyze demographic parameters, etiology, and clinical features and therapeutic outcomes.Methods and materialAll patients treated for NK with serum eye drops (SED), amnionic membrane transplantation (AMT), or penetrating keratoplasty (PK) in 2013–2017 were identified. Age, sex, etiology of NK, visual acuity, disease stage, treatment, and visual acuity were analyzed. Incidence and prevalence of NK in our hospital and the overall population of the city were calculated.ResultsIn 63 eyes of 60 patients (56.7% male; 68 ± 16 years), the most common underlying diseases were herpetic infections (23.8%), neurological causes (19%), and diabetes mellitus (14.3%). The annual incidence of NK in our tertiary referral center ranges between 5/10,000 and 3/10,000, the prevalence between 9/10,00 and 22/10,000. In all patients treated with corneal ulcers, the prevalence was up to 27% (2706/10,000). The incidence in the overall population is estimated at 0.1–0.3/10,000, the prevalence at 0.2–0.5/10,000 to 0.5/10,000.ConclusionBased on our assessment, the prevalence of NK in the overall population is lower than estimated before. However, in patients with corneal ulcers, the percentage of NK is comparably high. The disease may still be underdiagnosed due to the variety of underlying disorders and unknown comorbidities. Thus, in cases of therapy-refractive superficial keratopathy or ulcerations, NK should be considered more frequently.

Does essential tremor increase the risk of dementia? No.

Essential tremor (ET) is the most common neurological cause of tremor affecting adult humans affecting about 6% of those over age 65 years. In the United States, dementia has a prevalence of 15% in those age 68 and older. Overlap of the two conditions is therefore not surprising. Several studies report mild subclinical cognitive dysfunction in non-demented people with ET, likely related to overactivity of fronto-cerebellar circuitry involved in tremor pathophysiology. Frontal/executive dysfunction is often though not exclusively noted, and some studies have even shown areas of cognitive strengths. Mild cognitive impairment (MCI) is impairment which a person is aware of but does not interfere significantly with daily activities. While MCI has been considered to presage dementia this is not necessarily the case, as some persons with MCI revert to normal cognition in follow-up. Dementia is a clinical syndrome with cognitive impairment interfering with daily activities. Population-based and clinic-based studies have shown mixed results regarding rates of MCI in ET. A handful of studies have looked at development of dementia in ET with differing results. Brain pathology studies in ET and dementia or investigating Alzheimer-type pathology have thus far been unrevealing. There is evidence by some investigators supporting a greater risk of dementia for those having older onset tremor, while those having ET at a younger age faring at least as well as controls regarding risk of cognitive impairment and dementia. At present the evidence is inconclusive that ET as a group are at a greater risk of developing dementia.

Abstract- Poster

Catatonia is a constellation of neuropsychiatric symptoms including cognitive, behavioral, motor, and affective due to medical, neurological, psychiatric illnesses, or withdrawal of medications. Catatonia is understudied in an older population, despite its higher prevalence and there are high chances of medical or neurological causes of catatonia and further complications. The available literature on catatonia in older adults reports neurological, medical illnesses, and psychiatric illnesses as common causes. The affective disorder is the most common cause amongst psychiatric illnesses and abundant literature is available on catatonia in affective disorders and psychotic disorders but there is a paucity of literature on catatonia in other common conditions like anxiety disorders and delirium, especially in older adults. Here we are reporting interesting case series of catatonia with extreme variations in presentations and course of illness. One with Generalized anxiety disorder and the other with delirium superimposed on dementia. Out of which patient with an anxiety disorder had apositive lorazepam challenge test while a patient with delirium superimposed on dementia was negative. Patients with Generalized anxiety disorder improved on Tablet Escitalopram 20mg and Tablet lorazepam 2mg per day, but patients with delirium superimposed on dementia did not improve significantly.

Intractable hiccups, nausea, and vomiting, an unnerving cause of vision loss

Acute optic neuritis (ON) is caused by variety of complex disorders that can be differentiated with the help of history, radiology, and serology. Identification of nonneurological symptoms that occur before the demyelinating event aids in timely diagnosis and prevention of further neurological attacks. We describe a case of unilateral ON with a history of intractable hiccups, nausea, and vomiting, wherein the possibility of area postrema syndrome (APS) was overlooked until the development of visual symptoms. APS recently identified as a hallmark of neuromyelitis optica spectrum disorder is a rare neurologic cause of gastrointestinal symptoms. This atypical presentation of APS results from autoantibodies directed against the aquaporin-4 rich sites, such as area postrema. This case brings to light the importance of eliciting history of intractable hiccups, nausea, and vomiting in a patient with ON. Despite being a commonly encountered symptom, it may rarely raise a suspicion for neuromyelitis optica.