Motor and Non-motor Features: Differences between Patients with Isolated Essential Tremor and Patients with Both Essential Tremor and Parkinson’s Disease

Background: Patients with essential tremor (ET) who develop Parkinson’s disease (ET->PD) may differ with respect to motor features (MFs) and non-motor features (NMFs) from patients with isolated ET. Few studies have assessed this issue. Methods: In this retrospective chart review, we analyzed data on MFs and NMFs of 175 patients, including 54 ET->PD and 121 ET, actively followed in the Athens University 1st Neurology Department. Results: Significantly more ET->PD than ET patients reported asymmetric tremor at ET onset (68.5% vs. 14.9%, pPD patients had head tremor (43.5% vs. 13.2%, pPD patients reported hearing impairment (65.3% vs. 28.3%, pPD than ET patients reported rapid eye movement behavior disorder (51.9% vs. 10.0%, p<0.001), constipation (67.9% vs. 36.4%, p<0.001), and olfactory dysfunction (83.3% vs. 36.4%, p<0.001). Discussion: The subset of ET->PD patients may have distinct MFs and NMFs that should be assessed further for the possible predictive value for the emergence of PD

OLFACTION IN NEUROLOGY: OLFACTORY DEFICITS IN PARKINSON'S DISEASE

REVIEW OF ANATOMY, PHYSIOLOGY, NORMAL FUNCTION, METHODS OF EXPLORATION OF THE OLFACTORY SYSTEM. EXISTING DATA ABOUT OLFACTION IN CENTRAL NERVOUS SYSTEM DISEASES. PROPOSITION ABOUT A SIMPLE, CLINICAL, METHOD OF EXPLORATION AND APPLICATION IN A POPULATION OF 80 PATIENTS WITH PARKINSON'S DISEASE. AN OLFACTORY DEFICIT CONCERNING ODOUR IDENTIFICATION IS REVEALED. THE NATURE OF THE DYSFUNCTION IS DISCUSSED ON THE BASIS OF CLINICAL DATA ABOUT OLFACTION AND ELEMENTS ABOUTPHYSIOLOGY OF OLFACTORY LIMBIC SYSTEM AND PARALLEL FUNCTIONING OF BASAL GANGLIA-THALAMUS- CORTEX CIRCUITS. HYPOTHESIS INCLUDE THE POSSIBILITY OF AN OLFACTORY AGNOSIA AND A HIGHER PROCESSING DISORDER.ΕΠΙΣΚΟΠΗΣΗ ΤΗΣ ΑΝΑΤΟΜΙΑΣ, ΦΥΣΙΟΛΟΓΙΑΣ, ΦΥΣΙΟΛΟΓΙΚΗΣ ΛΕΙΤΟΥΡΓΙΑΣ ΚΑΙ ΜΕΘΟΔΩΝ ΔΙΕΡΕΥΝΗΣΗΣ ΤΟΥ ΟΣΦΡΗΤΙΚΟΥ ΣΥΣΤΗΜΑΤΟΣ. ΚΛΙΝΙΚΑ ΔΕΔΟΜΕΝΑ ΣΤΙΣ ΝΟΣΟΥΣ ΤΟΥ ΚΕΝΤΡΙΚΟΥ ΝΕΥΡΙΚΟΥ ΣΥΣΤΗΜΑΤΟΣ. ΠΡΟΤΑΣΗ ΑΠΛΗΣ, ΚΛΙΝΙΚΗΣ, ΜΕΘΟΔΟΥ ΕΞΕΤΑΣΗΣ ΤΗΣ ΟΣΦΡΗΣΗΣ ΚΑΙ ΕΦΑΡΜΟΓΗ ΣΕ ΠΛΗΘΥΣΜΟ ΑΣΘΕΝΩΝ ΜΕ ΝΟΣΟ ΤΟΥ PARKINSON. ΑΠΟΚΑΛΥΠΤΕΤΑΙ ΔΙΑΤΑΡΑΧΗ ΤΗΣ ΤΑΥΤΟΠΟΙΗΣΗΣ ΤΩΝ ΟΣΜΩΝ ΠΟΥ ΕΞΑΡΤΑΤΑΙ ΑΠΟ ΤΗΝ ΗΛΙΚΙΑ ΚΑΙ ΤΗ ΒΑΡΥΤΗΤΑ ΤΗΣ ΝΟΣΟΥ. Η ΣΥΖΗΤΗΣΗ ΑΝΤΙΜΕΤΩΠΙΖΕΙ ΤΙΣ ΥΠΟΘΕΣΕΙΣ ΤΗΣ ΟΣΦΡΗΤΙΚΗΣ ΑΓΝΩΣΙΑΣ Η ΤΗΣ ΠΕΡΙΦΕΡΙΚΗΣ ΔΙΑΤΑΡΑΧΗΣ, ΜΕ ΒΑΣΗ ΣΤΟΙΧΕΙΑ ΑΠΟ ΤΗΝ ΚΛΙΝΙΚΗ ΕΜΠΕΙΡΙΑ, ΤΗ ΦΥΣΙΟΛΟΓΙΑ ΤΟΥ ΜΕΤΑΙΧΜΙΑΚΟΥ ΣΥΣΤΗΜΑΤΟΣ ΚΑΙ ΤΩΝ ΚΥΚΛΩΜΑΤΩΝ ΒΑΣΙΚΩΝ ΓΑΓΓΛΙΩΝ-ΘΑΛΑΜΟΥ-ΦΛΟΙΟΥ

Motor and Non-motor Features: Differences between Patients with Isolated Essential Tremor and Patients with Both Essential Tremor and Parkinson’s Disease.

BACKGROUND: Patients with essential tremor (ET) who develop Parkinson&apos;s disease (PD) (i.e., ET→PD) may differ with respect to motor features (MFs) and non-motor features (NMFs) from patients with isolated ET. Few studies have assessed this issue. METHODS: In this retrospective chart review, we analyzed data on MFs and NMFs of 175 patients, including 54 ET→PD and 121 ET, actively followed in the Athens University 1st Neurology Department. RESULTS: Significantly more ET→PD than ET patients reported asymmetric tremor at ET onset (68.5\% vs. 14.9\%, p{\textless}0.001). Significantly more ET than ET→PD patients had head tremor (43.5\% vs. 13.2\%, p{\textless}0.001) and cerebellar signs (41.3\% vs. 9.3\%, p{\textless}0.001). More ET than ET→PD patients reported hearing impairment (65.3\% vs. 28.3\%, p{\textless}0.001) and restless legs syndrome (34.8\% vs. 3.7\%, p{\textless}0.001). Conversely, a larger proportion of ET→PD than ET patients reported rapid eye movement behavior disorder (51.9\% vs. 10.0\%, p{\textless}0.001), constipation (67.9\% vs. 36.4\%, p{\textless}0.001), and olfactory dysfunction (83.3\% vs. 36.4\%, p{\textless}0.001). DISCUSSION: The subset of ET→PD patients may have distinct MFs and NMFs that should be assessed further for the possible predictive value for the emergence of PD

Moyamoya Disease May Mimic Multiple Sclerosis?

Introduction. A wide range of medical conditions may mimic multiple sclerosis. Among them, cerebrovascular diseases, including moyamoya disease, need to be excluded since they share common clinical features and radiographic findings with multiple sclerosis. Case Report. A 44-year-old woman experienced transient numbness of her right sided face and arm and was referred to our unit due to small brain lesions in magnetic resonance imaging, with a possible diagnosis of multiple sclerosis. Neurological examination was unremarkable except for plantar reflexes and jerky deep tendon reflexes. Brain magnetic resonance angiography revealed findings typically seen in moyamoya disease, confirmed with digital subtraction angiography. Antiplatelet therapy started, but few days later, she developed suddenly global aphasia and right hemiparesis (National Institutes of Health Stroke Scale/NIHSS 6). Brain magnetic resonance imaging revealed acute infarct in the distribution of the left middle cerebral artery. At her discharge, she was significantly improved (NIHSS 3). Conclusion. Diagnosis of multiple sclerosis is often challenging. In particular, in young patients with transient neurological symptoms and atypical white matter lesions in magnetic resonance imaging, cerebrovascular disorders such as moyamoya disease should be considered in the differential diagnosis. Detailed clinical and neuroimaging evaluation are mandatory for the correct diagnosis

Dementia as presenting symptom of primary hyperparathyroidism: Favourable outcome after surgery

The case of a 76-year-old female patient is presented with a two-year history of progressive dementia, apathy and gait impairment. Initially, Alzheimer’s disease was diagnosed and she was given donepezil for one year with no significant improvement. An extensive blood and biochemical control revealed high serum calcium and parathormone levels, and normal thyroid hormones and anti-thyroid antibodies. Ultrasound of thyroid and parathyroid glands revealed an adenoma of the right parathyroid. The detailed investigation for causes of secondary hyperparathyroidism was negative. Due to the absence of clinical hyperparathyroidism she was initially treated conservatively. At referral, the neurological picture consisted of. mild signs of parkinsonism, moderate dementia (MMSE = 15) and severe behavioural disturbances. Because of the continuous aggravation of the cognitive deficit, parathyroidectomy was decided although there were no clinical or laboratory signs of involvement from other organs. Three weeks after the operation the neurological picture showed dramatical improvement. Parkinsonism and behavioural disorders were remarkably reduced and the MMSE score raised to 25. In summary we report an exceptional case of primary hyperparathyroidism (PHPT) presenting as dementia and treated successfully by parathyroidectomy. (C) 2008 Elsevier B.V. All rights reserved