An unusual delusion of duplication in a patient affected by Dementia with Lewy bodies

Background: Dementia with Lewy bodies (DLB) is the second most frequent diagnosis of progressive degenerative dementia in older people. Delusions are common features in DLB and, among them, Capgras syndrome represents the most frequent disturbance, characterized by the recurrent and transient belief that a familiar person, often a close family member or caregiver, has been replaced by an identical-looking imposter. However, other delusional conditions near to misidentification syndromes can occur in DLB patients and may represent a major psychiatric disorder, although rarely studied systematically. Case presentation: We reported on a female patient affected by DLB who presented with an unusual delusion of duplication. Referring to the female professional caregiver engaged by her relatives for her care, the patient constantly described the presence of two different female persons, with a disorder framed in the context of a delusion of duplication. A brain 99Tc-hexamethylpropyleneamineoxime SPECT was performed showing moderate hypoperfusion in both occipital lobes, and associated with marked decreased perfusion in parieto-fronto-temporal lobes bilaterally. Conclusions: An occipital hypoperfusion was identified, although in association with a marked global decrease of perfusion in the remaining lobes. The role of posterior lobes is certainly important in all misidentification syndromes where a natural dissociation between recognition and identification is present. Moreover, the concomitant presence of severe attentional and executive deficits evocative for a frontal syndrome and the marked global decrease of perfusion in the remaining lobes at the SPECT scan also suggest a possible dysfunction in an abnormal connectivity between anterior and posterior areas

Case Report Focal 123 I-FP-CIT SPECT Abnormality in Midbrain Vascular Parkinsonism

Cerebrovascular diseases are considered among possible causes of acute/subacute parkinsonism, representing up to 22% of secondary movement disorders. In cases of suspected vascular parkinsonism (VP), dopamine transporter SPECT has been highly recommended to exclude nigrostriatal dopaminergic degeneration. We report the case of a hemiparkinsonism related to a left midbrain infarct with focal lateralized putaminal abnormalities at 123 I-FP-CIT SPECT imaging. The asymmetric uptake at dopamine transporter SPECT was different to findings commonly observed in typical PD pattern, because the ipsilateral striatum, in opposite to idiopathic PD, showed normal tracer binding. However, this selective parkinsonism after infarction of the midbrain was responsive to levodopa. In conclusion, we retain that there is a need of more functional imaging studies in VP addressed to a more consistent classification of its different clinical forms and to a better understanding of the adequate pharmacological management

Low in‑hospital mortality rate in patients with COVID‑19 receiving thromboprophylaxis: data from the multicentre observational START‑COVID Register

Abstract COVID-19 infection causes respiratory pathology with severe interstitial pneumonia and extra-pulmonary complications; in particular, it may predispose to thromboembolic disease. The current guidelines recommend the use of thromboprophylaxis in patients with COVID-19, however, the optimal heparin dosage treatment is not well-established. We conducted a multicentre, Italian, retrospective, observational study on COVID-19 patients admitted to ordinary wards, to describe clinical characteristic of patients at admission, bleeding and thrombotic events occurring during hospital stay. The strategies used for thromboprophylaxis and its role on patient outcome were, also, described. 1091 patients hospitalized were included in the START-COVID-19 Register. During hospital stay, 769 (70.7%) patients were treated with antithrombotic drugs: low molecular weight heparin (the great majority enoxaparin), fondaparinux, or unfractioned heparin. These patients were more frequently affected by comorbidities, such as hypertension, atrial fibrillation, previous thromboembolism, neurological disease,and cancer with respect to patients who did not receive thromboprophylaxis. During hospital stay, 1.2% patients had a major bleeding event. All patients were treated with antithrombotic drugs; 5.4%, had venous thromboembolism [30.5% deep vein thrombosis (DVT), 66.1% pulmonary embolism (PE), and 3.4% patients had DVT + PE]. In our cohort the mortality rate was 18.3%. Heparin use was independently associated with survival in patients aged ≥ 59 years at multivariable analysis. We confirmed the high mortality rate of COVID-19 in hospitalized patients in ordinary wards. Treatment with antithrombotic drugs is significantly associated with a reduction of mortality rates especially in patients older than 59 years

Parieto-premotor functional connectivity changes during parietal lobe seizures are associated with motor semiology

International audienceObjectives: Parietal lobe seizures (PLS) are characterized by multiple clinical manifestations including motor signs. The mechanisms underlying the occurrence of motor signs are poorly understood. The main objective of this work was to estimate the functional coupling of brain regions associated with this clinical presentation.Methods: We retrospectively selected patients affected by drug-resistant epilepsy who underwent Stereoelectroencephalography (SEEG) for pre-surgical evaluation and in whom the seizure onset zone (SOZ) was located in the parietal cortex. The SOZ was defined visually and quantitatively by the epileptogenicity index (EI) method. Two groups of seizures were defined according to the presence (“motor seizures”) or the absence (“non-motor seizures”) of motor signs. Functional connectivity (FC) estimation was based on pairwise nonlinear regression analysis (h2 coefficient). To study FC changes between parietal, frontal and temporal regions, for each patient, z-score values of 16 cortico-cortical interactions were obtained comparing h2 coefficients of pre-ictal, seizure onset and seizure propagation periods.Results: We included 22 patients, 13 with “motor seizures” and 9 with “non-motor seizures”. Resective surgery was performed in 14 patients, 8 patients had a positive surgical outcome (Engel’s class I and II). During seizure onset period, a decrease of FC was observed and was significantly more important (in comparison with background period) in “motor” seizures. This was particularly observed between parietal operculum/post-central gyrus (OP/PoCg) and mesial temporal areas. During seizure propagation, a FC increase was significantly more important (in comparison with seizure onset) in “motor seizures”, in particular between lateral pre-motor (pmL) area and precuneus, pmL and superior parietal lobule (SPL) and between inferior parietal lobule (IPL) and supplementary motor area (SMA).Conclusions: Our study shows that motor semiology in PLS is accompanied by an increase of FC between parietal and premotor cortices, significantly different than what is observed in PLS without motor semiology.Significance: Our results indicate that preferential routes of coupling between parietal and premotor cortices are responsible for the prominent motor presentation during PLS

Long-term eddy covariance fluxes and xylem anatomy for understanding carbon fixation in white pine woody biomass

Improving our understanding of the carbon cycle is key to addressing the challenges of climate change. In this study, we investigated the relationships between intra and inter-annual climate variations, carbon fluxes, and the xylem biomass in an 80-year plantation of Pinus strobus at Turkey Point, Ontario, Canada. From eddy covariance tower, we obtained daily Gross Primary Production (GPP), precipitation and air temperature for the period 2003-2018. To determine inter-and intra-annual xylem biomass we selected 12 trees and built wood anatomical trait chronologies (cell lumen area, cell wall thickness, cell number, cell wall area and ring wall area) over the past 50 years. Using moving windows, we correlated all chronologies with daily climate data and GPP to analyse their associations at intra-annual scale. The analysis showed that cell lumen area and cell wall thickness were strongly influenced by spring and summer temperature and precipitation. For the first time, we observed strong positive and significant correlations between GPP in the growing season and the cell wall area (which estimates the amount of carbon in each xylem cell) both in earlywood (May 10 - Aug 4, r = 0.685) and latewood (Jul 3 – Sep 3, r = 0.885). Strong positive correlations were also found between GPP and cell number and ring wall area. These results suggest a direct linkage between CO2 fluxes and the accumulation of carbon in woody biomass. This work will help to reconcile two important techniques that are widely used to study carbon sequestration in forests. It will help to reduce uncertainty in woody carbon accumulation and will open new perspectives in the study of the forest carbon cycle

Revealing intra-annual carbon sequestration patterns through xylem anatomy and eddy covariance fluxes in eastern white pine

Forests are major terrestrial carbon sinks, playing a crucial role in climate change mitigation. Nonetheless, the long-term seasonal carbon sequestration dynamics are scarcely understood. Here, we investigated the relationships between climate variability, carbon fluxes, and the xylem biomass in an 80-year-old plantation of Pinus strobus in Ontario, Canada. From Eddy Covariance tower, we obtained daily Gross Primary Production (GPP), precipitation, VPD and air temperature for the period 2003-2018. To estimate inter-and intra-annual xylem biomass accumulation we selected 12 trees and built wood anatomical chronologies of cell number (CN), cell wall area (CWA) and overall wall area per ring (RWA). We used moving windows correlations of daily climate data and GPP with anatomical chronologies to analyse their associations at intra-annual scale. Temperature in early spring and precipitation in mid-spring and summer strongly positively affected GPP, while summer VPD had a negative effect. For the first time, we observed strong positive correlations between GPP in the growing season and CWA (proxy for carbon quantity in each xylem cell) both in earlywood (May 10 – Aug 1, r = 0.652) and latewood (Jul 3 – Sep 3, r = 0.885). Strong positive correlations were also found between GPP and CN and RWA (r ≥ 0.724). Our results suggest a direct influence of CO2 fluxes on the accumulation of carbon in woody biomass. This work will help to reduce uncertainties in woody carbon accumulation dynamics, opening new perspectives in the study of forest carbon cycle

A study of C and O isotopes in the Martian atmosphere with PFS data.

International audienc

Anatomical electroclinical correlations during an SEEG-recorded seizure with autoscopic hallucination

International audienc

A study of C and O isotopes in the Martian atmosphere with PFS data.

International audienc

Anatomical electroclinical correlations during an SEEG-recorded seizure with autoscopic hallucination

International audienc