Headache and spontaneous glabellar ecchymosis: More than a self-injury behavior?

A33-YEAR-OLD MAN PRESENTED to our outpatient clinic for evaluation of severe headaches located at the left eye and forehead and multiple episodes of discoloration of the superior glabella. The pain was described as throbbing lasting for 30–45 min about 2–3 times per month with minimal nausea, photophobia, left eye tearing, redness, and ptosis. The erythema-like lesion developed after a severe headache episode and gradually resolved over the next few days. The patient disclosed habitually rubbing the forehead or face during pain episodes, making an ‘artificial’ post-traumatic skin ecchymosis unlikely

Age related differences in the recognition of facial expression: Evidence from EEG event-related brain oscillations

Facial Expression (FE) recognition is a major marker of emotional ability. Behavioral studies show that FE recognition ability decreases with aging. Studying how event-related brain oscillations change with normal aging is important to better understand the underlying mechanisms of emotional processes. The aim of this study is to investigate changes in FE recognition due to normal aging using the EEG-Brain Oscillations approach.Fifteen young and fifteen elderly healthy subjects were included in the study. 15 photographs were used with 5 different FEs (angry, happy, neutral, sad, fearful). After each EEG recording session, subjects were asked to identify the FEs that were presented. Event-related delta, theta and, alpha phase-locking and frequency-band responses were analyzed.In the FE recognition part of the study, young subjects obtained better scores than the elderly subjects. There was a significant result regarding the locationXgroup comparison in the delta response; the young group had a higher delta response than the elderly group over the occipital area. There were significant locationXgroup differences in the theta and alpha phase locking values; the elderly group had higher theta and alpha phase locking values than the young group in the frontal area. Group differences were significant in the theta response and theta phase locking; the elderly individuals' theta response and phase locking values were higher compared to those of the young individuals.In elderly individuals, FE recognition impairment has been observed. It has been shown that the impairment may be characterized by decreased occipital delta responses and phase locking. This can be interpreted to mean that elderly individuals may have developed different brain dynamics as a compensating mechanism since they are not as efficient as young individuals in performing these functions

Clinical deterioration of Alzheimer's disease patients during the Covid-19 pandemic and caregiver burden

To investigate a possible deterioration of the symptoms of Alzheimer's disease (AD) patients during a quarantine period of 60 days, and the impact on caregiver burden. This study consisted of 54 individuals (36 female, 18 male) aged 60 years and over who had been diagnosed with AD. During the quarantine period, caregivers of the patients (child, spouse, relatives) who were confined to their homes were contacted by phone and administered a survey composed of questions for neuropsychiatric symptoms and caregiver burden. Patients' mean age was 77.18±6.96 years. The most worsening symptom was forgetfulness (35.2%) and agitation (24.1%). Incoherent speech, introversion, sleep disturbance, hallucinations, carry on with hobbies, reduced personal care, changes in appetite, and incontinence were less deteriorated. Of the caregivers, 61.1% thought that something terrible would happen to the patient, and 38.9% felt they could not find time for themselves. Drug rejection increased the burden twofold. Telemedicine methods, providing opportunities for the caregiver and the patient to walk outside, and giving medication that dissolves in the mouth or epidermal patches may be useful to prevent disease progression during the lockdown

Time irreversibility of resting-state activity in the healthy brain and pathology

Characterizing brain activity at rest is of paramount importance to our understanding both of general principles of brain functioning and of the way brain dynamics is affected in the presence of neurological or psychiatric pathologies. We measured the time-reversal symmetry of spontaneous electroencephalographic brain activity recorded from three groups of patients and their respective control group under two experimental conditions (eyes open and closed). We evaluated differences in time irreversibility in terms of possible underlying physical generating mechanisms. The results showed that resting brain activity is generically time-irreversible at sufficiently long time scales, and that brain pathology is generally associated with a reduction in time-asymmetry, albeit with pathology-specific patterns. The significance of these results and their possible dynamical etiology are discussed. Some implications of the differential modulation of time asymmetry by pathology and experimental condition are examined

Toward a personalized medicine in wake-up stroke?

Ischemic stroke (IS), especially wake-up stroke, is reported to occur with a maximal peak in the morning hoursand usually associated with worse clinical outcome [1-3].Many proposed mechanisms are reported to be responsiblefor the impaired clinical outcomes in IS patients, includinghemostatic and hemodynamic factors. Despite this fact, recent reports have pointed out that circadian pattern independently affects the outcome of IS that persists even whencontrolling for vascular risk factors and different treatmentmodalities (such as anti-platelet or anticoagulant treatment

Therapeutic role of rifampicin in Alzheimer's disease

WOS: 000426795500003PubMed ID: 29315976Rifampicin exerts significant brain protective functions in multiple experimental models. Here we summarize the underlying mechanisms of the neuroprotective and pro-cognitive effects of rifampicin that are mediated by its anti-inflammatory, anti-tau, anti-amyloid, and cholinergic effects. Beyond suggesting that rifampicin shows strong brain protective effects in preclinical models of Alzheimer's disease, we also provide substantial clinical evidence for the neuroprotective and procognitive effects of rifampicin. Future neuroimaging studies combined with clinical assessment scores are the following steps to be taken in this field of research

Difüzyon manyetik rezonans görüntüleme bulguları ışığında creutzfeldt-jakob hastalığı

WOS: 000362665700008Fifty-seven year old male patient came to us with forgetfulness, sleepiness, hand tremor, sluggish movements and withdrawn mood. The patient’s place, time and people orientation was disrupted in his neurological examination. There was postural tremor in the bilateral upper extremities. There was no pathological reflex. Routine biochemistry, hemogram, sedimentation, vitamin B12, thyroid function tests, cranial magnetic resonance imaging (MRI) and electroencephalography (EEG) were assessed as normal. He scored 13/30 points in Mini-mental state evaluation. While the second cranial MRI at the 45th day was normal, the diffusion restrictions in the frontal pole, anterior interhemispheric fissure and bilateral insular cortex seen in the diffusion-weighted imaging (DWI) attracted attention (Figures 1, 2). There was a widespread sluggishness in the EEG.Elli yedi yaşında erkek hasta, dört aydır unutkanlık, aşırı uyku hali, ellerde titreme, hareketlerde yavaşlama, içine kapanma şikayetleri ile başvurdu. Nörolojik muayenesinde hastanın yer, zaman ve kişi oryantasyonu bozuktu. Bilateral üst ekstremitelerde postüral tremoru vardı. Patolojik refleksi yoktu. Rutin biyokimya, hemogram, sedimantasyon, vitamin B12, tiroid fonksiyon testleri, ilk yapılan kranyal manyetik rezonans görüntüleme (MRG) ve elektroensefalografi (EEG) normal olarak değerlendirildi. Mini-mental durum değerlendirme testinden 13/30 puan aldı. Kırk beş gün sonra yapılan ikinci kranyal MRG’de rutin sekanslar inceleme normalken, difüzyon ağırlıklı görüntülerde (DAG) frontal pol, anterior interhemisferik fissür, bilateral insulada sadece kortekste izlenen difüzyon kısıtlaması dikkati çekti (Şekil 1, 2). EEG’de hafif yaygın yavaşlama vardı. Subakut başlangıçlı demans etiyolojisine yönelik periferik kanda ve beyin-omurilik sıvısında bakılan enfeksiyon, otoimmün ve paraneoplastik belirteçler negatifti. Beyin-omurilik sıvısında; hücre yoktu, biyokimya testleri normaldi, 14-3-3 proteini pozitif, tau proteini ve nöron spesifik enolaz değerleri normaldi

Impairment in recognition of emotional facial expressions in Alzheimer's disease is represented by EEG theta and alpha responses

Behavioral studies have shown that the recognition of facial expressions may be impaired in patients with Alzheimer's disease (AD). The identification and recognition of a facial expression might be represented by event-related brain oscillations. The present study aims to analyze EEG event-related oscillations and determine the electrophysiological indicators of impaired facial expression recognition in AD patients. EEGs of 30 healthy controls and 30 AD patients were recorded during their perception of three different facial expressions (angry, happy, neutral). Event-related power spectrum and phase locking were analyzed in the theta (4‒7) and alpha (8‒13 Hz) frequency bands with the EEGLAB open toolbox. There was a significant facial Expression × Group interaction (p < 0.05) for the theta power spectrum; the healthy control group had higher theta power than the AD group during the perception of angry facial expressions (p < 0.05). There was a significant hemisphere difference between the two groups (p < 0.05). There was a right hemisphere alpha power dominance in healthy subjects. However, AD patients did not have this alpha power asymmetry. The present study, for the first time in the literature, presents the electrophysiological indicators of impaired recognition of facial expression in AD patients. The current study could be a basis for future studies that will analyze emotional processing in different kinds of dementia patients, and this study may have provided indicators of electrophysiological correlates of behavioral problems observed in clinical practice

Olfactory dysfunction and cognition in radiologically isolated syndrome and relapsing-remitting multiple sclerosis

BACKGROUND: Multiple Sclerosis (MS) is a neuroinflammatory, neurodegenerative, demyelinating disease that causes cognitive, olfactory, and other neurological dysfunctions. Radiologically Isolated Syndrome (RIS), in which only radiological findings are monitored, is accepted as the preclinical stage of demyelinating disease and is considered an important period for disease pathology. Therefore, in this study, we aimed to evaluate the olfactory and cognitive functions and their clinical correlation in RIS and Relapsing-Remitting MS (RRMS) patients and a healthy control group. METHODS: Our study included 10 RRMS patients, 10 RIS patients, and 10 healthy controls. We conducted an olfactor evaluation via the "Sniffin' Sticks" test. The subjects underwent a neuropsychometric test battery to evaluate cognitive functions, including memory, visuospatial, and executive functions. Depression was evaluated using the Beck depression scale. Fatigue and daily life activity were evaluated using the Fatigue Severity Scale (FSS) and the 36-Item Short Form Survey (SF-36), respectively. Disability assessment was done with the Expanded Disability Status Scale (EDSS). RESULTS: RRMS and RIS patients' olfactory test scores were significantly different from those in the control group (p < 0.05). There was a significant difference between the odor threshold scores of patients in the RRMS and RIS groups. There was a significant correlation between memory-oriented cognitive tests and olfactory tests in the RRMS and RIS groups. CONCLUSION: Olfactory dysfunction can be seen in RIS patients, like in RRMS patients. Cognitive and olfactory dysfunction may be together a sign of degeneration in demyelinating diseases

The therapeutic role of lamotrigine and topiramate in a depressive patient with anxiety symptoms and cognitive decline: Neurometabolic correlates

Background: Lamotrigine and topiramate are well-known agents with their antiepileptic and mood stabilizing effects. Their therapeutic effect is associated with significant alteration of brain metabolism. In our study, we aimed to investigate the neurometabolic correlates of the therapeutic effects of both agents in a depressive patient with anxiety symptoms and cognitive decline. Methods: In addition to structural Cranial Magnetic Resonance Imaging, we also have performed Neuropsychometric evaluation and FDG-PET Brain fludeoxyglucose positron emission tomography (F18) (FDG PET-CT) FDG-PET before and after the treatment. Brain fludeoxyglucose positron emission tomography (F18) (FDG PET-CT) images were taken before and after the treatment using Philips Gemini TF PET/CT equipped with 16 slice CT. The raw FDG-PET data was processed using NeuroQ software (Version 3,5. Syntermed, Inc Atlanta. USA). Results: Topiramate and lamotrigine additively reduced the neuropsychiatric symptoms and test scores which were associated with the improvement of cerebral glucose metabolism. Conclusion: Our present findings support that the therapeutic effect of lamotrigine and topiramate involves a modulatory effect on the glucose metabolism in cortico-subcortical network and suggests the functional role of a bi-directional hippocampal-cingulate connectivity