Positron Emission Tomography in Autoimmune Disorders of the Central Nervous System

This chapter covers the basic knowledge on interactions between the central nervous system and immunity. It presents information about the main factors and mechanisms that refer to the traditional and new concepts on immune privilege of the brain. In addition, the immune surveillance and tolerance are discussed in context of the central nervous system homeostasis, production of autoreactive lymphocytes, and neurons vulnerability

A diagnostic approach to examining the functional disorders of the sacroiliac joints

PURPOSE: Nowadays most physicians experience problems with the proper diagnosis of the sacroiliac joint dysfunction. It is mainly due to the presence of numerous diagnostic tests of unclear clinical reliability and insufficient research. The objective of this study is to develop a highly efficient diagnostic approach to the sacroiliac dysfunction.MATERIAL AND METHODS: A total of 120 patients with dysfunction of the sacroiliac joint were examined by means of 7 tests. These tests were provisionally divided according to their association with testing of the real movement in the sacroiliac joint into specific tests such as De Winter phenomenon, spine-test and Rosina test and non-specific ones such as Patrick, Mennel I, pseudo-Lassegue and 3-step test.RESULTS: Against the very common initial data from all the tests a very distinctive result difference after manual therapy was present. The non-specific tests demonstrated a low level of clinical reliability when applied right after restoring the joint functionality. On the other hand, the specific tests presented with a clinical reliability of more than 91%.CONCLUSION: An eventual positive result of two specific tests mentioned above provides a diagnostic accuracy of 94% concerning the functional disorder/blockage of the sacroiliac joint.Scripta Scientifica Medica 2013; 45(2): 70-74

Novel pharmacotherapy in refractory epilepsy associated with structural brain lesions

BACKGROUND: Patients with various structural brain lesions often suffer from seizures. Refractory epilepsy is the most common in brain tumors, vascular malformations, and sequel of cerebral infections, infarcts or trauma.OBJECTIVE: To evaluate the efficacy and safety of new AEDs in patients with medically refractory seizures associated with structural brain lesions.MATERIAL AND METHODS: Twenty-six (26) patients (8 M; 18 F), aged 48.4± 7.6 years, with simple (65%) or complex partial (35%) seizures associated with cerebral tumors (12 p) and non-neoplastic brain lesions (14 p) were included in the study. Diagnosis was based on the criteria of ILAE. Patients were treated with OXC (10 cases), LTG (9 cases), and LEV (7 cases) for at least six months. Efficacy and tolerability were assessed on the basis of changes in seizure frequency and reporting the drugs side effects. Structural neuroimaging, EEG, and clinical follow-up were performed before and after AEDs addition.RESULTS: Eighteen (18) patients (72%) were seizure-free after six to twenty-four months treatment period and 8 (28%) experienced some rare partial seizures but no more generalized attacks. Side effect of mild somnolence was observed in 4 patients treated with LTG during the first 3 weeks of the treatment, of transient dizziness in 3 patients under OXC, and transient fatigue in 2 patients treated with LEV.CONCLUSION: In accordance with our own findings and literature review, we suggest that new AEDs due to their efficacy and good safety profile might be useful for the epilepsy control in patients with medically refractory seizures associated with structural brain lesions

Use of 18FFDG PET/CT in Patients with Acute Ischemic Stroke

Introduction: Brain scintigraphy is one of the basic branches of nuclear medicine, which plays an important role in the diagnosis of neurological diseases. Functional neuroimaging techniques involve both SPECT and PET. More widely application found the coregistration of SPECT/CT and SPECT/MRI that integrate functional nuclear medicine with morphological images.Objective: To study the usefulness of (18F)-FDG PET/CT in patients with acute ischemic cerebral stroke.Material and methods: A total of 16 cases (10 males and 6 females, aged between 39 and 80) with acute ischemic cerebral stroke, admitted to First Clinic of Neurology at UMBAL `Sveta Marina` during the period of 2008-2013 year were included in the study. (18F)-FDG PET/CT scans were obtained by means of Phillips Gemini TF machinery, following the corresponding standard protocols. Results: In all patients were visualized hypodense and hypometabolic zones, corresponding to the location of brain infarction and border regions of reduced glucose metabolism, reflecting the so called `penumbra`.Conclusion: Based on the literature data and our own results, we confirm the clinical application of (18F)-FDG PET/CT in patients with acute ischemic strokes. We suggest that this modern method of co-registration might be useful for assessment of structural and metabolic cerebral disorders and possesses an important diagnostic and prognostic significance for the disease outcome

Miller Fisher syndrome: A case report

Miller Fisher syndrome is a rare neurological disease that is considered to be a variant of Guillain-Barré syndrome. It is characterized by abnormal muscle coordination (ataxia), paralysis of the eye muscles (ophthalmoplegia), and absence of the tendon reflexes (areflexia). Additional symptoms include generalized muscle weakness and respiratory failure. Symptoms are usually preceded by a viral illness. This paper describes a clinical case of the syndrome in a patient who presented primarily with blurred and double vision, and gait disturbance

Serum lipid anomalies in adult patients with acute ischemic stroke

Introduction: There is rising evidence of the role of hyperlipidemia and dyslipidemia in the development of acute ischemic stroke (AIS). There is a considerable risk for AIS in adult individuals with these abnormalities. Our purpose was to reveal the incidence rate of the disorders of lipid metabolism in adult AIS patients.Material and methods: We examined 129 male and 129 female patients with AIS at a mean age of 70.59±7.22 years hospitalized in the First Clinic of Neurology, St. Marina University Hospital of Varna in 2007-2013. The serum levels of total cholesterol, triglycerides, HDL- and LDL-cholesterol at admission were examined. Statistical data processing was performed by ANOVA as t-criterion was considered significant if p<0.05.Results: The mean values of total cholesterol and LDL-cholesterol were slightly elevated while those of triglycerides were slightly reduced. The mean values of total cholesterol and triglycerides were higher in males than in females. Total cholesterol values were considerably more commonly higher in females than in males as the mean total cholesterol concentrations were higher in the female patients with normal, decreased and increased levels of this parameter. LDL-cholesterol was more commonly elevated as its mean values were higher in the female patients with its normal, decreased and increased levels.Conclusion: A regular control of the parameters of lipid metabolism and keeping-up the healthy life-style in adult individuals and in patients with cardiovascular diseases could ensure a successful prevention of ischemic stroke

Use of levetiracetam in structural brain lesions associated with refractory seizures

BACKGROUND. Approximately 40% of all individuals with epilepsy have medically refractory or intractable seizures. Among the most common etiologies are Mesiotemporal and tuberous sclerosis, Sturge-Weber syndrome, cerebral tumors, arteriovenous malformations, developmental malformations, and sequel of cerebral infections, infarcts or trauma. Levetiracetam (LEV) is a second generation AED, indicated as adjunctive therapy in adults with partial seizures.OBJECTIVE. To assess the efficacy and safety of LEV add-on therapy in patients with structural brain lesions associated with medically refractory partial epilepsy.MATERIAL AND METHODS. Twelve patients (5 M and 7 F; aged 41.6 ±7.6 years) with tumor and non-neoplastic brain lesions associated with refractory seizures were included in the study. Diagnosis was based on the criteria of ILAE. All patients had an adjunctive therapy with LEV (1000-3000 mg/daily) for at least six months. Drug efficacy was assessed as change in seizure frequency. Safety was assessed as measurement of retention rate and reporting the drug related adverse effects. Neuroimaging, EEG, and clinical follow-up were performed before and after initiation of LEV add-on therapy. RESULTS. LEV add-on therapy reduced seizure frequency in 85 percent of patients and 46 percent became seizure free. Retention rate was 100 percent for patients treated with LEV. The most common side effect was transient somnolence, noted in 25 percent of patients.CONCLUSION. This study confirms the efficacy and safety of LEV as add-on therapy in patients with structural brain lesions. Due to its unique mechanisms of action, LEV presents a new therapeutic challenge even for patients with highly refractory partial epilepsy.BACKGROUND. Approximately 40% of all individuals with epilepsy have medically refractory or intracta­ble seizures. Among the most common etiologies are Mesiotemporal and tuberous sclerosis, Sturge-Weber syndrome, cerebral tumors, arteriovenous malformations, developmental malformations, and sequel of cere­bral infections, infarcts or trauma. Levetiracetam (LEV) is a second generation AED, indicated as adjunctive therapy in adults with partial seizures. OBJECTIVE. To assess the efficacy and safety of LEV add-on therapy in patients with structural brain lesions associated with medically refractory partial epilepsy. MATERIAL AND METHODS. Twelve patients (5 M and 7 F; aged 41.6 ±7.6 years) with tumor and non-neoplastic brain lesions associated with refractory seizures were included in the study. Diagnosis was based on the criteria of ILAE. All patients had an adjunctive therapy with LEV (1000-3000 mg/daily) for at least six months. Drug ef­ficacy was assessed as change in seizure frequency. Safety was assessed as measurement of retention rate and reporting the drug related adverse effects. Neuroimaging, EEG, and clinical follow-up were performed before and after initiation of LEV add-on therapy. RESULTS. LEV add-on therapy reduced seizure frequency in 85 percent of patients and 46 percent became seizure free. Retention rate was 100 percent for patients treated with LEV. The most common side effect was transient somnolence, noted in 25 percent of patients. CONCLUSION. This study confirms the efficacy and safety of LEV as add-on therapy in patients with struc­tural brain lesions. Due to its unique mechanisms of action, LEV presents a new therapeutic challenge even for patients with highly refractory partial epilepsy

Tc-99m MIBI SPECT in the differential diagnosis of non-neoplastic brain lesions associated with epilepsy

Although considered experimental or investigational, techne tium scintigraphy has been reported to be useful in the diagnosis of structural brain lesions. Many series have evaluated its efficacy in the differentiation of brain malignancies from radiation necrosis, vascularmal formations, stroke, trauma or cerebral abscess. Accordingly, we decided to assess the usefulness of Tc-99m MIBI SPECT for the final diagnosis of suspected non-neoplas tic brain lesions associated with epilepsy. Ten patients (6 males and 4 fe males; mean age, 46.4±9.8 years) with symptomatic epilepsy asso ciated with finally non-neoplastic diagnosis were included in the study. SPECT was per formed 20 and 120 min after administration of 740 MBq (20 mCi) Tc-99m MIBI. Transverse, sagittal, and coronal views were reconstructed, and MIBI up take index was calculated on SPECT imaging. All patients under went structural neuroimaging (CT and/or MRI) that supposed cystic lesion in five patients, vascular abnormality in four and hemorrhage in one. In all cases SPECT showed no radiotracer accumulation. A correlation between lack of MIBI up take and non-tumor origin of the lesions was noted. In conclusion, we suggest that Tc-99m MIBI SPECT may be a useful noninvasive tool for the precise diagnosis of non-neoplastic brain lesions.Scripta Scientifica Medica 2009; 41(2): 179-181

Retrobulbar optic neuritis and cystoid macular edema as a first manifestation of lyme disease

Lyme disease is a multi-system disorder caused by the spirochete Borrelia burgdoferi. Eye manifestations are a rare involvement. We report two cases of patients who developed a retrobulbar optic neuritis and a cystoid macular edema as a sole clinical presenting in Lyme disease.A 42-year-old female presented with left eye decreased visual acuity and painful ocular movement. Dilated funduscopy and neurological examination were normal. A diagnosis of left eye retrobulbar optic neuritis was made. The brain and spinal cord MRI showed typical lesions characteristic of MS. Serological tests for Lyme disease revealed positive results for IgM ELISA and Western blot. The possible serologically proven Lyme disease was diagnosed. Visual acuity returned to normal following a course of high-dose steroids and intravenous antibiotic, after by oral antibiotic. A 28-year-old male presented with left eye blurred vision and intermittent blurring vision in his right eye. Dilated funduscopy revealed bilateral cystoid macular edema (left more than right). He was positive for Lyme serology, IgM ELISA and Western blot, and intravenous antibiotic therapy was commenced, followed by oral antibiotic. Visual acuity was restored and fuduscopy was normal.In summary, although Lyme disease is an uncommon cause of these neuro-ophthalmic complications, our two patients highlight the importance of considering this disorder as a differential diagnosis and to initiate an early adequate therapy

Disorders of blood glucose levels in adult patients with acute Ischemic stroke

Introduction: Effective and timely prevention of acute ischemic stroke (AIS) is characterized by a rising socio-medical importance as this is the most common cerebrovascular disease worldwide and in Bulgaria as well. Our purpose was to reveal the incidence rate of the disorders of glucose metabolism in AIS development among adult patients.Material and methods: We examined 129 male and 129 female patients with AIS at a mean age of 70.59±7.22 years hospitalized in the First Clinic of Neurology, St. Marina University Hospital of Varna in 2007-2013. Blood glucose concentrations at admission were examined. Statistical data processing was performed by variation (ANOVA as t-criterion was considered significant if p<0.05) and correlation (Pearson`s coefficient) analyses.Results: Mean fasting blood glucose levels were most commonly elevated and total ones were higher in males than in females except for the minimal value. The males with abnormally elevated blood glucose values present with higher mean and maximal values than the females. The number and relative share of the patients with increased blood glucose values at admission considerably prevailed. The difference between the number of the males with increased values and that of those with normal values was statistically significant (t=3.33; p<0.01). There was moderate correlation between the level of blood glucose and the preceding diabetes mellitus (r=0.431) and a strong one between this level and the newly-diagnosed diabetes mellitus (r=0.733) among our AIS patients.Conclusion: The regular control of blood glucose by the general practitioners and the promotion of the healthy life-style in cardiovascular disease patients could successfully prevent AIS in Bulgaria