Posterior reversible encephalopathy syndrome (PRES) and CT perfusion changes

Posterior reversible encephalopathy syndrome (PRES) can present with focal neurologic deficits, mimicking a stroke and can often represent a diagnostic challenge when presenting atypically. A high degree of suspicion is required in the clinical setting in order to yield the diagnosis. Cerebral CT perfusion (CTP) is utilized in many institutions as the first line in acute stroke imaging. CTP has proved to be a very sensitive measure of cerebral blood flow dynamics, most commonly employed to delineate the infarcted tissue from penumbra (at-risk tissue) in ischemic strokes. But abnormal CTP is also seen in stroke mimics such as seizures, hypoglycemia, tumors, migraines and PRES. In this article we describe a case of PRES in an elderly bone marrow transplant recipient who presented with focal neurological deficits concerning for a cerebrovascular accident. CTP played a pivotal role in the diagnosis and initiation of appropriate management. We also briefly discuss the pathophysiology of PRES

A Comprehensive Update on Treatment of Dementia.

Treatment of dementias represents an important but relatively neglected part of neurological care of the elderly population. Individual therapeutic interventions may make only small changes to the quality of life of individuals afflicted with dementia, but when used in combination these interventions synergize and can make a significant difference. Additionally, given the societal scale of the problem of dementia care, the overall impact, in economic and sociological terms, of such therapies is of consequence. Presently there are no disease-modifying treatments for any of the neurodegenerative dementias. Instead, the clinician has several therapeutic tools to mitigate cognitive and behavioral consequences of dementias. There are also strategies to minimize harm to patients with dementia. In this article, we aim to review these tools and place them in the greater context of dementia care

Radiotherapy is not associated with an increased rate of Second Primary Tumours in Oral Squamous Carcinoma: A study of 370 patients

Oral Squamous Cell Carcinoma (OSCC) remains a public health scourge. Radiotherapy (RT) is a major treatment modality and has been implicated in possible formation of Second Primary Tumours (SPT). In a single centre retrospective study of 370 patients with OSCCs (1967-2004) associations between RT, diagnosis of SPTs, median SPT diagnostic time lag, Disease Free Survival (DFS) and overall survival (OS) were analysed. Sixty-eight (18.4%) patients developed metachronous SPTs. Two hundred and twenty patients (59.3%) underwent some form of RT whilst 151 (40.7%) patients were not exposed to RT. No significant increased incidence of SPTs was demonstrated in the RT group. No significant difference in SPT diagnostic time lag was noted amongst the groups. This study suggests that RT is neither a risk for SPT induction nor increases the relative diagnostic time delay of upper aero-digestive tract SPTs

Correlation between p33ING1b cytoplasmic transfer and lymph node metastasis in oral squamous cell carcinoma

Background: Oral squamous cell carcinoma is the sixth most common malignancy in the world today. ING1b/p33 is a newly-discovered tumor suppressor which enhances p53 activity. Transfer of p33 protein from nucleus to cytoplasmic compartment has been previously reported in leukemias. The objective of this study was to determine the correlation between p33ing1b cytoplasmic transfer and lymph node metastasis in oral squamous cell carcinoma. Methods: Fifty seven patients treated with surgery alone or surgery and adjuvant radiotherapy for primary oral squamous cell carcinoma were enrolled into this study. Immunohistochemical expression of all of the above-mentioned markers was studied. Results: Analysis of the sections demonstrated that p53 and MDM2 were expressed in 45.6% and 68.4% of patients, respectively. p33ING1b nuclear expression was completely absent while cytoplasmic translocation was noted in 78.9% of cases. Positive cytoplasmic expression of p33ING1b correlated with increased risk of lymphatic metastasis (p=0.04). No further correlation with overall disease recurrence or survival was noted. Conclusion: Apparently, p33ING1b cytoplasmic transfer correlates with lymph node metastasis in oral squamous cell carcinoma

Second primary tumours of the head and neck are not associated with adverse overall survival in oral sccs

Objective: Second primary tumours (SPT) have been implicated in the dismal overall survival (OS) of head and neck Squamous cell carcinomas (HNSCC). The incidence of SPT, the SPT diagnostic time-lag and the impact on OS were assessed. Subjects and methods: 363 consecutive patients treated for primary Oral SCC (1967-2004) were analyzed retrospectively in this study. 95.1% and 90.5% of patients reached a minimum follow-up period of 3 and 5 years respectively. Results: Of 363 patients; 68 (18.7%) were diagnosed with metachronous SPT, 49 (13.5%) developed upper aerodigestive tract (UAD)-SPT, 28 (7.7%) were diagnosed with HNSCC-SPT, and 21 (5.8%) developed lung or esophageal carcinoma. Patients with subsequent HNSCC-SPT had a better median survival during follow-up than those not diagnosed with SPTs (p=0.0018). The rate of mortality in these patients showed a substantial increase compared to patients with no subsequent SPT Diagnosis after 144 months. After 200 months the survival experience was no better than those without SPT. Conclusion: These results suggest a better OS for patients afflicted with HNSCC-SPT. This also reflects that at least some of the noted improved OS of HNSCC-SPT patients is due to a temporally cumulated risk associated of developing SPT

Dementia in Essential Tremor: A Visual Record

Background: Research studies have shown an association between essential tremor (ET) and dementia, although dementia in ET is not often regarded as a clinically important issue. Phenomenology Shown: We present three tangible visual records of patients with ET who have developed concurrent, comorbid dementia. Educational Value: ET is a risk factor for dementia. This non-motor feature of the disease has substantial effects on the lives of patients and their families

Mutant p53 and cyclin A1 protein expression in primary laryngeal squamous cell carcinomas do not correlate to second primary tumours of the head and neck

Background: Field cancerization is a feature of head and neck squamous cell carcinoma. No biological marker in the index tumour has been correlated to the development of second primary tumours (SPT). Cyclin A1 is a cell cycle regulator and a downstream target of p53. This study assessed predictive correlation of cyclin A1 and mut-p53 with clinicopathological parameters and occurrence of (SPT) 7in the head and neck. Methods: Using immunohistochemistry 106 patients treated for primary laryngeal squamous cell carcinoma were investigated for expression of cyclin A1 and mut-p53. Results: Expression of cyclin A1 and mut-p53 were noted in 83 of 106 (78.3%) and 25 of 106 (23.6%) patients. There was a weak but significant correlation between mut-p53 and cyclin A1 (r = 0.301, P = 0.002) expression. During the follow-up period (median 41.0 months (range 1-205 months)), 21 of 106 (19.8%) patients developed an SPT. There was no statistically significant correlation between the markers investigated and disease recurrence, SPT diagnosis or clinicopathological parameters. Conclusion: Second primary tumours are an intriguing problem in treatment of HNSCC and a predictive marker identifying those greatest at risk would be a leap forward

Intracranial hypotension masquerading as nonconvulsive status epilepticus: report of 3 cases

Intracranial hypotension (IH) has been a known entity in neurocritical care since 1938. Even though many cases are spontaneous, the incidence of intracranial hypotension in the neurocritical care setting is increasing by virtue of the increased number of neurosurgical interventions. Whether spontaneous or secondary in etiology, diagnosis of IH usually requires the presence of orthostatic symptoms, including headaches and nausea with low opening CSF pressure. However, typical clinical features in the appropriate clinical context and imaging, even with normal CSF pressure, can indicate IH. In the neurocritical care setting, challenges for accurate semiology include altered sensorium and reduced levels of responsiveness for which many etiologies may exist, including metabolic dysfunction, traumatic brain injury, IH, or nonconvulsive status epilepticus (NCSE). The authors describe 3 patients whose clinical picture and electroencephalography (EEG) findings initially suggested NCSE but who did not respond to treatment with antiepileptic drugs alone. Neuroimaging suggested IH, and subsequent treatment of IH successfully improved the patient\u27s clinical status. To the authors\u27 knowledge this paper is the first in the literature that reports a correlation of IH with electrographic findings similar to NCSE as cause and effect. The authors\u27 hypothesis is that thalamocortical dysfunction causes EEG findings that appear to be similar to those in NCSE but that these conditions do not coexist. The EEG activity is not epileptogenic, and IH results in blocking network pathways producing thalamocortical dysfunction. The authors discuss the hypothesis and pathophysiology of these epileptiform changes in relation to IH