Slowly Progressive Invasive Rhino-orbito-cerebral Aspergillosis: Case Report And Literature Review

This is a report of a patient with aspergillosis infection, which was thought to be a tumoral lesion during its investigation. This is not a common disease in Western countries, and this report should increase our awareness for differential diagnosis of nasal masses. Early diagnosis is desired in order to increase the survival rates.5321822

Sleep state misperception: is there a CNS structural source?

Introduction: We describe a case of sleep state misperception in a patient with a neurotoxoplasmosis lesion in the left nucleocapsular region. Case report: A 40-year-old female patient presented relating sleeplessness over the past 2 years, concurrent with progressive headaches, dizziness and motor and sensory deficits in the right upper and lower limbs. She had a history of AIDS, on irregular antiretroviral therapy and neurotoxoplasmosis. A polysomnography confirmed the hypothesis of sleep state misperception, and magnetic resonance imaging revealed a residual lesion in the left nucleocapsular region.Conclusion: Different models consider that the sleep state misperception could be correlated to structural abnormalities of the central nervous system. A recent study showed that the medial prefrontal cortex had a lower activation in patients with unrefreshing sleep due to chronic fatigue syndrome. This case report highlights the possibility of sleep state misperception having - at least partially - an anatomical substrate in the left nucleocapsular region

Evaluation of olfaction and body composition in patients with narcolepsy

Introdução: A Narcolepsia é um transtorno do sono caracterizado pela sonolência excessiva diurna, cataplexia, paralisia do sono, alucinações hipnagógicas e hipnopômpicas e fragmentação do sono. Além desses aspectos, a doença está relacionada a outras mudanças em diversos sistemas, incluindo alterações olfatórias, maior ganho ponderal, diminuição da saciedade alimentar, transtornos psicológicos, sintomas relacionados à disautonomia e aumento da prevalência do transtorno comportamental do sono REM. Dessa forma, esse estudo busca avaliar e encontrar correlações entre os diversos sintomas secundários da narcolepsia que, apesar de não serem seus definidores, podem auxiliar no diagnóstico e, devem ser reconhecidos e tratados nos indivíduos acometidos. Métodos: Foi realizado um estudo transversal, com a participação de pacientes com diagnóstico de narcolepsia, com deficiência de hipocretina-1 e níveis de hipocretina-1 dentro da normalidade. Para a detecção de distúrbios olfatórios foi utilizado o University of Pennsylvania Smell Identification Test (UPSIT). A avaliação da composição corporal foi realizada através das medidas antropométricas, por bioimpedância tetrapolar, de pesquisa da presença de compulsão alimentar por meio da Escala de Compulsão Alimentar Periódica (ECAP). Foram investigadas queixas de alterações do sistema nervoso autonômico e de Transtorno Comportamental do sono REM através de questionários. Resultados: Foram incluídos 42 participantes no estudo, com diagnóstico de narcolepsia. Não houve diferenças significantes na avaliação olfatória entre pacientes com níveis de hipocretina-1 baixos quando comparados aos com níveis de hipocretina-1 normais, embora uma leve diminuição da função olfatória tenha sido observada em grande parte dos indivíduos, de ambos os grupos (grupo com deficiência de hipocretina-1: mediana 32,50, intervalo 10-38; grupo com níveis normais de hipocretina-1: mediana: 33,00, intervalo 16-39; p=0,86). Constatou-se diferença nos parâmetros antropométricos, com maior tendência à obesidade nos indivíduos com deficiência de hipocretina-1 (grupo com deficiência de hipocretina-1: 32,64±5,88; grupo com níveis normais de hipocretina-1: 26,40±7,68; p=0,01). Houve melhor desempenho no UPSIT naqueles que apresentavam mais anos de estudo (grupo com resultados olfatórios normais 15,19±4,3 versus grupo com resultados olfatórios alterados: 11,10±4,84; p=0,01). Os resultados obtidos através do questionário que avaliou carga de sintomas do sistema nervoso autonômico se mostraram elevados entre os pacientes, com e sem deficiência de hipocetina-1, apesar de não haver diferenças significantes entre eles (resultado COMPASS-31 total - grupo com deficiência de hipocretina-1: 26,6±16,46 versus grupo com níveis normais de hipocretina-1: 16,46±11,46; p=0,39). O Questionário de Triagem de Transtorno Comportamental do sono REM também apontou pontuações elevadas nos dois grupos (grupo com deficiência de hipocretina-1: 8,39±2,69 versus grupo com níveis normais de hipocretina-1: 7,27±4,65; p=0,41). Houve relação entre a pontuação obtida no questionário de triagem para transtorno comportamental do sono REM e queixas de disautonomia apresentadas através do COMPASS-31 (r=0,41, p=0,03), que foram ainda maiores quando considerados somente as pessoas com deficiência de hipocretina-1 (r=0,64; p=0,003). Conclusão: A pesquisa mostrou que as alterações olfatórias estão presentes nos pacientes com narcolepsia, independentemente dos níveis de hipocretina-1 dosados. Observou-se também diversas queixas de disautonomia e sintomas de transtorno comportamental do sono REM nos participantes do estudo, além de elevação nas diversas medidas na composição corporal daqueles com deficiência de hipocretina-1. Essas disfunções secundárias da narcolepsia podem se tornar futuros biomarcadores da doença e o reconhecimento e tratamento trazem melhora das comorbidades e qualidade de vida aos indivíduos acometidos.Introduction: Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, hypnagogic and hypnopompic hallucinations, and sleep fragmentation. In addition to sleep-related symptoms, narcolepsy is linked to changes in many systems, including olfaction, greater weight gain, diminished feeding satiety, psychological changes, an increased incidence of symptoms of dysautonomia, and REM-Sleep Behavior Disorder. Because of that, this study intends to assess and find correlations between the multiple secondary symptoms of the disease which, despite not being part of the definition of narcolepsy, may aid in diagnosing it and should be recognized and treated in individuals affected by the disease. Hypocretin deficiency, which is present in type-1 narcolepsy, seems to be related to changes in many other systems, including the olfactory system. Methods: A cross-sectional study was performed with patients diagnosed with narcolepsy that had either hypocretin-1 deficiency or normal hypocretin-1 levels in the cerebrospinal fluid. The University of Pennsylvania Smell Identification Test (UPSIT) was utilized to assess olfaction, body composition was evaluated using tetrapolar bioimpedance, and eating compulsion was evaluated using the Binge Eating Scale. Complaints of changes in the autonomic nervous system and REM Sleep Behavior Disorders were evaluated using questionnaires. Results: 42 patients were evaluated. There were no significant differences in the olfaction assessments of people with narcolepsy with reduced and normal levels of hypocretin-1, even though some degree of hyposmia has been observed in a large part of patients in both groups (hypocretin-1 deficiency group: median score 32.50, ranging between 10-38; normal hypocretin-1 group: median score 33.00, ranging between 16-39; p=0.86). Significant differences in anthropometric parameters were found between the two groups, with patients with hypocretin deficiency presenting a higher trend to obesity [hypocretin-1 deficiency group: mean Body Mass Index = 32.64 SD= 5.88; normal hypocretin-1 group: mean BMI= 26.40, SD= 7.68; p=0.01]. Patients with more years of education performed better at UPSIT (Group with normal olfaction results: mean years of study= 15.19, SD 4.3; Group with altered olfaction results: mean years of study=11.10, SD=4.84; p=0.01). The scores obtained from questionnaires for the assessment of changes in the autonomous nervous system were high in patients with narcolepsy, both with and without hypocretin-1 deficiency, though there was no significant difference between the two groups (COMPASS-31 total score: hypocretin-1 deficiency group: mean= 26.6 SD= 16.46; normal hypocretin-1 group: mean= 16.46, SD= 11.46; p=0.39). The Rapid Eye Movement Sleep Behavior Disorder Screening Questionnaire also showed high scores in both groups (hypocretin-1 deficiency group: mean= 8.39, SD= 2.69; normal hypocretin-1 group: mean 7.27, SD= 4.65; p=0.41). There was a significant correlation between the score obtained from the Rapid Eye Movement Sleep Behavior Disorder Screening Questionnaire and complaints of dysautonomia displayed on COMPASS-31 (r=0.41, p=0.03), and they were even stronger when only individuals with hypocretin-1 were considered (r=0.64; p=0.003). Conclusion: the study has shown that olfactory alterations are present in patients with narcolepsy, regardless of the measured levels of hypocretin-1. It was also observed that in both groups there were many symptoms of dysautonomia and REM sleep behavior disorder in most patients, in addition to an increase in the various measures of body composition in patients with hypocretin-1 deficiency. These secondary alterations of narcolepsy may be possible markers of the disease, and recognizing and treating them may improve comorbidities and the quality of life of patients with narcolepsy

Human hypocretin-deficient narcolepsy - aberrant food choice due to impaired taste?

Authors demonstrate that patients with narcolepsy type 1 (N1) have more tendency of eat salty snacks after satiety than health volunteers. A few mechanisms to explain the weight gain have been discussed in narcolepsy. The hypocretin-1 deficiency can influence the olfactory system. The olfactory system should be modulated through hypocretin-1 via connections from the hypothalamic to other brain regions. Likewise, hypocretin-1 can be synthesized locally in our olfactory mucosa with possible private role modulating the olfactory. In experimental studies, different kinds of smell influence the preference for type of diet. Olfactory and taste sensations help control of appetite and regulate the quantity and quality of foods that will be chosen. N1 patients have lower levels of hypocretin-1 and consequent inferior olfactory threshold, less olfactory discrimination, and these findings improved after nasal hypocretin-1 administration. It is possible that the hyposmia influenced the quality and quantity of food by narcoleptic patients. We suggest that a complementary analysis of olfactory function should be done concomitant with food preferences to compare narcoleptic patients with and without hypocretin-1 deficiency

The brain-gut-microbiota axis in the treatment of neurologic and psychiatric disorders

The human gut microbiota is a complex ecosystem made of trillions of microorganisms. The composition can be affected by diet, metabolism, age, geography, stress, seasons, temperature, sleep, and medications. The increasing evidence about the existence of a close and bi-directional correlation between the gut microbiota and the brain indicates that intestinal imbalance may play a vital role in the development, function, and disorders of the central nervous system. The mechanisms of interaction between the gut-microbiota on neuronal activity are widely discussed. Several potential pathways are involved with the brain-gut-microbiota axis, including the vagus nerve, endocrine, immune, and biochemical pathways. Gut dysbiosis has been linked to neurological disorders in different ways that involve activation of the hypothalamic-pituitary-adrenal axis, imbalance in neurotransmitter release, systemic inflammation, and increase in the permeability of the intestinal and the blood-brain barrier. Mental and neurological diseases have become more prevalent during the coronavirus disease 2019pandemic and are an essential issue in public health globally. Understanding the importance of diagnosing, preventing, and treating dysbiosis is critical because gut microbial imbalance is a significant risk factor for these disorders. This review summarizes evidence demonstrating the influence of gut dysbiosis on mental and neurological disorders

Slowly progressive invasive rhino-orbito-cerebral aspergillosis: case report and literature review

This is a report of a patient with aspergillosis infection, which was thought to be a tumoral lesion during its investigation. This is not a common disease in Western countries, and this report should increase our awareness for differential diagnosis of nasal masses. Early diagnosis is desired in order to increase the survival rates53218224sem informaçã