82 research outputs found
Water Exchange across the Blood-Brain Barrier in Obstructive Sleep Apnea: An MRI Diffusion-Weighted Pseudo-Continuous Arterial Spin Labeling Study
Obstructive sleep apnea (OSA) subjects show brain injury in sites that control autonomic, cognitive, and mood functions that are deficient in the condition. The processes contributing to injury may include altered blood-brain barrier (BBB) actions. Our aim was to examine BBB function, based on diffusion-weighted pseudo-continuous arterial spin labeling (DW-pCASL) procedures, in OSA compared to controls. We performed DW-pCASL imaging in nine OSA and nine controls on a 3.0-Tesla MRI scanner. Global mean gray and white matter arterial transient time (ATT, an index of large artery integrity), water exchange rate across the BBB (Kw, BBB function), DW-pCASL ratio, and cerebral blood flow (CBF) values were compared between OSA and control subjects. RESULTS: Global mean gray and white matter ATT (OSA vs. controls; gray matter, 1.691 ± .120 vs. 1.658 ± .109 second, P = .49; white matter, 1.700 ± .115 vs. 1.650 ± .114 second, P = .44), and CBF values (gray matter, 57.4 ± 15.8 vs. 58.2 ± 10.7 ml/100 g/min, P = .67; white matter, 24.2 ± 7.0 vs. 24.6 ± 6.7 ml/100 g/min, P = .91) did not differ significantly, but global gray and white matter Kw (gray matter, 158.0 ± 28.9 vs. 220.8 ± 40.6 min-1, P = .002; white matter, 177.5 ± 57.2 vs. 261.1 ± 51.0 min-1, P = .006), and DW-pCASL ratio (gray matter, .727 ± .076 vs. .823 ± .069, P = .011; white matter, .722 ± .144 vs. .888 ± .100, P = .004) values were significantly reduced in OSA over controls. OSA subjects show compromised BBB function, but intact large artery integrity. The BBB alterations may introduce neural damage contributing to abnormal functions in OSA, and suggest a need to repair BBB function with strategies commonly used in other fields
Diverse Presentation of Neurotoxicity After CAR-T Therapy in Multiple Myeloma Patients
https://openworks.mdanderson.org/aprn-week-23/1020/thumbnail.jp
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Herpes myelitis after thoracic spine surgery
Herpes simplex or herpes zoster reactivation after spinal surgery is rarely reported. This case report and review of the literature describes patients in whom this reactivation occurs to clarify the diagnosis and management. In addition to reporting their case, the authors reviewed case reports and series published between 1980 and 2012 found through a PubMed search. Herpes reactivation is generally confined to a vesicular rash that can be treated with acyclovir. However, occasional dissemination has occurred and has led to myelitis or encephalitis. Atypical presentations led to delays in diagnosis, delayed treatment, and poor neurological outcome. While rare, herpes simplex or herpes zoster reactivation is a complication of spine surgery that must be considered in the face of new-onset focal neurological symptoms in a dermatome pattern without a structural cause, even without a rash
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Ifosfamide related encephalopathy: the need for a timely EEG evaluation
Ifosfamide is an alkylating agent useful in the treatment of a wide range of cancers including sarcomas, lymphoma, gynecologic and testicular cancers. Encephalopathy has been reported in 10-40% of patients receiving high-dose IV ifosfamide.
To highlight the role of electroencephalogram (EEG) in the early detection and management of ifosfamide related encephalopathy.
Retrospective chart review including clinical data and EEG recordings was done on five patients, admitted to MD Anderson Cancer Center between years 2009 and 2012, who developed ifosfamide related acute encephalopathy.
All five patients experienced symptoms of encephalopathy soon after (within 12 h-2 days) receiving ifosfamide. Two patients developed generalized convulsions while one patient developed continuous non-convulsive status epilepticus (NCSE) that required ICU admission and intubation. Initial EEG showed epileptiform discharges in three patients; run of triphasic waves in one patient and moderate degree diffuse generalized slowing. Mixed pattern with the presence of both sharps and triphasic waves were also noted. Repeat EEGs within 24_h of symptom onset showed marked improvement that was correlated with clinical improvement.
Severity of ifosfamide related encephalopathy correlates with EEG changes. We suggest a timely EEG evaluation for patients receiving ifosfamide who develop features of encephalopathy
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Unusual case of paroxysmal sympathetic hyperactivity in a patient with leukemia
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Electrographic patterns in patients with posterior reversible encephalopathy syndrome and seizures
Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic encephalopathic state associated with reversible cerebral vasogenic edema. Seizures are a common clinical presentation in PRES, however its electroencephalographic and radiologic pattern correlation is limited in this subset of patients. The aim of this study is to analyze the origin of electrographic dysfunction according to the radiologic pattern in patients with PRES and seizures.
We retrospectively identified 46 cancer patients who developed PRES and seizures at The University of Texas MD Anderson Cancer Center between January 2006 and June 2012. Clinical, radiographic and electroencephalographic data were abstracted from their records and reviewed for our analysis.
The average age at presentation was 49.9±19.7years. Thirty-four (73.9%) patients were women. Twenty-two (47.8%) patients had a primary hematological malignancy whereas the rest had a solid tumor. Thirty-three (71.7%) patients had received some form of chemotherapy. The mean systolic blood pressure (SBP) variation was 23.7±16.4mmHg at onset of symptoms. On brain MRI, 32 (69.6%) patients had typical pattern while 14 (30.4%) had an atypical pattern. Thirty-seven (80.4%) patients had scalp electroencephalogram (EEG) evaluation. Thirty-three (89.2%) had abnormal EEG findings: diffuse theta/delta slowing (N=12, 36.4%), followed by diffuse slowing with focal dysfunction (N=8, 24.2%), focal dysfunction with epileptiform discharges (N=4, 12.1%), non-convulsive status epilepticus (N=4, 12.1%), focal seizure activity and burst suppression (N=2, 6.1% each). Lateralized Periodic Discharges (LPDs) were recorded in 1 case. Four patients had focal dysfunction localized to areas without conventional MRI signal changes. Four patients had recurrent seizures, of which 3 had an atypical PRES pattern.
PRES appears to be a diffuse neurotoxic encephalopathic state. Origin of seizures seen on scalp EEG may not correlate with the location of vasogenic edema/MRI signal changes raising the possibility of greater degree of dysfunction which may exist beyond those areas
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