Neurol. Int., Volume 10, Issue 4 (December 2018) – 7 articles

Continuous glucose monitoring (CGM) is a method to examine glucose concentration in subcutaneous interstitial fluid sequentially. CGM can disclose glucose fluctuation (GF), which can be unrecognized in routine blood tests. A limited number of studies suggest advanced Parkinsonian syndromes (PS) is at risk of GF, however, the report of CGM in PS is scarce. We performed CGM for 72 h in 11 nondiabetic patients with advanced PS. The etiology was Parkinson’s disease, multiple system atrophy, progressive supranuclear palsy, or dementia with Lewy bodies. All participants were bedridden, elderly (≥65 year-old), and receiving enteral nutrition. The retrospective data was obtained after the removal of CGM device. In the glucose concentration, 9 (81.8%) participants showed nocturnal decline (≤70 mg/dL; 4 of them reached recordable limit of 40 mg/dL), and 6 (54.5%) participants showed remarkable elevation (≥200 mg/dL) postprandially. In the majority, these abnormalities were difficult to predict from routine blood tests. Standard deviation and mean of sequential glucose concentration were higher than those in precedent reports of young or middle-aged healthy controls. CGM in nondiabetic and elderly patients with advanced PS can disclose GF, with features of nocturnal decline and/or postprandial remarkable elevation of glucose concentration. Owing to limitations such as small sample size, heterogeneity of etiology, and retrospectivity of CGM data, further investigations are required. Full article

Heart failure and restrictive respiratory insufficiency are complications in muscular dystrophies. We aimed to assess the accuracy of the B-natriuretic peptide (BNP) for the diagnosis of decompensated heart failure in muscular dystrophy. We included patients with muscular dystrophy and chronic respiratory insufficiency admitted in the Intensive Care Unit of the Raymond Poincare hospital (Garches, France) for suspected decompensated heart failure. Thirtyseven patients were included, among them, 23 Duchenne muscular dystrophy (DMD) (62%), 10 myotonic dystrophy type 1(DM1) (27%). Median age was 35 years [27.5; 48.5]. 86.5% of patients were on home mechanical ventilation (HMV). Median left ventricular ejection fraction (LVEF) was 47% [35.0; 59.5]. Median BNP blood level was 104 pg/mL [50; 399]. The BNP level was significantly inversely associated with LVEF (r= –0.37, p 0.03) and positively associated with the LVEDD (left ventricular end diastolic diameter) (r=0.59, P<0.001). The discriminative value of the BNP level for the diagnosis of decompensated heart failure was high with an AUROC=0.94 (P<0.001). The best discriminating BNP threshold was 307 pg/mL (Youden index 0.85). The BNP level measurement may add a supplemental key for the final diagnosis of decompensated heart failure. Full article

Drug-induced Parkinsonism is often reversible after withdrawal of the causative drug. Its clinical course, however, is not well understood, as the majority of cases are caused by drugs prescribed by departments outside of neurology. We reviewed 21 cases of drug-induced parkinsonism for several factors, including age, sex, causative drug and reason for prescription, department by which it was prescribed, and outcome. The age at onset ranged from 40 to 87 years, with an average Hoehn and Yahr Scale score of 4, indicating severe disability. Sulpiride was the most commonly observed causative drug (71.4%). All causative drugs were prescribed in non-neurological departments and over one half were prescribed in non-psychiatric departments; most were prescribed to treat depression or abdominal discomfort. Ten patients (48%) were previously diagnosed with a neuromuscular disease, including cerebrovascular diseases and Parkinson’s disease. Recovery was observed in 15 cases (71%) after withdrawal of the causative drug, but lingering symptoms were observed in the remaining cases. It is suggested that physicians should be more cautious of Parkinsonian side effects when prescribing such drugs. Full article

The visual acuity loss enables the brain to access new pathways in the quest to overcome the visual limitation and this is wellknown as neuroplasticity which have mechanisms to cortical reorganization. In this review, we related the evidences about the neuroplasticity as well as cortical anatomical differences and functional repercussions in visual impairments. We performed a systematic review of PUBMED database, without date or status publication restrictions. The findings demonstrate that the visual impairment produce a compensatory sensorial effect, in which non-visual areas are related to both cross (visual congenital) and multimodal (late blind) neuroplasticity. Full article

The pathogenesis of anterior choroidal artery (AChA) territory infarction includes various mechanisms, but hemodynamic causes are rare and difficult to diagnose. 77-year-old man, who had moderate left ICA stenosis and he had treated with STA-MCA bypass surgery for severe symptomatic left MCA stenosis 10 years earlier, was admitted with right hemiparesis and confused state. On admission, magnetic resonance imaging and angiography demonstrated patent bypass, but severe stenosis of left ICA with no opacification of the left AChA and A1 portion of the left ACA. Diffusionweighted imaging demonstrated ischemic lesion in the left corona radiata. Together with clinical findings, hemodynamic ischemia of the AChA region was suspected and left carotid artery stenting resulted in prompt improvement of symptoms. Hemodynamic ischemia of the AChA territory is rare, however, should be considered as a potential target of treatment when the ipsilateral ICA, A1 and M1 show stenoocclusive lesions. Full article

A 46-year-old woman developed slowly progressive tongue weakness with a pseudohypertrophic change on the right side of her tongue. She subsequently developed weakness in her proximal lower extremities, skin erythema and a sustained increase of muscle enzymes at 11 M after the onset. A biopsy of the quadriceps muscle showed necrotizing myopathy and a skin biopsy showed erythema nodosum. The present case showed characteristic clinical manifestations that may represent a rare variant of sarcoidosis. Full article

In view of recent data on the linkage of Gas7 protein to schizophrenia, and in view of its role in neurite outgrowth, histochemical localization of the Gas7 protein was studied in normal human brain tissue using an online tissue atlas. Selective localization to neurons in the cerebral cortex was found with moderate levels in the hippocampus and caudate, but fairly low levels were noted within the human cerebellum and was limited to small granule cells as well as the neuropil of the cerebellar molecular layers. Despite this low intensity histochemical localization in the cerebellum, molecular data indicate a substantially large number of RNA transcripts in the cerebellum that exceeded the cerebral cortex as determined by sequencing studies. Full article