Neurological Disorders

Background: The differences in clinical presentation and surgical outcome between children and adults with craniopharyngioma have not been well-described and there are few data available for Asian population. The aim of this study is to investigate the differences between paediatric and adult patients with craniopharyngioma at a single medical centre in southern Taiwan.

Methods: The clinical records of 40 patients with craniopharyngioma who were all surgically treated at Kaohsiung Medical University Hospital from January 1990 to December 2012 were reviewed. The patients were divided into two groups based on age: children (= 20 years) and adults (>20 years). MRI and CT images were obtained pre- and post-operatively. Histopathological examination diagnosed tumors. Statistical analyses were performed to compare the differences in the two groups.

Results: Among the patients, 17 were children and 23 were adults. The children group demonstrated more diagnoses of large or giant tumors (p<0.001), a higher rate of tumors with both solid and cystic composition (p=0.027) as well as adamantinomatous type tumors (p=0.020). The children group also had a higher surgical complication rate of diabetes insipidus (p=0.023).

Conclusions: There are significant differences between children and adults with craniopharyngioma with regard to tumor size, histopathology type of tumor and hormone-related surgical complications. These findings are useful for improving the strategies for managing patients with craniopharyngioma.

Parkinson’s disease is the second most common chronic neurodegenerative disease of central nervous system predominant in elderly people characterised by tremor, akinesia, rigidity and gait disturbances. The annual cost of management of Parkinson’s disease is double than that of control population. Evidence- based management of Parkinson’s disease in developing nation is unmet needs. This article is authors’ endeavour to summarise the facts in different publications on Parkinson’s disease. Electronic databases like MEDLINE/Pub Med, Google Scholar, IMSEAR (Index Medicus for South-East Asia Region) and Scope med were extensively searched with MeSH (Medical Subject Headings) terms “Parkinson’s disease”, “treatment”, and “anti-Parkinson drugs” from the earliest possible date of 1966 to March 2017. Articles in any languages especially those published in recent years were given preference. This review deals mostly with evidence based management of Parkinson’s disease.

Introduction: The effects of traumatic brain injury (TBI) can result in severe disability or death and have an important social and economic impact. Its annual direct and indirect costs amount to roughly 2.5 billion euros. Our objective was to evaluate whether hypocalcaemia of serum ionized calcium (defined as <1.10 mmol/L (4.5 mg/dL) is a prognostic factor for mortality and morbidity (defined as GOS ≤ 3) in early moderate and severe TBI.

Material and methods: Prospective study from January 2014 to December 2015. Patients were between 16 and 87 years old and had a Glasgow Coma Scale (GCS) of 3-13 points following TBI, with demonstrable intracranial lesions in cranial computed tomography (CT).

Results: We recruited 61 patients who suffered moderate and severe TBI with a median age of 42 years old (range: 17 to 86). Forty-three (70.50%) male 18 (29.50%) female. Twenty-one (34.42%) patients had a GOS ≤ 3 and 40 (65.58%) a GOS >3. We found a significant statistical difference (0.009) in ionized serum calcium, Protein S-100b (0.002), IL 6 (0.007) and Haemoglobin (0.011) on day three of admission between GOS ≤ 3 and >3 (disability/death). The best logistic regression model included: age, absent pupillary reactivity, hypocalcaemia of ionized serum calcium (<1.10 mmol/L), Protein S100 b and IL6 on day three.

Conclusion: Hypocalcaemia looks like being an epiphenomenon of several factors. It seems to play a role as prognosticator, however not as leverage point for therapy.

Cerebral amyloid angiopathy (CAA) is a well-known pathology of Alzheimer’s disease among elderly individuals. CAA-related inflammation (CAAri) has been increasingly viewed as a rare presentation of CAA. We report the case a 65-year-old man who presented with subacute dementia and reversible delirium secondary to probable CAAri. His laboratory findings were negative except for elevated cerebrospinal fluid protein levels. Brain magnetic resonance imaging (MRI) revealed disseminated microbleeds in both the cerebral hemispheres on T2 weighted gradient images and prominent confluent T2-hyperintense white matter lesions in the bilateral temporo-occipital subcortical areas. Suspecting CAAri, we prescribed steroid pulse therapy with oral steroid tapering. The acute delirium and agitation improved after medication. However, the CAAri-induced damage to the brain function persisted, as evidenced in the follow-up clinical performance and serial Mini-Mental State Examination (MMSE).

The identification and accurate diagnosis of CAAri are important because the disease may respond to immunosuppressive therapy. In clinical settings, the detection of CAA with diffuse microbleeds in the brain is essential for making a tentative diagnosis of CAAri. Immunosuppressive therapy is the cornerstone of treatment. However, the optimal treatment duration is currently uncertain and warrants further investigation. In conclusion, the possible diagnosis of CAAri should always be considered when a patient presents with sub-acute cognitive decline and compatible MRI findings (T2-hyperintense lesions with diffuse microbleeds).

Essential tremor is the most prevalent form of movement disorders in the world and is 10 times more prevalent than that of Parkinson’s disease. Even though it is traditionally considered as a benign disease all the patients of essential tremor have tremor induced disabilities. Essential tremor which shows kinetic, postural and resting is tremor mimicker of all tremor associated disease so often misdiagnosed and mismanaged. This article is authors’ endeavor to summarize the facts in different publications on essential tremor. Electronic databases like MEDLINE/Pub Med, Google Scholar, IMSEAR (Index Medicus for South-East Asia Region) and Scopemed were extensively searched with MeSH (Medical Subject Headings) terms “essential tremor”, “clinical features” “pathophysiology” and “treatment” from the earliest possible date of 1966 to Feb 2017. Articles in any languages especially those published in recent years were given preference. This review deals mostly with the clinical features and evidence-based management of essential tremor.

Background: Despite an overabundance of literature the PubMed database has more than 50,000 hits for the search term “traumatic brain injury” the complex area of TBI is actually somewhat overlooked in both medical training and subsequent general medical and neuropsychiatric practice. We pretend to review the available literature on the effects of hypocalcaemia regarding prognosis in early phases after moderate- severe TBI, to identify the gaps in the literature, and to try filling these gaps by including our proposed pathophysiological schema leading to posttraumatic hypocalcaemia. Material and methods: The data from 282 patients (180 retrospective and 102 prospective) suffering moderatesevere TBI distributed in three different works was analyzed. Patients meeting the following criteria were included: Age: 16 to 87 years, Glasgow Coma Scale (GCS) from 3 to 13 points, Cranial Computed Tomography (CCT) upon admission and Calcium and/or ionized calcium measurements taken on the day of TBI, as well as on days 3 and 7. Results: The expectation that non-ionized serum calcium (serum calcium), as seen in the collective of 122 Mexican patients, would be a significant predictive factor regarding TBI was surprisingly, not the case; rather, in the retrospective and prospective German patient collectives, this factor was non-significant. Instead, a more specific calcium measure, namely ionized serum calcium, was significant as a predictor regarding mortality/morbidity in patients suffering TBI. Conclusion: Hypocalcaemia is a marker for the depth of brain damage as a result of a cascade of various pathologic mechanisms such as direct mechanical trauma, neuro-inflammation, altered vessel-autoregulation and hypoxia.

Medullar infarcts are rare and are responsible for various neurological deficits that may consist of severe paraplegia or quadriplegia. The incidence of medullar infarcts is very low compared to that of cerebral infarcts

We report a case of medullar infarct of the posterior spinal cervical area observed in a 55-year-old patient hospitalized in the neurology department of the University Hospital of Cocody, Abidjan, Ivory Coast.

Introduction: As depression is a multifactorial disease, it has been treated using medications, psychotherapy, dietary reeducation and various complementary treatments, including neurofeedback. Of the symptoms, impairment in the level of attention has been a concern for several researchers because of the risk of accidents.

Objective: The aim of this study was to evaluate changes in the level of attention of patients with depression treated by QEEG of the neurofeedback TQ-7 system.

Method: Forty-one patients of both genders were evaluated: 13 male and 28 female patients. The evaluation was divided into three steps. In the first, The Learning Curve (TLC) research protocol of the TQ-7 system was used; in the second stage, the level of attention of patients was evaluated before treatment and in the last stage, it was evaluated after treatment. The Digit symbol, d2, Digit Span in correct and inverse order and the Paced Auditory Serial Addition Test (PASAT) were used to assess attention. The results were analyzed using the paired t-test and expressed as means ± standard error of the mean (SEM) with significance set for p-values ≤0.05.

Results: For both women and men, the scores for focus improved with training by 0.429 and 13.461 (p-value <0.001 for both), sustained attention improved by 39.07 (p-value=0.033) and 69.61 (p-value <0.001), and resistance to interference improved by 0.4 and 2.24 (p-value=0.005 for both), respectively. Short-term memory improved significantly just for the women (0.68; p-value <0.001).

Conclusion: The level of attention increases in patients with depression when treated by QEEG using the neurofeedback TQ-7 system.

Newer antiepileptic drugs (AEDs) are supposed to be more beneficial at controlling seizures than older AEDs. We substituted newer AEDs for older AEDs while conducting a transient add-on of an intravenous (IV) antiepileptic drug (AED) as a base therapy (AED adjustment), and in the present paper we evaluate the efficacy and safety of this method. The study participants were 40 consecutive referral patients with intractable epilepsy who had been treated with two or more AEDs but had epileptic seizure which spoiled their quality of life. Five of the patients were excluded because any IV AEDs exacerbated their clinical seizures and electro-encephalography (EEG). The mean age of the remaining 35 patients was 7.5 (range: 1.2 - 20.5). The patients had been on two to five AEDs (mean 3.3), and experienced seizures ranging from 0.2 to 100 times/day (mean 13.0). We kept the patients on one or two key oral AEDs and terminated the other oral AEDs simultaneously while they were treated with a base IV AED. After adjusting their dose, the patients were on two to four oral AEDs (mean 2.8) two years later, and the frequency of seizures was reduced to 0 to 10 times/day (mean 1.4). It took about one month of hospitalization to adjust the AEDs, and both seizure frequency and the number of drugs decreased significantly after AED adjustment (p<0.001). There were no serious side effects of clinical seizures or in their blood and chemistry tests. The adjusted AEDs included newer ones, and the older ones were still necessary. AED adjustment was possible and useful for epileptic patients once a transient add-on of intravenous antiepileptic drugs was done.