-
Journal of Neurovirology Oct 2023Intensive immunosuppression has enabled liver transplantation even in recipients with preformed donor-specific antibodies (DSA), an independent risk factor for graft...
Intensive immunosuppression has enabled liver transplantation even in recipients with preformed donor-specific antibodies (DSA), an independent risk factor for graft rejection. However, these recipients may also be at high risk of progressive multifocal encephalopathy (PML) due to the comorbid immunosuppressed status. A 58-year-old woman presented with self-limited focal-to-bilateral tonic-clonic seizures 9 months after liver transplantation. She was desensitized using rituximab and plasma exchange before transplantation and was subsequently treated with steroids, tacrolimus, and everolimus after transplantation for her preformed DSA. Neurological examination revealed mild acalculia and agraphia. Cranial MRI showed asymmetric, cortex-sparing white matter lesions that increased over a week in the left frontal, left parietal, and right parieto-occipital lobes. Polymerase chain reaction (PCR) of the cerebrospinal fluid for the JC supported the diagnosis of PML. Immune reconstitution by reducing the immunosuppressant dose stopped lesion expansion, and PCR of the cerebrospinal fluid for the JC virus became negative. Graft rejection occurred 2 months after immune reconstitution, requiring readjustment of immunosuppressants. Forty-eight months after PML onset, the patient lived at home without disabling deficits. Intensive immunosuppression may predispose recipients to PML after liver transplantation with preformed DSA. Early immune reconstitution and careful monitoring of graft rejection may help improve outcomes.
Topics: Humans; Female; Middle Aged; Leukoencephalopathy, Progressive Multifocal; Liver Transplantation; Living Donors; JC Virus; Immunosuppressive Agents
PubMed: 37668873
DOI: 10.1007/s13365-023-01171-x -
Rinsho Shinkeigaku = Clinical Neurology Aug 2023A 72-year-old male developed neurological symptoms such as difficulty in charging his electronic money card and making his mobile-phone call ten months before admission....
[Classical cortical superficial siderosis presenting as extensive higher brain dysfunction with hypoperfusion in the frontoparietal lobe on the I-IMP-SPECT: a case report].
A 72-year-old male developed neurological symptoms such as difficulty in charging his electronic money card and making his mobile-phone call ten months before admission. On admission, neurological examination revealed extensive higher brain dysfunction such as impairment in recent memory, executive function disorders, constructional disturbance, agraphia and acalculia. Brain MRI revealed a low intensity lesion on the surface of the cerebral cortex diffusely and symmetrically on T*-weighted images. MRI images are consistent with superficial siderosis. However, the lack of hemosiderin deposition in the brain stem and cerebellar hemisphere was atypical of the classical type of superficial siderosis. I-IMP-SPECT revealed hypoperfusion dominantly in the left hemisphere, particularly in the left frontal and parietal lobes. According to the Boston criteria, the patient with the cerebral microbleeds and cortical superficial siderosis was diagnosed with probable CAA (cerebral amyloid angiopathy).
Topics: Male; Humans; Aged; Siderosis; Brain Diseases; Cerebral Amyloid Angiopathy; Cerebral Cortex; Magnetic Resonance Imaging; Tomography, Emission-Computed, Single-Photon; Cerebral Hemorrhage
PubMed: 37518020
DOI: 10.5692/clinicalneurol.cn-001828 -
Cortex; a Journal Devoted To the Study... Sep 2023It has been suggested that Gerstmann's syndrome is the result of subcortical disconnection rather than emerging from damage of a multifunctional brain region within the...
It has been suggested that Gerstmann's syndrome is the result of subcortical disconnection rather than emerging from damage of a multifunctional brain region within the parietal lobe. However, patterns of white matter tract disconnection following parietal damage have been barely investigated. This single case study allows characterising Gerstmann's syndrome in terms of disconnected networks. We report the case of a left parietal patient affected by Gerstmann's tetrad: agraphia, acalculia, left/right orientation problems, and finger agnosia. Lesion mapping, atlas-based estimation of probability of disconnection, and DTI-based tractography revealed that the lesion was mainly located in the superior parietal lobule, and it caused disruption of both intraparietal tracts passing through the inferior parietal lobule (e.g., tracts connecting the angular, supramarginal, postcentral gyri, and the superior parietal lobule) and fronto-parietal long tracts (e.g., the superior longitudinal fasciculus). The lesion site appears to be located more superiorly as compared to the cerebral regions shown active by other studies during tasks impaired in the syndrome, and it reached the subcortical area potentially critical in the emergence of the syndrome, as hypothesised in previous studies. Importantly, the reconstruction of tracts connecting regions within the parietal lobe indicates that this critical subcortical area is mainly crossed by white matter tracts connecting the angular gyrus and the superior parietal lobule. Taken together, these findings suggest that this case study might be considered as empirical evidence of Gerstmann's tetrad caused by disconnection of intraparietal white matter tracts.
Topics: Humans; Gerstmann Syndrome; White Matter; Parietal Lobe; Brain; Agnosia
PubMed: 37478549
DOI: 10.1016/j.cortex.2023.05.016 -
Acta Neurologica Belgica Oct 2023
Topics: Male; Humans; Aged; Alexia, Pure; COVID-19; Stroke; Agraphia
PubMed: 35750954
DOI: 10.1007/s13760-022-02014-y -
Physiotherapy Theory and Practice Oct 2023This report examines the effects of a multimodal rehabilitation program which includes cognitive, physical, and somatosensory rehabilitation after right temporo-parietal...
The effects of cognitive, physical, and somatosensory rehabilitation after right temporo-parietal tumor resection on cognitive, motor, somatosensory, and electrophysiological parameters: A case report.
INTRODUCTION
This report examines the effects of a multimodal rehabilitation program which includes cognitive, physical, and somatosensory rehabilitation after right temporo-parietal tumor resection on cognitive, motor, somatosensory, and electrophysiological parameters.
CASE DESCRIPTION
A 22-year-old patient presented with sensory loss in the dominant left hand and reduced writing ability after right temporo-parietal lobe resection. Cognitive, motor, and sensory evaluations were carried out pre and post-treatment. The patient's spontaneous electroencephalo-gram (EEG) and an EEG during application of transcutaneous electrical nerve stimulation (TENS) (TENS EEG) were recorded. As a reference for the patient's electrophysiological values, EEGs of 4 healthy individuals were also taken. Over a period of 1 year, the patient received multimodal rehabilitation which includes cognitive, physical, and somato-sensory rehabilitation on 2 days each week.
OUTCOMES
An improvement of the patient's cognitive capacities, motor strength, superficial, deep and cortical sensations was achieved. After rehabilitation, an increase in parietal and occipital alpha activity as well as in frontal and parietal beta activity was seen both in spontaneous EEG and in TENS EEG. With increasing TENS intensity, alpha and beta power increased as well.
CONCLUSION
Our findings suggest that a multimodal rehabilitation program may improve cognitive, sensory, and motor effects after resection due to tumor surgery.
Topics: Humans; Young Adult; Adult; Parietal Lobe; Hand; Electroencephalography; Cognition; Neoplasms; Transcutaneous Electric Nerve Stimulation
PubMed: 35436161
DOI: 10.1080/09593985.2022.2064787 -
Disability and Rehabilitation.... Nov 2023Learning disabilities or learning disorders are umbrella terms used for wide variety of learning problems like Dyslexia, Dyscalculia, Dysgraphia, and Dyspraxia. These...
PURPOSE
Learning disabilities or learning disorders are umbrella terms used for wide variety of learning problems like Dyslexia, Dyscalculia, Dysgraphia, and Dyspraxia. These disabilities are due to the neurological disorders which affects brain functions. Early diagnosis of these disabilities in kids from age 3 to 6 will help to start early medical treatments and get them back to the normal condition.
MATERIAL AND METHOD
we developed a software-based Learning Disability Evaluation Kit called YALU with computer Game Modules for kids targeting their learning disabilities. These Computer game-based modules of the YALU consist of different tasks for the different age levels to identify the symptoms of the disabilities mentioned above. The children's interaction results to each task of the game modules with the answers of the questioner about the children given by the parents will be evaluated with the threshold values given by a panel of consultant psychologist and paediatrician of the normal kids to identify the learning disabilities in kids aged 3-6 years. The result will be given to the respective parties and uploaded to the Website under the child's name.
RESULT
YALU has been tested using 50 students in age 3-5 in three preschools. The teachers have identified Fourteen students with some learning disability symptoms. Using YALU, twelve out of fourteen students had been clearly identified. Hence, the YALU Evaluation Kit to have an accuracy 85% in diagnosing the right disability. However, the accuracy could be increased with the accurate assessments of the parents about their kids.IMPLICATIONS FOR REHABILITATIONLearning disabilities are neurological disorders that affect the brain's ability to receive, process, store, respond to and communicate information; and there are four types (Dyslexia, Dyspraxia, Dysgraphia and Dyscalculia)In this paper, we present the extracted computational techniques targeting the Dyslexia, Dyspraxia, Dysgraphia and Dyscalculia and developed a software application (YALU Learning Disability Evaluation Kit) which consists of computer game modules for the kids for evaluation their learning disabilities.The developed game modules can screen the learning disabilities and these gamification modules (YALU) consists of tasks which are based on symptoms of the said disabilities. The outcomes of each module is evaluated these learning disabilities in kids age from 3 years to 6 years by analysing children's interactions to the each tasks, the child condition and then compare the result with the threshold values of the normal kids given by consultant psychologist and paediatrician.
Topics: Child; Child, Preschool; Humans; Dyscalculia; Agraphia; Learning Disabilities; Dyslexia; Apraxias; Early Diagnosis; Video Games
PubMed: 34784486
DOI: 10.1080/17483107.2021.2003454 -
Journal of Neurosurgical Sciences Apr 2024Deep brain stimulation (DBS) has been proven to be a safe, reversible, cost-effective procedure for treatment of Parkinson's disease. Final electrode position remains a...
BACKGROUND
Deep brain stimulation (DBS) has been proven to be a safe, reversible, cost-effective procedure for treatment of Parkinson's disease. Final electrode position remains a significant factor determining the outcomes of subthalamic nucleus DBS (STN-DBS). This study aims to analyze the final lead position in three-dimensional plane and its effect on gross and fine motor outcomes in cases of advanced Parkinson's disease operated for STN-DBS.
METHODS
Patients who underwent bilateral STN-DBS were prospectively followed for improvement in gross motor outcomes at 6 months. Improvement in dysgraphia was analyzed by Fahn-Tolosa-Marin Tremor Rating Scale Part B Score. Postoperative outcomes were correlated with final electrode position.
RESULTS
A total of 64 Patients (128 leads) were analyzed. Patients who were less than 65 years of age at time of surgery had more significant reduction in UPDRS III (P=0.02). Cases with deviation of left x less than 3 mm had significant reduction in UPDRS III (P=0.05) and speech sub-scores (P=0.05). Deviation less than 2 mm in left x was associated with reduction in gait sub-scores (P=0.04). Optimal placement of right y electrode was associated with reduction in UPDRS III (P=0.02). Significant reduction in Fahn-Tolosa-Marin Tremor Rating Scale Part B Score was noted after DBS (P=0.001).
CONCLUSIONS
Subthalamic nucleus DBS thus results in significantly improved functional outcome particularly in patients with age less than 65 years. Accurate final electrode position is associated with maximum clinical benefit and improvement in dysgraphia.
Topics: Humans; Aged; Parkinson Disease; Tremor; Agraphia; Treatment Outcome; Deep Brain Stimulation; Electrodes
PubMed: 34647713
DOI: 10.23736/S0390-5616.21.05461-8