Agata Zajkowska

Evaluation of Visinin-Like Protein 1 Concentrations in the Cerebrospinal Fluid of Patients with Mild Cognitive Impairment as a Dynamic Biomarker of Alzheimer's Disease

BACKGROUND The correlations between pathology of neurodegenerative diseases, especially Alzheimers disease (AD), and concentrations of neuronal calcium sensor proteins, such as visinin-like protein 1 (VILIP-1), in cerebrospinal fluid (CSF) have been discussed in the literature but its utility as biomarker of AD in comparison with mild cognitive impairment (MCI) has not been studied yet. OBJECTIVE Therefore, the aim of our study was to assess the clinical utility of the measurement of CSF concentrations of VILIP-1 in patients with AD, MCI subjects, and non-demented controls. The clinical and neuropsychological diagnoses were supported by CSF biomarkers of neurochemical dementia diagnostics: decreased concentrations of Aβ1-42 and/or Aβ42/40 ratio and increased concentrations of Tau and pTau181 proteins. METHODS The study included 33 AD patients, 15 subjects with MCI, and 18 elderly individuals without cognitive deficits. The CSF concentrations of biomarkers tested were determined by using the ELISA method. RESULTS Concentrations of VILIP-1 in CSF were significantly higher in AD patients compared to the MCI subjects and elderly individuals without cognitive impairment. Increased concentrations of VILIP-1 correlated significantly with reduced Aβ42/40 ratio and higher pTau181 in AD group. CONCLUSION Our findings suggest that VILIP-1 may play a role in the AD pathophysiology and is a good candidate for dynamic biomarker of AD, although this issue requires further investigation.

Cerebrovascular Manifestations of Lyme Neuroborreliosis—A Systematic Review of Published Cases

Background Lyme neuroborreliosis (LNB) is a disease caused by spirochete Borrelia burgdorferi, involving the nervous system. It usually manifests as lymphocytic meningoradiculitis, but in rare cases, it can also lead to cerebrovascular complications. We aimed to perform a systematic review of all reported cases of LNB complicated by central nervous system vasculitis and stroke or transient ischemic attack (TIA). Materials and methods We conducted a systematic review of literature between May 1987 and December 2016 with patients who presented with cerebrovascular course of LNB. Results This study included 88 patients with a median age of 46 years. The median interval from onset of symptoms suggesting Lyme disease to first symptoms of cerebrovascular manifestations of LNB was 3.5 months. The most common cerebrovascular manifestation of LNB was ischemic stroke (76.1%), followed by TIA (11.4%). The posterior circulation was affected alone in 37.8% of patients, the anterior circulation in 24.4% of patients, and in 37.8% of cases, posterior and anterior circulations were affected simultaneously. The most common affected vessels were middle cerebral artery—in 19 cases, basilar artery—in 17 cases, and anterior cerebral artery—in 16 cases. A good response to antibiotic treatment was achieved in the vast number of patients (75.3%). The overall mortality rate was 4.7%. Conclusion Cerebral vasculitis and stroke due to LNB should be considered, especially in patients who live in or have come from areas with high prevalence of tick-borne diseases, as well as in those without cardiovascular risk factors, but with stroke-like symptoms of unknown cause.

Listerial Rhombencephalitis in an Immunocompetent Woman

Listeriosis usually affects immunocompromised patients including elderly people and pregnant women, but it may also affect otherwise healthy individuals. In our report, we present a case of a rare and very severe form of listeriosis-rhombencephalitis in a 61-year-old female with no history of immunosuppression, who, because of history, clinical picture, and laboratory results as well as negative cultures, was at first diagnosed with viral encephalitis. This paper underlines that Listeria monocytogenes infection should be taken into consideration in case of lymphocytic encephalitis even in immunocompetent patients. Typical MRI picture may be crucial in establishing a proper diagnosis as the lab results may be misleading.

Infectious spondylodiscitis – A case series analysis

PURPOSE We aimed to describe the clinical and laboratory features as well as diagnostic difficulties in the case series of spondylodiscitis. MATERIALS/METHODS We retrospectively reviewed 11 cases of spondylodiscitis. The diagnosis of spondylodiscitis was based on clinical, radiological and microbiological evidence and by the response to antimicrobial therapy. RESULTS There were 7 men and 4 women, and the age ranged from 21 to 74 years. Risk factors of spondylodiscitis were observed in 7 patients. The approximate time from onset of symptoms to diagnosis was from 2 to 7 months (median 45 days). Back pain was the most common symptom. The most frequent location of spondylodiscitis was lumbar spine. Pathogens were isolated in 6 cases and were as follows: Staphylococcus aureus (4 cases), Staphylococcus warneri (1 case) and Escherichia coli (1 case). After therapy, all patients had rapid regression of symptoms and no permanent neurological impairments and recurrence of infection were observed. CONCLUSIONS Diagnosis of spondylodiscitis is frequently delayed. This disease should be taken into consideration in differential diagnosis in patients with root syndromes accompanied by back pain and usually fever as well as increased values of CRP and ESR.

Meningitis, Clinical Presentation of Tetanus

Background. Tetanus is an acute disease caused by a neurotoxin produced by Clostridium tetani. Tetanus immunization has been available since the late 1930s but sporadic cases still occur, usually in incompletely vaccinated or unvaccinated individuals. Case Report. An elderly previously vaccinated female contracted tetanus following foot injury. Clinically she presented with meningitis causing diagnostic and therapeutic delays. Why Should Physician Be Aware of This? Even in developed countries the differential diagnosis of meningitis, especially in the elderly, should include tetanus. Treatment in intensive care unit is required. General population might benefit from vaccine boosters and education on this potentially fatal disease.

Blindness resulting from orbital complications of ophthalmic zoster

Herpes zoster ophthalmicus occurs when the latent varicella zoster virus (VZV) reactivates in the trigeminal ganglion and ophthalmic branch of the trigeminal nerve. In the elderly, there is a sharp increase in the tendency of secondary skin bacterial infections occurrence due to the deterioration of capabilities of self-care and changed sanitation. We present a case of patient who developed phlegmon of the orbit, which resulted with complete unilateral blindness. Varicella zoster virus infection in the elderly may have a severe course due to the progressive weakening of the immune system related to the age. Moreover, skin lesions around the eye socket require special care in prevention of bacterial superinfections due to the extremely high risk of life-threatening complications or disability. Neuralgia resistant to pharmacological treatment present in the course of ophthalmic zoster and difficulty in caring about skin lesions predispose to the occurrence of complications.

Madelung's disease in a patient with chronic alcohol abuse

A 47-year-old man with a history of chronic alcohol abuse was admitted to our hospital because of symmetrical face soft tissue enlargement for differential diagnosis. The lesions had appeared 4 years earlier and had been asymptomatic. Physical examination revealed painless, elastic tumors of the subcutaneous tissue in the mandibular angle region, with no clear relation to lymph nodes or salivary glands (Figure 1A). The laboratory tests showed elevated aspartate aminotransferase (ALT), 127 U/l; elevated alanine aminotransferase (ALT), 91 U/l, elevated γ-glutamyl transpeptidase (GGT), 643 U/l, and elevated lactate dehydrogenase (LDH) activity, 342 U/l. Test for antinuclear antibodies (ANA) was negative. HIV and HCV infections were excluded. Lipid profile results were within the normal range. An abdominal ultrasound revealed a fatty liver, but no other abnormality was noted. Ultrasonography of the parotid, submandibular and cervical region confirmed the correct size and structure of the salivary and thyroid glands and slight enlargement of the lymph nodes in both submandibular regions. In the place of visible symmetric thickening there was a tissue described as lipofibroma, 49 mm × 24 mm on the right side and 44 mm × 23 mm in size on the left side. Fine-needle biopsy revealed lipomatous tissue. A diagnosis of Madelungs disease was made. Figure 1 A – Frontal view of the patient at time of first hospitalization with visible symmetrical fatty masses. B, C – Frontal and lateral view of the patient at follow-up visit after 1 year; increase in the primary fatty deposit At the follow-up visit after 1 year, the patient had a computed tomography (CT) scan performed, which showed a slight increase in the primary fatty deposit and the appearance of another in the neck area (Figure 2A–C). Six months later the patient was disqualified from surgical treatment. The decision was motivated by the non-life-threatening condition and asymptomatic nature of the masses. Figure 2A–C Head and neck CT showing the symmetrical enhancement of the lipomatous tissue Madelungs disease (also known as benign symmetric lipomatosis or Launois-Bensaude syndrome) is a rare metabolic disorder of unknown etiology [1]. This disease usually affects men at the age of 30 to 60 years from the Mediterranean area. In reported cases, almost 90% of patients had a history of long-term alcohol abuse [2]. The disease is characterized by the presence of prominent, symmetrical deposits of non-encapsulated adipose tissue in the region of head, neck, nape and upper parts of the trunk [2, 3]. In contrast to other cases described in the literature, in our patient, the primary subcutaneous fat masses appeared in the parotid region, while the most common initial location is the neck. Although benign in nature, sometimes the fatty masses can reach very large sizes causing dyspnea, dysphagia, fatigue, and reduced neck movement ability [4]. The differential diagnosis includes familial multiple lipomatosis, simple obesity, Cushings syndrome, angiolipoma, neurofibroma and liposarcoma [2, 4, 5]. The most effective treatment is surgery, especially in patients with esthetic deformity or compression of the aerodigestive tract [1, 3].