Arash Salardini

Posterior reversible encephalopathy syndrome (PRES) and CT perfusion changes

Posterior reversible encephalopathy syndrome ( PRES) can present with focal neurologic deficits, mimicking a stroke and can often represent a diagnostic challenge when presenting atypically. A high degree of suspicion is required in the clinical setting in order to yield the diagnosis. Cerebral CT perfusion (CTP) is utilized in many institutions as the first line in acute stroke imaging. CTP has proved to be a very sensitive measure of cerebral blood flow dynamics, most commonly employed to delineate the infarcted tissue from penumbra (at-risk tissue) in ischemic strokes. But abnormal CTP is also seen in stroke mimics such as seizures, hypoglycemia, tumors, migraines and PRES. In this article we describe a case of PRES in an elderly bone marrow transplant recipient who presented with focal neurological deficits concerning for a cerebrovascular accident. CTP played a pivotal role in the diagnosis and initiation of appropriate management. We also briefly discuss the pathophysiology of PRES.

Botulinum Toxin A for Treatment of Allodynia of Complex Regional Pain Syndrome: A Pilot Study

OBJECTIVE To investigate the efficacy and tolerability of Botulinum toxin A (BoNT-A) in allodynia of patients with complex regional pain syndrome. DESIGN A total of 14 patients were studied. Eight patients were participants of a randomized, prospective, double-blind, placebo-controlled protocol. Six patients were studied prospectively in an open-label protocol. Patients were rated at baseline and at 3 weeks and 2 months after BoNT-A administration. Ratings included brief pain inventory, McGill pain questionnaire, clinical pain impact questionnaire, quantitative skin sensory test, sleep satisfaction scale, and patient global satisfaction scale. BoNT-A was injected intradermally and subcutaneously, five units/site into the allodynic area (total dose 40-200 units). RESULTS None of the patients with allodynia showed a significant response after treatment. The treatment was painful and poorly tolerated. CONCLUSION Intrademal and subcutaneous administration of BoNT-A into the allodynic skin of the patients with complex regional pain syndrome (CRPS) failed to improve pain and was poorly tolerated.

Radiotherapy in Larynx Squamous Cell Carcinoma is not Associated with an Increased Diagnosis of Second Primary Tumours

AIMS Larynx cancer is the most common form of head and neck squamous cell carcinoma (HNSCC). Radiotherapy is a major treatment modality and is implicated in the possible formation of second primary tumours (SPT). The aims of this retrospective study were to establish the incidence of SPTs and their correlation with previous radiotherapy and to establish overall survival and the SPT diagnostic time lag from the index tumour according to subtype as well as radiotherapy status. MATERIALS AND METHODS In a retrospective study of 987 patients with larynx SCCs (1967-2004) associations between radiotherapy, diagnosis of SPTs, median SPT diagnostic time lag, disease-free survival and overall survival were analysed. RESULTS In total, 184 (18.6%) patients developed metachronous SPTs with an overall survival of 93.0 (standard error 6.8 months). One hundred and seventy (92.4%) underwent radiotherapy, whereas 14 (7.6%) patients were not exposed to radiotherapy. No significant increased incidence of SPT was shown in the radiotherapy group. A statistically non-significant increase in SPT diagnostic time lag trend was noted for both HNSCC SPTs (radiotherapy vs non-radiotherapy; 76.0 [standard error 6.7] vs 50.0 [standard error 23.0]) and lung SPTs (45.0 [standard error 12.1] vs 24.0 [standard error 4.9]) months. CONCLUSION This study suggests that radiotherapy is not a risk for SPT induction; it may, however, neutralise a proportion of cancerised fields in the lung and head and neck areas without any significant benefit on overall survival.

Serotonergic neurons in the brainstem of the wallaby, Macropus eugenii.

The organisation and cytoarchitecture of the serotonergic neurons in a diprotodont marsupial were examined by using serial sections of the brainstem processed for serotonin immunohistochemistry and routine histology. The topographic distribution of serotonergic neurons in the brainstem of the adult wallaby (Macropus eugenii) was similar to that of eutherian mammals. Serotonergic neurons were divided into rostral and caudal groups, separated by an oblique boundary through the pontomedullary junction. Approximately 52% of the serotonergic neurons in the wallaby brainstem were located in the rostral midline nuclei (caudal linear nucleus, dorsal, median, and pontine raphe nuclei and the interpeduncular nucleus), whereas 21% were found in the caudal midline region (nuclei raphe magnus, obscurus, and pallidus). The remaining serotonergic neurons (27%) were located in more lateral regions such as the pedunculopontine tegmental nuclei, the supralemniscal nuclei (B9 group), and the ventrolateral medulla. The largest serotonergic group, the dorsal raphe, contained one‐third of the brainstem serotonergic neurons and showed five subdivisions, similar to that described in other species. In contrast, the median raphe did not show clear subdivisions. The internal complexity of the raphe nuclei and the degree of lateralisation of serotonergic neurons suggest that the wallaby serotonergic system is similar in organisation to that described for the cat and rabbit. This study supports the suggestion that the serotonergic system is evolutionally well conserved and provides baseline data for a quantitative study of serotonergic innervation of the developing cortex in the wallaby. J. Comp. Neurol. 411:535–549, 1999.

Diagnosis of second head and neck tumors in primary laryngeal SCC is an indicator of overall survival and not associated with poorer overall survival: A single centre study in 987 patients

Second primary tumors (SPTs) have been implicated in poor overall survival (OS) of head and neck squamous cell carcinomas (HNSCCs). Confusion remains regarding their actual incidence and prognostic impact. This study assessed the incidence of SPTs; the SPT diagnostic time lag; the impact on OS; and the mean annual risk.

Radiotherapy is not associated with an increased rate of Second Primary Tumours in Oral Squamous Carcinoma: A study of 370 patients

Oral Squamous Cell Carcinoma (OSCC) remains a public health scourge. Radiotherapy (RT) is a major treatment modality and has been implicated in possible formation of Second Primary Tumours (SPT). In a single centre retrospective study of 370 patients with OSCCs (1967-2004) associations between RT, diagnosis of SPTs, median SPT diagnostic time lag, Disease Free Survival (DFS) and overall survival (OS) were analysed. Sixty-eight (18.4%) patients developed metachronous SPTs. Two hundred and twenty patients (59.3%) underwent some form of RT whilst 151 (40.7%) patients were not exposed to RT. No significant increased incidence of SPTs was demonstrated in the RT group. No significant difference in SPT diagnostic time lag was noted amongst the groups. This study suggests that RT is neither a risk for SPT induction nor increases the relative diagnostic time delay of upper aero-digestive tract SPTs.

Relief of intractable pruritus after administration of botulinum toxin A (botox): a case report.

A 55-year-old woman sought assistance for intractable pruritus of 6-year duration, affecting the right side of the forehead. She had surgery on the right frontal area for treatment of a frontal sinus condition, a few years earlier. The itch failed to respond to a variety of medical interventions, including oral antipruritic agents and local injections of anesthetic. Administration of botulinum toxin A (Allergan Inc, Irvine, CA) into the pruritic area resulted in a significant relief of pruritus in this patient.

Mutant p53 and cyclin A1 protein expression in primary laryngeal squamous cell carcinomas do not correlate to second primary tumours of the head and neck.

Background:  Field cancerization is a feature of head and neck squamous cell carcinoma. No biological marker in the index tumour has been correlated to the development of second primary tumours (SPT). Cyclin A1 is a cell cycle regulator and a downstream target of p53. This study assessed predictive correlation of cyclin A1 and mut‐p53 with clinicopathological parameters and occurrence of (SPT) 7in the head and neck.

Ipsilateral synkinesia involves the supplementary motor area

The supplementary motor area coordinates movements. Synkinesia is a rare disorder in which an involuntary movement occurs coordinated with a voluntary movement. Here, we test the hypothesis that the supplementary motor area is involved in involuntary coordination of movement. We collected functional magnetic resonance imaging (fMRI) data from two patients with ipsilateral hand-foot synkinesia and two control participants while they performed rhythmic tasks. In synkinesia patients, both the supplementary motor area and the foot motor cortex were significantly activated during the hand motor task. This pattern was not seen in controls. Our findings suggest that the supplementary motor area plays a central role in involuntary coordination observed in synkinesia, and provides insight into how the supplementary motor area orchestrates movements.

Second Primary Tumours of the Head and Neck are not Associated With Adverse Overall Survival in Oral Sccs

Objective: Second primary tumours (SPT) have been implicated in the dismal overall survival (OS) of head and neck Squamous cell carcinomas (HNSCC). The incidence of SPT, the SPT diagnostic time-lag and the impact on OS were assessed. Subjects and methods: 363 consecutive patients treated for primary Oral SCCs (1967-2004) were analyzed retrospectively in this study. 95.1% and 90.5% of patients reached a minimum follow-up period of 3 and 5 years respectively. Results: Of 363 patients; 68 (18.7%) were diagnosed with metachronous SPT, 49 (13.5%) developed upper aerodigestive tract (UAD)-SPT, 28 (7.7%) were diagnosed with HNSCC-SPT, and 21 (5.8%) developed lung or esophageal carcinoma. Patients with subsequent HNSCC-SPT had a better median survival during follow-up than those not diagnosed with SPTs (p=0.0018). The rate of mortality in these patients showed a substantial increase compared to patients with no subsequent SPT Diagnosis after 144 months. After 200 months the survival experience was no better than those without SPT. Conclusion: These results suggest a better OS for patients afflicted with HNSCC-SPT. This also reflects that at least some of the noted improved OS of HNSCC-SPT patients is due to temporally cumulated risk associated with developing SPT.