G. P. Paraskevas

Cerebrospinal fluid tau, phospho-tau181 and β-amyloid1−42 in idiopathic normal pressure hydrocephalus: a discrimination from Alzheimer's disease

The aim of the present study was the quantitation of total tau protein (τT), tau phosphorylated at threonine 181 (τP‐181) and β‐amyloid1−42 (Aβ42) in the cerebrospinal fluid (CSF) of patients with idiopathic normal pressure hydrocephalus (iNPH), Alzheimers disease (AD) and controls. Double sandwich ELISAs (Innogenetics) were used for the measurements. Total tau was significantly increased in iNPH and highly increased in AD as compared with the control group, whilst Aβ42 was decreased in both diseases. CSF τP−181 levels were significantly increased only in AD, but not in iNPH as compared with the controls. A cut‐off level for τT at 300 pg/ml, successfully discriminated AD from normal aging with a 95.8% specificity and 91% sensitivity; whilst the τP‐181/τT ratio (cut‐off value 0.169) was more specific (100%) but less sensitive (92.5%). For the discrimination of iNPH from AD τT achieved low specificity (77.8%) but high sensitivity (92.5%), whilst τP‐181 (cut‐off value 47.4) was both sensitive and specific (88.7% and 86.7% respectively) for the discrimination of these disorders. The present study, despite being clinical, supports the notion that CSF τP‐181 alone or in combination with τT may be a useful marker in the discrimination of iNPH from AD.

CSF tau protein and β‐amyloid (1–42) in Alzheimer's disease diagnosis: discrimination from normal ageing and other dementias in the Greek population

Cerebrospinal fluid (CSF) levels of tau protein and amyloid β(1–42) peptide (Aβ42) have been suggested as possible diagnostic markers of Alzheimers disease (AD). In order to evaluate their diagnostic potential in clinical practice, we measured tau and Aβ42 levels in the CSF of 49 AD patients, 15 patients with non‐AD neurodegenerative dementias (NAND), six patients with vascular dementia (VD) and 49 elderly controls. All the subjects were of Greek origin. A marked increase in tau, a decrease in Aβ42 and a marked increase in the tau/Aβ42 ratio was noted in AD. Aβ42 alone had a specificity of 80% and a sensitivity of 82% in differentiating AD from normal ageing, whilst the corresponding values for differentiating AD from NAND or VD were 80 and 71, or 67 and 82%, respectively. Tau was better in differentiating AD, from normal ageing (specificity 96%, sensitivity 88%), NAND (specificity 93%, sensitivity 71%) and VD (specificity 83%, sensitivity 94%). The tau/Aβ42 ratio achieved values comparable or even better than tau for differentiating AD from normal ageing (specificity 86%, sensitivity 96%) and VD (specificity 83%, sensitivity 90%) and definitely better than any of the candidate markers alone, for differentiating AD from NAND (specificity 100%, sensitivity 71%). Thus, the combined use of CSF tau and Aβ42 in the form of the tau/Aβ42 ratio is a simple, safe and useful adjuvant to clinical criteria for dementia diagnosis.

The Stroop Effect in Greek Healthy Population: Normative Data for the Stroop Neuropsychological Screening Test

The Stroop Test is a quick and frequently used measure in screening for brain damage, dysfunction of selective attention, and cognitive flexibility. The purpose of the present study is to provide normative data for Trenerrys Stroop Neuropsychological Screening Test (SNST) in a sample of 605 healthy Greek participants (age range: 18-84 years, education range: 6-18 years). Results revealed that age and education significantly contributed to SNST scores, accounting for a significant proportion of variance in time needed to complete the color task and in the interference Color-Word score. Performance on most of the measures decreases with increasing age and lower levels of education. Normative data stratified by age and education for the Greek adult population are provided as a useful set of norms for clinical practice.

CSF biomarker profile and diagnostic value in vascular dementia

Background and purpose:  The differential diagnosis between vascular dementia (VD) and Alzheimer’s disease (AD) or mixed dementia (MD) is not always easy in clinical practice. The purpose of the present study was to evaluate the cerebrospinal fluid (CSF) biomarkers tau protein in its total (τT) or hyperphosphorylated at threonin‐181(τP‐181) form and beta amyloid peptide 1–42 (Aβ42) alone and their combinations to investigate their diagnostic value in the discrimination between VD and AD or MD.

Incidence of rotational vertigo in supratentorial stroke: a prospective analysis of 112 consecutive patients.

BACKGROUND Single cases with hemispheric, cortical or subcortical, ischemic lesions presenting with rotational vertigo (RV), that challenge the notion of infratentorial or peripheral generation of RV have been published, but the incidence of this symptom in a larger series is unknown. The aim of this study was to investigate whether acute hemispheric cerebrovascular lesions cause vertiginous sensations with particular emphasis on RV. METHODS A total of 112 consecutive stroke patients were assessed in a prospective single-center study over a 22-month inclusion period. Rotational or other vertiginous sensations were assessed using a structured 5-item questionnaire and patients with vertigo were further evaluated with Yardleys Vertigo Symptom Scale. All subjects underwent standard clinical neuro-ophthalmological and neuro-otological testing and data were correlated to imaging findings. RESULTS RV was absent among our patients. Few subjects reported non-rotational vertiginous sensations with stroke onset. These were mainly right-hemispheric strokes with concomitant subcortical leukoaraiosis. CONCLUSION In this case series we did not find any patients with spinning sensations which is supportive of the dogma that supratenotrial lesions do not cause RV. Certain hemispheric stroke patterns, however, may be related to non-rotational dizziness.

Etiology and treatment of ischaemic stroke in patients with β‐thalassemia major

Background and purpose:  Although hypercoagulability‐induced thromboembolism is generally accepted as cause of cerebral ischaemia in thalassemic patients, cardiogenic embolism has been recently suggested as another possible stroke etiology.

Painful ophthalmoplegia with simultaneous orbital myositis, optic and oculomotor nerve inflammation and trigeminal nucleus involvement in a patient with herpes zoster ophthalmicus

Viral infection is a rare cause of painful ophthalmoplegia. We report on a 67-year-old patient who developed painful double vision after a vesicular skin rash on the left forehead. MRI disclosed simultaneous inflammatory lesions in all extraocular muscles, the second and third cranial nerve, as well as pathological signal intensity along the spinal trigeminal tract and nucleus within the medulla oblongata and the pons. Cerebrospinal fluid and serum tests for varicella zoster were positive. The patient was treated effectively with intravenous acyclovir and methylprednisolone. Simultaneous lesions in various neighbouring neural structures may be characteristic for the highly neurotropic behaviour of the herpesviridae and should be considered as a cause of painful ophthalmoplegia that can be depicted by appropriate imaging.

Can Executive Cognitive Measures Differentiate Between Patients with Spinal- and Bulbar-Onset Amyotrophic Lateral Sclerosis?

Although executive functions in sporadic non-demented amyotrophic lateral sclerosis (ALS) patients are mostly affected, it remains unclear whether executive measures can differentiate between patients with bulbar and spinal ALS forms. Thirty spinal and 18 bulbar-onset ALS patients (ALS-s and ALS-b, respectively) as well as 47 demographically related healthy controls were examined in executive processes (Trail Making Test-part B [TMT-(B-A)]; Stroop Neuropsychological Screening Test [SNST]; Similarities subtest of the Wechsler Adult Intelligence Scale [WAIS Similarities]; Wisconsin Card Sorting Test [WCST]). ALS subgroups were similar with regard to demographic characteristics and disease duration; yet, ALS-b showed greater disease severity compared with ALS-s patients (p = .006). Both ALS-s and ALS-b patients were significantly inferior to healthy controls on TMT-(B-A) (p < .001), SNST (p = .009 and p = .02, respectively) and WAIS Similarities (p = .031 and p = .021, respectively), whereas ALS-s performed significantly worse than controls on the WCST perseverative responses (p = .005). However, neuropsychological measures did not significantly differ between ALS subgroups (p > .05). Despite the fact that ALS-b patients may present greater disease severity, specific executive impairments that are present early in the course of ALS seems to be independent of the site of onset.

Lack of visual evoked potential habituation in the syndrome of HaNDL

Sirs, Diagnosis of migraine implicates the exclusion of structural brain abnormalities, as well as infectious CNS diseases like meningoencephalitis. The latter can be assured by the absence of increased cell counts in cerebrospinal fluid (CSF) samples. A rare entity, however, was first described in 1981 characterized by episodes of migrainous headache in subjects without prior migraine, accompanied by transient neurologic deficits and CSF pleocytosis. Importantly, the condition was self limited in all cases [3]. The benign character of the disorder was established in two subsequent case series [5, 10], where the terms ‘‘headache with neurological deficits and CSF lymphocytosis’’ (HaNDL) and ‘‘pseudomigraine with lymphocytic pleocytosis’’, respectively, were used. The episodes of headache and the clinical deficits recur over less than 3 months. During the acute period of the disease differentiation from a viral or other form of aseptic meningitis is difficult, and in most cases, HaNDL remains a diagnosis of exclusion that is often established retrospectively. Due to the phenotypical similarities with the classical migraine with aura, some authors postulate similar pathophysiological abnormalities during the headache episodes [6, 8, 12]. Consequently, one might take advantage of certain migraine biomarkers, such as the known interictal electrophysiological changes, in order to support an earlier diagnosis of HaNDL. Indeed, there is one recent report of a female teenager suffering from HaNDL that demonstrated a lack of habituation of the P100-amplitude during sequential averaging of pattern-reversal stimuli [9]. Nevertheless, this patient, had a clear familial predisposition to migraine, since her father suffered from migraine with simple visual aura and her mother from migraine without aura. In fact, the lack of VEP-habituation persisted one year after the acute HaNDL period indicating a permanent electrophysiological trait. Unfortunately, this second, follow-up recording was not accompanied by CSF analysis. In this report we describe an adult patient with HaNDL, without prior migraine and without familial predisposition for migraine. We focus on the phenomenon of VEPpotentiation and its correlation with CSF parameters during the course of the syndrome. A 33-year-old man without personal or familial history of migraine noticed a severe left hemiparesis which involved the face, the upper and the lower limb, as well as difficulty in finding the appropriate words. These symptoms lasted approximately 25 min followed by an intense, bitemporal, throbbing headache, accompanied by vomiting and photophobia that persisted over 10 h. Physical examination on admission was unremarkable. The patient was afebrile and routine blood tests were normal. The acute brain-CT, as well as the MRI and MR-angiography on the following day showed no abnormalities. An EEG conducted 3 days after the episode exhibited a high percentage of generalized theta waves. Three similar episodes occurred in the following 15 days. CSF analysis conducted after the second episode revealed 296 cells/mm (95% lymphocytes), 113 mg/dl protein and a markedly elevated opening pressure of 350 mmH2O. Extensive testing for a variety of neurotropic viruses, as well as for borrelia burgdoriferi, syphilis and tuberculosis was negative. Routine blood tests, immunological markers and screening for thrombophilia were also normal. Furthermore, carotidE. Anagnostou (&) K. Spengos D. Naoumis G. P. Paraskevas S. Vassilopoulou V. Zis D. Vassilopoulos Department of Neurology, Eginition Hospital, University of Athens, Vas. Sophias Avenue 74, 11528 Athens, Greece e-mail: granavan@yahoo.com

Selective Reminding Test: Demographic Predictors of Performance and Normative Data for the Greek Population

The Buschke Selective Reminding Test (SRT) measures verbal learning and memory during a multiple-trial list-learning task, which allows for analysis of encoding, storage, and retrieval data. This study of 443 healthy participants (ages 18 to 83 years with 3 to 18 years of education) presents normative data for the Greek population. Statistical analysis indicated that age and educational level were correlated with all the variables as well as sex, although to a considerably lesser extent. Performance on most of the measures decreased with increasing age and lower education, whereas sex differences favored women over men. Based on these results, the sample was stratified into six age groups and three levels of education, with mean and standard deviation for each group. Current norms for the Selective Reminding Test represent a useful neuropsychological tool in clinical practice for patients with memory dysfunction, irrespective of etiology.