Katharina A. Schindlbeck

Spot Sign in Acute Intracerebral Hemorrhage in Dynamic T1-Weighted Magnetic Resonance Imaging

Background and Purpose— In computed tomographic imaging of acute intracerebral hemorrhage spot sign on computed tomographic angiography has been established as a marker for hematoma expansion and poor clinical outcome. Although, magnetic resonance imaging (MRI) can accurately visualize acute intracerebral hemorrhage, a corresponding MRI marker is lacking to date. Methods— We prospectively examined 50 consecutive patients with acute intracerebral hemorrhage within 24 hours of symptom onset. The MRI protocol consisted of a standard stroke protocol and dynamic contrast-enhanced T1-weighted imaging with a time resolution of 7.07 s/batch. Stroke scores were assessed at admission and at time of discharge. Volume measurements of hematoma size and spot sign were performed with MRIcron. Results— Contrast extravasation within sites of the hemorrhage (MRI spot sign) was seen in 46% of the patients. Patients with an MRI spot sign had a significantly shorter time to imaging than those without (P<0.001). The clinical outcome measured by the modified Rankin Scale was significantly worse in patients with spot sign compared with those without (P⩽0.001). Hematoma expansion was observed in the spot sign group compared with the nonspot sign group, although the differences were not significant. Conclusions— Spot sign can be detected using MRI on postcontrast T1-weighted and dynamic T1-weighted images. It is associated with worse clinical outcome. The time course of contrast extravasation in dynamic T1 images indicates that these spots represent ongoing bleeding.

Disturbance of verticality perception and postural dysfunction in Parkinson's disease

Verticality perception is known to be abnormal in Parkinsons disease (PD), but in which stage respective dysfunctions arise and how they relate to postural disorders remains to be settled. These issues were studied with respect to different dimensions of the subjective visual vertical (SVV) in relation to clinical parameters of postural control.

Theory of mind performance in Parkinson’s disease is associated with motor and cognitive functions, but not with symptom lateralization

Abstract Next to the typical motor signs, Parkinson’s disease (PD) goes along with neuropsychiatric symptoms, amongst others affecting social cognition. Particularly, Theory of Mind (ToM) impairments have mostly been associated with right hemispherical brain dysfunction, so that it might prevail in patients with left dominant PD. Fourty-four PD patients, twenty-four with left and twenty with right dominant motor symptoms, engaged in the Reading the Mind in the Eyes (RME) and the Faux Pas Detection Test (FPD) to assess affective and cognitive ToM. The results were correlated with performance in further cognitive tests, and analyzed with respect to associations with the side of motor symptom dominance and severity of motor symptoms. No association of ToM performance with right hemispheric dysfunction was found. RME results were inversely correlated with motor symptom severity, while FPD performance was found to correlate with the performance in verbal fluency tasks and the overall cognitive evaluation. Affective ToM was found associated with motor symptom severity and cognitive ToM predominantly with executive function, but no effect of PD lateralization on this was identified. The results suggest that deficits in social cognition occur as a sequel of the general corticobasal pathology in PD, rather than as a result of hemisphere-specific dysfunction.

Impact of restless legs syndrome in patients with inflammatory bowel disease on sleep, fatigue, and quality of life

PurposeInflammatory bowel disease has been associated with neurological symptoms including restless legs syndrome. Here, we investigated the impact of restless legs syndrome in patients with inflammatory bowel disease on sleep, fatigue, mood, cognition, and quality of life.MethodsTwo groups of inflammatory bowel disease patients, with and without restless legs syndrome, were prospectively evaluated for sleep disorders, fatigue, daytime sleepiness, depression, anxiety, and health-related quality of life. Furthermore, global cognitive function, executive function, attention, and concentration were assessed in both groups. Disease activity and duration of inflammatory bowel disease as well as current medication were assessed by interview. Inflammatory bowel disease patients with and without restless legs syndrome were matched for age, education, severity, and duration of their inflammatory bowel disease.ResultsPatients with inflammatory bowel disease and clinically relevant restless leg syndrome suffered significantly more frequent from sleep disturbances including sleep latency and duration, more fatigue, and worse health-related quality of life as compared to inflammatory bowel disease patients without restless legs syndrome. Affect and cognitive function including cognitive flexibility, attention, and concentration showed no significant differences among groups, indicating to be not related to restless legs syndrome.ConclusionsSleep disorders including longer sleep latency, shorter sleep duration, and fatigue are characteristic symptoms of restless legs syndrome in inflammatory bowel disease patients, resulting in worse health-related quality of life. Therefore, clinicians treating patients with inflammatory bowel disease should be alert for restless legs syndrome.

Response to Letter Regarding Article, “Spot Sign in Acute Intracerebral Hemorrhage in Dynamic T1-Weighted Magnetic Resonance Imaging”

We read the letter by Murai et al with great interest and thank them for their detailed comments. In our article, our main intent was to describe the spot sign in magnetic resonance imaging from a methodological point of view.1 Therefore, we used T1 dynamic and T1 postcontrast imaging to show whether the spot sign can be reliably diagnosed with T1-weighted magnetic resonance imaging at 3 T. In terms of clinical impact of this potential imaging marker, we could show that spot sign was associated with worse clinical outcome. The number of patients in our study to receive an imaging follow-up was too small to evaluate hematoma expansion. This …

Dysfunctional action control as a specific feature of Parkinson's disease.

Parkinson’s disease (PD) is characterised by motor deficits as well as cognitive alterations, particularly concerning frontal lobe control. Here, we were interested in whether executive function is abnormal already early in PD, as well as whether this dysfunction worsens as a part of the dementia in PD. The following groups engaged in tasks addressing action control: PD patients with mild and advanced motor symptoms (aPD) without dementia, PD patients with dementia (PDD), patients with Alzheimer’s disease (AD) and healthy subjects (CON). Subjects either had to perform or inhibit button presses upon go and no-go cues, respectively. These cues were preceded by pre-cues, either randomly instructive of right or left hand preparation (switch condition), or repetitively instructive for one side only (non-switch condition). PDD and aPD omitted more go responses than CON. Furthermore, PDD disproportionally committed failures upon no-go cues compared to CON. In the non-switch condition, PDD performed worse than AD, whose deficits increased to the level of PDD in the switch condition. Over all PD patients, task performance correlated with disease severity. Under the switch condition, task performance was low in both PDD and AD. In the non-switch condition, this also held true for advanced PD patients (with and without dementia), but not for AD. Thus, the deficits evident in PDD appear to develop from imbalanced inhibitory-to-excitatory action control generally inherent to PD. These results specify the concept of dysexecution in PD and differentiate the cognitive profile of PDD from that of AD patients.

Relationships between activity and well-being in people with parkinson's disease

The complex symptomatology of Parkinson’ disease (PD) usually goes along with reduced physical activity. Previous studies have indicated positive effects of activating therapies on patients’ well‐being. This study, therefore, examined how activity in daily life is related to patients’ subjective condition.

Necessity of long-term alertness in levodopa-carbidopa intestinal gel infusion for PD patients.

Levodopa/carbidopa intestinal gel (LCIG) is a treatment for Parkinson’s disease patients with motor fluctuations refractory to conventional drug therapy. LCIG is pumped via a jejunal tube through a percutaneous endoscopic gastrostomy (Jet-PEG). Severe adverse events (SAEs) cluster shortly after Jet-PEG insertion. However, during chronic treatment (later than 1 month after LCIG initiation) we saw several SAEs (strongly reducing quality of life or life threatening). Of 56 patients (35/31 male/female, average age/disease duration at LCIG initiation 72/18 years; 200 cumulated treatment years), 6 were affected (P1-6; 4/2 male/female, average age/disease duration 72/16 years).