Lsw Li

A case-controlled MRI/MRA study of neurovascular contact in hemifacial spasm

BACKGROUND Neurovascular contact (NVC) with the root exit zone (REZ) of the ipsilateral facial nerve is associated with hemifacial spasm (HFS), but unresolved issues remain. OBJECTIVES To 1) determine the frequency of symptomatic and nonsymptomatic NVC, 2) determine the features of NVC associated with HFS, and 3) correlate severity of HFS to these features. METHODS Two independent, blinded, prospective assessments of high-resolution MR and MR angiography (MRA) images were performed on Chinese cases (HFS: n = 44; age-matched control subjects: n = 20). RESULTS Over 88% of 44 symptomatic sides in patients with HFS had NVC of the ipsilateral facial nerve. At least 80% of symptomatic sides involved NVC at the anterior aspect of the REZ [REZ(ant.)]. Although NVC was observed in approximately half of nonsymptomatic sides, at least 70% of them were not at REZ(ant.). NVC at the cisternal and intracanalicular portions of the facial nerve were not associated with HFS. Half of our patients with HFS had bilateral NVC, but none had bilateral symptoms. Most of our MR/MRA images showed that the size and position of the arterial branches of the vertebrobasilar system were markedly asymmetric. Of patients with bilateral NVC, over 83% had asymmetric NVC sites. The anterior inferior cerebellar artery was the most common vessel involved in NVC, but was not significantly associated with HFS. Most of the NVC involved one vessel at one contact point with no indentation. The development of HFS was significantly associated with nerve indentation in NVC. The development and severity of HFS were not associated with multiple contact points in NVC. No significant interobserver variability existed between the blinded assessments. CONCLUSIONS MRI/MR angiography are accurate, fast, and safe in characterizing neurovascular contact (NVC) at the brainstem. The site of NVC and ipsilateral facial nerve indentation in NVC are significant determinants for the development of hemifacial spasm (HFS). The lack of bilateral NVC at the anterior aspect of the root exit zone of the facial nerve could explain in part the lack of bilateral symptoms. The development and severity of HFS are not associated with a specific blood vessel or multiple contact points in NVC.

Neuronavigated high-frequency repetitive transcranial magnetic stimulation for chronic post-stroke dysphagia: A randomized controlled study

OBJECTIVE There are potential benefits of repetitive transcranial magnetic stimulation (rTMS) in improving swallowing functions after stroke; however, few studies have been performed in the chronic stroke population. This study aims to distil the key effects of rTMS on swallowing functions and swallowing-related quality of life. METHODS Twenty-two participants with chronic post-stroke dysphagia were randomly assigned into active or sham rTMS groups. Seven participants withdrew from the study, thus data from 15 participants (mean age 64.6 years) were analysed. Participants received 3,000 pulses of 5 Hz rTMS (active: n = 11; sham: n = 4) on the tongue area of the motor cortex for 10 days over a period of 2 weeks. All participants were assessed 1 week before, and 2 months, 6 months and 12 months after stimulation. Outcomes were measured by a videofluoroscopic swallowing study, swallowing-related quality-of-life questionnaire and Iowa Oral Performance Instrument. RESULTS No statistically significant effects were identified for any outcome measures. CONCLUSION This study indicates that 5 Hz rTMS applied over the tongue area of the motor cortex is not effective for improving swallowing function in individuals with chronic post-stroke dysphagia. Possible explanations for these non-significant results are dis cussed. Future studies should explore the potential of the current protocol in conjunction with conventional dysphagia therapy.

Defective ubiquitinated mitochondria accumulation in aged parkinsonian LRRK2 R1441G knockin mice

This free journal suppl. entitled: Supplement: Abstracts of the Twentieth International Congress of Parkinsons Disease and Movement DisordersObjective: To investigate the possible disease-association and pathogenic mechanisms of heterozygous PINK1 mutations from a genetic, functional, and structural perspective. Background: It has been postulated that heterozygous mutations in recessive PD genes may increase disease risk. In particular, the PINK1 p.G411S mutation has been reported in families with dominant inheritance patterns, suggesting that it might confer a sizeable disease risk. Methods: We performed a pedigree analysis of seven patients with a heterozygous PINK1 p.G411S mutation with at least one additional affected family member. We screened five case-control series and performed a meta-analysis of previous studies that had examined the variant. For functional cell-based analyses, we used patients skin fibroblast from PINK1 p.G411S or p.Q456X heterozygotes and investigated endogenous protein levels and kinase activity by biochemistry and imaging. For structural analyses, we performed molecular modeling and generated monomeric and dimeric forms of wild type (WT) and mutant PINK1 protein. Using molecular dynamics simulations, we analyzed effects of the p.G411S mutation on WT PINK1 in a heterodimeric complex over time. Results: Our analyses revealed a genetic association of heterozygous PINK1 p.G411S mutation with an increased risk for PD and a possible dominant inheritance with incomplete co-segregation. In patients skin fibroblasts, we establish a dominant negative mode for heterozygous p.G411S mutations under endogenous conditions. While total PINK1 protein levels were similar to controls upon mitochondrial stress, cellular PINK1 kinase activity was significantly reduced in p.G411S heterozygotes compared to WT and importantly to p.Q456X heterozygotes, which resulted in 50% reduction of PINK1 protein levels. Structural analyses supported our hypothesis that the p.G411S mutation can poison PINK1 WT in a heterodimeric complex and thus effectively reduce cellular PINK1 kinase activity. This in turn impairs the protective functions of the PINK1/PARKIN-mediated mitochondrial quality control. Conclusions: Our study uncovers increased disease risk and molecular mechanisms of a particular heterozygous mutation in a recessive PD gene. Based on genetic and clinical evaluation as well as functional and structural characterization, we established PINK1 p.G411S as a rare genetic risk factor with a relatively large effect size conferred by a dominant negative function phenotype. (Less)Objective: The aim of this study is to develop and evaluate methods for quantifying motor symptoms in Parkinson’s disease (PD) using combined upper limb motor test data collected during tapping and ...20th International Congress of Parkinson’s disease and Movement Disorders, Berlin, Germany, 19-23 June, 2016Upper limb motor tests are related to clinical ratings of motor function in advanced Parkinsons disease

Cancer patients are at increased risk of recurrent stroke and cardiovascular mortality

WCN 2013 No: 1538 Topic: 3 — Stroke Stroke awareness in Munich and Moscow Y. Fris, P. Kamchatnov, R. Kalla. The Russian National Research Medical University, Moscow, Russia; Ludwig–Maximilians-University Munich, Klinikum Groshadern, Munich, Germany Background: Different data of public stroke awareness in several researches may result from different methods of investigations. Objectives: We aimed to compare the stroke awareness among patients in Moscow and Munich. Material andmethods: 180 patients in Moscow (48% female, mean age 63.09 ± 13.83) and 180 patients in Munich (47.8% female, mean age 61.12 ± 14) hospitals, divided into three groups (after stroke, high risk of stroke and without risk of stroke) answered 33 questions, including 4 open-ended questions about stroke symptoms (SS) and risk factors (RF). Results: In group of patients without risk of stroke the difference in number of SS named was not significant. In group of patients with high risk of stroke the awareness of SS (1.96 ± 1.28 in Munich and 1.03 ± 1.07 in Moscow, p = 0.000) and the awareness of stroke RF (2.25 ± 1.29 in Munich and 1.34 ± 1.2 in Moscow, p = 0.000) were better among patients in Munich. In group of patients with stroke in anamnesis the awareness of SS (2.08 ± 0.99 inMunich and 1.25 ± 0.89 in Moscow, p = 0.000) was also better among patients in Munich. The difference in awareness of stroke RF in this group was not significant. The direct dialogue with the doctor and specialized brochure was named as most preferable forms of increasing the knowledge of risk factors and stroke symptoms. Conclusion: The educational activities inMoscow should be focused on patients with high risk of stroke and should increase the recognition of stroke onset and highlight the importance of early hospitalization. doi:10.1016/j.jns.2013.07.814 Abstract — WCN 2013 No: 1550 Topic: 3 — Stroke Arterial CNS involvement in Behcets disease WCN 2013 No: 1550 Topic: 3 — Stroke Arterial CNS involvement in Behcets disease G. Akman-Demir, E. Shugaiv, M. Kurtuncu, M. Mutlu, N. YesilotBarlas, E. Tuzun, O. Coban, S. Bahar. Department of Neurology, Istanbul Bilim University Medical School, Turkey; Department of Neurology, Istanbul University Faculty of Medicine, Turkey; Department of Neurology, Istanbul University School of Medicine, Istanbul, Turkey Background and objective: Although Behcet disease (BD) tends to involve vascular structures, the incidence of arterial involvement is far behind that of venous involvement. In this study, we evaluated all the cases with BD and arterial CNS involvement. Methods: All the files of Neuro-Behcet outpatient clinic of Istanbul Medical Faculty were retrospectively evaluated. Demographical findings, clinical characteristics and radiological findings were evaluated. Results: Between 1984 and 2011 there were 18 cases with BD and cranial arterial involvement out of 400 patients with neurological involvement. 4were female and 14weremale (M:F = 3.5). Their age at arterial CNS involvement ranged between 25 and 64 years (median: 42; 42.5 ± 11.7). 15 had presented with acute hemiparesis/hemiplegia, accompanied by aphasia in two, ataxia in one, crossed brainstem syndrome in two patients. One patient had an asymptomatic intracranial aneurysm. One patient presented with seizures due to ACA infarct, and one patient presented with multiple cranial neuropathies due to external carotid aneurysm. One of the female patients had an underlying rheumatic mitral stenosis, and 3 patients were over age 50 which may suggest that stroke may not be directly associated to BD in those 4 cases. In 2 patients vasculitic involvement could be shown on angiography. In the remaining patients no other etiologies were found. Conclusions: Arterial CNS involvement is rarely seen in BD. A minority of those cases could be shown to have vasculitis. Other etiological factors unrelated to BD should be sought exclusively in such cases before attributing the stroke to BD. doi:10.1016/j.jns.2013.07.815 Abstract — WCN 2013 No: 1572 Topic: 3 — Stroke Cancer patients are at increased risk of recurrent stroke and cardiovascular mortality WCN 2013 No: 1572 Topic: 3 — Stroke Cancer patients are at increased risk of recurrent stroke and cardiovascular mortality K.K. Lau, Y.-K. Wong, K.-H. Chan, K.-C. Teo, S.F.-K. Hon, W. Mak, R.T.-F. Cheung, S.-L. Ho, L.S.-W. Li, H.-F. Tse, C.-W. Siu. The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region Background: Cancer patients are at increased risk of cardiovascular and cerebrovascular events. However, the risk of recurrent stroke or cardiovascular mortality amongst cancer patients with stroke is currently unknown. Objective: To determine the risk of recurrent stroke and cardiovascular mortality in cancer patients with ischemic stroke. Patients and methods: This is a single center, observational study comparing the clinical characteristics and outcome of 58 ischemic stroke patients with cancer to 1047 ischemic stroke patients without cancer recruited from 2004 to 2008. Mean follow-up period was 76 ± 18months. Primary endpoint was recurrent stroke and secondary endpoint was cardiovascular mortality. Results: The three most common malignancies were breast (17%), colorectal (14%) and nasopharynx (13%). 26% of cancer subjects had active malignancy and 7% had metastatic disease. 22 patients with cancer (38%, 13.94 per 100 patient-years) and 219 patients without cancer (21%, 4.65 per 100 patient-years) developed a recurrent stroke (p b 0.01). 13 patients with cancer (22%, 4.3 per 100 patientyears) and 143 patients without cancer (14%, 2.35 per 100 patientyears, p = 0.08) died due to cardiovascular causes. After adjusting for age, gender, cardiovascular risk factors and co-morbidities, cancer was an independent predictor for recurrent stroke (HR 2.68; 95% CI: 1.58 to 4.54, p b 0.01) and cardiovascular mortality (HR 2.17; 95% CI: 1.12 to 4.22, p= 0.02). Conclusion: Stroke patients with underlying cancer are at increased risk of developing recurrent stroke and cardiovascular mortality. doi:10.1016/j.jns.2013.07.816 Abstracts / Journal of the Neurological Sciences 333 (2013) e152–e214 e204

Emotion recognition, morphed emotions, neural substrates

This study examined school-aged childrens time monitoring in relation to individual differences in executive control functions. The present study involved an individual-difference approach with th ...

Factor predicting the persistency of dysphagia in acute stroke patients.

2ND WORLD CONGRESS IN NEUROLOGICAL REHABILITATION APRIL 14-17, 1999 THE SHERATON CENTRE HOTEL TORONTO, ONTARIO, CANADA Neurorehabilitation and Neural Repair 1999;13:23-82