Maria Cecilia Fernandez

Cardiovascular risk factors and frontotemporal dementia: a case–control study

Cardiovascular risk factors (CRF) were widely described as related to dementia. There are very few studies regarding this association in FTD. The objective of the study was to compare the frequency of CRF in our population with FTD and controls. 100 consecutive subjects with FTD diagnosis according to Lund-Manchester clinical criteria and 200 controls matched by age and sex were included between January 2003 to February 2007 at the Cognitive and Behavior Unit of Hospital Italiano de Buenos Aires. Clinical evaluation, laboratory tests, brain images (CT/MRI), neuropsychological and neuropsychiatric assessment were performed. Multiple regression analysis was performed to analyze the association in CRF between FTD patients vs. controls. The mean age in FTD was 69.7 ± 0.9 vs. 70.1 ± 0.8 in controls (p 0.12). No difference in gender was observed between cases and controls. No differences were identified between patients and controls regarding hypertension (HTA) (65% vs. 67,3% p 0.44); dyslipidemia (57% vs. 54.7% p 0.74); obesity (39% vs. 27.6% p 0.14) and hypothyroidism (26% vs. 17.1% p 0.1). A significant difference was observed for Diabetes Mellitus (39% vs. 22.6% p 0.001). In our population, Diabetes Mellitus was associated as an independent risk factor for FTD. To our knowledge this is the first report in which CRF were evaluated prospectively in FTD patients. More studies are needed to confirm this finding in larger populations.

Unusual Benign Paratesticular Tumor in an Infant Mimicking Rhabdomyosarcoma

Paratesticular tumors are extremely rare, with paratesticular rhabdomyosarcoma being the most common finding. A 6-month-old boy presented with an asymptomatic, right intrascrotal mass whereby the testicle was surrounded by a friable lipomatous tumor. Frozen section revealed an inflammatory process, negative for malignancy. Tumorectomy with vaginal resection was performed, maintaining the testicle and excretory ducts. Histopathologic findings showed a juvenile xanthogranuloma, a non-Langerhans histiocytosis commonly described in infants in the skin and skeletal muscle. The patient is doing well 2 years after surgery and is the first such case reported in the literature with successful conservative treatment.

Hepatotoxicidad por tetrabamato. Presentación de 7 casos y revisión de la bibliografía

Objetivos . Analisis de todos los casos de toxicidad hepatica secundaria a tetrabamato remitidos al registro andaluz de hepatopatias asociadas a medicamentos y comparacion con los casos publicados en la bibliografia. Material Y Metodo . La informacion se recogio en un protocolo estructurado. La imputabilidad de tetrabamato se estimo en cada uno de los casos mediante la escala diagnostica del Council for International Organizations of Medical Sciences (CIOMS). Resultados . Se han recogido 7 casos de hepatotoxicidad atribuible a tetrabamato de un total de 327 pacientes (2%), con una edad media 57 anos (4 varones). En un 57% de los casos la indicacion fue el temblor. El periodo de latencia oscilo entre 15 y 730 dias. El patron de dano hepatico fue predominantemente citolitico, sin presentar manifestaciones de hipersensibilidad. Todos los casos evolucionaron a la recuperacion sin secuelas en 60-120 dias. La imputabilidad de tetrabamato estimada mediante la escala diagnostica de CIOMS define la relacion causal como altamente probable en 6 casos y como probable en uno. Conclusion . Tetrabamato puede inducir hepatotoxicidad probablemente por un mecanismo de idiosincrasia metabolica. Teniendo en cuenta este hecho, y la existencia de alternativas terapeuticas mas idoneas, el farmaco no deberia indicarse en el tratamiento de la desintoxicacion alcoholica.

Teaching NeuroImages: Hippocampal foci of restricted diffusion in transient global amnesia.

A 71-year-old man presented with a sudden onset of anterograde amnesia and repetitive questioning. Symptoms lasted 12 hours. MRI performed 48 hours after onset showed right hippocampal restricted diffusion foci (figure, A and B).

MoCA Utility as a Quick Testing Tool for Neurocognitive Disorders in HIV Patients: Analysis of a Prospective Cohort

Abstract Background Since the introduction of highly active antiretroviral therapy, asymptomatic and mild neurocognitive impairment are the main clinical manifiestations of HIV associated neurocognitive disorders (HAND), compromising adherence to treatment, daily performance, quality of life, and even increasing the risk of mortality. We do not have validated screening tools for early detection of HAND applicable to the routine medical visit. The Montreal Cognitive Assessment test (MoCA) is a simple questionnaire used in Alzheimer’s disease, but its utility as a screening tool for HAND remains controversial. Methods We designed a prospective study to establish MoCA´s usefulness as a rapid and sensitive tool for the detection of HAND, compared with a gold-standard test (GST) that includes Mini-mental State Examination (MMSE) and a battery of assays that evaluate several neurological domains. Adult patients with HIV infection attending our institution were included. The MoCA test was performed by infectious diseases specialists, and the GST by neurologists. History of recent stroke, neurological disease, opportunistic central nervous system infection, major depression, schizophrenia, bipolar disorder, substance abuse or dependence on alcohol, were exclusion criteria. We analized demographic and clinical variables. Results Fifty HIV-infected patients were enrolled, 94% males, with a mean age of 45.6 years (range 20–75), and an average of 14.8 years of education (range 3–26). The mean CD4 cell count was 596 cells/ml (range 65–1130), and 70% of the patients had undetectable viral load (≤20 copies/mL) at the time of the evaluation. Compared with GST, MoCA had a sensibility (S) of 94.12% (CI 71.3–99.8), specificity (E) 78.79% (CI 61.09–91.02), positive predictive value (PPV) 69.57% (CI 47–86.79) and negative predictive value (NPV) 96.3 (CI 81–99.9). In contrast, the MMSE presented S 11.76% (CI 1.46–36.44), E 100% (CI 89.4–100), PPV 100% (CI 15.8–100) and NPV 68.75% (CI 53.7–81.3). Cohen’s kappa coefficient between MoCA and GST was 0.67 (95% CI 0.46–0.87), reflecting an adequate agreement. Conclusion MoCA’s performance as a screening test was adequate compared with GST and far superior to MMSE for early detection of HAND. Although specifity could be optimized, MoCA test remains a valuable screening tool in the routine medical visit in our HIV population. Disclosures All authors: No reported disclosures.