Wednesday, January 31, 2007

Hashimoto's Encephalopathy by other names

Chong Jy and Rowland LP. What's in a NAIM? (editorial) Arch Neurol 2006 63:175-176

Hashimoto's encephalopathy (named by Lord Brain) is also called by "steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT)" or "nonvasculitic autoimmune meningoencephalitis (NAIM). CJD may present identically except without steroid responsiveness.

Monday, January 29, 2007

TGA Mechanism

Bartsch T et al. Brain 2006;129:2874-2884. Selective affection of hippocampal CCA-1 neurons in patients with TGA without long term sequelae.

71 percent occurred after physical exertion, stress, Vasalva, or postural changes, most in the morning or afternoon. Of 41 patients, 29 had 36 DWI lesions and corresponding T2 lesions in hippocampus 48-72 hours after , almost all (34/36) in CA1 secotr, one in CA3 sector and one in cornu ammonis. Left sided lesions favored 20-16 with episodic verbal deficits seen in those tested acutely and visuospatial deficits in those with right sided lesions tested acutely. MRI lesions did not persist.

A hypoplastic transverse sinus with slight left sided predominance was seen in 88 %

Neurologic cosequences of starvation

Basoglu M et al. Neurological consequences of prolonged hunger strike. Eur J Neurol 2006; 13; 1089-1097.

Extensive studies were carried out of Turkish hunger strikers. Patients typically developed gaze evoked nystagmus (vertical in 9/41), limb ataxia in 3, and lateral rectus palsy in 14. All had muscle atrophy but only 11 were demonstrably weak. 15 had paresthesias, and 17 had abnormal vibratory or position sense. All patients were treated with thiamine when they reached the point of confusion. Nystagmus and ataxia resolved, sensory function normalized, but anterograde and retrograde amnesia remained in all.

Michael Rubin commented that although Wernicke-Korsakoff s. was diagnosed in all, osmotic myelinolysis with shift from normonatremic to hypernatremic state was reported in an Algerian hunger striker (Neurology 2005; 64;574-5).

CATIE-AD study

Schneider LS etr al. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. NEJM 2006; 355:1533-1538.

Design 421 patients with average MMSE 15 enrolled at 42 sites. Subjects were randomized to placebo, 5.5 mg/d olanzepine, 1 mg/day risperidone, or 56.5 mg/day of quetiapine. Endpoint was the time until the physician switched the medication. Results were not significantly different in the various groups except on minor measures. AE's included higher eps in patients receiving risperidone or olanzepine, and sedation with olanzepine and quetiapine (more than risperidone). Cognitive disturbances were higher in patients on olanzepine (7%) and increased agitation in those getting quetiapine.

In Neurology Alert, Norman Relkin comments that treatment of psychosis in AL is not a matter of writing a drug, but looking at all drugs, precipitants, sleep wake cycle and nutrition, supportive environment and caregiver education, none of which were controlled for. The study did not show the antipsychotic drugs were ineffective, just that they have risks as well. The lay press has misinterpreted the results.