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  • ISSN: 2334-2307
    Early Online
    Volume 7, Issue 1
    Research Article
    Dao-Ming Tong*, Ye-Ting Zhou, Shao-Dan Wang, Guang-Sheng Wang, Yuan-Wei Wang, and Ying Wang
    Background: The early risk and influence factors on death of sepsis following acute intracerebral hemorrhage (ICH) was previously unclear.
    Methods: We retrospectively enrolled patients with identified sepsis after acute ICH from an ICU in China. We used Systemic Inflammatory Response Syndrome (SIRS) criteria to screen infection, and used Sequential Organ Failure Assessment (SOFA) criteria to diagnosis sepsis after acute ICH. The odd ratios (OR) of risk and outcome for sepsis were estimated by logistic regression.
    Results: Among 507 acute ICH patients, 189 (37.3%, 189/507) had sepsis events during their hospitalizations. The early risk of sepsis in ICH patients at initial 48 hours was in 21.9% (111/507). The mortality of sepsis at initial 48 hours was in 49.5%. The main factor of influence early death was related to no using antibiotics within initial 3 hours (OR, 0.3; 95% CI, 0.153- 0.506), higher SOFA score (OR, 1.5; 95% CI, 0.304- 0.673), and higher SIRS criteria (OR, 1.5; 95% CI, 1.209- 1.938). At 30 days, the mortality of sepsis after ICH was in 55.6%, and the influence on death was associated with elevated serum lactate levels (OR, 1.3; 95% CI, 1.190-1.402), elevated SOFA scores (OR, 1.1; 95% CI, 1.032-1.151), higher NIHSS scores (OR, 1.1; 95% CI, 1.074-1.141), less ICU days (OR, 0.8; 95% CI, 0.734-845), and decreased GCS scores (OR, 0.7; 95% CI, 0.641-0.834).
    Conclusions: High risk sepsis is an early complication and with high mortality following acute ICH. The antibiotics treatment for sepsis after ICH must be performed early.
    Robert J. Parmer*, Yun Gong, Seung Hyun Yoo and Lindsey A. Miles
    t-PA has a widespread neuroendocrine distribution including prominent expression in chromaffin cells of the sympathoadrenal system. Chromaffin cell t-PA is sorted into catecholamine storage vesicles and co-released with catecholamines in response to sympathoadrenal activation, suggesting that catecholamine storage vesicles may serve as a reservoir for the rapid release of t-PA. Chromogranin A (CgA), a major core protein in secretory vesicles throughout the neuroendocrine system, may play a crucial role in targeting proteins into the regulated secretory pathway, by forming aggregated granin complexes to which other proteins destined for the regulated secretory vesicle bind and become separated from constitutively secreted proteins in the trans-Golgi network (TGN). Formation of such complexes is facilitated by conditions of the TGN (low pH, high Ca+2). We tested the hypothesis that t-PA interacts specifically with CgA and that this interaction is enhanced under conditions of the TGN. Immobilized t-PA was incubated with 125I-CgA. t-PA interacted specifically and saturably with CgA and the interaction was domain-specific, mediated by the EGF/finger and kringle 1 domains of t-PA and by a specific internal hydrophilic domain within CgA (KERTHQQKKHSSYEDELSEVL) as assessed by antibody and peptide competition studies. The interaction of t-PA with aggregated CgA complexes may play a role in the targeting of t-PA and its release from neurosecretory cells. These results may have broad implications for the regulation of local neurosecretory cell plasminogen activation under both normal physiological conditions and pathological conditions including cerebral ischemia.
    Case Report
    Whitfield Lewis*, Wan Yee Kong, Shishir Rao, and Kumar Rajamani
    Posterior circulation stroke is a potentially life threatening and functionally disabling stroke. Nevertheless, patients with posterior circulation stroke may initially presents with a constellation of nonspecific symptoms mimicking other pathologies, causing delay in diagnosis. With the improvement of acute stroke management, patients who have a timely diagnosis of acute ischemic stroke can benefit tremendously from intravenous thrombolysis or mechanical thrombectomy. We present a patient with acute posterior circulation ischemia who presented with dizziness and acute vestibular syndrome. Although his NIHSS was 0, he had significant truncal ataxia, being unable to even ambulate. He was treated successful with intravenous tPA. Further workup revealed a medial PICA territorial infarction from large vessel atherosclerosis. Medial PICA infarction is a common cause of isolated truncal ataxia and NIHSS 0 strokes. We reviewed the common presentation of posterior circulation ischemia, challenges and pitfalls in diagnoses and the limitation of the current stroke scale in quantifying posterior circulation stroke severity. A clinical approach tailored to accurate detection of posterior circulation ischemia is outlined in this case report.
    Whitfield Lewis*, Kushak Suchdev, Sandra Narayanan, and Kumar Rajamani
    Background: Extracranial carotid artery stenosis represents 8.0% of ischemic strokes in the USA. Patients with symptomatic carotid stenosis are those who have had a recent ischemic stroke or TIA along the ipsilateral carotid artery distribution. Aggressive endovascular or surgical treatment is reserved for patients with symptomatic carotid stenosis when there is a moderate or high degree of stenosis. However, there are other morphological features that are associated with a high risk of early recurrent stroke. The presence of a free-floating thrombus (FFT), is a well-documented feature of imminent thrombo-embolism, and should be treated with aggressive therapy irrespective of the degree of carotid stenosis.
    Case description: A 62-year-old male presents with recurrent middle cerebral artery occlusion from a free-floating thrombus of the common carotid artery. The degree ofcarotid artery stenosis was 50% on diagnostic angiogram. He was initially started on dual anti-platelet but had a recurrent right MCA infarction the following month. The treatment strategy then employed was partialthrombectomy followed by continual dual anti-platelet therapy. At 1-month follow-up, total dissolution of the thrombus was achieved.
    Discussion: The presence of a free-floating thrombus is another morphological feature suggesting imminent thromboembolic infarction [3-5]. Successful treatments included dual anti-platelet therapy, systemic anticoagulation, endovascular therapy, and surgical therapy [3].
    Conclusion: Urgent intervention is needed to reduce the risk of thromboembolic infarction in patients presenting with a FFT of the carotid artery. Partial endovascular thrombectomy followed by dual anti-platelet therapy is an effective approach to achieve complete dissolution of the FFT.
    Streeter CC*, Gerbarg PM, Nyer MB, and Brown RP
    There is a need for adjunctive treatments for poorly controlled seizure disorders. In people with epilepsy, between 25% and 40% treated with antiepileptic drugs (AEDs) have uncontrolled seizures. In adults, the majority of uncontrolled seizures have a temporal lobe focus. The temporal lobes contain structures that mediate a persons response to stress. As stress is a contributing factor to seizure frequency, treatments that reduce stress should be considered in developing a treatment plan for individuals with epilepsy. Yoga practices have been associated with decreased stress, decreased cortisol, a biologic marker of stress, increased vagal activity, a biologic marker for parasympathetic activity, increased gamma aminobutyric acid, a neurotransmitter implicated in the actions of many AEDS, and decreased seizure frequency. While yoga is promising as an adjunctive treatment for epilepsy, the current quality of research regarding the use of yoga to reduce seizure frequency is of low quality. More research with well-designed controlled studies is needed to develop optimal yoga interventions to safely and effectively improve seizure control and quality of life for epileptic individuals.
    Special Issue on Parkinson's Disease
    Research Article
    Asako Yoritaka1,2*, Yasushi Shimo1, Masashi Takanashi1, Jiro Fukae1,3, Taku Hatano1, Toshiki Nakahara1, Nobukazu Miyamato1,4, Takao Urabe1,4 and Nobutaka Hattori1
    Background and Purpose: We examined the prevalence of clinical symptoms and cumulative dose of anti-parkinsonian drugs in Japanese patients with Parkinson’s disease (PD).
    Methods: We retrospectively reviewed the charts of patients (n = 1453; 650 males) who had visited our outpatient neurology clinic between January and June 2010. Cumulative dose was calculated by calendar day to the day of onset of events, or the day of the examination. Prevalence and risk of events (pain, wearing-off, camptocormia, sleep attack, orthostatic hypotension, psychosis, and pneumonia) were analyzed using Kaplan–Meier survival curves, calculated odds ratios, and hazard ratios (HRs).
    Results: Most patients (1292, 88.9%) received levodopa, and the cumulative dose was 1263 (SD 1190) g. Moreover, 1182 patients (81.3%) received dopamine agonists (DAs; average cumulative dose, 827 (1466) g. The cumulative doses of trihexyphenidyl (n = 561), amantadine (n = 598), and selegiline (n = 620) were 8246.1 (11156.7) mg, 386.5 (829.2) g, and 7587.4 (11006.9) mg, respectively. The HRs were as follows: 0.998 (p < 0.001) for the cumulative dose of levodopa to the onset of pain, wearing-off, camptocormia, and psychosis; 0.997 (p < 0.001) for the cumulative dose of levodopa to the onset of orthostatic hypotension; 0.999 (p < 0.001) for the cumulative dose of DAs to the onset of camptocormia; and 0.999 (p < 0.001) and 0.999 (p < 0.05) for the cumulative doses of levodopa and DA to the onset of pneumonia. However, the HRs were close to 1.0.
    Conclusions: There was no relationship between the cumulative dose of anti-parkinsonian drugs and the prevalence of symptoms.
    Review Article
    Asako Yoritaka*
    Abstract: A common early non-motor symptom of Parkinson’s disease (PD) is sleep disturbance. Indeed, rapid eye movement (REM) sleep behavior disorder (RBD) and excessive daytime sleepiness (EDS) are predictors of PD. EDS and RBD are thought to be risk factors for the cognitive disturbances observed in PD. Some researchers have suggested that RBD can be used as a predictor of the pathological progression of PD. Thus far, sleep disturbances have not been recognized as a component in the progression of the disease, and therefore have not been routinely and adequately controlled in this patient population. In this review, we present evidence that the assessment of sleep (i. e. , the presence of fragmented sleep, insomnia, RBD, EDS, and sudden onset of sleep) should be a part of the routine evaluation of patients with PD.
    Yasushi Shimo and Nobutaka Hattori*
    Recently, much attention has been paid to not only motor symptoms but also Non-Motor Symptoms (NMS) of Parkinson’s disease [1]. NMS include sleep disorders, autonomic nervous system dysfunction, sensory impairment, and neuropsychiatric symptoms. Neuropsychiatric symptoms include depression, apathy, anxiety, anhedonia, attention deficit, hallucinations, confusion, Impulse Control Disorders (ICD), and cognitive dysfunction [1]. These symptoms are risk factors that influence a patient’s quality of life, and the prevalence of NMS increases along with disease progression [2].
    Special Issue on Neuropsychiatric Disorders and Microglia
    Review Article
    Akira Monji1*, Yoshito Mizoguchi1 and Takahiro A Kato2
    Abstract: The etiology of schizophrenia remains unclear while, in many aspects, the neuropathology of schizophrenia has recently been reported to be closely associated with microglia dysfunction. Microglia, which are the major players of innate immunity in the CNS, respond rapidly to even minor pathological changes in the brain and contribute directly to neuroinflammation by producing various pro-inflammatory cytokines and free radicals. Recent human studies have revealed microglial activation in schizophrenia using postmortem brains or in vivo neuroimaging techniques. We and other researchers have recently shown the inhibitory effects of some antipsychotics on the release of inflammatory cytokines and free radicals from activated microglia, both of which have recently been known to cause the synaptic pathology, a decrease in neurogenesis, and white matter abnormalities often found in the brains of patients with schizophrenia. In addition, recent evidence strongly suggests a neurodevelopmental role of microglia in regulating synapse formation/function by their interaction with synapses and phagocytotic activity. It is not known whether microglia dysfunction and microglia-orchestrated neuroinflammation are the primary cause of schizophrenia but they are closely related to the progression and outcomes of schizophrenia. Understanding microglial pathology may shed new light on the therapeutic strategies for schizophrenia.
    Yoshinori Hayashi1, Zhou Wu1 and Hiroshi Nakanishi1,2*
    Abstract: Pío del Río Hortega first discovered microglia by histological staining with silver carbonate. He thought that microglia with highly branched fine processes in the healthy brain were quiescent and called these cells as resting microglia. After brain injury, microglia changes their morphology into activated type, which has phagocytic activity at the sites of neuronal damage and inflammation. At 90 years after the discovery of microglia, resting microglia in the healthy brain were found to be very dynamic, much more than any other cells in a live mouse brain using the two-photon scanning laser microscope. Beyond the roles as brain-resident macrophages, many lines of evidence have revealed that microglia have essential roles in the maturation and maintenance of neuronal circuits in the brain through both elimination and formation of dendritic spines through their processes. Furthermore, length and structural complexity of highly branched fine processes are regulated by microglial intrinsic molecular clock. Dysfunction of dendritic spine and disturbance of circadian clock system are widely accepted characteristic abnormalities in neuropsychiatric disorders. Therefore, the growing understanding of movement and functions of microglial processes may aid in the development of novel pharmacological interventions against neuropsychiatric disorders, which are associated with synapse loss and aberrant neuronal connectivity.
    Sadayuki Hashioka1*, Patrick L. McGeer2, Tsuyoshi Miyaoka1, Rei Wake1 and Jun Horiguchi1
    Abstract: Microglial activation is one of common pathological findings in the lesions of many neurodegenerative diseases. In the 1980’s immunohistochemical studies, using anti-major histocompatibility complex class II (MHCII) antibodies identified activated microglia in postmortem brains of neurodegenerative diseases. Microglial activation in the brains of patients with neurodegenerative diseases has been demonstrated since 2000 by positron emission tomography studies employing PK11195. Moreover, activated microglia have also recently been implicated in endogenous psychiatric disorders, such as schizophrenia and mood disorders, where common pathological findings had never before been identified. However, the exact functional states of microglial activation in neuropsychiatric diseases remain to be clarified, since an increase in expression of a microglial marker MHC II or PK11195 is not necessarily an indicator of classical inflammatory microglial activation. Accumulating evidence shows that both antidepressants and antipsychotics attenuate the classical activation of microglia, suggesting that such an action may be associated with their therapeutic effects. It is clearly desirable to establish reliable markers that would identify specific microglial activation states in neuropsychiatric diseases.
    Special Issue on Autism and its Treatment
    Research Article
    Fructuoso Ayala-Guerrero*, Graciela Mexicano and Sarahí Huicochea-Arredondo
    Abstract: Abstract: Autism Spectrum Disorder (ASD) is a heterogeneous, behaviorally defined neurodevelopmental disorder. Patients with ASD might also have co-morbid disorders such as intellectual impairment, epilepsy, and anxiety.
    Findings from questionnaire studies have revealed the existence of several sleep problems in pediatric patients with ASD. However, few studies have analyzed the relationship between these disturbances and Polysomnographic (PSG) findings.
    On the other hand, about a third of people with autism also suffer from epilepsy. For this reason, long-duration electroencephalograms including an adequate amount of slow wave sleep should be carried out in order to detect epileptiform activity.
    The aim of this work is to describe the sleep characteristics and to detect EEG anormalities in ASD patients using polysomnographic recordings.
    Methods: Polysomnographic recordings were carried out in 12 autistic children for two consecutive nights and compared to those of the age and sex-matched controls. Sleep efficiency as well as percentages of each sleep phase were obtained from the two groups of participating children. Distribution of SWS and REM sleep throughout the night was also obtained and compared between both groups. Simultaneously, EEG characteristics were analyzed and compared.
    Results: ASD children presented low sleep efficiency, fragmented sleep and reduction in both SWS and REM sleep. Epileptifom brain activity was observed in 50% of ASD children.
    Conclusion: ASD patients presented quantitative and qualitative sleep disturbances as well as EEG abnormalities.
    Special Issue on Multiple Sclerosis
    Review Article
    Mari Yoshida*
    Abstract: We reviewed and compared the neuropathology of multiple sclerosis (MS), neuromyelitis optica (NMO), neuromyelitis optica spectrum disorders (NMOSD) and acute disseminated encephalomyelitis (ADEM) in Japan. Demyelinating lesions of MS are well circumscribed as compared with the lesions of NMO and NMOSD, which reveal variable, irregularly shaped and ill-defined borders that extend longitudinally along vessels, causing destructive changes with poor gliosis. Although the optic nerves and chiasm, spinal cord, cerebral white matter, brainstem, and cerebellum are involved in both MS and NMO/NMOSDs, the formation patterns of demyelinating lesions appear to differ between MS and NMO/NMOSD. NMO/NMOSD preferentially exhibit central lesions of the spinal cord with strongly softening features. Furthermore, the expression of myelin basic protein (MBP) is strongly diminished in the demyelinating lesions of MS, without loss of aquaporin-4 (AQP4) or GFAP expression. However, AQP4 and GFAP expression is decreased in the demyelinating lesions of NMO/NMOSD. Therefore, AQP4 and MBP immunoreactivity may distinguish NMO/NMOSD from MS neuropathologically. Serial sections of the spinal cord demonstrate longitudinally extensive lesions in NMO/NMOSD, although some cases with MS also reveal similar longitudinally extensive lesions of the spinal cord. In ADEM, demyelinating lesions form primarily in small perivenous foci that differ from the lesions of MS and NMO/NMOSD. Therefore, the shape and formation patterns of demyelinating lesions appear to be disease specific, and it might be possible to distinguish among MS, NMO and ADEM; the immunoreactivity patterns of MBP, AQP4, and GFAP may also aid diagnosis.
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