The absence of survival motor neuron 2 gene may play a role in multifocal motor neuropathy.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
P Larrodé
Publications and source records attributed to P Larrodé.
[Peripheral neuropathy associated with intestinal inflammatory disease].
The association of outlying peripheral neuropathy and inflammatory bowel disease is a rare fact leaving aside factors like the deficit of intestinal absorption of vitamins or the neurotoxicity of drugs employed for the treatment of the inflammatory bowel disease. We presented a series of four patients with this association, to whom a retrospective study was carried out. In all cases polineuropathy followed a course parallel to the inflammatory bowel disease, being acute and reversible in two cases. The polyneuropathy could be attributed to a deficit of vitamin B12 in one case and to metronidazole neurotoxicity in the other; in the remaining two cases the polineuropathy was chronic and no etiological factor could be found except for the own activity of the inflammatory bowel disease. We think that the neuropathy can represent a rare extraintestinal manifestation of the illness with a common autoimmune pathogenic mechanism. In one of our cases, the nerve biopsy demonstrated an axonal neuropathy with an alteration of the epineural vessels which showed a healed aspect.
Adult↗
[Sjögren's syndrome and multiple sclerosis].
INTRODUCTION: Multiple sclerosis (MS) usually follows a relapsing-remitting course and attacks multiple areas of the central nervous system (CNS). Certain rheumatic diseases, including Sjögren's syndrome (SS), can present with a similar clinical picture. RESULTS: Two patients out 67 of 100 with MS exhibited xerophthalmia and xerostomia and positive Ro antibodies, thus fulfilling 55 diagnostic criteria. Case 1. A 62-year-old woman developed several episodes of numbress and weakness in her left extremity and ataxia. MRI demonstrated a high-intensity areas in periventricular white matter. Initial laboratory studies failure to demonstrate antinuclear antibodies. Xerostomia and xerophthalmia were apparent. Follow-up laboratory examinations showed elevated ANA, Anti-SSA and anti-SSB. Case 2. A 58-year-old woman was diagnosed as having MS at the age of 53 years. Several high-signal foci on MRI were demonstrated in the white matter. Initial serum findings including autoantibodies were unremarkable. Sicca syndrome was present. Laboratory investigations included elevated anti-SSA, anti-SSARo52 and ANA while anti-SSB was within normal limits. DISCUSSION: Primary SS is a chronic autoimmune inflammatory disease of unknown etiology. The CNS symptoms are present in 20-25% of the patients with SS. Some patients have a relapsing-remitting course mimicking MS. Focal brain lesions in SS can occur in the cerebral white matter. The features of our patients sufficiently mimicked those of MS and this disorder was the diagnosis in each patient at the time of initial evaluation. SS should be considered in th
Antibodies, Antinuclear↗
[Peripheral nervous system neurotoxicity secondary to chemotherapy treatment] .
Peripheral neurotoxicity is a crucial side effect of chemotherapeutic agents. It is the only situation where there is no preventive treatment. Neuromuscular toxicity has become the major dose limiting side effect for many chemotherapeutic agents. The iatrogenic toxic neuropathy is a growing neurologic problem, as cancer patients are beign treated with increasing doses of chemotherapy drugs. Major advances in cancer treatment have resulted from the use of drug combinations; for some combinations this raises the possibility of sinergistic neurotoxicity. The following report reviews the SNP toxicities encountered with cisplatin, vincristine, taxanes and others, and methods to minimize the deleterious effect of chemotherapeutic agents.
Anti-HIV Agents↗
Reversible peripheral neuropathy induced by a single administration of high-dose paclitaxel.
Peripheral neuropathy (PN) is the main side effect with cycles of paclitaxel at standard doses (175 mg/m2 for 21 days). Administration of a single high-dose paclitaxel (HDP) is a novel approach for the treatment of cancer. We have prospectively measured neurotoxicity induced by HDP during a phase I trial. Nineteen patients were treated with escalating doses of paclitaxel by 24-hour infusion. In our study, PN induced by HDP was moderate, reversible, and not dose limiting. Severe PN was seen in patients who had received previous neurotoxic chemotherapy, and caution on the administration of HDP in this setting is warranted.
Adult↗
[Response to treatment of chronic daily headache with analgesic abuse].
The overuse of analgesics in patients with chronic daily headache (CDH) perpetuates and worsens the headache. The aim of this study was to evaluate the clinical response to withdrawal of analgesics and to preventive treatment in a group of patients with CDH. Eighty-four patients who were taking daily symptomatic medications, and suffering from CDH were studied. Treatment consisted of withdrawal of daily symptomatic medications and prophylactic therapy. Improvement was considered when intensity and frequency of the headache were reduced more than 50%. After a 2-15 months follow-up, 57 of the 76 patients that continued in the study had improved. From these, 98% had reduced the consumption of analgesics below the figures considered as abuse and a 94% took the prophylactic medications correctly. After giving up the preventive treatment, 26% of the patient presented CDH and the 60% overuse again of analgesics. These results show that withdrawal of analgesics is necessary for improvement in patients with CDH, but the possibility of relapses is elevated. We think that there are other factors implicated in the development of CDH. We therefore believe that in order to avoid the relapses this group of patients need follow-up and preventive treatments during long periods of time.
Analgesics↗
[Isolated vasculitis of the peripheral nervous system].
We present a patient with a subacute asymmetrical sensorimotor polyneuropathy. The pathological features were predominantly loss of nerve fibers, axonal degeneration and healed vasculitis. The epineural vessels were involved, while endoneurial capillaires were preserved. Muscle biopsy revealed neurogenic features with normal blood vessels. After three years, motor and sensory function was almost normal, without any specific treatment. No abnormal findings suggesting collagen diseases or other underlying immunological disorders were obtained by various laboratory tests. In conclusion, the present case strongly suggests that the vasculitis was confined to the peripheral nerves.
Humans↗
[Clinical features of daily chronic headache].
INTRODUCTION: Although the International Headache Society considers chronic tension headache to be a chronic headache, patients with daily chronic headache may have pain which is not only due to tension but also has migrainous features. OBJECTIVE: To evaluate the clinical differences and abuse of drugs in a group of patients with chronic daily headache who were consecutively evaluated in the Neurology Clinic. MATERIAL AND METHODS: We consider the patients to have daily chronic headache when they have had pain at least 6 days a week for the past 6 months. Using this criterion, we studied 112 patients, of whom 90 (80.4%) were women and 22 (19.6%) men. Results. Sixty nine (61.6%) had transformed migraine and 43 (38.4%) tension headache. There were no differences in their current ages but the age of onset of the headaches varied (p = 0.000,t). Unilateral pain, trigger factors and a family history were more frequent in the cases of transformed migraine. Eighty four patients (75%) abused analgesics. Although we found different pain intensities (p = 0.000, chi 2) there was no difference in the weekly consumption of analgesics (p = 0.64, t) in the mg/week of ergotamine (p = 0.96, t) nor in absence from work between the two types of headache. CONCLUSIONS: In spite of clinical differences between transformed migraine and tension headache, which may help diagnosis, in our series abuse of analgesics (including ergotamine) was a common characteristic.
Acetaminophen↗
[Mandibular neuropathy due to infiltration of the Gasser ganglion].
INTRODUCTION: The numb chin syndrome is characterized by oral and facial numbness restricted to the distribution of the mental nerve. This uncommon neuropathy has been described in association with a number conditions including malignant disease even in the patients no known to have cancer. Numb chin syndrome may be caused by metastatic involvement of the mental nerve, by involvement of the proximal mandibular root at the base of the skull or by intracranial leptomeningeal spread. CLINICAL CASE/DISCUSSION: We described a case of neuropathy of the chin as the initial symptom of the breast cancer. We suggested that the lesion was in the trigeminal ganglion based on enlargement and gadolinium enhancement of the trigeminal ganglia on MRI. A mental neuropathy should initiate a search for cancer that includes MRI of the head.
Breast Neoplasms↗
[Status epilepticus and multiple sclerosis].
Explore the source record for details and available documents.
Adult↗
[Peripheral neuropathy and mixed cryoglobulinemia].
Explore the source record for details and available documents.
Cryoglobulinemia↗
[Peripheral neuropathy and mixed cryoglobulinemia: clinical, neuro- physiological and pathological signs in a group of 12 patients].
This retrospective study involved a series of 12 patients with peripheral neuropathy and mixed type III cryoglobulinemia. The predominating symptoms were sensory. In patients with essential cryoglobulinemia, neuropathy most often presented as multiple mononeuropathy, while polyneuropathic forms were most common among those with secondary cryoglobulinemia. The absence of cryosensitivity was evident in secondary forms. Both neurophysiological and morphological examination revealed a predominance of axonal neuropathy. Two cases of demyelinating neuropathy were found among those with secondary cryoglobulinemia associated with monoclonal gammopathy. Although the vascular lesion was clearly demonstrable in muscle and skin tissue, this was not so in the nervous system.
Adult↗
[Acute transverse myelitis secondary to hepatitis B vaccination].
INTRODUCTION: Acute transverse myelitis is an inflammatory disorder. The pathogenesis is unclear, but the probable mechanism involves an autoimmune phenomenon. Possible causes included multiple sclerosis and parainfectious and postvaccinal events. Myelitis has rarely been reported secondary to vaccinations including hepatitis B. We present a case of acute myelitis, which seems secondary to the administration of the hepatitis B vaccine. CLINICAL CASE: A 15-years-old female presented with progressive numbness of the right arm and leg, with right leg weakness. Symptom began one week after receiving the first dose of the hepatitis B vaccine. Spinal cord magnetic resonance (MR) revealed a diffuse increased signal extending from C6 to D2. Cerebral MR and cerebrospinal fluid were normal. She was treated with high doses of methylprednisolone with a complete recovery of neurological functional. Repeat medullar cord MR was normal. There was no relapse during a four years follow up. CONCLUSIONS: Potential causal relationship between vaccination against hepatitis B and multiple sclerosis was brought to the attention and to public debate. However, no conclusive association could be made between vaccination and demyelination. In the clinical setting, the distinction between a first episode of multiple sclerosis or postvaccinal myelitis depends upon subsequent course.
Acute Disease↗
[Steroid treatment of acute psychosis associated with multiple sclerosis]].
INTRODUCTION: Psychiatric disorders are common in patients suffering from multiple sclerosis (MS). Psychosis is a rare complication in this condition. We present two patients with MS and psychosis. CLINICAL CASES: Case 1. A 45-year-old man was admitted to the hospital because an acute psychosis. The diagnosis of clinical definitive MS was made two years before. Cranial magnetic resonance imaging (MRI) and single positron emission computerized tomography (SPECT) showed lesions in the left temporal lobe. He was treated with a 3-day course of high-dose corticosteroid and neuroleptic. The patient's status gradually improved within the following weeks. Case 2. A 41-year-old man with MS was hospitalized in a Psychiatric Department for acute psychosis. He was treated with high-dose of neuroleptic. Thereafter two remissions and relapses of MS have occurred. In 1998, the patient was evaluated in the Service of Psychiatric for new paranoid acute psychosis. CONCLUSIONS: Psychosis is not a prominent feature of the disease, occurring in 5% of cases. The relationship between lesions of the central nervous system and psychiatric illness has not been established although some reports have implicated the temporal lobe. The propensity of steroids to exacerbate psychosis usually argues against this option, but steroids could theoretically improve psychosis related to acute demyelination.
Acute Disease↗
[Neurological alterations related to Crohn's disease].
INTRODUCTION: The incidence of alterations of the central and/or peripheral nervous system in a patient with Crohn s disease (EC) is 33.2%. Casual association may occur in 19.3% of the cases. The disorder of the nervous system may precede the diagnosis of EC. DEVELOPMENT: We review the main neurological complications of EC. The predominant cerebral vascular pathology is arterial although cases of venous thrombosis have been reported. One of the mechanisms involved is the state of hypercoagulability secondary to thrombocytosis and increase in the factors V, V111 and fibrinogen. In other cases there was confirmation of the presence of antiphospholipid antibodies and lupus anticoagulant, and therefore of an autoimmune mechanisms being involved. Other neurological features include peripheral neuropathy (axonal, demyelinating and autonomic), myopathies, pseudotumor cerebri, papilloedema, psychiatric disorders (anxiety, phobias, depression) and association with syndromes such as multiple sclerosis, Cogan s syndrome, Melkersson Rosenthal syndrome, connective tissue disorders and vasculitis. CONCLUSION: As well as hypercoagulability being one of the pathogenic mechanisms of cerebral ischaemia, there is alteration of humoral and cellular immunity in patients with EC. This justifies this and other neurological manifestations, and explains its association with other immunity disorders.
Antiphospholipid Syndrome↗
[Pure lower motoneurone syndrome in a series of six patients].
INTRODUCTION: Lower motoneurone syndromes (SMNI) have been defined by their clinical pattern, anomalies in nerve conduction and the presence of antiglycolipid antibodies. The possible response to immunotherapy is another characteristic which makes these syndromes interesting. PATIENTS AND METHODS: We studied the clinical and electrophysiological data, clinical progress and response to treatment of a series of six patients, with a pure lower motoneurone syndrome, with a follow up period of between 5 and 13 years. CONCLUSIONS: The clinical phenotype of our patients was: male, middle aged, the clinical topography showed only lower motoneurone involvement, predominantly or exclusively limited to the upper limbs, asymmetrical, distal rather than proximal, with a chronic course progressing initially but later becoming stable. From the electrophysiological point of view some of our cases were of SMNI. In these the conduction block was not permanent although there were signs of axon loss and multifocal demyelination. Response to treatment with intravenous immunoglobulins was seen in patients with anti GMI antibodies of IgM type and recent signs of clinical deterioration, whether there were conduction blocks present or not. In the cases which responded to this treatment there was tolerance and dependence following repeated transfusions of IV IgG.
Adult↗