The Experts below are selected from a list of 309 Experts worldwide ranked by ideXlab platform
Julio Pascual - One of the best experts on this subject based on the ideXlab platform.
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pseudomigraine with Lymphocytic Pleocytosis
Current Pain and Headache Reports, 2003Co-Authors: Julio Pascual, Natalia ValleAbstract:Pseudomigraine with temporary neurologic symptoms and Lymphocytic Pleocytosis is a self-limited syndrome of unknown origin characterized by headache accompanied by transient neurologic symptoms and cerebrospinal fluid lymphocytosis. Patients with this condition are between 15 and 40 years of age. The syndrome is more frequent in men. The clinical picture encompasses one to 12 episodes of changing variable neurologic deficits accompanied by moderate to severe headache and occasional fever. These headaches are described as predominantly throbbing and bilateral with a variable duration (mean, 19 hours). The average duration of the transient neurologic deficit is 5 hours. Sensory (78% episodes), aphasic (66%), and motor (56%) disturbances are the most common. Migraine-like visual symptoms are relatively rare (18% episodes). Patients are asymptomatic between episodes and after the symptomatic period (duration > 3 months). Lymphocytic Pleocytosis (10 to 760 cells mm3) and increased cerebrospinal fluid protein are found with negative bacteriologic, viral, fungal, and immunologic studies. Brain computed tomography and magnetic resonance imaging are normal, but an electroencephalogram frequently shows focal slowing over the symptomatic brain area. Single photon emission computed tomography reveals transient focal areas of decreased uptake consistent with the clinical symptoms. It is possible that pseudomigraine with temporary neurologic symptoms and Lymphocytic Pleocytosis could result from an activation of the immune system secondary to a recent viral infection, which would produce antibodies against neuronal or vascular antigens. This autoimmune attack may induce an aseptic leptomeningeal vasculitis, accounting for the headache and the transient symptoms likely through a spreading depression-like mechanism.
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pseudomigraine with temporary neurological symptoms and Lymphocytic Pleocytosis a report of 50 cases
Brain, 1997Co-Authors: F Gomezaranda, F Canadillas, Jose Felix Martimasso, Exuperio Dieztejedor, P J Serrano, Rogelio Leira, M Gracia, Julio PascualAbstract:This is the first large series, comprising 50 patients who suffered a total of 164 episodes, of pseudomigraine with temporary neurological symptoms and Lymphocytic Pleocytosis (PMP syndrome). Onset of PMP was between the ages of 14 and 39 years and was most frequent in males (68%). Eight males (24%) and five females (31%) had a personal history of migraine. One-quarter had had a viral-like illness up to 3 weeks prior to the onset of the syndrome. The clinical picture consisted of one to 12 episodes of changing variable neurological deficits accompanied by moderate-to-severe headache and occasionally fever. The headaches were described as predominantly throbbing and bilateral with variable duration (mean, 19 h). The mean duration of the transient neurological deficits was 5 h. Sensory symptoms were most common (78% of episodes), followed by aphasic (66%) and motor (56%) symptoms. Visual symptoms appeared in only 12% of episodes. The most frequent combinations were motor aphasia plus sensory and motor right hemibody symptoms (19% of episodes), motor aphasia plus right sensory symptoms (10%) and isolated right (9%) or left (9%) sensory symptoms. All patients were asymptomatic between episodes and following the symptomatic period (maximum duration 49 days). Lymphocytic Pleocytosis ranged from 10 to 760 Lymphocytic cells/mm3 CSF (mean, 199). In CSF, protein was increased in 96% of patients, IgG was normal in 80% of cases and oligoclonal bands were not found. Adensoine deaminase values were slightly above normal in two out of 16 patients tested. Extensive microbiological determinations, including viral HIV and borrelia serologies, were negative. Brain CT and MRI were always within normal limits, while EEG frequently showed focal slowing. Conventional cranial angiography was performed on 12 patients. In only one were there abnormalities suggestive of localized vascular inflammation, coincident with the focal neurological symptoms. Two patients developed PMP symptoms immediately after angiography. SPECT, performed on only three patients in the symptomatic period, revealed focal areas of decreased uptake consistent with the clinical symptoms. PMP aetiology remains a mystery; chronic arachnoiditis, viral meningoencephalitis or migraine are not plausible aetiological explanations. Because a number of patients had had a prodromic viral-like illness, we hypothesize here that such a viral infection could activate the immune system, thereby producing antibodies that would induce an aseptic inflammation of the leptomeningeal vasculature, possibly accounting for this clinical picture.
Joel Victor Fluss - One of the best experts on this subject based on the ideXlab platform.
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pediatric stroke related to lyme neuroborreliosis data from the swiss neuropaediatric stroke registry and literature review
European Journal of Paediatric Neurology, 2018Co-Authors: O Monteventi, Maja Steinlin, Maria Regenyi, Eliane Rouletperez, P Weber, Joel Victor FlussAbstract:Abstract Background Cerebrovascular complications of Lyme neuroborreliosis (LNB) are poorly documented in the paediatric population. Methods We performed a retrospective analysis from prospectively registered cases of acute ischemic stroke (AIS) from the Swiss NeuroPaediatric Stroke Registry (SNPSR) from 2000 to 2015. Only cases with serologically confirmed LNB were included. In addition, a literature review on paediatric stroke cases secondary to Lyme neuroborreliosis in the same time frame was performed. Results 4 children out of 229 children with arterial ischemic childhood stroke and serologically confirmed LNB were identified in the SNPSR giving a global incidence of 1.7%. Median age was 9.9 years. A prior history of tick bites or erythema migrans (EM) was reported in two cases. Clinical presenting signs were suggestive of acute cerebellar/brainstem dysfunction. On imaging, three children demonstrated a stroke in the distribution of the posterior inferior cerebellar artery. The remaining fourth child had a “stroke-like” picture with scattered white matter lesions and a multifocal vasculitis with prominent basilar artery involvement. Lymphocytic Pleocytosis as well as intrathecal synthesis of Borrelia burgdorferi antibodies were typical biological features. Acute intravenous third generation cephalosporins proved to be effective with rapid improvement in all patients. No child had recurrent stroke. Data from the literature concerning eight patients gave similar results, with prominent posterior circulation stroke, multifocal vasculitis and abnormal CSF as distinctive features. Conclusions Lyme Neuroborreliosis accounts for a small proportion of paediatric stroke even in an endemic country. The strong predilection towards posterior cerebral circulation with clinical occurrence of brainstem signs associated with meningeal symptoms and CSF lymphocytosis are suggestive features that should rapidly point to the diagnosis. This can be confirmed by appropriate serological testing in the serum and CSF. Clinicians must be aware of this rare neurological complication of Lyme disease that demands specific antibiotic treatment.
Natalia Valle - One of the best experts on this subject based on the ideXlab platform.
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pseudomigraine with Lymphocytic Pleocytosis
Current Pain and Headache Reports, 2003Co-Authors: Julio Pascual, Natalia ValleAbstract:Pseudomigraine with temporary neurologic symptoms and Lymphocytic Pleocytosis is a self-limited syndrome of unknown origin characterized by headache accompanied by transient neurologic symptoms and cerebrospinal fluid lymphocytosis. Patients with this condition are between 15 and 40 years of age. The syndrome is more frequent in men. The clinical picture encompasses one to 12 episodes of changing variable neurologic deficits accompanied by moderate to severe headache and occasional fever. These headaches are described as predominantly throbbing and bilateral with a variable duration (mean, 19 hours). The average duration of the transient neurologic deficit is 5 hours. Sensory (78% episodes), aphasic (66%), and motor (56%) disturbances are the most common. Migraine-like visual symptoms are relatively rare (18% episodes). Patients are asymptomatic between episodes and after the symptomatic period (duration > 3 months). Lymphocytic Pleocytosis (10 to 760 cells mm3) and increased cerebrospinal fluid protein are found with negative bacteriologic, viral, fungal, and immunologic studies. Brain computed tomography and magnetic resonance imaging are normal, but an electroencephalogram frequently shows focal slowing over the symptomatic brain area. Single photon emission computed tomography reveals transient focal areas of decreased uptake consistent with the clinical symptoms. It is possible that pseudomigraine with temporary neurologic symptoms and Lymphocytic Pleocytosis could result from an activation of the immune system secondary to a recent viral infection, which would produce antibodies against neuronal or vascular antigens. This autoimmune attack may induce an aseptic leptomeningeal vasculitis, accounting for the headache and the transient symptoms likely through a spreading depression-like mechanism.
P M Leuenberger - One of the best experts on this subject based on the ideXlab platform.
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detection of anticytomegalovirus antibody synthesis in the anterior chamber in vogt koyanagi harada syndrome
British Journal of Ophthalmology, 1998Co-Authors: Edoardo Baglivo, B Rossillion, P De Gottrau, P M LeuenbergerAbstract:Editor,—Vogt–Koyanagi–Harada (VKH) syndrome has long been suspected to be the consequence of autoimmunity or hypersensitivity against melanocytes. Nevertheless, to date no certain aetiological factors has been reported. ### CASE REPORT A previously healthy 30 year old Portuguese woman was admitted complaining of progressive visual loss in both eyes, over 2 weeks, associated with headaches and pain on eye movements and meningismus. Symptoms appeared 24 hours after the beginning of a flu-like syndrome. The patient had no past history of ocular trauma or surgery. On examination, the visual acuity was 20/100 in both eyes. Slit-lamp examination revealed 2+ cells in both anterior chambers with non-granulomatous keratic precipitates. Intraocular pressure was 10 mm Hg in both eyes. There were 1+ cells in the anterior vitreous of both eyes. Fundus examination revealed a bilateral papilloedema and the fluorescein angiography showed focal areas of leakage at the level of the retinal pigment epithelium and staining of the optic disc (Fig 1A, B). Figure 1 Late phase of the fluorescein angiogram, right eye (A) and left eye (B). Focal areas of leakage at the level of the retinal pigment epithelium (arrows) and staining of the optic disc. The initial clinical examination revealed an erythrocyte sedimentation rate of 10 mm in the first hour (normal range 1–12), a white blood count of 4.2 g/l (normal range 4–11 g/l) with a normal differential count. Chest x ray was normal. A lumbar puncture showed a Lymphocytic Pleocytosis (proteins 0.37 g/l, white cells 77×106/l, lymphocytes 96%), without oligoclonal bands on electrophoresis. A magnetic resonance cerebral scan was normal. Suspecting a herpetic infection, aciclovir …
Josep Dalmau - One of the best experts on this subject based on the ideXlab platform.
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anti nmda receptor encephalitis causing prolonged nonconvulsive status epilepticus
Neurology, 2010Co-Authors: Nicholas E Johnson, Craig Henry, James A Fessler, Josep DalmauAbstract:Anti-NMDA receptor encephalitis is characterized by dyskinesias, psychosis, and seizures1 secondary to antibodies to the NR1-NR2B heteromer of the NMDA receptor.2 This syndrome, more common in women, is often related to an ovarian tumor1; the prognosis is better if the tumor is identified within 3 months of onset. Our case had nonconvulsive status epilepticus lasting 6 months, with marked improvement following removal of the ovarian tumor. ### Case report. A 35-year-old woman, previously healthy and without history of psychosis, had a 3-week history of progressive headaches, short-term memory loss, and irritability. On admission, she was psychotic, requiring physical and chemical restraints. She was unable to follow commands, had echolalia, and had occasional dystonic posturing of her limbs. One week later, she became unresponsive to external stimuli. An EEG demonstrated persistent nonconvulsive status epilepticus (NCSE). Initial CSF studies were remarkable for a Lymphocytic Pleocytosis with 386 leukocytes. Brain MRI showed diffusion-weighted imaging hyperintensity in the right medial temporal lobe transitioning to fluid-attenuated inversion recovery hyperintensity on repeat imaging (figure 1A). Tests for multiple viral and bacterial pathogens, including herpes simplex virus, were negative. A paraneoplastic …
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opsoclonus myoclonus syndrome in anti n methyl d aspartate receptor encephalitis
JAMA Neurology, 2010Co-Authors: Mary Kurian, Patrice H Lalive, Josep Dalmau, Judit HorvathAbstract:Background Anti– N -methyl-D-aspartate receptor (anti-NMDAR) encephalitis has been recently reported as autoimmune/paraneoplastic encephalitis, affecting mostly young females. Objective To describe opsoclonus-myoclonus syndrome in association with anti-NMDAR antibodies. Design Case report. Setting Geneva University Hospital. Patient A 23-year-old woman with opsoclonus-myoclonus syndrome. Results Two weeks after an episode of gastroenteritis, the patient developed symptoms of depression associated with psychomotor slowing, progressive gait instability, and opsoclonus-myoclonus. Cerebrospinal fluid examination showed mild Lymphocytic Pleocytosis and intrathecal IgG synthesis with oligoclonal bands. The patient's condition worsened rapidly to an akinetic mutism, followed by a period of agitation, delirium, and hallucinations. These gradually subsided; however, a frontal behavior and executive dysfunction persisted 5 months after symptom presentation. No tumor was found. Anti-NMDAR antibodies were found in the cerebrospinal fluid. Conclusions Opsoclonus-myoclonus may occur in patients with anti-NMDAR encephalitis. Prompt diagnosis of this disorder is important because after tumor removal and immunomodulatory therapies it has a relatively good prognosis.
