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This Month in Archives of Neurology
August 2004

This Month in The Archives of Neurology

Arch Neurol. 2004;61(8):1172-1173. doi:10.1001/archneur.61.8.1172
Neurology Weighs In

As Berger points out, weight is a national obsession. Bariatric surgery is a successful procedure and increasing in frequency. However, it is not without neurological complications, and this timely review indicates the important associated syndromes that require urgent evaluation and treatment.

West Nile Virus Infection in the United States

Tyler provides a comprehensive and elegant review of the epidemiological, clinical, neuropathologic, and therapeutic issues involved in cases of West Nile virus infection seen in the United States since 1999.

Apolipoprotein E Receptors and Alzheimer Disease

Scherzer and colleagues report the loss of the microarray-derived apolipoprotein E receptor LR11 in neurons of brains with Alzheimer disease. It is an important observation indicating that a specific apolipoprotein E receptor function, in addition to allele type, can be involved in selected patients with Alzheimer disease and thus is one of the late-onset polygenetic factors that summate with other genetic variations that can be causal of the dementia of Alzheimer disease type. It extends, as well, the role of altered cholesterol metabolism in Alzheimer disease. Editorial comment is provided by Benjamin Wolozin, MD, PhD.

West Nile Virus Encephalitis in Transplant Recipients  

Kleinschmidt-DeMasters and colleagues describe their experience with 11 immunosuppressed transplant recipients in whom severe encephalitis developed. These patients developed neurological deficits at the severe end of the spectrum of West Nile virus encephalitis compared with nonimmunocompromised individuals. Editorial comment is provided by Roger N. Rosenberg, MD.

Imaging Early Parkinson Disease

Jennings and colleagues evaluate the diagnostic accuracy of dopamine transporter imaging using (123I) β-carboxymethyoxy-3-β-(4- iodophenyl)tropane in patients with suspected early parkinsonian syndrome. Thirty-five patients with parkinsonian syndrome were evaluated clinically and with imaging. Comparing the community neurologist’s diagnoses at referral with the gold standard diagnosis, there was disagreement in 25.7% of the cases. Comparing the imaging diagnoses with the gold standard, there was disagreement in 8.6% of the cases. Thus, functional imaging of the dopamine transporter at baseline can be a useful diagnostic intervention to detect patients with early parkinsonian syndrome at baseline.

Optic Nerve in Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy

Blood flow, volume, and velocity using a retina flowmeter in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy showed a significant decrease in overall blood flow and volume in the neuroretinal rim in comparison with healthy control subjects, as reported by Rufa and colleagues.

Magnetic Resonance Imaging in Patients With Migraine and Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy

Vahedi and colleagues find that migraine episodes in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy have an unusually high frequency with an atypical aura, including migraine aura without headache, hemiplegic migraine, basilar migraine, and acute onset aura. The distribution and extent of magnetic resonance imaging signal abnormalities did not differ according to the migraine phenotype.

Spinocerebellar Ataxia and Protein Kinase C

Stevanin and colleagues have identified families in France with spinocerebellar ataxia type 14 with missense mutations in the gene encoding the γ subunit of protein kinase C. A new spino cerebellar ataxia type 14 family with the first mutation (F643L) located in the catalytic domain of the enzyme is described, extending the molecular genotypes associated with spinocerebellar ataxias.

Serotonin Transport and Alzheimer Disease Phenotype

The association of the serotonin promoter, transporter, and receptor genes with neuropsychiatric symptoms in Alzheimer disease was studied by Assal and colleagues. A 5-HT2A serotonin receptor gene polymorphism was significantly associated with delusions and agitation or aggression. This observation indicates that a specific variation in serotonin receptor and transport function is related to a specific phenotype of Alzheimer disease, providing new insight into the biochemical and genetic basis of the clinical phenotype.

Inhalation Anesthetics and Status Epilepticus

Mirsattari and colleagues report the efficacy of inhalation anesthetics in treating refractory status epilepticus. Inhalation anesthetics were highly effective in suppressing status epilepticus. (See Figure.)

A, Longitudinal bipolar recording of left hemispheric seizure onset with secondary generalization (not shown). Sensitivity, 15 μV/mm; low-frequency filter (LFF) , 0.3 Hz; and high-frequency filter (HFF ), 70 Hz; notch filter off. B, Longitudinal bipolar recording of termination not controlled with boluses of lorazepam and continuous infusion of large doses of propofol (patient 3). Sensitivity, 15 μV/mm; LFF , 0.3 Hz; and HFF , 70 Hz; notch filter off. C, Longitudinal bipolar recording of the same patient with sustained, adequate burst suppression while receiving isoflurane. Sensitivity, 7 μV/mm; LFF , 0.3 Hz; and HFF, 70 Hz; notch filter off.

A, Longitudinal bipolar recording of left hemispheric seizure onset with secondary generalization (not shown). Sensitivity, 15 μV/mm; low-frequency filter (LFF) , 0.3 Hz; and high-frequency filter (HFF ), 70 Hz; notch filter off. B, Longitudinal bipolar recording of termination not controlled with boluses of lorazepam and continuous infusion of large doses of propofol (patient 3). Sensitivity, 15 μV/mm; LFF , 0.3 Hz; and HFF , 70 Hz; notch filter off. C, Longitudinal bipolar recording of the same patient with sustained, adequate burst suppression while receiving isoflurane. Sensitivity, 7 μV/mm; LFF , 0.3 Hz; and HFF, 70 Hz; notch filter off.

Recurrence of Sydenham Chorea

Korn-Lubetzki and colleagues report on 24 new cases of Sydenham chorea in which a relapse of rheumatic fever may not be involved. Other possible pathogenetic issues are discussed.

Cognitive Performance, Depression, and Alzheimer Disease

Depression as a major additive feature to impair cognition in patients with Alzheimer disease was studied by Powlishta and colleagues. They found no relation between the clinician’s diagnoses of depression and psychometric scores. Thus, depression does not worsen cognitive performance beyond the effect of dementia.

Neurological Dysfunction Due to Mass Hysteria

Roach and Langley observe 10 students from a small rural school with episodes resembling seizures or syncopal attacks. Seven students were treated with antiepileptic medications, and most underwent multiple diagnostic studies. Mass hysteria was the cause of symptoms in these students.

Mild Parkinsonian Signs: Predictor of Dementia

Louis and colleagues determined whether baseline mild parkinsonian signs are a good predictor of incident dementia. They found that the risk of incident dementia was 57% higher in participants with baseline parkinsonian signs than in those without baseline parkinsonian signs.

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