Acta neurologica Taiwanica最新文献

{"title":"Medical Treatment Guidelines for Preventive Treatment of Migraine.","authors":"Tzu-Chou Huang,&nbsp;Tzu-Hsien Lai,&nbsp;Treatment Guideline Subcommittee Of Taiwan Headache Society Taiwan Headache Society","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The Treatment Guideline Subcommittee of the Taiwan Headache Society evaluated the medications currently used for migraine prevention in Taiwan. We assessed the results of new published drug trials, information from medical database and referred to the latest guidelines published. After comprehensive discussion, we proposed Taiwanese consensus about the preventive treatment for migraine including recommendation levels, strength of evidences, and related prescription information regarding dosage and adverse effects. This guideline is updated from earlier version published in 2008. Migraine preventive medications currently available in Taiwan can be categorized into ß-blockers, antidepressants, calcium channel blockers, anticonvulsants, nonsteroid anti-inflammatory drugs, OnabotulinumtoxinA and miscellaneous medications. Propranolol has the best level of evidence and fewer side-effects, and is recommended as the first-line medication for episodic migraine prevention. Valproic acid, topiramate, flunarizine and amitriptyline are suggested as the second-line medications. The rest medications are used when the above medications fail. OnabotulinumtoxinA and topiramate are recommended for chronic migraine prevention. Those other medications used for episodic migraine could also be used as a second-line option. It is not recommended to use migraine preventive medication during pregnancy or lactation. For those women with menstrual migraine, nonsteroid anti-inflammatory drugs and triptans can be used for prevention during the menstrual period. The levels of evidences for migraine preventive medications in children/adolescents and elderly are low. The preventive medications should follow the \"start low and go slow\" doctrine to reach an effective dosage. This can prevent adverse events and improve tolerance. The efficacy of preventive medications cannot be evaluated until 3 to 4 weeks after treatment. If the improvement of migraine maintains for 6 months, physicians can gradually taper the medications. Physicians should notify the patients not to overuse acute medications during migraine prevention treatment.</p>","PeriodicalId":7102,"journal":{"name":"Acta neurologica Taiwanica","volume":"26 1","pages":"33-53"},"PeriodicalIF":0.0,"publicationDate":"2017-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35274027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Profile and Outcome of Myasthenic Crisis In Central Taiwan.","authors":"Yi-Sin Wong,&nbsp;Cheung-Ter Ong,&nbsp;Sheng-Feng Sung,&nbsp;Chi-Shun Wu,&nbsp;Yung-Chu Hsu,&nbsp;Yu-Hsiang Su,&nbsp;Ling-Chien Hung","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Myasthenia gravis (MG) is an autoimmune disease caused by antibodies to acetylcholine receptors of the skeletal muscle. Myasthenic crisis (MC) is a complication observed during both early and late stage MG cases. In this study, we examined current treatments and three years outcomes in patients with MG and MC. We also investigated the impact of thymectomy and systemic lupus erythematosus (SLE) in patients with MG and MC.</p><p><strong>Methods: </strong>In this retrospective study, we reviewed the medical records of all patients admitted to one teaching hospital between January 2006 and December 2014 and identified those for whom discharge diagnosis included the International Classification of Diseases, ninth revision (ICD-9) codes corresponding to MG (358.X, all extensions and all positions).</p><p><strong>Results: </strong>We identified 29 patients and 49 hospitalizations. Among these patients, the cause for initial hospitalization was MG in 16 cases and MC in 13 cases. Six out of the 16 MG patients were readmitted within 3 years; with 2 of the cases due to MC. Eight of the initial 13 MC patients were readmitted within 3 years, and 6 of the cases due to MC. Among these 15 MC patients, 14 were admitted to the intensive care unit (ICU), and 8 were intubation and put on mechanical ventilators. The median ICU stay was 7 days (3-45). Both MG patients who were also diagnosed with SLE experienced MC. One patient died during the first-time hospitalization, and one patient died during re-hospitalization within 2 years.</p><p><strong>Conclusion: </strong>Plasma exchange (PE) is the main treatment modality of MC, and most patients in our cohort had a good response. Infection is the most common trigger of MC and a significant cause of death. Despite significant morbidity and mortality in patients with MC, a favorable long-term outcome is possible with intensive treatment. Key Words: myathenia gravis, myasthenic crisis, systemic lupus erythematosus, outcome.</p>","PeriodicalId":7102,"journal":{"name":"Acta neurologica Taiwanica","volume":"25(4) ","pages":"129-135"},"PeriodicalIF":0.0,"publicationDate":"2016-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34890303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Mitochondrial Aldehyde Dehydrogenase 2 (ALDH2) in Neuropathology and Neurodegeneration.","authors":"Che-Hong Chen,&nbsp;Amit U Joshi,&nbsp;Daria Mochly-Rosen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Aldehydes-induced toxicity has been implicated in many neurodegenerative diseases. Exposure to reactive aldehydes from (1) alcohol and food metabolism; (2) environmental pollutants, including car, factory exhausts, smog, pesticides, herbicides; (3) metabolism of neurotransmitters, amino acids and (4) lipid peroxidation of biological membrane from excessive ROS, all contribute to 'aldehydic load' that has been linked to the pathology of neurodegenerative diseases. In particular, the α, β-unsaturated aldehydes derived from lipid peroxidation, 4-hydroxynonenal (4-HNE), DOPAL (MAO product of dopamine), malondialdehyde, acrolein and acetaldehyde, all readily form chemical adductions with proteins, DNA and lipids, thus causing neurotoxicity. Mitochondrial aldehyde dehydrogenase 2 (ALDH 2) is a major aldehyde metabolizing enzyme that protects against deleterious aldehyde buildup in brain, a tissue that has a particularly high mitochondrial content. In this review, we highlight the deleterious effects of increased aldehydic load in the neuropathology of ischemic stroke, Alzheimer's disease and Parkinson's disease. We also discuss evidence for the association between ALDH2 deficiency, a common East Asianspecific mutation, and these neuropathologies. A novel class of small molecule aldehyde dehydrogenase activators (Aldas), represented by Alda-1, reduces neuronal cell death in models of ischemic stroke, Alzheimer's disease and Parkinson's disease. Together, these data suggest that reducing aldeydic load by enhancing the activity of aldehyde dehydrogenases, such as ALDH2, represents as a therapeutic strategy for neurodegenerative diseases.</p>","PeriodicalId":7102,"journal":{"name":"Acta neurologica Taiwanica","volume":"25(4) ","pages":"111-123"},"PeriodicalIF":0.0,"publicationDate":"2016-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10618051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34890299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parkinsonism or Other Movement Disorders Presenting as Stroke Mimics.","authors":"Cheng-Yang Hsieh,&nbsp;Chih-Hung Chen,&nbsp;Sheng-Feng Sung,&nbsp;Wen-Juh Hwang","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>Patients with parkinsonism or other movement disorders may visit the emergency department due to acute deterioration of neurological status or consciousness disturbance. Under such circumstances, patients may be misdiagnosed as having a hyperacute stroke, i.e. stroke mimic. The purpose of the present study was to explore the clinical features and consequences of patients with parkinsonism or other movement disorders presenting as stroke mimics with activation of a stroke code.</p><p><strong>Methods: </strong>In this retrospective case-series study, we reviewed the charts and stroke code registry data in two stroke centers with high volume of stroke codes and thrombolytic therapy in the Southern Taiwan.</p><p><strong>Results: </strong>We found seven male patients (67.0 ± 12.8 years old): one with focal myoclonus, one with focal dystonia, and the other five with parkinsonism. The chief problems for emergency department visit included acute consciousness disturbance in one patient and motor weakness in other six patients. Five of the six patients with motor weakness complained unilateral symptoms. Six patients were evaluated by neurology residents (five by second-year residents, one by a third-year resident) and one by a board-certified neurologist, while a misdiagnosis of a stroke was made in three patients. All patients experienced neurological improvement when follow-up. One patient who received intravenous thrombolytic therapy had no intracranial hemorrhagic complications.</p><p><strong>Conclusion: </strong>Although rare, parkinsonism or other movement disorders may present as a stroke mimic with activation of a stroke code. Consulting neurologists should clarify the etiology for those patients with acute consciousness disturbance or motor weakness and avoid unnecessary thrombolysis. Key Words: Parkinson disease, parkinsonism, movement disorders, stroke code, thrombolysis.</p>","PeriodicalId":7102,"journal":{"name":"Acta neurologica Taiwanica","volume":"25(4) ","pages":"124-128"},"PeriodicalIF":0.0,"publicationDate":"2016-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34890301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Migraine with Multiple Sensory Auras.","authors":"Nicodemus E Oey,&nbsp;Yew Long Lo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Migraine auras are typically visual in nature but can manifest as disturbances in somatosensory, auditory, and olfactory senses. Reports of multiple sensory auras are rare in the literature, but their existence may offer novel insights into the pathogenesis of this highly common yet complex neurological condition. Here we report a case of multiple sensory auras involving somatosensory, auditory, and olfactory disturbances in a patient with migraine without visual manifestations. A 45-year-old woman with a 20-year history of migrainous headaches presented with complaints of rightsided facial and hand numbness and paraesthesia. In addition to somatosensory symptoms, she eventually presented with tinnitus, cutaneous allodynia, and phantosmia, each of which was temporally associated with episodes of headache. No abnormalities were detected on NCS, EEG, MRI, and laboratory investigations. Her symptoms were managed by prophylactic medications and acupuncture. The theories of cortical spreading depression, cortical sensitization, and thalamocortical network involvement were discussed as possible explanations for sensory auras in migraine. This case report of migraine with multiple sensory auras spanning somatosensory, auditory, and olfactory modalities offers novel insights into the pathophysiology of migrainous auras.</p>","PeriodicalId":7102,"journal":{"name":"Acta neurologica Taiwanica","volume":"25(4) ","pages":"148-151"},"PeriodicalIF":0.0,"publicationDate":"2016-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34890305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Multiple System Atrophy with Preexisting Alzheimer's Disease and Predating The Hot Cross Bun Sign.","authors":"Chi-Wei Lin,&nbsp;Chi-Yu Tseng,&nbsp;Chung-Ping Lo,&nbsp;Min-Chien Tu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>Synucleinopathy, tauopathy and amyloidopathy were classified as distinct clinical and pathological entities in traditional classification systems, and their interactions have been studied on neuropathology and molecular genetics recently.</p><p><strong>Case report: </strong>In this report, we present a 69-year-old male patient who had been diagnosed with probable Alzheimer's disease (AD) dementia due to progressive forgetfulness in February 2013. His Mini- Mental State Examination score was 21/30, and his Cognitive Abilities Screening Instrument score was 78/100, resulted from profound deficits in recent memory and abstract thinking domains. Initial brain magnetic resonance imaging (MRI) showed bilateral medial temporal lobe atrophy but was otherwise unremarkable. He presented with new-onset progressive gait disturbance 18 months after the diagnosis of AD, and mild ataxic gait and linear hyperintensity within the midline of the pons on axial T2-weighted MRI were documented. Neither extrapyramidal nor autonomic signs were observed. Ten months later, profound cerebellar signs, urinary incontinence, and mild axial rigidity consistent with the hot cross bun (HCB) sign were noted. Probable multiple system atrophy-cerebellar (MSA-C) type was finally diagnosed by the clinical and neuroimaging features. Of note, his diagnoses of AD and HCB sign predated the diagnosis of MSA-C by 28 and 10 months, respectively.</p><p><strong>Conclusion: </strong>Given that the HCB sign rarely predates overt symptoms or a diagnosis of MSA, we hypothesized that the preexisting amyloidopathy and tauopathy exerted additional neurotoxicity on the synucleinopathy. Key Words: Multiple system atrophy, hot cross bun sign, Alzheimer's disease.</p>","PeriodicalId":7102,"journal":{"name":"Acta neurologica Taiwanica","volume":"25(4) ","pages":"152-159"},"PeriodicalIF":0.0,"publicationDate":"2016-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34890306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduced Internal Carotid Artery Flow in Color-coded Carotid Duplex Sonography.","authors":"Fu-Yi Yang,&nbsp;Po-Ren Hsu,&nbsp;Shinn-Kuang Lin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>Reduced flow in the internal carotid artery (ICA) is related to cerebral ischemia. We established a classification of reduced ICA flow through color-coded carotid duplex (CCD) sonography.</p><p><strong>Methods: </strong>We retrospectively reviewed 25,000 CCD images in sonography laboratory.</p><p><strong>Results: </strong>Reduced ICA flow [flow volume (FV) less than 100 mL/min] was found in 1.2% of all studies, and 270 patients were enrolled. We included 8% patients with lesions proximal to the ICA in Group A, 27% with lesions at the proximal ICA in Group B, 49% with lesions distal to the visible ICA in Group C, and 16% with unknown causes in Group D. Distal ICA stenosis or occlusion is the most common cause of reduced ICA flow. Moyamoya disease, ICA hypoplasia, and ICA dissection were more prevalent in younger patients. CCD of the aforementioned diseases showed similar patterns of upstream high flow resistance with reduced FV in the ICA and were indistinguishable. The collateral flow from bilateral vertebral arteries increased in common carotid artery (CCA) or ICA disease (p less than 0.05) and was exceptionally high in ICA hypoplasia (p less than 0.001). Compared with the FV in the contralateral CCA, that of the ipsilateral CCA decreased in all groups (p less than 0.001), except in patients with low cardiac output.</p><p><strong>Conclusion: </strong>CCD should be carefully performed and appropriately interpreted in reduced ICA flow. Additional magnetic resonance angiography is helpful in distinguishing stenosis or occlusion from ICA dissection and moyamoya disease, and skull base computed tomography is warranted for the confirmatory diagnosis of ICA hypoplasia. Key Words: color-coded carotid duplex sonography, dissection, hypoplasia, internal carotid artery, reduced flow, stenosis.</p>","PeriodicalId":7102,"journal":{"name":"Acta neurologica Taiwanica","volume":"25(4) ","pages":"136-147"},"PeriodicalIF":0.0,"publicationDate":"2016-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34890304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generalized Convulsion Complicating Acute Diffuse Pulmonary Hemorrhage: The Report of a Rare Case.","authors":"Pei-Ya Chen,&nbsp;Mei-Chen Yang,&nbsp;Yi-Chih Huang,&nbsp;Shinn-Kuang Lin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>The immediate complications associated with a generalized tonic-clonic (GTC) seizure usually involve injuries such as aspiration pneumonia, head injury, skull or vertebral fracture and orolingual biting injury. Here we present a young man who suffered from GTC that was followed by a rare complication, acute diffuse pulmonary hemorrhage, which presented with massive hemoptysis and subsequent respiratory failure.</p><p><strong>Case report: </strong>An 18-year-old boy developed a GTC convulsion that lasted for about two minutes and then regained consciousness 15 minutes later. Another GTC convulsion occurred four hours later for about two minutes. Upon admission, coughing with blood clots was noted and was initially imputed to a bite wound affecting the tongue. However, massive hemoptysis developed soon after. A chest X-ray showed diffuse consolidation of the bilateral lungs. He was transferred to the intensive care unit and was intubated immediately owing to acute respiratory failure. A further chest CT also showed extensive consolidation of the bilateral lungs, mainly in the central and posterior portions. Bronchoscopy showed diffuse tracheal and bronchial erythematous mucosa and post-hemorrhage changes. Laboratory surveys for autoimmune disease, infectious disease, tuberculosis and intoxication gave normal results. After treatment with anticonvulsants, antibiotics and corticosteroids, he was stabilized and extubated on the 5th day of hospitalization.</p><p><strong>Conclusion: </strong>The disease entity of acute diffuse pulmonary hemorrhage is similar to neurogenic pulmonary edema. Physicians should be aware of this extremely rare but life-threatening complication, namely seizure-related acute diffuse pulmonary hemorrhage. The patient's response to respiratory support and corticosteroid is usually quite satisfactory.</p>","PeriodicalId":7102,"journal":{"name":"Acta neurologica Taiwanica","volume":"25 1","pages":"33-7"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34729822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erythromelalgia: a Red Neuralgia.","authors":"Chih-Hsiang Wang,&nbsp;Tzu-Hsien Lai","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":7102,"journal":{"name":"Acta neurologica Taiwanica","volume":"25 1","pages":"49-50"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34729823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypoxic Corpus Callosum Lesion after Cardiac Arrest with Good Prognosis.","authors":"Esra Eruyar,&nbsp;Sule Bilen,&nbsp;Yesim Sucullu Karadag,&nbsp;Neşe Oztekin,&nbsp;Fikri Ak","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Hypoxic ischemic damage of the corpus callosum after cardiac arrest is a rare condition. Lesions of the splenium of the corpus callosum after hypoxia are bilateral and lead to poor prognosis. Herein, we present a case with good prognosis after cardiac arrest with bilateral lesions of the splenium of corpus callosum. </p>","PeriodicalId":7102,"journal":{"name":"Acta neurologica Taiwanica","volume":"25 1","pages":"21-6"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34729820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}