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Objectives: The aim of this study was to compare the short‐term clinical outcome of patients with acute cerebral ischemia and mild symptoms receiving rt‐PA with that of patients with acute cerebral ischemia and mild symptoms not treated with rt‐PA, and to investigate the frequency of symptomatic intracranial hemorrhage (sICH) in these patients. Materials and methods: All patients with confirmed ischemic stroke/TIA and mild symptoms were included. Mild symptoms were defined as NIHSS score ≤5 on admission. Functional outcome was assessed with modified Rankin Scale (mRS) at day 7 or at earlier discharge. Excellent outcome was defined as mRS = 0. sICH was defined according to both NINDS and ECASS III criteria. Results: Of 2753 patients with confirmed ischemic stroke/TIA admitted between February 2006 and February 2013, 966 (35.3%) were excluded because of having admission NIHSS >5. A total of 1791 patients presented with mild symptoms on admission (NIHSS ≤5), of which 158 (8.8%) patients received rt‐PA. Treatment with rt‐PA and early admission were independently associated with excellent outcome. Higher NIHSS score on admission and prior ischemic stroke were independently associated with poor outcome. Three (1.9%) sICH were diagnosed in rt‐PA‐treated patients and one (0.1%) in patients not receiving rt‐PA. Conclusions: This study highlights the efficacy of rt‐PA in patients with acute cerebral ischemia presenting with mild symptoms and confirms the low‐risk profile of this treatment. [ABSTRACT FROM AUTHOR]

Winge K, Jennum P, Lokkegaard A, Werdelin L. Anal sphincter EMG in the diagnosis of parkinsonian syndromes. Acta Neurol Scand: 2010: 121: 198–203. © 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Background – The role of electromyography (EMG) recorded from the external anal sphincter (EAS) in the diagnosis of atypical parkinsonian syndromes is a matter for continuous debate. Most studies addressing this issue are retrospective. Methods – In this study, we prospectively investigated six patients with Parkinson’s Disease (IPD), 14 patients with multiple system atrophy (MSA) and eight with progressive supranuclear palsy (PSP) using EMG of the EAS, motor-evoked potential (MEP) to the EAS and EMG of m. gastrocnemius and nerve conduction velocity measured at the sural nerve. Patients were followed up for 2 years to secure correct diagnosis. Results – The mean duration of motor unit potentials (MUPs) recorded from the EAS was significantly longer in patients with MSA and PSP compared with MUPs recorded from patients with PD ( P < 0.005 for both). There were no signs of diffuse loss of motor neurons or peripheral neuropathy. MEP revealed signs of supranuclear affection in patients with MSA, whereas in patients with PSP the mechanism is a focal loss of motor neurons in Onuf’s nucleus. Conclusion – Abnormal EMG of the EAS is strongly suggestive of atypical parkinsonism and the pathophysiology may be different in patients with MSA and PSP. [ABSTRACT FROM AUTHOR]

Background – Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder. Increasing attention has been focused on the pain and health-related quality of life (HrQOL) in patients with PD. Objective – To evaluate the relationship between pain and the HrQOL in patients with PD. Methods – Eighty-two patients with PD were included and classified into two groups according to the presence of pain. The Hoehn and Yahr scale, the Unified Parkinson’s Disease Rating Scale (UPDRS), the Modified Somatic Perception Questionnaire (MSPQ), the Zung Depression Inventory – Self-rating Depression Scale (SDS), the Visual Analogue Scale and the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were administered. The factors influencing the pain, HrQOL and parkinsonian manifestations were evaluated. Results – The PD with pain group had higher UPDRS part III scores, lower SF-36 scores, higher SDS scores and higher MSPQ scores than the PD without pain group. The presence of pain, high Hoehn and Yahr stage, advanced age and somatic perception were the factors that had a negative effect on the physical component of the HrQOL. Depression and somatic perception were the most important predictive factors for the mental component of the HrQOL. Depression and poor parkinsonian motor abilities were the leading factors contributing to pain. Conclusion – Pain and depression were major detrimental factors affecting the physical and mental aspects of the HrQOL respectively. Therefore, the treatment of pain and depression can be important to improve the HrQOL. [ABSTRACT FROM AUTHOR]

Objective – To define characteristics of pediatric asymptomatic idiopathic intracranial hypertension (IIH). Patients and methods – We retrospectively reviewed our Neuro-Ophthalmology database (2000–2006) for all cases of symptomatic and asymptomatic pediatric IIH. Results – Out of 45 IIH cases, 14 (31.1%) were asymptomatic (incidental examination). When compared with children with symptomatic IIH, asymptomatic cases were younger [5.6 (1.8–15) vs 11.0 (5–17) years, P = 0.007], had lower percentage of obesity (14.3% vs 48.4%, P = 0.046), and had male predominance (71.4% vs 38.7%, P = 0.06). Asymptomatic cases required shorter duration of acetazolamide treatment [3 (0–8), vs 6 (0–20) months, P = 0.021], and resulted in complete resolution of swollen discs. Conclusions – We speculate that asymptomatic IIH may be more common in young children and could represent a milder form or a presymptomatic phase before evolving into classic symptomatic IIH. Further studies to assess the clinical significance of asymptomatic IIH are warranted. [ABSTRACT FROM AUTHOR]

Background – Parkinsonian syndrome related to intravenous use of a ‘designer’ psychostimulant, derived from pseudoephedrine using potassium permanganate as the oxidant, has been observed in drug addicts in Estonia. Objective – To describe the symptomatology of four young patients, history of drug administration and chemical analysis of a drug batch. Methods – Mental and motor function and quality of life were scored and ephedrone was analyzed using electrospray mass spectrometry. Manganese content of the final synthetic mixture was analyzed using Inductively Coupled Plasma-Atomic Emission Spectrometry. Results – None of the four cases scored below the dementia threshold in MMSE, while other ratings (UPDRS, H&Y, PDQ-39) corresponded to disabilities seen in relatively advanced Parkinson's disease. The ephedrone yield of the reaction was approximately 44% and the mixture was found to contain 0.6 g/l of manganese. Conclusions – The cases were exposed to extreme manganese load. Their symptomatology is probably identical to manganism. The role of ephedrone is presently unknown. Physicians must be aware of early signs of manganism in patients within social risk groups. [ABSTRACT FROM AUTHOR]

Objective – To investigate the relationship between the severity of white matter hyperintensities (WMH) and cortical acetylcholinesterase (AChE) activity in parkinsonian dementia (PDem). Methods – PDem ( n = 11) and control subjects ( n = 14) underwent [11C]methyl-4-piperidinyl propionate (11C-PMP) AChE brain positron emission tomography and magnetic resonance (MR) imaging. Presence of WMH on proton density and T2 MR images was scored using a modified version of the semi-quantitative rating scale by Scheltens et al. [ J Neurol Sci 114 (1993)]. Results – Analysis demonstrated significantly lower mean cortical 11C-PMP k3 hydrolysis rates in PDem (−19.9%) when compared with control subjects ( P < 0.0001). PDem subjects had higher mean severity of WMH (+20.1%) when compared with control subjects ( P < 0.05). When WMH severity was entered into the analysis of variance model, there was no significant co-variate effect on cortical AChE activity ( F = 0.24, ns). Conclusions – The concomitant presence of mild to moderate WMH in patients with PDem does not have a significant effect on cortical AChE activity. [ABSTRACT FROM AUTHOR]

Background – Psychosis is one of the most serious complications of advanced parkinsonism, but many patients are spared. The genetic factors predisposing to psychosis are unclear. Objectives – To assess the association between apolipoprotein E (APOE) polymorphism and the development of psychosis in patients with Parkinson's disease (PD). Methods – Eighty-seven patients with advanced PD were assessed. Psychosis was diagnosed in 50 patients who manifested paranoid delusions, hallucinations without insight, or disorders of perception. Time of onset of psychosis was retrieved from the medical records and caregivers’ recall. APOE genotype was determined by restriction enzyme digests of amplified alleles. Cox models of logistic regression and Kaplan–Meier survival curves were used to assess factors determining early development of psychosis. Results – APOE ℇ3/ ℇ4 allele was carried by 20 patients (14 with psychosis), ℇ2/ ℇ3 by 11 patients (10 with psychosis), ℇ3/ ℇ3 by 55 patients (25 with psychosis) and ℇ2/ ℇ4 by one patient who had psychosis. The mean age of onset of PD symptoms was 60.0 ± 12.5 years. The mean duration of motor symptoms at the onset of psychosis was 7.3 ± 4.3 years for the 15 patients harboring an APOE ℇ4 allele and 10.1 ± 6.2 years among those who did not carry APOE ℇ4 ( n = 35). The APOE ℇ4 allele was significantly associated with earlier onset of psychosis ( P < 0.05) when the age of onset of motor symptoms and presence of dementia were included in the Cox regression model. Carrying the APOE ℇ4 allele was a significant risk factor for earlier appearance of psychosis with a hazard ratio of 3.24 (95% CI 1.62–6.46) while dementia by itself did not increase the risk. Conclusion – Parkinson's disease patients who carry the APOE ℇ4 allele develop psychosis earlier. [ABSTRACT FROM AUTHOR]