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Hydrocephalus and dementia complicating spinal tumor

Case report

Henry D. Messer and Ray A. Brinker

edema is present, especially about the frontal horns. Neurological consultation was obtained on September 13, 1978, because it was thought that the increased CSF protein, hydrocephalus, and dementia could be caused by a spinal cord tumor. Although no café-au-lait areas were seen, it was considered that bilateral acoustic neurinomas resulting in hearing loss might also be present. A myelogram performed on September 15 showed a very large intradural tumor at T12-L1 ( Fig. 3 ). Fig. 3. Pantopaque myelogram from below. Anteroposterior (left) and lateral

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Deep brain stimulation for dementias

David S. Xu and Francisco A. Ponce

T he proportion of older people in the global population is constantly growing, with projections indicating that by 2050 more than 22% of the world’s inhabitants will be older than 60 years of age. 48 Concurrent with the aging of the populace, the global prevalence of dementia is expected to increase from 35.6 million cases in 2013 to more than 115.4 million by 2050. 48 As a result, the health and social burden of neurodegenerative conditions resulting in cognitive impairment and dementia will increase dramatically. Although much progress has been made in

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Intracranial pressure in patients with dementia and communicating hydrocephalus

Jagdish C. Chawla, A. Hulme, and R. Cooper

P resenile dementias are disorders of varying etiology characterized by the impairment of intellectual capacity, memory, judgment, speech, locomotion, and progressive disintegration of personality. Epilepsy can also be an associated feature. In the last decade considerable interest has been aroused by reports that progressive presenile dementia in some patients may be associated with the development of communicating hydrocephalus. The term “communicating hydrocephalus” is applied to excessive accumulation of cerebrospinal fluid (CSF) due to poor absorption

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Reversible dementia in patients with chronic subdural hematomas

Eiichi Ishikawa, Kiyoyuki Yanaka, Koichi Sugimoto, Satoshi Ayuzawa, and Tadao Nose

D ementia is a clinical syndrome characterized by acquired losses of cognitive and emotional abilities severe enough to interfere with daily functioning and quality of life. It occurs primarily in elderly persons. The prevalence is approximately 1% in persons 60 years of age and doubles with every 5-year increase in age. 4 With recent increases in the number of aging members of the population, the diagnosis and treatment of dementia has become an important social issue. Chronic subdural hematoma generally occurs in elderly persons; the average age of onset

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Nonvasculitic autoimmune inflammatory meningoencephalitis as a cause of potentially reversible dementia

Report of 4 cases

Mark K. Lyons, Richard J. Caselli, and Joseph E. Parisi

B rain biopsy sampling is an invasive diagnostic procedure rarely considered in the evaluation of patients with dementia. Nonvasculitic autoimmune inflammatory meningoencephalitis, however, causes diffuse encephalopathy that can manifest acutely or chronically and can be mistaken for irreversible degenerative dementia. We report on the cases of 4 patients who underwent brain biopsy sampling, received pathological confirmation of NAIM, and subsequently underwent successful treatment with prednisone. Three of these cases have been included in previous

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Increase in brain atrophy after subdural hematoma to rates greater than associated with dementia

Abdullah Bin Zahid, David Balser, Rebekah Thomas, Margaret Y. Mahan, Molly E. Hubbard, and Uzma Samadani

breakdown of red blood cells, a process that normally occurs in the spleen. The blood breakdown products, especially the iron-containing heme unit, can precipitate oxidation-reduction reactions and lead to neurotoxicity. 1 , 14 , 15 , 24 , 33 There is a pathophysiological basis for an intracranial hemorrhage to cause inflammation-related brain atrophy. 16 , 23 , 28 , 31 , 32 The clinical significance of this process in cSDH when compared with other atrophy-related neurodegenerative conditions, such as dementia, has not been well defined. Our laboratory has developed

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Reversible dementia due to macroprolactinoma

Case report

Michael H. Brisman, Michael R. Fetell, and Kalmon D. Post

pituitary tumor to present with personality changes or dementia if tumor growth extends as far as the deep subfrontal region; 11, 19 however, such cases are not enumerated, suggesting that these presentations rarely occur. We report a patient with a pituitary macroprolactinoma who presented with dementia; this is the first published case of dementia reversed by bromocriptine therapy. Case Report This 46-year-old left-handed man who was employed as a television director presented in April, 1989, with a 1-year history of what had been diagnosed as depression. For

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Reversal of dementia in normotensive hydrocephalus after removal of a cauda equina tumor

Case report

Colin R. Bamford and Enrique L. Labadie

M essert and Wannamaker 9 reviewed the syndrome of occult hydrocephalus and confirmed its clinical manifestations of dementia, apraxia, lack of emotional spontaneity, decreased voice volume, and incontinence. 1 Pneumoencephalography is a diagnostic aid; the results are consistent with normotensive hydrocephalus if the lateral ventricles are enlarged, air fails to pass over the convexities, and the callosal angle is less than 120° on the anteroposterior view. 18 In positive cases isotope cisternography demonstrates ventricular influx and occasional flow into

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Response of cerebral blood flow and cerebrovascular reactivity to acetazolamide in patients with dementia and idiopathic normal-pressure hydrocephalus

Chia-Cheng Chang, Nobumasa Kuwana, Susumu Ito, and Tadashi Ikegami

The responses of cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) to administration of acetazolamide were investigated in 16 patients with dementia and ventriculomegaly to clarify the cerebral hemodynamics in patients with idiopathic normal-pressure hydrocephalus (NPH).

The mean CBF velocity in the whole brain was measured by the Patlak plot method by using technetium-99m hexamethylpropyleneamine oxime single-photon emission computerized tomography. The CVR values were obtained from the response to administration of 500 mg of acetazolamide and calculated as the percentage of change from the baseline mean CBF value. The mean CBF value was significantly reduced (p < 0.01) in six patients with (35.2 ± 5 ml/100 g/minute) and 10 patients without (33.5 ± 2.8 ml/100 g/minute) NPH compared with the age-matched normal controls (40.8 ± 3.2 ml/100 g/minute), showing no significant difference. The CVR was significantly impaired in patients with NPH (0.8 ± 1.7%; p < 0.001), whereas in patients without NPH preserved CVR (11.3 ± 3%) was demonstrated compared with the normal controls (14.7 ± 1.1%). In patients with NPH a significantly lower CVR (p < 0.001) was shown than in those without NPH. The CVR significantly increased (p < 0.001) after placement of a shunt in patients with NPH.

Reductions in both CBF and CVR may be diagnostic indicators of NPH in patients with dementia in whom ventriculomegaly is present. In patients with dementia and idiopathic NPH both reduced CBF and extremely impaired CVR are shown. The results of the present study suggest that ischemia due to the process of NPH is responsible for the reduction of CBF and manifestation of symptoms in patients with idiopathic NPH.

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The diagnostic utility of brain biopsy procedures in patients with rapidly deteriorating neurological conditions or dementia

S. Andrew Josephson, Alexander M. Papanastassiou, Mitchel S. Berger, Nicholas M. Barbaro, Michael W. McDermott, Joan F. Hilton, Bruce L. Miller, and Michael D. Geschwind

with comprehensive medical records and a rapidly worsening neurological condition highlighted similarities in clinical presentation between groups of patients with PCNSL and CJD, which were the two most common definitive diagnoses found in both the entire cohort and the subgroup. This study will serve as a foundation for important prospective work that needs to be performed in the field of rapidly progressive dementias and rapidly worsening neurological conditions. The goal of these future studies would be to standardize this diagnostic algorithm in the hope of