Acta Neurologica Scandinavica (Acta Neurol Scand )

Publisher: Blackwell Publishing

Description

The aim of Acta Neurologica Scandinavica is to publish manuscripts of a high scientific quality representing original clinical, diagnostic or experimental work in neurology and neurosurgery. The scope is to act as an international forum for the dissemination of information advancing the science or practice of these disciplines. Papers in English will be welcomed, especially those which bring new knowledge and observations from the application of therapies or techniques in the combating of a broad spectrum of neurological disease and neurodegenerative disorders. Relevant articles on the basic neurosciences will be published where they extend present understanding of such disorders.

  • Impact factor
    2.47
  • 5-year impact
    2.33
  • Cited half-life
    0.00
  • Immediacy index
    0.56
  • Eigenfactor
    0.01
  • Article influence
    0.67
  • Website
    Acta Neurologica Scandinavica website
  • Other titles
    Acta neurologica Scandinavica (Online), Acta neurologica Scandinavica
  • ISSN
    1600-0404
  • OCLC
    46680937
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Blackwell Publishing

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
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    • Some journals impose embargoes typically of 6 or 12 months, occasionally of 24 months
    • no listing of affected journals available as yet
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    • See Wiley-Blackwell entry for articles after February 2007
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    • On author's server, institutional server or subject-based server
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    • Publisher copyright and source must be acknowledged with set statement ("The definitive version is available at www.blackwell-synergy.com")
    • Articles in some journals can be made Open Access on payment of additional charge
    • 'Blackwell Publishing' is an imprint of 'Wiley'
  • Classification
    ​ yellow

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives The study aims to investigate whether patients with mild cognitive impairment (MCI) who have significant vascular disease (MCI-vas) differ from those with no significant vascular disease (MCI-nov) in terms of cognitive profile when assessed with the cognitive assessment battery (CAB).Materials and methodsSeventy patients clinically diagnosed with MCI were included in the study, 32 were classified as MCI-vas, and 38 as MCI-nov, together with 40 healthy controls. CAB consists of six short tests measuring speed and attention, memory, visuospatial functions, language, and executive functions.ResultsThe healthy controls performed better than both MCI groups on CAB. MCI-vas patients were significantly older and had fewer years of education than MCI-nov patients. When adjusted for age and education, MCI-vas performed significantly worse than MCI-nov on memory, language, and executive tests.Conclusions The results suggest that CAB can differentiate between MCI patients with and without vascular disease and that their cognitive profiles differ. Furthermore, CAB classified the patients as vascular and non-vascular MCI with good sensitivity and specificity.
    Acta Neurologica Scandinavica 12/2014;
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    ABSTRACT: Objectives In patients who exhibit myotonic dystrophy type 1 (DM1), sleep disorders and breathing impairments are common; however, in those with DM type 2 (DM2), limited studies on polysomnography (PSG) and none on phrenic compound motor action potential (CMAP) have been performed, which is the aim of this study.Materials and methodsSixteen patients with DM2 were questioned about respiratory symptoms. They underwent PSG with morning arterial gas analyses (AGA). Respiratory functions and phrenic CMAPs were studied. The data were compared to those of 16 healthy controls and 25 patients with DM1.ResultsDaytime tiredness is the most common symptom, but orthopnea was reported in 13% of patients with DM2. A detailed sleep architecture analysis revealed a significantly greater proportion of time in stage 3 and REM sleep, and a shorter time in stage 2 in the DM2 than in controls. Lower respiratory volumes and pressures, abnormalities in AGA, night oxygen desaturation and higher EtCO2 are present in DM2, but are less pronounced than in the DM1 population. Small CMAP amplitudes were presented in 12% of patients with DM2, correlating with smaller respiratory functions and poorer sleep quality. AHI was abnormal in 38% of DM2, mainly due to obstructive apneas. PSG did not reveal hypoventilation.Conclusions Diaphragm weakness and sleep apneas might be present in patients with DM2; therefore, we suggest regular questioning about symptoms of respiratory insufficiency and monitoring of phrenic CMAP. PSG should be recorded, when patients have suggestive symptoms, abnormalities in AGA or higher BMI.
    Acta Neurologica Scandinavica 12/2014;
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    ABSTRACT: Background The role that oestradiol and testosterone play in Parkinson's disease and their potential to influence the course of the disease has been covered in medical literature. The aim of this work was to compare oestradiol, testosterone, sex hormone-binding protein and prolactin blood levels in males affected with Parkinson's disease and in an age-matched control group, and to show possible dependence between concentrations of plasma hormones and the progression of symptoms of Parkinson's disease.Methods The plasma levels of oestradiol, testosterone, prolactin and sex hormone-binding protein were examined in 36 patients affected with Parkinson's disease and in 69 age-matched control subjects, using chemiluminescent reactions. Patients with Parkinson's disease were examined using scales assessing their clinical state.ResultsThe level of prolactin was higher in the affected group. Concentrations of oestradiol and testosterone in the control group exceeded those found in patients. The level of sex hormones was positively correlated with better mood and quality of life in patients affected with Parkinson's disease; prolactin levels correlated negatively with sex steroid concentrations.Conclusions Lower blood levels of sex steroids and higher concentrations of prolactin and its antigonadotrophic activity in males affected with Parkinson's disease may result in a bigger susceptibility to the disease in men. The level of hormones may influence patients’ cognition, mood and quality of life.
    Acta Neurologica Scandinavica 11/2014;
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    ABSTRACT: Background The Parkinson's Disease Sleep Scale (PDSS)-2 is a recently developed tool for evaluating disease-related nocturnal disturbances in patients with Parkinson's disease (PD). However, its cutoff score has not been clinically assessed. We determined the optimal cutoff score of the Japanese version of the PDSS-2.Methods Patients with PD (n = 146) and controls (n = 100) completed the PDSS-2 and the Pittsburgh Sleep Quality Index (PSQI). Poor sleepers were defined as having global PSQI scores >5. Optimal cutoff scores for determining poor sleepers were assessed using the receiver operating characteristic curve.ResultsA PDSS-2 total score ≥14 exhibited 82.0% sensitivity and 70.6% specificity, whereas a PDSS-2 total score ≥15 provided 72.1% sensitivity and 72.9% specificity in distinguishing poor sleepers (PSQI score >5) from good sleepers (PSQI ≤5). Nocturnal disturbances were more frequently observed in patients with PD than in controls (PDSS-2 total score ≥14 or ≥15; 51.4% vs 20%; 45.9% vs 19%). Nocturnal disturbances were associated with higher Hoehn and Yahr stages and Unified Parkinson's Disease Rating Scale motor scores, impaired quality of life, daytime sleepiness, and depressive symptoms.Conclusion We suggest that PDSS-2 total scores ≥15 are useful for detecting poor sleepers among patients with PD.
    Acta Neurologica Scandinavica 11/2014;
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    ABSTRACT: Objectives Better identification and triage of acute posterior circulation (PC) stroke patients is needed as the PC ischemic stroke (IS) patients may be allowed longer thrombolysis window than anterior circulation (AC) IS patients and PC patients with hemorrhagic stroke (ICH) may require care in a neurosurgical unit possibly remote from stroke unit.Materials and methodsConsecutive stroke patients treated at a tertiary center with thrombolysis (100% for IS) and/or comprehensive stroke unit care.ResultsAltogether, 1641 patients had AC (75%) and 553 PC strokes. The PC-IS patients were younger (65 vs 70), had less often prior hypertension (51 vs 61%), and were twice more often on warfarin. They presented 3.5 times more often with seizure, vomited five times more often, had headache twice as often, and required intubation 2 to 3 times more often despite equal NIHSS (9 vs 8) or GCS (15 both) scores with AC-IS patients. Among PC patients, IS (n = 190) associated with younger age, prior atrial fibrillation (AF) in 25% and dyslipidemia in ~40%. One-third of PC-ICH patients (n = 363) had headache and vomited at the onset. PC-ICH patients had BP median of 177/92 mmHg and blood glucose 7.4 mmol/l on ER arrival. Warfarin use was twice as common in PC-ICH.Conclusions Despite being of typical age for multiple cardiovascular conditions the PC-ICH patients less often have a previous history of AF or dyslipidemia than IS patients do. The vomiting PC-ICH patient with hypertensive BP values often has headache and a red flag for hemorrhage is warfarin treatment.
    Acta Neurologica Scandinavica 11/2014;
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    ABSTRACT: Objectives Presence of oligoclonal bands (OCB) in cerebrospinal fluid (CSF) is a diagnostic hallmark of multiple sclerosis (MS). However, up to 10% of patients were OCB negative in routine laboratory tests. The aim of this study was to determine whether there is at least an oligoclonal restriction of intrathecal antibody synthesis against measles, rubella and/or varicella zoster virus (MRZ-specific OCB) in CSF from oligoclonal bands-negative patients with MS.MethodsCSF and serum samples from 17 well-defined OCB-negative patients with MS were analysed for MRZ-specific OCB. We performed isoelectric focusing (IEF) combined with affinity blotting using viral antigens, detection with a highly sensitive chemiluminescence technique and recording with X-ray films. Controls included 18 OCB-positive patients with MS and 11 patients with pseudotumor cerebri (PTC).ResultsExclusive or predominant MRZ-specific OCB in CSF against at least one virus species were present in 8 of 17 patients with MS (47.1%; P = 0.0422), suggesting an oligoclonal intrathecal immune response, although OCB of total IgG were absent. Only a very weak oligoclonal reaction against varicella zoster virus in CSF from one of the PTC controls was detectable. Thirteen of 18 (72.2%; P = 0.0013) OCB-positive patients with MS showed also MRZ-specific oligoclonal bands against at least 1 neurotropic virus in CSF.ConclusionsMRZ-specific OCB argue for existence of a chronic intrathecal immune reaction also in routine laboratory-OCB-negative patients with MS. This phenomenon reflects oligoclonal restriction of the humoral immunoreaction as well as polyspecific intrathecal antibody synthesis, which are both characteristics in the chronic inflammatory process of MS.
    Acta Neurologica Scandinavica 11/2014;
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    ABSTRACT: Determinants of risk of myocardial infarction (MI) after transient ischaemic attack (TIA) are not well defined. The aim of our study was to determine the risk and risk factors for MI after TIA.
    Acta Neurologica Scandinavica 10/2014;
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    ABSTRACT: Objectives Attention plays a fundamental role in cognitive performance and is closely interrelated with all major cognitive domains. In this retrospective study, we correlated different measures of attention with standard cognitive parameters in 85 cognitively impaired elderly individuals presenting with cognitive complaints to a memory clinic.Materials and MethodsZ-scores of all relevant cognitive parameters of a extended Consortium to Establish a Registry for Alzheimer's disease (CERAD-Plus) neuropsychological battery were correlated with tonic and phasic alertness, inhibition, and divided attention, assessed by a computerized test battery of attention. The pooled sample consisted of 36 patients with the diagnosis of mild AD, 30 patients with mild cognitive impairment, and 19 patients with major depressive disorder.ResultsSubjects of all diagnostic groups exhibited normal results in all subtests of attention. Reaction times of neither the tonic nor the phasic alertness task were correlated with any parameter of memory and global cognition. However, significant correlations were obtained between reaction times in the alertness tasks and the trail-making tests. Omissions in the divided attention task yielded the strongest correlations with deficits in cognitive performance, particularly in the verbal learning tasks, the Boston naming test, and the trail-making tests.Conclusions Our data demonstrate the relative independency of the CERAD-Plus on the variability of attention and particularly alertness suggesting its robustness in psychiatric memory clinic settings. Moreover, CERAD-Plus subtests correlated considerably with failure rates in divided attention, suggesting that impairment in divided attention tasks may be early markers of cognitive impairment.
    Acta Neurologica Scandinavica 10/2014;
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    ABSTRACT: Background Modified Atkins diet is a treatment option for patients with pharmacoresistant epilepsy that is not suitable for surgery. In the last few years, we have tried dietary treatment added to antiepileptic drugs (AEDs) in adult patients with severe epilepsy.Aim of the studyTo examine a possible pharmacokinetic interaction between the modified Atkins diet and AEDs.Methods In four patients, AED serum concentrations were measured before onset and after 4 and 12 weeks on the diet. The patients used combinations of two or three AEDs, including carbamazepine, clobazam, lamotrigine, nitrazepam, oxcarbazepine, valproate, zonisamide, and topiramate. The patients did not change the type or dose of their AEDs during the diet period.ResultsAfter 12 weeks on the diet, the average serum concentrations of the respective AEDs were reduced by 35% (range 6–46%) compared to prediet values.Conclusions Modified Atkins diet used as add-on therapy to AEDs in four patients with drug resistant seizures caused a considerable decrease in AED serum concentrations. In individual patients, this could be of clinical relevance, and we recommend that AED serum concentrations should be closely monitored when offering this diet to adults with epilepsy.
    Acta Neurologica Scandinavica 10/2014;
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    ABSTRACT: Objectives/AimsThis is an open-label trial of the safety of interferon gamma-1b (IFN-γ) and its effect on frataxin levels and neurologic measures in 12 children with Friedreich ataxia.Materials and Methods Interferon gamma-1b was administered via subcutaneous injection three times weekly. The dose increased from 10 to 50 mcg/m2 during the first four weeks and then remained at 50 mcg/m2 for final eight weeks. Safety assessments included laboratory testing, electrocardiogram, and monitoring of adverse events. The primary efficacy outcome measure was frataxin level in whole blood. Secondary measures included frataxin levels in multiple tissues, frataxin mRNA levels, Friedreich Ataxia Rating Scale (FARS) scores and other neurologic evaluations. Statistical analyses were performed via SAS and STATA.ResultsInterferon gamma-1b was well tolerated with no serious adverse events, and only two subjects reporting severe adverse events and subsequent dose reductions. Small but significant changes in frataxin levels were observed in red blood cells, PBMC, and platelets after 12 weeks of treatment. However, the magnitude of change was small and varied between tissues. Mean improvement in FARS score was equivalent to roughly 18 months of disease progression after 12 weeks of treatment (P = 0.008). No other statistically significant changes were observed. No statistically significant relationships were observed between frataxin protein levels, FARS scores, and in vivo IFN-γ levels.Conclusions Interferon gamma-1b improved FARS scores without a clear relationship to changes in frataxin levels. Larger, longer placebo-controlled trials including biochemical assessments in affected tissues are necessary to evaluate fully the efficacy and utility of IFN-γ in FRDA.
    Acta Neurologica Scandinavica 10/2014;
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    ABSTRACT: Objective To investigate whether those genes involved in the vitamin D pathway modulate the relationship between 25-hydroxyvitamin D (25(OH)D) and IFN-β, the relationship between IFN-β and sun in predicting 25(OH)D, and the interaction between IFN-β and 25(OH)D in modulating relapse risk in patients with MS.Methods Prospective cohort study of 169 participants with MS and genotype data followed 2002–2005. Gene-IFN-β and gene-IFN-β-sun interactions predicting 25(OH)D evaluated by multilevel mixed-effects linear regression. Gene-IFN-β interactions with 25(OH)D in modulating in relapse risk assessed using survival analysis.ResultsThe cohort was 71.6% female and of mean age 47.8. Two-independent intronic genotyped SNPs (rs10767935 and rs5030244) in WT1 significantly modified the IFN-β-25(OH)D association after adjustment (Pinteraction = 0.001, 0.0002; Padj = 0.003, 0.006, respectively). There was a marked difference in the interaction between self-reported sun exposure and IFN-β in predicting 25(OH)D by level of rs10767935, although this did not reach statistical significance. No SNPs modified the interaction between IFN-β and 25(OH)D in predicting relapse.Conclusions We have demonstrated that two-independent SNPs (rs10767935 and rs5030244) in WT1 modified the IFN-β-25(OH)D association in patients with MS. Some evidence was shown for a difference in the sun-IFN-β-25(OH)D association by level of rs10767935. These findings indicate that WT1 variants may play a role in altering the effects of IFN-β on vitamin D in MS.
    Acta Neurologica Scandinavica 10/2014;
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    ABSTRACT: Objective Up to one-third of individuals diagnosed as having epilepsy continue to have seizures despite appropriate anti-epileptic drug treatment. These patients are often referred for presurgical evaluation, and many are rejected from focal resective surgery due to medical reasons or, alternatively, they choose not to undergo it. We compared the outcomes and characteristics of the non-operated patients who continued on medical therapy alone with those who underwent vagus nerve stimulator (VNS) implantation in addition to medical therapy.Methods The medical records of consecutive adult patients referred for presurgical evaluation for suitability for epilepsy surgery in the Tel-Aviv Sourasky Medical Center between 2007 and 2011 and were rejected from or decided against surgery were reviewed. Updated information on seizure frequency was supplemented by telephone interviews between April and July, 2013.ResultsFifty-two patients who continued solely on medical therapy and 35 patients who additionally underwent VNS implantation were included in the study. Forty-seven of the former and 33 of the latter agreed to be interviewed. There was a significant improvement in the seizure frequency between the time of the presurgical evaluation and the time of the interview in both groups. Eight medically treated patients (17%) and 2 patients who also underwent VNS implantation (6%) reported being seizure-free during the preceding 3 months.ConclusionsA considerable minority of patients with refractory epilepsy who were rejected or chose not to undergo epilepsy surgery may improve over time and even become seizure-free following adjustment of anti-epileptic drugs with or without concomitant VNS.
    Acta Neurologica Scandinavica 10/2014;
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    ABSTRACT: Objectives Stimulation of the subthalamic nucleus (STN-DBS) is an established treatment with long-term beneficial effects on motor symptoms in patients with Parkinson's disease (PD). The efficacy of STN-DBS on non-dopaminergic motor symptoms remains less elucidated. In this study, we have examined short- and long-term impacts of STN-DBS on the development of the postural instability and gait difficulties (PIGD) phenotype, freezing of gait (FOG), and falls.Materials and methodsWe collected data from a prospectively followed cohort of patients that had been operated with STN-DBS 6–9 years before final examination and compared our findings to the longitudinal development of the same symptoms in a non-operated, historical reference population.ResultsDuring short-term follow-up after surgery, we observed a marked improvement in mean UPDRS-motor score from 27 to 18. We also found clear improvements in tremor, bradykinesia, rigidity, and PIGD scores. However, 6–9 years after surgery, all patients had a dominating PIGD pattern of parkinsonism and 50% of the patients had developed FOG and/or had become recurrent fallers. The disease development in a group of patients with PD from the presurgery period had a similar trajectory as among the operated patients. In addition, mean annual change of both bradykinesia and PIGD scores was nearly identical in both study groups while tremor and rigidity had a significant better development in the operated patients.Conclusions We found that STN-DBS induces an acute improvement of PIGD symptoms. The following long-term development was however characterized by a marked progression of non-dopaminergic symptoms.
    Acta Neurologica Scandinavica 10/2014;
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    ABSTRACT: Background Unruptured saccular intracranial aneurysm (SIA) is associated with an increased prevalence of migraine, but it is unclear whether this is altered by clipping of the aneurysm. The aim of our study was to determine whether remission rate of migraine and other recurrent headaches was greater in patients with SIA after clipping than in controls.Methods We prospectively studied 87 SIA patients with migraine or other recurrent headaches. They were interviewed about headaches in the preceding year before and 1 year after clipping using a validated semi-structured neurologist conducted interview. The remission rates of migraine and tension-type headache (TTH) in these patients were compared to 92 patients from a headache center. Diagnoses were made according to the ICHD-2.ResultsDuring 1 year preceding rupture 51 patients with SIA had migraine. During the year after clipping, this was reduced by 74.5% (P < 0.0001). At first encounter, 47 control patients had migraine during the preceding year, and during 1 year of treatment, it was 41, a reduction 12.8% (P > 0.5). The decrease of migraine in SIA patients was significantly higher than in controls: 74.5% vs 12.8% (P < 0.001). A history of TTH was given by 33 patients with SIA during the year preceding rupture and by 44 during 1 year after clipping (P > 0.75). Forty-one control patients had TTH, 27 after 1 year of treatment, a reduction 34.1% (P < 0.05). No factors except clipping of the aneurysm could explain the remission of migraine.Conclusions Migraine prevalence in patients with SIA decreases significantly after clipping. Further comparative studies of migraine after coiling vs clipping in SIA patients are needed.
    Acta Neurologica Scandinavica 10/2014;
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    ABSTRACT: Background Arachnoid cysts (AC) are benign, congenital malformations of the leptomeninges. In our experience, dizziness and vertigo are common complaints in patients with such cysts.Objective To quantify dizziness and imbalance in patients with arachnoid cysts in the posterior fossa using the Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale Short–Form (VSS-SF) and Computerized Dynamic Posturography (CDP). We also wanted to investigate whether any dizziness and imbalance are reversible after surgical cyst decompression.Methods The study includes four patients with AC in the posterior fossa (two in the cerebellopontine angle and two supracerebellar in the midline) and 15 control subjects undergoing ENT surgery for benign lesions of the larynx (n = 10) or the parotid glands (n = 5). All participants answered the DHI and VSS-SF and underwent CDP the day before, and at follow-up after surgery. The AC patients also graded their dizziness through the use of a Visual Analogue Scale (VAS).ResultsPreoperatively, cyst patients scored higher than controls on subjective symptoms (DHI, VSS-SF A and VSS-SF V) and had a lower score on postural sway (CDP). Symptom scores decreased after surgery; the cyst patients improved in the subjective tests (DHI, VAS and VSS-SF), and three of the patients improved their CDP scores. In the controls, symptom and CDP scores were unchanged after surgery.Conclusion Patients with fossa posterior cyst had a significant preoperative impairment compared with the controls, and they exhibited post-operative improvement in their subjective dizziness.
    Acta Neurologica Scandinavica 10/2014;
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    ABSTRACT: Background Uric acid (UA) could act as a natural peroxynitrite scavenger with antioxidant properties. It has been proposed that hyperuricemia might protect against multiple sclerosis (MS).Methods Patients with relapsing-remitting MS starting treatment with interferon beta-1a 44 µg sc 3/week were randomly assigned to receive either inosine 3 g/day or placebo in a double-blind manner. Follow-up was 12 months. Outcome measures were adverse events and UA laboratory results. Secondary end point was clinical and radiological activity of MS. Relapse rates, percentage of patients without relapses, and progression to secondary MS (SPMS) were assessed.ResultsThirty six patients were included. Two patients in the inosine group showed UA serum level above 10 mg/ml, and symptoms derived from renal colic not leading to hospital admission. Ten additional patients had asymptomatic hyperuricemia (>7 mg). Efficacy parameters (clinical and radiological) were similar between groups. No patient progressed to SPMSConclusions Inosine administration was associated with hyperuricemia and renal colic with no additional effect on MS. We cannot conclude inosine is a safe and well-tolerated drug. Doses of around 2 g/day may be more appropriate for future trials.
    Acta Neurologica Scandinavica 10/2014;
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    ABSTRACT: Objectives Since the routine use of polymerase chain reaction testing (PCR) in diagnosing herpes infections, varicella-zoster virus is increasingly recognized as a cause of varicella-zoster meningoencephalitis (VZV ME) among immunocompetent patients. We were interested to determine whether patients with VZV ME had VZV DNA in their saliva during the acute phase of the illness.Materials and methodsForty-five consecutive patients who underwent a lumbar puncture for diagnostic purposes were included in the study. The cerebrospinal fluid was examined for the presence of VZV DNA by PCR, and patients with positive findings were treated with acyclovir. The saliva was later analyzed in a blinded fashion for the presence of VZV DNA.ResultsVZV DNA was found in saliva in four of five (80%) patients with PCR confirmed VZV ME (sensitivity 0.8, specificity 0.84, and likelihood ratio 5). This was significantly more than in patients with non-zoster viral ME (0%, P = 0.009), parainfectious headache (12%, P = 0.03) and controls (9.5%, P = 0.007). In immunocompromised patients with systemic lymphoma and AIDS, VZV DNA was present at a similar rate (67%, P = 0.6).Conclusions We have found VZV DNA in saliva of patients with PCR confirmed VZV ME at a higher proportion than in controls and patients with non-VZV viral ME. This finding might be of clinical importance, especially in immunocompetent individuals with suspected VZV ME where the results of genetic and immunological testing are not conclusive.
    Acta Neurologica Scandinavica 10/2014;
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    ABSTRACT: Objectives To address the relationship between years lived with a disability (YLDs), prevalence and cost of neurological diseases, and to test whether there is a European North–South gradient for national health expenditure, disability, costs and prevalence of neurological diseases.Materials and methodsInformation on costs, prevalence and YLDs referred to 2010 were taken from the Study on the Cost of Disorders of the Brain and from the Global Burden of Disease study; data on health expenditure were taken from OECD reports. Selected conditions were as follows: brain tumours, stroke, dementia, Parkinson's disease, epilepsy, multiple sclerosis, migraine and tension-type headache; selected countries were from North (Denmark, Finland, Norway, Sweden) and South (Greece, Italy, Portugal, Spain) Europe. The association between the variables for each condition was tested using Spearman's correlation; Wilcoxon signed ranks test was used to test North–South Europe differences.ResultsCorrelations were largely non-significant (except for stroke). YLDs and cost were generally lower in South-European countries, and prevalence was lower in North-European countries, but no significant differences were found.Conclusions Health expenditure, YLDs, costs and prevalence of neurological conditions were generally not correlated across the eight countries. A clear North–South gradient was found for health expenditures, and partially for YLDs, costs and diseases' prevalence. We hypothesized that this is a consequence of the expansion of morbidity of neurological conditions connected to ageing, that health and welfare systems of selected countries were not prepared to face.
    Acta Neurologica Scandinavica 10/2014;
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    ABSTRACT: Patients with acute severe headache may have a secondary form of headache. Standard head computer tomography (CT) and cerebrospinal fluid (CSF) examination are often performed in the absence of neurological deficits to exclude subarachnoid hemorrhage (SAH). Increasingly, patients undergo subsequent CT angiography (CTA) to exclude cerebral venous thrombosis (CVT), dissection or reversible cerebral vasoconstriction syndrome (RCVS). It is unknown whether this additional imaging increases diagnostic yield. We aimed to evaluate the yield of CTA in patients with acute severe headache with normal neurological examination and no abnormalities at standard CT and CSF analysis. We included consecutive patients presenting to the emergency room between January 2008 and May 2011 with acute severe headache and without abnormalities at neurological examination, CT and CSF research, who received a CTA in the diagnostic process in our teaching hospital. All scans were rereviewed by an experienced neuroradiologist. We included 70 patients, 71% were women and average age was 45 years. We found a vascular abnormality in 13 (19%) of our patients. Four had either a prior aneurysm or CVT. Eight patients had an unruptured intracranial aneurysm (UIA) on CTA (11%), two had CVT (3%), two had RCVS (3%) and one had cerebral ischemia (1%). We found a high percentage of vascular abnormalities. A third of these patients had a prior episode of either an aneurysm or CVT. In patients with a history of UIA or CVT performing CTA despite normal CT and LP therefore seems warranted. A prospective study to delineate indications for CTA is needed.
    Acta Neurologica Scandinavica 10/2014;