Status cataplecticus misdiagnosed as recurrent syncope
ABSTRACT A 76-year-old patient, since the age of 45, presented with frequent attacks often triggered by emotional stimuli and characterised by forward head drop and a fall to the ground without loss of consciousness. Clinically these episodes were misinterpreted as pseudoseizures and treated with clomipramine for more than 20 years. In spite of this chronic therapy, during the last year, the attacks presented with a daily recurrence and, moreover, after arbitrary clomipramine withdrawal, they increased in frequency until they became subcontinuous. Videopolygraphic analysis, multiple sleep latency test (MSLT) and human leukocyte antigen (HLA) association studies were suggestive of narcolepsy and the recurrent episodes, diagnosed as status cataplecticus, recovered after citalopram administration.
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ABSTRACT: Episodes of transient loss of consciousness (TLOC) events pose diagnostic difficulties, as the causes are diverse, carry vastly different risks, and span various specialties. An inconsistent terminology contributes to the confusion. Here, we present a classification scheme for TLOC, based on ongoing multidisciplinary efforts including those of the Task Force on Syncope of the European Society of Cardiology. We also discuss the pathophysiology of TLOC and the key clinical features that aid diagnosis. TLOC is defined as an apparent loss of consciousness with an abrupt onset, a short duration, and a spontaneous and complete recovery. Syncope is defined as TLOC due to cerebral hypoperfusion, and is divided into reflex syncope (synonymous with neurally mediated syncope), syncope due to orthostatic hypotension, and cardiac syncope (arrhythmic or associated with structural cardiac disease). The other major groups of TLOC are generalized epileptic seizures, functional TLOC (psychogenic TLOC mimicking either epilepsy or syncope), and a further group of miscellaneous disorders. The management of patients who experience TLOC requires the recognition of the defining features of each of the major groups, and cooperation between different clinical specialties.Nature Reviews Neurology 09/2009; 5(8):438-48. DOI:10.1038/nrneurol.2009.99 · 14.10 Impact Factor
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ABSTRACT: A 30-year-old woman developed acute visual loss and optic disc elevation in the left eye after breastfeeding her second son. The initial diagnosis was optic neuritis. However, MRI showed a lesion in left intraorbital and intracanalicular optic nerve and several cerebral lesions with imaging features of cerebral cavernous malformations (CCMs). Genetic testing was positive for abnormalities known to predispose to CCMs in the patient and her father, who also showed MRI evidence of CCMs. During a 44-month follow-up period in which no intervention took place, the patient's vision in the affected eye fluctuated but eventually became extinguished. Serial MRIs did not always show lesion changes that explained the visual deterioration. In familial CCM, pregnancy might be a "second hit" to genetically predisposed tissue.Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society 03/2010; 30(2):126-31. DOI:10.1097/WNO.0b013e3181ceb428 · 1.81 Impact Factor
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ABSTRACT: Rod-shaped cellulose nanocrystals (CNCs) were manufactured and used to reinforce polyacrylamide (PAM) hydrogels through in situ free-radical polymerization. The gelation process of the nanocomposite hydrogels was monitored on a rheometer using oscillatory shear. The chemical structure, morphology, swelling property, and compression strength of the formed gels were investigated. A possible mechanism for forming hydrogels was proposed. The results showed that CNCs accelerated the formation of hydrogels and increased the effective crosslink density of hydrogels. Thus CNCs were not only a reinforcing agent for hydrogel, but also acted as a multifunctional cross-linker for gelation. The shear storage modulus, compression strength and elastic modulus of the nanocomposite hydrogels were significantly improved because of good dispersion of CNCs in PAM as well as enhanced interfacial interaction between these two components. Among the CNC contents used, a loading of 6.7 w/w% led to the maximum mechanical properties for nanocomposite hydrogels.Journal of Colloid and Interface Science 09/2010; 353(1):116-23. DOI:10.1016/j.jcis.2010.09.035 · 3.55 Impact Factor