Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
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Case Reports
Deep brain stimulation of the globus pallidus internal improves symptoms of chorea-acanthocytosis.
Chorea-acanthocytosis is a rare autosomal recessive disorder. To date, treatment is only symptomatic and supportive. Results from the few reports of chorea-acanthocytosis patients treated with deep brain stimulation (DBS) have been inconsistent. ⋯ One patient, however, did not improve with either low-frequency or high-frequency DBS. Bilateral DBS to the GPi can improve chorea and dystonia in some patients with intractable chorea-acanthocytosis. However, selection criteria for the most promising candidates must be defined, and the long-term benefits evaluated in clinical studies.
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Deferoxamine (DFX), a potent iron-chelating agent, reduces brain edema and neuronal cell injury that develop due to the hemolysis cascade. Statins have neuroprotective effects via anti-inflammatory action and increment of cerebral blood flow after intracerebral hemorrhage (ICH). The purpose of this study was to identify the effects of combined DFX and statins treatment in an experimental ICH rat model. ⋯ In the perihematomal area, the activated microglial cells were reduced in the combined treatment group. Among the four groups, a significant difference in immunohistochemical staining was identified (p < 0.05). These results suggest that combined treatment with DFX and statins improves neurologic outcomes after ICH through reduction of microglial infiltration, apoptosis, inflammation and brain edema.
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We have examined the role of inducible nitric oxide synthase (iNOS) within the dorsolateral periaqueductal gray mater (dlPAG) on cardiovascular responses during mechanical, thermal, and cold nociception in anesthetized rats. Mechanical stimulus was applied by a unilateral hindpaw pinch for 10 s that increased mean arterial pressure (MAP) and heart rate (HR). Bilateral microdialysis of a selective iNOS inhibitor, aminoguanidine (AGN; 10 μM), into the dlPAG for 30 min augmented MAP and HR responses during a mechanical stimulation. ⋯ In contrast, application of a cold stimulus by immersing one hindpaw at 10°C for 10 s resulted in depressor and bradycardic responses. A second cold stimulus resulted in a response that was not significantly different from that prior to or after recovery from the AGN infusion. These results demonstrate that iNOS within the dlPAG plays a differential role in modulating cardiovascular responses during mechanical-, heat-, and cold-mediated nociception.
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This article briefly reviews the spectrum of headaches associated with Chiari type I malformation (CMI) and specifically analyzes the current data on the possibility of this malformation as an etiology for some cases of chronic daily headache (CDH). CMI is definitely associated with cough headache and not with primary episodic headaches, with the rare exception of basilar migraine-like cases. ⋯ A magnetic resonance imaging (MRI) study would be justified only in patients showing either a Valsalva-aggravating component or cervicogenic features. Hydrocephalus and low-intracranial pressure syndrome should be ruled out in patients showing tonsillar herniation in an MRI study and consulting due to daily headache.