Movement disorders are not only realm of chronic disorders that are treated without requiring emergent intervention, but also they can present acutely with more aggressive forms
Movement disorders are not only realm of chronic disorders that are treated without requiring emergent intervention, but also they can present acutely with more aggressive forms
Altered proliferation and networks in neural cells derived from idiopathic au...Masuma Sani
Autism Spectrum Disorders; heterogeneous nature of genetic and brain pathology in ASD– which makes it difficult to produce relevant animal and cell models
74th ICREA Colloquium "Autoimmunity meets neurodegeneration: different pathwa...ICREA
Studies during the last 10 years have revealed a new category of brain diseases in which crucial neuronal receptors are attacked by autoantibodies. As a result of this attack there is a reduction of the target synaptic proteins leading to alterations in synaptic transmission. The clinical manifestations vary according to the receptor involved, and may resemble many of the symptoms caused by neurodegenerative diseases in which specific receptors are involved, including among others Parkinson, epilepsy, chronically progressive sleep disease, or schizophrenia.
This is a brief review of autoimmune epilepsies, especially autoimmune encephalitis, SREAT, NORSE, FIRES and Rasmussen's encephalitis. A brief overview of investigations and treatment is included.
a presentation on autoimmune encephalitis, paraneoplastic syndrome. their types and various imaging and lab finding
their differential diagnosis
acute and long term management plans
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Study of anticonvulsant activity of quinidine in albino rats using pentylenet...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
Lab diagnosis of Autoimmune Encephalitis
1. Laboratory Diagnosis work up
of a patient with Suspected
Autoimmune Encephalitis
Presenter Dr Santosh Dash
Chair Persons Dr Anita Mahadevan
Dr Netravathi M
1
NIMHANS, BANGALORE,INDIA
2. Autoimmune encephalitis
Definition
The term autoimmune encephalitis is used to
describe a group of disorders:-
Characterized by symptoms of the CNS (limbic,
extra-limbic, basal ganglia, autonomic structures
or more wide-spread) due to autoantibodies
against neuronal surface or synaptic
proteins, which are likely to mediate the disease.
2
6. Prevalence
A recent population based survey has shown that
autoimmune encephalitis are more common than
previously believed, accounting for 21% of
unselected encephalitis cases in the U.K. (Granerod et al.,
Lancet Infect Dis 2010;10(12):835–44
There are few studies from India which are
retrospective studies but exact prevalence in india is
not known.(Chandra SR et al :AIAN 2014;17:166-70, Pandit KA
et al : AIIN 2013 ;Oct 577-584)
6
7. When to suspect a case of
encephalitis as having autoimmune
cause ?
How to confirm the diagnosis
What investigations to do for
exclusion of other mimickers .
7
9. Criteria for Diagnosis
9
Acute or subacute (< 12
wks) onset of symptoms
Evidence of CNS
inflammation (at least
one of):
CSF,MRI,PET,Biopsy
Exclusion of other
causes
Angella vincent :JNNP-
2012;83:638-645
11. NMDA
Age- frequently 2– 40 years, 80% Female
Clinical features
Behavioural disturbance,Psychosis
catatonia
Seizures
Movement disorders including orolingual dyskinesias
and stereotypic movement.
Dysautonomia.
11
Barry H : BJ Psych Bull ,2015
Feb 19-23
12. LGI1
Age- 30–80 years (median 60 years), 65% male
Clinical Features
Faciobrachial dystonic seizures (FBDS)
limbic encephalitis
seizures including myoclonus
Rapidly progressive dementia like CJD
Sleep disorder (RBD)
12
Dalmau J : Lancet
Neurol 2008;7:327–340
13. Caspr2
45–80 years (median 60 years), 85% male.
Clinical features
Peripheral nerve hyperexcitability or
neuromyotonia (Isaacs’ syndrome)
Morvan’s syndrome
Limbic encephalitis
Sleep disorders.
13
Graus F :
J Neurol 2010;257:509–517
15. Anti-GABA-B receptor encephalitis
25–75 years (median 60 year),50% female.
Limbic encephalitis with prominent seizures in
up to 80% of patients.
Antibodies directed against the B1 subunit of
the GABA receptor
15
Ramanathan S :J Clin
Neurosci 2014;21:722–730
16. Glycine R
Age group 5–69 years (median 49 years)
Progressive encephalomyelitis with
rigidity(PREM)
stiff person syndrome
16
Vincent A:
Brain2004;127:701–712
17. GAD
It can be presented with
Stiff-person syndrome.
Refractory seizures.
Cerebellar syndrome.
Associated with both paraneoplastic and
nonparaneoplastic.
17
Simabukoro MM :Epileptic
Disord. 2015 Mar;17(1):9
18. Salient features
Most frequently, these antibodies are directed
against the voltage-gated potassium channel (VGKC)
complex and the N-methyl, D-aspartate (NMDA)
receptor.
The diseases are typically immunotherapy-
responsive.
They are only associated with cancer in a minority of
patients.
18
19. After clinical examination following
investigations to be carried out to
Confirm the diagnosis
Exclude other
mimickers
19
20. To confirm the diagnosis
Blood Test
Autoantibody
CSF STUDY
EEGMRI Brain
Functional
Imaging
20
22. Available Assays
Different assays are available for the diagnosis of
antibodies, both for CSF and serum:
Tissue-based assays (TBA; in-house or commercially
available)
Cell-based assay (CBA; in-house or com- mercially
available)
ELISA
Primary cultures of neurons
Immunoprecipitation
22
23. 1.Tissue-based assays
In the TBA, rat or mouse brains are stained with
CSF or serum of patients with an indirect
immunhistochemistry or immunofluorescence
technique.
Anti- neuronal antibodies attach to their
receptor or synaptic antigen in the rodent brain,
resulting in a neuropil staining pattern in the
hippocampus.
23
24. The TBA provides an excellent screening
method, which detects most of the currently
known neuronal cell surface auto antibodies
(with some limitations for the GlyR- and D2R-
antibodies).
Also can reveal new autoantibodies.
24
26. 2. Cell-based assay
In the CBA, cells (e.g., HEK293 cells) are transfected
with the respective surface receptor or synaptic
antigen and stained with CSF or serum of the
patients with an indirect immunofluorescence
technique.
Autoantibodies against the specifically expressed
receptor result in a membrane staining of the cells.
It is expressed as either end-point titers or relative
fluorescence units.
26
27. Most laboratories use the CBA for the diagnosis
of neuronal cell surface autoantibodies, which is
a highly sensitive and specific assay
But the disadvantage that new autoantibodies
are not detected.
27
28. To reach a maximum sensitivity and
specificity, a combination of TBA as
screening method and CBA as confirmatory
test should be considered.
28
29. 3.Primary cultures of neurons
Primary cultures of hippocampal neurons are
stained with CSF or serum of patients with an
indirect immunofluorescence technique and the
autoantibodies are visualized as surface staining
of neurons.
29
30. 4.Immunoprecipitation
In the IP, autoantibodies that are present in
serum of patients bind to a specific antigen, the
antigen–antibody complex is precipitated out of
solution and measured.
30
31. Staining of hippocampal neurons and IP is
mainly used in research but may be helpful in
selected individual cases
For example in samples which shows positive in
TBA but negative in CBA there to characterize
and ascertain that the patient’s autoantibodies
recognize a yet to be identified cell surface
antigen).
31
33. Methodology
Cell based indirect immunofluorescence antibody
(IFA) assay for the detection of NMDAR IgG
antibodies was approved by the US FDA.
For this test, human embryonic kidney (HEK-293)
cells transfected with the NR1 subunit of NMDAR,
as well as non-transfected cells grown on Biochips
are used as substrates. (Euroimmun AG, Lubeck, Germany).
33
34. 30µl of
CSF/serum 1:10
was taken
Incubation for 30
min at room
temperature
Rinsed with a
flush of PBS-
Tween
IgG was labeled
using Fluorescein-
conjugated goat
anti-human IgG
antibody
Mount with
slides and seen
under
microscope
34
35. Samples were classified as positive or negative
based on the intensity of surface
immunofluorescence of transfected cells in direct
comparison with non-transfected cells and control
sample.
It is based on the manufacturer's recommendations
for reading and interpretation.
35
43. Answer
Both should be tested (CSF and serum ) because
One can be positive and other is negative
Both can be negative but still can be
autoimmune encephalitis.
43
44. Evidence
At the time of diagnosis of this disease
autoantibodies are always present in CSF, the
serum can be negative in up to 14% of patients,
suggesting that serum examination alone may
be insufficient to exclude AIE
44
Titulaer MJ :Lancet
Neurol 2013;12:157-65
45. CSF findings
Abnormal CSF findings in 79% of patients
CSF revealed lymphocytic pleocytosis in more than
90% of cases.
Intrathecal protein increase in 33%.
Oligoclonal bands in approximately 25%.
Glucose is mostly normal.
DALAMU j : Lancet Neurology 2008 7.109
1098
45
48. In our patients most of the patients have normal
CSF finding with some having mildly elevated
protein and cells.
48
49. Antibody titer
There is a relation between antibody titers,
relapses, and outcome.
It has been shown that high autoantibody titers
were associated with a poorer outcome or the
presence of a teratoma in NMDA disease.
A rapid decrease of CSF autoantibody titers
within the first month of disease associated with
a better prognosis.
49
51. False Positive
Anti-NMDAR antibodies have been described in patients
Multiple sclerosis,
Seronegative NMO
Creutzfeldt–Jakob disease
Antibodies against VGKC complex have also been
described in patients
Amyotrophic lateral sclerosis
Bickerstaff encephalitis
Miller–Fisher syndrome
Influenza A
51
52. EEG
EEG is considered a sensitive test (90%), but
poorly specific (30-35%).
In early disease EEG monitoring may show
evidence of seizure activity.
Dalamu J ;Lancet Neurol.
2008
52
53. Most common abnormality is diffuse non-
specific slowing in theta and Delta range.
PLEDs
Non-convulsive status epilepticus is also
reported.
53
54. Epileptiform activity is less common than slow
waves but may include electrographic seizures
in approximately 60% when continuous
monitoring is undertaken.
54
57. It is characterized by rhythmic delta activity at 1−3 Hz
with superimposed bursts of rhythmic 20–30 Hz beta
frequency activity “riding” on each delta wave.
57
58. Significance of Delta brush
It resemblance to waveforms seen in premature
infants.
The presence of extreme delta brush was
associated with a more prolonged
hospitalization (mean 128.3 ± 47.5 vs 43.2 ± 39.0
days, p = 0.008) .
increased days of cEEG monitoring (mean 27.6 ±
42.3 vs 6.2 ± 5.6 days, p = 0.012)
58
59. 19 year old with NMDA encephalitis
Delta Brush59
62. MRI Brain Imaging
At presentation about 50 % of the patients have
abnormal MRI findings.
Most commonly increased signal on fluid-
attenuated inversion recovery (FLAIR) or T2
sequences medial temporal lobes ( 40%)
Abnormalities have been reported in other areas
such as corpus callosum or brainstem, insular
region .
62
63. There may be T2 signal changes in
periventricular signal, particularly in the trigone
area also described.
Faint or transient contrast enhancement may
occur in the cerebral or cerebellar cortex and
overlaying meninges.
63
64. Severe disease courses can result in
predominantly hippocampal or mild global
atrophy.(Dalamu et al 2007).
Interestingly, brain atrophy was partially
reversible and accompanied by clinical recovery
in two patients with follow-up for 5 and 7 years
(Iizuka et al., 2010)
64
65. 1st case
1.Pt R 17/F presented with acute onset behavioral
symptoms f/b stereotyped movements, mutism
and catatonic state. Her CSF routine test was
normal but NMDA was strongly positive.
65
70. 2nd case
2. pt S 61/M presented with one month history
of seizures and recent memory loss. Seizures
were both myoclonic jerks and facio-brachial
dystonic seizures. VGKC positive
70
75. 3rd case
Pt R 19/F presented with h/o psychiatric
symptoms f/b mutism. She was on treatment by
psychiatrist for 10 month later shifted to
neurology side. O/E she had stereotype
movements. NMDA positive
75
80. SPECT Imaging
SPECT revealed Hypoperfusion of the frontal,
parietal and medial temporal lobes, as well as
thalamus, and cerebellum which was
responsible for psychaitric symptoms.
Hyperperfusion in the motor strip and left
temporal lobe, which are areas related to some
of the patient's symptoms, including seizures,
orolingual dyskinesia, and Wernicke aphasia.
Brain Behav. 2011
Nov; 1(2): 70–722.
80
81. PET scan
18F FDG PET/CT is more sensitive than MRI.
FDG–PET can reveal pathological changes even when
MRI and CT scans are normal.
However findings can be variable depending on which
phase of illness is ongoing at the time of the scan.
In the acute phase FDG-PET generally shows cerebral
hypermetabolism anteriorly, with relative diffuse
posterior hypometabolism.
Vitaliani et al.,
200505
81
84. Tumor screening
Potential screening imaging modalities include
Ultrasonography of Abdomen and pelvis
Testicular ultrasound
CT chest ,abdomen and pelvis
MRI abdomen and pelvis
Mammography
PET scanning of whole body.
84
85. Paraneoplastic Antibody screen
Following paraneoplstic tests can be done in serum.
anti-Hu
anti-Yo
anti-CV2 (also called anti-CMRP-5)
anti-Ma2
anti-Ri
85
86. Florance et al. recommended periodic
ultrasound and MRI of the abdomen and pelvis
for at least two years following diagnosis is
required.
Tumor surveillance for males was not
recommended as the number of cases has been
too small.
FLORANCE NR :Anna
Neurology 66:11-18
86
88. Anti-thyroid antibodies (TPO) for Hashimotos
encephalopathy.
Serum Na to look for Hyponatraemia(60%)
CSF can be tested for Viral infection (HSV PCR)
88
89. 89
22 patients with new onset psychiatric symptoms
who did not respond to conventional treatment .
They were analyzed using EEG, MRI,CSF, screening
for malignancy, Vasculitic work-up and
autoantibody tests.
2014;17:166-70
90. 90
3 had systemic malignancy, 10 had chronic
infection, 1 with vasculitis, 1 had Hashimoto
encephalopathy and 2 with non-convulsive
status.
Conclusion: All patients who present with new
onset neuropsychiatric symptoms need to be
evaluated for sub-acute infections, inflammation,
autoimmune encephalitis and paraneoplastic
syndrome.
A repeated 20 minute EEG is a very effective
screening tool to detect organicity.
91. 91
Total 15 patients of autoimmune encephalitis.
The most common onset was sub acute (64%)
and four (29%) patients presented as SE.
Predominant clinical presentations was seizure
(100%).
AIAN 2013 Oct-Dec
92. 92
CSF was done in 10 patients; it was normal in
60%.
Brain MRI was done in all patients, in six (40%)
it was normal, six (40%) showed T2W and
FLAIR hyperintensities in bilateral limbic areas.
NMDA receptor antibody in seven (50%), VGKC
antibody in five (36%), two having anti GAD.
93. Third study
Total 22 patients with suspected AIE were
studied over a period of 3½ years and 16
patients had positive autoimmune antibodies.
Cognitive impairment and seizures were the
predominant symptoms present in nearly all
(100%) patients followed by psychiatric
disturbances (87.5%). Netravathi M et al.
Neurology India 2015 (In
Press)
93
94. EEG
EEG was abnormal in 81.25%.
Diffuse slowing of the background activity were the
predominant EEG changes.
Epileptiform discharges were seen in 3 (18.75%)
patients with anti-NMDA encephalitis and two of
them showed evidence of extreme delta brush.
94
95. CSF
CSF examination was available in 14 patients and
was normal in 10 (71.4%) patients.
One patient with anti-NMDA encephalitis had
lymphocytic pleocytosis with normal protein, sugar.
Three patients in each of the three subtypes of AIE
had mildly elevated protein with normal cell count
and sugars.
95
96. MRI
MRI was abnormal in 53.3% patients.
Abnormalities were seen in all patients with
voltage-gated potassium channels (VGKC); 60% of
patients with NMDA.
Imaging was normal in 26.7% of the patients.
PET-CT was done in 4 patients (2-VGKC, 2-NMDA)
and none of them had any evidence of internal
malignancy.
96
97. Take home Messages
It is very important to know the clinical features of
AIE to clinically diagnose a case.
Serum and CSF both to be used for diagnosis of AIE
because each having its own limitations.
Tumor work up should be carried out in all cases as
it affect prognosis.
Exclusion of other disease is important as its having
own therapeutic implication.
97