Publications by authors named "Carlos R Camara-Lemarroy"

58 Publications

Longitudinally extensive transverse myelitis with positive aquaporin-4 IgG associated with dengue infection: a case report and systematic review of cases.

Mult Scler Relat Disord 2021 Aug 8;55:103206. Epub 2021 Aug 8.

Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.

Background: Neuromyelitis Optica Spectrum Disorder can be associated with parainfectious and post-infectious triggers. Dengue virus infection is one of the most common arbovirus infections in the world, and may present with neurological manifestations.

Objectives: We present a case of DENV-associated with LETM and positive aquaporin-4 IgG, and a systematic review of published cases.

Methods: Medline (Ovid) and PubMed were search through June 2021, for case reports, series and observational studies that described patients with DENV-associated LETM and/or NMOSD.

Results: An adolescent girl who had recently immigrated from a Dengue-endemic region presented with a LETM with high positive AQP4-IgG titer and seropositive DENV IgM/IgG antibodies. She responded well to steroids and subsequently started maintenance rituximab for her NMOSD diagnosis.

Literature Review: 22 publications describing 27 patients met inclusion criteria. In addition to this case, three published cases met current criteria for NMOSD with serological evidence of acute DENV infection.

Conclusions: It is unknown whether there is a pathophysiological association between DENV infection and NMOSD. Regardless, if an immune-mediated event is suspected, particularly NMOSD, appropriate immunotherapy should be considered early. Decision regarding long term immunotherapy may depend on index of suspicion of true NMOSD, and this is where AQP4-IgG status and follow-up is helpful.
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http://dx.doi.org/10.1016/j.msard.2021.103206DOI Listing
August 2021

Osmotic Demyelination Syndrome: A New Mime in the Circus of Neurology.

Can J Neurol Sci 2021 Apr 13:1-2. Epub 2021 Apr 13.

Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.

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http://dx.doi.org/10.1017/cjn.2021.66DOI Listing
April 2021

Multimodal peripheral fluid biomarker analysis in clinically isolated syndrome and early multiple sclerosis.

Mult Scler Relat Disord 2021 May 3;50:102809. Epub 2021 Feb 3.

Departments of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Background: Increasing evidence suggests that various inflammatory, immunological and metabolic pathways are altered in the clinically isolated syndrome (CIS) of multiple sclerosis (MS). Moreover, recent diagnostic criteria have made possible the very early diagnosis of MS. We evaluated multiple fluid biomarkers in people with early MS and CIS.

Methods: We measured blood levels of cytokines, matrix metalloproteinases (MMPs), serum metabolomics and immune cell immunophenotyping in participants in the Trial of Minocycline in a Clinically Isolated Syndrome of Multiple Sclerosis.

Results: When compared with healthy controls, people with early MS/CIS had higher levels of eotaxin, MCP-3, IL-1 receptor antagonist, IL-1β, IL-9 and IP-10, as well as MMPs 1, 8 and 9. In metabolomics analysis, the alanine, aspartate and glutamate metabolism and the synthesis and degradation of ketone bodies pathways were altered compared to healthy controls. There were no differences in lymphocyte subpopulation numbers. Out of all these biomarkers, only MMP-1 was able to differentiate between early MS and CIS, and was found to correlate with lesion volume and gadolinium enhancing lesions on MRI.

Conclusion: The immunological and metabolic profile of CIS and early MS is remarkably similar, supporting that these are a continuum of a common underlying pathophysiological process.
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http://dx.doi.org/10.1016/j.msard.2021.102809DOI Listing
May 2021

Neurosarcoidosis presenting as isolated VI nerve palsy.

Neurol Sci 2021 04 23;42(4):1599-1601. Epub 2020 Oct 23.

Department of Clinical Neurosciences, MS Clinic, FMC, University of Calgary, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada.

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http://dx.doi.org/10.1007/s10072-020-04848-xDOI Listing
April 2021

Hypoglossal Canal Cyst Causing Unilateral XII Nerve Palsy.

Can J Neurol Sci 2021 07 20;48(4):560-561. Epub 2020 Oct 20.

Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

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http://dx.doi.org/10.1017/cjn.2020.235DOI Listing
July 2021

Remote ischemic preconditioning: Lung protection in the time of a pandemic?

J Clin Anesth 2020 Nov 2;66:109920. Epub 2020 Jun 2.

Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Service of Neurology, Department of Internal Medicine, UANL School of Medicine and University Hospital, Monterrey, NL, Mexico. Electronic address:

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http://dx.doi.org/10.1016/j.jclinane.2020.109920DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265848PMC
November 2020

A Glioma Presenting as a Posterior Circulation Stroke.

Can J Neurol Sci 2020 09 24;47(5):691-692. Epub 2020 Apr 24.

Departments of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

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http://dx.doi.org/10.1017/cjn.2020.77DOI Listing
September 2020

Late-Onset Neuromyelitis Optica Spectrum Disorder Presenting With Area Postrema Syndrome.

Can J Neurol Sci 2020 05;47(3):422-424

Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

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http://dx.doi.org/10.1017/cjn.2020.27DOI Listing
May 2020

Intractable Hiccups: A Pearl in Demyelinating Disease.

Can J Neurol Sci 2019 09 30;46(5):623-624. Epub 2019 Jul 30.

Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

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http://dx.doi.org/10.1017/cjn.2019.60DOI Listing
September 2019

Biomarkers of intestinal barrier function in multiple sclerosis are associated with disease activity.

Mult Scler 2020 10 18;26(11):1340-1350. Epub 2019 Jul 18.

Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada/Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

Background: Recent evidence suggests a role for the gut-brain axis in the pathophysiology of multiple sclerosis (MS).

Materials And Methods: We studied biomarkers of intestinal permeability in 126 people with MS (57 relapsing-remitting multiple sclerosis (RRMS) and 69 progressive MS) and in a group of healthy controls for comparison. Serum/plasma concentrations of zonulin (a regulator of enterocyte tight junctions), tight junction proteins (ZO-1 and occludin), intestinal fatty acid binding protein (IFABP)/ileal bile acid binding protein (IBABP), D-lactate, and lipopolysaccharide (LPS) binding protein were measured.

Results: Zonulin concentrations were significantly higher when a concurrent magnetic resonance imaging (MRI) confirmed the presence of blood-brain barrier (BBB) disruption (Gad+ RRMS) and were correlated with tight junction proteins. IBABP and D-lactate were elevated in people with RRMS compared to controls, but did not discriminate between Gad+ and Gad- subgroups. Baseline zonulin concentrations were associated with 1-year disease progression in progressive MS.

Conclusions: People with MS have altered biomarkers of intestinal barrier integrity. Zonulin concentrations are associated with 1-year disease progression in progressive MS and closely mirror BBB breakdown in RRMS. Zonulin may mediate breakdown of both the intestinal barrier and the BBB in gut dysbiosis through the regulation of tight junctions. This could explain how the gut-brain axis modulates neuroinflammation in MS.
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http://dx.doi.org/10.1177/1352458519863133DOI Listing
October 2020

Area Postrema Syndrome.

Neurohospitalist 2019 Jul 14;9(3):174-175. Epub 2018 Nov 14.

Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

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http://dx.doi.org/10.1177/1941874418809879DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6582378PMC
July 2019

Can Our Guts Tell Us Anything About MS?

J Neuroimmune Pharmacol 2019 09 15;14(3):367-368. Epub 2019 Feb 15.

Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada.

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http://dx.doi.org/10.1007/s11481-019-09841-6DOI Listing
September 2019

Novel Oral Anticoagulants as Treatment for Vertebral Artery Dissection: Case Report.

J Vasc Interv Neurol 2018 Nov;10(2):56-58

Servicio de Neurología del Hospital Universitario Dr. José Eleuterio González de la Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.

Background And Purpose: Cervical artery dissections, which may be traumatic or spontaneous, account for a significant proportion of strokes in the young. Antithrombotic therapy is the mainstay of treatment, but new oral anticoagulants could be an alternative treatment to the optimal strategy of anticoagulation followed by antiplatelet drugs.

Summary Of Case: We report the case of a 40-year-old patient with a spontaneous vertebral artery dissection who developed a cerebellar ischemic stroke, who had a favorable outcome and complete vessel recanalization after three months of treatment with the oral factor Xa inhibitor rivaroxaban.

Conclusion: New oral anticoagulant could constitute an alternative and new therapeutic option in cervical artery dissections.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350868PMC
November 2018

Area postrema syndrome: A short history of a pearl in demyelinating diseases.

Mult Scler 2019 03 22;25(3):325-329. Epub 2018 Nov 22.

Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

In this topical review, we discuss the history of the area postrema syndrome, with special attention given to early studies aimed at identifying the area postrema and its function, possible early cases of the syndrome and its current relevance in neuroimmunology and demyelinating diseases. In 1896, Retzius named a structure in the posterior medulla oblongata as the area postrema. The work of Borison in the middle of the 20th century led to the elucidation of its function as a "vomiting center." The historical medical literature is filled with excellent examples that could be described as "area postrema syndrome." While severe and bilateral optic neuritis and transverse myelitis still constitute the classic components of neuromyelitis optica spectrum disorder (NMOSD), intractable vomiting and hiccups due to area postrema involvement is now recognized as essentially pathognomonic, indeed a shiny pearl in neuroimmunology and demyelinating diseases.
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http://dx.doi.org/10.1177/1352458518813105DOI Listing
March 2019

Focus on the gut-brain axis: Multiple sclerosis, the intestinal barrier and the microbiome.

World J Gastroenterol 2018 Oct;24(37):4217-4223

Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary T2N 2T9, Canada.

The brain-gut axis serves as the bidirectional connection between the gut microbiome, the intestinal barrier and the immune system that might be relevant for the pathophysiology of inflammatory demyelinating diseases. People with multiple sclerosis have been shown to have an altered microbiome, increased intestinal permeability and changes in bile acid metabolism. Experimental evidence suggests that these changes can lead to profound alterations of peripheral and central nervous system immune regulation. Besides being of pathophysiological interest, the brain-gut axis could also open new avenues of therapeutic targets. Modification of the microbiome, the use of probiotics, fecal microbiota transplantation, supplementation with bile acids and intestinal barrier enhancers are all promising candidates. Hopefully, pre-clinical studies and clinical trials will soon yield significant results.
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http://dx.doi.org/10.3748/wjg.v24.i37.4217DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175760PMC
October 2018

Lyme borreliosis as a trigger for NMDA receptor encephalitis?

Neurol Sci 2018 Oct 14;39(10):1815-1817. Epub 2018 Jul 14.

Instituto de Neurologia y Neurocirugía, Tecnologico de Monterrey, Hospital Zambrano Hellion, Batallon de San Patricio 112 Colonia Residencial San Agustin, 66278, San Pedro Garza Garcia, N.L., Mexico.

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http://dx.doi.org/10.1007/s10072-018-3497-9DOI Listing
October 2018

Expanding the Potential Therapeutic Options for Remote Ischemic Preconditioning: Use in Multiple Sclerosis.

Front Neurol 2018 19;9:475. Epub 2018 Jun 19.

Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

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http://dx.doi.org/10.3389/fneur.2018.00475DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018107PMC
June 2018

The intestinal barrier in multiple sclerosis: implications for pathophysiology and therapeutics.

Brain 2018 07;141(7):1900-1916

Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Biological barriers are essential for the maintenance of homeostasis in health and disease. Breakdown of the intestinal barrier is an essential aspect of the pathophysiology of gastrointestinal inflammatory diseases, such as inflammatory bowel disease. A wealth of recent studies has shown that the intestinal microbiome, part of the brain-gut axis, could play a role in the pathophysiology of multiple sclerosis. However, an essential component of this axis, the intestinal barrier, has received much less attention. In this review, we describe the intestinal barrier as the physical and functional zone of interaction between the luminal microbiome and the host. Besides its essential role in the regulation of homeostatic processes, the intestinal barrier contains the gut mucosal immune system, a guardian of the integrity of the intestinal tract and the whole organism. Gastrointestinal disorders with intestinal barrier breakdown show evidence of CNS demyelination, and content of the intestinal microbiome entering into the circulation can impact the functions of CNS microglia. We highlight currently available studies suggesting that there is intestinal barrier dysfunction in multiple sclerosis. Finally, we address the mechanisms by which commonly used disease-modifying drugs in multiple sclerosis could alter the intestinal barrier and the microbiome, and we discuss the potential of barrier-stabilizing strategies, including probiotics and stabilization of tight junctions, as novel therapeutic avenues in multiple sclerosis.
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http://dx.doi.org/10.1093/brain/awy131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6022557PMC
July 2018

D-Lactate and intestinal fatty acid-binding protein are elevated in serum in patients with acute ischemic stroke.

Acta Neurol Belg 2021 Feb 21;121(1):87-93. Epub 2018 May 21.

Servicio de Neurología, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, 64700, Monterrey, NL, Mexico.

Experimental studies suggest that the intestinal barrier is affected in ischemic stroke. D-Lactate and intestinal fatty acid-binding protein (IFABP) are markers of intestinal mucosa integrity and barrier function. Our purpose was to evaluate the serum concentrations of these markers in patients with acute ischemic stroke (AIS). We included patients with AIS and used healthy subjects as controls. Clinical, demographic and outcome measures were recorded. Blood was drawn within 24 h of symptom onset. Serum concentrations of D-Lactate and IFABP were determined using commercially available colorimetric and ELISA kits, respectively. We included a total of 61 patients (median age of 64 years). The majority of patients were male (57.4%). The most common cause of stroke was atherosclerosis (34.4%), followed by small-vessel disease and cardioembolic (32.7% each). Mean admission NIHSS score was 8. Median IFABP and D-Lactate concentrations were significantly higher in patients than in controls. Concentrations were not associated with stroke severity or 3-month outcome. Patients with large-artery atherosclerosis and cardioembolic etiology had higher D-Lactate values than patients with small-vessel disease. D-Lactate and IFABP were significantly elevated in patients with AIS. This suggests that there is disruption of the intestinal barrier in patients with AIS.
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http://dx.doi.org/10.1007/s13760-018-0940-xDOI Listing
February 2021

Severe hypertriglyceridemia associated with teriflunomide in a patient with multiple sclerosis: A case report.

Mult Scler 2018 09 23;24(10):1383-1385. Epub 2018 Feb 23.

Servei de Neurología-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.

Objective: To describe a case of severe hypertriglyceridemia in a patient receiving teriflunomide.

Methods: This is a case study.

Results: Our patient developed severe hypertriglyceridemia (>5000 mg/dL) while on teriflunomide. The drug was withdrawn. Resolution began over 3 weeks later.

Conclusion: We describe the first probable case of teriflunomide-associated severe hypertriglyceridemia in a patient with multiple sclerosis, an adverse event previously associated with leflunomide in patients with rheumatologic diseases. Clinicians should be aware of this rare but potentially dangerous adverse event.
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http://dx.doi.org/10.1177/1352458518761185DOI Listing
September 2018

Concomitant neurosyphilis and herpes simplex encephalitis in an immunocompetent patient: a case report.

Neurol Sci 2018 01 15;39(1):185-187. Epub 2017 Sep 15.

Neurology Service, Hospital Universitario "Dr. José E. González" and Medical School, Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, 64460, Monterrey, NL, Mexico.

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http://dx.doi.org/10.1007/s10072-017-3115-2DOI Listing
January 2018

Abdominal Aortic Dissection and Cold-Intolerance After Whole-Body Cryotherapy: A Case Report.

Clin J Sport Med 2017 Sep;27(5):e67-e68

Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, México.

Whole-body cryotherapy (WBC) involves short exposures to air temperatures below -100°C and is purported to enhance recovery after exercise and accelerate rehabilitation after injury. It is generally considered a procedure with few side effects, but there are no large studies that have established its safety profile. We present the case of a 56-year-old patient who developed an abdominal aortic dissection after receiving 15 sessions of WBC. The patient had no other strong risk factors for aortic dissection. Exposure to cold temperatures, including WBC, has multiple hemodynamic effects, including increases in blood pressure, heart rate, and an adrenergic response. We suggest that these changes could act as a trigger for the onset of aortic dissections. This could be the first reported cardiovascular complication associated with WBC.
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http://dx.doi.org/10.1097/JSM.0000000000000376DOI Listing
September 2017

Affective symptoms and determinants of health-related quality of life in Mexican people with epilepsy.

Neurol Sci 2017 Oct 25;38(10):1829-1834. Epub 2017 Jul 25.

Department of Psychiatry, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, México.

Epilepsy is known to be associated with multiple psychiatric comorbidities, such as depression, sleep-disorders, and anxiety. The objective of this study was to determine the prevalence and impact of affective symptoms over health-related quality of life (QOL) in Mexican people with epilepsy (PWE). We performed a cross-sectional observational study on 73 consecutive PWE and corresponding age- and sex-matched controls. HrQOL was assessed using the QOLIE-10 (QOL in Epilepsy-10) instrument. Clinical and demographic characteristics were recorded, and instruments evaluating depressive/anxiety symptoms, sleep quality, and insomnia were completed. PWE had more depressive/anxiety symptoms when compared with controls. QOLIE-10 scores were significantly inversely correlated with poor sleep quality, insomnia symptoms, depressive/anxiety symptoms, and number of anti-epileptic drugs used, but not with seizure type or number of seizures per month. A poor QOL was independently associated only with anti-epileptic drug polytherapy. PWE are burdened with depressive/anxiety symptoms at alarming rates. The presence of depressive symptoms along with sleep disturbances and more significantly, anti-epileptic drug polytherapy, appears to negatively impact QOL, to a greater degree than short-term seizure control.
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http://dx.doi.org/10.1007/s10072-017-3075-6DOI Listing
October 2017

Acute toxic leukoencephalopathy associated with a non-prescription weight loss supplement: a report of two cases.

Neurol Sci 2017 Dec 27;38(12):2199-2201. Epub 2017 Jun 27.

Instituto de Neurología y Neurocirugía, Centro Medico Zambrano Hellion, Tecnológico de Monterrey, Ave Batallón de San Patricio # 112, Colonia Real de San Agustín, 66278, San Pedro Garza García, N.L., Mexico.

Weight loss dietary supplements are used with some frequency by an increasingly overweight population. Some products are not adequately regulated and may pose potential health risks. We report two new cases of acute toxic leukoencephalopathy (ATL) due to the use of a supplement marketed as a thermogenic weight loss aid. ATL is a heterogeneous clinic-radiological entity that has been associated with various compounds, such as chemotherapeutic drugs and immunomodulators. It is characterized by an often reversible periventricular and infratentorial demyelination. The commercialization of non-regulated weight loss products continues to be a health risk in our population.
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http://dx.doi.org/10.1007/s10072-017-3028-0DOI Listing
December 2017

CSF concentrations of adipsin and adiponectin in patients with amyotrophic lateral sclerosis.

Acta Neurol Belg 2017 Dec 26;117(4):879-883. Epub 2017 May 26.

Instituto de Medicina Interna, Centro Medico Zambrano Hellion, Tecnológico de Monterrey, Monterrey, Mexico.

Amyotrophic lateral sclerosis (ALS) is described as a neurodegenerative disorder. However, neuroinflammation and chemokine expression are prominent pathological finding at sites of injury. Adipsin and adiponectin are molecules that are implicated in the pathogenesis of neurodegenerative and neuroimmune disorders. Adipsin and adiponectin concentrations were determined in the CSF of ALS patients and controls and the relationship of these chemokines with clinical severity and disease duration in ALS was determined. Seventy-seven ALS patients (mean age 49.5 ± 10.4 years) (mean body mass index 23.5 ± 4.5) were included. Twenty patients had bulbar, 53 spinal, and four bulbospinal onset ALS. Median adipsin CSF level was 12,650.94 pg/ml in ALS patients and 3290.98 pg/ml in controls (p < 0.001). Median adiponectin CSF level was 4608 pg/ml in ALS patients and 3453 pg/ml in controls (p = 0.1). No differences were observed in disease duration, progression rate or disease severity. There was a significant positive correlation between adipsin and adiponectin concentrations (r = 0.379, p = 0.01). No correlation with age, body mass index or ALFRS-R score was found. Adipsin was significantly elevated in CSF, suggesting that this chemokine might have a role in ALS pathogenesis. Adiponectin showed a trend towards higher concentrations, but failed to reach statistical significance. Due to the clinical heterogeneity in our cohort, these chemokines do not appear to be associated with disease duration or severity.
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http://dx.doi.org/10.1007/s13760-017-0798-3DOI Listing
December 2017

Septo-optic dysplasia plus diagnosed in adulthood.

Neurol Sci 2017 09 4;38(9):1705-1707. Epub 2017 May 4.

Servicio de Neurologia, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, 64460, Monterrey, Nuevo León, Mexico.

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http://dx.doi.org/10.1007/s10072-017-2985-7DOI Listing
September 2017

Anti-ammonia treatment-responsive myoclonus as initial presentation of acquired hepatocerebral degeneration.

Gastroenterol Hepatol 2018 03 18;41(3):167-169. Epub 2017 Apr 18.

Servicio de Neurología, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, N.L., Mexico.

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http://dx.doi.org/10.1016/j.gastrohep.2017.03.006DOI Listing
March 2018

The varieties of psychosis in multiple sclerosis: A systematic review of cases.

Mult Scler Relat Disord 2017 Feb 23;12:9-14. Epub 2016 Dec 23.

Department of Neurology, Multiple sclerosis Center, University of Massachusetts Memorial Medical Center, Worcester, MA, USA.

Objectives: Multiple Sclerosis (MS) is known to be associated with a wide range of psychiatric symptoms, particularly with affective disorders. However, a link to psychotic disorders has not been fully established.

Methods: A systematic review of the PubMed/MEDLINE database was performed to identify cases of MS presenting with psychotic symptoms. Variables analyzed included patient demographics, clinical presentation, imaging characteristics and treatment.

Results: Ninety-one cases were identified. The mean age was 34.4, and there was a female predominance. The majority of patients did not have a prior history of MS or psychiatric disease. The majority of cases could be classified as having either Psychotic Disorders or Mood Disorders with psychotic features. Most patients received some type of antipsychotic therapy, with variable success. At least 26 patients were treated with corticosteroids in the acute phase of their psychotic symptoms, and the majority responded favorably. Imaging data was available for 50 patients. Of these, 60% had predominantly fronto-temporal lesions, and most had contrast enhancing lesions.

Conclusions: MS can present with a variety of psychotic symptoms. The presence of enhancing lesions and steroid-responsiveness suggests these could be characterized as flares.
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http://dx.doi.org/10.1016/j.msard.2016.12.012DOI Listing
February 2017

Posterior reversible leukoencephalopathy syndrome (PRES) associated with severe eclampsia: Clinical and biochemical features.

Pregnancy Hypertens 2017 Jan 16;7:44-49. Epub 2017 Jan 16.

Neurology Service, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, N.L., Mexico.

Objectives: Posterior Reversible Encephalopathy Syndrome (PRES) and eclampsia share clinical characteristics and patients may present with a combination of these two entities. Our aim was to study the proportion of patients with eclampsia having evidence of PRES in their brain imaging.

Methods: Retrospective study of pregnant patients diagnosed as having eclampsia that underwent brain magnetic resonance imaging (MRI) during their hospitalization. MRI diagnosis of PRES was assessed by 2 investigators blinded to group.

Results: We included a total of 29 patients with eclampsia, out of which 17 (58.6%) had MRI evidence of PRES. When patients with eclampsia and eclampsia/PRES were compared, there was no difference in demographic characteristics such as age, weight or multiparity. Patients with eclampsia/PRES had higher levels of creatinine, liver enzymes, mean platelet volume and there was a trend towards higher proteinuria. Infants of mothers with eclampsia/PRES also had worse 1min APGAR scores.

Conclusion: PRES appears to accompany eclampsia in over half of all cases. The clinical picture of patients with eclampsia with or without associated PRES is similar, but certain biochemical characteristics suggest that PRES might be indicative of a more severe disease process.
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http://dx.doi.org/10.1016/j.preghy.2017.01.003DOI Listing
January 2017
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