Volume 3 Isssue 1

Research Article: Post-Exertional Malaise in Patients with ME and CFS with Comorbid Fibromyalgia

Stephanie L. McManimen and Leonard A. Jason*

Background: Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS) share some similar symptoms with Fibromyalgia (FM). Prior research has found increased illness severity when patients have FM that is comorbid with ME and CFS. For example, Post-Exertional Malaise (PEM) has been shown to be more severe in those with comorbid FM. However, PEM can be separated into two factors, Muscle and General PEM. It is unknown if the more severe PEM findings in comorbid FM are due to the Muscle or General PEM factor.
Purpose: The purpose of this study was to determine if the PEM differences seen between patients with and without comorbid FM exist for the Muscle or General PEM factors.
Method: An international convenience sample was collected via an online questionnaire. The questionnaire assessed the frequency and severity of several PEM-related symptoms. Additionally, participants provided information regarding the course and characteristics of their illness.
Results: Participants that indicated a comorbid diagnosis of FM displayed significantly more frequent and severe PEM symptoms in the Muscle and General PEM factors. The FM group also indicated significantly worse physical functioning compared to the group without comorbid FM.
Discussion: The secondary diagnosis of FM in addition to ME and CFS appears to amplify the PEM symptomatology and worsen patients' physical functioning. The findings of this study have notable implications on the inclusion of patients with comorbid FM in ME and CFS research studies.
Keywords: Chronic fatigue syndrome; Myalgic encephalomyelitis; Fibromyalgia; Comorbidity; Post-exertional malaise

Cite this Article: McManimen SL, Jason LA. Post-Exertional Malaise in Patients with ME and CFS with Comorbid Fibromyalgia. Sci J Neuro Neurosur. 2017;3(1): 022-027.

Published: 10 March 2017

Research Article: Gamma Knife Surgery Targeting the Neurovascular Contact Complex in Management of Refractory Idiopathic Trigeminal Neuralgia: Outcome and Long Term Efficiency

Raef F. A. Hafez*, Tiit Rahn, Magad. S. Morgan, Osama. M. Fahmy, Yasser. O. Riyad and Hamdy. T. Hassan

Background: Typical Idiopathic Trigeminal Neuralgia (ITN) is considered to be one of the most severe forms of pain in the human experience. The presence of Neurovascular Contact Complex (NVC) on pre-treatment high resolution Magnetic Resonance Imaging (MRI) predicts an increased likelihood of an adequate response to Gamma Knife Surgery (GKS).
Objective: Evaluation of GKS effectiveness, possible complications, and predicating factors in management of refractory ITN when targeting neurovascular contact complex as the main detected associative pathology with this disease, through retrospective analyze of long term results achieved at our center.
Methods: Fifty eight patients with medically refractory ITN treated by GKS at our institution were followed up between 2005 and 2014. Mean maximum dose was 78 Gy (70-80 Gy). The NVC complex delineated by 3D-T2 MRI sequence of high resolution MRI was the target of GKS radiation. Clinical response was categorized on basis of pain outcome using BNI pain scale. We considered Group I as significant response without medication, Group II as adequate response with medication and Group III as failure to control pain. Mean duration of follow-up was 66 months (24 - 132 months).
Results: significant and Adequate response at last follow-up were achieved in 82.8% of patients, significant response alone without medication was achieved in 60.3% while failure to control pain was in 17.2% of patients. Favorable treatment response rates were significantly higher in patients who had no previous surgery 83%, with duration of symptoms < 10 years 77% and in 75% of those had no sensory dysfunction prior to GKS. New or worsening tolerable facial numbness was reported in 27.5%. New or worsening tolerable facial numbness was reported in 27.5%. At final outcome patients who achieved and maintaining significant and adequate pain control (Group I and Group II) were 82.8% at 2 years, 80% at 3 years, 77% at 5 years and 66% at 10 years.
Conclusion: GKS targeting NVC complex as the main detected associative pathology for treatment of ITN resulted in favorable outcomes compared with surgery in terms of pain relief and complication rates. GKS is a reasonable initial least minimally invasive surgical option for refractory ITN and for those unwilling or medically unsuitable to undergo other surgical approaches.

Cite this Article: Hafez RFA, Rahn T, Morgan MS, Fahmy OM, Riyad YO, et al. Gamma Knife Surgery Targeting the Neurovascular Contact Complex in Management of Refractory Idiopathic Trigeminal Neuralgia: Outcome and Long Term Efficiency. Sci J Neuro Neurosur. 2017;3(1): 015-021.

Published: 20 February 2017

Case Report: Cerebral Abscesses Masquerading as Metastasis

Danielle A. Cunningham, MS*, Robert Weidling, MS

In a patient presenting with focal neurologic signs and multiple brain lesions, the differential diagnosis includes cerebral abscesses and metastatic disease. While the two conditions are commonly distinguished by the patient's history and neuroimaging, the diagnosis is challenging in select patients.
A 56-year-old gentleman with a history of Hepatitis C, Autoimmune Hepatitis, and Crohn's disease controlled on prednisone and infliximab presented with a recent seizure, left hemiparesis, and acute respiratory failure. Workup was significant for metabolic acidosis, a ring enhancing 22 x 20 x 17 mm mass in the frontal lobe on head CT, and a normal CT angiography of the chest. An MRI of the brain revealed a 28 x 22 x 26 mm mass with surrounding edema in the anterior superior lateral right frontal lobe and a smaller 11 x 11 x 10 mm ring enhancing lesion with surrounding edema in the right head of the caudate. The frontal abscess was incised and drained, and the cultures revealed Viridans streptococci. The patient was started on intravenous antibiotics, and he had complete return to respiratory and neurologic function. Once alert, the patient reported a long history of severe periodontal disease with recent deep dental cleanings, likely providing a nidus of infection. This case exemplifies the difficulty in discerning cerebral abscess from malignancy in select cases, and the risk of infection in patients on immunomodulating medications.

Cite this Article: Cunningham DA, Weidling R. Cerebral Abscesses Masquerading as Metastasis . Sci J Neuro Neurosur. 2017;3(1): 011-014.

Published: 03 February 2017

Case Report: Early Epidural Hematoma after Cerebrospinal Fluid Shunt Followed by Subdural Hematoma

Hatim Belfquih*, Brahim El mostarchid

Ventriculo peritoneal shunt operations represent the most used choice for treating hydrocephalus. Occurrence of Epidural Hematoma (EH) after ventriculo peritoneal shunt operations is a catastrophic complication of a relatively minor neurosurgical procedure. The presence of a Cerebrospinal Fluid (CSF) shunt is a predisposing factor for the development of Subdural Hematoma (SDH) in patients with hydrocephalus. We present the ?rst case of early epidural hematoma after CSF shunt followed by subdural hematoma, discussing its pathophysiology.

Cite this Article: Belfquih H, El mostarchid B. Early Epidural Hematoma after Cerebrospinal Fluid Shunt Followed by Subdural Hematoma. Sci J Neuro Neurosur. 2017;3(1): 008-010.

Published: 25 January 2017

Research Article: Protein Expression of ETS2 in Alzheimer's Disease and Down's syndrome as a Personalized Insight: One Gene, One Feature in Common, Diverse-Function-and Diseases

Mehdipour P*, Javan F, Estiar MA, Khaleghian M, Novin N, G Zaeim Kohan H, Akhondzadeh S

Up-regulation of V-ets erythroblastosis virus E26 oncogene homolog 2 (ETS2) may result in increased neuronal vulnerability and degeneration. We aimed to investigate the ETS2 protein expression in the lymphocytes of Down's syndrome (DS) and Alzheimer (Alz) patients who have the neurodegeneration, as the key characteristics in common. Total lymphocyte cells of 69090 and 20130 were analyzed in DS- and Alz.- patients by flow cytometry respectively and confirmed by Immuno-fluorescence. The mean of cells with positive ETS2 was higher in DS than in either the aged-matched control or in Alz patients, it was also higher in females of DS than in Alz patients, but not in in the males of both groups. So, ETS2 has important role in pathogenesis of two different diseases, by reflecting a diverse cellular behavior, with a reliable significant difference for ETS2 protein expression in DS and Alz diseases which harbor two and three chromosome 21, respectively. This fact may pave the way towards the application of more influential strategy by considering the Gene Product-Based Therapy (GDT) and the personalized managements for both diseases as well.

Cite this Article: Mehdipour P, Javan F, Estiar MA, Khaleghian M, Novin N, et al. Protein Expression of ETS2 in Alzheimer's Disease and Down 's syndrome as a Personalized Insight: One Gene, One Feature in Common, Diverse-Function-and Diseases. Sci J Neuro Neurosur. 2017;3(1): 001-007.

Published: 16 January 2017

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