Search

Background: Dural arteriovenous fistulas (DAVFs) are abnormal communications between dural arteries and cortical, meningeal, or dural sinus veins. They represent 10‐15% of intracranial arteriovenous malformations. In rare cases, they have been associated with potentially reversible cognitive impairment and dementia. Method: This report presents a clinical case of reversible cognitive impairment associated with DAVF and a review of the literature. Literature research was conducted using PubMed with the following keywords: "Dementia AND Dural arteriovenous fistula"; "Reversible dementia AND dural arteriovenous fistula" and "Dural arteriovenous fistula AND cognitive impairment". Result: A case report was presented on a 72‐year‐old male patient who was hypertensive, a smoker, and had a history of headaches. The patient consulted for memory loss that had been ongoing for 3 years and had significantly progressed in the last year. The memory loss was associated with mild anomic aphasia and postural instability. During the examination, the patient exhibited impaired delayed recall and attention. The total score on the Mini‐Mental State Exam (MMSE) was 25 out of 30, and the clock drawing test was failed. The neuropsychological evaluation (NPE) revealed deficits in language, verbal memory, attention, executive functioning, and visuoconstruction. The magnetic resonance imaging (MRI) showed an unusual vascular pathway in the left basal temporal cortico‐subcortical region, with venous congestion mainly in the superior petrosal sinus and hyperperfusion in the left temporal‐insular area in the arterial spin‐labeling (ASL) sequence. Digital angiography confirmed the diagnosis of left petrosal DAVF with afferents from the ipsilateral round foramen, middle meningeal, and occipital arteries. The fistula was completely embolized, and the patient had a favorable outcome. The post‐treatment NEP demonstrated significant improvement, resulting in the normalization of all previously deficient cognitive domains. Conclusion: While cognitive manifestations secondary to DAVFs are rare, they should be considered as a potentially treatable cause of cognitive impairment. Early identification and adequate treatment have a favorable prognosis and usually lead to a reversal of symptoms, improving the patient's quality of life. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) is the most common cause of cognitive impairment and dementia. The objective of this work is to describe the pharmacological management of AD and the opinion on future pharmacological therapies in Argentina. Method: A cross‐sectional, descriptive study was carried out. An opinion anonymous survey about pharmacological treatments was designed. The survey was distributed electronically by the Argentine Neurology Society (ANS) to physicians who assessment patients with cognitive disorders (CD). Answers of specialists in CD (SCD) and non‐specialists in CD (NSCD) about recommended treatments (RT), non‐recommended treatments (NRT) and off‐label therapies were analyzed. Physicians who would indicate or were hesitant to indicate anti‐monoclonal beta amyloid protein antibodies (MABs) therapy were considered as potential MABs prescribers. A descriptive statistical and frequency assessment were performed. Result: 155 physicians (10,3% of the total to whom the questionnaire was directed) were surveyed. A 19,35% indicated at least one NRT for dementia and 78,06% prescribed at least one off‐label therapy or a NRT for mild cognitive impairment (MCI). A 31% would indicate MABs. For the management of psychotic symptoms, the most selected drug was quetiapine (88.4%) and for apathy, escitalopram (32,3%). One hundred physicians (64,5% of the total) were considered potential MABs indicators. Nevertheless, 42% of them were unaware of the adverse effects of MABs. Also, 70% would request biomarkers for brain beta amyloid in the initial assessment. There were significant differences in the responses of the SCD and the NSCD regarding indicating MABs (52.17% vs. 23.08, p<0.05) and considering knowledge of its adverse effects (76.09% vs. 38.46%, p<0.05). There were no significant differences between SCD and NSCD in the prescription for RT, NRT, and off‐label therapies. Conclusion: In the real life, our study shows that two‐thirds of the respondents would be potential MABs prescribers. At the same time, we identified a high rate of NRTs and off‐label medications indications for patients with CD. These results highlight the need for continuous medical education, particularly in low‐income countries such as Argentina considering the cost of biomarkers and the new therapies like MABs for AD and its impact on public health policies. [ABSTRACT FROM AUTHOR]

Although it is generally accepted that foster children are at greater risk for mental health problems than are children in the general population, very little is known about the smaller group of foster children admitted to psychiatric hospitals. The present study sought to determine whether foster children admitted to inpatient care are a distinct and more vulnerable group than other hospitalized children and found that they are. Youth admitted from the foster care system were found to have higher rates of externalizing problems and diagnoses and lower social competence relative to other inpatient children. They were also found to have a distinguishing pattern of service use including first admissions at younger ages, higher numbers of restraints in hospital, and greater likelihood of readmission. These findings point to pressing needs for additional research to improve understanding of the vulnerabilities and inpatient care needs of foster children and for better initiatives to prevent early and recurrent hospitalization. (Contains 2 tables.)

The star V2282 Sgr is positionally consistent with a strong Chandra X-ray and a Spitzer/IRAC mid-infrared source. We derived its long-term I-band light curve from the photographic archives of the Asiago and Catania Observatories, covering the years from 1965 to 1984. Also, CCD RC photometry of 2009 was re-analyzed. Optical spectra were collected at the Loiano Observatory in 2011 and 2012. J,H,Ks photometry, obtained from several sources in different epochs was compared and the Spitzer images were re-analyzed. V2282 Sgr was found to be irregular variable in all wavelengths. Spectroscopically, it shows strong emission features (H Balmer lines, [N II] 6584Å and [O III] 5007/4959Å) while the Na I D-doublet is very strong, indicating a circumstellar envelope. A single thermal energy distribution cannot reproduce the observed SED, while it can be explained as the sum of a G-type star plus a variable circumstellar disk, which mimics YSO of class 0/I. Most likely, V2282 Sgr is a 1–2 M⊙ mass pre-main-sequence star with an accretion disk.

Background: Vitamin B12 deficiency is associated with cognitive‐behavioral disorders, which may be potentially reversible. No specific associated cognitive domain has been established and alterations in episodic memory, verbal fluency, attention and executive functions, praxia and visuoconstruction have been described. The objective of this work is to evaluate and describe the cognitive domains affected in patients with cognitive impairment associated with vitamin B12 deficiency. Method: Cross‐sectional observational study conducted at the Trinidad Mitre sanatorium of Buenos Aires City. Patients with cognitive impairment and vitamin B12 deficiency were analyzed. Information was collected on the cognitive domain affected (taking as altered value the Z score ≤‐1.5 according to age and educational level, obtained in the neurocognitive evaluations), cognitive profile, magnetic resonance imaging features and mean consultation‐supplementation time. Result: 25 patients with vitamin B12 deficiency and cognitive complaint were analyzed, with a mean age of 68.5 years. 83% presented multidomain mild cognitive impairment being 60% with subcortical pattern. Memory and attention were the most affected domains in 80% of the sample, followed by executive functions with 52%. The most deficient tests were the direct digit test (68%), serial memory (56%), deferred logical memory (52%) and Trail Making B (52%). Nearly 52% presented mild depressive symptomatology. A 56% of the sample presented with severe B12 deficiency with 32% elevation of plasma homocysteine. Supplementation was performed intramuscularly in 68% of the patients with a mean symptomatology‐supplementation onset time of 10.8 months. 92% of the patients presented subjective improvement after supplementation, 32% had control global test evaluation with improvement in all of them and 50% of this group presented control cognitive evaluation with improvement in previously deficient domains. Conclusion: According to our findings we conclude that these patients with vitamin B12 deficiency present a multidomain pattern with special affectation of memory, attention and executive functions; of mild degree and potentially reversible. The reversibility of the picture could be related to high doses of B12 and early supplementation, using control cognitive assessments as an objective measure of improvement. References Reynolds E. Lancet Neurol. 2006 Nov;5(11):949‐60. Eastley R. Int J Geriatr Psychiatry. 2000 Mar;15(3):226‐33. Robins Wahlin. Biol Psychol. 2001 Jun;56(3):247‐65. [ABSTRACT FROM AUTHOR]

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)