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Background Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare and heterogeneous clinico-neuroradiological syndrome characterized by headache, altered mental status, seizures, and visual disturbances. Hypertension and immunosuppression are two of the main factors that predispose an individual to RPLS. However, RPLS can develop when no major risk factors are present. RPLS has been reported in pediatric nephrotic patients, but rarely in adults. Case presentation A 42-year-old Asian woman with nephrotic syndrome presented with seizures, headaches, and nausea. Her blood pressure was controlled, and no immunosuppressants had been prescribed. All symptoms and tests indicated RPLS following infection with pneumonia, which was successfully treated by immediate administration antibiotic and anti-epileptic medications. Seizures did not recur during a 2-year follow-up period. Conclusions When patients with nephrotic syndrome have an infection, RPLS symptoms should be investigated thoroughly. With early diagnosis and appropriate treatment of RPLS, morbidity and mortality can be prevented.

Diagnosis of attention-deficit hyperactivity disorder (ADHD) is currently based on core symptoms or checklists; however, the inevitability of practitioner subjectivity leads to over- and underdiagnosis. Although the Federal Drug Administration has approved an elevated theta/beta ratio (TBR) of the electroencephalogram (EEG) band as a tool for assisting ADHD diagnosis, several studies have reported no significant differences of the TBR between ADHD and control subjects. This study detailed the development of a method based on approximate entropy (ApEn) analysis of EEG to compare ADHD and control groups. Differences between ADHD presentation in boys and girls indicate the necessity of separate investigations. This study enrolled 30 girls with ADHD and 30 age-matched controls. The results revealed significantly higher ApEn values in most brain areas in the control group than in the ADHD group. Compared with TBR-related feature descriptors, ApEn-related feature descriptors can produce the higher average true positive rate (0.846), average true negative rate (0.814), average accuracy (0.817), and average area under the receiver operating characteristic curve value (0.862). Therefore, compared with TBR, ApEn possessed the better potential for differentiating between girls with ADHD and controls.

Periodic lateralized epileptiform discharges (PLEDs) on electroencephlography (EEG) usually indicate an acute, diffuse, and severe cerebral insult. Although hyperglycemic hemichorea–hemiballisum (HCHB) and striatal hyperintensity on T1-weighted magnetic resonance (MR) images is an accepted clinical entity, PLEDs have not previously been reported. Herein, we report a 74-year-old man with hyperglycemic HCHB, hyperintense putamen on T1-MR images and PLEDs on EEG. Aggressive sugar control with neuroleptic treatment only slightly improved the severity of HCHB. We also tried titrated oral and intravenous haloperidol, clonazepam, and propranolol sequentially and in combination; however, the effects were poor. Unlike the generally reversibility of hyperglycemic HCHB, the condition was still present 6 months later. Hyperglycemia can cause HCHB and produce subcortical type-PLEDs, which may explain the findings in our patient. In conclusion, PLEDs can be found in patients with hyperglycemic HCHB and striatal hyperintensity on T1-weighted MR images, and the appearance of PLEDs may indicate an irreversible outcome. EEG should be considered in such circumstances.

Diagnosis of aphasic status epilepticus is sometimes not easy because of its rarity and electroclinical dissociation. Although most cases are associated with organic brain lesions, nonketotic hyperglycemia (NKH)–related aphasic status epilepticus is rare, especially if it is isolated (without other clinical seizure activity). On the other hand, unlike other metabolic disorders, or hypoglycemia-related generalized seizures, focal motor seizure and epilepsia partialis continua can occur in 25% of NKH, with seizures being the initial manifestation in up to 50% of patients. However, the presentation of epileptic aphasia is rare in NKH patients. We report a rare case of NKH presenting initially as persistent and isolated aphasic status epilepticus. Brain magnetic resonance imaging did not reveal any focal lesion, but ictal electroencephalography (EEG) disclosed left frontotemporal continuous theta to delta waves, intermingled with epileptiform discharges. Correcting the hyperglycemia failed to improve the language disorder, and the seizure was controlled only by the addition of carbamazepine. Patients with NKH may initially present with isolated aphasic status epilepticus. Unlike stroke-related aphasia, accurate diagnosis is difficult if based solely on neurologic examination and brain neuroimaging. Use of EEG and blood sugar determination should be helpful in this special condition.

SUMMARY Two approaches to estimating a smooth regression function not specified by a finite number of parameters are (i) to fit a parametric model to the data, with the number of parameters selected by the Akaike information criterion, AIC, and (ii) to use nonparametric smoothing techniques, with the smoothing parameter selected by cross-validation or some other automatic method. We consider the relative rate of convergence of the mean integrated squared error of the selected estimator compared to the best possible estimator in the class of candidates under consideration. We extend results of Shibata (1981) to show that the relative rate of convergence using AIC in the parametric case can be as fast as op(n- + ) for arbitrary positive d. We also show that this rate can be attained in the special cases of polynomial and trigonometric regression.

This study aimed to investigate which cerebral cortices are involved in the central autonomic network and how they are linked to the peripheral (cardiac) autonomic network in Parkinson's disease (PD) patients and normal controls. 26 PD patients with autonomic dysfunction and 23 age- and sex-matched controls were evaluated by simultaneous spectral analysis of electroencephalography (EEG) and electrocardiography (ECG) recording along with autonomic questionnaires. Although the PD group has significantly more symptoms of autonomic dysfunction, frequency-domain HRV can not differentiate these two groups. However, different patterns of central oscillation and their correlation with peripheral autonomic indices could be found for the two groups. While the power of specific EEG bands under electrodes F4, F7, Cz and Pz (parietal-lateral premotor cortex, which is considered as a compensatory area for the relative deficiency of mesial frontal-striatal circuits in PD) correlated significantly with the power of peripheral heart rate variability (HRV) indices in the PD group, those under electrodes C3, P3, P4 and F8 had significant correlation in the control group. In conclusion, functional connectivity between areas of cerebral cortex and peripheral autonomic system can be measured and differs between PD patients with autonomic dysfunction and healthy controls. The central autonomic network may play a role in brain re-organization in PD patients with autonomic dysfunction.

J Oral Pathol Med (2010) 39: 155–161 Background: Our aim was to measure the relationship of FAS (−1377G>A and −670A>G), FASL (−844C>T) gene variants and risk of oral cancer. Methods: Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis was used to determine the FAS and FASL polymorphisms in 294 oral squamous cell carcinoma (OSCC), 53 oral submucous fibrosis (OSF), and 84 oral leukoplakia (OL) patients, as well as in 333 healthy controls. A standardized questionnaire was applied to collect demographic data, and potential confounding factors. JMP statistical software was used to analyze the association. Results: FAS and FASL polymorphisms were not correlated with OSCC development or the malignant potential of OL by simple and multivariate logistic regression. However, a two- to fourfold difference in the risks of betel quid chewing, alcohol consumption, and smoking on OSCC development were observed between participants with different FAS polymorphisms. FAS polymorphisms were significantly correlated with the malignant potential of OSF. Multivariate logistic regression analysis indicated that FAS A−1377-G−670 vs. G−1377-A−670 haplotype (OR = 2.26, 95% CI = 1.16–4.41) was correlated with the malignant potential of OSF. Conclusions: We suggest that FAS and FASL polymorphisms are not significantly correlated with OSCC development or malignant potential of OL. The impact of substance usage on OSCC development could be differentiated by FAS polymorphisms. FAS A−1377-G−670 haplotype may play a role in the malignant potential of OSF.

Acute insular infarction, due to its anatomic and functional complexity and wide connections, may present with various clinical presentations, such as somatosensory deficits, gustatory disorder, vestibular-like syndrome, cardiovascular disturbances, neuropsychological disorders, movement disorders, autonomic dysfunction and empathy impairment. However, there was no mention of the symptoms involving the cerebellar system in the related literature. We present a case of pure left insular cortex infarction with isolated truncal ataxia and demonstrate a crucial relationship between the left insular cortex and the cerebellar system. The possible connections are through the spinocerebellar and dentatorubrothalamic pathway. In conclusions, left insular cortex lesions should be considered in the differential diagnosis of isolated truncal ataxia.