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Background Rapidly progressive dementia can be caused by several factors like neurodegenerative, toxic/metabolic, infectious, autoimmune or neoplastic disorders. Here I present a case of this type and the diagnostic process leading to diagnosis. Material and methods This case describes a woman in her sixties admitted to hospital with dementia and anxiety as initial symptoWithin 2 month progression of these symptoms and appearance of apraxia, visual affection and cerebellar gait. The diagnostic process is illustrated. including consecutive EEGs, PET, MRi, CSF markers. Results Initial MRi was considered normal and first EEG with normal posterior dominant rhythm and bi-fronto-temporal 2–3 Hz activity (leftsided dominance) and no paroxystic activity. Repeated tests revealed classic changes seen in sporadic CJD on MRi in the form of cortical ribbon sign and adynamic periodic paroxyms and low frequency activity (2–3 Hz) lateralized in the EEG. CSF with normal count of protein and normal count of White blood cells and elevated count of total tau 1200 (normal range Conclusions Even though a definite diagnosis of Creutzfeldt-Jacob disease (CJD) can only be manifest by brain autopsy or biopsy post mortem a possible or likely diagnosis can be established combining CSF markers, brain imaging and EEG. This case illustrates the importance of EEG and especially consecutive EEGs in the diagnostic process of rapidly progressive dementia.

Cortical spreading depression (CSD) is associated with release of arachidonic acid, impaired neurovascular coupling, and reduced cerebral blood flow (CBF), caused by cortical vasoconstriction. We tested the hypothesis that the released arachidonic acid is metabolized by the cytochrome P450 enzyme to produce the vasoconstrictor 20-hydroxyeicosatetraenoic acid (20-HETE), and that this mechanism explains cortical vasoconstriction and vascular dysfunction after CSD. CSD was induced in the frontal cortex of rats and the cortical electrical activity and local field potentials recorded by glass microelectrodes, CBF by laser Doppler flowmetry, and tissue oxygen tension (tpO2) using polarographic microelectrodes. 20-HETE synthesis was measured in parallel experiments in cortical brain slices exposed to CSD. We used the specific inhibitor HET0016 (N-hydroxy-N′-(4-n-butyl-2-methylphenyl)formamidine) to block 20-HETE synthesis. CSD increased 20-HETE synthesis in brain slices for 120 min, and the time course of the increase in 20-HETE paralleled the reduction in CBF after CSDin vivo. HET0016 blocked the CSD-induced increase in 20-HETE synthesis and ameliorated the persistent reduction in CBF, but not the impaired neurovascular coupling after CSD. These findings suggest that CSD-induced increments in 20-HETE cause the reduction in CBF after CSD and that the attenuation of stimulation-induced CBF responses after CSD has a different mechanism. We suggest that blockade of 20-HETE synthesis may be clinically relevant to ameliorate reduced CBF in patients with migraine and acute brain cortex injuries.

Summary Objective Absence seizures in patients with idiopathic generalized epilepsy (IGE) may in part be explained by a decrease in phasic GABAA (type-A γ-aminobutyric acid) receptor function, but the mechanisms are only partly understood. Here we studied the relation between ictal and interictal spike-wave discharges (SWDs) and electroencephalography (EEG) gamma oscillatory activity (30–60 Hz) in patients with IGE. Methods EEG recordings were obtained of 14 children with IGE (mean age, 8.5 ± 5 years) and 14 age- and sex-matched controls. Time-frequency analysis of each seizure and seizure-free control epochs was performed and cross-coherences of neocortical gamma oscillations were calculated to describe interictal and ictal characteristics of generalized seizures. Results SWDs were characterized with an abrupt increase of oscillatory activity of 3–4 and 13–60 Hz, peaking at 3–4 and 30–60 Hz, and with a simultaneous decrease in the 8–12 Hz frequency band. The rise in EEG gamma oscillations was short-lasting and decreased before activity declined at lower frequency ranges. Compared to control patients, patients with epilepsy also showed higher interictal values of mean coherence of gamma activity, but this interictal increase was not significant after post hoc analysis. Significance Our data support the hypothesis that gamma oscillatory activity increase concomitantly with rises in activity of lower EEG frequencies during absence seizures and that the activity starts to cease earlier than lower EEG frequencies. The data did not support a change in gamma activity preceding the 3–4 Hz SWDs. SWDs are hypothetically generated by the synchronous interaction between the thalamus and the cortex, whereas the production of gamma activity is the result of activity in local inhibitory networks. Thus, the modification of SWD by gamma activity may be understood in terms of the cellular and synaptic mechanisms involved.

Spreading depolarizations (SD) are waves of abrupt, near-complete breakdown of neuronal transmembrane ion gradients, are the largest possible pathophysiologic disruption of viable cerebral gray matter, and are a crucial mechanism of lesion development. Spreading depolarizations are increasingly recorded during multimodal neuromonitoring in neurocritical care as a causal biomarker providing a diagnostic summary measure of metabolic failure and excitotoxic injury. Focal ischemia causes spreading depolarization within minutes. Further spreading depolarizations arise for hours to days due to energy supply-demand mismatch in viable tissue. Spreading depolarizations exacerbate neuronal injury through prolonged ionic breakdown and spreading depolarization-related hypoperfusion (spreading ischemia). Local duration of the depolarization indicates local tissue energy status and risk of injury. Regional electrocorticographic monitoring affords even remote detection of injury because spreading depolarizations propagate widely from ischemic or metabolically stressed zones; characteristic patterns, including temporal clusters of spreading depolarizations and persistent depression of spontaneous cortical activity, can be recognized and quantified. Here, we describe the experimental basis for interpreting these patterns and illustrate their translation to human disease. We further provide consensus recommendations for electrocorticographic methods to record, classify, and score spreading depolarizations and associated spreading depressions. These methods offer distinct advantages over other neuromonitoring modalities and allow for future refinement through less invasive and more automated approaches.

Cortical spreading depression (CSD) is associated with mitochondrial depolarization, increasing intracellular Ca2+, and the release of free fatty acids, which favor opening of the mitochondrial permeability transition pore (mPTP) and activation of calcineurin (CaN). Here, we test the hypothesis that cyclosporine A (CsA), which blocks both mPTP and CaN, ameliorates the persistent reduction of cerebral blood flow (CBF), impaired vascular reactivity, and a persistent rise in the cerebral metabolic rate of oxygen (CMRO2) following CSD. In addition to CsA, we used the specific mPTP blocker NIM811 and the specific CaN blocker FK506. Cortical spreading depression was induced in rat frontal cortex. Electrocortical activity was recorded by glass microelectrodes, CBF by laser Doppler flowmetry, and tissue oxygen tension with polarographic microelectrodes. Electrocortical activity, basal CBF, CMRO2, and neurovascular and neurometabolic coupling were unaffected by all three drugs under control conditions. NIM811 augmented the rise in CBF observed during CSD. Cyclosporine A and FK506 ameliorated the persistent decrease in CBF after CSD. All three drugs prevented disruption of neurovascular coupling after CSD; the rise in CMRO2 was unchanged. Our data suggest that blockade of mPTP formation and CaN activation may prevent persistent CBF reduction and vascular dysfunction after CSD.

One contention within the field of neuroimaging concerns the character of the depicted activity: Does it represent neuronal action potential generation (i.e., spiking) or postsynaptic excitation? This question is related to the metabolic costs of different aspects of neurosignaling. The cerebellar cortex is well suited for addressing this problem because synaptic input to and spiking of the principal cell, the Purkinje cell (PC), are spatially segregated. Also, PCs are pacemakers, able to generate spikes endogenously. We examined the contributions to cerebellar cortical oxygen consumption (CMRO2) of postsynaptic excitation and PC spiking during evoked and ongoing neuronal activity in the rat. By inhibiting excitatory synaptic input using ionotropic glutamate receptor blockers, we found that the increase in CMRO2 evoked by parallel fiber (PF) stimulation depended entirely on postsynaptic excitation. In contrast, PC spiking was largely responsible for the increase in CMRO2 when ongoing neuronal activity was increased by γ-aminobutyric acid type A receptor blockade. In this case, CMRO2 increased equally during PC spiking with excitatory synaptic activity as during PC pacemaker spiking without excitatory synaptic input. Subsequent inhibition of action potential propagation and neurotransmission by blocking voltage-gated Na+-channels eliminated the increases in CMRO2 due to PF stimulation and increased PC spiking, but left a large fraction of CMRO2, i.e., basal CMRO2, intact. In conclusion, whereas basal CMRO2 in anesthetized animals did not seem to be related to neurosignaling, increases in CMRO2 could be induced by all aspects of neurosignaling. Our findings imply that CMRO2 responses cannot a priori be assigned to specific neuronal activities.

Projections from the trigeminocerebellar pathway and the somatosensory cortex coincide spatially in the granule cell layer of Crus I/II of the cerebellar hemisphere. A biphasic field potential was seen: one peak at 10 ms (trigeminal input) and another at 20 ms (somatosensory input). Linear correlation analysis revealed only a weak coupling between somatosensory input and cerebellar blood flow responses to infraorbital nerve stimulation. In separate experiments, cortical spreading depression attenuated the field potential peak at 20 ms while blood flow responses remained unaltered. Thus, trigeminocerebellar activity explained the evoked blood flow responses. Our data provide further evidence that activity-dependent blood flow responses are context-sensitive and that interaction between excitatory neuronal circuits targeting the same cells may occlude vascular responses.

Objectives Neuromyotonia is a rare disease with typical electromyographical changes which can easily be overlooked or misdiagnosed. Neuromyotonia is characterized by stiffness; cramps, myokymia, increased sweating and occasionally sensory symptoms may be associated with a variety of inherited and acquired disorders. The diagnosis is based on neurophysiological findings. Though the consequently identified antibodies are supporting but not a requirement of the diagnosis. Here we present a follow up on diagnosis and outcome in patients found with clinical neurophysiological confirmed neuromyotonia. Methods We review retrospectively the reports and neurophysiological investigations performed in our out-patient department in the period from 2000 to present. In cases where neuromyotonia was found we made a follow up on the underlying diagnosis, looked into additional diagnostic markers found and looked at the outcome for the patients. Results We here present a case-series of 11 patients seen in our out-patient department during the period 2001–2016 who all during electrophysiological evaluation showed evidence of neuromyotonia. The most common complaint was stiffness in the involved muscles. We present cases where antibody testing showed antibodies against voltage-gated potassium channels (VGKC) which can be present in Isaacs or Morvans syndrome and one case with anti-GAD antibodies which can be found in cases of for example stiff-man syndrome. Discussion The differential diagnosis in neuromyotonia seen in Isaacs or Morvan syndrome can be paraneoplastic conditions where prognosis depent on the right medication applied in time or motor neuron disease (Amyotrophical lateral sclerosis). The latter condition with extremely pure prognosis. Conclusion/Significance It is important to raise the attention of these Neurophysiology based findings, and find the right cause, since about 50% of patients with neuromyotonia can be treated with the right medication when applied in time.

Cortical spreading depression (SD) has been known for more than 70 years. It has been a unique method investigating basic neurophysiology. A growing body of evidence indicates SD is involved in clinical conditions such as migraine with aura, subarachnoid hemorrhage, and traumatic brain injury. In this chapter we describe the application of SD in studying neurovascular and neurometabolic coupling in rat cerebral cortex. Description of the different techniques (electrophysiology, laser-Doppler flowmetry, and oxygensensitive electrodes) is followed by in depth step-by-step instructions on how to use them. This chapter will also describe the vascular consequences of SD and how to elicit SD experimentally.

Cortical spreading depression (CSD) is associated with a dramatic failure of brain ion homeostasis and increased energy metabolism. There is strong clinical and experimental evidence to suggest that CSD is the mechanism of migraine, and involved in progressive neuronal injury in stroke and head trauma. Here we tested the hypothesis that single episodes of CSD induced acute hypoxia, and prolonged impairment of neurovascular and neurometabolic coupling. Cortical spreading depression was induced in rat frontal cortex, whereas cortical electrical activity and local field potentials (LFPs) were recorded by glass microelectrodes, cerebral blood flow (CBF) by laser—Doppler flowmetry, and tissue oxygen tension (tpO2) with Polarographic microelectrodes. Cortical spreading depression increased cerebral metabolic rate of oxygen (CMRO2) by 71% ± 6.7% and CBF by 238% ± 48.1% for 1 to 2 mins. For the following 2 h, basal tpO2 and CBF were reduced whereas basal CMRO2 was persistently elevated by 8.1% ± 2.9%. In addition, within first hour after CSD we found impaired neurovascular coupling (LFP versus CBF), whereas neurometabolic coupling (LFP versus CMRO2) remained unaffected. Impaired neurovascular coupling was explained by both reduced vascular reactivity and suppressed function of cortical inhibitory interneurons. The protracted effects of CSD on basal CMRO2 and neurovascular coupling may contribute to cellular dysfunction in patients with migraine and acutely injured cerebral cortex.

Functional neuroimaging signals are generated, in part, by increases in cerebral blood flow (CBF) evoked by mediators, such as nitric oxide and arachidonic acid derivatives that are released in response to increased neurotransmission. However, it is unknown whether the vascular and metabolic responses within a given brain area differ when local neuronal activity is evoked by an activity in the distinct neuronal networks. In this study we assessed, for the first time, the differences in neuronal responses and changes in CBF and oxygen consumption that are evoked after the activation of two different inputs to a single cortical area. We show that, for a given level of glutamatergic synaptic activity, corticocortical and thalamocortical inputs evoked activity in pyramidal cells and different classes of interneurons, and produced different changes in oxygen consumption and CBF. Furthermore, increases in stimulation intensities either turned off or activated additional classes of inhibitory interneurons immunoreactive for different vasoactive molecules, which may contribute to increases in CBF. Our data imply that for a given cortical area, the amplitude of vascular signals will depend critically on the type of input, and that a positive blood oxygen level-dependent (BOLD) signal may be a consequence of the activation of both pyramidal cells and inhibitory interneurons.