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6. The Italian multicenter observational study on post-stroke depression (DESTRO)

Author

Paolucci, S. T., Gandolfo, C., Provinciali, L., Torta, R., TOSO AND ON THE BEHALF OF THE DESTRO STUDY GROUP, V., Lagalla, THE DESTRO STUDY GROUP INCLUDES G., Manicone, M. G., Del, M., Gobbo, Paolini, S., Ancona, Bottacchi, E., Corso, G., Aosta, Federico, F., Martino, D, Bari, Salsa, F., Turinese, E., BASSANO DEL GRAPPA VI, Gentile, M., Bogo, S., Belluno, Crisci, M., Sacquegna, T., Bologna, Santamato, V., Pietrarossa, G., Carbonara, Ba, Coppola, G., Toni, V., Trianni, G., Casarano, Le, Pennisi, Giovanni, Bella, Rita, Catania, Ricci, S., Amantini, K., Città, DELLA PIEVE PG, Buzzelli, S., DI FRANCESCO, L., ANGELO PE, CITTÀ S., Antonelli, B, Pelliccia, G., Fermo, Ap, Paolino, E., Iezzi, E., Ferrara, P, Nencini, Sarti, C., Florence, Neri, W., Galletti, G., Forli, Pretta, S., Sette, Genoa, Giaccaglini, E., Sconocchini, C., Iesi, An, Carolei, A., Capannolo, C, Laquila, Musolino, R., Gangemi, S., Vita, G., DI LEO, R., Messina, Comola, M., Mammi, S., Zamperetti, M. A., Defanti, C. A., Milan, DE FALCO, F. A., Santangelo, R., Scarano, V., Naples, M. T, Giordana, Sciolla, R., Orbassano, To, Meneghetti, G., Ottina, M., Padua, Ponari, A., Castiglia, R., Palermo, Mancia, D., Zanferrari, C., Parma, Micieli, G., Zambrelli, E., Pavia, Cardaioli, G., Gallai, V., Perugia, Badino, R., Tassinari, T., PIETRA LIGURE SV, Orlandi, G., Fanucchi, S., Pisa, Ciucci, G., Padoan, G., Ravenna, Gasparini, F., Guidetti, D., Reggio, Emilia, DE ANGELIS, D., Amabile, G. A., Fiermonte, G., Rome, Roberti, C., Foti, A., Roma, Cainelli, L., Chiusole, M., Rovereto, Tn, Pasqualino, S., Intiso, D., GIOVANNI ROTONDO FG, S., Tonizzo, M., Basile, A., VITO AL, S., Tagliamento, Pn, Viviani, P., SANT ARSENIO SA, Stromillo, M. L., Federico, A, Siena, Liboni, W., Pavanelli, E., Bergamasco, B., Cerrato, P., Boghi, A, Cicolin, A., Berra, C., Turin, Zorzon, M., Tommasi, M. A., Chiodo, F., Grandi, Koscica, N., Trieste, Micoli, B., Lorio, R., Venice, Bovi, P., Trabucco, G., Verona, Consoli, D., Galati, F., and Vibo, Valentia

Subjects
Adult, Male, medicine.medical_specialty, Pediatrics, Time Factors, Adolescent, Personality Inventory, Physical examination, Observation, Disability Evaluation, Quality of life, medicine, History of depression, Post-stroke depression, Humans, Psychiatry, Stroke, Depression (differential diagnoses), Aged, Retrospective Studies, Aged, 80 and over, Psychiatric Status Rating Scales, Chi-Square Distribution, medicine.diagnostic_test, Depression, Beck Depression Inventory, Retrospective cohort study, Middle Aged, medicine.disease, Neurology, Italy, Female, Neurology (clinical), Psychology
Abstract

Despite growing information, questions still surround various aspects of post-stroke depression (PSD). The Italian multicenter observational study Destro was designed to help clarify in a large sample the frequency and clinical impact of PSD. A total of 53 centers consecutively admitted 1064 patients with ischemic or hemorrhagic stroke, assessing them periodically in the first 9 months after the event. Patients with depression were followed for two years. Depression was diagnosed on clinical examination, verbal (Beck Depression Inventory) and non-verbal rating systems (Visual Analog Mood Scale), identifying the nosographic condition attributable to the mental state. The patient's clinical history, residual independence, and post-ictus quality of life were also taken into account. PSD was detected in 383 patients (36 %), most of whom had minor depression (80.17 %), with dysthymia, rather than major depression and adaptation disorder. About 80% developed depression within three months of the stroke. Cases with later onset tended to have less severe symptoms. Risk factors were a history of depression, severe disability, previous stroke and female sex, but not the type and site of the vascular lesion. PSD was not correlated with any increase in mortality or cerebrovascular recurrences, but these patients had lower autonomy and quality of life ratings. In conclusion, patients should be close observed in the first few weeks after a stroke in order to check for depression,which is more likely in those with clear risk factors and may spoil their quality of life.

Published
2006

7. The Italian multicenter observational study on post-stroke depression (DESTRO)

Author

Paolucci, S, Gandolfo, C, Provinciali, L, Torta, R, Toso, V, Lagalla, G., Manicone, M. G., Del Gobbo, M., Paolini, S., Bottacchi, E., Corso, G., Federico, F., Martino, D., Salsa, F., Turinese, E., Gentile, M., Bogo, S., Crisci, M., Sacquegna, T., Santamato, V., Pietrarossa, G., Coppola, G., Toni, V., Trianni, G., Pennisi, G., Bella, R., Ricci, S., Amantini, K., Buzzelli, S., Di Francesco, L., Antonelli, B., Pelliccia, G., Paolino, E., Iezzi, E., Nencini, P., Sarti, C., Neri, W., Galletti, G., Pretta, S., Del Sette, M., Giaccaglini, E., Sconocchini, C., Carolei, A., Capannolo, C., Musolino, Rosa Fortunata, Gangemi, S., Vita, Giuseppe, Di Leo, R., Comola, M., Mammi, S., Zamperetti, M. A., Defanti, C. A., De Falco, F. A., Santangelo, R., Scarano, . V., Giordana, M. T., Sciolla, R., Meneghetti, G., Ottina, M., Ponari, A., Castiglia, R., Mancia, D., Zanferrari, C., Micieli, G., Zambrelli, E., Cardaioli, G., Gallai, . V., Badino, R., Tassinari, T., Orlandi, G., Fanucchi, S., Ciucci, G., Padoan, G., Gasparini, F., Guidetti, D., De Angelis, D., Amabile, G. A., Fiermonte, G., Roberti, C., Foti, A., Cainelli, L., Chiusole, M., Pasqualino, S., Intiso, D., Tonizzo, M., Basile, A., Viviani, P., Stromillo, M. L., Federico, A., Liboni, W., Pavanelli, E., Bergamasco, B., Cerrato, P., Boghi, A., Cicolin, A., Berra, C., Zorzon, M., Tommasi, M. A., Chiodo Grandi, F., Koscica, N., Micoli, B., Lorio, R., Bovi, P., Trabucco, G., Consoli, D., Galati, F., Bortolon, F., Morra, M., Crespi, . V., and Braga, M.

Published
2006

8. Quantification of the risk of post-stroke depression: the Italian multicenter observational study (DESTRO)

Author

Paolucci, S, Gandolfo, C, Provinciali, L, Torta, R, Sommacal, S, Toso, V, Lagalla, G., Manicone, M. G., Del Gobbo, M., Paolini, S., Bottacchi, E., Corso, G., Federico, F., Martino, D., Salsa, F., Turinese, E., Gentile, M., Bogo, S., Crisci, M., Sacquegna, T., Santamato, V., Pietrarossa, G., Coppola, G., Toni, V., Trianni, G., Pennisi, G., Bella, R., Ricci, S., Amantini, K., Buzzelli, S., Di Francesco, L., Antonelli, B., Pelliccia, G., Paolino, E., Iezzi, E., Nencini, P., Sarti, C., Neri, W., Galletti, G., Pretta, S., Del Sette, M., Giaccaglini, E., Sconocchini, C., Carolei, A., Capannolo, C., Musolino, Rosa Fortunata, Gangemi, S., Vita, Giuseppe, Di Leo, R., Comola, M., Mammi, S., Zamperetti, M. A., Defanti, C. A., Grassivaro, N., Rudelli, G., De Falco, F. A., Santangelo, R., Scarano, V., Giordana, M. T., Sciolla, R., Meneghetti, G., Ottina, M., Ponari, A., Castiglia, R., Mancia, D., Zanferrari, C., Micieli, G., Zambrelli, E., Cardaioli, G., Gallai, V., Badino, R., Tassinari, T., Orlandi, G., Fanucchi, S., Ciucci, G., Padoan, G., Gasparini, F., Guidetti, D., De Angelis, D., Amabile, G. A., Roberti, G. Fiermonte C., Foti, A., Cainelli, L., Chiusole, M., Pasqualino, S., Intiso, D., Tonizzo, M., Basile, A., Viviani, P., Stromillo, M. L., Federico, A., Liboni, W., Pavanelli, E., Bergamasco, B., Cerrato, P., Boghi, A., Cicolin, A., Berra, C., Zorzon, M., Tommasi, M. A., Chiodo Grandi, F., Koscica, N., Micoli, B., Lorio, R., Bovi, P., Trabucco, G., Consoli, D., Galati, F., Bortolon, F., Morra, M., Crespi, V., and Braga, M.

Published
2005

9. Quantification of the risk of post stroke depression : the Italian multicenter observational study DESTRO

Author

Paolucci, S., Gandolfo, C., Provinciali, L., Torta, R., SOMMACAL ON BEHALF OF, S., DESTRO STUDY GROUP AND, Lagalla, V. TOSOPARTICIPANTS IN THE DESTRO STUDY INCLUDE G., M. G, Manicone, DEL GOBBO, M., Paolini, S., Ancona, Bottacchi, E., Corso, G., Aosta, Federico, F., Martino, D., Bari, Salsa, F., Turinese, E, BASSANO DEL GRAPPA VI, Gentile, M., Bogo, S., Belluno, Crisci, M., Sacquegna, T., Bologna, Santamato, V., Pietrarossa, G, Carbonara, Ba, Coppola, G., Toni, V., Trianni, G, Casarano, Le, Pennisi, Giovanni, Bella, Rita, Catania, S, Ricci, Amantini, K., CITTA DELLA PIEVE PG, Buzzelli, S., Di, L., Francesco, ANGELO PE, CITTA S., Antonelli, B., Pelliccia, G., Fermo, Ap, Paolino, E., Iezzi, E., Ferrara, Nencini, P., Sarti, C., Florence, Neri, W., Galletti, G., Forli, Pretta, S., DEL SETTE, M., Genoa, Giaccaglini, E., Sconocchini, C., Iesi, An, Carolei, A., Capannolo, C., Laquila, Musolino, R., Gangemi, S., Vita, G., DI LEO, R., Messina, Comola, M., Mammi, S., Zamperetti, M. A., Defanti, C. A., Grassivaro, N., Rudelli, G., Milan, F. A., De, Falco, Santangelo, R., Scarano, V., Naples, M. T, Giordana, Sciolla, R., Orbassano, To, Meneghetti, G., Ottina, M, Padua, Ponari, A., Castiglia, R., Palermo, Mancia, D., Zanferrari, C, Parma, Micieli, G., Zambrelli, E., Pavia, Cardaioli, G., Gallai, V., Perugia, Badino, R., Tassinari, T., Pietra, Ligure, Orlandi, G., Fanucchi, S., Pisa, Ciucci, G., Padoan, G., Ravenna, Gasparini, F., Guidetti, D., Reggio, Emilia, De, D., Angelis, Amabile, G. A., FIERMONTE ROME, G., Roberti, C., Foti, A, Roma, Cainelli, L., Chiusole, M., Rovereto, Tn, Pasqualino, S, Intiso, D., GIOVANNI ROTONDO FG, S., Tonizzo, M., Basile, A., VITO AL TAGLIAMENTO PN, S., Viviani, P., Santarsenio, Sa, Stromillo, M. L., Federico, A., Siena, W, Liboni, Pavanelli, E., Bergamasco, B., Cerrato, P., Boghi, A., Cicolin, A, Berra, C., Turin, Zorzon, M., Tommasi, M. A., F, Chiodo, Grandi, Koscica, N., Trieste, Micoli, B., Lorio, R., Venice, Bovi, P., Trabucco, G., Verona, Consoli, D., Galati, F., Vibo, Valentia, Bortolon, F., Morra, M., Vicenza, and Crespi, V.

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Multivariate analysis, Adolescent, Sex Factors, Risk Factors, mental disorders, medicine, Humans, Disabled Persons, Risk factor, Stroke, Depression (differential diagnoses), Aged, Aged, 80 and over, Psychiatric Status Rating Scales, Depression, business.industry, Beck Depression Inventory, Middle Aged, medicine.disease, Psychiatry and Mental health, Mood, Italy, Relative risk, Physical therapy, Female, Observational study, business, Follow-Up Studies
Abstract

Objective: The Italian multicenter observational study depression in stroke (DESTRO) aimed to identify risk factors for poststroke depression (PSD) and quantify the likelihood of it arising in various categories of patients. Method: Mood evaluation was performed in 1064 consecutive stroke patients by means of Beck Depression Inventory and Visual Analog Mood Scale. Depressive symptoms were classified using the DSM-IV and revised WHO criteria for depression in the course of a neurological disorder. Results: Poststroke depression was seen in 36% of the survivors, with dysthymia by far the predominant form (80.7%). Female sex, disability, previous cerebrovascular or depressive episodes were significantly associated with an increased risk of depression. Combinations of these factors raised the risk of PSD exponentially, from 24.3 to 89.1%. The site of the stroke did not come into the uni- or multivariate analysis. Conclusion.: At admission, it is possible to predict the likelihood of PSD and quantify the relative risk.

Published
2005

10. Post-stroke depression: research methodology of a large multicentre observational study (DESTRO)

Author

Toso, V, Gandolfo, C, Paolucci, S, Provinciali, L, Torta, R, Grassivaro, N, Lagalla, G., Manicone, M. G., Del Gobbo, M., Paolini, S., Bottacchi, E., Corso, G., Federico, F., Martino, D., Salsa, F., Turinese, E., Gentile, M., Bogo, S., Crisci, M., Sacquegna, T., Santamato, V., Pietrarossa, G., Coppola, G., Pennisi, G. T. r. i. a. n. n. i. G., Bella, R., Ricci, S., Amantini, K., Buzzelli, S., Di Francesco, L., Antonelli, B., Pelliccia, G., Paolino, E., Iezzi, E., Nencini, P., Sarti, C., Neri, W., Galletti, G., Pretta, S., Del Sette, M., Giaccaglini, E., Sconocchini, C., Carolei, A., Capannolo, C., De Falco, F. A., Santangelo, R., Musolino, Rosa Fortunata, Gangemi, S., Vita, Giuseppe, Di Leo, R., Comola, M., Mammi, S., Zamperetti, M. A., Defanti, C. A., Sommacal, S., Rudelli, G., Scarano, V., Giordana, M. T., Sciolla, R., Meneghetti, G., Ottina, M., Ponari, A., Castiglia, R., Mancia, D., Zanferrari, C., Micieli, G., Zambrelli, E., Cardaioli, G., Gallai, V., Badino, R., Tassinari, T., Orlandi, G., Fanucchi, S., Ciucci, G., Padoan, G., Gasparini, F., Guidetti, D., De Angelis, D., Amabile, G. A., Fiermonte, G., Roberti, C., Foti, A., Cainelli, L., Chiusole, M., Viviani, P., Stromillo, M. L., Federico, A., Liboni, W., Pavanelli, E., Bergamasco, B., Cerrato, P., Boghi, A., Cicolin, A., Berra, C., Zorzon, M., Tommasi, M. A., Chiodo Grandi, F., Koscica, N., Micoli, B., Lorio, R., Bovi, P., Trabucco, G., Consoli, D., Galati, F., Bortolon, F., Morra, M., Crespi, V., and Braga, M.

Published
2004

11. Amino acid supplementation in l-dopa treated Parkinson's disease patients

Author

Mauro Catalan, A. Cucca, Lucia Antonutti, S. Mazzucco, Gianni Biolo, F.G. Di Girolamo, G.L. Gigli, Gilberto Pizzolato, Nadia Koscica, A. Bursomanno, Cucca, Alberto, Mazzucco, Sara, Bursomanno, A., Antonutti, Lucia, DI GIROLAMO, FILIPPO GIORGIO, Pizzolato, Gilberto, Koscica, N., Gigli, G. L., Catalan, Mauro, and Biolo, Gianni

Subjects
Blood Glucose, Male, Parkinson's disease, medicine.medical_treatment, Pilot Projects, Critical Care and Intensive Care Medicine, Levodopa, 80 and over, Insulin, Medicine, Prospective Studies, Amino Acids, Prospective cohort study, Aged, 80 and over, Nutrition and Dietetics, biology, l-Dopa treatment, Amino acid supplementation, Insulin sensitivity, Motor fluctuations, L-Dopa treatment, Parkinson Disease, Motor fluctuation, Middle Aged, Glutathione, C-Reactive Protein, Cholesterol, Treatment Outcome, Aged, Cholesterol, HDL, Cholesterol, LDL, Double-Blind Method, Female, Humans, Insulin Resistance, Nutrition Assessment, Oxidative Stress, Triglycerides, Diet, Protein-Restricted, Dietary Supplements, medicine.drug, medicine.medical_specialty, HDL, Protein-Restricted, Placebo, LDL, Insulin resistance, Pharmacokinetics, Internal medicine, business.industry, C-reactive protein, Repeated measures design, medicine.disease, Diet, Endocrinology, Physical therapy, biology.protein, business
Abstract

BACKGROUND: The correlation between Parkinson disease and malnutrition is well established, however a protein-restricted diet is usually prescribed because of potentially negative interactions between dietary amino acids and l-dopa pharmacokinetics. This strategy could increase the risk of further nutritional deficits. METHODS: A monocentric, prospective, randomized, double-blind pilot study was performed on two groups of Parkinson-affected, protein-restricted, patients: Intervention (n = 7; amino acid supplementation twice daily) and Placebo (n = 7; placebo supplementation twice daily). At enrolment, after 3- and 6-month supplementation, neurological evaluations (UPDRS III, Hoenh-Yahr scale, l-dopa equivalent dose assessment) were performed and blood sample was collected to define insulin sensitivity (QUICKI index) and oxidative stress (oxidized and reduced glutathione). Repeated measure ANCOVA was applied to define time effect and time × treatment interaction. RESULTS: Participants were comparable at baseline for all assessed parameters. Neurological outcomes and l-dopa requirement were comparable in both group after 6-month of supplementation, without time × treatment interaction. The decrease in insulin sensitivity, as assessed by QUICKI index, observed after 6 months in both groups, was greater in Placebo than in Intervention (time effect p < 0.001; time × treatment interaction p = 0.01). Moreover, despite no changes in total erythrocyte glutathione concentrations, oxidized glutathione levels decreased by 28 ± 17% in the Intervention while increased by 55 ± 38% in Placebo (time effect p = 0.05; time × treatment interaction p = 0.05), after 6-month supplementation. CONCLUSIONS: Amino acid supplementation, assumed with shrewd temporal distribution, did not show detrimental effects on neurological and pharmacological control in protein-restricted Parkinson-affected patients, chronically treated with l-dopa. Furthermore, daily amino acid supplementation partially counteracted insulin resistance development and the loss in antioxidant availability.

Published
2015

12. Acute hemorrhagic leukoencephalitis with atypical features

Author

Mauro Catalan, Gilberto Pizzolato, Marcello Naccarato, Fabio Chiodo Grandi, Francesca Capozzoli, Nadia Koscica, Catalan, Mauro, Naccarato, M, Grandi, Fc, Capozzoli, F, Koscica, N, and Pizzolato, Gilberto

Subjects
Male, medicine.medical_specialty, Pediatrics, Pathology, Neurology, Ataxia, Acute hemorrhagic leukoencephalitis, Acyclovir, Hemiplegia, Dermatology, White matter, Pneumonia, Mycoplasma, medicine, Humans, Coma, Neuroradiology, Cerebral Cortex, Diplopia, business.industry, Brain, Plasmapheresis, Recovery of Function, General Medicine, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Hyperintensity, Leukoencephalitis, Acute Hemorrhagic, Psychiatry and Mental health, Pneumonia, Treatment Outcome, medicine.anatomical_structure, Disease Progression, Steroids, Neurology (clinical), medicine.symptom, business, Brain Stem
Abstract

Acute hemorrhagic leukoencephalitis (AHL) is a rare demyelinating disease mainly affecting children, characterized by acute onset, progressive course and high mortality. A 62-year-old man was admitted to our Unit for diplopia and ataxia ensuing 2 weeks after the onset of pneumonia. MRI T2-weighted images showed signal hyperintensities in the brainstem. Antibodies against Mycoplasma Pneumoniae and cold agglutinins were found. Two weeks later the patient had a worsening of his conditions: he developed left hemiplegia with motor focal seizures and the day after he was deeply comatose (GCS = 4). A second MRI scan showed extensive hyperintensities involving the whole right hemisphere white matter with a small parietal hemorrhagic area. The clinical and neuroimaging features suggested the diagnosis of AHL, Aciclovir in association with steroid therapy were administered and then plasmapheresis was started. After 30 days of coma, the patient gradually reacquired consciousness and motor functions; anyway a left hemiplegia persisted.

Published
2009

13. The role of cavernous sinus in cluster and other headaches

Author

N Koscica, G Musco, Corrado Negro, G Relja, G Nider, Relja, G, Nider, G, Koscica, N, Musco, G, and Negro, Corrado

Subjects
medicine.medical_specialty, Neurology, business.industry, General Neuroscience, Cluster headache, Cluster Headache, medicine.disease, Disease cluster, Cavernous sinus, Humans, Medicine, Cavernous Sinus, Neurology (clinical), Radiology, Neurosurgery, Headaches, medicine.symptom, business, Neuroradiology
Published
1999

14. Expression of the Endocannabinoid Receptor 1 in Human Stroke: An Autoptic Study.

Author

Caruso P, Naccarato M, Faoro V, Pracella D, Borando M, Dotti I, Koscica N, Stanta G, Pizzolato G, and Manganotti P

Subjects
Aged, Aged, 80 and over, Cerebral Cortex diagnostic imaging, Cerebral Cortex pathology, Female, Humans, Male, Postmortem Changes, Retrospective Studies, Statistics as Topic, Stroke diagnostic imaging, Tomography, X-Ray Computed, Autopsy, Cerebral Cortex metabolism, Receptor, Cannabinoid, CB1 metabolism, Stroke metabolism, Stroke pathology, Up-Regulation genetics
Abstract

Objective: Stroke is one of the leading causes of disability and death in the world. The endocannabinoid (eCB) system is upregulated in several neurological diseases including stroke. A previous animal study demonstrated an increased expression of the endocannabinoid receptor 1 (CB1R) in the penumbra area surrounding the ischemic core, suggesting a crucial role in inflammation/reperfusion after stroke. Regarding the localization of CB1/CB2 receptors, animal studies showed that cortical neurons, activated microglia, and astroglia are involved. Our aim was to evaluate the cerebral expression of CB1R in the ischemic brain areas of 9 patients who died due to acute cerebral infarction in the middle cerebral artery territory., Methods: The cerebral autoptic tissue was collected within 48 hours since death. Ischemic and contralateral normal-appearing areas were identified. After tissue preprocessing, 4-µm-thick cerebral sections were incubated with the primary CB1R antibodies (Cayman Chemical Company, Ann Arbor, MI). Thereafter, all cerebral sections were hematoxylin treated. In each section, the total cell number and CB1R-positive cells were counted and the CB1R-positive cell count ratio was calculated. For statistical analysis, Student's t-test was used., Results: In normal tissue, CB1R-positive neurons were the majority; a few non-neuronal cells expressed CB1R. In the ischemic areas, a few neurons were detectable. A significant increase in total CB1R staining was found in the ischemic regions compared to contralateral areas., Conclusions: We found an increase in CB1R expression in the ischemic region (neuronal and non-neuronal cell staining), suggesting the inflammatory reaction to the ischemic insult. Whether such response might mediate neuroprotective actions or excitotoxicity-related detrimental effects is still unclear., (Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Published
2016
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16. Acute hemorrhagic leukoencephalitis with atypical features.

Author

Catalan M, Naccarato M, Grandi FC, Capozzoli F, Koscica N, and Pizzolato G

Subjects
Acyclovir therapeutic use, Ataxia immunology, Ataxia pathology, Ataxia physiopathology, Brain physiopathology, Brain Stem immunology, Brain Stem pathology, Brain Stem physiopathology, Cerebral Cortex immunology, Cerebral Cortex pathology, Cerebral Cortex physiopathology, Coma immunology, Coma pathology, Coma physiopathology, Disease Progression, Hemiplegia immunology, Hemiplegia pathology, Hemiplegia physiopathology, Humans, Leukoencephalitis, Acute Hemorrhagic drug therapy, Magnetic Resonance Imaging, Male, Middle Aged, Plasmapheresis, Pneumonia, Mycoplasma complications, Recovery of Function physiology, Steroids therapeutic use, Treatment Outcome, Brain pathology, Leukoencephalitis, Acute Hemorrhagic pathology, Leukoencephalitis, Acute Hemorrhagic physiopathology
Abstract

Acute hemorrhagic leukoencephalitis (AHL) is a rare demyelinating disease mainly affecting children, characterized by acute onset, progressive course and high mortality. A 62-year-old man was admitted to our Unit for diplopia and ataxia ensuing 2 weeks after the onset of pneumonia. MRI T2-weighted images showed signal hyperintensities in the brainstem. Antibodies against Mycoplasma Pneumoniae and cold agglutinins were found. Two weeks later the patient had a worsening of his conditions: he developed left hemiplegia with motor focal seizures and the day after he was deeply comatose (GCS = 4). A second MRI scan showed extensive hyperintensities involving the whole right hemisphere white matter with a small parietal hemorrhagic area. The clinical and neuroimaging features suggested the diagnosis of AHL, Aciclovir in association with steroid therapy were administered and then plasmapheresis was started. After 30 days of coma, the patient gradually reacquired consciousness and motor functions; anyway a left hemiplegia persisted.

Published
2009
Full Text
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