Episodes of Fall Asleep During Day Time in an Elder Woman with Vascular Dementia: Impact on Cerebral Ischeamic Tolerance and Utility of ECG Holter Monitoring

Here we report the case of an 86-year-old woman with advanced dementia addressed to our service for routinary ECG Holter Monitoring (EHM) for bradycardia in AV block type I. Several day-time episodes of fall-asleep while sitting had been previously reported by the nurse and generally attributed to the dementia itself, without taking into consideration the hypothesis of an AV block. The EHM reading reported several and often subsequent pauses (561), many of them critical, the longest lasting 15,9 s with no changes in clinical condition of the patient. The results of the EHM were reported to the physicians in charge for the patient and subsequently the woman was referred to the arrhythmology unit for pace-maker device implantation. Generalizing our experience, we suggest that advanced dementia, often associated with episodes of fall-asleep, could mask a conduction disturbance causing critical pauses with syncope; therefore we suggest screening those patients for possible arrhythmic disorders. Finally, we remark that in our patient the pauses weren’t associated with a worsening of the patient as seen in the follow-up, and this fact supports the hypothesis that vascular dementia could increase cerebral ischaemic tolerance

Prospective evaluation of neurotoxicity in breast cancer patients treated with adjuvant paclitaxel.

Abstract Abstract #1115 Background: Taxanes are increasingly used in the treatment of early stage breast cancer (BC). Up to 30% of patients develop moderate-severe neurotoxicity during treatment. We recently reported that about 60% of BC patients complain of some neuropathy up to 2 years after completing adjuvant paclitaxel (T) treatment. The prevalence, severity, and natural history of this syndrome have not been well described.&amp;#x2028; Methods: Using a prospective cohort study design, women with stage I-III breast cancer undergoing adjuvant paclitaxel were enrolled. At baseline, 4 weeks, 8 weeks, 3 months, and 6 months, all patients completed the Functional Assessment of Cancer Therapy-Taxane (FACT-Tax) and quantitative sensory testing (touch perception and vibration threshold) was conducted. The FACT-Tax includes a 16-item subscale which measures the severity of neurotoxicity, where lower scores represent worsening symptoms. Blood was obtained at baseline and 2 weeks post-treatment to measure serum nerve growth factor (NGF) levels.&amp;#x2028; Results: A total of 34 out of a target of 50 patients have been enrolled to date; median age: 48 (32-77); White/Hispanic/Black/Other: 10/17/4/1; median body mass index (kg/m2): 28 (21-44); stage I/II/III: 4/19/8; paclitaxel regimen T q2wks x4/T q2wks x6/T qwk x12: 19/8/5. Compared to baseline, there was a significant decrease in vibration sense at 8 weeks during active treatment. Mean scores on the Neurotoxicity subscale of the FACT-Tax decreased from 37.3 at baseline to 30.7 at week 4 (p=0.009) and 29.7 at week 8 (p=0.006). These scores remained lower than baseline at 3 months and 6 months after completing paclitaxel treatment (33.7 and 33.2, respectively). At 6 months, up to 50% of patients reported persistent numbness or discomfort in the hands and feet. Serum NGF analyses are underway to determine whether this biomarker correlates with neuropathy symptoms.&amp;#x2028; Discussion: To our knowledge, this is one of the first studies to prospectively evaluate persistent neuropathy in women prior to, during and following adjuvant paclitaxel therapy. Over 50% of patients developed moderate to severe neuropathy during active treatment, which persisted 6 months post-treatment. Taxane-based chemotherapy has been shown to improve survival, however, neurotoxicity is the main long-term side effect. Understanding the natural history of this toxicity and validating appropriate measures to be used in interventions to prevent and treat taxane-induced neuropathy are critical. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1115.</jats:p

Multiple system atrophy: clinical-radiological correlation. Report of two cases Atrofia de múltiplos sistemas: correlação clínico-radiológica. Estudo de dois casos

Multiple system atrophy (MSA) is a sporadic, neurodegenerative disorder, clinically characterized by parkinsonian, autonomic, cerebellar and pyramidal signs. We describe two patients showing different presentations of the same disease. The patient on case 1 presents features of MSA-C or olivopontocerebellar atrophy with the pontine "cross sign" on brain MRI. The second case reports a patient presenting MSA-P or striatonigral degeneration and the brain MRI shows lenticular nucleus sign alteration. We think that brain MRI might increase the accuracy diagnostic of MSA.<br>A atrofia de múltiplos sistemas (AMS) é uma doença neurodegenerativa esporádica caracterizada clinicamente por diferentes combinações de sinais parkinsonianos, autonômicos, cerebelares e piramidais. Descrevemos dois pacientes apresentando diferentes formas clínicas da mesma afecção. O caso 1 tem características da AMS-C ou atrofia olivopontocerebelar, apresentando na ressonância magnética (RM) o "sinal da cruz" na ponte. Já o caso 2 tem AMS-P ou degeneração nigro-estriatal, a RM mostra alteração do sinal no núcleo lentiforme entre outras alterações. Acreditamos que a RM cerebral possa contribuir para o melhor diagnóstico da AMS