Repositorio Institucional Fleni
Not a member yet
602 research outputs found
Sort by
Childhood focal compressive mononeuropathies during the COVID-19 pandemic in Buenos Aires, Argentina
No full textIntroduction/aims: Focal peripheral neuropathies are infrequently seen in pediatric patients. The COVID-19 pandemic has disrupted normal life for many people, including complete lockdowns and school closing for long periods of time in many countries, which prompted children to stay at home. Our aim is to assess whether there has been an increased incidence of focal compressive peripheral neuropathies in the pediatric population during COVID-19-associated lockdown.
Methods: Clinical, electrophysiological, and imaging characteristics were reviewed for patients referred to the electrodiagnostic (EDx) laboratory with suspicion of a focal neuropathy. The incidence of focal compressive peripheral neuropathies seen during the period of March to September 2020 was compared with the same time period in 2019.
Results: An increased incidence of focal neuropathies was seen in 2020 (31%) compared with 2019 (6.8%). During 2020, 7 fibular (peroneal) mononeuropathies and 2 ulnar neuropathies were diagnosed. Most patients with focal neuropathies were underweight and acknowledged prolonged screen time periods. Electrophysiological findings consisted of mostly demyelinating lesions with an overall good clinical outcome.
Discussion: In this study we raise awareness about a possible increased incidence of focal compressive peripheral neuropathies in children during COVID-19-associated lockdown, which may be prevented with changing positions during sedentary activities.Fil: Brand, Patricio. Fleni. Departamento de Neurología; Argentina.Fil: Cejas, Claudia Patricia. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Rivero, Alberto Daniel. Fleni. Departamento de Neurología. Servicio de Neurofisiología Clínica; Argentina
Long-Term Remission With Low-Dose Rituximab in Myasthenia Gravis: A Retrospective Study
No full textObjetive: Rituximab (RTX) is a therapeutic option, for patients with myasthenia gravis (MG) not responding to conventional immunosuppressive treatment. In this cohort, we evaluated long-term efficacy of RTX in the treatment of refractory generalized MG.
Methods: A retrospective study was performed in adult patients with refractory generalized MG and at least 24 months of follow-up, between January/2015 and October/2021. The Myasthenia Gravis Status and Treatment Intensity Score was used to assess outcomes, and CD19/CD20+ B-cell counts were monitored.
Results: Sixteen patients with MG (8 antiacetylcholine receptor+ and 8 muscle-specific antikinase+; mean age 45.5 ± 16.2 years) treated with low-dose RTX protocols were included. CD19/CD20 levels remained undetectable 12 months after induction, and no new relapses were observed during follow-up. Conclusions: Low-dose RTX infusions were sufficient to achieve undetectable CD19/20 cell counts and sustained clinical remission. In low and middle-income countries, the impact of low-dose RTX therapy represents a paradigm shift in decision-making for long-term treatment.Fil: Castiglione, Juan Ignacio. Fleni. Departamento de NeurologíaFil: Rivero, Alberto. Fleni. Departamento de NeuologíaFil: Barroso, Fabio Adrián . Fleni. Departamento de NeurologíaFil: Brand, Patricio. Fleni. Departamento de NeurologíaFil: Lautre, Andrea. Fleni. Departamento de NeurologíaFil: Kohler, Alejandro A. Fleni. Departamento de Neurologí
The role of the gut microbiota in multiple sclerosis
No full textDuring the past decade, research has revealed that the vast community of micro-organisms that inhabit the gut - known as the gut microbiota - is intricately linked to human health and disease, partly as a result of its influence on systemic immune responses. Accumulating evidence demonstrates that these effects on immune function are important in neuroinflammatory diseases, such as multiple sclerosis (MS), and that modulation of the microbiome could be therapeutically beneficial in these conditions. In this Review, we examine the influence that the gut microbiota have on immune function via modulation of serotonin production in the gut and through complex interactions with components of the immune system, such as T cells and B cells. We then present evidence from studies in mice and humans that these effects of the gut microbiota on the immune system are important in the development and course of MS. We also consider how strategies for manipulating the composition of the gut microbiota could be used to influence disease-related immune dysfunction and form the basis of a new class of therapeutics. The strategies discussed include the use of probiotics, supplementation with bacterial metabolites, transplantation of faecal matter or defined microbial communities, and dietary intervention. Carefully designed studies with large human cohorts will be required to gain a full understanding of the microbiome changes involved in MS and to develop therapeutic strategies that target these changes.Fil: Correale, Jorge. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; ArgentinaFil: Hohlfeld, Reinhard. Ludwig Maximilian University. University Hospital. Institute of Clinical Neuroimmunology; Alemania. Munich Cluster for Systems Neurology; Alemania.Fil: Baranzini, Sergio E. University of California San Francisco. Department of Neurology. Weill Institute for Neurosciences; Estados Unidos
Recomendaciones para la realización de cateterismo cardíaco derecho en hipertensión pulmonar
No full textFil: Perrone, Sergio Victor. Fleni. Servicio de Cardiología; Argentina. Instituto Argentino de Diagnóstico y Tratamiento; Argentina. Hospital de Alta Complejidad en Red “El Cruce” Néstor Kirchner; Argentina.Fil: Coronel, María Lorena. Instituto de Cardiología J F Cabral. División Insuficiencia Cardíaca e Hipertensión Pulmonar; Argentina.Fil: Diez, Mirta. Instituto Cardiovascular de Buenos Aires. Sección de Insuficiencia Cardíaca y Trasplante; Argentina.Fil: Lema, Luis Roberto. Instituto Modelo de Cardiología Privado SRL. Departamento de Hipertensión Pulmonar,; Argentina.Fil: Lescano, Adrián José. Centro Gallego. Insuficiencia Cardíaca e Hipertensión Pulmonar; Argentina. Sanatorio Trinidad Quilmes. Departamento de Cardiología; Argentina
CC102. Paroxysmal facial pain in a patient with Parry Romberg Syndrome
No full textFil: Goicochea, María Teresa. Fleni. Departamento de Neurología. Clínica del Dolor. Clínica de Cefaleas; Argentina.Fil: Bravo, Yasmín. Fleni. Departamento de Neurología. Clínica del Dolor. Clínica de Cefaleas; Argentina.Fil: Esliman, Celeste. Fleni. Departamento de Neurología. Clínica del Dolor. Clínica de Cefaleas; Argentina.Fil: Arena, Julieta E. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina
Scalpel Sign in Spine Pathology: Presentation in 3 Different Rare Diagnoses
No full textBackground: The scalpel sign is a radiological finding observed on sagittal magnetic resonance imaging and computed tomography myelography corresponding to an indentation in the dorsal aspect of the spinal cord resembling a surgical scalpel blade. It is said to be a pathognomonic imaging discovery linked to dorsal arachnoid webs. However, other spine-related conditions may mimic dorsal arachnoid webs on magnetic resonance imaging, such as spinal arachnoid cysts or ventral spinal cord herniation, leading to misdiagnosis.
Methods: A retrospective review was performed of cases involving 3 different diagnoses at our institution in the last 5 years that shared in common the characteristic focal dorsal indentation of the spinal cord.
Results: Of 7 cases identified, all but 1 were treated and confirmed intraoperatively. All lesions were located at the dorsal spinal cord. Magnetic resonance imaging was the study of choice for evaluation. Clinical manifestations included back pain and lower extremity numbness and weakness together with compressive myelopathy signs and urinary symptoms. Mean follow-up was 16.8 months with satisfactory postoperative results.
Conclusions: Isolated radiological presentation of the scalpel sign is not sufficient to distinguish between dorsal arachnoid webs, arachnoid cysts, and ventral herniation of the spine. However, awareness of its importance is relevant for accurate curative surgical planning.Fil: Ruella, Mauro E. Francisco. Fleni. Departamento de Neurocirugía; Argentina.Fil: Marcó del Pont, Francisco. Fleni. Departamento de Neurocirugía; Argentina.Fil: Aguilar, Martin Santiago. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Giovannini, Sebastián Juan María. Fleni. Departamento de Neurocirugía; Argentina.Fil: Ries Centeno, Tomás. Fleni. Departamento de Neurocirugía; Argentina.Fil: Cervio, Andrés Eduardo. Fleni. Departamento de Neurocirugía; Argentina
Case Report: Progression of a Silent Corticotroph Tumor to an Aggressive Secreting Corticotroph Tumor, Treated by Temozolomide. Changes in the Clinic, the Pathology, and the β-Catenin and α-SMA Expression
No full textClinically silent corticotroph tumors are usually macroadenomas that comprise 20% of ACTH tumors. They frequently progress to aggressive tumors with high recurrence, invasiveness, and on rare occasions, they may become hormonally active causing Cushing's disease. Trustable biomarkers that can predict their aggressive course, as well as their response to traditional or new therapies, are paramount. Aberrant β-Catenin expression and localization have been proposed as responsible for several malignancies including pituitary tumors. Nevertheless, the role of β-Catenin in the aggressive transformation of silent corticotropinomas and their response to Temozolomide salvage treatment have not been explored yet. In this work, we present a case of a silent corticotroph tumor that invaded cavernous sinus and compressed optic chiasm and, after a first total resection and tumor remission it recurred six years later as an aggressive ACTH-secreting tumor. This lesion grew with carotid compromise and caused Cushing's signs. It required multiple medical treatments including Cabergoline, Ketoconazole, TMZ, and radiotherapy. Besides, other two surgeries were needed until it could be controlled. Interestingly, we found α-SMA vascular area reduction and differential β-Catenin cell localization in the more aggressive tumor stages characterized by high Ki-67 indexes and p53 expression. Our results may indicate a role of angiogenesis and β-Catenin trigged events in the pituitary tumor progression, which could in turn affect the response to TMZ and/or conventional treatments. These molecular findings in this unusual case could be useful for future management of aggressive pituitary tumors.Fil: Sevlever, Gustavo Emilio. Fleni. Departamento de Neuropatología y Biología Molecular. Laboratorio de Enfermedades Neurodegenerativas; Argentina.Fil: Demarchi, Gianin. Universidad Nacional del Noroeste de la Provincia de Buenos Aires. Centro de Investigaciones Básicas y Aplicadas; Argentina. Centro de Investigaciones y Transferencia del Noroeste de la Provincia de Buenos Aires; Argentina.Fil: Perrone, Sofía. Universidad Nacional del Noroeste de la Provincia de Buenos Aires. Centro de Investigaciones Básicas y Aplicadas; Argentina. Centro de Investigaciones y Transferencia del Noroeste de la Provincia de Buenos Aires; Argentina.Fil: Esper Romero, Gaela. Clínica Santa Isabel. Servicio de Neurocirugía; Argentina.Fil: De Bonis, Cristian. Clínica Santa Isabel. Servicio de Neurocirugía; Argentina.Fil: Casasco, Juan Pablo. Clínica Santa Isabel. Servicio de Neurocirugía; Argentina.Fil: Berner, Silvia Inés. Clínica Santa Isabel. Servicio de Neurocirugía; Argentina.Fil: Cristina, Carolina. Universidad Nacional del Noroeste de la Provincia de Buenos Aires. Centro de Investigaciones Básicas y Aplicadas; Argentina. Centro de Investigaciones y Transferencia del Noroeste de la Provincia de Buenos Aires; Argentina
Detection of emerging neurodegeneration using Bayesian linear mixed-effect modeling
No full textEarly detection of neurodegeneration, and prediction of when neurodegenerative diseases will lead to symptoms, are critical for developing and initiating disease modifying treatments for these disorders. While each neurodegenerative disease has a typical pattern of early changes in the brain, these disorders are heterogeneous, and early manifestations can vary greatly across people. Methods for detecting emerging neurodegeneration in any part of the brain are therefore needed. Prior publications have described the use of Bayesian linear mixed-effects (BLME) modeling for characterizing the trajectory of change across the brain in healthy controls and patients with neurodegenerative disease. Here, we use an extension of such a model to detect emerging neurodegeneration in cognitively healthy individuals at risk for dementia. We use BLME to quantify individualized rates of volume loss across the cerebral cortex from the first two MRIs in each person and then extend the BLME model to predict future values for each voxel. We then compare observed values at subsequent time points with the values that were expected from the initial rates of change and identify voxels that are lower than the expected values, indicating accelerated volume loss and neurodegeneration. We apply the model to longitudinal imaging data from cognitively normal participants in the Alzheimer's Disease Neuroimaging Initiative (ADNI), some of whom subsequently developed dementia, and two cognitively normal cases who developed pathology-proven frontotemporal lobar degeneration (FTLD). These analyses identified regions of accelerated volume loss prior to or accompanying the earliest symptoms, and expanding across the brain over time, in all cases. The changes were detected in regions that are typical for the likely diseases affecting each patient, including medial temporal regions in patients at risk for Alzheimer's disease, and insular, frontal, and/or anterior/inferior temporal regions in patients with likely or proven FTLD. In the cases where detailed histories were available, the first regions identified were consistent with early symptoms. Furthermore, survival analysis in the ADNI cases demonstrated that the rate of spread of accelerated volume loss across the brain was a statistically significant predictor of time to conversion to dementia. This method for detection of neurodegeneration is a potentially promising approach for identifying early changes due to a variety of diseases, without prior assumptions about what regions are most likely to be affected first in an individual.Fil: Allegri, Ricardo Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría. Centro de Memoria y Envejecimiento; Argentina.Fil: Cobigo, Yann. University of California. Department of Neurology. Memory and Aging Center; Estados Unidos.Fil: Goh, Matthew S. University of California. Department of Neurology. Memory and Aging Center; Estados Unidos.Fil: Wolf, Amy. University of California. Department of Neurology. Memory and Aging Center; Estados Unidos.Fil: Staffaroni, Adam M. University of California. Department of Neurology. Memory and Aging Center; Estados Unidos.Fil: Kornak, John. University of California. Department of Epidemiology and Biostatistics; Estados Unidos.Fil: Miller, Bruce L. University of California. Department of Neurology. Memory and Aging Center; Estados Unidos.Fil: Rabinovici, Gil D. University of California. Department of Neurology. Memory and Aging Center; Estados Unidos.Fil: Seeley, William W. University of California. Department of Neurology. Memory and Aging Center; Estados Unidos.Fil: Spina, Salvatore. University of California. Department of Neurology. Memory and Aging Center; Estados Unidos.Fil: Boxer, Adam L. University of California. Department of Neurology. Memory and Aging Center; Estados Unidos.Fil: Boeve, Bradley F. Mayo Clinic. Department of Neurology; Estados Unidos.Fil: Wang, Lei. Northwestern University Feinberg School of Medicine. Department of Psychiatry and Behavioral Sciences and Department Radiolog; Estados Unidos.Fil: Farlow, Marty. Indiana University; Estados Unidos.Fil: Mori, Hiroshi. Osaka City University Medical School. Department of Neurosciences; Japón.Fil: Perrin, Richard J. Washington University School of Medicine; Estados Unidos.Fil: Kramer, Joel. Washington University School of Medicine; Estados Unidos.Fil: Rosen, Howard J. University of California. Department of Neurology. Memory and Aging Center; Estados Unidos
Magnetothermal Neurostimulation: A Minimally Invasive and "Wireless" Alternative for Deep Brain Stimulation in Movement Disorders?
No full textFil: Castillo-Torres, Sergio Andrés. Edmond J. Safra Fellowship in Movement Disorders; Estados Unidos. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina.Fil: Páez-Maggio, Mauricio J. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina
Subarachnoid Hemorrhage From Rupture of an Undiagnosed Posterior Circulation Aneurysm During Sellar Tumor Surgery
No full textAssociation between cerebral aneurysms and sellar tumors has been previously reported. Rupture of anterior circulation aneurysms during a transsphenoidal surgery causing massive subarachnoid hemorrhage (SAH) is uncommon, but rupture of a posterior circulation aneurysm is an infrequent event. We present three cases of SAH secondary to rupture of an undetected posterior circulation aneurysm during transsphenoidal surgery to treat a sellar tumor. The common factor in these cases was the adverse outcome despite treatment. The fatal outcome seen in all these cases questions whether to include a (magnetic resonance) MR angiography or (computed tomography) CT angiography during preoperative evaluation for sellar tumors in order to identify inadvertently associated aneurysms.Fil: Mormandi, Rubén. Fleni. Departamento de Neurocirugía; Argentina.Fil: Cervio, Andres Eduardo. Fleni. Departamento de Neurocirugía; Argentina.Fil: Nathal, Edgar. Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez. Neurocirugía; México.Fil: Navarro-Garcia de Llano, Juan P. Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez. Neurocirugía; México.Fil: Ceja-Espinosa, Alejandro. Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez. Neurocirugía; México