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Eduardo Gonzalez-Toledo

Publications and source records attributed to Eduardo Gonzalez-Toledo.

9 recordsLinked to original sources
PubMed2006

Neuroimaging findings in neurosyphilis.

We report two cases of neurosyphilis with atypical clinical presentations that were compounded by atypical neuroimaging findings. In the first case, MRI brain scan findings were felt to be compatible with mesial temporal sclerosis or herpes simplex encephalitis. The second patient presented with a clinical picture compatible with normal pressure hydrocephalus as well as some degree of ventricular enlargement and prominent periventricular white matter changes by MRI brain scan. He actually underwent ventriculo-peritoneal shunting prior to determination that he had active syphilitic involvement of the central nervous system. Neurosyphilis, "the great imitator," is not only capable of mimicking various other neurological disease clinical presentations, it can also mimic neuroimaging features of various other disease processes as well.

Adult↗
PubMed2006

Central pontine myelinolysis, an update.

Central pontine myelinolysis (CPM) can be regarded as one of the demyelinating syndromes. First described by Adams et al. in 1959 in their chronic alcoholic patients, it has now been described in the malnourished, the chronically debilitated, the renal, the hepatic and the transplant patient among others. Pathologically, it is defined as a symmetric area of myelin disruption in the center of the basis pontis, although similar symmetric lesions have also been described occurring with CPM as well as independently in other brain areas (extrapontine myelinolysis or EPM) including the cerebellar and neocortical white/gray junctional areas, thalamus and striatum. Possible mechanisms include a hyperosmotically induced demyelination process resulting from rapid intracellular/ extracellular to intravascular water shifts producing relative glial dehydration and myelin degradation and/or oligodendroglial apoptosis. The process most often occurs during rapid rebalancing of the electrolyte parameters in the hyponatremic patient. Avoidance of CPM/EPM is dependent upon recognizing those patients with conditions pre-disposing them to osmotic myelinolysis and then moderating the rate of normalization of the electrolyte imbalance. The morbidity and mortality of CPM/EPM has been greatly reduced by recognition of pre-disposing conditions, increased understanding of the pathophysiology, intensive treatment, and rapid diagnosis and monitoring with advanced neuroimaging.

Animals↗
PubMed2006

Role of magnetic resonance spectroscopy in diagnosis and management of multiple sclerosis.

Application of magnetic resonance spectroscopy (MRS) to study the nature, pathogenesis, tissue injury and therapeutic response of MS patients has altered our view of multiple sclerosis (MS) fundamentally. By offering biochemical analysis of demyelinating lesions and axonal injury, MRS generates objective and quantifiable data on central nervous system tissue and metabolism during pathogenesis of MS. Of these biochemical markers, N-acetylaspartate, which serves as an indicator of neuronal and axonal injury and choline (Cho) peaks which demonstrate cell membrane metabolism, provide a plethora of data on the neuropathology of MS. Based on these findings, MRS provides neuroscientists with a unique diagnostic and prognostic tool to follow MS patients and assess their response to treatment with immunomodulators. MRS findings are so significant that consideration should be given to their routine inclusion as secondary outcome measures in clinical trials of MS patients.

Animals↗
PubMed2005

Soluble HLA measurement in saliva and cerebrospinal fluid in Caucasian patients with multiple sclerosis: a preliminary study.

BACKGROUND: Measurement of soluble HLA in body fluids has a potential role in assessing disease activity in autoimmune disorders. METHODS: We applied a solid phase, enzyme-linked immunoassay to measure soluble HLA class I (sHLA-I) and class II (sHLA-II) molecules in the saliva and cerebrospinal fluid (CSF) in 13 untreated patients with relapsing-remitting form of multiple sclerosis (MS). For comparison purposes, we also studied saliva from 53 healthy subjects. RESULTS: Saliva from normal controls had detectable sHLA-I levels in 41 of 53 individuals studied, with values ranging from 9-100 ng/ml (mean = 41 +/- 2.8 ng/ml). sHLA-I was undetectable in the saliva in 11 of 13 MS patients, and in none of the CSF specimens. In contrast, mean sHLA-II concentration in the saliva of MS patients was significantly increased compared to controls (386 +/- 52 unit/ml vs. 222 +/- 18.4 unit/ml, t = 8.68, P < 0.005). The mean CSF sHLA-II level (369 +/- 16 unit/ml) was equivalent to the mean sHLA-II concentration measured in saliva (mean = 386 +/- 52 unit/ml) (P = 0.7). In patients with brain magnetic resonance imaging (MRI) enhancing lesions (n = 5), reflective of more active disease, CSF sHLA-II averaged 356 +/- 26 unit/ml compared to 380 +/- 51 in saliva. Similarly, in patients with non-enhancing lesions (n = 8), CSF sHLA-II averaged 377 +/- 18 unit/ml compared to 390 +/- 77 unit/ml in saliva. Thus, the mean sHLA-II concentration in saliva and CSF was essentially equivalent for MS patients with or without enhancing plaques. CONCLUSION: Our data suggest that the measurement of soluble HLA in saliva, specifically sHLA-II, correlates with the level found in the CSF. Therefore, if sHLA correlates with disease activity in MS, as has been proposed, saliva measurements provide a noninvasive correlate of CSF measurement.

Journal Article↗
PubMed2005

Factors influencing outcome in intracerebral hematoma: a simple, reliable, and accurate method to grade intracerebral hemorrhage.

BACKGROUND: Intracerebral hemorrhage (ICH) is a major public health problem. This subset of stroke often coexists with other serious medical problems such as hypertension, diabetes, and obesity. Management of hemorrhagic stroke is controversial and there is no standardized system for assessing presentation and predicting outcome of this disease. We propose a new grading system based on clinical and radiologic factors important in influencing outcome in ICH that can be used by the entire health care team. METHODS: We conducted a retrospective study of the last 50 patients who presented with hypertensive ICHs to Louisiana State University Health Sciences Center in Shreveport during 2001 to 2003. Significant predictors of outcome at 6 months as measured by the Glasgow outcome score (GOS) were determined and a grading system based on clot volume, hydrocephalus on initial computed tomographic scan, and focal neurologic deficit was formulated. RESULTS: Three factors observed to have significant association with GOS were presence of a focal neurologic deficit on initial presentation (P = .003), presence of hydrocephalus on initial computed tomographic scan (P < .0001), and clot volume (P = .003). Patients were scored on these variables as follows: neurologically intact (0 point), any focal neurological deficit (1 point); absence of hydrocephalus (0 point), presence of hydrocephalus (1 point); and clot volume less than 20 mL (1 point), 20 to 50 mL (2 points), and greater than 50 mL (3 points) [corrected] The scores were summed to assign an ICH grade to each patient for predicting his GOS at 6 months. Given the nonsignificant difference between a patient's grade and his actual observed GOS (mean difference 0.04, P = .79), as well as their significant correlation (correlation coefficient = 0.76, P < .0001), we believe our grading system is useful for predicting a patient's GOS. CONCLUSION: An accurate and reliable grading scale for ICH is helpful in standardizing the management of ICH, improving communication of patient presentation among health care workers, and predicting outcomes.

Adult↗
PubMed2005

Stroke.

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Brain↗
PubMed2005

Soluble HLA class I and class II molecules in relapsing-remitting multiple sclerosis: acute response to interferon-beta1a treatment and their use as markers of disease activity.

During relapses in relapsing-remitting multiple sclerosis (RRMS), serum soluble HLA class I surface antigen (sHLA-I) levels are reported to either decrease or remain unchanged, whereas serum sHLA-II levels increase. Interferon-beta1b therapy was recently reported to increase serum sHLA-I in RRMS. In the present prospective study, solid-phase enzyme-linked immunosorbent assay was used to measure sHLA-I and sHLA-II in the sera of 21 RRMS patients during a clinical exacerbation, and then six weeks after treatment with high-dose interferon-beta1a (IFN-beta1a). Pretreatment serum sHLA-I was significantly lower in patients than in normal controls (P < 0.0005). Pretreatment sHLA-II was also significantly lower than in normal controls (P = .003) unless enhancing MRI lesions (objectified relapse) were present; then sHLA-II levels were similar to normal controls (relative increase). Six weeks after initiation of IFN-beta1a treatment, a significant increase in serum sHLA-I was observed in all 21 RRMS patients (P < .0005). Conversely, serum sHLA-II decreased significantly after treatment in the entire patient group (P < .0005). The acute effect of IFN-beta1a on serum sHLA-I and sHLA-II was observed to be the opposite of that occurring during RRMS relapses. Monitoring of both sHLA-I and sHLA-II appears necessary if these molecules are to be developed as RRMS activity markers.

Adult↗
PubMedDate not supplied

Calvarial and scalp metastases: an unusual presentation of non-small-cell lung cancer.

We report the case of a 64-year-old woman who presented with scalp and skull masses. Histological examination confirmed the diagnosis of metastatic tumor from non-small-cell lung cancer. To our knowledge, this is the sixth case reported in the English literature. Although the occurrence of the distant neoplastic spread was a preterminal event, local electron beam irradiation effected significant resolution of the metastatic tumors.

Carcinoma, Non-Small-Cell Lung↗