Contactin-associated protein-like 2 (CASPR2) antibodies are part of an expanding spectrum of disorders. Although they were initially associated with Morvan’s syndrome and peripheral nerve hyperexcitability, their clinical manifestations are more varied than previously recognized. In this report, we present a rare case of a middle-aged woman who experienced gait disturbances, sleep disturbances, behavioral changes, and postural abnormalities over a period of five months. A thorough examination revealed a Parkinsonian phenotype. Considering the timeline and symptomatology, an autoimmune work-up was conducted, which detected CASPR2 antibodies in the patient’s serum. Treatment with high-dose intravenous Methylprednisolone followed by rituximab effectively reversed her clinical manifestations without residual neurological deficits.
Background: In this study, we evaluated the efficacy of dynamic bodyweight-supported training on the gait quality of children with different neural disorders. Methods: Seventeen ambulatory children, aged 3 to 11 years, experiencing gait limitations, were selected to participate in the designed gait training program. Each child participated in 10 practice sessions held three days a week, with each training session using the dynamic body weight support system, comprising three stages, and lasting 20 minutes. Clinical assessments were conducted using four functional tests: "Five Time Sit to Stand Test (FSST)", "Modified Time Up and Go (MTUG)", "Time Up and Down Stairs (TUDS)", and "Pediatric Berg Balance Scale" (BBS). Results: Statistical tests demonstrated a significant increase in the post-values of the BBS after gait training. Notably, children with higher relative cognitive abilities showed more improvement. Additionally, there was a significant enhancement in the assigned score for the level of independence. As all participants had received conventional physical therapies for more than three years, reaching their maximum obtainable improvements with conventional training methods, the observed improvements could be attributed to the designed training protocol even without a control group. Conclusion: Designed gait training protocol using a dynamic weight support system proved effective in enhancing balance, improving gait quality, and increasing the level of independence during performing functional tests in ambulatory children suffering from different locomotor disabilities.
Intradural disk herniation (IDH) represents an uncommon instance of disk degeneration. The surgical treatment of IDH, preoperative, and intraoperative diagnosis are difficult. The present case report highlights difficult parts of diagnosis and surgery. A 44-year-old man presented with lower back pain radiating to his right leg. A disk protruding into the ventral dural sac and exhibiting the hawk-beak sign was discovered by MRI. The dorsal side was exposed and incised during L3/4 laminectomy, a puncture on the ventral side was detected, and subsequently, three fragments extending into the dura sac were discovered. The defect was corrected and completed internal fixing was done. Pathology identified it as nucleus pulposus tissue. At one-month follow-up, he was able to walk normally. An incredibly uncommon form of disc degeneration is lumbar IDH. MRI can assist in the diagnosis, however, surgical investigation and pathology are necessary for an accurate diagnosis.
Background: Arachnoid cysts are formations containing cerebrospinal fluid (CSF). They may be associated with the subarachnoid space. This feature is a factor that can affect the change in the size of arachnoid cysts over time. Hounsfield Unit (HU) value measurements provide rational numeric representation of imaging of tissues in computed tomography (CT) examinations. In this study, we aimed to define isolated or communicated arachnoid cysts, and whether arachnoid cysts communicate with the subarachnoid distance, with the HU values obtained in CT examinations. Methods: Patients with radiological diagnosis of arachnoid cyst were identified retrospectively by examining the CT database. HU value measurements were recorded over the Picture Archiving and Communication System (PACS) in the area where the arachnoid cyst was detected. HU value measurements are a method that rationally shows the amount of radiograph absorption of tissues in CT examinations. HU value measurements were performed in cerebrospinal fluid (CSF) and arachnoid cysts, and whether arachnoid cysts had equal HU values with CSF. They were defined as homogeneous or heterogeneous by measuring HU values in different regions of arachnoid cysts. Results: Data on 478 cases were obtained. An average of 2.82 CT scans were detected per case. A change in arachnoid cyst size was detected in 47 (9.8%) cases. In cases of arachnoid cysts of varying size, the mean HU value of arachnoid cysts was 9.32±1.93 (6.43±1.67 in the lateral ventricle and 7.04±1.71 in the fourth ventricle). HU value of arachnoid cysts with a change in size significantly differed from CSF. Conclusion: Arachnoid cysts with HU values equal to CSF are not real arachnoid cysts, and significant volume changes are not expected. Arachnoid cysts, which have a different HU value than CSF, may secrete a different fluid from CSF. This type of arachnoid cyst is a real cyst that can be detected in various sizes on CT examinations at different times since they are not in communication with the subarachnoid space.
Background: Attention deficit hyperactivity disorder (ADHD) is prevalent worldwide, affecting approximately 8-12% of children. Early detection and effective treatment of ADHD are crucial for improving academic, social, and emotional outcomes. Despite numerous studies on ADHD detection, existing models still lack accuracy distinguishing between ADHD and healthy control (HC) children. Methods: This study introduces an innovative methodology that utilizes granger causality (GC), a well-established brain connectivity analysis technique, to reduce the required EEG electrodes. We computed GC indexes (GCI) for the entire brain and specific brain regions, known as regional GCI, across different frequency bands. Subsequently, these GCIs were transformed into color-coded images and fed into a custom-developed 11-layer convolutional neural network. Results: The proposed model is evaluated through a five-fold cross-validation, achieving the highest accuracy of 99.80% in the gamma frequency band for the entire brain and an accuracy of 98.50% in distinguishing the theta frequency band of the right hemisphere of ADHD and HC children by only using eight electrodes. Conclusion: The proposed framework provides a powerful automated tool for accurately classifying ADHD and HC children. The study’s outcome demonstrates that the innovative proposed methodology utilizing GCI and a custom-developed convolutional neural network can significantly improve ADHD detection accuracy, improving affected children’s overall quality of life.
