Faculty Bibliography

Objective: To investigate sensory-motor disability in African Americans (AA) with MS.
Background(s): A more severe disease course has been reported in AA in comparison with Caucasians (CA) MS patients. Sociodemographic differences, such as longer disease duration related to younger age at onset or disparity in income wich may lead to delayed diagnosis and limited access to treatment have been often used to explain the different disability profile in the two groups. To date, an objective assessment of sensorymotor disability in AA and potential differences with CA patients is still lacking.
Method(s): Fifty-two AA patients (41F, mean age 38.56 +/- 11.05 yrs, mean disease duration 7.79 +/- 5.38 yrs), 38 AA healthy controls (HC) (26F, mean age 36.13 +/- 12.31 yrs), 49 CA patients (33F, mean age 38.92 +/- 10.43 yrs, mean disease duration 6.65 +/- 5.31 yrs) and 26 CA HC (16F, mean age 31.69 +/- 10.82 yrs) were prospectively enrolled as part of an ongoing longitudinal study. In all subjects, an extensive sensory-motor evaluation was performed, including 9-hole peg test (9-HPT), grooved pegboard test (GPT), finger tapping test (FTT), 25-foot walk test (25-FWT), 2-minutes walk test (2-MWT), evaluation of segmental strength, grip strength, vibration sensitivity and balance. Each patient's group was compared with a race-matched HC group via ANCOVA analysis, accounting for age, gender and socioeconomic status expressed as yearly income.
Result(s): AA and CA patients did not differ in age, gender, disease duration, while they did differ in yearly income (p=0.008). AA patients and AA HC did not differ in gender, age or socioeconomic status. CA patients and CA HC did not differ in gender, while they did differ in age (p=0.002) and socioeconomic status (p=0.031). Significant differences in 9-HPT (p=0.001), GPT (p=0.015), FTT (p=0.034), grip strength (p=0.033), 2-MWT (p=0.010), balance (p=0.001) and foot vibration sensitivity (p=0.046) were identified between AA patients and AA HC. Significant differences in 9-HPT (p=0.011), GPT (p< 0.001), 25-FWT (p=0.049) and 2-MWT (p< 0.001) were identified between CA patients and CA HC.
Conclusion(s): AA and CA patients showed similar deficits in ambulation and manual dexterity but AA patients showed additional involvement of motor speed and coordination, balance, strenght and sensitivity. These results suggest that, even accounting for sociodemographic features, AA patients with MS indeed show more severe and widespread disability than CAs patients with MS

Objective: To investigate cognitive deficits in African Americans (AA) with MS.
Background(s): Cognitive impairment is one of the most frequent and burdensome symptoms of MS. Although a more severe disease course has been descibed in AA in comparison with Caucasians (CA) patients, an objective assessment of the cognitive profile of AA and potential differences with CA patients has not been investigated yet.
Method(s): Fifty-one AA patients (40F, mean age 38.45 +/- 11.13 yrs, mean disease duration 7.88 +/- 5.39 yrs), 37 AA healthy controls (HC) (25F, mean age 35.97 +/- 12.44 yrs), 43 CA patients (32F, mean age 39.00 +/- 10.56 yrs, mean disease duration 6.67 +/- 7.00 yrs) and 18 CA HC (12F, mean age 30.72 +/- 6.94 yrs) were prospectively enrolled as part of an ongoing longitudinal study. In all subjects, an extensive neuropsychological evaluation was performed, including: Symbol Digit Modalities Test (SDMT), California Verbal Learning Test-II (CVLT), Brief Visuospatial Memory Test-Revised (BVMT), Stroop Color and Word Test (SCVT), Controlled Oral Word Association Test (COWAT), Pattern Comparison Processing Speed Test (PCPST) and a multitasking attention-memory test (MAMT). Each patient's group was compared with a race-matched HC group via ANCOVA analysis, accounting for age, gender, years of education, premorbid intelligence estimated with the Wechsler Test of Adult Reading (WTAR) and socioeconomic status expressed as yearly income.
Result(s): AA patients and HC did not differ in gender, age, years of education, WTAR score or socioeconomic status. CA patients and HC did not differ in gender, years of education and socioeconomic status, while significantly differ in age and WTAR scores (p=0.001 for both). Significant differences in SDMT (p=0.002), BVMT (p=0.012), COWAT (p=0.006), PCPST (p=0.008) and MAMT (p=0.018) scores were identified between AA patients and AA HC. Significant differences in SDMT (p=0.003), CVLT (p=0.009), BVMT (p=0.021), COWAT (p=0.003) and PCPST (p< 0.0001) scores were identified between CA patients and CA HC.
Conclusion(s): AA and CA patients showed similar deficits in information processing speed, attention, visuospatial memory and verbal fluency. CA patients showed additional impairment in the verbal memory domain, while AA patients showed deficits in multitasking capability. These results suggest that the cognitive profile of MS patients mostly overlaps across different races, although it seem to show group-specific deficits in specific domains

Bilateral thalamic strokes due to Artery of Percheron (AOP) occlusion are rare but have been previously reported in the literature. It is due to a rare anatomic variant where a solitary arterial trunk from the proximal segment of either posterior cerebral artery (PCA) supplies bilateral thalami and midbrain. Despite its description in the literature, these strokes are usually missed and patient's symptoms are not thought to be secondary to a vascular etiology. Through this report we aim to describe the clinical and radiographic features seen in these patients. We describe a series of 6 patients who present with varying levels of somnolence and oculomotor nerve palsies who had an occlusion of the AOP with bilateral thalamic infarcts with midbrain involvement. These clinical presentations, combined with the "V" sign on MRI are important in making the diagnosis.

The prevalence of nocturia in patients with multiple sclerosis (MS) is high, ranging from 20.9% to 48.8% in this population. Its underlying pathophysiology is complex and different from the non-neurogenic population. In the MS population, the pathophysiology may involve neurogenic lower urinary tract dysfunction (NLUTD) such as detrusor overactivity (NDO), detrusor-sphincter dyssynergia, or detrusor underactivity resulting in reduced bladder capacity. Nocturnal polyuria is also a significant contributor to the pathogenesis of nocturia in MS patients and may be the result of specific mechanisms such as nocturnal hypertension through autonomic cardiovascular dysfunction or lack of diurnal variation of antidiuretic hormone production (ADH) due to demyelinating lesions of the spinal cord. Nocturia might be particularly burdensome in MS patients by contributing to fatigue, a common and highly debilitating symptom in this population. There is likely a complex and multidirectional relationship between nocturia, other sleep disorders, and fatigue in the MS population that has yet to be explored. The assessment of nocturia in MS should rely upon a thorough history and physical examination. Urinalysis should be done to rule out urinary tract infection, a frequency-volume chart might help elucidating the underlying mechanisms, and post-void residual volume may be of interest to screen for urinary retention that could be asymptomatic in MS patients. Other tests such as urodynamics or polysomnography are indicated in selected patients. The treatment should be tailored to the underlying cause. The first steps involve behavioral interventions and treatment of cofactors. When possible, the predominant mechanism should be addressed first. In case of predominant NDO, antimuscarinics and beta-3 agonists should be offered as a first-line treatment and intradetrusor injections of botulinum toxin as a second-line treatment. In cases of incomplete bladder emptying, clean-intermittent self-catheterization is often used as part of multiple other interventions. In cases of nocturnal polyuria, desmopressin may be offered, inclusive of use of newer formulations (desmopressin acetate nasal spray, desmopressin orally disintegrated tablet) in countries where they are approved.

A 58-year-old man with a history of recurrent aphthous ulcers since childhood was admitted to the hospital with acute neurological decline characterised by loss of motor dexterity, dysarthria, dysphagia and unsteady gait. MRI brain was significant for symmetrical hyperintense T2 fluid attenuated inversion recovery (FLAIR) in the corticospinal tracts, including parts of the pons and the mesodiencephalic junction. Though initial concern was for neuro-Behçet's disease, brain biopsy ultimately revealed a diagnosis of astrocytoma. This report demonstrates a mimic of neuro-Behçet's disease and the importance of confirming the correct diagnosis prior to initiating therapy.