HIV Neurology Persistence of Cognitive Impairment Despite cart
|
|
- Godfrey McLaughlin
- 6 years ago
- Views:
Transcription
1 HIV Neurology Persistence of Cognitive Impairment Despite cart Victor Valcour MD PhD Professor of Medicine Memory and Aging Center, Dept. of Neurology University of California San Francisco, USA 8 th International workshop on HIV Treatment, Pathogenesis and Prevention Research in Resource Poor Settings; May 2014
2 Lecture Overview Update on the frequency and characteristics of cognitive disorders in the era of treatment Mechanisms of ongoing central nervous system (CNS) damage despite cart Ongoing injury from HIV itself and resorvoirs cart Too much? Too little? Cerebrovascular disease and other comorbidities
3 Very Early CNS Penetration and Brain Inflammation 0.35 Basal Ganglia 0.30 tcho/cr Acutes Chronics Controls Valcour et al JID 2012
4 HIV Neuropathology Perivascular monocytes and multinucleated giant cells (above) High frequency in white matter & deep grey matter Neuropathology of AIDS 1998
5 HIV-associated Cognitive Impairment Cognition Memory loss Concentration Mental slowing Comprehension Behavior Apathy Depression Agitation, Mania Motor Unsteady gait Poor coordination Tremor
6 Cognitive Diagnoses Pre-cART vs. Post-cART Pre-cART Post-cART HIV-associated dementia (HAD); Minor Neurocognitive disorder (MND); Asymptomatic Neurocognitive Impairment; (ANI) Neurocognitively normal (NN) n=1555 from US; subjects attending academic centers and have access to cart Modified from Ellis et al, 2007 Nat Rev Neurosci & Grant et al., 2009 CROI
7 Chaio et al AIDS Res Hum Retro 2013 Is ANI Really Asymptomatic? Performance on Tasks of Everyday Function Patients with Asymptomatic Neurocognitive Impairment (ANI) perform just as poorly on tasks of everyday functioning as do symptomatic subjects (MND)
8 Cognitive Deficits Despite cart Entebbe, Uganda 72% female, 83% were < 45 years old, 57% with < 8 years of education, ~2/3 on cart 64% scored <10/12 on the International HIV Dementia Scale Poor performance predicted by: Negative life events, stress and psychosocial impairment Nakku et al BMC Psychiatry 2013
9 HIV and Brain Atrophy 28 HIV+ from South Africa c/t 23 controls Subjects not on cart, CD4 ~ 190 cells, mean age 33 years Statistically significant levels of atrophy noted at thalamus, total white matter, & total grey matter Heaps et al JNV 2012
10 Tozzi et al JAIDS 2007 Persistent Cognitive Deficits n = 94 Neuropsychological impairment = (a) -1 SD on two tests or (b) -2 SD on one test out of 8 >50% probability of persistent neuropsychological deficits despite 5 years of cart
11 n=82 from South Africa; Severity of baseline deficits predicts 12 month deficits Joska et al BMC Infectious Ds Persistent deficits 12 months after initiation of cart
12 (a) ARV toxicity (b) poor CPE 5 1 CPE = CNS Penetration- Effectiveness
13 IQ measured by two separate techniques correlated to total infectious disease burden Hypothesized influence of competing metabolic demands during neurodevelopment
14 (a) ARV toxicity (b) poor CPE Persistent HIV associated effects despite suppression of plasma HIV RNA (viral load) CPE = CNS Penetration- Effectiveness
15 Evidence of Ongoing Neuronal Injury Despite cart Neurofilament (NFL) is a major structural element of myelinated fibers NFL is elevated in cart vs. controls; 85 subjects on cart for > 1 year with plasma HIV RNA < 50 copies Krut et al PlosOne 2014
16 Abnormalities in Diffusion Tensor Imaging in HIV n=56, all but 6 with suppressed plasma HIV RNA, age > 60 Broad abnormalities in DTI in HIV vs. controls; +: Exacerbated by APOE4 Fractional Anisotropy Nir et al. Human Brain Mapping 2013
17 Burdo et al AIDS 2013 Elevated scd163 Associated with Cognitive Impairment 34 CHARTER (US) participants with suppressed plasma HIV RNA, on cart > 1 year; CD4 > 500 CD163 = scavenger receptor involved in inflammation and secreted from monocytes as scd163 SCD163 elevated in cognitively impaired treated subjects
18 HIV DNA and Cognitive Impairment CD14+ HIV DNA Valcour et al Plos One 2013
19 Effect of cart on HIV Reservoir Size Before cart 6 months 12 months Differing response in those with dementia vs. those without Valcour et al J Leukocyte Biol 2010
20 Increased Macrophage Staining Despite cart n=10 cart vs. 9 NL Increased CD28 staining, a macrophage stain, seen in multiple brain areas, including frontal white matter and medial temporal lobes Anthony et all J Neuropath Exp Neuro 2005
21 7 asymptomatic subjects (9 years (3-22) of infection, on cart > 3 years, UD plasma HIV RNA 11 c -PK1116 PET ligand signal in corpus callosum, anterior cingulate, posterior cingulate, temporal and frontal lobes Correlated to poorer executive function Garvey et al AIDS 2014
22 (a) ARV toxicity (b) poor CPE CPE = CNS Penetration- Effectiveness
23 Neuronal Injury linked to Antiretroviral Therapy Schinburg et al JNV 2005
24 Exposure of neuronal cultures to ARVs at concentrations that are anticipated in CSF resulted in neuronal damage Decreased axonal integrity, axonal beading
25 Cognitive Performance During Treatment Interruption 167 subjects, mean CD4 > 400 before interruption; had been on cart > 4 years Overall cognitive performance did not deteriorate, in fact, a small but statistically significant improvement was seen Robertson et al, Neurology 2010
26 CNS Penetration- Effectiveness Ranks 2010
27 CPE and CSF viral load Proportion with detectable virus in CSF cart with higher BBB penetrationeffectiveness score Letendre et al, 2008 Arch Neurol
28 CSF viral load and cognition Improved control of CSF HIV RNA relates to greater improvements in cognitive performance. Ellis et al, Ann Neurol 2004
29 Counter-intuitive: Changing ARVs to those with higher CPE resulted in inferior outcomes
30 CNS Escape: Sub-Acute or Acute Neurological Syndromes (Case Series) Age CD4 Months VL<50 Neurological symptoms ARVs CSF HIV RNA Persistent headache TDF/FTC/ATZr 12, Memory disorder, cerebellar ataxia AZT/3TC/IDVr/T < Cerebellar dysarthria, cerebellar ataxia 3TC/ABC/ATV/IDVr 1190 < Tactile allodynia TDF/FTC/fAPRr Glasgow Coma Score of 3 3TC/ABC/TDF/DRVr 5035 < Persistent Headache DRVr 580 < Memory d/o, cerebellar ataxia, pyramidal syndrome FTC/ABC/ATVr 558 < Lower limb dysesthesia and hypoesthesia 3TC/AZT/ABC/EFV 1023 < Memory d/o, left lower limb dysesthesia 3TC/DDI/TDF/NVP 586 < Temporospatial disorientation, cerebellar ataxia 3TC/AZT/ATV 880 < Memory d/o, cerebellar dysarthria LPVr Plasma HIV RNA Adapted from Canestri et al, CID 2010
31 (a) ARV toxicity (b) poor CPE CPE = CNS Penetration- Effectiveness
32 Increasing Frequency of Ischemic Stroke in HIV Ovbagle and Nath 2011 Neurology & Chow et al 2011 JAIDS
33 White Matter Injury Subjects over the age of 60 in the US who are living with HIV as a chronic illness
34 Autopsy series in the US between 1999 to % had moderate to severe increased hyalinization of small vessels 25% had mild changes Associated with PI use;? Legacy effect Soontornniyomkij et al AIDS 2014
35 Conclusions Cognitive impairment remains frequent despite cart There is broad evidence that cart does not control HIV-related contributions
36 Conclusions Antiretroviral therapy may contribute to cognitive impairment There is broad acceptance that suppression of plasma HIV RNA is essential in the treatment of cognitive impairment Attention to CNS penetration effectiveness of ARVs is important in select circumstances
37 Conclusions The etiology of cognitive impairment is likely heterogeneous Contributions from cerebrovascular disease As patients age, neurodegeneration may be an issue Background comorbidity may play a role in the frequency of poor neuropsychological performance in some
Central Nervous System Penetration of ARVs: Does it Matter?
NORTHWEST AIDS EDUCATION AND TRAINING CENTER Central Nervous System Penetration of ARVs: Does it Matter? Christina M. Marra, MD Neurology and Medicine (Infectious Diseases) University of Washington 15
More informationOverview. HIV Brain Injury. HIV characteristics. HIV Dementia 11/6/2010
Overview HIV Brain Injury Victor Valcour MD Associate Professor Division of Geriatric Medicine and Department of Neurology/UCSF The neuropathology of HIV HIV Dementia a current snapshot Scenarios of rapid
More informationImaging in Pediatric `neurohiv Dr Jackie Hoare Head of Liaison Psychiatry Groote Schuur Hospital, UCT
Imaging in Pediatric `neurohiv Dr Jackie Hoare Head of Liaison Psychiatry Groote Schuur Hospital, UCT ? Spectrum of Neurocognitive disorders The adult literature on HIV related CNS damage supports a spectrum
More informationHIV associated CNS disease in the era of HAART
HIV associated CNS disease in the era of HAART CSF/CNS penetration and efficacy Acknowledgements Peter Portegies Department of Neurology, AMC Mark van der Valk Department of Internal Medicine/Infectious
More informationValutazione dei disturbi neurocognitivi e invecchiamento: non solo HAND. Workshop Nazionale CISAI Lecco 20 Marzo 2015
Valutazione dei disturbi neurocognitivi e invecchiamento: non solo HAND Workshop Nazionale CISAI Lecco 20 Marzo 2015 Paola Cinque Dipartimento di Malattie Infettive Istituto Scientifico San Raffaele, Milano
More informationHIV DISEASE! Neurobehavioral! Neuromedical. Igor Grant, MD, FRCP(C) Director HIV Neurobehavioral Research Program University of California, San Diego
Igor Grant, MD, FRCP(C) Director HIV Neurobehavioral Research Program University of California, San Diego HIV DISEASE! Neuromedical Neurobehavioral! HIV Neurobehavioral Disturbances HIV Associated Neurocognitive
More informationHIV and Dementia. London Dementia Clinical Network 14 June Dr Patricia McNamara MB BCh BAO MRCP PhD. Locum Consultant Neurologist, NHNN
HIV and Dementia London Dementia Clinical Network 14 June 2018 Dr Patricia McNamara MB BCh BAO MRCP PhD Locum Consultant Neurologist, NHNN Patricia.mcnamara2@nhs.net History of HIV Infection HIV 36 million
More informationAIDS 2011, 3, 2011 RW
Treating CNS HIV Infection and Disease Why, How and When? Richard W. Price, M.D. Department of Neurology, UCSF/SFGH Preface: Reasons for Renewed Interest in Treatment of CNS HIV Continued CNS infection/disease
More informationCerebral Small Vessel Disease and HAND in ARV-treated Subjects
Cerebral Small Vessel Disease and HAND in ARV-treated Subjects Cristian L. Achim, MD, PhD Ronald J. Ellis, MD, PhD Virawudh Soontornniyomkij, MD ARROW, Bucharest, Romania October 5-6, 2015 Rationale and
More informationDr Lucy Garvey. Imperial College Healthcare NHS Trust, London. 18 th Annual Conference of the British HIV Association (BHIVA)
18 th Annual Conference of the British HIV Association (BHIVA) Dr Lucy Garvey Imperial College Healthcare NHS Trust, London 18-20 April 2012, The International Convention Centre, Birmingham Microglial
More informationHIV AND CEREBROVASCULAR DISEASE: AN INTERSECTION OF EPIDEMICS
HIV AND CEREBROVASCULAR DISEASE: AN INTERSECTION OF EPIDEMICS Felicia C. Chow, MD, MAS University of California, San Francisco Departments of Neurology and Medicine (Infectious Diseases) September 26,
More informationInternational Symposium on. Barcelona, May 5 th and 6 th 2011
th International Symposium on Barcelona, May 5 th and 6 th 2011 4rd Symposium on Psychiatry and HIV --- Barcelona, May 6th 2010 Neurocognitive Testing in HIV Infection: How to Implement this Assessment
More informationHIV and Brain Func.on. Tristan J Barber Research Physician St Stephen s AIDS Trust Chelsea and Westminster Hospital
HIV and Brain Func.on Tristan J Barber Research Physician St Stephen s AIDS Trust Chelsea and Westminster Hospital HIV and the Brain When can HIV affect the brain? Seroconversion Long term infected (not
More informationDisclosures 12/7/17. UPDATES IN HIV NEUROLOGY Felicia Chow, MD, MAS University of California, San Francisco December 7, 2017
UPDATES IN HIV NEUROLOGY Felicia Chow, MD, MAS University of California, San Francisco December 7, 2017 Disclosures I have nothing to disclose. Brain Compartment Zayyad et al. Curr HIV/AIDS Rep 2015 Clinical
More informationInternational Symposium on. Barcelona, May 5 th and 6 th 2011
th International Symposium on Barcelona, May 5 th and 6 th 2011 Pathogenesis of Neurocognitive Impairment in HIV-infected persons Paola Cinque Dipartimento di Malattie Infettive Istituto Scientifico San
More informationHIV in the Brain MANAGING COMORBIDITIES IN PATIENTS WITH HIV
HIV in the Brain MANAGING COMORBIDITIES IN PATIENTS WITH HIV Shibani S. Mukerji MD, PhD Massachusetts General Hospital, Division of Immunologic, Inflammatory and Infectious Neurological Diseases Dana-Farber
More informationDr Alan Winston. Imperial College Healthcare NHS Trust London. 7-8 October 2010, Queen Elizabeth II Conference Centre, London.
BHIVA AUTUMN CONFERENCE 2010 Including CHIVA Parallel Sessions Dr Alan Winston Imperial College Healthcare NHS Trust London 7-8 October 2010, Queen Elizabeth II Conference Centre, London BHIVA AUTUMN CONFERENCE
More informationClinical notes: Management of HAART in patients with HAND
Clinical notes: Management of HAART in patients with HAND Paola Cinque Dipartment of Infectious Diseases San Raffaele Scientific Institute, Milano, Italy 11 Residential Course on Clinical Pharmacology
More informationHIV Associated Neurocognitive Disorders in the era of modern CART
HIV Associated Neurocognitive Disorders in the era of modern CART Igor Grant, MD, FRCP(C) Director HIV Neurobehavioral Research Program University of California, San Diego Points to be covered HIV associated
More informationBrain Structure and Function in Nephropathic Cystinosis
Brain Structure and Function in Nephropathic Cystinosis Doris A. Trauner M.D. Professor, Depts. of Neurosciences and Pediatrics University of California San Diego School of Medicine La Jolla, CA USA Cystinosis
More informationApproach to HIV Associated Neurocognitive disorders (HAND)
Approach to HIV Associated Neurocognitive disorders (HAND) Dinesh Singh MB ChB (Natal), M Med (Psych) (Natal), F CPsych (SA), MS (epi) (Columbia, USA), PhD (candidate UKZN) 2 October 2009 ICC, Durban Overview
More informationHIV & Women: Neurological Issues
HIV & Women: Neurological Issues Scott Letendre, M.D. Professor of Medicine University of California, San Diego 1 Do women differ from men in their risk for neurocognitive and mood disorders? 2 As the
More informationHIV-1 Dual Infection and Neurocognitive Impairment
HIV-1 Dual Infection and Neurocognitive Impairment Gabriel Wagner, MD Assistant Professor of Medicine Infectious Diseases & Global Public Health UC San Diego HIV-Associated End Organ Damage Antiretroviral
More informationThe Neurology of HIV Infection. Carolyn Barley Britton, MD, MS Associate Professor of Clinical Neurology Columbia University
The Neurology of HIV Infection Carolyn Barley Britton, MD, MS Associate Professor of Clinical Neurology Columbia University HIV/AIDS Epidemiology World-wide pandemic, 40 million affected U.S.- Disproportionate
More informationBHIVA Best Practice Management Session
BHIVA Best Practice Management Session CNS (The brain) - I keep forgetting things DEMENTIA DIAGNOSIS, CLASSIFICATION AND INVESTIGATIONS Paul Holmes Consultant Neurologist Guy s and St Thomas Hospitals
More informationSafety of Current Antiretroviral Therapy on the CNS Scott Letendre, M.D.
Safety of Current Antiretroviral Therapy on the CNS Scott Letendre, M.D. Professor of Medicine and Psychiatry University of California, San Diego Disclosures Research funds were paid to UC San Diego on
More informationThe Association Between Comorbidities and Neurocognitive Impairment in Aging Veterans with HIV
The Association Between Comorbidities and Neurocognitive Impairment in Aging Veterans with HIV Arianna Perra, P syd, Moira Dux, PhD Terry Lee- Wilk, PhD HIV and HCV in the VA VA is the largest provider
More informationDifferential diagnosis between depression and neurocognitive impairment in HIV-infected persons
Differential diagnosis between depression and neurocognitive impairment in HIV-infected persons Dr. Adriana Carvalhal, MD, MSc, PhD University of Toronto - Canada Disclosure Research: Canadian Institute
More informationThe Role of Cardiovascular Risk and Aging in Memory Performance in a Sample of Veterans with HIV
The Role of Cardiovascular Risk and Aging in Memory Performance in a Sample of Veterans with HIV LYNN KAKOS, PH.D. VA MARYLAND HEALTH CARE SYSTEM (VAMHCS) OBJECTIVES HIV in the VA Neurocognitive profile
More informationCentral nervous system
Central nervous system By Dr. Mohsen Dashti Clinical Medicine & Pathology 316 7 th Lecture Lecture outline Review of structure & function. Symptoms, signs & tests. Specific diseases. Review of structure
More information10/3/2016. T1 Anatomical structures are clearly identified, white matter (which has a high fat content) appears bright.
H2O -2 atoms of Hydrogen, 1 of Oxygen Hydrogen just has one single proton and orbited by one single electron Proton has a magnetic moment similar to the earths magnetic pole Also similar to earth in that
More informationNational HIV Nurses Association (NHIVNA) Study Day in collaboration with the British Psychological Society Current Issues in HIV
National HIV Nurses Association (NHIVNA) Study Day in collaboration with the British Psychological Society Current Issues in HIV Dr Matthew Jones-Chesters University of East London 17 October 2012, Hilton
More informationEmerging Considerations in neuroaids Internationally: Events in Acute and Early Infection
Emerging Considerations in neuroaids Internationally: Events in Acute and Early Infection Igor Grant, M.D. Director, HIV Neurobehavioral Research Center University of California, San Diego Although combination
More informationThe Brain on ADHD. Ms. Komas. Introduction to Healthcare Careers
The Brain on ADHD Ms. Komas Introduction to Healthcare Careers Ms. Komas Period 9/2/2016 Komas 1 HOOK: Attention Deficit Hyperactivity Disorder (ADHD) plagues between 5% and 7% of children and less than
More informationHIV and the Central Nervous System Impact of Drug Distribution Scott L. Letendre, MD. Professor of Medicine University of California, San Diego
HIV and the Central Nervous System Impact of Drug Distribution Scott L. Letendre, MD Professor of Medicine University of California, San Diego Disclosures Grant/research support Abbvie Gilead Sciences
More informationDistribution and Effectiveness of Antiretrovirals in the Central Nervous System
Distribution and Effectiveness of Antiretrovirals in the Central Nervous System Scott Letendre, MD Associate Professor of Medicine HIV Neurobehavioral Research Center and Antiviral Research Center University
More informationDementia. Stephen S. Flitman, MD Medical Director 21st Century Neurology
Dementia Stephen S. Flitman, MD Medical Director 21st Century Neurology www.neurozone.org Dementia is a syndrome Progressive memory loss, plus Progressive loss of one or more cognitive functions: Language
More informationLeah Militello, class of 2018
Leah Militello, class of 2018 Objectives 1. Describe the general organization of cerebral hemispheres. 2. Describe the locations and features of the different functional areas of cortex. 3. Understand
More informationHematopoietic Stem Cell Transplantation for Adrenoleukodystrophy
Hematopoietic Stem Cell Transplantation for Adrenoleukodystrophy 2011 NHLBI Pediatric Workshop Sept. 14, 2011 Paul Orchard, M.D. Division of Pediatric Blood and Marrow Transplant University of Minnesota
More informationHAND is Common and Important in Patients on ART
HAND is Common and Important in Patients on ART Igor Grant, MD, FRCP(C) Director HIV Neurobehavioral Research Program University of California, San Diego How is HAND diagnosed? How prevalent is it? Points
More informationCAB 59: HIV and neurocogni5ve impairment
HIV Neurology CAB 59: HIV and neurocogni5ve impairment Friday 8 th July 2016 Dr Nick Davies Consultant Neurologist, Chelsea & Westminster Hospital & Imperial College NHS Trust (Charing Cross Hospital),
More informationVascular Dementia. Laura Pedelty, PhD MD The University of Illinois at Chicago and Jesse Brown VA Medical Center
Vascular Dementia Laura Pedelty, PhD MD The University of Illinois at Chicago and Jesse Brown VA Medical Center none Disclosures Objectives To review the definition of Vascular Cognitive Impairment (VCI);
More informationStroke School for Internists Part 1
Stroke School for Internists Part 1 November 4, 2017 Dr. Albert Jin Dr. Gurpreet Jaswal Disclosures I receive a stipend for my role as Medical Director of the Stroke Network of SEO I have no commercial
More informationSystemic monocyte activation levels and developmental milestone attainment in HIV-infected. infants initiating antiretroviral therapy.
Systemic monocyte activation levels and developmental milestone attainment in HIV-infected infants initiating antiretroviral therapy Ira Martopullo A thesis submitted in partial fulfillment of the requirements
More informationNeuroradiology of AIDS
Neuroradiology of AIDS Frank Minja,, HMS IV Gillian Lieberman MD September 2002 AIDS 90% of HIV patients have CNS involvement 1 10% of AIDS patients present first with neurological symptoms 2 73-80% of
More informationDiffusion Tensor Imaging in Psychiatry
2003 KHBM DTI in Psychiatry Diffusion Tensor Imaging in Psychiatry KHBM 2003. 11. 21. 서울대학교 의과대학 정신과학교실 권준수 Neuropsychiatric conditions DTI has been studied in Alzheimer s disease Schizophrenia Alcoholism
More informationDelirium & Dementia. Nicholas J. Silvestri, MD
Delirium & Dementia Nicholas J. Silvestri, MD Outline Delirium vs. Dementia Neural pathways relating to consciousness Encephalopathy Stupor Coma Dementia Delirium vs. Dementia Delirium Abrupt onset Lasts
More informationHIV 101: Overview of the Physiologic Impact of HIV and Its Diagnosis Part 2: Immunologic Impact of HIV and its Effects on the Body
HIV 101: Overview of the Physiologic Impact of HIV and Its Diagnosis Part 2: Immunologic Impact of HIV and its Effects on the Body Melissa Badowski, PharmD, BCPS, AAHIVP Clinical Assistant Professor University
More information+ Fragile X Tremor Ataxia Syndrome (FXTAS)
+ Fragile X Tremor Ataxia Syndrome (FXTAS) Le point de vue du neurologue n Gaëtan Garraux n CHU de Liège n www.movere.org + Background FXTAS was first described by Hagerman and coll. (2001) as they collected
More informationPRESERVE: How intensively should we treat blood pressure in established cerebral small vessel disease? Guide to assessing MRI scans
PRESERVE: How intensively should we treat blood pressure in established cerebral small vessel disease? Guide to assessing MRI scans Inclusion Criteria Clinical syndrome Patients must have clinical evidence
More informationHow to Implement this Assessment in the Clinical Prac5ce?
5th Interna*onal Symposium on Neuropsychiatry HIV - - - Barcelona, May 24-25th, 2012 Neuropsychological Screening in HIV Infec6on: How to Implement this Assessment in the Clinical Prac5ce? Jose A. Muñoz-
More informationHistology of the CNS
Histology of the CNS Lecture Objectives Describe the histology of the cerebral cortex layers. Describe the histological features of the cerebellum; layers and cells of cerebellar cortex. Describe the elements
More informationForm D1: Clinician Diagnosis
Initial Visit Packet Form D: Clinician Diagnosis NACC Uniform Data Set (UDS) ADC name: Subject ID: Form date: / / Visit #: Examiner s initials: INSTRUCTIONS: This form is to be completed by the clinician.
More informationBlood Supply. Allen Chung, class of 2013
Blood Supply Allen Chung, class of 2013 Objectives Understand the importance of the cerebral circulation. Understand stroke and the types of vascular problems that cause it. Understand ischemic penumbra
More informationPost Stroke Brain Plasticity
Post Stroke Brain Plasticity François CHOLLET MD, PhD Neurology Department: Stroke Unit Toulouse University Hospital (CHU) Neurosciences Institute of Toulouse CNRS, INSERM, University, CHU Versailles le
More informationThe Epidemiology of Stroke and Vascular Risk Factors in Cognitive Aging
The Epidemiology of Stroke and Vascular Risk Factors in Cognitive Aging REBECCA F. GOTTESMAN, MD PHD ASSOCIATE PROFESSOR OF NEUROLOGY AND EPIDEMIOLOGY JOHNS HOPKINS UNIVERSITY OCTOBER 20, 2014 Outline
More informationNeuro degenerative PET image from FDG, amyloid to Tau
Neuro degenerative PET image from FDG, amyloid to Tau Kun Ju Lin ( ) MD, Ph.D Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital ( ) Department of Medical Imaging
More informationCentral Nervous System Immune Reconstitution Disease: Pathology
Central Nervous System Immune Reconstitution Disease: Pathology F.Gray, H.Adle-Biassette, F.Héran, G. Pialoux, A.Moulignier, APHP Hôpital Lariboisière Université Paris VII Introduction of HAART, which
More informationMarchiafava Bignami Disease (MBD) and Diffusion Tensor Image (DTI) Tractography. Priscilla Chukwueke, MD, MPH
Marchiafava Bignami Disease (MBD) and Diffusion Tensor Image (DTI) Tractography Priscilla Chukwueke, MD, MPH INTRODUCTION Definition: A rare CNS disease characterized by demyelination of the Corpus Callosum.
More informationIs DTI Increasing the Connectivity Between the Magnet Suite and the Clinic?
Current Literature In Clinical Science Is DTI Increasing the Connectivity Between the Magnet Suite and the Clinic? Spatial Patterns of Water Diffusion Along White Matter Tracts in Temporal Lobe Epilepsy.
More informationA Neurologist s Approach to Altered Mental Status
A Neurologist s Approach to Altered Mental Status S. Andrew Josephson, MD Department of Neurology University of California San Francisco October 23, 2008 The speaker has no disclosures Case 1 A 71 year-old
More informationVascular Disorders. Nervous System Disorders (Part B-1) Module 8 -Chapter 14. Cerebrovascular disease S/S 1/9/2013
Nervous System Disorders (Part B-1) Module 8 -Chapter 14 Overview ACUTE NEUROLOGIC DISORDERS Vascular Disorders Infections/Inflammation/Toxins Metabolic, Endocrinologic, Nutritional, Toxic Neoplastic Traumatic
More informationCOGNITIVE DYSFUNCTION AMONG HIV-POSITIVE PATIENTS ATTENDING CCC AT KENYATTA NATIONAL HOSPITAL
COGNITIVE DYSFUNCTION AMONG HIV-POSITIVE PATIENTS ATTENDING CCC AT KENYATTA NATIONAL HOSPITAL Principal Investigator Dr. Zaheer Bagha Supervisors Prof. E. Amayo Prof. A. M. Adam Dr. J. O. Mecha INTRODUCTION
More informationUpdate on Neurologic Complications in Persons With HIV Infection: 2017
Update on Neurologic Complications in Persons With HIV Infection: 2017 FORMATTED: MM/DD/YY Chicago, Illinois: May 10, 2017 Dennis Kolson, MD, PhD Professor of Neurology University of Pennsylvania Philadelphia,
More informationBHIVA Best of CROI Feedback Meetings. London Birmingham North West England Cardiff Gateshead Edinburgh
BHIVA Best of CROI Feedback Meetings London Birmingham North West England Cardiff Gateshead Edinburgh BHIVA Best of CROI Feedback Meetings 2010 COMPLICATIONS OF HIV DISEASE AND TREATMENT Overview Cardiovascular
More informationFunctional Neuroanatomy and Traumatic Brain Injury The Frontal Lobes
Functional Neuroanatomy and Traumatic Brain Injury The Frontal Lobes Jessica Matthes, Ph.D., ABN Barrow TBI Symposium March 23, 2019 jessica.matthes@dignityhealth.org Outline TBI Mechanisms of Injury Types
More informationCerebellum. Steven McLoon Department of Neuroscience University of Minnesota
Cerebellum Steven McLoon Department of Neuroscience University of Minnesota 1 Anatomy of the Cerebellum The cerebellum has approximately half of all the neurons in the central nervous system. The cerebellum
More informationDementia. Assessing Brain Damage. Mental Status Examination
Dementia Assessing Brain Damage Mental status examination Information about current behavior and thought including orientation to reality, memory, and ability to follow instructions Neuropsychological
More informationGuanhan Li. Section of Infections of the Nervous System National Institutes of Health, Bethesda, MD
Towards an HIV Cure Pre-Conference Symposium 20 & 21 July 2012 Guanhan Li Section of Infections of the Nervous System National Institutes of Health, Bethesda, MD Viral Reservoir in Astrocytes Ranki et
More informationPsychiatric Symptom Burden in Elders with HIV-Associated Neurocognitive Disorders
Psychiatric Symptom Burden in Elders with HIV-Associated Neurocognitive Disorders Benedetta Milanini 1, Stephanie Catella 2, Lauren Wendelken 2, Pardis Esmaeili 2, Hannah Jang 2, Robin Ketelle 2, Victor
More informationNeuroinflammation in preclinical AD: in vivo evidence
Neuroinflammation in preclinical AD: in vivo evidence Barbara Bendlin, PhD Assistant Professor UW-Madison Dept. of Medicine, Geriatrics bbb@medicine.wisc.edu Overview Background Preclinical effects of
More informationAnatomy Lab (1) Theoretical Part. Page (2 A) Page (2B)
Anatomy Lab (1) This sheet only includes the extra notes for the lab handout regarding the theoretical part, as for the practical part it includes everything the doctor mentioned. Theoretical Part Page
More informationMULTIPLE SCLEROSIS PROFILE
MULTIPLE SCLEROSIS PROFILE What is Multiple Sclerosis? Multiple sclerosis (MS) is a chronic, inflammatory disease of unknown etiology that involves an immune-mediated attack on the central nervous system
More informationSpring Semester OST 571 Neuromusculoskeletal Lecture-Lab Schedule Revised
Revised 1-07-16 Week 1: Monday, January 11, 2016 9:00-9:50 a.m. 001 - Principles of Neurobiology/Orientation Lovell Online 10:00-10:50 a.m. 002 - Cells, synapses & neurotransmitter systems Nazaroff Online
More informationThe Impact of HIV and Aging on the Brain Scott Letendre, M.D.
The Impact of HIV and Aging on the Brain Scott Letendre, M.D. Professor of Medicine and Psychiatry University of California, San Diego Disclosures Research funds were paid to UC San Diego on behalf of
More informationCerebral Cortex 1. Sarah Heilbronner
Cerebral Cortex 1 Sarah Heilbronner heilb028@umn.edu Want to meet? Coffee hour 10-11am Tuesday 11/27 Surdyk s Overview and organization of the cerebral cortex What is the cerebral cortex? Where is each
More informationPrion diseases or transmissible spongiform encephalopathies (TSEs)
Prion diseases or transmissible spongiform encephalopathies (TSEs) rare progressive neurodegenerative disorders that affect both humans and animals. They are distinguished by long incubation periods, characteristic
More informationThe NIHSS score is 4 (considering 2 pts for the ataxia involving upper and lower limbs.
Neuroscience case 5 1. Speech comprehension, ability to speak, and word use were normal in Mr. Washburn, indicating that aphasia (cortical language problem) was not involved. However, he did have a problem
More informationUnit VIII Problem 5 Physiology: Cerebellum
Unit VIII Problem 5 Physiology: Cerebellum - The word cerebellum means: the small brain. Note that the cerebellum is not completely separated into 2 hemispheres (they are not clearly demarcated) the vermis
More informationSpring Semester OST 571 Neuromusculoskeletal Lecture-Lab Schedule
Week 1: Monday, January 5, 2015 9:00-9:50 a.m. 001 - Principles of Neurobiology Lovell Online 10:00-10:50 a.m. 002 - Cells, synapses & neurotransmitters Nazaroff Online 11:00-11:50 a.m. 003 - Development
More informationMRI in ALS. Federica Agosta, MD, PhD
MRI in ALS Federica Agosta, MD, PhD Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan,
More informationHead Injury: Classification Most Severe to Least Severe
Head Injury: Classification Most Severe to Least Severe Douglas I. Katz, MD Professor, Dept. Neurology, Boston University School of Medicine, Boston MA Medical Director Brain Injury Program, HealthSouth
More informationFunding: NIDCF UL1 DE019583, NIA RL1 AG032119, NINDS RL1 NS062412, NIDA TL1 DA
The Effect of Cognitive Functioning, Age, and Molecular Variables on Brain Structure Among Carriers of the Fragile X Premutation: Deformation Based Morphometry Study Naomi J. Goodrich-Hunsaker*, Ling M.
More informationThe motor regulator. 2) The cerebellum
The motor regulator 2) The cerebellum Motor control systems outside the cortex Cerebellum -controls neural programs for the executionl of skilled movements Cerebellar Peduncles Atlas Fig. 2-31 Atlas Fig.
More informationPrinciples of Anatomy and Physiology
Principles of Anatomy and Physiology 14 th Edition CHAPTER 14 The Brain and Cranial Nerves Introduction The purpose of the chapter is to: 1. Understand how the brain is organized, protected, and supplied
More informationProf. Saeed Abuel Makarem & Dr.Sanaa Alshaarawy
Prof. Saeed Abuel Makarem & Dr.Sanaa Alshaarawy 1 Objectives By the end of the lecture, you should be able to: Describe the anatomy and main functions of the thalamus. Name and identify different nuclei
More informationCase Presentation JF
Case Presentation History, P/E and relevant labs Male 85 yo, HIV Dx 1996 (CD4-550, HIV-RNA 5000) referred for care 1999 PHx: syphilis, 50 pack-yr cigarettes Meds: none MSM, single, unemployed, previous
More informationMedical Neuroscience Tutorial Notes
Medical Neuroscience Tutorial Notes Blood Supply to the Brain MAP TO NEUROSCIENCE CORE CONCEPTS 1 NCC1. The brain is the body's most complex organ. LEARNING OBJECTIVES After study of the assigned learning
More informationEwa Pietraszkiewicz Hospital for Infectious Diseases in Warsaw
A patient with HIV/HCV co-infection on substitution methadone therapy and the history of alcohol and benzodiazepine abuse - a case of multifactorial neurological disorder. Ewa Pietraszkiewicz Hospital
More informationDiffusion-Weighted and Conventional MR Imaging Findings of Neuroaxonal Dystrophy
AJNR Am J Neuroradiol 25:1269 1273, August 2004 Diffusion-Weighted and Conventional MR Imaging Findings of Neuroaxonal Dystrophy R. Nuri Sener BACKGROUND AND PURPOSE: Neuroaxonal dystrophy is a rare progressive
More informationLEC 1B ANATOMY OF THE NERVOUS SYSTEM. Cogs 17 * UCSD
LEC 1B ANATOMY OF THE NERVOUS SYSTEM Cogs 17 * UCSD Cerebral Cortex A 6-layer sheet of cells, unfolded = < 1 m square X 3 mm thick Cortex 6 layers of cells Nissl Stain for Cell Bodies Info projected to
More informationCEREBRUM. Dr. Jamila EL Medany
CEREBRUM Dr. Jamila EL Medany Objectives At the end of the lecture, the student should be able to: List the parts of the cerebral hemisphere (cortex, medulla, basal nuclei, lateral ventricle). Describe
More informationBiomedical Technology Research Center 2011 Workshop San Francisco, CA
Diffusion Tensor Imaging: Parkinson s Disease and Atypical Parkinsonism David E. Vaillancourt court1@uic.edu Associate Professor at UIC Departments t of Kinesiology i and Nutrition, Bioengineering, and
More informationInternational Forum on HIV and Rehabilitation Research
Neurocognitive screening and behavioural interventions for HIV-Associated Neurocognitive Disorders (HAND) International Forum on HIV and Rehabilitation Research Translating Research Evidence from the Canada-UK
More informationManagement of Severe Primary HIV Infection
Management of Severe Primary HIV Infection Martin Fisher Brighton and Sussex University Hospitals Outline What is severe PHI? How frequent is severe PHI? Is this occurring more frequently? Is severe PHI
More informationDWI assessment of ischemic changes in the fetal brain
DWI assessment of ischemic changes in the fetal brain Dafi Bergman, 4 th year Medical student in the 4-year program, Sackler school of medicine B.Sc Life and Medical Sciences, Tel Aviv University Supervised
More informationEventi cerebro-vascolari: davvero una nuova frontiera?
Eventi cerebro-vascolari: davvero una nuova frontiera? Leonardo Calza Clinica di Malattie Infettive, Policlinico S.Orsola-Malpighi, Università di Bologna (Lancet 2016) Changes in leading 30 causes of death,
More informationSENSORY (ASCENDING) SPINAL TRACTS
SENSORY (ASCENDING) SPINAL TRACTS Dr. Jamila El-Medany Dr. Essam Eldin Salama OBJECTIVES By the end of the lecture, the student will be able to: Define the meaning of a tract. Distinguish between the different
More informationOverview of the Nervous System (some basic concepts) Steven McLoon Department of Neuroscience University of Minnesota
Overview of the Nervous System (some basic concepts) Steven McLoon Department of Neuroscience University of Minnesota 1 Coffee Hour Tuesday (Sept 11) 10:00-11:00am Friday (Sept 14) 8:30-9:30am Surdyk s
More informationDemyelinating Diseases of the Brain
Department of Radiology University of California San Diego Demyelinating Diseases of the Brain John R. Hesselink, M.D. T1-Weighted Images Normal White Matter Contents Axons with envelope of myelin Neuroglia
More information