Category: Disorders and Syndromes

It was a quiet Thursday afternoon when AS, a 68-year-old woman from a suburb of Chicago, awakened from a nap to the realization that something was terribly wrong.

Thus begins a Loyola University Medical Center paper on a rare and baffling neurological disorder called Balint's syndrome, which badly impairs a patient's ability to make sense of what he or she sees.

The article describes, in novelistic detail, the difficult adjustments two patients have had to make in their lives. The article is published in the Sept. 11, 2012, issue of Neurology®, the medical journal of the American Academy of Neurology. The paper was written by Jose Biller, MD, Murray Flaster, MD, and first author Jason Cuomo. Biller and Flaster are neurologists and Cuomo is a fourth-year medical student at Loyola University Chicago Stritch School of Medicine.

The authors note that amid the rigors of clinical practice, physicians can content themselves with understanding the phenomenon of disease to the exclusion of understanding the patient's experience. Their article "is an attempt to inform both our clinical and subjective understandings of Balint's syndrome through narratives of two patients suffering from this rare and unique neurological disorder."

Balint's syndrome is named after Austro-Hungarian neurologist Rezső Bálint, who first described it. The condition is caused by one or more strokes in certain regions of the brain. It causes three deficits: Difficulty initiating voluntary eye movements (such as following a physician's finger); inaccurate arm pointing (a patient can see an object, but is unable to pick it up); and constriction of the visual field (ask a patient to look at a parking lot, and all she sees is a lamp post or a car.)

When AS woke from her nap, she couldn't find where doors or cabinets were. She couldn't name or distinguish familiar household objects. She couldn't read a book or the numbers on her telephone. She couldn't see where the bedroom wall ended and the door began. Yet when she saw an ophthalmologist, her vision with glasses was 20/20. She and her husband left the ophthalmologist's office with a referral to see a neurologist, and "wondering what sort of ailment could rob her of her ability to see the bathroom sink, while leaving her with what we typically think of as perfect vision."

The second patient, JD, was a robust, hard-working owner of a trucking business. While driving to his son's house for Thanksgiving, he began to swerve. And at Thanksgiving dinner, he held the spoon upside down. He then experienced left-sided weakness and facial drooping, before losing consciousness. Doctors believe he had suffered a massive stroke, followed by a series of mini strokes.

AD has made many adjustments. For example, while getting ready in the morning, she must touch the sink at all times to remain oriented. While showering, she has to keep her hand on the shower bar. Before brushing her teeth, she puts the toothpaste directly in her mouth, then moves the toothbrush by trial and error to meet it. She has stopped driving. And because she can no longer read, she listens to audio books.

JD has suffered depression, a first for him. "He never once cried before," his wife said, "but now he cries often."

AD said she would not wish Balint's syndrome on anyone, "because not only is this a life-change, it's a mind change."

— A majority of sexual assault victims experience severe pain in the early aftermath of the crime but less than a third of these victims receive pain medications, according to research in The Journal of Pain, the peer review publication of the American Pain Society.

One in five U.S women experiences a sexual assault in their lifetimes. Like other physical trauma, severe acute pain occurs in sexual assault cases. When physical trauma is limited, factors such as stress-induced hyperalgesia may contribute to post-assault pain. Researchers from the University of North Carolina evaluated the distribution and severity of pain in sexual assault victims who presented for medical care from sexual assault nurse examiner (SANE) programs.

This was the first prospective study of pain symptoms in the early aftermath of sexual assault. Female sexual assault survivors 18 years and older who sought a SANE evaluation within 48 hours of the crime were recruited for the study. The subjects were questioned about pain intensity in eight body regions and asked to rate pain severity on a 1- to-10 scale.

Results showed that the majority of sexual assault victims experienced severe or moderate pain in the early aftermath of the attacks. More than half of the women reported pain in four or more body regions. Less than a third said they were treated with pain medications. The study concluded that pain in the aftermath of sexual assault is not only occurring from physical trauma but also might be a neurobiological complication caused by the stress from the frightening experience.

The authors recommended that acute pain caused by sexual assault should be identified and treated promptly to reduce immediate suffering and to help improve psychological outcomes. Also, pain education for SANE program nurses and others who provide care to victims should emphasize that pain is common after sexual assault and attending clinicians should conduct pain evaluations and treat with nonsteriodal anti-inflammatory drugs and perhaps opioid medications.

A 10-week program that fits easily into the high school curriculum could give students a lifetime of less anger and lower blood pressure, researchers report.

Health and physical education teachers taught anger and stress management to 86 ninth graders in Augusta, Ga., and found their ability to control anger increased, their anxiety decreased and their blood pressures were generally lower over the course of a day compared to 73 of their peers who received no intervention, according to a study published in the journal Translational Behavioral Medicine.

Among the 30 percent of participants with higher blood pressures, the diastolic measure — the bottom number reflecting pressure inside blood vessels when the heart is relaxed and filling with blood — decreased about two points, said Dr. Vernon A. Barnes, physiologist at the Institute of Public and Preventive Health at Georgia Health Sciences University.

Even a small downward shift in blood pressure in youth could substantially reduce hypertension risk and related cardiovascular disease risk over the long term and improve public health, the researchers said. The benefits held up at six months.

"We believe we have an effective method that any school could use to help curtail violence and keep adolescents out of trouble with an improved mental state that benefits their physical well-being," Barnes said. Further study is needed to measure the program's impact in hypertensive schoolchildren, he noted.

Escalating anger and violence among youths have been associated with increased levels of stress and anxiety, which in turn increases blood pressure in adolescents, the researcher said. Additionally, self-reported feelings of anger have been shown to predict aggression in youth.

The program taught in 10, 50-minute sessions at two high schools in 2005 and 2006 is protocol-driven, fits easily into the school day and has implications for improved decision making and coping skills for adolescents in any venue, the researchers said. It appears to be the first study to examine the impact of stress management on blood pressure and indices of anger and anxiety in schoolchildren.

Drs. Redford B. Williams and Virginia P. Williams, founders of Williams LifeSkills Inc. and study co-authors, developed the 10 skills taught in William LifeSkills workshops. The former directs Duke University's Behavioral Medicine Research Center and the latter led efforts to adapt the training for adolescents, citing its ability to lower blood pressure and improve overall health and well-being in adults.

The lessons help adolescents learn to be assertive without being aggressive, make sound decisions about whether to act on negative thoughts and increase their positive interactions. Some stressful situations students worked through in class were real-life situations they shared with classmates. Their blood pressure was measured around the clock and they received pre- and post-testing to assess anger and anxiety levels.

High blood pressure problems in children are becoming increasingly common. About 30 percent of U.S. adults are hypertensive, according to the Centers for Disease Control and Prevention, while about 5 percent of children already show evidence of high blood pressure.

The research was conducted at two inner-city high schools, T.W. Josey High School and the Academy of Richmond County, and funded by a $750,000 million grant from the National Heart, Lung and Blood Institute (grant R42 HL072644).

Ben W. Strowbridge, PhD, Professor of Neurosciences and Physiology/Biophysics, and Robert A. Hyde, a fourth year MD/PhD student in the neurosciences graduate program at Case Western Reserve University School of Medicine, have discovered how to store diverse forms of artificial short-term memories in isolated brain tissue.

"This is the first time anyone has found a way to store information over seconds about both temporal sequences and stimulus patterns directly in brain tissue," says Dr. Strowbridge. "This paves the way for future research to identify the specific brain circuits that allow us to form short-term memories."

Their study, entitled "Mnemonic Representations of Transient Stimuli and Temporal Sequences in Rodent Hippocampus In Vitro," is slated for publication in the October issue of Nature Neuroscience, and is currently available online.

Memories are often grouped into two categories: declarative memory, the short and long-term storage of facts like names, places and events; and implicit memory, the type of memory used to learn a skill like playing the piano.

In their study, the researchers sought to better understand the mechanisms underlying short-term declarative memories such as remembering a phone number or email address someone has just shared.

Using isolated pieces of rodent brain tissue, the researchers demonstrated that they could form a memory of which one of four input pathways was activated. The neural circuits contained within small isolated sections of the brain region called the hippocampus maintained the memory of stimulated input for more than 10 seconds. The information about which pathway was stimulated was evident by the changes in the ongoing activity of brain cells.

"The type of activity we triggered in isolated brain sections was similar to what other researchers have demonstrated in monkeys taught to perform short-term memory tasks," according to Mr. Hyde. "Both types of memory-related activity changes typically lasted for 5-10 seconds."

The researchers also demonstrated that they could generate memories for specific contexts, such as whether a particular pathway was activated alone or as part of a sequence of stimuli to different inputs. Changes in ongoing activity of hippocampal neurons accurately distinguished between two temporal sequences, akin to humans recognizing the difference between two different song melodies. The artificial memories Dr. Strowbridge's group created in the hippocampus continued to recognize each sequence even when the interval between stimuli was changed.

The new research expands upon a previous study, also published in Nature Neuroscience in 2010, in which Dr. Strowbridge's group found that isolated pieces of the hippocampus could store which one of two inputs was stimulated. That study also found that a relatively rare type of brain cell, originally described in the 1800's by the famous Spanish anatomist Santiago Ramón y Cajal, but ignored in modern times, played a critical role in the memory effect.

By demonstrating that the same neural circuits also can store information about context, the new study will likely increase the focus on these potential "memory cells" in the hippocampus, called semilunar granule cells, says Dr. Strowbridge.

Understanding normal memory function also lays the groundwork for understanding how neurodegenerative diseases, such as Alzheimer's or Parkinson's disease, affect memory and for developing new, more effective treatments for memory impairments associated with aging

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Journal Reference:

1. Robert A Hyde, Ben W Strowbridge. Mnemonic representations of transient stimuli and temporal sequences in the rodent hippocampus in vitro. Nature Neuroscience, 2012; DOI: 10.1038/nn.3208

The World Health Organization recently recognized environmental noise as harmful pollution, with adverse psychosocial and physiological effects on public health. A new study of noise pollution in Fulton County, Georgia, suggests that many residents are exposed to high noise levels that put them at risk of annoyance or sleep disturbance, which can have serious health consequences. The research is published in the October issue of American Journal of Preventive Medicine.

"Our research estimated that the percentage of the overall populations at risk of high annoyance is 9.5%, and highly disturbed sleep at 2.3%," says co-investigator James B. Holt, PhD, of the Epidemiology and Surveillance Branch, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. "Long-term exposure to noise could increase the risks of heart attack and high blood pressure. Nighttime noise can reduce sleep quality and increase morning tiredness and insomnia."

Fulton County, Georgia is a highly urbanized area incorporating the city of Atlanta and surrounding communities. Interstate Highway 285 runs around the heart of the county, and the area inside 285 has a complex high-density road network. Investigators collected a number of data sets to estimate road traffic noise exposure levels, including topographical information, vehicle volume and speed, and the mix of vehicle types. The US Federal Highway Administration's Traffic Noise Model was used to produce road traffic noise maps for daytime and nighttime. They calculated metrics to indicate the probability that certain percentages of the population, exposed to certain levels of road traffic noise, would be highly annoyed or have high levels of sleep disturbance, at a given point.

Three cities — Atlanta, Sandy Springs, and Alpharetta — contributed to 79% of the estimated total number of people who were highly annoyed by noise in Fulton County. Atlanta, Sandy Springs, and Roswell contributed to 78% of sleep disturbance. These cities also have the highest populations in the county. In terms of prevalence, the smaller city of College Park was the city most negatively impacted, with 11.3% of its daytime population and 3.7% of its nighttime population estimated to be at risk for experiencing annoyance or sleep disturbance. Most of the people affected appeared inside the I-285 corridor and contributed 68% and 64%, respectively, to the populations estimated to be at risk of experiencing high levels of annoyance and sleep disturbance.

In a US Census Bureau survey, the city of Atlanta had the lowest percentage of households among 38 metropolitan areas reporting the presence of road traffic noise. "It may be assumed that even more people would be affected in other densely populated areas of the US," notes Dr. Holt.

Dr. Holt suggests that more studies are needed to gain insights into the severity of road traffic noise in US urban communities. "We believe it is time to begin extensive traffic-related noise research and establish up-to-date policies to control and abate noise problems for our communities," he says. "Adequate restful sleep and mental well-being are as essential to good health as adequate nutrition and physical activity. Assessing and alleviating environmental noise is an essential element for improving or creating healthy communities where adults and children can play, work, and live."

Slow-wave sleep, or 'deep sleep', is intimately involved in the complex control of the onset of puberty, according to a recent study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology and Metabolism (JCEM).

The many changes that occur in boys and girls during puberty are triggered by changes in the brain. Previous studies have shown that the parts of the brain that control puberty first become active during sleep, but the present study shows that it is deep sleep, rather than sleep in general, that is associated with this activity.

"If the parts of the brain that activate the reproductive system depend on deep sleep, then we need to be concerned that inadequate or disturbed sleep in children and young adolescents may interfere with normal pubertal maturation," said Harvard researcher, Natalie Shaw, MD, of Massachusetts General Hospital and Boston Children's Hospital who led the study. "This is particularly true for children who have been diagnosed with sleep disorders, but may also have more widespread implications as recent studies have found that most adolescents get less sleep than they require."

In the study, researchers examined pulses of luteinizing hormone (LH) secretion in relation to specific sleep stages in children ages 9-15. LH is essential for reproduction and triggers ovulation in females and stimulates the production of testosterone in males. Researchers found that the majority of LH pulses that occur after sleep are preceded by deep sleep suggesting that deep sleep is intimately involved in pubertal onset.

Other Harvard researchers participating in the study included James Butler of Brigham & Women's Hospital; and Scott McKinney, Susan Nelson, Jeffery Ellenbogen and senior author Janet Hall, all of Massachusetts General Hospital.