Priscilla Chukwueke obtained her medical degree from American International School of Medicine, Guyana, South America, and has a Master’s degree in public health. She is currently pursuing her psychiatry residency at Harlem Hospital /Columbia University in New York, USA. This case report was done in conjunction with a neurologist- Dr. Anne Kleiman and a radiologist- Dr Leszek Pisinski all from Harlem Hospital / Columbia University and it has been published in clinical Neuropsychiatry journal in June 2015. She has presented posters nationally and internationally e.g. at The World psychiatric Congress in Madrid Spain in 2014.

Introduction: MBD is a rare central nervous system (CNS) disease characterized by demyelination of the corpus callosum mostly found in men with alcohol use disorder and malnutrition with cases reported worldwide across all races. The onset of the disease may be sudden presenting with stupor, coma or seizures while some may present with gait abnormality (spasticity), psychiatric problems, hemiparesis, aphasia, apraxia and incontinence with a resultant high morbidity and mortality rates. Case description: patient is a 30 year old left handed African-American with history of hypertension, diabetes type I, hypothyroidism, alcohol use disorder, who presented with c/o altered mental status, urinary incontinence, slurred speech and left-sided weakness. Work up was done to r/o acute ischemic stroke or hemorrhage, other causes of encephalopathy, seizures with post ictal state and all were negative. Lab findings was significant for anemia and hypoalbuminemia. He was followed by psychiatry for suicidal ideation, depression and agitation, CT brain without contrast was unremarkable but MRI brain showed bilateral centrum ovale restricting lesion with restriction in splenium of the corpus callosum. The diagnosis of MBD was confirmed with DTI Tractography which showed significantly diminished commissural fibers extending to the right central semiovale lesion, near absent or significantly diminished commissural fiber extending through the corpus callosum indicating demyelination. Management included empirical management for meningitis, seizures followed by management of malnutrition with dietary supplements, multivitamins and rehabilitation. He responded to treatment evidenced by resolution of his presenting symptoms and by day ten of hospitalization, he was cleared and discharged to home to follow up in the outpatient clinic. Discussion: MBD is often an incidental diagnosis with high morbidity and mortality. This is different from previous casas because of earlier onset as opposed to onset around age 45, rapid recovery and minimal disability as he could work independently before discharge from hospital. This case also shows added benefit of the DTI tractography in the diagnosis of MBD.

Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

Objective: Patients with BP-II have a higher prevalence rate of metabolic disturbance and obesity than do the general population. Genetic variants of the methylenetetrahydrofolate reductase (MTHFR) gene have been regarded as predictors of weight gain in schizophrenia. In the present study, we investigated whether the MTHFR C677T polymorphism may predict changes in metabolic indices after 12 weeks of treatment in patients with BP-II. Methods: First diagnosed patients (n = 117) with BP-II according to DSM-IV criteria were recruited. Metabolic profiles (cholesterol, triglyceride, HbA1C, fasting serum glucose, body mass index (BMI)) were measured at baseline and 2, 8, and 12 weeks post-treatment. The genotype of the MTHFR polymorphism was determined using a polymerase chain reaction-restriction fragment length polymorphism analysis. Multiple linear regressions with generalized estimating equation methods were used for analysis of repeated assessments. Results: Seventy-six (65.0%) patients completed the intervention. Significantly difference in BMI change was associated with the MTHFR C677T genotypes (P = 0.005). Patients with the C/C genotypes had higher frequency of metabolic syndrome at baseline than those with the C/T+T/T genotypes; no significant difference in frequency of metabolic syndrome was found at between the two genotypes after 12 weeks of treatment. Conclusion: We conclude that the MTHFR C677T polymorphism is associated with changes in BMI and metabolic syndrome in BP-II patients after 12 weeks of treatment.

Department of Psychiatry, National Cheng Kung University, Tainan, Taiwan

Objectivs: Bipolar II disorder (BP-II), characterized by recurrent dysregulation of mood, is a serious and chronic psychiatric illness. However, BP-II is commonly under-recognized, even in psychiatric settings. Because dopaminergic disturbance is thought to be involved in the development of bipolar disorder (BPD), it seems essential to investigate dopamine-related genes like the catechol-O-methyltransferase (COMT) gene, which are involved in dopamine metabolism, and the methylenetetrahydrofolate reductase (MTHFR) gene, which may affect COMT methylation and COMT function. The current study examined the association and interaction of the COMT Val158Met and MTHFR C677T variants with BP-II. Methods: Nine hundred seventy-eight participants were recruited: 531 with BP-II and 447 healthy controls. The genotypes of the COMT and MTHFR polymorphisms were determined using a polymerase chain reaction-restriction fragment length polymorphism analysis. Results: After the MTHFR C677T genotypes in BP-II patients and Controls had been stratified, the COMT Val/Val variant was significantly more frequently detected in Controls than in BP-II patients (P=0.008). Logistic regression analysis showed a significant interaction effect of the COMT Val158Met Val/Val genotype and the MTHFR C677T C/T+T/T genotype (OR = 0.57, P = 0.039). for the protective effect on the odds of developing BP-II. Conclusion: Our findings support preliminary evidence that the COMT and MTHFR genes interact in BP-II, and they imply the connection of both dopaminergic pathways and methylation pathways in the pathogenesis of BP-II.

Reeta Jaya Philip is a PhD scholar in Speech Language Pathology at Dr. S R Chandrasekhar Institute of Speech and Hearing, Bangalore University, India. Her area of research interest includes traumatic brain injury and related disorders and adult neurogenic language disorders.

Background: Arnold Chiari Malformation (ACM) is a group of congenital abnormality involving the cerebellum and spinal cord and type 1 Chiari malformation has its primary feature as the herniation of the cerebellar tonsils through the foramen magnum into the cervical spinal canal. Chiari malformation is reported to be a rare cause of bilateral vocal cord palsy in the adult population. Chawla, Wee and Arora (2008) reported a single case of bilateral vocal cord paralysis as a result of Chiari malformation in adults. There have been no reports that suggest the presence of unilateral vocal cord palsy in ACM. Aim: This study reports the occurrence of unilateral vocal cord palsy due to ACM and highlights voice characteristics that are considered critical in the assessment of individuals diagnosed with ACM. Methodology: The participant of the study was a 31 year old male with a diagnosis of Type 1 Arnold Chiari malformation. He reported witha concern of sudden change in voice. Detailed voice evaluation consisted of both perceptual and objective assessment. Perceptual voice evaluation was carried out using GRBAS scale, objective evaluation was carried out using Multi Dimensional Voice Program (CSL model 4500, Kay Elemetrics) and Stroboscopy. Results: The perceptual and acoustic evaluation results are discussed and showed good correlation. Stroboscopy findings revealed right vocal cord paresis. Conclusion: ACM needs to be considered as a possible cause of sudden onset vocal cord palsy and reported cases of Arnold Chiari malformation should be assessed for vocal cord palsy and related consequences.

Daly Sebastian is currently working as a junior Lecturer in Department of Speech Language Studies, Dr. S. R. Chandrasekhar Institute of Speech and Hearing, Bangalore University. Her areas of research interest are neurogenic communication disorders, Multilingualism and neuro cognition. She has published papers in reputed journals and contributed chapter in International text books.

Background: The consequences of cerebrovascular accidents are multifaceted. Vascular Cognitive Impairment (VCI) and Gerstmann’s Syndrome are examples of two conditions associated with vascular lesions. Co-existence of these two conditions is rare. Aim: To investigate the nature of cognitive linguistic deficits in co-morbid condition of VCI impairment with GS. Method: The participant of this study is a 31 year old Bilingual (Arabic-English) male who had an ischemic stroke involving the left middle cerebral artery leading to a large infarct in the left frontotemporoparietal lobe with a dominant parietal lobe lesion. The clinical tools used were Western Aphasia Battery (WAB), Mini Mental State Examination (MMSE), Addenbrooke’s Cognitive Examination (ACE-R) and check list based on International Classification of Functioning, Disability and Health (ICF) frame work. Results: The test battery approach used to identify these two conditions confirmed the co-morbidity of Vascular Cognitive Impairment with Gerstmann’s syndrome. Clinical evaluation revealed acalculia, alexia, finger agnosia, right-left confusion and memory loss. Cross linguistic deficits were also documented in Arabic and English. In addition, over all functionality was profiled by using ICF frame work. Conclusion: This current study provides an insight to the importance of carefully investigating the co-morbidity of conditions as a result of vascular lesions as these are overlooked in clinical settings and would therefore hinder the specific treatment approaches related to cognitive linguistic rehabilitation for the individual.

Makarenko O M has completed his PhD degree at the Moscow Medical Stomatological Institute. He has completed his MD degree at the Institute of Higher Nervous Activity in Moscow. He carries out his Post-doctorate researches at the Institute of higher nervous activity and T G Shevchenko National University of Kiev. He is a Professor of the Psychology Department, the author of more than 100 articles in reputed journals and 4 monographs.

Trophinotropins (TT) or neurotrophinotropic growth factors (NGF) are the group of endogenous therapeutic factors which are actively secreted by cells of the organism being in the state of restoration after pathological process modeling or under recovery/remission. A distinctive feature of TT action is the activating influence on the cells of damaged tissues and organs along with their protective and immune-corrective mechanisms of action. “Cerebral” is the agent separated from nerve cells of the cerebral cortex of pigs, experienced bihemispheric autohemorrhagic stroke. It contains a complex of low-molecular pharmacologically active peptides (less than 1200 Da). The drug is characterized by its cerebrotropic multimodal action on nerve cells which may effect is a trigger trophinotropic regulatory action on secretion of NGF and other cytokines. Application of ‘Cerebral’ increases the level of synthesis and secretion of NGF in the conditions of experimental hemorrhagic stroke and at the same time does not influence synthesis and secretion of this growth factor in the intact animals. In the experiment, NGF secretion in the CNS was increased under intranasal way of introduction because the concentration of mRNA NGF was 0.05- 0.74 pmol/l on the 2nd day after introduction (whereas concentration under intraperitoneal introduction was 0.05-0.10 pmol/l mRNA on the 2nd day) at the expense of express delivery of its molecules into the brain. The drug showed neuro-activating action in acute and remote from the beginning of stroke diseases periods, modifies cellular metabolism, restores unconditional reflex reactions and lost functions, activates the process of intellectual and psychoemotional activity.