RESUMEN

Formerly called normal pressure hydrocephalus, communicating chronic hydrocephalus (CCH) is a condition affecting 0.1 to 0.5% of patients over 60years of age. The pathophysiology of this disease is poorly understood, but a defect in cerebrospinal fluid (CSF) resorption appears to be commonly defined as the cause of the neurological disorders. The last important discovery is the description of the glymphatic system and its implication in CCH and CSF resorption. Comorbidities (Alzheimer's disease, microangiopathy, parkinsonism) are very frequent, and involve a diagnostic challenge. The clinical presentation is based on the Hakim and Adams triad, comprising gait disorders, mainly impairing walking, cognitive disorders, affecting executive functions, episodic memory, visuospatial cognition, and sphincter disorders as urinary incontinence (detrusor hyperactivity). The diagnosis is suspected through a set of arguments, combining the clinical presentation, the radiological data of the magnetic resonance imaging (MRI) showing a ventriculomegaly associated with signs of transependymomous resorption of the CSF and disappearance of the cortical sulci, and the clinical response to the depletion of CSF. In the presence of all these elements, or a strong clinical suspicion, the standard treatment will be of a permanent CSF shunt, using a ventriculoatrial or ventriculoperitoneal shunt. The effectiveness of this treatment defines the diagnosis. The clinical improvement is better when treatment occurs early after the onset of the disorders, reaching 75 to 90% of motor improvement.

Asunto(s)

RESUMEN

INTRODUCTION: Problematic use of the Internet (PUI) is more and more commonly seen among psychiatry patients. PUI is defined as an excessive preoccupation about and use of the Internet, which can be characterized by more time spent on-line than what was planned, with difficulties leading to distress or significant disorders. The new mode of interaction provided by the Internet facilitates self-disclosure, especially for socially anxious persons who feel safer and more comfortable in on-line compared with face-to-face interactions. Several studies point to the fact that insecure attachment, and particularly preoccupied attachment, is associated with problematic use of the Internet. Preoccupied attachment is characterized by a negative model of self and a positive model of others. Persons with a negative model of self feel anxious in interpersonal relationships. Because self-disclosure is easier on-line, it may play a role in problematic use of the Internet. AIMS: The aim of the study is to better understand the link between insecure attachment and problematic use of the Internet, by examining the mediating role of self-disclosure. METHOD: Participants anonymously completed the following self-questionnaires on-line: the Internet Addiction Test (IAT), which assesses problematic use of the Internet, the Relationship Scale Questionnaire (RSQ), which evaluates attachment, and the "Real-me" questionnaire, which measures increased self-disclosure on the Internet compared with face-to-face interactions. SAMPLE: Participants (n=200, 73 % women) were recruited via e-mails, social networks, ads in local stores and leaflets in public places, directing them towards a link in which they could complete the on-line questionnaires. DATA ANALYSIS: Descriptive analyses were conducted to examine the main characteristics of participants. A t-test was used to explore gender differences. Main analyses consisted of correlational analyses between attachment, the "Real-me", and problematic use of the Internet. A series of regression analyses were then used to test the mediating role of the "Real-me" in the link between insecure attachment and problematic use of the Internet. RESULTS: Results confirm the associations between problematic use of the Internet and, respectively, preoccupied and fearful attachment. Complete mediation of the "Real-me" in the association between negative model of self (attachment) and problematic use of the Internet was also confirmed. DISCUSSION AND CONCLUSION: Preoccupied and fearful attachments are both associated with problematic use of the Internet. These persons have a negative model of self which may hamper their ability to be at ease in face-to-face interactions. Being themselves on the Internet mediates the link between negative model of self and problematic use of the Internet. Resorting to a less threatening environment of exchange may thus explain these insecure individuals' tendency to overuse the Internet. Future research investigating the different activities on the Internet would be useful to better determine whether certain specific activities are more closely linked to problematic use of the Internet among insecure individuals.

Asunto(s)

RESUMEN

We have previously reported that 14-d chronic intermittent cold (CIC) stress induced a cognitive deficit in reversal learning on the rat attentional set-shifting test. This effect may be related to dysregulation of 5-HT function in orbitofrontal cortex, as a model of cognitive dysfunction in depression. To test the ability of chronic antidepressant drug treatment to reverse the cognitive deficit induced by CIC, it was first necessary to assess the temporal characteristics of the CIC-induced cognitive deficit. Thus, in the first experiment, we assessed the duration of the cognitive deficit following 2-wk CIC stress. Replicating previous experiments, CIC induced a reversal learning deficit tested 3 d after the last cold exposure. However, cognitive performance of CIC-stressed rats was no different from unstressed controls when tested 7, 14 or 21 d after termination of the stress treatment. We next compared behaviour 3 d after 2-wk CIC to that seen 3 d after 5-wk CIC, and found similar deficits in reversal learning. Thus, in the final experiment, antidepressant drug treatment was initiated after 2-wk CIC stress, and was maintained for 3 wk, concurrent with the continuation of CIC stress. Both chronic and acute treatment with the selective serotonin reuptake inhibitor, citalopram, but not the norepinephrine reuptake blocker, desipramine, reversed the cognitive deficit induced by CIC stress. Thus, this stress-induced cognitive deficit may be a useful model for cognitive deficits related to prefrontal cortical hypoactivity in depression, and for investigating neurobiological mechanisms underlying the beneficial effects of chronic antidepressant drug treatment.

Asunto(s)

RESUMEN

SUMMARY: We report two cases of aneurysm of the distal branches of the superior cerebellar artery presenting with cerebellar infarction. In both cases, the diagnosis required close correlation of the findings from different imaging techniques, as catheter angiography failed to opacify the lesions. In one patient endovascular parent vessel occlusion was performed, whereas in the second patient the aneurysm thrombosed spontaneously. We describe the clinical and radiologic presentation of these aneurysms and discuss their pathogenesis, diagnosis, and treatment.

Asunto(s)

Asunto(s)