Creating Waves of Awareness
Excellent article, thanks for sharing.
We read so many things during our education, but unfortunately forget many topics. Thanks for reminding this topic.
Does corticobasal degeneration exist? A clinicopathological re-evaluation
It appears diagnosis may take some time, including misdiagnosis of other similar diseases.
The pathological findings of corticobasal degeneration are associated with several distinct clinical syndromes, and the corticobasal syndrome has been linked with a number of diverse pathologies. We have reviewed all the archival cases in the Queen Square Brain Bank for Neurological Disorders over a 20-year period with either a clinical diagnosis of corticobasal syndrome or pathological diagnosis of corticobasal degeneration in an attempt to identify the main diagnostic pitfalls.
Of 19 pathologically confirmed corticobasal degeneration cases, only five had been diagnosed correctly in life (sensitivity = 26.3%) and four of these had received an alternative earlier diagnosis. All five of these had a unilateral presentation, clumsy useless limb, limb apraxia and myoclonus, four had cortical sensory impairment and focal limb dystonia and three had an alien limb.
Eight cases of corticobasal degeneration had been clinically diagnosed as progressive supranuclear palsy, all of whom had vertical supranuclear palsy and seven had falls within the first 2 years. On the other hand, of 21 cases with a clinical diagnosis of corticobasal syndrome, only five had corticobasal degeneration pathology, giving a positive predictive value of 23.8%; six others had progressive supranuclear palsy pathology, five had Alzheimer’s disease and the remaining five had other non-tau pathologies.
Corticobasal degeneration can present very commonly with a clinical picture closely resembling classical progressive supranuclear palsy or Richardson’s syndrome, and we propose the term corticobasal degeneration-Richardson’s syndrome for this subgroup. Cases of corticobasal degeneration-Richardson’s syndrome have delayed onset of vertical supranuclear gaze palsy (>3 years after onset of first symptom) and the infrequent occurrence of predominant downgaze abnormalities, both of which can be helpful pointers to their underlying corticobasal degeneration pathology.
Fourty-two per cent of corticobasal degeneration cases presented clinically with a progressive supranuclear palsy phenotype and 29% of cases with corticobasal syndrome had underlying progressive supranuclear palsy pathology. In contrast, in the Queen Square Brain Bank archival collection, corticobasal syndrome is a rare clinical presentation of progressive supranuclear palsy occurring in only 6 of the 179 pathologically diagnosed progressive supranuclear palsy cases (3%). Despite these diagnostic difficulties we conclude that corticobasal degeneration is a discrete clinicopathological entity but with a broader clinical spectrum than was originally proposed. ~ jaonnolz
Corticobasal degeneration is primarily a Syphilitic miasmatic condition. In this type of degeneration, there is a unique point that its initiation is due to Sycosis which may be in latent form initially. Due to Turmoil in life, at genetic level, the sycosis becomes active and starts fruiting. But due to fundamentally syphilitic trend, the syphilis is aroused due to partial interaction of Psora and both the miasms- Psora and Sycosis are SUPPRESSED while Syphilis becomes predominently active and manifests its full course, often ending in termination of life....
The treatment required is based on antimiasmatic ground. Firstly, we have to SUPPRESS Syphilis so that the degenerations could be immediately stopped. Then the Psora who triggered the Syphilis is to be treated, so that the Exciting cause of Syphilis might be removed. Now the syphilis is spontaneously towards regression. In last, we should treat Sycosis to establish perfact cure. But Remember- The permanent irriversible changes occured in body may not be cured and some deformity may persist even after a cure.
Thank you, Dr Rajneesh, for this explanation on miasms. Thus, this type of disease requires stages of healing and considerable amount of time to see improvement. Dr Arun, have you seen many cases of this nature?
You are welcome Debby.
your Intervention will help us to discuss CBD logically.yes I have not much cases but I am dealing two cases at a time one is 65 yrs old lady & another is 57yrs old.I am not sure about compleate cure but my both pt. is responding & runing well with Homoeopathy.
All the best Dr. Arun.
You are welcome Dr. Rajneesh kumar sharma,M.D(Hom).