Michael L. Rodriguez

Macquarie University

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Theodore J. Standiford

University of Michigan–Ann Arbor

Kazuhiro Tateda

Toho University

Tejaswi Kandula

Sydney Children’s Hospitals Network

Nagagopal Venna

Massachusetts General Hospital

Rebekah Ahmed

University College London

Leon McNally

St Vincent's Hospital Sydney

Graeme J. Hankey

Perron Institute for Neurological and Translational Science

Marcus A. Stoodley

Macquarie University

Wan C. Tsai

Kaiser Permanente Roseville Medical Center

P. Ian Andrews

Sydney Children's Hospital

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UNSW Sydney

University of Sydney

Sydney Children's Hospital

Sydney Children’s Hospitals Network

Children's Hospital at Westmead

Hospital de l'Esperança

Parc de Salut

St Vincent's Hospital Sydney

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St Vincent's Hospital

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Recurrence of progressive multifocal leukoencephalopathy despite immune recovery in two HIV seropositive individuals

Journal of NeuroVirology (2016)

Kate M. Crossley Shruti Agnihotri Joga Chaganti Michael L. Rodriguez Leon McNally

We present two cases of recurrent progressive multifocal leukoencephalopathy (PML) in patients with long standing virally suppressed human immunodeficiency virus (HIV) and normal CD4+ T cell count who were taking stable regimens of highly active antiretroviral therapy (HAART). This has significant implications for other patients with a past history of PML, not just those with HIV but also those on medications such as natalizumab or fumarates.

Natalizumab

JC Virus

Opportunistic infection

10.1007/s13365-015-0419-y

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Citations (17)

Clinical Characteristics and Functional Motor Outcomes of Enterovirus 71 Neurological Disease in Children

JAMA Neurology (2016)

Hooi-Ling Teoh Shekeeb S. Mohammad Philip N Britton Tejaswi Kandula Michelle Lorentzos

Enterovirus 71 (EV71) causes a spectrum of neurological complications with significant morbidity and mortality. Further understanding of the characteristics of EV71-related neurological disease, factors related to outcome, and potential responsiveness to treatments is important in developing therapeutic guidelines.To further characterize EV71-related neurological disease and neurological outcome in children.Prospective 2-hospital (The Sydney Children's Hospitals Network) inpatient study of 61 children with enterovirus-related neurological disease during a 2013 outbreak of EV71 in Sydney, Australia. The dates of our analysis were January 1, to June 30, 2013.Clinical, neuroimaging, laboratory, and pathological characteristics, together with treatment administered and functional motor outcomes, were assessed.Among 61 patients, there were 4 precipitous deaths (7%), despite resuscitation at presentation. Among 57 surviving patients, the age range was 0.3 to 5.2 years (median age, 1.5 years), and 36 (63%) were male. Fever (100% [57 of 57]), myoclonic jerks (86% [49 of 57]), ataxia (54% [29 of 54]), and vomiting (54% [29 of 54]) were common initial clinical manifestations. In 57 surviving patients, EV71 neurological disease included encephalomyelitis in 23 (40%), brainstem encephalitis in 20 (35%), encephalitis in 6 (11%), acute flaccid paralysis in 4 (7%), and autonomic dysregulation with pulmonary edema in 4 (7%). Enterovirus RNA was more commonly identified in feces (42 of 44 [95%]), rectal swabs (35 of 37 [95%]), and throat swabs (33 of 39 [85%]) rather than in cerebrospinal fluid (10 of 41 [24%]). Magnetic resonance imaging revealed characteristic increased T2-weighted signal in the dorsal pons and spinal cord. All 4 patients with pulmonary edema (severe disease) demonstrated dorsal brainstem restricted diffusion (odds ratio, 2; 95% CI, 1-4; P = .001). Brainstem or motor dysfunction had resolved in 44 of 57 (77%) at 2 months and in 51 of 57 (90%) at 12 months. Focal paresis was evident in 23 of 57 (40%) at presentation and was the most common persisting clinical and functional problem at 12 months (observed in 5 of 6 patients), with 1 patient also requiring invasive ventilation. Patients initially seen with acute flaccid paralysis or pulmonary edema had significantly greater frequencies of motor dysfunction at follow-up compared with patients initially seen with other syndromes (odds ratio, 15; 95% CI, 3-79; P < .001).Enterovirus 71 may cause serious neurological disease in young patients. The distinct clinicoradiological syndromes, predominantly within the spinal cord and brainstem, enable rapid recognition within evolving outbreaks. Long-term functional neurological morbidity is associated with paresis linked to involvement of gray matter in the brainstem or spinal cord.

Enterovirus 71

Myoclonic Jerk

10.1001/jamaneurol.2015.4388

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Citations (119)

Azithromycin Blocks Neutrophil Recruitment inPseudomonasEndobronchial Infection

American Journal of Respiratory and Critical Care Medicine (2004)

Wan C. Tsai Michael L. Rodriguez Katherine S. Young Jane C. Deng Victor J. Thannickal

Macrolides exert their effects on the host by modulation of immune responses. In this study, we assessed the therapeutic efficacy of azithromycin in a murine model of mucoid Pseudomonas aeruginosa endobronchial infection. The clearance of Pseudomonas from the airway of mice treated with the macrolide azithromycin was not different than untreated mice challenged with Pseudomonas beads. However, the azithromycin-treated mice showed a remarkable reduction in lung cellular infiltrate in response to Pseudomonas beads, as compared with untreated mice. This effect was associated with significant decreases in lung levels of tumor necrosis factor-alpha and keratinocyte-derived chemokine in azithromycin-treated mice compared with untreated mice. Furthermore, there was a significant reduction in the response of both mouse and human neutrophils to chemokine-dependent and -independent chemoattractants when studied in vitro. Inhibition of chemotaxis correlated with azithromycin-mediated inhibition of extracellular signal-regulated kinase-1 and -2 activation. This study indicates that the azithromycin treatment in vivo results in significant reduction in airway-specific inflammation, which occurs in part by inhibition of neutrophil recruitment to the lung through reduction in proinflammatory cytokine expression and inhibition of neutrophil migration via the extracellular signal-regulated kinase-1 and -2 signal transduction pathway.

10.1164/rccm.200402-200oc

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Citations (130)

Geriatric day hospital improves quality of life: A before and after study

European Geriatric Medicine (2013)

Elisabet de Jaime Olga Castro Michael L. Rodriguez E. Sevilla S. Burcet

Tinetti test

Nottingham Health Profile

Geriatric Depression Scale

Barthel index

Depression

10.1016/j.eurger.2013.06.004

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Citations (2)

The “locked‐in” syndrome and alcoholism — a preventable complication

The Medical Journal of Australia (1987)

Michael L. Rodriguez Graeme J. Hankey

Neuropathology

10.5694/j.1326-5377.1987.tb120365.x

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Citations (7)

De novo brain arteriovenous malformation after tumor resection: case report and literature review

Acta Neurochirurgica (2018)

Anna Lo Presti Jeffrey M. Rogers Nazih Assaad Michael L. Rodriguez Marcus A. Stoodley

Arteriovenous malformation

Neuroradiology

Digital subtraction angiography

Interventional radiology

Etiology

Vascular malformation

Intracranial Arteriovenous Malformations

10.1007/s00701-018-3668-8

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Citations (6)

Rapidly progressive dementia and ataxia in an elderly man

Practical Neurology (2013)

Rebekah Ahmed G. Michael Halmágyi Michael L. Rodriguez

### History A 76-year-old man, a university educated retired engineer, was referred with a 2-month history of deteriorating balance and memory. He took metformin for type 2 diabetes mellitus. He attended with his wife within 2 days of the referral and brought his recent MRI scans of the brain and abdomen. He was not concerned by any memory problems (his wife certainly was), but felt off-balance when walking. It became apparent that he had actually been losing balance and memory for about 12 months, but this had progressed more rapidly in the last 2 months. He had no headaches, sensory or urinary symptoms. He was sleeping and eating well and had not lost weight. He was an accomplished pianist and his musical abilities had not deteriorated. He had never smoked and drank little alcohol. ### Examination His wife said that he was his usual jocular self—possibly even fatuous. General examination, including heart, chest and abdomen, was normal. There was no cranial nerve abnormality, no papilloedema, no muscle wasting, normal muscle tone and strength throughout; reflexes were normal in the upper limbs, but knee jerks and ankle jerks were absent. His right plantar was extensor. Sensation was intact to pinprick; there was slight impairment of vibration and position sense at the toes. He walked with a wide-based unsteady gait and could not tandem walk; Romberg's test was positive. He scored 22/30 on the Mini-Mental State Examination, losing points for orientation, memory (recall) and repetition. On the Addenbrooke's Cognitive Examination he scored 62/100, losing points on memory (recall, anterograde and retrograde). Verbal fluency was decreased. Language, naming and comprehension were intact. His scores were: attention and orientation 14/18, memory 10/26, fluency 0/14, language 24/26, visuospatial 14/16. The MRI scan of brain (figure 1) he brought with him had been reported as follows: ‘There is moderate cerebral atrophy with prominence …

Clinical neurology

10.1136/practneurol-2012-000443

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Citations (2)