Showing papers in "Acta neurologica in 1992"

Long-term intrathecal baclofen treatment in supraspinal spasticity.

Abstract: Baclofen, a derivate of gamma-amino butyric acid (GABA), is known to be a useful drug in spasticity treatment. To achieve a good therapeutic response higher oral dosages have to be administered related with central side effects. Intrathecal application of Baclofen in microgram range dosages is proved to be effective in spinal spasticity. The efficiency of intrathecal Baclofen in patients suffering from supraspinal spasticity is discussed controversially. We report on 9 patients with long-term intrathecal Baclofen treatment, all of them responding well presenting a marked reduced muscle tone. In most cases an improvement of motor performance and in two cases improved bladder function was observed. The therapeutical dosages administered to patients with supraspinal spasticity exceed those administered to patients with spinal spasticity by approximately 100% without provoking central side effects. Despite the risks connected with this method it has to be considered as treatment of choice in cases of severe supraspinal spasticity.

Indication, efficiency and complications of intrathecal pump supported baclofen treatment in spinal spasticity.

Abstract: In 19 patients, who suffered from severe spinal spasticity of different etiologies and did not respond sufficiently to oral antispastic therapy, intrathecal Baclofen test boli were administered. In 11 patients a DAD (Drug Administration Device) [SynchroMedR Model 8611 H, Medtronic Inc. Minneapolis, USA] was implanted. Catheter dislocation or torsion was the most common complication to be observed in these 11 patients. Long term intrathecal Baclofen application was effective in all patients, as reducing spasticity, flexor spasms and spasm induced pain. In some cases the motor performance ameliorated.

Radioisotopic cisternography in benign intracranial hypertension of young obese women. A seven-case study and pathogenetic suggestions.

Abstract: The Authors report a series of seven obese women suffering from Benign Intracranial Hypertension (BIH), all submitted to radioisotopic cisternography. Cisternographic findings showed altered patterns of CSF clearance in all but one patient, suggesting that an increased arachnoid resistance to CSF efflux might be present in BIH of obese women. The pathophysiology of BIH is discussed: different pathogenetic mechanisms may contribute to its development with a relative importance depending on the specific etiology of the syndrome.

Study of the P300 event-related potential through brain mapping in phonological dyslexics.

Abstract: The auditory P300 was studied through brain mapping in 10 phonological dyslexics (7 M and 3 F), who were found to differ significantly from normals in presenting a longer P300 latency and smaller amplitude on the N2-P3 wave. Interesting too was the asymmetry of the P300 distribution between the two hemispheres, with less amplitude on the right. These findings confirm the hypothesis of reduced right hemisphere functioning during the process of information analysis in phonological dyslexics.

Cytokines in the pathogenesis of multiple sclerosis.

Abstract: The authors evaluate the involvement of various cytokines (interleukin-1, interleukin-2, interleukin-4, interleukin-6, tumor necrosis factor alpha and gamma-interferon) in the pathogenesis of multiple sclerosis. The cytokines might participate in nervous tissue damage by promoting demyelination and oligodendrocyte injury or by enhancing local immune response. In addition, several authors reported increased levels of some cytokines in serum and cerebrospinal fluid of patients with multiple sclerosis. These findings suggest that cytokines can play a significant role in the immunopathogenesis of the disease.

"Premorbid" personality of patients with Parkinson's disease.

Abstract: To elucidate the possible existence of a so called "premorbid parkinsonian personality" we studied 33 patients with Parkinson's disease (PD) and 66 controls who did not differ in age, sex, geographic origin, and cultural level, with the Spanish version of the Minnesota Multiphasic Personality Inventory (MMPI). Females of the PD group obtained significantly higher scores than females of the control group for the scales of hypochondria (p less than 0.01), depression (p less than 0.01), hysteria (p less than 0.05), and social introversion (p less than 0.01). The scores of the males with PD in all of the clinical scales of MMPI did not differ significantly from those of the male controls. These results, despite the difficulty of interpretation of a test done in a retrospective way, would agree with the hypothesis previously suggested of the possible existence of a "premorbid" parkinsonian personality, at least in females.

Trophic action of acetyl-L-carnitine in neuronal cultures.

Abstract: Daily addition of acetyl-L-carnitine (100 microM) to cultured cerebellar granule cells since the first day of maturation led to an increased rate of expression of D-[3H]aspartate uptake (an established marker of maturation of glutamatergic neurons) and of N-methyl-D-aspartate (NMDA) receptors linked to large conductance ion channels permeable to Ca2+. Acetyl-L-carnitine treatment also increased neuronal survival, as reflected by a greater percentage of cultures retaining functional NMDA receptors after 15 days of maturation. These results support the view that acetyl-L-carnitine exerts neuronotrophic activity and prevents age-dependent neuronal degeneration.

THINKable, a computerized cognitive remediation. First results.

Abstract: We have carried out the first study in Italy on the cognitive remediation by a new computerized system developed by IBM and called THINKable. Statistical analyses revealed that on some measures there was a significant improvement in the level of performance of the subjects at the time of the posttreatment assessment compared with the pretreatment assessment. Disorders of memory and higher cognitive functioning improved by structured retraining, independently of attention. Improvement has been matched by changes in the patients real-word functioning. Senile patients also took advantage from cognitive training. They were already followed before as outpatients and had no spontaneous recovery. The role of personal computers in neuropsychological training is discussed.

Megadolichobasilar anomaly. Clinical and diagnostic considerations on 30 cases.

Abstract: 30 patients with megadolichobasilar artery, explored by angiography, are reported; 23 among them were first studied by computerized tomography and 4 by magnetic resonance. From the clinical point of view, 9 had transient ischemic attacks or definitive ischemia, 7 had subarachnoid or intracerebral hemorrhage, and 7 had deficits of the cranial nerves; in the other 7 cases the condition was incidentally discovered as isolated asymptomatic anomaly or with other unrelated lesions. Among the patients with ischemic symptoms, vertebrobasilar insufficiency and pontine infarction were the most common clinico-radiological findings. Among the patients with intracranial hemorrhage, four had associated aneurysm or arteriovenous malformations. CT and MR allow a correct diagnosis of this anomaly. MR seems to be superior to CT in delineating the relationship of the anomalous artery with the nervous structures, and the coexisting pathology.

The use of EEG activating procedures in epileptology.

Abstract: Epileptic seizures and EEG interictal paroxysmal activity (PA) usually occur in an apparently unpredictable fashion, and a small number of patients with truly epileptic seizures may not present any PA on repeated EEGs. With the aim of increasing the possibility of recording interictal or ictal PA, several activation procedures are routinely carried out. In rarer instances, seizures seem to be more or less specifically evoked by unusual triggering procedures, or are chronologically related to biological rhythms. These different activating procedures may have different effectiveness depending on the type of epileptic syndrome. In the present paper the Authors describe the different activating procedures, both routinely employed and unusual ones. Their possible differential use with regard to the different epileptic syndromes and to the specific epileptologic history of the patient are examined. A selective use of these procedures is suggested, as an accurate choice of such techniques may increase the diagnostic usefulness of the EEG, in particular in patients whose basal recording is not contributory.

Blepharospasm associated with neurocysticercosis.

Abstract: We report a case of a 48-year-old woman who had a 4 years history of bilateral blepharospasm. CT-scan showed multiple intracranial calcifications (two of them in the left thalamus) corresponding to neurocysticerosis, and a lacunar infarction in right internal capsule area. To our knowledge this case is the first one reported in the literature of blepharospasm associated with (and perhaps symptomatic of?) neurocysticercosis.

In vivo administration of propranolol decreases exaggerated amounts of serum TNF-alpha in patients with migraine without aura. Possible mechanism of action.

Abstract: Patients with migraine without aura (MWA) display elevated amounts of Tumor Necrosis Factor (TNF)-alpha in their sera In this study in 18 patients with MWA the in vivo effect of propranolol, a beta blocker agent, was evaluated with regard to the TNF serum levels before and after treatment Results show that in 9 out 11 patients exaggerated serum concentrations of TNF reverted to normality after three months of therapy Some hypotheses on the mechanisms of action of propranolol in terms of modulation of the immune response are formulated

Dementia of Alzheimer type (DAT) in a man chronically exposed to pesticides.

Abstract: A patient chronically exposed to pesticides with dementia of Alzheimer type (DAT) is presented. We evaluate the pathogenic role of these substances in the disease and suggest the usefulness of an epidemiological attention on the environmental factors in certain neurodegenerative diseases.

Neurological damage mediated by cytokines.

Abstract: Our results suggest that CKs, in particular Interleukin-1 and Tumor Necrosis Factor (TNF)-alpha, are involved in the pathogenesis of some neurological disorders and HIV infection. Infact, we observed an exaggerated spontaneous release of TNF-alpha in patients with migraine without aura. Furthermore, in a broad spectrum of patients with HIV-infection we have also found increased amounts of serum TNF-alfa and IL-1. Interestingly, a strict correlation between plasma lipopolysaccharide (LPS) and IL-1 or TNF-alpha levels seems to exist in both group of patients, thus indicating that LPS could account for the production of CKs in the course of the above diseases.

Progress and controversies in neuropsychology of memory.

Abstract: In the first part of this paper we discuss some of the most important areas of progress and of controversy in the field of memory functions and of memory impairment. Three main issues are taken separately into account: (1) the fractionation of memory into a number of sub-systems and the relationships existing among these subsystems; (2) the main theories of amnesia and the mechanisms underlying memory disorders; (3) the main anatomoclinical forms of amnesia and the brain structures subserving various components of the amnesic syndrome. In the second part we shift from the basic research to the clinically oriented investigations, reporting the results of two studies that we have recently conducted on some aspects of memory disorders in dementia. In the first study we have shown that severity and qualitative aspects of amnesia can be used to distinguish the two most frequent clinical forms of dementia, namely the dementia of the Alzheimer's type (DAT) from the vascular forms of dementia. In the second study we have demonstrated that a fine grained analysis of memory impairment can help improving the most difficult differential diagnosis in this field, namely the distinction between DAT and depressive pseudo-dementia.

Olfactory groove meningioma and multiple aneurysms. Case report.

Abstract: We report a case of a patient with olfactory groove meningioma associated with multiple aneurysms. The association between intracranial aneurysms and meningiomas is infrequent and perhaps it is due to chance alone; many theories have been formulated to explain it. In the cases with both lesions, meningiomas are more frequently located at level of the convexity while aneurysms are more often located at level of the anterior cerebral-anterior communicating artery complex or at level of the middle cerebral artery.

Cerebral toxoplasmosis and AIDS. Clinical, neuroradiological and immunological findings in 15 patients.

Abstract: Cerebral toxoplasmosis is the most common cause of focal CNS disease complicating AIDS and its incidence ranges from 3% to 40% of such patients This opportunistic infection is generally due to reactivation of chronic toxoplasmosis as a consequence of severe immune deficiency We present the clinical, neuroradiological and immunological findings of 15 AIDS patients with cerebral toxoplasmosis All patients had focal neurological signs CT-scan (13 cases) and NMR (2 cases) showed single or multiple mass lesions and edema Serum IgG anti-Toxoplasma antibodies were positive in 14 patients; CSF specific IgG were positive in 5 out of 7 studied patients, while serum and CSF specific IgM were negative in all subjects The intrathecal synthesis of anti-Toxoplasma antibodies were high in all 7 patients A presumptive diagnosis of cerebral toxoplasmosis is based on the focal cerebral signs and neuroradiological findings It is more frequently confirmed by the improvement of the clinical and neuroradiological picture during the treatment with pyrimethamine-sulphadiazine or clindamycin

Brain SPECT and migraine in childhood.

Abstract: The recent development of SPECT has introduced a new procedure to evaluate neurological diseases. By mean of Tc99mHM-PAO we studied a group of 19 pediatric subjects (7 males and 12 females) with different form of migraine, within five days after the last headache attack. Postictally SPECT shows regionally decreased CBF in 3/4 of HM, in 5/6 of BAM, in 5/5 of CM and in 2/4 of M.

Cerebrospinal fluid interleukin-6 and IgE in bacterial and viral meningitis.

Abstract: The aim of the present study was to assess the significance of IgE and interleukin-6 (IL-6) in paired CSF and serum of patients with viral and bacterial infections of the central nervous system. The results suggest that the detection of IL-6 and IgE in CSF is an useful marker for monitoring course and prognosis of these patients.

Isolated amnesia following a bilateral paramedian thalamic infarct. Possible etiologic role of a whiplash injury.

Abstract: A previously healthy 45 years old carpenter suffered a whiplash injury in a road accident on July, 18th, 1990. He continued to work in spite of occipital headache, episodic sweatening and slight hypersomnia. On August, 8th, 1990 while parking his car into the deck of a ferry-boat he was found slightly confuse and markedly amnestic. A post-traumatic subdural haematoma was suspected. As a CT-scan of the brain was normal, a toxic encephalopathy or an hysterical amnesia were proposed. However, a MRI performed on August, 22th, 1990, apart from a small infarct in the white matter of the left occipital lobe, showed two small bilateral paramedian thalamic infarcts. The last lesions usually follow a thrombotic or embolic occlusion of the "basilar communicating artery" (BCA) belonging to the vertebro-basilar system. The possible etiologic relationship between this syndrome and the previous whiplash injury has been considered. Six months later, while a control MRI showed a reduction of the brain lesions, a neuropsychological examination revealed a slight improvement of memory dysfunction evident also at a distance of further 6 months. This case is interesting because it tests the high sensitivity of MRI in amnestic syndromes and because of the possible role of a whiplash injury in the etiology of BPTI.

Upper airway muscles dysfunction and levodopa responsiveness in Parkinson's disease.

Abstract: Pulmonary function tests were performed before and at different times after 250 mg L-Dopa in 12 patients with Parkinson's disease (PD). Six were de-novo patients, the other six patients had been taking L-Dopa over different periods. All patients had an abnormal basal flow-volume loop, which significantly improved only in de-novo patients. This improvement occurred early and was independent on improvement of neurological symptoms. The effect of L-Dopa on pulmonary function could be a useful test in differentiating PD from related extrapyramidal syndromes.

Are patients with constructional disorders different in visuo-spatial abilities?

Abstract: Many authors hypothesized a linkage between the anatomical region of damage and the nature of constructional apraxia. In particular, the functional impairment of right brain damaged patients should consist in a visuo-spatial defect. However a large amount of researches have showed impaired visuo-spatial abilities in apraxic subjects respect to non-apraxics, but independently by the side of brain damage. In these researches constructional and visuo-spatial abilities have been often evaluated by methods not comparable among them. Aim of this paper is to verify the constructional performances of left and right brain damaged patients, utilizing exclusively the copy of geometric figures and tasks considered specific in detecting visuo-spatial disabilities. The experimental results show that both left and right brain lesions produce impairments of visuo-spatial abilities. Lastly, the utility of a cognitive approach of study is discussed.

Metoclopramide-induced parkinsonism and depression.

Abstract: A 46-year-old female patient with metoclopramide-induced parkinsonism and depression was reported in view of the rarity of the concurrent development of these side effects. A risk of metoclopramide administration is suggested.

Photoparoxysmal response on eye closure in photosensitive patients.

Abstract: The Authors studied the presence of photoparoxysmal response (PPR) during intermittent photic stimulation (IPS) in 2,888 consecutive EEG recordings. PPR was present in 2.3% of EEGs and 10% of all patients referred to EEG laboratory for epilepsy (45 patients, 18 males, 27 females (M:F ratio 1:1.5), mean age 12 yrs). In 24 (53.3%) of these patients PPR was evident only (24.4%) or strikingly (28.9%) on eye closure during IPS. In 7 patients no other epileptic abnormalities were found on basal EEG and during hyperventilation, nor during IPS with eyes closed and with eyes open. The Authors consider the eye closure during IPS the most useful method to reveal a PPR in photosensitive patients and believe that a good IPS technique must include this procedure in the routine EEG examination.

Effectiveness of oxiracetam therapy in the treatment of cognitive deficiencies secondary to primary degenerative dementia.

Abstract: The effectiveness of oxiracetam (1600 mg/day) vs placebo was assessed in a group of 96 out-patients suffering from cognitive disorders secondary to primary degenerative dementia. The study, performed in double-blind, lasted 26 weeks and is expected to be continued in open conditions until a whole year of treatment is completed. The assessment of the results obtained at 6 months was carried out following both the methodology based on neuropsychological tests and scales, and the study of the simple reaction time by any of a computerised portable tachystoscope. The patients treated with oxiracetam showed a statistically significant improvement of cognitive function and simple reaction time. No significant variations in the scores of the tests used were observed in the placebo group. The patients themselves appeared in favour of oxiracetam. The drug tolerability proved to be very good for the whole duration of the treatment. The authors believe that oxiracetam favourably acts on the symptoms of senile cerebral deterioration and can improve the capability of information processing, as suggested by the better performances obtained at the reaction time tests.

Spinal cord injury: some epidemiological data. A review of 233 cases.

Abstract: Two hundred thirty-three consecutive cases of traumatic para- and tetraplegia admitted to a department of Neurosurgery in Naples within ten years were reviewed and categorized according to etiology, level of lesion and clinical features. The age of the patients at the time of injury varied from 7 to 74 years with a mean age of 37.1 +/- 17.1 (male mean age = 35.8 +/- 16.7; female mean age = 41.5 +/- 18.2). The male/female sex ratio was 4.8. Of these patients 66 were paraplegic and 167 were tetraplegic. The analysis of the various causes of the spinal cord injury showed that the occupational activities take the first place (32.2%); injuries in recreational activities and road accidents accounted for the majority of the remaining cases. Language: en

Plasma exchange and i.v.-immunoglobulins: new approaches to the treatment of Guillain-Barre' syndrome.

Abstract: We report the results obtained with plasma exchange (PE) in 26 patients (18 males, 8 females) with Guillain-Barre Syndrome (GBS) of maximal severity and also the results with IVGG in 7 patients (3 males, 4 females) where PE could not be employed. A complete clinical and neurophysiological evaluation was carried out. A follow-up was effected at regular intervals for a year. From this study the efficacy of PE in GBS was confirmed and a correlation was found between the amplitude of the muscular potential registered in the acute phase and the prognosis of the illness. PE is not effective for patients with a fulminant course and blocking of conduction. Good results have been obtained with IVGG therapy, which seems to be safe and effective whenever PE is not possible.

Slowly progressive aphasia: report of a case.

Abstract: We report on the case of a 66-year-old right-handed woman, who shows the clinical and behavioral features of "slowly progressive aphasia" described by MESULAM. At the age of 63 the patient began to develop progressive disturbances of word fluency and naming. The neuropsychological examination revealed amnestic aphasia and a mild impairment of verbal memory. Neuroradiological findings demonstrated left temporo-parietal atrophy. A neuropsychological evaluation performed two years later showed a worsening of language disorders and only a slight compromission in other cognitive areas, while the activities of daily living and the occupational functioning remained unimpaired.

Ergotamine: its use in the treatment of migraine and its complications.

Abstract: This paper gives a review of the use of ergotamine in the treatment of migraine and discusses its side effects and the treatment of possible complications. It is concluded that ergotamine is an effective and valuable substance in the treatment of acute attacks of migraine. However, ergotamine remains a potentially dangerous substance, its possible side effects being multiple and in some cases very serious. In view of the important adverse effects, the further study of other molecules effective in the treatment of acute migraine attacks is warranted.

Acute encephalopathy following lumbar myelography with iohexol.

Abstract: We report an unusual case of an acute encephalopathy following injection of iohexol for myelographic study, which was reversible after a treatment with water restriction and glucocorticoids. The pathophysiologic mechanism appears to be related with hyponatremia. We conclude that drinking of large amounts of fluids must be not recommendable in order to avoid the developing of encephalopathy.