Showing papers in "Acta Neurologica Scandinavica in 2009"
TL;DR: R is a useful test, the classification may be useful in clinical/therapeutical decisions, and CTS classification appeared reliable with significant differences between groups.
Abstract: Objectives To evaluate the following points about carpal tunnel syndrome (CTS): 1) characterization of a wide population; 2) sensitivity of electrodiagnostic tests, and particularly the contribution of disto-proximal ratio test; 3) validity of a neurophysiological classification developed by us. Material and methods Prospective study in 500 hands with CTS symptoms. Neurophysiological "standard" tests were always performed: sensory nerve conduction velocity (SNCV) first- and third digit-wrist and distal motor latency (DML). In "standard negative" hands disto-proximal ratio technique (R) was performed. Neurophysiological classification: Extreme CTS (absence of median motor, sensory responses), Severe (absence of sensory response, abnormal DML), Moderate (abnormal SNCV, abnormal DML), Mild (abnormal SNCV, normal DML), Minimal (abnormal R or other segmental/comparative test, normal standard tests). Results Sensibility of standard tests: 77%. R increased the diagnostic yield by 20%. CTS classification appeared reliable with significant differences between groups. Conclusion R is a useful test, the classification may be useful in clinical/therapeutical decisions.
417 citations
TL;DR: Rats with different levels of blood glucose concentration were exposed to 10 min of complete brain ischemia achieved by compression of neck vessels by a pneumatic cuff to study the effects of fasting on blood glucose levels.
Abstract: Rats with different levels of blood glucose concentration were exposed to 10 min of complete brain ischemia achieved by compression of neck vessels by a pneumatic cuff.
All normoglycemic rats survived the ischemic period and made the best clinical recovery. Hyperglycemic rats died within 12 h. Seizure activity was observed in all animals in this group. Three of eight hypo-glycemic rats died between 3 and 16 days. The clinical recovery was less complete than in the control group.
Thus, recovery from cerebral ischemia depends upon preischemic blood glucose concentration. Hyper- and hypoglycemia hamper the clinical recovery after transient cerebral ischemia.
381 citations
TL;DR: Juvenile myoclonic epilepsy is a special syndrome within the primary generalized epilepsies which is characterized clinically by irregular jerks of shoulders and arms after awakening and electroencephalographically by bilateral‐synchronous 4–6/s spike‐wave complexes, often in the form of multispike‐waves.
Abstract: – Juvenile myoclonic epilepsy (JME) is a special syndrome within the primary generalized epilepsies which is characterized clinically by irregular jerks of shoulders and arms (so-called impulsive petit mal) after awakening and electroencephalographically by bilateral-synchronous 4–6/s spike-wave complexes, often in the form of multispike-waves. The age of onset for this syndrome which occurs in 4–6% of all epilepsies is predominantly between 12 and 18 years. It mostly starts with isolated jerks which as a rule are soon followed by generalized tonic-clonic seizures (TCS). Jerks and TCS are provoked by sleep deprivation and predominantly occur after awakening (awakening epilepsy). Sleep deprivation and photostimulation are also very efficient in provoking specific EEG patterns. Exogenous factors have no etiological significance. Genetic studies suggest a polygenetic mode of inheritance and a lower threshold of manifestation in women. JME can be controlled very well by valproate and/or primidone. A complete cure, nevertheless, does not seem to be possible. Within the group of primary generalized epilepsies beginning in adolescence JME is closely related nosologically to the syndrome of juvenile absences and the syndrome of pure grand mal on awakening.
355 citations
TL;DR: It was confirmed that the distribution of the grey matter blood flow showed a hyperfrontal pattern, the flow in frontal regions being significantly (20‐40 %) higher than in postcentral, occipital and temporal regions.
Abstract: Regional cerebral blood flow was measured with the intra-arterial 133 Xenon clearance technique using a multidetector device in 11 patients undergoing carotid angiography (with normal findings). During the flow studies the patients were awake and strict resting conditions were observed. The patients did not move or speak, and sensory stimulation was kept at a minimum. It was confirmed that the distribution of the grey matter blood flow showed a hyperfrontal pattern, the flow in frontal regions being significantly (20-40 %) higher than in postcentral, occipital and temporal regions. There were no technical factors or morphological features of the telencephalon which could explain this difference. It was also shown that the distribution of the white matter flow and the relative weight of the grey matter corresponded in general to hemisphere morphology.
Since in normal nervous tissue the blood flow is regulated by the neuronal activity, the following interpretation is given of the main finding. The hyperfrontal flow distribution of the grey matter (cortical) flow during resting wakefulness shows that there is a high activity in frontal “efferent” (motor-behavior) regions. At the same time there is a low activity in post-central and temporal “afferent” (sensory-gnostic) cortical areas. The high frontal activity suggests that in the resting conscious state - unaccompanied by movements, speech or behavioral reactions - the brain is active with an anticipatiory “simulation of behavior”. The low postcentral flow, on the other hand, may possibly be related to a global inhibition of the sensory input. Several clinical as well as general biologic arguments are forwarded to support this interpretation.
It is further pointed out that the hyperfrontal distribution of the resting activity in the cerebral cortex correlates to the resting EEG, in which lower frequencies (the alpha rhythm) predominate in postcentral and temporal regions where there is a low flow/activity, and high frequencies in frontal areas where the blood flow is high. This is in agreement with the finding that the blood flow and metabolism of the brain correlate to the EEG frequency content.
322 citations
TL;DR: The topography of regional, selective neuron loss in this model corresponded to areas with pronounced glutamate high affinity uptake (presynaptic receptors), suggesting that transmitter glutamate is involved in the mechanism of neuron damage.
Abstract: Male Wistar rats were subjected to 20 min of cerebral ischemia by means of 4-vessel occlusion. The topography of regional, selective neuron loss in this model corresponded to areas with pronounced glutamate high affinity uptake (presynaptic receptors), suggesting that transmitter glutamate is involved in the mechanism of neuron damage. One group of animals was injected with the glutamate antagonist, glutamic acid diethyl ester (GDEE) before ischemia. The regional neuron loss was rated using a semiquantitative scale. No statistically significant difference was found between the groups. The results do not exclude a possible role of transmitter glutamate in the pathogenesis of ischemic brain damage. More specific and potent glutamate antagonists are needed in order to clarify such a mechanism.
311 citations
TL;DR: The aim of this study was to screen for and quantify the neurotoxic amino acid β‐N‐methylamino‐l‐alanine (BMAA) in a cohort of autopsy specimens taken from Alzheimer's disease, amyotrophic lateral sclerosis, Huntington’s disease, and non‐neurological controls.
Abstract: Objective – The aim of this study was to screen for and quantify the neurotoxic amino acid β-N-methylamino-l-alanine (BMAA) in a cohort of autopsy specimens taken from Alzheimer’s disease (AD), amyotrophic lateral sclerosis (ALS), Huntington’s disease (HD), and non-neurological controls. BMAA is produced by cyanobacteria found in a variety of freshwater, marine, and terrestrial habitats. The possibility of geographically broad human exposure to BMAA had been suggested by the discovery of BMAA in brain tissues of Chamorro patients with ALS/Parkinsonism dementia complex from Guam and more recently in AD patients from North America. These observations warranted an independent study of possible BMAA exposures outside of the Guam ecosystem.
Methods – Postmortem brain specimens were taken from neuropathologically confirmed cases of 13 ALS, 12 AD, 8 HD patients, and 12 age-matched non-neurological controls. BMAA was quantified using a validated fluorescent HPLC method previously used to detect BMAA in patients from Guam. Tandem mass spectrometric (MS) analysis was carried out to confirm the identification of BMAA in neurological specimens.
Results – We detected and quantified BMAA in neuroproteins from postmortem brain tissue of patients from the United States who died with sporadic AD and ALS but not HD. Incidental detections observed in two out of the 24 regions were analyzed from the controls. The concentrations of BMAA were below what had been reported previously in Chamarro ALS/ Parkinsonism dementia complex patients, but demonstrated a twofold range across disease and regional brain area comparisons. The presence of BMAA in these patients was confirmed by triple quadrupole liquid chromatography/mass spectrometry/mass spectrometry.
Conclusions – The occurrence of BMAA in North American ALS and AD patients suggests the possibility of a gene/environment interaction, with BMAA triggering neurodegeneration in vulnerable individuals.
307 citations
TL;DR: It is concluded that etiology and localization are of prognostic value in spontaneous intracerebral hemorrhage.
Abstract: To determine the prognostic value of etiology and localization in spontaneous intracerebral hemorrhage, 896 patients with spontaneous intracerebral hemorrhage, as proven by CT, operation or autopsy, were retrospectively studied using univariate data analysis. Etiologies were hypertension in 63.5%, cerebrovascular malformations in 8.5% and abnormal hemostasis in 15% of the patients. In 23% no etiology was determined. Main localizations were cerebral lobes in 49.2%, basal ganglia in 34.4%, brain stem in 6.9%, cerebellum in 6.7% and primary intraventricular in 2.3% of the patients. Ventricular extension was present in 47.0%. A higher case fatality correlated with: 1) ventricular extension (P<0.00001), 2) increasing age (P=0.00005), 3) surgical treatment (P=0.00010), 4) localization in basal ganglia (P=0.0108) and 5) hypertension as only etiology (P=0.01471). A lower case fatality was found in patients with cerebrovascular malformations (P=0.00006) and when the hemorrhage was localized to the cerebral lobes (P=0.0050). We conclude that etiology and localization are of prognostic value in spontaneous intracerebral hemorrhage.
248 citations
TL;DR: In the last decade the number of available studies has more than tripled as discussed by the authors, and available prevalence studies of multiple sclerosis (MS) seem to divide the world into three frequency zones for MS: high prevalence at 30 to 60 per 100,000 population; medium at 5 to 15; and low at less than 5 per 100 000.
Abstract: When reviewed some 10 years ago, available prevalence studies of multiple sclerosis (MS) seemed to divide the world into three frequency zones for MS: high prevalence at 30 to 60 per 100,000 population; medium at 5 to 15; and low at less than 5 per 100,000. In the last decade the number of the available studies has more than tripled. Their reassessment, including judgments of comparability, still indicates a high-medium-low division of MS frequency world-wide. The risk areas comprise northern Europe, northern United States, much of southern Canada, New Zealand, and probably southern Australia. Prevalence rates in these regions are mostly 30 to 80 per 100,000 population, centering at about 50. Medium frequency is defined as prevalence of 5 to 25, and is mostly 10 to 15. In Europe, the medium frequency zone bounds that of high frequency to the north, east, and south. The European Mediterranean basin is of medium prevalence with a sharp division from the high zone across France and Switzerland. It is likely that this division continues eastward across Austria, north of Hungary, and across the upper Ukraine to the Caspien Sea, but this is not definite. Medium risk areas of Europe thus include surveyed sites of Spain, Italy, Hungary, Jugoslavia, Bulgaria, and central Ukraine, together with southeastern France and southern Switzerland. Though Romania could be high, it is more likely to be of medium prevalence. Turkey measures low, but from incomplete data. From nationwide prevalence and mortality studies, the west coast of Norway and all Scandinavia above latitude 65 degrees north are of medium frequency. Based on hospital data, northwestern USSR is high, and central and southern USSR medium, in MS risk. Other medium risk areas include southern United States, most of Australia, one ethnic group only in South Africs, and possibly Hawaii. Low risk areas are allsurveyed sites of Asia, the Pacific islands, Africa, Latin America, Alaska, and Greenland.
248 citations
TL;DR: An easy and safe method for muscle biopsy is described that combines the advantage of the “open‐surgical” method‐sufficient quantity of material‐with the advantages of the needle methods‐easy to perform, not incapacitating and only slightly uncomfortable for the patient.
Abstract: An easy and safe method for muscle biopsy is described. The biopsy instrument is an alligator forceps (Weil-Bladesley's conchotome). With this method an adequate amount of muscle tissue can be obtained for both chemical and morphological studies. The method combines the advantage of the "open-surgical" method - sufficient quantity of material - with the advantages of the needle methods - easy to perform, not incapacitating and only slightly uncomfortable for the patient. Out of 959 consecutive biopsies with this method only 19 were impossible to evaluate because of too much artefact or too little tissue.
230 citations
TL;DR: The cerebrospinal fluid pressure‐volume curve was determined by measuring the pressure response to rapid injection of fluid into the cisterna magna of dogs, by means of a constant flow infusion pump.
Abstract: The cerebrospinal fluid pressure-volume curve was determined by measuring the pressure response to rapid injection of fluid into the cisterna magna of dogs, by means of a constant flow infusion pump. The shape of the curve is complex, with two plateaus at the levels of the venous and arterial pressures, respectively. The slope dP/dV is referred to as the elastance of the system (mmHg/ml). The elastance has a low value in the normal pressure range and shifts at a fluid pressure of about 15 mmHg to a value approximately 20 times higher, with a relatively minute change in the volume of the system.
229 citations
TL;DR: It is suggested that an unusual neurological syndrome in an Arab family with five affected siblings probably represents a new syndrome which is closely related but not identical to the pallido‐pyramidal syndrome.
Abstract: An unusual neurological syndrome in an Arab family with five affected siblings, is reported. Autosomal recessive inheritance is suggested by having multiple affected siblings born to phenotypically normal consanguineous parents. Similar to Davison's Pallido-pyramidal syndrome, they presented with the clinical signs and symptoms of severe parkinsonism as well as evidence of cortico-spinal tract disease. In addition, they had dementia and supranuclear upgaze paresis. MRI studies showed significant atrophy of the globus pallidus and the pyramids, as well as generalized brain atrophy in later stages. Therapy with levodopa resulted in significant improvement in the extrapyramidal dysfunction. We suggest that this probably represents a new syndrome which is closely related but not identical to the pallido-pyramidal syndrome.
TL;DR: Course of neurologic involvements was similar in acute or subacute and chronic sarcoidosis, and the effect of steroid treatment was inconsistent.
Abstract: Fifty consecutive patients with neurosarcoidosis were evaluated retrospectively. Sarcoidosis presented first with neurologic signs in 24 patients (48%), but systemic symptoms developed later in all but five. Main neurologic involvements were central nervous system lesions in 33 patients (66%), cranial nerve paresis in 12 (24%), and peripheral nerve lesions in five patients (10%). Seventeen patients (34%) had more than one type of neurologic involvement. Routine cerebrospinal fluid (CSF) parameters showed unspecific abnormalities in 35 patients (70%). CSF angiotensin converting enzyme was elevated in 18 of 31 patients (58%). Brain computerized tomography was abnormal in 13 of 32 patients (41%). Visual and brainstem evoked potentials were abnormal in ten (43%) and eight (35%) of 23 patients, respectively, suggesting subclinical lesions in 13 patients. Neurologic signs improved in 24 patients (48%), were stable in 11 (22%), and progressed in 15 patients (30%). Six patients died. Cranial nerve lesions improved most often. Course of neurologic involvements was similar in acute or subacute and chronic sarcoidosis. The effect of steroid treatment was inconsistent.
TL;DR: The authors suggest the depression in Parkinson's disease to be of both reactive and endogenous origins.
Abstract: Nineteen patients with L-DOPA treated parkinsonism involving depressive symptoms, the therapeutic effect of nortriptyline was compared to placebo in a controlled trial. The depressive and neurological symptoms were evaluated by rating scales. Nortriptyline had a clinical significant effect with regard to the depressive symptoms, whereas the neurological parameters were unchanged. The authors suggest the depression in Parkinson's disease to be of both reactive and endogenous origins.
TL;DR: The functional outcome and health‐related quality of life (HRQL) 10 years after moderate‐to‐severe traumatic brain injury (TBI) are described.
Abstract: OBJECTIVES: To describe the functional outcome and health-related quality of life (HRQL) 10 years after moderate-to-severe traumatic brain injury (TBI). MATERIAL AND METHODS: A retrospective, population-based study of 62 survivors of working-age with moderate-to-severe TBI injured in 1995/1996, and hospitalized at the Trauma Referral Center in Eastern Norway. Functional status was measured by the Glasgow Outcome Scale-Extended (GOS-E). HRQL was assessed by the SF-36 questionnaire. RESULTS: The mean current-age was 40.8 years. The frequency of epilepsy was 19% and the depression rate 31%. A majority had good recovery (48%) or moderate disability (44%). Employment rate was 58%. Functional and employment status were associated with initial injury severity in contrast to HRQL. Study patients had significantly lower scores in all SF-36 dimensions when compared with the general Norwegian population. CONCLUSION: At 10-years follow-up, our study population is still in their most productive years and affected domains should be considered in long-term follow-up and intervention programs. Language: en
TL;DR: Efficacy and tolerability of the new antiepileptic drug oxcarbazepine, was evaluated in a retrospective multicentre study and Rash was reported in 6% of patients, half of these patients had previously had an allergic reaction to carbamazepine.
Abstract: Efficacy and tolerability of the new antiepileptic drug oxcarbazepine, was evaluated in a retrospective multicentre study. The records of all 947 epilepsy patients treated with oxcarbazepine in the eight participating centres from 1981 through 1990 were examined. The median daily dose of oxcarbazepine was 30 mg/kg in children, 18 mg/kg in adults, and 15 mg/kg in elderly patients, given b.i.d. or t.i.d. The mean plasma levels of the main active metabolite of oxcarbazepine was 88, 79, and 68 mumol/l in children, adults, and elderly, respectively. In patients shifted to oxcarbazepine treatment, seizure frequency was unchanged in 51-66%, 32-48% had a decrease, and 1-10% an increase in seizure frequency, considering the individual seizure types separately. Adverse events were reported in one third of patients, most frequently affecting the CNS (dizziness: 6%; sedation: 6%; fatigue: 6%). Rash was reported in 6% of patients, half of these patients had previously had an allergic reaction to carbamazepine. Hyponatremia was found in about a quarter of the patients from whom data were available. No congenital malformations were seen in nine live-born, first trimester oxcarbazepine-exposed children.
TL;DR: The effect of L-DOPA and L-tryptophan on the cerebral blood flow was studied in anaesthetized dogs injected intravenously with one or other of the drugs.
Abstract: The effect of L-DOPA and L-tryptophan on the cerebral blood flow was studied in anaesthetized dogs injected intravenously with one or other of the drugs. Cerebral blood flow was measured with the radio-active gas elimination technique with external γ-registration. After L-DOPA there were signs of an increase of the cerebral blood flow followed later by a decrease. The effect of L-tryptophan on the cerebral blood flow in all experiments was a decrease.
TL;DR: It is suggested that the entire battery of neuropsychological tests should be applied and their results compared using the efficiency increment procedure, in order to establish a firm differential diagnosis between dementia and depression, and/or to detect the former when it is at a mild early stage.
Abstract: A battery of neuropsychological tests was examined to establish its value in differentiating mild dementia from depression. The battery was applied to 84 subjects: 31 dementia patients of several etiologies, 31 patients with major depression and 22 volunteers whose age and educational level was similar to that of the patients. The battery consisted of tests for immediate, recent and remote memory, the Mini Mental State examination, a screening test for language disorders, and tests measuring abstraction, calculation, judgement, praxic and gnosic functions. The results showed significant differences among the three groups in all memory tests. Deficits of abstraction, calculation, praxis and language functions were strongly associated with dementia. The epidemiological analysis of efficiency increment, with determination of sensitivity and specificity, showed a highly significant enhancement of efficiency for diagnostic purposes when the results of the tests were combined. These findings suggest that the entire battery of neuropsychological tests should be applied, and their results compared using the efficiency increment procedure, in order to establish a firm differential diagnosis between dementia and depression, and/or to detect the former when it is at a mild early stage.
TL;DR: An analysis was made of weight changes during treatment with valproate in 63 adult epileptic patients and the results confirmed that weight loss is associated with disease progression.
Abstract: An analysis was made of weight changes during treatment with valproate in 63 adult epileptic patients. 36 patients (57%) gained more than 4 kg in weight during treatment, while 27 patients (43%) were stable in weight with weight changes of less than +/- 4 kg. There were no significant differences between weight gainers and weight-stable patients with regard to age, sex, pretreatment overweight, duration of treatment, dosage or serum levels of valproate. From structured patient interviews, it appeared that the 2 groups of patients differed only insignificantly with regard to appetite, thirst and familial predispositions to obesity and diabetes. Consequently, no factors predictive for weight gain could be outlined. Presumable pathogenic mechanisms of importance are discussed.
TL;DR: The increased ADC in apparently normal white matter suggests that there may be a change in the composition of the white matter of chronic MS patients, perhaps related to oedema and expanded extracellular space.
Abstract: A new method for measurement of water self-diffusion compensating for zeroth and first order movements was used to study the apparent diffusion coefficient (ADC) in 15 patients with chronic multiple sclerosis (MS) and in two patients with acute MS. Ten healthy volunteers served as controls. A significantly higher ADC was found within chronic plaques compared to the apparently normal white matter of the chronic patients. The ADC was higher in the acute plaques compared to the chronic plaques. The ADC in apparently normal white matter of the chronic patients were significantly higher than in white matter of healthy volunteers. We hypothesize that an increase of the ADC in plaques may be related to an increase in the extracellular space due to oedema and demyelination. The increased ADC in apparently normal white matter suggests that there may be a change in the composition of the white matter of chronic MS patients, perhaps related to oedema and expanded extracellular space.
TL;DR: The Finnish cases of progressive myoclonus epilepsy do not belong to the Lafora body type of the disease and differ from this type mainly on the basis of the fairly high intelligence level.
Abstract: The purpose of the present study was to describe the characteristic features of the PME syndrome and their development during the progression of the disease, as well as to clarify the possible division of the patients into groups without interdependence on the basis of the EEG findings. Two hundred and six EEG's taken on 86 patients at the different stages of the disease were analysed, the patients being followed up for 6.7 years on the average. At the time of the recording the ages of the patients ranged from 6.6 to 46.7 years. Four patients were examined immediately after the appearance of the first symptoms of the disease. Some had been ill for more than 20 years. In order to elucidate latent and premorbid forms, EEG's were performed on the patients' parents and clinically healthy brothers and sisters. Thirty-one parents and 22 brothers and sisters were examined. On the basis of this investigation, the following conclusions were drawn: All the EEG's showed generalized spike and wave paroxysms of 3–5 Hz and a distinct photosensitivity. The dominant activity was slower and more disorganized than normal. As the disease progressed, the EEG's became characterized by an increasing number of paroxysms with their maximal presentation migrating to the frontal areas, attenuation of alpha activity and increase of beta activity. The PME patients were photosensitive at all stages of the disease. The sensitivity to sound and tactile stimulation increased during the disease. In the grouping analysis, the main separators were the duration of the disease and the age of the patient. There was no grouping according to the patients. The recordings run at different times on the same patient were often scattered into distinct groups. During the early years of the disease, one third of the patients exhibited an abundance of alpha activity, which decreased and attenuated later. In sleep records, spike and slow wave paroxysms were found during sleep stage one. The recordings of the patients' parents showed changes, possibly associated with age. The EEG's of sisters and brothers over 15 years of age did not show disturbances to any remarkable degree. The EEG's of sisters and brothers under 15 years of age showed paroxysmal disturbances. Some of these might represent a premorbid form of the PME syndrome.
TL;DR: Despite the comprehensive literature on s, illed paraproteinaemia, and also that on electrophoretic studies of CSF, there have been relatively few reports on the protein pattern of the CSF in myelomatosis.
Abstract: The interest associated with the protein pattern of the cerebrospinal fluid (CSF) has mainly been concentrated on primary neurological diseases. However, since electrophoretic techniques permit parallel investigations on serum and CSF, there have also been reports of the protein pattern of the CSF in medical diseases resulting in changes in the serum proteins, for example cirrhosis of the liver, the nephrotic syndrome, and myelomatosis. Despite the comprehensive literature on s, illed paraproteinaemia, and also that on electrophoretic studies of CSF, there have been relatively few reports on the protein pattern of the CSF in myelomatosis.
TL;DR: While sclerotic plaques in the central nervous system probably are of etiological significance for development of TN neither clinical nor neuropathological findings suggest that this is due to affection of trigeminal nuclei complex in the brain‐stem.
Abstract: The clinical characteristics of facial pain in patients with trigeminal neuralgia (TN) and associated multiple sclerosis (MS) were studied. Among 900 patients with TN 22 (2.4%) had associated MS. Sixteen patients had typical TN, while six had atypical TN. Facial pain commenced at a younger age (P less than 0.005) and a significantly higher proportion had bilateral facial pain (P less than 0.01) in the group with MS compared to TN patients without MS. In three patients TN was the first manifestation of MS, in the remainder facial pain occurred on an average of 12 years after onset of MS. Seventeen patients had associated signs of brain-stem involvement. The facial pain was, however, indistinguishable from the pain in patients without brain-stem deficits. While sclerotic plaques in the central nervous system probably are of etiological significance for development of TN neither clinical nor neuropathological findings suggest that this is due to affection of trigeminal nuclei complex in the brain-stem.
TL;DR: This review classifies stroke into ischaemic, haemorrhagic, cerebral venous thrombosis and other rarer types of cerebrovascular disease to identify the types of stroke most frequently associated with cancer, and give a practical view on the most common and most specific types.
Abstract: Stroke is a disabling disease and can add to the burden of patients already suffering from cancer. Several major mechanisms of stroke exist in cancer patients, which can be directly tumour related, because of coagulation disorders, infections, and therapy related. Stroke can also occur as the first sign of cancer, or lead to its detection. The classical literature suggests that stroke occurs more frequently in cancer patients than in the average population. More recent studies report a very similar incidence between cancer and non-cancer patients. However, there are several cancer-specific types and causes of stroke in cancer patients, which need to be considered in each patient. This review classifies stroke into ischaemic, haemorrhagic, cerebral venous thrombosis and other rarer types of cerebrovascular disease. Its aim is to identify the types of stroke most frequently associated with cancer, and give a practical view on the most common and most specific types of stroke. The diagnosis of the cause of stroke in cancer patients is crucial for treatment and prevention. Management of different stroke types will be briefly discussed.
TL;DR: The objective of this paper is to evaluate the accuracy of conventional diagnostic criteria for Parkinson's disease and give an overview of alternative causes to parkinsonian syndromes, and propose criteria for diagnostic subgroups of the disease classified at different levels of confidence.
Abstract: The objective of this paper is to evaluate the accuracy of conventional diagnostic criteria for Parkinson's disease and give an overview of alternative causes to parkinsonian syndromes. We also propose a new approach to the clinical diagnosis of Parkinson's disease, which may improve the diagnostic accuracy. The available information on autopsy findings in patients clinically diagnosed as Parkinson's disease shows that 20 to 30% of these patients do not have the typical neuropathological features with Lewy bodies and cell loss in the substantia nigra. The use of selected additional clinical criteria improves the diagnostic accuracy, however, at the cost of rejecting a rather large group of patients with idiopathic disease verified by autopsy. Based on this fact and a review of the literature on parkinsonian syndromes that may be confused with idiopathic Parkinson's disease, we propose criteria for diagnostic subgroups of the disease classified at different levels of confidence. The suggested diagnostic subgroups are clinical definite, probable and possible Parkinson's disease with a decreasing level of specificity and an increasing level of sensitivity in the different patient categories. The clinical features given special importance in this classification includes presence of resting tremor, asymmetrical disease, response to dopamine agonism and presence of atypical clinical features like dementia and clinical autonomic failure at onset and pyramidal or cerebellar signs at examination. In addition, a history indicating possible etiology for another parkinsonian syndrome will exclude the diagnosis.
TL;DR: Findings support the hypothesis that BBB disturbance is related to vascular factors, coexisting with AD and suggest that aging per se is not primarily associated with a decline in BBB function.
Abstract: One of the theories of the pathogenesis of Alzheimer’s disease (AD) is that blood-brain barrier (BBB) dysfunction is the primary event (for review see 1,2). Also in aging, BBB dysfunction has been suggested (for review see 2). AD is associated with aging, i.e., it is more frequent in higher age. Many other diseases are in the same way associated with aging and thus expected to occur together with AD quite frequently. Some of these age-associated diseases, for instance hypertension, diabetes mellitus and various manifestations of arteriosclerosis have an important effect on the cerebral vasculature and the BBB function (2,3). Thus, when examining the BBB function in aging and AD, the coexistence of other diseases suspected of interfering with the BBB function should be taken ino account.
TL;DR: After 2 weeks of abstinence, several liver function tests which were abnormal on admission had recovered, but only minimal changes in the CNS symptoms were observed, and the duration of abuse was only weakly correlated with neurological scores.
Abstract: 24 solvent abusers (mean age 23 +/- 4.4 years +/- SD) were studied in hospital. They reported using substances containing a mean of 425 +/- 366 mg of toluene per day for 6.3 +/- 3.9 years. There was no laboratory evidence of under-nutrition. No withdrawal symptoms were observed. Marked impairment was observed in neurological and neuropsychological test performances in 65% of the sample. Cerebellar symptoms were particularly prominent. The impairment was significantly correlated with CT scan measurements of the cerebellum, ventricles and cortical sulci, all of which abnormal in comparison to age-matched controls. CSF abnormalities were elevated C1-, low PO2 and very low anion gap. The duration of abuse was only weakly correlated with neurological scores. After 2 weeks of abstinence, several liver function tests which were abnormal on admission had recovered, but only minimal changes in the CNS symptoms were observed.
TL;DR: Since propranolol does not cause serious side effects provided certain patients are excluded, it seems justifiable to recommend this preparation where prophylactic therapy is indicated in cases of severe and frequent migraine.
Abstract: About 4 per cent of schoolchildren suffer from migraine. In some cases the attacks can be frequent and severe. Often symptomatic and prophylactic treatments are either ineffective or cause pronounced side effects. There have been reports on studies in which a prophylactic effect on migraine by propranolol has been noted. This beta-receptor blocking agent has been tested in a double-blind single crossover study in 32 children aged 7–16 with migraine. Propranolol had an excellent prophylactic effect on migraine attacks. Since propranolol does not cause serious side effects provided certain patients are excluded, it seems justifiable to recommend this preparation where prophylactic therapy is indicated in cases of severe and frequent migraine.]
TL;DR: On discharge, improvement was significantly better for patients with recent onset of symptoms (2 weeks or less) than for those with longstanding disturbances, and improvement was independent of psychiatric findings, coexistence of a neurological disease, age, and sex.
Abstract: Among 4470 consecutive neurological inpatients presenting "with typical neurological symptoms" 405 (9%) were found to have psychogenic rather than neurological dysfunction of the nervous system as the primary cause of admission. This probably represents a conservative figure, since secondary and minor pseudoneurological symptoms were not included. Retrospective analysis of these cases showed that pain was the most common psychogenic symptom, followed by motor symptoms (in particular stance and gait disturbances), dizziness, psychogenic seizures, sensory symptoms, and visual dysfunction. Unilateral motor and sensory symptoms were equally distributed to the left and right side of the body. Psychiatric abnormalities in these patients were heterogenous. Depressive syndromes were most common (38%), whereas hysterical features were less frequent than expected (9%). On discharge, improvement was significantly better for patients with recent onset of symptoms (2 weeks or less) than for those with longstanding disturbances. Short-term outcome was best for motor symptoms and worst for pain. Improvement was independent of psychiatric findings, coexistence of a neurological disease, age, and sex.
TL;DR: A large number of patients with a history of stroke experience swallowing problems in the period immediately after a stroke, and this research aims to investigate the reasons behind this phenomenon.
Abstract: Background – Up to one-third of patients experience swallowing problems in the period immediately after a stroke.
Objective – To investigate the therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) on post-stroke dysphagia.
Materials and methods – Twenty-six patients with post-stroke dysphagia due to monohemispheric stroke were randomly allocated to receive real (n = 14) or sham (n = 12) rTMS of the affected motor cortex. Each patient received a total of 300 rTMS pulses at an intensity of 120% hand motor threshold for five consecutive days. Clinical ratings of dysphagia and motor disability were assessed before and immediately after the last session and then again after 1 and 2 months. The amplitude of the motor-evoked potential (MEP) evoked by single-pulse TMS was also assessed before and at 1 month in 16 of the patients.
Results – There were no significant differences between patients who received real rTMS and the sham group in age, hand grip strength, Barthel Index or degree of dysphagia at the baseline assessment. Real rTMS led to a significantly greater improvement compared with sham in dysphagia and motor disability that was maintained over 2 months of follow-up. This was accompanied by a significant increase in the amplitude of the oesophageal MEP evoked from either the stroke or non-stroke hemisphere.
Conclusion – rTMS may be a useful adjunct to conventional therapy for dysphagia after stroke.
TL;DR: Elevated IL‐6 levels in the CSF of untreated parkinsonian patients may reflect the original condition in the course of disease and it is speculated that an endogenous upregulation of IL‐ 6 synthesis occurs in order to regenerate lesioned neurons probably at an early phase of the degenerative process in PD.
Abstract: Introduction - Several lines of evidence suggest that neuroimmune mechanisms may also be involved in neurodegeneration in Parkinson's disease (PD). The potential role of cytokines such as interleukin 6 (IL-6), in the interaction between neurons and immune system has been emphasized by recent findings. IL-6 induces acute phase protein synthesis, differentiation of neuronal cells and improves catecholaminergic and cholinergic cell survival in the brain. Subjects and methods - We determined levels of IL-6 in cerebrospinal fluid (CSF) of untreated parkinsonian patients and age- and sex-matched controls. Intensity of disease was evaluated by the Unified Parkinson's Disease Rating scale. Results - Significantly elevated levels of IL-6 were found in the CSF of parkinsonian patients. Moreover a significant inverse correlation between severity of PD and IL-6 CSF levels appeared. Discussion - Elevated IL-6 levels in the CSF of untreated parkinsonian patients may reflect the original condition in the course of disease. We speculate that an endogenous upregulation of IL-6 synthesis occurs in order to regenerate lesioned neurons probably at an early phase of the degenerative process in PD.