Showing papers in "JAMA Neurology in 1985"
TL;DR: The purpose of the meeting was to identify the most important scientific research opportunities and the crucial clinical and technical issues that influence the progress of research on the diagnosis of AD.
Abstract: Early and accurate diagnosis of Alzheimer's disease (AD) has a major impact on the progress of research on dementia. To address the problems involved in diagnosing AD in its earliest stages, the National Institute on Aging, the American Association of Retired Persons, the National Institute of Neurological and Communicative Disorders and Stroke, and the National Institute of Mental Health jointly sponsored a workshop for planning research. The purpose of the meeting was to identify the most important scientific research opportunities and the crucial clinical and technical issues that influence the progress of research on the diagnosis of AD. The 37 participants included some of the most knowledgeable and eminent scientists and physicians actively involved in the study of AD. The participants were divided among six panels representing the disciplines of neurochemistry, neuropathology, neuroradiology, neurology, neuropsychology, and psychiatry. Within each of the panels, participants discussed specific areas of research requiring further
2,351 citations
TL;DR: The hypothesis is that slowed growth within certain zones of the left hemisphere is likely to result in enlargement of other cortical regions, in particular, the homologous contralateral area, but also adjacent unfaffected regions.
Abstract: Part two of this three-part series commences with anomalous dominance and special talents. Part one appears in a previous issue of theArchives. 1 ANOMALOUS DOMINANCE AND SPECIAL TALENTS According to our hypothesis, slowed growth within certain zones of the left hemisphere is likely to result in enlargement of other cortical regions, in particular, the homologous contralateral area, but also adjacent unfaffected regions. The influences that favor anomalous dominance may thus favor talents associated with superior development of certain regions either in the right hemisphere or in adjacent parts of the left hemisphere. Even with excessive retardation of growth and the resultant migration abnormalities and learning disorders (LD), high talents may exist as a result of compensatory enlargement of other cortical regions. Several types of data are in concordance with these conclusions. Several studies have claimed that the average level of spatial talents is higher in male subiects. 2 Hier
1,888 citations
TL;DR: Cranial neuropathy was the most frequent problem, and a peripheral facial nerve palsy was the single most common abnormality, in patients seen at The Johns Hopkins Hospital, Baltimore, from 1975 through 1980.
Abstract: • Neurosarcoidosls is a disorder that is difficult to diagnose and manage. We assessed its neurological manifestations in 649 patients seen at The Johns Hopkins Hospital, Baltimore, from 1975 through 1980. Neurological problems could be attributed to neurosarcoidosis in 33 patients (5.1%). The presenting manifestation of sarcoidosis was neurological in 16 (48%) of them. Cranial neuropathy was the most frequent problem, and a peripheral facial nerve palsy was the single most common abnormality. Other manifestations were aseptic meningitis, hydrocephalus, parenchymatous disease of the central nervous system, peripheral neuropathy, and myopathy. Three-quarters of the patients were treated with steroids. The outcome was good in 27 (82%) of 33 episodes of neurological dysfunction in 25 patients with a well-documented clinical course. A thorough investigation of patients with suspected neurosarcoidosis is recommended to establish the diagnosis, delineate the extent of disease, and guide therapy.
650 citations
TL;DR: It is proposed that the memory disorder can be explained by malfunctioning in the hippocampal system, secondary to damage in the basal forebrain structures with which it is strongly interconnected, and might, in part, be caused by reduction of specific neurotransmitter innervation.
Abstract: • Of five patients with damage to the basal forebrain, four had lesions secondary to rupture of anterior cerebral or anterior communicating artery aneurysms, and one to the resection of an arteriovenous malformation. Computed tomographic scans and intraoperative reports confirmed damage to basal forebrain regions, which include septal nuclei, nucleus accumbens, substantia innominata, and related pathways. Behavioral disturbances featured a prominent amnesic syndrome and personality changes. The amnesia was distinguishable from that reported in patients HM and DRB and shared features with that seen in patients with Korsakoff's syndrome. We propose that the memory disorder can be explained by malfunctioning in the hippocampal system, secondary to damage in the basal forebrain structures with which it is strongly interconnected. The dysfunction might, in part, be caused by reduction of specific neurotransmitter innervation because the lesions are likely to damage cholinergic neurons and nearby catecholamine pathways within the basal forebrain.
426 citations
TL;DR: Depressed elderly patients with any of the following are at high risk to develop dementia: evidence of cerebrovascular, extrapyramidal, or spinocerebellar disease; a modified Hachinski ischemic score of 4 or greater; a Mental Status Questionnaire score under 8; a dementia behavior score of 7 or higher; or confusion on low doses of tricyclic antidepressants.
Abstract: Of 225 patients referred to a dementia clinic, depression occurred in 31 (70%) of 44 patients not thought to be demented, six (24%) of 25 with cognitive impairment not severe enough to warrant the label dementia, and 24 (15%) of 156 with various forms of dementia, including 19 (19%) of 99 with Alzheimer-type dementia. Follow-up over three years has shown that 16 (57%) of 28 of the depressed, nondemented patients went on to develop frank dementia. Thirteen of these 16 had some sign, often subtle, of organic neurologic disease. Depressed elderly patients with any of the following are at high risk to develop dementia: evidence of cerebrovascular, extrapyramidal, or spinocerebellar disease; a modified Hachinski ischemic score of 4 or greater; a Mental Status Questionnaire score under 8; a dementia behavior score of 7 or higher; or confusion on low doses of tricyclic antidepressants. Dementing illnesses can present as depression with relatively little cognitive impairment.
321 citations
TL;DR: It was possible to demonstrate, in humans, the three stages of secondary epileptogenesis previously documented in animals, and a pharmacologic test is described that separates the reversible from the irreversible stage of secondary epilepsy and allows prediction of the results of surgical removal of the primary focus.
Abstract: • It is difficult to prove the existence of secondary epileptogenesis in man. In the majority of cases of human focal epilepsy, where the cause is likely to be trauma, infection, or vascular disease, the occurrence of additional or new epileptogenic foci is usually attributed to multiple primary injuries (maturing at different rates), or to progressive disease. Cerebral tumor is the only common cause in which the probability of multiple primary lesions is vanishingly low. Therefore, a personally followed series of cases of cerebral tumor seen as epilepsy are reviewed in which clinical, electrophysiologic, and pharmacologic data are analyzed for evidence of secondary epileptogenesis. Such evidence was found in 34% of our tumor patients. It was possible to demonstrate, in humans, the three stages of secondary epileptogenesis previously documented in animals. A pharmacologic test is described that separates the reversible from the irreversible stage of secondary epileptogenesis and allows prediction of the results of surgical removal of the primary focus.
313 citations
TL;DR: Because several anatomic and behavioral characteristics of this case are different from those of previously reported cases of amnesia, they may provide new insight into the neuroanatomic substrate of human memory.
Abstract: • A 55-year-old right-handed man (patient DRB) had a major amnesic syndrome following extensive bilateral damage to the temporal lobe and basal forebrain, caused by herpes simplex encephalitis. His amnesia was both anterograde and retrograde. The retrograde amnesia spanned the five decades of his life, sparing only generic (semantic) material and shreds of previous experiences devoid of appropriate temporal and spatial placement. The anterograde amnesia encompassed both generic (semantic) and contextual (episodic) material. With the exception of preserved learning of a visuomotor skill, the patient did not show acquisition of any new information since his illness in 1975. Elementary perceptual, intellectual, and linguistic abilities remained intact. Because several anatomic and behavioral characteristics of this case are different from those of previously reported cases of amnesia, they may provide new insight into the neuroanatomic substrate of human memory.
300 citations
TL;DR: It is concluded that transient muteness may result from acute bilateral cerebellar injury and be associated with motor paralysis, loss of higher cognitive functions, or cranial nerve dysfunction.
Abstract: • Acute bilateral damage to large areas of both cerebellar hemispheres including the dentate nuclei led to temporary loss of speech in six children. In each case muteness was unassociated with motor paralysis, loss of higher cognitive functions, or cranial nerve dysfunction. Muteness lasted one to three months. All patients were severely dysarthric during recovery. We conclude that transient muteness may result from acute bilateral cerebellar injury.
286 citations
TL;DR: Key bedside criteria for distinguishing a pseudoseizure from a tonic-clonic seizure were identified and significant differences between the two groups of seizures were identified for the character of upper and lower extremity movements, the time of vocalization during the event, thecharacter of pelvic movements, and the nature of body tone during the events.
Abstract: • The spontaneous pseudoseizures resembling tonic-clonic seizures in 25 patients were recorded on simultaneous videotape and electroencephalograms and were compared with the seizures recorded from 25 patients with true tonicclonic epileptic events. The goal of the comparison was to identify bedside clinical criteria to assist in differentiating between the two groups. The variables of age, sex, and selected physical manifestations of the events were compared for the two groups by appropriate statistical methods, including a multivariate stepwise discriminate analysis. Significant differences between the two groups of seizures were identified for several variables, and most strikingly for the character of upper and lower extremity movements, the time of vocalization during the event, the character of pelvic movements, and the nature of body tone during the events. Useful bedside criteria for distinguishing a pseudoseizure from a tonicclonic seizure were identified.
269 citations
TL;DR: Twenty-three elderly patients were found to have a consistent pattern of leukoencephalopathy by computed tomography and nuclear magnetic resonance imaging, and the necropsy of one patient revealed arteriosclerotic vasculopathy characteristic of subcortical arteriosclerosis encephalopathy (SAE) or Binswanger's disease.
Abstract: • Twenty-three elderly patients were found to have a consistent pattern of leukoencephalopathy by computed tomography and nuclear magnetic resonance imaging. Eight patients presented with vague, nonspecific symptoms and had no neurologic deficits. The other 15 patients had neurologic deficits that presented in one of three ways: (1) stroke, seven patients; (2) slowly progressive dementia and gait disturbance, five patients; or (3) slowly progressive dementia alone, three patients. Risk factors for arteriosclerosis (hypertension, diabetes) were present in 18 patients (78%). The necropsy of one patient revealed arteriosclerotic vasculopathy characteristic of subcortical arteriosclerotic encephalopathy (SAE) or Binswanger's disease. Subcortical arteriosclerotic encephalopathy may be a relatively common affliction of elderly patients, most of whom have risk factors for arteriosclerosis. The modes of presentation and associated clinical signs are variable, and more than one third may have no neurologic deficit. In some cases SAE overlaps with normal pressure hydrocephalus by clinical and neuroimaging criteria. Some patients with normal pressure hydrocephalus who do not respond to ventricular shunting may actually have SAE.
253 citations
TL;DR: This double-blind crossover study documents that patients with cluster headache can benefit from oxygen inhalation during acute attacks.
Abstract: • Nineteen men, aged 20 to 50 years, were treated in a double-blind crossover study comparing oxygen v air inhalation at 6 L/min via nonrebreathing face masks for 15 minutes or less, for up to six headaches. Patients scored their own degree of relief for each treatment as none, slight, substantial, or complete relief. The average (±SE) relief score for all oxygen-treated patients was 1.93 ± 0.22 out of a possible total score of 3.0, and for air the treatment relief score was 0.77 ± 0.23. This difference is highly statistically significant by an analysis-of-variance F test; it documents that patients with cluster headache can benefit from oxygen inhalation during acute attacks.
TL;DR: A door-to-door survey was conducted in six cities of the People's Republic of China to determine the prevalence of major neurologic disorders, finding that after the fifth decade of life, the age-specific prevalence ratios increased with age.
Abstract: A door-to-door survey was conducted in six cities of the People's Republic of China. A total of 63,195 individuals were sampled during 1983 to determine the prevalence of major neurologic disorders. The survey involved a complete census, followed by a pretested interview and brief screening examination with a high level of sensitivity for detecting individuals with frequently occurring neurologic diseases, including movement disorders. Subjects with abnormal responses or findings were examined by a neurologist. There was 100% cooperation among the study subjects. Twenty-eight individuals alive on prevalence day (Jan 1, 1983) were identified as having Parkinson's disease, yielding an age-adjusted (to the 1960 US population) prevalence ratio of 57 per 100,000 population. All subjects were older than the age of 50 years. After the fifth decade of life, the age-specific prevalence ratios increased with age.
TL;DR: Preexisting hyperglycemia, as well as systemic complications, could explain the higher mortality in patients with acute hemispheric stroke compared with normoglycemic nondiabetic patients.
Abstract: • Prognostic significance of hyperglycemia on short-term survival was evaluated in 72 patients with acute hemispheric stroke. All patients were admitted within 48 hours of onset, and the neurologic deficit was assessed by means of a standardized score. A computed tomogram was taken in all cases on admission. Mortality was higher in hyperglycemic patients with no history of diabetes mellitus (78%) than in diabetic (45%) and in normoglycemic nondiabetic (29%) patients. In nondiabetic patients, the glucose level correlated with the neurologic score and with lesion size on computed tomogram. Reactive hyperglycemia due to a major stress response accounts for the worse prognosis of these patients. This correlation was not found in diabetic patients. Preexisting hyperglycemia, as well as systemic complications, could explain the higher mortality in these patients compared with normoglycemic nondiabetic patients.
TL;DR: The literature on acute massive pituitary infarction is reviewed to create an awareness of predisposing factors, the pathophysiologic mechanisms responsible for its heterogeneous manifestations, and possible options for investigation and management.
Abstract: • Pituitary apoplexy, a rare but life-threatening condition, may be highly variable in its clinical appearance and therefore should be considered in any patient with abrupt neurologic deterioration. We reviewed the literature on acute massive pituitary infarction to create an awareness of predisposing factors, the pathophysiologic mechanisms responsible for its heterogeneous manifestations, and possible options for investigation and management. These concepts are reinforced by examining the course and outcome of a rare case of pituitary apoplexy manifesting a full range of neurologic and endocrine abnormalities.
TL;DR: The prevalence ratios of all severe dementia and clinically diagnosed severe senile dementia of the Alzheimer's type were at least as large among blacks as among whites and for either race, the corresponding prevalence ratios were greater in females.
Abstract: • The purpose of this investigation was to document the prevalence of severe dementia among different racial groups residing in the same community—Copiah County, Mississippi. Both household and institutionalized populations were included. For either sex, the prevalence ratios of all severe dementia and clinically diagnosed severe senile dementia of the Alzheimer's type were at least as large among blacks as among whites. For either race, the corresponding prevalence ratios were greater in females. For each race and sex, the corresponding prevalence ratios increased with advancing age. Finally, in the population studied, approximately 1% of individuals 40 years old or older had severe dementia. This figure increased to 7% for individuals 80 years old or older.
TL;DR: Using CT measurements, the width of the third ventricle proved to be the best indicator of intellectual and memory dysfunction and measures of cognition and ventricular size did not correlate with length of illness or overall disability.
Abstract: • Forty-seven patients with chronic progressive multiple sclerosis were examined to assess the possible relationship between cerebral atrophy (by computed tomography [CT]) and performance on neuropsychological tests of memory and verbal intelligence. Nineteen patients were found to have mildly dilated ventricles and another nine patients had moderate to severe ventricular enlargement. Performance on memory and intelligence testing was related to the degree of ventriculomegaly. Three linear CT measurements were also recorded. Using this method, the width of the third ventricle proved to be the best indicator of intellectual and memory dysfunction. Measures of cognition and ventricular size did not correlate with length of illness or overall disability as rated by the Kurtzke Disability Status Score.
TL;DR: The issue of whether or not to lower elevated blood pressures acutely, an old debate, is not simply endothelial pounding; rather, the problem engages the crucial complexities of ensuring adequate blood flow to ischemically compromised tissue, the so-called ischemic penumbra menacingly threatened by infarction.
Abstract: Like the sea storm's pummeling effects in eroding a coastline, elevated blood pressures immediately after the onset of acute ischemic strokes might similarly be expected to batter impaired and vulnerable brain cells.1,2But the issue of whether or not to lower elevated blood pressures acutely, an old debate, is not simply endothelial pounding; rather, the problem engages the crucial complexities of ensuring adequate blood flow to ischemically compromised tissue, the so-called ischemic penumbra3menacingly threatened by infarction. Justification and rationale for not treating hypertension in acute ischemic strokes to optimize blood flow are fourfold: (1) occurrence of altered autoregulation of cerebral blood flow in patients who were hypertensive prior to their stroke; (2) impaired autoregulation caused by strokes; (3) the hazards of inducing "watershed" infarction with hypotensive therapy; and (4) extension of ischemic damage in strokes that initially only partially occlude a major artery. 1. Chronic hypertension, the
TL;DR: Visual contrast sensitivity to sinusoidal gratings of five spatial frequencies was measured in 15 patients with Alzheimer's disease and in eight control subjects; the 15th patient was unique: she had an impairment in object and face recognition so severe that she could not recognize her husband visually.
Abstract: • Visual contrast sensitivity to sinusoidal gratings of five spatial frequencies was measured in 15 patients with Alzheimer's disease and in eight control subjects. Contrast sensitivity thresholds were elevated at all frequencies in 14 patients compared with control subjects. The 15th patient was unique: she had an impairment in object and face recognition so severe that she could not recognize her husband visually. Her sensitivity to low and intermediate frequencies was markedly reduced in relation to that of other patients, whereas her sensitivity to the highest frequency tested equaled theirs. These observations emphasize the importance of low spatial frequency information for visual object and face recognition.
TL;DR: Interobserver reliability in obtaining neurologic histories and examinations was investigated among neurologists collaborating in the Stroke Data Bank and improvement in interobserver agreement due to data editing for intra-observer consistency was shown.
Abstract: • Interobserver reliability in obtaining neurologic histories and examinations was investigated among neurologists collaborating in the Stroke Data Bank (SDB). Seventeen in-hospital stroke patients were examined by six neurologists experienced in stroke over the course of three days. Patients were examined twice a day for two successive days, with each patient seen by four different neurologists. Data were recorded on SDB forms, according to definitions and procedures established for the SDB. Percent agreement and κ coefficients were calculated to assess the levels of agreement for each item. Important differences in levels of agreement were found among items on both neurologic history and examination. Agreement among neurologists was higher for neurologic examination than for history. Patterns of agreement for items with low prevalence or with numerous unknown ratings are discussed. Improvement in interobserver agreement due to data editing for intra-observer consistency was shown.
TL;DR: Although most focal ischemic lesions that occur during pregnancy seem to be the result of arterial occlusion, cerebral venous thrombosis is still a prominent factor in causing such lesions.
Abstract: • Pregnancy increases the risk of focal ischemic cerebrovascular events, apparently to about 13 times the expected rate outside of pregnancy in the case of cerebral infarction. The distribution of the underlying pathophysiologic mechanisms causing the cerebrovascular symptoms in pregnant patients differs considerably from the distribution in the general population. Although most focal ischemic lesions that occur during pregnancy seem to be the result of arterial occlusion, cerebral venous thrombosis is still a prominent factor in causing such lesions. Arterial occlusions tend to occur during the second and third trimesters of pregnancy and during the first week after delivery, whereas the venous occlusions tend to occur one to four weeks after childbirth. When possible, treatment of patients with focal ischemic neurologic symptoms is based on a precise definition of the underlying pathophysiologic mechanism and its appropriate treatment. When this is not possible, patients are treated according to categorization based on the temporal profile of the focal deficit.
TL;DR: Overall, RBDs used facial expression and intonation less frequently than the other two groups, and speech output channel was analyzed, oral expression of feelings in the RBD, relative to the LBDs and NCs was less appropriate, more propositional than prosodic, and more descriptive than affective.
Abstract: • The contribution of facial, intonational, and speech channels to spontaneous emotional expression was examined in right brain-damaged (RBD), left braindamaged (LBD), and normal control (NC) subjects. Subjects were videotaped while viewing and responding to a series of emotionally laden slides; the videotapes were then rated for the three channels of communication. Overall, RBDs used facial expression and intonation less frequently than the other two groups. When the speech output channel was analyzed, oral expression of feelings in the RBDs, relative to the LBDs and NCs, was less appropriate, more propositional than prosodic, and more descriptive than affective. When the ratings for the three channels of communication were examined, facial expression and intonation were significantly correlated for all subjects.
TL;DR: Results indicated that anesthetic rather than sympathomimetic effects are responsible for cocaine-medicated abortion of cluster headache, that transmission of pain in cluster headache likely occurs via the sphenopalatine fossa, and that topical lidocaine is effective in rapidly aborting acute cluster headache.
Abstract: • Cocainization of the sphenopalatine fossa region has been shown to abort acute cluster headaches rapidly. Whether this response occurs by sympathomimetic action or via local anesthetic effect has been unknown. In this study, lidocaine hydrochloride was given as a therapeutic abortive agent to patients with cluster headache to elucidate cocaine's mechanism of action in relieving symptoms and to search for a safe, nonaddicting agent for self-administration. Using a 4% lidocaine solution applied to the sphenopalatine fossa, four of five patients obtained rapid relief of nitrate-induced cluster headaches and associated signs. Lidocaine was also effective in relieving spontaneous attacks. These results indicated that anesthetic rather than sympathomimetic effects are responsible for cocaine-medicated abortion of cluster headache, that transmission of pain in cluster headache likely occurs via the sphenopalatine fossa, and that topical lidocaine is effective in rapidly aborting acute cluster headache.
TL;DR: Since the effect of environmental stress on cardiac dysfunction must be modulated via the brain, the review is briefly extended to examine the role of stress in the production of severe cardiac dysfunction in people as well as animals.
Abstract: • This review focuses on the relations between neural structures and the heart in the pathogenesis of severe cardiac dysfunction (namely, cardiac arrhythmias, focal cardiac lesions, and the sudden death syndrome). After establishing the anatomic connections between the brain and the heart and then reviewing ways to assess the integrity of nerves to the heart, the clinical literature relating human brain dysfunction to cardiologic problems is reviewed. Next the experimental literature is briefly reviewed. The organization of the information is based on whether or not the heart of the experimental animal is normal as well as on the part of the nervous system involved (ie, either central or peripheral). In addition, since the effect of environmental stress on cardiac dysfunction must be modulated via the brain, the review is briefly extended to examine the role of stress in the production of severe cardiac dysfunction in people as well as animals.
TL;DR: The longest follow-ups have been in some of the studies with the lowest conversion rates and this has led to isolated ON enjoying a diagnostic status approaching that of a specific disease despite the fact that ON is not a clinical pathologic entity.
Abstract: Pespite many studies on the rate of conversion of optic neuritis (ON) to multiple sclerosis (MS) the subject remains controversial. There are hardly two studies that have treated the problem in quite the same manner, reflecting the fact that many variables affect the calculated outcome, some beyond the control of individual investigators. Most investigators accept a close relationship since many patients with clinically definite MS have an ON at some point in the course of their disease and many patients with ON have converted to clinically definite MS in follow-up. Frequencies of conversion ranging from 13% to 85% have been reported in the literature. 1,2 The longest follow-ups have been in some of the studies with the lowest conversion rates and this has led to isolated ON enjoying a diagnostic status approaching that of a specific disease despite the fact that ON is not a clinical pathologic entity. No
TL;DR: A study of the epidemiologic and clinical features of Guillain-Barré syndrome in the population of Olmsted County, Minnesota, over the 46-year period 1935 through 1980 was conducted through the centralized diagnostic index maintained at Mayo Clinic, Rochester, Minn.
Abstract: • A study of the epidemiologic and clinical features of Guillain-Barre syndrome in the population of Olmsted County, Minnesota, over the 46-year period 1935 through 1980 was conducted through the centralized diagnostic index maintained at Mayo Clinic, Rochester, Minn. A total of 48 cases were identified, giving an age- and sex-adjusted incidence of 1.8 per 100,000 person-years. The rate increased over time from 1.2 in the interval 1935 through 1956 to 2.4 in the interval 1970 through 1980. Males were affected more than females (age-adjusted rates of 2.3 and 1.2, respectively). The rate increased with age from 0.8 in those under 18 years old to 3.2 for those 60 years and older. Antecedent infectious diseases were reported in 65% of the cases. Implications with regard to the incidence of Guillain-Barre syndrome associated with the A/New Jersey/76 (swine flu) vaccine are discussed.
TL;DR: The screened dyslexic group performed more rapidly on five of six movements and had fewer qualitative signs of dysrhythmia or overflow than the otherwise matched group, which had been screened for attentional disorders.
Abstract: Motor proficiency, in terms of speed, rhythm and absence of overflow, has previously been shown to distinguish nonlearning disabled hyperactive boys from matched controls. Accepted screening methods for selecting children with dyslexia do not include assessments of hyperactivity or other attentional deficits. Dyslexic children selected in this customary manner were compared with an otherwise matched group that had been screened for attentional disorders, on a series of repetitive and alternating movements of the fingers, hands, and feet. The screened dyslexic group performed more rapidly on five of six movements and had fewer qualitative signs of dysrhythmia or overflow.
TL;DR: The problem of a patient presenting to an emergency room with severe hypertension and a central nervous system (CNS) deficit is a common, dangerous, and vexing one, and advocates of the hands-off policy believe that abrupt lowering of blood pressure is dangerous.
Abstract: The problem of a patient presenting to an emergency room with severe hypertension and a central nervous system (CNS) deficit is a common, dangerous, and vexing one. The received wisdom for many years has been: "in a patient with stroke, one must not treat the blood pressure, for fear of making the stroke worse." Indeed, examples abound of the disastrous consequences of aggressive treatment of severe hypertension. Even in patients presenting without any initial focal neurologic deficit, abrupt lowering of blood pressure may produce collapse, seizures, focal CNS deficits, and optic neuropathy, which have been assumed to be ischemic. 1-3 Presumably, advocates of the hands-off policy believe that abrupt lowering of blood pressure is dangerous because sudden reduction of cerebral perfusion pressure may render ischemic those parts of the brain whose blood supply is borderline because of arterial disease (eg, carotid occlusion) or areas of brain in which blood supply
TL;DR: Use of pulse therapy at five-day intervals for the management of severe MG seems to have an advantage in that it produces less initial worsening and more rapid improvement in MG, enabling smaller daily maintenance doses to be employed, with fewer side effects.
Abstract: • Corticosteroids have been useful in the management of myasthenia gravis (MG), but their efficacy has been limited by the slow onset of improvement, initial worsening of MG, refractoriness of some patients, and side effects of large daily doses High-dose intravenous methylprednisolone pulses have been reported to produce rapid improvement in several immunologic disorders In this study we administered 2 g of methylprednisolone intravenously every five days to 15 consecutive patients who had exacerbation of generalized MG Satisfactory improvement occurred in ten of 15 patients after two courses and in two of five patients after a third course Onset of improvement began a mean (±SD) of 3 ± 11 days after the first infusion, 21 ± 1 days after the second, and 24 ± 1 days after the third, and reached its maximum level 89 ± 61 days after the last infusion A decrease in strength occurred in three patients 143 ± 130 days after each infusion, was not marked, and lasted three days, following which improvement generally occurred Side effects were minimal After improvement, a daily dose of prednisone (30 mg) was used to maintain improvement Use of pulse therapy at five-day intervals for the management of severe MG seems to have an advantage in that it produces less initial worsening and more rapid improvement in MG, enabling smaller daily maintenance doses to be employed, with fewer side effects
TL;DR: Results indicate involvement of the serotoninergic system in DAT and might lead to development of a diagnostic test for DAT.
Abstract: • Serotonin (5-HT), its precursor 5-hydroxytryptophan (5-HTP), and its major metabolite 5-hydroxyindoleacetic acid (5-HIAA) were measured in the cerebrospinal fluid (CSF) of 14 patients with dementia of the Alzheimer type (DAT) and in nine controls by high-performance liquid chromatography with a novel multisensor coulometric detection system. Concentrations of both 5-HT and 5-HIAA detected by this system were lower than the concentrations obtained using conventional amperometric detection. This difference was caused by coelution of compounds that could be resolved from 5-HT and 5-HIAA by the multisensor coulometric system. One of the coelution compounds, observed in DAT but not in control CSF, behaved like a partially oxidized 5-HT. A compound behaving like partially oxidized 5-HTP was also observed in DAT CSF. Concentrations of 5-HTP, 5-HT, and 5-HIAA were lower in DAT CSF than in a corresponding fraction of control CSF. These results indicate involvement of the serotoninergic system in DAT and might lead to development of a diagnostic test for DAT.
TL;DR: Rates of abnormal responses remained constant until age 70 years, after which they increased significantly and the number of abnormal signs per subject increased, especially over 70 years of age.
Abstract: • We examined 2,029 volunteers 50 to 93 years of age in a cross-sectional study of nine bedside neurologic tests to determine the frequency of "abnormal" responses in uncomplicated aging (senescence). Rates of abnormal responses remained constant until age 70 years, after which they increased significantly. The number of abnormal signs per subject also increased, especially over 70 years of age. These results provide normative data against which these signs may be compared when applied as a clinical screening battery for diffuse cerebral dysfunction.