Showing papers in "Journal of Neurology, Neurosurgery, and Psychiatry in 1978"
335 citations
TL;DR: The occurrence of IgM antibody before IgM antibodies in two patients during the early stages of myasthenia gravis suggests that the antibody is not a primary cause of the disease.
Abstract: Antibodies to cholinergic receptor structures were found in 75% of 76 Finnish and 93% of 175 Swedish patients with myasthenia gravis. The amount of antibodies showed a positive correlation to the severity of the disease, and was reduced during immunosuppressive treatment, and by thymectomy. Thymoma patients had high values. The antibody was also found in the cerebrospinal fluid. Two healthy newborn babies of myasthenic mothers had antibodies during the first weeks of life, in spite of no clinical symptoms. The occurrence of IgM antibodies before IgM antibodies in two patients during the early stages of myasthenia gravis suggests that the antibody is not a primary cause of the disease.
333 citations
TL;DR: Work, leisure activities, and contact with friends were the areas of life most affected, whereas family life and marital relationships appeared to withstand changes at this stage in the recovery process.
Abstract: The level of social recovery achieved by a representative series of 50 young adults was assessed six months after a severe closed head injury (post-traumatic amnesia greater than 24 hours). Work, leisure activities, and contact with friends were the areas of life most affected, whereas family life and marital relationships appeared to withstand changes at this stage in the recovery process. Many patients were still suffering from subjective symptoms, but these appeared to have relatively minor effects on ability to resume normal activities. Physical disability was a much more important factor at this stage. A control group of patients with limb injuries suffered similar disruption of their lives, but reported few subjective complaints.
294 citations
TL;DR: The practical reliability of the Glasgow scale enhances its value, both for monitoring individual cases and for making meaningful comparisons between series of patients with acute brain damage.
Abstract: Head-injured patients were examined by a number of observers whose assessments were compared. Considerable discrepancies occurred when overall "levels" of consciousness and coma were used, and also with some terms which are in common use. More consistent assessments were obtained by employing the "Glasgow Coma Scale," which describes eye opening, verbal behaviour, and motor responsiveness. Nurses and general surgeons were as consistent as neurosurgeons when using this scale, and it was relatively resistant to language or cultural differences between observers. The practical reliability of the Glasgow scale enhances its value, both for monitoring individual cases and for making meaningful comparisons between series of patients with acute brain damage.
277 citations
TL;DR: The effectiveness of the guanethidine blocks shows that the pain and the hyperpathia are maintained by the emission of noradrenaline in the periphery.
Abstract: In various chronic painful states, the sympathetic nerve supply was blocked either by injecting the sympathetic chain and ganglia with local anaesthesia or by the injection of guanethidine during occlusion of the circulation. There was a striking relation between the presence of hyperpathia and the relief of pain by the blocks. The sympathetic block was unlikely to relieve the pain unless hyperpathia accompanied the pain; when hyperpathia was present, a sympathetic block relieved both the constant pain and the hyperpathia. The effectiveness of the guanethidine blocks shows that the pain and the hyperpathia are maintained by the emission of noradrenaline in the periphery. The facts related to the sympathetic system and sensibility are discussed.
272 citations
TL;DR: Anosognosia (denial of weakness) and "anosognosic phenomena" (other abnormal attitudes to a weak limb) were studied in 100 acute hemiplegics; explanations in terms of "unilateral neglect" and "agnosia" are discussed.
Abstract: Anosognosia (denial of weakness) and "anosognosic phenomena" (other abnormal attitudes to a weak limb) were studied in 100 acute hemiplegics. Both conditions were associated with lesions of either hemisphere. Apathy, visual field defect, and impaired picture identification were particularly prominent in anosognosia. A failure to integrate information from one side of the body was regarded as fundamental to the condition; explanations in terms of "unilateral neglect" and "agnosia" are discussed.
250 citations
TL;DR: With the patient in the supine position, the subarachnoidal space was infused with artificial CSF at several constant pressure levels and the resulting flow of liquid was recorded.
Abstract: With the patient in the supine position, the subarachnoidal space was infused with artificial CSF at several constant pressure levels. The resulting flow of liquid was recorded. By draining CSF at a low pressure the CSF production rate was determined. Normal values are given and discussed for (1) the resting pressure, (2) the conductance of the CSF outflow pathways, (3) the formation rate of CSF, (4) the pressure difference across the CSF outflow pathways, and (5) the sagittal sinus pressure. None of the variables showed any age dependence, nor was there any sex difference.
231 citations
TL;DR: The reader already familiar with the problems of motor neurone disease may find little new information in this book but it does summarise usefully the present state of knowledge of the condition.
Abstract: Motor Neurone Disease Edited by F. Clifford Rose. (Pp. 147; illustrated; £7.00.) Pitman Medical Press: Tunbridge Wells. 1977. It is now some five years since the last symposium on motor neurone disease at the Johns Hopkins Hospital. The present volume is a report on the proceedings of the latest symposium on this condition. The editor has produced a balanced presentation from clinical and epidemiological, pathological and electrophysiological disciplines. The 13 chapters are contained in 140 pages including the references so that each is a fairly short and, in all cases, readable review of a particular approach to the problem. The reader already familiar with the problems of motor neurone disease may find little new information in this book but it does summarise usefully the present state of knowledge of the condition. Some pointers for further research are outlined, the application of studies of axonal transport to motor neurone disease, and the question of slow viruses in the aetiology of the condition. I think, however, that the reader will be left with the impression that, despite the accumulation of much information on the disease, there is as yet little evidence that we are much nearer to an understanding of its aetiology. This is a clear summary of the present state of knowledge of motor neurone disease and it should certainly be read by everyone who has an interest in that condition.
216 citations
TL;DR: Angiographic studies on 150 pituitary adenomas and 33 craniopharyngiomas presenting for surgical treatment are reviewed and the relevance of vascular abnormalities to surgical treatment is sufficient to justify routine magnification angiography.
Abstract: Angiographic studies on 150 pituitary adenomas and 33 craniopharyngiomas presenting for surgical treatment are reviewed. Eleven incidental silent aneurysms (four arising from the intracavernous and four from the supraclinoid carotid artery, and three from the anterior cerebral artery complex) are shown. Intracavernous aneurysms were also present in two acromegalic patients who had been treated previously with yttrium implantation. Although encasement of vessels by these tumours is unusual, the relevance of vascular abnormalities to surgical treatment is sufficient to justify routine magnification angiography.
179 citations
TL;DR: A Clinician's View of Neuromuscular Diseases By Michael H. Brooke is a well-written and readable book which should find appeal with a wide audience of clinicians at all levels.
Abstract: A Clinician's View of Neuromuscular Diseases By Michael H. Brooke. (Pp. 225; illustrated; $18.95.) Williams and Wilkins: Baltimore. 1977. In this well-written and readable book Dr Brooke has achieved a comprehensive clinical review of the whole spectrum of neuromuscular disorders. The tone and pace of the book are well set by the epithet to the first chapter on symptoms and signs\"Please listen to the patient, he's trying to tell you what disease he has,\" and by the opening sentence-\"It often seems that the urgency with which physicians rush their patients off for laboratory studies has its historical equal only in the migration of lemmings. ... Individual chapters are devoted to systematic descriptions of disorders of the motor neurone, peripheral neuropathies, diseases of the neuromuscular junction, muscular dystrophies, myotonia, inflammatory myopathies, metabolic muscle diseases, abnormal muscle activity, and ending with \"congenital (more or less)\" muscle diseases. The descriptions are concise but comprehensive and interspersed with clinical photographs and an occasional biopsy photomicrograph. The bibliography is intentionally selective and often recent rather than historical or original. This is a highly individual work which should find appeal with a wide audience of clinicians at all levels.
171 citations
TL;DR: The results indicate that reduction in length of the two internodes closest to the demyelinated region, to approximately one-third of normal length or less, will facilitate conduction beyond the plaque.
Abstract: Clinical and laboratory observations both suggest that it may be possible for action potentials to traverse, in a continuous manner and without interruption, demyelinated zones along some axons. This continuous mode of conduction requires the presence of sufficient numbers of sodium channels in the demyelinated region. One of the factors which will tend to prevent such conduction is the impedance mismatch at sites of focal demyelination, which may result in a reduction in current density sufficient to cause conduction failure. As part of an effort to examine the conditions which would promote conduction into, and beyond, the demyelinated region, we examined, using computer simulations, the effects of reduction in length of the proximal internodes closest to the demyelinated region. Our results indicate that reduction in length of the two internodes closest to the demyelinated region. to approximately one-third of normal length or less, will facilitate conduction beyond the plaque. The results suggest that reductions in internode length, which have been histologically observed along some demyelinated fibres, may have functional significance in terms of facilitating conduction past focally demyelinated zones.
TL;DR: One hundred and fourteen consecutive adult patients treated surgically for chronic subdural haematoma are described and their clinical features presented in detail, suggesting that patients presenting in coma have a much better prognosis than might be expected.
Abstract: One hundred and fourteen consecutive adult patients treated surgically for chronic subdural haematoma are described and their clinical features presented in detail. The diagnostic investigations are evaluated and a regime of surgical management is described. The three main modes of clinical presentation and the diagnostic role of carotid angiography are emphasised. It is suggested that the neurological state at the time of operation has no bearing on the prognosis and that, in particular, patients presenting in coma have a much better prognosis than might be expected. The average follow-up period was two years and the longest 11 years.
TL;DR: Choice reaction time discriminated better and continued to do so throughout the whole period of follow-up of a closed head injury group, and seems to have some value for monitoring recovery and predicting final outcome.
Abstract: A follow-up study covering two years after a closed head injury was carried out on a group of 57 young males. Their reaction time was tested on both a simple and a four choice visual reaction task. The group was divided into three subgroups according to length of unconsciousness after the injury. Reaction time discriminated between subgroups, and a highly significant improvement during follow-up was shown. Choice reaction time discriminated better and continued to do so throughout the whole period of follow-up. Some relations of reaction time with clinical variables and outcome are discussed. The choice reaction in particular seems to have some value for monitoring recovery and predicting final outcome.
TL;DR: This single case study describes the preservation of a simple semantic category in a severely anomic patient and the implications for the organisation of semantic knowledge are discussed.
Abstract: The report of this single case study describes the preservation of a simple semantic category in a severely anomic patient. The implications for the organisation of semantic knowledge are discussed.
TL;DR: It is concluded that the facilitating effect of the Jendrassik manoeuvre on the alpha-motoneurones is not predominantly routed via the gamma-loop.
Abstract: The facilitating effect of the Jendrassik manoeuvre on monosynaptic reflexes in man has been studied by comparing H and T reflexes of the soleus and by blocking the effects of spindle activation by ischaemia of the leg. The Jendrassik manoeuvre equally enhances H and T reflexes provided that the test reflexes are small. The H reflex remains facilitated when the spindle activation cannot affect the soleus alpha-motoneurones--that is, when the Ia afferent nerve fibres from the soleus are blocked by ischaemia. It is concluded that the facilitating effect of the Jendrassik manoeuvre on the alpha-motoneurones is not predominantly routed via the gamma-loop.
TL;DR: The behaviour of an individual neurone is consistent in different activation periods, and when a neurone has few responses at rest the frequency increases under activation of the contralateral or ipsilateral muscle and there is a decrease under activation.
Abstract: Recurrent responses of single human motor neurones after antidromic activation, the so-called F response, have been studied in the abductor digiti minimi muscle in normal subjects and in spastic patients with the single fibre EMG technique. The F response occurs rarely and in groups. Half of all motor neurones did not produce any F response within an arbitrarily chosen time interval of 200 successive stimuli at 1 and 2 Hz. Spastic patients had as many silent neurones as the normal subjects but the responding neurones more frequently produced F responses (P less than 0.001). When a neurone has few responses at rest the frequency increases under activation of the contralateral or ipsilateral muscle (P less than 0.05). When there are many responses in the relaxed state there is a decrease (P less than 0.001) under activation. The behaviour of an individual neurone is consistent in different activation periods.
TL;DR: The carotid angiograms of 96 patients who had died from non-missile head injury were reviewed and assessed for evidence of arterial spasm, slowing of the cerebral circulation, and the presence of intracranial haemotoma.
Abstract: The carotid angiograms of 96 patients who had died from non-missile head injury were reviewed and assessed for evidence of arterial spasm, slowing of the cerebral circulation, and the presence of intracranial haemotoma. As bilateral angiography had been done in 44 cases the results are based on a correlation between the angiographic appearances and the presence or absence of ischaemic brain damage in the cortex of 140 cerebral hemispheres. There was a significant relationship between spasm alone, the presence of intracranial haematoma alone, or their combination, and ischaemic damage in the ipsilateral cortex. Apart from an association between the more severe grades of spasm and slowing of circulation in the group with ischaemia within arterial territories, there was none between slowing of the circulation or the combination of slowing with either spasm or haematoma and ischaemic brain damage.
TL;DR: The results indicate that reinnervation in motor neur one disease is sufficient to compensate completely for the loss of up to 50% of the motor neurone pool supplying the muscle.
Abstract: Thirty-two patients with motor neurone disease were investigated using quantitative electrophysiological techniques. Estimates of the number of surviving motor units in the extensor digitorum brevis muscle and measurements of the electrophysiological parameters of these units are present along with the values for motor nerve conduction velocities. The results indicate that reinnervation in motor neurone disease is sufficient to compensate completely for the loss of up to 50% of the motor neurone pool supplying the muscle. The capacity for reinnervation is greater than we have found in a number of neuropathies but the efficiency of reinnervation decreases as the number of surviving motor units falls. Reinnervation appears to cease when 5% or less of the motor units remain viable. There is no electrophysiological evidence of a preferential loss of fast conducting axons, of pathological slowing of conduction nor of a dying-back process affecting the motor axon. Comparison of the electrophysiological parameters in progressive muscular atrophy and amyotrophic lateral sclerosis shows no significant differences. The underlying pathophysiological mechanisms are discussed in terms of the results.
TL;DR: The neurological complications secondary to embolism from atrial myxoma are reviewed and a patient with intracranial and skeletal metastases is described to highlight the malignant potentiality of this tumour.
Abstract: The neurological complications secondary to embolism from atrial myxoma are reviewed. A patient with intracranial and skeletal metastases is described to emphasise the malignant potentiality of this tumour. A classification of atrial myxoma metastases is presented.
TL;DR: A patient who developed topographical memory loss after a closed head injury is described, his symptoms and the psychological test results indicate a selective deficit of topography memory.
Abstract: We describe a patient who developed topographical memory loss after a closed head injury. His symptoms and the psychological test results indicate a selective deficit of topographical memory, his perceptual and spatial skills being relatively unimpaired.
TL;DR: Of 500 left brain-damaged patients with educational level above elementary school investigated with a standard quantitative battery for dissociation between oral and written expression, speech was found to be selectively impaired in seven patients, with evidence of a selective association between pure agraphia and lesions of the upper left parietal lobule.
Abstract: Of 500 left brain-damaged patients with educational level above elementary school investigated with a standard quantitative battery for dissociation between oral and written expression, speech was found to be selectively impaired in seven (three with "pure anarthria," two with anarthria in the context of Broca's aphasia, and two with fluent aphasia with remarkable sparing of writing), and writing in another seven (two with "pure" agraphia, two with "agraphia with mild alexia," and three with "agraphia with mild fluent aphasia.") The nature of three conditions (pure anarthria, fluent aphasia with sparing of writing, and pure agraphia) is discussed, with evidence of a selective association between pure agraphia and lesions of the upper left parietal lobule.
TL;DR: Evidence partly from threshold studies, shows that the low threshold cutaneous afferent fibres were responsible for activating the generators of the potentials and probably have the same generator, the neurones of the dorsal horn.
Abstract: Somatosensory evoked potentials were recorded from the skin overlying the cervical and lumbar spinal cord of man after stimulation of median and tibial nerves respectively. The early negative component (N11) of the cervical potential and the negative lumbar potential (N14) were studied. The spatial properties of N11 and N14 indicate a spinal cord origin. Evidence partly from threshold studies, shows that the low threshold cutaneous afferent fibres were responsible for activating the generators of the potentials. A conditioning test stimulation procedure supports a postsynaptic generator. It is concluded that N11 and N14 have properties similar to the cord dorsum potentials recorded in animals and probably have the same generator, the neurones of the dorsal horn.
TL;DR: The variations of foramina appear to follow a pattern at various vertebral levels, and the possible factors involved in causing these variations-for example, mechanical stress, size, course, and number of vertebral vessels-were analysed.
Abstract: Four hundred and eighty foramina transversaria in dry cervical vertebrae of 36 spines and in a number of dissections were studied and classified according to size, shape, and direction of their main diameter. A coefficient of roundness was then elaborated. The variations of foramina appear to follow a pattern at various vertebral levels. The possible factors (in addition to the embryological ones) involved in causing these variations-for example, mechanical stress, size, course, and number of vertebral vessels-were analysed. The importance of the correct interpretation of the variations in the foramina transversaria in radiographic or computerised axial tomography is discussed. The contribution of the present study to the understanding and diagnosis of pathological conditions related to the vertebral artery and its sympathetic plexus is stressed.
TL;DR: Seven of the 16 subjects with left hemisphere dysfunction and none of the eight subjects with right hemisphere dysfunction showed an elevation on the depression scale, demonstrating that these asymmetries cannot be ascribed completely to hemisphere-related differences in cognitive deficits or expressive abilities.
Abstract: Patients with left hemisphere disease have been noted to be depressed while those with right hemisphere disease appear indifferent. While patients with left hemisphere disease frequently have a greater cognitive deficit, patients with right hemisphere disease have difficulty in expressing affectively intoned speech. The Minnesota Multiphasic Personality Inventory (MMPI) can demonstrate underlying affective experience and is not dependent on affectively intoned speech. The purpose of this study was to determine whether a difference in affective moods, as assessed by the MMPI, was related to laterality of lesion in patients matched for severity of cognitive and motor dysfunction. Seven of the 16 subjects with left hemisphere dysfunction and none of the eight subjects with right hemisphere dysfunction showed an elevation on the depression scale. This observation not only confirms previous clinical observations but also demonstrates that these asymmetries cannot be ascribed completely to hemisphere-related differences in cognitive deficits or expressive abilities.
TL;DR: The outcome in 37 adult patients with idiopathic communicating hydrocephalus treated by ventriculoatrial shunting is presented, and the high frequency of serious complications suggests caution in recommending a shunt procedure.
Abstract: The outcome in 37 adult patients with idiopathic communicating hydrocephalus treated by ventriculoatrial shunting is presented. Only 33% showed definite improvement, and no diagnostic procedures accurately predicted the outcome of surgery. These were compared with a "control" group of 12 patients who were not shunted; 50% of these were stable for up to 36 months. These findings, and the high frequency of serious complications (35%), suggest caution in recommending a shunt procedure.
TL;DR: It is concluded that this syndrome is caused by a lesion of the afferent fibres of the posterior nerve roots which causes frequent spontaneous impulses in the posterior roots which activate local circuits of interneurone and motoneurones and result in co-ordinated movements involving local muscles.
Abstract: A condition of painful legs with moving toes was described in 1971. Further examples of this condition are now reported, showing lesions in the posterior root ganglion, cauda equina, nerve roots, or a peripheral nerve of the lower limb. It is concluded that this syndrome is caused by a lesion of the afferent fibres of the posterior nerve roots. It is likely that this lesion causes frequent spontaneous impulses in the posterior roots which activate local circuits of interneurones and motoneurones and result in co-ordinated movements involving local muscles.
TL;DR: A retrospective study of 70 consecutive patients with a cauda equina tumour who were admitted to Neurosurgical Department at the Radcliffe Infirmary, Oxford is presented.
Abstract: A retrospective study of 70 consecutive patients with a cauda equina tumour who were admitted to Neurosurgical Department at the Radcliffe Infirmary, Oxford is presented. The diagnosis of these tumours is often difficult and delayed. The quality of life largely depends upon the neurological disability at presentation. The diagnostic features and investigations are discussed together with the treatment and prognosis.
TL;DR: Surface electrodes have been used to record potentials evoked in the lumbosacral region of 15 healthy volunteers after tibial nerve stimulation and it was possible to identify the neural substrates responsible for several of the components in the responses.
Abstract: Surface electrodes have been used to record potentials evoked in the lumbosacral region of 15 healthy volunteers after tibial nerve stimulation. By monitoring the M waves and H reflexes in the triceps surae muslces and by comparing the responses recorded over the roots with those over the lower cord, it was possible to identify the neural substrates responsible for several of the components in the responses. The findings are compared with those of previous studies in man and in other mammalian preparations.
TL;DR: These procedures provide a well-quantified and reliable measure of muscle tone and hyperreflexia which is well correlated with the patient's clinical status.
Abstract: Sinusoidally modulated torque was applied to rotate the ankle joint of normal subjects and clinically spastic patients. Measurements were made of the effective joint compliance and of the evoked EMG activity. These procedures provide a well-quantified and reliable measure of muscle tone and hyperreflexia which is well correlated with the patient's clinical status.