Showing papers in "Neurology in 1977"
TL;DR: Physostigmine, a pharmacologic antagonist of scopolamine, markedly improved M/C functions; amphetamine failed to produce M/ cognitive improvement, although alertness was improved, and activity in catecholaminergic neurons presumably increased, which supports a specific role for cholinergic neurons in M-C processes.
Abstract: Interference with cholinergic function produces disruption of memory/cognitive (M/C) performance in both animals and man. It is uncertain whether this disruption is due to a specific relation of cholinergic neurons to M/C functions, or whether the effect is nonspecific, resulting either from alteration of alertness and attention, or from a “mass action” effect, with loss of functioning neurons. Scopolamine was given to normal subjects to produce an M/C impairment. Half the test subjects then received physostigmine and half d-amphetamine. Physostigmine, a pharmacologic antagonist of scopolamine, markedly improved M/C functions; amphetamine failed to produce M/C improvement, although alertness was improved, and activity in catecholaminergic neurons presumably increased. This comparison supports a specific role for cholinergic neurons in M/C processes. Possible mechanisms of cholinergic neural functioning in memory include plasticity of cholinergic synapses, as well as other acetylcholine-depended operations of the limbic system crucial to memory.
641 citations
TL;DR: Investigation of short-latency auditory evoked responses suggested that waves I-VII largely reflect activity at the following levels of the auditory pathway: acoustic nerve, pontomedullary junction, caudal pons, rostral pons or midbrain, and thalamus or auditory radiation.
Abstract: Short-latency auditory evoked responses were recorded in over 100 neurologic patients. Abnormalities of each response component were correlated with postmortem or radiologic localization of different brain stem lesions. These findings suggested that waves I-VII largely reflect activity at the following levels of the auditory pathway: acoustic nerve (I), pontomedullary junction (II), caudal pons (III), rostral pons or midbrain (IV), midbrain (V), thalamus (VI), and thalamus or auditory radiation (VII). When this information was applied prospectively to the evaluation of brain stem dysfunction, response abnormalities proved useful in detecting and localizing certain lesions not revealed by other tests. Serial recordings provided information about the evolution of brain stem lesions and their response to therapy.
596 citations
TL;DR: Marked edema of a cerebral hemisphere when no surgical decompression is provided may produce unilateral delta activity by pressure on or displacement of the brain stem or diencephalon.
Abstract: Localized delta activity appears in cortex overlying a circumscribed white matter lesion. Less commonly, localized delta activity may result from a localized thalamic lesion. Unilateral diffuse delta activity appears on the side of thalamic or hypothalamic lesions. Bilateral delta activity results from bilateral lesions of the midbrain tegmentum. Localized lesions of the cerebral cortex, unilateral mesencephalic tegmental lesions, and vasogenic edema of the cerebral white matter do not produce delta activity. Marked edema of a cerebral hemisphere when no surgical decompression is provided may produce unilateral delta activity by pressure on or displacement of the brain stem or diencephalon.
422 citations
TL;DR: Ability to discriminate affective speech and ability to repeat emotionally bland sentences with affective tones were tested in patients with right parietal dysfunction and neglect, conduction aphasics with left hemispheric lesions, and patients without intracranial disease.
Abstract: Patients with right parietal disease have disturbed comprehension of affective speech. Ability to discriminate affective speech (make same/different discriminations) and ability to repeat emotionally bland sentences with affective tones were tested in three groups of subjects—patients with right parietal dysfunction and neglect, conduction aphasics with left hemispheric lesions, and patients without intracranial disease. Patients with right parietal dysfunction performed significantly poorer than did aphasic controls on both a recognition and discrimination task. Patients with right parietal dysfunction also scored poorer on the evocative task than the nonaphasic controls.
394 citations
TL;DR: Peroxidase-conjugated α-bungarotoxin (P-BGT) was used for the ultrastructural localization of the acetylcholine receptor in end-plates in external intercostal muscles of four patients with myasthenia gravis, in forelimb digit extensor muscles of rats with advanced chronic experimental autoimmune myasthensia Gravis, and in suitable human and rat controls.
Abstract: Peroxidase-conjugated alpha-bungarotoxin (P-BGT) was used for the ultrastructural localization of the acetylcholine receptor in end-plates in external intercostal muscles of four patients with myasthenia gravis, in forelimb digit extensor muscles of rats with advanced chronic experimental autoimmune myasthenia gravis, and in suitable human and rat controls. In control end-plates, the previously reported localization of acetylcholine receptor on the terminal expansions of the postsynaptic folds and, in traces, on the presynaptic membrane was confirmed. By contrast, in myasthenia gravis some postsynaptic regions bound no P-BGT; in other regions, the folds displayed only faint traces of the reaction product, or only some segments of the postsynaptic membrane showed the reaction product; finally, in some regions there was no apparent decrease in reaction product. In general, those postsynaptic regions showing the greatest decrease in P-BGT binding were also the simplest or showed the most degenerative changes, and the presynaptic staining was decreased in proportion to the decrease in the adjacent postsynaptic P-BGT binding. In the experimental animals, the abnormalities in the amount and distribution of the acetylcholine receptor were essentially like those in the more severely affected patients. Morphometric estimates of the postsynaptic acetylcholine receptor surface correlated well with the patients' clinical status and linearly with the miniature end-plate potential amplitude.
236 citations
TL;DR: It is concluded that metastases of choriocarcinoma, melanoma, and bronchogenic carcinoma are most prone to massive bleeding.
Abstract: Fifteen cases of metastatic brain tumors associated with massive subarachnoid, intracerebral, or intraventricular hemorrhage or a combination thereof are reported. Four patients had multiple bleeding cerebral metastasis. In 10 patients, stroke was the first manifestation of the neoplastic disease. It is concluded that metastases of choriocarcinoma, melanoma, and bronchogenic carcinoma are most prone to massive bleeding. The average survival from the beginning of neurologic symptoms was 65 days, but in seven patients, it was 11 days or less. Surgery seems to be beneficial in selected patients. Massive hemorrhage was a complication in 14 percent of our patients with metastases to brain versus 0.8 percent of those with gliomas.
212 citations
TL;DR: Although not entirely specific for multiple sclerosis, the presence of material in the cerebrospinal fluid of multiple sclerosis patients cross-reacting with encephalitogenic protein-P1 appears to be a characteristic of acute exacerbations.
Abstract: With a double-antibody radioimmunoassay performed on unconcentrated cerebrospinal fluid, eight of 14 patients in an acute phase of multiple sclerosis had levels of 3.4 to 15.4 ng per milliliter of the P1 fragment (residues 43–88) of myelin encephalitogenic protein. Encephalitogenic protein-P1 was found only in the acute phase and was present in six of seven persons in the first week of an exacerbation and absent in 29 multiple sclerosis patients who were stable or had a gradually progressive course. Six of 117 controls had detectable cerebrospinal fluid encephalitogenic protein-P1. Only in two of these, one with a recent cerebral infarction and one with diabetic nephropathy who was in coma, were the levels in the range encountered in patients in the acute phase of multiple sclerosis. Although not entirely specific for multiple sclerosis, the presence of material in the cerebrospinal fluid of multiple sclerosis patients cross-reacting with encephalitogenic protein-P1 appears to be a characteristic of acute exacerbations.
197 citations
TL;DR: Adrenal insufficiency beginning in childhood and developed progressive spastic paraparesis in the third decade probably represents a clinically and genetically distinct variant of childhood adrenoleukodystrophy.
Abstract: We have studied four unrelated males with a heritable disorder that we term adrenomyeloneuropathy; limited clinical information is available on a fifth case. All had adrenal insufficiency beginning in childhood and developed progressive spastic paraparesis in the third decade. Hypogonadism of variable severity was present in all four cases appropriately examined. Neurologic features included peripheral neuropathy, impotence, and sphincter disturbances. Late manifestations were cerebellar dysfunction in one case and dementia and hemiparesis in another. A family history of adrenal disease or spastic paraparesis was present in two cases and absent in one; in the other two, no family history was available. Although males are predominantly affected, the mode of inheritance is uncertain. Adrenomyeloneuropathy probably represents a clinically and genetically distinct variant of childhood adrenoleukodystrophy.
194 citations
TL;DR: Brain mast cells were studied in mice, rats, rabbits, hamsters, guinea pigs, cats, cows, monkeys, and humans with use of a variety of techniques and characterized by their ultrastructural appearance and by the presence of histochemically demonstrable histamine.
Abstract: Brain mast cells were studied in mice, rats, rabbits, hamsters, guinea pigs, cats, cows, monkeys, and humans with use of a variety of techniques. They were localized by staining with Astrablau or by toluidine blue-induced metachromasia and characterized by their ultrastructural appearance and by the presence of histochemically demonstrable histamine ( o -phthaldialdehyde fluorescence method). The identity of the fluorophore was secured by microspectrofluorometry. Mast cells in brain usually had a perivascular localization but were also found scattered in the parenchyma. The regional variations in the number of mast cells agreed with the histamine concentration as measured fluorometrically. The variation was in the order leptomeninges > hypothalamus > cerebral cortex = mesencephalon > cerebellum = brain stem. In addition to histamine, murine mast cells stored serotonin, whereas bovine mast cells contained dopamine, visualized histochemically by the formaldehyde technique.
191 citations
TL;DR: The “psychotropic” effects of carbamazepine were evaluated with phenytoin (Dilantin) as reference agent in a counterbalanced, crossover study, and the findings were consistent with patient reports of improvement in alertness and mental functioning.
Abstract: The "psychotropic" effects of carbamazepine were evaluated with phenytoin (Dilantin) as reference agent in a counterbalanced, crossover study. Forty adult epileptics were given a series of neuropsychologic tests and the MMPI after 4 months on each agent. Most abilities were much the same with either anticonvulsant, but there were fewer errors with carbamazepine on mental tasks requiring attention and problem solving, and some improvement in emotional status was suggested. The findings were consistent with patient reports of improvement in alertness and mental functioning. These results combine with the excellent anticonvulsant properties of carbamazepine to support its use as an anticonvulsant.
183 citations
TL;DR: In this paper, abnormalities of local brain glucose utilization were studied 90 minutes following occlusion of the left middle cerebral and common carotid arteries in a series of pentobarbital-anesthetized cats.
Abstract: By means of an autoradiographic technique employing 14C-2-deoxyglucose, abnormalities of local brain glucose utilization were studied 90 minutes following occlusion of the left middle cerebral and common carotid arteries in a series of pentobarbital-anesthetized cats. Sham-insulted control animals exhibited a normal pattern of regional glucose utilization. In animals with vascular occlusion, a zone of greatly suppressed glucose utilization occupied the caudate nucleus of the ischemic hemisphere, with variable extension, and was surrounded by a narrow rim of increased local brain glucose utilization, suggesting the occurrence of enhanced anaerobic glycolysis in the latter zones. The cerebral cortex, which was less constantly affected, showed alternating regions of increased and decreased glucose utilization. Quantitation of local brain glucose utilization values from the contralateral nonischemic hemisphere revealed a mild suppression of cortical glucose utilization relative to the control animals. This may be the metabolic equivalent of diaschisis.
TL;DR: Platelet hyperaggregability is found to be a concomitant feature of the migraine syndrome but not dependent on the occurrence of the actual headache, which may help explain the increased incidence of stroke and heart attack in migraine patients.
Abstract: Employing optical density methods, platelet aggregation in response to 1.275, 1.7, and 3.4 micrometer adenosine diphosphate was tested in 46 patients with migraine and 46 controls matched by age, sex, and race. The migraine patients demonstrated platelet hyperaggregability when compared with controls, as manifested by a lower threshold for the platelet-release reaction and increased platelet stickiness following aggregation. There was no correlation of platelet hyperaggregability with the severity of migraine or with the occurrence of migraine-associated neurologic symptoms, suggesting that platelet hyperaggregability is a concomitant feature of the migraine syndrome but not dependent on the occurrence of the actual headache. As platelet hyperaggregability may predispose to development of intravascular platelet aggregates or mural thrombi, the hyperaggregability found here may help explain the increased incidence of stroke and heart attack in migraine patients that has been reported elsewhere.
TL;DR: The main conclusion is that the frontal lobe appears to be partially connected with motor activity.
Abstract: We describe ictal clinical manifestations of frontal lobe epileptic seizures in 22 patients. After examination of all ictal clinical data, 14 catergories of signs and symptoms were established. The validity of the ictal clinical data used was confirmed on the basis of 99 frontal lobe seizures recorded by tele-electroencephalogram or tele-stereo-electroencephalogram. The main conclusion is that the frontal lobe appears to be partially connected with motor acitivity.
TL;DR: Cerebral Commissurotomy or the “split-brain” procedure may be a valuable adjunct to anticonvulsants for the control of seizures in people whose epilepsy cannot be relieved by anticonVulsants alone, and who are not candidates for the standard methods of surgery.
Abstract: Cerebral commissurotomy or the "split-brain" procedure may be a valuable adjunct to anticonvulsants for the control of seizures in people whose epilepsy cannot be relieved by anticonvulsants alone, and who are not candidate for the standard methods of surgery. Corpus callosotomy, a revised form of the usual division of many commissures, is a safer operation and appears to be equally effective. The complex clinical aspects of cure and treatment are emphasized.
TL;DR: The eponym “Lennox-Gastaut” syndrome is appropriate for a patient who has slow spike-wave activity in the EEG, exhibits mental retardation, and has intractable seizures of various types, but the syndrome does not imply a pathologic entity because many diverse processes, both static and progressive, can produce this syndrome.
Abstract: Clinical features were studied in 83 patients with slow spike-wave activity in the EEG. Epileptic seizures, usually intractable, occurred in 82 patients. The majority had the onset of seizures during the first 2 years of life. Minor motor seizures alone or in combination with other types of seizures occurred in 80 percent, and most had more than one type of seizure. The combination of tonic-clonic, minor motor, and absence seizures was the commonest, occurring in 37 percent. Sixty-six patients were definitely retarded and 49 showed definite motor impairment. Etiologic factors responsible for cerebral insult were identified in 53 patients. Serial EEG studies showed a close relationship between the EEG patterns of hypsarrhythmia, independent multifocal spike discharges, and slow spike-wave activity. The eponym "Lennox-Gastaut" syndrome is appropriate for a patient who has slow spike-wave activity in the EEG, exhibits mental retardation, and has intractable seizures of various types. However, the syndrome does not imply a pathologic entity because many diverse processes, both static and progressive, can produce this syndrome.
TL;DR: Despite differences in clinical presentation and neuropathology, adrenomyeloneuropathy probably represents a distinct variant of adrenoleukodystrophy.
Abstract: Histopathologic features were studied in postmortem examination of two men with adrenomyeloneuropathy, and biochemical studies were performed on one of these individuals. The histopathologic picture of one case included dying-back features in the nervous system and lamellar cytoplasmic inclusions in the brain, adrenal gland, and testis similar to those in adrenoleukodystrophy. Biochemical studies of the cerebral white matter of this individual revealed increased amounts of long-chain saturated fatty acids in cholesterol esters, an abnormality characteristic of adrenoleukodystrophy. Despite differences in clinical presentation and neuropathology, adrenomyeloneuropathy probably represents a distinct variant of adrenoleukodystrophy.
TL;DR: In patients who had craniotomy for brain tumor, subarachnoid hemorrhage, or subdural hematomas, calf compression reduced the incidence of venous thrombosis from nine of 49 control patients (18.4 percent) to one of 53 patients (1.9 percent) given prophylaxis.
Abstract: In a randomized study of 128 patients, we evaluated intermittent pneumatic compression of the calf in the prevention of leg scan-detected venous thrombosis in intracranial disease. Pneumatic compression of the calf for 5 days reduced the rate of venous thrombosis from 12 of 63 control patients (19.1 percent) to one of 65 patients (1.5 percent) given prophylaxis (p = 0.00082). In patients who had craniotomy for brain tumor, subarachnoid hemorrhage, or subdural hematomas, calf compression reduced the incidence of venous thrombosis from nine of 49 control patients (18.4 percent) to one of 53 patients (1.9 percent) given prophylaxis (p = 0.0051). In patients who remained at risk after 5 days, the rate of venous thrombosis was no different in the control group than in the group that had received prophylaxis.
TL;DR: It is suggested that individuals with Huntington disease have impairments in the encoding of new information and the consistent retrieval from storage of learned material, particularly in the realm of episodic memory.
Abstract: Methods have been developed for assessing the cognitive parameters contributing to a memory disorder Our findings suggest that individuals with Huntington disease have impairments in the encoding of new information and the consistent retrieval from storage of learned material Their difficulties lie particularly in the realm of episodic memory
TL;DR: The linguistic capacity of each separate cerebral hemisphere was examined in a 15-year-old, callosally sectioned, normally right-handed male and demonstrated that while the right hemisphere was not capable of expressive speech, it could comprehend nouns and verbs, and also possessed the motor engrams necessary to carry out verbal and pictorial commands.
Abstract: The linguistic capacity of each separate cerebral hemisphere was examined in a 15-year-old, callosally sectioned, normally right-handed male. The results demonstrated that while the right hemisphere was not capable of expressive speech, it could comprehend nouns and verbs, and also possessed the motor engrams necessary to carry out verbal and pictorial commands. In addition, the mute hemisphere was found to be capable of spelling the names of visually presented items by arranging letters as well as by writing with the left hand. Finally, the manner in which the left hemisphere dealt with the overt bodily response to commands presented to the right hemisphere suggested clues to what we feel are mechanisms by which a personal sense of conscious reality is created in the normal brain.
TL;DR: An analysis has been made of the clinical manifestations in 18 cases of hypertensive thalamic hemorrhage diagnosed by computed tomography (CT) and a sensorimotor hemiplegia or hemiparesis was present in all cases.
Abstract: An analysis has been made of the clinical manifestations in 18 cases of hypertensive thalamic hemorrhage diagnosed by computed tomography (CT). CT scans permitted accurate determination of the site, size, and extension of the hemorrhages. A sensorimotor hemiplegia or hemiparesis was present in all cases. Diagnostic clinical features included limitation of vertical gaze, downward deviation of the eyes, and small unreactive or sluggish pupils. All hemorrhages larger than 3.3 cm in diameter were fatal.
TL;DR: Both spinal cord edema and clinical symptoms are lessened by treating symptomatic animals with dexamethasone and evidence for vasogenic edema in spinal cord compressed by tumor includes increased water content, leakage of horseradish peroxidase into gray matter, and histologic evidence of edema.
Abstract: We have developed an experimental model of spinal cord compression in rats. Tumor injected anterior to the T-12 vertebral body grows through the intervertebral foraminato compress the cord and produces paraplegia in 3 to 4 weeks. Evidence for vasogenic edema in spinal cord compressed by tumor includes increased water content, leakage of horseradish peroxidase into gray matter, and histologic evidence of edema. The vascular supply to the cord overlying the tumor appears to be compromised. Both spinal cord edema and clinical symptoms are lessened by treating symptomatic animals with dexamethasone.
TL;DR: It is suggested that the possibility of central pontine myelinolysis be considered in any patient with hyponatremia and neurologic dysfunction.
Abstract: Autopsy in a patient with severe hyponatremia showed central pontine myelinolysis. Review of our patients with central pontine myelinolysis and those described in the English literature to date disclosed that 61 percent had documented hyponatremia. While the exact mechanism involving hyponatremia and central pontine myelinolysis cannot be defined, a circumstantial relationship is apparent. The purpose of this paper is to emphasize this relationship and to suggest that the possibility of central pontine myelinolysis be considered in any patient with hyponatremia and neurologic dysfunction.
TL;DR: Patients and relatives with Tourette's syndrome, members of 21 selected families, participated in a 1-day clinic, and no evidence of abnormality was found in plasma dopamine beta hydroxylase, or norepinephrine levels.
Abstract: Eighty-one patients and relatives with Tourette's syndrome, members of 21 selected families, participated in a 1-day clinic. In 12 of the 13 Jewish families and six of the eight non-Jewish families, there were multiple members with motor and vocal tics by observation or history. Males predominated among those with persistent symptoms, but among those with spontaneous clearing, females predominated. Twelve propositi had troublesome sexual and aggressive impulses, differing only quantitatively from normal. No evidence of abnormality was found in plasma dopamine beta hydroxylase, or norepinephrine levels.
TL;DR: Conduction velocities of the proximal segments of the median and ulnar nerves were measured by evoking F-wave responses and felt to be useful in differentiating between distal and proximal entrapments.
Abstract: Conduction velocities of the proximal segments of the median and ulnar nerves were measured by evoking F-wave responses. The results of these and conventional motor and sensory studies from 60 control subjects were compared with the results in 30 patients with carpal tunnel syndromes, 18 patients with cubital tunnel syndromes, and 23 patients with suspected proximal entrapments. Sixty-seven percent of patients with proximal lesions (confirmed by myelography in 60 percent of cases) had abnormalities in their F-wave studies. Conventional motor studies were normal. Twenty-three percent of the patients with carpal tunnel syndrome and 11 percent of the patients with cubital tunnel syndrome also had abnormal F-wave studies, indicating an additional element of proximal entrapment. This technique is felt bo be useful in differentiating between distal and proximal entrapments.
TL;DR: A detailed questionnaire concerning life history of headache and its characteristics was administered to 1,809 nonmedical volunteers, and an association between hypertension and severe headache was found in women, between asthma and severe headaches in men.
Abstract: A detailed questionnaire concerning life history of headache and its characteristics was administered to 1,809 nonmedical volunteers. Questions dealt with severity of headache, the nature of preceding and accompanying phenomena (nausea, visual scotomata, neurologic symptoms), precipitating factors, and history of other illness. For the total sample and in the 25 to 39 age group, severe or disabling headaches were significantly more frequent in women and mild headaches were significantly more common in men. Migraine characteristics were common with mild headache. An association between hypertension and severe headache was found in women, between asthma and severe headache in men.
TL;DR: Salivary concentrations of these drugs were found to be equivalent to the plasma free drug and to correlate closely with the total plasma levels, and its plasma and salivary levels were equal.
Abstract: Phenobarbital, phenytoin, carbamazepine, primidone, and ethosuximide were measured in saliva and plasma obtained simultaneously from 115 patients. A method to correct for the effect of salivary pH on phenobarbital concentration of saliva was developed. Salivary concentrations of these drugs were found to be equivalent to the plasma free drug and to correlate closely with the total plasma levels. Expressed as percent of total plasma drug, the salivary (S) and plasma free (P) concentrations were: phenytoin, S 11.1 ± 2.0 percent (mean ± SD), P 10.1 ± 2.4 percent (r = 0.97); carbamazepine, S 26.0 ± 2.4 percent, P 25.9 t 3.4 percent (r = 0.97); phenobarbital, S 43.1 ± 5.2 percent, P 40.8 ± 7.9 percent (r = 0.91); primidone, S 75.4 ± 24.9 percent, P 66.4 ± 8.8 percent (r = 0.76). Ethosuximide was not bound by plasma proteins, and its plasma and salivary levels were equal.
TL;DR: The presence of acid maltase activity in muscle, liver, and, to a greater extent, leukocytes in late-onset but not infantile kcid maltase deficiency and the failure of the two disease forms to occur in the same family suggest that they are genetically distinct.
Abstract: Residual acid maltase activity was found by a sensitive fluorometric assay in muscle biopsies from 15 patients with late-onset acid maltase deficiency (mean, 6.91 percent; range, 2.4 to 12.2) but not in biopsy or autopsy muscle from three patients with the infantile form. Electrophoresis, kinetic characteristics, and subcellular fractionation indicated that the residual activity was lysosomal acid maltase and not a contaminating isozyme of neutral maltase. There was no correlation between the amount of residual acid maltase activity and the severity of the clinical picture or glycogen accumulation. The presence of acid maltase activity in muscle, liver, and, to a greater extent, leukocytes in late-onset but not infantile acid maltase deficiency and the failure of the two disease forms to occur in the same family suggest that they are genetically distinct.
TL;DR: Oligoclonal bands were seen in cerebrospinal fluid from all patients with clinically definite multiple sclerosis, even though some had normal cerebroSpinal fluid gamma globulin levels, and in most patients with presumptive multiple sclerosis or other inflammatory conditions of the nervous system.
Abstract: The gamma globulins in cerebrospinal fluid from almost all patients with multiple sclerosis migrate in agarose electrophoresis as abnormal discrete populations, so-called oligoclonal bands. Such bands have also appeared in cerebrospinal fluid from patients with other types of inflammatory pathology such as neurosyphilis, acute idiopathic polyneuropathy, and subacute sclerosing panencephalitis. The demonstration of cerebrospinal fluid oligoclonal bands may aid in the evaluation of patients with early or atypical multiple sclerosis. This report describes a simple method for demonstrating cerebrospinal fluid oligoclonal bands using readily available commercial reagents and apparatus. Oligoclonal bands were seen in cerebrospinal fluid from all patients with clinically definite multiple sclerosis, even though some had normal cerebrospinal fluid gamma globulin levels, and in most patients with presumptive multiple sclerosis or other inflammatory conditions of the nervous system. They were not seen in cerebrospinal fluid of control patients with a variety of other neurologic diseases.
TL;DR: It is concluded that these epileptiform transients of sleep, which have been called “small sharp spikes,” are normal and are of no diagnostic value in the evaluation of patients with seizures.
Abstract: Electroencephalograms were performed on 120 normal subjects sleep deprived for 24 hours. Twenty-four percent of the volunteers exhibited one or more epileptiform transients during stages 1 or 2 of non-rapid eye movement sleep. These potentials usually appeared as monophasic or diphasic spikes unaccompanied by sharp waves or focal slowing. When abundant, they occurred sporadically and independently over both hemispheres but were best developed in the anteromesial temporal regions. A 20 percent incidence of similar spikes was found in 599 consecutively referred patients recorded under the same conditions. We conclude that these epileptiform transients of sleep, which have been called "small sharp spikes," are normal and are of no diagnostic value in the evaluation of patients with seizures.
TL;DR: Changes in cerebral blood flow after acute decrease in the intracranial pressure were not helpful in differentiating patients with normal pressure hydrocephalus from patients with cerebral atrophy, as similar changes in cerebral circulation and metabolism were seen in both groups.
Abstract: Patients with dementia had significant decreases in cerebral blood flow and cerebral oxygen utilization and a mild, but not significant, increase in cerebral blood volume. These studies were not useful in distinguishing patients with cerebral atrophy from patients with normal pressure hydrocephalus, as similar changes in cerebral circulation and metabolism were seen in both groups. Changes in cerebral blood flow after acute decrease in the intracranial pressure also were not helpful in differentiating patients with normal pressure hydrocephalus from patients with cerebral atrophy.