摘要:

In a four‐and‐a‐half year period, 19 patients with focal neurological deficits accompanied by a focal electrographic status epilepticus were encountered. Sixteen of these patients showed clouding of consciousness or confusion. Computed tomography of the brain revealed focal lesiohs in 15 patients. In 7 patients the lesions were the result of a recent cerebral event and in 8 patients they were long‐standing. All patients were treated with anti‐epileptic drugs. Ten of the 12 patients without an acute lesion showed a complete recovery in a few days. In these patients the symptoms may have been caused by the continuous seizure activity, classifying them as cases of non‐convulsive focal status epilepticus. Only 2 of the 7 patients with an acute lesion had a full recovery. In patients with an acute lesion the part played by the electrographic status epilepticus in the acquired deficits is unclear. Continuous or frequent intermittent focal epileptic discharges on the EEG may warrant treatment with anti‐epileptic drugs in patients with focal neurological deficits, even when one of the hallmarks of epilepsy, clonic movemen

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1995.tb01687.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Introduction– The aim of this study was to determine the effect of routine withdrawal of antiepileptic drugs (AEDs) during preoperative evaluation on cognitive functions and also to clarify whether short‐term withdrawal of AED would help to lateralize the epileptic focus and to highlight focal dysfunction of memory in patients with temporal lobe epilepsy.Material&methods– Cognitive function was evaluated in 25 patients on full medication and after 1‐week during the ongoing AED withdrawal. Six additional patients without AED withdrawal were studied during the same time interval and served as controls. The effect of AED withdrawal on memory tests was evaluated in a subgroup of 11 patients with temporal lobe epilepsy (TLE group).Results– In the TLE group, verbal recurrent‐sequences learning tasks deteriorated significantly in patients with left‐sided foci during AED withdrawal. In the whole group, attention, concentration and mental flexibility improved both in patients and in controls; the improvement was interpreted as being the result of the practice effect. During AED withdrawal, the number of errors in these tests decreased or remained unchanged.Conclusion– We suggest that preoperative neuropsychological testing can be scheduled at any time in patients referred for epilepsy surgery. In patients with temporal lobe epilepsy, the lateralizing results of selective memory tests may be most reliable if the testing is performed during

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1995.tb01688.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Myositis linked to HTLV‐1 is unfrequent. Over a period of 8 years, 14 patients with inflammatory myopathy were diagnosed in Martinique. Seven were seropositive for HTLV 1 antibody; the clinical and pathological data of whom are presented herein. Five patients presented with polymyositis, two with dermatomyositis. All seven patients had extra‐muscular clinical features including neuropathy (4/7) and myelopathy (6/7), resulting in a quite peculiar clinical picture. Muscle biopsy showed a neurogenic process combined with myositic changes in 3/7 patients. Corticotherapy led to dramatic improvement in only one case, but with no sustained effect. HTLV 1 may be considered the etiological agent of this form of dermato‐polymyositis, characterized by a clearly distinctive clinico‐pathological picture, and a poor response to corticotherapy. As in the case of tropical spastic paraparesis/HTLV 1 associated myelopathy, careful assessment of non‐steroidal therapy is now

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1995.tb01689.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Introduction– In patients with human T‐cell lymphotropic virus type 1 (HTLV‐1) associated myelopathy/tropical spastic paraparesis (HAM/TSP), we investigated the significance of HTLV‐1 specific antibodies in the cerebrospinal fluid (CSF).Material and methods– The quantities of HTLV‐1 specific immunoglobulin G (IgG) in paired CSF and serum were evaluated by a sensitive enzyme immunoassay (EIA). The specificity of antiviral IgG was determined by radioimmunoprecipitation of HTLV‐1 antigens.Results– In 17 of 20 HAM/TSP patients, quantitative evaluation by EIA supplied evidence for antiviral IgG synthesis within the CNS. Radioimmunoprecipitation demonstrated IgG antibodies against HTLV‐1 envelope and core proteins in all HAM/TSP CSF and sera tested. Regarding the 3 sample pairs indeterminate in EIA for intrathecal synthesis, 2 showed stronger precipitation of HTLV‐1 antigens by CSF IgG than by equal amounts of serum IgG.Conclusion– Intrathecal antibody synthesis specific for both HTLV‐1 core and envelope antigens is common in HAM/TSP, thus providing conclusive evidence for an immune response t

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1995.tb01690.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Central motor conduction time (CMCT) after transcranial magnetic stimulation (TMS) of the cortex, electromyography and nerve conduction velocity were performed in 24 patients with multiple system (MSA) and late onset cerebellar atrophy (LOCA) (often olivopontocerebellar atrophy –OPCA –). CMCT was abnormal in 7 patients with OPCA and one with LOCA. CMCT abnormalities (43% of cases) and increased threshold (68%) were more often found within OPCA group than in another multisystem atrophy and LOCA. Reduction in amplitude of the response after TMS was significantly correlated with cerebral hemispheres's atrophy. Increased threshold was correlated with upper vermal hemisphere atrophy and enlargement of the fourth ventricle. Electrophysiologic signs of mixed peripheral neuropathy were found in 8 patients. TMS abnormalities were not related to peripheral nerve involvement. Marked variation in CMCT suggests heterogeneity in these diseases. However, the percentage of CMCT abnormalities in OPCA group suggests that TMS seems to play a role in the neurophysiological diagnosis of these heterogeneous disord

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1995.tb01691.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

In biopsic material collected from the frontal cortex of 6 patients with subacute sclerosing panencephalitis (SSPE) and 5 patients with posterior fossa tumors, we estimated the neuronal and synaptic numerical densities as well as the mean volume of the neurons from layers II and III. The thickness of these layers was also determined. The evaluation of the layer's thickness suggested that there was no difference in the shrinkage in SSPE as compared to controls. No differences were found between the neuronal numerical densities and the neuronal soma sizes from SSPE and controls. Conversely the synaptic numerical density was reduced in SSPE. Given the maintenance of the neuronal numerical density in the frontal cortex of patients with SSPE, the presence of a decreased density of synapses must be regarded as a consequence of the dendritic and axonal degeneration that we previously described in this condition. It must then be borne in mind that SSPE's functional and behavioral changes might spring from alterations of the frontal cortex neuronal circuitry.

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1995.tb01692.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

In a prospective study we compared duplex‐ultrasound characteristics of symptomatic internal carotid artery (ICA) stenoses with cranial computerized tomographic (CCT) findings in 82 patients suffering from completed or transient middle cerebral artery symptoms. The aim was to assess the pathogenic role of ICA plaque morphology and the potential embolic risk of ICA plaques. The degree of carotid stenosis was estimated by spectral analysis of the pulsed Doppler signal. The CCT findings were classified as being either normal, lacunar lesions, hemodynamically induced low‐perfusion infarctions, or territorial embolic infarctions. According to their ultrasonic features we characterized the ICA plaque surface as smooth or irregular and their structure as homogeneous or heterogeneous. Plaques with an irregular surface and heterogeneous echogenicity dominated significantly in CCT‐territorial infarctions (p%) dominated in both territorial infarctions and low‐perfusion infarctions, as compared to ipsilateral normal CCT or lacunes (p<0.05). Normal CCT and lacunar infarctions were associated with homogeneous and smooth plaques (both p50% ICA stenoses can cause both hemodynamically induced low‐perfusion infarctions as well as thromboembolic territorial infarctions, whereas ulcerated and heterogeneous plaques constitute a high risk factor for arterio‐arterial embolic stroke. Furthermore, carotid ultrasound may help to estimate the clinical significance of ca

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1995.tb01693.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Intellectual changes observed in progressive supranuclear palsy (PSP) are sometimes seen with lesser intensity in Parkinson's disease (PD). Cognitive impairment of PSP has been attributed to a frontal lobe dysfunction explaining the frontal cortex hypometabolism detected by PET. To establish whether this frontal hypometabolism is more pronounced in PSP than in PD, we compared frontal and temporo‐parietal cerebral blood flow (CBF) indexes studied by SPECT using Tc99m HmPAO in 18 PSP, 18 PD and 8 control subjects. For each patient neuropsychological performances were also assessed. A significant left frontal hypoperfusion was observed in PSP (mean index value: 0.78 ± 0.03, p<0.01) and PD (0.78 ± 0.04, p<0.05) as compared to controls (0.84 ± 0.03), whereas there was no difference between PSP and PD. No correlation was discovered between neuropsychological performances and frontal cortical index changes. This frontal uptake reduction of Tc99m HmPAO in PSP and PD could result from a disconnection phenomenon secondary to subcortical lesions. In both groups mean frontal indexes showed only a left frontal hypoperfusion suggesting that subcortical structures might be asymmetrically involved in early stages of the diseases. The lack of difference for indexe values between PSP and PD might be explained by the difference between the mean disease duration: 4.3 years for the PSP and 7.8 years for the PD. It might also suggest that frontal CBF reduction exists in the same proportions in PD and PSP, but at a later stage in the former

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1995.tb01694.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

A total of 141 subjects with tight stenosis (≥75%) or occlusion of internal carotid artery were followed up at intervals 3–6 months regularly for 40 ± 16 months. The direction of ophthalmic artery flow was used as a parameter of risk indicator on cerebral ischemic events. Eleven patients with bilateral carotid tight stenosis/occlusion were excluded in the analysis. Thus, the 130 carotid arteries were divided into three groups: (1) carotid artery with ipsilateral hemispheric TIA or stroke (85 patients), (2) carotid arteries with contralateral hemispheric TIA/stroke or VBI (15 patients), and (3) carotid arteries of asymptomatic patients (30 patients). The symptomatic carotid artery group (group 1) had significantly more often reversed ophthalmic flow than the other two groups (group 2 and 3, p<0.001). During follow‐up prospectively for four years, 41 patients had cerebral ischemic events, three had cardiac ischemic events and six died of malignancy. Patients with reversed OA flow had more often subsequent cerebral ischemic events than those with forward flow (27vs14, p = 0.010). However, the difference remained significant only in the asymptomatic patients (group 3, 4vs0, P<0.001), not for groups 1 and 2, after further analysis. Our work supported that the clinical role of ophthalmic artery collateral varied between asymptomatic and symptomatic pa

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1995.tb01695.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

In this study levels of neuron‐specific enolase (NSE), S‐100 protein (S‐100) and myelin basic protein (MBP) in cerebrospinal fluid (CSF) of children and adults with distinct neurological disorders were examined. A previous study from our department demonstrated age related reference values for these brain‐specific proteins in CSF. The median concentration level of the 3 proteins in 17 different neurological disease groups versus the reference group was compared. Significantly higher MBP values were observed in patients with multiple sclerosis (MS), cerebrovascular accident (CVA), metabolic disorder and infection. Furthermore, significantly higher values were demonstrated for S‐100 in CVA and for NSE in metabolic diseases. In CVA, the NSE and S‐100 values were significantly related with MBP values, whereas in MS the NSE and S‐100 were not related wi

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1995.tb01696.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY