摘要:

We present a 71 year old woman with predominantly right sided parkinsonism of sudden onset, but without tremor. Magnetic resonance imaging (MRI) depicted lesions affecting the substantia nigra (SN) bilaterally, but more pronounced on the left side. There were no other discernible structural lesions. Using positron emission tomography (PET), we investigated regional cerebral metabolic rate of glucose (rCMRG) using the tracer [18F]‐fluorodeoxyglucose (FDG), and striatal dopa decarboxylase capacity using the tracer [18F]‐L‐6‐fluorodopa (FDOPA). The degree and pattern of distribution of FDOPA uptake reductions (putamen>caudate nuclei) were similar to those in idiopathic Parkinson's disease (PD). FDG uptake also revealed similar changes (reductions in frontal cortex and cerebellum, but increases in thalamus), except for putamen which showed reduced rCMRG. In conclusion, the absence of tremor at rest accords with experimental SN lesions. The PET findings in this atypical condition are explained in terms of deafferentation of various brain regions involved in motor control. Furthermore, they illustrate the metabolic effects related to acute focal lesions of the SN as opposed to the progressive degeneration in idiopathic PD and may serve to help unravel the complicated pathophysiology underlying these con

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1996.tb00015.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Oxcarbazepine (OCBZ) is a new antiepileptic drug with a chemical structure similar to carbamazepine. We investigated the daily fluctuations of 10‐OH‐carbazepine (monohydroxy derivative, MHD), the clinically relevant metabolite of OCBZ, in patients with or without comedication. Twenty‐two profiles of (total) serum concentrations of MHD from 18 epileptic patients on a b.i.d. OCBZ regimen were determined at 8.00, 11.00, 14.00, 17.00, 20.00 h (and 22.00 h/23.00 h). A patient was only considered twice if his comedication or OCBZ dosage had been changed. The maximal MHD concentrations were about 33%±14% higher than the minimal MHD concentrations during the day. The free MHD concentrations were determined in 17 profiles. The mean free fraction of MHD was 56.7%±5.5%. In combination with valproic acid the free fraction (64.0%±1.4%) was slightly, but significantly higher (p<0.05) than in monotherapy (52.3%±0.9%) or in combination (58.0%±2.6%) with other antiepileptic drugs (2 × phenobarbital, 2 × methsuximide, 1 × sulthiame). Further studies are necessary to clarify if the observed fluctuations of MHD are of clinic

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1996.tb00016.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

We investigated the EEG frequency distribution by quantitative EEG (QEEG) in 28 children with type 1 diabetes and 28 age‐ and sex‐matched control children. Among the diabetic children, 15 had experienced episodes of severe hypoglycemia (SH group) and 13 had not experienced such episodes (non‐SH group). The EEG analysis was blind. Frequency analysis of 15 EEG epochs, each of 4 s duration, was performed. QEEG showed increased theta activity in the SH group bilaterally in the frontocentral region and a slight trend toward more delta activity in diabetic children than control children bilaterally in the occipital electrodes. The relative alpha amplitude was decreased in the SH group at several locations. Abnormal standard EEG (diffuse theta activity) was observed in two SH patients and one non‐SH patient. All control children had normal standard EEG. We conclude that episodes of severe hypoglycemia may affect frontocentral function slightly in some diabetic c

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1996.tb00017.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Aims– To further delimit the specific verbal operations occurring in the dorsolateral frontal cortex during the generation of words,methods– different verbal fluency tasks guided by distinct specifications (phonological, semantic, or automatic production of words) were used in a functional magnetic resonance study. The study group comprised 10 right‐handed normal subjects ranging in age from 23 to 27 years. Functional magnetic resonance images were obtained in a 1.5‐Tesla magnet using a spoiled GRASS sequence.Results– Noticeable activation was found during the word generation tasks in the dorsolateral frontal cortex. The region showing the most prominent activation was the posterior part of the left middle frontal gyrus. Nevertheless, the different tasks each had a different activation effect. The phonologically guided generation of words produced the most consistent activation of the middle frontal gyrus, which mainly involved the premotor cortex.Conclusion– The results suggest that operations concerned with the generation of sound sequences, rather than the amount of produced words or their semantics, are responsible for sustained focal activity observed in the frontal lobes during verbal fl

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1996.tb00018.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Introduction– During the extended course of multiple sclerosis (MS) there are ample opportunities for the patients to develop other illnesses including cancer, a potential long‐term complication of the immunosuppressive drug treatment in MS.Material and methods– A retrospective cohort study was done to estimate the relative risk of cancer in a population of MS‐patients from three Norwegian counties by record linkage with the Cancer Registry of Norway. The cohort comprised 1271 MS‐patients, 530 men and 741 women, identified in five longitudinal population‐based incidence studies. The reporting of cancer cases has been compulsory in Norway since 1952.Results– We found 73 cancer cases (standardized incidence ratio (SIR) = 0.86, 95% CI 0.68–1.09). Mean follow‐up time was 18.4 years. A significant excess of breast cancers was observed (SIR = 1.70, 95% CI 1.05–2.60). A non‐significant excess of cancer in the urinary tract was observed. No significantly increased risk in hematologic and lymphatic malignancies or malignant brain tumors was observed. The incidence of cancer of the digestive organs was significantly lower than expected (SIR = 0.51, 95% CI 0.24–0.93).Conclusion– Overall, the study indicates that an MS‐patient is not at any unusual risk for subsequent development of cancer compar

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1996.tb00019.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objectives– The humoral immune response seems to play a role in the pathogenesis of multiple sclerosis (MS). The blood‐brain‐barrier (BBB) and particularly the endothelial cell may be a possible target for this immune response.Material&methods– using an ELISA technique, we have investigated the prevalence of antibodies directed against human vein endothelial cells in the sera of 84 patients with MS, 35 stroke patients, 50 systemic lupus erythematosus (SLE) and 76 normal controls. The measurements in MS patients were tested a second time after cytokine stimulation with gamma and beta‐interferon at different doses. Seven MS patients (two positive and five negative) had three or more clinical assessments including the Expanded Disability Status Scale (EDSS) over a three‐month period, and at least three AECA determinations were carried out. Gadolinium MRI examinations were performed monthly during these three months.Results– anti‐endothelial cell antibodies (AECA) have been identified in 9 of 84 patients suffering from MS (10.71%), in 3 of 35 stroke patients (8.57%) and in 20 of 50 SLE patients (40%). None of 76 normal controls had a positive titre of AECA. Cytokine stimulations did not modify the detection of these antibodies. No correlation between AECA and different clinical parameters such as onset age, clinical symptoms at onset and at sampling, clinical course and score measured by the EDSS was found in MS patients. No relationship was found between MRI activity and the presence of AECA.Conclusion– AECA do not seem to be a marker for a specific subs

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1996.tb00020.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Thirty‐six HIV‐1‐infected predominantly well‐functioning subjects were followed up for one year by repeated neuropsychological, clinical neurological, neuroradiological, and immunological examinations. Changes in cognitive performance related to the severity of HIV‐1 infection as well as to neuroradiological or immunological changes were studied. A decline in cognitive speed and flexibility was found in symptomatic subjects (ARC, AIDS). The impairment was especially pronounced in patients with progression of brain atrophy. These findings suggest a brain pathology underlying the cognitive decline in ambulatory outpatients with symptomatic HIV‐1 infection. A practice effect was found in asymptomatic subjects (ASX, LAS) and in those with unchanged CT/MRI scans. No systematic relationship was found between cognitive change and immunolog

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1996.tb00021.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Aims– The traditional description of the clinical picture of acquired childhood aphasia (ACA) claims that ACA is invariably nonfluent, that recovery of language disorder is rapid and complete, and that ACA commonly occurs after right hemisphere damage. However, since the late 1970s the publication of several case studies has led to reject this longstanding standard doctrine. This review, which concerns the revised insights into ACA, aims at making an inventory of the recently described aphasic symptomatologies and neuroradiological data.Material– The literature on ACA with emphasis on the studies published since 1978.Results– Recent case studies show a great variety of aphasic symptomatologies including auditory comprehension disorders, paraphasias, neologisms, logorrhoea, jargon, impaired repetition abilities, and a host of linguistic deficits in reading and writing. Not only the typology of the aphasias but also the recently established clinicoradiological correlations appear to resemble those found in adults. Also, recovery from ACA shows to be less complete than previously thought.Conclusion– These findings bear consequences as to theories on cerebral organization of language in childhood. It appears that already in infancy the two cerebral hemispheres are no equal substrate for language representation. Therefore, prognosis and final outcome of ACA are not uniformly fav

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1996.tb00022.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Sympathetic skin response (SSR) was measured in 20 normal healthy subjects and in 22 patients with chronic renal failure on regular hemodialysis, and its correlation with abnormalities of sensorimotor nerve conduction study and clinical autonomic symptoms was investigated. Nerve conduction studies (NCS) were abnormal in 17 of 22 patients (77.3%), and SSR was absent in 14 of 22 patients (63.6%). Patients were divided into three groups based on their SSR response: patients with normal SSR (n:8, 36.4%), patients with absent SSR in the foot only (n:9, 40.9%), and patients with absent SSR in both hand and foot (n : 5, 22.7%). Good correlation between abnormalities of NCS and absent SSR was observed. No correlation was noted between patient age, sex, duration of hemodialysis, duration of renal failure history, and absent SSR. However, statistically significant correlation was found between mean amplitude of the foot SSRs and sensorimotor nerve conduction velocities, and weekly frequency of hemodialysis.

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1996.tb00023.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objectives– stenoses of the middle and anterior cerebral artery (MCA,ACA) are a clinical relevant complication of bacterial meningitis. We examined the involvement of the posterior cerebral (PCA) and of the basilar artery (BA) into the inflammatory process.Material&methods– 39 unselected patients (26 men, 13 women; meanSD age, 49±17 years) with bacterial (n = 37) and fungal (n = 2) meningitis underwent serial transcranial Doppler sonography recordings of the mean blood velocity (MBV) and the pulsatility index (PI) in the MCA, AC A and PCA, in the BA and in the submandibular internal carotid artery on Days 1, 3, 5, 8, 14 and 21 after admission. The results of the PCA and of the BA were compared to normal reference values and correlated to corresponding neurological signs. The criterion to assume a stenosis was: for the BA an MBV ±95 cm/s, for the PCA an MBV ±85 cm/s.Results– compared with the controls MBV in both arteries was normal on Days 1 and 8‐21, but significantly increased on Days 3 and 5. The PI was significantly increased in the BA on all days and in the PCA on Days 1 and 8‐21. Stenoses of the PCA (4 of 43) and of the BA (4 of 32) remained without corresponding neurological signs, and occurred only in patients with two or more narrowed arteries of the anterior circulation (p<0.05).Conclusion– in bacterial meningitis, hemodynamic disturbances in the posterior circulation are less severe than in the anterior circulation and are clinically

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1996.tb00024.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY