摘要:

Introduction‐ Interobserver variation among four observers in evaluation of eight selected neurological signs was investigated.Material&methods‐ Two hundred and two consecutive unselected inpatients were examined by two senior neurologists and two trainees, all without knowledge of the neurological case history. The signs examined were: anisocoria, jerky eye movements, facial palsy, elbow extension force, finger‐nose test, Barré sign, knee jerk, and extensor plantar reflex. Observed agreement rates and kappa coefficients were calculated in order to compare the interobserver variability among neurologists and trainees, and to evaluate differences in the interobserver variability between signs.Results‐ Observed agreement rates varied from 0.80 to 0.95 for neurologists and from 0.65 to 0.98 for trainees. For neurologists kappa coefficients ranged from 0.40 to 0.67 and for trainees from 0.22 to 0.81. The neurologists had higher kappa values than the trainees in 5 signs, but this difference was only statistically significant for jerky eye movements. For the individual signs the observed agreement rates were between 0.50 and 0.93 for all four examiners combined, and overall kappa values varied from 0.32 to 0.71 with highest agreement for facial palsy and lowest for knee jerk.Conclusion‐ The magnitude of the interobserver and intersign variation indicates that the interpretation of the neurological signs tested, without knowledge of the case history, should be done with so

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb02697.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Recent studies of mortality from motor neurone disease (MND) in Sweden have demonstrated rising levels of mortality from the disease, especially amongst older age groups. Case‐control investigations have suggested that certain environmental factors are significantly related to variations in mortality from the disease, and are associated with a probable individual susceptibility to MND. This study applies an innovative epidemiological technique to longitudinal and cohort analysis of Swedish mortality from MND during the period 1961 to 1990. Survival modelling shows that a subpopulation susceptible to MND exists in Sweden, as has been demonstrated in other countries. The increased life expectancy of the Swedish population since 1961 has resulted in more of that susceptible population living to the ages at which MND is expressed, explaining the majority of the increase in mortality from the disease. However, environmental factors may play a role in accelerating the course of MND and may affect the timing of death within the susceptible sub‐populat

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb02698.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The etiology of Parkinson's disease is mainly unknown. Immune abnormalities have been described, but the cause of such abnormalities has not been resolved. We examined by two‐colour flow cytometry HLA‐DR antigen expression on monocytes from cerebrospinal fluid (CSF) and blood and, moreover, lymphocyte subpopulations (CD4+CD45RO+, CD4+CD45RA+, CD8+CD11b+high) in peripheral blood from patients with Parkinson's disease compared with age‐matched patients with other neurological diseases (OND) and tension headache. We found higher HLA‐DR expression on CSF monocytes compared with blood monocytes. This difference was restricted to Parkinson's disease patients. T helper cell analysis revealed a decreased percentage of CD45RA+“naive” and an increased percentage of CD45RO+“memory” T cell subset from CD4+T cells in peripheral blood of patients with Parkinson's disease compared with patients with tension headache. The proportions of CD8+CD11b+high“suppressor” T cells remained unchanged, among the three patient groups compared. A selective loss of CD4+CD45RA+cells, previously observed in diseases like multiple sclerosis and Down's syndrome as compared with healthy controls suggests a common immunological abnormality in neu

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb02699.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

We studied 18 patients with a single ischemic thalamic lesion, who had somatosensory disturbances and/or central pain in the opposite hemibody, by correlating their clinical symptoms, somatosensory evoked potentials (SEPs), and computed tomography (CT) findings. Patients were divided into three groups: (1) those with somatosensory deficits, central pain, and abnormal SEPs, which comprised two thirds of the patients (classic thalamic pain syndrome), (2) those with somatosensory deficits, no central pain, and abnormal SEPs (analgetic thalamic syndrome), and (3) those with almost normal sense perception, central pain, and normal SEPs (pure algetic thalamic syndrome). CT evidence of a paramedian or anterolateral thalamic lesion might be an indicator for the development of central pain, because these types of infarctions occurred only in patients with the classic thalamic syndrome or the pure algetic thalamic syndrome. The differentiation of the thalamic syndrome into three subtypes is of prognostic value, because patients with a loss of cortical SEPs and a posterolateral ischemic thalamic lesion on the CT scan probably will not exhibit central pain.

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb02700.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Fifty‐five patients with a permanent or intermittent subclavian steal syndrome demonstrated by continuous wave Doppler were included in a prospective study: 25 patients without vertebro‐basilar symptoms, 8 symptomatic patients with defined vertebro‐basilar symptoms and 22 with hemodynamic vertebro‐basilar occurences. The basilar artery velocity was recorded by Transcranial Doppler Sonography in baseline conditions, and after a hyperaemia test to the upper limb. A spontaneous, incomplete basilar steal was diagnosed in seven patients, and a complete basilar steal in one patient, (14.5% of the cases). After hyperaemia test, 18 other incomplete basilar steal were observed. The occurence of a basilar steal was higher in the vertebro‐basilar group (57% of the cases) especially in 7 of the 8 cases with defined vertebro‐basilar symptoms; it was lower in the patients without vertebro‐basilar occurences (36% of the cases). This basilar steal was also seen in five of the six symptomatic patients with opposite vertebral artery stenosis above a 50% diameter. Transcranial Doppler Sonography could help to define a subgroup of subclavian steal syndrome with a high ri

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb02701.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The diagnostic utility of various electrophysiological techniques was evaluated in patients with thoracic outlet compression syndrome (TOCS). Our results suggest that in true neurogenic TOCS, there is no standard electrophysiological picture, but that this evolves with the severity of the syndrome. The first changes observed are electromyographic, followed by changes in F‐wave and SEPs, followed finally by changes in nerve conduction parameters. EMG study was certainly more informative, showing neurogenic damage not only in limbs with neurological signs but also in about 1/4 of limbs with only subjective symptoms. The study of F‐wave and SEPs does not seem to be particularly helpful, however, in view of the peculiar changes found in these patients, SEPs may be a useful complement to EMG. Nerve conduction studies were of little utility since changes in these parameters are only found in patients with long‐standing anomalies and severe at

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb02702.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Increased dopamine D2receptor binding in basal ganglia has been reported in human narcolepsy. These studies have been based on post‐mortem material of 8 patients, most of them also medicated for narcolepsy. We studied six narcoleptics without stimulant or anticataplectic medication. The patients had an unambiguous history of cataplexy, and they were also studied polygraphically. Single photon emission computed tomography (SPECT) imaging was performed. The D2receptor density was determined by using123I‐iodobenzamide (IBZM). The control subjects were 8 unmedicated Parkinson patients with one‐sided (hemiparkinsonian) clinical symptoms. The D2receptor density in them is known to be normal or somewhat increased compared to healthy normals. The striatum/frontal D2activity ratio was 1.331 ± 0.084 (with phantom study correction 2.101 ± 0.300) in the narcoleptic patients, and in the parkinsonian controls 1.321 ± 0.052 (2.067 ± 0.185) for the asymptomatic side and 1.335 ± 0.025 (2.117 ± 0.090) for the symptomatic side (i.e. contralateral to the side with the clinical extrapyramidal signs). There was no statistical difference between the groups or between the symptomatic and asymptomatic side in the Parkinson patients. Thus, our results differ from the earlier post‐m

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb02703.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Twenty‐one patients with normal pressure hydrocephalus (NPH), 8 patients with various brain diseases with an element of hydrocephalus, and 7 patients with miscellaneous dementia disorders were investigated with quantitative radionuclide cisternography (RC) using single photon emission computerized tomography (SPECT). The total intracranial counts as well as the counts in the lateral and third ventricles were measured. All 15 NPH patients accessible for postoperative examination were improved after shunt surgery. In all groups the ventricular and total intracranial counts level increased during the measurement period but remained constant in distribution in each group. The NPH patients had a higher relative count value in the lateral and third ventricles compared to the patients with miscellaneous dementia disorders. The relative values in the third and lateral ventricles were predictive for the outcome of shunt surgery. Quantitative SPECT RC appears to be a useful diagnostic procedure in NPH investigation

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb02704.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

In the present study, a modified Robinson‐Smith procedure was used surgery for cervical radiculopathy in 52 patients. Thirty‐one one‐level and 21 two‐level operations were performed. All patients were followed up between 1 and 3 years (mean 23 months) after surgery with a clinical evaluation by an independent investigator including a radiological examination. In 26 patients the postoperative result was classified as excellent, in 23 the result was good, in 2 satisfactory, while one patient was unchanged compared to the preoperative examination. No patient developed worsening of symptoms after surgery. Of 18 patients with duration of symptoms of more than 4 years, 16 demonstrated markedly improvement. No permanent postoperative complications were seen. A modified Robinson‐Smith procedure appears to be safe and reliable and can be recommended in surgery for cervical radi

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb02705.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The purpose of the study was to determine the extent to which a temporal resection may be undertaken without producing risk to temporal language areas. Patients undergoing craniotomy and placement of a subdural electrode array (SEA) for evaluation of intractable epilepsy were studied to determine the variability of distance of temporal language cortex from the temporal pole. Hemisphere dominance was determined by intracarotid sodium amytal injection. Temporal lobe speech arrest (SA) was mapped with a 64 contact point SEA. Thirty‐one patients had left dominant hemisphere SEAs. Thirty had SA 5 cm to 9 cm from the temporal pole (median 7 cm). One had SA at 3 cm. Twenty‐one patients subsequently had temporal lobectomy (TL). Mean extent of resection was 5.7 cm (range 3 to 9 cm). In 18 TL patients who had neuropsychometric evaluation of language function pre‐ and post‐surgery, there was no significant deterioration. Thirty‐nine patients had right non‐dominant SEAs placed. Eighteen had TL. Thirteen of these had pre‐ and post‐surgery language evaluation and there was no significant change. Comparison of preoperative scores showed significant superiority of the right non‐dominant group over the left dominant group for naming. TL up to 5 cm without stimulation mapping of language areas would be safe in the majority of cases, but one subject (3%) had SA mapped anterior to this and a small number of cases may therefore be at risk to language function following a 5 cm TL. Extensive lateral resections up to 9 cm are possible with preservation of language function with stimulation

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb02706.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY