摘要:

Clinical decision analysis can be a useful scientific tool for individual patient management, for planning of clinical research and for reaching consensus about clinical problems. We systematically reviewed the decision analytic studies in the clinical neurosciences that were published between 1975 and July 1994. All studies were assessed on aspects of clinical applicability: presence of case and context description, completeness of the analysed strategies from a clinical point of view, extendibility of the analyses to different patient profiles, and up‐to‐date‐ness. Fifty‐nine decision analyses of twenty‐eight different clinical problems were identified. Twenty‐eight analyses were based on the theory of subjective expected utility, twelve on cost‐effectiveness analysis. Four studies used ROC analysis, and fifteen were risk‐, or risk‐benefit analyses. At least six studies could have been improved by more elaborately disclosing the context of the clinical problem that was addressed. In eleven studies, the effect of different, yet plausible assumptions was not explored, and in eighteen studies the reader was not informed how to extend the results of the analysis to patients with (slightly) different clinical characterisitics. All studies had, by nature, the potential to promote insight into the clinical problem and focus the discussion on clinically important aspects, and gave clinically useful advice. We conclude that clinical decision analysis, as an explicit, quantitative approach to uncertainty in decision making in the clinical neurosciences will fulfill a growing need i

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00170.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

We examined the prevalence and correlates of apathy and irritability in a consecutive series of 101 patients with probable Alzheimer's disease (AD). Based on clinical criteria, 46 (46%) patients had apathy, and 13 (13%) patients had irritability. Apathy was significantly associated with more severe impairments in activities of daily living, significantly more severe extrapyramidal signs, and a significantly higher frequency of both major depression and dysthymia. Patients with irritability had significantly more severe impairments in activities of daily living and significantly higher depression and anosognosia scores. On the other hand, neither apathy nor irritability were significantly associated with deficits in specific cognitive domains.

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00171.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Corticobasal degeneration is a degenerative disease characterized by asymmetric brain atrophy and clinically by asymmetric onset of an akinetic‐rigid syndrome with apraxia, dysarthria and dysphagia. Diagnosis must be confirmed by autopsy. We have investigated the ability of MRI to detect asymmetric atrophy to support the clinical diagnosis and permit differential diagnosis against other degenerative disorders.Ten patients with clinical suspicion of corticobasal degeneration were studied by brain MRI, and the images were reviewed with the side of greater clinical involvement unknown to the reviewer. The original reports of MR scans were also reviewed.MRI demonstrates that cortical atrophy is asymmetric and more marked in the posterior frontal and mainly in the parietal regions on the side contralateral to the clinical symptoms. Asymmetry was rarely detected on the first reading.Our review of MRI findings demonstrates that it is possible to detect asymmetrical parietal atrophy, thus supporting the clinical diagnosis of corticobasal degeneration. It is essential to be aware of the disease and alert for asymmetries in order to discern the more involved side. No abnormalities were detected in the basal gangli

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00172.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Movement disorders (bemichorea‐hemiballismus, hemidystonia and isolated tremor) are an uncommon clinical manifestation in ischemic stroke (IS), and their anatomical basis is poorly understood. We analyzed the clinical and neuroimaging characteristics of 22 consecutive patients who bad movement disorders associated with cerebral infarction (MDCI), studied at four institutions over 8 years. In one institution (from the La Alianza‐Central Hospital of Barcelona Stroke Registry) nine patients with MDCI were identified among 1099 consecutive first ever stroke patients (0.8%) (908 with IS, 1%).Fifteen out of 22 patients (68%) had hemichorea‐hemiballismus, five (23%) hemidystonia and two (9%) isolated tremor. MDCI were more often left sided (n= 15, 68%), being bilateral in one patient (4.5%). A lesion was found on neuroimaging (CT and/or MRI) in 15 patients (68%), in the territory of the posterior cerebral artery (n= 8) and middle cerebral artery (six deep and one superficial). The most commonly involved structure was the thalamus (n= 8, 36.5%). IS subtypes were; presumed lacunar infarcts in 14 patients (64%), atherothrombotic infarcts in two patients (9%), cardioembolic infarcts in two patients (9%) and infarcts of unknown etiology in four patients (18%).Hemichorea‐hemiballismus was the most common type of MDCI in our study, usually being the result of a thalamic infarction. The thalamus was the most frequently damaged structure underlying all types of MDCI. There was a striking propensity of MDCI which resulted from nondominant deep hemispheric small vessel infa

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00173.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

In the Dutch Guillain‐Barré trial, three EMGs were performed according to a rigid protocol at early stages of the disease in 147 Guillain‐Barré patients who were unable to walk independently. Independent locomotion 8 weeks and 6 months after entry were considered to be the outcome measures of most clinical value. Electrodiagnostic data obtained 1 week after entry were concluded to be most important for studying prognostic value. This has been attributed to the fact that 87% of the patients were in the nadir of their disease at that moment In univariate analysis, CMAP amplitudes of thenar and hypothenar muscles obtained after distal and proximal stimulation, as well as the recruitment pattern on maximal voluntary effort in these tested muscles, were significant predictors for outcome 8 weeks and 6 months after entry to the study. Motor nerve conduction velocity and distal motor latencies of ulnar and median nerves were weak predictors for outcome at 8 weeks after entry. In multivariate analysis the hypothenar CMAP amplitude on distal stimulation and recruitment pattern of abductor digiti minimi muscle both had an independent predictive value for independent locomotion 8 weeks after

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00174.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Transcranial Doppler (TCD) monitoring of the middle cerebral artery (MCA) permits the detection of high intensity transient signals (HITS), which are believed to represent microemboli. Non‐valvular atrial fibrillation (NVAF) and prosthetic heart valves (PV) are important risk factors for embolic stroke. We evaluated both the prevalence and the frequency of microemboli in these high risk groups and the correlation with previous stroke. Sixty‐six patients were monitored for 30 min on both MCAs sequentially. Twenty healthy subjects were studied as well. The total number of HITS recorded on both sides, expressed as HITS/h, was used for comparison. In NVAF patients (n= 24) the prevalence of HITS was 25%, in PV (n= 16) 62% and in those patients in whom PV coexisted with atrial fibrillation (PVAF) (n= 26), it was 42%. None in the control group showed HITS. HITS occurred significantly more frequently in PVAF (12.3/h) than in both NVAF (1.4/h, p = 0.007) and PV (2.7/h,p= 0.011), whereas there was no difference between PV and NVAF. The prevalence of HITS was not statistically different in patients with and without previous stroke, but among HITS positive patients those with previous stroke had a significantly higher HITS frequency (18.9 vs 8.5/h,p= 0.04). In conclusion, in patients with cardiac embolic sources the frequency of HITS increases from the classes with the lower (NVAF, PV) to the class with the highest (PVAF) risk factor. Patients with previous stroke have more HITS than asymptomatic ones. Therefore, embolus detection monitoring seems a promising tool in the assessment of the individual stroke risk in patients with cardiac embolic sour

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00175.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

A 37 year old male was admitted with the diagnosis of bacterial meningitis. Pneumococci were seen in the Gram stain of the cerebrospinal fluid. The clinical condition did not suggest severely raised intracranial pressure, there were no localizing signs and symptoms. CSF was turpid, with 20.100/3/mm3, mainly polymorphonuclear cells. Tumor necrosis factor alpha in CSp was greatly increased with 813 pg/ml. Parallel to the application of intravenous Penicillin G a CSF filtration was carried out. Within 214 h 225 ml CSF were filtrated through a Pall‐filter, using a bidirectional pump. Cell count dropped to 720/3 cells/mm3, TNF‐alpha to 39 pg/ml. The clinical course was uneventful, on day 12 the patient could be discharged without sequelae.CSF filtration may be a highly effective method to reduce from the CSF pathogenetically important cytokines, such as TNF‐alpha, being responsible for intrathecal/meningeal inflammatory processes and triggered by cell‐wall components of bacteria, e.g. pneu

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00176.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

We have identified the A3243G heteroplasmic point mutation in mitochondrial DNA from a female patient with headache as the main clinical feature. The mitochondrial origin of her disease was only suspected because of her brother with MELAS syndrome. Morphological and biochemical studies failed to reveal mitochondrial respiratory chain dysfunction in her muscle which contained 65% of mutated mitochondrial DNA molecules. Molecular studies performed among four generations (in the blood of seven subjects) showed the variable transmission of mutated molecules and pointed out the difficulty in giving genetic counsel.

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00177.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Polymorphisms of the CYP2D6 gene have been reported in association with susceptibility to Parkinson's disease (PD). In a Japanese population, a HhaI polymorphism in the CYP2D6 gene was associated with a 5.56‐fold risk of PD (Tsuneokaet al., 1993). We investigated the frequency of this polymorphism in Caucasian patients with sporadic PD and in healthy controls. Although the frequency of the polymorphism was significantly higher in Caucasians compared with Japanese, there was no association with P

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00178.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

We report a case of pure word deafness, clinically expressed as deaf–mutism in a 17‐year‐old girl, who was affected from encephalitis when she was 18 months old and hadn't acquired language skills. Actually, physical examination revealed buccolingual apraxia and absence of spontaneous speech, auditory comprehension, repetition and denomination, whereas perception of non‐verbal sounds was preserved. The seven waves of brainstem auditory evoked responses (BAER) were present with normal latencies; middle latency responses (MLR) were also normal. Magnetic resonance imaging (MRI) showed bilateral temporoparietal lesions. This case proves that lesions which may give rise to word deafness, when they occur in prelingual age, can determine a peculiar deafmutism clinical

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00179.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY