摘要:

In recent years many important advances have been made in the knowledge of the mechanisms that may produce peripheral nerve damage. Data in the literature indicate that in some chronic demyelinating neuropathy autoantibodies against myelin antigens may play a pathogenic role. The pathogenic role of T cells, cytokines, complement, and class II molecules has also been studied. Identification of specific immune‐related demyelinating polyneuropathies provides clues to future therapeutic approaches. This paper focuses on the chronic inflammatory demyelinating polyneuropathy, chronic demyelinating neuropathies associated with monoclonal gammapathies of undetermined significance, and multifocal motor neuropathy, and reviews their clinical, patophysiological and immunological feature

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1996.tb00420.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

We report on 18 patients with the Shy–Drager syndrome who were referred for assessment of a sleep‐related breathing disorder. The main symptoms of snoring, apnoea, stridor and daytime hypersomnolence were detailed and vocal cord movement graded by laryngoscopy as normal, mild weakness of abduction or near paralysis of vocal cord movement Sleep studies involving oximetry and observations were performed. Obstructive and central apnoeas were detected in six patients. Many patients with near paralysis of vocal cord abduction had normal sleep studies. Successful management strategies of obstructive cases included CPAP, nasal surgery and tracheostomy or arytenoidectomy alone or in combination. Sleep‐related breathing disorders in the Shy–Drager syndrome may involve significant nocturnal desaturation; investigation with suitable medical or surgical treatment should be employed in these p

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1996.tb00421.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

This study aimed to determine the incidence of AIDS dementia complex (ADC), the clinical data which distinguish it from other neurological complications of HIV infection, and the impact of zidovudine (AZT) therapy on the appearance and course of this condition. Data on the neurological complications of HIV patients treated at a community hospital from 1988 to 1992 were collected prospectively. Out of 500 AIDS patients treated at the hospital, there were 142 patients with neurological complications, with an average of 1.42 complications/patient There were 23 patients diagnosed as having ADC; with an estimated incidence of 4.6%, it was the most frequent neurological complication, after cerebral toxoplasmosis. Age was higher in patients with ADC as first manifestation of AIDS with respect to ADC patients with previous AIDS diagnosed. Compared with the group of patients suffering from other neurological complications, patients with ADC showed significant differences in several biological markers of progression to AIDS, such as hemoglobin, hematocrit, global lymphocyte count, serum β2‐microglobulin and serum IgA. CD4 count was similar in both groups. Ten ADC patients had been treated previously with AZT. Dementia continued progressing in seven of these patients and remained stable in three. Of the other 13 cases not treated previously with the drug, eight received AZT therapy, and a favourable response was obtained in three patients (p= 0.068). ADC represents a major neurological complication in AIDS patients. AZT therapy may delay the appearance of ADC, but not prevent it. A trend towards a favourable response to AZT was observed in ADC patients who had not been treated with it previous

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1996.tb00422.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The Mini‐Mental State Examination (MMSE), a brief test to assess cognitive status, is heavily influenced by age and education. It was administered to 1019 elderly subjects (aged 65–89 years) living in three different Italian cities. A statistical non‐linear regression model was built up in order to obtain adjustment coefficients to reduce the influence of demographic variables on the MMSE raw scores. Age and educational level were significantly and independently associated with the MMSE score. Results of a multiple linear regression with transformation of age and education provided adjustment coefficients of the MMSE raw scores. Data from this study will ameliorate the overall reliability of MMSE as a screening test for cognitive impairment in elderly p

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1996.tb00423.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Auditory hallucinations are found at the cross‐roads of otological, neurological and psychiatric practice. They are generally considered to be the manifestation of psychosis, delirium tremens and chronic alcoholism, toxic states, hemispheric (predominantly temporal lobe) involvement, brainstem disorders or acquired peripheral (acoustic nerve, cochlea or middle‐ear) deafness. Auditory hallucinosis in one case of brainstem lesion and musical hallucinations in two cases associated with acquired peripheral deafness are presented. Analogies and differences, pathophysiology and review of the literature are discus

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1996.tb00424.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The effect of temporarily suppressing the visual display of either the target or actual movement trajectory upon the accuracy of visuo‐motor tracking was studied in patients with Parkinson's disease (PD) and healthy subjects. Subjects made wrist movements to superimpose a movement cursor upon a target cursor on a VDU screen. The tracking of slow ramp and sinewave target waveforms was investigated. Trials involving the three conditions of visual suppression, namely, target suppressed (TS), movement suppressed (MS) and non‐suppressed (NS) were ordered randomly. In TS and MS trials, respectively, the target or movement cursor disappeared from the subject's view for a 4 s period whilst in NS trials both the target and movement cursors were continuously present. Prior to experimental trials, subjects initially practised a series of NS movements. Tracking errors were analysed by ANOVA for group, suppression condition and waveform effects. The tracking performance of the PD patients, during each form of suppression condition, was worse than that of healthy subjects. Both TS and MS elicited significant reductions in accuracy across groups and waveforms. TS induced a more pronounced impairment of tracking accuracy in the PD group than in the control group suggesting that parkinsonians exhibit an abnormally increased reliance upon visual information of the required trajectory during the present visuo‐motor tracking tasks. By contrast, there was no between‐group effect of MS in these tasks, suggesting that PD patients show a comparable dependence upon visual feedback of their own movements to that shown by c

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1996.tb00425.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

We assessed the nature of foot strike and the potential effect of acute levodopa dosing in Parkinsonian patients with mild to severe fluctuations of motor performances in comparison with healthy volunteers. Forty‐eight patients were enrolled in the study and compared with 33 age and gender matched controls. Each patient was assessed by a computerized electropodographic system before levodopa dosing and 1 and 2‐h after intake of a standard fasting morning dose of levodopa plus benserazide. Twelve foot strikes (six right, six left) were analysed per patient. The controls underwent three repeated examinations at 1‐h intervals. Patients' motor response to acute levodopa dosing was evaluated at fixed times by a battery of motor tests. Foot strike dynamics differed between patients and controls: in particular, first ground contact of the foot was significantly shifted from heel to forefoot in patients compared to controls. The forward shift in footprint during walking was more marked on the more affected body side but was unrelated to the severity and duration of Parkinsonism and unresponsive to levodopa dosing. Tapping and walking tests were overall responsive to acute levodopa intake. The system seemed suitable to detect irregular patterns of foot strike even at the early stages of Parkinsonism, when lower limb disorder was not clinically overt, and might be useful in the search for clinical markers of Parkinsonian

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1996.tb00426.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

A time–density curve study in contrast media transit is theoretically possible to evaluate an asymmetric cerebral perfusion. In this study, we confirmed the correlation between the peak time difference in a regional time–density curve and the asymmetry of cerebral blood flow using positron emission tomography (PET). Five patients with a unilateral occlusion of the carotid or middle cerebral artery underwent intravenous digital subtraction angiography and PET on two successive days. We placed four pairs of regions of interest as appropriate in each study, and obtained the peak time of a regional time–density curve, regional cerebral vascular blood flow (rCVBF) and regional cerebral blood flow (rCBF). We obtained a significant linear correlation between the right‐to‐left difference of peak time and the difference of 1/rCVBF (r= 0.85,p<0.001). The peak time difference also showed good correlation to the absolute difference of rCBF (r= −0.84,p<0.001). A time–density curve study can detect the asymmetry of rCBF, and may be used to evaluate unilateral isc

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1996.tb00427.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Experimental allergic neuritis (EAN) is a T cell mediated inflammatory demyelinating disorder of the peripheral nervous system (PNS) and an animal model of the Guillain–Barré syndrome. Cytokines including interferon‐γ (IFN‐γ) have previously been shown to be upmodulated in lymphoid organs and assumed to be involved in the pathogenesis of EAN. Cytokines in the target organ for autoaggressive immunity in EAN, the PNS, could be pivotal for the development of EAN. By adoptingin situhybridization, we studied mRNA expression of the T helper 1 (Th1) cell associated IFN‐γ, the Th2 cell related interleukin‐4 (IL‐4) and the immune response down‐regulating TGF‐β1 in the sciatic nerve and, in parallel, in the lymph nodes and the spleen over the course of EAN actively induced by immunization with bovine peripheral nerve myelin (BPM) and Freund's complete adjuvant. The dynamics of IFN‐γ mRNA expression in the sciatic nerve followed approximately the clinical course of EAN with peak values around day 14 post immunization (p.i.), whereas IFN‐γ was transcribed earlier in the spleen and lymph nodes with maximum on day 7 p.i. In contrast, transcription of IL‐4 was only slightly enhanced in EAN, with minor fluctuations in the sciatic nerve peaking on days 11 and 28 p.i. In the lymph nodes, the highest numbers of TGF‐β mRNA positive cells were observed during the clinical improvement of EAN. The data argue for a major proinflammatory role for IFN‐γ, and a disease down‐regulating function

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1996.tb00428.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Amyotrophic lateral sclerosis may be an autoimmune disease. In this paper IgG subclasses levels in the CSF and sera and their intrathecal synthesis were studied. IgG subclasses levels were determined by ELISA method using monoclonal antibodies against human IgG subclasses, secondary biotinylated antibody and avidin‐biotin‐peroxidase complex. There was statistically significant elevation of IgG1 and IgG3 subclasses in the CSF of ALS patients. In sera of patients with ALS, IgG2 level was diminished, but there was no statistical difference in other IgG subclasses. IgG1 and IgG3 indices were elevated in patients with ALS, detecting synthesis of these subclasses in the CNS. General IgG index value did not differ from the control value. The results support the concept that autoimmune mechanisms may play a role in the pathogenesis of

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1996.tb00429.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY