摘要:

Migraine is a frequent paroxysmal headache disorder of unknown aetiology. Genetic factors may control attack frequency and possibly attack severity. Serotonin1D(5‐HT1Dβ) receptors have a prominent position within the final common pathway of the mechanisms involved in the headache and associated symptoms. Stimulation of these receptors by selective 5‐HT1Dβreceptor agonists such as sumatriptan and newer compounds including MK‐462 and 311C90, rapidly and fully blocks the symptoms of the headache phase. The efficacy depends on factors such as timing of administration during or before the headache, speed of initial rise of drug plasma levels, and possibly degree of brain penetration. All agonists at S‐HT1Dβreceptors share a short duration of action resulting in recurrence of the headache symptoms within 24 h in about one‐third of attacks in clinical trials. The risk for headache recurrence seems patient dependent: about 10% of patients treating multiple attacks experience headache recurrence in every treated attack, whereas 40% never experience recurrence. These differences are not related to simple pharmacokinetic differences between patients or drugs. Increasing plasma half‐life of the drug will most likely not reduce the risk of recurrence. “Breakthrough of peripheral suppressive effect” with an ongoing “central migraine generator”, rather than the occurrence of a new attack, seems to be the most likely underlying mechanism for headache recurrence. In a minority of, possibly predisposed, patients, use of sumatriptan may induce increase of attack frequency. Four mechanisms have been suggested for the antimigraine action of 5‐HT1Dβreceptor agonists: (1) vasoconstriction of cranial, most likely meningeal and dural blood vessels; (2) inhibition of release of vasoactive neuropeptides from perivascular trigeminal nerve terminals within dura mater and meninges; (3) blockade of trigeminal nerve terminal depolarization; and (4) central inhibition within the trigeminal nucleus caudatus in the brainstem. Which of these mechanisms is the most important, and whether or not vasoconstrictor action is necessary for antimigraine efficacy, is currently under extensive investigation. At this point all drugs with proven antimigraine efficacy share the ability to contract blood vessels and thus all feature also the potential risk of causing vasoconstriction of coronary vessels. In relation herewith, major efforts are put into the search for “the antimigraine receptor” and which receptor subtype mediates which action of sumatriptan‐like drugs. At this point, the 5‐HT1Dβreceptor subtype is thought to mediate vasoconstriction. Some investigators feel that the 5‐HT1Dαreceptor subtype mediates the neuronal effects of sumatriptan, while others are much less convinced about the physiological role of this subtype of receptor. Further research into receptor subtype specificity and affinity of compounds may promote the developm

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00087.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

We describe two patients who developed, in the first and second decades of life, mental retardation, some limitation of up gaze, poorly levodopa‐responsive parkinsonism and pyramidal signs. Recessive inheritance is suggested by the fact that they were subsequently found to be first cousins from consanguineous unions. A number of different possible diagnoses were considered, but despite extensive investigation these patients, who are both still living, thus far appear to be unique. In particular, unlike most cases of alleged “pallido‐pyramidal disease” in the literature, we do not feel it justifiable to use this denomination in the absence of either pathological orin vivoimaging evidence of pallidal inv

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00088.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Levels of homovanillic acid (MVA) were measured in lumbar cerebrospinal fluid from 24 patients affected by amyotrophic lateral sclerosis (ALS) and compared with those found in 11 patients with Parkinson's disease (PD) and 10 patients with lumbar disc herniations who served as controls. Mean HVA levels were significantly decreased in ALS and PD patients. These findings are consistent with impairment of central dopaminergic systems in ALS as well as suggesting degeneration of neuroanatomical structures other than motor neurons.

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00089.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The relation between cerebrospinal fluid pressure (pcsf) and arterial blood pressure (pa) was studied in pigs and in rabbits before and after an ischemia‐induced impairment of the cerebral autoregulation, in order to predict the effect of changes ofpaon thepcsf. Before the ischemic brain episode no clear correlation betweenpaandpcsfwas found. A close dependence emerged after the ischemic episode, and after each change inpathepcsfassumed immediately a new stationary level. The results suggest that intracranial pressure is at any moment a fraction of arterial blood pressure quantitatively determined by the coordinated action of cerebrovascular resistance, i.e. arteriolar resistanceRa, regulated by vasomotor tonus, and venous resistanceRv, which is mechanically passive in the same manner as a Starling resistor device. The relation is given bypcsf=pa[1 + (Ra/pv)]−1. Induced changes inpahave different effects onpcsf. However, this effect may be predicted to some extent because the relation betweenpcsfandpamay be represented mathematically as a rectangular hyperbola. This observation may be of relevance in neurological intensive care. Changes in arterial blood pressure are known to influence intracranial pressure in patients with deranged intracranial dynamics, as in the case of severe head injury. In clinical practice, both raising systemic arterial blood pressure in order to preserve cerebral perfusion pressure and induced arterial hypotension to reduce hydrostatic capillary pressure with consequent reduction of brain edema have been used in the management of patients with severe brain injury. While theoretical models of biological systems often have a limited value in practice because of inability to measure the relevant parameters from clinical data, the ratio of cerebrovascular resistances may be calculated at the beds

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00090.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Paucity of studies on the prognosis of ischaemic stroke prompted this study. Sixty‐seven patients with CT‐proven infarction were studied after a mean duration of 9 days to evaluate the role of a number of clinical, CT scan and evoked potential parameters in predicting the prognosis. Their mean age was 53 (range 22–82) years and 16 were females. Four of these patients died and 20 had poor recovery. Out of 24 clinical, CT scan and evoked potential parameters analysed by univariate analysis, 11 variables were found to be significant These were Canadian Neurological Scale, Glasgow Coma Scale (GCS), Motoricity Index, muscle tone, tendon reflex, incontinence, sensations, motor area involvement on CT scan, size of infarction, motor evoked potential and somatosensory evoked potential. Multivariate logistic regression analysis was employed to study the combined effect of different variables on the outcome. The best model included past history of stroke, GCS, pulse pressure and involvement of motor area on CT scan. The model proposed by us is simple and useful for predicting 3 month outcome of ischaemic stroke. A larger study is recommended to confirm these find

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00091.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

While pathological crying has classically been described as a disturbance of the motor concomitants of emotional affect that is unrelated to mood, recent studies indicate that there may in fact be a correlation. We therefore undertook a study of post‐stroke pathological crying in relation to mood score/depression and lesion site in an unselected stroke population the first year following stroke. The study population comprised 211 patients with first ever stroke (median age 69 years, range 25–80). The patients were included in the study within 7 days of the onset of stroke, and follow‐up examinations were made at 1 month, 6 months and 1 year. Computerized tomography brain scans were obtained on Days 5–10. The frequency of pathological crying was 14% at 1 month, 10% at 6 months and 11% at 1 year. The overall 1 year incidence was 19%. Pathological crying correlated significantly to mood score and post‐stroke depression (p<0.005), as well as to lesion size(p<0.05), Barthel Index (p<0.05), Motricity Index (p<0.005) and intellectual impairment (p<0.05), but not to lesion location, sex, age, history of stroke or depression, predisposing disease or social distress before the stroke incident Post‐stroke pathological crying was common and persistent in 11% of patients at 1 year and correlated strongly to mood score and post‐stroke depression. The indication for treatment of pathological crying is therefore further

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00092.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Recurrent back pain and leg monoparesis in a 38 year old woman could be traced back to a focus of intraspinal endometriosis. Upon admission, neurological examination revealed multiple sensory deficits and a proximal spastic paresis of the left leg. The patient complained about backache, which spontaneously disappeared some days later. History taking disclosed a relationship between the transient symptomatology and the menstrual cycle. Magnetic resonance imaging of the spine demonstrated a signal‐intense intraspinal structure at the Th 8/9 level on the 25th day of the menstrual cycle. On follow‐up examination at the beginning of the cycle the previously detected structure had vanished. Intraspinal endometriosis was confirmed by gynecological demonstration of additional endometriosis of the left ovary as well as positive response to treatment with a gonadotrophin releasing hormone ana

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00093.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00094.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00095.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00096.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY