摘要:

Marked, disabling fluctuations in motor performance (on-off phenomena) appear after chronic L-Dopa therapy in Parkinson’s disease (PD). Intravenous infusion of L-Dopa greatly reduces these motor fluctuations, but it is not reliable as a chronic treatment. Therefore, infusion of the potent, water-soluble dopaminergic agonist lisuride has been tested. However, many patients did not respond to infusion of lisuride alone, and no clinical parameter is known to correlate with the lacking response. In order to study this problem, we performed the TRH test (200 µg i.v.) in 8 PD patients with severe motor fluctuations; before and during lisuride subcutaneous infusion, we measured PRL and TSH responses to TRH. Both PRL and TSH receive an inhibitory control from dopaminergic receptors on pituitary cells, whereas they are stimulated by TRH. The TRH test, given during lisuride infusion, allows an indirect evaluation of the ‘brake function’ of the dopaminergic system on anterior pituitary, i.e. of dopaminergic receptor sensitivity in vivo. In our study, TRH induced a significant TSH rise in all PD patients, before and during lisuride infusion. Moreover, the lisuride responders (i.e. patients showing constant ‘on’ period during lisuride infusion, 4 patients) showed a significant lower TSH response as compared to nonresponders. PRL levels followed the same trend without reaching statistical significance. These data are compatible with the presence, in the two groups, of a different pituitary dopaminergic sensitivity which would suggest the presence of pharmacodynamic factors associated with the lacking response to intravenous lisurid

ISSN:0014-3022    

DOI:10.1159/000116793

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

A 48-year-old man with a long-standing history of communicating hydrocephalus is reported. Ventriculoperitoneal shunting led to clinical improvement, but symptoms recurred despite surgical re-exploration switching the shunt to an atrial drainage. Ten months after the last surgical procedure, an acute myelopathy developed. Concomitant pharyngeal granuloma examination identified Histoplasma capsulatum (Hc) yeasts. Despite initial response to amphotericin B, Hc was isolated from cerebrospinal fluid (CSF), valve reservoir and distal catheter after two courses of therapy. Fluconazole successfully sterilized CSF, but transverse myelopathy persisted unchanged, and shunting was needed to control hydrocephalus.

ISSN:0014-3022    

DOI:10.1159/000116794

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Once thought to be rare, leptomeningeal carcinomatosis from systemic cancer is becoming more common as cancer patients are living longer. Lung, breast and malignant melanoma comprise the majority of solid tumor cases with this condition. The hallmark of the disease and the differential diagnosis are discussed. Only the identification of malignant cells in the cerebrospinal fluid provides as clear-cut diagnosis. Biochemical markers, thus far, cannot substitute for a positive cytology, but may aid in the diagnosis. We report and discuss 3 cases of complete biochemical and radiological assessment and variable degree of aggressiveness of treatment. Better control of the systemic cancer may result in prolongation of life.

ISSN:0014-3022    

DOI:10.1159/000116795

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Routine and awake EEGs following 24-hour sleep deprivation were studied in 119 patients with closed head injury, 64 epileptics without any history of head injury and 53 healthy controls. The results were compared to CT brain scan findings. There were no epileptic discharges in routine EEGs, while EEGs after 24-hour sleep deprivation showed considerable activation, ranging from 28 to 37.5% in those with a history of head injury or epilepsy. No correlation was found between the period elapsed between the time of injury and the activation of the EEG. Most of the patients with EEG activation after sleep deprivation had abnormal CT scans. EEGs following 24-hour sleep deprivation therefore appear to be a useful adjunct to other methods used in detecting brain damage in patients with head injury or epilepsy.

ISSN:0014-3022    

DOI:10.1159/000116796

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

A 40-year-old Japanese woman, formerly diagnosed as having Vogt-Koyanagi-Harada disease (VKH), developed a consciousness disturbance. There were nuchal rigidity and mild right facial weakness. Ophthalmological findings were compatible with VKH. Lumbar puncture revealed moderate pleocytosis. MRI showed multiple focal lesions. This case verifies parenchymatous involvement of CNS in VKH.

ISSN:0014-3022    

DOI:10.1159/000116797

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

A 55-year-old previously healthy woman developed disseminated neurological symptoms together with an organic psychosis over a period of several months. The symptoms progressed continuously despite all therapeutic attempts, and finally the patient died in a state of tetraparesis and coma. Brain biopsy showed necrosis and gliosis of the white matter, but no vasculitic changes. Autopsy revealed numerous necroses of the cerebral cortex and white matter. Signs of inflammation were absent throughout the whole brain. The adventitia of the brain-supplying arteries, especially both carotid arteries, showed a marked cellular infiltrate that consisted mainly of plasma cells and foam cells. The findings represent an unusual type of cerebral vasculitis whose etiology and pathogenesis are unknown.

ISSN:0014-3022    

DOI:10.1159/000116798

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

A case of cervical spinal arachnoidal cyst is presented. The association with basilar impression and Arnold-Chiari malformation is a peculiarity seldom reported. The clinical aspects with remission and exacerbation are discussed. The importance of the neuroradiological findings and the usefulness of the neurophysiological examination (evoked potentials) are suggested.

ISSN:0014-3022    

DOI:10.1159/000116799

出版商:S. Karger AG    

年代:1992

数据来源: Karger

ISSN:0014-3022    

DOI:10.1159/000203181

出版商:S. Karger AG    

年代:1912

数据来源: Karger

摘要:

Three women who received epidural anesthesia for gynecological surgery developed spinal arachnoiditis leading to subarachnoid cysts and cord cavitation. MRI was useful to show the subarachnoid and intramedullary cysts, as well as to monitor lesion extent and progress. Associated MRI findings were a Chiari anomaly in 1 case and a tethered cord in another. Two cases underwent surgery: 1 improved, but the other suffered progressive neurological deterioration. Although the 3rd patient had no treatment, there was spontaneous reduction in cavity size and clinical improvement. Careful handling of this procedure is urged to avoid such severe complications in young mothers.

ISSN:0014-3022    

DOI:10.1159/000116801

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Geschwind (1975) postulated that a multiple motor system accounts for a discrepancy in apraxias in response to commands for truncal and limb movements. Kuypers (1968) provided experimental evidence of a multiple motor system in primates. We present evidence of this multiple motor system in the form of Fourier-transformed electromyographic data in humans of the predominantly short duration motor units for discrete control in hand musculature and the predominantly longer duration motor units in the truncal musculature. Furthermore, the right and left erector spinae muscles had different Fourier-transformed electromyographic data which, in our opinion, represent the medial motor system used by apraxias.

ISSN:0014-3022    

DOI:10.1159/000116802

出版商:S. Karger AG    

年代:1992

数据来源: Karger