摘要:

The following points should be considered in dealing with dementia occurring in patients with lacunar infarctions. Lacune is a pathological term and its definition rests on its size (from 2 to 15 mm in diameter). However, terms such as lacunar syndromes and lacunar infarctions are currently used in clinical parlance and recent papers. Patients with lacunar infarctions differ from patients with large infarctions, being more often hypertensive, showing a characteristic but not specific clinical syndrome, and disclosing a significantly lower recurrence rate for new episodes and a significantly higher survival rate. Patients with lacunar infarctions develop a state of dementia 5 times as often as the general population and 25 times as often as in the age group of our patients (65-69 years). Leukoaraiosis, significantly related to arterial hypertension, to lacunar infarction, to an extra risk of future stroke, may be considered an increased risk of cerebral vascular lesions possibly leading to dementia. The relationship between vascular lesions and dementia includes: the strategic location of the lesion (thalamus, corticothalamic areas, bilateral lesions); the whole cerebral hypoperfusion apart from the infarcted area, as shown by PET and SPET; remote effects of cerebral infarctions (diaschisis phenomenon); the so-called incomplete infarction; cerebral atrophy and, particularly, the enlargement of cerebral ventricles, significantly higher in patients with lacunes and dementia as compared with patients with lacunes without dementia. Dementia associated with lacunar infarctions is probably brought about by a series of factors, of which the enlargement of cerebral ventricles plays a significant role.

ISSN:0014-3022    

DOI:10.1159/000117126

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

A double-blind, placebo-controlled, randomized crossover trial of high-dose methylprednisolone (MP) was performed in 35 patients with a primarily chronic progressive form of multiple sclerosis as defined clinically according to Poser’s criteria. At time 0 of every course of treatment (1 g MP administered i.v. daily for 5 days followed by oral prednisone tapering over 4 days, or placebo) and at 10, 30 and 90 days thereafter, each patient underwent psychometric tests and was clinically tested according to Kurtzke’s Expanded Disability Status Scale (EDSS). The disability pattern of most patients who were treated with placebo either worsened or did not change. A statistically significant improvement (p < 0.001) of EDSS in MP-treated patients was recorded. The improvement mainly concerned the pyramidal, cerebellar and sensitive disorders; it was already evident at the first clinical follow-up and lasted for 3 months from the beginning of the treatment. No frequent and/or important side effects were detected throughout the tr

ISSN:0014-3022    

DOI:10.1159/000117127

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Seven patients (3 men, 4 women; age 15–48 years) from 6 families with mitochondrial encephalomyopathies were studied. There were 4 patients with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) and 3 patients with myoclonus epilepsy and ragged-red fibers (MERRF). The clinical course was variable in both MELAS and MERRF patients. Interestingly, one MERRF patient had putaminal hemorrhage with left hemiplegia. In MELAS patients, brain computed tomography (CT) revealed cerebral hypodensity lesions affecting all four lobes and relative sparing of the basal ganglia and the thalamus. The CT of MERRF patients showed cerebral and cerebellar cortical atrophies in two and ventricular dilatation in one. During the recovery stages, magnetic resonance images (MRI) revealed subcortical white matter lesions in two MELAS patients and one MERRF patient. These subcortical white matter lesions were most prominent in the paraventricular areas. The present data indicate that in MELAS the hypo-dense lesions tend to affect the cerebral hemisphere and to spare the subcortical gray matter. Furthermore, the involvement of the paraventricular white matter may occur in both MELAS and MERR

ISSN:0014-3022    

DOI:10.1159/000117128

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

In order to quantitatively assess the motor performance characteristics of 14 patients with congenital myotonia, the reaction time, speed of movement, synergy of different muscle groups and accuracy were measured. The Human Performance Measurement/Basic Elements of Performance device was used for recordings. Warned simple and choice reaction times (SRT, CRT) were significantly longer in the myotonic patients than in the controls. SRTs, consisting of one constant visual stimulus followed by a single movement response of the upper extremities (patients vs. controls) were 218 ± 48 ms (mean ± SD) and 172 ± 12 (p = 0.0038). In the lower extremities the corresponding results were 293 ± 46 and 239 ± 24 (p = 0.0018). 1-CRTs, consisting of the upper extremities response to one randomized light signal (patients vs. controls) were 265 ± 45 and 218 ± 26 (p = 0.0069), and those of the lower extremities 337 ± 73 and 279 ± 39 (p = 0.0107), respectively. 2-CRTs, consisting of two possible visual stimuli in randomized order followed by a movement response of the upper extremities (patients vs. controls), were 308 ±54 and 249 ± 33 (p = 0.0018), and those of the lower extremities 387 ± 53 and 323 ± 46 (p = 0.0028), respectively. We did not find any significant difference between the patient and the control groups in speed of movement, synergy of different muscle groups or accuracy. Nor was any significant correlation between the motor performance disability and the disease se

ISSN:0014-3022    

DOI:10.1159/000117129

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The relationship between anatomical configuration of collateral flow and the outcome of the internal carotid artery (ICA) occlusion was analyzed. Sixty-one patients with occlusion of ICA were studied with transcranial Doppler ultrasonography. The authors monitored blood flow velocities in the middle cerebral artery (MCA) ipsilateral to the ICA occlusion during a series of carotid compressions. Blood flow through three major collateral arteries (anterior and posterior communicating arteries and ophthalmic artery) was determined as a residual flow in MCA after each compression. Twelve subjects had asymptomatic occlusion and 46 had stroke; patients with stroke were divided into mild, moderate, and severe stroke groups. Subjects with asymptomatic occlusion had a higher number of patent collateral vessels than severe stroke patients (p < 0.001). The same relationship was found between mild and severe stroke patients (p < 0.001) and between moderate and severe stroke (p < 0.01). Patients with watershed ischemia had a lower number of patent collateral arteries than patients with thromboembolic ischemia as revealed by CT examination (p < 0.02). This study demonstrates the crucial role of collateral flow in the stroke pathogenesis and stroke outcome in subjects with extracranial ICA occlusions.

ISSN:0014-3022    

DOI:10.1159/000117130

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

We investigated the effect of long-term treatment of essential tremor (ET) with flunarizine (Fz) (10 mg/day) in 17 subjects who had a favorable response to 1 month of treatment. Side effects (dystonia, parkinsonism, weight gain and depression) occurred in 29.4% (5/17) of patients, leading to drug discontinuation. Fz was still effective at the end of 30 months of treatment in 41% (7/17) of patients. Loss of efficacy was observed in 29.4% (5/17) of patients. It is concluded that Fz is an alternative for long-term treatment of patients with ET; however, loss of efficacy and side effects are common.

ISSN:0014-3022    

DOI:10.1159/000117131

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Somatosensory evoked potentials (SEPs) to median nerve stimulation were studied with noncephalic reference in 4 patients with unilateral or bilateral infarctions in the upper medulla to decide the contribution of scalp-recorded P14, N18 in detecting medial medullary lesions. The P9-P14 interpeak latencies did not change, while the P14-N18 and P14-N20 intervals tended to be slightly prolonged on the severely affected side. The amplitude ratios of P14 and N20, evaluated by dividing the amplitude on the severely affected side by that on the unaffected or less severely affected side, were significantly smaller than that of the cervical N13/P13 component. The amplitude ratios of N18 and N13/ P13 did not differ significantly, and a preserved N18 with a depressed P14 in 2 cases indicates separate generators. A characteristic change of P14 in medial medullary infarction is that its amplitude is reduced without delay. Reduction of N18 indicates the presence of lesions in the lower brainstem; however, it is not necessarily associated with medial medullary lesions.

ISSN:0014-3022    

DOI:10.1159/000117132

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Recently abnormalities of chromatic visual perception were reported in treated patients with Parkinson’s disease (PD). We studied 28 previously untreated Parkinsonian patients and 28 age- and sex-matched controls using a computer-aided method to determine the chromatic fusion time (CFT). CFT indicates the acuity of the perception of monochromatic contours. Patients with PD have a shortened CFT especially for the light-blue and dark-green stimuli. The chromatic perception disorder is correlated with the severity of PD. It can be concluded from our data that the dysfunction of colour perception is related to the pathophysiology of P

ISSN:0014-3022    

DOI:10.1159/000117133

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

We report the clinical and neuroradiological follow-up of 2 Italian sisters, 10 and 6 years of age, affected by congenital muscular dystrophy (CMD) with divergent CNS involvement. In both, CMD was diagnosed by finding dystrophic alterations in muscle biopsy and muscular deficit at birth. The elder sister suffered also from marked intellectual deficit and epilepsy, as usually reported in children with Fukuyama CMD. In the same patient, at 2 years of age, CT scan showed severe hypodensity of cerebral white matter and severe ventricular dilatation of occipital horns. At 8 years of age, MRI also showed clearcut pachygyria mainly in the parietal and occipital lobes. MRI and CT scan at the same age showed improvement of the leukoencephalopathy and unchanged ventricular dilatation, as reported for patients with Fukuyama CMD. Unlike Japanese cases, however, she showed no progression in her muscular deficit and her muscle immunostaining of laminin M chain (merosin) was normal. The younger sister had normal mental development, never experienced epileptic fits and had always normal EEC However, as often seen in classical CMD, her CT scan showed moderate hypomyelination of cerebral white matter and mild dilatation of lateral ventricles. MRI did not show any other brain abnormalities. Sequential CT scan at 2, 4 and 6 years of age showed improvement of the leukoencephalopathy. Her muscular deficit had a stationary clinical course. Her immunostaining of muscle merosin was moderately reduced. The finding of Fukuyama-like and classical CMD in 2 sisters indicates the possibility that different forms of CMD may be different expressions of the same genetic disease.

ISSN:0014-3022    

DOI:10.1159/000117134

出版商:S. Karger AG    

年代:1995

数据来源: Karger

ISSN:0014-3022    

DOI:10.1159/000117135

出版商:S. Karger AG    

年代:1995

数据来源: Karger