ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00072.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.tb00073.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

At present, no therapy for acute ischemic stroke has been established. Vascular occlusions are demonstrated in up to 75–90% of ischemic stroke patients, and it is assumed that rapid lysis of the causal vascular occlusion will improve outcome of ischemic stroke. The purpose of the ECASS study is to evaluate whether thrombolytic therapy with recombinant tissue plasminogen activator, alteplase, improves outcome compared to a placebo‐treated control group. Patients with acute ischemic hemispheric stroke in whom intravenous rt‐PA (alteplase) could be initiated within 6 h from the onset of symptoms were evaluated by neurological examination and cerebral computed tomographic scans (CT scans) of the brain. Patients fulfilling inclusion criteria and not meeting any exclusion criteria were, after informed consent, treated by 1.1 mg rt‐PA per kg body weight (max 100 mg) intravenously or placebo. No angiographic evaluation was included in the trial. In total, 623 patients were randomized in 14 European countries. In addition, 81 patients were treated in an open pilot phase with the active drug. Treatment effect was evaluated using the Barthel Index and the Modified Rankin Scale at 90 ± 7 days in both an intention‐to‐treat analysis and an explanatory analysis. The clinical course was evaluated by repeated neurological ratings on the Scandinavian Stroke Scale. Adverse events (intracranial hemorrhage or cerebral edema) were evaluated by repeating CT scans at 24 h and at 7 days. Recruitment was terminated in March 1994. Follow‐up evaluations were terminated in late June 1994. The first unblinded results are expected in February 1995. Overall mortality was 18.5% in the pilot study and 18.9% in the randomized trial. The incidence of cerebral bleeding complications associated with clinical deterioration was 11.1% (pilot) and 6.5% (ran

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00074.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Progressive supranuclear palsy (PSP), a neurodegenerative disease with frontal lobe‐like features, shows brain hypometabolism which predominates in frontal cortex, although the most severe histopathological lesions are subcortical. To test the hypothesis of the subcortical origin of the metabolic dysfunction in frontal cortex, we used previously obtained data measured using positron emission tomography (PET) in PSP patients and controls to examine the metabolic links between cortical and subcortical brain regions. We calculated interregional correlations of metabolic values in PSP patients and we compared these values to those obtained in controls. Compared to 20 age‐matched controls, the 20 PSP patients studied showed an increase in positive metabolic coupling between frontal and non‐frontal cortical regions. There was an abnormal linkage between frontal cortex and thalamus hypometabolism, the latter partly coupled to caudate nucleus hypometabolism. This study suggests a subcortical origin for frontal cortex hypometabolism in which thalamic activity appears to play a pivotal

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00075.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Cerebral amyloid angiopathy (CAA) is a well‐established cause of brain hemorrhage in the elderly. The association of CAA with other structural brain lesions is less well known. We report a 69 year old diabetic woman with dementia of acute onset Cranial CT and MRI showed diffuse leukoencephalopathy with predominant right parieto‐occipital distribution. Pathological study demonstrated severe CAA. We review the association of CAA with dementia and leukoencephalopa

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00076.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

We monitored disease progression in 27 patients with clinically or laboratory‐supported definite multiple sclerosis by means of clinical assessments [expanded disability status scale (EDSS), and the neurologic rating scale (NRS)] repeated at 6 month intervals for 2 years. Each clinical assessment was accompanied by evoked potentials (EP; visual, brain stem auditory, and somatosensory evoked potentials), motor evoked potentials elicited by magnetic stimulation, and magnetic resonance imaging of the brain and brain stem. Central conduction indices were calculated for each central pathway. According to the EDSS 18 patients deteriorated, eight were unchanged and one improved. The central motor conduction index (CMCI) was the only conduction parameter which correlated significantly with both EDSS and NRS at baseline [rho=0.51 (EDSS); ‐0.65 (NRS)], at final investigation, and when individual changes from baseline to final investigation were addressed (rho=0.38; ‐0.38). Individual deteriorations or improvements of the CMCI during the 2 years correlated with changes in both EDSS and NRS (rho = 0.51; ‐0.38). The MRI parameters did not correlate with the clinical scores. The concordance between MRI and CMCI in detection of disease activity was 63%. We conclude that the CMCI stands out as an objective, accurate and easily obtained outcome pa

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00077.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

We assessed electromyographic (EMG) activity in neck muscles before and after botulinum toxin injections in 28 patients with spasmodic torticollis (ST) to investigate possible changes in muscle activation after treatment. A six‐channel EMG with surface electrodes was used to record activity of sternocleiodomastoid, trapezius and splenius capitis bilaterally. Objective benefit (>25% reduction in Tsui's score) occurred in 22 patients (78%). Of the 168 muscles studied before botulinum toxin injections, 90 presented EMG activity. Sixty‐eight of these muscles were injected and a decrease in EMG activity occurred in 44 (65%) of them. A decrease in EMG activity was also detected in 15 (68%) of those which were not injected. On the other hand, 70 of the 78 muscles without pre‐botulinum toxin EMG activity were not injected. However, after treatment, EMG activity increased in 37 (52%) of these muscles. These changes involved 18 patients and occurred without concomitant change in the main direction of head deviation despite the improvement observed in most cases. These results suggest that in ST head turning results from an abnormal central motor program which results in non‐specific neck muscle act

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00078.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The premorbid personality traits of 102 patients with Parkinson's disease (PD) and 57 age‐matched healthy controls were studied by the recently developed Tridimensional Personality Questionnaire. We found significantly fewer (p<0.05) of a group of traits called “novelty seeking” (NS), but no changes in “harm avoidance” (HA) and “reward dependence” (RD), in PD patients, for the period approximately 5–10 years before the onset of the disease, compared to controls. Individuals who are lower than average in NS and average in HA and RD are described as reflective, rigid, loyal, stoic, slow‐tempered, frugal, orderly, and persistent Since NS is thought to be directly related to central dopaminergic reactivity, the premorbid expression of these behaviors may be the reflection of neurochemical deficits (hypodopaminergic tone) accompanying the presympto

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00079.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Our recent description of a 17‐ and 2‐fold increased risk of cluster headache among first‐ and second‐degree relatives, respectively, strongly suggests that cluster headache has a genetic cause. Eighteen families with familial occurrence of cluster headache according to the criteria of the International Headache Society were included. Clinical intra‐ and interfamilial variability of cluster headaches was analyzed in 44 cases (31 males and 13 females) from 18 families. None of the families showed a distinctive pattern of symptoms except for the two families with chronic cluster headache. Their affected male relatives had a high number (1–8) of attacks per day in their cluster periods. Children had a significantly lower age at onset than parents (p= 0.018), but it is uncertain whether this is a real phenomenon or caused by memory bias. However, the possible existence of anticipation is important in the search for the gene. Co‐occurrence of migraine with and without aura was not increased in familial cases of cluster headache compared with the prevalence of migraine with and without aura in the Danish population, implying different etiologies. Our results suggest that episodic, chronic and chronic cluster headaches evolved from episodic have a common etiology and genetic heterogeneity is unlikely on cli

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00080.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.tb00081.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY