ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1994.tb00045.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Guillain‐Barré syndrome (GBS) is a heterogeneous condition with a variable prognosis. We studied nine patients who were unable to walk unaided 12 months after the onset of their illness to discover whether they belonged to a more homogeneous subgroup. Sis of the nine patients had symptoms of gastroenteritis shortly before the onset of their neuropathic symptoms and a hyperacute onset of weakness so that they were bed‐bound within 24 h. These patients had predominantly motor rather than sensory involvement We compared these nine poor outcome patients with 66 patients with lesser degrees of persistent disability of whom only three had both a history of prodromal gastroenteritis and a hyperacute onset (p<0.0001). The poor and better outcome groups did not differ significantly in the severity of disability or other clinical or neurophysiological features in the acute stage. Patients with previous gastroenteritis and hyperacute onset of weakness may represent a relatively homogeneous subgroup of “hyperacute GB” in which severe axonal damage is caused by an aberrant immune response to a gastrointestinal pathogen such asCampylobacte

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1994.tb00046.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Clinical symptoms and findings in cranial computed tomography (CT) were evaluated in 326 patients with intracerebral hemorrhage (ICH). Localizations of ICH were the lobes (n= 254), the basal ganglia (n= 46), the pons and brain stem (n= 13) and the cerebellum (n= 8). Multiple hematomas were present in nine patients. An initial coma (n= 225) was most frequent in ICH of the pons (n= 7), cerebellum (n= 6), and the frontal (n= 71) and temporal (n= 66) lobes. Epileptic seizures (n= 70) were most common in hematomas of the frontal (n= 24), temporal (n= 19) and parietal (n= 12) lobes and the basal ganglia (n= 6). A history of hypertension was given in 140 patients; 119 of these had an ICH with a size of ≥3 cm. Mortality (n= 162) was high with ICH in the pons and brain stem (10 out of 13), in the frontal (54 out of 98) and parietal (32 out of 58) lobes and the basal ganglia (n= 23). A size of the ICH of 3 cm or more in cranial CT and an associated ventricular hemorrhage were associated with a bad outcome. An initial disturbance of consciousness was the only reliable clinical predictor of outcome (chi‐square,p<0.001). Katamnestic evaluation of 66 of the 164 survivors after 5.2 years revealed seizures in 20 patients and mild neurological deficits in 41. Another 14 patients were partially, and nine totally dependent Nineteen patients had died in between; there was only one death attributable to another

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1994.tb00047.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

In 92 migraine patients and 44 healthy control subjects we recorded regional cerebral blood flow (rCBF) with single photon emission computerized tomography and133Xe inhalation or with i.v.99mTc‐HMPAO. Migraine patients were studied interictally. A quantitated analysis of right‐left asymmetry indices in a fixed set of regions of interest was compared with the normal asymmetry indices in the healthy controls. An asymmetry index deviating more than ± 2.5 S.D.s in normals was defined as pathological asymmetry. By quantitated analysis 47% of images from patients with aura attacks and 48% of images from patients without aura attacks were established to contain higher rate of asymmetries, the difference being statistically significant (p<0.05, Wilcoxon). A blinded visual analysis and scoring by a four level scale were done by four experienced observers. rCBF images from 18% of patients having attacks with aura and from 19% of patients without aura attacks was scored as containing abnormal right‐left asymmetries by the visual analysis. Images from healthy controls were all scored to be normal. In 37% of the images (all from patients) there was lack of consensus among observers (κ = 0.28). There was no correlation between visual or quantitated abnormalities and age, duration of migraine, frequency of attacks or prophylactic medication. No correlation could be established between asymmetries and the usual side of headache or aura symptoms. Two conclusions emerged: (1) visual evaluation of interictal migraine rCBF images is insufficient to pick up abnormalities; (2) almost 50% of the migraine sufferers had abnormal rCBF/asymmetries. However, these are discrete compared with those typically seen during the aura phase of a migraine attack. One explanation to the patchy rCBF patterns might be that they reflect interictal cerebrovascular dysregulation which might to be a common feature in both types of m

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1994.tb00048.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

An intensive weekly regimen of cisplatin was administered to 66 patients with solid cancer in doses varying from 70 to 85 mg/m2. The occurrence of sensory neuropathy was prospectively examined by assessment of neuropathic signs and symptoms and measurement of vibration perception threshold (VPT). Evaluation was performed before initiation of therapy and during follow‐up until 3–12 months after the last cycle of cisplatin. A mild or moderate neuropathy developed in 47% of patients at 2 weeks after treatment This neuropathy continued to deteriorate until approximately 3 months after cessation of chemotherapy leading to a mild or moderate neuropathy in 71% of patients and a severe neuropathy in 9% of patients. Thereafter we observed a gradual but incomplete recovery. The high incidence of neuropathy we found may be explained by the prolonged observation period compared with earlier reports. The only factor correlated with severity of neuropathy was the cumulative dose of cisplatin, while there was no association with either pre‐treatment VPT, age, sex, tumor type or co‐treatment with etoposide. The progressing course up to approximately 3 months after the end of treatment underscores the need for prolonged follow‐up in future studies on cisplatin ne

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1994.tb00049.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

We describe a female presenting with a progressive bulbar palsy, deafness and respiratory failure necessitating long‐term ventilation. These clinical features are consistent with the Brown‐Vialetto‐van Laere syndrome, a rare, sometimes inherited progressive ponto‐bulbar neuronopathy with associated deafness. This case provides further evidence of the genetic heterogeneity of the syndrome and we describe a previously unreported form of treatment which had negative results. We suggest that improved recognition of this rare syndrome is essential to provide aetiological clues and we describe the worthwhile symptomatic improvement which can be achieved with simple supportive m

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1994.tb00050.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The activities of the metalloproteinase gelatinase B, and the presence of IL‐6, an inducer of metalloproteinase inhibitors, were investigated in CSF samples of 190 patients with multiple sclerosis (MS;n= 55), optic neuritis (ON;n= 46), other inflammatory neurological diseases (OIND;n= 27) or control patients (CON) with non‐inflammatory neurological diseases (n= 62). IL‐6, measurable as hybridoma growth factor activity (detection limit 3 pg/ml), was found in only four of these 190 CSF samples (three OIND, one CON). Elevated CSF gelatinase B levels were detected in 40%, 35% and 54% of the patients with MS, ON and OIND, respectively, while all control CSFs were devoid of gelatinase B activity. Clinical and laboratory data were compared with gelatinase B levels. No correlation was found between the CSF cytoses and gelatinase B levels, suggesting that this enzyme in the CSF originates from CNS lesions rather than from CSF cells. However, the occurrence of the gelatinase B significantly correlated with the IgG index in the MS patient group. This study stimulates further investigation into the possible usage of protease inhibition in demyelinating dis

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1994.tb00051.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Clinical outcome and relevance of genetic and epidemiological factors were evaluated in 161 patients with idiopathic Parkinson's disease (PD) with regard to onset symptoms [tremor (T) vs non‐tremor (NT)], to clinical classification into tremor‐dominant (TD), alkineto‐rigid (AR), and equivalent (EQ) subtypes, and to disease onset before the 45th year of age (EO) and after age 69 (LO). Patients were investigated by questionnaire‐based personal interview and clinical examination. Allegedly symptomatic first‐degree relatives were examined personally or had sufficient medical documentation to allow neurological diagnosis. Disease course was more favorable in T than in NT, in TD than in AR or EQ, and in EO compared with LO. Among EO and LO patients, clinical subtypes TD, AR and EQ were not differently distributed. Frequency of first‐degree relatives with PD or essential tremor and any epidemiological variable tested were not elicited differently between TD, AR and EQ patients, with the exception that TD reported more frequent premorbid travelling. EO patients reported higher frequencies of premorbid head trauma and rural living than LO patients. The more favorable disease prognosis of patients with predominant tremor at presentation and of patients with early disease onset is corroborated. Clinical subgroups do not differ in genetic and epidemiologi

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1994.tb00052.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Supersensitivity to induction of headache and arterial dilatation by a donor of nitric oxide (nitroglycerin) has recently been demonstrated in migraine sufferers. The aims of the present study were to examine whether the nitric oxide donor nitroglycerin may induce a typical migraine attack, to exclude placebo‐related effects and to describe the relation between middle cerebral artery dilatation and provoked migraine. Nitroglycerin (0.5 μg/kg/min for 20 min) or placebo was infused into 12 migraine patients in a double‐blind cross‐over trial. Blood velocity in the middle cerebral artery was measured with transcranial Doppler and characteristics of headache and accompanying symptoms were recorded frequently. Headache occurred during the nitroglycerin infusion as previously described but peak headache intensity did first occur 5.5 h after infusion. At this time the induced headaches in 8 of 10 completing patients fulfilled the diagnostic criteria for migraine without aura of the International Headache Society. Furthermore, all patients who normally had unilateral spontaneous migraine attacks also had unilateral headaches after nitroglycerin. Only one subject developed migraine after placebo (p<0.03). The time pattern of headache and estimated middle cerebral artery dilatation corresponded well. The study therefore demonstrates that activation of the nitric oxide cGMP pathway may cause typical migraine a

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1994.tb00053.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Individual cognitive profiles and correlations between cognitive functions and regional cerebral blood flow (rCBF) were analyzed in 20 consecutive patients with a clinical diagnosis of probable Alzheimer's disease (AD). CBF was measured with high resolution single photon emission computed tomography (SPECT) and [99mTc]d,l‐HMPAO. The analysis of cognitive profiles was based on the composite scores for six cognitive domains, derived from a detailed neuropsychological test battery, as compared with corresponding test data obtained in a control group of 28 age‐matched healthy volunteers. The cognitive profiles displayed a marked heterogeneity as concerned the general level of cognitive impairment, the number of significantly affected cognitive domains, the spectrum of affected and non‐affected cognitive domains, and the severity of each cognitive dysfunction. Statistically significant correlations with rCBF were found for memory scores (right frontal and temporal cortex), abstraction scores (frontal/parietal ratio of rCBF), language scores (left frontal and temporal cortex), visual perception scores (rCBF throughout the right hemisphere), and for visuo‐construction scores (side‐to‐side asymmetry of parietal rCBF). We conclude that the previously observed topographical heterogeneity of rCBF distribution patterns in probable AD was reflected by differences in cognitive profiles. The observed heterogeneities stress the relevance of analyzing individual cognitive and rCBF data, as a supplement to group comparisons of data, in the investigation of diseases with potential heterogeneous affections o

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1994.tb00054.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY