ASYMMETRY IN HAND GRIP STRENGTH AND FATIGUE IN LOW- AND HIGH-HOSTILE MEN

The present study examined the relationship between hostility level and cerebral hemispheric motor functioning of 70 left cerebral dominant men. Using the Cook-Medley Hostility Scale, the subject group was divided into thirds: One-third (N = 23) were classified as low-hostile, one-third (N = 23) were classified as high-hostile, and the remainder (N = 24) were excluded from analysis. A hand dynamometer was used to assess hand grip strength, perseveration, and fatigue, as measures of hemispheric motor functioning. Results yielded a hand-by-hostility group interaction, which indicated that high-hostile men evidenced sig nificantly less hand grip strength at the right hand and significantly greater hand grip strength at the left hand relative to low-hostile men. These results suggest that high-hostile men may experience relatively greater right-cerebral arousal relative to their low-hostile counterparts. In other results, both groups showed greater perseveration at the left hand than at the right hand. Both groups also showed significant fatigue across trials at both hands. Analysis also revealed a hand-by-trial interaction, indicating that the right hand fatigued more quickly than the left hand across trials. Resistance to fatigue at the left hand and overestimation or relative imprecision in motor movement at the left hand are discussed in terms of arousal theory. These results and others are cited as contributing inroads into distinguishing between the emotional problems of depression, anxiety, and hostility.     

TONIC ANKLE REFLEX IN PARKINSONIAN RIGIDITY AND IN SPASTICITY

The size of the tonic ankle reflex response to a constant submaximal mechanical stimulus was recorded electrically and mechanically. Electrically the response was measured by integrating, voltage-to-frequency converting, and counting the electromyogram. Mechanically the response was measured by the extension of the triceps surae, as indicated by the potentiometer of a myograph, giving the degree of dorsiflexion of the ankle joint at different loads. Ten normal controls, 20 Parkinsonian patients, and 10 spastics were examined.—In normal subjects the sustained muscle stretch resulted in no significant tonic reflex response. In all Parkinsonians the same muscle stretch elicited a definite tonic reflex. In spastics the mean value was intermediate to the two groups.—A peripheral selective blockade of small sized nerve fibres in three Pakinsonian patients caused a temporary decrease in the augmented tonic reflex contraction without any blocking effect of the alpha motor or muscle spindle Ia afferent fibres.—The increased position sensitivity and the modest velocity sensitivity to length increment of the Parkinsonian muscle, together with the effects of the peripheral selective nerve blockade, suggest that an increased fusimotor innervation to the static muscle spindle system contributes to the rigidity in Parkinsonians.     

APHASIA AND EPILEPSY IN CHILDHOOD

The syndrome of progressive aphasia and epilepsy in childhood is delineated. Four cases are presented, three of which show the typical gradual onset, fluctuating course and EEG changes with bilateral foci of spike and spike-wave activity, and, finally, normalization after some years of the EEG. Also the aphasia tends to subside, but often with considerable delay in relation to the other features. Neuropsychological assessment showed varying residual defects mainly of language functions. The actiology is unknown. No pathoanatomical data on this disorder has hitherto been published. In one of the present cases a cortical biopsy was performed on suspicion of a left temporal tumour. The biopsy showed changes indicative of a slow virus infection. It is therefore suggested that the newly established language function in children particularly is vulnerable to a subchronic viral encephalitis affecting both hemispheres.     

CHRONIC PHYSICAL ILLNESS IN CHILDHOOD: PSYCHOLOGICAL AND SOCIAL EFFECTS IN ADOLESCENCE AND ADULT LIFE

A national birth cohort followed for 36 years was used to compare the life chances of individuals with chronic physical illness in childhood with those of controls. The majority of those who had been chronically physically ill in childhood were found to differ very little in social and psychological circumstances by 36 years of age, but earlier in adult life there had been signs of difficulties. However, there was a disturbing tendency for those from lower social-group families to be in significantly worse social and psychological circumstances, and by 36 years they showed signs of relatively poor life chances and of basic social support, including the death of both parents.     

PROTEINS IN SERUM AND CEREBROSPINAL FLUID IN DEMENTED PATIENTS

Sixteen plasma proteins, including the immunoglobulins, were determined in cerebrospinal fluid (CSF) and serum from 12 demented patients. Furthermore, the total protein content was measured, haptoglobin was typed and serum was tested for precipitins against water-extractable human brain antigens. No specific quantitative changes in the plasma proteins in either CSF or serum were found. In CSF, an increased permeability of the blood-liquor-barrier, reflected in raised CSF total protein values, dominated the picture. In serum, no changes specific to brain atrophy were found, neither were any precipitins against human brain antigens revealed.     

CEREBRAL BLOOD FLOW AND METABOLISM IN COMPLETE APALLIC SYNDROMES, IN STATES OF SEVERE DEMENTIA, AND IN AKINETIC MUTISM

In complete apallic syndromes with (almost total) loss of the telencephalic grey matter, the supratentorial blood flow and oxygen uptake were found to be only about 20 per cent of the normal. Such cases show no signs of higher functions and they have an isoelectric EEG. Due to the retention of brain stem structures they may, however, show clear-cut signs of arousability with lively brain stem reflexes and primitive motor reactions. In a permanently comatose case—also without higher functions—due to a selective reticular brain stem infarction, but with retained telencephalic morphology on the whole, extremely low values (about 20 per cent of normal) for the supratentorial oxygen uptake and blood flow were also demonstrated. Other states with a severe reduction, but not a complete loss of higher functions, due to posttraumatic stupor and advanced Alzheimer's disease showed higher cerebral blood flow and metabolic values than those related above. Such cases also showed a retention of an often pathological EEG. Two patients with akinetic mutism showed relatively high flow values and by and large a normal relative weight of the cortical grey matter, as well as a normal EEG. Both cases showed slight but definite signs of remaining higher functions. It is concluded that measurements of the supratentorial cerebral oxygen uptake and blood flow may be used to quantitate the functional state of the brain in patients with a loss of, or with a severe reduction of higher functions (signs of conscious awareness, voluntary motor activity, speech, and memory). It is emphasized that a complete loss of such functions may be caused by a total loss of the cortical grey matter (the complete apallic state), or by a selective lesion of the reticular system of the brain stem.     

DYSAUTONOMIA IN CRYOGLOBULINEMIC AND ALCOHOLIC NEUROPATHIES

Sympathetic Skin Response (SSR) can evaluate the activity of both sensory afferent and sudomotor sympathetic efferent fibres in peripheral neuropathy (PN). This electrophysiological test was performed in two groups of patients: one with HCV-related mixed cryoglobulinemia (MC) and the other with chronic alcoholism (CA). Thirty consecutive HCV-related MC patients, 25 female and 5 male, aged 35–74 years and thirty-three consecutive CA patients, 8 female and 25 male, aged 24–69 years were studied. In all cases, neurological exam, peroneal, sural and ulnar nerve conduction velocity, standardised test battery for autonomic disorder (defined according to Bellavere, 1990) and SSR (recorded with electrodes attached to the palm and sole and considered abnormal if no response was recorded) were performed.
PN was found in 27 MC patients (90%) and in 23 CA patients (69.6%). Autonomic dysfunction, shown by cardiovascular tests, was found in 3 MC patients, all with PN and in 6 CA subjects, all but one with PN. SSR resulted absent in 12 MC patients (40%): three of them with and 9 without dysautonomia; SSR was also absent in 9 CA patients (27.2%) (1 with and 8 without dysautonomia).
In MC and CA patients, autonomic dysfunction frequency increases when SSR is studied together with standard cardiovascular tests. SSR provides further information about sympathetic autonomic system activity and therefore it is advisable to add this investigation to tests usually utilized in functional evaluation of autonomic nervous system.     

DISABILITY AND PROGRESSION IN PARKINSON'S DISEASE

Disability and progression in Parkinson's disease prior to levodopa treatment was investigated in a random group of 442 patients representing 91 per cent of all known cases with Parkinson's disease in a defined area. Almost half the patients were totally independent, 27 per cent needed help occasionally, and 25 per cent were dependent on other people. Ten per cent of the patients had only unilateral symptoms, 57 per cent had bilateral involvement with mild disability, 20 per cent had a moderately advanced disease, and 13 per cent were severely disabled. A great variation was found in progression rates. In individual cases, however, the progression rate seemed to be relatively fixed. Concurrent arteriosclerosis was found to worsen the prognosis, whereas the beginning of the disease with tremor and the occurrence of prominent tremor promised a slower progression. Twenty-six patients with only unilateral symptoms 10 years after onset of the disease were found to correspond to postencephalitic patients in age structure, and in such cases a history of preceeding viral infection of the central nervous system was observed on four occasions.