Clinical study of cerebral blood flow in unilateral chronic subdural hematoma measured by 99mTc-HMPAO SPECT]

Cerebral blood flow (CBF) measured by 99mTc-HMPAO SPECT before operation was studied in 60 patients with unilateral chronic subdural hematoma. The regional CBF was measured in 26 regions of the fronto-occipital 10 cortices, putamen, thalamus and cerebellar hemisphere on both sides. Sixty cases with unilateral chronic subdural hematoma were classified into four groups on the basis of clinical symptoms: 17 cases with headache (headache group), 34 cases with hemiparesis (hemiparesis group) and 9 cases with consciousness disturbance or dementia (consciousness disturbance group), and into three groups on the basis of the degree of midline brain shift on MRI: 7 cases of mild shift group, 24 cases of moderate shift group and 29 cases of severe shift group. The average CBF in 60 patients in each region indicated that the regional CBF was reduced in frontal, occipital cortices and cerebellum on the non-hematoma side, and in putamen and thalamus on the hematoma side. In the headache group, the regional CBF reduction on the non-hematoma side was found in only frontal and occipital cortices compared with the corresponding regions on the hematoma side. In the hemiparesis group, the regional CBF was reduced in frontal and occipital cortices on the non-hematoma side and in putamen and thalamus on the hematoma side. The part of CBF reduction in both hemispheres was also noted in the hemiparesis group. In the consciousness disturbance group, the CBF reduction was markedly noted in whole brain. The CBF reductions in frontal and occipital cortices on the non-hematoma side and in putamen, thalamus and cerebellum on the hematoma side was not mutually related with the degree of midline brain shift. We concluded that the disturbance of CBF in chronic subdural hematoma was started from frontal and occipital cortices on the non-hematoma side observed in the headache group, and which was extended to putamen and thalamus on the hematoma side and a part of both hemispheres observed in the hemiparesis group. And such disturbance was finally observed as the CBF reductions in whole brain in the consciousness disturbance group.     

114例糖尿病患者神经电生理特征与相关因素分析

目的观察糖尿病患者神经电生理特征,分析糖尿病周围神经病变的相关危险因素。方法对114例糖尿病患者进行神经传导检测,并对糖尿病周围神经病变组(DPN)及神经传导正常(NDPN)组年龄、病程、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、低密度脂蛋白胆固醇(LDL-C)、血压及血同型半胱胺酸等进行分析。结果 114例2型糖尿病患者中94例出现周围神经病变,20例神经传导正常,总异常率82.5%。其中运动神经纤维受损:正中神经纤维异常率右侧31%,左侧19%;尺神经纤维异常率右侧9%,左侧9%;胫后神经纤维异常率右侧16%,左侧23%;腓总神经纤维异常率右侧28%,左侧29%。感觉神经纤维受损:正中神经纤维异常率右侧63%,左侧49%;尺神经纤维异常率右侧26%,左侧27%;胫后神经纤维异常率右侧70%,左侧67%;腓浅神经纤维异常率右侧67%,左侧61%;腓肠神经异常率右侧50%,左侧47%。DPN组较NDPN组病程更长,血HbA1c、FBG、LDL-C、同型半胱胺酸更高,差异均有统计学意义(P0.05)。结论糖尿病周围神经病变以感觉纤维受损为主,下肢重于上肢,病程、FBG、HbA1c、LDL-C、同型半胱胺酸等为糖尿病周围神经病变的危险因素。     

Cognitive correlates of schizophrenia signs and symptoms: III. Hallucinations and delusions

We examined the cognitive correlates of hallucinations and delusions in 47 schizophrenia spectrum individuals. Hallucinations were significantly negatively correlated with performance on episodic memory tasks, and were not significantly associated with performance on tasks measuring fluency or concentration/attention. Although hallucinations were more strongly associated with performance on verbal than non-verbal memory tasks, the difference was not statistically significant. There was also a trend for hallucinations to be associated with poorer performance on working memory tasks, though this association was eliminated when episodic memory performance was taken into account. Delusions were not significantly associated with any of the cognitive measures.     

The clinical spectrum of peripheral neuropathies associated with benign monoclonal IgM,IgG and IgA paraproteinaemia

Summary Observations have been made on a consecutive series of 62 patients with peripheral neuropathy associated with benign monoclonal paraproteinaemia. The paraprotein class was IgM in 46 cases, IgG in 11 and IgA in 5. Although showing variations between patients, the clinical picture was similar for those with either IgM or IgG paraproteins, usually consisting of a late-onset, slowly progressive, distal sensorimotor demyelinating polyneuropathy, often with tremor and ataxia as prominent features. Tremor was slightly more common in patients with IgM paraproteins, in whom there was a male preponderance. The patients with both paraprotein classes were indistinguishable clinically and electrophysiologically from chronic idiopathic demyelinating polyneuropathy. In the 5 patients with an IgA paraprotein, there was a distal sensorimotor neuropathy in 4 which was demyelinating in 1. In 1 there was proximal demyelinating motor neuropathy. Immunoglobulin deposition on myelin was observed only in the patients with IgM paraproteinaemia, more commonly with a kappa light chain. No deposition of immunoglobulin in the endoneurium was seen. IgM deposits on the perineurium are a feature of normal nerve and were present in all cases. Widely spaced myelin was confined to cases with IgM paraproteins in which immunoglobulin deposition was detected on myelin. The response to treatment could not be assessed systematically but, in general, the patients with IgG and IgA paraproteins responded more satisfactorily (to corticosteroids, cytotoxic drugs, or plasma exchange) than did those with an IgM paraprotein.     

Myasthenia, thymoma and hypophyseal tumor associated with heterogenous adenomatous proliferation and ganglioneuroma of the sella turcica]

The authors report a case of myasthenia gravis in which a tumour of the sella turcica, without clinical symptoms, was discovered on X-ray examination of the skull and was removed with success. Histological study showed endocrine and neural type cells with cells of intermediate type. Subsequent thoracic surgery was performed with removal of a thymoma which was not visible on X-ray examination of the chest. The first operation on the sella turcica had no effect on the myasthenia but after the second on the thymoma a definite improvement was noted. The association of myasthenia, thymoma and ganglioneuroma of the sella turcica is unknown. In order to explain this, the authors hypothesize a common origin in the neural crests of both tumours.     

Prognostic factors in presurgical assessment of frontal lobe epilepsy

OBJECTIVES: To determine predictors for surgical outcome in the presurgical assessment of frontal lobe epilepsy. METHODS: Thirty seven patients were operated on for frontal lobe epilepsy between 1975 and 1996. Their medical records were reviewed for ictal semiology, age at onset, duration of the epilepsy, age at operation, preoperative interictal and ictal encephalographic findings, and abnormalities on neuroimaging and neuropsychological testing. In addition, type of resection and pathology were compared with surgical outcome. RESULTS: Univariate statistical analysis showed that the presence of a focal abnormality on neuroimaging was associated with favourable outcome. The presence of the following ictal findings was associated with poor outcome: autonomic manifestations, eye deviation, head version contralateral to the operated side, and bilateral or multifocal ictal onset. Fifteen patients had secondarily generalised interictal discharges and, interestingly, their presence was not associated with poor outcome. Multivariate logistic regression showed that the presence of a focal abnormality on neuroimaging was significantly associated with a favourable outcome while contralateral head version was the only variable significantly associated with poor surgical outcome. CONCLUSIONS: A focal abnormality on neuroimaging was the only variable which was significantly associated with a favourable surgical outcome, whereas contralateral head version was the most significant predictor for a poor outcome. The presence of generalised discharges before surgery was not associated with poor outcome.     

The video-recorded Stroop Color-Word Test as a new model of experimentally-induced anxiety.

1. The use of the Stroop Color-Word Test as a model of experimentally induced anxiety was evaluated. 2. First, the authors examined the influence of trait anxiety and the type of instructions on the anxiety state level. Subjects with high trait anxiety (above 50 on State-Trait Anxiety Scale--STAI) showed a significant increase in anxiety state only with limited time (2 minutes) and error signal (with a ringing bell) procedures. This increase was blocked by diazepam (DZP) 5.0 mg p.o. both on pre- and post-test measures, but it was not changed by placebo administration. 3. The public performance simulation (with a video-camera) was effective to raise the anxiety state on normal volunteers with mean trait anxiety (between 30 and 50 on STAI). This raise was prevented with diazepam 5.0 mg p.o. but it was not prevented with placebo administration. 4. As a whole, these data suggest that the Video-recorded Stroop Color-Word Test is an effective anxiety provoking test, able to detect the effect of standard anxiolytic drug and stressed the importance of trait anxiety level and the instructions on tests that induced anxiety experimentally.     

Two autopsy cases of primary pituitary carcinoma

We studied two autopsy cases of primary pituitary carcinoma. Case-1. A 45 year old female was admitted on Oct. 4 1978, with a complaint of right homonymous hemianopsia. And diagnosis was pituitary adenoma. Partial removal of pituitary tumor was performed on Oct. 23 1978. She died on Dec. 5 1978 due to bleeding of gastrointestinal tract. Autopsy disclosed a pituitary carcinoma invading the left hypothalamus, mamillary body, optic and V cranial nerves, and mid brain as well as sphenoid bone. No extracranial metastasis was noted. Case-2. A 44 year old female with a history of acromegaly for 6 years was admitted with a complaint of headache on May 8 1976. She was diagnosed as having pituitary adenoma. The subtotal removal of pituitary tumor was performed on May 21 1976 and followed by 4500 rad irradiation. At this time, pathological diagnosis was eosinophilic adenoma. Seven years later, she complained of progressive right hearing disturbance, dysarthria and ataxic gait 1983. The second subtotal removal of pituitary tumor was performed with a diagnosis of recurrence of pituitary adenoma on Oct. 7 1983. After the operation, she complicated sepsis and died on Jan. 14 1984. An autopsy disclosed a pituitary carcinoma from residual pituitary gland, continuously extending to the subarachnoid space of the pons, and invading right cerebello-pontine angle and cerebellum. The histological examination revealed pituitary carcinoma with high pleomorphism and glioblastoma multiform-like feature were within the tumor.(ABSTRACT TRUNCATED AT 250 WORDS)     

Zoster myelitis in sickle cell anemia

A 17-year-old female patient, known case of sickle cell anemia was admitted to our hospital with 10 days history of fever, vomiting, and epigastric pain. On examination, her temperature was 38°C. There was a vesicular type of rash below the nipple and over the left chest involving the back. She was diagnosed as herpes zoster and was started on acyclovir with good hydration and analgesia. Three days later, she developed weakness and decreased sensation of the right leg. On the fifth day, examination revealed power of 1/5 on the right leg, and 4/5 on the left leg, there was proximal and distal increased tone and brisk reflexes and up going toe on the right side with sensory level at T4-T6. An MRI of the thoracolumbar spine showed high signal intensity at T4-T6. The CSF analysis revealed positive polymerase chain reaction for varicella zoster. She was treated with intravenous (IV) dexamethasone 4 mg, 4 times per day. After 3 days she developed left leg weakness, urine incontinence, and power in the left leg was 3/5. Reflex plantar was up going bilaterally with sensory level at the nipple, T4-T6. She was then stared on IV methylprednisolone one gm for 3 days followed by a tapering dose of prednisolone 50 mg for 2 weeks, after a week of starting medication she was able to walk. This case of transverse myelitis is related to varicella zoster infection, with sickle cell anemia, and was successfully treated with high dose IV methylprednisolone, IV acyclovir, and physiotherapy.     

Constitutive and visna virus induced expression of class I and II major histocompatibility complex antigens in the central nervous system of sheep and their role in the pathogenesis of visna lesions

Expression of major histocompatibility complex (MHC) antigens was studied in the brains of 10 healthy sheep 2 months to 5 years old and 13 sheep infected with visna virus by intracerebral inoculation and killed one and 6 months post infection (p.i.). In healthy sheep there was prominent expression of class I, mainly on endothelial cells but also detected on ependyma, choroid plexus and in the leptomeninges. Class II expression was sparse. It was observed on perivascular cells, in choroid plexus, leptomeninges and on microglial cells in the white matter. No definite increase with age in the constitutive expression of class I and II was observed, confirming that we are dealing with a true constitutive expression. In visna-infected sheep a considerable induction of MHC antigens on microglia was observed, which correlated with severity of lesions and was mainly found in or adjacent to inflammatory infiltrates of the white matter. Increase in class II antigen expression was detected in all sheep but class I only in sheep with the most severe lesions 6 months p.i., an indication of a higher threshold for induction of class I than class II antigens on microglia. Few cells expressed viral antigens, indicating that direct immune-mediated destruction of infected cells plays a minor role in evolution of lesions. Since the preferential induction of MHC antigens on microglia in the white matter correlated with the lesion pattern, activated microglia may play a considerable role in the pathogenesis of lesions.     

Judgements about numerosity by a commissurotomized subject.

A commissurotomized subject, L.B., was shown asterisks flashed at random locations, up to four in each field, and attempted either to compare the numbers in the two fields or to report the total number. The main results were: (a) Report was more accurate with unilateral than with bilateral presentation, suggesting that the difficulty integrating across fields was partly attentional; (b) in integrating across fields, attention was focused on one field, with only crude 'one-or-many' information from the other; (c) in cross-field comparisons, the focus was on the LVF, but in reporting the number it was on the RVF when report was oral or right-handed, and on the LVF when report was left-handed; (d) cross-field comparisons were improved when the locations were mirrored across the midline.     

Bilateral brachial plexopathy complicating Henoch-Schönlein purpura

An 11-year-old boy presented with convulsion, fever, rash, abdominal pain, swelling on the eyelids, elbow and wrists, oliguria and hematuria. Based on the abnormal findings the patient was diagnosed with Henoch-Schönlein purpura. On the 3rd day of admission, neurological examination showed ataxic gait, loss of deep tendon reflexes, and decreased (4/5) of muscle strength on all extremities. Additionally, bilateral loss of touch, pain and temperature sensation in a glove, from the elbows to distal region (on C5-T1 level) was diagnosed. Cerebrospinal fluid examination and cranial magnetic resonance imaging (MRI) were normal. The patient was discharged with oral prednisolone on the 7th day of admission. One week after discharging from the hospital, he was re-admitted with vertigo and seizures. He was in coma. MRI of cranial, cervical and cervical plexus were normal. Electromyography showed severe bilateral brachial plexopathy. Prednisolone and intravenous immunglobulin (IVIG) therapy were given without significant improvement. He was discharged from the hospital on the 17th day of admission. On the second month of follow-up, a second cure of IVIG was given because of no clinical improvement. Now, he is on the 4th month of follow-up, unfortunately, no improvement was noted on his muscle strength and sensorial abnormalities on the upper extremities.     

Teaching Reading Comprehension Skills to a Child with Autism Using Behaviour Skills Training

A multiple probe design across skills was used to examine the effects of behaviour skills training (BST) on teaching four reading comprehension skills (predicting, questioning, clarifying, and summarizing) to a 7th grade student with autism. Following baseline, the student received 12 sessions of BST during which each skill was taught to criterion. At each session, data was also collected on the accuracy of oral responses to 10 comprehension questions. BST was associated with clear gains in the participant’s performance on each comprehension skill, along with concomitant gains in reading comprehension both on the daily probes and a standardized measure. Skills maintained at follow-up support the conclusion that BST was effective in improving the comprehension skills of a child with autism.     

Distribution and analysis of surface charge on brain endothelium in vitro and in situ

Vascular endothelial cells are associated with a number of anionic molecules. These anions are important in endothelial function, particularly in regulating permeability, haemostasis and cellular traffic. To explore the nature and distribution of anions on the brain endothelial cell (BEC) surface, we have examined rat brain endothelium in culture, and in situ. The anionic sites were probed with cationic colloidal gold and cationised ferritin, and visualised by light microscopy. Additonally we compared the distribution of the anionic sites on BEC with that present on other endothelial cell types in culture. The predominant anion detected on BEC was heparan sulphate (HS). This was distributed throughout the cell membrane, but was most densely associated with intercellular junctions. This pattern was distinct from the anionic locations observed in endothelia from aorta and epididymal fat microvessels. The distribution of anions was dependent on the age of cultured cells, with only minimal levels of HS seen at the periphery of younger cells. The nature and distribution of negative charge was different in situ. Here, sialic acid was the major surface anion, with only a small contribution from HS. The significance of these findings are discussed in relation to endothelial function in normal tissue and in pathological conditions.     

Relation between depression after stroke, antidepressant therapy, and functional recovery

The aim was to evaluate the effects of poststroke depression and antidepressant therapy on the improvement of motor scores and disability, to verify if the negative effects of poststroke depression on functional recovery could be counterbalanced by taking antidepressant drugs. RESULTS OBTAINED BEFORE, DURING, AND AFTER REHABILITATION: On the Barthel index, Canadian neurological scale, and Rivermead mobility index-by 49 depressed patients with stroke, who had been treated (n=25) or not treated (n=24) according to the different therapeutic approaches of their physicians, were compared with results similarly obtained by 15 non-depressed patients with stroke. Analysis was by multivariate analysis of variance for repeated measures There was a non-significant difference between the groups in their motor and functional scores, and a significant improvement on time. A significant interaction between group and time was seen. This interaction was particularly significant on the Rivermead mobility index, and was due to the fact that the recovery of non-treated depressed patients with stroke was less than the non-depressed and the depressed but treated patients with stroke. Furthermore, recovery from depression was significantly greater in treated than in non-treated depressed patients with stroke. In conclusion, poststroke depression has negative effects on functional recovery, and a pharmacological treatment of depression can counterbalance this effect.     

Relationships between medication treatments and neuropsychological test performance in schizophrenia.

Few investigations have assessed the neuropsychological effects of psychotropic medications on schizophrenic patients. In this study, 44 clinically stable schizophrenic inpatients were administered a battery of neuropsychological tests, and their performance was correlated with dosage of neuroleptic medication and benztropine. Neuroleptic dose was correlated with poorer performance on tests of psychomotor speed and attention, and with the number of perserverative errors on the Wisconsin Card Sort. Anticholinergic dose was associated with poorer verbal learning, verbal fluency, and motor speed. Both medication dosages were associated with poorer verbal recognition memory, but this association was strongly influenced by the performance of individuals on the highest medication doses. The findings, which were independent of clinical state and intelligence, indicate that higher doses of neuroleptic and anticholinergic medications are associated with poorer neuropsychological functioning in schizophrenia.     

The hydrosoluble fiber Plantago ovata husk improves levodopa (with carbidopa) bioavailability after repeated administration

The influence of treatment duration (7 or 14 days) with Plantago ovata husk/levodopa/carbidopa in the bioavailability and other pharmacokinetic parameters of levodopa were evaluated in rabbits. Fiber was administered at two different doses, 100 and 400 mg/kg, and the dosage of levodopa/carbidopa was 20:5 mg/kg. These doses were administered once a day. When 100 mg/kg of fiber was administered, the mean AUC value obtained for levodopa increased 20.2% from day 1 to day 7, and 27.2% from day 1 to day 14; C(max) was 8.6% higher on day 7 and 11.7% higher on day 14. When administering 400 mg/kg of fiber, the increase in AUC values was 17.6% on day 7 and 24.9% on day 14, and that of C(max) 11.1% on day 7 and 11.3% on day 14. The concentration determined immediately before drug administration (C(min)) increased progressively with the duration of treatment, and the highest increase (53.2%) was observed on day 14 with 100 mg/kg of fiber. There was also a delay in levodopa elimination (higher MRT and lower Cl) in a fiber-dose dependent manner. In summary, we found that there was an improvement in the extent of levodopa absorbed with higher final concentrations and that levodopa elimination was slower with the administration of P. ovata husk.     

Preliminary study of working memory in children with stroke related to sickle cell disease

The verbal working memory abilities of children with stroke related to sickle cell disease (SCD) (n = 20) were compared to those of control children with SCD who had no history of stroke (n = 11). Memory span for one-, two-, and three-syllable words was assessed. For children with anterior infarcts, overall span was comparable to that of controls, but the typical effect of word length on span was reduced. For children with diffuse infarcts, overall span was reduced in comparison to that of controls, but the typical effect of word length on span was observed. For children with posterior infarcts, overall span was comparable to that of controls and the typical effect of word length on span was observed. These results provide preliminary evidence that patterns of working memory performance may vary across children with infarcts affecting different regions of the brain.     

Regional cerebral blood flow images of single photon emission computed tomography by N-isopropyl-p-[I-123] iodoamphetamine in patients with brain tumor

Regional cerebral blood flow (r-CBF) was studied by single photon emission computed tomography (SPECT) using N-isopropyl-p-[I-123] iodoamphetamine (IMP) in order to evaluate CBF in patients with brain tumor. Total 27 studies were carried out in 20 patient, including 8 patients with meningioma, 3 with glioblastoma multiforme, 2 with oligoastrocytoma, and 7 with other intracranial tumors. All CBF images by IMP-SPECT were obtained by using a rotating gamma camera with dual heads. In the serial scans, each scan was started at 20 minutes, 2 hours and 6 hours after intravenous injection of I-123 IMP (3 mCi). The all IMP-SPECT images were compared with cerebral angiogram, X-ray CT (plain and/or enhancement), and images of Kr-81 m SPECT and Tc-99 m SPECT. In 5 patients (4 patients with meningioma and 1 with glioblastoma multiforme) this comparative study was performed before and after surgery to evaluate the r-CBF changes surrounding tumor. The abnormal lesion on X-ray-CT was identified as hot area on CBF image by IMP-SPECT in two cases with meningioma, and in 14 cases the lesion showed cold area. Totally 80% of cases showed abnormal findings on CBF images by IMP-SPECT. The cases which showed no abnormal findings on IMP-SPECT images included 1 case with meningioma which located in frontal base, 2 with small intracranial brain tumor which was smaller than 2 cm in diameter, and 1 with pituitary adenoma. On the IMP-SPECT images scanned 2 hours after injection, hot area, which was identified in two cases with meningioma on the images 20 minutes after injection, was changed into cold area.(ABSTRACT TRUNCATED AT 250 WORDS)     

Exercise improves efficacy of levodopa in patients with Parkinson's disease.

The objective was to investigate the impact of exercise on absorption and efficacy of levodopa (LD) in patients with Parkinson's disease (PD). A soluble, immediate release LD formulation was given followed by exercise near the aerobic limit on one day to PD patients, who underwent the same procedure only at rest on the second day. LD plasma behavior did not significantly differ between both conditions, but the motor response was significantly better 120 and 150 min after LD intake on the day with exercise than on the day with rest. Moderate exercise increases clinical efficacy of LD.