Acute infantile hemiplegia in a patient with propionic acidaemia

A 10-month-old girl with mild developmental delay became hemiplegic after seizures. Cranial CT scan and magnetic resonance imaging (MRI) revealed no lesions related to vascular diseases, but brain atrophy on the right side was remarkable. Digital subtraction angiography showed slightly decreased visualization of peripheral branches of the right medial cerebral artery. Propionic acidaemia was diagnosed on the basis of high plasma levels of propionic acid and its metabolites and the elevated urinary excretion of these acids. With therapy, the levels of these acids fell, and her left hemiplegia disappeared 3 months later.     

Infantile hemiplegia: clinical,electroencephalographic and computerised tomography study

Thirty-one patients with post-neonatally acquired infantile hemiplegia were assessed clinically, electroencephalographically and by CT scan. The mean age of onset of illness and when first seen in the neurology clinic were 20·2±20·1 months and 16·8±8·4 yr, respectively. Epilepsy was seen in 74 per cent of cases and mental retardation in 70 percent. Among patients with epilepsy, the EEG and CT scan were abnormal in 83 per cent and 87 per cent respectively. There was a positive correlation between an abnormal EEG and CT scan in 84 per cent of cases. The cause of hemiplegia could be clinically determined in only eight cases (26%). However, the CT scan showed abnormalities like cortical atrophy and porencephalic cyst, suggestive of a vascular or inflammatory aetiology in 68 per cent. The usefulness of CT in determining the aetiology in acquired infantile hemiplegia, especially when seen many years after the onset of illness is, emphasized.     

Unilateral cerebral polymicrogyria with ipsilateral cerebral hemiatrophy

We evaluated six children in whom MR imaging showed unilateral cerebral polymicrogyria associated with ipsilateral cerebral atrophy and ipsilateral brain stem atrophy. The aim of this study was to clarify whether this disorder based on neuroimaging constitutes a new homogeneous clinical entity. The subjects were six children whose ages at the time of MR imaging ranged from 8 months to 11 years. Their clinical and MR features were analyzed. All of the children were born between 38 and 42 weeks gestation, without any significant perinatal events. Spastic hemiplegia and epilepsy were observed in all of the patients, and mental retardation was observed in four. The MR findings included unilateral cerebral polymicrogyria associated with ipsilateral cerebral hemiatrophy and ipsilateral brain stem atrophy in all patients. The ipsilateral sylvian fissure was hypoplastic in four patients. These patients showed relatively homogeneous clinical and neuroimaging features. Although the additional clinical features varied according to the site and the extent affected by the polymicrogyria, this disorder could constitute a new relatively homogeneous clinical entity.     

脑卒中后抑郁症动物模型的建立与评价

目的探讨脑卒中后抑郁(PSD)的大鼠模型建立的可行性和有效性。方法采用双侧颈总动脉永久性结扎后予以行为限制制作PSD大鼠模型,观察大鼠自发性行为改变,海马区单胺类神经递质的变化。结果模型组大鼠水平运动得分、垂直运动得分、清洁动作次数分别为(25.00±9.76)次/5min、(13.33±4.13)次/5min、(1.00±0.89)次/5min,与假手术组比较下降(P<0.01or0.05),海马区5-HT、5-HIAA、DA、NE水平分别为(0.39±0.11)μg/g、(1.01±0.78)μg/g、(0.44±0.15)μg/g、(0.35±0.18)μg/g,与假手术组比较下调(P<0.05)。盐酸氟西汀可以改善卒中后抑郁大鼠的行为及脑内5-HT水平。结论大鼠双侧颈总动脉永久性结扎结合行为限制,可为卒中后抑郁的实验及临床研究提供较为理想的动物模型。     

脑卒中后抑郁的临床研究

目的探讨脑卒中后抑郁症的发生、临床特征及治疗。方法于治疗前及治疗后第2、4、10w采用汉密顿尔顿抑郁量表评定临床疗效,并进行对比分析。结果治疗10w末汉密尔顿抑郁量表评定,两组有效率比较差异有极显著性(P<0.01)。结论脑卒中后抑郁影响患者神经功能康复,抗抑郁治疗能促进卒中神经功能康复。     

电针治疗40例中风偏瘫肩－手综合征临床观察

运用电针和毫针刺法分别治疗中风偏瘫肩－手综合征４０例，两个疗程后显示电针对手背水肿、手部皮温升高及屈指时手痛的疗效优于毫针刺法（Ｐ＜０．０５）；指关节和肩关节功能积分增加３分以上（包括３分）的疗效电针组分别优于毫针组（Ｐ＜０．０５）；总显效率电针组（７５％）优于毫针组（５０％，Ｐ＜０．０５）。提示电针产生肌肉节律性收缩具有＂肩－手泵＂样作用，这对消除手背水肿，防止手部肌肉萎缩有重要意义。     

小儿急性偏瘫综合征30例

研究目的探讨小儿急性偏瘫综合征的病因、诊断和治疗。研究方法按照诊断标准,对本组病例作必要的实验室检查,脑电图、CT扫描等,对确诊本征的病人,采用低分子右旋醣酐、肾上腺皮质激素和扩血管药物等治疗。结果本征以婴幼儿,冬春季发病者多。闭塞性脑动脉炎为本征的主要病因。本组病例应用低分子右旋醣酐、肾上腺皮质激素和扩血管药物取得较好的疗效。结论小儿急性偏瘫综合征的诊断,除一般实验室检查外,脑电图和CT扫描,不但能了解本征的病因,而且能及时指导适当治疗,以起到减少后遗症的作用。     

Prolonged deficits after focal inhibitory seizures

Introduction: Seizures are most commonly associated with positive phenomena such as tonic, clonic or myoclonic movements, automatisms, paresthesias and hallucinations. Negative phenomena, however, are not an uncommon manifestation of seizure activity. Examples of negative seizure phenomena include speech arrest, aphasia, amaurosis, amnesia, numbness, deafness, neglect and atonic seizures. Less commonly described in the literature are focal inhibitory motor seizures. Methods and Results: Two patients presenting with rapidly progressive, prolonged hemiparesis, sensory neglect and hemi-visual field obscuration are described. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain did not reveal progression of known structural lesions or new lesions. The superficial cortex of the hemisphere contralateral to the hemiparesis and sensory neglect enhanced diffusely with gadolinium on T1-weighted MRI images. Electroencephalography demonstrated periodic lateralized epileptiform discharges (PLEDs) in one patient and lateralized suppression and slowing in the other patient. Single photon emission computed tomography (SPECT) revealed hyperperfusion in the hemisphere contralateral to the hemiparesis and sensory neglect. The changes seen on MRI and SPECT resolved with resolution of the symptoms. Conclusion: Taken together with the clinical history, the results from these investigations suggest focal inhibitory seizure as the underlying etiology. A review of the literature and investigations helpful in making this difficult diagnosis are provided.     

Anosognosia for plegia: specificity, extension, partiality and disunity of bodily unawareness

This study of anosognosia for hemiplegia investigated: whether it is homogeneous; specificity to plegia of unawareness; extension to different kinds of and objects of awareness regarding plegia; partiality of unawareness. Sixty-four hemiplegic stroke patients were assessed with control subjects on (a) motor and somatosensory function, immediately followed by participants' evaluations of performance; (b) conventional structured interview questions addressing awareness of various capacities: (c) Neglect, Mental Flexibility, General Mental State, Verbal Fluency, Short-Term Memory; (d) pre- and post-performance estimates of ability on the last two; (e) estimates of current ability on bilateral and unilateral tasks, addressed by questions in 1st- and 3rd-person forms, explanations of how overestimated tasks would be accomplished, attempts at 3 bimanual tasks and post-attempt estimates of ability on these. Anosognosia for plegia was mostly associated with right-brain damage. No single factor or combination accounted for all patients. Double dissociations indicated that anosognosia can be specific to plegia: and patients do not generally overestimate other abilities. Although unawareness of paralysis and of its consequences appear linked, the latter is more widespread and persistent. Double dissociation showed that concurrent unawareness of movement failures is a separate deficit from these. There was differential awareness of different aspects of plegia. Further, some patients who overestimated current bilateral task ability when asked in 1st-person form did not overestimate when asked how well the examiner, if he was in their current condition, could do each task. This suggests split awareness of a single aspect of plegia. Patients anosognosic on conventional questioning showed two distinctions. (1) Some were unaware of movement failures when they occurred; others were aware but quickly forgot such failures and seem unable to update long-term body knowledge. (2) Some patients' explanations of bimanual task performance reflect unawareness of hemiplegia; others' explanations were bizarre and imply some awareness. The latter group's deficit appears to be nonspecific and linked to right-hemisphere predominance of anosognosia, an account of which is offered. Anosognosia for hemiplegia is not a unitary phenomenon: several factors underlie deficits in bodily awareness.     

Prediction of the response to citalopram and reboxetine in post-stroke depressed patients

Rationale and objective Depression is a significant complication of stroke. The effectiveness of antidepressant drugs in the management of post-stroke depression (PSD) has been widely investigated. However, the choice of antidepressant drug is critically influenced by its safety and tolerability and by its effect on concurrent pathologies. Here we investigate the efficacy and safety of a selective serotonin reuptake inhibitor (SSRI), citalopram, and a noradrenaline reuptake inhibitor (NARI), reboxetine, in post-stroke patients affected by anxious depression or retarded depression.Methods This was a randomized double-blind study. Seventy-four post-stroke depressed patients were diagnosed as affected by anxious or retarded depression by using a synoptic table. Randomisation was planned so that 50% of the patients in each subgroup were assigned for 16 weeks to treatment with citalopram and the remaining 50% were assigned to treatment with reboxetine. The Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale (HDRS) and a synoptic table were used to score depressive symptoms.Results Both citalopram and reboxetine showed good safety and tolerability. Citalopram exhibited greater efficacy in anxious depressed patients, while reboxetine was more effective in retarded depressed patients.Conclusions Citalopram or other SSRIs and reboxetine may be of first choice treatment in PSD because of their good efficacy and lack of severe side effects. In addition, PSD patients should be classified according to their clinical profile (similarly to patients affected by primary depression) for the selection of SSRIs or reboxetine as drugs of choice in particular subgroups of patients.