摘要:We herein report the case of a 46 year old man with chronic inflammatory demye linating polyneuropathy (CIDP)-with hyperIgEaemia. The patient presented with b ilateral weakness, generalized hyporeflexia, and mild paresthesia of the fingers of both hands. Nerve conduction studies revealed multiple sites of motor conduc tion block inthe absence of sensory abnormalities. Muscle strength increased, as did compound muscle action potential (CMAP)-amplitude immediately after the in travenous infusion of immunoglobulin (IVIg). Serum IgE levels also fluctuated in parallel with his relapsing-remitting clinical course. We propose that pure mo tor CIDP may be immune mediated and suggest that IgE-mediated allergy may be on e potential cause of this condition.
摘要:Familial hemiplegic migraine (FHM) is a rare inherited autosomal dominant diso rder. Migraine aura may last up to several weeks and then resolve without sequel . We report a 21 year old male with FHM since the age of 3 years. Diffusion w eighted magnetic resonance imaging (DWI), perfusion MR imaging (P MRI) and [9 9 mTc] hexamethyl propyleneamine oxime single photon emission tomography (HMPA O SPECT) were performed on day 2, when he was somnolent with right sided hemipl egia, on day 9 when a mild hemiparesis was still present and on day 24 after rec overy. The right central region showed normal findings in DWI, whereas P MRI an d SPECT revealed hyperperfusion on day 2, less marked on day 9, and normal findi ngs on day 24. In conclusion, this case report indicates for the first time, by means of SPECT, P MRI and DWI studies, that even extremely long lasting migrai ne aura is not associated with cerebral ischaemia. Therefore, it supports the re vised International Headache Society criteria where the term persistentaura is proposed.
摘要:This randomized, double blind, two attack, placebo controlled, crossover st udy explored the efficacy and tolerability of rizatriptan 10 mg compared with su matriptan 50 mg as well as rizatriptan 5 mg compared with sumatriptan 25 mg in t he acute treatment of migraine. Following randomization to one of six possible t reatment sequences, patients (n=1447) treated two sequential attacks, of moderat e or severe intensity, separated by at least 5 days. Patients assessed pain seve rity, migraine asso ciated symptoms, and functional disability at 0.5, 1, 1.5, and 2 h post treatment. Compared with placebo, all treatments were effective. O n the primary endpoint of time to pain relief, rizatriptan 10 mg was not statist ically different from sumatriptan 50 mg [odds ratio (OR) 1.10, P = 0.161], and r izatriptan 5 mg was statistically superior to sumatriptan 25 mg (OR 1.22, P=0.00 7). In general, rizatriptan 10 mg and 5 mg treatment resulted in improvement com pared with the corresponding doses of sumatriptan on measures of pain severity, migraine symptoms, and functional disability and the 5 mg dose reached statisti cal significance on almost all measures. All treatments were generally well tole rated.
摘要:Intravenous immunoglobulin (IVIg) treatment improves mus- cle strength in Lambert-Eaton myasthenic syndrome (LEMS), butits specific mod e of action is unknown. We have delineated its mode of action on neuromuscular b locking properties of LEMS IgG. The effect of sera and purified IgG from six pat ients with LEMS on evoked quantal release was investigated after direct applicat ion to the motor nerve terminal by the perfused macro-patch-clamp electrode in mouse hemidiaphragms. The effect of LEMS IgG was analyzed alone and after coinc ubation with different concentrations of IVIg or its Fab fragments. All LEMS ser a and purified LEMS IgG fractions taken before IVIg treatment inhibited evoked q uantal release in a dose-dependent manner. When LEMS IgG was coincubated with a therapeutic IVIg preparation, presynaptic inhibitory activity of LEMS IgG was d iminished in a dose-dependent fashion. Monovalent Fab fragments were as effecti ve in neutralizing the activity of LEMS IgG as whole IVIg. These direct neutrali zing effects of IVIg may explain its therapeutic efficacy.
摘要:Sildenafil, a selective inhibitor of the cyclic guanosine monophosphate (cGMP) degrading phosphodiestrase 5 (PDE5), induced migraine without aura in 10 of 12 migraine patients and in healthy subjects it induced significantly more headache than placebo. The aim of the present study was to determine whether the pain i nducing effects of sildenafil would be reflected in plasma levels of important s ignalling molecules in migraine: cGMP, cyclic adenosine monophosphate (cAMP) and calcitonin gene related peptide (CGRP). Ten healthy subjects (four women, six men) and 12 patients (12 women) suffering from migraine without aura were includ ed in two separate doubleblind, placebo controlled, cross over studies in whic h placebo or sildenafil 100 mg was administered orally. Plasma levels of CGRP, c AMP and cGMP were determined in blood from the antecubital vein. Despite the abi lity of sildenafil to induce headache and migraine, no significant differences i n plasma levels of CGRP, cGMP and cAMP were detected after sildenafil compared w ith placebo. In conclusion, plasma levels of CGRP, cGMP and cAMP remain normal d uring sildenafil in duced headache or migraine. However, since previous studie s indicate an important role of these signalling molecules, the present study qu estions whether cAMP and cGMP in peripheral.
摘要:Cognitive processing was investigated interictally in 18 children with migrain e without aura and 18 age matched controls by measuring event related potentia ls (ERPs) and reaction times (RTs) during an acoustic oddball paradigm. Results showed that N100 amplitude evoked by frequent stimuli was significantly smaller in patients compared with controls. Habituation of target P300 amplitude was obs erved in patients but not in controls. Mean RTs were equivalent in the two group s, but migraine children made more errors than controls.
摘要:The objectives of the present study were to describe the clinical characterist ics of patients with severe familial non hemiplegic migraine with aura (NHMA) a nd to compare these data to those from cases in previous population based Danis h studies using the same methodology. NHMA families were recruited from the Dani sh patient registry and from Danish neurology practices. A total of 362 NHMA pat ients were diagnosed according to the 1988 International Headache Society criter ia using a validated semistructured physician conducted interview. Visual aura occurred in almost every NHMA attack. In aura without headache visual aura occur red primarily in isolation. Aura without headache was most common in older, male patients. Several clinical characteristics of familial NHMA differed from migra ine with aura in the general population: firstly, the age at onset was lower, se condly, the age at cessation was higher, thirdly, aura symptoms were more severe and finally, the cooccurrence of migraine without aura was higher in familial N HMA. There seems to be a correlation between more severe symptoms and familial a ggregation. These results have both clinical and scientific implications.
摘要:Rituximab, a monoclonal antibody against B-cell membrane marker CD-20, is an effective treatment for immunoglobulinM (IgM) monoclonal anti-myelin-associat ed glycoprotein(MAG) neuropathies. We report a patient with an autonomicand pain ful sensory neuropathy associated with an IgM lambda monoclonal gammopathy, resp onsive to rituximab. Treatment resulted in a decline in total IgM and improvemen t in the patient’s painful neuropathy and dysautonomia. Rituximab maybe an effe ctive and tolerable treatment for autonomic and sensory neuropathy associated wi th IgM monoclonal gammopathy.
摘要:In this study the human glyceryltrinitrate (GTN) model of migraine was for the first time used to test the effect of a prophylactic drug. We chose to test val proate due to its well documented effect as a migraine prophylactic drug. Effica cy of this compound would support the usefulness of the model in prophylactic an timigraine drug development. Twelve patients with migraine without aura were inc luded in a randomized double blind crossover study. Valproate 1000 mg or placebo was given daily, each for a minimum of 13 days. On the last treatment day of ea ch arm a 20 min intravenous infusion of GTN (0.25 μg/kg/min) was given. Headach e was registered for 12 h after the infusion and headache intensity was scored o n a scale from 0 to 10. Fulfillment of IHS criteria was recorded for 24 h. The m iddle cerebral arteries were evaluated by transcranial Doppler and the diameter of the superficial temporal and radial arteries were measured with high frequenc y ultrasound. GTN evoked migraine fulfilling IHS criteria 1.1 in 6 patients afte r placebo and in 2 patients after valproate (P=0.125). Including additionally 3 patients on placebo and 1 patient on valproate who felt they had suffered a migr aine attack, but who had as associated symptoms only photophobia or phonophobia, a significant reduction in the number of patients with induced migraine after v alproate was seen (P=0.031). Median peak headache intensity was 1 (range 0-9) a fter valproate compared to 4.5 (range 0-8) after placebo (P= 0.120). Pretreatme nt with valproate as compared to placebo reduced the velocity in both middle cer ebral arteries after GTN (left P = 0.021, right P = 0.031). No effect of valproa te was seen in the diameter of the superficial temporal artery (P = 0.781) or th e radial artery (P = 0.367) before or after GTN. The study indicates that a prop hylactic effect of valproate may be demonstrated using the GTN human migraine mo del. Although, all headache parameters were reduced after valproate compared to placebo, only one parameter was statistically significantly reduced probably bec ause of the small number of patients. The sizeof the effect was similar to that of valproate in clinical trials. The GTN model may therefore be a valid tool for testing new prophylactic antimigraine drugs.
摘要:In chorea-acanthocytosis, a neurological disorder associated with multisystem degeneration, amyotrophy and peripheral neuropathy are sometimes conspicuous. W e describe a patient with chorea-acanthocytosis who showed dist ributed nemalin e rods in biopsied muscle. It has been suggested that in chorea-acanthocytosis, the muscle membranous structures are disordered, and our finding may be attribu table to this underlying myopathic condition.
摘要:Glutamatergic hyperactivity is implicated migraine pathogenesis. Also, LY29355 8, an α amino 3 hydroxy 5 methyl 4 isox azolepropionic acid (AMPA)/kain ate(KA) receptor antagonist, is effective in preclinical models of migraine. We therefore tested LY293558 in acute migraine. We conducted a randomized, triple blind, parallel group, double d ummy, multicentre trial of 1.2 mg/kg intravenous (IV) LY293558, 6 mg subcutaneou s (SC) sumatriptan, or placebo in the treatment of acute migraine. The primary e fficacy variable was the headache response rate, i.e. headache score improvement from mod erate/severe at baseline to mild/none at 2 h. Of 45 enrolled patients , 44 patients (20M:24F; mean age ±.SD = 40 ±.9 years) completed the study. Res ponse rates were 69%for LY293558 (P = 0.017 vs. placebo), 86%for sumatriptan ( P < .0.01 vs. placebo) and 25%for placebo. LY293558 and sumatriptan were superi or to placebo (P < .0.01 for all comparisons) on all other measures of improveme nt in pain and migraine associated symptoms. Fifteen percent of patients who too k LY293558 reported adverse events (AEs) (n = 2; one mild, one severe). Fifty t hree percent of patients who took sumatriptan (n = 8; seven mild, one moderate) and 31%of those who received placebo reported AEs (n = 5; four mild, one severe ). The efficacy and safety results of LY293558 in this small migraine proof of c oncept trial, together with supportive preclinical data, provide evidence for a potential role of nonvasoactive AMPA/KA antagonists in treating migraine. Larger trials are needed to further test the hypothesis.
摘要:Cystatin C, a protease inhibitor with widespread distribution,is upregulated i n response to injury. Levels are elevated in the brains of patients with Alzheim er disease (AD). We compared frequencies for the CST 3 exon 1 polymorphism in pa tients with AD and controls. A proportional odds model indicated that the CST 3 A and APOE4 combination carried a high risk: a 14-fold elevation for men and 16 -fold for women. These risks apply to risk at ages older than 64 years and to a shift in onset to ages younger than 65 years.
摘要:Hemicrania continua is a common, but unrecognized headache disorder. We descri be two patients with hemicrania continua whose symptoms started in the postpartu m period, coined as hemicrania continua postpartum.
摘要:The aim of this study was to document the frequency and types of aura symptoms , to define the relationship between aura symptoms and to define the aura freque ncy in different migraine types. In 952 migraine patients, aura frequency, durat ion, time to headache, characteristics and percentage of headaches with aura wer e analysed. Thirty eight percent of IHS 1.1-1.5 patients reported aura, 38.1% of females and 33.0%of males. Average percentage of aura occurrence with headac he was 19.7%of headaches, average aura duration 27.3 min and aura was followed by headache in 10.4 min on average. Visual disturbances occurred in 92.1%and au ra without visual aura was rare. Aura frequency was headache type dependent. Th e highest frequency of aura was seen in the more full blownmigraine attack. Visual aura is the overwhelming aura symptom. Even in patients with aura the pe rcentage of aura with migraine attacks is limited.
摘要:Both preclinical and clinical data link glutamate to the migraine pathophisiol ogy. Altered plasma, platelets and cerebrospinal (CSF) glutamate levels have bee n reported in migraine patients. Chronic migraine is comorbid with several condi tions. It has been recently shown chronic migraine comorbidity with fibromyalgia . The objective of this study was to study cerebrospinal fluid glutamate levels in chronic migraine patients with and without fibromyalgia. We studied 20 chroni c migraine patients, with and without fibromyalgia, compared to age sex matched controls. CSF glutamate levels were measured by HPLC. CSF glutamate demonstrate d significantly higher levels in patients with fibromyalgia compared to those wi thout fibromyalgia. Patients overall had higher CSF glutamate levels than contro ls. Mean pain score correlated with glutamate levels in chornic migraine patient s. Tender points, the hallmark of fibromyalgia, can be considered as pressure al lodynia, and is probably mediated by central sensitization, with increase in CSF glutamate levels. We postulate chronic migraine patients with fibromyalgia, in addition to have more disabling headaches, suffer from a more severe central sen sitization process. This subtype of patients may respond to medications modulati ng glutamate receptors. Headache intensity correlate with glutamate levels in ch ronic migraine patients.
摘要:Background: Thrombolytic treatment has been shown to be effective in the treat ment of ischemic stroke when initiated within 3 hours of symptom onset, yet few patients receive thrombolytics. Objective: To estimate expected increases in use of thrombolytics for ischemic stroke given the following interventions: educati ng patients to present earlier, optimizing Emergency Medical Services (EMS) resp onse/transport times, optimizing hospital systems, and extending the treatment w indow. Methods: As part of a Centers for Disease Control-sponsored Coverdell Ac ute Stroke Pilot Registry, the authors prospectively identified all patients wit h an initial diagnosis of ischemic stroke at 11 hospitals in California over a 3 -month period. Timing of symptom onset, EMS response,hospital arrival, treatmen t, and reasons for nontreatment were evaluated, and hypothetical treatment rates for thrombolysis for interventions on the stroke-care continuum were derived b ased on observed rates of eligibility and treatment. Results: Of 374 patients wi th ischemic stroke, 88 (23.5%) arrived at the emergency department within 3 hou rs of symptom onset, of whom 16 (4.3%) received thrombolysis. If all patients w ith known onset times had called 911 immediately, the expected overall rate of t hrombolytic treatment within 3 hours would have increased from 4.3 to 28.6%. Ex pected rates of thrombolysis were lower for other interventions: instantaneous p rehospital response 5.5%, perfect hospital care 11.5%, and extension of time w indow to 6 hours 8.3%. If all patients with known onset had arrived within 1 ho ur and been optimally treated, 57%could have been treated. Conclusion: Campaign s that educate patients to seek treatment sooner should be major components of s ystem-wide interventions to increase rates of thrombolysis for acute ischemic s troke.
摘要:Using data from a cross sectional survey and a prospective record linkage stu dy the aims of this study were to: (i) determine sources of advice and care for headaches in a population survey of adults, and (ii) investigate prospectively t he influences of headaches on general practice consultation in a 12 month follo w up of the responders to the population survey. A population based cross sect ional survey was mailed to 4885 adults (aged ≥18 years) with an adjusted respon se rate of 56%(n = 2662). The main outcome measures of interest were (i) selfre port advice and care seeking in the survey (ii) consultation with general pract itioner for headache and for other conditions in 12 month period subsequent to the survey. Reporting a recent GP consultation for headache was associated with younger age (mean: 46 vs 48 years), female gender (68%vs 60%), and greater hea dache severity as measured by frequency, pain, and associated disability. The commonest sources of advice an d care in the past were GPs (27%), opticians (21%), and pharmacists (8%). Con sultations for headache were not common in the 12 months following the survey ( n = 144); however, those reporting a recent headache were almost 4 times more li kely to consult subsequently with a headache than those not (relative risk; 95% CI: 3.7; 1.9, 7.0). Recent reporting of headache was also associated with an inc reased risk of consulting for mental disorders (1.7; 1.2, 2.6), diseases of the digestive (1.6; 1.1, 2.3) and respiratory system (1.4; 1.1, 1.8), and a decrease d risk of consulting for circulatory diseases (0.8; 0.7, 1.0). Only a minority o f headache sufferers consult their GP, regardless of severity, with opticians an d pharmacists being other important sources of information. Headache appears to have an additional impact upon GP workload through increased rates of consultati ons for nonheadache conditions amongst headache sufferers. The interesting findi ngs regarding rates of consultation for digestive and circulatory conditions amo ngst headache sufferers may be linked to the use of headache medication.
摘要:We report headache induced BOLD changes in an atypical case of trigeminal auto nomic cephalgia (TAC). A 68 year old patient was imaged using fMRI during thre e attacks of a periorbital head pain with a average duration of 3 min. During t he attacks, left sided conjunctival injection, rhinorrhea, lacrimation, facial s weating and hypersalivation were apparent. These attacks were usually partly res ponsive to oxygen administration but otherwise refractory to any drug. The patie nt described either attacks with a duration of one minute or less or longer atta cks persisting for maximum of 20 min with headaches occurring up to 100 times a day. When considering the symptoms, frequency, duration and therapeutic response of the patients headache, no clear cut classification to one of the sub typ es of trigeminal autonomic cephalgias (cluster headache, paroxysmal hemicrania, SUNCT) or trigeminal neuralgia was possible. The cerebral activation pattern was similar but not identical to those previously observed in cluster headache and SUNCT with a prominent activation in the hypothalamic grey matter. This case stu dy underlines the conceptual value of the term TAC for the group of headaches fo cusing around the trigeminal autonomic reflex. Our results emphasize the import ance of the hypothalamus as key region in the pathophysiology of this entity.
摘要:Riboflavin, which improves energy metabolism similarly to coenzymeQ10(CoQ10), is effective in migraine prophylaxis. We compared CoQ10 (3×100 mg/day) and plac ebo in 42 migraine patients in a double-blind,randomized, placebo-controlled t rial.CoQ10 was superior to placebo for attack-frequency, headache days and days -with-nausea in the third treatment month and well tolerated; 50%-responder -rate for attack frequency was 14.4%for placebo and 47.6%for CoQ10 (number-n eed- ed-to-treat: 3).CoQ10 is efficacious and well tolerated.
摘要:As clinic based studies show an association between headache and both high an d low levels of haemoglobin, we analysed this relationship in a population base d cross sectional study (the HUNT Study). A total of 2385 women aged 20 55 yea rs responded to a headache questionnaire and gave blood samples for measuring ha emoglobin and ferritin. In the multivariate analyses, adjusting for age and educ ation, there was a linear trend of decreasing prevalence of headache (P = 0.02) and migraine (P = 0.01) with decreasing haemoglobin. In particular, migraine was less likely among women with low haemoglobin (values < 11.5 g/dl) (odds ratio 0 .4, confidence interval 0.2, 0.9). There was no correlation between headache pre valence and ferritin. The present findings may be relevant for the headache repo rted in polycythaemia and chronic altitude sickness.
摘要:Objective: To investigate whether the periodic EEG patterns seen in healthy an d sick full term neonates (tracéalternant and burst suppression, respectively) have different frequency characteristics. Methods: Burst episodes were selected from the EEGs of 9 healthy and 9 post asphyctic full term neonates and subject ed to power spectrum analysis. Powers in two bands were estimated; 0-4 and 4-3 0 Hz, designated low and highfrequency activity, respectively (LFA, HFA). The s pectral edge frequency (SEF) was also assessed. Results: In bursts, the LFA powe r was ower in periods of burst suppression as compared to those of tracéalterna nt. The parameter that best discriminated between the groups was the relative am ount of low and highfrequency activity. The SEF parameter had a low sensitivity to the group differences. In healthy neonates, the LFApower was higher over the posterior right as compared to the posterior left region. Conclusions: Spectral power of low frequencies differs significantly between the burst episodes of he althy and sick neonates. Significance: These results can be used when monitoring cerebral function in neonates.
摘要:Objective: To study temporal and spatial development of EEG patterns in sporad ic and iatrogenic Creutzfeldt Jakob disease patients. Methods: Temporal and spa tial development of EEG patterns in 4 patients with sporadic Creutzfeldt Jakob disease and 2 patients with iatrogenic Creutzfeldt Jakob disease due to implant ation of contaminated brain depth electrodes were investigated. A total of 56 EE Gs were analyzed, over time spans ranging from 1272 to 3 days prior to death. Re sults: Frontal intermittent rhythmical delta activity (FIRDA) was seen at early timepoints in 4/6 patients and might represent an early EEG pattern that is asso ciated, with human prion diseases. EEG patterns associated with CJD are sensitiv e to midazolam. Initial EEG changes were seen at the site of prion exposure in i atrogenic Creutzfeldt Jakob disease patients, before they could be observed at distant sites, suggesting that prion disease was initiated at the site of prion exposure. Conclusions: Serial EEG recordings are a valuable tool not only in the early diagnosis of sporadic CJD, but also in the determination of prion exposur e in iatrogenic Creutzfeldt Jakob disease. Significance: FIRDA occur at an earl y stage of CJD and are progressively replaced by the classical PSWC. The EEG pat terns of CJD are sensitive to midazolam. The initial EEG changes in iatrogenic C JD are seen at the site of prion exposure.
摘要:Body lateropulsion may occur without signs of vestibular dysfunction and vesti bular nucleus involvement. The authors examined 10 such patients with three-dim ensional brainstem mapping. Boody lateropulsion without limb ataxia reflected an impairment of vestibulospinal postural control caused by a lesion of the descen ding lateral vestibulospinal tract, whereas body lateropulsion with limb ataxia was probably the consequence of impaired or absent proprioceptive information ca used by a lesion of the ascending dorsal spinocerebellar tract.
摘要:Objective: To describe a case with night terrors (NT) symptomatic of a thalami c lesion. Methods: Videopoly somnography and brain MRI were used to study a 48 year old woman with a recent onset of brief episodes, occurring exclusively duri ng nocturnal sleep, where she suddenly sat up in bed, screamed and appeared to b e very frightened. Results: Videopolysomnography recorded an episode suggestive of NT. Sleep fragmentation with frequent brief arousals or microarousals was als o evident mainly during slow wave sleep. The brain MRI showed increased T2 signa l from the right thalamus suggestive of a low grade tumor. Conclusions: Our cas e suggests that NT starting in adulthood can, rarely, be symptomatic of neurolog ical disease, and warrant further investigation with MRI. Significance: A thalam ic dysfunction, disrupting at this level the arousal system, may play a role in provoking NT.
摘要:Despite evidence for the efficacy of thrombolytic therapy in acute ischemic st roke, only 1 to 7%of patients receive this therapy. The authors sought to deter mine the reasons for exclusion from tissue plasminogen activator (tPA) in an acu te setting and found avoidable causes in 18%of patients. Improvements in intrah ospital coordination would increase the number of patients who might benefit fro m tPA treatment at the authors’center.
摘要:Objective: To quantify temperature induced changes (=Uhthoff phenomenon) in ce ntral motor conduction and their relation to clinical motor deficits in 20 multi ple sclerosis (MS) patients. Methods: Self assessment of vulnerability to tempe rature and clinical examination were performed. We used motor evoked potentials to measure central motor conduction time (CMCT) and applied the triple stimulat ion technique (TST) to assess conduction failure. The TST allows an accurate qua ntification of the proportion of conducting central motor neurons, expressed by the TST amplitude ratio (TST AR). Results: Temperature induced changes of TST AR were significantly more marked in patients with prolonged CMCT (P=0.037). The re was a significant linear correlation between changes of TST AR and walking v elocity (P=0.0002). Relationships were found between pronounced subjective vulne rability to temperature and (i) abnormal CMCT (P=0.02), (ii) temperature induced changes in TST AR (P=0.04) and (iii) temperature induced changes in walking ve locity (P=0.04). CMCT remained virtually unchanged by temperature modification. Conclusions: Uhthoff phenomena in the motor system are due to varying degrees of conduction block and associated with prolonged CMCT. In contrast to conduction block, CMCT is not importantly affected by temperature. Significance: This is th e first study quantifying the Uhthoff phenomenon in the pyramidal tract of MS pa tients. The results suggest that patients with central conduction slowing are pa rticularly vulnerable to develop temperature dependent central motor conduction blocks.
摘要:A 26 year old female with right mesial temporal sclerosis presented with event s characterized by repetitive piloerection (goose bumps). These events were moni tored using prolonged video EEG. The events occurred at a rate of one per every 15 min, and were demonstrated to be simple partial seizures of right mesial tem poral origin. The manifestations included piloerection, cold shivers and ictal t achycardia. These were effectively treated with lorazepam. Acute repetitive pilo motor seizures are rare. This is the first reported case with right mesial tempo ral sclerosis.
摘要:The authors reviewed the recruitment of stroke-affected sibling pairs using a letter-based, proband-initiated contact strategy.The authors randomly sampled 99 proband enrollment forms(Phase 1) and randomly sampled 50 sibling reply card s (Phase 2). The sibling response rate was 30.6%, for a pedigree response rate of 58%. Of the siblings who replied, 96%authorized further contact. Median tim e from proband enrollment to pedigree DNA banking, which required 3+probands, w as 134 days.
摘要:The authors reviewed the charts of 1,421 patients with cerebral hemorrhage to determine the cause of death. Limitation or withdrawal of life-sustaining interventions was the most common cause of death (68%) foll owed by brain death (28%). Neurologic reasons were the most common cause of del ayed decisions to withdraw or limit therapy. Brain death was more common in Afri can Americans, whereas life-sustaining interventions were withdrawn or limited early more often in whites.
摘要:Objective: The aim of this study is to elucidate the significance of electroph ysiological data of the palmar cutaneous branch of the median nerve (PCBm) in th e diagnosis entrapment of the PCBm concomitant with carpal tunnel syndrome (CTS) . Materials and Methods: Clinical and electrophysiological studies were conducte d for abnormal sensation of the thenar eminence in eight CTS patients. Sensory n erve action potentials (SNAPs) of the PCBm were recorded from bipolar surface el ectrodes over the forearm using an orthodromic method. The preoperative SNAP eva luation was compared with the operative findings. Results: The eight patients we re divided into two groups based on the characteristics of SNAPs of the PCBm; fi ve patients had normal SNAPs of the PCBm and three patients had delayed or absen t SNAPs. Open surgery confirmed entrapment of the PCBm in one patient in the fir st group and all patients in the latter group. Conclusions: Although clinical sy mptoms were not always reliable to diagnose entrapment of the PCBm in CTS, elect rophysiological study of the PCBm was highly sensitive (75%) and entirely speci fic (100%) to demonstrate the entrapment of the PCBm preoperatively.