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http://www.webmedcentral.com/images/Header_Logo.giftext/html2010-09-30T19:12:32+01:00http://www.webmedcentral.com/Prof. Uner TanFirst Cases of Uner Tan Syndrome in Anatolia, with Progressive Motor Improvement, Adaptive Self-Organization and Emergence of Late Childhood Quadrupedalism
http://www.webmedcentral.com/article_view/831
Background. Uner Tan Syndrome (UTS) was first described in 2005 and consists of three main symptoms: habitual locomotion on all four extremities, impaired intelligence with no conscious experience, and dysarthria. Since then, seven further families have been found, mostly in southern and eastern Turkey, giving a total of 23 individuals in eight families exhibiting UTS. We here present three new cases with late onset UTS residing in central Anatolia.
Methods. The family’s five children were given thorough neurological examinations, and blood samples were taken for genetic analysis. Sagittal and coronal MRI scans were performed, and videos were recorded of their locomotion.
Results. The pedigree suggested an autosomal recessive inheritance. All of the affected children (3/5) were born with severe hypotonia, but by the time they were three they could sit and crawl on hands and knees, and at eight they could stand up and walk upright despite severe truncal ataxia. It was around this time that they started to walk on all four extremities, first with some difficulty, but then with a fully developed skill and ease in quadrupedal locomotion. As well as quadrupedal locomotion, the patients exhibited the other symptoms of UTS: little or no speech, and severely impaired intelligence.
Conclusions. These newly discovered cases suggest a late onset Uner Tan Syndrome, with habitual quadrupedal locomotion emerging when the patients were eight years old. It was suggested that an adaptive self-organization process lasting for about eight years caused the emergence of human quadrupedalism in these patients as a result of dynamic interactions of many elements within the main dynamic system. text/html2010-09-02T22:36:24+01:00http://www.webmedcentral.com/Dr. Mark LyonsInfiltrative Brain Mass Due To Progressive Alzheimer\'s Disease
http://www.webmedcentral.com/article_view/505
Background: Magnetic resonance (MR) imaging in patients with Alzheimer’s disease can present challenging diagnostic dilemmas.
Methods: A seventy-five year old female presented with a slow history of memory loss over five years. An MR demonstrated development of a large area of T2 signal abnormality involving the medial left temporal lobe with extension into the insular cortex and hippocampal formation. The patient underwent a stereotactic brain biopsy.
Results: Pathology revealed no evidence of tumor, but there were extensive neurodegenerative changes with gliosis and was tau and beta amyloid positive.
Conclusions: An unusual radiographic presentation of progressive Alzheimer’s disease is discussed including possible immuno-inflammatory mechanisms.text/html2010-09-05T07:24:50+01:00http://www.webmedcentral.com/Mr. Sandeep KhareDiabetic Neuropathy And The Mitochondria,Can Coenzyme Q Be Of Help
http://www.webmedcentral.com/article_view/522
Abstract
The pathogenesis of neuropathy is multifaceted and complicated. Various researchers implicate oxidative stress, and point towards the central role of the mitochondria in development of this complication. Coenzyme Q is an important contributor to mitochondrial bioenergetics. This article reviews the hypothesis that Coenzyme Q can be used to manage diabetic neuropathy.
Key words: Diabetes, Neuropathy, Mitochondria, Coenzyme Q, Oxidative Stresstext/html2010-10-12T15:01:22+01:00http://www.webmedcentral.com/Dr. Huanmin GaoSubacute Epidural Hematoma Caused By Contrecoup Injury: A Case Report
http://www.webmedcentral.com/article_view/948
A 32-year-old woman presented with a rare case of contrecoup epidural hematoma (EDH) associated with coup EDH. On the 5th day of postpartum, she felled on the floor for a sudden dizziness while making a phone call with the stand posture, and struck the left parietal region of her head on the ground. She was dazed for a few minutes. On admission, she complained of mild postpartum fever and dizzy but exhibited no neurological deficits 10 days after head injury. Skull radiography revealed no linear fracture of the left temporal bone but a subscalp hematoma(4´4cm) at the left occipital. Computed tomography (CT) demonstrated a large EDH(62.8´35.5´40mm) in the right frontal region due to contrecoup injury. CT, taken 2 days later, revealed no enlargement of EDH. An emergent evacuation of the enlarged coup EDH was performed, but the patient refused the surgercal operation. This subacute contrecoup EDH was conservatively treated, in the absence of enlargement. She was discharged 15 days after the head injury without neurological deficits. On the 10 months of follow-up, she was still in good health, and the brain CT scan was normal.text/html2010-10-26T11:25:49+01:00http://www.webmedcentral.com/Prof. Uner TanFirst Quadruped Man Was Found In Turkey A Hundred Years Ago
http://www.webmedcentral.com/article_view/1074
It was believed that human quadrupedalism with the related novel syndrome (Uner Tan syndrome, UTS) first described in 2005 was the first to be discovered in the world. However, it was later revealed a boy with a paralyzed leg walking on all fours was already reported in 1901. The boy did not exhibit the whole symptom complex of UTS, however. We will report here a man walking on all fours probably exhibiting UTS, reported in 1914 in the vicinity of the middle Black Sea coast, within the borders of what was then the Ottoman Empire, which means we may need to revise the history of this syndrome.text/html2010-12-30T15:38:08+01:00http://www.webmedcentral.com/Dr. Vinod K GuptaConstipation-related Migraine Is Linked To The Effect Of The Valsalva Maneuver On The Eye: A Case Report And A Mechanistic Review
http://www.webmedcentral.com/article_view/1433
Constipation-induced migraine finds rare mention in headache literature. In this self-report, I describe occurrence of pulsating migrainous headache after straining at stools. Surprisingly, reducing rise in intra-thoracic pressure by keeping the mouth open, and, limiting choroidal congestion by forcibly screwing the eyelids together during constipation-related Valsalva maneuver prevented further development of migraine attacks. Constipation is a very common human experience and should be regarded as an important precipitating factor in some migraine patients, particularly those who are found refractory to routine preventive strategies.
Use of both adaptive maneuvers is suggested for migraine patients with severe constipation, whether or not they are aware of this potential pathogenetic link. I also describe my own migrainous positive scotoma and discuss the relevant mechanisms.text/html2011-03-11T22:26:00+01:00http://www.webmedcentral.com/Dr. Simon B ThompsonThompson Digital Switch: Helping Stroke Patients to Help Themselves by Promoting Proprioception During Therapy. Brief Report and Podcast as a Teaching Aid for Professionals
http://www.webmedcentral.com/article_view/1721
Stroke affects an estimated 4.6 million people with over 500 000 new cases each year and 100 000 people having a second stroke. There is a huge demand on our healthcare services for treating such people. Proprioception is the body?s natural feedback mechanism that becomes disrupted during a stroke because of damaged nerve pathways. Tapping into this phenomenon enables us to re-establish feedback and thus help stroke patients return some of their lost function. The Thompson Digital Switch (TDS) has been used for several decades in assisting occupational therapists and physiotherapists during rehabilitation of stroke patients. Use of the TDS to help other injuries such as leg trauma and deficits following surgery, are presented in a podcast that also informs professionals about the aetiology and prognosis of stroke that can be used as a teaching aid.text/html2012-01-06T14:45:26+01:00http://www.webmedcentral.com/Dr. Simon B ThompsonImproving Clinical Practice in Neurology
http://www.webmedcentral.com/article_view/2858
Neurology and neuropsychology is complex because it considers the intricate nature of human architecture as well as physiology and neurological pathways. Exploring ways of improving clinical practice in these areas is always welcomed; often experience of working in different cultures and in different financially dependent organisations provides valuable insight into how improvements may be made to the delivery of best clinical practice.text/html2012-05-28T12:23:28+01:00http://www.webmedcentral.com/Dr. Arockia X DossTrigeminal Neuralgia Treatment: A Case Report on Short-Term Follow up After Ultrasound Guided Autologous Platelet Rich Plasma Injections.
http://www.webmedcentral.com/article_view/3381
Autologous Platelet Rich Plasma (PRP) contains natural growth factors and is increasingly used in various painful musculoskeletal conditions. This report is on the use of autologous PRP in a case of Trigeminal Neuralgia (TN).text/html2012-07-05T21:16:22+01:00http://www.webmedcentral.com/Dr. Simon B ThompsonTrial to Investigate the Maintenance Effects of Yawning on Salivary Cortisol levels: Thompson Cortisol Hypothesis. A Protocol
http://www.webmedcentral.com/article_view/3553
Introduction. Yawning consistently poses a conundrum to the medical profession and neuroscientists. Despite neurological evidence such as parakinesia brachialis oscitans in stroke patients and thermo-irregulation in multiple sclerosis patients, there is considerable debate over the reasons for yawning with the mechanisms and hormonal pathways still not fully understood. A study protocol is presented that attempts to discover the extent to which cortisol may be implicated during yawning and additionally, whether or not many neurological disorders may be linked via observed changes in cortisol levels during yawning. Evidence will be gathered to test the Thompson Cortisol Hypothesis that proposes the elevation of cortisol levels during yawning just as they are known to rise during stress and fatigue. Method & Analysis. 100 male and female volunteers aged between 18-65 years will be exposed to conditions that provoke a yawning response in a randomised controlled trial. Saliva samples will be collected at start and again after yawning response together with electro-myographical data of the jaw muscles to determine rest and yawning phases of neural activity. Yawning susceptibility scale, Hospital Anxiety and Depression Scale, General Health Questionnaire, demographic and health details are also to be collected from each participant. A comprehensive data set should allow comparison between yawners and non-yawners as well as between rest and yawning phases. Electro-myographical data collected from the yawning phase is novel and it is hoped this will provide new information about neuro-muscular activity related to cortisol levels. Exclusion criteria will include chronic fatigue, diabetes, fibromyalgia, heart condition, high blood pressure, hormone replacement therapy, multiples sclerosis, stroke. Between- and within-subjects data comparisons will be made. We hope to devise a diagnostic tool based on changes in cortisol levels that may assist in the early diagnosis of neurological disorders based on these data collected. A further longitudinal study is then planned to test neurological patients. Ethics. Bournemouth University Research & Ethics approval has been granted: BU-PS5/10/11-PS1/3/12. Professional code of conduct, confidentiality, and safety issues have been addressed and approved in the Ethics submission. Trials ID: ISRCTN61942768. http://www.controlled-trials.com/isrctn/
text/html2013-02-18T12:31:50+01:00http://www.webmedcentral.com/Dr. Amit Nandan Dhar DwivediCT Angiography and hsCRP evaluated in Type II Diabetes Complicated with Stroke. Anatomical and Biochemical Correlation
http://www.webmedcentral.com/article_view/4038
Aims and objectives: Endothelial dysfunction is considered as root cause of vascular diseases like stroke, myocardial infarction (MI) and venous thromboembolism. Soluble endothelial dysfunction markers are emerging as surrogate markers of disease risk. We aim to correlate the findings of Computed Tomography Angiography (CTA) with hsCRP in patients of Type II Diabetes presenting with stroke.
Material and method: 40 patients of Type II Diabetes diagnosed to have ischemic stroke or Transient Ischemic Attack (TIA) based on clinical history, examinations and imaging were included. We assessed high sensitive C - reactive protein (hsCRP), levels in all patients within 24 hours and CT-Angiography of bilateral neck vessels within 48 hours of hospital admission.
Results: Increase in hsCRP, was significant in cases as compared to controls. This biochemical marker correlated significantly with CT Angiographic findings.
Conclusion: This study demonstrates that hsCRP, is good surrogate biochemical marker for assessing disease risk and burden in patient of Type II Diabetes presenting with stroke. It showed a linear correlation and statistical significance with CT angiography score. Our study gives a good opportunity to combine anatomical details with disease pathophysiology at biochemical level.text/html2010-09-09T21:14:24+01:00http://www.webmedcentral.com/Dr. Matthew B JensenDiplopia Secondary To West Nile Virus Meningitis
http://www.webmedcentral.com/article_view/580
Cranial nerve involvement has been reported with West Nile Virus infection. We report a case of diplopia secondary to West Nile Virus meningitis.text/html2010-09-17T18:11:12+01:00http://www.webmedcentral.com/Prof. Uner TanTwo New Cases of Uner Tan Syndrome: One Man with Transition from Quadrupedalism to Bipedalism; One Man with Consistent Quadrupedalism
http://www.webmedcentral.com/article_view/645
Background: Uner Tan syndrome, first described in 2005, consists of three main symptoms: habitual locomotion on all four extremities, impaired intelligence, and dysarthric or no speech. This extremely rare syndrome shows an autosomal recessive inheritance due to consanguineous marriages between parents. In general, there is a cerebellovermial hypoplasia with a mild gyral simplification in the cerebral cortex. Truncal ataxia is the main neurological finding, causing difficulty in standing and upright walking on two legs. Methods: As soon as the new cases came to light, the family was visited. After taking the basic information about the family members, the traditional neurological examinations were performed, MRI scans of the patients and of a healthy family member were taken in a hospital nearest to the residence (a small village near Kars, Turkey). The patients were also filmed to analyze their walking patterns.Results: Two individuals (case 1, 44y; case 2, 43y) among six siblings from a family with consanguineous parents exhibited Uner Tan syndrome, with quadrupedalism, impaired intelligence, and dysarthric speech. Their pedigree suggested an autosomal recessive inheritance. MRI scans showed inferior cerebellovermial and pontobulbar hypoplasia.Case 1 did not display hypotonia, while case 2 had been hypotonic for two years after birth. Case 2’s hypotonia progressively disappeared, and at three years old he started to sit, and could walk on all fours by the age of four. Case 1 was quadrupedal for 20 years, and then walked upright with the aid of a walking stick. Tendon reflexes were normal in case 1 but hyperactive in the lower extremities of case 2; Babinsky was absent in case 1 but bilaterally present in case 2. There was no nystagmus, no strabismus, and no pes pedus in either case. Cognition was severely impaired in both. Conclusion: The emergence of quadrupedalism during development, with a transition into bipedalism in case 1, and the emergence of the quadrupedalism after a full hypotonia and no locomotion in case 2, were considered as examples of the processes of adaptive self-organization, from the viewpoint of dynamic systems theory.text/html2010-09-19T15:58:08+01:00http://www.webmedcentral.com/Dr. Thirunavukkarasu Arun babuCurrent trends in the management of subacute sclerosing panencephalitis
http://www.webmedcentral.com/article_view/680
Subacute sclerosing panencephalitis (SSPE) is slow viral encephalitic sequlae occurring secondary to measles infection. Symptoms occur insidiously and progresses to coma and death. This condition carries a very high mortality. This article discusses the various drug therapies tried in this condition. The currently proven drug regimens include Isoprinosine , Interferon alpha and their combination.text/html2010-09-28T21:47:37+01:00http://www.webmedcentral.com/Dr. Harinder JasejaShoe-smell Application as a First-aid Interventional Measure in Controlling Epileptic Attacks in an Urban Population in India: A Fortuitous Empirical Finding
http://www.webmedcentral.com/article_view/791
Diseases possessing long history of existence have been associated with various kinds of interventional (pharmacological and non-pharmacological) measures adopted by the patients or their caretakers in attempt to abort or attenuate the severity/intensity of the disease. One such disease is epilepsy, which has been known for thousands of years. This disorder is known to be associated with trigger factors and their self-perception and has been subjected to a wide range of remedial interventions. One such remedial measure, which has persisted for centuries in India, is application of shoe-smell in controlling the epileptic attacks. The present study was primarily conducted to survey the prevalence of trigger factors and their self-perception in the patients with epilepsy seeking medical advice at a tertiary epilepsy center. The study also included questionnaire on adoption of any interventional measures by the patients or their caretakers. The prevalence of application of shoe-smell emerged as a fortuitous finding; surprisingly, it was also claimed to be highly effective in limiting the duration of the epileptic attacks. Although, not intended to promote this remedial measure, the study underscores the importance of a larger, well-designed study for an insightful exploration of the prevalence and effectiveness of this measure, which persists even today in India despite its denouncement as a myth.text/html2010-10-07T19:57:56+01:00http://www.webmedcentral.com/Dr. Daniel E JacomePost Hemorrhagic Hemicrania Continua In A Patient With Orgasmic Paroxysmal Hemicrania
http://www.webmedcentral.com/article_view/881
BACKGROUND: In its classic form sentinel headache heralds an underlying intracranial aneurysm near rupture. Headache related to sexual activity is normally benign and does not represent a sentinel headache to ulterior intracranial bleeding. Hemicrania continua is a primary headache only exceptionally precipitated by acute central nervous system (CNS) pathology.METHODS: Clinical case history, repeated neurological examinations, ancillary imaging procedures and review of literature.RESULTS: A patient with recurrent orgasmic headache manifested as severe left hemicrania of abrupt onset lasting for several hours, developed in the course of her illness a very severe left side headache while performing physiological valsalva during defecation, associated with an opposite side right anterior capsule intracranial bleed. Subsequently she transitioned into hemicrania continua without dysautonomia, ameliorated by valproic acid and by diet-induced weight loss. Her imaging studies showed no evidence of arteriovenous malformation or intracranial aneurysms. CONCLUSION: On this unusual patient, orgasmic hemicrania was premonitory of a contralateral hemorrhagic stroke, representing a variant of sentinel headache later evolving into hemicrania continua.text/html2010-10-09T06:08:52+01:00http://www.webmedcentral.com/Dr. Daniel E JacomeGastroenteric-induced Bilateral Paroxysmal Hemicrania
http://www.webmedcentral.com/article_view/925
BACKGROUND: Functional gastrointestinal disorders; i.e., irritable bowel syndrome, cyclic vomiting, gastro-esophageal reflux and dyspepsia, are more common in individuals with migraine. Autonomic manifestations of migraine, and less commonly of paroxysmal hemicranias (PH), include those of gastrointestinal (GI) tract origin. METHODS: Repeated clinical neurological examinations, long term follow up and ancillary medical tests including imaging procedures.CASE REPORT: An 81 year old female patient had recurrent episodes of bilateral paroxysmal hemicrania with limited cranial autonomic symptoms, consistently triggered a few minutes after beginning to eat, in the absence of concurrent GI or other autonomic symptoms. There was no specific food trigger and drinking fluids (i.e., cold water) did not cause headache. Repeated clinical examinations and ancillary testing were normal. The patient symptoms were terminated by a course of corticosteroids.CONCLUSION: Exceptionally, bilateral paroxysmal hemicrania is precipitated by eating, in the absence of underlying structural brain lesionstext/html2010-10-13T10:11:57+01:00http://www.webmedcentral.com/Dr. Daniel E JacomeNew Daily Persistent Headache As A Presenting Symptom Of Hashimoto\'s Encephalopathy
http://www.webmedcentral.com/article_view/960
BACKGROUND: Hashimoto’s encephalopathy (HE) is a rare autoimmune neurological disorder often unrecognized. Although headache is experienced by a significant number of patients with this condition, it is overshadowed by more striking neuropsychiatric symptoms and normally is not a presenting complaint. A patient with Hashimoto’s encephalopathy and symptoms simulating migraine with aura was previously reported.METHODS: Repeated clinical neurological examinations and follow-up, ancillary tests including serology, imaging procedures, electroencephalogram (EEG), spinal fluid examinations (CSF) and neuropsychological evaluationCASE REPORT: A patient is described with HE manifested as new daily persistent headache, taking the form of hemicrania continua without cranial autonomic signs. Headache was associated with non-fluent aphasia. Indomethacin was ineffective but he responded to steroids and to monthly intravenous immunoglobulin infusions.CONCLUSION: Hashimoto’s encephalopathy may present with headache with a mixed phenotype of both new daily persistent headache and atypical hemicrania continua, amenable to treatment by immunosuppressant agents.text/html2010-10-19T16:38:33+01:00http://www.webmedcentral.com/Dr. Eugen TarnowWhy The Atkinson-shiffrin Model Was Wrong From The Beginning
http://www.webmedcentral.com/article_view/1021
The Atkinson-Shiffrin (1968) model, a standard model of short term memory cited over three thousand times, mimics the characteristic shape of the free recall curves from Murdock (1962). However, I note that it is not a theoretically coherent explanation and that it does not fit any other relationships present in the same Murdock data. As a result, future theorists are challenged with defining the buffer concept properly, with defining the long term store properly, and with correctly predicting new relationships found in the Murdock data that directly probe various theoretical concepts.text/html2010-10-19T18:10:47+01:00http://www.webmedcentral.com/Dr. Harinder JasejaIdentification Of Attainment Of Meditation-state: A Challenge To Be Solved
http://www.webmedcentral.com/article_view/1038
Meditation has been known and practiced for a long period of time. Presently, its practice is being advocated and promoted mainly as an effective remedial measure against the deleterious effects of challenges and stress of modern life. However, the unambiguous identification of attainment of meditation-state has yet to be established. Meditation is known to be associated with alterations in neurochemistry and neurophysiology that are responsible for diverse experiences observed in meditators. This brief paper attempts to highlight the significance of EEG in meditation and consequently recommend it as an appropriate and invaluable tool in determining the attainment of meditation-state.text/html2010-11-15T18:11:24+01:00http://www.webmedcentral.com/Prof. Uner TanA Post-polio Paraplegic Couple: A Woman With Palmigrade, Saltatoric Locomotion; A Man With Inability To Walk; A Dynamical Systems Theoretical Perspective
http://www.webmedcentral.com/article_view/1176
A couple with post-polio paraplegia was presented in the current work. The man and woman were quite normal in the psychomotor domain except that each had two paralyzed legs. The woman also had a strong palmomental reflex. MRI scans showed no abnormalities in the cerebro-cerebellar structures. The woman exhibited habitual saltatoric palmigrade locomotion, while the man was always sitting without locomotion, using a wheelchair to move around. The woman rejected all offers of devices to help her move around, and strongly preferred walking on all fours while jerking the legs forward with the help of her back muscles. Despite having similar neurological deficits, the man and woman showed different attractors: a palmigrade locomotion on all fours in the woman, which apparently resulted from a spontaneous and randomly occurring self-organization process, while the man exhibited no transition from sitting to a walking state. It was suggested that (i) these different human beings with similar neurological deficits but different attractor states would provide good evidence for the random and unpredictable outputs of the self-organizing processes; (ii) the co-occurrence of a primitive reflex with a primitive walking style would be consistent with the theory of reverse evolution in human beings.text/html2010-12-10T19:37:28+01:00http://www.webmedcentral.com/Dr. Daniel E JacomeSound Induced Photisms In Pontine And Extra-pontine Myelinolysis
http://www.webmedcentral.com/article_view/1296
BACKGROUND: Synesthesia refers to the simultaneous experience of one primary sensation in another sense mode. Central pontine myelinolysis (CPM) is a non-inflammatory condition affecting the pons more often seen in individuals with alcoholism or on whom presenting hyponatremia is rapidly corrected to supra-normal levels. Asymptomatic cases of CPM have been reported previously. Sound induced photisms represent a form of acquired synesthesia secondary to anterior visual pathways compromise.CASE REPORT: A patient with history of chronic alcohol abuse developed sound induced binocular photisms. His brain magnetic resonance imaging (MRI) showed signal abnormalities compatible with pontine and extrapontine myelinolysis. He had remote history of pituitary apoplexy, panhypopituitarism and empty sella turcica. There was no evidence of optic chiasm herniation into the sella, dolichoectasia of the anterior cerebral arteries, or evidence of visual pathways abnormalities.CONCLUSSION: Sound induced photisms may constitute restoration to consciousness of primitive hierarchical phenomena in evolutive and ontogenetic terms, facilitated by central nervous system (CNS) demyelination not directly affecting anterior visual pathways.text/html2011-01-01T19:28:57+01:00http://www.webmedcentral.com/Mr. Akiyoshi MatsugiVestibular-induced Modulation Of Leg Motoneuron Pool Excitability In Standing And Prone Positions
http://www.webmedcentral.com/article_view/1436
The purpose of this study was to investigate whether vestibular stimulation modulates leg motoneuron pool excitability in standing and prone positions. Galvanic vestibular stimulation (GVS) was delivered to 7 healthy humans in standing and in prone positions. Background EMG activity and H-reflex were recorded from the soleus muscle 100 ms or 200 ms after GVS onset. Background EMG activity and H-reflex excitability were depressed 200 ms after GVS onset on the anodal GVS side in the standing position, although the depression was absent 100 ms after GVS onset. The depression was absent on the cathodal GVS side in the standing position. Furthermore, the depression was absent on both the anodal and cathodal GVS sides in the prone position. These findings indicate that vestibular-induced modulation of leg motoneuron pool excitability is absent in prone position but present in standing position. Head position, postural stability or motoneuron pool sensitivity are possible determinants of this difference.text/html2011-01-18T20:28:58+01:00http://www.webmedcentral.com/Dr. Matthew B JensenParadoxical Patellar Reflex As A Presenting Sign Of Acute Inflammatory Demyelinating Polyradiculoneuropathy
http://www.webmedcentral.com/article_view/1473
We report a case of paradoxical patellar reflex as a presenting sign of acute inflammatory demyelinating polyradiculoneuropathy.text/html2011-02-01T10:48:27+01:00http://www.webmedcentral.com/Dr. Patrick M FoyeElectrodiagnostic Findings In Brachial Plexopathy After Influenza Vaccination
http://www.webmedcentral.com/article_view/1530
Brachial plexopathy after vaccination is an uncommon but clinically important phenomenon, which can be diagnosed by electrodiagnostic studies. We describe the case of a 59 year old female who received a prophylactic influenza vaccination in her left deltoid and within days experienced painful dysesthesias predominantly in the sensory region supplied by the left axillary nerve. Due to progressive pain, she presented to our physiatric practice for evaluation ten weeks later. Electromyography (EMG) and nerve conduction studies revealed an incomplete left brachial plexopathy, predominantly involving the posterior cord. Left upper limb EMG abnormalities included spontaneous activity limited to the distribution of the left axillary and radial nerves, with normal paraspinal muscles. Motor nerve conduction studies of the bilateral axillary nerves, using surface pickup over the lateral deltoids, revealed normal and symmetric bilateral latencies, but an amplitude that was 44% less on the left than on the right. We present a discussion of post-vaccination neuropathies, including diagnosis, complications, and treatment. Physiatrists, neurologists, electromyographers and other clinicians should be aware of brachial plexopathy after vaccination, an uncommon but clinically important entity that can be most definitively diagnosed by electromyography and nerve conduction studies.text/html2011-02-25T22:20:31+01:00http://www.webmedcentral.com/Dr. Simon B ThompsonIs Yawning A Warning, Neurologically?
http://www.webmedcentral.com/article_view/1610
Yawning has fascinated scientists for centuries. Hippocrates included it I his list of “useful natures” and Hindus used to regard yawning as a religious “offence”. Some ancient superstitions saw yawning as the escaping of the soul. However, scientists today are still amazed with the extent to yawning tells us about many other neurological conditions (e.g. Thompson, 2010). The importance of yawning in helping us understand other neurological mechanisms has led to La Société Française de Neurologie et La Société des Neurosciences convening the first international conference on yawning at l’Hôpital de la Pitié-Salpêtrière, Paris, France in June 2010 to which the author was invited as one of the Invited Speakers.text/html2011-02-27T18:48:43+01:00http://www.webmedcentral.com/Dr. Gentian VyshkaGenetics of Pain and Spinal Cord Stimulation: A Review of the Literature
http://www.webmedcentral.com/article_view/1635
1.Genetics of pain and genetic mediation of pain-related traitsThere is a number of genetic models displaying large divergence in analgesic sensitivity; and the investigations into the genetic mediation of pain-related traits have gain clinical consistency and diagnostic value more and more. These pain-related traits, whose genetic basis has been supposed and studied, are mainly based on experimental date gathered on mammals such as knock-out mice (Mogil, 1996). The two main issues in discussing and studying the genetics of pain-related traits have been:a- Nociceptive and neuropathic pain sensitivityb- Sensitivity to endogenous and exogenous analgesics.Because the large number of subjects required for sustainable genetic investigations, the studies have been performed by using the hot-plates and/or tail-flick tests of nociception. In a previous study, without entering in genetic details, we studied the pain and temperature threshold, whose relevance for different neurological diseases is clearly approved (Vyshka, 2003). The study was made on healthy probands, but the correlations with clinically important human pain states were not tested, if there were correlations to be found at all.Among the human diseases with genetic effect of pain, different authors mention:1. Hereditary sensory neuropathy type I,2. Familial hemiplegic migraine,3. Painful congenital myotonia.Genetic traits of the above mentioned diseases have been reliably formulated; HSAN (Hereditary Sensory & Autonomous Neuropathies) as a large and non homogenous group provide the most interesting nosology, mainly due to the fact that the disease inflicts only small fiber loss; safeguarding some large-fiber functionality assures the efficacy of spinal cord stimulation, as we shall further discuss. HSAN molecular diagnostics suggested a dominant inheritance, traits related to the Chromosome 9q22.1-q22.3; and an enzyme named serine palmitoyltransferase, long-chain base subunit 1 (SPTLC1) has been accused as important in the pathogenesis of the disease. (Reilly, 1998). Studies have interested other neuropathies as well as complex regional pain syndromes.The analysis of a genetic model of chronic pain is clinically important and well worth of the efforts made up to now. There have been confirmed relationships between a murine gene and pain-related traits for pro-opio-melanocortin and opioid stress-induced analgesia, but as said before, studies have been mainly focused on knockout mice. This for some authors is not a disadvantage, since 80% of mouse genome is estimated to match conserved regions of human genome (Copeland, 1993).The use of hot-plates and tail-flick tests of nociception might reflect only poorly important human pain situations, but they predict the effectiveness of analgesics (Hammond, 1989). Considerable evidence suggests that different types of nociception are mediated by separable physiological mechanisms (Dennis, 1979). Therefore we might well expect that the genetic mediations of sensitivity to these pain modalities will be different as well. Genetic factors also play an important role in the sensitivity expressed toward opiate inhibition of different pain modalities (Jacob, 1983; Oliverio 1975); as indicators of lower or higher sensitivity have been used the latencies of responses gathered during application of hot-plates and tail-flicks in KO mouse (Mogil, 1996).Investigations into the genetic mechanics of pain-related traits should somehow provide relevant clinical data; the sensitivity toward opiate administration, or spinal cord stimulation, or whatever antalgic measure to be conducted, will become a screening pre-test before entering the patient in a long-term pain therapy.2.Neuropathic pain and dorsal horn alterationsNeuropathic pain might become manifest, persist and seriously hurt the patient, even in the absence of any evidence of peripheral tissue damages. There have been several neural mechanisms suggested in triggering and upholding the neuropathic pain in general:---at the peripheral nerve stage, the deafferentation might be the cause. The loss of sensory axons due to post-herpetic neuralgia, will reflect not only the sensory deficit, but the severe pain the patients will suffer thereafter (Oaklander, 1998).---neuroma formation and axonal damages may generate ectopic impulses; a very common process during different types of neuropathies. These ectopic impulses will reenter antidromically in a process known as ephaptic transmission.---the hyper-expression of α-adrenergic receptors has been suggested as a pathological mechanism in the CRPS (complex regional pain syndrome), as it happens after a partial peripheral nerve damage (Woolf, 1999).---central structures might become hypersensitive as well; dorsal horn, periacqueductal substance, thalamus, rostro-ventral medulla, all these structures have shown deficiency in modulating the pain perception through the serotoninergic descending pathways that normally filter the painful experiences.Anatomic and functional changes in the dorsal horn of medulla have been widely discussed; there is evidence that the interneurons of second lamina of Rexed undergo a massive apoptosis after peripheral nerve damage, maybe through an excitotoxic mechanism (Sugimoto, 1990). Opioids, GABA-enhancing drugs, clonidine and spinal cord stimulation might quite will mimic the descending pain inhibition in such cases. NMDA receptors have been accused as well, because NMDA antagonists (dextrometorphan, ketamine) will remove the hypersensitivity toward pain in patient with neuropathy (Nelson, 1997).At the level of actual knowledge, it is widely accepted that the dorsal horn undergoes anatomic and functional changes, causing hyperexcitability and hyperalgesia (Yakhnitsa, 1999); genetic traits of analgesic efficacy should be clinically very important in providing relief and in suggesting the patients a specific analgesic treatment, such as the spinal cord stimulation. 3.Spinal cord stimulation as a rostral extension of peripheral nerve stimulationSince the Melzack-Wall gate theory of pain (1965), there have been several attempts to translate the neurophysiological findings in the clinical practice. Spinal Cord Stimulation (SCS) was introduced as a rostral extension of peripheral nerve stimulation, with the precise aim to stimulate the spinal dorsal columns. Through this stimulation, an activation of large-caliber myelinated fibers (Ab) will follow, fibers that on the other hand will modulate or inhibite pain transmission in small-caliber unmyelinated (C) and thin myelinated (Ad) nerve fibers.Fig. 1 – Left side: raports of C and Ad fibers with Ab fibers in the dorsal root ganglion and dorsal horn. Right side: further pain processing in the spinothalamic tract.The above figure (no.1) illustrates the raports of C and Ad fibers with Ab fibers and other structures of the dorsal horn (Mense, 2004), and further pain processing in the spinothalamic tract (Paulev, 2000). In order for the SCS to be effective, there should be considered following points:(A)The patient has to undergo a trial period, during which percutaneous temporary electrodes will be implanted. The patients have to refer at least 50% improvement in the pain (Kim, 2001; North, 2002), through questionnaires such as VAS and other pain rating scales.(B)Pain relief occurs only in areas where the stimulation produces paresthesias. Therefore the patient is kept awake during the device implantation (Giller, 2003; Van Buyten, 2001) so that the electrode position can be modified as needed. However, other surgeons prefer the general anesthesia during the surgical implantation of the SCS device, and therefore a monitoring way of electrode placement has been widely required. The use of antidromic evoked potentials has been reported as a reliable way to precise placement of dorsal cord disc electrodes (Yingling, 1986). According to authors, antidromic recordings are preferable to orthodromic ones, for the purpose of intraoperative evaluation of dorsal cord electrode placement.There are still some technical problems regarding the paresthesias’ obtaining in the painful areas:***Achieving stable paresthesias can be difficult, due to the complexity of the pain pattern (Giller, 2003);***The electrodes can migrate;***Other intrinsic reasons for failure of the implanted device can play a role. A major technical issue that may limit and influence the clinical efficacy, is the range of stimulation amplitudes between the perception threshold (PT) and the discomfort threshold (DT) – often preventing a complete coverage of the painful area by paresthesia to provide maximum therapeutic effect (Holsheimer 1997). Another technical problem will be that of stimulating the dorsal root instead of / or as well as – stimulating the dorsal columns, which is the main purpose of the stimulation (Ibid.).
text/html2011-03-31T18:52:24+01:00http://www.webmedcentral.com/Dr. Ipek MidiCentral Nervous System Lupus: Case Report
http://www.webmedcentral.com/article_view/1829
Cerebral infarction is a presentation of systemic lupus erythematosus (SLE) and generally appears during advanced, active phases of the disease.A thirty- two year old female was admitted to hospital with a history of diarrhea, agitation, headache and left hemiparesis. On physical examination her body temperature was high, lymphadenopathy and pretibial edema were noticed. Cranial diffusion weighted images were performed and acute bilateral disseminated multiple cortical and subcortical areas of high signal intensities on T2 and T1-weighted images compatible with vasculitis were detected. On laboratory tests, low complement levels, thrombocytopenia, neutropenia, lymphopenia, positive antinuclear antibodies (ANA) (1/320), persistently elevated anti-DNA titres and proteinuria were found. Renal biopsy confirmed lupus nephritis. Chest X-ray showed cardiomegaly and pleural effusion.This case presentation shows evidence of ischemia in patients with active SLE and also shows that the first symptom of SLE can be an acute ischemic stroke.text/html2011-04-11T18:09:10+01:00http://www.webmedcentral.com/Dr. Simon B ThompsonAssessing Effort During Clinical Neuropsychological Testing of Patients: Relevance to Law Suits, Patients with Neurological Disorders and Financially Motivated Claimants
http://www.webmedcentral.com/article_view/1862
For some time, clinicians and researchers have attempted to find measures of effort and malingering. The problem has arisen from increasing litigation suits and the various motives of patients seeking compensation. Insurers are also under increasing pressure to determine whether or not claimants are genuine and for law courts to be assured that claimants are being honest. There are no single tests that determine effort and there is continuing debate over the usefulness of tests that purport to measure effort and malingering versus the clinical interview.text/html2011-11-14T15:03:21+01:00http://www.webmedcentral.com/Dr. Daniel E JacomeHemicrania Continua and Hypoglossal Nerve Palsy: Signs of Intracranial Hypertension
http://www.webmedcentral.com/article_view/2449
A 50 year old male with obstructive sleep apnea developed de novo, daily, intense, continuous, left side pounding headache with superimposed stabbing pains, fluctuating in severity. Headache was associated with ptosis of the left eye, left hypoglossal palsy and eventual tongue hemiatrophy, in the absence of papilledema. His Brain and neck imaging procedures (MRI, MRA, MRV) and a left temporal artery biopsy were normal, while his cerebrospinal fluid (CSF) opening pressure was found elevated.text/html2011-12-01T11:59:07+01:00http://www.webmedcentral.com/Dr. Daniel E JacomeMultiple Sclerosis and Intracranial Hypertension Presenting as Paroxysmal Kinesigenic Dyskinesia
http://www.webmedcentral.com/article_view/2544
Background: Paroxysmal movements in the form of tonic spasms, dystonia, choreoathetosis and hemidyskinesia have been reported in patient with multiple sclerosis (MS). Intracranial hypertension with headache and papilledema resembling idiopathic intracranial hypertension (IIH) exceptionally occurs in patient with MS. Conversely, IIH may rarely present as movement disorder in children.Aims of the study: Report an unusual patient with MS and intracranial hypertension anteceded by movement disorder.Methods: Clinical examinations and ancillary diagnostic testing.Results: A 54 year old patient presented one year earlier to her diagnosis of MS with symptoms of paroxysmal kinesigenic diskinesia (PKD). Her initial neurologic examination and brain MRI were normal. A year later her examination became abnormal and her MRI showed demyelination. Her cerebrospinal fluid contained oligoclonal bands and the opening pressure was markedly elevated, in the absence of headache and papilledema.Conclusion: PKD may antecede MS and acephalgic intracranial hypertension without papilledema in exceptional patients.text/html2012-01-12T07:34:49+01:00http://www.webmedcentral.com/Dr. Gentian VyshkaRetrospective Study of a Series of 512 Cases of Carotid Artery Ultrasonography
http://www.webmedcentral.com/article_view/2875
Background: Carotid ultrasound is useful examination for prevention and management of ischemic stroke and atherosclerosis linked with vascular risk factors. Age and gender are independent factors for stroke. Lacunar stroke is more attributed to chronic hypertension, diabetes mellitus and alcohol abuse, while nonlacunar infarction to carotid artery stenosis and atrial fibrillation.Methods: A retrospective case review study of patients that performed carotid ultrasound in our unit. The sample of data was retrieved from in-hospital admitted patients and outpatients. Data are expressed in average mean value and standard deviation. Data analysis was performed using the statistical software for social science SPSS 15.0. Significance was considered the values of p < 0, 05. Among the cases under this study 110 cerebral nonlacunar infarction patients and 178 cerebral lacunar infarction patients who performed CT scanning and/or magnetic resonance imaging were examined for carotid artery stenosis and compare.Results: According the coefficient of correlation Pearson, there is a significant statistical connection between age and the grade of carotid artery stenosis (P = 0.001) Test of student for two independent samples there is a significant statistical distinction between genders with male dominance in CAS (t = 3.825, df = 510, P = 0.001). Correlation was found with the grade of carotid artery stenosis: sharp rise in CAS between 50 and 60 years old) with the highest risk for stenosis and ischemic stroke at the age 65 and 75 years old. After the coefficient of correlation Kendall, there is a significant correlation between grade of carotid artery stenosis and smoking (P = 0.001), CAS and HTA (P = 0.001), CAS and diabetes (P = 0.001), CAS and high cholesterol (P = 0.001). According to the coefficient of correlation Kendall, there is not a significant correlation between grade of carotid artery stenosis and alcohol consumption (N 512, P=0.03) An important statistical difference between carotid artery atherosclerotic plaques in nonlacunar (55%, SD 17.83) versus lacunar infarction (35%, SD 14.57) (p < 0,001) was observed.Conclusions: In patients with risk factors age between 40 and 60 years old is reasonable for screening with carotid ultrasound and follow up. There is a significant statistical distinction between genders with male dominance. Age, smoking, hypertension, cholesterol and diabetes are significant risk factor for CAS. Alcohol consumption has not significant correlation with grade of carotid artery stenosis. The carotid stenosis is more evident in nonlacunar compare to the lacunar cerebral infarction. This evidence is in favour that in lacunars stroke there is a distinct lacunar small cerebral arteriopathy relatively sparing medium sized carotid arteriestext/html2012-03-01T10:20:43+01:00http://www.webmedcentral.com/Mr. Anil K NairBaseline Characteristics of Patients Attending the www.TheAlzCenter.org Memory Clinic Serving the South Shore of Boston
http://www.webmedcentral.com/article_view/3085
We describe baseline characteristics of 173 memory clinic patients at www.TheAlzCenter.org. Patients mostly from the South Shore of Boston came in for a neurological evaluation regarding their memory. A database such as the one created by www.TheAlzCenter.org will be useful for screening patients for clinical trials and other interventional therapies with specific indications. We plan to reach out to aging agencies to screen community dwelling controls in the future.text/html2012-04-03T17:47:21+01:00http://www.webmedcentral.com/Dr. Daniel E JacomeTransient Recurrent Acquired Delayed Eidetic Memory: TRADEM Syndrome-Remembering the Present
http://www.webmedcentral.com/article_view/3210
A seventy eight year old psychiatrist developed recurrent transient episodes of sectoral visual colorful and detailed memories, as the actual identical events that have occurred in real life and registered by him in previous hours, resurrecting the actual original experience in a clear sensorium. He had no additional symptoms. In contrast to a previously reported patient with multiple sclerosis, these “remembered hallucinations” were not under volitional control and were mute. They differed from palinopsia because its complexity, its vivid detailed overtones, its delayed presentation, their logical evolving concatenation, and because they were not precipitated by external visual cues but originated from within. They could be suppressed by eye movement and by eye closure but not by blinking. They were also clinically distinct from the hallucinations of Charles Bonnet syndrome. Symptoms followed influenza vaccination and dissipated after four months, to never return. Extensive neurological investigations revealed only the presence of bilateral retro-bulbar optic neuropathy, suggesting a peripheral visual pathogenic mechanism for the replayed eidetic memories.text/html2012-11-30T20:34:13+01:00http://www.webmedcentral.com/Dr. Riazahmed SyedWernicke Like Encephalopathy in a Child: A Reversible Cause
http://www.webmedcentral.com/article_view/3597
Wernicke’s encephalopathy (WE) is the best known neurological complication of thiamine deficiency, characterized by ocular, symptoms, mental confusion and ataxia. we report herewith a male child with unusual features, suggestive of WE and with thiamine treatment, the response was dramatic.Participated in the national seminar on Consumerism in DNR College, Bvrmtext/html2012-11-11T00:46:28+01:00http://www.webmedcentral.com/Dr. Gentian VyshkaMigraine Burden in an Albanian Patient\'s Cohort
http://www.webmedcentral.com/article_view/3816
Purpose: To find the correlation between migraine and work ability by using the MIDAS questionnaire.
Method: We studied the data of 106 migraine patients randomly presented at the Specialist's Polyclinic Nr 2 of Tirana. The diagnosis is made according ICHD IIR1 criteria (2005). The MIDAS questionnaire, Albanian variant, evaluated in a previous study (2000, MK, JK) is used. The age of patients, age of headache, gender, education and the drug treatment are used as variables of the study. The neurological examination and possibly the laboratory exams are required. The SPSS 17.0 program is applied to get the statistical data.
Results: The mean age of patients was 34.57 years old (SD 11.22). There were 83 (78.3%) female and 23 (21.7%) male. 71.7% of patients were suffering of migraine without aura. 58 patients (54.7%) had finished the high school and 23 (21.7%) the undergraduate studies. There were 38 patients (35.8%) under correct treatment and 68 (64.2%) using wrong treatment regimen. There is a statistically significant correlation between the age of disease and the treatment and between the treatment and MIDAS degree. No significant correlation between migraine form and age of patients and migraine form and gender or education is found.
Conclusion: The correct treatment of migraine is an important factor in diminishing the burden of migraine especially in the newly diagnosed patients.text/html2012-11-30T20:33:17+01:00http://www.webmedcentral.com/Dr. Daniel E JacomePost-Orgasmic New Daily Persistent Headache In a Patient With Hemochromatosis and Idiopathic Intracranial Hypertension Without Papilledema
http://www.webmedcentral.com/article_view/3859
A 56 year old female with hemochromatosis-HFE C282Y homozygous gene mutation and remote history of infrequent isolated visual auras developed new daily persistent headache (NDPH) following a single orgasm. Headache was eventually ameliorated by amytriptiline and topiramate after 18 months following the precipitating event. Her neurological examination and ancillary imaging procedures including head CT, brain MRI-MRA and MRV were normal except for a very small parietal meningioma representing an incidental finding. There was no evidence of reversible vasoconstriction syndrome (RCVS). Her cerebrospinal (CSF) pressure was elevated compatible with idiopathic intracranial hypertension (IIH) without papilledema. There was no sign of bleeding in the CSF but her protein content was mildly increased in the absence of oligoclonal bands. Hemochromatosis (HC) predisposes to migraine in women. The origin of this patient’s headache remains unclear, but the association of primary post-orgasmic NDPH, hemochromatosis and IIH represents a unique clinical presentation.text/html2012-12-31T18:25:25+01:00http://www.webmedcentral.com/Dr. Daniel E JacomeAnorgasmic Sexual Headache
http://www.webmedcentral.com/article_view/3920
A forty six year old female with history of migraine without aura and isolated visual auras recently increasing in frequency, was prescribed topiramate as a preventative drug against migraine. Her repeated neurological examinations and her imaging procedures were normal. Topiramate at a dose of 50 mg b.i.d. was effective in controlling her spontaneous headaches but resulted in the appearance of recurrent headache only with sexual activity in attempting to reach orgasm (i.e., anorgasmic headache) while reporting no headaches with other modalities of physical activity, cough or sneezing. A slight reduction on the dose of topiramate was sufficient to suppress her sexual anorgasmic headaches by allowing her achieving orgasms once more. After a few months, restoration to the originally intended dose was accomplished without causing a recurrence on her anogasmic headaches, or interference with sexual climax. Anorgasmic sexual headache may occur in isolation in cases of dose dependant topiramate-induced anorgasmia on a temporary basis, permitting the continuation of its use if efficacious otherwise in controlling spontaneous migraine, and causing no other significant adverse reactions.text/html2013-02-01T06:27:17+01:00http://www.webmedcentral.com/Dr. Daniel E JacomeMigrainous Binocular Peripheral Oscillopsia: A typical Persistent Visual Aura Without Infarction
http://www.webmedcentral.com/article_view/3984
An 18 year old female with history of migraine without aura reported the abrupt onset of continuous, irregular, rapid (“shaking”) movements of objects perceived on the periphery of her visual fields over both eyes, when fixating on any given target. Symptoms were not suppressed by monocular eye closure. In some form, she experienced incomplete tunnel vision (“pseudo-tunnel”), since the periphery of her fields was not totally dark, lost coloration or was populated by phosphenes. She had some inconsistent lightheadedness but no vertigo, and reported a moderate continuous mid-facial headache. She denied symptoms referable to any other cranial nerve dysfunction. Her ophthalmologic and repeated neurological examinations were normal showing symmetric eye movements, normal saccades and smooth pursuit, no nystagmus and no ataxia. Her brain MRI and MRA of the extra and intracranial vessels were normal. Her EEG showed a normal background in the absence of a focal slowing, epileptic discharges or periodic complexes. Her visual evoked responses were symmetric with normal latencies. Her visual field testing revealed no deficits, yet, she had initially persistent peripheral movement illusion over both eyes. Her ocular symptoms lasted for several weeks progressively dissipating with the prophylactic administration of topiramate. I suggest that this patient’s binocular peripheral oscillopsia represented persistent cortical oscillopsia without nystagmus, as a very rare atypical variant of migraine persistent visual aura without infarction. Cortical oscillopsia without nystagmus constitutes a neuro-ophtalmological syndrome, recently validated in a patient with neuromyelitis optica (NMO) and visual pathways demyelinating lesions. In my belief, this patient’s symptoms probably emanated from sustained cortical occipital hyper-excitability and from reverberating spreading cortical depression (CSD).text/html2013-03-26T06:53:52+01:00http://www.webmedcentral.com/Dr. Gentian VyshkaCerebral vasculitides and non-arteriosclerotic vasculopathies: A Theoretical Review
http://www.webmedcentral.com/article_view/4164
Gross division of vasculitides is still today dependent upon the histological characteristics of the disease; nevertheless anatomic-pathological classifications mainly rely upon the diameter of the injured vessel and also upon the fact that the process is granulomatous, or not.Authors describe main cerebral vasculitides of primary and secondary origin, as well as some of the main non-atherosclerotic vasculopathies (CADASIL, Moya-Moya syndrome and fibromuscular dysplasia).A review of several updated bibliographic sources is thereby completed.text/html2013-08-16T05:19:41+01:00http://www.webmedcentral.com/Dr. Simon B ThompsonHow to catch a yawn: initial observations of a randomized controlled trial
http://www.webmedcentral.com/article_view/4371
Background: Yawning continually poses a difficulty for many scientists and clinicians over their agreement about the mechanism, origin, and neuro-chemicals involved. There has previously been no reliable way of profiling a yawn, scientifically, except by observation.Objective: To represent the yawn episode in terms of jaw-muscle nerve electro-myographical (EMG) data as well as by direct observation. Method. 20 male and female volunteers aged between 18-53 years were exposed to conditions that provoked a yawning response in a randomised controlled trial. This paper is a discussion paper about some of these findings from the larger study. In particular, a profile of the yawn phase is represented to encourage further discussion about the possibilities of using EMG data for early diagnosis of neurological disease.Conclusions: It is possible to represent yawning with EMG data; however, there is evidence to suggest that the yawning phase is individual and variable and tends to be very small measurements of a millionth of a volt.Ethics: Bournemouth University Research & Ethics approval granted: BU-PS5/10/11-PS1/3/12. Professional code of conduct, confidentiality, and safety issues have been addressed and approved in the Ethics submission.TrialsID:ISRCTN61942768. http://www.controlled-trials.com/isrctn/text/html2013-12-30T05:55:42+01:00http://www.webmedcentral.com/Dr. Gentian VyshkaBitemporal Lobe Epilepsy Versus Unitemporal Lobe Epilepsy
http://www.webmedcentral.com/article_view/4476
Temporal lobe epilepsy (TLE) is the commonest form of focal epilepsy syndrome ranging in surgical series, between 60 - 75% of patients operated on for drug resistant epilepsies (Blumcke et al., 2002; Lahl et al. 2003). Starting from the fifties, following Falconer’s observations (1964) and later on Margerison and Corsellis (1966) neuropathological work, hippocampal sclerosis (HS) has been recognized as the most frequent pathological finding in TLE surgical series related to the so-called mesial temporal epilepsy and characterized by drug-refractory focal epilepsy, strong association with febrile convulsions (FC), complex partial seizures, anterior temporal interictal epileptic EEG abnormalities, lateralized neuropsychological deficits, and good post-surgical outcome (French et al 1993; Williamson et al 1993; Wiebe et al 2001). Almost 70% of patients with medically refractory temporal lobe epilepsy have MTLE-HS. Surgical therapy is often indicated for medically refractory temporal lobe epilepsy. Most evidence suggests that the best candidates for surgery are those subjects in whom all seizures originate from one side, and in whom all clinical, interictal EEG, neuroimaging, and neuropsychological findings are concordant with ictal onsets. Controversy arises when evidence exists for bitemporal epilepsy, defined here as clinical seizures arising independently from both temporal lobes, based on scalp EEG (Holmes at al 2003). About 10-20% of all TLE patients suffer from bitemporal epilepsy ( R.Kuba, I,Rektor: EJN 2003). Bitemporal lobe epilepsy is a particular group of focal epilepsy with a poor temporal lobe surgery prognosis. (Hirsch et al, 1991; Hufnagel et al,1994). Clinical seizures semiology as assessed during prolonged video EEG monitoring can provide important information on the lateralization of the seizure onset. The distinction between uni and bitemporal patients seems to be important because in bitemporal disease a more rapid contralateral seizure spread with consecutive wrong clinical lateralization can be expected. In MTLE-HS the interictal EEG abnormalities are anterior temporal spikes and sharp waves, and these can be bilaterally independent in up to 1/3 of patients.Clinical Criteria (Baumgartner; Neurology,1998; 50; 742-747)Ipsilateral signs:
1. Unilateral upper extremity2. Nonversive (early) head turning 3. Postictal nosewiping4. Unilateral eye lid blinkingContralateral signs:
1. Tonic dystonic posturing 2. Mouth deviation 3. Version, tonic position of the head and eyes 4. Postictal paresisDominant hemisphere:
1. Postictal dysnomiaNondominant hemisphere:
Ictal speech
Sometimes we can find other clinical features: automatisms with preserved responsiveness, ictal vomiting/retching, ictal spitting, peri-ictal urinary urge, peri-ictal water drinking, postictal coughing, ictal smile, peri-ictal crying.
Seizures are classified clinically lateralized if at least one of the mentioned symptoms could be identified. If these ictal features are pointed to different sides or none occurred, seizures are regarded as not lateralized. Pataraia showed that more than 70% of seizures could be lateralized and lateralization was correct in the unitemporal group, while in the bitemporal group, lateralization was possible in only 51.4% of seizures, and was correct in only 58.3% of them. (Pataraia et al.1998)text/html2014-01-09T06:34:38+01:00http://www.webmedcentral.com/Dr. Daniel E JacomeCough-Induced Transient Global Amnesia
http://www.webmedcentral.com/article_view/4512
Two patients developed acute loss of short term memory of several hours duration while preserving autobiographic memory and exhibiting no focal signs and symptoms following a crisis of severe coughing. The first patient had recurrent allergic bronchitis; the second patient had hereditary pressure palsy neuropathy (HPPN) secondary to a mutation in the PMP 22 gene manifested by protracted cough, eventually ameliorated by the administration of Levetiracetam. Neither of the two patients had history of migraine or epilepsy. Imaging studies failed to show structural or acute vascular lesions on either patient. Symptoms were typical of transient global amnesia (TGA). Because primary TGA (no lesions apparent on imaging) may represent a migraine phenomenon according to previous reports, I propose that these two patients exhibited “cough-induced TGA”, precipitated by a similar mechanism causing cough headache but presenting as pure confusional migraine, or more formally defined, as “cough-induced persistent cognitive migraine aura without stroke.”text/html2014-08-28T08:40:10+01:00http://www.webmedcentral.com/Dr. Daniel E JacomeCorpalgia Pseudoathetosica: Another Face for an Old Syndrome?
http://www.webmedcentral.com/article_view/4682
Background:
Restless legs syndrome (RLS) is a chronic common condition, often debilitating. Variants of RLS include restless arms and restless genital syndrome. Restless legs may occur in patients with chronic pain.
Aims of the Study:
To report three female patients with generalized involuntary movements superimposed on restless legs in the background of generalized pain
Methods:
Repeated clinical examinations and ancillary testing
Results:
Three female patients are described. The first patient had Charcot Marie Tooth polyneuropathy, painful legs –moving toes syndrome, RLS, dysautonomia, neurogenic bladder, chronic generalized pain and choreoathetosis of late onset. The second patient had severe fibromyalgia, chronic tension headache, temporomandibular joint syndrome and irritable bowel syndrome in addition to athetoid irregular multifocal movements. The third patient had involuntary athetoid movements of the limbs, familial RLS, fibromyalgia and attention deficit disorder-inattentive type.
Conclusion:
Corpalgia pseudoathetosica-CPA- (pseudoathetosis associated with generalized chronic body pain) represents an expanded clinical version of restless legs syndrome in patients with underlying chronic pain that needs to be distinguished from typical akathisia. Movements may constitute a self-therapeutic or compensatory physiologic pre-conscious response to pain, in virtue of the known analgesic properties of motor cortex stimulation.text/html2015-05-07T07:49:08+01:00http://www.webmedcentral.com/Dr. Jae-Myun ChungMigraineurs without nausea: how do they differ from migraineurs with nausea?
http://www.webmedcentral.com/article_view/4868
Background: Nausea is regarded as an essential element in the diagnosis of migraine. However, some patients with migraine do not experience nausea during their migraine attacks. These patients may show different clinical features that demand different management strategies. The authors evaluated how migraineurs without nausea differ from those with nausea in a headache clinic.
Methods: This study enrolled 182 consecutive patients (156 female, 26 male) satisfying the International Classification of Headache Disorders-II criteria of migraine with or without aura from August 2009 to July 2011. Patients who overused medications were excluded. All enrolled patients underwent interviews using a structured questionnaire regarding demographic and clinical features performed by a neurologist specialized in headache disorders.
Results: Of the 182 patients with migraine, 21 never experienced nausea during their migraine attacks (11.5%). These 21 patients were older and experienced a lower frequency of vomiting, osmophobia, and pulsating headache quality (p < 0.05). However, they did not differ from patients who usually suffered from nausea in terms of the presence of an aura, gender, body mass index, headache years, headache severity expressed on a visual analogue scale, Headache Impact Test-6 score, presence of family history, photophobia, or phonophobia.
Conclusions: Migraineurs without nausea showed a tendency to be older and experience less vomiting and osmophobia, and their headache was usually dull and aching rather than pulsating. These results suggest that migraine-associated symptoms have peculiar characteristics that require elucidation by further studies in terms of their clinical significance and role in migraine pathophysiology. text/html2020-08-17T07:56:41+01:00http://www.webmedcentral.com/Dr. Gentian VyshkaYoung Females and Cerebral Venous Thrombosis
http://www.webmedcentral.com/article_view/5627
Cerebral venous thrombosis (CVT), is an under diagnosed condition for acute or slowly progressive neurological deficit. CVT has a wide spectrum of signs and symptoms, which may evolve suddenly or over the weeks. It is clinically challenging and mimics neurological conditions, such as: meningitis, encephalopathy, benign intracranial hypertension, and stroke. We have seen 12 female patients of CVT, during 2011-2012. The mean age was 29.75 years (25-40 years old). Of the 12 females, 8 were postpartum, 2 were pregnant, one was on oral contraceptives and in one Antiphospholipid antibodies were positive.
CVT cases are now being diagnosed more frequently. Newer imaging procedures have led to easier recognition of CVT, offering the opportunity for early therapeutic measures. Headache is the most frequent symptom in patients with CVT, present in about 80% of cases. Sixth cranial nerve palsy usually manifests as false localizing sign. Patients may have seizures that can be recurrent. CVT, an important cause of stroke in puerperium is frequently observed in Albania.