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Biomedical subjects

A Janati

Publications and source records attributed to A Janati.

At least 19 recordsLinked to original sources

Positive temporal sharp waves in neonatal EEG.

The clinical correlates and EEG characteristics of rolandic positive sharp waves in neonatal EEG have been studied systematically. Morphologically similar positive sharp waves have been reported to occur in the temporal areas (PTS). Their significance is, however, unclear. We reviewed fifty-two EEGs on patients from the Neonatal Intensive Care Unit of the University of Arkansas for Medical Sciences. Twenty-one of the EEGs which were reviewed had PTS. We correlated the PTS with the results of ultrasound of the head and with clinical evaluations. PTS are more strongly correlated with the occurrence of non-hemorrhagic than of hemorrhagic intracranial pathology.

Cerebral Hemorrhage

Blepharospasm associated with olivopontocerebellar atrophy.

We report two cases of cranial dystonia (blepharospasm) associated with olivopontocerebellar atrophy (OPCA). The pathophysiology of blepharospasm appears to involve an increased excitability of the interneurons of the blink and corneal reflexes. It is hypothesized that blepharospasm associated with OPCA might be due to rostral brainstem lesions disrupting central dopaminergic and cholinergic pathways, resulting in disinhibition of brainstem reflexes or denervation supersensitivity of the facial nuclear complex.

Blepharospasm

Unilateral alpha rhythm and Cheyne-Stokes respirations.

A case of unilateral basal ganglion hemorrhage with Cheyne-Stokes respirations is presented. During the hyperpneic periods there was rhythmic alpha activity in the hemisphere contralateral to the basal ganglion hemorrhage. We postulate that the hemorrhage interrupted the thalamocortical fibers on the involved side. The implications of this clinical evidence are discussed in the light of the theory of cerebral autorhythmicity.

Alpha Rhythm

The anterior temporal electrode in the EEG of the adult.

The anterior temporal cerebral region is not well covered, electroencephalographically, by the usual EEG electrodes. Numerous attempts have been made to add anterior temporal electrodes. There has been discussion regarding the amount of additional information actually attributable to those electrodes. We systematically evaluated the abnormalities revealed by one such noninvasive set of anterior temporal electrodes, D. Silverman's T1 and T2. A total of 624 consecutive EEGs were reviewed. We conclude that, in the adult, anterior temporal electrodes can add significantly to the information contained in the routine interictal EEG.

Adult

Guillain-Barré syndrome after vaccination with purified tetanus toxoid.

A 47-year-old patient had Guillain-Barré syndrome after the injection of pure tetanus toxoid. He demonstrated a hypersensitive lymphoblastic transformation to purified tetanus antigen, and typing for disease-associated antigens showed him to be homozygous for HLA-B8. This is the first reported case of nonrelapsing Guillain-Barré syndrome after tetanus toxoid vaccination.

Accidents, Occupational

Oculomotor palsy and papilledema with pial-dural arteriovenous malformation.

A 62-year-old man presented with papilledema, a cranial bruit, and a partial left oculomotor nerve palsy. Arteriography revealed a large mixed pial-dural arteriovenous malformation involving the superior sagittal and both transverse sinuses. After the superior part of the malformation was embolized, the patient's papilledema and ocular motility disturbance resolved. The oculomotor disturbance may have been a nonspecific sign of increased intracranial pressure. Cranial auscultation should be performed in all cases of papilledema and cranial nerve palsy.

Dura Mater

Coexisting alpha pattern coma, theta pattern coma and spindle coma.

Abnormal ectopic rhythms, such as alpha-theta activities and spindles, occur in comatose patients. A case is presented in which the EEG of a comatose patient showed coexisting alpha-theta pattern activities and spindles. It is concluded that the coexistence of these rhythmic patterns in the EEG of a comatose patient implies continued physiologic functioning of a thalamocortical system deafferented by brainstem dysfunction and a lesser degree of cortical dysfunction.

Alpha Rhythm

Frontal intermittent rhythmic delta activity (FIRDA) in pial-dural arteriovenous malformation.

We report a case of FIRDA associated with a pial-dural arteriovenous malformation (AVM). The patient presented with headaches, papilledema and partial oculomotor nerve palsy. CT scan had failed to discover the AVM. After partial embolization of the AVM, the patient's symptoms and signs resolved, and the FIRDA disappeared. FIRDA has been thought to be caused by frontal lobe ischemia or periventricular edema. It has not been reported in benign intracranial hypertension (BIH). We postulate that the FIRDA in this case was due to the circulatory "steal" effect of the AVM, and not to the intracranial hypertension. Five percent of patients with dural AVM's present with a picture consistent with BIH. We recommend a diligent search for additional pathology if FIRDA is seen in association with presumed BIH.

Cerebral Angiography

A comparative study of electroencephalography and computed axial tomography in recent cerebral infarction.

In order to re-assess the present role of electroencephalography in the investigation of cerebral infarct, we prospectively studied 50 adults with recent supratentorial cerebral infarction over a ten-month period. All 50 patients had EEG's and CT scans within the first two weeks of the apoplectic event. The time span between the two procedures was one week or less in all patients. We monitored the following EEG parameters: characteristics of alpha rhythm (depressed, unchanged, or enhanced); prevalence, type, rhythmicity, and topography of focal slowing; and presence or absence of FIRDA. We grouped the patients on the basis of CT findings as follows: depth of the infarct (cortical-subcortical, deep white matter, or lacunar); size of the infarct (large, medium, or small); and presence or absence of mass effect. Statistical analysis revealed no differences with regard to the EEG parameters between the groups. However, when patients were categorized according to topography of the infarct, the group with parietal infarct showed a significantly higher incidence of depressed alpha rhythm compared with the groups with frontal or occipital infarct. Of the 50 patients, four patients whose history and clinical presentation suggested infarct had normal CT scans despite the presence of EEG abnormality. On the contrary, in two patients, the EEG was normal, whereas the CT confirmed the infarct. Our data suggested that physiological factors may play a major role in the pathogenesis of EEG abnormalities in cerebral infarct, thus accounting for the discrepancies between the EEG parameters and CT findings observed in our population. It was also suggested that EEG's be included routinely in the investigation of cerebral infarct.

Adult

Progressive supranuclear palsy: report of a case with torticollis, blepharospasm, and dysfluency.

A 76-year-old man is reported with advanced progressive supranuclear palsy (PSP) who developed a persistent, gradually progressive torticollis over a period of several months. Blepharospasm and dysfluency of the extrapyramidal type antedated the torticollis. This first report of torticollis in PSP reinforces previous notions that torticollis is related to pathologic changes in the striatum and brainstem. In addition, the combination of torticollis and blepharospasm in our patient supports the previous concept that these two "focal dystonias" have a common pathophysiologic mechanism. This also suggests that dysfluency in PSP may be an expression of a focal dystonia involving the muscles of articulation.

Aged

Successful treatment of neuroleptic malignant syndrome with bromocriptine.

From our four cases, we conclude that prompt diagnosis, intensive care monitoring and support, and early use of bromocriptine can markedly reduce the duration of the symptom complex of neuroleptic malignant syndrome, as well as significantly improve the 20% mortality previously reported.

Administration, Oral

Spindle activity in the waking electroencephalogram: report of a case with hemispheric glioblastoma.

In this paper, we reported a patient with a hemispheric glioblastoma extending into the lateral thalamus and the posterior limb of the internal capsule. The waking electroencephalogram showed spindle activity on the side ipsilateral to the tumor. Based on the topography of the tumor in our patient, we speculate that a disruption of the synaptic pathways within the thalamus-cortex-thalamus circuit was primarily involved in the pathogenesis of abnormal spindling.

Aged

Suppression-burst pattern associated with generalized epileptiform discharges and alpha-theta pattern coma.

In this paper we reported a patient with multisystem failure, whose EEG immediately preceding death demonstrated a unique combination of suppression-burst pattern, generalized epileptiform discharges, and alpha-theta pattern coma. Post-mortem examination showed ischemic-anoxic lesions involving cortical and sub-cortical gray matter. The lack of white matter pathology in our patient indicates that white matter lesions may not be involved in the pathogenesis of the above EEG patterns in anoxic encephalopathy.

Aged

Episodic anterior drowsy theta in adults.

The present study included 1300 adults with various clinical problems. We prospectively studied the EEG's of this population over an 18-month period. Ninety-two patients showed episodic generalized or frontal-central bursts of theta activity, occurring synchronously over both hemispheres in drowsiness (episodic anterior drowsy theta or EADT). We found no interaction between the parameters involving the above theta rhythms (amplitude, rhythmicity, topography and presence or absence in the waking EEG), demographic variables (age, sex), and clinical presentation. Our data, however, did suggest that the incidence of the EADT may be higher in young females. We also found a tendency for the EADT in otherwise abnormal EEGs to be rhythmic and present awake. Our data indicated that the presence of EADT is non-specific as to etiology.

Electroencephalography

Coexistence of ectopic rhythms and periodic EEG pattern in anoxic encephalopathy.

In this paper, we reported unique EEG patterns in two patients with anoxic encephalopathy. In the patient with a longer survival, the early EEG showed: suppression-burst pattern and theta pattern coma during quiet states; and quasi-periodic, generalized, epileptiform discharges associated with alpha-theta pattern coma during periods of arousal. A second EEG showed a disappearance of suppression-burst pattern and alpha coma. A third EEG demonstrated a disappearance of quasi-periodic epileptiform discharges. Such distinct evolution of the electroencephalogram was associated clinically with increased responsiveness despite a fatal course of illness. The second patient who had a more dramatic course, had an EEG immediately preceding death, which showed a combination of periodic pattern and theta pattern coma.

Aged

Periodic lateralized epileptiform discharges (PLEDs): a possible role for metabolic factors in pathogenesis.

Periodic, lateralized, epileptiform discharges (PLEDs) in the electroencephalogram have been reported in association with a variety of structural lesions of the brain. Although a great deal of attention has been directed to the neuropathological basis of PLEDs, little emphasis has been placed on the functional basis of this EEG syndrome. In this paper, we reported a patient with multiple systemic problems whose EEG showed PLEDs. However, radiological and pathological studies revealed no neuropathological basis for the occurrence of this EEG syndrome. Thus, we presented evidence that metabolic factors may play a part in the pathogenesis of PLEDs.

Acidosis