Biomedical subjects
Publications and source records attributed to D I Peterson.
Autopsy findings in a patient who had an adrenal-to-brain transplant for Parkinson's disease 4 months before his death showed adrenal tissue in the basal ganglia, but it was necrotic. Symptomatic improvement lasted for only 2 weeks.
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Unilateral asterixis was ipsilateral to the brainstem lesions in 2 patients. The finding of unilateral asterixis has been consistently associated with structural neurological disease, but contrary to previous reports it is not a reliable localizing or lateralizing finding.
Two additional cases of nonsteroidal anti-inflammatory drug induced meningitis are reported. Consideration should be given to this etiology in all cases of meningitis in which a specific etiology is not found, especially if the meningitis is recurrent.
Radiation therapy may cause accelerated arteriosclerosis of carotid and vertebral vessels which can cause cerebral infarction. This is a late complication which usually occurs several years after therapy and often affects vessels in locations where severe arteriosclerotic change is uncommon.
Eighteen cases of unilateral asterixis were studied. A good correlation was found between the presence of unilateral asterixis and structural intracranial disease. For this reason, unilateral asterixis is a valuable sign when found on the neurological examination. It is not helpful in localizing intracranial pathology or in determining etiology.
Atrial myxomas are uncommon, but when present they often cause neurological abnormalities. Those that arise from the left atrium are a well-recognized source of cerebral emboli while those that arise in the right atrium may cause recurrent attacks of syncope. Twelve cases of atrial myxoma were treated at Loma Linda University Medical Center from 1968 to 1984. Loss of consciousness was one of the symptoms in all three of the right-sided lesions. Surgical removal of the tumor eliminated the attacks of syncope in each case. Right atrial myxoma is a rare lesion, but it should be considered in the differential diagnosis of loss of consciousness of unknown etiology.
Headache is a common problem for both patient and physician, but appropriate evaluation can usually lead to correct diagnosis and therapy. A simple new method of treatment described in the article can help 90 per cent of patients with chronic headache.
It is commonly believed that Dandy-Walker malformation is due to increased intracranial pressure resulting from atresia of the foramina of the fourth ventricle, but this is not true in all cases. An adult with asymptomatic Dandy-Walker malformation without hydrocephalus was studied. Increased intracranial pressure could not have caused the malformation in the posterior fossa in this case since no hydrocephalus was present. The findings in this case support the view that Dandy-Walker malformation is due to congenital abnormalities that are not necessarily related to obstruction of CSF flow from the fourth ventricular foramina.
Phenytoin absorption is decreased in patients with jejunoileal bypass. Although adequate absorption can be achieved, increased dosages of this agent probably will be necessary in most cases to achieve a therapeutic plasma level and clinical control of seizures.
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Bacteriodes meningitis without associated cerebral abscess occurred in an elderly man who had a long history of chronic otitis media. Anaerobic cultures of the cerebrospinal fluid revealed bacteroides organisms. Sensitivity testing showed them to be resistant to penicillin and chloramphenicol but sensitive to metronidazole. Appropriate therapy with this agent eradicated the causative organisms and produced rapid clinical improvement.
A new mechanism of myelopathic changes in patients with mucopolysaccharidosis is described. Two similar cases had myelographic evidence of marked concentric impingement of the cervical subarachnoid space and cord compression due to thickening of the dura. Myelography is indicated in the evaluation of these patients because surgical decompression may reverse the progressive neurological deficits.
Cervical spondylosis or chronic diskogenic disease of the cervical spine is a relatively common cause of myelopathy, but it is often not recognized or is incorrectly diagnosed. The clinical presentation may mimic several types of neurological disease including multiple sclerosis and amyotrophic lateral sclerosis. Even more frequently, and especially early in the course of the disease, neurologic impairment is not recognized and the symptoms are thought to be due to osteoarthritis. Early recognition of this condition is important since adequate treatment can prevent slowly progressive neurologic impairment. Knowledge of the pathophysiology of myelopathy due to cervical spondylosis and adequate radiographic evaluation will often lead to treatment that can prevent progressive spinal cord damage. Cervical spondylosis with myelopathy is one of the most frequently unrecognized and misdiagnosed, yet treatable, conditions affecting the nervous system.
Myelopathy due to compression of the cervical spinal cord by thickened dura developed in a patient with Maroteaux-Lamy syndrome. During the last trimester of pregnancy there was severe neurological deterioration with spastic quadriparesis and impairment of sphincter function. Two months after delivery ther had been no improvement, so a cervical laminectomy and longitudinal splitting of the dura from C-5 to the foramen magnum was done. Good return of function resulted.
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