Toxicity to the nervous system of diphenylhydantoin: a review.
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Biomedical subjects
Publications and source records attributed to D K Ziegler.
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We report a case in which glioma with apparent major involvement of the right thalamus was manifested initially solely by abrupt onset of severe impairment of both recent and moderately remote memory. Distracting stimuli plays a role in prevention of consolidation of memory.
The fungus Sporotrichum schenckii caused chronic meningitis in a 48-year-old man. Only three other firmly diagnosed cases were reported previously.
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A detailed questionnaire concerning life history of headache and its characteristics was administered to 1,809 nonmedical volunteers. Questions dealt with severity of headache, the nature of preceding and accompanying phenomena (nausea, visual scotomata, neurologic symptoms), precipitating factors, and history of other illness. For the total sample and in the 25 to 39 age group, severe or disabling headaches were significantly more frequent in women and mild headaches were significantly more common in men. Migraine characteristics were common with mild headache. An association between hypertension and severe headache was found in women, between asthma and severe headache in men.
In a double-blind study of 80 migraine patients, headache was precipitated by ingestion of 200 mg tyramine and not by placebo in eight individuals, but retesting of seven of these patients did not produce the same results. Placebo produced as severe headache as tyramine and in an even larger number of patients. It is concluded that dietary tyramine alone is rarely, if ever, the major precipitant of a migraine attack, although the possibility remains that it has such a role in the presence of particular physiologic states.
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Amitriptyline was evaluated as a prophylactic antimigraine agent in 110 patients with severe migraine. This agent improved the migraine more than 50 percent in 72 percent of patients and more than 80 percent in 57 percent of patients. Most of the 31 patients with less than 50 percent improvement had virtually no response. Depression, measured with the Zung Self-Rating Depression Scale, was absent in 40 patients, borderline in 53, and moderate to severe in 17. Overall, depression ratings improved minimally with therapy. There was a weak relationship between improvement in depression and improvement in migraine. Subgroups with a stronger correlation of these could not be found. This work suggests that amitriptyline is effective in migraine prophylaxis and that it has a primary effect on migraine that is relatively independent of its antidepressant action.
Two patients who had had no previous psychiatric symptoms became psychotic after their antiparkinsonism medication was changed from levodopa alone to a combination of levodopa and carbidopa, despite adherence to the appropriate and recommended dosage. Psychiatric symptoms disappeared after treatment with levodopa alone was resumed.
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In ten cases of amyotrophic lateral sclerosis, creatine phosphokinase was, without exception, elevated. In 12 cases of other diseases of the central or peripheral nervous system, values were elevated only in two cases of peripheral neuropathy.
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