[New treatments for multiple sclerosis].
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Anti-Inflammatory Agents↗
Biomedical subjects
J C Masdeu
Publications and source records attributed to J C Masdeu.
Single-photon emission computed tomography of the brain in acute mania and schizophrenia.
Single-photon emission computed tomography (SPECT) imaging with n-isopropyliodoamphetamine (IMP) was performed on 11 patients with bipolar mania, 21 acute schizophrenics, and 15 healthy control subjects. Subjects were evaluated with neuropsychological tests and psychiatric rating scales. SPECT brain studies were blindly evaluated to assess the degree of radiopharmaceutical uptake in three neuroanatomical regions of interest in each hemisphere. All the control subjects, 1 manic patient, and 1 schizophrenic patient had normal brain SPECT uptake patterns. The scans of all others were read as abnormal. Hypofrontality was noted in some schizophrenics and maniacs. A significant increase in tracer uptake in temporal lobes was observed in both patient groups, more prominently in the manic patients. Increased and decreased basal ganglia uptake was also observed in patients. Both manic and schizophrenic patients showed cortical tracer heterogeneity of varying degree. The patterns of cerebral SPECT uptake seen in these acute psychoses were not specific for a diagnosis, but may be associated with dimensions of psychopathology. Because the patterns are different from those seen in cerebrovascular disease and the dementias, they may prove to be helpful in differential diagnosis.
Adult↗
SPECT imaging of stroke.
Single-photon emission computed tomography (SPECT) is a helpful tool for the management of stroke patients. Brain perfusion SPECT can help differentiate an ischemic event from peri-ictal phenomena such as Todd's paresis. Initial data suggest that SPECT may be useful in prognosticating the likelihood of an early stroke after a transient ischemic attack and in distinguishing lacunar from cortical stroke. After an acute stroke, early SPECT depicts the area of ischemia with greater accuracy than either computed tomography or magnetic resonance imaging. When the perfusion defect is large, the likelihood of hemorrhagic complications or herniation increases. Reperfusion of an arterial territory after thrombolysis can be documented more conveniently with SPECT than with angiography. SPECT before and after the injection of acetazolamide has been used to assess the vascular reserve in patients with severe stenosis of the proximal vessels of the cerebrovascular tree. Combined with transcranial Doppler studies, SPECT is used to document ischemia after subarachnoid hemorrhage. It has also been used to assess the effect of arterial ligation intended to treat arteriovenous malformations or aneurysms on brain perfusion and to evaluate ischemia secondary to pressure from an intracranial hemorrhage.
Brain Ischemia↗
Viral infections of the brain.
Brain infections are generally well visualized by contrast-enhanced computed tomography or magnetic resonance imaging. However, these modalities are often unrevealing in the encephalopathy produced by the human immunodeficiency virus and in the early stages of herpes simplex encephalitis. Several studies have documented the greater sensitivity of perfusion single-photon emission computed tomography (SPECT) in human immunodeficiency virus encephalopathy. In herpes simplex encephalitis, a few case reports have documented that SPECT may depict increased perfusion in the characteristically involved temporal and other limbic structures when computed tomography and magnetic resonance imaging are normal.
AIDS Dementia Complex↗
Head trauma: use of SPECT.
Brain damage inflicted by head trauma may not be visible on computed tomography or magnetic resonance imaging. This is true not only for mild head trauma, but also for moderate and severe head trauma. Perfusion imaging with single-photon emission computed tomography has proved in several controlled studies to be more sensitive than either computed tomography or magnetic resonance imaging in detecting brain abnormalities in patients with head trauma.
Brain Injuries↗
Astasia and gait failure with damage of the pontomesencephalic locomotor region.
Although there is evidence in experimental animals of the importance of the pedunculopontine area in locomotion, clinical lesion reports are lacking. An 83-year-old woman became unable to stand and to generate stepping movements after a hemorrhage at the pontomesencephalic junction involving the right pedunculopontine area. Her deficit resembled the gait failure present in some elderly individuals.
Aged↗
Early single-photon emission computed tomography in mild head trauma. A controlled study.
Although computed tomography (CT) and magnetic resonance imaging scans often appear normal after mild head trauma, many patients experience attentional or other cognitive disturbances that are difficult to quantify by neuropsychological testing in the absence of a premorbid profile. Within 2 days of mild head trauma, 14 patients with normal-appearing brain CTs were studied with single-photon emission computed tomography (SPECT). They were compared to 15 normal control subjects and to 12 patients with mild human immunodeficiency virus (HIV) encephalopathy. Ten of 14 head trauma patients were separated from the normal control subjects by both independent readers, blinded to the clinical diagnosis. None of the SPECT results from normal control subjects were "read" as trauma. Trauma could not be differentiated from HIV encephalopathy. The observed percentage agreement between raters was 0.83 (kappa = 0.72). SPECT is more sensitive than CT in detecting brain injury after mild head trauma.
AIDS Dementia Complex↗
Brain single-photon emission computed tomography.
Single-photon emission computed tomography (SPECT) provides cost-effective information on regional cerebral perfusion and, indirectly, on regional cerebral metabolism. Its ease of use facilitates the application of SPECT in clinical neurology. SPECT is emerging as a useful tool for the management of patients with stroke, epilepsy, recurrent brain neoplasms, and some forms of dementia. The applications being investigated, such as in vivo receptor labeling for benzodiazepines, serotonin, dopamine, and muscarinic receptors, may expand the clinical usefulness of this technique in the future.
Brain Death↗
The role of single photon emission computed tomography brain imaging with 99mTc-bicisate in the localization and definition of mechanism of ischemic stroke.
99mTc-bicisate (99mTc-ECD) is a new brain perfusion imaging agent formulated from a radiochemically stable kit (Neurolite). A multicenter trial was conducted to determine the sensitivity and specificity of single photon emission computed tomography (SPECT) imaging with 99mTc-bicisate in the localization of ischemic stroke; 170 subjects were enrolled, 128 patients with stroke and 42 controls. Imaging results from 148 subjects (107 stroke patients and 41 controls) were considered evaluable. In the evaluable subjects, SPECT brain imaging with 99mTc-bicisate (21.0 +/- 2.5 mCi) was interpreted without clinical information and was compared with a final assessment using all clinical, diagnostic, and laboratory procedures except the 99mTc-bicisate SPECT results. 99mTc-bicisate was safe and well-tolerated. SPECT imaging with 99mTc-bicisate demonstrated a specificity of 98% and a sensitivity of 86% for localization of strokes (kappa, 0.75; 95% confidence interval, 0.64-0.86). Results were unchanged over time and were similar for all stroke mechanisms except for lacunar disease (sensitivity, 58%). In a secondary analysis, a normal image or small, deep (e.g., subcortical) perfusion defect was highly predictive of a lacunar mechanism. Defects involving the cortical surface were strongly associated with nonlacunar mechanisms. SPECT imaging with 99mTc-bicisate is a sensitive marker in the localization of perfusion defects associated with ischemic stroke and may assist in the determination of the underlying mechanism of a stroke.
Adult↗
Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop.
Criteria for the diagnosis of vascular dementia (VaD) that are reliable, valid, and readily applicable in a variety of settings are urgently needed for both clinical and research purposes. To address this need, the Neuroepidemiology Branch of the National Institute of Neurological Disorders and Stroke (NINDS) convened an International Workshop with support from the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (AIREN), resulting in research criteria for the diagnosis of VaD. Compared with other current criteria, these guidelines emphasize (1) the heterogeneity of vascular dementia syndromes and pathologic subtypes including ischemic and hemorrhagic strokes, cerebral hypoxic-ischemic events, and senile leukoencephalopathic lesions; (2) the variability in clinical course, which may be static, remitting, or progressive; (3) specific clinical findings early in the course (eg, gait disorder, incontinence, or mood and personality changes) that support a vascular rather than a degenerative cause; (4) the need to establish a temporal relationship between stroke and dementia onset for a secure diagnosis; (5) the importance of brain imaging to support clinical findings; (6) the value of neuropsychological testing to document impairments in multiple cognitive domains; and (7) a protocol for neuropathologic evaluations and correlative studies of clinical, radiologic, and neuropsychological features. These criteria are intended as a guide for case definition in neuroepidemiologic studies, stratified by levels of certainty (definite, probable, and possible). They await testing and validation and will be revised as more information becomes available.
Brain↗
Perception of different frequencies of cranial transcutaneous electrical nerve stimulation in normal and HIV-positive individuals.
Sine-wave transcutaneous electrical nerve stimulation (TENS) of varying frequencies applied across the cranium (ear to ear) has been demonstrated to evoke three different noncutaneous sensations in three discrete, nonoverlapping frequency bands in normal, healthy subjects. This report describes two studies which evaluate perception of these cranial TENS-evoked, frequency-dependent sensations in normal and HIV-positive individuals. In Exp. I, all of 50 normal, healthy subjects reported perceiving the same three noncutaneous sensations in the same three nonoverlapping frequency bands as long as stimulated and over repeated trials. In Exp. II, 34 HIV-positive individuals (14 asymptomatic, 9 ARC, 11 AIDS) who were free of neurological symptoms differed significantly from 10 normal, healthy controls, and from the norms observed in Exp. I, on perception of the three different TENS-evoked sensations. Also, inability to maintain perception of the stimulus over repeated trials, observed only in the HIV-positive individuals, increased significantly with severity of HIV infection.
AIDS Dementia Complex↗
Interventions and functional brain imaging.
Assessment of regional cerebral blood flow (rCBF) is useful in the evaluation of cerebral vascular disease. However, a single resting study has limitations in that a normal rCBF may be present with diminished cerebral vascular flow reserve and regions of decreased rCBF may be seen with diaschisis or selective neuronal loss and an intact vascular supply. To help differentiate these conditions a stress rCBF study can be obtained following the administration of vasodilatory stimulus. The topic of this review is the discussion of single photon emission computed tomography (SPECT) and vascular intervention, primarily, acetazolamide (Diamox, Lederle Laboratory Division, Pearl River, NY) augmented SPECT in the evaluation of cerebral vascular disease.
Acetazolamide↗
Extrapyramidal symptoms due to dopamine-blocking agents in patients with AIDS encephalopathy.
OBJECTIVE: The authors attempted to determine whether patients with AIDS are more susceptible to neuroleptic side effects than other patients. METHOD: Retrospective chart review was used to assess the frequency and severity of extrapyramidal symptoms in patients with AIDS and psychotic patients without AIDS who had taken dopamine-blocking agents. The charts of 804 men younger than 50 years were reviewed, and patients were excluded if they had not taken dopamine blockers, had taken them for more than 1 month, had received concomitant antiparkinsonian agents, had focal brain lesions or histories of Parkinson's disease or meningitis, had used cocaine, amphetamines, or opiates within 1 month of admission, or, among the comparison group, had HIV risk factors. For the remaining 31 AIDS and 32 comparison patients, age, duration of dopamine blocker treatment, dose in chlorpromazine equivalents, and nature and severity of parkinsonian complications were recorded. RESULTS: The mean drug dose and body weight were significantly lower in the AIDS group. The likelihood of developing extrapyramidal symptoms was 2.4 times as high among the AIDS patients as among the comparison group. Such symptoms were developed by 50% of the AIDS patients who received less than 4 mg/kg of chlorpromazine equivalents per day and 78% of those who received more than 4 mg/kg per day. CONCLUSIONS: These preliminary results suggest that AIDS patients are more susceptible to extrapyramidal symptoms than psychotic patients without AIDS and that neuroleptics should be used cautiously and in lower doses for patients with AIDS.
AIDS Dementia Complex↗
Monocular elevation weakness and ptosis: an oculomotor fascicular syndrome?
The topographic arrangement of the fascicular portion of the oculomotor nerve in the midbrain is not known. A patient with infarction involving the lateral portion of the fascicle had isolated monocular elevation paresis and ptosis, suggesting that the fibers destined to the elevators of the eye and eyelid course laterally in the fascicle.
Aged↗
Single-photon emission computed tomography in human immunodeficiency virus encephalopathy: a preliminary report.
Depression or psychosis in a previously asymptomatic individual infected with the human immunodeficiency virus (HIV) may be psychogenic, related to brain involvement by the HIV or both. Although prognosis and treatment differ depending on etiology, computed tomography (CT) and magnetic resonance imaging (MRI) are usually unrevealing in early HIV encephalopathy and therefore cannot differentiate it from psychogenic conditions. Thirty of 32 patients (94%) with HIV encephalopathy had single-photon emission computed tomography (SPECT) findings that differed from the findings in 15 patients with non-HIV psychoses and 6 controls. SPECT showed multifocal cortical and subcortical areas of hypoperfusion. In 4 cases, cognitive improvement after 6-8 weeks of zidovudine (AZT) therapy was reflected in amelioration of SPECT findings. CT remained unchanged. SPECT may be a useful technique for the evaluation of HIV encephalopathy.
AIDS Dementia Complex↗
Neurologic complications of cloacogenic carcinoma.
Cloacogenic carcinoma is a rare tumor, originating from epithelium of the anal transition zone. We report a 63-yr-old man with pathologically proven cloacogenic carcinoma which caused a rapidly progressive paraparesis and changes in mental status. These were related to extramedullary deposits around the spinal cord and cauda equina and intramedullary deposits in the brain. This pattern of neural involvement with anal canal carcinoma has not been reported previously.
Anus Neoplasms↗
Chronic lymphocytic leukemia with hypothalamic invasion.
Headaches and a state of confusion developed in a patient with chronic lymphocytic leukemia (CLL). A computed tomography (CT) scan of the head showed a hyperdense lesion in the hypothalamus with obstruction of the foramina of Monro. Leukemic cells with monoclonal lambda B-cell markers were identified in the ventricular fluid at the time of surgical decompression. Similar cells were identified in the peripheral blood. This lesion has not been described as a complication of CLL, a disease that, unlike other leukemias, rarely has central nervous system manifestations.
Aged↗
Brain white-matter changes in the elderly prone to falling.
Falls and impaired gait are a major source of morbidity in the elderly. Why some elderly become prone to falling is often unclear. We analyzed the gait, equilibrium, and brain computed tomography results of 40 elderly subjects without evidence of neurologic disease known to be associated with falls. Twenty of these subjects were prone to falling and the remaining 20 were nonfalling controls. These two groups were comparable in terms of age and sex (mean age, 83.3 years [SE, 1.7 years]). The group of fallers had significantly worse gait and equilibrium scores and a greater degree of white-matter hypodensity on computed tomography. White-matter hypodensity correlated with impaired gait and equilibrium scores but not with impaired performance on cognitive testing. This study reveals the association of white-matter disease with gait and balance impairment leading to falls in the elderly.
Accidental Falls↗