Objective assessment of bilateral conjunctival injection during cluster headache attacks.
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Adult↗
Biomedical subjects
J L Dobato
Publications and source records attributed to J L Dobato.
Numular headache: a coin-shaped cephalgia.
Numular headache is a chronic, mild to moderate, pressurelike pain in a circumscribed cranial area of approximately 2 to 6 cm in diameter. Pain usually is limited to the parietal region, although it may appear in any cranial site. It is a benign process of usually unknown origin.
Adult↗
Objective assessment of autonomic signs during triggered first division trigeminal neuralgia.
A total of 26 episodes of V-1 trigeminal neuralgia attacks have been recorded in two female patients. Autonomic phenomena were assessed according to a semiquantitative scale. Attacks lasted 17 +/- 5 s. Mild lacrimation without conjunctival hyperaemia, rhinorrhea or ptosis was observed, even in relatively long lasting episodes. This is in clear contradiction with SUNCT (shortlasting, unilateral, neuralgiform headache with conjunctival injection, tearing and rhinorrhea) attacks that are always dramatically accompanied by both lacrimation and conjunctival injection of the symptomatic side from the very onset of symptoms. Carbamazepine provided complete and sustained relief of symptoms in both patients. Herein we will show differential autonomic features of V-1 trigeminal neuralgia vs. SUNCT that will both aid the clinician to distinguish both syndromes and stress that both entities are nosologicaly different.
Aged↗
Native language shifts across sleep-wake states in bilingual sleeptalkers.
STUDY OBJECTIVES: To assess language used during episodes of sleeptalking in bilingual children. DESIGN: The investigation was accomplished through the parents who, after having received appropriate information, participated by filling out a survey on sleeptalking. SETTINGS: The study was performed in three bilingual schools of the Basque country, a region in northern Spain in which two completely different official languages are spoken. PATIENTS: A total of 1000 parents agreed to participate, and 681 children were studied. MEASUREMENTS AND RESULTS: Sleeptalking was reported by 383 (56.3%) of children (mean age 9 years; range: 3-17). Most individuals used their dominant (i.e., native) language during sleep. However, a minority (< 4%) were found to use their non-dominant language persistently during episodes of sleeptalking. CONCLUSIONS: Balanced bilinguals (those who have equal proficiency in both languages) may sleeptalk in either of the two languages. Dominant bilinguals (i.e., having greater proficiency in one language) may preferentially sleeptalk in their dominant language, with immediate past events probably influencing language use in individual subjects on particular nights. Several considerations are postulated as an explanation for the group who systematically exhibited a dominance shift during sleep.
Adolescent↗
[EEG pattern indicative of dialysis encephalopathy].
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Aged↗
Chronic paroxysmal hemicrania-tic syndrome.
We report the coexistence of both chronic paroxysmal hemicrania (CPH) and trigeminal neuralgia (tic douloureux) in a female patient. The clinical features combined to make a configuration of CPH-tic syndrome. The two components of the syndrome appeared synchronously in the same orbital region--first branch of the trigeminal nerve--with a latency of several years after the onset of isolated tic attacks of the second and third trigeminal divisions. The concurrence of both types of pain in the same symptomatic area may have some significance for pathogenic, clinical, and pharmacological aspects of such a syndrome. We discuss all these and postulate a provisional distinction between CPH-V2,3 tic and CPH-V1 tic.
Aged↗
[Vehicle drivers with Parkinson disease: behavior schedules of a patient sample from the Community of Madrid].
The aim of this study was to evaluate features of the disease, habits patterns at the wheel, and reasons to give up driving motor vehicles in subjects with Parkinson's disease (PD). Prospective study using a semistructured questionnaire comparing current or former drivers with PD patients and a control group matched for age, sex and social background. In a PD and movement disorders clinic in an university hospital. Sixty-two out of 166 PD subjects interviewed owned a driving licence. Only 19.2% of PD subjects were currently active drivers. Compared to parkinsonian ex-drivers, they were 6 years younger on average, most were in disease stage II, and were less often under antidepressant medication. Nevertheless, disabling motor fluctuations and dyskinesias were present in 19% of the patients. A 47% of the active drivers reported no difficulty at the wheel; the remaining declared to experience a wide range of difficulties, particularly to manage pedals or to assess distances properly. PD itself lead to driving withdrawal in 80% of ex-drivers in contrast to 6% of controls who stop driving due to other illness. Only 40% of PD subjects were driving 5 years after diagnosis. Medical advice was influential in deciding to stop driving in a single patient. Disease onset in early adulthood often allowed to keep driving for 10 years or longer. Most subjects with PD give up driving during the first 5 years following disease onset, most due to the disease itself. Most active drivers adapt themselves to their physical circumstances, either by reducing the number of hours at the wheel or reducing speed. They are usually in early stages of the disease, despite which many experience subjective motor and visuospatial difficulties during driving. A minority keep on driving despite disabling fluctuations. This subset presumably represent a group at risk to suffer an increased rate of traffic accidents and in whom medical advice would be desirable.
Accidents, Traffic↗
[Mini-mental state examination: proposal of protocol to be used].
The Mini-Mental State Examination (MMSE) is currently one of the most widely used tools for the assessment and screening of cognitive impairment despite a number of issues raised regarding the sensitivity of some subtests and the negative impact of advanced age and poor education. The informal use of invalidated and poor quality translations of the MMSE into Spanish language is widespread, and presumably this further increases some of the uncertainties linked to this test. The result may be misleading, not only as it may overestimate the prevalence of dementia but because it decreases interrater consistency with a view to epidemiological projects. A validated translation of the MMSE into Spanish is therefore much needed. Such a version would not only pay attention to educational and age issues but it would also take into account potential cultural and linguistics inter-community difference of some subtests when specifically applied in Spain which may represent another potential source of inconsistency throughout the country. Furthermore, subtle inhomogeneities in the way the test is administered may result in gross intra-rater and inter-rater variability, hence further decreasing reliability. On the basis of experience gained from a large hospital-based experience in administering the traditional MMSE to neurological patients we propose a standardized version to apply MMSE in Spanish with the alm to improve reliability. This is a preliminary step toward developing a reliable and sensitive Spanish version of the MMSE.
Aged↗
[Depressive pseudodementia in early Parkinson's disease: lessons from a case with long-term follow-up].
A common observation in neurological practice is parkinsonism with concomitant cognitive decline, an association that usually arises from various underlying degenerative or vascular conditions, most of which are untreatable. An elderly woman with no history of psychiatric disease presented complaining of memory and cognitive impairment serious enough to interfere with daily life activities over the preceding year. She soon developed a predominantly left-sided tremor, rigidity and bradykinesia. She had had only 2 years of formal education. Neuropsychological assessment showed poor performance on Wechsler memory scale sub-items, as well as constructional apraxia, dyscalculia, reasoning difficulties and gross information deficits. A 3-month trial course of levodopa was followed by dramatic improvement in both parkinsonian symptoms and cognitive performance, including a 7-point gain in the Mini-Mental Status Examination score. At the same time, the Beck Depression Inventory score fell from 27 (baseline) to 18. Over the 10-year follow-up period the patient developed late levodopa syndrome and a persistent but mild dysthymic disorder, but never manifested dementia as defined by DSM-III-R criteria. This patient's case illustrates three important principles. First, although parkinsonism is known to be preceded by depressive episodes, particularly in a subgroup of younger patients, the symptoms of the elderly patient whose Parkinson's disease is foreshadowed by depression can mimic depressive pseudodementia, potentially leading to diagnostic confusion. Second, impaired motivation and disturbances in cognitive function are different from mood disorders, as the former involve the mesolimbic/mesocortical dopamine system, explaining the beneficial effect of levodopa on motivation and cognition in this patient even as mood was unaffected. Finally, depressive pseudodementia in Parkinson's disease does not necessarily herald the development of organic dementia in the long term.
Aged↗
[Driving licence renewal in persons with Parkinson disease].
INTRODUCTION: The legal requirement to renew a driving licence is feared by most symptomatic or already formally diagnosed individuals with Parkinson's disease (PD) as the medical assessment they are required to submit may eventually conclude in withdrawal of their driving licence. OBJECTIVE AND METHODS: The purpose of our study was to gain information about PD patients applying for a driving licence renovation and their willingness to uncover his or her illness to medical personnel in charge, and how often current medical assessment procedures proved unable to detect abnormalities among parkinsonian applicants who retain data on their health status. Using a confidential, 'face-to-face' questionnaire, we obtained information from 62 licensed parkinsonian drivers (32 current drivers) and 120 age and sex matched drivers controls gathered from an identical socioeconomic background. RESULTS: Thirty eight individuals with symptomatic PD (in 30 of who the disorder has been already diagnosed) applied with a view to licence renovation. Drivers with PD did not retain information regarding their health status more often than sex- and age-matched control drivers with various other chronic ailments as 63.1% and 77% respectively, abstained from declaring (z = 0.945; p = 0.344). A parkinsonian subject illegally managed to renew his driving licence without submission to any medical assessment. The attending physicians perceived abnormalities related to motor difficulties in 30.4% of those parkinsonian who withdrew information. A similar proportion of controls (29.1%) were also informed about health problems during their medical assessment, in the vast majority related to sight problems. CONCLUSIONS: Overall, the exam concluded in cancellation of the driving licence in 10.8% of the parkinsonian and 1.6% of the controls, a significant difference (z = 2.075; p = 0.03). We conclude that at the time of renewal of a driving licence parkinsonian patients do not retain problems related to fitness to drive more often than the general population afflicted by other medical conditions do. However, current tests for driving performance appears to be not sensitive enough to detect selective difficulties in motor execution tasks that may impair driving ability in persons with PD.
Aged↗
[Idiopathic pulsating headache].
Idiopathic stabbing headache is described as a primary, benign headache seen mainly in women. It is characterized by ultra-brief attacks of pain lasting one second or less and having either single or multiple foci. The orbital region is by far the most frequently affected. Hardly any triggering factors or accompanying symptoms have been identified. The frequency of paroxysms is highly variable, ranging from one attack per year to more than 50 per day. Under extreme circumstances, stabbing pains can come as often as one attack per minute. The timing is erratic, with paroxysms that can be either sporadic or grouped within symptomatic periods, but rarely is the clinical course persistently chronic. Treatment with indomethacin usually provides considerable relief. Idiopathic stabbing headache may exist per se, with its own category, but often occurs alongside other primary headaches. In such cases the two types of pain may coincide or not.
Adolescent↗
[Drug-induced and masked drug parkinsonism].
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Aged↗
A first case of progressive supranuclear palsy and pre-clinical REM sleep behavior disorder presenting as inhibition of speech during wakefulness and somniloquy with phasic muscle twitching during REM sleep.
It is known that a pre-clinical stage may precede the full-fledged form of REM sleep behavior disorder (RBD) and that somniloquy, yelling and limb jerking may be prodromes of RBD. In the present paper, the case of a woman exhibiting both somniloquy and daytime inhibition of speech is discussed. Clinical and polysomnographic findings were consistent with the dual diagnosis of progressive supranuclear palsy (PSP) and preclinical RBD. Severe akinesia and supranuclear palsy of phonation are postulated as likely mechanisms for the inhibition of speech, whereas the overexcitation of the motor system by the RBD process seemed to account for the sleeptalking episodes.
Aged↗
[Depression and Parkinson's disease: neurobiologic foundations and therapeutic management].
The prevalence of depression in Parkinson's disease (PD) is estimated to be around 40% and generally takes the form of dysthymia. Although psychological factors probably contribute to depression, data point to a relation to structural and biochemical changes linked to PD. Thus, the onset of motor impairment is often preceded by a depressive episode, although there is no consistency between the seriousness of motor disability and depression. Furthermore, depression aggravates the memory and language impairments of PD and is thought to be a risk factor for developing dementia. Regional cerebral blood flow abnormalities in the medial frontal and cingulate cortices and low 5-HIIA concentrations in cerebro-spinal fluid suggest that degeneration of the mesocorticolimbic dopaminergic system as well as dorsal raphe changes may be implicated. Assessment of depression in PD is difficult, as none of the currently available scales were specifically designed for patients with this disease Furthermore, there is a lack of well-controlled studies showing that current antidepressants are effective in PD patients or are safe for use when the motor, cognitive and autonomic impairments of PD are present.
Brain↗
[Aggravation of Parkinson's disease after inadequate use of levodopa in controlled-release preparations].
We describe 16 patients with Parkinson's disease seen during a 6-month period because of aggravation related to the recent introduction of a levodopa/carbidopa controlled-release (CR) preparation, either in combination with or substituting for the standard levodopa preparations. Disease duration was longer than 5 years (mean 8.4 +/- 5.9 years) in most cases at the time the CR preparation was introduced, and the patients were suffering from either severe late levodopa syndrome or progression in disability. For 9 out of 14 patients the CR formula had replaced the older preparation overnight. Though patients often accumulated multiple side-effects, we were able to identify 3 subgroups based on the main problem developing after the CR preparation had been introduced: a) apparent acceleration of the course of disease in patients in advanced stages, even if their response to treatment was otherwise stable (n = 4); b) subacute onset or aggravation of dyskinesias or painful "off"-period dystonia that often prompted reevaluation of the patient (n = 4); c) deterioration of akinetic "off" periods in patients already experiencing response fluctuations (n = 5) or appearance of dose failures in patients who had so far been enjoying stable responses (n = 3). These problems appeared in spite of a significant increase (p = 0.046) in total levodopa daily dose even though there were no differences (p = 0.685) in dose frequency between the CR preparation and standard levodopa.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
[Caudate hemorrhage: a frequent diagnostic error].
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Caudate Nucleus↗
[Arnold-Chiari malformation with multiple paroxysmal manifestations induced by coughing].
We present a 66-year old woman suffering from a chronic disorder characterized by multiple paroxysmal symptoms precipitated by coughing. These included cephalalgia, syncope, binocular photopsia phenomena with blurred vision, and an "electric-like" paroxysmal tingling of the hands. In addition to a central spinal cord cavity and hindbrain herniation, magnetic resonance imaging showed multiple skeletal anomalies and the craniospinal junction which included a narrow clivo-axial angle, basilar impression of the skull and a tight foramen magnum. Resonance magnetic imaging showed a high-signal intensity lesion on T2-weighted images at the posterior medullo-spinal junction suggesting focal demyelination. We propose that paroxysmal symptoms induced by coughing in patients bearing hindbrain ectopia and skeletal anomalies at the foramen magnum region may involve different pathogenetic mechanisms, including ectopic axonal activity and ephaptic transmission at the sensory pathways. This caused a Lhermitte-like phenomenon precipitated by coughing, rather than by forward flexion of the neck. However, increased pressure at the posterior fossa presumably underlies all these phenomena, and may therefore be potentially relieved by suboccipital decompressive craniotomy.
Arnold-Chiari Malformation↗
Sensory ataxic hemiparesis in thalamic hemorrhage.
Ataxic hemiparesis with cerebellar-like features has been reported following infarction or hemorrhage of the thalamus. We describe five patients with incoordination and corticospinal tract signs in the limbs opposite a dorsolateral thalamic hemorrhage. In four patients the hemorrhage extended superiorly into the lateral ventricle, the adjacent paraventricular region, and the upper and medial parts of the posterior limb of the internal capsule. Instead of cerebellar dysfunction, these patients exhibited directional errors of movement that improved distinctly when performed under visual guidance. We explain the incoordination on the basis of conscious deep sensory loss in the involved limbs. Perception of light touch, painful pinprick, and temperature were preserved in all patients. We use the term "sensory ataxic hemiparesis" to distinguish these patients from those with "classic" ataxic hemiparesis and cerebellar-like features, a distinction that may be important when planning functional rehabilitation.
Adult↗