Biomedical subjects
Publications and source records attributed to L A Rolak.
Magnetic resonance imaging of the brain in a patient with moyamoya disease demonstrated multiple scattered white matter lesions, but was not sufficiently specific to confirm the diagnosis without other techniques.
Two men, aged 25 and 33 years, had progressive hemidystonia and an arteriovenous malformation (AVM) in the contralateral cerebral hemisphere. One patient with an AVM in the posterior basal ganglia of the right hemisphere had an older brother with severe generalized dystonia. The second patient had an AVM in the left cortical and subcortical parietal area with no obvious lesion in the basal ganglia. Unlike generalized dystonia, a focal lesion is commonly found in patients with unilateral dystonia. The association of AVM-induced hemidystonia and family history of dystonia suggests that genetic predisposition may be important in some patients with hemidystonia.
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Seventy-three consecutive diabetic adults with symptomatic peripheral neuropathy were evaluated for the presence of cardiovascular autonomic neuropathy and electrocardiographic evidence of myocardial infarction (MI). Twenty-five (34.2%) patients demonstrated cardiovascular autonomic neuropathy, and ten (13.7%) patients had electrocardiographic evidence of MI. Of the ten MI identified, seven were asymptomatic (silent) by history. The incidence of silent MI was significantly higher (P less than .04) in patients with cardiovascular autonomic neuropathy. It is postulated that sudden death in diabetic patients with cardiovascular autonomic neuropathy may be due to silent MI.
Flight of colors (FOC), the rapidly changing series of colored afterimages perceived when a bright light briefly strikes the eye, is impaired or absent in patients with lesions affecting central visual fields, especially optic neuropathies (ONs). The effectiveness of a bedside test of FOC using a pocket flashlight was compared with that of pattern-reversal visual evoked responses (PRVERs) in examining 74 subjects): 20 controls, seven patients with ON not due to multiple sclerosis (MS), 26 patients with MS, and 21 patients with possible MS and no clinical ON. The FOC test correctly identified 95 of 99 normal eyes and 45 of 49 eyes with ON, and accurately diagnosed 140 (95%) of 148 eyes overall. In 84 eyes examined by PRVER and FOC, the results agreed in 73 cases (87%), including those of subclinical ON.
We studied 50 patients with definite, probable, and possible multiple sclerosis (MS), prospectively (20 patients) and retrospectively (30 patients), to determine the value of the hot bath test for diagnosing MS and to compare it to visual evoked responses and oligoclonal bands. The hot bath test was abnormal in 8 of the 23 patients with definite MS (35%), and 4 of the 27 patients with probable or possible MS (15%). Only one patient with an abnormal hot bath test did not also have other evidence of definite multiple sclerosis. Our results suggest that the hot bath test seldom adds diagnostic information, especially when tests for evoked responses and oligoclonal bands are available.
Coronary artery disease is the cause of death in most patients who have transient ischemic attacks or stroke. Evaluation for this condition is not routinely performed in such patients, and no prospective studies have been reported. We prospectively examined 50 consecutive patients with transient ischemic attacks or mild stroke to determine the prevalence and importance of coronary artery disease. All patients were examined by a cardiologist and underwent both exercise thallium-201 scintigraphy and exercise radionuclide ventriculography. Sixteen patients were suspected to have coronary artery disease on the basis of clinical evaluation. In 15 of these the was confirmed by the nuclear scans. The remaining 34 patients had no clinical evidence of heart disease, yet 14 had abnormal cardiac scans. Twenty of 22 patients with abnormal scans who underwent cardiac catheterization had significant coronary artery disease or a cardiomyopathy. The discovery of heart disease altered clinical management in 13 patients. Overall, 29 of 50 patients had significant coronary artery disease, compared with a 7% prevalence of the condition in other patients of similar age at the same institution.
The development of mononeuritis multiplex brought three men to medical attention weeks to months prior to the diagnosis of a malignancy. In each case, sural nerve biopsy exhibited active wallerian degeneration with vasculitis. Two of the men died and at autopsy were found to have clinically unrecognized oat cell carcinoma and carcinomatous sensory neuropathy with brainstem encephalitis. The third patient is still alive but was found to have a lymphoma and has subsequently developed a liposarcoma. The vasculitis in all 3 cases seems limited mainly to the peripheral nervous system. Mononeuritis multiplex due to vasculitis may represent a new remote effect of cancer on the nervous system.
A prospective clinical study was performed in 32 patients with multiple sclerosis (MS) to evaluate the sensitivity of lesion detection and accuracy of lesion localization by neurologic examination, delayed enhanced computed tomography (CT) with a double dose of contrast material, and proton magnetic resonance (MR) imaging. After neurologic examination patients were classified by probability of MS (possible, four patients; probable, three patients; and definite, 25 patients) and by disease activity (acute, chronic with acute exacerbation, or chronic progressive). Subsequently they underwent delayed enhanced CT scanning and MR imaging with more than one spin-echo technique. In five of seven patients with possible or probable MS, both MR imaging and delayed enhanced CT were negative. In 25 cases of definite MS, MR imaging detected pathology in 19 (76%) cases, while CT detected lesions in 15 (60%) of 25 cases. In acute lesions (acute or chronic with acute exacerbation), the two techniques were of similar sensitivity (delayed CT was positive in 65% and MR imaging in 60%), while in chronic progressive MS, MR imaging was superior in lesion detection (MR imaging positive in 75%; delayed CT in 25%). While most lesions (55%) were seen in corresponding locations in both studies, neither MR nor delayed CT correlated well with lesion localization by neurologic examination because a large number of asymptomatic lesions were imaged and many symptomatic lesions were undetected.(ABSTRACT TRUNCATED AT 250 WORDS)