Biomedical subjects
Publications and source records attributed to M D O'Brien.
Details of a 23 year old patient who suffered the spontaneous onset of an anterior interosseous nerve palsy are recorded together with the results of a full neurophysiological investigation.
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A number of methods which might improve the detection of carriers of Duchenne muscular dystrophy, based on the estimation of serum creatine kinase (CK), have been tried in an attempt to improve the 70% detection rate obtained with random samples. One series of experiments involved controlled exercise on a bicycle ergometer, the second series was based on sampling of muscle venous blood after controlled ischaemic exercise, and a third series of experiments was carried out to see whether the rate of enzyme inactivation was different in carriers of Duchenne dystrophy compared with controls. These methods were not found to improve the carrier detection rate based upon serum CK estimation.
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Cerebral cortex perfusion rates (CPR) were measured in 11 patients with dementia. In six patients the dementia appeared to be due to a primary neuronal degeneration and in the remainder it appeared to be secondary to vascular disease. In the context of blood flow measurement, it is suggested that the terms primary and secondary dementia are preferable to the terms presenile and senile dementia, because the latter are classified by age alone and the terms have no aetiological or pathological significance. The perfusion rates in patients with primary dementia were within normal limits for their age, whereas those in patients with secondary dementia were significantly reduced. This difference is likely to apply only if the measurements are made early in the course of the disease.
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This study examines the relative risks and benefits of conservative and surgical management of dural tear secondary to middle third facial fracture and ascertains the type of skull and facial injury most often associated with the development of posttraumatic meningitis. Two projects were undertaken. First, the histories of 247 cases of major middle third facial fracture were reviewed with a recent follow-up of those patients who also sustained a dural tear. Second, 280 cases of bacterial meningitis were reviewed and particular attention was given to cases of posttraumatic meningitis. Of the 247 cases of middle third facial fractures studied, 43% (107/247) had evidence of a dural tear; of this group, 76 patients were managed conservatively and 31 patients were managed surgically. In the former group, there were three instances of recurrent cerebrospinal fluid rhinorrhea (CFR). In the surgically managed group, 77% (24/31) sustained surgical complications including two cases of posttraumatic meningitis and 21 cases of neurological deficit. Of the 280 cases of bacterial meningitis, 48 patients had sustained dural tear following trauma. The prognosis for posttraumatic meningitis is considerably better than for other forms of meningitis. The preceding trauma involved the vault of the skull in 90% (43/48) of cases, and discrete middle third facial fracture in one case (2.1%). Posttraumatic meningitis followed a previous operative repair in 15% (7/48) of the patients. The results of this study indicate that dural tear subsequent to middle third facial fractures is a different proposition than dural tear subsequent to direct skull trauma.(ABSTRACT TRUNCATED AT 250 WORDS)
There are several factors that might be important in the development of dementia due to cerebrovascular disease. These include the volume of infarcted brain, the bilaterality and symmetry of lesions, the strategic location of small lesions, the number of lesions, the extent and density of white matter lesions and the coexistence of other pathologies, particularly Alzheimer's disease. No one factor is solely related to dementia and in most patients several of these factors combine to exceed the critical threshold for normal cognition. It is the extent of the disease which determines the development of dementia, rather than its etiology. Conversely, the possibility of treatment depends more on the etiology of the vascular disease than on the extent.
The genesis of ischemic cerebral edema is multi-factorial and the relative importance of these many factors varies throughout the lesion and with time. The initial event is intracellular edema which may be followed by extracellular edema. This situation precludes any simple treatment, particularly because the favorable alteration of one factor might be detrimental to another.
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Falls are common in the elderly, often causing considerable morbidity and mortality. Prevention is therefore important and is based on determining the cause. We present an elderly patient who had multiple falls during the day due to recurrent daytime sleep episodes, an entity we believe has not previously been reported.