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Biomedical subjects

M Mumenthaler

Publications and source records attributed to M Mumenthaler.

At least 55 records · Page 3Linked to original sources

Increased energy cost of walking in multiple sclerosis: effect of spasticity, ataxia, and weakness.

Multiple sclerosis patients with motor involvement of the lower extremities and the trunk often experience exertional dyspnea and generalized or leg fatigue on walking, and their walking performance is reduced. It has recently been suggested that a high energy cost of walking (Cw) may be an important contributing factor to the observed dyspnea and fatigue. The purpose of this study was to determine which factors influence Cw. Clinical tests were used to assess the major alterations of the motor system. Thirty-three patients (mean age 41 years, mean maximal speed 2.8 km/h, range 1.2 to 6.2 km/h) in a stable phase of their disease were examined. Cost of walking (mean +/- SE) at 1.8 km/h was 0.287 +/- 0.018 ml 02.kg-1.m-1 (normal value 0.163 +/- 0.007, p less than 0.001). A multivariate regression analysis showed that Cw was significantly related to spasticity of the lower extremities, whereas lower extremity and truncal weakness did not contribute to the observed high Cw.

Adult↗

[Extra-pulmonary complications in Mycoplasma pneumoniae infections].

It is not rare that extrapulmonary complications and not pneumonia dominate the clinical picture in infections with Mycoplasma pneumoniae, as is illustrated by three cases. In the first, a young woman developed an acute, but ultimately completely reversible, polyradiculitis after a Mycoplasma pneumonia. The second patient sustained a thoracic transverse myelitis which regressed rapidly and completely under treatment with erythromycin and prednisone. In the third one, the Mycoplasma pneumonia was complicated by a generalized hypersensitivity vasculitis affecting many organs. A largely reversible renal vasculitis was demonstrated angiographically.

Adult↗

[Buccolinguofacial apraxia--a probably psychogenic speech and deglutition disorder].

Difficulties in swallowing and speaking may in rare cases be due to buccolinguofacial apraxia, which usually results from lesions of the frontal operculum--mostly on the left side--or of connections to and from it. Two cases with this disorder, probably due to a multiple sclerosis, are presented and the differential diagnosis is discussed.

Adult↗

[Reversible and preventable dementias].

Dementias which are either reversible or avoidable are discussed in the light of the literature. The frequency is between 6 and 32%. The most important etiological groups are immunological vasculopathies, hyperlipidemia, some types of encephalitis and, mainly, progressive dementia of the insane, benign tumors and in particular meningioma, low pressure hydrocephalus, intoxications due to drugs, industrial products and alcohol, metabolic disturbances, encephalopathy in dialysed patients, ileo-jejunal-bypass encephalopathy and encephalopathy due to neoplasms. Dementias are also seen in endocrinological disturbances and particularly in hypothyroidism. Vitamin B12 and folate deficiency, as well as epilepsy, may be causes of dementia. Depression may mimic a state of dementia. Some features of reversible dementias are listed, including in particular the somewhat more rapid onset, the younger age of patients, and accompanying neurological symptoms such as headache, gait disturbances, ataxia, polyneuropathy, myoclonus or epileptic fits.

Aged↗

Nontraumatic spinal epidural and subdural hematomas.

Ten patients with a nontraumatic spinal extramedullary hematoma are reported, nine of the hematomas localized in the epidural space. Seven of the patients were taking anticoagulant drugs and five showed signs of liver disease, mostly due to alcoholism. The invariable first symptom was an intense local pain in the spine, followed in all but one case by radicular irradiation and in all by bladder disturbances and sensory and motor deficits of the spinal cord or cauda equina. All the patients had myelography to verify the spinal mass and were operated on as fast as possible. The outcome depended mainly on the preoperative neurologic status. If there was only an incomplete sensory and motor lesion before the operation, the patients recovered fairly well or completely. The patients who did not become capable of walking again were completely paralytic preoperatively.

Adult↗

[Electrically induced cutaneo-muscular reflex from the m. extensor digitorum brevis].

We recorded the cutaneo-muscular reflexes in 90 normal subjects from the extensor digitorum brevis muscle following electrical stimulation at the second toe. In 88 subjects an early and a late EMG response were obtained. The mean latency of the second reflex response was 91.9 +/- 12.1 ms and the mean duration was 27.3 +/- 11.6 ms. However, there was considerable variability of the interindividual amplitudes. Comparison of the age related changes in the latencies of the first and second reflexes yielded results consistent with the transcortical or spino-bulbo-spinal hypothesis.

Adult↗

[Polyneuropathy, organomegaly, endocrinopathy and skin changes in a case of solitary myeloma].

The case is reported of a 32-year-old woman with polyneuropathy, organomegaly, edema, endocrinopathy, dark skin and solitary myeloma with monoclonal gammopathy of IgG/lambda type. More than 100 cases of this rare disorder have been observed up to now, mainly in Japan. In recent reviews the terms POEMS-syndrome or Crow-Fukase-syndrome have been used. Local radiotherapy of the myeloma led to lasting regression of symptoms. Studies with immunocytochemistry and immunoelectroblotting revealed specific antibody activity against hypophysis, suggesting that the pathologic monoclonal myeloma antibodies may damage the neuroendocrinic centers in hypothalamus and hypophysis as the primary target. Most of the multisystemic symptoms would thus be explained as secondary alterations.

Adult↗

[Atypical neurologic symptoms in the course of acquired immunodeficiency syndrome (AIDS)].

Unusual neurological symptoms were observed in three homosexual men in whom antibodies against HTLV-III were demonstrated. In case 1, with a known Kaposi sarcoma, multiple intracerebral space-occupying lesions with severe perifocal oedema resulted in marked focal neurological deficits. In case 2, there occurred a transitory myelopathic syndrome lasting a few days, followed by severe retinal changes, associated with a generalized cytomegalic infection, and a cerebrovascular accident in the brainstem. In case 3, a severe myositis especially of the shoulder girdle was diagnosed and treated one year before the demonstration of the HTLV-III infection. The pathogenetic relationship between these illnesses and the HTLV-III infection remains unexplained.

Acquired Immunodeficiency Syndrome↗

Benign migraine-like syndrome with CSF pleocytosis in children.

Four children with symptoms consistent with complicated migraine had CSF pleocytosis, in three cases lymphocytic and in the fourth polymorphonuclear. In one case the CSF abnormality was found during two separate attacks of complicated migraine. On the basis of the 23 cases reported in the literature and these four personal cases, the authors conclude that, as a rule, pleocytosis is a secondary phenomenon of an attack of complicated migraine. However, in exceptional cases an infectious disease might produce both a migraine attack and CSF pleocytosis.

Adolescent↗

[Amnestic episodes. Analysis of 111 personal cases].

A typical episode of transient global amnesia has been observed in 111 personal cases. In these elderly patients a sudden disturbance of memory, which may last several hours, makes it impossible for them to store fresh information. During this period there is also retrograde amnesia which covers a period of several weeks or months prior to onset of the acute episode. The disturbance ends suddenly and the retrograde amnesia gap fills up again. The age distribution, vascular risk factors and triggering mechanisms in these personal cases are described. 22 of 111 patients had 1 or more relapses, in one case after a 15 years' interval. It is our opinion that transient global amnesia is a vascular disturbance in the hippocampal region. One example of localized (ischemic) area in this region has been shown by computed tomography.

Adult↗