Biomedical subjects
Publications and source records attributed to R D Rollinson.
A family with a disorder characterized by muscle cramps that cause painful posturing of the hands and feet was studied. Three generations are affected and the trait is transmitted by autosomal dominant inheritance. The disorder begins in childhood and does not seem to be progressive. A primary abnormality in the motor neuron is suspected on the basis of electrophysiological studies.
Three patients with ocular myasthenia in childhood experienced complete and prolonged remissions lasting 4 to 14 years and then suffered recurrences of ocular myasthenia. One had another spontaneous remission and then relapsed again. All were subsequently in remission on oral steroid medication.
Transient global amnesia (TGA) was found in 41 of 76 patients admitted to the North Carolina Baptist Hospital with temporary disturbances of memory. Risk factors for stroke were present in 26 (63%) of these 41 patients, and additional risk factors developed in 9 (27%) of the 33 patients available for follow-up. Follow-up evaluation in 33 patients (80%) for periods ranging from 1 to 17 years (mean, 60.3 months) revealed a low rate of recurrence (18%) and a still lower rate of progression to stroke (6%). No transient ischemic attacks were reported during this period. In 2 patients, multiple recurrences of TGA ceased after treatment of the underlying condition (polycythemia in 1 case and myxomatous degeneration of the mitral valve in the other.
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A patient with postanoxic action myoclonus (Lance-Adams syndrome) was severely disabled with this movement disorder. Valproate sodium was administered orally, with complete resolution of the myoclonus. This favorable response has been maintained for two years. Excessive yawning, the only side effect encountered, was dose related and was abolished with the addition of pimozide to the drug regimen.
The surgical management of a patient with symptomatic lesions of the carotid and coronary arteries is presented. The association of these lesions is discussed along with the rationale of a combined surgical approach.
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TGA is a clearly recognisable clinical syndrome with many and varied aetiologies, the most ubiquitous being transient cerebral ischaemia. This entity is probably much more common than the literature suggests, many patients not coming to the attention of a physician due to the transient nature of the isolated memory defect and the risk of recurrence being low, it is of interest that many of the original patients described tended to be the more prominent members of the community, e.g. physicians and relatives of physicians, perhaps suggesting that the occurrence of TGA in such a person is less likely to pass unnoticed. In the differential diagnosis one should include the following: transient cerebral ischaemia, epilepsy, migraine, temporal lobe encephalitis, psychogenic fugues, post-traumatic, and rarely cerebral neoplasms.
A 12-year-old male presented with a one-day history of visual failure. The clinical features were consistent with bilateral optic neuritis. Treatment with prednisolone resulted in visual function returning to normal. Bilateral optic neuritis in childhood is an uncommon condition. The aetiological factors differ from those of the adolescent and adult with optic neuritis. The childhood condition is not associated with the high risk of developing demyelination disease at some later stage.
A 46-year-old female presented with a three year history of progressive weakness. Asymptomatic apart from proximal myopathy, multi channel screening and radiological features indicated primary hyperparathyroidism with severe metabolic bone disease. Removal of a parathyroid adenoma led to improvement of muscle strength and regression of bony and metabolic changes.