Biomedical subjects
Publications and source records attributed to S Honigman.
Sphenoid sinusitis is a frequently misdiagnosed infection. Delay in recognition and treatment carries a very poor prognosis. An unusual case of sphenoid sinusitis mimicking a syndrome of chronic meningitis is presented. This case emphasizes the diagnostic challenge of sphenoid sinusitis which may present only through its complications.
A case is presented in which computerized tomography (CT) demonstrated a supratentorial and parafalcial purulent collection. However, neither carotid angiography nor CT revealed the small scattered pockets of pus that were found over the convexity at operation. The entire subdural space was exposed by a wide craniectomy, permitting adequate subdural drainage and decompression of the brain. It is thought that thorough drainage of the entire subdural space is crucial for the attainment of a successful result in a single-state operation.
Visual motor control (VMC) of arm movements is disturbed in patients with Parkinson's disease. The effect of antiparkinsonian medications on VMC is unknown. To assess the effect of deprenyl, a monoamine oxidase type B inhibitor, on VMC in the early stages of parkinsonism. Fourteen recently diagnosed, unmedicated patients with primary degenerative parkinsonism, mean age 61.9 +/- 2.8 years, were assessed by a computerized VMC system for tracking and tracing on a sine wave, circle, and square. Score was given for total time of test performance, directional error, arm velocity, and number of interruptions in tracking. All patients performed the first VMC test at baseline, prior to any antiparkinsonian treatment. The second test was performed after a month of treatment with 2.5 mg/d of deprenyl, and the third test was done after an additional month of treatment with 10 mg/d of deprenyl. Results were compared with 15 healthy volunteers with a mean age of 63.1 +/- 1.2 years. Parkinsonian patients performed significantly poorer on the VMC when compared to controls. Tracing was more affected than tracking. Tracing total time was almost twice as long as for controls (p < .0005). Treatment with 2.5 mg/d and 10 mg/d of deprenyl improved performance significantly (p < .05 and p < .005, respectively). Velocity of arm movement was not affected by deprenyl treatment in either dose. Directional control (tracing), severely disturbed in the parkinsonian group, improved back to the performance of healthy controls after 10 mg/d of deprenyl. In recently diagnosed parkinsonian patients internally guided VMC tasks were disturbed more than externally guided ones. Deprenyl treatment selectively improved directional control of arm movement in a dose related manner.
Tetrabenazine (TBZ) is a catecholamine depletor used for the treatment of a variety of movement disorders. The purpose of this study was to assess the efficacy of TBZ in a retrospective chart review in 3 tertiary care movement disorders centers over long-term treatment. Of 150 patients to whom TBZ was prescribed, 118 were followed up and assessed using the Clinical Global Impression of Change (CGIC), (-3 to +3), a composite grade from a patient and caregiver scale over variable periods. The patients had a variety of hyperkinetic movement disorders including dystonia (generalized and focal: axial, Meige syndrome, torticollis, blepharospasm, bruxism), Huntington disease (HD) or other choreas, tardive dyskinesia (TD) or akathisia, and Tourette syndrome. Mean patient age was 48.8 +/- 18.7 years; 48 were men (40.7%) with a mean disease duration of 93 months. The mean follow-up time was 22 months and the mean TBZ dose was 76.2 +/- 22.5 mg/d (median 75 mg, range 25-175 mg/d). The mean CGIC score was +1 (mild improvement). The group of patients who scored +3 on the CGIC (very good improvement) represented 18.6% (n = 22) of all patients. They had HD or other types of chorea 7.6% (n = 9), facial dystonia/dyskinesia (n = 7, 5.9%), 1 with TD, 2 with trunk dystonia, 2 with Tourette syndrome, and 1 with tardive akathisia. This group had the longest treatment duration and received a mean TBZ dose of 70.5 mg/d (median 75 mg/d) for a mean of 25.4 +/- 21.3 months. The report concludes that TBZ is a moderately effective treatment of a large variety of hyperkinetic movement disorders, with excellent effects in a subgroup with chorea and facial dystonia/dyskinesias.