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Biomedical subjects

U Lying-Tunell

Publications and source records attributed to U Lying-Tunell.

At least 19 recordsLinked to original sources

Gait apraxia in normal-pressure hydrocephalus: patterns of movement and muscle activation.

We made gait recordings in 11 patients with normal-pressure hydrocephalus. Sagittal rotations in hip, knee, and ankle joints were determined with intermittent light photography or with polarized light goniometry. In eight patients, gait muscle activation was determined with integrated surface EMG from six leg muscles on one side. We assessed the patterns of movement and muscle activity by averaging data from 20 gait cycles. Reduced speed and range of movements, short steps, small foot-floor clearance, and low swing-to-stance ratio were typical. The activation of the calf muscles was regularly premature and low. In severe disorders, there was continuous activity in the antigravity muscles acting on hip and knee joints. Gait records verified improvement after CSF drainage or shunting.

Aged

Chromosome analysis and sister chromatid exchange in encephalo-trigeminal angiodysplasia.

A female, aged 32, with facial birthmarks and suffering migraine headaches and a slight hemiparesis was examined with isotope scanning, CT and angiography. She was found to have a massive, unilateral angiodysplasia, transforming the right cerebral hemisphere into an expanding vascular sponge-like structure. There was a family history of red facial birthmarks. The patient and her father were analysed cytogenetically by estimating the frequency of chromosome aberrations and sister chromatid exchanges (SCE). The frequency of gaps and breaks was normal compared to healthy controls, but the patient showed a significantly higher level of spontaneous SCE's. The patient and her father also had a higher than normal number of SCE's after addition of mitomycin C (MMC) to the blood culture. Numerical and structural chromosome deviations markedly exceeded normal in both, possibly representing a genetic imbalance in this syndrome.

Adult

Cerebral blood flow and metabolic rate of oxygen, glucose, lactate, pyruvate, ketone bodies and amino acids.

The cerebral blood flow (CBF) and cerebral metabolic rate (CMR) of oxygen, glucose, lactate, pyruvate, ketone bodies and 24 amino acids were examined in 12 patients with presenile dementia and in seven with normal-pressure hydrocephalus. Both groups of patients showed significantly lower values of CBF and cerebral uptake of oxygen and glucose than 10 healthy subjects examined concurrently. The values decreased roughly in proportion to the degree of clinical deterioration. Furthermore, the patients exhibited a significant release of lactate and pyruvate. A positive correlation was found between CMR and arterial concentration of ketone bodies. The group with presenile dementia showed no uptake of amino acids, but a significant release of phenylalanine; in addition, CMR of alanine and threonine was significantly lower than in the healthy subjects. These findings suggest a cerebral catabolic state. Four patients with normal-pressure hydrocephalus were also studied after shunt operations. All showed an increase of CMR glucose and a decrease of CMR ketone bodies, acetoacetate as well as D-beta-hydroxybutyrate, which could not be attributed to a consistent decrease of arterial levels of ketone bodies.

Aged

Cerebellar dysfunction related to toluene sniffing.

Only few cases with prolonged cerebellar symptoms after toluene sniffing have previously been reported. We describe here an 18-year-old female who inhaled pure toluene since the age of 12. She developed neurological symptoms with broad-based ataxic gait, incoordination of arms and legs, unsteadiness, dysarthria, downbeat nystagmus, bilateral positive Babinski sign, and poor concentration and abstracting ability. During her 5 weeks in hospital when she did not inhale toluene, her symptoms persisted but decreased and after 8 months had disappeared.

Adolescent

Cerebral blood flow and metabolic rate of oxygen, glucose, lactate, pyruvate, ketone bodies and amino acids.

The cerebral blood flow (CBF) and cerebral metabolic rate (CMR) of oxygen, glucose, lactate, pyruvate, ketone bodies, and 24 amino acids were examined in 10 healthy subjects, five 21-24 and five 55-65 years old. The subjects were free from drugs. The results of psychometric and neurological examinations were negative. CBF was determined with the nitrous oxide method on the subjects who were awake and normocapnic and had fasted overnight. No differences were found between the young and the old groups except in arterial levels of four amino acids, viz. aspartic acid, methionine, lysine, and tryptophan. In the whole group of 10 subjects, a significant cerebral net uptake (expressed as median values in mumol X kg-1 X min-1) was found not only for oxygen (1719) and glucose (248), but also for acetoacetate (4.3), D-beta-hydroxybutyrate (6.2), arginine (2.0), leucine (5.2), and isoleucine (1.2). There was a significant net release of lactate (-28). CBF was positively correlated to the CMR of oxygen and D-beta-hydroxybutyrate. Arterial concentrations and CMR were positively correlated for ketone bodies, glutamic acid, proline and taurine. It is of particular interest that the whole group of healthy subjects showed a significant cerebral uptake of branched-chain and dibasic amino acids.

Adult

Psychotic symptoms in normal-pressure hydrocephalus.

Two patients with a psychiatric history of about 20 years, and clinical and neuroradiological signs of normal-pressure hydrocephalus (NPH) are reported. One had a periodic psychosis subsequent to a tuberculous meningitis, and this overshadowed the slight classical symptoms of NPH. She had received at least 120 treatments with electro-convulsive therapy. The second patient suffered from a paranoid psychosis; other signs of NPH were moderate though progressive. Both patients showed definite improvement of their NPH symptoms after ventriculo-atrial shunting, and psychotic symptoms ceased totally. Follow-up was 5 years for the patient with periodic psychosis. The other patient died from septicaemia 2.5 years after shunting. A large-scale screening of patients with psychiatric symptoms or dementia, particularly when combined with gait disturbance, should be done by using computerized tomography. Patients suspected of having NPH should then be referred for further examination with the aim of selecting patients suitable for shunting. These measures seem well motivated from humanitarian as well as economic points of view.

Aged

Quantitative cisternography.

By quantitative cisternography using a stationary detector system with correction for tissue background, an exponential elimination of 131I-HSA from the basal cisterns was demonstrated, allowing calculation of a biologic half time (BHT) of the clearance curve of a satisfactory level of reproducibility. 'Normal' range of BHT was calculated. Demented patients had significantly longer BHT. In 4 patients with normal pressure hydrocephalus prolonged BHT turned normal after shunting, paralleled by marked clinical improvement, in contrast to previous findings in 4 patients with presenile dementia. The method is now being modified employing 111In-DTPA and a computer assisted gamma camera for regional dynamic analysis.

Aged

Constancy of convexity air block on pneumoencephalography.

Twenty-two patients with dementia were examined by pneumoencephalography using special technic with the aim of filling the subarachnoid convexity space. Seven had no obvious hydrocephalus. All patients had convexity blocks which were more or less extensive. Ten had bilateral air block in the frontal, parietal and occipital regions. It was concluded that convexity air block is not a technical artifact and consequently seems to have an organic background.

Adult

Cerebrospinal fluid turnover and convexity block in mental impairment. A controlled prospective study.

A prospective study with a 3-year follow-up was made of 82 patients examined consecutively by pneumoencephalography. Several types of cerebral diseases were represented. The degree of mental impairment was rated. Qauntitative cisternography was performed in 70 of these patients, in which the exponential elimination of injected iodine 131-l human serum albumin from the basal cisterns was calculated. Mental impairment was found to be strongly correlated with a lack of air filling over the parietal convexities and with a slow isotope elimination from the basal cisterns, indicating a slow cerebrospinal fluid turnover. Hydrocephalus was not always present. Only eight had a convexity block for the passage of isotopes.

Adult

A triad of airencephalographic findings in patients with mental impairment: a controlled prospective study.

A controlled prospective study of 82 patients examined consecutively during one year by airencephalography was made. Care was taken to excude bias and to assess observer error. A close correlation was found between mental impairment (as a sign of "organic brain syndrome", resulting from various cerebral diseases), and three airencephalographic findings, namely 1) lack of air filling over the parietal convexities (parietal air block), 2) widening of the lateral and third ventricles and 3) widening of the Sylvian and interhemispheric fissures. Of these, parietal air block was found to be the most sensitive sign. In addition to the patients with normal-pressure hydrocephalus, the majority of patients with presenile dementia and alcoholic encephalopathy had parietal air block. The results are in agreement with those reported in an earlier retrospective study. Leptomeningeal changes may account for the finding of parietal air block in certain patients, but in the majority of cases there is no complete obstruction of the subarachnoid space, as judged from the results of isotope cisternography. Organic changes in the brain and leptomeninges may create special physical conditions for the appearance of convexity air block at airencephalography. Recognition of convexity air blocks seems to have considerable diagnostic and therapeutic implications, since it contributes appreciably to the judgment whether a patient's condition is basically determined by an organic brain syndrome or constitutes a functional mental disorder. The possible pathophysiological association between mental impairment and parietal air block warrants attention.

Adult

Air filling of the subarachnoid space over the cerebral convexities at repeat encephalography.

In order to check the constancy of convexity block, the airencephalograms (AEG) of seventeen patients who had undergone two separate examinations were reexamined. A satisfactory filling by air of the basal cisterns or Sylvian fissures was a prerequisite for including the AEG in this series. Consistent results related to air filling of the parietal region were obtained at the two examinations except in one patient with clinical signs of a pontine neoplasm. When the AEG was repeated in a very short time and with unchanged clinical conditions, the degree of air filling over the convexity was practically identical. But, with progressive neurological signs, the parietal air blocks showed a slight increase and also extended to the frontal region. It was concluded, firstly, that upper convexity block is a reproducible finding; secondly, that it is related to organic brain disease, the extent of the convexity block being correlated to the degree of clinical deterioration. As judged from other studies using isotope cisternography, the subarachnoid space is usually not complelely obstructed. It is suggested that the organically changed brain and leptomeninges create special physical conditions for the appearance of convexity air block in the AEG.

Adult