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PubMed2003

Predictive value of assessment of general movements for neurological development of high-risk preterm infants: comparative study.

AIM: To assess the predictive value of normal, abnormal, or absent general movements in high-risk preterm infants for the later neurological development. METHODS: The study involved 120 high-risk preterm infants (gestational age, < or =37 weeks) having at least three or more antenatal, perinatal, or neonatal risk factors for impaired neurological development, and 112 age-matched controls. The method of general movements of fidgety character assessment was compared with classical neurological examinations performed longitudinally until the corrected age of two years. The age-adequate neurological examinations based on the criteria by Amiel-Tison and Grenier and Illingworth were used. Specialists in clinical psychology also monitored the child's development. The results of specialists' examinations were taken into account. RESULTS: Out of 83 high-risk preterm infants with normal fidgety movements, 81 (97%) had a normal neurological outcome. Abnormal or absent fidgety movements were followed by abnormal neurological outcome in 30 (81%) out of 37 infants. Cerebral palsy was diagnosed in 13 children, mental retardation in one, whereas 16 children had both cerebral palsy and mental retardation. The validity of the general movement assessment was 92%, sensitivity 94%, specificity 92%, positive predictive value 81%, and negative predictive value 98%. These values were better than those of the classical neurologic examination (60%, 97%, 43%, 44%, and 97%, respectively). CONCLUSION: The method of general movement assessment had significantly better validity, sensitivity, specificity, positive, and negative predictive value than classical neurological examination of high-risk preterm infants.

Cerebral Palsy↗
PubMedDate not supplied

[Clinical techniques for use in neurological physical examinations. II. Motor and reflex functions].

AIMS: The aim of this study is to highlight the chief practical aspects of the techniques used in the neurological physical examination of the motor and reflex functions. DEVELOPMENT: We recommend clinicians to carry out a brief but consistent and effective exploration in a systematic, flexible and orderly manner to check for abnormalities in the motor and reflex functions of the nervous system. Should any anomalies be detected, then a more detailed and thorough neurological exploration must be performed selectively. We present a detailed review of the practical aspects of the main techniques used in the physical examination of these neurological categories. The motor function is explored using techniques that examine muscle tone, muscle strength, muscle fatigability, hypokinesia, tremor, coordination and gait. Lastly, in this category several manoeuvres that are useful in hysterical or mimicking paralyses are also dealt with. Reflexes to examination are usually divided into: 1. Myotatic reflexes; 2. Cutaneomucous reflexes; 3. Spinal cord or defence automatism reflexes; 4. Posture and attitude reflexes. We also add the study of primitive pathological reflexes, remote reflexes, synkinesias and signs of meningeal irritation. CONCLUSIONS: We present a detailed description of the main clinical techniques used in the neurological physical examination of motility and reflexes, as well as an approach that allows them to be performed on adult patients. In addition, we underline the importance of physically examining the nervous system in contemporary medicine and the need to continually perfect the way these techniques are performed in order to achieve an efficient clinical practice.

Humans↗
PubMed1997

Predictors of intracranial pathologic findings in patients who seek emergency care because of headache.

BACKGROUND: Clinical criteria to select patients with headache in whom structural diagnostic studies (computed tomography) have a high yield disclosing intracranial pathologic findings, independent of abnormal findings on neurologic examination, have not been defined. OBJECTIVE: To determine which clinical characteristics predict the presence of intracranial pathologic findings, independently of neurologic examination, in patients with headache. DESIGN: Case-control, consecutive sample. SETTING: Major metropolitan trauma center emergency department. PATIENTS AND MATERIALS: Hospital records of 139 hospitalized and 329 randomly selected patients from 1720 nonhospitalized adult patients, consecutively evaluated for headache in the emergency department, were reviewed. Demographic data, clinical characteristics of the headache, results of neurologic and physical examinations, and diagnostic radiologic and laboratory results were correlated with final diagnosis and outcome at 6 months after emergency department visit. DATA ANALYSIS: Nonparametric statistical analysis. RESULTS: Intracranial pathologic findings were found in 18 (3.8%) of 468 patients. Acute onset and occipitonuchal location of headache, presence of associated symptoms, and patient age of 55 years or older were significantly associated with the finding of intracranial pathology, independently of the findings from neurologic examination. Abnormal findings on neurologic examination alone, whether focal or nonfocal, had a highly significant association and a positive predictive value for intracranial pathology of 39%. CONCLUSIONS: Abnormal results from neurologic examination are the best clinical parameters to predict structural intracranial pathology; however, in patients 55 years or older with headache of acute onset located in the occipitonuchal region that has associated symptoms, computed tomographic scan of the head is justified as part of their clinical evaluation independently of the findings of the neurologic examination.

Adult↗
PubMed2000

High dose methylprednisolone in the management of acute spinal cord injury - a systematic review from a clinical perspective.

STUDY DESIGN: Systematic literature review for primary data using predefined inclusion, exclusion and validity criteria. Primary outcome measure was standardised neurological examination or neurological function. Secondary outcomes; acute mortality, early morbidity. OBJECTIVES: To access the literature available to clinicians systematically and evaluate the evidence for an effect of high dose methylprednisolone (MPSS) on neurological improvement following acute spinal cord injury (ACSI). METHODS: Information retrieval was based on Medline search (1966 through December 1999) using the strategy 'spinal cord injury' and 'methylprednisolone' (or 'dexamethasone') with no other restrictions. Primary data publications using high dose steroids given within 12 h following spinal cord injury and reporting outcome measures separately for steroid and non-steroid treated groups were selected. Evaluation followed the guides of Guyatt et al7 (for the Evidence Based Working Group in Canada). Studies with questionable validity were excluded. Level of evidence and treatment recommendation utilised the Canadian Task Force on the Periodic Health Examination criteria.6 Experimental spinal cord injury studies on larger animals were included; small mammal experiments were considered beyond evaluation. RESULTS: Three clinical trials and six cohort study publications were found to satisfy the review criteria. The evidence they provide supports 'the recommendation that the manoeuvre (high dose methylpredisolone) be excluded from consideration as an intervention for the condition'10 (acute spinal cord injury). Twelve larger animal publications were detailed. Validity and the functional significance of results was of concern in many. The weight of evidence lay with those studies demonstrating no definite effect of MPSS on functional outcome. In cat experiments with higher level cord damage, deaths in the MPSS treated groups were notable. CONCLUSION: The evidence produced by this systematic review does not support the use of high dose methylprednisolone in acute spinal cord injury to improve neurological recovery. A deleterious effect on early mortality and morbidity cannot be excluded by this evidence.

Acute Disease↗
PubMed1996

Neurologic assessment and cardiac surgery.

Cerebral injury remains a significant complication of cardiac surgery. This complication is evaluated by clinical means that include a neurologic examination. In this report, the most important components of this type of evaluation are described. The neurologic complications of cardiac surgery can be determined by comparing structured preoperative and postoperative clinical evaluations. The neurologic examination must include a mental state examination, examination of cranial nerves, motor, sensory, and cerebellar systems, examination of gait and station, and deep tendon and primitive reflexes. The purpose of this report is to discuss the relevance of the neurologic examination in the assessment of cerebral injury after cardiac surgery, review the components of a structured neurologic examination, and explore the role of "quantitative" stroke scales as a research tool.

Brain Diseases↗
PubMed1982

[Problems on recurrence after removal of teratoma in pineal region--an experience of recurrence of pineal teratoma 4 years after tumor removal].

A case of teratoma in the pineal region which recurred 4 years after the first tumor removal was reported in this paper. When the patient was 5 years old, she, complained of headache and vomiting, and visited our hospital. As a heterogeneous mass with no enhancement effect was found in the pineal region by CT scan, she was admitted on November 9, 1976. There was no abnormalities on physical examination but neurological examination revealed slight disturbance of conjugate upward gaze (Parinaud's sign). Left vertebral angiogram demonstrated posterior superior displacement of posterior choroidal artery and downward displacement of Rosenthal vein, but early venous filling and tumor stain were not seen. Under preoperative diagnosis of a teratoma in the pineal region, the first operation (left occipital craniotomy and total removal of the tumor) was performed on November 24, 1975. Microscopic examinations revealed that the removed tumor was a mature teratoma in the pineal region. Postoperative course was uneventful and discharged on December 20, 1975. The follow-up study was continued at outside clinic after discharge. There was no signs of recurrence until 3 years after the first operation, but on January, 1981 (4 years after the first operation), she suffered from severe headache and vomiting again and re-admitted to our hospital on February 3, 1981. There was no remarkable neurological deficits except for the mild intracranial hypertensive sign and no changes of findings on angiogram. But CT findings were markedly characteristic. It revealed a heterogenous mass with remarkable enhancement effect in the pineal region and ventricular enlargement. Because a mixed type (teratomatous and germinomatous) of pineal tumors was suspected from the CT findings, irradiation was done after V-P shunt. The tumor was reduced to half size after the first course of 2000 rads irradiation, but there is no more reduction of the size of the tumor following the second course of 2000 rads (total 4000 rads) irradiation. Against the residual tumor, tumor removal was performed on June 2, 1981. Microscopically, the most part of the resected tumor showed fibrous changes caused by irradiation and partially teratomatous compartment. From this result (radiosensitivity and histology) the authors assumed that the recurred tumor could be a mixed type (germinoma and teratoma) of pineal tumor. Postoperative course was uneventful except for a transient disturbance of conjugate upward gaze and she was discharged on June 25, 1981. And now, there is no signs of recurrence 12 months after the second operation. Conclusively, it will be stressed that we should continue follow-up study the case even after total removal of teratoma, especially in the pineal region. Moreover, it was considered that there is a possibility of the changes of the histological features on recurrence of the pineal teratoma. When germinomatous compartment is suspected, irradiation is the first choice and then microsurgical operation should be done against residual tumor.

Brain Neoplasms↗
PubMed1992

Seizure recurrence in infants with neonatal convulsions. A follow-up study.

Twenty three infants with neonatal seizures were followed prospectively to a mean age of 11 months. Only 2 were pre-term and birth weight ranged from 1700 to 4230 grams, with 17 male and 6 female infants. Hypoxic-ischemic encephalopathy was the most common etiology (82.6%). Focal clonic convulsions were the predominant seizure type, present in 7/16 infants in which the seizure type could be identified. All infants had a neurological examination and EEG, and 18 had a cranial ultrasonography performed at the follow-up. Anticonvulsant medication was discontinued, if follow-up EEG and neurological examination were normal. At the follow-up, seizure recurrence was observed in 7/23 (30%) infants. Abnormal EEG, neurological examination and cranial ultrasonography were statistically correlated with seizure recurrence. We conclude that infants with neonatal seizures can remain free of anticonvulsant medication provided they have normal neurological examination, EEG and cranial ultrasonography.

Echoencephalography↗
PubMedDate not supplied

Growth retardation as the initial manifestation of intracranial tumors: report of two cases.

Two boys (9 years and 14 years old) were brought to visit our pediatric endocrine clinic with the chief complaint of short stature. Because of growth retardation, they were admitted for further evaluation. Physical examinations, including neurological examinations, were unremarkable but the laboratory examination confirmed the diagnosis of hypopituitarism in both patients. Skull radiography examinations showed some calcifications at suprasellar regions in the case 1 but negative findings in case 2. Furthermore, computed tomography (CT) of the head of case 2 performed at an outside hospital half a year before was reported to be normal, so case 2 fits the conventional diagnosis of idiopathic hypopituitarism. However, magnetic resonance image (MRI) study of the head disclosed that both of them are victims of an intracranial tumor, craniopharyngioma and germ cell tumors respectively. After surgical intervention, followed by radiotherapy, both patients were stable without any neurological deficit. Our experience confirmed that an MRI study of sellar region is warranted in search of the etiology of hypopituitarism.

Adolescent↗
PubMed1994

The effects of 4-aminopyridine in multiple sclerosis patients: results of a randomized, placebo-controlled, double-blind, concentration-controlled, crossover trial.

Because 4-aminopyridine (AP) improves residual deficits in some multiple sclerosis (MS) patients but has a narrow toxic-to-therapeutic margin, we compared the safety and efficacy of two target peak serum concentration ranges (low: 30 to 59 ng/ml and high: 60 to 100 ng/ml). We enrolled eight MS patients with temperature-sensitive visual and motor deficits in a randomized, placebo-controlled, double-blind, crossover trial of short-term oral AP treatment. We randomized patients to a sequence of three treatments on three separate days: placebo, low serum concentration, and high serum concentration. We determined dosing to achieve the desired steady-state peak serum concentration ranges from a test dose and population pharmacokinetic parameters using bayesian estimation. Contrast sensitivity, standard neurologic examination, ratings of videotaped neurologic examinations, and quantitative strength assessment all improved with treatment, but flicker fusion frequency, visual evoked response latencies, and Expanded Disability Status Scale scores did not. All patients experienced side effects during the high-serum-concentration arm. A grand mal seizure occurred at a serum AP level of 104 ng/ml, and an acute confusional episode occurred at 114 ng/ml. AP treatment produced improvements in residual deficits in MS patients, but the occurrence of significant toxicity suggests that AP serum levels should be monitored and peak levels above 100 ng/ml should be avoided. Concentration-control methodology may be useful in testing putative treatments for other neurologic diseases.

4-Aminopyridine↗
PubMed1995

Neurological 'soft' signs may identify children with sickle cell disease who are at risk for stroke.

UNLABELLED: Stroke is one of the most frequent complications of sickle cell disease (HbSS), occurring in 7-17% of children. Recent studies recognized more minor lesions on MRI, not associated with clinical signs on standard neurological examination, which however have been found to be a risk factor for developing stroke later. The aim of this study was to evaluate whether minor lesions observed on imaging could be associated with 'soft' neurological signs not detectable on conventional neurological examination. Fourteen children with HbSS were assessed with MRI, standard neurological examination and evaluation of 'soft' signs (Zurich Neuromotor Test) and motor function (Movement ABC). Eight of the 14 children scanned showed lesions on MRI but only 3 of the full cohort were abnormal on standard neurological examination. However, all of the eight children with MRI lesions also showed abnormal signs on at least one of the two tests (Zurich and Movement ABC). All the children with normal MRI were normal on all the tests performed. The sensitivity of Zurich Neuromotor Test and Movement ABC in the group of children with MRI lesions is 0.88 and 0.75, respectively, and increases to 1 when the two tests are used together. The specificity of both tests is 1 even when the tests are used separately. CONCLUSION: Although the number of cases is small, 'soft' signs may reliably identify the presence of even minor MRI lesions, allow the evaluation of the global incidence of major and minor neurological signs and may also help to identify the population at risk for developing strokes. This population could then be closely monitored and benefit from early intervention.

Adolescent↗
PubMed1984

Cerebral metastases from lung carcinoma: neurological and CT correlation. Work in progress.

To determine the role of brain CT in neurologically asymptomatic lung cancer patients, a review was made of the CT and clinical findings in 279 patients. Neurological status in these patients was categorized as (a) normal, (b) abnormal with specific signs and symptoms, and (c) abnormal with vague signs and symptoms. Brain metastases were found in 94.5% of patients (69/73) with specific abnormal neurological findings, 26.6% of patients (16/60) with vague neurological signs and symptoms, 11% of patients (10/92) with oat cell carcinoma and a normal neurological examination, and 40% of patients (8/20) with adenocarcinoma and a normal neurological examination. Brain metastasis was not seen on CT in the 29 patients with squamous cell carcinoma and a normal neurological examination. It is concluded that brain CT is useful for the detection of occult brain metastases, particularly oat cell carcinoma and adenocarcinoma, in neurologically asymptomatic lung cancer patients.

Adenocarcinoma↗
PubMed2002

Severe generalized dystonia due to primary putaminal degeneration: case report and review of the literature.

Putaminal lesions of a variety of etiologies may cause secondary dystonia. We report on a case of primary putaminal degeneration as a cause of severe childhood-onset generalized dystonia and review the literature of the pathology of dystonia. A 44-year-old patient with severe generalized childhood-onset dystonia and macrocephaly underwent neurological evaluation and neuropathological examination. Neurological examination was normal apart from dystonia and signs referable to prior cryothalamotomy. Workup for metabolic and genetic causes of dystonia was negative. Neuroimaging showed severe bilateral putaminal degeneration, which subsequently correlated with the neuropathological findings of gliosis, spongiform degeneration, and cavitation. The substantia nigra pars compacta contained a normal number of neurons but decreased tyrosine hydroxylase immunoreactivity. There were no histopathological markers of other metabolic or degenerative diseases.

Adult↗
PubMed1998

Dysphagia in stroke: a prospective study of quantitative aspects of swallowing in dysphagic patients.

This is a prospective study of 100 consecutive stroke patients. Within 24 h after stroke onset they were asked specifically about swallowing complaints and subjected to a clinical examination including neurologic examination, Mini-Mental test, and Barthel score. Dysphagic patients were examined with the repetitive oral suction swallow test (the ROSS test) for quantitative evaluation of oral and pharyngeal function at 24 h, after 1 week, and after 1 month. At 6 months, the patients were interviewed about persistent dysphagia. Seventy-two patients could respond reliably at 24 h after the stroke onset and 14 of these complained of dysphagia. Non-evaluable patients were either unconscious, aphasic, or demented. The presence of dysphagia was not influenced by age or other risk factors for stroke. Facial paresis, but no other clinical findings, were associated with dysphagia. Dysphagia 24 h after stroke increased the risk of pneumonia but did not influence the length of hospital stay, the manner of discharge from hospital, or the mortality. The initial ROSS test, during which the seated patient ingests water through a straw, was abnormal in all dysphagic stroke patients. One-third of the patients were unable to perform the test completely. Above all, dysfunction was disclosed during forced, repetitive swallow. All phases of the ingestion cycle were prolonged whereas the suction pressures, bolus volumes, and swallowing capacities were low. Abnormalities of quantitative swallowing variables decreased with time whereas the prevalences of swallowing incoordination and abnormal feeding-respiratory pattern became more frequent. After 6 months, 7 patients had persistent dysphagia. Five of these were initially non-evaluable because of unconsciousness, aphasia, or dementia.

Aged↗
PubMed2006

High prolactin levels as a worsening factor for migraine.

Many factors should be considered when an episodic migraine worsens and becomes chronic. Prolactin (PRL) was linked to the origin of pain in patients with microprolactinomas who developed different types of headaches. Our team carried out studies on 27 patients with a background of episodic headaches that became chronic. The patients were evaluated by means of a general examination, a neurological examination and a hormonal profile. Of the 27 patients, 7 of them had an increased level of prolactinaemia. All the patients were women, ranging from 17 to 57 years of age. Four of them had a pure form of migraine without aura, whereas 3 patients had both migraines without aura and tension-type headaches. They suffered from headache for a period ranging from 3 to 32 years and their headache became chronic 4-12 months prior to the visit. Their headache did not change in type, but only in severity and frequency. Two patients had no symptoms referable to high PRL levels; 4 patients had irregular menses or amenorrhoea. One of these patients also suffered galactorrhoea and two of these patients had a microprolactinoma at MRI; one patient was using estroprogestinic drugs, so her menstrual alteration could not be considered. The patients were followed-up for a period of 6-16 months. Six patients responded favourably after being treated with cabergoline, although some had already tried other drugs, which, however, had no effect on their headache. One patient improved after ceasing to take estroprogestinic, in spite of increased levels of PRL. Therefore, on this basis, PRL levels should always be considered when headache worsens. It is an adjunctive worsening factor, which can be easily eliminated.

Adolescent↗
PubMed1978

Fetal heart rate patterns and development in the first year of life.

The development of 50 high-risk infants who were provided intrauterine monitoring during labor was prospectively evaluated. Twelve infants had normal fetal heart rate patterns, 16 moderate-severe variable patterns, and 22 severe variable or late deceleration patterns. The parity, socioeconomic status, race of the mothers, and sex of the infants were similar in each group. The infants were examined neurologically 48 to 72 hours after birth and at 2, 4, 6, 9, and 12 months of age. Denver Developmental Standard testing was performed at 2, 4, 6, 9, and 12 months of age. A statistically significant developmental bias was seen favoring those infants with normal fetal heart patterns. Fetal heart rate patterns predicted abnormal performance more accurately than did Apgar scores. Although this data is incomplete, the duration of ominous fetal heart rate patterns appears to adversely affect development.

Apgar Score↗
PubMed1996

The lazaroid U74389G protects normal brain from stereotactic radiosurgery-induced radiation injury.

PURPOSE: To test an established model of stereotactic radiosurgery-induced radiation injury with pretreatments of either methylprednisolone or the lazaroid U74389G. METHODS AND MATERIALS: Nine cats received stereotactic radiosurgery with a linear accelerator using and animal radiosurgery device. Each received a dose of 125.0 Gy prescribed to the 84% isodose shell to the anterior limb of the right internal capsule. One animal received no pretreatment, two received citrate vehicle, three received 30 mg/kg of methylprednisolone, and three received 5 mg/kg of U74389G. After irradiation, the animals had frequent neurologic examinations, and neurologic deficits developed in all of them. Six months after the radiation treatment, the animals were anesthetized, and had gadolinium-enhanced magnetic resonance (MR) scans, followed by Evans blue dye perfusion, euthanasia, and brain fixation. RESULTS: Magnetic resonance scans revealed a decrease in the size of the lesions from a mean volume of 0.45 +/- 0.06 cm(3) in the control, vehicle-treated, and methylpredniosolone-treated animals to 0.22 +/- 0.14 cm(3) in the U74389G-treated group. The scans also suggested the absence of necrosis and ventricular dilatation in the lazaroid-treated group. Gross pathology revealed that lesions produced in the untreated, vehicle-treated, and methylprednisolone-treated cats were similar and were characterized by a peripheral zone of Evans blue dye staining with a central zone of a mature coagulative necrosis and focal hemorrhage. However, in the U74389G-treated animals, the lesions were found to have an area of Evans blue dye staining, but lacked discrete areas of necrosis and hemorrhage. CONCLUSION: These results suggest that the lazaroid U74389G protects the normal brain from radiation injury produced by stereotactic radiosurgery.

Animals↗
PubMed1996

Sequelae in long-term survivors of small cell lung cancer.

PURPOSE: Central nervous system (CNS) effects of chemotherapy and prophylactic cranial irradiation (PCI) are studied in long-term small cell lung cancer (SCLC) survivors. The exact significance and pathogenesis of the neurotoxicity is still unknown, as studies on this subject lack sufficient patient numbers and are performed in an extremely varied manner. METHODS AND MATERIALS: Fifty-nine survivors (> 2 years from diagnosis) were examined neurologically and neuropsychologically, and underwent a cranial computer tomography (CT) scan or magnetic resonance (MR). Eight patients were excluded from further analysis for various reasons (not SCLC-related CNS disease, n = 6; no chemotherapy nor PCI treatment, n = 2). The remaining 51 patients were divided into three groups; group 1 = chemotherapy alone (n = 21), group 2 = sequential PCI (n = 19), and group 3 = concurrent or sandwiched PCI (n = 11). Groups were neuropsychologically compared in matched controls. RESULTS: Performance status did not differ significantly between various treatment groups; all patients remained ambulatory and capable of self-care. Mental impairment (n = 20), motor abnormalities (n = 9), and visual complaints (n = 1), were found in five patients in group 1 (24%), eight patients in group 2 (42%), and eight patients in group 3 (73%). Analysis of brain atrophy revealed no significant results; however, white matter abnormalities were found more frequently in group 3. Neuropsychologically no significant group differences existed, although interference sensitivity and difficulties with divided attention tended to occur more frequently in patients treated with PCI. Mean neuropsychometric results of treatment groups were significantly worse than those of matched controls. CONCLUSIONS: Although more intensively treated patients showed more neurologic impairment and patients in group 3 had more white matter abnormalities, there was no statistic evidence for additional neurotoxicity of PCI. Marked neuropsychometric differences between patients and matched controls may indicate that cognitive impairment is partly disease related, probably due to emotional distress and deteriorated physical condition.

Atrophy↗