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PubMed1998

Neurodevelopmental profile in low-risk preterm infants at 5 years of age.

The goal of this study is to determine the neurodevelopmental profile of a group of low-risk preterm infants and to determine whether the potentially unfavourable outcome is due to a few infants with moderate to severe impairments or to a majority of infants with only slight impairments. In a prospective study 44 low-risk preterm infants, i.e. infants with a neonatal risk score indicating a favourable outcome, born between 25-34 weeks gestational age, and 18 healthy term infants were examined neurologically and tested neuropsychologically at 5 years of age. The more unfavourable outcome in the group of low-risk preterm infants compared with the term infants was largely attributable to a poorer outcome in 12 of the 44 low-risk preterm infants. The remaining low-risk preterm infants showed similar test scores compared with the term infants. From these results we conclude that the unfavourable neurodevelopmental outcome of low-risk preterm infants is due to moderate to severe impairment in a few low-risk preterm infants, rather than slight impairment in the majority. The low-risk preterm infants with an unfavourable outcome showed particular impairment on measures of visual-motor integration, concentration and auditory memory in combination with integrative functions.

Birth Weight↗

PubMed2004

Eosinophilic meningitis in a child raising snails as pets.

The rat lungworm (Angiostrongylus cantonensis) is the principal cause of eosinophilic meningitis or meningoencephalitis worldwide. It is endemic in Taiwan and the Asia Pacific area. We report the case of a 10-year-old boy who was referred to us suffering from intermittent headache, low-grade fever and blurred vision of 4-5 days' duration. He had been treated for gastroenteritis just prior to referral. The patient's history was unremarkable, except that he raised snail (Ampullarium canaliculatus) as pet at home. On physical examination, the patient's consciousness was alert and well oriented. No papilledema was found on fundal examination. The neurological examination revealed normal cranial nerve function, mild weakness of both lower limbs and normal deep tendon reflexes, but positive Babinski and Kernig signs. Laboratory findings showed peripheral eosinophilia, elevated immunoglobulin E level, cerebrospinal fluid eosinophilic pleocytosis and the presence of stage 3 A. cantonensis larvae, which confirmed the diagnosis of eosinophilic meningitis. A 2-week course of mebendazole combined the glucocorticosteroids was beneficial in relieving headache, paresthesia and the other eosinophilic meningitis symptoms in the patient.

Angiostrongylus cantonensis↗

PubMed1997

The content and efficacy of conventional methods of follow-up in neuro-oncology: the need for new strategies.

In a combined retrospective and prospective analysis, we examined the content and outcome of conventional follow-up of patients with malignant brain tumours. Most consultations consisted of discussion and advice from the clinic doctor or nurse in certain well defined areas. Clinical examination, including neurological examination, was ineffective at detecting tumour recurrence. All recurrences presented with clinical features noted by the patient or by carers prior to the clinic attendance. The analysis of content and outcome of conventional outpatient consultation suggests that patients with high grade gliomas might be better served by methods of follow-up other than routine hospital attendance. There is a need to develop new follow-up strategies which are patient orientated and which address issues specific to the disease type other than tumour recurrence alone.

Brain Neoplasms↗

PubMed1997

Neurologic findings in coronary artery bypass patients: perioperative or preexisting?

OBJECTIVES/DESIGN: This prospective study compares the incidence of preexisting neurologic findings in elective cardiac surgery patients presenting with and without coronary atherosclerosis. SETTING: This single-center study was conducted at a tertiary care hospital. PARTICIPANTS/INTERVENTIONS: After Review Board approval and obtaining written informed consent, 11 patients undergoing valvular heart surgery, 9 patients undergoing similar valvular procedures with concomitant coronary artery bypass surgery, and 4 patients undergoing coronary artery bypass surgery alone were enrolled. Preoperatively, all patients underwent a structured neurologic assessment, and the latter four additionally had preoperative magnetic resonance imaging. MEASUREMENTS AND MAIN RESULTS: The patients, 9 of 24 of whom were female, were aged 46 to 78 years and, other than ischemic heart disease, had medical histories that were similar between groups, with the exception of one patient having scleroderma. None of the patients had a clinical history of neurologic or cerebrovascular disease. Nine percent (1 of 11) of the valve-only patients showed subtle preoperative neurologic abnormalities, compared with 89% (eight of nine) of the valve patients having concomitant coronary surgery and 100% (four of four) of coronary artery bypass-only patients. Additionally, brain imaging scans of all four coronary bypass patients showed nonspecific changes reported as scattered punctate areas of high signal less than 3 to 4 mm in diameter. CONCLUSION: This survey shows that both subtle neurological abnormalities and magnetic resonance imaging lesions can be found in a high percentage of patients with coronary atherosclerosis. Furthermore, this study indicates that without a standardized preoperative neurological examination, postoperative neurologic dysfunction cannot necessarily be ascribed to perioperative events.

Aged↗

PubMed1981

Clinical investigations of intermittent breathy dysphonia.

Case history and voice data for 17 patients who presented with intermittent moments of breathy dysphonia (IBD) in contextual speech were analyzed. From recorded samples of vowel prolongation four variants of phonation were identified. Of 13 patients examined neurologically, 10 (77%) had positive neurologic signs. Psychiatric and physical illnesses were often associated with onset of the voice disorder. Sex ratio of the patients in this study was nearly the same as that for adductor spastic dysphonia. Age at onset was similar to that which has been described for "functional" voice disorders. Different therapies were generally ineffective in alleviating the disorder. Although not conclusive, patients presenting with IBD in connected speech may have an underlying neurologic or psychologic disorders.

Adolescent↗

PubMed1993

[Whiplash trauma of the cervical spine from the neurosurgical, traumatologic and psychologic viewpoint].

Since the early 50's, whiplash injury has been a subject of intensive study in order to find out the genesis of this disease. Unfortunately, most of the studies were planned retrospectively and were based on inhomogeneous groups of patients. In our prospective study, we tried to keep the patient group homogeneous. 62 patients were examined neurologically and radiologically immediately after the accident. Furthermore, they underwent a psychological test, the so-called Freiburg personality profile. 6 months later the patients were checked again. On the basis on our findings, the suspected psychological influence has to be confirmed. Preexisting degenerative lesions of the cervical spine, also, are undoubtedly prognostic for longer-lasting symptoms.

Adult↗

PubMed2001

Clinical experience with iomeprol in myelography and myelo-CT: clinical pharmacology and double-blind comparisons with iopamidol, iohexol, and iotrolan.

RATIONALE AND OBJECTIVES: To evaluate iomeprol, a new nonionic iodinated contrast medium, as a contrast agent for myelography and to compare it with iopamidol, iohexol, and iotrolan. METHODS: An extensive clinical program was conducted on more than 600 patients to assess iomeprol's pharmacokinetics, tolerability, safety, and efficacy after intrathecal injection. RESULTS: Pharmacokinetics study results showed that after intrathecal administration iomeprol is completely absorbed from the cerebrospinal fluid compartment; once absorbed into the systemic circulation, it is rapidly excreted, unmetabolized, by glomerular filtration. Dose-finding studies showed that the opacification produced by iomeprol depends on the injected dose. Although a dose-dependent increase in efficacy was observed, no differences in neurotolerability and safety were detected between the doses tested. Doses of iomeprol greater than 3 g I did not cause a greater incidence of adverse events and produced significantly better contrast efficacy. Comparative clinical trials showed that iomeprol and iopamidol, iohexol, and iotrolan always provided adequate opacification of the subarachnoid space, both in conventional myelography and myelo-CT, with adequate delineation of normal structures and pathologic processes. No serious adverse events occurred up to a total dose of 4.5 g I. No differences between the agents with regard to tolerance, adverse events, and effects on vital signs, physical examination, and neurologic examination were observed. CONCLUSIONS: Iomeprol is safe and effective and can be recommended for myelography and myelo-CT.

Adult↗

PubMed1999

Effects of postischemic halothane administration on outcome from transient focal cerebral ischemia in the rat.

This study examined the effect of prolonged postischemic halothane administration on outcome from transient focal cerebral ischemia in rats. Conscious normothermic rats were subjected to 75 minutes of filament middle cerebral artery occlusion (MCAO). Animals were then divided into two groups. The Awake group (n = 15) remained awake following ischemia. The Halothane group (n = 15) received 1.3-1.4% halothane for 5 hours after onset of recirculation. In both groups, brain temperature was maintained at 37.5 degrees C during ischemia and the first 22 hours of recovery. Seven days after ischemia, the severity of hemiparesis and cerebral infarct size were examined. Neurologic scores did not differ between groups (Awake = 1+/-2.75; Halothane = 2+/-2; p = 0.772, median +/- interquartile range). Neurologic scores and total infarct volumes were correlated (R = 0.653; p = 0.0004). Cortical (Awake = 76+/-57 mm3; Halothane = 90+/-57 mm3; p = 0.494, mean +/- standard deviation), subcortical (Awake = 71+/-33 mm3; Halothane = 80+/-35 mm3; p = 0.472), and total (Awake = 147+/-88 mm3; Halothane = 171+/-91 mm3; p = 0.477) infarct volumes were not significantly different between groups. The data indicate that postischemic halothane administration offers no benefit in ameliorating damage from focal cerebral ischemia. This suggests that the neuroprotective effect of halothane observed in other studies is consistent with influences on intra-ischemic pathophysiology only.

Anesthesia, Inhalation↗

PubMed1998

A preliminary analysis of incidence of dementia in Shanghai, China.

The incidence of dementia based on DSM-III criteria and the impact of age and education on the development of dementia using the data of a longitudinal community population survey is discussed. Study subjects were randomly sampled from the community and were assessed by a two-stage procedure twice during a 5-year period. The screening instrument was the Mini-Mental State Examination and the second stage measures include a medical history and physical examination, a neurological examination and an intensive neuropsychiatric interview and testings (i.e. Blessed Dementia Scale, Activity of Daily Living, Fuld Object Memory Test and Block Design Test. All identified cases from the second stage interview were further verified by computed tomographic scan and laboratory tests. A total of 1970 subjects of non-dementia aged 65 or older in 1987 were re-surveyed after 5 years, of whom 114 new cases of dementia were identified. The incidence of dementia in total was 1.15% annually, 0.98% for males and 1.27% for females. The incidence for Alzheimer's disease, vascular dementia and dementia by other causes was 0.74, 0.33 and 0.08%, respectively. The highest rate (2.02%) was found in illiterate individuals. The incidence of dementia in the Shanghai cohort is similar to that from other countries. Age and education are closely related to the occurrence of dementia. While age increases by each 5 years for those aged 65 and over the likelihood of developing dementia increases nearly one-fold (74%). Education shows great protective effect on the development of dementia. The non-educated has a higher risk of suffering from dementia than does the educated.

Aged↗

PubMed1991

Physician practices in the diagnosis of dementing disorders.

Because there are both treatable and untreatable causes of dementia, the physician's ability to conduct (or refer a patient for) a differential diagnosis could have a profound effect on health outcomes for patients and on health care costs. This study was undertaken to assess physician practices with regard to the diagnosis of dementing disorders. Data from 53 physicians (a response rate of 48%) in several specialties were obtained from a self-administered mail questionnaire. Results indicate that the majority of physicians provided history taking, physical examination, and neurological examination. Physicians were more likely to refer patients for psychiatric and neuropsychological examinations than to provide these services themselves. The results also point to deficiencies in two key areas: the use of formal, published diagnostic criteria, and the use of mental status and cognitive function tests. Over 75% of physicians surveyed did not use either DSM-III or NINCDS-ADRDA diagnostic criteria, and 42% of physicians did not provide any mental status tests themselves. The need for continuing education to close knowledge gaps is emphasized.

Aged↗

PubMed1991

Familial narcolepsy in Finland.

Five patients with narcolepsy-cataplexy (aged 31-69, mean age at onset 15 years) and their 47 relatives were examined. They were interviewed in detail, all patients and 16 relatives (including all symptomatic cases) were examined neurologically and a multiple sleep latency test and HLA-typing were done. One case of narcolepsy and two cases of idiopathic hypersomnia were identified. All the other 45 relatives were symptom-free. The observed rate of familial cases (1/5 for narcolepsy and 2/5 for idiopathic hypersomnia) corresponds the results of other recent studies.

Adult↗

PubMed1997

Neuropsychological, psychiatric, and cerebral perfusion correlates of leukoaraiosis in Alzheimer's disease.

OBJECTIVE: To examine neurological, neuropsychological, psychiatric, and cerebral perfusion correlates of leukoaraiosis in Alzheimer's disease. METHODS: A consecutive series of patients with probable Alzheimer's disease was assessed with a comprehensive neuropsychological battery, a structured psychiatric evaluation, the unified Parkinson's disease rating scale, MRI, and single photon emission computed tomography with technetium 99m hexamethylpropyleneamine oxime (HMPAO) and regional cerebral perfusion measurements. RESULTS: Patients with Alzheimer's disease and leukoaraiosis were significantly more apathetic and had significantly more extrapyramidal signs than patients with Alzheimer's disease without leukoaraiosis. Patients with Alzheimer's disease with leukoaraiosis also had significantly lower bilateral perfusion in the basal ganglia, thalamus, and frontal lobes than patients with Alzheimer's disease without leukoaraiosis. On the other hand, there were no significant differences between groups in age, duration of illness, depression scores, severity of delusions, or deficits on specific neuropsychological tasks. CONCLUSIONS: Leukoaraiosis in Alzheimer's disease may produce significant basal ganglia, and thalamic and frontal lobe dysfunction, which may be associated with more severe apathy and extrapyramidal signs.

Aged↗

PubMed2004

Disabling foot cramping in a runner secondary to paramyotonia congenita: a case report.

An 18-year-old male runner was referred to the authors' clinic with a 1-year history of cramping left foot pain. His symptoms developed insidiously when he increased his training, with an onset of severe left foot pain and tightness that would develop after about 20 minutes of exercise. The more he continued to run, the more the symptoms were aggravated and evolved to the toes curling with intrinsic muscle spasm. This symptom was easily provoked when he was exposed to cold temperature. A family history of similar symptoms was revealed in his sister and uncle. Physical examination including neurologic examination was normal. Diagnostic workup revealed generalized myotonia. According to the history, physical examination, and diagnostic workup, his diagnosis was considered to be most compatible to paramyotonia congenita. He was given phenytoin, which lessened his symptoms and allowed him to continue running with minimal symptoms, but he stopped running because he was not able to maintain mileage high enough to compete successfully.

Adolescent↗

PubMed1996

Blood-Brain Barrier Integrity in HIV Infection:Evaluation by Contrast-Enhanced Magnetic Resonance Imaging.

This study assesses the integrity of the blood-brain barrier (BBB) in human immunodeficiency virus (HIV) seropositive individuals to magnetic resonance imaging (MRI) contrast agent Gd-DTPA. Twelve HIV seropositive patients and six control subjects had T2-weighted and serial pre- and post-contrast TI-weighted MRI. Ten of the twelve seropositive patients demonstrated white matter hyperintensity with or without atrophy on T2-weighted MRI and 8/10 who underwent neurological examination demonstrated neurological abnormalities. No statistically significant differences of trends in white matter pixel values were observed between pre- and post-contrast scans in any of the patients or controls. Serial T1-weighted MRI does not demonstrate any change in the integrity of the BBB to Gd-DTPA in HIV seropositive patients, regardless of the presence or absence of white matter hyperintensity with or without atrophy on T2-weighted MRI or clinical signs of HIV-I associated with cognitive/motor complex.

Blood-Brain Barrier↗

PubMed1984

Detection and exclusion of alcoholism in men on the basis of clinical laboratory findings.

Alcoholism is a common disease; it is found in 10% to 15% of all patients admitted to general hospitals. There is no single characteristic finding, but on the other hand, changes as compared with normal values have been reported in the literature for more than 30 frequently assayed clinical chemical and haematological parameters. In the project reported here all 24 clinical chemical parameters and all 8 haematological parameters frequently assayed were studied in each of 82 hospitalized men with a confirmed diagnosis of alcoholism. The diagnosis of alcoholism was made on the basis of the Munich Alcoholism Test (MALT) together with the following standardized assessments and examinations: past history, an alcohol questionnaire, general physical examination and neurological examination. All forms were filled in completely. All steps in the clinical laboratory investigations were standardized, and all were subject to ongoing reliability control. The clinical problem is usually not to differentiate alcohol abusers or alcoholics from healthy persons but rather to identify the alcoholics among a population of patients with a variety of illnesses. For this reason 70 patients from two hospitals who were clearly neither alcohol abusers nor alcoholics were studied in exactly the same manner as the alcoholics. In this combined group of 152 hospitalized patients significant differences were found in the distribution of the values for the alcoholics and the non-alcoholics for the following clinical chemical and haematological parameters: at the 0.1% level gamma-glutamyltransferase, aspartate aminotransferase, urea, creatinine and mean corpuscular volume (MCV), and at the 1% level glutamate dehydrogenase, alanine aminotransferase and alkaline phosphatase. From these eight parameters those combinations of between two and six parameters were selected that discriminated best between the alcoholics and the non-alcoholics. Using conventional decision limits the following was found: For the alcoholics two or more of the results for the following five parameters were outside the decision limits given in parentheses: gamma-glutamyltransferase (greater than or equal to 28 U/l), aspartate aminotransferase (greater than or equal to 18 U/l), alanine aminotransferase (greater than or equal to 22 U/l), MCV (greater than or equal to 96 fl), creatinine (less than or equal to 66.3 mumol/l). The diagnostic sensitivity (alcoholics) is 85%, the diagnostic specificity (non-alcoholics) is 64%.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1977

[Cerebrospinal fluid in the healthy preterm newborn infant].

The cerebrospinal fluid (CSF) composition was studied in 54 premature infants. The pregnancy was normal and the delivery normal and non traumatic in all of them, and the 5 minutes Apgar score ranged from 6 to 9. No abnormalities were found on physical examination including neurological examination. Blood cell countings and blood gasometry were normal. CSF composition was studied as to: total cell count and total protein, glucose, bilirrubin and hemoglobin concentrations. Data found permit to stablish as physiologic the following values: leucocytes, until 16 per cumm; erithrocytes, until 1,280 per cumm; total protein content until 300 mgm/100 ml; bilirrubin until 80 micrometer/1; hemoglobin until 8 micrometer/1; glucose, two thirds of the concentration found in the blood. Protein, bilirrubin and hemoglobin are significantly increased as compared to values found for the CSF of 79 fullterm normal newborn babies evaluated previously. Hemoglobin was not detected in the CSF of any full term newborn baby. The differences found are probably due to a less efficient blood-CSF barrier in premature infants as compared to full-term newborn babies.

Cerebrospinal Fluid↗

PubMed2005

[Attention-deficit hyperactivity disorder comorbidity in a school sample of children].

OBJECTIVE: To evaluate the frequency of conduct disorder (CD), oppositional defiant disorder (ODD) and obsessive-compulsive disorder (OCD) in children with attention-deficit hyperactivity disorder (ADHD). METHOD: This study was performed with children between 7 and 11 years old who fit the DSM-IV diagnostic criteria (n=35) to ADHD, normal neurologic examination and abnormal evolutionary neurological examination (ENE) by Lefèvre. Parents answered a questionnaire with DSM-IV criteria to ADHD and comorbidities. RESULT: ADHD combined subtype was the most prevalent (51.4%). Fourteen (40%) had CD, including two with both CD and OCD. Five (14.2%) had only ODD and one (2.8%) only OCD. Eleven of fourteen children (78.5%) with CD had also ADHD combined subtype, with significant statistical difference (p<0.05). Eleven of fifteen children (73.3%) without comorbidity had inattentive or hyperactive subtype (p<0.05). CONCLUSION: The frequency of association between CD and ADHD was high, much more in combined subtype.

Attention Deficit Disorder with Hyperactivity↗

PubMed2006

[Vascular risk factors in healthy population in the repeated screening examinations].

UNLABELLED: An epidemiological study on vascular risk factors have been repeated two times in a two years interval in a cohort of 4511 healthy subjects. The participants in this study were volunteer members of Dimenzio Health Insurance. METHODS: Data on life style, family history of vascular diseases have been documented. Detailed physical examination including neurological examination and structured questionnaire on stress and related problems, blood glucose, and cholesterol level, carotid Doppler ultrasound and ECG examinations made complete this screening program. RESULTS: Blood pressure, total cholesterol, glucose level increased steadily and significantly by age. Significant differences between male and female groups have been noted in favor of females in all age groups. In subjects having positive family history of vascular diseases, all the blood pressure, cholesterol and glucose level were significantly higher as in the sex and age matched subjects with negative family history. Comparing the dataset of two consecutive screening periods, the average value of blood pressure of different age groups did not increase, even decreased in the older age groups. Smoking habit is also decreased. Interestingly enough the cholesterol level increased significantly in all age groups by the time of second examination. CONCLUSION: Stressful life has been reported mostly by females. The frequency of stress increased significantly by the two years lapsed between the two data collections. Parallel with the stress frequency consumption of antidepressants and anxiolytics increased significantly. The average blood pressure of subjects with stressful life was significantly higher compared to subjects without stress. This cohort study is the first in this country in which we used repeatedly a screening program for identifying high risk subjects, or high risk age groups in a healthy population. Data subtracted from this study could support a prevention strategy.

Adolescent↗