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PubMed1987

[Diagnosis and therapy of female incontinence].

The different types of urinary incontinence in the female are defined and described. A meticulous differential diagnosis is a prerequisite for adequate treatment. The pre-treatment examination includes a detailed history, a residual urine, a gynaecological examination, a neurological examination, an intravenous pyelogram, the incontinence test, the Bonney and Bethoux tests, and a urethrocystoscopy. In difficult cases urodynamic tests and X-rays of the bladder and the pelvic organs are added to the workup. Two types of incontinence can be differentiated. We recommend to manage type 1 with an anterior vaginal repair or with colposuspension. Type 2 should be treated with colposuspension and if necessary vaginal repair or levatorplasty. Recurrences should be managed always with colposuspension. It is stressed that after correction of incontinence bladder outlet obstruction can occur.

Female↗
PubMed1978

[The differential diagnosis of female urinary incontinence (author's transl)].

The different types of urinary incontinence in the female are defined and described. A meticulous differential diagnosis is a prerequisite for adequate treatment. The pre-treatment examination includes a detailed history, a residual urine, a gynaecological examination, a neurological examination, an intraveinous pyelogram, the incontinence test, the Bonney and the Bethoux tests, and a urethro-cystoscopy. In difficult cases urodynamic tests and X-rays of the bladder and the pelvic organs are added to the workup. Among 54 patients with urinary incontinence, 31 had stress incontinence and 23 had incontinence of another cause such as detrusor instability or a urethral syndrome.

Cystoscopy↗
PubMed1984

Excessive consumption of alcohol in men as a biological influence factor in clinical laboratory investigations.

It is known that excessive alcohol consumption leads to changes in clinical chemical and haematological parameters that are reversed to a greater or lesser degree after alcohol consumption ceases. Such factors that lead to changes in vivo in the parameters studied are termed biological influence factors. In the study reported here the biological influence factor "excessive alcohol consumption" was assessed in its most severe form, namely alcoholism. To this end 24 clinical chemical parameters and 8 haematological parameters were studied in 82 male alcoholics. The diagnoses of alcohol abuse and alcoholism were made on the basis of the Munich Alcoholism Test (MALT) and the information obtained in the following standardized interviews 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. In the comparison of the analytical results for the alcoholics with reference intervals for healthy persons (normal ranges) the following alterations were found, the percentage of the alcoholics being given in parentheses. (Table: see text) Furthermore, the result was below the location parameter of the reference sample group for: Urea (80%) Thus excessive alcohol consumption is clearly a biological influence factor that must be taken into consideration in the medical assessment of analytical results for numerous clinical chemical and haematological parameters. In determining reference values and reference intervals for the transverse assessment of analytical results for these parameters it is therefore absolutely essential that subjects with excessive alcohol consumption be excluded from the reference sample group. According to the present data, alcoholism can be neither detected nor excluded by evaluating a single parameter, i.e. on the basis of only one clinical chemical finding.

Adult↗
PubMed1981

How can we avoid unnecessary CT scanning for psychiatric patients.

We studied 135 psychiatric patients who had CT scans of the brain in addition to psychiatric mental status examination (ME), neurological examination (NE), EEG and Canter's Background Interference Procedure for the Bender Gestalt Test (BIP). The results suggested that CT scans were unnecessary in about a quarter of these patients. Those who had normal ME, NE, EEG and BIP could safely be excluded. Those who had normal ME and NE but abnormal BIP or EEG could also be excluded if they were 40 years or younger with no history of head injury.

Adolescent↗
PubMed1993

Visual functions in relation with neonatal cerebral ultrasound, neurology and cognitive development in very-low-birthweight children.

In order to determine the relationship between visual functions and neonatal cerebral ultrasound, neurological examinations and cognitive development, a prospective longitudinal study was conducted in 69 high-risk very-low-birthweight children. Visual development was studied at 1 and 2.6 years of corrected age by assessment of visual acuity, binocular visual fields, optokinetic nystagmus and strabismus. Visual impairments were found in 33% at age 1 and in 28% at age 2.6. Visual impairments were related to intraparenchymal damage, as detected by neonatal cerebral ultrasound, as well as to abnormal neurological examinations and lower mean developmental indices. A stepwise multiple regression analysis with neonatal cerebral ultrasound as the dependent variable and visual functions at ages 1 and 2.6 and neurological examinations at ages 1 and 2 as independent variables, however, demonstrated that standardized neurological examinations were better markers of neonatal cerebral damage than visual functions. In cognitive development at ages 1 and 2, the neurological examination at age 1 was the most important variable. In cognitive development at age 3.6, visual functions at age 2.6 were more important. Early visual impairments might thus influence later cognitive development. The effectiveness of appropriate early intervention strategies to stimulate visual and cognitive development in infants with less severe visual impairments should be subject to further study.

Brain↗
PubMed1996

Prospective optimization of patient selection for emergency cranial computed tomography: univariate and multivariate analyses.

RATIONALE AND OBJECTIVES: To determine if the clinical variables that are important for selecting patients for emergency cranial computed tomography (CT) are population dependent. METHODS: Prior to obtaining scans, physicians working in an emergency department in a level II trauma center completed a form describing the indication for the CT examination. These data were matched to the CT scan results and analyzed statistically using univariate and multivariate methods. These results were compared with a prior study at a level I trauma center. RESULTS: Of 551 patients having cranial CT, neurologic examination was positive in 340 and CT scan was positive in 122. The neurologic examination correlated strongly with the results of the CT scan (P < 0.00001). In this patient population, the most important clinical predictors of 17 abnormal CT scans from the 211 patients without positive neurologic examinations were seizure and a history of neoplasm. These high-yield variables differ from our prior retrospective study in which intoxication and amnesia were the important predictors in patients with negative examinations. The difference in predictors between the populations most likely results from different prevalences of trauma and ischemic disease. CONCLUSIONS: Abnormal neurologic examination is the most important criterion available to select patients for emergency cranial CT. Other variables (eg, seizure, amnesia, intoxication, and history of neoplasm) that help select patients without neurologic findings appear to be population dependent.

Brain↗
PubMed1988

Prediction in very preterm infants of satisfactory neurodevelopmental progress at 12 months.

This study was performed to find out how well ultrasound brain-scanning and neurological examination of very preterm infants, together and separately, predicted normal neurodevelopmental progress at 12 months corrected age. 111 infants born at less than 33 weeks gestation were scanned at discharge from the neonatal unit, and neurological examinations were performed at a gestation-equivalent age at or near term. During the first year of life repeated neurological and developmental testing was carried out. At 12 months a diagnosis of normal progress or of major or minor neurodevelopmental disorders was made. 56 (50 per cent) infants with both a favourable ultrasound scan and normal neurological findings had a 98 per cent (90 to 99 per cent) probability of normal progress at 12 months, and a 100 per cent (93 to 100 per cent) probability of having no major disorder. Separately, ultrasound scanning and neurological examination were not such good predictors of normal outcome, although they selected larger groups of infants with high probabilities of progressing normally. Ultrasound brain-scanning and neurological examination can be used in combination to identify potentially normal preterm infants when they are discharged to their homes.

Central Nervous System↗
PubMed2003

Neurological assessment at five years of age in infants born preterm.

AIM: To evaluate the agreement between Touwen's neurological examination and a derived simplified one, created to be applied at the age of 5 y to infants born preterm. METHODS: 185 children born at a gestational age (GA) of <33 wk and/or with a birthweight <1501 g, free of cerebral palsy, underwent Touwen's neurological examination at a mean age of 5 y and 8 mo (5-6.5 y). One-hundred and seventy had a full examination and were included into the study. They were born at a mean GA of 30 wk (range 24-35 wk) with a mean birthweight of 1250 g (range 600-2690 g). A simplified examination, based on the clinical experience of two of the authors, was created a priori. The data were reviewed retrospectively and the concordance between the two forms was assessed. The reviewers were blinded to the original categorization from the long form. RESULTS: On the basis of the original Touwen's neurological examination, the 170 children were classified into 122 with a normal neurological examination, 41 with grade 1 minor neurological dysfunction (MND) and 7 with grade 2 MND, giving 28% of the cohort with MND. The concordance between the two forms was excellent, with an agreement in 169 out of 170 subjects. None of the infants with the most complex form of MND was misclassified. CONCLUSION: The simplicity of this examination could allow its diffusion and its use in follow-up programmes. It could improve the quality of routinely collected follow-up data of preterm neonates.

Birth Weight↗
PubMed1979

Computed tomography and childhood seizure disorders.

Computerized tomography (CT) was performed on 256 children with seizure disorders. The incidence of abnormal scans was closely related to seizure type, and permitted separation of patients into a low-yield and a high-yield group. Low-yield groups included children with idiopathic generalized seizures, children in whom both the neurologic examination and electroencephalogram (EEG) were normal, and children with a generalized seizure of unknown etiology in whom the neurologic examination and the EEG were normal. The high-yield groups included children with partial seizures with elementary symptomatology, partial seizures with complex symptomatology, generalized seizures with known etiology, neonates with seizures, and children whose seizures began as neonates. The overall incidence of abnormalities in the entire group was 33 percent. An abnormal neurologic examination increased the incidence of abnormal CT scans to 64 percent. EEGs were abnormal in 65 percent of the children, but only focal slowing resulted in a significant increase in the incidence of abnormal CT scans. Seven children (2.7 percent) had intracranial abnormalities requiring surgery. If the neurologic examination and EEG were normal, the yield of abnormal CT scans was only 5 percent of the total.

Adolescent↗
PubMed2002

A pilot study of cidofovir for progressive multifocal leukoencephalopathy in AIDS.

OBJECTIVE: To assess the safety, tolerability and effect of cidofovir for HIV-1 associated progressive multifocal leukoencephalopathy. DESIGN: Prospective, open-label study in nine AIDS Clinical Trials Units. PATIENTS AND METHODS: Twenty-four HIV-1-infected individuals, with neuroimaging and clinical findings consistent with PML, and symptoms for 90 days or less, whose diagnosis was confirmed by the detection of JC virus DNA in the cerebrospinal fluid or brain biopsy, received cidofovir 5 mg/kg intravenously at baseline and 1 week, followed by infusions every 2 weeks with the dose adjusted for renal function. Follow-up continued to 24 weeks. The safety of cidofovir and changes in neurological examination scores between baseline and week 8 were assessed. RESULTS: Seventeen subjects were receiving potent antiretroviral agents. Survival at 12 weeks was 54%. The CD4 cell count at entry was significantly associated with survival (P = 0.02). Five subjects discontinued treatment because of toxicity: a 50% or greater decrease in intraocular pressure in either eye in four, and proteinuria in one. Overall, magnetic resonance imaging abnormalities and neurological examination scores worsened. Only two subjects experienced a 25% or greater improvement in neurological examination scores at week 8, which were significantly better in subjects with HIV-1-RNA levels of 500 copies/ml or less at entry compared with those with HIV-1-RNA levels over 500 copies/ml (P = 0.05). CONCLUSION: Cidofovir did not improve neurological examination scores at week 8. However, such scores were significantly better in subjects who entered with suppressed plasma HIV-1-RNA levels, which could be the result of control of HIV-1 infection itself or cidofovir.

Adult↗
PubMed1999

Plasma glucose alone does not predict neurologic dysfunction in hypoglycemic nondiabetic subjects.

STUDY OBJECTIVE: To assess the value of plasma glucose concentration alone as a predictor of neurologic dysfunction in nondiabetic subjects with normal baseline neurologic examination and electroencephalographic (EEG) findings. METHODS: Neurologic function and EEG results were evaluated in 17 subjects before and during insulin-induced hypoglycemia using relevant and reliable clinical tools for bedside use. RESULTS: Hypoglycemia (mean nadir concentration, 30 mg/dL) was without effect on level of consciousness or cranial nerve, motor, sensory, vestibulocerebellar, language, or simple visuospatial functions. Attention was minimally impaired in all subjects, but memory in only 3. EEG results remained normal in 5 subjects; minimal to moderate nonspecific changes occurred in the rest. All patients manifested signs of sympathetic stimulation from hypoglycemia, including tremor, tachycardia, and diaphoresis. The manifestations of neuroglycopenia did not correlate significantly with nadir plasma glucose or duration of hypoglycemia. CONCLUSION: Moderately severe hypoglycemia of short duration can be neurologically occult, or subtle inattention can be its first and only clinical manifestation. Our findings are at variance with reports in the emergency medicine literature in which marked deficits are universally present at glucose concentrations equal to those attained in this study. This discrepancy suggests that the expression of neuroglycopenia is multifactorially determined and that plasma glucose concentration alone does not predict neurologic dysfunction in nondiabetic subjects with normal baseline neurologic examinations.

Adult↗
PubMedDate not supplied

Central nervous system effects of chronic toluene abuse--clinical, brainstem evoked response and magnetic resonance imaging studies.

We describe the results of neurological evaluation, magnetic resonance imaging (MRI) of the brain and brainstem auditory evoked response (BAER) testing in 11 chronic toluene vapor abusers. Neurological abnormalities were seen in four of 11 individuals and included cognitive, pyramidal, cerebellar and brainstem findings. MRI of the brain was abnormal in three of 11 individuals and revealed the following abnormalities: 1) Diffuse cerebral, cerebellar, and brainstem atrophy; 2) Loss of differentiation between the gray and white matter throughout the CNS; and 3) Increased periventricular white matter signal intensity on T2 weighted images. BAERs were abnormal (control mean +/- 3 S.D.) in five of 11 individuals. As a group, the latency of V (p less than 0.01), the III-V interpeak (p less than 0.05) and the I-V interpeak latencies were prolonged compared to controls. All three individuals with abnormal MRI scans also had abnormal neurological examinations and BAERs. Two of five individuals with abnormal BAERs, however, had normal neurological examinations and MRI scans. Our data support previous findings of diffuse white matter involvement in chronic toluene abusers and suggest that BAERs may detect early CNS injury from toluene inhalation even at a time when neurological examination and MRI scans are normal. BAERs, therefore, may be a sensitive screening test to monitor individuals at risk from toluene exposure (either abusers or industrially exposed individuals) for early evidence of CNS injury.

Adult↗
PubMed1984

Mini-mental state examination in neurological patients.

The Mini-Mental State examination has been found to be a quick and valuable test for simple bedside screening, and for serial assessment of cognitive function in a population of 126 neurological patients. Amongst those with cognitive impairment, there was a close relation between the Mini-Mental State examination and the conventional Weschler Adult Intelligence Scale (WAIS). However, the Mini-Mental test was not a sensitive indicator of focal versus diffuse hemisphere disease. Further refinement in the areas of language and visuo-spatial function may improve its value.

Adolescent↗
PubMed1996

[Quantification and evaluation of 5 neurological equilibrium tests in test subjects and patients].

OBJECTIVE: Quantification and evaluation of five neurological balance tests as part of the routine neurological examination in order to obtain objective test results for healthy individuals and several neurological patient groups. SETTING: Department of neurology, University Hospital Groningen, the Netherlands. DESIGN: Prospective, controlled study. METHODS: 220 subjects (113 healthy individuals and 107 neurological patients) participated in a balance test investigation comprising gang board, Romberg's test, tandem gait, one-leg-stance, hopping. Tests were performed on a hopscotch (3 meters long, divided in 6 rectangles of 20 by 50 cm) and using a stopwatch to register times and faults. RESULTS: All five quantified tests were feasible for healthy individuals. Up to the age of 70 results gradually declined, above 70 a strong decline was observed. Patients with gait and balance disorders performed less well in all tests except the Romberg's test. CONCLUSIONS: Taking into account a strict standardisation of these five existing tests standard values were obtained for a fast and simple quantification of balance in the routine neurological examination, which can also be used to monitor progress. Especially the results obtained in tandem gait, one-leg-stance and hopping differ significantly between healthy individuals and patients. The gang board appears to be useful for quantifying serious balance disorders. Romberg's test is a specific test for the perceptual sensibility and does not belong in the routine neurological examination of balance.

Adult↗
PubMed1993

Seizure patient selection for emergency computed tomography.

STUDY PURPOSE: We evaluated the need for emergency noncontrast cranial computed tomography (CT) among patients presenting to an emergency department with a complaint of seizure. METHODS: We retrospectively evaluated the medical records of 115 consecutive patients who presented to a trauma Level I ED with a complaint of seizure and underwent a noncontrast cranial CT. RESULTS: Sixty patients had a known seizure disorder, 38 had new-onset seizure, and 17 had possible seizure. The results of the neurologic examination and CT could be compared in 105 of the patients. An abnormal neurologic examination predicted 19 of 20 positive CT scans (95%) and demonstrated a strong association with CT results (P < .00004). Only a history of malignancy correlated to CT findings (P < .008). No other catalogued variable showed a statistical relationship with CT findings. CONCLUSION: Our data suggest that patients with either a history of malignancy or an abnormal neurologic examination at the time of examination in the ED will derive the greatest benefit from emergency CT.

Adolescent↗
PubMed1996

Study of hereditary cerebellar degeneration in cats.

OBJECTIVE: To elucidate the nature of ataxia observed in 3 cats spanning 2 generations. DESIGN: Experimental breeding was attempted to confirm heritability of the disease and establish the mode of inheritance; the original 3 cats and their offspring were studied. ANIMALS: Seven diseased cats spanning 3 generations and 11 neurologically normal cats. PROCEDURE: Cats were examined by use of the following methods: clinical observation, hematologic and serum biochemical examinations, neurologic examination, electrodiagnostics, magnetic resonance imaging, lysosomal enzyme activity assay, horizontal transmission test, and virologic and pathologic examinations. RESULTS: All kittens (1 male and 3 females) obtained by backcrosses developed pure cerebellar dysfunction from the age of 7 to 8 weeks onward. It became progressively worse, but not fatal, between 1 and 2.5 months. Prenatal or perinatal infection with feline panleukopenia virus, inherited lysosomal storage diseases, including gangliosidosis and mannosidosis, and feline hereditary neuroaxonal dystrophy were excluded. Magnetic resonance imaging indicated that size of the cerebellum of diseased cats was markedly reduced. Cerebellar cortical degeneration, especially with extensive destruction of Purkinje cells, was observed microscopically. CONCLUSION: The disease was concluded to be cerebellar degeneration of a new clinical form in cats having an autosomal recessive mode of inheritance. CLINICAL RELEVANCE: When cerebellar dysfunction is diagnosed in a cat, hereditary cerebellar degeneration of this type should be considered in the differential diagnosis.

Animals↗
PubMed1996

Evolutional neurologic evaluation of seven year-old children born prematurely.

A sample of 51 children aged 7 with a history of prematurity was compared to 44 age-matched children who were born at term at the HCPA. The premature children had had gestational ages up to 37 weeks and 6 days and were born weighing less than 2,500 g. The control group consisted of children born with gestational age between 38 and 42 weeks and weights above 2,500 g. The evaluation criteria were clinical examination, neurological examination and the evolutional neurological evaluation (ENE). The results pointed out that impulsiveness, aggressiveness, disorganization and enuresis were prevalent symptoms of developmental disturbances in the sample of prematures. Alterations at neurological examination did not discriminate between the two groups, although cerebral palsy occurred only in the group of prematures. The ENE functions which differentiated the two groups studied were dynamic balance, appendicular and trunk-limb coordination and motor persistence.

Birth Weight↗