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PubMed1994

Neuron-specific enolase and myelin basic protein: relationship of cerebrospinal fluid concentrations to the neurologic condition of asphyxiated full-term infants.

OBJECTIVE: We questioned whether neuron-specific enolase (NSE) and myelin basic protein (MBP) concentrations in cerebrospinal fluid (CSF) in the first 72 hours of life are correlated with the neurologic condition of asphyxiated full-term infants in the neonatal period and at 1 year of age. PATIENTS AND METHODS: Sixty-nine asphyxiated infants were studied with serial neurologic examination, cranial ultrasonography, and neurologic follow-up. CSF samples were obtained by lumbar puncture at 12 and 72 hours of life. NSE was measured by enzyme immunoassay, and MBP was measured by radioimmunoassay. RESULTS: Twenty infants had no neonatal encephalopathy and 49 exhibited different stages of encephalopathy. NSE and MBP concentrations in CSF at 12 and 72 hours of life were related to the degree of neonatal encephalopathy. Neither NSE nor MBP levels were correlated with any perinatal factors. Infants with documented brain injury had the highest concentrations of both NSE and MBP. The concentrations of these two biochemical markers at both 12 and 72 hours correlated with adverse outcome (death or cerebral palsy at 1 year). Based on a receiver operating characteristics curve analysis for any given specificity, NSE at 12 hours was a more accurate marker than MBP at either 12 or 72 hours for distinguishing infants with motor impairment at age 1 year from infants with normal outcome at the same age. CONCLUSIONS: Our findings suggest that NSE and MBP are reliable biochemical markers for early estimates of hypoxic-ischemic brain damage in asphyctic full-term newborns, NSE being superior to MBP.

Asphyxia Neonatorum↗

PubMed1996

[Traumatic damage to the lower cervical spine--a diagnostic problem?].

Even today fractures and dislocations of the lower cervical spine are usually not recognized, or the interpretation of the results of the diagnostic procedures is not correct. These diagnostic failures are often caused by an incomplete representation of the cervical spine in the conventional radiograms, particularly in the lateral projection. Beyond that, the interpretation of the results of the neurological examination of patients with motoric or sensoric deficits after spine injury can be incorrect. Ignorance of the distribution of the segmental innervation of the upper extremities could lead to the wrong diagnosis of paraplegia in a tetraplegic patient. Two patients with injuries of the lower cervical spine are reported, in whom these problems led to an incorrect diagnosis. With regard to these cases we propose a standard diagnostic procedure for the clinical and radiological emergency examination of patients with neurological deficits after spine injury. The technical possibilities of obtaining correct radiographs of the lower cervical spine are described in detail.

Adult↗

PubMed1992

[Cerebral embolism following trivial trauma in children--report of three cases].

Three cases of cerebral embolism secondary to trivial trauma are reported. Case 1: A 12-year-old male suffered a severe headache followed by a generalized convulsion after he turned his head when he was flying a kite. A neurological examination on admission demonstrated right hemiparesis and aphasia. A CT revealed a low density in the left putamen, temporal lobe and frontal lobe. Left carotid angiography (CAG) showed irregular narrowing of the internal carotid with an embolic occlusion and narrowing of the middle cerebral artery with the intraluminal presence of emboli both in the anterior and middle cerebral arteries. He is now doing well but has right hemiparesis. Case 2: This 6-year-old female could not grasp chopsticks and had neck pain 10 minutes after being pulled up by the right arm by her father. Neurological examination demonstrated a right hemiparesis and aphasia. A CT scan and magnetic resonance imaging (MRI) of the head showed an infarcted area in the left caudate head, anterior limb of the internal capsule and putamen. Left CAG revealed an obstruction of the trunk of the middle cerebral artery. She has slight weakness in her right extremities. Case 3: This 11-year-old female noted a weakness in her left lower limb soon after her hair was pulled backward. On admission, a neurological examination failed to demonstrate any abnormality. CT showed an ill defined low density lesion in the right putamen. MRI revealed a high intensity lesion in a T2 weighted image. Right CAG showed an irregularity of the arterial wall in the cavernous portion of the right internal carotid artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidental Falls↗

PubMed2004

Clinical and laboratory assessment of distal peripheral nerves in Gulf War veterans and spouses.

BACKGROUND: The prevalence of symptoms suggesting distal symmetric polyneuropathy (DSP) was reported to be higher among deployed veterans (DV) to the Persian Gulf in 1990-1991 than to control non-deployed veterans (NDV). The authors therefore compared the prevalence of DSP by direct examination of DV and their spouses to control NDV and spouses. METHODS: The authors performed standardized neurologic examinations on 1,061 DV and 1,128 NDV selected from a cohort of veterans who previously participated in a national mail and telephone survey. Presence of DSP was evaluated by history, physical examination, and standardized electrophysiologic assessment of motor and sensory nerves. Similar examinations were performed without electrophysiologic tests in 484 DV spouses and 533 NDV spouses. Statistical analyses were performed with appropriate adjustments for the stratified sampling scheme. RESULTS: No differences between adjusted population prevalence of DSP in DV and NDV were found by electrophysiology (3.7% vs 6.3%, p = 0.07), by neurologic examination (3.1% vs 2.6%, p = 0.60), or by the methods combined (6.3% vs 7.3%, p = 0.47). Excluding veterans with non-military service related diseases that may cause DSP did not alter outcomes. DV potentially exposed to neurotoxins from the Khamisiyah ammunition depot explosion did not significantly differ in DSP prevalence compared to non-exposed DV. The prevalence of DSP in DV spouses did not differ from NDV spouses (2.7% vs 3.2%, p = 0.64). CONCLUSIONS: Neither veterans deployed during the Gulf War era nor their spouses had a higher prevalence of DSP compared to NDV and spouses.

Adult↗

PubMed1996

Neurological signs, aging, and the neurodegenerative syndromes.

OBJECTIVES: To identify the prevalence of neurological signs said to be associated with "normal" aging in subjects 75 years and older. To examine the association of these signs with age, stroke, the neurodegenerative diagnoses (dementia, cognitive impairment, gait ataxia, gait slowing, and parkinsonism), and systemic diseases. DESIGN: Subjects participated in a standardized clinical history, examination, neurological evaluation, and neuropsychological assessment battery. A linear regression model that allowed the simultaneous consideration of multiple parameters was used to assess the independent contribution of age and disease to the presence of the signs. Correlations between the signs and age in the subgroup free of neurological diagnoses were performed. SETTING: Community-based study in Sydney, Australia. PARTICIPANTS: A random sample of 647 community-dwelling subjects older than 75 years. MAIN OUTCOME MEASURES: Standardized neurological examination in 537 subjects. RESULTS: With the exception of impaired vibration sense (beta = .009, P < .01), loss of upward gaze (beta = .005, P < .01), and bradykinesia (beta = .005, P < .01), all signs were associated with the neurodegenerative syndromes and stroke. Analysis of the subgroup free of neurological diagnoses confirmed these findings. Apart from impaired vibration sense of the thumbs (r = 0.22, P < .01) and gait instability (r = 0.20, P < .05), no significant associations with age were identified. CONCLUSION: It is not aging to which many neurological signs should be attributed, but rather to the neurodegenerative syndromes that accompany aging.

Aged↗

PubMed1995

Association of Chiari I malformation and Williams syndrome.

Two Williams syndrome patients are presented who had neurologic symptoms secondary to Chiari malformation type I. Both patients had many of the well-known medical problems found in Williams syndrome. In addition, Patient 1 developed headache, diplopia, and tinnitus at 26 years of age. Neurologic examination revealed intermittent nystagmus and brisk reflexes. Magnetic resonance imaging demonstrated Chiari malformation type I; neurologic symptoms abated following surgery. Patient 2 had a normal neurologic examination at 2 years of age except for hyperreflexia and tight heel cords. At age 10 years, she had generalized contractures, decreased strength and wasting of hand musculature, and hyperreflexia. Magnetic resonance imaging documented Chiari malformation type I. Both patients have significant dysphagia and fusion of cervical spine segments noted on radiography. Morphometric analyses of intracranial contents based on midsagittal magnetic resonance images were performed. This analysis suggests that, compared to age-matched controls, the posterior fossa size is selectively diminished in Williams syndrome, whereas the cerebellum is normal in size. This "mismatch" between the size of the posterior fossa bony compartment and its neural contents may place Williams syndrome patients at high risk for developing Chiari malformation type I.

Abnormalities, Multiple↗

PubMed1986

[Intermediate neurological development of 60 neonates weighing 1500 grams or less at birth. Predictive value of initial findings (clinical aspects, electroencephalograms and brain imaging)].

60 low birthweight (less than or equal to 1,500 g) are distributed according to existence or not, and intensity of brain disturbances, during the neonatal period; appreciated by neurological examinations, early EEG and brain imaging during the second month of life. At 18 months, at least, neurological outcome is normal for 46 children (but 6 had transient neuromotor anomalies), 14 have sequelae (7 mild, 7 major). All children with clinical neurological examination carried out during the neonatal period are normal at follow up. It is true also for the children without EEG anomaly and normal brain imaging. The early prediction of neurological outcome can be made easily with consideration of these three data. Standardised test are proposed, during the neonatal period, for these low birth weight infants.

Brain↗

PubMed1998

Predictive value of plasma and cerebrospinal fluid tumour necrosis factor-alpha and interleukin-1 beta concentrations on outcome of full term infants with hypoxic-ischaemic encephalopathy.

AIM: To determine the predictive value of plasma and cerebrospinal fluid (CSF) tumour necrosis factor-alpha (TNF-alpha) and interleukin-1 beta (IL-1 beta) concentrations on the outcome of hypoxic-ischaemic encephalopathy (HIE) in full term infants. METHODS: Thirty term infants with HIE were included in the study. HIE was classified according to the criteria of Sarnat and Sarnat. Blood and CSF were obtained within the first 24 hours of life and stored until assay. Five infants died soon after hypoxic insult. Neurological examinations and Denver Developmental Screening Test (DDST) were performed at 12 months in the survivors. RESULTS: At the age of 12 months neurological examination and DDST showed that 11 infants were normal; 14 had abnormal neurological findings and/or an abnormal DDST result. Eleven normal infants were classified as group 1 and 19 infants (14 with abnormal neurological findings and/or an abnormal DDST and five who died) as group 2. CSF IL-1 beta and TNF-alpha concentrations in group 2 were significantly higher than those in group 1. Plasma IL-1 beta and TNF-alpha concentrations were not significantly different between the two groups. IL-1 beta, but not TNF-alpha concentrations, in group 2 were even higher than those in group 1, although non-survivors were excluded from group 2. When the patients were evaluated according to the stages of Sarnat, the difference in the three groups was again significant. Patients whose CSF samples were taken within 6 hours of the hypoxic insult had higher IL-1 beta and TNF-alpha concentrations than the patients whose samples were taken after 6 hours. CONCLUSIONS: Both cytokines probably contribute to the damage sustained by the central nervous system after hypoxic insult. IL-1 beta seems to be a better predictor of HIE than TNF-alpha.

Brain Damage, Chronic↗

PubMed1995

Neurologic abnormalities in murderers.

Thirty-one individuals awaiting trial or sentencing for murder or undergoing an appeal process requested a neurologic examination through legal counsel. We attempted in each instance to obtain EEG, MRI or CT, and neuropsychological testing. Neurologic examination revealed evidence of "frontal" dysfunction in 20 (64.5%). There were symptoms or some other evidence of temporal lobe abnormality in nine (29%). We made a specific neurologic diagnosis in 20 individuals (64.5%), including borderline or full mental retardation (9) and cerebral palsy (2), among others. Neuropsychological testing revealed abnormalities in all subjects tested. There were EEG abnormalities in eight of the 20 subjects tested, consisting mainly of bilateral sharp waves with slowing. There were MRI or CT abnormalities in nine of the 19 subjects tested, consisting primarily of atrophy and white matter changes. Psychiatric diagnoses included paranoid schizophrenia (8), dissociative disorder (4), and depression (9). Virtually all subjects had paranoid ideas and misunderstood social situations. There was a documented history of profound, protracted physical abuse in 26 (83.8%) and of sexual abuse in 10 (32.3%). It is likely that prolonged, severe physical abuse, paranoia, and neurologic brain dysfunction interact to form the matrix of violent behavior.

Adolescent↗

PubMed2004

The neurologic assessment and treatment of the "difficult to extubate" patient.

Neurologic issues are involved in the patient who is difficult to wean. Assessing the patient and performing a complete neurologic examination are important when developing a successful weaning strategy. The neurologist contributes to this process by providing expertise in the various neurologic conditions and skill in performing a thorough neurologic examination.

Brain Diseases↗

PubMed1977

Neurological manifestations of aging.

A group of 51 socially active, self-declared neurologically normal subjects ranging from 61 to 84 years of age were studied with a battery of clinical neurological examinations and a semiquantitative vibration perception test. None of the subjects showed a consistent pattern of neurological deficit that could be identified as pathological. On review of systems, the most frequent complaints were difficulty remembering names, numbness and tingling of fingers and toes, and headaches. In the neurological examination, the most commonly observed abnormalities were positive palmomental reflex, snout reflex, abnormalities in pursuit eye movements, convergence insufficiency, and minor mistakes in perception of light touch. There was no apparent trend of worsening of symptoms and signs with advancing age. In the semiquantitative testing of vibration perception, there was a slight trend toward worsening of vibration perception in the upper and lower extremities with advancing age. Motor abnormalities were absent, and there were relatively few subjects who showed reflex abnormalities. This study confirms the previously reported diminution of vibration perception with aging. Caution must be exercised before attributing myotatic reflex and motor abnormalities to the aging process alone.

Aged↗

PubMed1989

Impairment of cerebral function following cardiac and other major surgery.

Patients undergoing routine coronary artery surgery (N = 76) were compared with those undergoing other major operations (N = 29) in a prospective multidisciplinary study designed to define the incidence of neurological and psychological sequelae. The preoperative state of the carotid and vertebral arteries was defined by digital subtraction angiography. Changes in clinical neurological examination, detailed neuropsychological testing, psychiatric assessment and cerebral blood flow were measured. All preoperative studies were repeated 8 days and 8 weeks after surgery. Clinical neurological examination was repeated in addition on the 1st postoperative day. New focal neurological signs were found in 8% of the cardiac patients and none of the comparison group 24 h after operation (P = 0.9). Global transient neurological dysfunction occurred in 59% of the coronary group in the 1st postoperative day compared with 21% in other forms of surgery (P = 0.0007) but this correlated with postoperative narcotic and sedative drugs. A deterioration in neuropsychological performance was detectable in 73% of coronary cases at 8 days which was more likely to occur with increasing age, longer bypass time and lower perfusion pressure, but similar neuropsychological changes also occurred in 50% of the comparison group. By 8 weeks, there was a significant improvement in the cardiac patients (37%, P less than 0.001) but not in the other group. Cerebral blood flow was reduced at 8 days in the coronary bypass patients but not in the comparison group suggesting that the mechanism of cerebral change may be different in the two groups.

Adult↗

PubMed1997

Cerebral dysfunction after coronary artery bypass grafting done with mild or moderate hypothermia.

OBJECTIVE: Ninety-nine patients undergoing elective coronary artery bypass grafting were enrolled in a prospective, randomized study to evaluate the incidence of cerebral dysfunction after "mild" or "moderate" hypothermia during cardiopulmonary bypass. METHODS: Patients were evaluated before and after operation before hospital discharge and in some cases at follow-up at least 6 weeks later with a complete neurologic examination (85 patients) and a battery of standard neuropsychometric tests (86 patients). RESULTS: Postoperative changes detected by neurologic examination consisted of the appearance of new primitive reflexes in both groups. No statistically significant differences in incidence were found. The neuropsychometric performances of the two groups were statistically similar by either event-rate or group-rate analysis. CONCLUSIONS: There is no detectable difference in postoperative cerebral dysfunction in patients undergoing coronary artery bypass grafting who are supported by cardiopulmonary bypass with either mild or moderate hypothermia.

Aged↗

PubMed2006

Alterations in neurobehavior at term reflect differing perinatal exposures in very preterm infants.

OBJECTIVES: Preterm infants have higher rates of cognitive and behavioral difficulties at school age than their term-born peers. We hypothesized that neurobehavior at term would be different in very preterm infants compared with term infants and that perinatal exposures would be associated with these alterations in neurobehavior. PATIENTS AND METHODS: Two standardized neurobehavioral evaluations were completed on 207 infants at term equivalent, including 168 very preterm infants (<1250 g or <30 weeks' gestation) and 39 term control infants. The assessments used were the Neonatal Intensive Care Unit Network Neurobehavioral Scale and the revised Hammersmith Neonatal Neurologic Examination. The relationship of perinatal variables to preterm infant neurobehavioral scores for both evaluations was examined. RESULTS: Compared with term-born infants, preterm infant neurobehavior was significantly altered for the Hammersmith Neonatal Neurologic Examination total score and all of the subtotals. Similarly, preterm infants displayed altered neurobehavior for the majority of the Neonatal Intensive Care Unit Network Neurobehavioral Scale summary scores. Complete perinatal data were available for 157 of 168 very preterm infants. The perinatal variables most strongly associated with altered preterm infant neurobehavior on multivariate regression analysis included the total number of days of assisted ventilation, intraventricular hemorrhage, and necrotizing enterocolitis. Positive perinatal influences on neurobehavioral performance at term on multivariate analysis included maternal antenatal steroids, female gender, and infants receiving breast milk at discharge home. CONCLUSIONS: Preterm infants at term equivalent showed alterations in motor behavior and higher cortically integrated functions. The pattern of abnormality in neurobehavior differed in relation to perinatal exposures. Neurobehavioral examination at term equivalent age is useful in evaluating the impact of neonatal intensive care.

Female↗

PubMed2006

Effect of early administration of the N-methyl-d-aspartate receptor antagonist amantadine on the development of postmastectomy pain syndrome: a prospective pilot study.

UNLABELLED: Postmastectomy pain syndrome (PMPS) is a neuropathic pain syndrome that might develop after breast surgery. Like many other forms of neuropathic pain, it is relatively resistant to treatment and negatively affects the quality of life. A double-blind, randomized, placebo-controlled pilot trial was conducted to study the analgesic efficacy of perioperative administration of the N-methyl-D-aspatrate (NMDA) receptor antagonist amantadine in preventing PMPS after mastectomy plus axillary lymph node dissection (ALND). In the study group, a regimen of 200 mg/day of amantadine was started 1 day before surgery and continued for 14 days, whereas the control group received a placebo. Patients were required to indicate the exact location of their pain and to record its level at 1, 3, and 6 months after surgery. Neurologic examination and Quantitative Thermal Testing (QTT) were performed 1 and 6 months after surgery. On both the neurologic examination and the QTT, all patients, regardless of the perioperative intervention (amantadine or placebo), presented evidence for nerve injury, manifested primarily by painful hypoesthesia (anesthesia dolorosa) in the axilla or inner arm. PMPS persisted for the entire duration of the study in 82% of the patients who were available for follow-up. The average intensity of the pain was moderate in both groups and tended not to decline over time. No differences between the 2 groups in any of the outcome parameters reached statistical significance. According to the results of the present pilot study, the NMDA antagonist amantadine does not prevent the development of PMPS in patients who undergo breast surgery with ALND. PERSPECTIVE: Breast surgery that involves ALND seems to uniformly cause nerve injury, which cannot be prevented by the perioperative administration of 200 mg of amantadine. It is most commonly presented by painful hypoesthesia or anesthesia dolorosa in the axillary/inner arm area, which is moderate in intensity and likely to persist for at least 6 months.

Adolescent↗

PubMed1981

Neurological 'soft' signs in low-birthweight children.

Sixty-six longitudinally studied prematurely born children who had weighed between 1000 and 1750g at birth were examined neurologically at eight years of age. 13 of these children had localizing neurological findings and another 20 were found to have two or more non-localizing ('soft') signs of CNS dysfunction. These 33 children were significantly more likely to have sustained perinatal complications than were children whose neurological examinations were normal. However, a history of prenatal complications was significantly more frequent among children who subsequently developed 'soft' signs, while children with localizing findings were significantly more likely to have experienced postnatal complications. No significant differences in IQ or reading and arithmetic achievement test-score levels were found between children with 'soft' signs and those who were neurologically normal. Nevertheless, children with 'soft' signs were significantly more likely to have received special education and to have been referred for psychiatric consultation than were children who were neurologically normal.

Central Nervous System Diseases↗

PubMed1977

Neonatal and prospective follow-up study of infants delivered by vacuum extraction (VE).

Forty infants delivered by vacuum extraction have been studied in the neonatal period--neurological examination, neonatal CSF-examinations, skull X-ray examination, transillumination and sonoencephalography --and at 14 months of age--developmental and behavioural evaluation, neurological examination, skull X-ray examination, sonoencephalography and electroencephalography. Two infants died in the neonatal period but in both cases a life-threatening situation of the fetus required immediate delivery. CSF cytological signs of haemorrhage were observed in 42% of the 26 infants who had a successful lumbar tap, compared to 10% found in normal deliveries. The result of the neonatal neurological study did not differ from that in a control group. The result of the skull X-ray examination and sonoencephalography were also within normal limits. In the follow-up study behavioural problems were found in 25%, but otherwise very few abnormalities were found. The deviatiosn found do not for the present indicate any later signs of brain lesions. It is concluded that this prospective study has shown that VE-delivery in fullterm babies seem to imply no risk fo serious cerebral sequelae. Further follow-up studies at a later age in order to evaluate the incidence of so-called minimal brain damage in VE-delivered children are required.

Adult↗

PubMed2005

Brain parenchymal damage after haematopoietic stem cell transplantation for severe sickle cell disease.

Prospective magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), neuropsychological testing and neurological examinations were performed to determine the long-term effect of successful haematopoietic stem cell transplantation on the neurological status of nine children with sickle cell disease. A scoring system for severity of brain parenchymal and vascular lesions was developed and applied. Neurological examinations and neuropsychometric tests were stable, but MRI and MRA studies were not. Transient changes occurred early in two patients. Persistent changes occurred in five. Parenchymal lesions occurred in zero of two patients without prior lacunae or infarcts and in all seven with prior lacunae or infarcts (P = 0.0278).

Adolescent↗