bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic resonance imaging findings in 22 cases of myelitis: comparison between patients with and without multiple sclerosis
Authors: Bakshi R. , Kinkel P.R. , Mechtler L.L. , Bates V.E. , Lindsay B.D. , Esposito S.E. , Kinkel W.R.
Published: March 2003

We reviewed the magnetic resonance imaging (MRI) database of the Dent Neurologic Institute to study the abnormal findings in myelitis. We identified 22 patients, and compared non‐MS‐related acute transverse myelitis (ATM, n= 9), to myelitis associated with multiple sclerosis (MS‐myelitis, n= 13). The ATM patients were significantly older than MS patients at the time of the myelitis diagnosis (mean age 46 vs 35, p < 0.05). ATM appeared as a “longitudinal myelitis”, with fusiform cord expansion on T1‐weighted images and intramedullary increased signal on T2‐weighted images, each involving multiple spinal levels (mean = 7–8). However, MS‐myelitis lesions appeared focal, involving significantly fewer spinal levels (mean = 1–2, p < 0.001), although the lesions were equally likely to expand the cord. Four (42%) of the ATM lesions showed abnormal, variable enhancement, whereas none of the MS myelitis lesions enhanced. Cranial MRI was more likely to be normal in ATM (78%) than in MS‐myelitis patients (15%, p < 0.001). Although readily distinguishable from lesions due to MS, the various etiologies for ATM, including post‐infectious (n= 2), post‐vaccination (n= 3), and idiopathic (n= 4) were indistinguishable on MRI. The MRI findings of an extensively lesioned, swollen cord, suspicious for an intramedullary tumor and providing a temptation for a biopsy, may reflect a non‐neoplastic inflammatory disorder.
Cerebral blood flow correlated with carotid blood flow in neurologically normal elderly with severe white matter lesions
Authors: Meguro Kenichi , Hatazawa Jun , Itoh Masatoshi , Miyazawa Hidemitsu , Matsuzawa Taiju , Yamadori Atsushi
Published: March 2003

Previous studies of white matter signal hyperintensity (WMSH) on T2‐weighted MRI (magnetic resonance imaging) have shown it to he related to decreased cerebral blood flow (CBF). However, there have been few studies on the relationship of WMSH and the internal carotid blood flow (CaBF). Doppler ultrasound sonography is widely used for evaluation of CaBF. We analyzed the relationship between CBF, CaBF, and WMSH. The subjects had not suffered cerebral ischemic episodes although they had some risk factors for stroke. They received MRI and were classified into three groups, i.e. mild, moderate, and severe WMSH. The % stenosis of the internal carotid artery (ICA) was measured with angiography. Doppler sonography was used to measure the mean bilateral CaBF. The oxygen‐15 steady‐state technique and PET (positron emission tomography) were used to measure CBF. There were significant correlations between the % stenosis of ICA and the ipsilateral CaBF and between the % stenosis of ICA and hemispheric CBF. There was a significant relationship between CBF and CaBF in the severe WMSH group, remaining significant after partialling out of the effects of the % stenosis. This indicated that an atherosclerotic change of the cerebral artery occurred in a way that carotid vascular resistence and cerebrovascular resistence were 'proportional'.
CADASIL: a review with proposed diagnostic criteria
Authors: Davous P.
Published: March 2003

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) can be considered as a new disease predominantly affecting the small vessels of the brain with an autosomal dominant transmission linked to chromosome 19. This review includes an historical perspective showing how the disease was identified from the spectrum of vascular leukoencephalopathies. More than two hundred patients have now been described, belonging to at least 30 unrelated pedigrees in Europe, America and Asia. The clinical features include four major neurological presentations associated in variable degrees during the course of the disease: migraine with or without aura, strokes or stroke‐like episodes, major psychiatric symptoms and dementia. The patients are free of the classical vascular risk factors. The disease has a progressive or stepwise course with age at onset in the forties and a mean duration of 13.6 I 10.7 years. Death occurs in the fifties in a characteristic condition associating a pseudo‐bulbar syndrome and subcortical dementia. Cerebral magnetic resonance imaging (MRI) is highly contributive to the diagnosis, showing a diffuse leukoencephalopathy with subcortical infarcts in the basal ganglia and white matter. Pathological data show macroscopic lesions similar to Binswanger's disease but different lesions of the small vessels including thickening of the media, characteristic PAS+ granular material and narrowing of the lumen. Skin biopsy may be a valuable diagnostic tool, showing ultrastructural alterations of skin vessels similar to those of brain vessels. The disease is highly homogeneous on a genetic basis and the identification of the gene Notch 3 on chromosome 19 has opened new avenues for research and genetic counselling. The pathogenesis of the disease has still to be elucidated. A definite diagnosis relies on genetical or pathological data. Diagnostic criteria are proposed to recognize the disease on clinical and imaging parameters. So far, no treatment has been reported to be successful for CADASIL.
Systemic lupus erythematosus presenting with steroid‐responsive parkinsonism and post‐hemiplegic dystonia
Authors: Lim S.M. , Oldfield M. , Abbott R.J.
Published: March 2003

A young male patient who presented with steroid‐responsive parkinsonism, hemiplegia, thrombocytopaenia and systemic illness who was subsequently diagnosed to have systemic lupus erythematosus (SLE) is described. He later developed post‐hemiplegic dystonia. Thalamic lesions on magnetic resonance imaging (MRI) are demonstrated. Clinical features and neuropathology of central nervous system lupus are discussed. This is the first report of SLE presenting with Parkinsonism, and the first to demonstrate anatomically‐relevant MRI lesions in Parkinsonism associated with SLE.
Clinical and autopsy findings in spinal cord compression due to metastatic disease
Authors: Helweg‐Larsen Susanne , Laursen Henning
Published: March 2003

Clinical and autopsy findings are described in 14 patients who had suffered from spinal cord compression due to metastatic disease. All patients were clinically examined at the time of diagnosis of spinal cord compression, and followed until death. Autopsy studies of the cord revealed microscopic tumors similar to the primary tumor in seven cases. There were white matter lesions varying from slight to severe loss of myelin in seven cases. A correlation between the myelin damage and the patients ambulation just before death was found.
Primary progressive aphasia: a case report
Authors: Nagy Tamas Gergely , Jelencsik Ilona , Szirmai Imre
Published: March 2003

We report a 69‐year‐old male patient whose motor aphasia started at the age of 61. The language disability remained isolated and progressed over a period of eight years without any additional cognitive deficits. Computed tomography (CT) and magnetic resonance imaging (MRI) showed moderate cortical atrophy with frontal dominance. Single photon emission tomography (SPECT) showed hypoperfusion in the frontotemporoparietal region, positron emission tomography (PET) demonstrated a global cortical reduction of glucose utilization with a lesser decrement in the occipital lobes. The clinical symptoms and the neuropsychological findings fit the diagnosis of primary progressive aphasia.
Fall‐related injuries in dementia with Lewy bodies (DLB) and Alzheimer’s disease
Authors: Imamura T. , Hirono N. , Hashimoto M. , Kazui H. , Tanimukai S. , Hanihara T. , Takahara A. , Mori E.
Published: March 2003

Repeated falls are reported as one of the clinical characteristics in dementia with Lewy bodies (DLB). We examined the incidence of fall‐related injuries in 561 dementia patients with various clinical diagnoses, including DLB and Alzheimer’s disease (AD), in a ward established for dementia research. The incidence of fall‐related injuries was significantly higher in DLB patients (10.7%) than in AD patients (1.1%) (P < 0.001). The high incidence in those patients with DLB cannot be attributed to Parkinsonism because none of the DLB patients with injuries showed extrapyramidal sign. Our observations suggest that patients with a clinical diagnosis of DLB have a high risk of fall‐related injuries, even though they do not show Parkinsonism. An appropriate clinical discrimination between DLB and AD is recommended to manage and prevent fall‐related injuries.
Acute axonal form of Guillain–Barré syndrome in a multiple sclerosis patient: chance association or linked disorders?
Authors: Capello E. , Roccatagliata L. , Schenone A. , Gazzola P. , Inglese M. , Abbruzzese M. , Mancardi G. L.
Published: March 2003

Multiple sclerosis (MS) is characterized by inflammation, demyelination and gliosis, involving the central nervous system (CNS) and commonly sparing the peripheral nervous system (PNS). Coexistence of CNS and PNS chronic demyelination has been rarely demonstrated in chronic inflammatory demyelinating polyradiculoneuropathies (CIDP) and in MS, but the occurrence of acute polyradiculoneuropathy in a patient with MS is even more unusual. We describe the case of a woman with relapsing–remitting MS who presented with an acute severe tetraparesis. Cerebrospinal fluid (CSF) examination together with neurophysiological data and sural nerve biopsy study demonstrated an axonal form of Guillain–Barré Syndrome (GBS). It remains unresolved if the association of an axonal form of GBS and MS is fortuitous or, on the contrary, is indicative of the coexistence in some individuals of common pathogenetic mechanisms.
Immunological effects of oral high‐dose methylprednisolone in acute optic neuritis and multiple sclerosis
Authors: Sellebjerg F. , Christiansen M. , Jensen J. , Frederiksen J. L.
Published: March 2003

The immunological effects of high‐dose methylprednisolone in attacks of multiple sclerosis and acute optic neuritis have only been examined in a few randomized, controlled trials. We studied immunological changes in 50 patients with optic neuritis or multiple sclerosis who underwent lumbar puncture before and 1 week after completing a 15‐day course of oral high‐dose methylprednisolone treatment. Treatment resulted in a decrease in the concentration of myelin basic protein, a decrease in the serum concentration of immunoglobulin G (IgG) and intrathecal IgG synthesis, an increase in the cerebrospinal fluid concentration of transforming growth factor‐β1, and changes in the expression of CD25, CD26, and human leukocyte antigen‐DR (HLA‐DR) on CD4 T‐cells. No effect was seen on the cerebrospinal fluid leucocyte count or the cerebrospinal fluid activity of matrix metalloproteinase‐9 (MMP‐9). The lack of a persistent effect on cerebrospinal fluid leucocyte recruitment and MMP‐9 activity, despite changes in IgG synthesis, T‐cell activation, and cytokine production, suggests that modulation of the function of inflammatory cells may contribute to the clinical efficacy of oral high‐dose methylprednisolone treatment in optic neuritis and multiple sclerosis.
Electromyographic evaluation of cervical dystonia for planning of botulinum toxin therapy
Authors: Dressler D.
Published: March 2003

The success of botulinum toxin (BT) injections for treatment of cervical dystonia depends on precise identification of dystonic muscles and on quantification of their dystonic involvement. Conventionally, this is attempted by clinical examination analysing the dystonic head position. In this presentation, a more systematic approach is sought by using an electromyography (EMG)‐based evaluation procedure.

In 10 consecutive patients with cervical dystonia not previously exposed to BT clinical examination, analysing the dystonic head position was performed to classify patients into four groups with similar dystonic head positions. Additionally, a 2‐channel concentric needle EMG was used to measure the amplitudes of dystonic and maximal voluntary activities in sternocleidomastoid (SCM), splenius capitis (SC) and trapezius/semispinalis capitis (T/SS) muscles bilaterally. The ratio between both amplitudes, the dystonia ratio, was used to quantify dystonic muscle involvement.

In all patients dystonia ratios could be calculated. In patients with similar head positions, EMG evaluation revealed different qualitative and quantitative dystonic involvement patterns. In six patients, there were discrepancies in identification of dystonic muscles between clinical examination and EMG evaluation. EMG evaluation excluded dystonic involvement in five patients. All excluded muscles were SCM. In one of these patients, additional T/SS involvement was detected by EMG evaluation. In one patient, SC involvement was revealed by EMG evaluation. All dystonic muscle involvement detected by EMG evaluation represented genuine dystonic muscle coactivation rather than compensatory muscle activity.

The EMG evaluation presented allows quantitative and qualitative identification of dystonic muscle involvement which cannot be achieved by clinical examination. Both pieces of information may be helpful for optimization of BT therapy.
The effect of botulinum toxin type A on the functional ability of the child with spastic hemiplegia a randomized controlled trial
Authors: Love S. C. , Valentine J. P. , Blair E. M. , Price C. J. , Cole J. H. , Chauvel P. J.
Published: March 2003

It has been demonstrated that botulinum toxin type A (BTX‐A) injections reduce spasticity and improve muscle growth in children with spasticity. It has been postulated that BTX‐A allows the learning of more normal movement patterns. The aim of this study was to measure the effect of this treatment on functional ability, as measured by the Gross Motor Function Measure (GMFM), in children with spastic hemiplegic cerebral palsy. Children of 3–13 years and meeting the selection criteria were randomly allocated to the control or injection group using a matched pair design. A match constituted a child within 6 months of age with the same Modified Ashworth Score (MAS) for the gastroc‐soleus and within 10% of the same goal scores on the Gross Motor Function Measure. Twelve matched pairs were enrolled. Outcomes were measured on enrolment and at 1, 3 and 6 months post injection. The time course of the response to BTX‐A was assessed with measurements of the MAS, dynamic range of motion (R1) and static muscle length (R2). Motor function was assessed using the 88‐item GMFM and parental satisfaction with a 10‐point visual analogue scale. Within pair comparisons of the GMFM using the Wilcoxon signed rank test indicated that the treatment group made significantly greater gains than controls at 3 months (P=0.02) with even greater differences seen at 6 months (P=0.004). Using parametric statistics, the intrapair difference in proportional change of GMFM increased from 35% (4 to 65) at 3 months to 52% (17–87) at 6 months. Response to injection was confirmed by a decrease in MAS in the treatment group and very little change in controls. This difference was significant (P=0.002) at 3 months and was attenuated but still significant (P=0.016) at 6 months; the difference in proportional change decreased from 44% at 3 months to 22% at 6 months. Changes in R1 reflected those of MAS in the treatment group and deteriorated significantly over the study period in controls. Parents of children in the treatment group were more satisfied than controls, but satisfaction scores did not correlate with changes in function or technical outcomes suggesting that this may be a placebo effect. The changes in GMFM correlated with changes in technical outcomes at 3 months, suggesting a causal relationship. The intrapair differences in GMFM continued to increase even after the local response to injection had started to wane.
A prospective, open‐label treatment trial to compare the effect of IFN β‐1a (Avonex), IFNβ‐1b (Betaseron), and glatiramer acetate (Copaxone) on the relapse rate in relapsing‐remitting multiple sclerosis
Authors: Khan O. A. , Tselis A. C. , Kamholz J. A. , Garbern J. Y. , Lewis R. A. , Lisak R. P.
Published: March 2003

A prospective, non‐randomized, open‐label treatment trial was performed in patients with relapsing‐remitting multiple sclerosis (RRMS), with follow up for 12 months. Our primary objective was to prospectively compare the effect of IFNβ‐1a (Avonex), IFNβ‐1b (Betaseron), and glatiramer acetate (GA, Copaxone) on the relapse rate in patients with RRMS. Between August 1996 and September 1999, 156 consecutive patients with clinically definite RRMS with a Kurtzke scale (EDSS) score of 4 or less were followed for 12 months, from the time of initiating therapy or electing to remain untreated. Prior 2‐year relapse history and available chart information was carefully reviewed at the time of enrolment. Thirty‐three of 156 elected no treatment (mean age 32.5 years; mean EDSS 2.64) at enrolment; 40 elected IFNβ‐1a (mean age 32.4 years; mean EDSS 2.69), 41 IFNβ‐1b (mean age 32.1 years; mean EDSS 2.56), and 42 chose GA (mean age 31.5 years; mean EDSS 2.57). Annual relapse rate based upon the 2 years prior to enrolment was 1.08 in the untreated group, 1.20 in the AV group, 1.21 in the BE group, and 1.10 in the GA group. There were no statistically significant differences among the four groups at enrolment. After 12 months of treatment, patients in the untreated groups had a relapse rate of 0.97, whereas patients in the IFNβ‐1a, IFNβ‐1b, and GA groups had relapse rate of 0.85, 0.61, and 0.62, respectively. Compared to the untreated group, reduction in the relapse rate was statistically significant only in the GA (P=0.003) and IFNβ‐1b (P=0.002) groups, in contrast to the IFNβ‐1a treated patients, who did not show a significant reduction (P=0.309). Compared to the untreated patients, mean EDSS was significantly reduced only in the GA (P=0.001) and IFNβ‐1b (P=0.01), in contrast to IFNβ‐1a treated patients (P=0.51). In this prospective, controlled, open‐label, non‐randomized 12‐month study, treatment with only GA and IFNβ‐1b significantly reduced the relapse rate compared to untreated patients, supporting early treatment in RRMS. Our results are similar to the observations made after 12 months of therapy in phase III studies of IFNβ‐1a, IFNβ‐1b, and GA. Despite some limitations of the study design, the results provide helpful clinical information regarding the relative efficacy of each therapy in mildly affected treatment‐naïve RRMS patients.
Combined use of sphenoidal electrodes and the dipole localization method for the identification of the mesial temporal focus
Authors: Yoshinaga H. , Hattori J. , Nakahori T. , Ohtsuka Y. , Oka E. , Tomita S. , Ohmoto T. , Miyamoto K.
Published: March 2003

We attempted to sub‐classify four cases who show temporal spikes on standard scalp electroencephalogram (EEG), using sphenoidal electrodes and the dipole localization method. In a case with mesial temporal epilepsy, spikes showed phase reversal in a sphenoidal electrode, and the spike dipoles were estimated to be in the mesial temporal lobe. In a case with lateral temporal epilepsy, spikes showed no phase reversal in a sphenoidal electrode, and the spike dipoles were estimated to be in the lateral temporal lobe. In two cases out of four, spikes showed phase reversal in sphenoidal electrodes, whilst the dipoles were estimated to be in the frontal lobe. Clinical features also suggested a diagnosis of frontal lobe epilepsy. In one of the two cases in which frontal lobe epilepsy was suspected, ictal dipoles as well as interictal spike dipoles indicated participation of the frontal lobe in the genesis of seizures. Nevertheless, only mesial temporal lobectomy was performed based on results obtained by invasive subdural electrodes. As a result, seizures were not controlled. Although sphenoidal electrodes were useful for differentiating between mesial and lateral temporal lobe foci, it is advisable to use them in combination with the dipole localization method to identify frontal lobe foci.
A survey of neuroimaging research in European neurological departments
Authors: Herholz K. , Perani D. , Fazekas F. , Markus H. , Baumgartner R. W. , Baron J.‐C.
Published: March 2003

In the international neurological literature, neuroimaging research plays an important role. Neuroimaging techniques are also of steadily increasing importance for clinical diagnosis and treatment monitoring. Therefore, neuroimaging research activities were surveyed by a questionnaire, which was completed by 100 neurological centres across Europe. It showed that most groups use magnetic resonance imaging (MRI), fMRI, computerized tomography (CT) and single photon emission computerized tomography (SPECT). Positron emission tomography (PET) and ultrasound are also employed by nearly half of the centres. Neuroimaging research involves co‐operation amongst typically five to 10 disciplines. Cerebrovascular disease, dementia, cognitive disorders, epilepsy, movement disorders, brain tumours and multiple sclerosis are frequently being studied. Many groups rely on small budgets, have few full‐time scientists and limited access to expensive resources. There is little exchange of scientists amongst laboratories. It was felt that funding and co‐operation needed improvement in order to maintain a high standard in neuroimaging research.
Diffusion‐weighted magnetic resonance imaging in two patients with polycythemia rubra vera and early ischemic stroke
Authors: Koennecke Hans‐Christian , Bernarding Johannes
Published: March 2003

Polycythemia rubra vera (PRV) is a rare myeloproliferative disorder with a high risk of ischemic stroke. Although thrombosis of large cerebral arteries is the most frequently presumed pathomechanism, various infarct patterns have been described in patients with PRV and ischemic stroke. We report two patients with mild acute ischemic strokes and known PRV, in whom a scattered lesion pattern was detected by diffusion‐weighted magnetic resonance imaging (DWI), but was not visible on computed tomography (CT) and conventional magnetic resonance imaging (MRI). Further diagnostic work‐up including extra‐ and transcranial Doppler sonography (ECD, TCD), transesophageal echocardiography (TEE), magnetic resonance angiography and Holter monitoring revealed no obvious sources of cerebral embolism in both cases. However, TEE in one patient demonstrated spontaneous echo contrast (SEC) in the left atrium. In both patients the symptomatology resolved completely. The detection of a scattered infarct pattern by DWI in patients with PRV and acute ischemic stroke has not been reported previously. DWI findings together with the SEC in one patient emphasize the assumption that a prothrombotic state with subsequent arterial embolism rather than local arterial thrombosis may be the underlying pathomechanism of stroke in some patients with PRV. Adding DWI to the diagnostic work‐up may help to clarify etiology in patients with PRV and acute ischemic stroke.
Acute cervical hyperextension–hyperflexion injury may precipitate and/or exacerbate symptomatic multiple sclerosis
Authors: Chaudhuri A. , Behan P. O.
Published: March 2003

We report here 39 cases in which definite multiple sclerosis (MS) was precipitated or exacerbated by specific hyperextension–hyperflexion cervical cord trauma. The worsening or onset of the symptomatic disease bore a striking temporal relationship to the focal injury. Our data suggests that central nervous system (CNS)‐specific acute physical trauma such as cervical cord hyperextension–hyperflexion injury may aggravate latent clinical symptoms in MS. The deterioration of MS bore no direct relationship with the severity of neck injury. Possible pathogenic mechanisms of focal CNS‐specific trauma aggravating the course of asymptomatic or benign MS are discussed. This may have implications in improving our understanding of the factors that may modify the clinical course of MS.
Alcoholic skeletal muscle myopathy: definitions, features, contribution of neuropathy, impact and diagnosis
Authors: Preedy V. R. , Adachi J. , Ueno Y. , Ahmed S. , Mantle D. , Mullatti N. , Rajendram R. , Peters T. J.
Published: March 2003

Alcohol misusers frequently have difficulties in gait, and various muscle symptoms such as cramps, local pain and reduced muscle mass. These symptoms are common in alcoholic patients and have previously been ascribed as neuropathological in origin. However, biochemical lesions and/or the presence of a defined myopathy occur in alcoholics as a direct consequence of alcohol misuse. The myopathy occurs independently of peripheral neuropathy, malnutrition and overt liver disease. Chronic alcoholic myopathy is characterized by selective atrophy of Type II fibres and the entire muscle mass may be reduced by up to 30%. This myopathy is arguably the most prevalent skeletal muscle disorder in the Western Hemisphere and occurs in approximately 50% of alcohol misusers. Alcohol and acetaldehyde are potent inhibitors of muscle protein synthesis, and both contractile and non‐contractile proteins are affected by acute and chronic alcohol dosage. Muscle RNA is also reduced by mechanisms involving increased RNase activities. In general, muscle protease activities are either reduced or unaltered, although markers of muscle membrane damage are increased which may be related to injury by reactive oxygen species. This supposition is supported by the observation that in the UK, α‐tocopherol status is poor in myopathic alcoholics. Reduced α‐tocopherol may pre‐dispose the muscle to metabolic injury. However, experimental α‐tocopherol supplementation is ineffective in preventing ethanol‐induced lesions in muscle as defined by reduced rates of protein synthesis and in Spanish alcoholics with myopathy, there is no evidence of impaired α‐tocopherol status. In conclusion, by a complex series of mechanisms, alcohol adversely affects skeletal muscle. In addition to the mechanical changes to muscle, there are important metabolic consequences, by virtue of the fact that skeletal muscle is 40% of body mass and an important contributor to whole‐body protein turnover.
Ropinirole for the treatment of tremor in early Parkinson's disease
Authors: Schrag A. , Keens J. , Warner J.
Published: March 2003

The effect of Ropinirole on tremor in early Parkinson's disease (PD) was assessed. The results of three multicentre, randomized, double‐blind trials comparing ropinirole monotherapy with levodopa, bromocriptine and placebo treatment were analysed retrospectively with respect to improvement of resting tremor and postural/action tremor as measured by items 20 and 21 of the motor section of the Unified Parkinson's Disease Rating Scale (UPDRS). Improvements in resting tremor were significantly better with ropinirole than placebo. There were no significant differences between the effect of ropinirole and those of levodopa (L‐dopa) or bromocriptine on resting tremor. Postural/action tremor was mild in these early therapy studies, and there were no significant differences between treatment groups. These results suggest that ropinirole monotherapy is effective in treating resting tremor in early PD. On the other hand, response of postural/action tremor to dopaminergic treatment in early PD was not significantly better than to placebo at the dosages used in these trials.
Post‐stroke depression, executive dysfunction and functional outcome
Authors: Pohjasvaara T. , Leskelä M. , Vataja R. , Kalska H. , Ylikoski R. , Hietanen M. , Leppävuori A. , Kaste M. , Erkinjuntti T.
Published: March 2003

The early diagnosis of vascular cognitive impairment has been challenged and executive control function has been suggested to be a rational basis for the diagnosis of vascular dementia. We sought to examine the correlates of executive dysfunction in a well‐defined stroke cohort. A group of 256 patients from a consecutive cohort of 486 patients with ischaemic stroke, aged 55–85 years, was subjected to a comprehensive neuropsychological examination 3–4 months after ischaemic stroke and 188 of them in addition to detailed psychiatric examination. Basic and complex activities of daily living (ADLs) (bADLs and cADLs) post‐stroke were assessed. The DSM‐III‐R criteria were used for the diagnosis of the depressive disorders. Altogether 40.6% (n=104) of the patients had executive dysfunction. The patients with executive dysfunction were older, had lower level of education, were more often dependent, did worse in bADLs and cADLs, had more often DSM‐III dementia, had worse cognition as measured by Mini Mental State Examination (MMSE) and were more depressed as measured by the BECK depression scale, but not with the more detailed psychiatric evaluation. They had more often stroke in the anterior circulation and less often in the posterior circulation. The independent correlates of executive dysfunction were cADLs (OR 1.1, 95% CI 1.03–1.16), each point of worsening in cognition by MMSE (OR 1.7, 95% CI 1.42–1.97) and stroke in the posterior circulation area (OR 0.4, 95% CI 0.18–0.84). Clinically significant executive dysfunction is frequent after ischaemic stroke and is closely connected with cADLs and to overall cognitive status but could be distinguished from depression by detailed neuropsychological examination. Executive measures may detect patients at risk of dementia and disability post‐stroke.
The neural networks of music
Authors: Baeck E.
Published: March 2003

Recent neuropsychological, transcranial Doppler sonographic, positron emission tomographic and functional nuclear magnetic resonance studies have indicated that musical perception is not dependent on the right hemisphere but on neural networks corresponding to the fundamental components of music in both hemispheres. In the brain there is no centre for music. Musicians have cerebral characteristics, anatomical as well as functional, which are correlated with the age at which they began their musical studies. This argues for cortical reorganization as a result of musical training. Whether these characteristics are to be ascribed to cortical plasticity alone, or to an innate structural property, or to both, remains an open question, however. Investigation of chromosomal defects, biochemical abnormalities and morphological features of congenital and degenerative brain diseases can provide further insight into the cerebral substrate of musicality.
Spectrum of anterior cerebral artery territory infarction: clinical and MRI findings
Authors: Kumral E. , Bayulkem G. , Evyapan D. , Yunten N.
Published: March 2003

To evaluate and review the clinical spectrum of anterior cerebral artery (ACA) territory infarction, we studied 48 consecutive patients who admitted to our stroke unit over a 6‐year period. We performed magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) in all patients, and diffusion magnetic resonance imaging (DWI) in 21. In our stroke registry, patients with ACA infarction represented 1.3% of 3705 patients with ischemic stroke. The main risk factors of ACA infarcts was hypertension in 58% of patients, diabetes mellitus in 29%, hypercholesterolemia in 25%, cigarette smoking in 19%, atrial fibrillation in 19%, and myocardial infarct in 6%. Presumed causes of ACA infarct were large‐artery disease and cardioembolism in 13 patients each, small‐artery disease (SAD) in the territory of Heubner's artery in two and atherosclerosis of large‐arteries (<50% stenosis) in 16. On clinico‐radiologic analysis there were three main clinical patterns depending on lesion side; left‐side infarction (30 patients) consisting of mutism, transcortical motor aphasia, and hemiparesis with lower limb predominance; right side infarction (16 patients) accompanied by acute confusional state, motor hemineglect and hemiparesis; bilateral infarction (two patients) presented with akinetic mutism, severe sphincter dysfunction, and dependent functional outcome. Our findings suggest that clinical and etiologic spectrum of ACA infarction may present similar features as that of middle cerebral artery infarction, but frontal dysfunctions and callosal syndromes can help to make a clinical differential diagnosis. Moreover, at the early phase of stroke, DWI is useful imaging method to locate and delineate the boundary of lesion in the territory of ACA.
No difference in efficacy of two different doses of intravenous immunoglobulins in MS: clinical and MRI assessment
Authors: Lewańska M. , Siger‐Zajdel M. , Selmaj K.
Published: March 2003

We performed a double‐blind, placebo‐controlled study to evaluate the efficacy of low and high dose of intravenous immunoglobulins (IVIG) in relapsing/remitting (RR) multiple sclerosis (MS). Patients (n = 49) with clinical definite RR MS were randomly allocated to three groups and treated with 0.2 g/kg (n = 17) or 0.4 g/kg (n = 15) once a month of IVIG and placebo (n = 17) for 12 months. Clinical data were assessed monthly and magnetic resonance imaging (MRI) was performed every 3 months during the study period. Annual relapse rate (ARR) and change of the mean Expanded Disability Status Scale (EDSS) and Neurological Rating Scale Score (NRSS) from baseline to study conclusion were used as the clinical end‐points. For MRI activity total lesion volume on T2‐weighted image (T2WI), new lesions and gadolinium (Gd)‐enhanced lesions on T1WI were analysed. ARR in both IVIG groups (0.88 for 0.2 g/kg and 0.86 for 0.4 g/kg) was reduced compared with placebo (1.24) during treatment period. Neurological disability measured with EDSS decreased slightly in both the IVIG groups (0.029 and 0.066, respectively) and increased by 0.29 in placebo (P = 0.0117). The neurologic impairment measured by NRSS showed similar trend. The total lesion volume on T2WI increased by 13.56% in placebo whereas in the 0.4 g/kg IVIG group decreased by −3.95% and in the 0.2 g/kg IVIG group increased by 3.6%. The cumulative numbers of Gd‐enhancing lesions and new T2WI lesions in the IVIG groups were reduced in comparison with the placebo group. Our findings suggest that the dose 0.2 g/kg of IVIG is equally effective as 0.4 g/kg in reducing MS activity.
Outcome measures of spasticity
Authors: Johnson G. R.
Published: March 2003

Spasticity is characterized by a velocity‐dependent increase in muscle resistance, in response to a passive stretch. Whilst clinical scales probably represent the most common approach to its measurement, these are limited by poor reliability and difficulties with some definitions. However, recently, a simple system has been used to provide the clinician with a measure of the force applied during the Ashworth Test. The Wartenberg Pendulum Test has been devised for measuring spasticity at the knee, but has been shown to be unsuitable for measuring more severe spasticity. Powered systems have been used in research studies, but are rarely considered suitable for routine clinical use. However, one method of interest, using a low inertia torque motor to measuring stiffness at the wrist, has been shown to provide rapid measurements which correspond to the degree of spasticity defined by other scales. Clinical gait analysis may have an important role to play in assessing spasticity – since there are clear associations between lower limb spasticity and gait problems – but it does not provide a true measure of the condition. In summary, while scales remain the most common method of measuring spasticity, there is considerable potential in instrumented techniques that can provide greater reliability and precision of measurement.
Electrophysiology to predict mechanical ventilation in Guillain–Barré syndrome
Authors: Durand M.‐C. , Lofaso F. , Lefaucheur J.‐P. , Chevret S. , Gajdos Ph. , Raphaël J.‐C. , Sharshar T.
Published: March 2003

To determine whether electrophysiological features predict endotracheal mechanical ventilation (ETMV) in Guillain–Barré syndrome (GBS). Non‐ventilated GBS patients admitted to an ICU underwent standard electrophysiological testing. Endotracheal mechanical ventilation was decided by physicians who were unaware of electrophysiological results. Sixty consecutive patients underwent electrophysiological testing within 17 days of GBS onset; based on Hadden's criteria, 37 (62%) had primary demyelinating, 18 (30%) equivocal and five (8%) axonal disease. Time at electrophysiological testing and proportions of patients treated by plasma exchange and intravenous immunoglobulins were similar in the three groups, whereas primary demyelinating patients had worse results for disability grade and arm grade. The ETMV was required within 20 days of electrophysiological testing in 20 patients, 17 (46%) in the primary demyelinating group, three (17%) in equivocal group and none in the axonal group (P = 0.02). This prospective study suggests that electrophysiological demyelination may predict a need for ETMV in GBS.
Depression in Parkinson's disease
Authors: Burn D. J.
Published: March 2003

Depression in Parkinson's disease (PD) is a common complication, with a major impact on quality of life. Failure to recognize and treat depression can lead to premature and inappropriate discontinuation of antiparkinsonian therapies. Cited frequency for depression in PD varies between 2.7 and 70%. Methodological differences account for much of the disparity. The aetiology of depression in PD is complex, with ‘tonic’ (slowly changing and persistent) and ‘phasic’ (short‐lived and fluctuating) components. Both depression and anxiety may predate the onset of the motor disorder by some years. Hedonistic homeostatic dysregulation is a cyclical mood disorder associated with excessive intake of dopaminergic therapies, inappropriate for the motor state. Negative affective symptoms occur on attempted reduction of medication, reinforcing the abnormal medication pattern. The Montgomery‐Åsberg Depression Rating Scale and the Hamilton Rating Scale for Depression have good diagnostic sensitivity and specificity for assessing depression in PD. There is a dearth of sizeable, placebo‐controlled studies for evaluating drug treatment of depression in PD. Dopaminergic drugs have variable antidepressant properties. Selective serotonin reuptake inhibitors are currently the most commonly prescribed group of antidepressants in the depressed PD patient. Depression in the PD patient may be associated with a more rapid deterioration in cognitive and motor functions.
The Cluster-Tic Syndrome and Its Surgical Therapy
Authors: Solomon Seymour , Apfelbaum Ronald I , Guglielmo Karen M
Published: March 2003

The term cluster-tic syndrome (CTS) is used to designate a clinical pain pattern in which symptoms of cluster headache (CH) and tic douloureux (TD) coexist. The TD elements of the attack occur in paroxysms of many seconds or minutes, always affect the maxillary or mandibular divisions of the trigeminal nerve, with spread into the ophthalmic division in some cases, and may be triggered by slight superficial stimuli. These features may occur independent of CH elements but more often the two blend together. Four patients with CTS unresponsive to medication underwent surgery. Blood vessels were found to cross compress the trigeminal nerve in all four patients and the nerve was decompressed. A similar condition was found affecting the facial nerve in two of the three patients in whom that nerve was explored and the facial nerve was decompressed in these two. The TD component of the CTS disappeared after surgery in all four patients. The CH component of the syndrome returned after surgery but in a modified form. In three patients, the CH changed from what had been chronic cluster to infrequent episodic cluster periods; additionally in two patients, the duration of cluster was shorter and the pain was of lesser severity.
Neurogenically Mediated Plasma Extravasation in Dura Mater: Effect of Ergot Alkaloids: A Possible Mechanism of Action in Vascular Headache
Authors: Markowitz Stephen , Saito Kiyoshi , Moskowitz Michael A
Published: March 2003

C-fiber- dependent neurogenic plasma extravasation developed in the dura mater but not the brain after electric stimulation of the rat trigeminal ganglion or after chemical stimulation of perivascular axons with intravenous capsaicin, a drug that depolarizes sensory nerve fibers. C-fiber- independent extravasation also developed in this tissue after intravenous injections of substance P or neurokinin A (two constituents of unmyelinated C fibers) and after serotonin, bradykinin, or allergic challenge in presensitized animals. Intravenous dihydroergotamine or ergotamine tartrate, in doses similar to those used to treat migraine and cluster headache, prevented the stimulation-induced leakage of plasma proteins within the dura mater. Not unexpectedly, the acute administration of methysergide, a drug effective in the prophylactic treatment of headache, was inactive in this acute model. Neither acute nor chronic administration of propranolol affected stimulation-induced leakage of plasma protein. These results demonstrate that neurogenic inflammation develops within the dura mater in the rat and that ergot alkaloids prevent the process by a C-fiber-dependent mechanism.
Urinary Melatonin Excretion Throughout the Ovarian Cycle in Menstrually Related Migraine
Authors: Murialdo G , Fonzi S , Costelli P , Solinas GP , Parodi C , Marabini S , Fanciullacci M , Polleri A
Published: March 2003

Nocturnal urinary melatonin excretion was significantly decreased throughout an ovarian cycle in 12 migraine without aura patients compared to 8 healthy controls. Normal increases in urinary melatonin excretion during the luteal phase was less pronounced in the migraine patients. Melatonin excretion was further decreased during headache. The data indicate impaired pineal function in migraine.
Nocturnal Melatonin Excretion is Decreased in Patients With Migraine Without Aura Attacks Associated With Menses
Authors: Brun J , Claustrat B , Saddier P , Chazot G
Published: March 2003

Nocturnal melatonin excretion was studied throughout a complete menstrual cycle in 10 women with migraine without aura attacks associated with menses and 9 women controls. Urine melatonin was determined by radioimmunoassay. The mean nocturnal melatonin excretion throughout the cycle was significantly lower in the migraine patients than in controls. In the control group, melatonin excretion increased significantly from the follicular to the luteal phase, whereas no difference was observed in the migraine group. Results are discussed in view of the role of the pineal gland in the organization of biological rhythms and homeostasis in relation to environmental conditions.
Flunarizine in Migraine Prophylaxis: Predictive Factors for A Positive Response
Authors: Lucetti C , Nuti A , Pavese N , Gambaccini G , Rossi G , Bonuccelli U
Published: March 2003

The efficacy of flunarizine in migraine prophylaxis is confirmed in both open and controlled trials. However, it is unknown what factors may influence a good response to prophylaxis with flunarizine. The aim of this study was to determine the possible predictive factors for therapeutic responsiveness to 3 months' treatment with flunarizine. One-hundred headache patients treated with flunarizine were evaluated. We considered “responders” those patients who recorded a reduction in migraine frequency of 75% after treatment. Statistical analysis revealed four factors which might influence therapeutic responsiveness in our patients. Positive factors were a family history ( p<0.01) and high intensity of pain ( p<0.01); negative factors were frequent attacks ( p<0.01) and a history of analgesic abuse ( p<0.001). Patients with no previous history of analgesic abuse, low frequency of attacks at baseline, higher levels of migraine pain, and positive family history constitute the prototype of flunarizine long-term treatment responders.
Platelet Nitric Oxide Metabolites in Migraine
Authors: Shimomura T , Murakami F , Kotani K , Ikawa S , Kono S
Published: March 2003

Nitric oxide (NO) is a candidate as a causative molecule in migraine. We determined nitrite, total nitrate/nitrite, and cyclic guanosine 3',5'-monophosphate (cGMP) concentrations in platelets from 30 migraine without aura (MwoA) patients and 17 migraine with aura (MwA) patients. All migraine patients were studied during their migraine attacks. The control group consisted of 28 healthy volunteers. Concentrations of platelet nitrite and total nitrate/nitrite were determined using simple and sensitive nitrate/nitrite fluorometric assay techniques. High concentrations of platelet nitrite and total nitrate/nitrite were found in patients with MwoA and MwA when compared with healthy controls. High concentrations of platelet cGMP were also found in patients with MwoA and MwA. The levels of platelet total nitrate/nitrite significantly decreased in headache-free periods after treatment with oral propranolol. These findings suggest that NO is produced in platelets during migraine attacks. It maylilso be related to the migrainous pain and the changes in cerebral blood flow experienced during migraine attacks. These data may provide new strategies for the treatment of migraine.
Efficacy and Safety of Metamizol vs. Acetylsalicylic Acid in Patients With Moderate Episodic Tension-Type Headache: A Randomized, Double-Blind, Placebo- and Active-Controlled, Multicentre Study
Authors: Martínez-Martín P , Raffaelli E , Titus F , Despuig J , Fragoso YD , Díez-Tejedor E , Liaño H , Leira R , Cornet ME , van Toor BSJ , Cámara J , Peil H , Vix JM , Ortiz P ,   the Co-operative Study Group
Published: March 2003

We assessed the efficacy and safety of oral single doses of 0.5 and 1 g metamizol vs. 1 g acetylsalicylic acid (ASA) in 417 patients with moderate episodic tension-type headache included in a randomized, double-blind, placebo- and active-controlled, parallel, multicentre trial. Eligibility criteria included 18–65 years of age, history of at least two episodes of tension-type headache per month in the 3 months prior to enrolment, and successful previous pain relief with a non-opioid analgesic. Treatment arms were metamizol 0.5 g ( n = 102), metamizol 1 g ( n = 108), ASA 1 g ( n = 102) and placebo ( n = 105). The analgesic efficacy of 0.5 and 1 g metamizol vs. placebo was highly statistically significant (α: 0.025; one-sided) for sum of pain intensity differences, maximum pain intensity difference, number of patients with at least 50% pain reduction, time to 50% pain reduction, maximum pain relief and total pain relief. A trend towards an earlier onset of a more profound pain relief of 0.5 and 1 g metamizol over 1 g ASA was noticed. All medications including placebo were almost equally safe and well tolerated.
Hemicrania Continua with Aura
Authors: Peres MFP , Siow Hua Chiang , Rozen TD
Published: March 2003

Hemicrania continua is a primary headache disorder that is characterized by a continuous unilateral headache of moderate severity, exacerbations of severe pain and complete responsiveness to indomethacin. We report four patients with a unique variant of hemicrania continua: visual auras that precede or accompany the pain exacerbations.