bluuebunny/crossref_metadata_2025 huggingface dataset:
Current Management of Aneurysmal Subarachnoid Hemorrhage Guidelines from the Canadian Neurosurgical Society
Authors:   a Canadian Neurosurgical Society practice guidelines review group
Published: February 2016

Published medical evidence pertaining to the management of aneurysmal subarachnoid hemorrhage (SAH) was critically reviewed in order to prepare practice guidelines for this condition. SAH should be considered as a possible cause of all sudden and/or unusual headaches, and every attempt should be made to recognize mild SAHs, as they are still frequently misdiagnosed. The first test for SAH is computed tomography (CT), followed by lumbar puncture when the CT is negative for intracranial bleeding (the case in only several per cent of patients within 24 hours of aneurysm bleeding). Urgent cerebral angiography is necessary to detect the underlying cerebral aneurysm. The advantage of rapid diagnosis of SAH followed by early aneurysm repair is minimizing the risk of catastrophic aneurysm rebleeding. Early surgery for aneurysm repair is often possible and is recommended, unless the aneurysm location or size renders it technically difficult to expose in clot-laden subarachnoid cisterns beneath an acutely swollen brain. Aneurysm ablation is optimally accomplished with open microsurgery and clipping of the aneurysm neck, although other options include proximal parent artery occlusion, “trapping” of the aneurysmal segment of the artery, and embolization of thrombogenic materials (e.g., platinum “microcoils”) directly into the aneurysm dome using endovascular techniques. Neurological outcome following SAH is also optimized through the prevention of secondary SAH complications, and further management specific for ruptured cerebral aneurysms can include anticonvulsants, neuroprotectants, and various agents and techniques to prevent or reverse delayed-onset cerebral vasospasm. All patients with aneurysmal SAH should be treated with the calcium antagonist nimodipine, and in certain circumstances patients should receive anticonvulsants. Induced arterial hypertension, hypervolemia and in some instances percutaneous balloon angioplasty are recommended to reverse vasospasm causing symptomatic cerebral ischemia prior to cerebral infarction.
Neurotrophin Regulation of Gene Expression
Authors: Bonni Azad , Greenberg Michael E.
Published: February 2016

The neurotrophins comprise a family of secreted proteins that elicit profound responses in cells of the developing and mature vertebrate nervous system including the regulation of neuronal survival and differentiation. The molecular mechanisms by which the neurotrophins exert their effects have been the subject of intense investigation. The neurotrophins elicit responses in neurons via members of the Trk family of receptors and the p75 neurotrophin receptor. Once activated, neurotrophin receptors trigger a large number of biochemical events that propagate the neurotrophin signal from the plasma membrane to the interior of the cell. An important target of the neurotrophin-induced signaling pathways is the nucleus, where neurotrophin-induced signals are coupled to alterations in gene expression. These neurotrophin-induced changes in gene expression are critical for many of. the phenotypic effects of neurotrophins including the regulation of neuronal survival and differentiation.
Causes of Morbidity and Mortality Following Intracranial Aneurysm Rupture
Authors: Findlay J. Max , Deagle Gail M.
Published: February 2016

Objective:

To determine the current recovery rates and causes for morbidity and mortality in patients suffering aneurysmal subarachnoid hemorrhage (SAH).

Methods:

We reviewed a recent consecutive series of 95 patients with ruptured intracranial aneurysms who presented to our hospital between 1994 and 1995. When administered, active treatment consisted of early surgery for aneurysm clipping and aggressive prevention and treatment of SAH-related complications.

Results:

Eighty-eight (93%) of the patients were admitted within 24 hours of rupture. One-quarter of the patients in this series did not undergo aneurysm clipping due to poor neurological condition on presentation. Of the 75 patients initially considered for active treatment, 83% underwent surgery within 48 hours of rupture, all received nimodipine, 16% received tissue plasminogen activator to lyse subarachnoid or intraventricular clots, 40% underwent hypertensive treatment, and 7% underwent transluminal balloon angioplasty for vasospasm. At one year followup, 29% of patients had died, 7% had severe disabilities, 13% had moderate disabilities, 51% had made a good recovery, and 64% of all surviving patients had returned to their previous work status. Primary and contributing causes of death and disability, affecting 47 patients at one year, were: direct effects of the initial hemorrhage (79% of affected patients), surgical complications (13%), vasospasm (11%), rebleeding (11%) and medical complications (13%).

Conclusions:

Almost two-thirds of patients suffering aneurysm rupture make a satisfactory recovery with modern treatment. While vasospasm has become a less common cause of poor outcome following SAH, surgical complications remain an important problem.
Platelet Monoamine Oxidase B Activity in “de novo” and L-Dopa Treated Parkinsonian Patients and Controls
Authors: Kuhn Wilfried , Müller Thomas , Gerstner Anja , Winkel Regina , Goetz Mario E.
Published: February 2016

Objective:

Previous studies demonstrated controversial results regarding monoamine oxidase B (MAO-B) activity in platelets in the periphery in parkinsonian patients (PD).

Subjects and Methods:

Therefore we determined platelet MAO-B activity in three age- and sex-matched groups of 17 untreated, so called “de novo” patients with Parkinson's disease (PD), 17 parkinsonian patients, receiving levodopa, and 17 controls by a radio enzymatic assay.

Results:

No significant differences of MAO-B activity appeared.

Conclusion:

This result suggests that phenotypic determination of MAO-B activity in platelets may not be used as peripheral marker in PD and that levodopa treatment does not alter MAO-B activity in the periphery.
Drawing with the Non-dominant Hand: Implications for the Study of Construction
Authors: Zacharias Sherma , Kirk Andrew
Published: February 2016

Background:

Constructional impairment following left vs. right hemisphere damage has been extensively studied using drawing tasks. A confounding factor in these studies is that right-handed patients with left hemisphere damage (LHD) are often forced by weakness to use their non-dominant (left) hand or hemiparetic dominant hand. Qualitative differences in the drawing characteristics of left and right hand drawings by normal subjects have not previously been characterized. The present study was undertaken to determine the qualitative differences between left and right hand drawings of normal subjects.

Methods:

Thirty right-handed, elderly subjects without a history of neurological disease were asked to draw, from memory, seven objects using the right and left hand. Half of the subjects were randomly assigned to draw with the left hand first, and half the right hand first. Right and left hand drawings were compared using a standardized scoring system utilized in several previous studies of drawing in focal and diffuse neurological disease. Each drawing was scored on eighteen criteria. Right and left hand drawing scores were then compared using the t-test for paired samples or the Wilcoxon matched-pairs test

Results:

Drawings made using the left hand were found to be significantly simpler, more tremulous and of poorer overall quality than drawings made by the same subjects using the right hand.

Conclusions:

The deficits found in left versus right hand drawings of normals are similar to those found in patients with LHD, suggesting that much of the drawing impairment seen following LHD is due to an elementary motor disturbance related to use of the non-dominant hand.
Reflections on the History of the Canadian Association for Child Neurology
Authors: Dunn Henry G. , Tibbles John A.R.
Published: February 2016

The Canadian Association for Child Neurology (CACN) was founded in June 1971 to combine neurologists interested in children and paediatricians interested in the nervous system into an organization which would promote the development of this subspecialty. Initially, the members of the Association mostly wished to have a training programme under the combined supervision of University Departments of Paediatrics and Neurology. However, under the influence of the Royal College of Physicians & Surgeons of Canada, and its Committee on Neurology, the training of child neurologists was organized in a manner analogous to that of neurologists for adults, though with an initial one or two years of paediatrics instead of medicine. By 1975, four years within a recognized neurological training programme could lead to the Certification Examination in Neurology, as modified for paediatric neurology. In 1981, the CACN also joined the Canadian Congress of Neurological Sciences. It has played an increasing part in child care and also in academic studies. However, evidence will be presented to show that the present number of paediatric neurologists in Canada is insufficient. The number of trainees also appears inadequate, and increased funding for training positions is needed. Close cooperation between paediatric neurologists, rehabilitation experts, developmental paediatricians and related subspecialists is required.
Rash in Adult and Pediatric Patients Treated with Lamotrigine
Authors: Messenheimer John A.
Published: February 2016

Data from clinical trials with lamotrigine indicate that the risk of serious rash in pediatric patients is higher than in adults. The incidence of rash associated with hospitalization among adults treated with lamotrigine is 0.3% and among pediatric patients 1.0%. The incidence of cases reported as possible Stevens-Johnson syndrome is 0.1% for adult patients and 0.5% for pediatric patients. These rates reflect lamotrigine dosing and concomitant AEDs used in these trials, both of which are risk factors for rash. Since many of the trials were conducted prior to the establishment of the current dosing recommendations, the incidence of serious rash in clinical trials does not necessarily reflect the incidence to be expected with use of current dosing recommendations. The higher incidence of serious rash in pediatric patients may at least partially be accounted for by the differential effects of the risk factors of dosing and concomitant use of valproic acid in these patients.
Hemi-Cauda Equina Syndrome from Herniated Lumbar Disc: a Neurosurgical Emergency?
Authors: Bartels Ronald H.M.A. , de Vries Joost
Published: February 2016

Background: We report experience with patients presenting with a specific combination of symptoms: unilateral sciatica, unilateral sensibility loss in the dermatomes SI to S5 (hemi-saddle) and subjective micturation problems secondary to ruptured lumbar disc. Because of its similarities with a cauda equina syndrome, this combination of symptoms was thought to be a unilateral cauda equina syndrome and it was called hemi-cauda equina syndrome. Consequently, it was treated as an emergency. Methods: Ten patients were evaluated. They compromised 2.3% of all patients undergoing lumbar discectomy. Results: Outcome is good with only 10% persisting minor neurologic deficit (sensibility loss in dermatomes S3 to S5). With the exception of urinary retention or incontinence, duration of symptoms and signs does not seem to influence outcome. Comparing signs, symptoms and radiographic findings with those of a cauda equina syndrome which were recently and thoroughly studied, they were found to be more severe in cases of cauda equina syndrome. Especially, the good outcome, (apparently unrelated to the duration of symptoms in cases of hemi-cauda equina syndrome) contrasted with the treatment results of cauda equina syndrome. Conclusions: We defined the hemi-cauda equina syndrome from ruptured disc as a combination of unilateral leg pain, unilateral sensibility loss in dermatomes SI to S5 and sphincter paralysis (proven urinary retention or incontinence). Motor deficit is not necessarily present. Emergency surgery is warranted. Patients presenting with micturation complaints other than urinary retention or incontinence do not suffer from a hemi-cauda equina syndrome.
Historical Vignette: Cerebral Cortical Stimulation and Surgery for Epilepsy
Authors: Maroun F. , Fitzgerald W. , Rasmussen T. , Jacob J. C. , Sadler M. , Murray G.
Published: February 2016

In 1909, in an isolated community hospital, on the northern tip of the Province of Newfoundland and Labrador, Canada, Dr. John Mason Little, Jr. performed electrical stimulation of the cerebral cortex, prior to cortical excision, as treatment of recurrent cerebral seizures in three patients. Extracts from Dr. Little’s written records of the clinical features, the neurosurgical procedures and cerebral cortical stimulation are summarised. A brief review of the contemporaneous history of neurosurgical procedures for epilepsy provides a prospective of Dr. Little’s remarkable surgical virtuosity.
Perioperative Problems in Parkinson’s Disease and Their Management: Apomorphine with Rectal Domperidone
Authors: Gálvez-Jimenez Néstor , Lang Anthony E.
Published: February 2016

Objective: To present guidelines on the use of apomorphine in combination with rectal domperidone in Parkinson’s disease (PD) patients undergoing abdominal surgery and to review the perioperative problems encountered in such patients. Background: PD patients undergoing abdominal surgery present a major therapeutic challenge. Because most antiparkinsonian medications must be withheld until the patient is able to resume oral intake, resulting rigidity and akinesia as well as alterations in gastrointestinal motility, respiratory function and swallowing mechanisms predispose these patients to numerous serious postoperative complications. We have found that parenteral apomorphine in combination with rectal domperidone markedly facilitates the care of these difficult patients. Methods: Presentation of two illustrative cases with review of the literature. Results: A standardized protocol using subcutaneous apomorphine and rectal domperidone was used in two PD patients who underwent abdominal surgery. Excellent control of parkinsonian symptomatology was obtained without side effects. The simplicity of the protocol was emphasized in our second patient who required urgent reoperation; the surgery nursing staff was able to restart the apomorphine immediately without having to wait for neurological follow-up assessment. Conclusions: The use of parenteral apomorphine with rectal domperidone in the immediate postoperative period for patients unable to take oral antiparkinson drugs increases patient comfort, facilitates nursing care and may reduce serious postoperative complications.
Levodopa Reduces Muscle Tone and Lower Extremity Tremor in Parkinson’s Disease
Authors: Burleigh Anne , Horak Fay , Nutt John , Frank James
Published: February 2016

Objective

We have quantified the effects of levodopa treatment in Parkinsonian subjects during maintained stance.

Methods

Electromyographic muscle activity during quiet stance was assessed in subjects with Parkinson’s disease, who exhibited a fluctuating response to levodopa, and in age-matched control subjects. Stance stability was also assessed from mean displacement and velocity of the center of pressure excursions during stance.

Results

Lower extremity and trunk muscles showed high amplitude activity in all Parkinson’s subjects when “off”, and a 4–5 Hz tremor in three of these subjects. When “on”, the amplitude of muscle activity was reduced in the distal muscles more than the proximal, while tremor was suppressed in all muscles. Corresponding to the excessive muscle activity, the Parkinson’s subjects had increased velocity and variability of velocity in the anterior-posterior center of foot pressure excursions, but the mean displacement of the center of pressure excursion was not different from the controls. The velocity of center of pressure excursions in the Parkinson’s subjects “on”, approached those of the control subjects suggesting that the excessive distal muscle amplitude and tremor contributed to the high velocity of the center of pressure.

Conclusions

These findings suggest that dopaminergic systems are involved in the regulation of muscle tone during stance. Depletion of dopaminergic transmission results in increased muscle tone and tremor in the lower extremities which may contribute to changes in posture and stability.
EEG Results are Rarely the Same if Repeated within Six Months in Childhood Epilepsy
Authors: Camfield Peter , Gordon Kevin , Camfield Carol , Tibbies John , Dooley Joseph , Smith Bruce
Published: February 2016

Objective

To assess the reliability of interictal spike discharge in routine electroencephalography (EEG) testing in children.

Method

EEG results of all children diagnosed in Nova Scotia with epilepsy onset between 1977–85 (excluding myoclonic, akinetic-atonic and absence) were reviewed. The results of the EEG at time of diagnosis (EEG1) were compared with those of a second EEG (EEG2) within 6 months.

Results

Of 504 children with epilepsy, 159 had both EEG1 and EEG2. EEG2 was more likely ordered if EEG1 was normal or showed focal slowing but less likely if EEG1 contained sleep (p < 0.05). EEG1 and EEG2 were both normal in 23%. If EEG1 was abnormal, there was a 40–70% discordance for the type of abnormality on EEG2. Abnormalities were present on both EEG1 and EEG2 in 67 cases. Of the 42/67 with major focal abnormalities on EEG1, 7 had only generalized spike wave on EEG2. Of the 17/67 with only generalized spike wave on EEG 1, 7 showed only major focal abnormalities on EEG2. Statistical testing showed low Kappa scores indicating low reliability.

Conclusions

The interictal EEG in childhood epilepsy appears to be an unstable test. A repeat EEG within 6 months of a first EEG may yield different and sometimes conflicting information.
Nerve Microvessel Changes in Diabetes are Prevented by Aldose Reductase Inhibition
Authors: Benstead Timothy J. , Sangalang Virgilio E.
Published: February 2016

Background

Despite the potential importance of endoneurial microvessel abnormalities in diabetic neuropathy, the pathogenesis of these abnormalities is incompletely understood. We wished to evaluate the effect of experimental diabetes on endoneurial microvessels and determine if an aldose reductase inhibitor alters any of the changes induced by diabetes.

Methods

We compared streptozocin diabetic rats with and without aldose reductase inhibitor treatment to non-diabetic rats after 10 months of diabetes. Transverse microvessels from the mid-sciatic level were studied by electron microscopic morphometric evaluation.

Results

Microvessel endothelial, pericyte, basement membrane and total mural area were greater in untreated diabetic animals than non-diabetic animals. Aldose reductase inhibitor treated diabetic animals had greater endothelial area and possibly pericyte area but not basement membrane or total mural area.

Conclusions

This study demonstrates that endoneurial microvessel abnormalities can be detected in experimental diabetic neuropathy. Microvessel basement membrane thickening will be prevented by an aldose reductase inhibitor. One mechanism by which abnormal polyol pathway activity may contribute to diabetic neuropathy could be through damage to microvessels.
Screening for Major Depression in the Early Stages of Multiple Sclerosis
Authors: Sullivan Michael J.L. , Weinshenker Brian , Mikail Samuel , Bishop Scott R.
Published: February 2016

Background

Multiple Sclerosis (MS) is associated with a high risk of developing major depression, but depression in MS patients frequently goes undetected and untreated. The current study examined the clinical utility of the Beck Depression Inventory (BDI) as a screening measure for major depression in newly diagnosed MS patients.

Methods

Forty-six new referrals to an MS clinic completed the BDI and participated in a structured interview for major depression, within 2 months of the diagnosis of MS.

Results

According to DSM-III-R criteria, 40% of patients were diagnosed with major depression, 22% had adjustment disorder with depressed mood, and 37% showed no evidence of mood disorder. Sensitivity and specificity values, and positive and negative predictive values are reported for every BDI cut-off score between 9 and 21.

Conclusions

A BDI cut-off score of 13 (sensitivity = .71, specificity = .79) is recommended as optimal for use in screening for major depression in newly diagnosed MS patients. The use of the BDI as a screening measure for major depression must proceed with caution given that a cut-off score of 13 still yielded a false-negative rate of 30%.
Cholinergic Mechanisms in Generalized Seizures: Importance of the Zona Incerta
Authors: Brudzynski Stefan M. , Cruickshank James W. , McLachlan Richard S.
Published: February 2016

Objective:

Stimulation of the central cholinergic system results in generalized epileptic seizures. The goal of this study was to map the epileptogenic effects of the cholinergic agonist, carbachol injected into different sites of the basal forebrain and diencephalon of the rat brain.

Methods:

Carbachol was injected directly into the brain in a dose of 1 or 3 (jg. Seizures were assessed behaviourally on a five-stage scale with electroencephalographic controls. Seizures at stage 1 were the least severe and those at stage 5 the most severe.

Results:

Injections of high dose carbachol (3 (jg) induced seizures from 40% of all injected brain sites. Injections of low dose carbachol (1 ug) or isotonic saline into the same brain sites did not cause any behavioural or electrographic seizures. The majority of sites (84%) producing generalized seizures (stage 5) were concentrated in or around the zona incerta.

Conclusions:

Within the anatomical limits of the study, the zona incerta is the area most sensitive to carbachol-induced generalized seizures.
Preparatory Postural Adjustments in Parkinsonian Patients with Postural Instability
Authors: Lee Robert G. , Tonolli Ida , Viallet Francois , Aurenty Roslyn , Massion Jean
Published: February 2016

Background:

Postural instability is a common problem in patients with Parkinson’s disease. This paper reports results of a study undertaken to investigate some of the possible mechanisms responsible for this instability.

Methods:

Preparatory postural adjustments associated with a lateral leg raising task were studied in five parkinsonian patients and four age-matched controls. Recordings included ground reaction forces, kinematics, and surgace EMG activity from multiple leg muscles.

Results:

In normal subjects there was a well-defined sequence of events preceding the onset of leg elevation, beginning with a transfer of centre of foot pressure (CP), initially toward the moving leg and then back to the support side, followed by displacement of the trunk toward the support side. In the more severely affected parkinsonian patients, the amplitude of the the initial displacement of CP was markedly reduced. The interval between the earliest force changes and the onset of leg elevation was prolonged and the relative timing of the kenematic adjustments during this interval was disrupted. In addition the alternating burst and periods of inhibition observed in the EMG recordings from the normal subjects were replaced by continuous tonic EMG activity.

Conclusions:

These observations suggest that abnormalities in programming preparatory postural adjustments may contribute to postural instability in some patients with advanced Parkinson’s disease.
Myoclonic-like Finger Microdisplacements in Patients With Cerebellar Deficits
Authors: Beuter Anne , Milton John G. , Labrie Christiane , Black Deborah
Published: February 2016

Background:

Here we assess the ability of patients with cerebellar disease to execute a simple visually-guided movement task involving tracking of a target with the index finger.

Methods:

Spontaneous microdisplacements in index finger position are compared in patients with cerebellar deficits (ischemia [n = 3], multiple sclerosis [n = 3], degenerative cerebellar disease [n = 3]) and age-matched healthy subjects. Subjects were required to maintain a constant finger position relative to a stationary baseline displayed on an oscilloscope.

Results:

Unusual transient abrupt movements (saccadic or myoclonic-like) directed with or against gravity were seen in patients whose neurological deficits were the most severe (7/9 patients). These abrupt myoclonic-like movements occurred independently of visual input, were not associated with clinically observable myoclonus, and were not detected previously in patients with Parkinson’s disease. These abrupt myoclonic-like movements were not associated with abnormalities in either physiological tremor, or oscillations in finger microdisplacements induced by insertion of a delay (300–1400 ms) into the visual feedback of this finger “holding” experiment. An unexpected finding is that the results obtained for patients with cerebellar deficits by insertion of an experimental delay are not significantly different from those obtained with their age-matched controls.

Conclusions:

These observations suggest that abrupt myoclonic-like movements are a characteristic abnormality of patients with a variety of cerebellar deficits and emphasize the value of this simple motor tracking task for characterizing movement disorders.
Delayed Myelopathy After Trivial Neck Injury in a Patient With a Cervical Neurenteric Cyst
Authors: Midha Rajiv , Gray Bruce , Becker Laurence , Drake James
Published: February 2016

Background:

Neurenteric cysts are rare spinal lesions of congenital origin. They usually present insidiously with a long history of local spinal pain, radiculopathy and myelopathy. We report a 14-year-old male with a high cervical neurenteric cyst who developed a progressive myelopathy after minor neck trauma. Full recovery followed a partial cyst excision and decompressive procedure.

Significance and conclusion:

The possible pathogenic mechanisms for this unusual presentation include hemorrhage into the cyst, sudden mechanical compression from abnormal spinal movement of a chronically distorted and compressed spinal cord, or an increase in the size of the cyst secondary to accumulation of cyst fluid. In this case a small increase in the cyst size may have resulted in increased mechanical distortion and spinal cord dysfunction on a compressive and ischemic basis.
Electrical Stimulation of the Human Descending Motor Tracts at Several Levels
Authors: Ugawa Yoshikazu , Genba-Shimizu Kieko , Kanazawa Ichiro
Published: February 2016

The descending motor tracts were activated using a high voltage electrical stimulation technique at four levels: the motor cortex, brainstem (around the pyramidal decussation), and the first and sixth thoracic vertebral levels (Tl, T6). Electromyographic activity was recorded from the tibialis anterior or extensor digitorum brevis muscles. Consistent motor action potentials could be evoked in all normal subjects. The conduction velocity of the descending tracts was estimated to be 62 to 79 m/s. The sum of synaptic delay and utilization time at the motoneurons (spinal delay time) was estimated to be 0.5 ± 0.3 ms indicating a mono- or oligosynaptic connection. In patients with diffusely affected descending tracts, the technique showed slowed conduction along the descending tracts and prolonged spinal delay time which may include the time required for temporal summation of excitatory postsynaptic potentials as well as synaptic delay and utilization time. In patients with a localized lesion, localized conduction delay was found at the appropriate segment.
The Prognosis and Treatment of Headaches in Children – a Ten Year Follow-up
Authors: Dooley Joseph , Bagnell Alexa
Published: February 2016

The prognosis and methods of treating headaches were studied in a group of children, 10 years after their initial diagnosis in 1983. Follow-up was achieved for 77 patients (81%). Headaches persisted in 72.7% but were much improved in 81.3%. Medication use was uncommon, with non-prescription medications used by 30.3% and prescription medications by only two. These data suggest that although childhood onset headaches are likely to persist, children who receive early education regarding the use of non-pharmaceutical methods of headache control appear to rely on these methods even after an interval of 10 years.
Canadian Guidelines for the Development of Antidementia Therapies: a Conceptual Summary
Authors: Mohr Erich , Feldman Howard , Gauthier Serge
Published: February 2016

The magnitude of the problems faced by Canadian society as a result of an aging population has been identified. Perhaps the most important concern related to this greying of Canada is the increasing incidence of dementia and Alzheimer’s disease. Therapeutic options for these disorders have been limited to date. Advances in biotechnology and molecular biology will offer novel approaches to treatment. These and the expansion of more traditional therapeutic avenues require guidelines with the aim of optimizing their development.
Striatonigral Degeneration: Iron Deposition in Putamen Correlates with the Slit-like Void Signal of Magnetic Resonance Imaging
Authors: Lang Anthony E. , Curran Terry , Provias John , Bergeron Catherine
Published: February 2016

We report three patients with striatonigral degeneration highlighting the correlation between magnetic resonance imaging (MRI) and the pathological changes. The “slit-like void signal” observed in the putamen is typical of striatonigral degeneration and can be used to assist diagnosis during life. Our histochemical studies support the concept that increased iron deposition in the putamen is responsible for this MRI picture.
Neuropsychological Functioning in Unilateral Cerebellar Damage
Authors: Botez-Marquard Thérèse , Léveillé Jean , Botez M.I.
Published: February 2016

A woman had a left superior cerebellar artery infarct associated with reduced hexamethyl-propileneamine oxime uptake on SPECT scan of the basal ganglia and frontoparietal areas of the opposite hemisphere performed poorly in some neuropsychological tests indicating right hemisphere dysfunction. There was a lengthening of reaction and movement times with the hand ipsilateral to the lesion. These deficits were temporary. A unilateral cerebellar lesion can produce neuropsychological deficits, possibly because of hypoperfusion in contralateral frontoparietal regions, but spontaneous neuropsychological remissions may occur.
Adaptive Control of Eye Movements: Clinical Implications
Authors: Zee David S.
Published: February 2016

This paper is directed primarily to clinicians who diagnose and treat patients with neurological disorders. It is an attempt to illustrate that even with modern imaging technology and other advances in laboratory testing, a thorough understanding of neurophysiology and its anatomical substrate still plays an important role in the diagnosis and management of patients with neurological diseases. One area in neurophysiology in which there has been great progress in the last few decades is the ocular motor system. Particular interest has been focused on the ways that the brain can adapt to lesions, and more specifically, how the ocular motor system keeps itself calibrated in the face of normal development and aging as well as in response to disease and trauma. Since disorders of eye movements are such common and often dramatic manifestations of neurological disease it seems appropriate to bring some of the newer concepts in ocular motor physiology to the “bedside”.
A Prevalence Study of Multiple Sclerosis in the Crowsnest Pass Region of Southern Alberta
Authors: Klein G.M. , Rose M.S. , Seland T.P.
Published: February 2016

Reports of a high prevalence rate for multiple sclerosis in Southern Alberta led to an epidemiologic study of this disease in the Crowsnest Pass and Cardston regions. In Cardston, the prevalence rate for multiple sclerosis was 88 per 100,000. In the Crowsnest Pass, the prevalence rate was 217 per 100,000. Previous epidemiologic studies of the prevalence rate of multiple sclerosis in Western Canada have shown rates between 93 and 111 per 100,000. Two prevalence studies of multiple sclerosis in Barrhead County, Alberta and Westlock County, Alberta show prevalence rates of 196 and 201 per 100,000. The prevalence rate in the Crowsnest Pass is comparable to the prevalence in Barrhead County and Westlock County, Alberta. However, there is no statistically significant difference between prevalence rates in the Cardston and Crowsnest Pass regions and our overall feeling is that the results of studies of small populations should be interpreted with caution.
A Quarter Century's Experience with Intraoperative Nerve Action Potential Recording
Authors: Kline David G. , Happel Leo T.
Published: February 2016

The rationale, basic considerations, and technique of intraoperative nerve action potential (NAP) recording have been reviewed. Experience using this technique in several thousand patients over a 25 year period has been summarized. The most frequent serious nerve injury is one that leaves it in continuity. Resection of such a lesion that is regenerating does the patient a great disservice as does exploration without repair of one with little or no potential for useful spontaneous recovery. The frequency of lesions in continuity as well as the difficulties in evaluating them in the early months by electromyography let alone by surgical inspection has led to the development of intraoperative NAP recording. Where neurolysis was based on a recordable NAP across a lesion in continuity, 93% recovered good function. Where resection of the lesion was based on absence of an NAP, the injury was, without exception, neurotmetic and/or one with poor potential for useful recovery without repair. Some lesions had an NAP across their lesion but a portion of the cross-sectional area appeared more seriously injured. By use of NAP recordings, a split repair was done and usually with good results.
Epidemiology of Multiple Sclerosis: A Critical Overview
Authors: Sadovnick A.D. , Ebers G.C.
Published: February 2016

The decisive conclusions to be drawn from the available epidemiological data, mostly geography and prevalence, of MS are: (1) a north-south (as well as west-east in the United States) gradient exists independent of genetic/racial factors; (2) major differences in prevalence occur in the absence of latitude differences; (3) individuals from the same ethnic derivation have either similar prevalence rates or very different prevalence rates in widely separated geographical areas and (4) specific resistant isolates are shown to exist regardless of latitude. Existing information leads to the almost inescapable conclusion that the epidemiology of MS cannot be explained by any single known environmental or genetic factor(s) in isolation. A combination of a heterogeneous distribution of both genetic and environmental factors appears to be required to explain the available data on MS.
Single-Blind Study of Dystrophin Staining in Carriers of Duchenne Muscular Dystrophy
Authors: Bernier Francois P. , Greenberg Cheryl R. , Halliday William C. , Wrogemann Klaus
Published: February 2016

A single-blind study of dystrophin staining in skeletal muscle was performed in 13 biopsies from carriers of Duchenne Muscular Dystrophy (DMD) and controls. The results indicate that immunohistochemical analysis of dystrophin staining is a valuable diagnostic test for DMD carriers when DNA for testing is unavailable from critical family members or is uninformative, when creatine kinase (CK) values are conflicting or when CK values must be used in isolation.
Epineurial Peptides: A Role in Neuropathic Pain?
Authors: Zochodne D.W.
Published: February 2016

Neuropathic pain is not well understood. Although central dorsal horn remodelling is likely important in maintaining chronic neuropathic pain, afferent activity from injured nerves or ganglia may initiate these changes. It is suggested, in this review that the peripheral nerve trunk is capable of sustaining a “flare” response as observed in injured skin and other tissues. The injury response may be associated with local vasodilatation, plasma extravasation and the generation of painful local afferent activity sustained by locally originating peptidergic fibers (nervi nervorum). These fibers contain substance P, calcitonin gene-related peptide and other peptides that have been linked to nociceptive transmission. Manipulation of the local injury response of the nerve trunk by pharmacologic means may provide one strategy in the treatment of neuropathic pain.
Neural Networks and Parkinson's Disease
Authors: Borrett Donald S. , Yeap Tet H. , Kwan Hon C.
Published: February 2016

A closed-loop or recurrent neural network was taught to generate output discharges to reproduce the prototypical activations in agonist and antagonist muscles which produce the displacement of a limb about a single joint. By introducing a generalized decrease in the excitability of the pre-output layer in the network, the network made the displacement more slowly and also showed an inability to maintain a repetitive movement. These concepts can be applied to the human nervous system in the understanding of the physical basis of movement and its disorders. It is suggested that a movement represents the output of a closed-loop network, such as the cortical-basal ganglia-thalamic-cortical motor loop, which iterates repetitively to its end point or attractor. The model provides an explanation of how the state of thalamic inhibition seen in Parkinson's disease physically may produce bradykinesia and the inability to maintain a repetitive movement.
High Dose Tamoxifen in the Treatment of Recurrent High Grade Glioma: A Report of Clinical Stabilization and Tumour Regression
Authors: Baltuch Gordon , Shenouda George , Langleben Adrian , Villemure Jean-Guy
Published: February 2016

We present a case of recurrent glioma, previously treated with maximal surgery and radiation in which a high dose of tamoxifen has stabilized the tumour clinically and has resulted in it's radiologic regression. Given tamoxifen's relative lack of toxicity, it might serve as a useful adjuvant in the treatment of recurrent glioma.
The Usefulness of CT Scanning in Diagnosing Dementia of the Alzheimer Type
Authors: Willmer J. , Carruthers A. , Guzman D.A. , Collins B. , Pogue J. , Stuss D.T.
Published: February 2016

In order to determine the usefulness of Computerized Tomography (CT) scanning in making a diagnosis of dementia of the Alzheimer type, a group of patients diagnosed by NINCDS - ADRDA criteria (n = 22) were compared to a group of normal subjects (n = 49) using certain defined linear CT scan measurements. These measurements included specific measurements of the temporal lobes (temporal horns). Subjects were classified correctly 91.5% of the time with a high degree of probability. A diagnostic equation is presented which will allow testing of these methods in a prospective fashion.
William John Horsey, M.D., F.R.C.S.C Neurosurgeon to St. Michael's Hospital, Toronto
Authors: Max Findlay J. , William S. Tucker
Published: February 2016

After just completing his neurosurgical training in 1954 Dr. William Horsey visited Queen Square, England, where on one occasion he attended a pathological conference discussing a young man who had died from complications following biopsy of a low grade astrocytoma. One of the surgeons present, none other than the brilliant, mercurial and sometimes flamboyant Wylie McKissock, asked young Horsey what he thought of the case. What followed was not the primitive, colonial opinion that might have been expected. Unintimidated, Dr. Horsey said that he probably would not have operated on the man in the first place, since he was neurologically well-preserved bearing an intrinsic tumor causing minimal deformity of the ventriculogram. But if he had operated, Horsey went on, he would have finished the job with a proper decompression of the affected temporal lobe, rather than just a biopsy. And, he continued, if he had made the decision to treat this young man's tumor, he would also have treated his postoperative clot, with a second operation, to save the patient's life. It was this kind of sharp intelligence and sensibility, which so silenced a crowded Queen Square conference room that morning, combined with a superb operating technique and a particular dedication to teaching that characterized Bill Horsey's neurosurgical career.
Autosomal Recessive Motor and Sensory Neuropathy with Excessive Myelin Outfolding in Two Siblings
Authors: Barbieri F. , Santangelo R. , Capparelli G. , Ciccarelli A. , Crisci C.
Published: February 2016

Two siblings, a 35-year-old male and a 37-year-old female, offspring of first cousins, presented with a hereditary motor and sensory neuropathy with type I clinical features which began to manifest at about age 10 years. Nerve biopsy in the proband showed it to be a type characterized by excessive myelin outfolding. Morphometric study revealed hypomyelination with focal thickenings due to outfoldings. Clinical, electrophysiological and morphological findings are virtually identical to those described by Ohnishi et al. The peculiarity of the neuropathological picture suggests a particular form of hereditary motor and senory neuropathy.
Newborn Apnea Caused by a Neurofibroma at the Craniocervical Junction
Authors: Clarke David B. , Farmer Jean-Pierre , Montes José L. , Watters Gordon V. , Rouleau Guy
Published: February 2016

The authors report, for the first time, the finding by magnetic resonance imaging of a neurofibroma at the craniocervical junction with upper cervical cord and lower brainstem compression causing complete apnea from birth. Subsequent subtotal resection of the neurofibroma resulted in the successful extubation of a previously ventilator-dependent patient. After a two month period of breathing spontaneously, the newborn developed an upper respiratory tract infection and was reintubated. The patient, unable to be weaned off of the respirator, was extubated and expired shortly thereafter, at the age of five months. The authors suggest that in newborns with unexplained apnea, MRI of the craniocervical junction is indicated. Certain patients may be discovered who have less compromised cervicomedullary function and are afflicted by less aggressive forms of neurofibromatosis type 1. These patients may benefit permanently from a surgical decompression.
Adult Diastematomyelia
Authors: Russell Neville A. , Benoit Brien G. , Joaquin Andrew J. , Fayez Nayef Al
Published: February 2016

With modern imaging techniques, various types of spinal dysraphism are being diagnosed in adults with increasing frequency. We report a 42-year-old woman with diastematomyelia whose symptoms characteristically were precipated by trauma. She exhibited other typical features such as a posterior midline hair patch and vetebral malformations. Metrizamide myelography with computerized tomography showed a bony septum at Tl 1 with a cleft at T9-T11 separating two dural tubes each of which contained a single spinal hemicord. The septum was excised with complete relief of symptoms.
Hippocampal Stimulation of Fornical-lesioned Rats Improves Working Memory
Authors: Turnbull J. , Jiang F. , Racine R.
Published: February 2016

Intrinsic rhythmic electrical activity in the brain, such as the hippocampal theta rhythm, might serve important roles in normal cognition. Lesions to the medial septal nuclei, or to the fimbria/fornix, disrupt the hippocampal theta rhythm and lead to memory impairment. We have superimposed an artifical stimulating rhythm to the hippocampus of rats with prior lesion of the fornix, during testing in the Morris water maze. This intervention improves performance in a test of working memory, and lends support to the view that intrinsic rhythmic activity may play an important role in normal physiology, and in certain disease states.
Immunological Associations in Familial and Non-Familial Alzheimer Patients and Their Families
Authors: Frecker M.F. , Pryse-Philli W.E.M. , Strong H.R.
Published: February 2016

A number of autoimmune diseases and immune-related conditions were investigated in a series of 100 Alzheimer patients and their families. The group was divided into those who had familial dementia of the Alzheimer type and non-familial dementia of the Alzheimer type. HLA DR3 was associated with the familial dementia of the Alzheimer type patients. Adult exposure to tuberculosis appeared to be a risk factor for familial dementia of the Alzheimer type patients. Autoimmune diseases clustered among the non-familial dementia of the Alzheimer type patients, and also among their relatives. Asthma and infertility were also significantly increased among non-familial dementia of the Alzheimer type relatives. The analysis showed that (1) autoimmunity may be important in the sporadic form of Alzheimer disease; (2) it may be possible to confer a decreased risk for Alzheimer disease among relatives when many autoimmune diseases occur in the family; (3) it may be important to assess environmental risk factors for Alzheimer disease separately in patients with familial and sporadic disease; and (4) the efficacy of drug therapies may be dependent on whether the patients have a familial or sporadic form of Alzheimer disease.
Long-Term Results after Glycerol Rhizotomy for Multiple Sclerosis-Related Trigeminal Neuralgia
Authors: Kondziolka Douglas , Lunsford L. Dade , Bissonette David J.
Published: February 2016

Percutaneous retrogasserian glycerol rhizotomy (PRGR) was used during an 11-year interval in 53 patients with typical trigeminal neuralgia associated with multiple sclerosis. All patients had failed extensive medical trials prior to PRGR. Long-term (median follow-up, 36 months) complete pain relief (no further medication) was achieved in 29 (59%) of 49 evaluable patients. Eight patients (16%) had satisfactory pain control but required occasional medication. Twelve patients (25%) had initial unsatisfactory results with inadequate pain relief; nine underwent alternative surgical procedures. Sixteen patients (30%) subsequently required repeat glycerol rhizotomies to reachieve pain control. Twenty-seven patients (60% of 45 patients evaluated for this finding) retained normal trigeminal sensation after injection. Major trigeminal sensory loss developed in a single patient who had four glycerol rhizotomies over a 25-month interval. No patient developed deafferentation pain. We believe that PRGR is a low-morbidity, effective, and repeatable surgical procedure for the management of trigeminal neuralgia in the setting of multiple sclerosis.
Neurosurgery at the Toronto General Hospital, 1924 - 1990: Part 1
Authors: Findlay J. Max
Published: February 2016

The specialty of neurological surgery in this country began when Kenneth G. McKenzie was appointed to the Toronto General Hospital surgical staff in 1924, Canada's first dedicated neurosurgeon. In the years and decades that followed McKenzie and his successors established the Toronto General Hospital as one of the leading clinical and teaching neurosurgical units in the world. It was not without some sadness, therefore, that in 1990 neurosurgery left the walls of the Toronto General Hospital, the service transferred to join with the neurosurgical division of a sister hospital, the Toronto Western, during a merger which created the new, two-site, Toronto Hospital. The following story is of the men and women at the Toronto General Hospital who provided, advanced, and taught neurosurgical care. Many persons, among them orderlies, nurses and physicians, will not receive the mention they deserve in the pages that follow, but are no less remembered.