RESUMO
BACKGROUND: Data showing a role for the mid-thoracic spinal cord (SC) in the control of hemodynamic changes is scarce despite existing evidence for its involvement in autonomic regulation. STUDY DESIGN: On the basis of the open label prospective series comparing three groups. OBJECTIVE: To determine whether the mid-thoracic SC has a role in hemodynamic regulation during head-up tilt (HUT). SETTING: Spinal Research Laboratory, Loewenstein Rehabilitation Hospital. METHODS: A total of 13 healthy control subjects, 10 patients with T(4)-T(6) paraplegia and 11 with C(4)-C(7) tetraplegia were examined during supine rest and during HUT. Heart rate (HR), blood pressure (BP), HR spectral components (lower frequency fluctuation (LF), higher frequency fluctuations (HF) and LF/HF) and cerebral blood flow velocity (CBFV) were continuously measured or calculated. RESULTS: BP response to HUT differed among these groups (P<0.02). During HUT, BP decreased markedly in the tetraplegia group (from a mean value of 81.65 to 67.69 mm Hg), and increased in the control groups (from 92.89 to 95.44 mm Hg) and in the T(4)-T(6) paraplegia group (from 96.24 to 97.86 mm Hg). Significant correlation was found in the control and tetraplegia groups between increases in HR LF/HF and HR at HUT (r>0.7; P<0.01). No such correlation was found in the paraplegia group. HUT effect on HR and CBFV was significant in all groups (P<0.001), but group differences were statistically non-significant. CONCLUSION: Findings were generally compatible with those of comparable previously published studies, but they also support a role for the mid-thoracic SC in hemodynamic regulation, which should be considered in clinical setting and in research.
Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Hemodinâmica/fisiologia , Traumatismos da Medula Espinal/fisiopatologia , Adulto , Doenças do Sistema Nervoso Autônomo/etiologia , Doenças Cardiovasculares/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paraplegia/complicações , Paraplegia/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Quadriplegia/complicações , Quadriplegia/fisiopatologia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/diagnósticoRESUMO
STUDY DESIGN: Controlled experimental human study. OBJECTIVES: To assess insulin resistance (IR) in tetraplegia and paraplegia, and the role of the spinal cord (SC) in glucose regulation. SETTING: Laboratory of Spinal Research, Loewenstein Rehabilitation Hospital. METHODS: Glucose and insulin levels and the heart rate variation spectral components LF (low frequency), HF (high frequency) and LF/HF were studied at supine rest, head-up tilt and after a standard meal in three groups: 13 healthy subjects, 7 patients with T(4)-T(6) paraplegia and 11 patients with C(4)-C(7) tetraplegia. RESULTS: Glucose and insulin increased significantly after the meal in all groups (P<0.001). Glucose increased significantly more in the tetraplegia than in the other groups (P<0.01). Increases in insulin level tended to accompany increases in LF/HF after the meal in the tetraplegia and control groups but not in the paraplegia group. CONCLUSION: Post-prandial IR appears in C(4)-C(7) but not in T(4)-T(6) SC injury. The results of the study, combined with previously published findings, are consistent with the hypotheses that IR is related to activation of the sympathetic nervous system, and that below T(4) the mid-thoracic SC is involved in the regulation of glucose and insulin levels.
Assuntos
Glicemia/metabolismo , Resistência à Insulina/fisiologia , Paraplegia/metabolismo , Quadriplegia/metabolismo , Traumatismos da Medula Espinal/metabolismo , Adulto , Glicemia/biossíntese , Vértebras Cervicais/lesões , Feminino , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/etiologia , Hiperglicemia/metabolismo , Masculino , Pessoa de Meia-Idade , Paraplegia/complicações , Quadriplegia/complicações , Medula Espinal/metabolismo , Medula Espinal/patologia , Traumatismos da Medula Espinal/complicações , Vértebras Torácicas/lesões , Adulto JovemRESUMO
We present a rare complication of pneumococcal meningitis. A 56-year-old female patient with pneumococcal meningitis developed acute hyposplenism. Left-sided hypochondriacal pain accompanied by a marked thrombocytosis developed during the convalescent period. Abdominal radionuclide and computed tomographic scans demonstrated damage to the spleen. The findings were compatible with autosplenectomy.
Assuntos
Meningite Pneumocócica/complicações , Esplenopatias/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Esplenopatias/diagnóstico , Trombocitose/etiologiaRESUMO
Skin wrinkling of the fingers following immersion in warm water depends on intact sympathetic innervation. It is abolished by lesions affecting both central and peripheral sympathetic pathways. It affords a simple and reliable clinical test of sympathetic function.
Assuntos
Imersão/fisiopatologia , Pele/inervação , Sistema Nervoso Simpático/fisiopatologia , Adolescente , Adulto , Fibras Autônomas Pré-Ganglionares/fisiopatologia , Tronco Encefálico/fisiopatologia , Criança , Feminino , Gânglios Autônomos/fisiopatologia , Mãos/inervação , Síndrome de Horner/fisiopatologia , Humanos , Hiperidrose/cirurgia , Masculino , Pessoa de Meia-Idade , Absorção Cutânea , SimpatectomiaRESUMO
BACKGROUND: The question of whether to start antiepileptic treatment after a single unprovoked seizure remains controversial and has been the subject of much debate in the relevant literature. OBJECTIVES: To determine the rate of recurrence of a second attack after a single unprovoked epileptic seizure by using 2 study groups of treated and untreated patients and, thus, to establish a treatment policy for these patients. PATIENTS AND METHODS: A group of 91 patients with a single generalized tonic-clonic seizure were prospectively studied; 87 of these patients completed the study. The end point of the study was 36 months after the single attack or the occurrence of a subsequent epileptic attack. The patients were randomly divided into 2 groups; 45 patients who immediately received anticonvulsive treatment and 42 who remained untreated for the follow-up period. Patients in the treated group were given monotherapy with carbamazepine. The results of recurrences were statistically analyzed by using the Kaplan-Meier method. RESULTS: Results indicated a significantly higher percentage of seizure-free patients in the treated group compared with that in the untreated group (P = .001). The treated men were proved to be less at risk for recurrent seizures compared with treated women (P < .001 vs P = .03, respectively). CONCLUSION: Treatment after a single unprovoked seizure leads to a significant reduction in the risk of relapse of generalized tonic-clonic epilepsy.
Assuntos
Carbamazepina/uso terapêutico , Epilepsia Tônico-Clônica/tratamento farmacológico , Adulto , Feminino , Humanos , Masculino , Prognóstico , Recidiva , Fatores de TempoRESUMO
Ten patients with relapsing-remitting multiple sclerosis were treated with intravenous immune globulin, 0.4 g/kg per day for 5 consecutive days, and then with additional booster doses of immune globulin of 0.4 g/kg, once every 2 months, for the next 12 months. Ten untreated patients with relapsing-remitting multiple sclerosis who were matched with the study patients for age, disease duration, and number of attacks per year served as controls. Immune globulin treatment was well tolerated, with no side effects. The exacerbation rate decreased from 3.7 +/- 1.2 exacerbations per year before treatment to 1.0 +/- 0.7 exacerbations per year during the treatment in the immune globulin-treated patients, while it remained unaltered in the controls. The posttreatment Kurtzke Expanded Disability Status Scale score decreased from a mean of 4.45 to 4.15, whereas in controls it increased from 3.55 to 3.75. The results suggest that immune globulin suppresses the ongoing pathologic process in multiple sclerosis and may be a promising treatment to prevent disease exacerbations.
Assuntos
Imunoglobulinas Intravenosas/uso terapêutico , Esclerose Múltipla/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We describe a patient with left parietotemporal hemorrhage with selective acalculia for addition, multiplication, and division, but with an intact ability to subtract. There was no impairment in the ability to distinguish mathematical signs. This case suggests that different processing systems are responsible for each of the basic arithmetic operations.
Assuntos
Hemorragia Cerebral/complicações , Transtornos da Linguagem/etiologia , Matemática , Lobo Parietal/irrigação sanguínea , Lobo Temporal/irrigação sanguínea , Hemorragia Cerebral/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
We conducted a double-blind, placebo-controlled study of 40 patients (aged 19 to 60 years) with clinical definite relapsing remitting (RR) MS and brain MRI confirmed. Patients were randomly assigned to receive a loading dose of immunoglobulin IgG (0.4 g/kg/body weight per day for 5 consecutive days), followed by single booster doses (0.4 g/kg/body weight) or placebo once every 2 months for 2 years. The primary outcome measures were change in the yearly exacerbation rate (YER), proportion of exacerbation-free patients, and time until first exacerbation. Neurologic disability, exacerbation severity, and changes in brain MRI lesion score were the secondary outcome measures, all determined at baseline, 1 year, and on completion. Treated patients showed a reduction in YER from 1.85 to 0.75 after 1 year and 0.42 after 2 years versus 1.55 to 1.8 after 1 year and to 1.4 after 2 years in the placebo group (p = 0.0006, overall), reflecting a 38.6% reduction in relapse rate. Six patients in the IVIg group were exacerbation free throughout the 2-year period of the study, whereas none were exacerbation free in the placebo group. The median time to first exacerbation was 233 days in the IVIg group versus 82 days in the placebo group (p = 0.003). Neurologic disability as measured by the Expanded Disability Status Scale (EDSS score) decreased by 0.3 in the IVIg group and increased by 0.15 in the placebo group. Total lesion score evaluated by brain MRI did not show a significant difference between groups. Side effects were minor and occurred in only 19 of 630 (3.0%) infusions administered in both groups. Our results suggest that IVIg may be safe and effective in reducing the frequency of exacerbations in RR-MS.
Assuntos
Imunoglobulinas Intravenosas/uso terapêutico , Esclerose Múltipla/terapia , Adulto , Encéfalo/patologia , Avaliação da Deficiência , Intervalo Livre de Doença , Método Duplo-Cego , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/fisiopatologia , Placebos , Probabilidade , Recidiva , Análise de Sobrevida , Fatores de TempoRESUMO
UNLABELLED: The aim of this case report was to present a patient with complete anarthria and orofacial apraxia without other relevant neurological deficit. The clinical features are compatible with anterior operculum syndrome. METHODS: A regional brain perfusion scan was done using 99mTc-HMPAO and a SPECT gamma camera. A brain CT scan and an MRI were also performed. RESULTS: Brain CT and MRI were not diagnostic. On brain SPECT, hypoperfusion of the left inferior area of the frontal lobe was noted. CONCLUSION: The patient studied showed an uncommon case of anterior operculum syndrome of focal degenerative origin localized by SPECT. SPECT may be a useful and effective method for diagnosis of this unusual neurological deficit.
Assuntos
Apraxias/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Disartria/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Transtornos de Deglutição/diagnóstico por imagem , Humanos , Masculino , Compostos de Organotecnécio , Oximas , Compostos Radiofarmacêuticos , Síndrome , Tecnécio Tc 99m ExametazimaRESUMO
Intravenous immunoglobulin (IVIg) pooled from healthy human volunteers has a role in several immunomodulating mechanisms which may affect the pathogenesis of multiple sclerosis. Modulation of the disease course by IVIg is achieved both by limiting the inflammatory process and by enhancing remyelination. Clinical evidence of the effects of IVIg in multiple sclerosis is based on the results of several trials demonstrating the beneficial effects of IVIg on the relapse rate and on neurological disability. Brain magnetic resonance imaging studies support the clinical results by showing a decrease in both the disease burden and the appearance of new lesions. Preliminary results have demonstrated an improvement in the parameters of isometric muscle testing, chronic optic neuritis and the prevention of postpartum relapses. However, design and sample size limitations require larger controlled studies to substantiate these reports. Integrating the accumulating experimental data with clinical experience will assist in defining the specific mechanisms by which IVIg suppresses the disease process and clarify the future indications for IVIg treatment in multiple sclerosis.
RESUMO
Magnesium has been reported to have a dilatatory effect on cerebral arteries. Reduction of extracellular Mg+2 has been shown to be directly correlated with the intensity of cerebral spasm. A neuroprotective effect of magnesium in stroke has also been hypothesized. The aim of our study was to examine the Mg+2 levels in serum and cerebrospinal fluid (CSF) in the early stage of stroke and to evaluate the correlation between Mg+2 levels and the development of neurological deficits. Between 1986 and 1994, 96 patients who had a stroke of 24- to 48-h duration were enrolled in the study. Serum and CSF levels of magnesium were checked on admission, 2448 h after the onset of stroke. Using a neurological score, the neurological deficit was assessed on the 1st day, 1 and 4 weeks later. Computed tomography (CT) was performed after 1 week, and the volume and location of infarction were calculated and measured. Statistical analysis was performed for cortical and subcortical patients separately, using Spearman correlation and multiple linear and logistic regression analyses. Significant correlation was found between CSF Mg+2 and the size of the infarct (P < 0.0001). There was no correlation between serum Mg+2 and CSF Mg+2 levels. Regression analysis demonstrated an increase in the values of the Mathew Neurological Score with higher CSF Mg+2 levels. This association remained true after other factors such as age, associated heart disease, diabetes and infarction size had been taken into account by the regression model. The results confirm that there is a relationship between a low Mg+2 concentration in CSF during the first 48 h after onset of ischaemic stroke and the intensity of the neurological deficit. The therapeutic consequence of this finding may have some importance.
Assuntos
Ataque Isquêmico Transitório/líquido cefalorraquidiano , Magnésio/líquido cefalorraquidiano , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Prognóstico , Estudos ProspectivosRESUMO
The presentation of multiple sclerosis (MS) in childhood has traditionally been thought to be rare. However, more paediatric cases are now being reported, as a result of progress in diagnostic techniques with the use of sensitive imaging modalities of the brain and spinal cord. Management from an early age and the availability of new treatment options have changed the outcome of paediatric MS. Drugs currently available for treatment, such as beta-interferons, copolymer-1 and intravenous immunoglobulin G, have been found to reduce relapse rate, disease severity and progression to disability in adults, but have not been investigated in children and adolescents. The overall outcome of MS in children is apparently no worse than in adults and the disease may even be less aggressive in children. In juvenile MS, disease progression does not appear to be related to age of onset, severity of neurological involvement or mono/polysymptomatic involvement at presentation. The potential to treat MS has significantly changed the prognosis. Early diagnosis is important, as early treatment can prevent or delay the development of disability.
Assuntos
Esclerose Múltipla/epidemiologia , Esclerose Múltipla/prevenção & controle , Adolescente , Adulto , Distribuição por Idade , Idade de Início , Criança , Pré-Escolar , Progressão da Doença , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Esclerose Múltipla/fisiopatologia , Exame Neurológico , Prognóstico , Fatores SexuaisRESUMO
Four young patients who developed weight gain induced by carbamazepine therapy are described. The patients received the carbamazepine as anticonvulsant treatment, and soon after starting the drug, abruptly developed an increase in appetite with a concomitant increase in food intake. During a period of 2 months the patients' weights rose by between 7 and 15 kg. Dietary restriction during the carbamazepine treatment was ineffective in promoting weight loss, and loss of the excess weight was achieved only when the drug was discontinued. These patients demonstrate an as yet unpublished adverse effect of carbamazepine. In carbamazepine-induced weight gain, overeating and fat deposition must be taken into consideration as a differential diagnosis to the hitherto described water retention and edema.
Assuntos
Apetite/efeitos dos fármacos , Carbamazepina/efeitos adversos , Ingestão de Alimentos/efeitos dos fármacos , Epilepsia/tratamento farmacológico , Aumento de Peso/efeitos dos fármacos , Adolescente , Carbamazepina/uso terapêutico , Criança , Feminino , Humanos , MasculinoRESUMO
Some recent studies have shown that clozapine (CLZ) has myopathic side effects and causes alterations in motor force control. The aim of this study was to evaluate the neurologic and electrophysiologic characteristics of patients with schizophrenia who are undergoing long-term CLZ treatment. Ninety-four patients with schizophrenia treated with CLZ for 18.2 +/- 15.5 months were studied retrospectively and prospectively (40% and 60%, respectively) for serum creatine kinase (CK) levels before and after initiation of CLZ treatment. An electrodiagnostic study was performed on patients with CK elevation above normal limits, complained of general weakness or muscle pains, and/or had abnormal clinically significant findings. In 13 patients (13.8%), abnormal CK levels were found. Six patients complained of some muscular weakness. In two patients, clinical assessment revealed mild general muscular weakness; one revealed decreased tendon reflexes and, in both, CK levels were above 1,750 IU/L. On electrophysiologic examinations performed in the six patients with abnormal neurologic findings, the motor and sensory nerve conduction velocity were within normal range in all but one patient, who exhibited some prolongation of distal latency in the lower limbs. In two patients, the electromyography demonstrated a myopathic pattern. In 2.1% of medically healthy patients with schizophrenia treated with clozapine on a long-term basis, signs of myotoxicity were found. It seems warranted to discontinue CLZ therapy in patients who exhibit abnormal CK levels and myopathic features during treatment. Further studies are needed to provide more objective data on the impact of CLZ treatment on muscle tissue.
Assuntos
Antipsicóticos/efeitos adversos , Clozapina/efeitos adversos , Creatina Quinase/sangue , Doenças Musculares/sangue , Esquizofrenia/sangue , Adulto , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculares/induzido quimicamente , Esquizofrenia/tratamento farmacológicoRESUMO
Three members of one family, diagnosed as dyslexic, are described. All of them have variations of midline cavity: cavum vergae or cavum septum pellucidum, diagnosed by neuroradiological examination. In contrast, the non dyslexic members of the same family have no neuroanatomical congenital variations. We raise the possibility of a functional correlation between the dyslexia and the anatomical findings in the affected members of this family.
Assuntos
Dislexia/genética , Septo Pelúcido/anormalidades , Adolescente , Dislexia/diagnóstico , Feminino , Lateralidade Funcional/genética , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Septo Pelúcido/patologia , Tomografia Computadorizada por Raios XRESUMO
Sensory-motor deficit in a peripheral nerve pattern due to brain lesion is rarely documented. We report on seven patients with a clinical manifestation of sensory-motor deficit, imitating peripheral nerve involvement, due to lacunar brain infarcts verified by brain computed tomography scan. Five of the patients had an ulnar nerve-like deficit and two median nerve-like deficits. The infarcts were located in the thalamus and the corona radiata. No clinical or electrophysiological evidence for peripheral nerve involvement was found. The unusual peripheral nerve pattern of lesions caused by lacunar brain infarcts can be defined as an additional lacunar syndrome and must be taken into consideration in the clinical evaluation of peripheral nerve deficits with normal nerve conduction velocity.
Assuntos
Infarto Cerebral/fisiopatologia , Nervo Mediano/fisiopatologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Doenças Talâmicas/fisiopatologia , Nervo Ulnar/fisiopatologia , Idoso , Infarto Cerebral/diagnóstico , Eletromiografia , Feminino , Mãos/inervação , Humanos , Masculino , Pessoa de Meia-Idade , Neurônios Motores/fisiologia , Exame Neurológico , Doenças do Sistema Nervoso Periférico/diagnóstico , Sensação/fisiologia , Transmissão Sináptica/fisiologia , Doenças Talâmicas/diagnóstico , Tálamo/irrigação sanguínea , Tomografia Computadorizada por Raios XRESUMO
The authors studied the recently reported very high frequency (VHF) peaks in the heart rate (HR) and blood pressure (BP) power spectra of heart transplant (HT) patients. These VHF peaks appear at frequencies much higher than the respiratory frequency, in addition to the typical low-frequency and high-frequency peaks. Twenty-five recordings obtained from 13 male HT patients (0.5-65 months following surgery) were compared with recordings from 14 normal male subjects. The ECG, continuous BP and respiration were recorded during 45min of supine rest. Eight recordings from HT patients were excluded owing to arrhythmias. Spectral analysis was performed on all other recordings. VHF peaks were found in the spectra of both BP and HR in nine recordings obtained from six HT patients. In some cases, the power in the VHF peaks was markedly higher than that of the high-frequency peak. No VHF peaks were observed in eight recordings obtained from four HT patients or in recording from any of the normal subjects. No correlation was found between the incidence of VHF peaks and time after transplant. It was proved that the VHF peaks were not artifactual, and their significance within the framework of the theory of communication systems is discussed. The presence of those peaks was attributed to vagal denervation.
Assuntos
Pressão Sanguínea , Frequência Cardíaca , Transplante de Coração , Monitorização Fisiológica/métodos , Processamento de Sinais Assistido por Computador , Adulto , Idoso , Estudos de Casos e Controles , Eletrocardiografia Ambulatorial , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , RespiraçãoRESUMO
Cardiorespiratory synchronization, studied within the framework of phase synchronization, has recently raised interest as one of the interactions in the cardiorespiratory system. In this work, we present a quantitative approach to the analysis of this nonlinear phenomenon. Our primary aim is to determine whether synchronization between HR and respiration rate is a real phenomenon or a random one. First, we developed an algorithm, which detects epochs of synchronization automatically and objectively. The algorithm was applied to recordings of respiration and HR obtained from 13 normal subjects and 13 heart transplant patients. Surrogate data sets were constructed from the original recordings, specifically lacking the coupling between HR and respiration. The statistical properties of synchronization in the two data sets and in their surrogates were compared. Synchronization was observed in all groups: in normal subjects, in the heart transplant patients and in the surrogates. Interestingly, synchronization was less abundant in normal subjects than in the transplant patients, indicating that the unique physiological condition of the latter promote cardiorespiratory synchronization. The duration of synchronization epochs was significantly shorter in the surrogate data of both data sets, suggesting that at least some of the synchronization epochs are real. In view of those results, cardiorespiratory synchronization, although not a major feature of cardiorespiratory interaction, seems to be a real phenomenon rather than an artifact.
Assuntos
Sistema Cardiovascular , Transplante de Coração , Algoritmos , Fenômenos Biofísicos , Biofísica , Testes de Função Cardíaca , Humanos , Respiração , Estatística como Assunto , Fatores de TempoRESUMO
Twelve women who developed an average postpartum weight gain of 18.3kgs (SD +/- 6.09) entered an open trial, for three months, of fluoxetine 20 mg daily. The weight gain during their pregnancies was nearly twice that recommended by the treating gynecologists. Seventy-five percent success rate was achieved -8/12 were +/- 5% of their pre-pregnancy weights upon completion of the trial. Mean weight upon entering the trial was 82.25kgs (SD +/- 13.39), and at termination, 65.75kgs (SD +/- 8.59), P < 0.001. Anorexia and weight loss (more than 5% of body weight) have been reported in the literature in 9% and 13%, respectively, of depressed patients treated with fluoxetine. The use of this drug to promote weight loss is here reported in a selected population of women without signs or symptoms of depression, whose weight gain during pregnancy was excessive.