Brain iron in patients with Parkinson disease: MR visualization using gradient modification.

In patients with Parkinson disease, improved visualization of brain iron on a mid-field-strength magnet can be obtained with T2-weighted images and elimination of phase-encoding artifacts. A long echo delay time accentuates the loss of signal from brain iron. However, the long pulse sequence creates phase-encoding artifacts from CSF pulsations at the level of the basal ganglia. These artifacts are eliminated and resolving power increased with additional pulsing in the slice-selective and read gradients. Elimination of motion artifacts enhances visualization of brain iron in three ways: (1) extrapyramidal nuclei containing iron have better definition, (2) abnormalities are better identified, and (3) pseudolesions disappear. Our findings suggest there is significant improvement in the resolving power of brain iron on MR scans made with a mid-field-strength scanner when gradient modification is used.

Quantitative measurement of neurologic impairment in patients with multiple sclerosis.

Eleven patients with clinically diagnosed multiple sclerosis were simultaneously evaluated with history, physical, and neurologic evaluations and a series of objective neurophysiologic tests. Patients were then scored independently on clinical stage of their disease using a system based on symptoms in history or findings on physical or neurologic examination. Test scores on objective tests were compared with clinical scores with each evaluator. Patients with high test scores on clinical evaluation usually had high test scores on objective testing. Symptoms and physical findings were then correlated with abnormalities on objective tests. Objective abnormalities in visual evoked response and auditory evoked response on several occasions preceded the development of symptoms. All patients except for two had more than one abnormality on objective testing, suggesting a high likelihood that objective tests are helpful in the diagnosis of early-stage multiple sclerosis.

AAEM minimonograph #45: the early development of electromyography.

The use of electricity for therapeutic purposes began in the first century and became more refined as the properties of electricity became more understood. The works of Franklin, Galvani, Volta, and others contributed to this body of knowledge. Development of the string galvanometer, the advent of the vacuum tube, the introduction of concentric needle electrodes, and the development of the cathode-ray oscilloscope occurred during the first half of the 20th century. The science of electromyography and electrodiagnosis grew in its sophistication, leading to the formation of the American Association of Electromyography and Electrodiagnosis (now the American Association of Electrodiagnostic Medicine) with James Golseth, MD, as its first president in 1953.

Bilateral striopallidodentate calcinosis: cerebrospinal fluid, imaging, and electrophysiological studies.

We report the genetic, clinical, electrophysiological, and imaging studies in a family with bilateral striopallidodentate calcinosis (Fahr's disease). The intracerebral calcium deposits occurred before onset of the symptoms in the third decade of life. Progressive neurological deterioration occurred in the fifth decade of life in the proband. Cerebrospinal fluid homocarnosine, a central nervous system-specific peptide, was increased twofold in patients with autosomal dominant bilateral stripallidodentate calcinosis; in sporadic cases, there was no detectable homocarnosine and a decreased level of histidine. With advancing age, the amount of calcification increases, but it has not been determined if a critical amount must be reached before symptoms occur. Computerized tomography is superior to magnetic resonance imaging for radiological diagnosis. Despite diffuse striatal calcification, striatal 6-[18F]fluoro-L-dopa uptake did not reveal any difference between patients and control subjects, from which we infer persisting integrity of the nigrostriatal dopaminergic pathway.

Brainstem auditory and visual evoked potentials in type 1 (insulin-dependent) diabetic patients.

Brainstem auditory evoked potentials and pattern shift visual evoked potentials were measured in 34 Type 1 (insulin-dependent) diabetic patients with long-standing disease and in 43 control subjects. Thirty-two percent of diabetic patients had abnormal brainstem auditory evoked potentials and 15% had abnormal visual evoked potentials. These abnormalities were not related to duration of diabetes, diabetic control or individual diabetic complications (retinopathy, nephropathy, peripheral or autonomic neuropathy). The aetiology of the abnormalities must remain a subject for speculation. The findings of this study are consistent with a central diabetic neuropathy involving the brainstem in long-standing diabetic patients.