Growth hormone/insulin-like growth factor I axis in neurodegenerative diseases.

Neurodegenerative diseases (ND) are a group of heterogeneous disorders characterized by unknown etiology, subtle onset, and progressive involvement of neuronal systems leading to degeneration and dysfunction. They represent a challenge for basic science and clinical medicine because of increasing prevalence, social cost, complex biochemistry and pathology, and lack of mechanism-based treatments. Endocrine modifications may accompany the progression of ND, due to the intimate connections between central nervous and endocrine systems. Reported data on endocrine changes in different ND have often been non-conclusive or conflicting. GH/IGF-I axis is involved in the regulation of brain growth, development, and metabolism. Dysfunctions in GH/IGF-I axis in most of ND are therefore reviewed. Whether GH deficiency, when present, may act as a contributory factor in the pathogenesis of these diseases, or might represent a consequence of it is presently unknown. A thorough effort in investigating every possible involvement of GH/IGF-I axis is warranted, in the light of future possible therapeutic strategies.

Bromocriptine test in the evaluation of patients with syncope of unknown aetiology. A case-control study.

The aim of the present study was to evaluate, through a case-control study, the specificity of the upright tilt test with bromocriptine as a marker of neurally mediated syncope of unknown aetiology. We have compared upright tilt test with bromocriptine (2.5 mg p.o.) in patients with syncope of unknown aetiology and controls. A total of 23 patients and controls matched by age and sex had upright tilt test with bromocriptine. The upright tilt test procedure consisted of 10 min in supine position, 10 min of 60 degree head-up tilt and a further 10 min with the subject supine; this procedure was performed in baseline condition and 60, 120, 180 and 240 min after the administration of bromocriptine. The protocol end points were the development of syncope or presyncope in association with hypotension with or without bradycardia. A positive response to bromocriptine test was found in 78% (95% CI, 61% to 95%) of patients and in 13% (95% CI, 0% to 26%) of controls (P<0.001). No significant differences were detectable among patients and controls showing a positive response to the test. Bromocriptine test seems to be a useful alternative tool for the diagnosis of neuromediated syncope also suggesting that dopaminergic supersensitivity may, at various and to varying degrees, play a role in the pathogenesis of syncopal episodes.

Indomethacin increases the effect of isosorbide dinitrate on cerebral hemodynamic in migraine patients: pathogenetic and therapeutic implications.

Intracerebral vascular reactivity induced by the nitric oxide (NO) donor isosorbide dinitrate (IDN, 5 mg sublingually) is more major and longer-lasting in migraine patients who develop delayed headache in response to the drug. The headache is purportedly due to neuronally-mediated vascular mechanisms. Indomethacin inhibits prostaglandin synthesis, which is involved in NO generation. Indomethacin also decreases cerebral blood flow by constricting precapillary resistance vessels. In the present study, the hemodynamic effects of indomethacin were evaluated in migraine patients and healthy controls by means of transcranial Doppler monitoring. Indomethacin caused a significant decrease in mean flow velocity in the middle cerebral artery. This was an additional effect to the mean velocity decrease induced by IDN. The interactions between the two drugs suggest that their effects on cerebral hemodynamics (and pain) may be of relevance both in understanding the role of NO in migraine pathogenesis and in evaluating symptomatic treatments for migraine attacks.

Haemodynamic correlates of early and delayed responses to sublingual administration of isosorbide dinitrate in migraine patients: a transcranial Doppler study.

In normal subjects or migraine patients, nitrates induce a non-specific early headache caused by vasodilation of intracranial arteries. In migraineurs a delayed headache response to nitrates may have a typical clinical profile of a spontaneous migraine attack. The cerebral vasomotor changes of this delayed response require further study. Isosorbide dinitrate (IDN), an exogenous nitric oxide (NO) donor, was given at a dose of 5 mg sublingually and a bilateral transcranial Doppler device was used to monitor bilateral mean velocity (Vm) changes at the middle cerebral artery (MCA) after IDN administration and until delayed headache occurred. Spontaneous migraine-like headache occurred only in migraine patients during the delayed phase after IDN and was accompanied by a prolonged arterial vasodilation compared to normal subjects. This vasomotor response was more evident on the customary side of the head pain of a spontaneous migraine attack. Our findings suggest a particular vasomotor response to nitrates in migraine patients. This response is associated with the nitrate-induced headache and it is not evident in healthy pain-free controls during the delayed phase after administration of an NO donor. Owing to the short half-life of NO, the neurotransmitter released by IDN, and because of the late onset of headache, we believe the mechanism is unlikely to be vascular in origin, but may have a neurogenic component.

Internal carotid occlusion associated with migraine syndrome: a case study of a 22-year-old female.

Migraine and migraine-like headaches are sometimes associated with acquired types of carotid artery disease. We examined a 22-year-old female suffering from periodic migraine, sometimes with "atypical" features. Color Flow Duplex Sonography revealed an occlusion of the right internal carotid artery (ICA) and a possible severe stenosis of the cervical segment of the left ICA. Digital Subtraction Angiography combined with Angio-Magnetic Resonance Imaging and Echographic Imaging suggested the possibility of a fibromuscular dysplasia involving both ICAs. It is suggested that some atypical features of headache could represent symptoms of a carotid pathology.

Environmental and genetic risk factors in Parkinson's disease: a case-control study in southern Italy.

To clarify the role of heredity and of some environment risk factors in the etiology of idiopathic Parkinson's disease, we performed a case-control study in two regions of southern Italy, Campania and Molise. We selected two controls for each parkinsonian patient, the patient's spouse and a sex- and age-matched neurological control. One hundred sixteen consecutive outpatients with Parkinson's disease (77 men, 39 women; mean age +/- SD = 62.5 +/- 9.9) and the same number of spouses and neurological controls were interviewed about five environmental risk factors (cigarette smoking, well-water drinking, head trauma with loss of consciousness, strict diets, general anesthesia) and two genetic risk factors (family history of Parkinson's disease or of essential tremor). Well-water drinking and family history of Parkinson's disease or essential tremor showed a positive association with Parkinson's disease; smoking showed a negative association. The most relevant risk factor was history of familial Parkinson's disease (odds ratio = 14.6; 95% confidence interval = 7.2 - 29.6); 33% of our patients had at least one affected relative. We also showed a unilateral distribution of ancestral secondary cases on the paternal or on the maternal side, which suggests a dominant inheritance. Clinical and epidemiologic features of cases with familial Parkinson's disease showed no peculiarity. The study suggests a strong role of the genetic factors in the etiology of Parkinson's disease.

"Rubral" tremor after thalamic haemorrhage.

Tremors in association with thalamic haemorrhage have been infrequently reported, and delayed rubral tremor as a complication of such an event is quite rare. We describe a patient with a combined resting-postural-kinetic tremor due a thalamic haemorrhage. Magnetic resonance imaging showed evidence of a subthalamic involvement but failed to reveal any mesencephalic lesion. Five years after the original stroke there was rapid and almost complete suppression of her abnormal movements, probably related to an ischaemic capsular lesion. Involuntary movements, which resemble rubral tremor, can be due to lesions upstream of the rubral and nigral outflow system.

Prevalence of hereditary ataxias and spastic paraplegias in Molise, a region of Italy.

An epidemiological survey of hereditary ataxias and paraplegias was conducted in Molise, a region of Italy (335, 211 inhabitants on 1 January 1989). Total prevalence was 7.5 x 10(-5) inhabitants (95% confidence limits 4.8-11.1). There were 7 patients with Friedreich's disease, 5 with early onset cerebellar ataxia with retained tendon reflexes, 4 with ataxia-telangiectasia, 9 with hereditary spastic paraplegias (2 autosomal dominant and 7 autosomal recessive cases). There was no patient with autosomal dominant cerebellar ataxia.

[The role of inflammatory infiltrate as a prognostic criterion in cerebral metastases. Preliminary results]. / Ruolo dell'infiltrato infiammatorio quale criterio prognostico nelle metastasi cerebrali. Risultati preliminari.

Data concerning a preliminary study on the prognostic significance of inflammatory infiltration in cerebral metastases are reported. Seventeen cases of operated cerebral metastases have been studied to investigate their histotype and grade of necrosis, stromal reaction, and inflammatory infiltration. Finally, the results obtained are discussed in relation to the postoperative survival rate of the patients.

The operation of arthrodesis for malformations of the occipito-atloid joint, according to Gilles Bertrand.

Malformations of the occipito-vertebral hinge destabilize the bones and injure the neural structures of the bulbo-spinal junction and of the cervico-spinal cord. The Authors have found the Gilles Bertrand intra-articular C/1-C/2 bilateral arthrodesis to be an extremely efficient surgical procedure for stabilizing the occipito-atlo-axial region, producing a relative lowering of the odontoid and relieving pressure in the occipito-atloid region. Excellent post-operative results derive from the relatively easy and non-destabilizing operative procedure. No deaths have been recorded in connection with this operation. This contrasts with the traditional occipito-atloid pressure-relieving procedure (either with or without opening of the dura mater), a procedure which, in addition to not stabilizing the upper cervical spine, sometimes results in the patient's death.

Herpes zoster ophthalmicus and ipsilateral infarction in the territory of the anterior choroidal artery.

We report a further case of retarded contralateral hemiplegia syndrome after herpes zoster ophthalmicus in which the motor deficit was caused by an ischemic infarction in the territory supplied by the anterior choroidal artery. We discuss the clinical and physiopathogenetic features of the case and consider the computed tomographic and neurological patterns of anterior choroidal infarction.

[Role of echocardiography in the diagnosis of cerebral ischemic attacks of embolic origin]. / Ruolo dell'ecocardiografia nella diagnosi degli accidenti cerebrali ischemici di origine embolica.

An echocardiographic study of 50 patients with cerebral infarction confirm the importance of this technique in the diagnosis of cerebral ischaemia originating in a cardiac embolism, an importance that has already been underlined by others. The particular value of this technique in young patients in relation to possible treatment is also pointed out.

[Role of hypernephroma in a case of intracerebral hemorrhage as a 1st sign of metastasis. Case report]. / Ruolo dell'ipernefroma in un caso di emorragia intracerebrale come primo segno di metastasi. Caso clinico.

They have reported a case of multiple hepatic and cerebral metastasis of hypernephroma. The cerebral metastasis, probably after the hepatic one, are present respectively at a cerebellar and parietal-occipital level; the latter is the cause of a cerebral haemorrhage in a quite precocious phase of development.