Sleep--wake and body core temperature rhythms in multiple sclerosis with fatigue.

OBJECTIVE: To study sleep-wake and body core temperature (BCT) circadian rhythms in patients with multiple sclerosis (MS)-associated with chronic fatigue. METHODS: Six relapsing-remitting MS patients with chronic fatigue underwent 48 consecutive hours polysomnography (PSG) with BCT measurement, followed by a Multiple Sleep Latency Test (MSLT). All patients were relapse- and drug-free. Mood depression, brain and cervical cord enhanced MRI, dynamic spirometry and Fatigue Severity Scale (FSS) were assessed just before PSG. RESULTS: In all patients mood depression was absent and dynamic spirometry normal, but FSS confirmed fatigue. MRI showed non-enhancing lesions. Nocturnal sleep was characterized by normal architecture and mean sleep efficiency was only slightly reduced. Arousal index was normal and periodic limb movements during sleep (PLMS) were present in four patients, with an increased index (PLMS-I) in only two of them. Upon MSLT, mean sleep latency was normal in all patients with one sleep onset REM period in one patient. All patients displayed a normal BCT 24-h rhythm. Mesor, amplitude and acrophase of BCT rhythm did not show significant differences between MS and controls. CONCLUSIONS: We found substantially normal sleep-wake and BCT rhythmicity in six patients with MS and fatigue. Non-restorative sleep and abnormal BCT regulation were unlikely mechanisms of chronic fatigue in our MS patients. SIGNIFICANCE: Subjective fatigue and abnormal sleep and BCT can be independent manifestation in MS patients. The findings support the notion that objective measures of fatigue comparable to the MSLT for sleepiness do not exist.

Cognitive function and quality of life in multiple sclerosis patients.

This is a study on the longitudinal evaluation of cognitive functions in multiple sclerosis (MS) patients and their quality of life (QoL). The study follow-up lasted for 3 years and the evaluation was performed every 9 months for four times altogether. We present data on the first and second session, when we evaluated the frontal component of cognitive functions, behavioural memory and quality of life. We administered the Luria Frontal Lobe Syndrome test (LFLS), the Rivermead Behavioural Memory Test (RBMT), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), SF-36 for QoL evaluation. The frontal component of cognitive functions and behavioural memory involvement is related to a worsening of QoL, in particular in the Physical Functioning and the Mental Health of SF-36.

Benign arterial dissections of the posterior circulation.

Four young adults with spontaneous dissection of the vertebrobasilar system are reported. Clinically, two patients presented with subarachnoid hemorrhage and two with brain-stem ischemia. In two cases of ruptured arterial dissection of the posterior cerebral artery, angiography demonstrated fusiform and "sausage-like" dilatation of the involved vessel. In two cases of occlusive dissection of the basilar artery, angiography revealed the typical "string sign." All four patients were treated conservatively: three survive in good clinical condition and one remains disabled. Follow-up angiograms showed spontaneous healing of the lesion with return to an almost normal arterial configuration in two cases; residual narrowing corresponding to the dissection was the most notable finding in the other two. It is recommended that, in a subset of neurologically stable patients, angiographic monitoring is undertaken to assess the tendency for spontaneous repair before surgical intervention is planned.

Computed tomographic scans in posttraumatic epilepsy.

The occurrence of posttraumatic epilepsy was studied in 219 patients who had had a computed tomographic (CT) scan within three days after a civilian head trauma. Posttraumatic epilepsy was observed in 13 patients. All of them had focal brain damage shown by CT scan. The predicting power of both clinical risk factors and CT scans was analyzed by multiple logistic regression. Only an intracerebral hemorrhage and intracerebral hemorrhage plus satellite extracerebral hematoma proved significantly associated with posttraumatic epilepsy. This result has important implications in the design of posttraumatic prophylaxis trials.

Fifty-five thousand cerebral angiographies.

A large series of patients submitted to cerebral angiography at the Bellaria Hospital in Bologna are presented in a preliminary report. Experience gained is discussed from the standpoints of success versus failure and of the complications. It is concluded that direct percutaneous cerebral angiography, if used selectively, still has a role to fill in a modern neuroradiology department, because of its safety. It is especially well suited for the examination of older patients. For angiography of the external carotid and the vertebral artery femoral catheterization is more suitable.

CT scan prediction of late post-traumatic epilepsy.

Out of 233 patients admitted for head trauma during 1977-1978, 93 had a CT scan examination within the first 48 hours. Forty-nine of these had at least one clinical risk factor for post-traumatic epilepsy. Ten of this group developed post-traumatic epilepsy. In all cases early CT scan showed focal brain damage, which was related more significantly to post-traumatic epilepsy than to risk factors.

Programmed serial CT scans in the surgical and radio-chemotherapeutic management of cerebral gliomas.

On the basis of a 4 year experience with CT scan in cerebral gliomas and of previous personal contributions in this field, a neuroradiological protocol of these patients is proposed. The protocol consists of a complete preoperative neuroradiological evaluation and of CT assessments at the end of the surgical procedure, before initiating radio-chemotherapy, and at the completion of each of its cycles, respectively. Attention is drawn to the importance of contrast enhancement, to the role played by the changes in the blood-brain barrier (BBB), either due to surgery or to the effect of radio-chemotherapy and to the identification of residual tumor or of recurrences. CT scan to be performed at the end of the operation is proposed on the assumption that, in spite of the increased possibility of artifacts due to blood, air, etc., it may provide an immediate and better evaluation of the surgical results as compared to the CT picture at the beginning of radio-chemotherapy, when changes in the patient's brain may already have occurred.

Postoperative CT changes.

An analysis is made of 36 cases of severe postoperative changes, some of which are undoubtedly of iatrogenic origin. CT has considerably improved the possibilities of postoperative control. By this means it is easy to check the result of the operation. Moreover the neuroradiologist can verify the quality (indication and technique) of the work of his surgical colleagues in the same way that the neurosurgeon can verify the neuroradiologist's work in the operating theater. This will result in a better knowledge of each other and, even more important, in better care of the patient.

Computerized tomography and encephalography.

This preliminary paper compares encephalography and computed tomography as regards the duration of the examinations, the technical difficulties and their diagnostic values. Some examples are reported to demonstrate the complementary importance of the two techniques.