Stimulation of the cholinergic neurotransmissions enhances the efficacy of vestibular rehabilitation.

The primary aim of this study was to investigate the efficacy of vestibular rehabilitation in a cohort of elderly labyrinthine-defective patients also affected by a moderate cognitive impairment of vascular origin. A secondary aim was to establish whether additional treatment with a cholinergic precursor (choline alphascerate) might enhance the results of the physical therapy in these patients. A retrospective clinical design was employed and data were collected from the vestibular rehabilitation treatment charts of 42 selected elderly patients who attended the tertiary referral centre of the Audiology and Vestibology of the University Hospital of Modena, Italy, in the period 1998-2008. Two groups of patients, well-matched for sex, age, and as close as possible for the vestibular examination upon admittance, were selected; Group A included 20 patients who had undergone vestibular rehabilitation training for one month and Group B included 22 patients who had attended the same physical therapy sessions as the former and had also received daily medication with 1200 mg of choline alphascerate per os. The outcome measures of the two forms of treatments were obtained from comparisons between posturographic and electronystagmographic examinations at baseline and 3 weeks after the end of treatment. Instrumental findings were completed by recording scores of the Dynamic Gait Index, the Dizziness Handicap Inventory and the Hospital Anxiety and Depression Scale before and after treatment. A statistically significant improvement in postural control (p < 0.05) and gait and balance performances (p < 0.005) was recorded in both groups; a relevant and statistically significant reduction of the asymmetry of the vestibular-ocular reflexes was also observed (p < 0.005). The self-rated dizziness handicap and psychological distress were significantly reduced (p < 0.005). Comparisons between the two groups revealed that patients who had also received medication, had achieved significantly better results than the other patients with respect to postural control in response to optokinetic stimulations (p < 0.05) and to Dynamic Gait Index (p < 0.05), thus suggesting, a reinforcement of cholinergic stimulation on vestibular compensation when tested in clinical conditions that require complex perceptual-motor skills and make a significant demand upon cognitive spatial processing resources. Further applications of stimulation of the cholinergic neurotransmission are discussed with particular regard to vestibular compensation in patients with no cognitive impairment or recurrent vertigo attacks of labyrinthine origin.

Bilateral posterior medullary and cervical stroke: a case report.

Spinal strokes are often localised in the anterior spinal artery territory, whereas an involvement of the posterior spinal arteries (PSA) is uncommon, and usually unilateral. Bilateral PSA stroke is exceptional. A 70-year-old woman, after a mild head trauma, presented with cervical pain, left hypoaesthesia and sensitive ataxia, which then extended to the right hemibody, including face. A Doppler ultrasound showed an only systolic flow signal in the left vertebral artery (VA). MR showed a bilateral infarction extending from the posterior medulla oblongata to C4 and a left hypoplasic VA with lack of visualisation of the V3 segment. This case was peculiar, implying a bilateral stroke in the PSA territory, possibly related to a left VA dissection, and in the presence of a dominant PSA, originating from the hypoplasic VA and of hyposupply of posterior radiculomedullary arteries and anastomoses.

Magnetic resonance imaging in cerebral sinus thrombosis. Report of a case.

We report the entire course of a case of thrombosis of the venous sinuses, very probably caused by contraceptive pill use, documented by MR imaging. MRI appears to be the examination of choice in such cases.

Pseudotumor cerebri: clinical features and evolution.

Risk factors, neurological, neuroradiological and ophthalmological features of 13 cases of acute pseudotumor cerebri were studied. After a 53-month period of mean follow-up, ophthalmological complications were taken into consideration: one patient (8%) showed unilateral optic atrophy with complete loss of vision, another subject complained of visual field constriction, and a third one of transient horizontal diplopia. Papilledema, which was present in 100% of the patients in the acute phase, persisted in 62%.

Mitochondrial oculoskeletal myopathy: case report.

We report a case of oculoskeletal myopathy with abnormal mitochondria in which the chief clinical feature was ophthalmoplegia. Muscle weakness was mild and there were no retinal or cerebellar abnormalities, no deafness and no cardiac defects. The muscle biopsy specimen revealed subsarcolemmal mitochondrial aggregates and ragged red fibers. Electronmicroscopy showed that the aggregates were made up of mitochondria of variable size with structural abnormalities of the cristae and crystalloid inclusions. We believe that this oculoskeletal myopathy is distinct from Kearn-Sayre syndrome.

Epidemiology of amyotrophic lateral sclerosis in the province of Modena, Italy. Influence of environmental exposure to lead.

A retrospective study of all admissions to the University of Modena Neurological Department from 1976-1986; 51 cases of amyotrophic lateral sclerosis (ALS) were found. ALS mean annual incidence was 0.78/100,000 inhabitants, while prevalence was 2.35/100,000. Mean age at onset was 61.43 years, mean and median duration of illness were, respectively, 28.83 and 24.5 months, and survival at 5 years post-onset was 24.4%. A tendency to higher incidence and prevalence of ALS in the ceramic district, when compared with those of the rest of the province was found. However, the small number of cases did not allow any conclusive statistical correlation between environmental exposure to lead and frequency of ALS.

Lumbosacral herpes zoster myelitis.

We present a case of herpes zoster (HZ) with some uncommon features, namely lumbar localization and muscle weakness with a distribution different from the site of cutaneous eruptions and sensory deficits. Spread of HZ virus from sensory ganglion to anterior horn cells seems the only possible explanation of these clinical features. Urinary retention and CSF data confirm the hypothesis of HZ myelitis.

Vascular ataxic hemiparesis: a prospective clinical and CT study.

Ataxic hemiparesis is a relatively frequent clinical syndrome in which motor and cerebellar deficits on the same side are associated. A prospective study conducted on 27 patients who displayed these vascular symptoms confirms that the areas crucial to the onset of this syndrome are the capsular region (posterior limb-corona radiata) and the upper basis pontis.

[Crossed aphasia: considerations on a clinical case]. / L'afasia crociata: considerazioni su un caso clinico.

A right-handed patient with no family history of either neurological disorders or of left-handedness was affected by crossed aphasia due to a focal hemorrhagic lesion in the right hemisphere at the level of the basal ganglia. The CAT-scan revealed the site of the brain change. Our case is uncommon in that the aphasia. Assessed by neuropsychological tests, was associated with impairment of right functions such as visual and spatial cognition. Thus he does not fit the classic description of crossed aphasia, exhibiting instead language disorders similar to those following deep brain lesions. Various hypotheses were considered in attempting to explain the pathogenesis of our neurological data, none of which proved adequate to account for all the reported findings.

CT and cerebral ischemic infarcts. Correlations between morphological and clinical-prognostic findings.

A total of 66 patients with supratentorial ischemic infarct underwent serial CT scans in order to study the relationship between CT images and clinical evolution of the infarct. Little information of prognostic value is given by CT in patients with slight neurological deficits, whereas it enables factors with a negative influence on the prognosis to be identified in patients with moderate to severe deficits.

[Foix-Chavany-Marie syndrome. Case report]. / Sindrome di Foix-Chavany-Marie descrizione di un caso.

Foix-Chavany-Marie syndrome is characterized by diplegia involving the face, the pharynx, the tongue and the masticatory muscles, with automatic-voluntary dissociation due to vascular damage of both operculi. The prognosis is usually good for life expectancy. The authors describe a 46-year-old man in whom one operculum was destroyed because of a birth trauma, the other one was injured by an ischemic infarct in the territory of the middle cerebral artery. The clinical correlations to the site of the lesions are discussed. They confirm the diagnostic value of CT scan in evaluating this syndrome.

[Risk of cerebral infarct in young adults (author's transl)]. / Incidenza dei fattori di rischio nell'infarto cerebrale degli adulti giovani.

From 1978 to 1980, thirty-one patients aged forty years or less, had cerebral ischemic events as TIA, RIND or complete stroke. These patients have been studied, both clinically and with laboratory tests to assess the most common causes of their disorder. It was found that hypertension, excess smoking, diabetes and disorders of the lipid metabolism are the most common causes of the atherosclerosis, which plays a role in enhancing ischemic cerebro-vascular accidents during youth. The detection as well as the localization of the site of the ischemic lesions was difficult; only in six out of the seventeen patients examined it was possible to show angiographically a stenosis of one cerebral vessel. Comparison between the 31 patients and 31 subjects of the same age without clinical symptoms or neurological signs, showed a significant incidence of causes of atherosclerosis in the control subjects. In view of the limited number of controls it was not possible to predict a clearcut prognosis.