Idiopathic Spinal Cord Herniation Associated With a Thoracic Disc Herniation: Case Report, Surgical Video, and Literature Review.

PURPOSE: The aim of this publication is to present a case of idiopathic spinal cord herniation (ISCH) associated with a transdural disk herniation, demonstrate an operative technique used to treat this condition and provide an updated review the literature. BACKGROUND CONTEXT: ISCH is an infrequent condition that can cause progressive myelopathy leading to severe neurological dysfunction. This condition is characterized by ventral displacement of the spinal cord across a defect in the dura, either congenital or acquired, resulting in vascular compromise and adhesion that subsequently causes injury to the spinal cord. We present the management of such a patient, in addition to a review of the literature regarding management of ISCH. METHODS: This patient underwent surgery using the dural graft sling technique for repair of the dural defect and restoration of normal spinal cord position within the thecal sac. A review of the literature revealed a total of 171 patients supplemented by our 1 patient, which were then analyzed. RESULTS: The majority of patients, treated with a variety of surgical techniques, experienced improvements in symptomatology. Our patient experienced significant improvement in symptomatology. CONCLUSIONS: Although ISCH is a rare clinical condition that causes myelopathy, patients managed with surgery generally, though not universally, have a favorable neurological outcome. The associated surgical technique video demonstrates the dural sling technique for the treatment of this rare disorder.

[The use of lamotrigine in the psychosocial readaptation of patients with epilepsy]. / Uso de lamotrigina en la readaptación psicosocial del paciente con epilepsia.

INTRODUCTION AND OBJECTIVES: Epilepsy is a chronic illness which causes psychosocial problems in the patients affected. These disorders may be investigated by using the Washington Psychosocial Inventory (WPSI). We wish to show the variables which affect the WPSI most and also the changes seen in the results of this test and the control of seizures after treatment with lamotrigine for a year. PATIENTS AND METHODS: Using the WPSI, we studied 70 patients in the epilepsy outpatient clinic of the Psychiatric Hospital in La Habana during the period February-March 1998. The results of the WPSI were analysed according to the following variables: cerebral lesion, age of onset of epilepsy, frequency of seizures, more than one seizure per patient, and the antiepileptic drug used. The patients were followed-up during one year of treatment with lamotrigine, and the WPSI was repeated after one year (in March 1999). The following statistical tests were used to find the level of significance: variance analysis, standard deviation, chi deviation and difference between means. RESULTS: The WPSI showed initially, at almost all levels, poor scoring; 48.86% had generally poor psychosocial function (FPG). Only the greater frequency of seizures significantly altered the WPSI. After treatment with lamotrigine for one year there was better seizure control, a better WPSI result and only 11.43% had poor FPG. CONCLUSIONS: We consider that the high frequency of seizures is the variable which most affects the WPSI and that lamotrigine is useful both for control of epileptic seizures and to obtain psychosocial rehabilitation.

[Frontal lobe dysfunction in patients with epilepsy and chronic psychosis]. / Disfunción del lóbulo frontal en pacientes con epilepsia y psicosis crónica.

PATIENTS AND METHODS: Fifty patients diagnosed as having epileptic crises were given neuropsychological tests including the Wechsler Adult Intelligence Scale or WAIS, Luria's neuropsychological test and a quantitative EEG examination. Multivariate analysis was done of the following variables: presence or absence of inter-octal psychosis, onset of crises before the age of 10 years, frequency of crises or status epilepticus greater than 100, known cause or otherwise of epilepsy, and the presence of more than one type of crisis in a particular patient. The working hypothesis was to show that the association of epilepsy and psychosis causes alterations in superior psychic functions (SPF) particularly of the frontal lobes. The WAIS test, intelligence, verbal and executive quotients and the 11 subtests were evaluated using multivariate analysis (ANOVA) conditioned by the different variables studied. The broad band spectral measurements of the quantitative EEG (BBSM) were studied using a statistical programme (COMPARA) by which the groups of individuals were compared with a standard group, using the Student t and Fisher tests. The different BBSM variables studied were: absolute power, relative power and total dominant frequency. RESULTS: Amongst the most important results were: reduction in the performance scale of epileptics with chronic psychosis, alterations on the verbal scale in epileptics with more than one type of crisis, presence of frontal and fronto-temporal dysfunction in epileptics with chronic psychosis and negative signs of schizophrenia. On the quantitative EEG in epileptics with psychosis there was abnormally slow activity predominantly in the frontal lobes. CONCLUSIONS: From the overall results we may conclude that in patients with epilepsy and chronic psychosis there is cortical dysfunction of the frontal lobe.

La onda P300 por estimilación visual en pacientes con psicosis epilética / The wave P300 of the visual estimulation in epilethic psicosis patients

En este trabajo, después de hacer algunas consideraciones teórico-metodológicas en ralación com la onda P300, son estudiados 30 pacientes con epilepsia: 15 con psicosis crónica interictal y 15 sin psicosis asociada, procedentes de la consulta externa de epilepsia, que funciona en el Departamento de Tratamientos Especializados (DTE). El diagnóstico de epilepsia fue formulado conforme con los criterios de la Liga Internacional contra la Epilepsia (ILAE), y el de psicosis interictal según los conceptos de trimble y del Manuel de Diagnóstico y Estadística (DSM-III-R). A los pacientes incluidos en la muestra, e les hizo el registro de la onda P300 por estimulación visual en un equipo MEDICID-)3M, los resultados fueron comparados estadísticamente mediante el uso de métodos paramétricos (análisis de varianza, t - Student) y no paramétricos (Mann Whitney, Kruskal Wallis y Wald Waldfowitz). Observamos que los pacientes con psicosis crónicas interictal presentaban latencias más prolongadas de la onda P300 y la amplitud promedio se encontró disminuida en los dos grupos

La onda P300 por estimulacion visual en pacientes con psicosis epileptica

En este trabajo, despues de hacer algunas consideraciones teorico-metodologicas en relacion con la onda P300, son estudiados 30 pacientes con epilepsia: 15 con psicosis cronica interictal y 15 sin psicosis asociada, procedentes de la consulta externa de epilepsia, que funciona en el Departamento de Tratamientos Especializados (DTE). El diagnostico de epilepsia fue formulado conforme con los criterios de la Liga Internacional contra la Epilepsia (ILAE), y el de psicosis interictal segun los conceptos de Trimble y del Manuel de Diagnostico y Estadistica (DSM-III-R). A los pacientes incluidos en la nuestra, se les hizo el registro de la onda P300 por estimulacion visual en un equipo MEDICID-03M, los resultados fueron comparados estadisticamente mediante el uso de metodos parametricos (analise de varianza, t - Student) y no parametricos (Mam Whitney Kruskal Wallis y Wald Waldfowitz). Observamos que los pacientes con psicosis cronicas interictal presentaban latencias mas prolongadas de la P300 y la amplitud promedio se encontro disminuida en los dos grupos.

A chlamydial major outer membrane protein extract as a trachoma vaccine candidate.

PURPOSE: As shown in infected humans and in animal models of chlamydial infection, the major outer membrane protein (MOMP) of Chlamydia trachomatis is immunogenically potent. The purpose of this investigation was to test in the cynomolgus monkey model of trachoma a new extract of MOMP as a candidate vaccine against ocular chlamydial infection. METHOD: The nonionic detergent octyl-beta-D glucopyranoside (OGP) was used to extract MOMP from purified C. trachomatis (serovar C) elementary bodies. Protective immunization with OGP-MOMP by mucosal and systemic routes was compared in the cynomolgus monkey model of trachoma. All control and immunized monkeys were challenged by topical application of infectious C. trachomatis to the conjunctivae 35 days after the initiation of immunization. RESULTS: Immunization with OGP-extracted MOMP successfully induced chlamydia-specific local and systemic immunity to MOMP and to whole organism before challenge and early clearance of infection by systemically immunized monkeys. Although ocular disease was not significantly reduced in either immunized group compared to control animals, the lowest clinical and microbiologic disease scores developed in two animals in the mucosal group with the highest immunoglobulin A tear antibody titers at day 0 to 14, whereas higher tear and serum immunoglobulin G correlated with reduced disease in the systemically immunized group. CONCLUSIONS: These data demonstrate that despite evidence of vigorous MOMP-specific and other chlamydia-specific serologic and cell-mediated immunity, as well as anamnestic serologic responses to chlamydia, vaccination with OGP-MOMP was only partially protective against chlamydial ocular disease. The partial protection correlated best with tear immunoglobulin A responses after mucosal immunization and with local and systemic immunoglobulin G responses after peripheral immunization, suggesting that alternative chlamydial antigens may have to be considered in future vaccine development to induce more effective protective immunity and that evaluation of efficacy must be appropriate to route of immunization.

Alteraciones cerebrovasculares encontradas en pacientes del Hospital Psiquiátrico de La Habana fallecidos en el período 1971-1980 (informe preliminar) / Brain vascular alterations founded in patients of the Psychiatric Hospital of Havana during 1971-1980 (preliminar report)

Se realiza en el Hospital Psiquiátrico de La Habana el estudio de las enfermedades cerebrovasculares, y en el lapso comprendido entre enero de 1971 y diciembre de 1980, se analizan 523 protocolos de necropsias, con estudio del sistema nervioso central. Entre otras cosas, se encontró que las enfermedades cerebrovasculares fueron la causa básica de muerte sólo en 3, 2 por ciento de los pacientes, cuyos casos fueron estudiados. Sin embargo, aunque estas enfermedades no se encuentran entre las tres primeras causas de muerte en nuestro hospital, sí se hallaron, en el 14 por ciento de los pacientes estudiados, manifestaciones neuropatológicas de diferentes enfermedades cerebrovasculares. Se observó, además, cómo los accidentes vasculares oclusivos eran más frecuentes que los hemorrágicos, mientras que la aterosclerosis cerebral se encontró en el 23, 94 por ciento de los protocolos revisados(AU)

Estudio sobre la morbimortalidad por enfermedades neurológicas en el servicio de intercurrencias clinicoquirúrgicas del Hospital Psiquiátrico de La Habana durante 1980 / Study about morbi-mortality on account of neurological diseases in the psychiatric Hospital of Havana Clinical surgical intercurrence service during 1980

Se realiza un estudio neuroepidemiológico sobre la frecuencia de las enfermedades neurológicas en el Hospital Psiquiátrico de La Habana; se analizó cómo se presentaron éstas en el servicio de intercurrencias clínicas de dicho hospital, en el transcurso del año 1980. Mediante los resultados obtenidos se encuentra que las enfermedades neurológicas ocupan el segundo lugar en frecuencia de ingresos en el servicio clínico. También pudimos observar cómo entre estas enfermedades, el grupo con afección toxometaboliconutricional ocupó el primer lugar; el de los epilépticos, el segundo; y el de pacientes con enfermedades vasculares, el tercero. Entre los hallazgos necrópsicos, el más interesante fue el que las alteraciones del SNC alcanzaron el 42, 37 por ciento del total de casos necropsiados, y dentro de estas ocuparon el primer lugar las alteraciones neurovasculares(AU)