A population-based study of brain arteriovenous malformation: long-term treatment outcomes.

BACKGROUND AND PURPOSE: By undertaking long-term follow-up of a functionally isolated population study group, we sought to achieve a true picture of intrinsic brain arteriovenous malformation (BAVM). We sought to assess the validity of earlier population-based series and to determine the effects of newer treatment methods on the overall morbidity and mortality of BAVM. METHODS: We excluded other intracranial vascular pathologies by defining criteria. By retrospective and prospective study, 240 patients with BAVM were followed for a mean of 10.11 years from first diagnosis. RESULTS: Death rates were as follows: all causes, 12.9%; all BAVM related, 8.75%; BAVM related during conservative management, 24.6%; and BAVM related during active management, 3.9% (P=0.031). Mean diagnosis-to-death interval was 10.6 years. Oxford neurological disability scale grades of 209 survivors (July 2001) were as follows: grades 0 to 2, 74.1%; grade 3, 17.2%; and grades 4 to 5, 9.5%. Death rates were higher for patients who had bled or suffered nonhemorrhagic neurological deficit at original presentation. Incidence of first-ever hemorrhage in untreated patients was as follows: 0 to 9 years, 4.6% (P=0.0035); 30 to 39 years, 21% (P=0.02); and 60 to 69 years, 40.0% (P=0.045). The first bleed was fatal in 4.6%. CONCLUSIONS: We find no evidence of a substantial undiagnosed reservoir of nonsymptomatic BAVM. All BAVM are potentially hazardous. The great majority of BAVM patients become symptomatic during the patient's lifetime, and the majority will bleed. The risk of first hemorrhage is lifelong and rises with age. Compared with earlier population-based series, our low overall patient mortality is predominantly due to higher proportions of active treatment in the 1980s and 1990s.

Adjunctive therapy with bromocriptine in Parkinson's disease.

Patients with moderately severe Parkinson's disease complicated by the adverse effects of chronic levodopa use benefited from the addition of bromocriptine (Parlodel; Sandoz) in doses up to 26 mg daily, which allowed an approximate 30% reduction of levodopa dose. This resulted in a significant decrease in the amount of levodopa side-effects while maintaining or improving the original parkinsonian clinical stage. Increased effectiveness in these patients was not associated with increased dosage beyond 25-30 mg daily. When the doses of bromocriptine were increased slowly, the adverse reactions were minor and usually transient.

The value of magnetic resonance imaging in multiple sclerosis in South African-born patients.

The results of magnetic resonance imaging (MRI) in supporting the diagnosis of multiple sclerosis in 24 South African-born white patients were studied. MRI confirmed the diagnosis in 87.5% of cases. It appears that MRI is useful in strengthening the diagnosis of multiple sclerosis in patients with clinically established disease. This study supports the validity of the clinical diagnosis of multiple sclerosis in South African patients and stresses the need for re-evaluation of the incidence and prevalence of multiple sclerosis in this country.

Lateral dominance and visual evoked potentials in albinos.

Lateral preferences for the use of eye, hand, and foot were assessed in 17 male and female albino subjects, aged 15 to 52 yr. Visual evoked potential (VEP) recordings suggested that optic fibres were abnormally decussated in these subjects, as others have shown. Fewer albino subjects showed the lateral preference for the use of hand/eye and foot/eye similar to that of normals. It is postulated that the abnormal decussation of optic fibres may underlie the reduced preference for the use of the same hand and eye, and foot and eye, in albinos.

Treatment of acute post-infective polyneuropathy by means of plasma exchange.

15 patients with acute post-infective polyneuropathy of the Guillain-Barré type have been treated by means of plasma exchange. The clinical course and outcome of these patients is compared to that in a retrospectively matched control series who were treated with supportive therapy only. All patients had severe rapidly evolving muscle weakness and approximately half the patients in each group required ventilatory assistance. Both the duration of muscle weakness and the hospitalisation time was significantly shorter in the patients treated by means of plasma exchange. These results suggest that plasma exchange is of significant benefit in the treatment of patients with the Guillain-Barré syndrome.

Life-threatening hypotension associated with azathioprine therapy. A case report.

We report a case of azathioprine sensitivity manifesting with severe hypotension and diarrhoea. This sequence of events occurred on two separate occasions after administration of the drug.

Experience with neuromuscular respiratory failure in an intensive care unit.

Between 1976 and 1980, 32 patients with respiratory failure primarily due to neuromuscular disease were admitted on 34 occasions to the Respiratory Intensive Care Unit of the Johannesburg Hospital. Ninety-four per cent of patients admitted survived and were discharged from hospital. Ninety per cent of the survivors are fully rehabilitated and another 6.7% continue to improve. Despite a frequently prolonged illness, these patients have an excellent prognosis. Early diagnosis and management of respiratory failure in an intensive care unit are essential if their survival is to be ensured.