Progressive multifocal leukoencephalopathy in HIV infection presenting as Balint's syndrome.

We report a patient with AIDS presenting with Balint's syndrome. CT and MRI showed the characteristic lesions of a progressive multifocal leukoencephalopathy, which was confirmed by histologic examination.

Serum levels of beta-carotene and other carotenoids in Parkinson's disease.

To elucidate the possible role of carotenoids in the risk for developing Parkinson's disease (PD), we compared serum levels of beta-carotene, alpha-carotene and lycopene, measured by high performance liquid chromatography, of 61 PD patients using their spouses as the control group. The serum levels of these 3 carotenoids did not differ significantly between PD patients and control groups. There was no influence of antiparkinsonian therapy on serum carotenoids levels, and these did not correlate with age, age at onset, scores of the Unified Parkinson Disease Rating Scale or the Hoehn and Yahr staging in the PD group. These results show that serum carotenoids concentrations are apparently unrelated to the risk for developing PD.

Bilateral primary writing tremor.

Primary writing tremor is a task-specific tremor that is considered to be unilateral. We report a 59-year-old man with a 5-year history of a typical primary writing tremor in the right hand who developed similar symptoms in the left hand. Copyright 1998 Lippincott Williams & Wilkins

Serum levels of ascorbic acid (vitamin C) in patients with Parkinson's disease.

To elucidate the possible role of vitamin C in the risk for developing Parkinson's disease (PD), we compared serum levels of ascorbic acid (vitamin C), measured by a fluorometric method, of 63 PD patients using their spouses as the control group. The serum levels of vitamin C did not differ significantly between the groups (47.13 +/- 0.89 micrograms/ml for PD and 47.60 +/- 0.60 micrograms/ml for controls). There was no influence of antiparkinsonian therapy on vitamin C. Serum levels of vitamin C did not correlate with age, age at onset and duration of the disease, scores of the Unified PD Rating Scale or the Hoehn and Yahr staging in the PD group. These results suggest that serum vitamin C concentrations are apparently unrelated to the risk of developing PD.

Plasma levels of nitrates in patients with Parkinson's disease.

It has been suggested that nitric oxide (NO) could be implicated in the neuronal degeneration of substantia nigra compacta in patients with Parkinson's disease (PD). To ascertain the possible role of NO as risk factor for PD, we studied the plasma levels of nitrate (oxidation product that provides an indirect estimation of NO), in 68 PD patients and 68 matched-controls. The plasma levels of nitrate did not differ significantly between PD patient and control groups (44.5 +/- 2.46 and 44.8 +/- 2.67 mumol/l, respectively). They were not influenced by antiparkinsonian drug and they did not correlate with age at onset, duration, scores of the Unified Parkinson's Disease Rating scales and Hoehn and Yahr staging in the PD group. These data suggest that plasma levels of nitrate are apparently unrelated to the risk for PD.

Peripheral iron metabolism in patients with Parkinson's disease.

To elucidate the possible role of peripheral metabolism of iron in the risk for developing Parkinson's disease (PD), we compared serum levels of iron, transferrin and ferritin, and 24-h iron excretion in urine after a single intramuscular dose of 1 mg/kg desferrioxamine, in 68 PD patients and their spouses as the control group. All these values did not differ significantly between the groups, they were not influenced by antiparkinsonian therapy, and they did not correlate with age, age at onset and duration of the disease, scores of the Unified PD Rating Scale or the Hoehn and Yahr staging in the PD group, with the exception of the 24-h urinary iron excretion with the duration of the disease (r = 0.32, p < 0.05). These results suggest that peripheral metabolism of iron is apparently unrelated to the risk of developing PD.

Cerebrospinal fluid carnitine levels in patients with Alzheimer's disease.

We assessed free carnitine (FC) and acylcarnitine esters (AC) in both cerebrospinal fluid (CSF) and plasma from 24 patients with diagnostic criteria for Alzheimer's disease (AD), and from 28 healthy matched-controls. We found no significant correlation between FC and AC levels in CSF. FC and AC levels in CSF did not differ significantly between AD patients and controls, but plasma FC levels were significantly lower in AD patients. CSF and plasma FC and AC levels did not correlate with age, age at onset of AD, duration of AD, and scores of the Minimental State Examination of Folstein. Although these results suggest that CSF carnitine levels are apparently unrelated with the risk for AD, the trend of the FC/AC ratio to be higher in AD patients might suggest the possibility of a lower carnitine acetyltransferase activity in AD, as previously reported in some brain areas.

Parkinsonism unmasked by verapamil.

We report the case of a 55-year-old man who had a parkinsonian syndrome unresponsive to levodopa for 5 years and had been taking verapamil during the past 8 years. Parkinsonian signs improved markedly after withdrawal of verapamil, suggesting its role in unmasking the parkinsonism. To our knowledge, this side effect of verapamil has not been described previously.

Orthostatic tremor: successful treatment with phenobarbital.

This article describes two patients with orthostatic tremor. The tremor affected the legs while standing and had a frequency of 14-16 Hz. We remark on the success of therapy with phenobarbital.

Drug-induced parkinsonism in a movement disorders unit: A four-year survey.

UNLABELLED: To establish the frequency of drug-induced parkinsonism (DIP) and the drugs responsible for this side-effect we reviewed the database of our Movement Disorders Unit during the first 4 years of its use. The diagnostic criteria for DIP included: (1) the presence of two or more cardinal symptoms of parkinsonism, (2) an absence of parkinsonian symptoms before the exposure to the offending drug, (3) a disappearance or significant improvement in parkinsonism after withdrawal of the offending drug, (4) no better explanation for the parkinsonism. One-hundred and five patients fulfilled the diagnostic criteria for DIP (16.3% of total patients referred and 33.8% of patients with parkinsonian syndromes). Drug-induced parkinsonism was related to 1, 2, 3, 4, 5 and 7 drugs in 62, 30, 9, 1, 2 and 1 patients, respectively. The most frequently offending drugs were: calcium-channel blockers (61 cases), antipsychotic drugs (29 cases), thiethylperazine (18 cases), clebopride (14 cases), and sulpiride (10 cases). When compared with idiopathic Parkinson's disease patients, DIP patients were predominantly female and showed an older age at the onset of parkinsonian signs. Parkinsonian signs only disappeared completely in 41 patients (39.0%). IN CONCLUSION: (1) DIP was a frequent cause of parkinsonism in our Movement Disorder Unit, (2) calcium-channel blockers, and/or orthopramides and substituted benzamides were a frequent cause of DIP in our series, (3) old age and the female gender were frequent among DIP patients, (4) DIP is not always reversible.

Premorbid dietetic habits and risk for Parkinson's disease.

To evaluate the possible role of antioxidant (vitamins A, E, C, beta-carotene, zinc, selenium) or pro-oxidant (iron, copper, manganese) factors present in the diet, in the risk for Parkinson's disease (PD), we conducted a dietetic study (pre- and postmarriage) which included 91 foodstuffs. We interviewed separately 119 PD patients (64 males, 55 females, age 65.3 +/- 8.5 years, age at marriage 27.8 +/- 5.9 years) and their spouses (age 65.0 +/- 9.2 years, age at marriage 27.2 +/- 5.9 years) as the control group (C). Premarriage consumption for each foodstuff was classified into: (1) rarely of annually, (2) monthly, or (3) weekly; and postmarriage consumption (which included the period between age at marruage and age 40 years; only concordant answers were considered to be valid) into: (1) PD > Control, (2) Control > PD, and (3) PD = Control. The premarriage interview showed a trend towards a lower consumption of peas in PD patients as compared to controls. The postmarriage interview in PD patients showed a higher tendency for the consumption of rice, bluefish, liver paté and eggs, and a less consumption of tea than controls. We were unable to find any consistent trend towards a lower consumption of vitamins E and C during adulthood in PD patients, but they seemed to have eaten selenium-rich foodstuffs more frequently than controls. These results differ from those obtained by previous studies, and question the possible role of premorbid dietary habits on the risk for PD.

Clinical features of essential tremor seen in neurology practice: a study of 357 patients.

To assess the clinical features of essential tremor (ET), we studied 357 patients with diagnostic criteria for this disease who were referred to the Neurology departments of three urban hospitals. This is not a true epidemiological study, and can be biased in favour of patients with functional disability. There was a predominance of affectation of females and a peak of age at onset in the sixth and seventh decades. Family history of tremor was positive in 46.8% of patients. Females showed a a significantly higher frequency of inheritance through maternal than through paternal line, and had a higher frequency of head and voice tremor, than males. When compared with patients without family history, those with family history of tremor had lower age at onset of tremor, and lower frequency of jaw and trunk tremor in non-familial cases.

[Dysfunction of the upper respiratory airways in patients with essential tremor]. / Dysfonction des voies respiratoires supérieures chez des patients ayant un tremblement essentiel.

OBJECTIVES: To investigate pulmonary function abnormalities in essential tremor. METHODS: We obtained maximal inspiratory and expiratory flow-volume curves in 41 unselected patients with essential tremor (14 males, 27 females, age 61.7 +/- 2.14 years). Severity of essential tremor was evaluated using the Fahn, Tolosa and Marin clinical scale. RESULTS: Sixteen patients (39.0%) had flow oscillations on the flow-volume curves (8 only during inspiration, 7 during inspiration and expiration, and 1 with flow oscillations during inspiration and obstructive pattern). The duration and severity of the essential tremor did not influence the pattern of the curve, but abnormal curves were more frequent in patients with voice tremor. Although there were a number of significant correlations between essential tremor scales and spirographic parameters, they were of very low range. Four patients (9.8%) fulfilled criteria for physiological upper airway obstruction: 2 had smooth flow-volume loop contour and 2 had flow oscillations in inspiration and expiration. CONCLUSION: Abnormalities in flow-volume loop contour are a usual finding in essential tremor. This probably reflects involvement of the upper airway musculature, that in some patients can produce clinical upper airway obstruction.

[Brown-Séquard syndrome as the initial clinical manifestation ofmultiple sclerosis]. / Síndrome de Brown-Séquard como primera manifestación clínica de esclerosis múltiple.

Multiple sclerosis is a disorder with different forms of clinical presentation. The Brown-Séquard syndrome has occasionally been described in association with multiple sclerosis. We present the case of a patient whose initial clinical presentation of multiple sclerosis was the Brown-Séquard syndrome.

[Do antioxidants in the diet affect the risk of developing Parkinson disease?]. / Influyen los antioxidantes de la dieta en el riesgo para desarrollar enfermedad de Parkinson?

OBJECTIVE: A number of studies suggest the existence of 'oxidative stress' in the substantia nigra from parkinsonian patients. If 'oxidative stress' should be relevant in the pathogenesis of Parkinson's disease (PD), the consumption of antioxidant or prooxidant substances in the diet could theoretically influence the risk for this disease. DEVELOPMENT: A critical up to date review of the literature regarding premorbid consumption of antioxidants or prooxidants by PD patients and controls has been done. Most studies have been retrospective, they have been performed following different designs, and disclosed contradictory results. CONCLUSION: From the current literature, it is unlikely that dietetic consumption of prooxidants and antioxidant, specially vitamin E (the most frequently studied antioxidant) have any influence on the risk for PD.

[Bilateral hand dystonia secondary to a bilateral opercular syndrome or Foix-Chavany-Marie syndrome]. / Mano distónica bilateral secundaria a síndrome biopercular o síndrome de Foix-Chavany-Marie.

INTRODUCTION: The main clinical feature of the opercular syndrome (Foix Chavany Marie) is the automatic voluntary dissociation of the facio glosso pharyngeal movements (that is, the alteration of voluntary motility with preservation of authomatic movements). Less frequently, it is presented with movement disorders as dystonia. CASE REPORT: We report a male patient aged 40 years who developed a biopercular syndrome of vascular etiology (confirmed by neuroimaging), in the context or a clinical picture of global hipoxemia, for which the most outstanding clinical manifestation was the presence of dystonic posturing. CONCLUSION: Although dystonia is usually related with damage or dysfunction of the basal ganglia or thalamus, in some case it can be caused by lesions in other locations, such as in some patients with biopercular syndrome as in the present case