Predictive value of lumbar infusion test in normal pressure hydrocephalus

To detect the ability of the lumbar infusion test to predict the outcome of shunt surgery in patients with suspected normal pressure hydrocephalus. Twenty patients with suspected normal pressure hydrocephalus were studied. Preoperative CT and/ or MRI of the brain was done in all cases. The absence of preceding history indicated idiopathic disease. All patients were assessed with walking and psychometric tests before lumbar infusion test and tap test assessments. Tap test was done in all cases because it is the standard test used in these cases. The lumbar infusion test was done using a constant infusion rate [0.80 ml/min] using a syringe pump and regarded as positive if the steady state CSF plateau pressure reached levels of > 22 mm Hg [16 cm H2O]. The tap test was regarded as positive if two or more of three different test items improved after CSF removal. Walking and psychometric tests were used to assess patients postoperatively. The results of the CSF tap test and the lumbar infusion test agreed in only 40% of cases. Of all cases in the study, 18 [90%] had positive test results and were operated on; 16 [80%] of patients reported subjective improvement, and postoperative assessments verified the improvements in 15 patients [75%]. Improvements were highly significant in walking and memory. Most of the patients improved by surgery [90%] were selected by a positive lumbar infusion test, and only 67% by a positive tap test. Both the lumbar infusion test and the tap test can predict a positive outcome of shunt operations in patients with suspected normal pressure hydrocephalus. Lumbar infusion test has a higher predictive value than the CSF tab test. The two tests are complementary and should be used together for a better patient selection. Key Words: - Normal pressure hydrocephalus - Lumbar infusion test - Tap test"

Comparative study between electroencephalographic EEG in relatives of idiopathic epilepsy and normal population

The aim of the present work is to study the EEG changes in relatives of idiopathic epilepsy compared with that in a sample of normal population. The study included two groups; Group I consists of 100 relatives of patients with idiopathic epilepsy collected from the Epilepsy Center in EL-Hadara University Hospital and Group II consists of 100 normal subjects with no family history of epilepsy. The relatives in group I were further divided into 4 subgroups according to the type of epilepsy of their epileptic relatives; generalized tonic clonic type [GTC], complex partial type [CP], juvenile myoclonic epilepsy type [JME] and Lennox gastout type [LG]. Both groups were subjected to: Thorough history taking including: age, history of epilepsy, detailed family history of epilepsy, the degree of kinship and the type of epilepsy. Relatives with general medical problems including renal diseases, hepatic disorder, history of neurological deficits, intake of drugs depressing central nervous system were excluded from the study. Both groups were submitted to: Complete general and neurological examination, laboratory investigations included the following: Complete blood picture, Fasting blood glucose, Liver transaminase enzymes. [ALT, AST], Renal function tests [serum creatinine, blood urea], Erythrocytic sedimentation rate and Serum calcium. EEG study: EEG examination was performed by [10-20 system] under standard conditions with different provocation methods as hyperventilation, photic stimulation and sleep deprivation. The results of the study showed that: Pathological EEG changes, in the form of spikes, sharp waves or spike and slow waves complexes were present in 34 out of 100 subjects [34%] of group I, on the other hand only 9 subjects of group II [9%]. The difference was statistically highly significant. [P<0.0001]. Studying the relation of EEG changes and types of epilepsy showed that the percentage of subjects with positive EEG changes in LG group 5 [83.3%] was statistically higher than those in the other 3 subgroups GTC, CP and JME 18[31.0%], 8[30.8%] and 3[30.0%] respectively. Comparing the percentage of generalized EEG changes in relatives of GTCs patients [88.9%] to that of partial EEG changes in the same group [11.2%] was statistically significant [P=0.001]. The comparison of the percentage of partial EEG changes in relatives of CP patients [75.0%] to that of generalized EEG changes in the same group [25.0%], was statistically significant [P<0.001]. Genetics play an important role in idiopathic epilepsy, with variations among its subtypes

Catatonia due to different causes; case series

Catatonia is a serious and fascinating syndrome. It calls for diagnostic rigor and knowledgeable treatment on the part of the Physician and sometimes the Surgeon. Both of them seek to reattach their catatonic patients to their community from which these patients were separated. Kahlbum attributed the condition to organic cerebral disease. In this article we mentioned six cases of catatonia due to different causes including schizophrenia, depression, hyperparathyroidism, central pontine and extrapontine myelinolysis [due to overrapid correction of hyponatremia], carbon monoxide poisoning and systemic lupus erythematosis. All these cases presented by catatonia and number of different medical specialties shard in their diagnosis and treatment. Really, catatonia is a unique syndrome in which we stand to gain valuable insight into how motivation and movement are mediated in the brain