Anterior cervical discectomy with or without fusion with acrylate. A randomized trial.

STUDY DESIGN: A prospective randomized trial with assessment of treatment results by an independent observer and by patient questionnaire. OBJECTIVES: This study evaluated whether implantation of polymethylmethacrylate after anterior cervical discectomy improved clinical results and whether polymethylmethacrylate provided a solid bony union with preservation of anatomical relations of the cervical spine. SUMMARY OF BACKGROUND DATA: Discectomy without fusion disturbs anatomical relations of the cervical spine. Use of an autologous bone graft frequently causes donor-site complications. Therefore, synthetic materials such as polymethylmethacrylate have been used instead of bone to obtain spinal fusion. Whether these implants improve the clinical results of anterior discectomy is unknown. In addition, the radiological follow-up of discectomy with polymethylmethacrylate has hardly been investigated. METHODS: Between April, 1986, and April, 1990, all patients with radiologically proven cervical disc pathology and a radicular syndrome were eligible for this study. The primary endpoint of the study was the clinical result after 2 years. Assessment of the result was rated both by an independent observer using Odom's criteria and by the patient using a written questionnaire. Before surgery and during follow-up, radiographs were obtained. RESULTS: Two patients died during follow up. A good result was obtained in 28 of 42 patients (70%) treated with polymethylmethacrylate and in 30 of 39 patients (77%) of patients treated with discectomy only. Pre-operative neck pain subsided earlier if polymethylmethacrylate was used, but the difference was temporary and clinically insignificant. The use of polymethylmethacrylate resulted in a significant lower bony union rate. Polymethylmethacrylate frequently migrated into adjacent vertebrae. CONCLUSIONS: No relevant clinical differences between treatments were found. The radiological results of anterior discectomy with polymethylmethacrylate were inferior to those of discectomy only. Based on these results, the use of polymethylmethacrylate to obtain fusion after anterior discectomy is not recommended.

The role of visual discrimination disorders and neglect in perceptual categorization deficits in right and left hemisphere damaged patients.

This study was designed to investigate the role of visual sensory deficits and neglect in perceptual categorization deficits in a group of 35 patients with unilateral cerebral lesions. From theoretical point of view, it was expected that right hemisphere lesions would play a critical role in eliciting perceptual categorization deficits which could not be accounted for by visual sensory deficits or neglect. The results revealed that perceptual categorization deficits were not confined to RHD patients, but they were also found in LHD patients. RHD patients were impaired regardless of the nature of the task (verbal vs. nonverbal), while LHD patients were impaired on nonverbal tasks, and in a lesser degree on verbal tasks. In both braindamaged groups, perceptual categorization deficits were highly associated with visual sensory deficits, however, perceptual categorization deficits were also found without impairments in the visual sensory system. Neglect to be less important determinant of perceptual categorization deficits. The present findings are discussed in the light of Warrington's model of object agnosia.

[Neuropedagogic aspects of children with acquired craniocerebral trauma--an overview]. / Neuropädagogische Aspekte bei Kindern mit erworbenem Schdel-Hirn-Trauma--Eine Ubersicht.

In this article a review is given of the neuropedagogical aspects of children with acquired head injury (cerebral concussion). For this purpose attention has been paid to a study of the literature in the period 1970-1991. The attention has been focused on the most frequently occurring disorders such as cognitive and other neuropsychological disorders, behavior disorders and the post-traumatic syndrome. It appeared that the views about the origin of the disorders are very diverse. This applies in particular to cognitive and other neuropsychological disorders and behavior disorders. A consensus for the existence of a post-traumatic syndrome has not been found.

Prolonged remission of primary central nervous system lymphoma after discontinuation of steroid therapy.

The case of a 63-year old man is presented in whom remission of a primary central nervous system lymphoma was achieved by corticosteroids only. After discontinuation of steroid therapy the remission persisted for two and a half years. Recurrences appeared at other sites of the brain, and were steroid resistant.

The result of treatment of the masticatory system of chronic headache patients.

Fifty-five of 100 chronic headache patients, referred consecutively to a neurologist, exhibited craniomandibular pain during examination of the stomatognathic system. This suggests a possible relationship between the headaches and the condition of the masticatory muscles. The patients were randomly divided into two groups. One group was treated by a neurologist and the other by a dentist. More of the patients treated by the dentist reported a decreased intensity of the headache (P less than 0.025) or a reduction in medication (P less than 0.05). Changes in headache frequency were also reported more often in the craniomandibular disorder treatment group (P less than 0.025).

Craniomandibular disorders in patients with different types of headache.

One hundred recurrent headache patients, referred for neurologic examination, were randomly invited for a functional examination of their stomatognathic system. The patients were grouped on the basis of headache localization, neurologic diagnosis of the headache, and stomatognathic diagnosis. The relationship between groups was analyzed. Several significant correlations were found between the clinical findings and the localization of headache (P less than 0.05 to P less than 0.001). Patients with or without a definite craniomandibular disorder pain displayed differences in mouth opening capacity (P less than 0.001). The results indicate a close relationship between recurrent headache and craniomandibular disorders, independent of the neurologic diagnosis of the headache.

Craniomandibular asymmetry in headache patients.

The stomatognathic system was examined in 100 chronic recurrent headache patients, and the asymmetry in clinical and radiographic findings was studied. A clinically recorded facial asymmetry was found more frequently in patients with a definite CMD pain (P less than 0.001), in patients with mainly a unilateral headache (P less than 0.01), and in patients with a head injury in the history (P less than 0.05). The radiographically determined asymmetry in condylar height in these headache patients was high. More condylar asymmetry was found in migraine patients than in patients with tension headache (P less than 0.05). Asymmetric findings in the hard-tissue condition of the temporomandibular joint were more prevalent in patients with a definite CMD pain and in those with mainly bilateral headaches.

Differences in headache patients regarding response to treatment of the masticatory system.

Twenty-three neurologically examined headache patients completed treatment for a concomitantly diagnosed craniomandibular disorder. More than two-thirds of the subjects responded favorably to the treatment and headaches decreased. Differences between patients regarding the response to treatment were studied. Patients with a decreased headache intensity reported more coexisting neck problems before treatment (P less than 0.05). Patients with an alleviation of headaches showed a larger distance between passive and active maximum mouth opening before treatment (P less than 0.05). The probability of headache improvement by craniomandibular disorder treatment was found to be greater in patients with a difference of 5 mm or more between passive and active maximum mouth opening (P less than 0.05).

The Landau-Kleffner syndrome--case report and theoretical considerations.

The Landau-Kleffner syndrome is an acquired condition in children consisting of aphasia and epileptic discharges in the EEG with or without clinical manifestation of epilepsy. We describe a case of a very young child whose neurologic and language development before onset of the illness was uniquely well documented. Apart from her aphasia she showed several other disturbances of higher cortical functions in the acute phase of the illness. No anatomical basis has been discovered for this disease till the present day. We discuss the possibility of an electrical dysregulation in several parts of the cortex as a pathophysiological basis for this syndrome.

Craniomandibular disorders in headache patients.

Fifty patients with recurrent headache who had been referred to a neurologist were randomly invited for an examination of their stomatognathic system. The prevalence and distribution of the findings in many ways resemble the clinical findings in CMD patients. In 66% of the patients, a myogenous or arthrogenous origin of CMD pain could be detected. Headache occurred more bilaterally, but unilateral findings were more common at the functional examination. The results did not show any statistical differences between the sexes.

Different mechanisms of ipsilateral and contralateral ear extinction in aphasic patients.

Dichotic listening performance was studied in 35 aphasic patients with unilateral brain lesions. Within this group, 30 patients exhibited an abnormal ear discrepancy: 20 patients showed a left-ear advantage (right-ear extinction), and 10 patients showed a right-ear advantage (left-ear extinction). All subjects were given a number of verbal tasks in order to evaluate several aspects of their linguistic abilities. For the left-ear advantage group, verbal scores were positively related to left-ear scores, but not to right-ear scores. For the right-ear advantage group, verbal scores were positively related to both left- and right-ear scores. The present results lend partial support for the prediction that right-ear extinction is associated with damage to the temporal lobe involving the geniculo-temporal system. No support was found for the prediction that left-ear extinction is associated with lesions placed in the deep structures of the parietal or parieto-occipital lobe involving the corpus callosum system. Our data indicate that the initial severity of brain injury is a critical factor in determining the direction of ear extinction, the lesions being larger in the left-ear advantage group. Results are discussed in relationship to other explanations of ipsilateral and contralateral extinction in aphasic patients.

Results of a questionnaire in 100 ALS patients and 100 control cases.

A questionnaire with 54 relevant questions was studied in 100 ALS patients and 100 age and sex matched control cases. The findings were discussed in relation to 7 questionnaires in the literature. No differences were found between ALS patients and controls. Especially the increase of frequency of gastrointestinal operations, previous poliomyelitis, toxic metal exposure frequency, antecedent fractures and excess milk drinking as described in the literature were not confirmed.

Flunarizine, the vestibular system and migraine.

The vestibular function was extensively investigated in 75 patients suffering from migraine. Pathological findings were present in 62 patients (82.6%). With the exception of position nystagmus, vestibular abnormalities were not related to migraine characteristics. Fifty-six patients were treated with flunarizine 10 mg daily for three months. A favourable effect on headache was obtained in 44 patients (78.5%). Flunarizine therapy influenced significantly gaze nystagmus and position nystagmus. The latter tended to be related to anti-migraine efficacy. Other electronystagmographic parameters were not substantially influenced. The authors assume that the vestibular abnormalities in migraine are side phenomena, the clinical relevance of which, at least during the headache-free phase, is not yet well understood.

Diffuse sclerosis. Clinical, neuroradiological and neuropathological findings.

The clinical radiological and pathological findings in a case of diffuse sclerosis are described with special emphasis on the premortem diagnosis.