Subject(s)
Cerebral Cortex/physiology , Electroconvulsive Therapy , Seizures/etiology , Artifacts , Electrodes , Humans , Monitoring, PhysiologicABSTRACT
The rate of diagnosis of radiologically significant abnormalities in outpatients following requests of magnetic resonance imaging (MRI) of the brain and spine by general practitioners was compared with the rate following MRI scan requests by hospital clinicians. A similar rate of significant pathology was diagnosed in both groups in both the brain and the spine. Under carefully controlled conditions, open-access MRI scanning of the brain and spine can contribute to effective patient management.
Subject(s)
Brain Diseases/diagnosis , Magnetic Resonance Imaging , Spinal Cord Diseases/diagnosis , Spinal Diseases/diagnosis , Family Practice , Humans , Pilot ProjectsABSTRACT
OBJECTIVES: To investigate the efficacy of a second subcutaneous dose of 6 mg sumatriptan in the treatment of recurrence of headache after successful treatment of a migraine attack with an initial 6 mg dose. METHODS: In a prospective, randomised, placebo controlled, double blind, parallel group study, 803 patients were treated for one to three migraine attacks with severe or moderate headache with a subcutaneous injection of 6 mg sumatriptan. Any subsequent recurrence of migraine headache was treated with a randomised second injection of sumatriptan or placebo. Recurrence was defined as a headache of moderate or severe intensity occurring 1-24 hours after the initial dose in a patient whose headache had been relieved by sumatriptan (reduction of headache severity from severe or moderate to mild or none after one hour). RESULTS: Headache recurrence was reported by 10%-15% of patients. At each attack, 6 mg sumatriptan given subcutaneously was significantly (P < 0.0005) more effective than placebo at relieving recurrent headache after one hour (84%-93% v 31%-50% of patients); 76%-83% of patients reported headache relief one hour after the initial dose of sumatriptan. Sumatriptan was generally well tolerated. CONCLUSIONS: Up to 15% of patients with migraine experience significant recurrence of headache after successful treatment with subcutaneous sumatriptan, and this recurrence is effectively treated by a further dose of subcutaneous sumatriptan.
Subject(s)
Migraine Disorders/drug therapy , Sumatriptan/administration & dosage , Sumatriptan/therapeutic use , Vasoconstrictor Agents/administration & dosage , Vasoconstrictor Agents/therapeutic use , Adolescent , Adult , Age of Onset , Aged , Double-Blind Method , Female , Humans , Injections, Subcutaneous , Male , Middle Aged , Placebos , Prospective Studies , Recurrence , Severity of Illness Index , Treatment OutcomeSubject(s)
Migraine Disorders/etiology , Adult , Age of Onset , Female , Humans , Male , Middle AgedABSTRACT
Sixty-nine patients presenting with migraine, with or without aura, after age 40 were investigated with CT or MRI brain scanning, carotid ultrasound and serum antibody studies. A 2:1 female:male predominance was found, the mean age of presentation being 51.6 years. Migraine with aura was reported in 86% of patients. 46% of the females had active menopausal symptoms. No significant haematological or serological abnormalities were detected. CT or MRI brain imaging was normal in 93% of cases; 4 patients had evidence of cerebral infarction. No cerebral tumour or vascular malformation was found. Three patients had evidence of mild-moderate carotid atheroma on ultrasound scanning. Routine detailed investigation of late-onset migraine is unlikely to be of value unless the history is atypical or abnormalities are present on clinical examination.
Subject(s)
Migraine Disorders/diagnosis , Adult , Age of Onset , Aged , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Migraine Disorders/epidemiology , Migraine Disorders/etiology , Prospective Studies , Risk Factors , Tomography, X-Ray ComputedSubject(s)
Facial Paralysis/therapy , Axons/physiology , Facial Expression , Facial Muscles/innervation , Facial Muscles/physiopathology , Facial Nerve/physiopathology , Facial Nerve/surgery , Facial Paralysis/etiology , Facial Paralysis/physiopathology , Humans , Nerve Degeneration/physiology , Nerve Regeneration/physiology , Prognosis , Treatment OutcomeABSTRACT
Cerebrovascular reserve (CVR) was studied in 104 consecutive patients with symptomatic carotid territory disease and ipsilateral internal carotid artery stenosis. Overall, 30 of 104 patients (29 per cent) had impaired CVR. The frequency of CVR impairment increased with the severity of internal carotid artery stenosis: impairment was present in none of 11 patients with stenosis of less than 50 per cent, four of 24 with stenosis of 50-69 per cent, 14 of 41 with stenosis of 70-89 per cent and 12 of 28 with stenosis of 90-99 per cent. Patients presenting with a stroke were significantly more likely to have impaired CVR than those with transient ischaemic attacks and/or amaurosis fugax (odds ratio 3.7 (95 per cent confidence interval (c.i.) 1.5-9.0)), as were those with a residual neurological deficit (odds ratio 4.3 (95 per cent c.i. 1.6-11.5)) and evidence of infarction from computed tomography (odds ratio 3.8 (95 per cent c.i. 1.6-9.4)).
Subject(s)
Carotid Artery Diseases/physiopathology , Cerebrovascular Circulation/physiology , Adult , Aged , Carotid Artery, Internal/physiopathology , Carotid Stenosis/physiopathology , Female , Hemodynamics , Humans , Ischemic Attack, Transient/physiopathology , Male , Middle Aged , Prospective StudiesABSTRACT
Serum samples from patients suffering from multiple sclerosis, other neurological diseases and normal controls were screened by "western blotting" for antibody directed against proteins of human brain vessels purified from a post mortem brain. A small number of sera contained autoantibodies against some of the proteins of the brain vessels, particularly in patients suffering from MS, epilepsy and migraine. The significance of these results is discussed.
Subject(s)
Autoantibodies/analysis , Blotting, Western , Brain/blood supply , Endothelium, Vascular/immunology , Multiple Sclerosis/immunology , Muscle, Smooth, Vascular/immunology , Antibody Specificity/immunology , Blood-Brain Barrier/immunology , Humans , Immunoglobulin G/analysis , Microscopy, Electron, Scanning , Nervous System Diseases/immunologyABSTRACT
There have been several attempts at establishing a grading system to estimate the severity of a facial palsy. This study compares the validity and consistency of all the leading systems. The results indicate that the systems are comparable and overall none had the advantage over the others. Interobserver variation had a significant effect on the consistency of the systems used, but experience of the observer was not a significant factor. The simplest classification studied was the House-Brackman system which is recommended.
Subject(s)
Facial Paralysis/diagnosis , Facial Paralysis/epidemiology , Humans , Observer Variation , Photography , Severity of Illness Index , Videotape RecordingABSTRACT
Anticardiolipin antibodies (aCL), one of a group of antiphospholipid antibodies which include the lupus anticoagulant (LA), may occur in association with systemic lupus erythematosus (SLE) and are less commonly detected in other diseases. We retrospectively reviewed the clinical and immunological features of 39 consecutive patients with abnormal aCL identified by one laboratory, to examine the spectrum of neurological disease in those patients without SLE. Fourteen patients in this category are described, 6 of whom did not have evidence of LA. All but 1 presented with neurological symptoms. Stroke and migraine dominated the clinical presentation, but many patients had features to suggest the presence of a hypercoagulable state. This study lends support to the concept of a primary antiphospholipid syndrome.
Subject(s)
Autoantibodies/analysis , Brain Diseases/immunology , Cardiolipins/immunology , Adult , Brain Diseases/complications , Cerebrovascular Disorders/complications , Cerebrovascular Disorders/immunology , Enzyme-Linked Immunosorbent Assay , Epilepsy/complications , Epilepsy/immunology , Female , Humans , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/immunology , Male , Middle Aged , Migraine Disorders/complications , Migraine Disorders/immunology , Prognosis , Retrospective StudiesABSTRACT
The search for an internationally acceptable facial grading system has resulted in an assessment of existing methods by several investigators. These studies were based on observations of video film taken of patients with varying degrees of facial malfunction. Although the grading systems were evaluated, the use of videotape has never been compared with clinical examination and its suitability for this type of work is, therefore, unknown. We used nine facial grading systems to compare the results of clinical observation with those of photographic methods of presentation. The latter included videotape, photographic slides, and a combination of the two. The correlation between clinical examination findings and findings of any of the photographic methods was poor, suggesting the need for a standard form of presentation when grading patients. The most consistent results were found with either clinical examination or photographic slides; videotape was the least reliable.
Subject(s)
Facial Paralysis/classification , Photography/methods , Data Interpretation, Statistical , Humans , Movement , Observer Variation , Reference Standards , Videotape RecordingABSTRACT
Nine patients referred for neurological opinion over a 4 yr. period were identified as having migraine occurring for the first time with pregnancy. The nature of their attacks, results of investigation, the progress of the pregnancy and the prognosis for headache post-partum are presented. One patient had common migraine, the remainder, either classical or complicated attacks. Patients presented at variable stages of pregnancy; four developed complications, including pre-eclamptic toxemia in two. The prognosis for headache during the follow up period of up to 54 months was excellent. The factors influencing migraine in pregnancy are discussed.
Subject(s)
Migraine Disorders/complications , Pregnancy Complications, Cardiovascular , Acute Disease , Adolescent , Adult , Estrogens/physiology , Female , Follow-Up Studies , Humans , Menstrual Cycle , Migraine Disorders/physiopathology , Postpartum Period , Pregnancy , Pregnancy Complications, Cardiovascular/physiopathology , PrognosisABSTRACT
Using somatosensory and visual evoked potential techniques we have looked for evidence of central neuropathy in a group of insulin-dependent diabetics with mild peripheral neuropathy. The N9, N13, and N20 components of the somatosensory evoked potential were significantly (P less than 0.001) delayed in the diabetic group compared with the control subjects. There was a small but non-significant increase in the interpeak N13-9 and N20-13 latencies in the diabetic group. The visual evoked potential (P100) showed a small but insignificant delay. The delay in cerebral evoked potentials was mostly attributable to peripheral neuropathic damage and no firm evidence was obtained in favour of central diabetic neuropathy.
Subject(s)
Diabetes Mellitus, Type 1/physiopathology , Diabetic Neuropathies/physiopathology , Evoked Potentials, Somatosensory , Evoked Potentials, Visual , Adult , Female , Humans , Male , Middle Aged , Reference ValuesABSTRACT
Forty-nine patients with Bell's palsy were studied neurophysiologically within 10 days of the onset of symptoms and the results analysed according to the clinical outcome. Electroneuronography was not helpful in predicting outcome at this stage. The presence of a blink reflex was a good prognostic sign and all patients with an intact blink reflex recovered well.
Subject(s)
Blinking , Facial Paralysis/diagnosis , Predictive Value of Tests , Adult , Aged , Electric Stimulation , Electromyography , Facial Paralysis/physiopathology , Humans , Middle Aged , Neural Conduction , Prognosis , Retrospective StudiesABSTRACT
Two cases of Lambert Eaton syndrome unassociated with an underlying malignancy are described. Both had mild autonomic symptoms but markedly abnormal autonomic function tests. These results are suggestive of a widespread defect in cholinergic transmission in addition to that at the skeletal neuromuscular junction.
Subject(s)
Autonomic Nervous System Diseases/physiopathology , Myasthenia Gravis/physiopathology , Aged , Autonomic Nervous System/physiopathology , Electromyography , Humans , Male , Middle Aged , Neuromuscular Junction/physiopathologyABSTRACT
Forty-four patients with idiopathic facial (Bell's) palsy were studied. They were assessed by the eventual clinical outcome and on this basis 3 groups were formed. Various clinical parameters were studied and those factors associated with a poor prognosis were identified. The factors of significance include age, initial severity of the palsy and the time taken for spontaneous improvement. All other parameters fail to show any statistically significant correlation with prognosis.