Serum leptin level in women with idiopathic intracranial hypertension.

Leptin is a protein secreted by adipose cells which influences regulation of energy balance and body weight. Idiopathic intracranial hypertension (IIH) is recognised as a neurological disorder mainly affecting obese females. The aim of this study was to evaluate the association between IIH and serum leptin level in 15 obese patients and compare the results with those for 16 obese and 15 non-obese women. A significantly higher serum leptin level was found in patients with IIH than in controls (p<0.0001), and this did not correlate with body mass index (BMI). Serum leptin levels were significantly associated with BMI in both control groups (p<0.0006). Additional factors must therefore be involved in the phenomenon of serum leptin increase beyond weight gain. The cause can only be hypothesised, but it seems that the origin is central, probably hypothalamic.

Intravenous administration of magnesium sulfate in acute stroke: a randomized double-blind study.

A randomized, placebo-controlled, double-blind study was performed as a pilot study to examine the benefit of the administration of magnesium sulfate given intravenously as a protective substance during the first 24 hours following a stroke. Patients who had cortical infarction in the middle cerebral artery territory with moderate to severe neurologic deficits lasting for more than 15 minutes with onset less than 24 hours were included. The patients were treated with magnesium sulfate or placebo for 5 days and examined by a blinded investigator. Patients had follow-up for 30 days. The primary efficacy variable was the proportion of patients reaching mild to moderate neurologic deficit on the Orgogozo scale (80 points) and relative functional independence on the Barthel index (60 points). Orgogozo scale and Mathew scale values were obtained on admission and days 2, 4, 8, and 30 after stroke. Barthel activities of daily living index and Rankin disability score were obtained on day 30. Forty-one patients (22 given treatment and 19 given placebo) demonstrated significant beneficial effects on the Orgogozo scale (84 +/- 11 vs. 64 +/- 10, p < 0.0001) and (83 +/- 14 vs. 70 +/- 15, p < 0.009), respectively. At the end of 1-month follow-up, the Barthel ADL index was nonsignificantly higher and the Rankin disability score was marginally significantly lower in the magnesium-treated group (84 +/- 26 vs. 71.8 +/- 26, p < 0.143) than in control subjects (2.3 +/- 1.1 vs. 3 +/- 1.3, p < 0.077). Intravenous magnesium sulfate had significant positive effect on the outcome in patients with acute stroke. Further studies on a larger scale are needed to confirm these findings.

Ultrasound imaging-guided noninvasive ultrasound thrombolysis: preclinical results.

BACKGROUND: Catheter-based therapeutic ultrasound thrombolysis was recently shown to be effective and safe. The purpose of this work was to study the safety and efficacy of external high-intensity focused ultrasound thrombolysis guided by ultrasound imaging in experimental settings. METHODS AND RESULTS: A therapeutic transducer was constructed from an acoustic lens and integrated with an ultrasound imaging transducer. In vitro clots were inserted into bovine arterial segments and sonicated under real-time ultrasound imaging guidance in a water tank. With pulsed-wave (PW) ultrasound, the total sonication time correlated with thrombolysis efficiency (r(2)=0.7666). A thrombolysis efficiency of 91% was achieved with optimal PW parameters (1:25 duty cycle, 200-micros pulse length) at an intensity (I(spta)) of >35+/-5 W/cm(2). Ultrasound imaging during sonication showed the cavitation field as a spherical cloud of echo-dense material. Within <2 minutes, the vessel lumen evidenced neither residual clot nor damage to the arterial wall. On serial filtration, 93+/-1% of the lysed clot became subcapillary in size (<8 microm). In vitro safety studies, however, showed arterial damage when an I(spta) of 45 W/cm(2) was used for periods of >/=300 seconds. CONCLUSIONS: External high-intensity focused ultrasound thrombolysis using optimal PW parameters for periods of

Acculturation attitudes and sociocultural adjustment of sojourner youth in Israel.

Among 300 Jewish sojourner youth (age range: 15-18 years) from the Russian Federation, the authors investigated associations of acculturation attitudes, measures of sociocultural adjustment, and length of the encounter with the host society, Israel. All the youth were participating in a 1-3-year program of high school studies in Israel. In the light of J. W. Berry's (1997) acculturation model, the authors examined the assumptions that the participants' adjustment to Israeli society would require readiness to abandon some of their previous identity and to adopt elements of a new identity characteristic of the host society. Lower degrees of separation and higher degrees of integration were positively linked with measures of sociocultural adjustment. The adjustment scores tended to decrease over time spent in Israel.

Mother and caregiver representations of toddlers in a kibbutz setting.

Seventy-seven mother-caregiver pairs were interviewed by a 10-item instrument in order to evaluate their perception of children which they cared for, and their dyadic relationships with him or her. Children's ages ranged between 16-38 months. Results indicated that mothers presented more elaborated and more positive descriptions of their children, and perceived them as more developed as compared with caregivers. Mothers' emotional tone in describing the child was more ambivalent, namely more anxious and at the same time also more enthusiastic, as compared with the caregivers. Results are discussed in terms of the distinction between the meaning attributed by mothers and caregivers to their respective experiences of caregiving role-relations with the same child, and their different representations of the same child.

Representation of goodness or badness in contacts of 5-year-old children with mother and nursery school teacher.

The present study assessed children's evaluation of their own 'goodness' or 'badness' in interactions with a caregiver. These assessments were derived from 5-year-olds' responses to interviews where (a) the adult takes the role of a child and addresses the child as a knowledgeable fairy (with the help of two appropriate dolls), and (b) the adult addresses the child directly. These interviews referred to positive as well as negative contacts with two different adult figures, mother and nursery school teacher; and two different child-rearing settings, town and kibbutz. The sample consisted of 72 5-year-olds drawn from both kibbutzim and towns in Israel. Results indicated that children's representation of self-goodness or self-badness, in positive as well as negative contacts, was more positive in the role of self than in the role of a fairy. The difference between these representations was larger among kibbutz children than among town peers. Statistical interactions were obtained (three-way child role by nature of contact by place of origin) for contacts with mother, and were not replicated in child contacts with the nursery school teacher. These findings suggest that the regulation of feelings of goodness or badness of 5-year-old children is facilitated and sustained by 'lived' experiences with significant other, as compared with as if relations.

Effects of in-group bias on planned encounters of Jewish and Arab youths.

In a sample of 9th-grade Jewish (n = 118) and Arab (n = 100) students in Israel who participated in planned binational encounters, the author examined in-group biases as a function of (a) their perceptions of the encounter between the groups as interpersonal or as intergroup contact and (b) their views of the status of their respective national groups in Israel as legitimate and stable. In comparisons of the 2 encounter groups (of equal status), both groups showed in-group biases. In comparisons of the national groups at large (of unequal status), the Arab students considered their group similar to the Jewish group, whereas the Jewish students rated their group more favorably than they rated the Arab group. For the Jewish, but not the Arab, students, in-group bias was contingent on simultaneous ratings (legitimate-illegitimate; stable-unstable) of the binational situation in Israel. The data support a 2-dimensional model rather than a 1-dimensional model of intergroup-interpersonal definition of the encounter.

Self-enhancement, generality level of self-evaluation, and emotional adjustment.

Three hypotheses regarding self-concept and emotional adjustment were tested: (a) self-concept has a hierarchical structure in which self-evaluations become more positive as they become more general, (b) self-enhancement is positively associated with emotional adjustment, and (c) prediction of emotional adjustment is improved as more general levels of self-enhancement are involved. Three independent samples consisting of 708 students in 7th and 8th grades in Israel participated. The data supported Hypotheses 1 and 3, which were replicated in independent samples, for 2 different content domains of self-evaluation. Hypothesis 2 was partially supported.

Cerebrospinal fluid magnesium level as a prognostic factor in ischaemic stroke.

Magnesium has been reported to have a dilatatory effect on cerebral arteries. Reduction of extracellular Mg+2 has been shown to be directly correlated with the intensity of cerebral spasm. A neuroprotective effect of magnesium in stroke has also been hypothesized. The aim of our study was to examine the Mg+2 levels in serum and cerebrospinal fluid (CSF) in the early stage of stroke and to evaluate the correlation between Mg+2 levels and the development of neurological deficits. Between 1986 and 1994, 96 patients who had a stroke of 24- to 48-h duration were enrolled in the study. Serum and CSF levels of magnesium were checked on admission, 2448 h after the onset of stroke. Using a neurological score, the neurological deficit was assessed on the 1st day, 1 and 4 weeks later. Computed tomography (CT) was performed after 1 week, and the volume and location of infarction were calculated and measured. Statistical analysis was performed for cortical and subcortical patients separately, using Spearman correlation and multiple linear and logistic regression analyses. Significant correlation was found between CSF Mg+2 and the size of the infarct (P < 0.0001). There was no correlation between serum Mg+2 and CSF Mg+2 levels. Regression analysis demonstrated an increase in the values of the Mathew Neurological Score with higher CSF Mg+2 levels. This association remained true after other factors such as age, associated heart disease, diabetes and infarction size had been taken into account by the regression model. The results confirm that there is a relationship between a low Mg+2 concentration in CSF during the first 48 h after onset of ischaemic stroke and the intensity of the neurological deficit. The therapeutic consequence of this finding may have some importance.

Friends, lovers and spouses: intimacy in young adults.

Intimacy in young heterosexual adults was studied as a function of their familial roles. The 168 males and females employed represented four familial role groups: late adolescents, single adults, married people and parents. Participants were administered two forms of an Intimacy Scale (Sharabany, 1994) in which they described their desired and their obtained intimacy with a same-sex and an opposite-sex best friend. Results indicated that (a) intimacy of adults with opposite-sex partner was higher than intimacy with same-sex friend. (b) Although no direct effect of familial role on intimacy was found, the married and parent groups displayed greater intimacy towards their spouses than late adolescents and single adults towards their opposite-sex partners. (c) Women who were late adolescents and women who were married scored significantly higher than men in intimacy. However, single women expressed significantly lower intimacy than single men. (d) Higher intimacy with opposite-sex partner was associated with a concurrent lower same-sex intimacy. (e) Satisfaction with other-sex partner was higher in the married group than in the other groups.

Anterior operculum syndrome localized by SPECT.

UNLABELLED: The aim of this case report was to present a patient with complete anarthria and orofacial apraxia without other relevant neurological deficit. The clinical features are compatible with anterior operculum syndrome. METHODS: A regional brain perfusion scan was done using 99mTc-HMPAO and a SPECT gamma camera. A brain CT scan and an MRI were also performed. RESULTS: Brain CT and MRI were not diagnostic. On brain SPECT, hypoperfusion of the left inferior area of the frontal lobe was noted. CONCLUSION: The patient studied showed an uncommon case of anterior operculum syndrome of focal degenerative origin localized by SPECT. SPECT may be a useful and effective method for diagnosis of this unusual neurological deficit.

Familial dyslexia associated with cavum vergae.

Three members of one family, diagnosed as dyslexic, are described. All of them have variations of midline cavity: cavum vergae or cavum septum pellucidum, diagnosed by neuroradiological examination. In contrast, the non dyslexic members of the same family have no neuroanatomical congenital variations. We raise the possibility of a functional correlation between the dyslexia and the anatomical findings in the affected members of this family.

Correlation between source asymmetry and scalp potential asymmetry in a prolate spheroid model of the head.

The correlation between electric source asymmetry in the brain and potential amplitude asymmetry developed on the scalp was investigated using a computerized analytical prolate spheroid model of the head. The source was modeled by a single current dipole located in the occipital region of the brain. The potential created by the dipole was calculated using Laplace's equation with boundary conditions while allowing a quasi-static formulation and linear media. The dipole was located in the inner part of a four-compartment medium representing the scalp, the skull (with non-isotropic conduction), the cerebrospinal fluid (CSF), and the cortex. The asymmetry was modeled by a dipole located with an angle to the major axis connecting the nasion and the inion. The present study shows that source asymmetry can cause non-negligible asymmetries in the potential amplitude measured on the scalp above homotopic points of the two hemispheres. A potential asymmetry of up to 15% in the O1-O2 pair of electrodes was found when the dipole is rotated from the symmetric major axis at an angle of 10 degrees. The source asymmetry in the occipital region can be related to falx deviation, which is an asymmetry present in the majority of the population. Since this asymmetry is not related to real physiologic and psychologic sources of potential amplitude asymmetries, it should be taken under consideration when potential distribution analysis is performed.

Cerebrospinal fluid soluble interleukin-2 receptor in cerebral lupus.

Cerebrospinal fluid (CSF) and serum samples of 20 young adults (mean age 41 +/- 3.4 yr) with a first episode of stroke were tested for interleukin-2 (IL-2), soluble interleukin-2 receptor (SIL-2R), tumour necrosis factor-alpha (TNF-alpha) and interleukin-1-beta (IL-1 beta) levels. The results were compared to 20 patients who had neurological symptoms without evidence of a neurological disease. Three subgroups were formed according to the aetiological source of the stroke, determined by the neurological examination and evaluation. In 13 patients, the presence of atheromatous carotid plaque or cardiac disease was found. In five of the patients, stroke was the presenting symptom of systemic lupus erythematosus (SLE), which developed during the follow-up period. In two patients, no obvious aetiology could be demonstrated. The SIL-2R level was significantly higher in the CSF of patients who later developed definite SLE (P = 0.001). Other CSF interleukins and all serum interleukin levels were not significantly different in any of the groups. No correlation between albumin quotient and CSF SIL-2R was found. The SIL-2R level in the CSF may be used as a diagnostic tool to differentiate immunologically mediated vascular processes in the CNS from stroke of other origin.

Early treatment of a single generalized tonic-clonic seizure to prevent recurrence.

BACKGROUND: The question of whether to start antiepileptic treatment after a single unprovoked seizure remains controversial and has been the subject of much debate in the relevant literature. OBJECTIVES: To determine the rate of recurrence of a second attack after a single unprovoked epileptic seizure by using 2 study groups of treated and untreated patients and, thus, to establish a treatment policy for these patients. PATIENTS AND METHODS: A group of 91 patients with a single generalized tonic-clonic seizure were prospectively studied; 87 of these patients completed the study. The end point of the study was 36 months after the single attack or the occurrence of a subsequent epileptic attack. The patients were randomly divided into 2 groups; 45 patients who immediately received anticonvulsive treatment and 42 who remained untreated for the follow-up period. Patients in the treated group were given monotherapy with carbamazepine. The results of recurrences were statistically analyzed by using the Kaplan-Meier method. RESULTS: Results indicated a significantly higher percentage of seizure-free patients in the treated group compared with that in the untreated group (P = .001). The treated men were proved to be less at risk for recurrent seizures compared with treated women (P < .001 vs P = .03, respectively). CONCLUSION: Treatment after a single unprovoked seizure leads to a significant reduction in the risk of relapse of generalized tonic-clonic epilepsy.

Neurological and functional outcome in patients with supratentorial hemorrhages. A prospective study.

BACKGROUND AND PURPOSE: A prospective study was performed to evaluate neurological and functional outcome after spontaneous supratentorial bleeding. The aim of the study was to determine whether clinical or neuroradiological parameters could predict the outcome of these patients during the first hours of hospitalization. METHODS: Two hundred seventy-nine patients--52 with thalamic, 87 with putaminal, and 140 with lobar hemorrhages--were followed prospectively and examined on admission and at 2 weeks, 3 months, and 6 months after onset. The patients underwent clinical (according to the Glasgow Coma Scale) and neuroradiological examinations on admission and were scored clinically and functionally (according to Stroke Severity score and Barthel Index) on the follow-up periods. Risk factors and the correlation between findings on admission and the latest clinical and functional results were calculated with the chi 2 test, Pearson correlation test, and Student's t test. Multivariate analysis was calculated with the stepwise regression test. RESULTS: In all of the bleeding locations, lethal outcome was significantly correlated with size of the hematoma (P < .001) and Glasgow Coma Scale score on admission (P < .001). Intraventricular blood expansion was found to have a better prognosis in thalamic bleeding (P < .007) and a worse prognosis in lobar hemorrhage (P < .01). The functional outcome after 6 months was directly correlated with the size of the bleeding area in lobar and putaminal hemorrhages. No correlation was found in thalamic bleeding. A worse functional outcome was found in putaminocapsular bleeding (P = .004) and in patients with ischemic heart disease. A limited better recovery prognosis was found in patients with lobar hematoma in the temporal lobe (P = .052). CONCLUSIONS: The probability of lethal outcome can be calculated on admission in all patients with supratentorial bleeding and in correlation with the location and size of the bleeding area and level of consciousness. Intraventricular expansion of blood is a better prognostic factor in thalamic bleeding and a worse one in lobar hematoma. Functional outcome is correlated with size of the bleeding area and level of consciousness on admission in putaminal and lobar hemorrhages but has no correlation to thalamic hemorrhage.

Strokes mimicking peripheral nerve lesions.

Sensory-motor deficit in a peripheral nerve pattern due to brain lesion is rarely documented. We report on seven patients with a clinical manifestation of sensory-motor deficit, imitating peripheral nerve involvement, due to lacunar brain infarcts verified by brain computed tomography scan. Five of the patients had an ulnar nerve-like deficit and two median nerve-like deficits. The infarcts were located in the thalamus and the corona radiata. No clinical or electrophysiological evidence for peripheral nerve involvement was found. The unusual peripheral nerve pattern of lesions caused by lacunar brain infarcts can be defined as an additional lacunar syndrome and must be taken into consideration in the clinical evaluation of peripheral nerve deficits with normal nerve conduction velocity.

Splinting therapy for congenital auricular deformities with the use of soft material.

Congenital auricular deformities present serious esthetic problems. To avoid surgical correction, splinting during the early neonatal period has been attempted. We describe the results and follow-up of splinting therapy with a special soft material in 30 neonates, as compared with results in a control group of 20 untreated newborn infants. Good results were achieved in 85% of the patients and sufficient results in 15% when the treatment was continuous over the entire 4-week period. However, when treatment was partial or discontinuous, only 10% had good results. None of the infants in the control group showed spontaneous improvement during the period of study. Moreover, early initiation of treatment (first week of life) proved more effective than later treatment (second week of life). Strong parental cooperation and close follow-up are also important for success.

Correlation between skull thickness asymmetry and scalp potential estimated by a numerical model of the head.

The contribution of asymmetric skull thickness to the scalp potential amplitude was investigated numerically. The model consisted of four conductive layers representing the scalp, the skull, the cerebrospinal fluid, and the cortex with a current dipole in the occipital region. The potential created by the dipole was calculated assuming quasistatic formulation and linear media. The governing equation was discretized by the finite volume method to ensure the conservation of fluxes even in regions with abrupt changes of the conductivity. The large set of the algebraic equations for the electric potential was solved iteratively by the successive overrelaxation method. The model confirmed previous experimental studies suggesting that the potential amplitude is 60% smaller on the side with the thicker bone if the asymmetry of the skull thickness exceeds 40%. The model developed suggests that skull thickness asymmetry can create nonnegligible asymmetries in the potential measured on the scalp above homotopic points of the two hemispheres.