ABSTRACT
Percutaneous endoscopic gastrostomy (PEG) is being used increasingly in the treatment of patients with neurogenic dysphagia to improve nutrition and prevent choking and aspiration pneumonia. PEG is used in a wide range of general medical conditions, but its role in clinical neurology is sometimes controversial. This paper reviews the place of PEG in the management of 32 patients with a variety of chronic and progressive neurological disorders. All the patients found it to be an effective and acceptable method of feeding that prevented weight loss, reduced chest infections, facilitated nursing care and improved their quality of life. PEG has an important role in neurological rehabilitation.
Subject(s)
Deglutition Disorders/therapy , Enteral Nutrition , Gastrostomy/instrumentation , Nervous System Diseases/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Deglutition Disorders/etiology , Female , Gastrostomy/economics , Humans , Male , Middle Aged , Nervous System Diseases/complications , Quality of Life , Retrospective StudiesABSTRACT
The value of routine computerised axial tomography of the brain (CT scanning) was assessed in 220 consecutive patients with epilepsy or isolated seizures. Abnormal CT scans were found in more than half the patients with focal seizures associated with focal signs or a delta focus on the electroencephalogram (EEG). In patients without focal features the CT scan was normal in 94%. Only a quarter of the abnormalities found on CT scanning were potentially treatable by surgery, and only 10% of all the patients had their management changed as a result of CT scanning. In 3 patients with tumours the first scan had been normal. Careful clinical assessment and examination supported by an EEG remain of paramount importance in the management of epilepsy, and CT scanning should be reserved for patients with focal features.
Subject(s)
Epilepsies, Partial/diagnostic imaging , Epilepsy/diagnostic imaging , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Child , Child, Preschool , Costs and Cost Analysis , Electroencephalography , Epilepsy/etiology , Epilepsy/surgery , Epilepsy, Temporal Lobe/diagnostic imaging , Humans , Middle Aged , Referral and Consultation , Skull/diagnostic imaging , Tomography, X-Ray Computed/economicsABSTRACT
A family is reported in which myasthenia gravis and thyroid disease occur over three generations. The grandmother and granddaughter have ocular myasthenia and an aunt in the second generation had generalised myasthenia gravis with a thymoma. The pattern of histocompatibility antigens (HLA) haplotypes, anti-AChR antibodies, anti-striate muscle antibodies and thyroid disease is described. The haplotype HLA-A1, B8 was found in affected members of the first and third generation but the family study showed that this was not the same haplotype because the HLA-A1, B8 haplotype in the third generation was contributed by an unaffected person marrying into the family in the second generation.
Subject(s)
Myasthenia Gravis/genetics , Adult , Aged , Autoantibodies/analysis , Female , HLA Antigens/genetics , Humans , Middle Aged , Myasthenia Gravis/immunology , Pedigree , Receptors, Cholinergic/immunologyABSTRACT
An epidemic of hysterical blackouts in a modern comprehensive school affected 60 teenage girls and three boys, who from September 1978 to June 1980 had a total of 447 blackouts. The chronic nature of the epidemic was unusual, and several reasons for this emerged. The visible impact of the epidemic was diluted by the large size of the school and because affected pupils used general-practitioner services and hospital departments in the neighbourhood. As a result, eight received inappropriate treatment for epilepsy, and this may have helped to establish the behaviour pattern within the school. In addition, a small core of eight girls with a high incidence of behaviour and family problems were repeatedly affected and may have acted as triggers for new cases. Once medical supervision was centered on one neurology outpatient clinic the epidemic gradually resolved.
Subject(s)
Disease Outbreaks/epidemiology , Hysteria/epidemiology , Schools , Unconsciousness , Adolescent , Child , Diagnosis, Differential , Epilepsy/diagnosis , Female , Humans , Hysteria/diagnosis , MaleABSTRACT
A case of primary polycythaemia presenting with severe chorea is reported and compared with previous cases. The aetiological factors of the chorea are discussed and the importance of early diagnosis stressed.
Subject(s)
Chorea/etiology , Polycythemia/complications , Chorea/diagnosis , Humans , Male , Middle AgedABSTRACT
A patient with the clinical picture of quadriceps myopathy was shown to have an underlying myositis. Review of the literature showed myositis to be a rare cause of the 'quadriceps syndrome' but it is important to identify this group because they are potentially treatable with corticosteroids.
Subject(s)
Muscular Diseases/etiology , Myositis/complications , Adult , Humans , Male , Muscles/pathology , Muscular Diseases/pathology , Syndrome , Thigh/pathologyABSTRACT
Thirty-one patients with thoracic outlet syndrome have been studied in detail in the neurological and vascular clinics at this hospital. The patients were classified on the basis of their presenting symptoms into four groups--predominantly vascular, neurological, combined vascular and neurological, and pain and paraesthesiae alone. The majority of patients had radiological abnormalities and all had structural lesions in the superior thoracic aperture seen at operation. All operations were carried out through a standard supraclavicular approach, enabling the compressive structures to be visualized. This would not have been the case had the commoner trans-axillary approach for first rib resection been followed and in fact none of the operations included removal of the first rib. The results of operation were evident in our patients with a marked relief in their vascular symptoms, their pain and paraesthesiae and a slight but definite improvement in muscle bulk and power.
Subject(s)
Cervical Rib Syndrome/diagnosis , Thoracic Outlet Syndrome/diagnosis , Adolescent , Adult , Arm/blood supply , Cervical Rib Syndrome/genetics , Cervical Rib Syndrome/surgery , Child , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Ischemia/diagnosis , Male , Middle Aged , Muscular Atrophy/diagnosis , Paresthesia/diagnosisABSTRACT
A ward has been set up for adolescents, who, being neither children nor adults, have special needs. It provides a pleasant and enthusiastic atmosphere that allows the patients to mix together socially alties is important, but not more than 20% should be long-stay patients. Those needing intensive care or specialised investigations and those likely to be a disruptive influence are excluded. No serious sexual problems have been encountered.
Subject(s)
Adolescent , Hospital Units , Adult , Child , England , Female , Humans , Length of Stay , Male , Medicine , Nervous System Diseases/therapy , Nurses , SpecializationABSTRACT
This paper reports 40 patients with primary cerebellar ectopia investigated in the University of Manchester departments of neurology and neurosurgery over the five years, 1968-1973. A review of the clinical and surgical findings showed that (a) pain of varying type was the most common symptom, (b) four main clinical groups could be recognized--syringomyelia, paraparesis, cerebellar syndrome and 'raised pressure' syndrome and (c) surgical decompression of the posterior fossa and upper cervical spine resulted in improvement in over 70 per cent of patients with a small incidence of post-operative complications. It should be emphasised that primary cerebellar ectopia is not uncommon and is an important syndrome in its own right. It is often not accompanied by syringomyelia and in these patients the diagnosis can be difficult without supine myelography.
Subject(s)
Arnold-Chiari Malformation/diagnosis , Adult , Arnold-Chiari Malformation/surgery , Female , Humans , Intracranial Pressure , Male , Middle Aged , Pain/complications , Paralysis/etiology , Syringomyelia/complicationsABSTRACT
A group of six subjects was trained, using biofeedback procedures, in the voluntary regulation of hand temperature as a means of controlling migraine attacks. The training procedure and its relationship to migraine activity is described. Daily records of migraine activity were kept during base-line, training, and follow-up periods. Analysis of this data revealed statistically and clinically significant improvement on several indices of migraine activity. Evidence for a concomitant improvement in the ability of subjects to produce voluntary increases in hand temperature is presented.
Subject(s)
Biofeedback, Psychology , Migraine Disorders/therapy , Adult , Evaluation Studies as Topic , Female , Hand , Humans , Male , Middle Aged , Pilot Projects , Skin TemperatureABSTRACT
A patient with systemic lupus erythematosus (SLE) developed attacks of unilateral cataplexy precipitated by laughter. Unilateral cataplexy has not been described previously in detail and its association with SLE is unique. The clinical details, investigations, and diagnostic criteria are discussed and a causal relationship between cataplexy and SLE is suggested.
Subject(s)
Cataplexy/complications , Lupus Erythematosus, Systemic/complications , Adult , Female , Humans , Lupus Erythematosus, Systemic/diagnosisABSTRACT
The clinical and thymic histological features of 23 patients who underwent thymectomy for myasthenia gravis have been examined and compared. Eighty-two per cent of patients with a non-neoplastic gland containing numerous germinal centres improved postoperatively, whereas 83% of patients with a non-neoplastic gland containing no germinal centres deteriorated or died. Glands with only slight involution and containing numerous germinal centres were more commonly seen in young female patients. The evidence relating thymic histological appearances with the postoperative progress of patients with myasthenia gravis is reviewed.
