Cerebral blood flow and somatosensory evoked response changes induced by spinal cord stimulation: preliminary follow-up observations.

A group of 6 patients undergoing cervical spinal cord stimulation (SCS) because of different pathologies was studied. Multipolar leads (QUAD-Medtronic) were inserted percutaneously; following an SCS test period, leads were connected to a multiprogrammable, fully implantable generator (ITREL II). Neither surgical nor other side effects were found. Regional cerebral blood flow (rCBF) (xenon-133 inhalation) was determined in the basal condition and after 30 min of SCS. Somatosensory-evoked potential (SSERs) from the legs were recorded in basal conditions and after 45 min of SCS. In 2 patients SSERs could not be evaluated due to electrical noise from SCS. CBF increased mainly in anterior regions in 4/6 patients (P300 improved in 1 of them and in another case), and was unchanged in 2 patients. rCBF was retested after a mean of 9.5 months of continuous SCS with the same parameters. rCBF returned to basal values in the 4 patients showing an early flow increase; in contrast, rCBF increased in the other 2 cases without early flow changes. These preliminary data seem to support the view of an acute effect of SCS on rCBF as well as on SSER, at least in some patients. Differences in long-term rCBF modifications might depend on either the underlying pathology or on the different neuronal system involved by SCS.

Ischemic stroke and atrial fibrillation. A clinical study.

In view of the higher prevalence of severe ischemic stroke among patients with atrial fibrillation (AF) and of the recently reported higher frequency of stroke with AF in females, 516 consecutive patients with ischemic stroke, of whom 93 had AF, were retrospectively evaluated. The main anamnestic, clinical and laboratory features of the AF and non-AF groups were statistically compared and the features of the AF group were statistically evaluated according to gender and age. Our results confirm the greater severity of stroke in AF patients than in non-AF patients and the higher frequency of stroke with AF in female patients. Moreover, a significantly higher frequency of stroke with AF was found in the male 60-69 and the female 80-89 age groups than in the other age groups. Relevant risk factors in females aged 80-89 were hypertension and left ventricular hypertrophy (LVH), while diabetes, alcohol, smoking and LVH prevailed among 60-69 year old males.

Anatomopathological study of dementia syndrome linked with an abnormal cerebrospinal fluid flow. Report of literature and personal observations.

The authors have analysed the data of the literature to identify the cases of normotensive hydrocephalus that underwent surgery and then died after the operation; some of these patients died over varying periods of time after the operation and the death was due to accidents. It seems that the anatomopathological lesions are less important in cases that benefited from the operation compared with cases that did not present perceptable clinical variations. The authors report the anatomopathological data of four personal cases which, from the clinical point of view, presented the dementia symptom associated in varying degrees to other neurological symptoms such as disturbances of the gait and of the sphincters functions (Adams' triad). All four subjects presented dilatation of the cerebral ventricles without cortical atrophy. From the histological point of view, there was: exfoliation of the ependyma, subependymal gliosis, demyelination of the white periventricular matter and spongiosis; there were no lesions of the meninges, of the cerebral cortex, no vascular alterations, except for those due to age, or stenosis of the aqueduct. The cause of the ventricular dilatation that was responsible for the clinical symptoms was not clear from the histological examination; the value and the significance of the histopathological data obtained and from the data available from the review of the literature are discussed and they point out the fact that many of the lesions encountered seem to be the consequence rather than the cause of the hydrocephalus.(ABSTRACT TRUNCATED AT 250 WORDS)

Scinticisternography in presenile and senile degenerative disease.

86 patients suffering from various senile and presenile degenerative diseases were studied using scinticisternography with In111-DTPA. Flow reversal and delayed clearance were observed in 62 of these patients. These alterations, possibly related to the cerebrospinal fluid dynamics, show the aspecificity of the SC picture. The SC picture does not seem to be correlated to the clinical signs.

Spinal cord softenings of identifiable cause: anatomical and clinical features.

To complete our bibliographic review of spinal cord softenings, we now discuss the clinical and pathological findings in the cases of known or probable cause. Comparison of the diagnostic groups yields some differences in respect of sex, age and mode of onset, survival and extent of the anatomical lesion. Further differences, especially in age at onset, clinical pattern and lesion site, emerge from a comparison of these cases of known or probable cause with those whose cause is not apparent.

Some little-known aspects of spinal cord softening.

311 cases of spinal cord softening, were selected for review. The following points emerged from this study: 1) spinal cord softening is a rare occurrence; 2) while formerly syphilis was the most frequent cause, recently reports of cases secondary to aortic disease or to embolism with diffuse signs of arteriosclerosis and circulatory failure pointing to a different pathogenesis have become more frequent; 3) the site of softening rarely corresponds to the vascular spinal territories as defined by the anatomists, from which it may be argued that often several arterial territories may be involved simultaneously or, alternatively, that the arterial territories are not so rigidly defined as anatomical research has led us to suppose; 4) the few cases of multiple vascular lesions show that, as happens in the brain, the cord may be damaged contemporaneously or successively in several areas.

VEP changes in Parkinson's disease are stimulus dependent.

Two stimulus configurations (gratings and checkerboards) have been presented to a series of consecutive patients with the aim of exploring VEP changes in Parkinson's disease. The outcome turned out to be quite different according to the stimulus employed. Specifically, grating pattern produced a high diagnostic yield as opposite to checkerboard, which did not reveal substantial modifications of the latency of the VEP major positive peak with respect to a control group. This finding raises problems as to the characteristics of visual changes associated with Parkinson's disease.

Further evidence for asymmetry of point localization in normals and unilateral brain damaged patients.

The properties of errors made by normals and unilateral brain damaged patients in localizing points in each half of a plane have been further investigated. A lesion of either hemisphere affects specifically the performance in the left half of the plane, where controls attain the highest degree of constancy. Consideration of the orientation of pathologic vectors may contribute to differentiation between damage of the two hemispheres.

[Effect of fenfluramine in Huntington Chorea]. / Effet de la fenfluramine dans la chorée de Huntington.

Serotoninergic function has been evaluated in 15 H.C. patients. Therapeutic results obtained with an inhibitor of 5 HT reuptake (Fenfluramine) were evaluated in comparison to the effects of L-5HTP, CSF-5HIAA measurements were performed is each case before and after treatment. The pathological role of 5HT impairment in H. C. can not be excluded by the behavioral effects and CSF-5HIAA modifications that were observed.