The combination of neuronavigation with transcranial magnetic stimulation for treatment of opercular gliomas of the dominant brain hemisphere.

OBJECTIVE: The objective of this study is to investigate the application of transcranial magnetic stimulation combined with neuronavigation for preoperative mapping of the language area in neurosurgical interventions on the opercular area of the dominant hemisphere. METHODS: Five patients were operated upon gliomas in the opercular area. For localization of the speech area a transcranial magnetic stimulator MEDTRONIC-MagPro was used. BrainLAB-VectorVision Neuronavigation system was utilized for precise planning of the operative approach. RESULTS: Gross total resection was achieved in all patients. Three-month postoperative follow-up was done. Three of the patients had a transient postoperative motor aphasia which resolved within 1 month. CONCLUSION: This method is useful for preoperative localization of the speech area, as well as preoperative planning of the operative approach and intra-operative planning of the direction of brain retraction and operative corridor.

Clinical and EMG findings in patient with mononeuropathy multiplex associated with livedo reticularis: a case report.

We report on the combination of biopsy-proven idiopathic livedo reticularis and mononeuropathy multiplex, mild to moderate in severity and remitting-relapsing in course, observed in a young otherwise healthy woman. Neurologic relapses were always accompanied or preceded by exacerbation of the skin lesion. After 18 years followup we did not detect clinical or instrumental evidence of brain or visceral involvement. This excludes the classical Sneddon's syndrome and points at an unusual variant of this syndrome in our patient.

Detection of elastin derived peptides in cerebrospinal fluid of patients with first ever ischaemic stroke.

OBJECTIVE: We have previously reported the optimized methods for the detection of elastin derived peptides (EDP) in the serum, synovial fluid, and bronchoalveolar lavage. The aim of the present study was to investigate whether EDP are detectable in cerebrospinal fluid (CSF) of patients with acute brain ischaemia. PATIENTS AND METHODS: Twenty-seven first ever ischaemic stroke patients (mean age 61.5+/-10.8 years; age range 47-70 years; 12 women) were studied in acute phase (1-15 days after the onset) with clinical evaluations, radiological assessments, and the analysis of serum and CSF based on Western blot and ELISA for the detection and quantification of EDP. RESULTS: None of the serum EDP concentrations are significantly higher in stroke patients compared with 25 healthy control individuals. However, EDP levels in CSF are strongly (p<0.0001) elevated compared with healthy subjects. They correlated with total cholesterol (r=0.53; p=0.02), triglycerides (r=0.67; p=0.004) and retinopathy (r=0.24; p=0.03), and with the interval between the stroke onset and the time of lumbar puncture (r=0.35; p=0.02). CONCLUSION: EDPs are detectable in CSF of healthy subjects and patients with ischaemic stroke. Acute brain infarction is followed by increased levels of EDP in CSF.

Increased levels of elastin-derived peptides in cerebrospinal fluid of patients with lacunar stroke.

OBJECTIVE: To investigate whether elastin-derived peptides (EDP) are detectable in the cerebrospinal fluid (CSF) of healthy controls and of patients with acute brain ischemia and if so to assess possible trends in EDP levels in different groups of ischemic stroke patients (small-vessel disease vs. other ischemic strokes; first-ever vs. recurrent stroke). PATIENTS AND METHODS: Levels of EDP were determined by ELISA in blood sera and CSF of 80 patients with acute ischemic stroke (mean age 61.5+/-10.8; age range 47-70; 22 women) and in 15 healthy age- and sex-matched controls (mean age 57.3+/-13.4; age range 50-65). The patients were divided into a group with first ever lacunar stroke (27); first ever non-lacunar ischemic stroke (27) and recurrent stroke (26). EDP were measured early (mean 7 days, range 1-15) after stroke onset. RESULTS: Serum EDP levels were mildly higher in recurrent strokes as compared to first ever lacunar lesion and controls. However, in the CSF the concentrations of EDP in stroke patients were strongly elevated (from 2 up to 30 times depending on subgroup) as compared with healthy subjects. The highest level of EDP in CSF and in the serum was found in recurrent strokes. Subgroup analysis revealed a trend for significantly higher EDP concentrations in CSF in lacunar and recurrent stroke as compared with non-lacunar. CONCLUSIONS: This study is the first application of elastin peptide measurement to human CSF and stroke patients. The increased levels of EDP were detected in CSF of patients with lacunar and recurrent strokes.

Correlation between cognitive P300 changes and the grade of closed head injury.

OBJECTIVE: To investigate the use of auditory oddball cognitive P300 changes in an attempt to find out the correlation between the grade and consequences of closed head injury. MATERIALS AND METHODS: Twenty patients with cerebral concussion (mean age 38.5 +/- 10.5 years) and twenty patients with cerebral contusion (mean age 35.5 +/- 9.8 years) underwent auditory oddball P300 investigation within 0.5 - 28 months after the incident. CT was performed in all of patients before P300 testing. The control group consisted of 30 healthy persons, age and sex matched to the study cohort. RESULTS: All of the patients with concussion showed normal results in P300. Sixteen cases with contusion (80%, CI 62.5-97.3%, p < 0.05) revealed abnormal P300 (latency more than 360 msec and absent P300 response in 4 cases). CONCLUSION: Years after the head injury, cognitive P300 changes make cerebral contusion objective.

Utility (or futility?) of electrodiagnosis in thoracic outlet syndrome.

The objective diagnosis of thoracic outlet syndrome (TOS) remains a challenge. The purpose was to present our experience and discuss the utility of electromyography, electroneurography and somatosensory evoked potentials after ulnar nerve stimulation in patients with surgically verified neurovascular compression at the thoracic outlet. Twenty patients (median age 29.5, 16 women) with operatively verified neurovascular compression by a cervical rib or band were examined. All complained of pain and paraesthesias in the hand. In 12 vasomotor disturbances (pallor or lividity, low skin temperature, Raynaud's phenomenon) were also observed. Clinical diagnosis was supported by the provocative tests (Adson, Wright, costoclavicular) in 14persons. Neurologic signs were present in 2 patients in "pseudoulnar" distribution. Anterior scalenectomy was performed with success in 15 cases, 4 remained unchanged and 1 worsened. Electrodiagnostic tests were normal in all 18 patients without neurologic signs. We note a tendency for the digital nerves sensory action potentials in patients with TOS to be higher than usual It is concluded that electrodiagnosis is useless in confirming the presence of TOS, but it is very useful to exclude other painful conditions that require other treatments (carpal and cubital tunnel syndromes, cervical radiculopathies etc).