MR imaging of the wrist in carpal tunnel syndrome.

PURPOSE: To determine whether specific parameters measured on MR images correlated to electrophysiological changes in carpal tunnel syndrome (CTS). MATERIAL AND METHODS: Prospective clinical examinations were made of 20 patients with suspected CTS. We performed bilateral electrophysiological examinations of the median nerve and bilateral MR imaging of the wrists. RESULTS: The electrophysiological examination suggested median nerve entrapment in 18 wrists. These wrists were compared to the remaining 22 electrophysiologically normal wrists. In addition, we compared both wrists in 12 patients with unilateral symptoms of CTS without reference to the electrophysiological findings. We found no difference in specific MR parameters between the 2 groups. CONCLUSION: Neither symptoms nor electrophysiological findings in CTS were related to specific MR parameters.

[Intracranial distribution of iohexol and iotrolan after cervical myelography]. / Intrakranial fordeling af iohexol og iotrolan efter cervikal myelografi.

Twenty-eight consecutive patients undergoing cervical myelography were examined with either iohexol (14) or iotrolan (14). Just before the myelography a cranial CT was performed and control CT (3-5 slices) examinations were performed three, six, 24 and 48 hours afterwards. In all 28 patients CT showed intracranial contrast medium distribution after cervical myelography. The contrast medium distributed mainly in the subarachnoid space, first to the basal cisterns and the insular fissures, and to the 4th ventricle. The densities in the subarachnoid spaces were significantly higher after iotrolan than iohexol in the basal cisterns three and six hours after myelography, and in the 4th ventricle. The subcortical density was still increasing 48 hours after iotrolanmyelography while the subcortical density reached the maximum 24 hours after iohexolmyelography. Following cervical myelography the contrast media iohexol and iotrolan distribute intracranially and iotrolan seems to be eliminated more slowly than iohexol.

Intracranial iotrolan distribution following cervical myelography. Postmyelographic registration of adverse effects, psychometric assessment and electroencephalographic recording.

Following iotrolan cervical myelography 14 consecutive patients were evaluated with respect to intracranial contrast distribution and elimination, side effects, EEG-changes and psychometric assessments. The contrast medium is distributed in the subarachnoid space, in the ventricles and finally extracellularly in the cortex. Headache was the most prevalent side effect, occurring in half of the patients, 43% of "severe" grade. Eight patients showed mild nonspecific EEG-changes and all patients showed neuropsychologic disturbances.

Self-care and multiple sclerosis: a view from two cultures.

The role of self-care in the management of chronic illnesses is essential to successful patient care. This paper compares and contrasts self-initiated self-care practices of 51 Danish and 35 American persons with multiple sclerosis at various levels of disability. Respondents were asked about ways they managed their symptoms and problems during periods of non-medical contact--including methods of following the medical regimen; alternative treatments; use of lay-referral systems; and, sources of information regarding physical, psychological, social, and environmental dimensions of coping with the illness. The two groups of respondents varied regarding adaptation strategies and primary sources of information used. The ultimate aim, however, of using these strategies was similar; to gain control over uncertainty, dependency, and physical and emotional decline. This study suggests that the empowering role of self-initiated self-care strategies in chronic illness may transcend differences in health care systems.

In vivo evaluation of the reproducibility of T1 and T2 measured in the brain of patients with multiple sclerosis.

The precision (reproducibility) of relaxation times derived from magnetic resonance images of patients with multiple sclerosis (MS) were investigated. Measurements of 10 MS patients were performed at 1.5 T on two occasions within 1 wk. T1 and T2 was measured using a partial saturation inversion recovery sequence (6 points) and a Carr-Purcell-Meiboom-Gill phase alternating-phase shift multiple spin-echo sequence with 32 echoes. Regions of interest (ROI) were placed both in apparently normal white matter and plaques. The precision (+/- 1.96 SD) and the confidence intervals for T1 and T2 for white matter and plaques were calculated. The precision of T1 for white matter and plaques was respectively +/- 94 msec and +/- 208 msec. The precision of T2 for white matter and plaques was respectively +/- 18 msec and +/- 26 msec. For all measurements the coefficient of variation was about 9%. Judging from our own study and others as well, a precision better than 10% for T1 and T2 would seem unrealistic at present.

Intracranial iohexol-distribution following cervical myelography, postmyelographic registration of adverse effects, psychometric assessment and electroencephalographic recording.

Cervical myelography (CM) was taken from 14 cases with cervical root-compression symptoms. Prior to myelography, there was complete cranial CT registration to assess the subarachnoid, intraventricular, subcortical and periventricular densities. Control scans at 3,6,24 and 48 h following myelography disclosed intracranial contrast medium at level of basal cisterns, the fourth ventricle and fissura Sylvii. Nine and 11 patients, respectively, had enhancement in the third and lateral ventricles. All patients had subcortical enhancement, and 9 patients had periventricular enhancement; at the 3-h control CT after myelography a minor subcortical edema was disclosed, which declined during the following hours. Two days after myelography, a minimal residual contrast was disclosed subcortically at the level of fissura Sylvii and in the subarachnoid space at the level of fissura Sylvii and the convexity. Hence, we recommend, that diagnostic cranial CT is performed before or postponed until 3 days after cervical myelography. The patients were questioned about adverse effects, and they underwent psychometric assessment and EEG-recordings: 11 had adverse effects, chiefly mild and exclusively transient, without sequelae. Three patients had no side effect. The psychometric assessment, however, disclosed pronounced deterioration in all patients at test 28 h after myelography, especially marked in the verbal paired associates test, however these disturbances were totally absent at retest one week later. No EEG-abnormalities developed; consistently, no patient had seizures. In conclusion, following CM iohexol is taken up by the brain parenchyma, gradually disappearing within 48 h, during which time a brain CT will be disturbed. During the same period some deterioration of psychometric tests may be found.

[Intrathecal distribution of iohexol after cervical myelography]. / Intratekal iohexolfordeling efter cervikal myelografi.

Cervical myelography was performed in fourteen patients under suspicion of cervical disc herniation. Prior to myelography, complete cranial-CT registration of the density in the subarachnoid space, intraventricularly, subcorticaly and periventriculary was performed. Control scans 3, 6, 24 and 48 hours following myelography disclosed intracranial contrast media at level of basal cistern, the fourth ventricle and Sylvian fissure. Nine and eleven patients, respectively, had enhancement in the third and lateral ventricles. All patients had subcortical enhancement and nine patients had periventricular enhancement. At the first three hours after cervical myelography minor subcortical and periventricular edema was disclosed, which resolved during the subsequent hours. Two days after myelography, minimal residual contrast was disclosed subcortically at the level at the Sylvian fissure and in the subarachnoid space at the level of the Sylvian fissure and the convexity. It is recommended, that diagnostic cranial-CT is performed before cervical myelography or at a minimum of three days after cervical myelography.

[Klippel-Trenaunay-Weber syndrome. Magnetic resonance imaging diagnosis of medullary involvement]. / Klippel-Trenaunay-Weber-syndrom. Magnetisk resonans billeddiagnostik ved medullaer affektion.

The Klippel-Trenaunay-Weber (KTW) syndrome is a rare congenital syndrome of unknown etiology consisting of the triad: a large cutaneous naevus, congenital varicosities and hypertrophy of bones and soft tissues. A heterogenous group of vascular malformations may also occur. The case record of acute myelopathy in a patient aged 42 years with recognized KTW syndrome is presented. It is concluded that magnetic resonance imaging is indicated in cases of suspected intramedullary haemorrhage in patients with congenital vascular malformations.

Assessment of demyelination, edema, and gliosis by in vivo determination of T1 and T2 in the brain of patients with acute attack of multiple sclerosis.

This study intended to investigate the possibility of magnetic resonance (MR) to characterize the acute plaque due to multiple sclerosis (MS). To obtain information, in vivo measurements of relaxation processes were performed in 10 patients with known acute MS plaques, using a whole-body superconductive MR-scanner, operating at 1.5 T. The measurements were repeated several times, from onset of the disease and during remission by use of six-point partial saturation inversion recovery and 32-echo multiple spin-echo sequences, giving T1 and T2, respectively. We also focused on the issue, whether T1 and T2 relaxation processes in fact were monoexponential. The results of the first T1 and T2 measurements of the acute plaques were not clearly different from T1 and T2 of presumably chronic plaques obtained in a group of chronic MS patients previously (H.B.W. Larsson, J. Frederiksen, L. Kjär, O. Hendriksen, and J. Olesen, Magn. Reson. Med. 7, 43 (1988)). In some of the acute plaques a slight initial increase in T1 and T2 was seen, when the measurement was repeated in about 10 days. Thereafter T1 decreased slowly in all but one patient as a function of days. In all cases the T1 relaxation process followed a monoexponential course. The T2 relaxation process was a monoexponential function in the acute plaques, when measured within 20 days from onset of disease. After an average of 78 days, however, the T2 relaxation process clearly became biexponential in all but two patients. Later some of the relaxation curves changed back toward monoexponentiality. Thus, the study shows that it is possible to detect significant changes in MR parameters during the evolution of the disease, and these changes are discussed in relation to knowledge of pathoanatomical events in MS.

Increased level of cerebrospinal fluid beta 2-microglobulin is related to neurologic impairment in multiple sclerosis.

beta 2-microglobulin was measured in the CSF of 33 MS patients (age range 26-66 years) and compared with the 95% confidence interval determined in an age-matched reference group of 32 patients without neurologic disease. Six MS (18%) had moderately increased concentrations and this subgroup was characterized by severe neurologic impairment according to Kurtzke's expanded disability scale. Increased CSF beta 2-microglobulin concentration in MS may reflect lesion formation.

The antineoplastic effect of methylprednisolone pulse therapy in two patients with glucocorticoid receptor-positive glioblastoma multiforme.

Glucocorticoids in high concentrations inhibit in vitro the growth rate of glioblastoma multiforme. This presupposes the presence of glucocorticoid receptors in the cytoplasma. Glucocorticoid receptor positive patients with histological glioblastoma multiforme were postoperatively treated with high dose methylprednisolone pulse therapy during which CT-scanning initially demonstrated tumor regression. One patient's tumor size was unchanged after 24 weeks, whereas in the other patient, the tumor size after decreasing for 1 month began increasing again. The survival rate, at the present 15 and 10 months, without irradiation therapy and the decreasing glucocorticoid receptor concentrations at reoperations indicate an antineoplastic effect by continuous high-dose glucocorticoid pulse therapy.

Increased cerebrospinal fluid concentrations of C- but not N-terminal cholecystokinin fragments in multiple sclerosis.

The sulfated N-terminus and the carboxyamidated C-terminus of cholecystokinin octapeptide (CCK-8) were radioimmunoassayed in cerebrospinal fluid from 19 patients with multiple sclerosis (MS) and 17 control subjects. While the N-terminal immunoreactivity was normal in all phases of MS, the concentration of C-terminal CCK immunoreactivity was significantly increased from 3.7 +/- 0.3 to 7.9 +/- 1.0 pmol/l (mean +/- S.E.M.) in both progressive and stable phases. The results indicate that C-terminal forms of CCK are released at an increased rate or that increased amounts of CCK-8 are released together with enhanced aminopeptidase activity in MS.

Chronic pain treatment with intravenous lidocaine.

In a few uncontrolled studies intravenous lidocaine has been used in the treatment of chronic pain. In a controlled study we used intravenous lidocaine in 18 patients with severe chronic pain states due to various but mainly neurological diseases. After the infusion of lidocaine 14 patients (78%) had significant pain relief ranging from 2 hours to 25 days. There was no significant effect of placebo infusion with isotonic saline. The mechanism of the pain relieving ability of intravenous lidocaine is unknown.

A randomized general practice group-comparative study of femoxetine and placebo in the prophylaxis of migraine.

In a randomized general practice study, the prophylactice effect of femoxetive (a 5HT uptake inhibitor) was compared with placebo in migraine patients. Treatment, with separate randomization schedules in each practice, was allocated to 65 patients. Each patient was treated for 16 weeks with 200 mg increasing during the first nine days to 600 mg daily. No effect of femoxetine could be demonstrated in attack frequency and headache index. Separate analysis of maximum reduction in serotonin concentration during treatment revealed no difference in efficacy when compared with placebo. This supports earlier studies that femoxetine generally exerts no prophylactic effect on migraine, and the hypothesis that platelet 5HT might be of major importance in the pathogenesis of migraine is not supported.

Evoked potentials in multiple sclerosis before and after high-dose methylprednisolone infusion.

We studied 8 patients with definite multiple sclerosis (3 with acute relapse, 5 with progression), and 2 patients with acute optic neuritis, who were treated with methylprednisolone infusions, 1 g daily for 3 days. Visual, brain stem-auditory and somatosensory-evoked potentials were used to test the effect of therapy. There were no manifest changes of the evoked potentials parameters parallel to the clinical effect of high-dose therapy.

Immune complexes and the complement factors C4 and C3 in cerebrospinal fluid and serum from patients with chronic progressive multiple sclerosis.

Immune complexes (IC) have been found in both serum and cerebrospinal fluid (CSF) in multiple sclerosis (MS). The complement system is known to play a major role as a mediator of inflammation in immune complex disease. Therefore, we have investigated paired samples of serum and CSF from 32 patients with progressive MS for IC, the levels of the complement factors C4 and C3, and presence of their activation products (AP). IC was found in serum from 17 of the 32 MS patients (53%) and in CSF from 9 of 31 MS patients (29%). No correlation was found between the occurrence of IC in serum and in CSF. The levels of C3 in serum and CSF from the MS patients did not differ from the levels in a control group, whereas the levels of C4 in MS-serum were elevated and the C4 levels in MS-CSF reduced. A low level of CSF-C4 correlated significantly to the occurrence of CSF-IC. AP of C4 and C3 in serum were seen in 11 of the 32 patients (34%), appearing significantly more frequently among patients with circulating IC. No C4- or C3AP could be identified in CSF.

Evaluation of disability, incapacity and environmental status scales in multiple sclerosis.

From the Danish Multiple Sclerosis (MS) population a representative sample of 249 patients with a clinically definite diagnosis of MS has been tested by use of the Functional System Scale and Disability Status Scale of Kurtzke and the Incapacity and Environmental Status Scales of the IFMSS. Validity and reliability of the items and the properties of summed scales have been estimated. A statistical evaluation showed that generally the Incapacity and the Environmental Status Scales worked well. Problems encountered with the use of the Incapacity scale are mentioned and on statistical grounds a proposal of an incapacity scale with fewer items is presented.

Reaction time deficit in multiple sclerosis.

50 multiple sclerosis (MS) patients were evaluated, according to an objective weighting scale measuring neurologic deficit, and investigated with continuous reaction time (CRT). Compared to a group of 105 controls, the reaction times of the MS patients were significantly delayed. The CRT method could correctly classify 80% of the controls and 72% of the patients. The CRT was especially sensitive for patients in the progressive phase of the disease and independent of dyscoordination.

The effect of serum from multiple sclerosis patients in remission on the incubated rat brain slices.

Addition of human serum to incubated rat cerebral slices induced increased generation of myelin-related, membranous fragments floating on 0.32 M sucrose. Sera from 20 healthy subjects and 19 patients with various neurological disorders were equally active in this respect. On the other hand, the myelin-degrading activity of sera from 20 multiple sclerosis patients in remission was found to be significantly elevated by about 50%. The present findings support the contention that the serum of multiple sclerosis patients possesses increased potency to induce myelin sheath alterations.