The relation between functional deficits, motor and sensory conduction times and MRI findings in syringomyelia.

Opinions about the relation between the dimensions of the syrinx and the severity and distribution of symptoms in patients with syringomyelia are controversial. Therefore, this study investigates the relation of clinical symptoms, a disability score, quantified (1- and 2-dimensional) radiological findings (magnetic resonance imaging, MRI) and electrophysiological data (somatosensory and motor evoked potentials) in 22 patients with syringomyelia. There was a close relation between clinical symptoms and electrophysiological data. By both electrophysiological methods subclinical deficits could be detected. Furthermore, the results disclosed that the clinical symptoms, the degree of disability and the duration of the disease are not related to the dimensions of the syrinx or the electrophysiological results obtained by investigating the long ascending and descending spinal tracts of the lower limbs. Our findings suggest that, besides the syrinx, other factors not directly visible in the MRI are responsible for the development and progress of clinical symptoms.

"Symptomatic migraine": intracranial lesions mimicking migrainous headache--a report of three cases.

Case reports of three headache patients, two with intracerebral meningioma and one with hydrocephalus are presented, in whom the clinical picture fulfilled the criteria of the International Headache Society (IHS) for the diagnosis of migraine. The symptomatic (ie, lesional) nature of the headaches could be detected by neither clinical neurological examination nor routine investigations such as EEG and skull x-ray. On the other hand, brain imaging techniques (CT, MRI) were found to be of particular in value diagnosing the lesions. Our cases indicate that neuroimaging with CT or MRI in the assessment of headache patients should not be handled too restrictively. Compared to CT, however, the additional diagnostic value of MRI in headache seems to be limited.

Single photon emission computed tomography with technetium-99m hexamethyl propylenamino oxime in the pain-free interval of migraine and cluster headache.

Thirty-three headache-free patients (19 F/14 M) suffering from common (n = 9) and classic migraine (n = 19) as well as cluster headache (n = 5) were investigated using the flow tracer 99mTc-hexamethyl propylenamino oxime and single photon emmission computed tomography. A regional decrease of cerebral tracer uptake was observed in 16 patients with common migraine, but only in 3 patients with classic migraine and in no patient with cluster headache. In 10 of 15 cases with hemiplegic symptoms during migraine attack the areas of decreased tracer uptake showed a topographic relationship to neurological deficits. It appears that migraine attacks occur in connection with exacerbations of preexisting changes of neuronal activities, cerebral perfusion and metabolism.

N-isopropyl-p-123I-amphetamine single photon emission computer tomography in motor neuron disease.

N-Isopropyl-p-123I-amphetamine (123I-IMP) single photon emission computer tomography studies were performed on 17 patients suffering from amyotrophic lateral sclerosis (ALS). All patients displayed varying degrees of impaired fixation of 123I-IMP in the whole brain. These findings were not related to the clinical variants of ALS and the age of the patients. A correlation between the severity of the disease and the degree of impaired fixation could be observed. In addition, patients suffering from ALS for longer periods showed more pronounced impairment of 123I-IMP fixation.

[Dysfunction of the sural nerve in cigarette smokers]. / Dysfunktion des Nervus suralis bei Zigarettenrauchern.

Sural nerve conduction velocity (NCV) and relative refractory period (RRP) using paired stimuli was performed on 34 healthy smokers and on 34 healthy non-smokers. No smoking probands showed a NCV of 52.2 +/- 4.1 m/sec, the smoking probands 50.7 +/- 4.1 m/sec. The RRP of the first group was 2.6 +/- 1.3%. On contrast to these results the RRP of smoking probands was 5.8 +/- 1.5%. The differences of the RRP between smokers and non-smokers are significant (p less than 0.001 Wilcoxon-test). In order to investigate the persistence of this functional impairment of the sural nerve, 19 healthy probands, who had stopped smoking (R = 0.25-13 years), were examined also. The NCV of this group was 52.2 +/- 4.5 m/sec and the RRP 3.9 +/- 1.9%. The RRP of ex-smokers is different from smoking and non smoking probands (Wilcoxon-test, p less than 0.05). The results of our investigation clearly demonstrate, that smoking induces a slight dysfunction of the sural nerve, which is not completely reversible. This may suggest, that smoking induces for example subclinical changes of the myelin sheath. In general, healthy probands are not asked for their smoking habits. It may be concluded that smoking represents an important and problematical factor concerning the age-dependency of peripheral nerve function.

Chronic ergotamine abuse: evidence of functional impairment of long ascending spinal tracts.

22 migraine patients with a history of chronic ergotamine abuse were compared with 12 patients with a similar intake of dihydroergotamine. The study of somatosensory-evoked potentials showed that 50% of the patients with a history of ergotamine abuse had increased central conduction times after stimulation of the tibial nerve. Corticomotoneuronal latencies obtained by noninvasive electrical stimulation of the motor cortex were normal in 5 patients. The functional sensory deficits were not related to clinical impairment and were more frequently observed in patients with a comparatively high mean daily and cumulative intake.

beta-Endorphin-induced release of 5-hydroxytryptamine from human platelets.

Platelets of healthy human subjects were incubated with 5-hydroxytryptamine (5-HT) followed by a second incubation with either beta-endorphin (beta-end) or the combination of beta-end and naloxone. beta-End (300 pg/ml) reduced the levels of 5-HT to 50% of initial values within 15-40 min. After 40-80 min incubation, the levels of 5-HT decreased to approximately zero. Addition of increasing amounts of beta-end (up to 300 pg/ml) produced increasing releases of 5-HT with increasing doses of beta-end. The response was dose-related, however variable, across subjects. Addition of either 28.7 or 57.4 pg naloxone to 300 pg beta-end did not antagonize the effects of beta-end on 5-HT.

A rapid gas liquid chromatography method for simultaneous determination of various anticonvulsants.

The purpose of this study was to develop a rapid GLC method for the simultaneous determination of the following anticonvulsants: Carbamazepine, Diphenylhydantoin, Phenobarbital, and Primidone. Using a metal column (OV-17) with flash heater methylation as well as high N2 flow-rate, a quantitative methylation of the above anticonvulsants was obtained. A selective temperature program proved to be the decisive factor in separating the various methylated anticonvulsants. The GLC program was completed within 13 min. This method permits a rapid, simultanous and quantitative determination of various important anticonvulsants.

Serotonin metabolism with idiopathic grand mal seizures.

Serotonin was determined in platelets of 140 patients with idiopathic mal seizures. According to anticonvulsive therapy these patients were divided into the following five groups: no medication, Diphenylhydantoin, Diphenylhydantoin calcium, Primidon, and combination of various of the anticonvulsants mentioned. The results obtained in the entire group of patients as well as in the various subgroups were compared with those of a group of healthy persons without therapy. In addition the various subgroups were compared to each other. There were significantly reduced serotonin values in the patients with idiopathic grand mal seizures as well as in each of its various groups as compared with the values obtained in healthy persons. Furthermore, significantly higher values were observed in the patients receiving primidone as compared with those receiving no anticonvulsants, Diphenylhydantoin, and a combination of various anticonvulsants. Our results taken together with those reported in the literature point to the possibility that a special imbalance in the cerebral neurotransmitter system, including a deficiency of serotonin, may represent a pathogenetic factor for idiopathic grand mal seizures. In addition, this investigation indicates that primidone elevates serotonin in platelets of patients with grand mal seizures.

[Serotonin metabolism in chronic alcoholism (author's transl)]. / Serotoninstoffwechsel bei chronischen Alkoholismus.

Serotonin was determined in platelets of 47 patients with alcoholism during the state of withdrawal as well as in a group of healthy persons. The results show that serotonin values were significantly lower in the group of patients with alcoholism as compared with the control group of healthy persons.

Tryptophan metabolism in nervous disease.

The paper describes effects of tryptophan loading on tryptophan metabolism in healthy persons as well as alterations of tryptophan metabolism observed in varians diseases associated with nervous symptoms, i.e. Wilson's disease, Hartnup disease, phenylketonuria and acute intermittent porphyria. The results are discussed.