RESUMO
The term "senile chorea" is applied to cases of sporadic chorea with onset after the age of 50 years. The causes of senile chorea are numerous and include drugs, medications, cerebrovascular disease, genetic and sporadic neurodegenerations, and a range of systemic (hematological, metabolic, immune) disorders. The cause of senile chorea can be determined after systematic investigation in most cases.
Assuntos
Coreia , Coreia/complicações , Coreia/etiologia , Coreia/genética , HumanosRESUMO
Reversible cerebral vasoconstriction is a rare and poorly understood syndrome, without clear diagnostic criteria. It has been described in association with multiple disorders, but has only been reported rarely in the setting of carotid artery dissection and, to our knowledge, never before in association with renal artery stenosis.
Assuntos
Encéfalo/irrigação sanguínea , Dissecação da Artéria Carótida Interna/complicações , Obstrução da Artéria Renal/complicações , Vasoconstrição , Adulto , Anti-Hipertensivos/uso terapêutico , Encéfalo/patologia , Dissecação da Artéria Carótida Interna/patologia , Circulação Cerebrovascular/efeitos dos fármacos , Circulação Cerebrovascular/fisiologia , Feminino , Transtornos da Cefaleia Primários/etiologia , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Nimodipina/uso terapêutico , Obstrução da Artéria Renal/patologia , Vasodilatadores/uso terapêuticoRESUMO
Repetitive and compulsive behaviours can occur in association with the use of dopaminergic medications for the treatment of Parkinson's disease (PD). This syndrome has been referred to as the 'dopamine dysregulation syndrome'. The prognosis for patients with this syndrome is unclear. We report five PD patients in whom the abnormal behaviours resolved completely after withdrawal of dopamine agonist therapy. We alert clinicians to the apparent role of dopamine agonists in this syndrome. In addition, we highlight the potential reversibility of the syndrome, its varied phenomenology and its potential pathophysiology.
Assuntos
Antiparkinsonianos/efeitos adversos , Comportamento Compulsivo/induzido quimicamente , Transtornos Disruptivos, de Controle do Impulso e da Conduta/induzido quimicamente , Agonistas de Dopamina/efeitos adversos , Comportamento Estereotipado/efeitos dos fármacos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/tratamento farmacológicoAssuntos
Catárticos/efeitos adversos , Gastroenteropatias/complicações , Doença Enxerto-Hospedeiro/complicações , Magnésio/efeitos adversos , Magnésio/sangue , Doença Aguda , Adulto , Catárticos/administração & dosagem , Catárticos/uso terapêutico , Gastroenteropatias/tratamento farmacológico , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/tratamento farmacológico , Humanos , Magnésio/administração & dosagem , MasculinoRESUMO
Voluntary finger-nose movements of the arm were analysed in six patients undergoing stereotaxic nucleus ventralis intermedius thalamotomy for relief of severe Parkinsonian tremor. In all cases thalamotomy acutely abolished tremor in the contralateral arm. In the early postoperative phase, ataxia of the arm contralateral to the operated side was also seen. Ataxia was transient, lasting between 7 and 21 days postoperatively. This observation suggests that a lesion of the Vim nucleus interrupts cerebellar input to the thalamus, and supports the concept that abnormal cerebellar activity is an important contributor to the generation of tremor in Parkinson's disease.
Assuntos
Ataxia/etiologia , Doença de Parkinson/cirurgia , Complicações Pós-Operatórias/etiologia , Técnicas Estereotáxicas , Tremor/cirurgia , Núcleos Ventrais do Tálamo/cirurgia , Idoso , Braço/inervação , Ataxia/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Vias Neurais/fisiopatologia , Vias Neurais/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Núcleos Ventrais do Tálamo/fisiopatologiaAssuntos
Doenças dos Gânglios da Base/metabolismo , Doenças dos Gânglios da Base/patologia , Encéfalo/metabolismo , Calcinose/patologia , Coreia/diagnóstico , Ferro/análise , Ferro/metabolismo , Idoso , Idoso de 80 Anos ou mais , Doenças dos Gânglios da Base/complicações , Calcinose/complicações , Coreia/complicações , Evolução Fatal , Globo Pálido/patologia , Humanos , Masculino , Neutrófilos/patologiaRESUMO
Blink rates were measured in 25 patients with fluctuating Parkinson's disease in the "off' and "on" periods. In 17 patients, the "off"-period blink rate was low and increased after administration of levodopa. In the remaining eight patients, the "off"-period blink rate was high and returned to normal levels after levodopa. It is suggested that increased blink rate in the latter group represents a new form of "off"-period dystonia.
Assuntos
Antiparkinsonianos/farmacologia , Piscadela/efeitos dos fármacos , Levodopa/farmacologia , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/fisiopatologia , Adulto , Idoso , Estudos de Casos e Controles , Distonia/tratamento farmacológico , Distonia/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Índice de Gravidade de DoençaRESUMO
The cortical silent period has not previously been studied in tetanus. Transcranial magnetic brain stimulation in a patient with generalized tetanus revealed enlarged electromyographic (EMG) responses and absence or reduction of the late phase of EMG silence following the motor evoked potential in sternomastoid and biceps brachii muscles. Following clinical recovery, the silent period returned to normal. This observation is interpreted as evidence of impaired inhibitory mechanisms at multiple levels of the nervous system, including the cortex, in generalized tetanus.
Assuntos
Potencial Evocado Motor , Magnetismo , Inibição Neural/fisiologia , Tétano/diagnóstico , Tétano/fisiopatologia , Estimulação Elétrica , Eletromiografia , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Motor/fisiologia , Músculo Esquelético/fisiologia , Tempo de Reação/fisiologiaRESUMO
The mechanisms of improvement in parkinsonian bradykinesia after posteroventral pallidotomy were investigated in 17 patients undergoing unilateral pallidotomy for severe Parkinson's disease. Clinical ratings of 'off' period bradykinesia demonstrated a maximal improvement of 22% 3 months postoperatively. Kinematic assessments of rapid repetitive finger and sequential arm movements were performed after overnight withdrawal of antiparkinsonian medications. There was a bilateral reduction in the inter-onset latency of a two-stage sequential arm movement and a contralateral increase in speed of arm movement after pallidotomy. There was no significant improvement postoperatively in the rhythm, amplitude or speed of repetitive finger movements. The results confirm the clinical impression that pallidotomy improves bradykinesia. This was more evident for complex limb movements, which used attentional strategies and external (visual and auditory) cues, than for repetitive fingertapping movements, which were largely internally generated. Since ablation of the pallidum can only reduce inhibitory pallidal outflow, it is unlikely to restore the normal pallidal influence on thalamocortical motor circuits. Therefore, any improvement in bradykinesia after pallidotomy must be related to mechanisms other than restoration of pallidothalamocortical connectivity. Based on the above observations, we suggest that some of the changes in motor control may be explained by the greater efficacy of external cues in facilitating movement after withdrawal of the abnormal pallidal discharge.
Assuntos
Globo Pálido/cirurgia , Movimento/fisiologia , Doença de Parkinson/fisiopatologia , Volição/fisiologia , Idoso , Antiparkinsonianos/uso terapêutico , Terapia Combinada , Sinais (Psicologia) , Feminino , Humanos , Levodopa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/cirurgia , Desempenho PsicomotorAssuntos
Doença Mista do Tecido Conjuntivo/complicações , Doenças Musculares/etiologia , Doenças do Sistema Nervoso Periférico/etiologia , Vasculite/etiologia , Idoso , Feminino , Humanos , Doenças Musculares/patologia , Doenças do Sistema Nervoso Periférico/patologia , Nervo Sural/patologia , Vasculite/patologiaRESUMO
Female monozygotic twins developed upper and lower limb neurogenic weakness in their thirties, followed by cerebellar ataxia, dysarthria and death after an illness duration of about 20 years. Autopsy revealed pathological features typical of neuronal intranuclear inclusion disease (NIID) and positive ubiquitin immunostaining of the inclusions. Two adult sons of one of the twins have now developed an identical illness. This family provides strong evidence of an hereditary form of NIID.
Assuntos
Doenças em Gêmeos/genética , Corpos de Inclusão/química , Proteínas do Tecido Nervoso/análise , Doenças Neurodegenerativas/genética , Gêmeos Monozigóticos/genética , Ubiquitinas/análise , Adulto , Evolução Fatal , Feminino , Genes Dominantes , Humanos , Doenças Neurodegenerativas/metabolismo , Doenças Neurodegenerativas/patologia , LinhagemRESUMO
OBJECTIVES: To study the role of corticomotor neuronal pathways in primary orthostatic tremor. METHODS: Transcranial magnetic stimuli at an intensity 10% above the resting motor threshold were delivered over the leg motor cortex in two patients with primary orthostatic tremor while standing still. Electromyographic responses in both tibialis anterior muscles were recorded after 20 stimuli given randomly at intervals of 120 to 180 seconds. Differences between predicted and actual times of occurrence of tremor bursts after the stimuli were used to calculate a resetting index, with a value of 0 representing no resetting and a value of 1 representing complete resetting. RESULTS: Transcranial magnetic stimulation evoked EMG responses in both tibialis anterior muscles, followed by transient suppression of tremor before reappearance of rhythmic EMG activity. Analysis of the timing of tremor bursts from EMG recordings before and after the magnetic stimuli disclosed that the phase of orthostatic tremor could be reset by brain stimulation (mean resetting indices 0.93 and 0.82). CONCLUSION: The results suggest that a central oscillator, involving the motor cortex, has a crucial role in either the generation or modulation of orthostatic tremor.