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Clinical Neuroscience - 1996;49(09-10)
Content
Clinical Neuroscience
SEPTEMBER 20, 1996
[Hemodynamic adaptation of fetal brain]
[Doppler color ultrasonography of the middle cerebral and umbilical arteries was performed on 104 fetuses born at term. A total of 254 investigations were carried out. Of the 104 fetuses studied, 52 infants had birth weights appropriate for gestational age (mean 3409.2 g) and 52 infants were small for gestational age (mean 2272.1 g). Cerebral hemodynamic adaptation was observed in growth retarded fetuses due to placenta! insufficiency. ln these cases the elevated umbilical vascular resistance evidenced the placenta! insufficiency. At the same time the decrease of the cerebral vascular velocimetry indexes indicated the improving cerebral blood supply. Only the systolic/diastolic ratio was significantly reduced in growth retarded fetuses when compared with normal controls. ln the umbilical artery the pulsatility index and systolic/diastolic ratio were raised significantly in growth retarded fetuses. The ratio of the cerebral arterial to umbilical cord artery index values proved a better indicator of the difference between growth retarded and normal controls than the index of the cerebral or umbilical artery alone. The ratios of all three index values of the growth retarded fetuses were significantly smaller than those of the normal controls (pulsatility index 1.03 versus 1. 60, resistance index 0.84 versus 1.19 and systolic/diastolic ratio 1.01 versus 2.02). The ratios of the small for date fetuses due to other, nonplacental causes were simi lar to the normal controls. The blood circulation disorder evokes hemodynamic adaptation in the feta! brain. The intrauterine growth restriction is a consequence of this disturbed blood supply. The cerebral circulatory adaptation failed in the small for date fetuses non associated with decreased blood supply.]
Clinical Neuroscience
SEPTEMBER 20, 1996
[Distal Ulnar Neuropathies]
[Compression of the distal part of the ulnar nerve is an uncommon entrapment neuropathy. Depending on the site of compression it may result in pure motor symptoms. The atrophy of the small hand muscles without sensory deficit may mimic motor neuron disease. Correct clinical examination and electrophysiology including measurement of ulnar distal motor latency to the first dorsal interosseous muscle can reveal the correct diagnosis. 46 surgically treated cases of distal ulnar neuropathy are reported. 12 patients had only muscle weakness without sensory abnormalities. 6 of them showed motor deficit restricted to the first dorsal interosseous and adductor pollicis muscles. 34 patients were followed up 31 of them improved, 3 cases should be reoperated because of recidive lipoma.]
Clinical Neuroscience
SEPTEMBER 20, 1996
[Importance of sociological and psychological factors in pathogenesis of ischaemic stroke]
[The authors investigate sociological and psychological factors in the pathogenesis of ischaemic stroke, as a follow up of their earlier study. In the first part of the recent study patients and control subjects are compared in terms of frequency, severity, type and the temporal distribution of life events within the 5 years preceding the stroke. In the second part the importance of coping-style and psychological characteristics are studied. It is shown that the likely factors leading to stroke are: lower life events score in the more distant period, but higher life events score preceding the stroke, poor coping, greater emotional instability, trait-anxiety, hostility, and decreased job involvement. The type of life events, global Type-A behaviour, "speed and impatience", "hard driving and competitiveness” seem indifferent. On the basis of these results a successful stroke-programme should consider the complexity of somatic, sociological and psychological factors.]
Clinical Neuroscience
SEPTEMBER 20, 1996
[Transoesophageal echocardiography after stroke]
[40 stroke patients were studied by both transoesophageal and transthoracic echocardiography. The diagnosis of stroke was based on medical history, physical examination and computerized tomographic brain scan. 39 patients underwent carotid duplex scan as well. Transoesphageal echocardiography was used to examine 40 patients of whom 19 had cardiac source of embolism. Out of these, 7 patients had definitive, whereas 12 had possible cardiac source of embolism. Transthoracic echocardiography was diagnostic only in 8 cases. Using carotid duplex scan, carotid stenosis was detected in 8 patients and sclerosis without significant stenosis in 8 others. From each of these two groups 4 patients had coexistent cardiac source of embolism as well. In the 8 patients with atrial fibrillation the left atrial thrombus and spontaneous echo contrast were more frequent than in patients with sinus rhythm. The transoesophageal echocardiography altered the management of antico agulation in 3 patients. The authors concluded that transoesophageal echocardiography is necessary in stroke patients.]
Clinical Neuroscience
SEPTEMBER 20, 1996
[Prognosis of neuroepithelial tumours by means of cell proliferation studies]
[Cell-kinetic analysis of tumours has recently been widely used in clinical oncology for prognosis of patients treated with malignant neoplasms and for controlling the efficiency of treatment protocols. Definition of biological nature of neuroepithelial tumours was based on grading depending on the severity of cellular anaplasia. Neuroepithelial tumours can be characterized not only by the histological features but also by the DNA content and abnormalities of the cell proliferation – though the relationship between histological malignancy, proliferative activity and cellular aneuploidity was found to be rather controversial according to the literature. In this review article the clinical value of cell cycle analysis such as distribution of DNA content, DNA index; S-phase fraction; proliferation-markers [MIB 1 antibody, bromdeoxy uridin labelling index, mitotic index, definition of nucleolar organization region) are discussed on the basis of personal experience and review of the appropriate literature. Flow cytometry and examination of proliferation markers have a significant role in the definition of prognosis of patients suffering from WHO grade II and III neuroepithelial tumours. Gliomas giving rise to recidivism have a rapid cell cycle already at their first occurrence, which is characterized by raised proliferation indices, and occurrence of aneuploid cell clones. An unfavourable outcome can be prognosed in patients suffering from a WHO grade II or III glioma if the DNA index is above or below 1+0.1 if the value of the S phase fraction is above 6%, if more than 1 mitosis is found in 10 large magnification field, and if the number of cells labelled with MIB 1 antibody exceeds 3 in 1 large magnification field. The literature confirms our notion that further studies of proliferation characteristics may help in the production of a malignity score of gliomas that could support the efficiency of traditional histological grading in prognosis and control of complex therapy of these tumours.]
Clinical Neuroscience
SEPTEMBER 20, 1996
[Apolipoprotein E4 as a genetic risk factor in Alzheimer's Disease]
[Apolipoprotein E (apoE) is a glycoprotein participating in the lipid transport and metabolism and in the neuronal regeneration processes. The gene of apo (APOE) is localized on the long arm of chromosome 19. The genetic polymorphism of APOE is manifested in three common alleles. The frequencies of these alleles, APOE2, APOE3, APOE4 are different in various human populations depending on their geographical origin. The APOE alleles have been considered to be responsible for the inter-individual variations of the serum cholesterol level. Besides its function in lipid transport, there are other relatively unknown but proven functions of apoE in the development of the nervous system and in peripheral nerve regeneration after injury. ApoE is considered as an important etiophathogenetic factor of atherosclerosis, familial hypercholesterolaemia and hyperlipoproteinaemia type III. The results of biochemical, molecular biological, population genetic and neuropathological examinations of the last three years have provided evidence that APOE4 alleles could be important risk factors of Alzheimer's dementia (AD). Recent findings regarding the relationship of apoE and AD are reviewed by the authors in connection with other aetiopathogenetic factors such as development of senile plaques, mutations of amyloid precursor protein gene, familial and sporadic forms of AD. These factors are discussed in relation to the therapeutic implications and dilemmas of genetic testing of APOE in AD.]
Clinical Neuroscience
SEPTEMBER 20, 1996
KTP/532 precutaneous laser decompression for lumbar disc prolapse
The efficacy of percutaneous laser disc demompression with the potassium titanyl phosphate laser (KTP/PLDD) for the treatment of sciatica due to lumbar disc prolapse was evaluated in a consecutive series of 109 patients. All patients had low-back pain and leg pain with positive tension signs and had received conservative treatment for an average of 11.4 (1-28) months without relief of symptoms. Disc porlapse was confirmed by computed tomography or magnetic resonance imaging and evaluated with intraoperative discography. Patients with an uncontained disc porlapse were excluded from the study. Results at an average of 18 (12-28) months were based on the MacNab outcome criteria and on patient satisfaction after surgery. Overall success was noted in 75.2% (82/109). Failure was associated with severe lateral recess stenosis. Patients without known risk factors for a bad otucome (including severe lateral recess stenosis, back pain predominant over leg pain, previous surgery at the same disc level, unsettled compensation claim and singificant functional component) had an excellent or good result in 84% (42/50). KTP/PLDD has proven a safe and efficacious procedure for outpatient treatment of sciatica due to contained disc prolapse.
Clinical Neuroscience
SEPTEMBER 20, 1996
[Trigeminovascular hypothesis of cluster headache]
[Cluster headache is a rare, very severe disorder which is clinically well characterized with a relatively poorly defined pathomechanism. Concerning the pathomechanism of cluster type headache, from the clinical symptoms three things can be inferred. The fact that head pain is centred dominantly around the eye and fore head makes it probable that the unilateral trigeminal nociceptive pathways are involved. Lacrimation and rhinorrhoea suggest the activation of the parasympa thetic, while ptosis and miosis suggest the sympathetic innervation of the region. There is a reflex connection within the brainstem that may be activated when the Gasserion ganglion is stimulated. The afferent of the reflex circle comes from the central branch of the ophthalmic division as the sensory trigeminal nerve. The parasympathetic nuclei of the seventh and ninth cranial nerves are the centre. The efferents are the parasympathetic peripheral branches of the VIlth and IXth cranial nerves. During spontaneous and nitroglycerin induced cluster attacks the levels of CGRP and VIP increased in the blood of external jugular vein. Oxygen inhalation or subcutaneous administration of sumatriptan reduced the CGRP concentration to normal. This observation supports the function of the trigeminovascular reflex in cluster headache.]
Clinical Neuroscience
SEPTEMBER 20, 1996
Clinical Neuroscience
SEPTEMBER 20, 1996
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