Clinical Neuroscience

[Stimulated single fiber electromyography]

KÓMÁR József1, KISS Gábor1

MARCH 20, 1993

Clinical Neuroscience - 1993;46(03-04)

[The authors review the nethod of stimulated single fiber electromyography, the normal values of stimulated jitter, and the advantages and disadvantages of the method and the pitfalls.]

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  1. Újpesti Városi Kórház, Ideggyógyászat

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Clinical Neuroscience

[Post-stroke depression]

ASZALÓS Zsuzsa, PATAKY Ilona, SIMON Andrea, NAGY Zoltán

[The pathogenesis of depression following cerebrovascular accident (post-stroke depression) is poorly understood. Thirty seven (28%) out of 134 patients from the „Budapest Stroke Data Bank" were found to be depressed. Thirty two patients (86%) in this group were affected by depression within three months or the stroke. Diagnosis of depression was bades on CES-D, Ham-D and Zung scales, and a word fluency test was performed with 11 depressed and 11 non-depressed patients. Comparing the frequency of post-stroke depression in groups with ischemic damage of the carotid versus the vertebrobasilar system, as well as the left versus right middle cerebral artery, no significant differences were found. Depression reduced the activities of daily living (score: 7.8) compared to the activities of non-depressed patients (score: 3.8) at the same score of stroke – severity (4.7 versus 4.1). These observations suggest that post-stroke depression influences the rehabilitation of stroke patients, therefore the diagnosis and treatment of post-stroke depression may increase the efficacy of stroke rehabilitation.]

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[The role of brainstem auditory evoked potentials in the diagnosis of vertebrobasilar insufficiency]

MOGYORÓS Ilona

[The diagnostic usefulness of brainstem auditory evoked potentials was compared with other diagnostic possibilities. Brainstem auditory evoked potential was examined in patients with vertebrobasilar insufficiency. Based on the duration of clinical symptoms, patients were divided into three groups: 85 patients with transient ischaemic attack (TIA), 31 patients with prolonged ischaemic symptoms, and 35 patients with chronic symptoms were examined. The latency and interpeak latency of the auditory evoked potentials increased in 49,3 per cent. A subgroup within the TIA group was specially tested. The patients belonging to this group were admitted to the clinic soon after the onset of TIA. Acoustic evoked potentials showed increased latencies and interpeak latencies in 45,8 per cent of this group. The increasing latencies of the waves I. and III. and the interpeak latancies of I-II. and I-V. waves were the most frequent differences. Otoneurology demonstrated more frequent functional disturbances in brainstem than in acoustic evoked potentials in the second and third group. Computerized tomography is a really helpful only in examining chronic cases, while the CT reports 3,6 per cent hypodensities in the first group and 17,3 per cent in the third group. Brainstem auditory evoked potential testing is the most sensitive diagnostic method in the diagnosis of transient ischaemic attack.]

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[Spontaneous intracerebral haematomas in children]

VELKEY Imre, DOBAI József, GYARMATI János

[The authors report two cases of spontaneous intracerebral haematomas in children. Both children presented with serious symptoms of acute intracerebral haemorrhage. Investigations do not reveal the cause of the haemorrhage in either of the cases and angiography detected no arteriovenous malformation. The term ,,occult” is reserved for these cases, as spontaneous intracerebral haematomas do not result in space-occupying process or CSF passage blockage and may be treated medically.]

Clinical Neuroscience

[The effect of cerebrospinal fluid drainage on middle cerebral artery blood flow velocity in conditions with raised intracarnial pressure]

BARZÓ Pál, DÓCZI Tamás, KOPNICZKY Zsolt, ROTYIS Mária, BODOSI Mihály

[Middle cerebral artery (MCA) blood flow velocity and intracranial pressure (ICP) were recorded in 42 patients suffering from raised ICP. A major (ICP25 mmHg) or moderate (251CP15 mmHg) degree of intracranial hypertension was reduced by means of either continuous or intermittent CSF drainage. Measurements of MCA blood flow velocity were carried out with transcranial Doppler sonography (TCD). Three types of reactions were observed with regard to cerebral blood flow velocity (CBFV) changes in response to CSF drainage. Patients in Group 1 demonstrated pressure passive CBFV changes throughout the observed cerebral perfusion pressure (PP) range. In Group 2, cerebrospinal fluid (CSF) drainage brought about a transitory increase in CBFV for a few minutes. In Group 3, the reduction of ICP to the normal level did not influence CBFV at all. The pulsatility index (PI) of the cerebrovascular reserve capacity (CVR), which was highest in Group 1, changed in contrast with the CBFV changes in Groups 1 and 2. The pressure-passive velocity pattern (in Group 1) suggests that the blood vessels were at nearly maximum dilatation and were perhaps failing to constrict properly in response to increased PP. As recovery proceeded (Group 2), the mechanism became effective, thereby reestablishing autoregulation. Whereas clinical signs and computed tomography reveal only the trend of the ICP, TCD provides the possibility of a semi-quantitative evaluation of ICP changes and seems especially promising in the rapid assessment of the efficacy of treatment aimed at ICP reduction.]

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[Measurements of regional cerebral blood flow and blood flow velocity in experimental intracarnial hypertension: infusion via the cisterna magna in rabbits]

BARZÓ Pál, DÓCZI Tamás, CSETE Klára, BUZA Zoltán, BODOSI Mihály

[The cerebral blood flow velocity (CBFV), as measured by transcranial Doppler sonography (TCD) via the transorbital route in the intracranial segment of internal carotid artery (ICA), and the regional cerebral blood (volume) flow (rCBF) in the corresponding cortical areas, as measured by the hydrogen clearance technique, were determined in 8 New Zealand White rabbits undergoing cisterna magna infusion for elevation of the intracranial pressure (ICP). In the lower range of autoregulation, i. e. at perfusion pressures (PP) between 80 and 40 mm of mercury and even below this, the changes in (CBFV) and CBF showed a strong correlation (0,86) under conditions with standard PCO2 (PaCO2)=35+2 mm of mercury). Autoregulation was exhausted at 40 mm of mercury and the cerebrovascular resistance (CVR) was minimal. Below this PP, the CBF and CBV dropped sharply, whereas CVR, gradually increased, indicating that, despite the maximally dilated resistance vessels, the intracranial hypertension causes the vascular resistance to increase, possibly via blocking of the venous outflow. Our results confirmed that non-invasive and easily (even at the bedside) applicable measurements of CBFV changes could substitute the cumbersome and expensive isotope measurements of CBF in intracranial hypertension.]

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[Kennedy syndrome is a late-onset, bulbar-spinal type of muscular atrophy, with X-linked recessive inheritance. The characteristic features of the disease become prominent in the 4-5th decades: proximal muscle wasting and weakness, bulbar signs, fasciculations in skeletal muscles, subtle signs of endocrine dysfunction, such as gynaecomastia or testicular atrophy. The electrophysiological examinations are the keypoint to the diagnosis. Electroneurography shows normal conduction velocity in peripheral nerves, but the sensory nerves usually show axonal degeneration, which causes only very mild or subclinical neurological deficits. Electromyography shows chronic anterior horn cell degeneration in skeletal muscles. Molecular genetic diagnosis was introduced in 1991, when an abnormal expansion of CAG repeat was found in the first exon of the androgen receptor gene on chromosome X with a frequency of 100% in the affected population. Since the progression is very slow and these patients can expect a normal life span, it is essential to distinguish this syndrome from other, often more severe diseases, such as ALS. There is no proven therapy for Kennedy's disease yet. This is the first case of Kennedy's disease published in Hungary.]

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[IMPROVING FUNCTIONAL ELECTRICAL STIMULATION DRIVEN CYCLING BY PROPER SYNCHRONIZATION OF THE MUSCLES]

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[Personnel and technical conditions for ECT (electroconvulsive therapy) is legally determined. In this article the author reviews studies focused on the technical questions of ECT. After the comparison of the unilateral and bilateral electrode placement an analysis is given on the physical properties of the stimulus used to elicit seizures. After discussing the questions of dose, vaweform frequency and polarity, the anatomical and physiological factors of impedance are evaluated. The author then discuss gender, age and encephalopathy as factors influencing seizure threshold. The connection between symmetry, regularity, and postictal suppression registered on the EEG and efficacy is observed. The EEG and EMG concordance is supposed to be connected also with the efficacy. In the discussion the author gives recommendations based on the literature.]