Refractory status epilepticus is defined as seizures, which last longer than 60 minutes despite treatment with a benzodiazepine and an adequate loading dose of intravenous antiepileptic drug. 1It has a high mortality and requires prompt management. Currently available drugs like midazolam, pentobarbitol and propofol can cause hypotension and respiratory depression. We present control of Refractory status in three critically ill patients using intravenous levetiracetam, which has a unique drug profile.
{"title":"Intravenous Levetiracetam in Refractory Status Epilepticus","authors":"P. Bhargava","doi":"10.5580/4a0","DOIUrl":"https://doi.org/10.5580/4a0","url":null,"abstract":"Refractory status epilepticus is defined as seizures, which last longer than 60 minutes despite treatment with a benzodiazepine and an adequate loading dose of intravenous antiepileptic drug. 1It has a high mortality and requires prompt management. Currently available drugs like midazolam, pentobarbitol and propofol can cause hypotension and respiratory depression. We present control of Refractory status in three critically ill patients using intravenous levetiracetam, which has a unique drug profile.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124970143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To perform neuro-ophthalmologic evaluations in patients with symptomatic Adult Chiari Malformations (ACM).Methods: Observational case series of 56 patients with symptoms and neuro-imaging consistent with ACM. Comprehensive histories and complete neuro-ophthalmic examinations were performed. Findings: Sixteen men and forty women were evaluated. The mean age was 41 years old (range 8 - 73 years old). The most common visual complaint was transient visual obscurations lasting seconds (n= 34). Pain or fullness behind the eyes was present in 32 patients. Forty-eight patients had headaches. Other frequent symptoms included neck pain, dizziness, facial pain, and numbness. Fundus examination was remarkable for absent spontaneous venous pulsations in one or both eyes in 28 patients. Interpretation: Adult Chiari Malformation (ACM) presents with characteristic symptoms that may be overlooked or misdiagnosed. Neuro-ophthalmic evaluation is helpful in ruling out other entities and identifying characteristic absent venous pulsations.
{"title":"The Role of Spontaneous Venous Pulsations in the Diagnosis of Adult Chiari Malformation","authors":"K. Cockerhamn, G. Bejjani, De. Monya","doi":"10.5580/878","DOIUrl":"https://doi.org/10.5580/878","url":null,"abstract":"Objective: To perform neuro-ophthalmologic evaluations in patients with symptomatic Adult Chiari Malformations (ACM).Methods: Observational case series of 56 patients with symptoms and neuro-imaging consistent with ACM. Comprehensive histories and complete neuro-ophthalmic examinations were performed. Findings: Sixteen men and forty women were evaluated. The mean age was 41 years old (range 8 - 73 years old). The most common visual complaint was transient visual obscurations lasting seconds (n= 34). Pain or fullness behind the eyes was present in 32 patients. Forty-eight patients had headaches. Other frequent symptoms included neck pain, dizziness, facial pain, and numbness. Fundus examination was remarkable for absent spontaneous venous pulsations in one or both eyes in 28 patients. Interpretation: Adult Chiari Malformation (ACM) presents with characteristic symptoms that may be overlooked or misdiagnosed. Neuro-ophthalmic evaluation is helpful in ruling out other entities and identifying characteristic absent venous pulsations.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"125 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125356450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Restless legs syndrome (RLS) is a chronic condition, with onset at any age, characterized by urgency to move the legs and unpleasant sensations, worsening at rest and in the evening and relieved by the movement. Pharmacological approaches, including benzodiazepines, dopaminoagonists, levodopa and antiepileptics, showed substantial inter-individual variability of efficacy and side effects. We report the case of a woman who did not respond to any previous pharmacological treatment, successfully treated with hydroxyzine hydrochloride. The efficacy of this first-generation antihistamine with potent anticholinergic properties in our RLS case may resemble the action of several anticholinergic drugs in Parkinson Disease, reasserting the possibility of a common pathophysiological background shared by these two distinct clinical entities.
{"title":"Hydroxyzine Hydrochloride in Restless Legs Syndrome","authors":"R. Fabio, C. Casali, F. Pierelli","doi":"10.5580/1b1f","DOIUrl":"https://doi.org/10.5580/1b1f","url":null,"abstract":"Restless legs syndrome (RLS) is a chronic condition, with onset at any age, characterized by urgency to move the legs and unpleasant sensations, worsening at rest and in the evening and relieved by the movement. Pharmacological approaches, including benzodiazepines, dopaminoagonists, levodopa and antiepileptics, showed substantial inter-individual variability of efficacy and side effects. We report the case of a woman who did not respond to any previous pharmacological treatment, successfully treated with hydroxyzine hydrochloride. The efficacy of this first-generation antihistamine with potent anticholinergic properties in our RLS case may resemble the action of several anticholinergic drugs in Parkinson Disease, reasserting the possibility of a common pathophysiological background shared by these two distinct clinical entities.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"96 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125468707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of this study was to evaluate the role of stimulated single fiber electromyography (ST‐SFEMG) in differentiating ocular myasthenia gravis (OMG) from some myopathies with ocular involvement. We performed ST‐SFEMG in the orbicularis oculi muscle in 65 patients diagnosed with OMG, in 11 chronic progressive external ophthalmoplegia and 3 oculopharyngeal muscular dystrophy. 97% of OMG and 21.4% of myopathic patients had 10% o more motor potentials (MP) exceeding 35 μs. 95% of OMG and 14.3% of myopathic patients had 15% o more MP exceeding 35 μs. 89% of OMG and 7.1% of myopathic patients had 20% o more MP exceeding 35 μs. 72% of OMG and 0% of myopathic patients had 25% o more MP exceeding 35 μs. It is possible to discern between OMG and ocular myopathy by ST‐SFEMG and that the cutoff criteria is 25% MP with jitter over 35μs in orbicularis oculi muscle.
{"title":"Stimulated Single-Fiber EMG In The Ocular Myasthenia Gravis And In Some Ocular Myopathies","authors":"J. Valls-Canals","doi":"10.5580/85b","DOIUrl":"https://doi.org/10.5580/85b","url":null,"abstract":"The aim of this study was to evaluate the role of stimulated single fiber electromyography (ST‐SFEMG) in differentiating ocular myasthenia gravis (OMG) from some myopathies with ocular involvement. We performed ST‐SFEMG in the orbicularis oculi muscle in 65 patients diagnosed with OMG, in 11 chronic progressive external ophthalmoplegia and 3 oculopharyngeal muscular dystrophy. 97% of OMG and 21.4% of myopathic patients had 10% o more motor potentials (MP) exceeding 35 μs. 95% of OMG and 14.3% of myopathic patients had 15% o more MP exceeding 35 μs. 89% of OMG and 7.1% of myopathic patients had 20% o more MP exceeding 35 μs. 72% of OMG and 0% of myopathic patients had 25% o more MP exceeding 35 μs. It is possible to discern between OMG and ocular myopathy by ST‐SFEMG and that the cutoff criteria is 25% MP with jitter over 35μs in orbicularis oculi muscle.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"547 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127661651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Milanes-Rodríguez, L. Ibañez-Valdés, H. Foyaca-Sibat, M. Pérez-Fernández
Because abducens palsy is a very common problem in our daily practice we decide to review the anatomical variations of abducens nerves that could explain clinical variations under the similar etiologies. Therefore, we report our findings on fixed brain specimens looking for anatomical variations of abducens nerves at the Department of Anatomy from Walter Sisulu University in Mthatha, South Africa.
{"title":"The Abducens Nerve in Neurology","authors":"G. Milanes-Rodríguez, L. Ibañez-Valdés, H. Foyaca-Sibat, M. Pérez-Fernández","doi":"10.5580/14ce","DOIUrl":"https://doi.org/10.5580/14ce","url":null,"abstract":"Because abducens palsy is a very common problem in our daily practice we decide to review the anatomical variations of abducens nerves that could explain clinical variations under the similar etiologies. Therefore, we report our findings on fixed brain specimens looking for anatomical variations of abducens nerves at the Department of Anatomy from Walter Sisulu University in Mthatha, South Africa.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133682507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Ghandehari, M. Shams, A. Atalu, Azadeh Afzalnia, F. Ahmadi, M. Khazaei, M. Kalhor, H. Akhbari, K. Mohsen
Background: Causes of Cerebral Venous Thrombosis (CVT) varies around the world. Oral Contraceptive (OCP) are among the most frequent causes of CVT.Methods: Consecutive patients admitted with CVT in Ghaem hospital, Mashhad during 2005-2008 were prospectively investigated. Diagnosis of CVT was made by corresponding results of MRI, and MRV or conventional angiography. All of the patients had a complete medical history, physical examination and underwent a standard battery of diagnostic investigations by stroke neurologists. Results: 62 patients (51 females, 11 males) with mean age 32.3 ranged 18-62 years were admitted with CVT. OCP consumption was found as risk factor in 56.8% of females with CVT. This group of females have been used LD and HD types of OCP in 97% and 3% respectively. 41% of females with CVT; (21/51) have been on short term OCP consumption. In this later group of females, Ramadan and Hadj religious months were the reason of using short term OCP in 86% and 5% respectively.Conclusion:Short term OCP consumption is the most common cause of CVT in Iranian women. Programs for public awarness should be conducted for reducing use of OCP in short term periods during Ramadan and Hadj months.
{"title":"Oral Contraceptive Consumption And Cerebral Venous Thrombosis In Mashhad, Iran","authors":"K. Ghandehari, M. Shams, A. Atalu, Azadeh Afzalnia, F. Ahmadi, M. Khazaei, M. Kalhor, H. Akhbari, K. Mohsen","doi":"10.5580/f4b","DOIUrl":"https://doi.org/10.5580/f4b","url":null,"abstract":"Background: Causes of Cerebral Venous Thrombosis (CVT) varies around the world. Oral Contraceptive (OCP) are among the most frequent causes of CVT.Methods: Consecutive patients admitted with CVT in Ghaem hospital, Mashhad during 2005-2008 were prospectively investigated. Diagnosis of CVT was made by corresponding results of MRI, and MRV or conventional angiography. All of the patients had a complete medical history, physical examination and underwent a standard battery of diagnostic investigations by stroke neurologists. Results: 62 patients (51 females, 11 males) with mean age 32.3 ranged 18-62 years were admitted with CVT. OCP consumption was found as risk factor in 56.8% of females with CVT. This group of females have been used LD and HD types of OCP in 97% and 3% respectively. 41% of females with CVT; (21/51) have been on short term OCP consumption. In this later group of females, Ramadan and Hadj religious months were the reason of using short term OCP in 86% and 5% respectively.Conclusion:Short term OCP consumption is the most common cause of CVT in Iranian women. Programs for public awarness should be conducted for reducing use of OCP in short term periods during Ramadan and Hadj months.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134049733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chemicals with behavioral activity are delivered to users when tobacco products are ingested. Nicotine in tobacco causes depression of locomotor activity in rats; but, tolerance to this activity develops following chronic administration. However there is a controversy in the way rodents differ in their sensitivity and direction of the effect (increased or decreased activity) of nicotine. This study aims to determine such a status in the albino Wistar rats. The open field maze (arena) was used to study locomotor, exploratory and anxiety related behaviors in 32 albino Wistar rats weighing between 180g – 230g. The rats were grouped into 4 consisting of 8 rats each. Group 1 animals which served as control had free access to normal rat chow and clean drinking water. Group 2 animals received 15% w/w tobacco diet; group 3 animals received 24% w/w tobacco diet; while group 4 animals received 30% w/w tobacco diet. Each animal was tested in the open maze for 5 minutes and behaviors scored. ANOVA and post-hoc t-test were employed for statistical analysis and p<.05, accepted as significant. Our results revealed changes in behaviour that may likely result from the total constituents of tobacco as against reported effects of nicotine alone.
{"title":"Neurobehavioural Activity In Albino Wistar Rats In The Open Field Maze Following Long Term Tobacco Diet Ingestion","authors":"O. Mesembe, S. Bisong, Moses B. Ekong, Ao Ekeoma","doi":"10.5580/2405","DOIUrl":"https://doi.org/10.5580/2405","url":null,"abstract":"Chemicals with behavioral activity are delivered to users when tobacco products are ingested. Nicotine in tobacco causes depression of locomotor activity in rats; but, tolerance to this activity develops following chronic administration. However there is a controversy in the way rodents differ in their sensitivity and direction of the effect (increased or decreased activity) of nicotine. This study aims to determine such a status in the albino Wistar rats. The open field maze (arena) was used to study locomotor, exploratory and anxiety related behaviors in 32 albino Wistar rats weighing between 180g – 230g. The rats were grouped into 4 consisting of 8 rats each. Group 1 animals which served as control had free access to normal rat chow and clean drinking water. Group 2 animals received 15% w/w tobacco diet; group 3 animals received 24% w/w tobacco diet; while group 4 animals received 30% w/w tobacco diet. Each animal was tested in the open maze for 5 minutes and behaviors scored. ANOVA and post-hoc t-test were employed for statistical analysis and p<.05, accepted as significant. Our results revealed changes in behaviour that may likely result from the total constituents of tobacco as against reported effects of nicotine alone.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125367764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Mathis, G. Godenèche, I. Balabo, F. D. Boisguéheneuc, J. Neau
Background and purpose . Defecation can precipitate the onset of acute cardiovascular diseases.Case report. A 54 year-old woman presented 3 episodes of right brachiofacial weakness with left amaurosis after an intensive effort of defecation in a context of severe constipation. These neurological disorders were secondary to a left internal carotid artery dissection triggered by defecation.Conclusion . To the best of our knowledge, it’s the first description of an internal artery dissection induced by an effort of defecation.
{"title":"Internal carotid artery dissection triggered by the act of defecation","authors":"S. Mathis, G. Godenèche, I. Balabo, F. D. Boisguéheneuc, J. Neau","doi":"10.5580/8bc","DOIUrl":"https://doi.org/10.5580/8bc","url":null,"abstract":"Background and purpose . Defecation can precipitate the onset of acute cardiovascular diseases.Case report. A 54 year-old woman presented 3 episodes of right brachiofacial weakness with left amaurosis after an intensive effort of defecation in a context of severe constipation. These neurological disorders were secondary to a left internal carotid artery dissection triggered by defecation.Conclusion . To the best of our knowledge, it’s the first description of an internal artery dissection induced by an effort of defecation.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133446285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Many of the neurodegenerative diseases share common features and molecular patterns that suggest their pathology may be directly comparable. Diseases such as Parkinson’s disease, Alzheimer’s disease and Prion diseases are all characterised by abnormal accumulations of proteins and selective neuronal degeneration. This article reviews the known pathology and aetiology of these diseases in order to explore the links between them including defective free radical accumulation, mitochondrial dysfunction and impairment of protein degradation pathways.
{"title":"Protein-misfolding in neurodegenerative disease","authors":"Hc Scott","doi":"10.5580/23f3","DOIUrl":"https://doi.org/10.5580/23f3","url":null,"abstract":"Many of the neurodegenerative diseases share common features and molecular patterns that suggest their pathology may be directly comparable. Diseases such as Parkinson’s disease, Alzheimer’s disease and Prion diseases are all characterised by abnormal accumulations of proteins and selective neuronal degeneration. This article reviews the known pathology and aetiology of these diseases in order to explore the links between them including defective free radical accumulation, mitochondrial dysfunction and impairment of protein degradation pathways.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122475089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Sharma, B. Kumawat, G. Tripathi, A. Kankane, S. Dixit
A 18-year male was presented with diplopia on looking toward the left since five days. There was no headache, vomiting, drooping of eyelid, visual impairment, and pain around the eye, diurnal variation or weakness of limbs. Examination revealed no ptosis, nystagmus; pupils were bilaterally symmetrical in size & reactive to light. Fundus examination was normal. Extra ocular movements on both sides were normal except restriction of adduction of right eye. The rest of the neurological examination was normal. The investigations revealed normal routine hemogram including erythrocyte sedimentation rate and biochemistry. Enzyme-linked immunosorbent assay (ELISA) for cysticercus was positive both in cerebrospinal fluid examination (CSF) and serum. The other parameters of CSF were normal. Computerized tomogram of orbit revealed swollen medial rectus with ring lesion. Patient received albendazole therapy (15mg/kg for 4 weeks) under cover of steroids and started showing improvement in diplopia within a week. Figure 1 Figure: CT scan of orbit showing cysticercal cyst in medial rectus, which resolved after treatment.
{"title":"Medial Rectus Cysticercosis","authors":"C. Sharma, B. Kumawat, G. Tripathi, A. Kankane, S. Dixit","doi":"10.5580/285e","DOIUrl":"https://doi.org/10.5580/285e","url":null,"abstract":"A 18-year male was presented with diplopia on looking toward the left since five days. There was no headache, vomiting, drooping of eyelid, visual impairment, and pain around the eye, diurnal variation or weakness of limbs. Examination revealed no ptosis, nystagmus; pupils were bilaterally symmetrical in size & reactive to light. Fundus examination was normal. Extra ocular movements on both sides were normal except restriction of adduction of right eye. The rest of the neurological examination was normal. The investigations revealed normal routine hemogram including erythrocyte sedimentation rate and biochemistry. Enzyme-linked immunosorbent assay (ELISA) for cysticercus was positive both in cerebrospinal fluid examination (CSF) and serum. The other parameters of CSF were normal. Computerized tomogram of orbit revealed swollen medial rectus with ring lesion. Patient received albendazole therapy (15mg/kg for 4 weeks) under cover of steroids and started showing improvement in diplopia within a week. Figure 1 Figure: CT scan of orbit showing cysticercal cyst in medial rectus, which resolved after treatment.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"122 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124179921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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