Neurologia-Neurocirugia Psiquiatria最新文献

A new method is presented to test language, worked out by one of the authors (R.R.L.). Briefly, it consists of the systematic and ordered exploration of the functions from the cortical sensory and motor areas, the interchange of the sensorial information from the sensory to the motor areas. Nine patients with different aphasic syndromes were examined independently from each other. The test was divided in two ranks; the sensory interchange and the motor-oral-manual. The Spearman Correlation Coefficient and its statistical meaning was calculated for each rank. For the internal reliability tests, the results achieved by two successive examination on the same patient were compared by the same explorer. For the external reliability, the results from two sucessive tests on the same patient were compared by two different explorers. The Spearman Correlation Coefficient rate in all the cases varied between 1 and 0.88 with a probability of more than 0.0005 and high statistical significance, with exception of the motor rank of case 4, where it was 0.87 with a probability of more than 0.005 and less than 0.0005 with still some statistical meaning.

The mechanisms of petit mal epilepsy remain a mystery despite successful therapy. Previous workers have proposed that paroxysmal activity of cortical inhibitory systems plays a role in absence seizures. In this study, we have compared the effects of bicuculline, a potent convulsive agent and GABA antagonist, with ethosuximide, a drug used to treat petit mal epilepsy, on the thalamocortical motor system of the cat. Under chloralose anesthesia, sequential pairs of pulses were delivered to ventrolateral thalamus (VL) varying either pulse amplitude or interval. The evoked responses were recorded from sensorimotor cortex, analyzed on-line by computer, and plotted as an excitability curve (mean response amplitude as a function of pulse interval), or a family of threshold curves (mean response amplitude as a function of stimulus amplitude at various fixed intervals). Administration of each drug resulted in increased thalamocortical excitability and decreased threshold to stimulation for short pulse-pair intervals, with diminished duration of the excitability curve. Increased alertness was produced by both drugs. Studies with grand mal anticonvulsants demonstrated entirely different effects. Because GABA is thought to be the primary inhibitory transmitter in VL and cerebral cortex, bicuculline would be expected to result in disinhibition. The similarity of the data for ethosuximide suggests that ethosuximide also suppresses inhibition in the thalamocortical motor system and adds further to the accumulating evidence of the role of inhibitory system in petit mal epilepsy.

Two years ago, we performed a precocious evolutive EEG study of a specimen not selected from the virus ME to ECHO 4 burst (cepa prima) late 1972 to early 1973 (6). Some time between the appearance of the first symptoms and the 8 weeks following, alterations of cerebral electrogenesis became manifest in this study. These alterations disappeared or dimished in significance in the more tardy outlines: focalization tendency, tendency to change from "suffering" to "irritative" aspect. During this year, the test has been repeated on 82% of these patients, plus at the same time a minimum clinical survey. Until now, the results are the following. There are no clinical signs of the CNS in any case. School progress has not been affected, except moderately, for two patients. The EEG has become totally normal in more than 2/3 of the cases. Persistent EEG net signs of minimum "suffering" in three cases. There are "irritative" generalized signs in only 2 patients and "irritative" certified focal signs in 6 patients. Other EEG manifestations are of doubtful interpretation due to the age of the patients.

Primary amebic meningoencephalitis (PAM) is an infectious disease essentially confined to the central nervous system (CNS) and caused by free-living ameboflagellates of the genus Naegleria (N) and Acanthamoeba (A). N produces an acute fulminant, usually fatal hemorrhagic-necrotizing meningoencephalitis, associated with an inflammatory reaction composed of neutrophils, eosinophils, macrophages and a few lymphocytes. The incubation period is between 3-7 days. Typically, PAM occurs in healthy, young individuals, who frequently have a history of swimming or washing their face in infested waters. The portal of entry into the CNS is through the olfactory neuroepithelium, at the level of the cribriform plate and invasion of the amyelinic submucosal nervous plexus. Trophozoites are the only amebic forms found in the lesions. By contrast, A produces a sub-acute or chronic granulamotous meningoencephalitis (AM) with multinucleated foreign body giant cells, lymphocytes and monocytes. Cysts and trophozoites may be present in the lesions. AM have been reported in chronically ill debilitated individuals, some of them under immunosuppressive therapy, without history of recent swimming. The portal of entry into the CNS appears to be by hematogenous route. The incubation period is unknown, but perhaps more than 10 days. This comparison indicates that infection due to Naegleria produces a clearly defined clinco-pathological entity, which differs significantly from that due to Acanthamoeba, and both species of amebus should be considered in the differential diagnosis of amebic meningoencephalitis.

The author mentions the needs and the type of work psychiatrists do in a general hospital; he underlines the importance of good communication between the psychiatrists and the general practitioner. Success depends on the selection of patients and of the analytic framework the author uses. It is mentioned that the therapist-patient relationship can be damaging or beneficial according to the way it is handled.

To date, there is little information available on stroke risk factors in a major ethnic minority such as Mexican-Americans (M-A) in the USA. Forty-three M-A patients were admitted to The Methodist Hospital and Ben Taub General Hospital (Houston) for a 12-month period, with diagnosis of atherosclerotic stroke. Thrombosis was diagnosed in 31 patients (72%), embolism from atherosclerotic sources in seven (16.4%), and parenchymal hemorrhage in five (11.6%). Hypertension was a common risk factor in all groups, being higher in hemorrhage followed by thrombosis and embolism. Arteriosclerotic heart disease was a common risk to all stroke types. TIAs, hyperlipidemia, diabetes, associated atherosclerotic lesions, smoking, obesity, erythrocytosis and sedentary life were significantly associated with embolism; less so with thrombosis or hemorrhage. Gout was only associated with thrombosis. These results indicate similar risk factors for Anglo-saxons and M-A in the USA with some minor differences between the Mexican and the USA stroke series.

An epidemiology analysis is carried out in a hospital population of 500 epileptic patients older than 14 years of age, pertaining to the outpatient department of the Instituto de Neurología, Hospital de Clínicas, Monevideo". This information gathered, corresponds to the period, 1966-1975. Specially formulated records of precoded-type data were used for this research and the data was processed by automation. This work deals fundamentally with a descriptive study in which the character of the population and of its epilepsy is studied by means of 20 items. Analyzed from within the social aspects, the school attendance and the occupation of the patients, amounts, similar to those of the general population of the country, were found. An elevated incidence of family epilepsy antecedents (17%) in the group and also of perinatal pathology (19%), is emphasized. An analytic study of the clinical type of crisis and of the factors unleashed by the attacks is made. Dividing the population into two groups, according to the beginning of epilepsy, before or after the 25 years, the different etiology for both groups is specially pointed out, the juvenile epilepsy predominating in the unknown etiology, genetics and that which is produced by perinatal pathology, while in the tary epilepsy, the vascular and tumoral etiology, above all, is most frequent.

CNS involvement includes: 1) acute phase: scattered focal meningoencephalitic lesions, meningeal and cerebral edema, disseminated microgranulomas containing microgliocytes and situated in relation to cerebral blood vessels, and moderate cerebral fluid pleocytosis. Acute chagasic meningoencephalitis is always fatal, and does not become chronic, as occurres with the myocardial lesions; 2) chronic phase: tromboembolic phenomena due to the chronic myocarditis, and cerebral and cerebelar atrophy of obscure pathogenesis and without inflammatory changes. B) vegetative nervous system involvement includes: 1) acute phase: neuronal destruction, with neuronal loss of varying intensity; 2) chronic phase: visceral dilatation due to neuronal loss during the acute phase.

A Community Psychiatry program was begun, based on the needs and requests of a clinic (this approach is restricted because there are institutional factors that only the institution can change). The work was aimed at sensitizing the beneficiaries and change clinic factors modifiable through operative group technique. When a great deal of every day stereotypes appeared, role playing was used: as a result, people in the clinic realized how they acted and how they asked from others behaviors that they themselves found difficult to show. As results, it was found that when workers were confronted with reality, desertion from operative groups appeared, with projection of problems (them, not me), great fear of change (fantasized in different ways), group passivity and the image of the institution, that the group saw as a persecutor.