Acta neurologica最新文献

The concept of "Inner cerebral trauma" (ICT) has been preliminary defined as a characteristic topographic pattern of deep brain lesions produced by physical forces occurring within the cranial cavity in closed head injury of the acceleration/deceleration type. The lesions, based on neuropathological examinations, are characteristically localized in the "centro-axial" regions of the brain. The extent of ICT is often underestimated by CT. Due to assess the value of MR imaging, 83 patients with ICT were examined on a 1.5 T unit in different stages after trauma. The pattern of lesions, as shown with MR imaging, correlated well with neuropathological studies, suggesting a multifocal pathogenesis of severe traumatic brain injury.

The authors describe the first case in literature of Gerstmann's syndrome (agraphia, acalculia, finger agnosia) occurred in HIV correlated encephalopathy developed as the first severe manifestation of HIV infection in a patient with prevalent white matter neuroradiologic alterations. The PDL rapidly extended from the left subcortical parietal-occipital regions to the pre-rolandic one, with subsequent involvement of the corpus calosum splenium and the bilateral temporal lobes white matter. The authors indicate the extent of the lesions and the involvement of the interhemispheric connection fibres as the pathogenetic mechanism of the "Gerstmann syndrome", that until today has not been reported in the literature of the wide variety of AIDS dementia complex. The administration of 1 g of zidovudine for about 9 months did not avoid the establishing of the neurologic damage, but the sudden suspension of the drug could have enhanced the exacerbation of inflammation and the involvement of areas whose lesion is classically believed responsible for cognitive impairment.

Two cases of primary antiphospholipid antibody syndrome are reported. One patient presented multiple abortions and epilepsy. The second patient was affected by a brain vascular accident, with a residual hemiparesis. Both cases showed livedo reticularis in arms, NMR evidence of diffuse lesions of the white matter, high serum levels of anticardiolipin antibodies and cardiopathy. Lupus anticoagulant was also found in the serum of the first patient, and cortisone and antiaggregants enabled her to reach term in a fifth pregnancy after four miscarriages. In the other case histological examination of specimens of skin, peripheral nerve and skeletal muscle revealed occlusive, non arteriosclerotic vasculopathy and an absence of inflammatory lesions. Histological study has rarely been performed in primary antiphospholipid syndrome but suggests that the mechanism of thrombosis is not vascular; in our subjects it revealed findings similar to those in Sneddon syndrome.

Hyaluronan (HYA) is a large molecular weight polysaccharide which functions in various roles throughout the body. Little is known regarding HYA in human cerebrospinal fluid (CSF). We measured CSF and serum HYA concentrations in eleven patients with varying degrees of head injury. In these patients, CSF HYA ranged from 46 to 772 micrograms/l and serum HYA from 16 to 573 micrograms/l. We did not find any relationship between HYA values in CSF or serum and underlying disease or Glasgow Coma Scale (GCS). The role of CSF HYA in the injured human brain has yet to be elucidated.

The case of a 32-year-old man with a giant, partially thrombosed, basilar artery aneurysm associated with moya-moya disease is described. The patient exhibited symptoms due to compression of the aneurysm on the right cerebral peduncle. He was discharged after conservative treatment for 10 days. Pathogenesis and management of this rare case are discussed in the light of data reported from the literature.

We have studied 122 patients (52 men and 70 women) with definite Multiple Sclerosis (MS) to evaluate the frequency and clinical characteristics of pain in MS. The Hamilton Rating Scale for depression, the Beck-Self Depression Inventory and the Kurtzke Disability Status Scale were used in all patients. We have divided the patients with pain in two groups: patients with pain syndromes at onset and patients with pain syndromes during the course of MS disease. We found that 57% of all our MS patients complained of pain syndromes at some time during the MS course, while 21% reported pain as a symptom at onset of MS. The majority of patients suffered from chronic pain (constant or intermittent pain lasting more than one month). The most frequent chronic syndromes were dysesthetic extremity pain, painful spasms and tonic seizures. We did not find a significant differences with respect to age, sex, disease duration, physical impairment, depressive symptoms between the patients of pain-free group and of pain groups. There was a significant difference in mean disease duration from diagnosis in patients reporting pain at onset of the disease. In conclusion, the pain in MS is not a rare symptom; the role of physiopathological mechanism underlying pain syndromes arise unclear.

Hand deformities cause severe discomfort and functional limitations to patients with Parkinson disease (PD) and related disorders. In clinical practice the problem is often overlooked or misdiagnosed. This paper reports on four cases whose characteristics are discussed.

A case of idiopathic superficial hemosiderosis (SH) of the central nervous system and a review of the literature are presented. The patient suffered from progressive cerebellar ataxia, hearing loss, anosmia, spastic paraparesis, but no mental deterioration. The diagnosis was made with brain and spinal MRI, that showed in T2 weighted images superficial hypointensity of spinal cord, medulla oblungata, pons, mesencephalon, cerebellum and cerebral hemispheres, images that are considered pathognomonic of SH. Repeated spinal fluid examinations were negative, suggesting that evidence of overt subarachnoidal bleeding is not essential in the diagnosis. In patients with SH of unknown etiology no valid therapy is yet available.

We previously reported nocturnal plasma IL-1 beta (beta) increases during sleep in absence of stress-induced activation of hypothalamic-pituitary-adrenal (HPA) axis. In this paper we evaluate the presence of plasma IL-1 beta secretion in nine healthy volunteers (mean age 31.2 +/- 4.2) during post-prandial naps, after the administration of zolpidem, a benzodiazepine receptorial agonist. Although a significant increase in IL-1 beta plasma levels during spontaneous sleep was present in only four subjects when compared to those obtained during wake and induced-sleep, spontaneous sleep IL-1 beta mean plasma levels appeared slightly higher than both wake and induced-sleep values. Moreover, a negative correlation was present between IL-1 beta and cortisol (F) values obtained during the early afternoon (r = 7; p < 0.05). Our findings are consistent with a possible association of IL-1 beta secretion to physiologic sleep also during daytime spontaneous naps, with the presence of F influence on this phenomenon, and with the lack of IL-1 beta association to daytime naps after sleep-inducer pharmacological agents.