Acta neurologica最新文献

The authors discuss the case of an elderly female patient with thyrotoxicosis and chorea. T3 and T4 serum values were high. Since the chorea disappeared with euthyroidism but reappeared whenever there was a further increase in T3 and T4, its relationship on hyperthyroidism and its reversibility are clearly demonstrated. The chorea therefore appears to be another clinical condition present in hyperthyroidism.

The Authors report on 150 cases of patients suffering from Parkinson's disease. The patients represent 8.3% of total parkinsonian patients and are selected on the basis of clinical and laboratory criteria that allow the diagnosis of "angiopathic parkinsonism" as an autonomous entity. Cerebral blood flow alterations in Parkinson's disease and associated dementing symptoms are also discussed. In conclusion, the Authors emphasize the usefulness of recognizing the "angiopathic parkinsonism" in view of therapeutical implications.

A case of congenital lipodystrophy complicated by complex-partial epilepsy is reported in a nine-year-old girl. The peculiarity of this rare case is represented by partial complex epilepsy with diffuse electroencephalographic alterations represented by a continuous seizure-like pattern that persisted unmodified despite the successful antiepileptic treatment. Although the etiopathology of lipodystrophy is, at present, still elusive, we hypothesize that the primitive dysfunction of lipidic metabolism plays a critical role in both determining central nervous system (CNS) alterations and the findings that characterized this extremely rare disease.

In 22 migraine patients and 5 healthy controls an investigation has been performed on lymphocyte subsets in basal conditions and 90 minutes after sublingual isosorbide dinitrate (IDN) administration. In all patients the drug assumption induced a typical migraine attack with increase in all examined lymphocyte subsets with except of NK cells. A statistically significant increase (p < 0.05) in T lymphocyte subsets we found during the crisis, whereas in healthy controls neither a migraine attack nor any modification in lymphocyte subsets could be observed. These results seem to confirm the immune alteration we have previously found in migraineous patients and suggest the possible role of IDN-stimulated endothelium not only in vasodilatation but also in production of substances responsible of the observed immune modifications.

A preliminary trial with fluoxetine, a 5-HT reuptake inhibitor, was carried out on two young male patients (21 and 32 years old) affected by Gilles de la Tourette syndrome. They both underwent a complete neurological evaluation also including neuroradiological, neurophysiological and neuropsychological assessment. Both patients had already been treated with benzodiazepines and amitriptyline; the older one was also given haloperidol and chlorimipramine with definite, but short-lasting improvement. During hospitalization a therapeutic trial with fluoxetine (20 mg/day in the younger patient and 40 mg/day in the older) in association with chlorimipramine (75 mg/day) was initiated, leading to a significant reduction (at least 50%) of abnormal movements and obsessive-compulsive behaviour. The older patient had no side effects while the 21 year old subject complained of insomnia, urinary retention and anorexia; despite the objective improvement, these side effects led us to modify the therapy after the first month. The favourable action of serotoninergic agents on TS symptoms supports the hypothesis that the multiple tics of the syndrome are motor compulsions.

Polyarteritis nodosa (PN) is frequently cause of both central and peripheral neurological disorders. However, involvement of the central nervous system is rare at the beginning of the disease. In this paper we report a case of a 38-year-old woman hospitalized in our Neurosurgical Service because of left hemiparesis in presence of cutaneous arteritis (PN). At computed tomography (CT) an intracerebral hemorrhage was found. No radiographic evidences of vasculitis of the visible arterial branches, at angiography, were seen. Cerebral arteritis should be suspected as a cause for intracranial hemorrhage in patients without hypertension or other risk factors.

Multiple sclerosis presenting at onset with clinical signs and CT picture suggesting a cerebral neoplasm or a slowly evolving stroke, is uncommon. We report one patient in whom cerebral tumour was suspected not only clinically but also from CT features. M.R.I., demonstrating multifocal, high intensity, unsuspected periventricular and white-matter lesions, permitted to diagnose what seemed an intracranial left parietal neoplasm as an acute plaque of demyelination. In fact, in the follow-up, this large low-intensity left parietal area acquired structural and volumetrical homogeneity compared to all other present hyperintense lesions. Instead multimodal EPs, though disclosing subclinical dysfunction in the early stage of the disease, did not correlate with changes in neurological examination to follow-up. So they, unlike the M.R.I., seem of no particular usefulness to serially monitor the clinical modification of MS.

Literature suggests that not only homozygotes but also heterozygotes for ataxia-telangiectasia have a high incidence of cancer, probably due to an impairment in DNA repair. The most frequent associations are with breast, lung, bladder, prostate and stomach tumors, while no correlation with colorectal cancer has been demonstrated. The affected family reported in this paper seems to have a high incidence of gastrointestinal tract tumors, including the colorectal ones.

From 1974 to 1988, 15 adult patients (aged over 16 years) with cerebellar medulloblastomas were observed in our Neurosurgical Department. All were treated by total (8 patients) or subtotal (7 patients) resection of the tumor, followed by radiation therapy to the posterior cranial fossa, spine and whole brain. A 5-year survival was achieved in 7 patients (46.6%). Local tumor recurrence occurred in 4 patients. The best treatment and the factors that influence the prognosis and survival of adult medulloblastomas are discussed also from the analysis of the pertinent literature.

As far as we know, only 20 patients with association of aneurysm and arteriovenous malformation (AVM) on the posterior inferior cerebellar artery (PICA) have been reported so far. Further three personal cases are presented here and the pertinent literature is reviewed, the coexistence of aneurysm(s) and AVM on the PICA district increases the risk of intracranial bleeding compared with patients harbouring this association in the cerebral hemispheres. The direct approach of both lesions (excision of the AVM and clipping of the aneurysm) in one-stage operation is the treatment of choice.