Rivista di neurologia最新文献

The Authors studied a group of patients with ideomotor apraxia (LBD+) to verify if these patients had some difficulties in multiple learning tasks in respect to non-apraxic patients and normal control subjects. All five groups were submitted to gesture learning task, motor skill learning task, supra-span (Corsi) learning task. The results indicate that learning difficulties were present in LBD+ patients, as demonstrated by their low performance in gesture sequence, motor skill and score of block-tapping supra-span task. This fact may be seen as a basic learning deficit and therefore linked to memory impairment. On the other hand, this could be tied to an aspecific more diffuse deterioration of attention if we consider that our apraxic patients had a greater cerebral lesion than non-apraxic patients.

The Tolosa Hunt Syndrome is a rare neurological disease. It can be the consequence of a number of processes localized in the cavernous sinus or near to it. The diagnosis has been until now a diagnosis of exclusion, even if the phlebography can give more informations. Recently the possibility of demonstrating the process has been obtained by the high resolution CT scan that can show peculiar findings as in the case that we are describing.

Electrophysiological tests have proved to be a valuable method in assessing multiple sclerosis (MS) patients. In the last few years, scalp recorded short latency somatosensory evoked potentials to stimulation of nerves in the "lower extremity" have been more and more extensively employed. Some studies have aimed at comparing the sensitivity of MR imaging and multimodality evoked potentials, with somewhat conflicting results. In the present study posterior tibial nerve somatosensory evoked potentials (ptnSEPs) were performed in 29 MS patients with the aim to investigate the ability in revealing spinal cord conduction abnormalities and the sensitivity towards other evoked potentials and MR in MS. ptnSEPs showed a high percentage of abnormalities which did not significantly differ from that of visual evoked potentials; moreover in conjunction with median nerve SEPs can be used to localize thoracic or lumbar cord demielinating lesions, not evidenced on MR imaging. These results confirm that ptnSEPs, although non specific and crude in terms of precise localization, are a sensitive tool in detecting lesions, even subclinical, in MS patients. Moreover in anatomic regions like spinal cord where MR imaging is not very sensitive because the lower signal-to-noise ratio, they represent the only method available for demonstrating lesions.

The authors describe a patient who experienced the sudden occurrence of hemicorea-hemiballism on the left side of the body and the contemporary agnosia of it. An unenhanced CT-scan disclosed an ischemic lesion involving the head of the caudate nucleus and of the anterior limb of the internal capsule of the contralateral hemisphere. The authors discuss the possible pathophysiologic mechanisms explaining the rare association of these two symptoms and suggest that the involvement of the pyramidal tract in the internal capsule usually does not allow hyperkinesis to manifest itself.

A young woman, during an autoimmune thyroiditis with hyperthyroidism, suffered from progressive proximal weakness at her four limbs. The diagnosis of a concomitant polymyositis was indicated by a marked increase of plasma CPK, myopathic findings at EMG and a clearcut picture of inflammatory alterations at muscle biopsy. Steroid therapy brought a full recovery of both thyroid and muscular symptoms. In the following months, the patient suffered from a second episode of thyroiditis and subsequently from another poussée of polymyositis. The possible pathogenesis underlying the unusual association of an autoimmune thyroiditis with a polymyositis is discussed.

The aim of our research is to investigate the success of the vasoactive intracavernous therapy in subjects suffering impotence only on a neurological basis. We have submitted 50 subjects to a multisciplinary study including P.B.P.I., intracavernous minitest plus V.S.S., M.M.P.I., B.C.R. latency, duration, aspect and an hormonal screening (SH, LH, PRL, F. TEST, 17 BE2). The patients, or their partners, were instructed in the technique of self intracavernous injection (S.I.C.I.) of vasoactive drugs. Papaverine alone was given to 37 patients in a mean dose of 20.8 +/- 11.7 mg. Other 13 patients were treated with papaverine plus phentolamine in order to obtain a full erection. Comprehensive results of the treatment were judged at 80% effective: only 10 patients discontinued self injection treatment, unable to perform this technique properly.

Epidemiological data of the U.L.S.S. n. 22 of Este-Montagnana (PD) show a prevalence of Epilepsy of 5.94%. These data are referred to an observation period of ten years (1978-1987) and confirm the results of major epidemiological trials in U.K. and U.S.A. Distribution by sex and types of crises is the same. The Authors underline the importance of alcohol-related crises; however this is not yet confirmed by precise parallel data.

The Guillain Barré poliradicoloneuritis shows a high incidence of permanent sequelae and exitus. Recently the plasmapheresis has been applied in the acute stage with a beneficial effect to the rapidity and the degree of the recovery. In the present study the results obtained in a group of patients with Guillain Barré of maximal severity are reported. All the patients have received plasmapheresis (3-5 exchanges) in the first days of the disease. Eventual side effects during the procedure have been evaluated together to the neurophysiological findings. The recovery has been evaluated in the brief and in the long term. From this study the efficacy of the plasmapheresis in Guillain Barré poliradicoloneuritis is confirmed. Furthermore a correlation has been evidenced between the amplitude of the muscular potential (CMAP) registered in the acute phase and the prognosis of the illness.

The association between Multiple Sclerosis (MS) and DR2 HLA antigen is well known in Caucasoids. In the past few years a significant correlation has been found between DQwl and MS in North-East Scotland and in several other countries. In previous HLA studies in Italian MS patients, a lack of any association or an increased frequency of DR2 have been observed; however, the results of most Italian surveys derive from heterogeneous sample of affected individuals. This study was carried out in a homogeneous population of patients living in and originating from the province of Ferrara, Northern-Italy. Among the prevalence cases, 116, indigenous, unrelated patients, were typed for HLA-A-B, -DR and DQ antigens. The comparisons with 185 healthy individuals, originating from the same area, revealed an increased prevalence of DR2 antigen in Ferrara MS patients. This antigen does not appear to be related to the clinical variables of the disease.

According to Merton (1954), Bigland-Ritchie (1978), Edwards (1981) and De Luca (1984), two groups of mechanisms, central and peripheral, may be distinguished in physiopathology of fatigue process. Central mechanisms are related to subjective phenomena, like fatigue sensation or motivation, and to objective aspects as spatial and temporal motoneurones recruitment.