Rivista di neurologia最新文献

A case of cerebral angioma: non-invasive assessments. A 65-year-old woman, suffering from epileptic seizures since the age of 6, was examined. Transcranial Doppler (TCD) ultrasounds, SEPs and EEG brain mapping by means of median nerve stimulation, were performed, followed by a NMR of the brain, which revealed an arteriovenous malformation in the left hemisphere (frontal and parietal lobe). By comparing the results of the neurophysiological tests, the diagnostic value of TCD, confirmed by the neuroradiologic findings, was established. EEG and SEPs were also abnormal, but their actual effectiveness in clinical studies is discussed. We conclude that these electrophysiological examinations do not allow a reliable diagnosis as with TCD.

We accomplished polygraphies in two groups of infants: 1) preterm infants born before 33 weeks CA, and recorded between 33 and 48 weeks CA; 2) full term infants, recorded between 39 and 48 weeks CA. We compared in each group of infants: 1) the development of behavioral states organization; 2) the maturation of cortical bioelectric activities; 3) the development of concordance between behavioral states and EEG pattern; 4) sequences of behavioral states and EEG pattern when the babies fall asleep. In all the aspects considered, we describe some developmental changes, to understand how, through these changes, the newborn sleep-wake ultradian cycle is replaced by 24 hr-cycle, typical of the infantile period. This basic process is expression of maturation of the central nervous system because it is related to CA and not to extrauterine experience. The EEG-polygraph usually used in clinical practice allow us to follow these extraordinary transformations very closely.

A patient with a pure acquired dysgraphia is reported. The pattern of the patient's performance is discussed in relation to current functional models of writing. The case may be interpreted by assuming a selective impairment to the graphemic buffer.

Twenty consecutive patients with chronic partial seizures with onset before twenty years of age were investigated by means of 0.5 T MRI (20) and HM-PAO (19) in order to identify focal alterations amenable to surgical therapy. MRI evidentiated parenchymal lesions in 7 patients. Findings consistent with unilateral medial temporal sclerosis and cortico-subcortical parietal scars were found in two patients each. Small solid nodular lesions in the temporal lobe were observed in two patients. These and one additional patient with nodular partially cystic lesions in temporal lobe were administered a paramagnetic contrast agent (Gadolinium DPA) intravenously. In one case a contrast enhancement was observed. Histologic examination post surgery revealed a low grade glioma in one patient. HM-PAO SPECT examination showed area of abnormal captation in 9 of 19 patients. Aspects of EEG correlation with the MRI and SPECT findings are discussed. Our data supported the usefulness of magnetic resonance and SPECT imaging in the completion of pre-surgical assessment in this kind of patients.

A case of Herpes Simplex Encephalitis with a benign course was present in a 66-year-old patient. A year after the acute phase of the illness, the patient continued to suffer from inability to fix verbal material in memory. During the acute phase, cerebral NMR revealed a large evolving lesion in the right temporal region, and an old lesion located in the same region of the opposite hemisphere. From the medical history, we learned that the patient, 35 years earlier, suffered a similar episode, including a short-term memory deficit. In the following study, we will discuss this case report in relation to data found in the literature dealing with memory deficit, caused by mono and bilateral, temporal lesions.

We described a case of Central Pontine Myelinolysis, typical with regard to pathogenesis (excessive correction of hyponatremia), neuroanatomical damage revealed by imaging techniques (Magnetic Resonance Imaging) and clinical symptomatology. Serially performed BAEPs recordings during patient's hospitalization, showed interesting data on functional recovery which well correlate with the evolution of clinical symptomatology. These data strongly suggest the usefulness of such electrophysiological technique for a prognostic evaluation.

Cognitive disturbances are frequently encountered in advancing Parkinson's disease (PD). Typically there are visuo-spatial disorders, memory impairment and bradyphrenia, defined as 'subcortical dementia' to distinguish it from the dementia that occurs in Alzheimer's disease, where the most prominent dysfunctions are agnosia, apraxia and aphasia. An electrophysiological test to study cognitive processing is the P300 (or P3) of the Event Related Potentials; in particular the latency of the P3 seems to correlate with cognitive decline. Thirty patients affected with idiopathic PD were investigated using a classic auditory "oddball" paradigm (rare tone--"target"--3000 Hz, frequent tone--"non target"--1000 Hz; the patients were instructed to recognize and keep a mental count of the number of rare tones). Electrophysiological findings were compared with those obtained in twenty normal subjects, age and sex matched with the patient's group. The parameters of P300 were correlated with patient's age, duration of the disease, motor and cognitive impairment levels and L-Dopa therapy. The P300 was loss in 16.6% (5 p.) and delayed in 33.3% (10 p.). Significative correlations were found only with age and cognitive impairment scores, but not with other variables analyzed. These results suggest that P300 could be a useful test to identify demented patients among those with PD, despite different motor disabilities.

The Authors introduce some questions concerning cognitive impairment in Parkinsonian patients and they focus the attention on 'bradyphrenia'. They briefly discuss the methodological difficulties in studying this kind of disturbances in Parkinson's disease (PD) and the approach to this problem with the help of the Event-Related Potentials or ERPs. Finally, they review literature and their data on Contingent Negative Variation (CNV) and P300 in PD and conclude that interesting and useful informations can be obtained by means of the electrophysiological methods.

The study deals with the data resulting from the analysis of 3497 passive orthoclinostatic tests performed in the neurological Clinic of Pisa during the last 10 years. Blood pressure and heart rate values both in supine and upright positions have been analyzed, particularly focusing the orthostatic hypotension, which were 184 over 3497 tests. The results show that in young subjects only hypersympatheticotonic hypotension are present, due to a dysfunction of the regulating hypothalamic centres, while at more advanced age there is a prevalence of orthostatic hypotension with low differential values of heart rate. Differential values of heart rate as a function of age have been the calculated.

Apomorphine is a powerful dopaminergic drug, able to improve cardinal symptoms of Parkinson's disease in few minutes, when injected subcutaneously. We administered different doses of apomorphine s.c. against placebo in 25 patients with a Parkinsonian syndrome, with the aim of discriminating Parkinson's disease from other Parkinsonism. A positive response to apomorphine was predictive (88%) of good responsiveness to levodopa therapy. Our data, together with those of other groups, indicate that apomorphine test is a useful tool in the diagnosis of Parkinsonian syndromes.