Non-neurological Symptoms Research Articles

Chronic sequelae and irreversible injuries following acute pyrethroid intoxication

For patients the author has observed, the majority of complaints following an acute pyrethroid intoxication disappeared after the end of exposure. Residuals frequently observed after more than 2 years were: (1) cerebro-organic disorders (reduced intellectual performance with 20–30% reduction of endurance during mental work, personality disorder), visual disturbances, dysacousia, tinnitus; (2) sensomotor-polyneuropathy most frequently in the lower legs; (3) vegetative nervous disorders (paroxysmal tachycardia, pollakisuria, increased heat-sensitivity, orthostatic hypotonia and reduced exercise tolerance due to circulatory disorder). Non-neurological symptoms include deficiency of cellular and humoral immune system established by laboratory findings: opportunistic infections, especially Candida-infections of the gastro-intestinal tract, relapsing infections of the urinary and respiratory tract, the latter often aggravating to respiratory obstruction. Most of the patients exhibit positive epi- or intracutantest against pyrethroids or pyrethrines, and acquainted sensitivity also to other antigens. Many of these patients exhibit pathological autoimmune diagnostical findings and developed autoimmune diseases as for instance sclerodermia-like syndrome, myasthenia-like syndrome with progredient muscle atrophy, autoimmun-hemolysis and autoimmun-thrombocytopenic purpura.

Clinical and molecular characteristics of Japanese Gaucher disease.

Clinical signs and symptoms of Gaucher disease are more severe in Japanese than in Jewish and other non-Japanese patients. A higher percentage of bone crises and splenectomy was demonstrated by Japanese patients, and there were five fatalities among patients with type 1 Gaucher disease. Additionally, neonatal Gaucher disease, clinically characterized by hydrops foetalis, was observed. Japanese patients with type 2 and type 3 disease also demonstrate clinical heterogeneity. About 100 alleles of patients with Japanese Gaucher disease were examined for genotype determination with the PCR and SSCP methods. About 18 different mutations, including several novel mutations in Japanese patients, were identified. The most common mutations in Japanese patients were 1448C(L444P), accounting for 41 (41%) of alleles. The second most prevalent mutation was 754A(F2131), accounting for 14 (14%) of alleles. Other alleles identified included the 1324C, IVS2 and other mutations. Unidentified alleles comprised 16% of the total number of alleles studied. To date, neither the 1226G (N370S) nor the 84GG mutation has been identified in the Japanese population, although these mutations account for about 70% and 10% of the mutations in Jewish and other non-Japanese populations, respectively. The phenotype-genotype correlation in Japanese patients is more complex compared with that of the Jewish population. In Japanese patients, the 1448C mutation, in either heteroallelic or homoallelic forms, exhibits both neurological and non-neurological phenotypes. Japanese patients with the 754A mutation also exhibit both neuronopathic and non-neuronopathic disease. On the other hand, patients with the D409H mutation show only type 3 neurological disease, and those with the 1447-1466 del 20 ins TG mutation have the severe, neonatal neurological form of Gaucher disease. The 1503T allele was present only in patients with type 1 non-neurological disease. However, since this correlation was observed only in young patients, we do not as yet know the final phenotypic outcome of this mutation. Probably, Japanese patients with Gaucher disease have few mutations that exhibit non-neurological signs and symptoms.

Abnormal Cerebral Blood Flow Associated with Antiphospholipid Antibody Syndrome —Four Case Reports—

Patients with antiphospholipid antibody syndrome manifesting as neurological symptoms (one patient with twice repeated cerebral ischemic symptoms in the left parietal and frontal lobes, and the other patient with cerebral infarction of the right temporal lobe) and non-neurological symptoms (one patient with occlusion of the superior mesenteric artery and the other patient with thrombophlebitis) underwent cerebral blood flow (CBF) studies using xenon-enhanced computed tomography. The patients with neurological symptoms had decreased CBF at the affected sites. The patients with non-neurological symptoms had decreased CBF in the left parietal and temporal lobes and/or corona radiata. Subtle preclinical thrombosis may cause chronic cerebral hypoperfusion in patients with antiphospholipid antibody syndrome.

Myeloradicular features as the initial presentation of sarcomas of childhood

Sarcomas (chondrosarcoma, Ewing sarcoma, rhabdomyosarcoma, and undifferentiated sarcoma) generally present with nonneurologic symptoms at the onset. Five children with sarcomas who presented with spinal cord compression or radiculopathy as their initial problems are described. These patients appear to be older than those with the more commonly encountered neuroblastoma-related spinal cord compression. Our patients had a favorable neurologic recovery initially, but ultimately succumbed to systemic complications from spread of the sarcoma.

The duration of seeking help following traumatic brain injury: The persistence of nonneurological symptoms

Abstract Traumatic brain injury is a major health problem. Studies have concluded that there is an incidence of 400,000 to 600,000 new injuries annually. However, little information is available on the duration of symptom complaints after injury and thus a lack of information on the prevalence of these complaints in the injured. This study surveyed the persistence of sympton complaints when patients sought help from a neuropsychology service as outpatients after traumatic brain injury. A retrospective review of patient records found that patients sought help an average of 7.3 years after injury. This can be extrapolated to mean that there are as many as 3 to 4.4 million survivors of brain injury with residual difficulties in the U.S. Patients whose injuries were at least 1 year old sought help an average of 9.9 years after injury. Overall, the most frequent complaints were cognitive, job/school, medical, and emotional problems. The implications and limitations of the survey are discussed.

Somatic emotional disorders in childhood and adolescence.

We conducted a short-term follow-up study of severe somatic emotional disorders in 93 children and adolescents. Our aim was to investigate whether the type of physical presentation influenced the outcome in terms of symptoms and subsequent use of medical services. Three groups of patients were identified. Two groups presented with neurological symptoms and were divided into a pseudo-epilepsy group (n = 23) and other hysterias (n = 30); and a third presented with non-neurological symptoms which we termed 'other somatic presentations' (n = 40). Cases in the hysteria groups were significantly more likely to be female and post-pubertal. Polysymptomatic presentations accounted for 85% of all cases and were as common in boys as in girls at all ages. The greatest number of symptoms was found in the pseudo-epilepsy group. None of the hysterias met DSM III-R criteria for somatization disorder. Outcome in terms of residual physical symptoms and subsequent use of medical services was poorest for the pseudo-epilepsy group, and nearly 40% of these patients were judged by their general practitioner to be unchanged since discharge. By comparison, 85% of all other somatic cases were judged improved since discharge from hospital out-patients. Neither polysymtomatic presentations nor persistent physical symptoms at discharge predicted a poor outcome in any group. The general practitioners considered the psychiatric treatment to have been helpful in the majority of cases, even when the somatic outcome was rated as unchanged.

Humoral immunity in measles infection: A critical factor?

Cell-mediated immunity is generally regarded as the essentiel factor in recovery from measles infection. In other viral infections humoral immunity has been considered a critical factor when antibody titres were correlated with outcome or when serum therapy proved protective. A review of available studies of severe-to-fatal cases of measles infection having non-neurological symptoms indicate that the antibody response is depressed in virtually all cases. The current view of immune globulin being an ineffective therapeutic agent is based on treatment of measles encephalities; in fact, the least effect should be expected among encephalitis cases since some already have antibodies from the onset of symptoms. Larger examinations of measles with other than neurological symptoms suggest that immune globulin has a beneficial impact on the clinical course of infection. There are indications that hyperimmune globulin increases the efficacy of this form of treatment. Since measles is still a major cause of hospitalization and mortality, further studies of the therapeutic effect of specific immune globulin are warranted. From our current knowledge, both the humoral and cell-mediated immunity seem to be critical factors in recovery from measles infection.

Size‐dependent myelinated fiber loss in the corticospinal tract in Shy‐Drager syndrome and amyotrophic lateral sclerosis

Morphometric evaluation was performed on myelinated fibers of the corticospinal tract at the seventh thoracic spinal cord segment from three patients with Shy-Drager syndrome (SDS), six patients with amyotrophic lateral sclerosis (ALS), and five patients with nonneurologic symptoms. In SDS, small-sized myelinated fibers were nearly completely depleted, while large-sized myelinated fibers were considerably well preserved. In ALS, on the contrary, large myelinated fibers were predominantly decreased. These results suggested that selective vulnerability of axonal loss depends on fiber size and should be considered in interpretation of pathology of corticospinal tracts.