Reflex Disturbances Research Articles

Venous flow disturbance links to the cognitive function in the ultrasonographical validation study

AbstractBackgroundAccording to the dementia progression, especially in Alzheimer’s disease (AD), venous reflex disturbance may be concerned. We previously found and reported that the validation of the spontaneous echo contrast or velocities of the internal jugular vein are convenient AD diagnosis screening methods and that the venous reflux disturbance correlates with AD development (Matsuzono K et al. J Alzheimers Dis. 2021;84(2):787‐796). In order to clear the relationship between venous reflex disturbance and dementia, we performed the additional study using the transesophageal echocardiography (TEE).MethodWe performed the TEE examination and the higher brain function test to the 80 participants. According to the TEE examination, we validated 1) the spontaneous echo contrast in heart, 2) shunt including the patent foramen ovale, 3) velocities at the left atrial appendage, and 4) the plaque length at the aortic arch. According to the higher brain function, we validated the Mini‐Mental State Examination (MMSE), Hasegawa Dementia Rating Scale‐Revised (HDS‐R), and Frontal Assessment Battery (FAB).ResultTwenty‐six (32.5%) of the 80 participants showed positive spontaneous echo contrast in the heart. All the MMSE, HDS‐R, and FAB scores of the positive group was significantly lower than that of the negative (26 vs 24, 26 vs 22.5, 14 vs 10.5, p<0.05). According to the shunt, there was no significant relationship to the cognitive function. The velocities at the left atrial appendage showed positive correlation while the plaque length at the aortic arch showed negative correlation to the cognitive function (r = 0.2).ConclusionIn both of the internal jugular vein and of the heart, the spontaneous echo contrast significantly correlates with the cognitive impairment. Our study using the ultrasonographical examination shows the venous reflex disturbance concerns with the dementia progression.

Radiofrequency Lesioning Surgery for Movement Disorders

Radiofrequency lesioning surgery is primarily performed to treat Parkinson's disease, dystonia, and tremor. Its effects are similar to those of deep brain stimulation (DBS). However, Radiofrequency lesioning surgery has not been popularized, possibly due to the over-evaluation of its risks. The current most available targets for the treatment of movement disorders include ventral intermediate (Vim) nucleus, ventral oral (Vo) nucleus, and globus pallidus internus (GPi). Vim thalamotomy is available for Parkinsonian tremor, essential tremor, dystonic tremor, and other various kinds of tremor, and it is highly effective. Bilateral vim thalamotomy is feasible when properly performed on tiny lesions on the bilateral vim nucleus. Vo thalamotomy is mainly available for focal hand dystonia. The safety profile of bilateral Vo thalamotomy has not yet been established, but it is thought that it may lead to irreversible hypophonia and dysarthria. Pallidotomy is selected for treatment of dystonia and Parkinson's disease. Although unilateral pallidotomy is a safe procedure, it can cause medically refractory parkinsonism including postural reflex disturbance and gait disorder. Delayed infarction on the posterior limb of internal capsule is another major concern associated with pallidotomy and can lead to hemiparesis. Correct understanding is absolutely essential to ensure the safety of radiofrequency lesioning surgery.

The impact of lesion location on dysphagia incidence, pattern and complications in acute stroke. Part 2: Oropharyngeal residue, swallow and cough response, and pneumonia.

Dysphagia is a well-known complication of acute stroke. Given the complexity of cerebral swallowing control it is still difficult to predict which patients are likely to develop swallowing dysfunction based on their neuroimaging. In Part 2 of a comprehensive voxel-based imaging study, whether the location of a stroke lesion can be correlated with further dysfunctional swallowing patterns, pulmonary protective reflexes and pneumonia was evaluated. In all, 200 acute stroke cases were investigated applying flexible endoscopic evaluation of swallowing within 96 h from admission. Lesions were mapped using patients' computed tomography/magnetic resonance images and these were registered to a standard space. The percentage of lesioned volume of 137 anatomically defined brain regions was determined on a voxel basis (FSL5.0). Region-specific odds ratios (ORs) were calculated with respect to the presence of oropharyngeal residue, delayed swallow response, insufficient cough reflex and occurrence of pneumonia during hospital stay. Colour-coded lesion location maps of brain regions with significant ORs were created (P < 0.05). Lesion maps for residue and impaired swallow response depicted parietal-temporal areas of the right hemisphere. Limbic structures in the right hemisphere and sensory regions on the left were associated with cough reflex disturbance. There was no overlap of lesion maps for impaired swallow response and insufficient cough reflex or pneumonia, but substantial overlap between the last two conditions. This study gives new insights on the cortical representation of single components of swallowing and airway protection behaviours. The lesion model may help to risk-stratify patients for dysphagia and pneumonia based on their brain scan.

Frequency matters: beta-band subthalamic nucleus deep-brain stimulation induces Parkinsonian-like blink abnormalities in normal rats.

The synchronized beta-band oscillations in the basal ganglia-cortical networks in Parkinson's disease (PD) may be responsible for PD motor symptoms or an epiphenomenon of dopamine loss. We investigated the causal role of beta-band activity in PD motor symptoms by testing the effects of beta-frequency subthalamic nucleus deep-brain stimulation (STN DBS) on the blink reflex excitability, amplitude, and plasticity in normal rats. Delivering 16Hz STN DBS produced the same increase in blink reflex excitability and impairment in blink reflex plasticity in normal rats as occurs in rats with 6-hydroxydopamine lesions and patients with PD. These deficits were not an artifact of STN DBS because, when these normal rats received 130Hz STN DBS, their blink characteristics were the same as without STN DBS. To demonstrate that the blink reflex disturbances with 16Hz STN DBS were frequency specific, we tested the same rats with 7Hz STN DBS, a theta-band frequency typical of dystonia. In contrast to beta stimulation, 7Hz STN DBS exaggerated the blink reflex plasticity as occurs in focal dystonia. Thus, without destroying dopamine neurons or blocking dopamine receptors, frequency-specific STN DBS can be used to create PD-like or dystonic-like symptoms in a normal rat.

Clinical Spectrum of Propionic Acidaemia

Objectives. To evaluate the clinical features, physical findings, diagnosis, and laboratory parameters of the patients with propionic acidaemia (PA). Methods. The records of diagnosed cases of propionic acidaemia were reviewed, retrospectively. Results. Twenty-six patients with PA had 133 admissions. The majority (85%) of the patients exhibited clinical manifestations in the 1st week of life. Regarding clinical features, lethargy, fever, poor feeding, vomiting, dehydration, muscular hypotonia, respiratory symptoms, encephalopathy, disturbance of tone and reflexes, and malnutrition were observed in 51–92% admissions. Metabolic crises, respiratory diseases, hyperammonaemia, metabolic acidosis, hypoalbuminaemia, and hypocalcaemia were observed in 30–96% admissions. Pancytopenia, ketonuria, hypoproteinemia, hypoglycaemia, and mildly disturbed liver enzymes were found in 12–41% admissions. Generalised brain oedema was detected in 17% and cerebral atrophy in 25% admissions. Gender-wise odd ratio analysis showed value of 1.9 for lethargy, 1.99 for respiratory diseases, 0.55 for anaemia, and 1.82 for hypocalcaemia. Conclusion. Propionic acidaemia usually presents with wide spectrum of clinical features and disturbances of laboratory parameters in early neonatal age. It is associated with significant complications which deteriorate the patients' quality of life. Perhaps with early diagnosis of the disease and in time intervention, these may be preventable.

Motor and Non-Motor Features of Parkinson’s Disease – A Review of Clinical and Experimental Studies

Classically, Parkinson's disease (PD) is considered to be a motor system affliction and its diagnosis is based on the presence of a set of cardinal motor signs (e.g. rigidity, bradykinesia, rest tremor and postural reflex disturbance). However, there is considerable evidence showing that non-motor alterations (e.g. anxiety, depression, sleep, gastrointestinal and cognitive functions) precede the classical motor symptoms seen in PD. The management of these nonmotor symptoms remains a challenge. A pattern of regional neurodegeneration that varies considerably depending upon the neuronal population affected may explain the different symptoms. In fact, differential mechanisms of neuronal vulnerability within the substantia nigra pars compacta (SNpc) suggests that factors other than location contribute to the susceptibility of these neurons. In this review we discuss how these factors interact to ultimately target the SNpc. Remarkably, this region consists of approximately 95% of the tyrosine hydroxylase (TH)-immunoreactive neurons in both human and rat brains, and consequently this implicates elevated levels of dopamine metabolites, free radicals and other hazard species in these neurons. An understanding of how these factors promote neuronal death may be useful for the development of novel neuroprotective and/or neurorestorative strategies for PD.

Adductor T reflex abnormalities in patients with decreased patellar reflexes

The adductor reflex (AR) is a tendon reflex that has various features that differ from other tendon reflexes. This reflex was tested in different disorders presenting with diminished patellar reflexes such as diabetic lumbosacral radiculoplexus neuropathy (DLRPN), L2-L4 radiculopathy, and distal symmetric diabetic neuropathy (diabetic PNP). The AR and crossed-AR (elicited by tapping the contralateral patellar tendon) were recorded using concentric needle electrodes. Additionally, the patellar T reflex (vm-TR) and vastus medialis H reflex (vm-HR) were recorded using surface electrodes. AR was recorded in only one out of eight patients with DLRPN, but it was recorded in 21 out of 22 patients with L2-L4 radiculopathy (95.5%). Of these reflexes, only AR showed prolonged latency in the L2-L4 radiculopathy group. The latencies of AR, vm-TR, and vm-HR were prolonged in patients with diabetic PNP. We conclude that AR can be useful in the differential diagnosis of some lower motor neuron disorders that present with patellar reflex disturbance. Muscle Nerve 40: 264-270, 2009.

The effects of glossy screens on the acceptance of flat‐panel displays

Abstract— The TCO requirements provide well‐known and recognized quality labels for displays. For these requirements to remain useful, they must continuously be reviewed and updated when necessary. The study described here was performed in response to the market trend of designing flat‐panel displays and notebooks with glare panels. The purpose of this study was to investigate subjective responses to display screens of different gloss levels for office workers working on different tasks under normal office‐lighting conditions. The study consisted of three parts, one where the users should set an acceptable reflex level, one where the user should rate their disturbance on a category scale, and one where the visual acuity of the users were investigated whether they were affected by glare or not. The results show that increasing gloss and increasing luminance levels had negative effects on the acceptance and the disturbance of reflexes. There were statistically significant differences in the acceptance and the disturbance levels between screens with low gloss and screens with high gloss, which suggests that screens with the highest gloss levels should be avoided. The study did not show an effect on the performance based on acuity testing.

Tonic Pupil as the Presenting Sign of Relapsed Acute Myeloid Leukemia

A 23-year-old woman complained of photophobia, lacrimation, and redness of the left eye of 1 week's duration and a dilated left pupil. Acute myeloid leukemia (AML) had been diagnosed 5 years earlier and treated with a stem cell transplant. She had developed graft vs host disease (GVHD) affecting her skin and had undergone psoralen plus UVA (PUVA) treatment. The AML had been in remission for 3 years before her ophthalmic visit. Medications included acyclovir, fluconazole, penicillin, cyclosporine, and mycophenolate. Systemic corticosteroid treatment had recently been discontinued. Best-corrected visual acuities were 20/20 in the right eye and 20/40 in the left eye, improving to 20/30 with pinhole. In the left eye, the palpebral fissure was slightly narrow but with normal levator function, the tear break-up time was reduced, and there was punctate staining of the cornea. The pupils measured 2 mm in the right eye and 4 mm in the left eye in minimal illumination. On bright light stimulation with the indirect ophthalmoscope light, the right pupil constricted to 1 mm and the left remained at 4 mm. After stimulation by a near target the left pupil also constricted to 1 mm. The left eye showed vermiform movements of the iris on slit lamp examination. Dilute pilocarpine (0.125%) was then instilled in both eyes. After this both pupils measured 2 mm, demonstrating hypersensitivity of the left pupil. She was orthophoric and had a full range of ocular movements. Posterior subcapsular lens opacities were present in both eyes. Ophthalmoscopy was normal. The punctuate epitheliopathy of the cornea was attributed to GVHD and the cataracts to the use of systemic corticosteroids. Left tonic pupil was diagnosed. Lubricants were prescribed for the epitheliopathy. Two days later, she returned complaining of blurred vision. Best-corrected visual acuities were 20/80 in the right eye and 20/40 in the left eye. There was no change in the anterior segment findings of either eye. Ophthalmoscopy showed localized elevation of the retina in the macular region in both eyes. B scan ultrasound showed thickening and irregular elevations of the choroid in both eyes (Fig. 1). Fluorescein angiography showed pinpoint areas of hyperfluorescence of increasing brightness in the macular region of both eyes.FIG. 1: B scan ultrasound of the left eye shows thickening and irregularity of the choroid (arrowhead) and overlying serous retinal detachment.Blood tests showed an elevated white cell count, indicating relapse of leukemia. Brain and orbit MRI showed only faint mucosal thickening of the sinuses. Chemotherapy was begun. The leukemia could not be controlled, and she subsequently died of systemic complications. Tonic pupil can be caused by Adie syndrome, systemic neuropathic diseases, or local lesions (1). Adie syndrome is characterized by tonic pupil and disturbance of deep tendon reflexes without evidence of local ocular or orbital disease or generalized peripheral or autonomic system dysfunction. Orbito-ocular causes of tonic pupil include inflammation, infection, or infiltration that affects ciliary ganglion or the ciliary nerves in the retrobulbar region or in the suprachoroidal space. Tonic pupil has been reported in siderosis caused by retained intraocular foreign body (2); injury to the final cholinergic fibers within the suprachoroidal space was postulated as the likely pathologic mechanism. Postganglionic denervation by damage within the suprachoroidal space has also been reported with retinal detachment surgery using explants (3) and after laser photocoagulation for diabetic retinopathy (4). Leukemia can cause tonic pupil by direct infiltration of the orbit or the choroid. However, postganglionic nerve injury at the level of the eye in choroidal cancer has been reported only once (5). In our patient, there was no imaging evidence of orbital infiltration at presentation. The ultrasound study showed extensive choroidal thickening and irregularity. The fluorescein evidence of pinpoint leaks and serous retinal detachment indirectly indicated dysfunction of the retinal pigment epithelium. A similar phenomenon caused by choroidal infiltration has been reported (6). Hence it is likely that the damage to the ciliary nerves occurred at the suprachoroidal level. Mandagere R. Vishwanath, FRCSEd Stephen J. Charles, MA, MD, FRCOphth Manchester Royal Eye Hospital Manchester, United Kingdom [email protected]

Lumbar Spinal Stenosis in Elderly Patients

Over a 3-year period in our clinic, surgeons operated on 32 persons over 65 years old with lumbar spinal stenosis. This article presents the retrospective analysis of the clinical, radiological, and short-term surgical outcomes. The stenosis seen most commonly among the elderly develops focally at the intervertebral junctions as a result of a complex process of disc degeneration, facet arthropathy, ligamentum flavum hypertrophy, spondylosis, and sometimes spondylolisthesis. All patients underwent a midline decompressive laminectomy with foraminotomies at the affected levels, and discectomy was performed in persons with lumbar disc hernia. Average age was 71.15 +/- 5.09 (65-80); 50% (16) were women, and 50% (16) were men. The most frequent symptoms were pain (96.9%) and neurological claudication (90.6%). The average preoperative duration of the symptoms was 139.87 +/- 115.03 weeks. The most frequent neurological symptoms were reflex disturbances (62.5%), Lasèques's sign (SLR) (+)(53%), and motor deficit (50%). The anteroposterior diameter of the spinal canal was less than 11.5 mm in 71.9% of the cases. In 62.5% of the patients, partial recovery was observed in the short term; 68.8% of the patients underwent laminectomy. Of those, 87.5% had total and 12.5% had partial laminectomies. In addition to laminectomy, discectomy was performed in 31.3% of the patients. Total laminectomy was more likely to be performed on patients older than 65 years, because the anteroposterior diameter was more likely to be below 11.5 mm in this cohort of patients. In lumbar stenosis, surgical treatment-decompression-is an effective method. Surgery has been demonstrated to be effective even in patients over the age of 75 years.

Severe bradycardia and hypotension after connecting negative pressure to the subgaleal drain during craniotomy closure

Negative pressure drainage systems are often used after craniotomy for evacuation of potential bleeding. There are several reports of haemodynamic disturbances with epidural negative pressure drainage, but such reports are very few for subgaleal drains placed over the bone flap. We report a case in which a patient developed severe cardiovascular disturbances after the vacuum drainage was connected to a subgaleal drain after craniotomy for aneurysm clipping. The patient had no significant cardiac history, had an uneventful intra-operative course and yet developed bradycardia and hypotension, which were reproducible and severe enough to require atropine administration. Anaesthetists must be aware of these effects, so that they can anticipate and treat such complications.

The spectrum of presentations of venous infarction caused by deep cerebral vein thrombosis

The classic features of thrombosis of the deep cerebral venous system are severe dysfunction of the diencephalon, reflected by coma and disturbances of eye movements and pupillary reflexes, resulting in poor outcome. However, partial syndromes without a decrease in the level of consciousness or brainstem signs exist, which may lead to initial misdiagnoses. The spectrum of clinical symptoms reflects the degree of venous congestion, which depends not only on the extent of thrombosis in the deep veins but also on the territory of the involved vessels and the establishment of venous collaterals. For example, thrombosis of the internal cerebral veins with (partially) patent basal veins and sufficient collaterals may result in relatively mild symptoms. Deep cerebral venous system thrombosis is an underdiagnosed condition when symptoms are mild, even in the presence of a venous hemorrhagic congestion. Identification of venous obstruction has important therapeutic implications. The diagnosis should be strongly suspected if the patient is a young woman, if the lesion is within the basal ganglia or thalamus, and especially if it is bilateral.

The spectrum of presentations of venous infarction caused by deep cerebral vein thrombosis

The classic features of thrombosis of the deep cerebral venous system are severe dysfunction of the diencephalon, reflected by coma and disturbances of eye movements and pupillary reflexes, resulting in poor outcome. However, partial syndromes without a decrease in the level of consciousness or brainstem signs exist, which may lead to initial misdiagnoses. The spectrum of clinical symptoms reflects the degree of venous congestion, which depends not only on the extent of thrombosis in the deep veins but also on the territory of the involved vessels and the establishment of venous collaterals. For example, thrombosis of the internal cerebral veins with (partially) patent basal veins and sufficient collaterals may result in relatively mild symptoms. Deep cerebral venous system thrombosis is an underdiagnosed condition when symptoms are mild, even in the presence of a venous hemorrhagic congestion. Identification of venous obstruction has important therapeutic implications. The diagnosis should be strongly suspected if the patient is a young woman, if the lesion is within the basal ganglia or thalamus, and especially if it is bilateral.

Comparison of clinical, magnetic resonance and evoked potentials data in a case of valproic-acid-related hyperammonemic coma

Magnetic resonance (MR) multimodality evoked potentials (MEPs) and clinical findings were correlated in a 47-year-old epileptic man in whom parenteral valproic acid (VPA) therapy induced severe comatose hyperammonemic encephalopathy without biological signs of hepatotoxicity (or hepatocytic dysfunction). Although the plasma VPA level remained within a normal therapeutic range, the ammoniemia increased to a toxic peak level at 411 micromol/l 24 h after symptom onset, requiring VPA therapy discontinuation. Brain MR monitoring demonstrated early cytotoxic edema evolving into delayed vasogenic edema and final brain atrophy. Concomitantly to abnormalities within the brainstem on MR images, an increase in brainstem conduction at MEPs and clinical disturbance of brainstem reflexes were observed at the initial phase of the disease course. Later, the resolution of the MR and MEPs abnormalities paralleled the clinical recovery of the reflexes.

建物によるテレビ電波反射障害防止用電波透過型カーテンウォール

建物によるテレビ電波反射障害防止用電波透過型カーテンウォール

こんなところに複合材料 高層ビルによるテレビ電波反射障害の防止用カーテンウォール

こんなところに複合材料 高層ビルによるテレビ電波反射障害の防止用カーテンウォール

A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part I: Clinical features related to radiographic findings.

A prospective study of consecutive patients undergoing surgery for central lumbar spinal stenosis. To evaluate symptoms and signs in patients undergoing surgery for central spinal stenosis and to correlate the findings to age, preoperative duration of symptoms, and radiographically detected constriction. The degree of constriction of the spinal canal considered to be symptomatic of lumbar canal stenosis is not clear, nor is the relation between the clinical appearance of the disease and the degree of radiographically verified constriction. One hundred five consecutive patients scheduled for decompression surgery were included in a prospective study. The day before surgery, all patients were interviewed and examined, using a defined protocol that included data on age, gender, preoperative duration of symptoms, walking ability, and occurrence of pain at rest and at night. Included were data recording straight leg raising test results, reflex disturbance, and extensor hallucis longus muscle weakness. All radiographs were examined by a neuroradiologist. The anteroposterior diameters at each site from L1-L2 to L5-S1 were recorded. For the computer analysis, the site of and width at the narrowest site was registered, as well as the number of sites with an anteroposterior diameter of less than 10 mm. A statistical analysis was performed using chi-square analysis, nonparametric tests, analysis of variance, and logistic regression. Pain at rest and at night was reported by 68 and 60 patients, respectively, and was more common in younger patients (P = 0.065 and 0.015, respectively). A severe reduction of walking ability (< 0.5 km) was reported by 70 patients. The straight leg raising test results were negative in 70 patients, positive > 60 degrees in 16, positive 30-60 degrees in 14, and positive < 30 degrees in 5. Younger patients had a positive straight leg raising result (P = 0.028, analysis of variance) more often. Reflex disturbances correlated to patient age: Older patients had reflex disturbances more often. There was no correlation between preoperative duration and pain or neurologic disturbances: Patients with longer preoperative duration of symptoms did not demonstrate more severe symptoms. There was a total myelographic block of the spinal canal in 13 patients. The mean value of the antero-posterior diameter in the other patients was 6.8 mm (range, 4-11 mm). In patients younger than 70 years L4-L5 was the site for the most pronounced constriction, whereas L3-L4 was the narrowest site in the older patients. Degenerative spondylolisthesis was found in 32 patients, and they had a more pronounced constriction of the spinal canal (5.6 mm compared with 6.7 mm in those without displacement, P = 0.02). There was a (nonsignificant) tendency toward more walking disturbances in patients with a more pronounced constriction of the spine. There was no correlation between reflex disturbances or extensor hallucis longus weakness and radiographically detected constriction. Pain was more intense and positive straight leg raising test results were more common in younger patients, whereas reflex disturbances were more common in the elderly. The vertebral site for the lowest anteroposterior value was higher with higher age. Preoperative duration did not affect the severity of symptoms or signs. Patients with more pronounced stenosis tended to have a more severe reduction of walking ability. There was no correlation between symptoms and signs and radiographically detected constriction.

Cold caloric microcirculatory reflex disturbance in patients with Parkinson's disease.

The basal skin microcirculatory blood flow and its change in response to a cold caloric stimulus (cold water, 5 degrees C, exposure of one foot for 30 s) were investigated in nine patients with Parkinson's disease (PD) and nine normal subjects (controls). The results revealed a significant (p < 0.001) difference between the groups. In the controls there was a strong decrease in the red cell flux (RCF) on cold water exposure, while eight of the nine PD patients revealed no detectable change in RCF; in one patient only there was a less pronounced reaction. It was concluded that the regulation of the microcirculatory blood flow was affected in PD patients; the cold caloric reflex was attenuated or absent but there was no difference in the basal microcirculatory blood flow compared to normal subjects.

Changes in Vestibulo-ocular Reflex of Elderly People

Dizziness is a common symptom in elderly people. Head autorotation test (HART) has earlier shown no significant vestibulo-ocular reflex (VOR) disturbances in healthy elderly subjects. We used our recently developed HART to determine VOR in 14 elderly volunteers without otoneurological diseases and sedative medications. Gain and phase were determined in 5 frequency bands from 0.5 to 5 Hz. The gain of the elderly was significantly increased to 1.11–1.27 in the frequency range of 3–5 Hz compared with the controls. The phase lead of 7–8 degrees in the frequency bands of 2 and 4 Hz differed significantly from normative values of the controls. The percentage of the elderly to reach high-frequency head movements was diminished to 50% in the frequency band of 3 Hz and to 36% in the frequency band of 4 Hz (controls 100% and 95%, respectively). The individual HART results were abnormal in 86%) of the elderly. The high-frequency VOR of the elderly was inaccurate in magnitude and timing. More than half of aged subjects were not able to generate voluntary fast head movements. These findings may explain the high prevalence of dizziness and falls in elderly subjects.

Neurologic signs in lumbar disc herniation. Preoperative affliction and postoperative recovery in 150 cases.

We studied prospectively 165 consecutive patients operated on for lumbar disc herniations. Neurologic examination was performed preoperatively and at 4, 12, and 24 months postoperatively according to a protocol. Preoperatively 69% of the patients showed a neurological disturbance corresponding to the level of disc herniation and 62% a corresponding sensory deficit. Recovery of the neurological deficit was seen in half of the cases at 2 years postoperatively, the main part of this improvement occurred within 4 months after the operation. Neurologic recovery correlated to a good surgical outcome, and a short history of disc herniation prior to the operation correlated to postoperative neurologic improvement. The straight leg raising test correlated to preoperative neurologic deficit, but not to postoperative recovery. Motor power disturbance of the extensor hallucis longus muscle recovered in more patients than reflex disturbances. Sensory disturbances had the lowest recovery rate. Our study demonstrates a correlation between routine postoperative neurologic findings and the patient's self-assessed outcome of surgery.