Severity Of Neurological Symptoms Research Articles

Systemic effects of inhalational methyl bromide poisoning: a study of nine cases occupationally exposed due to inadvertent spread during fumigation.

Systemic methyl bromide (CH3Br) poisoning with signs and symptoms of varying severity developed in nine greenhouse workers after acute inhalational exposure on two consecutive days. Measurements of CH3Br, carried out at the site within hours after the accident, suggest that exposure on the second day may have been in excess of 200 ppm (800 mg/m3) CH3Br. All workers were admitted for observation. Seven of them were discharged after an uneventful overnight observation and residual symptoms, if any, subsided within three weeks of the accident. Two patients needed intensive care for several weeks because of severe reactive myoclonus and tonic-clonic generalised convulsions. These conditions were unresponsive to repeated doses of diazepam, clonazepam, and diphenylhydantoin but could be suppressed effectively by induction of a thiopental coma that had to be continued for three weeks. In some of the patients prior subchronic exposure to CH3Br, as shown by their occupational histories and high serum bromide (Br-) concentrations, is likely to have been a factor contributing to the severity of their symptoms. A direct association between serum Br- concentrations and the severity of neurological symptoms, however, seemed to be absent. An on site investigation into the circumstances leading to the accident showed the presence of an empty and out of use drainage system that covered both sections of the greenhouse. This was probably the most important factor contributing to the rapid and inadvertent spread of CH3Br.

Novel complications with HTLV-1-associated myelopathy/tropical spastic paraparesis: interstitial cystitis and persistent prostatitis.

Lower urinary symptoms associated with HTLV‐1‐associated myelopathy/tropical spastic paraparesis (HAM/TSF) are common, but have been regarded as ‘neurogenic’ due to spinal involvements. However, in some cases, these symptoms are persistent, progressive, and not directly correlated with the severity of other neurologic symptoms of the lower spinal cord. These findings prompted us to locate organic lesions in the lower urinary tract and to correlate them with HTLV‐1 infection. Among 35 HAM patients with lower urinary symptoms, we found 4 cases with the symptoms persistent and progressive: 3 with contracted bladder and another with persistent prostatitis. Histological or cytological examinations indicated local lymphocytic infiltrations in the lower urinary tract in all cases: 3 by the infiltration in the bladder and the other by a high concentration of lymphocytes in expressed prostatic secretions. Of 3 cases whose urinary samples were available, 2 showed significant increase in the concentration of urinary anti‐HTLV‐1 antibody of IgA class. The urinary IgA antibody of the third case was not elevated, but the sample had been obtained after resection of the affected bladder. None of the control cases showed significant anti‐HTLV‐1 IgA antibody in urine except for a case of gross hematuria due to chemotherapy directed against adult T‐cell leukemia. We suggest inclusion of these processes into the spectrum of complications for HAM/TSP. The elevated excretion of anti‐HTLV‐1 of IgA class in urine may be an indicator of these complications.

Personality variables, neurological and psychopathological symptoms in patients suffering from spasmodic torticollis

Thirty-two patients, suffering from idiopathic spasmodic torticollis (ST) since 9 ± 8 years, participated. In addition to a rating of the neurological symptoms (posture, reduced motility, rigidity, tremor, spasmodic movements, neck pain) and a psychiatric exploration, as well as two questionnaires on personality variables (Minnesota Multiphasic Personality Inventory [MMPI]) and coping styles (Millon Behavioral Health Inventory) were investigated. A control group of patients with Parkinson's disease also filled out both questionnaires. Three patients had another neurological and two another psychiatric disease. MMPI scores, in particular hypochondriasis, depression and hysteria, were highly elevated in approximately 50% of the patients and correlated with the severity of neurological symptoms (i.e., pain). Patients with Parkinson's disease had similar abnormal personality profiles. This resemblance between both patient groups indicates that psychiatric symptoms in ST are nonspecific and represent the consequence of a chronic disabling disease. Since among ST patients no distinct patterns of symptoms, psychiatric or psychological variables were found, no clinically relevant subgroup could be identified.

CT contrast enhancement on brain scans and blood-CSF barrier disturbances in cerebral ischemic infarction.

CT contrast enhancement of the ischemic infarction, blood-CSF barrier function for albumin, and severity of neurological symptoms were evaluated at predefined intervals in 41 patients with supratentorial ischemic infarctions. Contrast enhancement was most frequently observed in the 2nd and 3rd week after the stroke. This late CT enhancement was not related to infarction size and severity of blood-CSF barrier disturbance. The rare appearance of CT enhancement in the 1st week was usually associated with extensive infarctions and accompanied by blood-CSF barrier disturbances. These barrier disturbances, which occurred with higher frequency and greater severity in extensive infarctions (peak 3rd day), generally persisted for several weeks. We suggest that contrast enhancement in the 1st week after an ischemic stroke is due to diapedesis from necrotic capillaries; the more frequently observed late enhancement might be the result of a blood-brain barrier disturbance which in turn is hypothetically attributed to increased pinocytotic activity of regenerated endothelial cells.

Calcium antagonist PY 108-068: demonstration of its efficacy in various types of experimental brain ischemia.

The protective properties of PY 108-068 against ischemic disturbances in the brain were investigated in vitro and in vivo. The calcium antagonistic effects were demonstrated on isolated, calcium-loaded arterial rings of feline cerebral arteries. Determination of brain tissue oxygenation with pO2 microelectrodes showed that PY 108-068 improved oxygen supply in the cortex of cats subjected to epicerebral arterial occlusion. In a model of cerebral vasospasm induced by autologous blood superfusion, PY 108-068 reversed the spastic state of cortical microvessels. In a chronic stroke model (microsphere embolization in rats) PY 108-068 led to a significant reduction in mortality and in the severity of neurological symptoms, whereby the peroral efficacy of the drug could be demonstrated. The efficacy of PY 108-068 in a variety of ischemic insults makes this drug a promising aid in the treatment of cerebrovascular accidents.

Is siphon disease important in predicting outcome of carotid endarterectomy?

The prevalence of atherosclerosis at the carotid bifurcation and in the siphon was reviewed in 141 patients who underwent 149 endarterectomies. The relationship between the presence and severity of siphon lesions and focal neurologic symptoms, both before and after operation, was also examined. Siphon disease was found in 84% of the 282 sides. Most lesions (42%) were in the 20% to 49% diameter-reduction category. Only 9% were stenoses greater than 50%, and 10% were occlusions. The majority (65%) were smooth. No relationship was found between the severity of disease at the carotid bifurcation and in the siphon. No pattern of siphon disease could be related to the occurrence of symptoms. Furthermore, no relation was found between the severity of siphon disease and recurrent symptoms after endarterectomy.

Biochemical changes during graded brain ischemia in gerbils: Part 2. Regional evaluation of cerebral blood flow and brain metabolites

Regional changes of cerebral blood flow and biochemical substrates were assessed in the gerbil brain following different grades of cerebral ischemia. Ischemia was produced by occlusion of the right common carotid and left external carotid arteries. Gerbils were classified according to the severity of neurological symptoms as animals without, with mild and with severe neurological deficits. Brains were frozen in situ, sliced in 20-μm sections and processed for pictorial presentation of glucose and ATP, using bioluminescence techniques. Cerebral blood flow was determined in adjacent brain sections, using [ 14C]iodoantipyrine autoradiography. NADH fluorescence was recorded by illuminating the surface of the tissue block with ultraviolet light. Most animals without visible neurological symptoms exhibited reduced blood flow in circumscribed regions of cortex and basal ganglia of the right hemisphere without concomitant changes of biochemical substrates. In animals with mild neurological symptoms, blood flow in the right hemisphere was reduced, glucose and ATP decreased, and NADH fluorescence inhomogeneously enhanced. In animals with severe neurological symptoms blood flow was almost arrested in the right hemisphere and was distinctly reduced in the medial parts of the left hemisphere. The ischemic tissue was depleted from glucose and ATP, and exhibited bright NADH fluorescence. The severity of neurological symptoms, in consequence, correlated closely with both the degree and the size of biochemical lesions observed in the ischemic territory.

Ethambutol Neuropathy: Clinical and Electroneuromyographic Studies

Clinical features including changes in the peripheral nerve conduction were analzyed in 10 cases with ethambutol neuropathy. There were abnormalities in the visual field in seven and optic atrophy in five of 10 cases. Seven of 10 cases complained of numbness in the lower limbs. The age of onset and dose of ethambutol the patients continue to take after the occurrence of visual impairment were found to be important in determining the severity of neurological symptoms. A functional disturbance was more conspicuous in ethambutol neuropathy, particularly in the sensory system than in the motor system so far as the peripheral nerve conduction was serially examined. Some cases still had serious optic disturbances even about seven years after the onset of the disease and the presence of irreversible lesions was suspected.

Bony Anomalies with Neurological Symptoms in the Upper Cervical Region

The interesting cases of bony anomalies with various neurological symptoms in the upper cervical region were presented to discuss the relationship between the degree of bony anomalies and the severity of neurological symptoms.Case 1: acute complete quadriplegia due to atlantoaxial dislocation with os odontoideum.Case 2: Klippel-Feil syndrome with spondylotic myelopathy.Case 3: atlantooccipital assimilation with the severe symptoms of the brain stem and the upper cervical cord.Case 4: Arnold-Chiari malformation with remarkable cerebellar symptoms.Craniometry concerning the diagnosis of basilar impression was done on the x-ray films. All of the cases were accompanied with the various degree of basilar impression.In conclusion, the severity of neurological symptoms was in proportion to the degree of the narrowing of the foramen magnum and the cervical canal.

Spasmodic torticollis

Thirty-two patients, suffering from idiopathic spasmodic torticollis (ST) since 9 ± 8 years, participated. In addition to a rating of the neurological symptoms (posture, reduced motility, rigidity, tremor, spasmodic movements, neck pain) and a psychiatric exploration, as well as two questionnaires on personality variables (Minnesota Multiphasic Personality Inventory [MMPI]) and coping styles (Millon Behavioral Health Inventory) were investigated. A control group of patients with Parkinson's disease also filled out both questionnaires. Three patients had another neurological and two another psychiatric disease. MMPI scores, in particular hypochondriasis, depression and hysteria, were highly elevated in approximately 50% of the patients and correlated with the severity of neurological symptoms (i.e., pain). Patients with Parkinson's disease had similar abnormal personality profiles. This resemblance between both patient groups indicates that psychiatric symptoms in ST are nonspecific and represent the consequence of a chronic disabling disease. Since among ST patients no distinct patterns of symptoms, psychiatric or psychological variables were found, no clinically relevant subgroup could be identified.

Spasmodic torticollis: A psychogenic condition?

Thirty-two patients, suffering from idiopathic spasmodic torticollis (ST) since 9 ± 8 years, participated. In addition to a rating of the neurological symptoms (posture, reduced motility, rigidity, tremor, spasmodic movements, neck pain) and a psychiatric exploration, as well as two questionnaires on personality variables (Minnesota Multiphasic Personality Inventory [MMPI]) and coping styles (Millon Behavioral Health Inventory) were investigated. A control group of patients with Parkinson's disease also filled out both questionnaires. Three patients had another neurological and two another psychiatric disease. MMPI scores, in particular hypochondriasis, depression and hysteria, were highly elevated in approximately 50% of the patients and correlated with the severity of neurological symptoms (i.e., pain). Patients with Parkinson's disease had similar abnormal personality profiles. This resemblance between both patient groups indicates that psychiatric symptoms in ST are nonspecific and represent the consequence of a chronic disabling disease. Since among ST patients no distinct patterns of symptoms, psychiatric or psychological variables were found, no clinically relevant subgroup could be identified.