Acta neurologica Scandinavica. Supplementum最新文献

{"title":"Tomographic cerebral blood flow measurements in patients with ischemic cerebrovascular disease and evaluation of the vasodilatory capacity by the acetazolamide test.","authors":"S Vorstrup","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cerebral blood flow (CBF) was measured in a series of patients with ischemic cerebrovascular disease using xenon-133 inhalation and single photon emission computer tomography. The spontaneous course of CBF changes in a consecutive series of stroke patients was evaluated. A quite heterogeneous pattern of flow changes was observed: In patients with large cortical/subcortical infarcts, extensive hypoperfused areas were observed, often significantly larger than the corresponding hypodense lesion on the CT scan. Smaller CT lesions caused relatively smaller flow changes. Patients with lacunar infarcts showed only a discrete reduction of CBF, but comprising most of the ipsilateral hemisphere. Repeated CBF studies in the chronic phase showed, that the clinical improvement commonly noted in stroke patients is not related to a CBF increase. On the contrary, the CBF lesions tended to become somewhat larger and more demarcated even in cases where the finding of a normal angiogram and a transient state of hyperemia suggested a dissolution of the intracerebral embolus. The pathogenetic mechanisms for these persisting low flow areas in CT intact structures was discussed. One possibility was a selective neuronal cell damage in the peri-infarct areas caused by the ischemic insult. Such lesions would leave the structures macroscopically intact, but decrease both the metabolic demands and CBF. However, this interpretation finds little support in recent microscopic neuropathological studies in man. A more likely possibility was then considered to be disconnection (diaschisis) where the reduced flow is due to a decreased neuronal function caused by undercutting of afferent or efferent nervefibers. A crossed cerebellar diaschisis was observed in all patients with major infarcts in the forebrain. These findings were observed already in the acute phase, but persisted quite unchanged throughout the subacute and chronic phases. The patients with lacunar infarcts showed cerebellar diaschisis in the acute phase only, suggesting that a transient suppression of remote areas is possible too. In order to differentiate between permanent flow changes caused by a functional impairment and a possible hemodynamic component, CBF was measured before and after administration of a potent cerebral vasodilator, acetazolamide (Diamox). In normal cases tested with Diamox, an even CBF increase is noted throughout the hemispheres, while the cerebral metabolic rate for oxygen remains stable. In patients having a severe stenosis or occlusion of the internal carotid artery, this vasodilatory stress test will identify the patients having poor collateral capacity via the circle of Willis.(ABSTRACT TRUNCATED AT 400 WORDS)</p>","PeriodicalId":75395,"journal":{"name":"Acta neurologica Scandinavica. Supplementum","volume":"114 ","pages":"1-48"},"PeriodicalIF":0.0,"publicationDate":"1988-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14386916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical treatment of epilepsy. Proceedings from a workshop. Denmark, May 17-19, 1987.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75395,"journal":{"name":"Acta neurologica Scandinavica. Supplementum","volume":"117 ","pages":"1-154"},"PeriodicalIF":0.0,"publicationDate":"1988-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14306465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical treatment of epilepsy. Clinical aspects in children.","authors":"O Henriksen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Neurosurgery, mainly temporal lobectomy, has given substantial relief of serious seizure problems in two-thirds of children with intractable epilepsy. Since the prognoses of children with an intractable epilepsy is poor, surgery should be considered. To prevent sequela of a long standing seizure disorder and side effects of antiepileptic medication as well as the development of mirror foci, surgery should be considered at an early age. The age at which surgery should be undertaken depends upon several factors, for instance: the seizure problem, the EEG findings--are they persistently focal and do they fit with the seizures? Is there a malignant development of the epilepsy and little or no chance of remission? And especially, if there is brain pathology in concordance with the clinical findings and EEG signs, neurosurgery should not be postponed. It is of great advantage for children with an intractable epilepsy to be evaluated at an epilepsy center. Both the children and their parents will profit from the evaluation and information gained as well as education by a multiprofessional team. This will optimise the difficult decision process which may lead to neurosurgery.</p>","PeriodicalId":75395,"journal":{"name":"Acta neurologica Scandinavica. Supplementum","volume":"117 ","pages":"47-51"},"PeriodicalIF":0.0,"publicationDate":"1988-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14306470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proceedings of the 27th Scandinavian Congress of Neurology. Kuopio, Finland, June 15-18, 1988.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75395,"journal":{"name":"Acta neurologica Scandinavica. Supplementum","volume":"116 ","pages":"1-145"},"PeriodicalIF":0.0,"publicationDate":"1988-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14295425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Studies on activation variables in multiple sclerosis.","authors":"S Fredrikson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The study aimed to evaluate the usefulness of some selected immune variables as markers of disease activation, progression and possible etiopathogenesis of multiple sclerosis (MS). Levels of neopterin, a factor known to be released from macrophages and monocytes at increased rates in cellular immune reactions were higher in cerebrospinal fluid (CSF) from patients with MS during exacerbations in comparison with remissions. The elevation in CSF during exacerbations was not reflected in serum. Expression of HLA class II antigens (DR) on activated T lymphocytes in CSF were encountered at elevated percentage in only 10% of patients with MS, against 81% of patients with acute aseptic meningoencephalitis (AM). In patients with AM, the DR expression on CSF T cells was found on both CD8+ and CD4+ cells. There was no correlation between percentage of DR+ T cells in CSF and disability, exacerbation/remission or recent onset of disease in patients with MS. Phenotypic characterization of mononuclear cells in CSF and peripheral blood revealed increased proportion of CD5+ cells in CSF compared to peripheral blood which in MS was not reflected by any changes in CD4+ or CD8+ cells, while in AM the increase of CD5+ cells in CSF was followed by increase of CD4+ cells. A population of CD5+, CD8-, CD4- cells might be postulated to occur in MS CSF. Levels of CD8+ cells in peripheral blood and CSF did not fluctuate in parallel with disease activity as measured as clinical exacerbation. OKB7+, OKM1+ and HLA-DR+ cells differed significantly between CSF and peripheral blood, indicative of a selective passage of cells into the central nervous system (CNS) - CSF compartment. Proliferating cells expressing transferrin receptors (OKT9) were generally few or absent in CSF of patients with MS. MS patients' bone marrow mononuclear cells showed higher spontaneous proliferation both in comparison with cells from bone marrow of control subjects and peripheral blood lymphocytes from MS patients. PHA response of bone marrow mononuclear cells from MS patients was also higher than that from controls. There was, however, no significant difference in proliferative response of peripheral blood lymphocytes between MS patients and controls. Seven of 11 MS patients showed morphological signs of activation in their bone marrow, without correlation to patients' clinical condition. Higher levels of undifferentiated or activated cells, measured as OKT10+ cells were found in peripheral blood of patients with MS compared to controls.(ABSTRACT TRUNCATED AT 400 WORDS)</p>","PeriodicalId":75395,"journal":{"name":"Acta neurologica Scandinavica. Supplementum","volume":"115 ","pages":"1-103"},"PeriodicalIF":0.0,"publicationDate":"1988-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13976733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracranial pressure: cerebrospinal fluid dynamics and pressure-volume relations.","authors":"M Kosteljanetz","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Continuous measurement of the intracranial pressure (ICP) is routine in todays evaluation of various intracranial diseases and increased ICP is a common therapeutical problem in neurosurgical patients. Still, very little is known about the patho-physiological and biomechanic events that lead to increased ICP. ICP is governed by 1) the resistance to absorption of cerebrospinal fluid (Rout), 2) the production rate of CSF (If) (taken together Rout and If are referred to as the \"CSF dynamics\"), and 3) the pressure in the Sagittal Sinus (Pss) in accordance with the equation: ICP = If X Rout + Pss. When an intracranial mass grows the cranio-spinal volume buffering capacity is exhausted and the ICP subsequently rises. This event has been imitated in experiments and is described by the classical exponential pressure-volume curve. In a semilogarithmic coordinate system the curve will be linear and if one exchanges the abscissa and ordinate (x = log ICP, y = volume) the slope is the pressure-volume index (PVI). In normal adults PVI = 25 ml and defines the volume that theoretically will increase the ICP tenfold when injected into the CSF space. The main goal of the present study was to analyse the ICP in accordance with the above mentioned principles by measurements of Rout and the PVI. Furthermore, to evaluate the PVI method (synonymous with the \"bolus injection\" method) described by Marmarou and coworkers. By this method a bolus of a few milliliters of fluid is injected into the ventricles via an intraventricular cannula. PVI is computed based on the immidate ICP rise. The following slowlier ICP decrement defines the Rout. Another goal was to analyse whether measurements of the ICP pulse amplitude, which cancels the need of manipulations of the CSF space, could replace PVI measurements. Finally, to evaluate whether or not CT of the brain depicts pressure-volume relations and Rout in adult patients with hydrocephalus. The study comprised 63 patients with subarachnoid haemorrhage, cranio-cerebral injury or so-called normal-pressure hydrocephalus. The following variables were measured: 1) ICP, 2) pulseamplitude, 3) PVI and 4) Rout. The latter was measured by means of the PVI method and in some instances for reasons of comparison with the constant rate infusion technique and \"controlled withdrawal\". The main conclusions of the studies were: 1) For estimates of PVI the bolus injection technique was applicable. For Rout measurements the method was only safe at relatively low ICP levels.(ABSTRACT TRUNCATED AT 400 WORDS)</p>","PeriodicalId":75395,"journal":{"name":"Acta neurologica Scandinavica. Supplementum","volume":"111 ","pages":"1-23"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14599527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Studies on the prevalence of paralysis agitans by tracer methodology.","authors":"J de Pedro Cuesta","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The present study was motivated by the methodological issues revealed by a review of previous studies on Paralysis Agitans (PA) epidemiology. The study was given the following aims: To identify an easy available, inexpensive marker of PA frequency in populations; to develop, standardize and validate a model for measurement of PA prevalence by using that tracer; to study the geographical distribution of PA in Sweden, and to use the model in environmental risk analysis (ERA) for PA. Information on diagnoses and anti-parkinsonian drugs (APD) utilization from Swedish registers was analyzed, in order to select the group of APD which would best fulfill the prerequisites of specificity and preference of choice, and combined with prevalence data from direct surveys. Levodopa drugs were found to be the most suitable tracer for PA prevalence. A mathematical model was formulated to generate annual estimates for average age specific prevalences from total sales of levodopa, age specific population and figures for infant mortality rates. The following was required in order for the model to yield accurate estimates: high quality of the information to be used, good availability of levodopa drugs, a minimal size of the studied population of 100,000, an IMR lower than 28.8 per 1000 and that levodopa diffusion had reached the late adoption phase. Underdiagnosis was found to constitute an important cause of bias in classical surveys. Standardization for age and health services effectiveness by using infant mortality rates was shown to improve comparability of prevalence figures. The model was validated and showed internal consistency for age specific data on levodopa sales and on prevalence from Sweden and six Chinese towns, respectively. Estimates for prevalence for Iceland and Sardinia fitted historical data from direct surveys. The results of the ERA study showed that a high latitude and a low population density in 1900-20 were correlated with an increase in PA prevalence as measured by surveys or estimated by the use of the tracer method. Further analysis indicated that several so-called risk factors or concomitant diseases are associated with low population density. The geographical distribution of standardized PA prevalences in Swedish counties was studied for the period 1977-84. The findings were in accordance with the figures expected from the natural characteristics of the disease as determined by latitude and population density except in the county of Gävleborg which showed a significantly higher, and continuously increasing prevalence.(ABSTRACT TRUNCATED AT 400 WORDS)</p>","PeriodicalId":75395,"journal":{"name":"Acta neurologica Scandinavica. Supplementum","volume":"112 ","pages":"1-106"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14431997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral blood flow in migraine and cortical spreading depression.","authors":"M Lauritzen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Migraine is a common disease which expresses itself by paroxysmal headache, commonly accompanied by transient neurological symptoms. There are at the moment two important theories concerning the cerebral mechanisms of migraine: The vascular theory which attributes migraine to spasm of a cerebral artery causing local hypoxia and transient focal symptoms followed by neurogenically mediated extra- and/or intracranial vasodilation causing headache, i.e. migraine is understood in terms of a primary perturbation of blood vessel function. Another, but neglected viewpoint relates migraine to a paroxysmal, transient depolarization of primarily cortical neurones causing transient focal symptoms and headache, i.e. migraine is understood in terms of a primary perturbance of neuronal function. This review summarizes clinical and experimental studies concerning these two theories with special emphasis on classic migraine, i.e. paroxysmal headache accompanied by focal symptoms of short duration. At begin of the classic migraine attack regional cerebral blood flow (rCBF) declines in the posterior part of the brain. Subsequently the hypoperfused region expands anteriorly, independent of the territories of supply of the large cerebral arteries. This observation speaks clearly against reduced perfusion as consequence of arterial spasm. The rate of spread of the reduced perfusion is about 2 mm/min and the changes of perfusion appear to follow the cortex corresponding to the convexities. Tests of regulation of rCBF show normal blood pressure autoregulation, but reduced responsiveness to change of arterial carbon dioxide tension and in response to mental activation. These observations are consistent with arteriolar vasoconstriction as cause of reduced perfusion. Vascular tone at the arteriolar level is, however, mainly determined by local factors, and change of local neuronal function could therefore be the basis of increased arteriolar tone and reduced rCBF. Analysis of the time course of perfusion reduction and symptoms reveals that perfusion frequently declines before the patient experiences any focal symptoms. The focal symptoms frequently start after spread of the hypoperfusion has begun, but usually ceases altogether within another 30 minutes, while the reduced perfusion persists for a couple of hours, when the patient suffers from headache. This temporal relationship between symptoms and rCBF changes precludes that the focal symptoms are secondary to reduced rCBF. Furthermore, migraine headache is not related to increased rCBF. On this background the acute migraine attack can hardly be explained by a primary arterial vasospasm.(ABSTRACT TRUNCATED AT 400 WORDS)</p>","PeriodicalId":75395,"journal":{"name":"Acta neurologica Scandinavica. Supplementum","volume":"113 ","pages":"1-40"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14451964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seizures of childhood. A population-based and clinic-based study.","authors":"T Tsuboi","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75395,"journal":{"name":"Acta neurologica Scandinavica. Supplementum","volume":"110 ","pages":"1-237"},"PeriodicalIF":0.0,"publicationDate":"1986-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14586931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hereditary ataxias. Occurrence and clinical features.","authors":"L Werdelin","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75395,"journal":{"name":"Acta neurologica Scandinavica. Supplementum","volume":"106 ","pages":"1-124"},"PeriodicalIF":0.0,"publicationDate":"1986-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14585316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}