Journal of Neurology, Neurosurgery and Psychiatry articles from September 2003

Journal of Neurology, Neurosurgery and Psychiatry archives from September 2003

Priority setting: learning to make tough decisions; the costs of trying to provide modern medical care for all who could potentially benefit exceed the capacity of most countries.(Priority setting)
September 1, 2003... Priority setting (also termed resource allocation) for healthcare expenditure is inevitable in all societies, even the most affluent. (1) New technologies are the dominant driving forces. (2) Although these advances have been successful both in...

Acetylcholinesterase inhibition in the treatment of hypotension; pyridostigmine reduces tilt induced hypotension.(Acetylcholinesterase inhibition)
September 1, 2003... Assuming an upright posture causes translocation of approximately 800 ml of blood from the intrathoracic venous compartment to veins of the buttocks, pelvis, and legs. The bulk of venous pooling occurs within the first 10 seconds and the total...

Mitochondria.(Neuroscience for Neurologists)
September 1, 2003... Following the discovery in the early 1960s that mitochondria contain their own DNA (mtDNA), there were two major advances, both in the 1980s: the human mtDNA sequence was published in 1981, and in 1988 the first pathogenic mtDNA mutations were...

Intrathecal inflammation precedes development of Alzheimer's disease.(Paper)
September 1, 2003... Objectives: To analyse the cerebrospinal fluid (CSF) values of the proinflammatory cytokines, interleukin 1[beta] (IL1[beta]), tumour necrosis factor a (TNF[alpha]), GM-CSF, of the anti-inflammatory cytokine TGF[beta], of tau protein, a marker...

The prevalence and causes of dementia in people under the age of 65 years.(Paper)
September 1, 2003... Objectives: To determine the prevalence of dementia in people under the age of 65 in a large catchment area, and use these figures to estimate the number of younger people affected by dementia in the UK. Design: Epidemiological catchment...

A prospective study of CSF markers in 250 patients with possible Creutzfeldt-Jakob disease.(Paper)
September 1, 2003... Objective: To investigate various cerebrospinal fluid (CSF) markers that could assist in the clinical diagnosis of Creutzfeldt-Jakob disease (CJD). Methods: CSF samples were analysed for the presence of 14-3-3 protein, microtubule...

Performance on the dementia rating scale in Parkinson's disease with dementia and dementia with Lewy bodies: comparison with progressive supranuclear palsy and Alzheimer's disease.(Paper)
September 1, 2003... Background: The relation between dementia with Lewy bodies (DLB) and Parkinson's disease with dementia (PDD) is unknown. Objectives: To compare the cognitive profiles of patients with DLB and PDD, and compare those with the performance of...

Dietary treatment of gluten ataxia.(Paper)
September 1, 2003... Background: Gluten ataxia is an immune mediated disease, part of the spectrum of gluten sensitivity, and accounts for up to 40% of cases of idiopathic sporadic ataxia. No systematic study of the effect of gluten-free diet on gluten ataxia has...

A randomised controlled trial comparing rehabilitation against standard therapy in multiple sclerosis patients receiving intravenous steroid treatment.(Paper)
September 1, 2003... Background: There is evidence to support both the use of intravenous methylprednisolone (IVMP) in multiple sclerosis (MS) relapse and physiotherapy in the management of MS, but no studies have investigated the combination of steroids and...

Working memory deficits in multiple sclerosis: a controlled study with auditory P600 correlates.(Paper)
September 1, 2003... Background: Recently, the P600 component of event related potentials, a waveform that is conceived to be generated and/or modulated by basal ganglia and cingulate area has been considered an index of the completion of any synchronised operation...

A sensitive radioimmunoprecipitation assay for assessing the clinical relevance of antibodies to IFN [beta].(Paper)
September 1, 2003... Background: Some multiple sclerosis (MS) patients treated with interferon beta (IFN [beta]) develop antibodies to the drug. Neutralising antibody (NAB) assays for IFN [beta] are expensive and the clinical relevance of the results has been...

Contralateral medial temporal lobe damage in right but not left temporal lobe epilepsy: a [sup.1]H magnetic resonance spectroscopy study.(Paper)
September 1, 2003... Background: Proton magnetic resonance spectroscopy (MRS) of the hippocampus is useful in lateralising the epileptic focus in temporal lobe epilepsy for subsequent surgical resection. Previous studies have reported abnormal contralateral MRS...

Acute childhood hemiplegia.(Historical Note)
September 1, 2003... Acute hemiplegia in childhood has many causes. Many are vascular, some follow trauma or a variety of encephalitides. Carotid and other basal vascular occlusions may result from cardiac emboli, angiomata, small vessel disease, or in some cases...

Amygdala volumetry in "imaging-negative" temporal lobe epilepsy.(Paper)
September 1, 2003... Objective: Although amygdala abnormalities are sometimes suspected in "imaging-negative" patients with video EEG confirmed unilateral focal epilepsy suggestive of temporal lobe epilepsy (TLE), amygdala asymmetry is difficult to assess visually....

Diffusion tensor imaging detects corticospinal tract involvement at multiple levels in amyotrophic lateral sclerosis.(Paper)
September 1, 2003... Background: Histopathological studies of amyotrophic lateral sclerosis (ALS) are of end stage disease. Diffusion tensor imaging (DTI) provides the opportunity to investigate indirectly corticospinal tract pathology of ALS in vivo. Methods:...

Effect of a multidisciplinary amyotrophic lateral sclerosis (ALS) clinic on ALS survival: a population based study, 1996-2000.(Paper)
September 1, 2003... Background: In recent years, there has been a paradigm shift in the method of healthcare delivery to amyotrophic lateral sclerosis (ALS) patients with the emergence of multidisciplinary ALS clinics that cater exclusively for patients with this...

Serum IgG antibodies to P0 dimer and 35 kDa P0 related protein in neuropathy associated with monoclonal gammopathy.(Paper)
September 1, 2003... Background: Peripheral neuropathies (PN) associated with monoclonal gammopathy (MG) are widely considered as autoimmune disorders, but the putative role of incriminated antigens is still not understood. Objective: Fifty five patients with...

Peripheral neuropathy in hepatitis C virus infection with and without cryoglobulinaemia.(Paper)
September 1, 2003... Objectives: Hepatitis C virus (HCV) infection is often associated with cryoglobulinaemia (CG). Peripheral neuropathy (PN) is a comparatively common complication of CG associated with HCV infection and it is thought to be attributable to nerve...

Pubcrawler: www.pubcrawler.ie.(Neuronline)
September 1, 2003... All of us suffer from significant difficulty in keeping up to speed with the neurological literature. One study suggested that a dedicated doctor would have to read no less than 17 scientific articles a day, in order to keep pace with the...

CSF galanin and cognition after shunt surgery in normal pressure hydrocephalus.(Paper)
September 1, 2003... Background: "Normal" pressure hydrocephalus (NPH) is associated with injury to neurotransmitter and neuropeptide systems that recovers after surgery. This could be linked to changes in galanin, a neuropeptide with inhibitory effects on basal...

Charcot on "provoked trepidation", or clonus.(Historical Note)
September 1, 2003... The classic signs of upper motor neurone lesions became recognised in the second half of the 19th century. Charcot and his colleagues first distinguished them from the flaccid weakness of poliomyelitis, posterior column lesions (locomotor...

The effect of brain tumour laterality on anxiety levels among neurosurgical patients.(Paper)
September 1, 2003... Objectives: The aim of this study was to investigate the level of anxiety in patients with a primary, brain tumour and to analyse the effect of tumour laterality and histology on the level of anxiety. Recurrent measurements were assessed...

Focused high frequency repetitive transcranial magnetic stimulation for localisation of the unexposed primary motor cortex during brain tumour surgery.(Paper)
September 1, 2003... Objectives: To investigate if intraoperative focused high frequency repetitive transcranial magnetic stimulation (rTMS) can localise the primary motor cortex without exposure of the cortical surface. Methods: A high frequency train (357 Hz)...

Clinical experience with gamma knife stereotactic radiosurgery in the management of vestibular schwannomas secondary to type 2 neurofibromatosis.(Paper)
September 1, 2003... Objective: To evaluate the results of stereotactic radiosurgery treating vestibular schwannomas secondary to type 2 neurofibromatosis. Methods: A retrospective review of 122 type 2 neurofibromatosis vestibular schwannomas consecutively...

Acetylcholinesterase inhibition: a novel approach in the treatment of neurogenic orthostatic hypotension.(Paper)
September 1, 2003... Background: Pharmacological treatment of orthostatic hypotension is often limited because of troublesome supine hypertension. Objective: To investigate a novel approach to treatment using acetylcholinesterase inhibition, based on the theory...

Access to intensive care unit beds for neurosurgery patients: a qualitative case study. (Paper>.
September 1, 2003... Objectives: The purpose of this study was to describe the process used to decide which patients are admitted to the intensive care unit (ICU) at a hospital with special focus on access for neurosurgery patients, and evaluate it using...

Effects of levodopa on upper limb mobility and gait in Parkinson's disease.(Short Report)
September 1, 2003... Background: Most clinicians rely on clinical scales such as the unified Parkinson's disease rating scale (UDPRS) for evaluating parkinsonian patients and assessing their response to levodopa. Gait analysis is not commonly used, probably because...

Physical anhedonia in Parkinson's disease.(Short Report)
September 1, 2003... Besides motor and cognitive symptoms, affective and behavioural disturbances are often observed during the course of Parkinson's disease (PD). (1) Attention of clinicians and researchers has classically focused on depression, although other...

A case of manganese induced parkinsonism in hereditary haemorrhagic telangiectasia.(Short Report)
September 1, 2003... A 44 year old right handed woman complained of difficulty in moving. She and her relatives had skin telangiectasia or recurrent epistaxis. On neurological examination, she had a mask-like facies and bradykinesia in both extremities. Laboratory...

Predictors of institutionalisation in people with dementia.(Short Report)
September 1, 2003... Objective: To identify what patient and carer characteristics influence transition into residential care for people with dementia. Method: Longitudinal study of a cohort of people with dementia and their carers in contact with old age...

Myalgia as the revealing symptom of multicore disease and fibre type disproportion myopathy.(Short Report)
September 1, 2003... Background: Multicore disease and congenital fibre type disproportion myopathy are diseases assigned to the heterogeneous group of congenital myopathies. Although hypotonia and muscle weakness appearing in early life are the commonest...

Sjogren's syndrome associated painful sensory neuropathy without sensory ataxia.(Short Report)
September 1, 2003... Sensory neuropathy with prominent ataxia reflecting kinesthetic sensory impairment is a well recognised form of neuropathy associated with Sjogren's syndrome. (1-4) Pathologically, T cell invasion of dorsal root ganglia, loss of large sensory...

Brain stem encephalitis caused by primary herpes simplex 2 infection in a young woman.(Short Report)
September 1, 2003... A 27 year old woman developed a vesicular genital rash and cerebellar dysfunction with progressive neurological deterioration suggesting brain stem encephalitis. Respiratory support was required. Magnetic resonance imaging (MRI) of the brain on...

Superficial siderosis of the central nervous system many years after neurosurgical procedures.(Short Report)
September 1, 2003... Recurrent haemorrhage into the subarachnoid space causes superficial siderosis, which clinically manifests as cerebellar ataxia, sensorineural hearing loss, and myelopathy. Two patients developed clinical, radiological, and biochemical evidence...

Transcutaneous cervical root stimulation in the diagnosis of multifocal motor neuropathy with conduction block.(Short Report)
September 1, 2003... Multifocal motor neuropathy (MMN) classically presents as a chronic, progressive, asymmetrical, predominantly distal, upper limb weakness with variable degrees of atrophy and minimal or no sensory abnormalities. (1-4) The clinical picture...

Anti-Ma2 antibody related paraneoplastic limbic/brain stem encephalitis associated with breast cancer expressing Ma1, Ma2, and Ma3 mRNAs.(Short Report)
September 1, 2003... Paraneoplastic neurological syndromes are neurological degenerative disorders that occur in patients with neoplasms outside the nervous system, associated with anti-neuronal cell antibodies that provide antitumour immunity. Fifty per cent of...

Cerebrotendinous xanthomatosis.(Neurological Picture)
September 1, 2003... A 37 year old patient was admitted for a generalised seizure. He was treated with valproic acid for partial epilepsy. Neurological examination revealed a cerebellar and pyramidal syndrome, moderate mental retardation, and enlargement of...

Anterior canal failure: ocular torsion without perceptual tilt due to preserved otolith function.(Short Report)
September 1, 2003... Healthy subjects are able to adjust their subjective visual vertical (SVV) within a precision of [+ or -][2.5.sup][degrees] when placed in front of an unstructured background providing no cues for visual orientation. This ability is attributed...

Severe infantile hyperkalaemic periodic paralysis and paramyotonia congenita: broadening the clinical spectrum associated with the T704M mutation in SCN4A.(Short Report)
September 1, 2003... Hyperkalaemic periodic paralysis (hyperPP) and paramyotonia congenita (PMC) are autosomal dominant allelic diseases caused by mutations in the skeletal muscle voltage gated sodium channel gene (SCN4A) on chromosome 17q23. (1) HyperPP is...

Splinting for carpal tunnel syndrome: prognostic indicators of success.(Short Report)
September 1, 2003... Carpal tunnel syndrome (CTS) is a common disorder, (1 2) for which several conservative (3) and surgical (4) treatment options are available. A randomised controlled trial (RCT) comparing splinting and surgery for the treatment of CTS reported...

Hereditary diffuse leucoencephalopathy with spheroids.(Short Report)
September 1, 2003... A 45 year old white woman presented with a 16 month history of progressive cognitive decline characterised by depressive symptoms: emotional blunting, lack of spontaneity, lack of initiation, and disturbed diurnal rhythm. The patient had...

Hypothalamic amnesia and frontal lobe function disorders after Langerhans cell histiocytosis.(Letters)
September 1, 2003... Langerhans cell histiocytosis (LCH), a rare disease previously known as histiocytosis X, is characterised by abnormal cell proliferation. If the CNS is invaded, the hypothalamus is the typical site location. There are virtually no...

Meningioma of the optic nerve sheath: treatment with hydroxyurea.(Letters)
September 1, 2003... The best treatment of optic nerve sheath meningiomas remains controversial. Recent reports have emphasised the efficacy of fractionated stereotactic or conformal radiotherapy, and some clinicians favour this approach instead of surgery or...

Recurrent anti-GQ1b IgG antibody syndrome showing different phenotypes in different periods.(Letters)
September 1, 2003... Anti-GQ1b IgG antibody is often found in the sera of patients with Miller Fisher syndrome, Bickerstaff's brain stem encephalitis, Guillain-Barre syndrome with ophthalmoplegia, acute ophthalmoparesis without ataxia, and occasionally, in isolated...

Sydenham's chorea may be a risk factor for drug induced parkinsonism.(Letters)
September 1, 2003... Sydenham's chorea, the most common cause of acquired chorea in childhood, is a delayed complication of group A [beta]-haemolytic streptococcal infection. (1) It is thought to be caused by antibodies induced by streptococci which cross react...

Comparison of the tendon and plantar strike methods of eliciting the ankle reflex.(Letters)
September 1, 2003... Little work has evaluated the various ways of eliciting the ankle reflex. A previous study of elderly patients with normal/absent reflexes found greater intraobserver and interobserver agreement with the plantar compared with the tendon strike...

Mirror movements of the non-affected hand in hemiparkinsonian patients: a reflection of ipsilateral motor overactivity?(Letters)
September 1, 2003... Mirror movements may result from a primary motor efferent system dysfunction with secondary motor reorganisation. A profound dysfunction of the motor pathways has been reported in Parkinson's disease (PD) during execution of motor tasks. (1 2)...

Calculation of the resistance to CSF outflow.(PostScript)(Letter to the Editor)
September 1, 2003... We read the paper by Kahlon et al with great interest. (1) Comparative studies about the use of different diagnostic techniques to predict the response to shunting in hydrocephalus are of great value as they are likely to form a landmark for...

Myasthenia Gravis and Related Disorders.(Book Review)
September 1, 2003... Edited by H J Kaminski. The Humana Press, Totowa, 2002, US$125.00, pp 396. ISBN 1 58829 058 1 This is a scientific and clinical review of myasthenia gravis (MG) with chapters on Lambert-Eaton syndrome, congenital myasthenic syndromes,...

Spinal Cord Medicine, Principles and Practice.(Book Review)
September 1, 2003... Edited by D Cardenas, N C Cutter, F Frost, et al. Demos Medical Publishing, New York, 2002, US$225.00, pp 1085. ISBN 1-888799-61 7 Basically, this is a book about the consequences of severe spinal cord lesions, mainly traumatic injury...

A Clinical Guide to Epileptic Syndromes and Their Treatment.(Book Review)
September 1, 2003... Edited by C P Panayiotopoulos. Bladon Medical Publishing Limited, Chipping Norton, 2002, 39.95 [pond sterling], pp 239. ISBN 1-904218-23-7 This book is a delightful rarity. It represents the distillation of over 30 years and 100 original...

Pediatric Psychopharmacology: Principles & Practice.(Book Review)
September 1, 2003... Edited by Andres Martin, Lawrence Scahill, Dennis S Charney and James F Leckman. Oxford University Press, New York, 2002, 99.50 [pond sterling], pp 755. ISBN 0-19-514173-3 This is a weighty text--at nearly 800 pages and nearly 51/2 lbs in...

The Maudsley Handbook of Practical Psychiatry, 4th Edition.(Book Review)
September 1, 2003... Edited by David Goldberg and Robin Murray. Oxford University Press, Oxford, 2002, 19.95 [pounds sterling], pp 186. ISBN 0-19-851609-6 This is a pocket sized reference book with a colourful cover that is engaging and forms a good initial...

The Neuropsychiatry of Epilepsy.(Book Review)
September 1, 2003... Edited by Michael Trimble and Bettina Schmitz. Cambridge University Press, Cambridge, 2002, 39.95 [pounds sterling], pp 337. ISBN 0-521-81374-3 Various reviews on links between epilepsy and neuropsychiatry are to be found in this book. One...

Presumed Curable.(Book Review)
September 1, 2003... By Colin Gale & Robert Howard. Wrightson Biomedical Publishing Ltd, Petersfield, 2003, 14.50 [pounds sterling], pp 128. ISBN 1-871816-48-3 After 38 years as a clinical psychiatrist I still find a good description of a psychiatric patient a...

Neurosurgery of Arteriovenous Malformations and Fistulas. A Multimodal Approach.(Book Review)
September 1, 2003... Edited by Hans-Jakob Steiger, Robert Schmid-Elsaesser, Alexander Muacevic, Hartmut Bruckmann, and Berndt Wowra. Springer, New York, 2002, 228 [pounds sterling], pp 473. ISBN 3-2-11-83703-5 This is an interesting text aimed solely at...

HIV Neurology.(Book Review)
September 1, 2003... B J Brew. Oxford University Press, New York, 2001, 75.00 [pounds sterling], pp 252. ISBN 0-19513363-3 Do we need books anymore? I found myself asking this rather shocking question when an exceptionally keen medical student brought a series...

Ageing and Dementia. Current and Future Concepts.(Book Review)
September 1, 2003... Edited by KA Jellinger, R Schmidt and M Windisch. Springer Wien New York, Wien, 2002, 108 000 [euro], pp 376. ISBN 3-211 83797-3 This contribution represents a summary of an international symposium on "ageing and dementia", which took place...

The nucleus of Theodor Meynert (1833-1892).(Historical Note)
September 1, 2003... In 1664 Thomas Willis described distinct subcortical structures, then called the corpus striatum. It was believed to be the "sensorium commune" as defined by Aristotle; a central structure that received sensory modalities and initiated motor...

Intensive care neurology and the autonomic nervous system.
September 1, 2003... Specialists often feel somewhat uneasy when they step outside their area of expertise. When seeing a patient with a neurological problem on the intensive care unit (ICU) the neurologist is both inside (the patient has a neurological problem...

Admission to neurological intensive care: who, when and why?
September 1, 2003... The majority of neurologists work in district general or teaching hospitals with large general intensive care units (ICUs). In this setting, ICUs require an increasing input from neurologists, especially with regard to the assessment of hypoxic...

General medical care on the neuromedical intensive care unit.
September 1, 2003... The role of an intensive care unit is to maintain a patient's normal physiological homeostasis while actively treating the underlying cause of any physiological derangement. Modern neurological intensive care evolved from the neurorespiratory...

Neurological consultations in the medical intensive care unit.
September 1, 2003... Critical care therapy has advanced over the past two decades, treating more patients and providing more complex care. However, the improved survival from septic shock, adult respiratory distress syndrome (ARDS), and multiple organ system...

Long term ventilation in neurogenic respiratory failure.
September 1, 2003... Respiratory failure, often acutely precipitated by aspiration and/or infection, is a common cause of death in advanced nervous system disease. Importantly, chronic respiratory failure, or symptoms relating to respiratory limitation, may occur...

Autonomic diseases: clinical features and laboratory evaluation.
September 1, 2003... The autonomic nervous system has a craniosacral parasympathetic and a thoracolumbar sympathetic pathway (fig 1) and supplies every organ in the body. It influences localised organ function and also integrated processes that control vital...

Autonomic diseases: management.
September 1, 2003... The management of autonomic disease encompasses a number of aspects. Of immediate and practical importance is alleviation of symptoms. The ideal is to rectify the autonomic deficit and cure the underlying disorder. Autonomic disease often...

Neurology of swallowing and oral feeding disorders: assessment and management.
September 1, 2003... An appreciation of the normal swallowing process (1) and how it may be affected by neurological disease can inform the clinical diagnosis and management of patients who complain of swallowing problems or present with the nutritional and...