Journal of the neurological sciences
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Multicenter Study Comparative Study Clinical Trial
Effects of admission glucose level on mortality after subarachnoid hemorrhage: a comparison between short-term and long-term mortality.
Admission hyperglycemia is associated with poor functional outcomes and risk of death in nondiabetic patients with acute ischemic stroke. However, there is still some debate about the effects of hyperglycemia in subarachnoid hemorrhage (SAH) patients. The purpose of this study was to assess whether the admission glucose level in patients with SAH is associated with short- and/or long-term mortality. ⋯ We demonstrated that admission hyperglycemia has a harmful effect on short-term mortality, but not with long-term mortality in SAH patients without diabetes. Our results may be used as further evidence to support a hypothesis of harmful effects of hyperglycemia in SAH patients.
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Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder. To determine predictors of survival, we studied different parameters in our ALS Database including 479 patients. The effects of individual prognostic factors of survival were studied using Kaplan-Meier life table. ⋯ However, age, site of onset, forced vital capacity, symptom duration and ALSFRS-R score at the first visit were independent prognostic factors in our population (log-rank p<0.01). The ratio of ALSFRS-R score between first symptom and first examination, during whole disease or within 100 days, correlates with survival time. We conclude that the ratio of ALSFRS-R score within 100 days is a useful parameter for clinical trials and daily clinical work in a tertiary ALS-clinic.
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Clinical Trial
The effects of bilateral subthalamic nucleus deep brain stimulation (STN DBS) on cognition in Parkinson disease.
The effects of subthalamic nucleus (STN) stimulation on cognition and mood have not been well established. The authors estimated cognitive and mood effects of bilateral subthalamic nucleus deep brain stimulation (STN DBS) in patients with Parkinson's disease (PD) at 6 months and 1 year postoperatively. Forty-six patients were recruited from the Movement Disorder Center at Seoul National University Hospital. ⋯ The correlation of motor improvement and cognitive deterioration was not significant, which suggests that the stimulation effect is rather confined to the motor-related part in the STN. In conclusion, bilateral STN DBS in Parkinson's disease did not lead to a significant global deterioration in cognitive function. However, our findings suggest that it has minor detrimental long-term impacts on memory and frontal lobe function.
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Controlled Clinical Trial
The influence of repetitive painful stimulation on peripheral and trigeminal pain thresholds.
We were interested in how continuous painful stimulation which is performed as inurement exercises in some Asian martial arts influences sensory and pain perception. Therefore, we examined 15 Kung Fu disciples before and after a 14 day period with repetitive inurement exercises and measured sensory and pain thresholds and intensities in both the trigeminal and the peripheral (peroneal nerve) region. The results of the probands were compared to those of 15 healthy control subjects who were performing sports without painful stimulation during this period. ⋯ This suggests a change of central sensitisation and inhibitory control mechanisms in the nociceptive spinal or cerebral pathways by inurement exercises. In addition, pain thresholds showed an (not significant) increase after the study period whereas the control subjects showed a significant decrease of pain thresholds. In summary, our pilot study suggests that inurement exercises, i.e. repetitive painful stimulation, over a period of 14 days might induce changes of pain perception resulting in trigeminal pain habituation and higher pain thresholds.
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Case Reports
Ataxia and migraine-like headache in a girl with a cerebellar developmental venous anomaly.
Cerebral developmental venous anomalies (DVAs) are generally considered as anatomical variants of the venous system without clinical importance. We report the case of a 15-year-old girl with recurrent episodes of migraine-like headache who presented with subacute vertigo and ataxia associated with intense occipital pain. Magnetic resonance imaging (MRI) showed a DVA with signal modifications of the surrounding brain parenchyma in the left cerebellar hemisphere. ⋯ On a follow-up MRI 4 years later the venous malformation and the parenchymal abnormalities were unchanged. We attribute the patient's focal neurological dysfunction to regional changes in the brain parenchyma, possibly secondary to venous hypertension. Our report provides evidence that also uncomplicated DVAs can become symptomatic and supports the role of the venous congestion within the DVA territory in pathogenesis of some brain parenchymal abnormalities associated with DVAs.