Journal of the neurological sciences
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Fourteen patients were identified with (1) pain and sensory changes in a brachial plexus distribution, (2) aggravation of pain with use of the affected extremity, and (3) pain on palpation over the brachial plexus. All patients had minimal or no intrinsic hand muscle atrophy. Only one patient had cervical ribs. ⋯ A compressive brachial plexopathy from abnormally attached or enlarged scalene muscles that affected both upper and lower trunks of the brachial plexus was found at surgery in all patients. In 13 patients, at least one fibrous band compressed the lower trunk of the brachial plexus. Therefore, neurogenic thoracic outlet syndrome can occur from cervical bands and scalene muscle anomalies without intrinsic hand muscle atrophy, cervical ribs, enlarged C7 transverse processes, or EMG abnormalities.
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Comparative Study
Differentiation of embolic and thrombotic middle cerebral artery occlusion using ultrasonic carotid flow velocity analysis.
The purpose of this study was to determine the value of Duplex ultrasound of the carotid arteries in the differentiation of embolic from thrombotic middle cerebral artery (MCA) occlusion. We report here the results of carotid Duplex ultrasound study from 164 patients with acute ischemic stroke. Flow velocity and diameter were measured in bilateral common carotid arteries (CCA). ⋯ PI in the affected artery was increased in groups I and III (p < 0.01). Embolic occlusion was characterized by > 30% decrease in Ved in the absence of > 80% carotid stenosis, and an increase in PI. The results indicate that these two conditions can be differentiated using Duplex ultrasound in carotid arteries.
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Values for thermal specific and thermal pain thresholds were determined in 150 healthy volunteers, 67 women and 83 men, aged from 10 to 73 years. Warm-cold difference limen, heat pain and cold pain thresholds were assessed at the face, thenar, medial surface of the upper- and forearm, lateral mammary, lateral umbilical, anterior thigh and lateral leg regions, and lateral aspect of the dorsum of the foot. Temperature and pain sensitivity were assessed by the Marstock method. ⋯ Small intraindividual variability was found in measurements repeated in 4 consecutive days and after 4 weeks. Body length did not influence thermal and pain perception thresholds. There were no differences found in thermal and pain sensitivity between the left and the right side of the body.
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Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neurological disorder that results in relentless damage to the motor neuron system. Although about 5-10% of cases are familial, the pathophysiologic process of ALS remains unknown. We identified a novel point mutation A to G in exon 2 of the Cu/Zn SOD gene, resulting in an amino acid substitution of histidine46 by arginine (H46R), in two Japanese familial ALS (FALS) families. ⋯ The enzymatic activities of Cu/Zn SOD of peripheral red blood cell lysate were reduced to about 80% in the affected members, compared with other non-affected family members. The patients in these families are clinically characterized by relative late onset, initial involvement in lower extremities, relative rare impairment of bulbar muscles and much slow progression of muscular weakness and atrophy, compared with other Japanese FALS cases who have no mutation in the Cu/Zn SOD gene. These findings suggest that the H46R mutation in Cu/Zn SOD gene is highly related to this unique subtype of FALS.
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The effects of DNIC (diffuse noxious inhibitory control) in humans were evaluated by means of pain SEPs (somatosensory evoked potentials) and pain visual analogue scale (VAS) following CO2 laser stimulation applied to the left knee while conditioning stimuli (non-noxious and noxious thermal stimuli) applied to the right hand. Pain SEPs were recorded from scalp electrodes following laser stimulation applied to the left knee during various conditions as follows: (1) control (without any interference), (2) non-noxious (dipping the right hand in water at 41 degrees C for 3 min), (3) noxious (dipping the right hand in water at 46 degrees C for 3 min), and (4) after-effect (3-6 min after taking the hand from the water at 46 degrees C). The present pain SEPs findings confirmed the presence of DNIC in humans, and indicates: (1) degree of pain relief was significantly correlated with changes in pain SEPs, particularly a marked decrease in amplitude, and a decrease in VAS; (2) DNIC was more effective on the second pain than the first pain; (3) the effect of DNIC gradually increased over time, but it rapidly disappeared after the conditioning stimuli ceased; and (4) DNIC was not due merely to changes of attention. I propose that the site responsible for DNIC is the brainstem or the spinal cord rather than the cerebral hemisphere.