Arch Neurol Chicago
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Arch Neurol Chicago · Sep 1991
Abnormalities of cutaneous blood flow regulation in patients with reflex sympathetic dystrophy as measured by laser Doppler fluxmetry.
The response of cutaneous blood flow to autonomic stimuli was evaluated in eight patients with clinically staged reflex sympathetic dystrophy and eight healthy control subjects. Blood flow was measured in the affected and contralateral extremities by laser Doppler fluxmetry. Five autonomic stimuli were applied to the contralateral extremity during blood flow measurement in the ipsilateral affected extremity. ⋯ Reflex sympathetic dystrophy stage did not affect response to the procedures. Control subjects demonstrated a rhythmic cycling of cutaneous blood flow that was absent in patients with reflex sympathetic dystrophy. These results support a central abnormality of the sympathetic nervous system in reflex sympathetic dystrophy.
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Arch Neurol Chicago · Jun 1991
Historical ArticleLiterary neurologic syndromes. Alice in Wonderland.
Many neurologic syndromes are named for literary characters. For example, the "Alice in Wonderland" syndrome of altered body perceptions, usually caused by migrainous ischemia, is so called because of the resemblance of its symptoms to the fluctuations in size and shape that plague the main character in Lewis Carroll's 1865 novel Alice in Wonderland. The medical symptoms of distorted body images match the literary description so precisely that illustrations from the original book depict them very accurately. Because Lewis Carroll suffered from classic migraine headaches, scholars have speculated that he may have experienced this syndrome himself.
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Arch Neurol Chicago · Nov 1990
Nontraumatic coma. Glasgow coma score and coma etiology as predictors of 2-week outcome.
In 1987 and 1988, we carried out a prospective study of patients older than 10 years with nontraumatic coma in the intensive care units of Columbia-Presbyterian Medical Center, New York, NY. Of 188 patients with Glasgow Coma Scale (GCS) determinations within 72 hours, 61% were dead or in persistent coma by 2 weeks from onset. Age, sex, and ethnicity did not influence outcome. ⋯ Patients with an initial GCS score of 6 to 8 were seven times more likely to waken than those with a score of 3 to 5. The motor subscore alone was a significant independent predictor of 2-week outcome. Modification of coma score to include etiology may give more accurate predictions of 2-week outcome after nontraumatic coma.
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Arch Neurol Chicago · Nov 1990
Case ReportsVariable expressivity in familial restless legs syndrome.
A 62-year-old man with a 20-year history of excessive daytime somnolence and kicking during sleep was an obligate carrier of the restless legs syndrome gene because his paternal grandfather, father, and all three of his children had symptoms of restless legs syndrome. The patient himself, however, denied motor restlessness after a careful and exhaustive medical history and he was originally believed to have periodic movements in sleep without restless legs. Close clinical observation did reveal nighttime motor restlessness, although the patient continued to deny its importance. ⋯ We conclude that there can be variable expressivity of the clinical features in familial restless legs syndrome and that there are probably some relatively nonrestless patients with prominent periodic movements in sleep who are carriers of the restless legs syndrome gene. Some sleep-disordered patients who are believed to have only periodic movements in sleep may have a forme fruste of autosomal dominant restless legs syndrome. If one does not examine these patients carefully at night and take an adequate family history, one may miss the diagnosis of restless legs syndrome.