Arch Neurol Chicago
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Arch Neurol Chicago · Jan 1989
Biography Historical ArticleBabinski's sign in medieval, Renaissance, and baroque art.
In 1896, Joseph François Babinski first described his well-known sign of dorsiflexion of the big toe on stimulating the sole of the foot. However, unknown to Babinski, several painters had previously demonstrated this phenomenon in their paintings. Sandro Botticelli (1445-1510), a Florentine Renaissance painter, demonstrated this reflex in his Madonna and Child with Angels 400 years before the publication of Babinski's discovery. ⋯ Raphael (1483-1520) presented the extensor plantar responses in the child when sole pressure is applied in Small Cowper Madonna. Leonardo da Vinci, with his nude model drawings (1503-1507) seemed to have been aware of this response. There is no indication that any of these artists fully understood the physiology behind the response; therefore, the value of this sign in neurologic disease must still rely on Babinski's demonstration several hundred years after its initial demonstration in artistic literature.
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In thrombosis of the basilar artery, not infrequently a hemiparesis is present at an early stage, when brain-stem signs may be absent or few, slight or equivocal. It is natural to suspect that such a hemiparesis signifies localization in a cerebral hemisphere, but unexpectedly in a few hours bilateral hemiplegia appears associated with coma or a locked-in syndrome, indicating basilar artery occlusion. I would term this disarming hemiparesis the "herald hemiparesis" of basilar artery occlusion. If the true nature of the condition is recognized early, the use of heparin and other measures may forestall disaster.
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Arch Neurol Chicago · Sep 1988
Warning headache in aneurysmal subarachnoid hemorrhage. A case-control study.
Thirty consecutive patients with aneurysmal subarachnoid hemorrhage (SAH), 20 patients with ischemic stroke, and 100 controls were extensively interviewed about previous episodes of sudden headache, according to a standard pro forma. Thirteen patients with SAH (43%) had a history of a forewarning headache, compared with only one of the patients with ischemic stroke and none of the controls. The interval from the warning headache to the admission rupture was between one week and two months in all patients but one with SAH. ⋯ The outcome was slightly worse in patients with a warning headache, but the differences did not reach statistical significance. These data emphasize the frequent occurrence of warning headaches in SAH. Measures to increase the recognition of sudden headaches should be considered.
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Two patients who were treated with lithium for psychiatric illness developed primary position downbeat nystagmus. Previous reports have suggested that lithium causes this type of nystagmus, but other known causes were present in most cases. ⋯ Lithium carbonate is a cause of primary position downbeat nystagmus. The nystagmus may be permanent or require several months of abstinence for improvement.
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Arch Neurol Chicago · Jul 1988
ReviewDangers from methylprednisolone acetate therapy by intraspinal injection.
Clinical trials first began in 1960 with methylprednisolone acetate (Depo-Medrol) administered intrathecally, in an attempt to treat both disk disease and multiple sclerosis. After a few reports of salubrious results, there began an outpouring of contradictory data, which continues in 1988. During this time span, researchers who cautiously tested the different theses of improvement began to publish serious warnings of many complications. ⋯ Therefore, the various spaces and membranes are not only contiguous, but continuous. It follows that an injection of methylprednisolone acetate into the epidural space does not guarantee that it will remain isolated there. Finally, the inadvertency of injections by the epidural route occurs with the following frequency: 40% of injections can be inadvertently made into interspinous ligaments, and 2.5% into the subarachnoid space.