Arch Neurol Chicago
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The major concerns in the pregnant epileptic patient are loss of seizure control and the teratogenic effects of antiepileptic drugs on the fetus. Loss of seizure control is usually caused by a progressive decline of antiepileptic plasma levels throughout pregnancy. ⋯ Only trimethadione has been convincingly linked to fetal malformation. Recommendations for the management of epilepsy in pregnancy are made.
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Arch Neurol Chicago · Oct 1979
Case ReportsAmyotrophic lateral sclerosis with ophthalmoplegia. A clinicopathologic study.
Ophthalmoplegia is rarely observed in patients with amyotrophic lateral sclerosis (ALS). We describe a patient with ALS in whom ophthalmoplegia, initially appearing midway in her course, progressed to total paralysis of extraocular movements by the time of death. In addition to the usual postmortem findings of ALS in the brain stem and spinal cord, there was extensive neuronal loss and gliosis involving the caudal portions of the dorsal and intermediate components of the oculomotor nuclei, the caudal part of the trochlear nuclei, and the abducens nuclei. This represents the first detailed report of the findings in the nuclei of cranial nerves III, IV, and VI in a patient with ALS and ophthalmoplegia.
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A 62-year-old man had an acute, transient, flaccid paraplegia. Examination showed a primary cardiac tumor with emboli to major branches of the aorta. A myxoma was removed from the left atrium, and normal function returned. Left atrial myxoma should be suspected as a cause for embolism to the CNS.
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In 53 cases of injury of the lumbosacral plexus, 31 were due to trauma and 22 followed operations on the hip joint. Post-traumatic lesions occur mostly in conjunction with severe bony injuries, especially fractures of the acetabulum and of the pelvic ring. Nearly always, it is the sacral portion of the plexus that is involved, either predominantly or exclusively. ⋯ In the postoperative lesions the lumbar plexus portion is most frequently involved. Ninety-one percent of all of our cases were misdiagnosed in previous clinical examinations, that is, as a lesion of the femoral or sciatic nerve, or they were unrecognized because of lack of awareness of the possibility of plexus damage or because the signs were obscured by the associated bony injuries or hip-joint disease. In order to make an exact diagnosis, a detailed electromyographic investigation is necessary.
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Arch Neurol Chicago · Jan 1978
The clinical significance of spontaneous pulsations of the retinal vein.
A search for spontaneous retinal venous pulsations was carried out in 218 subjects. Spontaneous venous pulsations were present in 87.6% of 146 unselected subjects 20 to 90 years of age and absent in 100% of 33 patients with raised intracranial pressure without papilledema and ten patients with papilledema. ⋯ Some normal subjects with absent pulsations showed definite pulsations on subsequent examinations. These findings confirm that the presence of spontaneous venous pulsations is a reliable indicator of an intracranial pressure below 180 to 190 mm H2O, while the absence of pulsations may be found with normal intracranial pressure and is therefore not a reliable guide to raised intracranial pressure.