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
Case ReportsCervical myelopathy due to ossification of the posterior longitudinal ligament: a clinicopathologic study.
A clinicopathologic study was done of a Japanese patient with symptomatic ossification of the posterior longitudinal ligament in the cervical spine. Post-mortem specimen showed characteristic distribution of degenerations at C5-6 segments similar to chronic cervical spondylosis or disk protrusion. ⋯ Spinal immobilization produced by the ossified ligament may have contributed to the long clinical course, lasting for 30 years. Review of literature showed that the myelopathy can be distinguished clinically and radiographically from that produced by cervical spondylosis.