Neurology
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We investigated whether moderate, transient whole-body hyperthermia (approximately 39.6 degrees C), if imposed 1 day following a brief episode of forebrain ischemia, would affect the neuropathologic outcome. Forty-two Wistar rats were subjected to either a 5- or 7-minute period of bilateral common carotid artery occlusion plus hypotension (50 mm Hg), or to the equivalent sham procedure. Twenty-four hours later, rats of one subgroup were placed into a hyperthermic chamber containing high-intensity lamps designed to elevate rectal temperature to 39 to 40 degrees C for 3 hours. ⋯ In rats with 7-minute forebrain ischemia, delayed hyperthermia increased mean numbers of ischemic neurons by 2.6- to 2.7-fold in all subsectors of area CA1 (p < 0.05, ANOVA). Delayed hyperthermia in 5-minute ischemic rats also tended to increase mean numbers of ischemic neurons (by 11-fold in lateral, 6-fold in middle, and 5-fold in medial CA1 subsectors), but these differences were not statistically significant. We conclude that moderate, transient hyperthermia, even if occurring 1 day after a 7-minute global ischemic insult, exacerbates the extent of ischemic neuronal injury.
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To assess the relationship between CSF creatine kinase BB isoenzyme activity (CSF CKBB) and neurologic outcome after cardiac arrest in clinical practice. ⋯ CSF CKBB measurement helps to estimate degree of brain damage and thus neurologic prognosis after cardiac arrest. However, results of this retrospective study could reflect in part a self-fulfilling prophecy.
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Clinical Trial Controlled Clinical Trial
Intradermal recombinant human nerve growth factor induces pressure allodynia and lowered heat-pain threshold in humans.
Nerve growth factor (NGF) plays a biologic role in the development and maintenance of sympathetic and small sensory neurons. Because it facilitates nerve fiber regeneration, lowers heat-pain threshold (hyperalgesia), and prevents or improves nerve dysfunction in experimental neuropathy, it is being considered as a putative treatment for certain human polyneuropathies. In 16 healthy subjects, we tested whether intradermal injection of minute doses of recombinant human NGF (1 or 3 micrograms) compared with saline induces hyperalgesia or alters cutaneous sensation (at the site of injection) as measured by symptom scores, clinical examination, or quantitative sensory testing with Computer Assisted Sensory Examination (CASE IV). ⋯ The time course of pressure allodynia and heat-pain hyperalgesia is too rapid to be explained by uptake of NGF by nociception terminals, retrograde transport, and upregulation of pain modulators. Local tissue mechanisms appear to be implicated. It remains to be tested whether recombinant human NGF prevents, stabilizes, or ameliorates small fiber human neuropathies.
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Neuropathic pain syndromes are commonly seen in clinical practice and are frequently used as pain models in testing new therapies. However, no pain scale exists with the primary purpose to measure pain in neuropathic syndromes. ⋯ Moreover, the NPS items appear to be sensitive to treatments known to impact neuropathic pain. These findings provide support for the further development of the NPS.
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Biography Historical Article
Hughlings Jackson's deductive science of the nervous system: a product of his thought collective and formative years.
This paper examines the life and work of John Hughlings Jackson (1835-1911), with particular attention to his early years in London, the "thought collective" into which he was initiated, and the consequent social ties, professional interests, hospital affiliations, scientific pursuits, aims, and ambitions that defined his medical career spanning almost half a century. There exists an abundant body of literature on Jackson, although it is far less extensive and substantive than his own writings (about 350 in number) in understanding his position and attitude concerning the study of diseases of the nervous system. This elucidation of the nature Jackson's pursuits throughout his career draws upon primary sources of information-the elaborate writings of Jackson himself and of his Victorian mentors and confreres. ⋯ Jackson's thought collective and their shared beliefs and pursuits were instrumental in shaping Jackson's career as reflected by his later works. Jackson's professional pursuits and extensive writings marked a lifetime dedicated to developing a "Science of the Nervous System" according to a Millian-Spencerian form of deductive reasoning, to ultimately establish a rational basis for the treatment of nervous disease. Jackson and his contemporaries initiated and developed a deductive ideology and methodology that continue to be widely employed by neurologists today, and thus form the basis of the current neurological paradigm.