Neurology
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Serum anticonvulsant determinations made possible the identification of an unusual cause of status epilepticus and assisted with appropriate therapy in an epileptic patient with second-degree burns. The seizures were associated with a serum phenytoin concentration of 3.5 mug per milliliter. This suboptimal concentration of drug developed despite continuation of the patient's customary oral dose of phenytoin led to the conclusion that the unexpected decrement in serum anticonvulsant concentration was related to an experiment in absorption of that drug, possibly caused by the concurrent administration of oral oxacillin.
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Comparative Study
Optimal utilization of computerized cranial tomography and radionuclide brain imaging.
The results of computerized cranial tomography and radionuclide brain imaging in 490 patients were compared in relationship to the patients' clinical presentation. In 195 patients with focal neurologic abnormalities, both tests detected most lesions, but computerized cranial tomography was slightly more accurate overall. ⋯ An exception is the patient presenting with dementia, in whom computerized cranial tomography provides details of the anatomy of the ventricular cavities and cerebral cortex. This study demonstrates a continuing role of importance for radionuclide imaging in the evaluation of patients with neurologic disease and provides data to allow a rational approach to the optimum use of both techniques.
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A patient is described who became paraplegic because of postmeningitic spinal arachnoiditis. Twelve years later, upper limb signs appeared. Syringomyelia of an unusal communicating type was demonstrated by air myelography: Air, introduced by lumbar route, filled syrinx up to the level of the first cervical vertebra, through a communication with the subarachnoid space at the thoracic level.
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Comparative Study
Correlation between computerized transaxial tomography and radionuclide cisternography in dementia.
A study of the findings on cisternograms and computerized transaxial tomography (CTT) of 144 patients showed good correlation between the two tests. Patients with a cisternographic pattern of communicating hydrocephalus tended to show more severe degrees of lateral ventricular dilation, with involvement of the third and fourth ventricles and relative sparing of the cerebral sulci. ⋯ The statistical significance of the individual CTT findings in these patients is presented, and a cheme for interpretation is proposed. The study shows that CTT can replace pneumoencephalography in evaluating patients with dementia, while cisternography contributes complementary information.
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Clinical Trial Controlled Clinical Trial
An evaluation of baclofen treatment for certain symptoms in patients with spinal cord lesions. A double-blind, cross-over study.
Baclofen (a gamma aminobutylic acid derivative) and a placebo were compared for their efficacy in relieving certain symptoms in patients with long-standing spinal cord lesions and "spinal spasticity." In a double-blind, cross-over clinical investigation, 22 patients with chronic spinal cord disease were studied. Baclofen regularly alleviated involuntary flexor or extensor spasms and increased resistance to passive movement of the legs but did not alter strength, gait, stretch reflexes, or clonus. Side effects were mild and transient. This study demonstrates that (1) baclofen is useful for the treatment of flexor spasms and (2) in evaluating a new mode of therapy, one must consider selectively the response of individual components of such global syndromes as "spasticity."