Journal of neurology
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Journal of neurology · Feb 1986
Long-term effects of spinal cord stimulation in chronic pain syndromes.
A total of 50 patients with chronic pain syndromes were selected for treatment with spinal cord stimulation. Correct positioning of electrodes was obtained in 44 patients, leading to an initial alleviation of pain in 25 patients. ⋯ Only 8 patients had at least some beneficial effect lasting for more than 3 years. The long-term results in patients with more severe psychological disturbances were no worse than those of the other patients.
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Journal of neurology · Feb 1986
Somatosensory evoked potentials in comatose patients: correlation with outcome and neuropathological findings.
Subcortical and early cortical somatosensory evoked potentials (SEPs) were recorded in 63 comatose patients and classified into five salient SEP grades, which were defined as follows: grade 1, normal SEP; grade 2, SEPs with a clearly recognizable scalp component N20, normal central conduction time but clearly distorted wave N20-P25; grade 3, SEPs with a still recognizable N20 but delayed central conduction time and severely altered wave N20-P25; grade 4, SEPs with absence of N20 but with a more or less recognizable P15; grade 5, SEPs with absence of both N20 and P15. When these five patterns were compared with outcome, it was found that bilaterally normal SEPs or only unilaterally distorted SEPs were generally followed by good outcomes. Bilaterally altered SEPs (grade 2 or 3) were indicative of reduced chances of full recovery. ⋯ In 31 patients, it was found post mortem that grade-2 SEPs reflected cortical brain damage, whereas grade-3 SEPs correlated well with subcortical lesions. In post-traumatic patients, this SEP pattern corresponded to diffuse subcortical shearing lesions. Patients with grade 4 or 5 SEPs were found to have severe brain oedema giving rise to transtentorial herniation, which was combined with secondary midbrain haemorrhage and tonsillar herniation in all patients with bilateral grade-5 SEPs.
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Journal of neurology · Feb 1986
Case ReportsLate rupture of a mycotic aneurysm after "cure" of bacterial endocarditis.
Rupture of a mycotic aneurysm often occurs before the diagnosis of bacterial endocarditis is made or whilst the patient is being treated with antibiotics. It is recognised that cerebral embolism continues to occur after adequate antibiotic treatment, but the late rupture of a mycotic aneurysm seems to be very unusual. We report such a case where rupture of a peripherally sited aneurysm, demonstrated angiographically and pathologically, occurred 6 months after bacteriologically adequate treatment of streptococcal bacterial endocarditis.
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Journal of neurology · Jan 1985
Comparative StudyDo true remissions in myasthenia really exist? An electrophysiological study.
To answer the question whether true remissions in myasthenia gravis occurred, 20 patients were studied with a history of evident, typical myasthenia but in full clinical remission. Two control groups served as a comparison: one of 10 healthy volunteers and the other of 10 patients with generalized, presently active myasthenia. In 17 of the 20 patients in remission single-fibre EMG (SFEMG) abnormalities were found, indicating some subclinical disturbances of neuromuscular transmission (in 3 cases the results were overtly pathological, in 11 cases moderately pathological, and in 3 cases slightly pathological). ⋯ Three weeks later a full clinical relapse occurred. The results obtained suggest that in the majority of patients the remissions are only apparently complete. A pathological jitter in a patient in remission calls for special attention: the patient must be spared any immunological stimuli such as vaccination, injections of sera, infections etc.; no drugs can be given which may increase the neuromuscular block; an immunosuppressive course of treatment should be considered; prognosis should be reconsidered.
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Journal of neurology · Jan 1985
Long-term prognosis of subarachnoid hemorrhages of unknown etiology.
Forty-nine patients who suffered a spontaneous subarachnoid hemorrhage (SAH), and in whom panangiography did not show the cause of the bleeding, were evaluated after a long follow-up (median 8 years). No relationship was found between outcome and antifibrinolytic treatment or blood pressure level. Angiography was repeated in cases with spasm or after rebleeding: one aneurysm was found (7%). ⋯ The early mortality was 2%. Late functional capacity was normal in 94% of the patients. No particular restrictions should therefore be recommended.