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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The incidence of TIA, stroke, and neuropathy was studied in a community-based maturity-onset diabetic population. The frequencies of TIA and stroke were increased in maturity-onset diabetic patients as compared to the population of Rochester, Minnesota. The median age of occurrence of TIA and stroke in diabetics was 74 years, not significantly different from that in non-diabetics. Diabetic patients with hypertension at the time of diagnosis of diabetes mellitus had an increased frequency of TIA and stroke. Control of hypertension and/or diabetes mellitus was associated with a decreased frequency of TIA or stroke. Obesity, clinical coronary heart disease, and an abnormal electrocardiogram at the time of diagnosis of diabetes mellitus were not associated with a significantly increased frequency of TIA or stroke. The most common type of peripheral neuropathy in diabetes mellitus was distal polyneuropathy. Mononeuropathy and autonomic neuropathy were much less frequent. The frequency of distal polyneuropathy increased with the duration of diabetes mellitus. The frequency of neuropathy was increased in patients with poor control, reemphasizing the importance of diabetic control in the prevention of diabetic complications.
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PMID:Neurologic complications of diabetes mellitus: transient ischemic attack, stroke, and peripheral neuropathy. 21 54

Cogan syndrome is a multisystem inflammatory vascular disease, characterized by nonsyphilitic interstitial keratitis and vestibuloauditory symptoms. Recent reports have directed attention to involvement of other organ systems. Respiratory, cardiovascular, gastrointestinal, and musculoskeletal problems are common, as are laboratory abnormalities and general symptoms such as fever, chills, and weight loss. Prominent neurologic problems in two patients prompted a review of 79 cases of Cogan syndrome. More than half had nervous system involvement, including electroencephalographic or spinal fluid abnormality, headache, psychosis, coma, convulsion, neuropathy, and stroke. Cogan syndrome should be considered when neurologic deficits are accompanied by eye, ear, and systemic symptoms.
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PMID:Neurologic manifestations of Cogan syndrome. 30 11

Clinical observations for 49 diabetic patients who required chronic hemodialysis or renal transplantation during a four year period are presented. Twenty-seven dialysis patients had a two year cumulative survival of 74% compared to 54% for 22 transplantation patients. The cumulative survival of live-related donor recipients (77%) was similar to that of the dialysis group and significantly better than that of cadaveric allograft recipients (36%). While the incidences of cardiomegaly and of motor neuropathy were high among live-related donor recipients, dialysis patients more often demonstrated peripheral vascular disease. Causes of death in hemodialysis patients included cardipulmonary arrest and patient decision to discontinue therapy; in the transplantation group included cardiopulmonary arrest, sepsis, and stroke. Living-related transplantation remains the preferred mode of therapy because of the potential for rehabilitation. In terms of patient survival, the risks of cadaver transplantation must be weighted against the discomforts of chronic dialysis.
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PMID:Chronic renal failure in diabetes: survival with hemodialysis vs. transplantation. 34 20

In the Western Hemisphere, prior to 1950, there were few reliable data on the incidence, geographic distribution or population patterns of diseases of the nervous system. Impressions of prevalence were generally derived from the European literature and from a variety of case reports and relative frequencies based on clinic or hospital admissions or selected autopsy series. Since such data from different sources generally defy comparison, it has been necessary to develop data sources for defined populations to provide incidence and prevalence rates. Such an effort, initially concerned with multiple sclerosis, was launched in 1950 by NIH. International mortality statistics were also collected and analyzed and intensive population surveys in the United States and Canada were planned and carried out. In time, such efforts were extended to cover a wide variety of other chronic and subacute diseases of the nervous system, and support was provided by NIH and voluntary agencies for studies in many other countries. Independently, population studies were developed at various Universities and health care facilities in Latin America. ISSSTE in Mexico City provided a broad experience on multiple sclerosis, ALS, epilepsy, stroke and brain tumor; studies developed in the West Indies on Jamaican Neuropathy; and there were studies in several countries on cysticercosis, Chagas' disease and epilepsy. Also notable are recent studies in Guatemala and plans for geographic comparisons over the broad range of latitude in Chile. The advantages and limitations of mortality statistics will be discussed. The priorities in the selection of the disorders which were to be studied, the procedures which were developed, and the highlights of the results of such investigations will be presented. In addition to descriptive population surveys, case control comparisons and prospective studies are also being developed which seek to identify the risk factors or etiologic determinants that may account for the population pattern which have been observed.
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PMID:25 years of neuroepidemiology in the Americas. 35 5

Thirty-three cases of systemic lupus erythematosus in women are studied in retrospect. Eight patients (24 percent) presented a total of ten neuropsychiatric episodes that could be attributed to the underlying disease. The neuropsychiatric manifestation that was most often observed was cerebrovascular stroke (40 percent) followed by psychic disturbances and convulsions. A facial paralysis coinciding with an hypertensive crisis was noticed in one case. Another patient presented a peripheral sensitive neuropathy. Five episodes occurred prior to diagnosis or during the first year of the disease. In two patients the neuropsychiatric manifestations constituted the initial symptom of systemic lupus erythematosus. ECG proved to be one of the most valuable diagnostic tools among the complementary studies. It was altered in cases of organic pathology and normal when disturbances were of psychic origin. The C3 fraction of the serum complement revealed a definite difference between patients with and without neuropsychiatric manifestations. Concentrations were lower in persons which psychic disturbances than in patients without them. The pathogenesis of neuropsychiatric manifestations of systemic lupus erythematosus is discussed. They cannot be attributed exclusively to coagulation disturbances nor to treatment with corticosteroids. The immediate prognosis of neuropsychiatric episodes was good: there was partial or total recuperation in eight of the ten episodes. However, the long-term course of systemic lupus erythematosus shows that these manifestations represent an unfavourable prognostic factor in this disease.
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PMID:[Neuropsychic manifestations in systemic lupus erythematosus (author's transl)]. 43 Nov 77

Eighteen patients with idiopathic optic neuropathy lacked symptoms and signs of cardiovascular and cerebrovascular disease, especially when compared to three groups of patients with sudden visual loss caused by retinal infarction, transient ischemia, and cerebral infarction. Many patients in the latter groups had hypertension, carotid bruits, heart disease, transient ischemic attack, and stroke. But among the patients with ischemic optic neuropathy, hypertension was the only evidence of cardiovascular disease, affecting 44% of the patients. We argue that, in many cases, ischemic optic neuropathy represents a direct and early complication of hypertension arterial disease affecting small arterioles supplying the anterior part of the optic nerve. The pathologic process may thus be similar or identical to lacunar infarction of the brain.
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PMID:Ischemic optic neuropathy as a possible early complication of vascular hypertension. 51 8

Five patients are presented, all of whom had middle cerebral artery syndrome with hemiplegia on the contralateral side. All five had electromyographic evidence consistent with neuropathy involving the upper trunk of the brachial plexus on the side affected by the stroke. All patients were exposed to intensive rehabilitation team effort involving range of motion, strengthening exercises, positioning, splinting, coordination exercises and exercises designed to increase ability at arm placement. Three patients regained EMG evidence of innervation of the shoulder girdle muscles after more than eight months, during which time a rehabilitative effort was made. The other two patients have not yet regained control over the muscles of the shoulder girdle by EMG or clinical criteria. The EMG evidence of brachial plexus injury in those patients who eventually showed reinnervation took 8 to 12 months to resolve. The rehabilitation of the patients with stroke involving the upper extremity may have been set back significantly as a result of the neuropathy. It is suggested that patients with stroke and brachial plexus injury probably will have a more arduous and prolonged course in rehabilitation of the upper extremity as a result.
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PMID:Stroke and brachial plexus injury: a difficult problem. 90 58

The clinical situation of acute optic disc infarction in middle-aged and senescent patients is not uncommon, yet with the exception of those instances due to giant-cell arteritis, pathophysiological mechanisms remain obscure. In hopes of elucidating this syndrome, the clinical profile and natural history of 37 cases of non-arteritic ischaemic optic neuropathy were reviewed. For contrast, 13 cases of arteritic optic neuropathy were surveyed. The salient features of idiopathic optic neuropathy may be summarized as follows: (1) the syndrome occurs primarily in 55-70-year-old patients who, for the most part, are otherwise well; (2) mild hypertension is present in about half of the cases, but does not determine a separate variant of the disorder; (3) there is no significant association with extracranial carotid occlusive disease; (4) over long follow-up periods there appears to be no increased incidence of stroke; (5) the syndrome should be easily recognized on clinical grounds, consisting of sudden or rapidly progressive monocular visual deficit associated with optic disc swelling, with stable visual defects of variable degree; (6) after an interval of months to many years, the second eye is involved in about 40% of cases (old optic atrophy coupled with contralateral fresh disc infarction may be confused with the Foster-Kennedy syndrome); (7) no form of therapy has proved efficacious; (8) pathophysiological mechanisms remain speculative. It is the responsibility of the physician, be he ophthalmologist or neurologist, to distinguish the patient with occult arteritis (history, physical examination, sedimentation rate, arterial biopsy) and institute immediate high-dosage corticosteroid therapy. It is also incumbent upon the clinician to desist from unnecessary and unrewarding diagnostic procedures, in particular cerebral angiography, when confronted with an instance of non-arteritic ischaemic optic neuropathy.
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PMID:Ischaemic optic neuropathy. The clinical profile and history. 121 73

Diagnosis of respiratory chain defects in cultured skin fibroblasts is a difficult diagnostic procedure. We investigated the feasibility of using survival of skin fibroblasts in culture medium with galactose as the major carbon source as a method of quickly diagnosing cell lines that were compromised in oxidative metabolism. We found that cells from patients with most forms of cytochrome oxidase deficiency, cells with complex I deficiency, cells with multiple respiratory chain defects and cells with severe pyruvate dehydrogenase (PDH) complex deficiency failed to survive when subcultured into galactose (5 mM) medium. Cells from patients with Lebers hereditary optic neuropathy (LHON), Kearns-Sayre syndrome (KSS), myoclonus-epilepsy-lactic acidosis-stroke (MELAS), the hepatic form of cytochrome oxidase deficiency, and mild PDH complex deficiency survived well in galactose (5 mM)-containing medium. This could be used as a rapid screening test for skin fibroblasts with major oxidative defects.
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PMID:Nonviability of cells with oxidative defects in galactose medium: a screening test for affected patient fibroblasts. 132 73

Eighteen patients with neurobrucellosis are described. Eleven patients had meningitis alone or with papilledema, optic neuropathy, or radiculopathy. Four patients had meningovascular complications manifested by stroke or intracerebral hemorrhage from a presumed mycotic aneurysm. Two patients had parenchymatous dysfunction, including a child who had a cerebellar syndrome without evidence of direct infection of the central nervous system. One patient presented with polyradiculopathy. Twelve of 16 patients had pleocytosis; none had cell counts greater than 419 x 10(6)/L. Most patients had hypoglycorrhachia and elevated levels of protein in the cerebrospinal fluid (CSF). Results of an agglutination test for Brucella in serum were positive for all patients. Six of 16 patients had positive blood cultures, and four of 14 had positive CSF cultures. Antimicrobial treatment included concurrent administration of two or more of the following drugs: streptomycin, tetracycline (or doxycycline), rifampin, and trimethoprim-sulfamethoxazole. Eleven patients fully recovered. Five patients were left with residual neurological deficits. Four of these patients suffered permanent hearing loss, one of whom also had significant loss of vision in one eye. One elderly senile patient with meningovascular brucellosis remained in a vegetative state despite receiving antimicrobial therapy for 6 months. One patient died due to rupture of a mycotic aneurysm within 7 days of initiation of therapy. One other patient was treated after sustaining an intracerebral hemorrhage, but this patient's condition was diagnosed only after discharge.
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PMID:Neurobrucellosis: clinical and therapeutic features. 142 Jun 70


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