Joe R. Brown

Neurologic aspects of temporal arteritis

IN THE YEARS 1931 to 1959, 175 patients with temporal arteritis were seen at the Mayo Clinic. At least 111 of these patients were referred to the Clinic with symptoms or signs suggesting possible involvement of the central nervous system, and 88 were seen primarily or in consultation by a neurologist at the Clinic. The referring physicians sent 41 patients because of headaches, 37 because of blindness, and 4 because of diplopia without any specific diagnosis. Brain tumor was suggested in 11, trigeminal neuralgia in 8, meningitis in 2, subarachnoid hemorrhage in 2, “stroke” in 2, histaminic cephalgia in 2, pituitary cyst in 1, and other diseases in 52 (Table 1) . Only 13 patients were referred with conditions already diagnosed specifically as temporal arteritis. Although temporal arteritis is seemingly rarely fatal, at least in the United States, it is often incapacitating. The importance of establishing the diagnosis rapidly can be appreciated when it is realized that 42% of the patients seen at the Clinic became blind in one or both eyes before diagnosis was made, even though loss of sight might have been prevented by early adequate steroid therapy.

The design of clinical studies to assess therapeutic efficacy in multiple sclerosis

Poorly designed trials of therapy for multiple sclerosis (MS) can waste time and money, and may lead either to false hopes or to the overlooking of a potentially effective treatment. A well-designed trial may well develop useful scientific information even if the putative therapy fails to show any therapeutic effect. The diagnosis, clinical course, and definitions of the stages of MS are discussed as they relate to trials of therapy. The goals of such trials include favorable modification of an exacerbation, favorable modification or prevention of future exacerbations, effective treatment of the progressive stage, and improvement of function in the stable-deficit stage. There should be an orderly progression from a small preliminary trial to a modest pilot trial and, when indicated, a full trial. All types of trials require careful organization and management, appropriate selection of patients, and properly planned and recorded observations. The treatment contrast-how the new treatment will be evaluated-provides the essential structure of the trial. The hypothesis being examined, the treatment contrast, and the observations being made in the designed clinical trial will govern the form of the analysis and the nature of the interpretations. Each goal requires that specific strategies and design considerations be applied to preliminary, pilot, and full trials.

Organic voice tremor. A tremor of phonation.

IN RECENT YEARS there has been increased interest in normal and abnormal tremor, that observed in the upper extremities being most freciuently the subject of study. Brumlikl reported that normal tremor of the upper extremities at rest has the amplitude, frequency, and wave form of a ballistocardiogram and persists after neuromuscular blockade with succinylcholine. Van Buskirk and Fink2 reported that normal tremor at rest persists even after the spinal cord is removed in experimental animals. Normal tremor on use of the extremity (use tremor, postural tremor, static tremor, intention tremor) has different characteristics. I t has a frequency of 6 to 12 oscillations per second, and its amplitude is reduced by loss of proprioception and by ischemia of the limb.2 These and other factors attest to at least some neuromuscular component of tremor on use of the extremity. Brumlikl suggested that such tremor may have both ballistic and neuromuscular components. Friedlander3 found that all subjects examined had ;i mensurable postural tremor and that the tremor due to anxiety differed from the normal only in amplitude. In most alcholics, the tremor resembled that due to anxiety. He further reported no correlation between age and either frequency or amplitude of tremor. In contrast to this, Marshall‘ reported an average frequenc\; of postural tremor of 10 per second in most adults, but a tremor of about 6 per second in children and in the aged. He suggested that different control mechanisms might be relied on in children and old adults than in vouiig adults. Critchlevs pointed out that the essential tremor of the hands has a frequency of 4 to 12 oscillations per second, is present in static postures, has only a slight terminal crescendo, and is slight or absent at rest. Marshall6 recently measured tremor of the upper extremities in

Language changes after neurosurgery for parkinsonism

Approximately one-fourth of a series of 123 patients with parkinsonism and other movement disorders showed language changes after thalamotomy, pallidectomy, and mixed pallidectomy-thalamotomy. Incidence of language change was higher in cases of left thalamotomy, multiple thalamotomies, and mixed procedures. Language impairments were predominantly of higher language functions and were not attributable to generalized intellectual impairment.

Problems in evaluating new treatments for multiple sclerosis

There are multiple difficulties in evaluating new treatments for multiple sclerosis (MS). The clinical diagnosis is imprecise, and the correlation between lesion and clinical dysfunction is incomplete. The neurologic evaluation is complex and lacks full precision. The course of MS is complex and has limited predictability. There is no laboratory test that can be accepted now as compensating for the defects in diagnosis, lesion-symptom correlation, course, and neurologic evaluation. Because of these problems, which appear inherent in MS, there are limitations to the statistical methods that can be properly applied to trials of therapy. Most trials of definitive nature will require a random design. When improvement is seen in a trial of therapy, there may be difficulty in determining the mechanism.

A clinical study of 100 aphasic patients. 1. Observations on lateralization and localization of lesions.

MANY DIFFERENT APPROACHES have been made to the problems of aphasia. The psychologist, the anatomist, the neurologist, and the speech pathologist may examine and each may interpret differently the phenomena seen in aphasic patients. This leads to divergent views and theories concerning aphasia. Also, the literature concerning the subject has been replete with words of considerable length, complexity, and variability. On occasion, an identical word will have greatly different meanings to different disciplines.

Degenerative cerebellar ataxias.

DESCRIPTIONS OF various families with genetic cerebellar ataxias are of undoubted value. Unfortunately, the ataxic patient arriving in the neurologist’s office often fails to reveal a positive family history and frequently does not fall into any of the classic syndromes that have been described. This study reviews the etiologic data, the symptoms, and the signs in the 103 patients with degenerative cerebellar ataxia seen at the Mayo Clinic during 1957. The term “degenerative” is intended to include cerebellar ataxias of genetic origin as well as those of uncertain or undetermined cause. Excluded were patients with convincing evidence of tumors, multiple sclerosis, encephalitis, or other specific disease. The method of the study consisted of abstracting information concerning pertinent symptoms, signs, tests, and general disease from the patient’s clinical record. This information was scrutinized for similarities and differences without submitting it to formalized statistical methods. In evaluating the symptoms, a reasonable temporal relationship was required in order to consider a particular symptom as possibly significant to the ataxic illness. Symptoms and signs due to obvious cause, those not temporally related, or those common for the age of the patient were excluded as not significant. Specifically excluded on the latter basis were minor diminution of hearing beyond the age of 55, minor impairment of vibratory sense in the lower extremities after the age of 60, and mild loss of memory or absence of abdominal reflexes beyond the age of 65. These exclusions were set arbitrarily and were based on the author’s personal opinion that the findings mentioned were, in general, too common at those ages to be useful as evidence. A study of the phenomena obsPnted in these patients revealed certain similarities and differences which fell naturally into 3 reasonably distinct categories. It was noted that the status of the muscle-stretch reflexes acted as an indicator for each category. This permitted the simple classification of the degenerative cerebellar ataxias into normoreflexic, hyporeflexic, and hyperreflexic forms. The characteristics of each of these forms will be described in detail later. Some characteristics were common to the group of 103 patients as a whole. These characteristics will be described first, because there were few qualitative differences between the 3 forms in reference to these particular characteristics.

The early years ot the American Academy of Neurology

The year 1973 marks the twenty-fifth anniversary of the American Academy of Neurology and thus is an appropriate time to review the history of the organization. In this article, the formative years of the Academy are discussed in detail, with particular emphasis on the people on the neurologic scene in the late 1940s and on the circumstances that led to the formation of the Academy. This history is given in the context of the development of neurology since the mid-1800s and its progress during the maturing years of the Academy.

Management of patients with brain damage.

IN THE management of patients suffering from the effects of a damaged brain, one must keep many factors in mind. The direct physical effects of neurologic damage, the psychologic effects of brain damage, the general medical condition of the patient, the psychologic adaptation to disability, and the social implications of a handicapping illness are all to be considered. Of particular interest and importance in the diagnosis and treatment of patients with neurologic diseases are the limiting effects on adaptation imposed by the brain injury. These psychologic effects of organic brain damage form the focal point of this discussion. The theoretical aspects of the problem are gleaned from the literature on the subject. The semantics employed must be considered as largely the author’s responsibility. Case material is presented for illustrative purposes and cannot be considered as documentary proof in any strict scientific sense. The practical application of the principles is based on clinical observations and interpretations. Jackson1 observed that the direct effect of an injury to the nervous system is the loss of function (negative symptom), while positive symptoms result from the “activity of nervous elements untouched by any pathologic process; that they arise during activity on the lower level of evolution remaining.” He further pointed out that the highest functions of the nervous system are those which are most flexible, most complex, and most voluntary. In the presence of brain damage there is partial loss of these highest functions and the

Living with Multiple Sclerosis: A Social Psychological Analysis

Will reading habit influence your life? Many say yes. Reading living with multiple sclerosis a social psychological analysis is a good habit; you can develop this habit to be such interesting way. Yeah, reading habit will not only make you have any favourite activity. It will be one of guidance of your life. When reading has become a habit, you will not make it as disturbing activities or as boring activity. You can gain many benefits and importances of reading.