Patrick J. Sweeney

Ischemic optic neuropathy A complication of cardiopulmonary bypass surgery

Ischemic optic neuropathy followed cardiopulmonary bypass surgery in the postoperative period in 7 of 7685 consecutive procedures. The visual loss was unilateral in four patients and bilateral in three and there was little improvement. This ischemic infarction of the optic nerve disk was attributed to hypotension, hypothermia, and activation of certain complement factors by the bypass procedure.

STRENGTH TRAINING CAN IMPROVE STEADINESS IN PERSONS WITH ESSENTIAL TREMOR

We evaluated the effect of a strength‐training program on the ability of persons with essential tremor to exert steady forces with the index finger. Thirteen subjects with a diagnosis of essential tremor were assigned to three different groups: one group trained with heavy loads, one with light loads, and one did not perform any training. Subjects attempted to generate steady contractions during both postural and constant‐force tasks. Steadiness was quantified by the root mean square amplitude of acceleration during postural tasks and the standard deviation and coefficient of variation of force during the constant‐force tasks. Subjects who performed the training program with heavy loads experienced an increase in steadiness around the target force during the constant‐force tasks. Subjects in the other two groups did not exhibit any changes. These findings suggest that strength training can decrease the magnitude of tremor. However, we did not observe any associated improvements in functional abilities.

Spinal accessory (11th) nerve palsy following carotid endarterectomy

We report three cases of ipsilateral spinal accessory nerve palsy complicating carotid endarterectomy. Awareness of this cranial nerve injury, as a complication of this common surgical procedure, can lead to early diagnosis and avoids unnecessary investigations. This should be considered whenever such patients complain postoperatively of ipsilateral shoulder pain/weakness or “aching” about the ear, even if some time has elapsed since surgery.

Stroke: a neurologic complication of wrestl i ng: A case of brainstem stroke in a 17-year-old athlete

D -stroke E-cm vertebral arte.trauma has been 1 .LI...J.J’&dquo; .l.J.J...,...a,-, &dquo;’&dquo; fro ! artery reported with a vanety of cervical rotational and extension injuries ranging from chiropractic manipulation of the neck to the performance of yoga.I-18 Studies of vertebral artery anatomy and changes in its blood flow with neck position have contributed to a better understanding of this syndrome. This paper describes a young athlete with brainstem stroke following

Ewing's tumor metastatic to the clivus, simulating meningitis: case report.

Ewings sarcoma, which is regarded as one of the most lethal primary bone tumors, lies in the domain of the orthopedic surgeon because it occurs most commonly in the shaft of the long bones, especially in the lower extremities. Pain, leukocytosis, fever, anemia, and an elevated erythrocyte sedimentation rate are commonly seen. We are presenting a case of Ewings sarcoma of the left greater trochanter with metastasis to the clivus producing a bilateral 6th nerve palsy. The presence of fever, nuchal rigidity, and photophobia simulated meningitis. The rapid evolution of radiological signs will be discussed.

Comprehensive, Multidisciplinary Deep Brain Stimulation Screening for Parkinson Patients: No Room for “Short Cuts”

Careful, often cumbersome, screening is a fundamental part of DBS evaluation in Parkinsons disease (PD). It often involves a brain MRI, neuropsychological testing, neurological, surgical, and psychiatric evaluation, and “ON/OFF” motor testing. Given that DBS has now been a standard treatment for advanced PD, with clinicians’ improved comfort and confidence in screening and referring patients for DBS, we wondered whether we can now streamline our lengthy evaluation process. We reviewed all PD patients evaluated for DBS at our center between 2006 and 2011 and analyzed the reasons for exclusion and for dropping out despite passing the screening process. A total of 223 PD patients who underwent DBS evaluation had complete charting. Only 131 (58.7%) patients were successfully implanted. Sixty‐one (27.3%) patients were excluded after screening because of significant cognitive decline (32.7%), early disease with room for medication adjustment (29.5%), behavioral dysfunction (21.3%), suspected secondary parkinsonism or atypical parkinsonism syndrome (13.1%), PD, but with poor levodopa response (11.4%), unrealistic goals (9.8%), PD with predominant axial symptoms (6.5%), significant comorbidities (6.5%), or abnormal brain imaging (3.2%). In addition, 31 (13.9%) patients were cleared for surgery, but either chose not have it (18 patients), were lost to follow‐up (12 patients), or were denied by medical insurance (1 patient). Through careful screening, a significant percentage of surgical candidates continue to be identified as less suitable because of a variety of reasons. This underscores the continued need for a comprehensive, multidisciplinary screening process.

What's in a name? Dr. Lewey and the Lewy body

If background training is a predictor of future success, then by any measure Fritz Heinrich Lewy was destined to succeed. He received his medical degree from the University of Berlin in 1910 and trained in both clinical neurology and psychiatry under Oppenheim and Kraepelin. The trio of Nissl, Alzheimer, and Spielmeyer directed his training in neuropathology. Between the years 1912 and 1914, he was director of the Neuropsychiatric Laboratory at the University of Breslau Medical School. In his first year at Breslau, he described the distinctive eosinophilic inclusions1 that Tretiakoff, in 1919, named in his honor.2,3 During World War I, while in the German army, he was in charge of field hospitals in France, Russia, and Turkey. In 1934, with the flames of antisemitism spreading throughout Europe, he immigrated to the United States with …

Dopamine Transporter (DaT) Scan Utilization in a Movement Disorder Center

The aim of this work was to describe utilization patterns of dopamine transporter (DaT) scan and its influence on patient management at a single movement disorders center. DaT scan helps differentiate between neurodegenerative from non‐neurodegenerative parkinsonism and essential tremor (ET). It has been recently approved in the United States in 2011.

Familial ophthalmoplegia-plus syndrome with corneal endothelial disorder

The authors report two brothers with an ophthalmoplegia-plus syndrome characterized by chronic progressive external ophthalmoplegia associated with hypogonadism, primary testicular failure, neural deafness, cone-rod degeneration and mild optic atrophy. One brother, the proband, was a daily soft contact lens wearer who developed persistent epithelial and stromal edema of the right cornea and had bilaterally thickened corneas by ultrasonic pachymetry. Endothelial studies of both brothers revealed marked polymegathism, and pleomorphism. Stressing the inherently abnormal endothelium with contact lens wear may have resulted in further endothelial compromise and corneal edema in the proband.Endothelial abnormalities may be another clinical finding within the spectrum of ophthalmoplegia-plus syndrome and should be searched for before fitting these individuals with contact lenses.

Issac Newton and the optic chiasm

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