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ABSTRACT: Patients with unilateral facial flushing are occasionally referred to clinical neurophysiological evaluation with the question of the site of lesion. These patients may have a mixture of autonomic and sensory symptoms. We wanted to study to which extent a combined autonomic and sensory clinical neurophysiological testing before and after exercise may help in the diagnostic evaluation of the patients.
Five patients were investigated at rest with quantitative sensory thresholds (QST, measurement of thermal thresholds) and quantitative sudomotor axon reflex test (QSART) in all extremities. Sweet volumes (QSWEAT) and skin temperatures were then measured after 30 to 60minutes of exercise.
Marked side-to-side differences were observed for QST and QSART at rest as well as for QSWEAT and skin temperatures following exercise, in accordance with the patients' symptoms. However, asymptomatic abnormal findings were also demonstrated in the feet of four patients, following both crossed and non-crossed distributions. EMG/neurography and MRI-findings were normal in all patients and no aetiological explanations were found.
Combined autonomic and sensory testing including the legs provided evidence of unexpectedly more widespread abnormalities, including asymptomatic findings. Although the patients presented with seemingly similar symptoms, there was a striking heterogeneity in their results, suggesting different sites of dysfunction. An extracranial lesion was considered likely in one or maybe two patients, while the possibility of a central lesion had to be considered in the three other patients.
Neurophysiologie Clinique/Clinical Neurophysiology 01/2013; 43(1):1-10. · 1.98 Impact Factor
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ABSTRACT: Deep brain stimulation of the internal globus pallidus (GPi-DBS) is established as an effective treatment of primary generalised dystonia in controlled studies. In cervical dystonia (CD), only one previous study has reported observer-blinded outcome assessment of long-term GPi-DBS, with 1-year follow-up.
In this prospective, single-centre study, eight patients with CD (7 women:1 man, 4 focal:4 segmental) treated with bilateral GPi-DBS for median (range) 30 (12-48) months, were evaluated by the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS; Severity, Disability and Pain scores), the Short-Form Health Survey-36 (SF-36), and the Becks Depression Index in an open design. In addition, a blinded rater assessed the TWSTRS Severity score from videos obtained preoperatively and at the last follow-up.
In the blinded evaluation, median (range) TWSTRS Severity score improved from 25 (19-30) to 8 (4-23) (P = 0.028), thus a 70% (23-82) score reduction. In the open evaluation, median Severity score improvement at the last follow-up was 73%, representing a significant further improvement from 50% at 6 months. The Disability and Pain scores improved by median 91% and 92%, respectively, and the SF-36 subdomain scores improved significantly. A reversible right hemiparesis and aphasia occured in one patient 4 days postoperatively, because of reversible oedema around the left electrode. No other serious adverse effects and no permanent morbidity were observed.
This single-blinded study shows good long-term efficacy of GPi-DBS in CD patients and supports using this treatment in those who have insufficient response to medical treatment.
European Journal of Neurology 11/2011; 19(4):610-5. · 3.69 Impact Factor
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ABSTRACT: To observe cerebrospinal fluid opening pressure (CSFOP) in different clinical settings and in patients with acute, chronic and no pain and to observe possible differences because of age and sex.
In this prospective study, CSFOP was measured in lumbar puncture in three different settings of clinical investigations; patients with acute headache investigated for subarachnoidal haemorrhage (n = 222), patients with sciatica undergoing myelography (n = 61), and patients in an outpatient neurological clinic (n = 65).
The mean CSFOP in cm H(2)O was 17.3 for the myelography patients, 19.1 for the outpatients, 19.3 for the primary headache patients and 22.4 for the patients with secondary headache. Large proportions of patients in all groups had CSFOP above 20 cm H(2)O. The female patients in all groups had lower mean CSFOP than the male patients.
The CSFOP levels found in clinical practice among patients without intracranial lesions or infectious conditions were broader than expected. Measurement of CSFOP is of limited value as diagnostic procedure if not closely linked to clinical symptoms and finds.
Acta neurologica Scandinavica. Supplementum 01/2010;
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European Journal of Neurology 02/2009; 16(1):14. · 3.69 Impact Factor
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ABSTRACT: Cytokines have been measured in cerebrospinal fluid (CSF) from headache patients [infrequent episodic tension-type headache (TTH) and migraine with or without aura, all during attack, and cervicogenic headache] and compared with levels in pain-free individuals. Both proinflammatory [interleukin (IL)-1beta, tumour necrosis factor-alpha and monocyte chemoattractant protein-1 (MCP-1)] and anti-inflammatory cytokines [IL-1 receptor antagonist (IL-1ra), IL-4, IL-10 and transforming growth factor-beta1 (TGF-beta1)] were included. There were significant group differences in IL-1ra, TGF-beta1 and MCP-1 in episodic TTH and migraine compared with controls, and a significant difference in MCP-1 between cervicogenic headache and migraine with aura. Intrathecal MCP-1 correlated with IL-1ra, IL-10 and TGF-beta1 in episodic TTH, and MCP-1 with IL-10 in migraine with aura. Cytokine increases were modest compared with those often accompanying serious neurological conditions, and may represent a mild response to pain. We believe this to be the first comparative study of CSF cytokine levels in connection with headache.
Cephalalgia 11/2008; 29(3):365-72. · 3.43 Impact Factor
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ABSTRACT: To find a specified diagnosis for every patient investigated in the hospital emergency room for acute headache suspicious of subarachnoid haemorrhage (SAH), and to describe similarities and differences between the diagnostic groups.
We used a standardized set of questionnaires and supplementary tests, including cerebral computed tomography (CT) and if needed lumbar puncture, in the investigation of the patients. Two neurologists diagnosed the same cases independently.
We found 30 different diagnoses as the cause of acute headache. Sixteen per cent had a SAH, and 57% had a primary headache. Patient characteristics, conditions at headache onset and accompanying symptoms were surprisingly similar in the diagnostic groups. For three SAH patients, it took 30 min to reach maximum pain intensity. In all diagnostic groups, a large proportion of the patients reached maximum pain within 60 s.
To distinguish between benign and malignant causes of acute headache is difficult based on clinical features. The consistent use of CT and lumbar puncture is valuable when investigating sudden onset 'first or worst headache ever'. This can reduce the risk of missing a SAH diagnosis, and make it possible to give more exact diagnoses to patients suffering from both primary and secondary headaches.
European Journal of Neurology 10/2008; 15(12):1293-9. · 3.69 Impact Factor
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ABSTRACT: Stereotactic implantation of electrodes for deep brain stimulation (DBS) in the subthalamic nucleus (STN) is a well-established treatment for Parkinson's disease. The treatment gives stable effect over years on the motor symptoms of Parkinson's disease. Psychiatric effects of STN-DBS have attracted increasing attention, with a growing number of reports on psychiatric side effects or exacerbations of known psychiatric disease. However, little is known about the possible unmasking of hidden psychiatric symptoms after surgery.
The aim of this clinical commentary is to illustrate unmasking of psychiatric disease by STN-DBS through the presentation of a case from our clinic.
A patient with Parkinson's disease underwent implantation of STN stimulation electrodes with good results on his motor symptoms. He did not disclose his previous psychiatric history. Soon after the onset of stimulation he developed affective symptoms with manic, aggressive and depressive behaviour, and also an attempted suicide. The stimulation was reduced and his dopaminergic medication increased after the attempted suicide. His previous history of depression and anxiety was now revealed. He received psychiatric attention, and the affective symptoms resolved. The effect of the stimulation on motor symptoms remained stable.
The unmasking of previous psychiatric problems after STN stimulation may be an underestimated problem. It is necessary to fully penetrate the psychiatric anamnesis, especially in patients with a strong wish to be operated and a consequent reluctance to reveal previous problems. Patients with a previous history of a psychiatric disorder are not the best candidates for implantation of STN electrodes.
Acta neurologica Scandinavica. Supplementum 02/2008; 188:41-5.
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E Dietrichs
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ABSTRACT: Neural pathways connect different parts of the cerebellum to different parts of the central nervous system. The cerebellum may be divided anatomically and functionally into three major regions. The cerebellar hemispheres and a small part of the posterior lobe vermis form the pontocerebellum, which receives inputs from the cerebral cortex via the pontine nuclei. The anterior lobe and most of the posterior lobe vermis make up the spinocerebellum, which receives afferents from the spinal cord. The nodulus and flocculus are connected with the vestibular nuclei and constitute the vestibulocerebellum. Most cases of cerebellar disease affect more than one region and different pathways. Hence, they cause generalized cerebellar symptoms dominated by impaired motor control and balance. Focal syndromes after restricted cerebellar lesions are rare. Isolated spinocerebellar affection may give gait ataxia. Vestibulocerebellar disease causes equilibrium disturbances with truncal ataxia and nystagmus. Pontocerebellar lesions typically give ipsilateral limb ataxia, but also dysartria and oculomotor dysfunction if vermal parts are involved. The clinical picture is in most cases of cerebellar disease dominated by motor disturbances, but the cerebellum also participates in the modulation of autonomic and affective responses and in cognitive functions. The cerebrocerebellar and hypothalamocerebellar circuits may be important for these tasks.
Acta neurologica Scandinavica. Supplementum 02/2008; 188:6-11.
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ABSTRACT: Microvascular decompression (MVD) is an effective and safe treatment in hemifacial spasm (HFS). Postoperative evaluations are usually made by neurosurgeons. Follow-up studies performed by neurologists and postoperative quality of life (QoL) investigations are lacking. All 25 HFS patients operated with MVD in our centre between 2000 and 2004 were evaluated with the recently validated HFS-7 scheme, extended with the item 'sleep disturbance due to HFS' (HFS-8). The patients underwent a careful neurological examination median 3 years after the operation. The evaluation focused on clinical aspects, changes in blood pressure and time until observable effect of MVD. The evaluation of HFS-7 questionnaire and the extended form (HFS-8) showed significant improvement in QoL after MVD. Neurological outcome was in almost all cases excellent or good. Eleven (44%) patients had no neurological deficits at all. Only one patient had serious complications with ipsilateral facial palsy, deafness, balance problems and vertigo. The other patients had minor neurological findings or symptoms. Eighteen (72%) patients experienced early effect within 3 months after MVD; seven (28%) patients had late effect between 6 and 14 months. Median age of the patients with late effect (62.6 years) was significantly higher than in those with early effect (52.7 years).
European Journal of Neurology 04/2007; 14(3):335-40. · 3.69 Impact Factor
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ABSTRACT: Acute headache may be the presenting symptom of several conditions. Sometimes, a headache with an abrupt onset and unusual severity may occur, experienced by the patient as the worst headache ever. The diagnostic evaluation primarily aims at ruling out subarachnoid haemorrhage (SAH), as well as other serious causes of acute headache, such as meningitis or stroke. The clinical examination should immediately be followed by cerebral computed tomography (CT). A CT scan will reveal 95% of SAHs, provided that it is performed within the first 24 hours after headache onset. If the CT scan is normal, a lumbar puncture should follow, preferably 12 hours after the onset of headache, unless infectious meningitis is suspected. If infectious meningitis is strongly suspected, lumbar puncture should be performed without delay. The spinal fluid should be investigated by spectrophotometry, in order to obtain optimal diagnostic accuracy for SAH. This article briefly reviews the various conditions that may present with an acute headache.
Tidsskrift for Den norske legeforening 12/2000; 120(29):3551-5.
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Movement Disorders 10/2000; 15(5):1026-8. · 4.51 Impact Factor
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ABSTRACT: A 40-year-old woman with myoclonic contractions bilaterally in the infrahyoid neck muscles, especially in the left cricothyroid muscle, was presented and successfully treated with botulinum toxin injections. The patient had a wide, aberrant vessel curving into the left dorsolateral reticular formation of the medulla oblongata. Based on our observations, we propose that symptomatic bulbar and palatal myoclonus is caused by pathology in the dorsolateral reticular formation, and not by inferior olivary dysfunction as is currently thought.
European Journal of Neurology 06/1999; 6(3):367-70. · 3.69 Impact Factor
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Tidsskrift for Den norske legeforening 09/1998; 118(19):2939.
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ABSTRACT: Experimental studies on a variety of mammals, including primates, have revealed direct and reciprocal connections between the hypothalamus and the cerebellum. Although widespread areas of the hypothalamus project to cerebellum, axons arise primarily from cells in the lateral, posterior, and dorsal hypothalamic areas; the supramammillary, tuberomammillary, and lateral mammillary nuclei; the dorsomedial and ventromedial nuclei; and the periventricular zone. Available evidence suggests that hypothalamocerebellar cortical fibers may terminate in relation to neurons in all layers of the cerebellar cortex. Cerebellohypothalamic axons arise from neurons of all four cerebellar nuclei, pass through the superior cerebellar peduncle, cross in its decussation, and enter the hypothalamus. Some axons recross the midline in caudal areas of the hypothalamus. These fibers terminate primarily in lateral, posterior, and dorsal hypothalamic areas and in the dorsomedial and paraventricular nuclei. Evidence of a cerebellar influence on the visceromotor system is presented in two patients with vascular lesions: one with a small defect in the medial cerebellar nucleus and the other with a larger area of damage involving primarily the globose and emboliform nuclei. Both patients exhibited an abnormal visceromotor response. The second, especially, showed abnormal visceromotor activity concurrent with tremor induced by voluntary movement. These experimental and clinical data suggest that the cerebellum is actively involved in the regulation of visceromotor functions.
International Review of Neurobiology 02/1997; 41:83-107. · 2.35 Impact Factor
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ABSTRACT: The frequency of intracranial infections caused by microorganisms which have been uncommon in Norway is increasing. Contributing factors are travel, immigration and acquired immune deficiency, either as the result of disease or medical treatment. This article presents some of these infections, and also briefly reviews some other unusual infections which should be considered as differential diagnoses in unclear disease of the central nervous system.
Tidsskrift for Den norske legeforening 06/1995; 115(12):1508-11.
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ABSTRACT: When reinnervation is allowed after a sciatic nerve cut in the adult rat, motoneuron axons may branch to innervate antagonistic muscles. This multiple innervation is widespread, but transient. Fourteen weeks after denervation isometric muscle contraction experiments and studies with anterograde transport of the fluorescent tracer Fast Blue showed that branches from the same motoneurons reached the distal part of the tibial nerve and either the soleus or the extensor digitorum longus muscles or both muscles. Retrogradely double-labeled motoneurons were found after injections of different fluorescent tracers into these muscles. Sixty-four to 88 weeks after the nerve cut, similar experiments showed that selective innervation was reestablished. The findings suggest a selective mechanism for axon withdrawal in an adult mammal.
Experimental Neurology 01/1995; 130(2):331-6. · 4.70 Impact Factor
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ABSTRACT: Cestode infections of the human central nervous system are reviewed. These conditions represent a major health problem in many countries, and neurocysticercosis is one of the major causes of epilepsy worldwide. Neither cysticercosis nor echinococcosis are endemic to Norway. Therefore, little attention has been paid to these conditions. However, owing to increased travelling and immigration, occasional cases are found. Five cases of neurocysticercosis and one case of presumable brain echinococcosis have recently been diagnosed in our department.
Tidsskrift for Den norske legeforening 11/1994; 114(26):3089-92.
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ABSTRACT: Cerebellar involvement in visceral and affective responses is known from physiological and behavioral studies, but the pathways involved in these responses have remained enigmatic. Over the last ten years neuroanatomical studies have shown that the cerebellum and hypothalamus are interconnected by direct hypothalamocerebellar and cerebellohypothalamic projections and by a multitude of indirect pathways. The hypothalamocerebellar projection terminates in the cerebellar nuclei and in all layers of the cerebellar cortex as multilayered fibres. This projection is, at least in part, histaminergic. New immunocytochemical experiments indicate that small numbers of hypothalamocerebellar neurones may contain GABA- or glycine-like immunoreactivity. GABA may function as a transmitter in hypothalamocerebellar fibres, probably in conjunction with histamine, but it is not clear whether glycine may also function as a transmitter or only serve metabolic functions. The bidirectional pathways between the cerebellum and hypothalamus may be part of the circuits through which the cerebellum participates in the modulation of a variety of nonsomatic events. In addition, new observations on patients with well localized cerebellar lesions reveal simultaneous somatic and visceral dysfunction. Recent research on direct hypothalamocerebellar pathways and on other connections between hypothalamus and cerebellum is reviewed. It is hypothesized that the cerebellum may act as a general modulator and coordinator of a wide range of central nervous activities, somatic as well as nonsomatic.
Histology and histopathology 08/1994; 9(3):603-14. · 2.48 Impact Factor
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ABSTRACT: The hypothalamic projection to the cerebellar nuclei and cortex in the cat was studied by means of retrograde transport of wheat germ agglutinin-horseradish peroxidase complex and various fluorescent tracers. The hypothalamocerebellar nuclear projection originates from various parts of the posterior hypothalamus and reaches mainly the ipsilateral fastigial and interposed nuclei, but all nuclei receive some hypothalamocerebellar fibres. It appears from our double labelling experiments that at least one half of the hypothalamocerebellar nuclear neurones by means of axon collaterals also projects to the cerebellar cortex. Experiments with depositions of fluorescent tracers in both cerebellar hemispheres show that some hypothalamocerebellar fibres branch to reach different parts of the cerebellar cortex. Previous studies have shown that hypothalamocerebellar axons may be branches of hypothalamic efferents to other sites. However, experiments with combined fluorescent tracer depositions in the cerebellum and hippocampus gave no evidence for hypothalamic neurones with axon collaterals to both these regions.
Archives italiennes de biologie 02/1994; 132(1):25-38. · 1.29 Impact Factor
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ABSTRACT: A patient with meningeal irritation and a small occipital cystic lesion is presented. Based on serological tests, the condition was diagnosed as presumably echinococcosis. To our knowledge, meningeal irritation has previously not been reported as an early symptom of cerebral Echinococcus infestation. Cysticercosis is discussed as a possible differential diagnosis.
Scandinavian Journal of Infectious Diseases 02/1994; 26(5):631-4. · 1.72 Impact Factor
