Archives of Neurology

Yahr, Melvin D.

doi: 10.1001/archneur.1978.00500280003001pmid: 346008

Abstract During the past decade, medical educators have become aware of a new breed of student among the hallowed amphitheaters of medical schools. At first glance, he bears little relationship to his predecessors who have been characterized over the years as being establishment people, totally immersed in their studies and relatively isolated and uninvolved with the political and social problems existing around them. To a considerable extent, the medical students of yesterday accepted the established traditions of medical teaching, training, and practice and rarely, at least in open forum, questioned the wisdom of authority—apparently wanting only to qualify for their rightful place in the medical and social hierarchy. But it seems that the observation of the well-known folk singer and hero of all under 30 years of age—Bob Dylan— applies to medicine: "The times they are α-changing." The situation as it exists today in medical schools has been the subject References 1. 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Eng, Gloria D.;Epstein, Burton S.;Engel, W. King;McKay, Douglas W.;McKay, Robert

doi: 10.1001/archneur.1978.00500280007002pmid: 637752

Abstract • We describe a development of a malignant hyperthermia (MH) syndrome, partially aborted by therapy, in a child with central core disease and congenital dislocating hips. Patients with central core disease appear to be more susceptible to MH; possibly those with elevated serum creatine phosphokinase levels, as in our patient, are especially susceptible. We review the clinical and pathologic aspects, possible pathogenesis, and treatment of the MH syndrome. An increased calcium level within the muscle fiber is suggested as the major cytodestructive factor, and that increase could be consequent to a plasmalemmal susceptibility to the provoking drugs hypothesized to be the basic defect in MH. Prevention of the full manifestations of MH is predicated on (1) a high index of suspicion in the search for history of anesthetic complications in the patient and his family, with or without evident neuromuscular disease, (2) recognition that there is a somewhat greater risk of MH developing in a patient who has certain "musculoskeletal" abnormalities or muscle weakness but that is not— except for central core disease—a classic clinicopathologically defined disease, (3) close monitoring of patients during anesthesia, and (4) if the syndrome develops, prompt therapeutic measures, including cessation of anesthesia. References 1. Tuttle JP: Heat stroke as a postoperative complication . JAMA 35:1685, 1900. 2. Moschcowitz AV: Heat stroke as a postoperative complication . JAMA 35:1685, 1900. 3. Moschcowitz AV: Postoperative heat stroke . Surg Gynecol Obstet 23:443-451, 1916. 4. Denborough MA, Dennett X, Anderson R McD: Correspondence . Br Med J 1:738-739, 1973.Crossref 5. 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Engel WK, Foster JB, Hughes BP, et al: Central core disease: An investigation of a rare muscle cell abnormality . Brain 84:167-185, 1961.Crossref 39. Shy GM, Magee K: A new congenital nonprogressive myopathy . Brain 79:610-621, 1956.Crossref 40. Bull AB, Harrison GG: Recent advances in the understanding of anesthetic-induced malignant hyperpyrexia . Acta Anesthesiol Belg 24:97-108, 1973. 41. Gatz EE: The Mechanism of induction of malignant hyperpyrexia based on in vitro to in vivo correlative studies, in Gordon RA, Britt BA, Kalow W (eds): International Symposium on Malignant Hyperthermia. Springfield, Ill, Charles C. Thomas Publisher, 1973, pp 399-408. 42. Isaacs H, Heffron JJA, Badenhorst M: Predictive tests of malignant hyperpyrexia . Br J Anaesth 47:1075-1079, 1975.Crossref 43. Kalow W: Some aspects of the pharmacology of muscle relaxants, in Gordon RA, Britt BA, Kalow W (eds): International Symposium on Malignant Hyperthermia. 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Lütschg, Jürg;Jerusalem, Felix;Ludin, Hans P.;Vassella, Franco;Mumenthaler, Marco

doi: 10.1001/archneur.1978.00500280016003pmid: 637753

Abstract • A 7-year-old boy who suffered from increasing stiffness and contractures of the extremities had distally pronounced atrophy and absent tendon reflexes. Electromyography showed continuous electrical activity during rest, sleep, after intravenous injection of diazepam, and after peripheral nerve block. The H reflex was elicitable; the silent period after the reflex was absent. Histopathological examination of the peroneus muscle disclosed a marked preponderance of type I fibers and slight atrophy of the type II fibers. Electron microscopic examination of the endplates demonstrated a marked atrophy of the postsynaptic regions and widened synaptic clefts. After one year's treatment with phenytoin, 200 mg daily, the patient showed an almost normal muscle tone. As not all of these electrophysiological phenomena can be fully explained by disturbances of the nerve terminals or the endplates, a further anomaly proximal from the peripheral nerve block seems to have been present. 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Hugon M, Delwaide P, Pierrot-Desselligny E, et al: A discussion of the methodology of the triceps surae T- and H reflexes , in Desmedt JE (ed): New Developments in Electromyography and Clinical Neurophysiology . Basel, Switzerland, S Karger, 1973, vol 3, pp 773-780. 21. Engel AG: Locating motor endplates for electron microscopy . Mayo Clin Proc 45:450-454, 1970. 22. Jerusalem F, Birchhausen R: Zur Technik der Muskelbiopsie . Nervenarzt 46:42-48, 1975. 23. Stonnington HH, Engel AG: Normal and denervated muscle . Neurology 23:714-724, 1973.Crossref 24. Gamstorp I, Wohlfart G: A syndrome characterized by myokymia, myotonia, muscular wasting and increased perspiration . Acta Psychiatr Scand 34:181-194, 1959.Crossref 25. Hopf HC: Ueber die Veränderung der Leit-funktion peripherer motorischer Nervenfasern durch Diphenylhydantoin . Dtsch Z Nervenheilkd 193:41-56, 1968.Crossref 26. Hopf HC: Anticonvulsant drugs and spike propagation of motor nerves and skeletal muscle . J Neurol Neurosurg Psychiatry 36:574-580, 1973.Crossref 27. Norris FH, Colella J, McFarlin D: Effect of diphenylhydantoin on neuromuscular synapses . Neurology 14:869-876, 1964.Crossref 28. Su PC, Feldmann OS: Motor nerve terminal and muscle membrane stabilization by diphenylhydantoin administration . Arch Neurol 28:376-379, 1973.Crossref 29. Isaacs H, Heffron JJA: The syndrome of "continuous muscle fibre activity" cured: Further studies . J Neurol Neurosurg Psychiatry 37:1231-1235, 1974.Crossref 30. Mertens HG, Ricker K: Uebererregbarkeit der Gamma Motoneurone beim Stiff Man Syndrome . Klin Wochenschr 48:33-42, 1968.Crossref 31. Scarlato G, Schönhuber R, Valli G: Histoenzymologische Besonderheiten in einem Fall von Neuromyotonie , in Deutsche Gesellschaft zur Bekämpfung der Muskelkrankheiten Freiburg i. Br. (ed): Fortschr Myol 1975, pp 289-295. 32. Cotter M, Hüdlicka O, Pette D, et al: Changes in capillary density and enzyme pattern in fast rabbit muscles during long-term stimulation . J Physiol 230:34-35, 1973. 33. Engel AG, Santa T: Histometric analysis of the ultrastructure of the neuromuscular junction in myasthenia gravis and in the myasthenic synrome . Ann NY Acad Sci 183:46-63, 1971.Crossref 34. Engel AG, Lambert EH, Santa T: Study of long-term anticholinesterase therapy: Effects on neuromuscular transmission and on motor endplate fine structure . Neurology 23:1273-1281, 1973.Crossref 35. Jerusalem F, Engel AG, Gomez MR: Duchenne dystrophy: II. Morphometric study of motor endplate fine structure . Brain 97:123-130, 1974.Crossref 36. Engel AG, Jerusalem F, Tsujihata M, et al: The Neuromuscular Junction in Myopathies: A Quantitative Ultrastructural Study, International Congress series 334. Amsterdam, Excerpta Medica, 1974. 37. Jerusalem F, Engel AG, Peterson HA: Human muscle fiber fine structure: Morphometric data on controls . Neurology 25:127-134, 1975.Crossref

Hayakawa, Toru;Waltz, Arthur G.

doi: 10.1001/archneur.1978.00500280024004pmid: 565199

Abstract • Autogenous blood was injected repeatedly into the intracranial subarachnoid space of cats, the heads of which were placed in one of four positions (prone, supine, left side down, and right side down). Epidural pressures, mean aortic blood pressures, and pulse rates were measured, and their responses to the repeated injections were analyzed. The distribution of the injected blood was different among the four groups. The cats in the supine position had the greatest amounts of blood in the posterior fossa and tolerated the injections least well. The position of the head at the time of a subarachnoid hemorrhage may influence the prognosis; positions that favor accumulations of blood around the brain stem carry the greatest risk. References 1. Helpern M, Rabson SM: Sudden and unexpected natural death: III. Spontaneous subarachnoid hemorrhage . Am J Med Sci 220:262-271, 1950.Crossref 2. Sugai M, Koni R: Pathological studies on subarachnoid hemorrhage, especially on the origin and localization of aneurysms of the basal arteries of the brain . Trans Soc Pathol Japan 44:330-345, 1956. 3. Freitag E: Fatal rupture of intracranial aneurysms: Survey of 250 medicolegal cases . Arch Pathol 81:418-424, 1966. 4. Gabor I, Potondi A: Hirnbasis-aneurysmen: Topographie und morphologische Befunde . Munch Med Wochenschr 109:224-226, 1967. 5. Lougheed WM, Tom M: A method of introducing blood into the subarachnoid space in the region of the circle of Willis in dogs . Can J Surg 4:329-337, 1961. 6. Takamatsu H: Experimental studies on the cause of death by rupture of aneurysm of the Willis ring: I. Observation on the subarachnoid blood volume, distribution pattern of the blood and change of small arteries of the brain stem in cases of sudden death . Sapporo Med J 32:307-325, 1967. 7. Hayakawa T, Waltz AG: Experimental subarachnoid hemorrhage from a middle cerebral artery: Neurologic deficits, intracranial pressures, blood pressures, and pulse rates . Stroke 8:421-426, 1977.Crossref 8. Hayakawa T, Waltz AG: Changes of epidural pressures after experimental occlusion of one middle cerebral artery in cats . J Neurol Sci 26:319-333, 1975.Crossref 9. McQueen JD, Jelsma LF: Intracranial hypertension: Cerebrospinal fluid pressure rises following intracisternal infusions of blood components in dogs . Arch Neurol 16:501-508, 1961.Crossref 10. Bito S: Studies on dynamics of cerebrospinal fluid pressure: The load test of cerebrospinal fluid . Handai-Ishi 14:145-180, 1962. 11. Leech PJ, Miller JD: Intracranial volumepressure relationships during experimental brain compression in primates: I. Pressure responses to changes in ventricular volume . J Neurol Neurosurg Psychiatry 37:1093-1098, 1974.Crossref 12. Leech PJ, Miller JD: Intracranial volumepressure relationships during experimental brain compression in primates: II. The effect of induced changes in systemic arterial pressure and cerebral blood flow . J Neurol Neurosurg Psychiatry 37:1099-1104, 1974.Crossref 13. Leech PJ, Miller JD: Intracranial volumepressure relationships during experimental brain compression in primates: III. The effect of mannitol and hyperventilation . J Neurol Neurosurg Psychiatry 37:1105-1111, 1974.Crossref 14. Miller JD, Leech P: Effects of mannitol and steroid therapy on intracranial volume-pressure relationships in patients . J Neurosurg 42:274-281, 1975.Crossref 15. Wolfson LI, Katzman R: Infusion manometric test in experimental subarachnoid hemorrhage in cats . Neurology 22:856-862, 1972.Crossref

Abu-Zeid, Hassan A. H.;Choi, Nung Won;Hsu, Ping-Hwa;Maini, Kuldip K.

doi: 10.1001/archneur.1978.00500280031005pmid: 637754

Abstract • Using the life table method, 962 cases of infarction, 279 cases of hemorrhage, and 243 cases of undetermined type of stroke, occurring in Manitoba between Jan 1, 1970, and June 30, 1971, were analyzed for factors affecting survival. Survival until Dec 31, 1973, was found to be adversely affected by the presence of coma or unconsciousness and the absence of localizing signs and symptoms. Also, the prognosis was poor if the heart was enlarged on the x-ray film or the ECG was abnormal. On the other hand, the presence of individual clinical entities such as hypertension, hypertensive heart disease, myocardial infarction, atrial fibrillation, or diabetes did not affect the survival significantly. These findings will help in predicting the prognosis and in planning for management of stroke cases. References 1. Abu-Zeid HAH, Choi NW, Hsu P-H, et al: Prognostic factors in the survival of 1,484 stroke cases observed for 30 to 48 months: I. Diagnostic types and descriptive variables . Arch Neurol 35:121-125, 1978.Crossref 2. Marquardsen J: The natural history of acute cerebrovascular disease: A retrospective study of 769 patients . Acta Med Scand , (suppl 38) , 1969, 45. 3. Robinson RW, Demirel M, LeBeau RJ: Natural history of cerebral thrombosis 9 to 19 year follow-up . J Chronic Dis 21:221-230, 1968.Crossref 4. Cooper ES, Ipsen J, Brown HD: Determining factors in the prognosis of stroke . Geriatrics 18:3-9, 1963. 5. Truscott BL, Kretschmann CM, Toole JF, et al: Early rehabilitative care in community hospitals: Effect on quality of survivorship following a stroke . Stroke 5:623-629, 1974.Crossref 6. Frittz G, Werner I: Studies on cerebrovascular strokes: II. Clinical findings and short-term prognosis in a stroke material . Acta Med Scand 199:133-140, 1976.Crossref 7. Robinson RW, Cohen WD, Higano N, et al: Life table analysis of survival after cerebral thrombosis: Ten-year experience . JAMA 169:1149-1152, 1959.Crossref 8. Haerer AF, Woosley PC: Prognosis and quality of survival in a hospitalized stroke population from the South . Stroke 6:543-548, 1975.Crossref 9. David NJ, Heyman A: Factors influencing the prognosis of cerebral thrombosis and infarction due to atherosclerosis . J Chronic Dis 11:394-404, 1960.Crossref 10. Marshall J, Kaeser AC: Survival after nonhaemorrhagic cerebrovascular accidents . Br Med J 2:73-77, 1961.Crossref 11. Acheson J: Factors affecting the natural history of focal cerebral vascular disease . Q J Med 40:25-46, 1971. 12. Shafer SQ, Bruun B, Richter RW: Epidemiology of in hospital deaths among black stroke patients . Stroke 4:923-927, 1973.Crossref 13. Millikan CH, Adams RD, Fang H, et al: A classification and outline of cerebrovascular disease: Report by an ad hoc committee established by the Advisory Council for the National Institute of Neurological Disease and Blindness, Public Health Service . Neurology 8:397-437, 1958.

Takeoka, Tsuneyuki;Gotoh, Fumio;Fukuuchi, Yasuo;Inagaki, Yasutaka

doi: 10.1001/archneur.1978.00500280037006pmid: 637755

Abstract • Diagnosis of Tolosa-Hunt syndrome was made in a 25-year-old woman on the basis of unilateral third and sixth nerve paresis and possible involvement of the first branch of the ipsilateral trigeminal nerve, accompanied by headaches and ocular pain, which responded promptly to corticosteroid administration. Irregular narrowing of the right carotid siphon and occlusion of the homolateral superior ophthalmic vein were observed. During steroid therapy this stenosis improved in association with almost complete clinical recovery, although the vein was not recanalized. Of ten reported cases with contrast radiographic abnormalities, including our own, only two showed pupillary involvement. We hypothesize that the third nerve paresis with pupillary sparing in this syndrome may be attributable to the same underlying mechanism as that of diabetic ophthalmoplegia. References 1. Tolosa E: Periarteritic lesions of the carotid siphon with the clinical features of a carotid infraclinoidal aneurysm . J Neurol Neurosurg Psychiatry 17:300-302, 1954.Crossref 2. Hunt WE, Meagher JN, LeFever HE, et al: Painful ophthalmoplegia: Its relation to indolent inflammation of the cavernous sinus . Neurology 11:56-62, 1961.Crossref 3. Smith JL, Taxdal DSR: Painful ophthalmoplegia: The Tolosa-Hunt syndrome . Am J Ophthalmol 61:1466-1472, 1966. 4. Walsh JP, O'Doherty DS: A possible explanation of the mechanism of ophthalmoplegic migraine . Neurology 10:1079-1084, 1960.Crossref 5. Bickerstaff MER: Ophthalmoplegic migraine . Rev Neurol 110:582-588, 1964. 6. Lakke JPWF: Superior orbital fissure syndrome: Report of a case caused by local pachymeningitis . Arch Neurol 7:289-300, 1962.Crossref 7. Hedges TR: Alternating exophthalmos with painful ophthalmoplegia . Arch Ophthalmol 74:625-627, 1965.Crossref 8. Berg E, Gay AJ: Tolosa-Hunt syndrome . Eye Ear Nose Throat Digest 29:51-52, 1967. 9. øther A: Painful ophthalmoplegia: Report of a case . Acta Ophthalmol 45:371-373, 1967.Crossref 10. Mathew NT, Chandy J: Painful ophthalmoplegia . J Neurol Sci 11:243-256, 1970.Crossref 11. Thomas JE, Yoss RE: The parasellar syndrome: Problems in determining etiology . Mayo Clin Proc 45:617-623, 1970. 12. Milstein BA, Morretin LB: Report of a case of sphenoid fissure syndrome studied by orbital venography . Am J Ophthalmol 72:600-603, 1971. 13. Sondheimer FK, Knapp J: Angiographic findings in the Tolosa-Hunt syndrome: Painful ophthalmoplegia . Radiology 106:105-112, 1973.Crossref 14. Hallpike JF: Superior orbital fissure syndrome: Some clinical and radiological observations . J Neurol Neurosurg Psychiatry 36:486-490, 1973.Crossref 15. Terrence CF, Samaha FJ: The Tolosa-Hunt syndrome (painful ophthalmoplegia) in children . Dev Med Child Neurol 15:506-509, 1973.Crossref 16. Adams AH, Warner AM: Painful ophthalmoplegia: Report of a case with cerebral involvement and psychiatric complications . Bull Los Angeles Neurol Soc 40:49-55, 1975. 17. Kettler HL, Martin JD: Arterial stationary wave phenomenon in Tolosa-Hunt syndrome . Neurology 25:765-770, 1975.Crossref 18. Wolfram A: Syndrom der schmerzhaften Ophthalmoplegie bei unspezifischer Entzündung im Sinus cavernosus: Tolosa-Hunt Syndrom . Nervenarzt 47:513-516, 1976. 19. Hunt WE: Tolosa-Hunt syndrome: One cause of painful ophthalmoplegia . J Neurosurg 44:544-549, 1976.Crossref 20. Lloyd GAS: The localization of lesions in the orbital apex and cavernous sinus by frontal venography . Br J Radiol 45:405-414, 1972.Crossref 21. Asbury AK, Aldredge H, Hershberg R, et al: Oculomotor palsy in diabetes mellitus: A clinico-pathological study . Brain 93:555-566, 1970.Crossref 22. Schnürer L-B, Stattin S: Vascular supply of intracranial dura from internal carotid artery with special reference to its angiographic significance . Acta Radiol Diagn 1:441-450, 1963. 23. Parkinson D: A surgical approach to the cavernous portion of the carotid artery: Anatomical studies and case report . J Neurosurg 23:474-483, 1965.Crossref 24. Rucker CW: Paralysis of the third, fourth and sixth cranial nerves . Am J Ophthalmol 46:787-794, 1958. 25. Goldstein JE, Cogan DG: Diabetic ophthalmoplegia with special reference to the pupil . Arch Ophthalmol 64:592-600, 1960.Crossref 26. Green WR, Hackett ER, Schlezinger NS: Neuro-ophthalmologic evaluation of oculomotor nerve paralysis . Arch Ophthalmol 72:154-167, 1964.Crossref 27. Zorrilla E, Kozak GP: Ophthalmoplegia in diabetes mellitus . Ann Intern Med 67:968-976, 1967.Crossref 28. Sunderland S, Hughes ESR: The pupilloconstrictor pathway and the nerves to the ocular muscles in man . Brain 69:301-309, 1946.Crossref 29. Dreyfus PM, Hakim S, Adams RD: Diabetic ophthalmoplegia . Arch Neurol Psychiatry 77:337-349, 1957.Crossref 30. Weber RB, Daroff RB, Mackey EA: Pathology of oculomotor nerve palsy in diabetes . Neurology 20:835-838, 1970.Crossref

Stern, Lawrence Z.;Cross, Harold E.;Crebo, Alan R.

doi: 10.1001/archneur.1978.00500280042007pmid: 637756

Abstract • The microvasculature of the iris was studied in 35 patients with neuromuscular disease and 14 control subjects, using anterior segment fluorescein angiography. Myotonic muscular dystrophy, in which a variety of ocular changes have previously been reported, was found to be associated with both focal and generalized vascular abnormalities. Changes were seen in the fluorescein angiograms of all nine of the myotonic dystrophy patients in which the iris vessels could be seen. No evidence of a microcirculatory disorder was seen in patients with Duchenne's dystrophy, for which a vascular pathogenesis has been proposed. The angiograms of patients with limb-girdle dystrophy, facioscapulohumeral dystrophy, and Friedreich's ataxia were also normal. References 1. Caughey JE, Myrianthopoulos NC: Dystrophia Myotonia and Related Disorders . Springfield, Ill, Charles C Thomas Publishers, 1963. 2. Pruzanski W: Myotonic dystrophy—A multisystem disease . Psychiatr Neurol 149:302-322, 1965.Crossref 3. Kilburn KH, Eagen JT, Heyman A: Cardiopulmonary insufficiency associated with myotonic dystrophy . Am J Med 26:929-935, 1959.Crossref 4. Cannon PJ: The heart and lungs in myotonic muscular atrophy . Am J Med 32:765-775, 1962.Crossref 5. Drucker WD, Rowland LP, Sterling K, et al: On the function of the endocrine glands in myotonic muscular dystrophy . Am J Med 31:941-950, 1961.Crossref 6. Caughey JE, Saucier J: Endocrine aspects of dystrophia myotonica . Brain 85:711-732, 1962.Crossref 7. Kohn NH, Faires JS, Rodman T: Unusual manifestations due to involvement of involuntary muscle in dystrophia myotonica . N Engl J Med 271:1179-1183, 1964.Crossref 8. Harney JC, Sherbourne DH, Siegel CI: Smooth muscle involvement in myotonic dystrophy . Am J Med 39:81-90, 1965.Crossref 9. Thompson HS, Van Allen MW, von Noorden GK: The pupil in myotonic dystrophy . Invest Ophthalmol 3:325-337, 1964. 10. Junge J: Ocular changes in dystrophia myotonica, paramyotonia and myotonia congenita . Doc Ophthalmol 21:1-116, 1966.Crossref 11. Burian HM, Burns CA: Ocular changes in myotonic dystrophy . Am J Ophthalmol 63:22-34, 1967. 12. Wochner DR, Drews G, Stroles W, et al: Accelerated breakdown of immunoglobulin G (IgG) in myotonic dystrophy: A hereditary error of immunoglobulin catabolism . J Clin Invest 45:321-329, 1966.Crossref 13. Bruun-Jensen J: Fluorescein angiography of the anterior segment . Am J Ophthalmol 67:842-845, 1969. 14. Craandijk A, Aan de Kerk AL: Fluorescence angiography of the iris . Br J Ophthalmol 54:229-232, 1970.Crossref 15. Cobb S, Shilling JS, Chisholm MB: Vascular tufts at the pupillary margin in myotonic dystrophy . Am J Ophthalmol 69:573-582, 1970. 16. Gifford SR, Bennett AE, Fairchild NM: Cataract in myotonic dystrophy . Arch Ophthalmol 1:335-345, 1929.Crossref 17. Roses AD, Appel SH: Phosphorylation of component of the human erythrocyte membrane in myotonic muscular dystrophy . J Membr Biol 20:51-58, 1975.Crossref 18. Roses AD, Appel SH: Protein kinase activity in erythrocyte ghosts of patients with myotonic dystrophy . Proc Nati Acad Sci 70:1155-1159, 1973.Crossref 19. Butterfield DA, Chestnut DB, Roses AD, et al: Electron spin resonance studies of erythrocytes from patients with myotonic muscular dystrophy . Proc Natl Acad Sci 71:909-913, 1974.Crossref 20. Hathaway PW, Engel WK, Zellweger H: Experimental myopathy after arterial embolization: Comparison with childhood X-linked pseudohypertrophic muscular dystrophy . Arch Neurol 22:365-377, 1970.Crossref 21. Mendell JR, Engel WK, Derrer EC: Duchenne muscular dystrophy: Functional ischemia reproduces its characteristic lesions . Science 172:1143-1145, 1971.Crossref 22. Karpati G, Carpenter SM: Experimental ischemic myopathy . J Neurol Sci 23:129-161, 1974.Crossref 23. Bradley WG, O'Brien MD, Walder DN, et al: Failure to confirm a vascular cause of muscular dystrophy . Arch Neurol 32:466-473, 1975.Crossref 24. Jerusalem F, Engel AG, Gomez MR: Duchenne dystrophy: Morphometric study of the muscle microvasculature . Brain 97:115-122, 1974.Crossref 25. Cobb B: Vascular tufts at the pupillary margin: A preliminary report on 44 patients . Trans Ophthalmol Soc UK 88:211-221, 1968.

Sohmer, Haim;Gafni, Mikhal;Chisin, Roland

doi: 10.1001/archneur.1978.00500280046008pmid: 637757

Abstract • The recording of auditory nerve and brain stem responses to click stimuli is being used for the diagnosis of several conditions such as suspected hearing loss and suspected neurological disorders. The responses obtained in the patient group (often infants and children) are compared with those obtained in normal subjects of similar age who, for ethical reasons, are not sedated. In this study, recordings were made in normal subjects while they were awake and when they were unconscious in drug-induced sleep (being prepared for dental surgery). No significant difference could be observed between the recordings obtained in the awake state and when unconscious in the same subjects. Therefore, one is justified in using recordings made in awake subjects as controls for recordings made in other unconscious patients. References 1. Sohmer H, Feinmesser M, Szabo G: Sources of electrocochleographic responses as studied in patients with brain damage . Electroencephalogr Clin Neurophysiol 37:663-669, 1974.Crossref 2. Starr A, Achor J: Auditory brain stem responses in neurological disease . Arch Neurol 32:761-768, 1975.Crossref 3. Thornton ARD, Hawkes CH: Neurological applications of surface recorded electrocochleography . J Neurol Neurosurg Psychiatry 39:586-592, 1976.Crossref 4. Sohmer H, Feinmesser M: Routine use of electrocochleography (cochlear audiometry) on human subjects . Audiology 12:167-173, 1973.Crossref 5. Sohmer H, Feinmesser M: Electrocochleography in clinical-audiological diagnosis . Arch Otorhinolaryngol 206:91-102, 1974.Crossref 6. Shochat S, Lewin-Epstein J, Superstine E: Preanesthetic suppository for ambulatory children: Importance of the base . Anesth Analg 48:427-436, 1969.Crossref 7. Lev A, Sohmer H: Sources of averaged neural responses recorded in animal and human subjects during cochlear audiometry (electrocochleogram) . Arch Klin Exp Ohren Nasem Kehlkopfheilkd 201:79-90, 1972.Crossref 8. Starr A, Hamilton AE: Correlation between confirmed sites of neurological lesions and abnormalities of far field auditory brainstem responses . Electroencephalogr Clin Neurophysiol 46:609-622, 1976. 9. Jewett DL, Romano MN: Neonatal development of auditory system potentials averaged from the scalp of rat and cat . Brain Res 36:101-115, 1972.Crossref 10. Amadeo M, Shagass C: Brief latency clickevoked potentials during waking and sleep in man . Psychophysiology 10:244-250, 1973.Crossref 11. Mathis A, Graf F: Erfahrungen mit der Elektrokochleographie zur objectiven Gehörmessung bei Kindern . Schweiz Med Wochenschr 104:886-892, 1974. 12. Bobbin RP, May JG, Lemoine RL: Effects of anesthesia on the latency of the early components of click-evoked potentials . J Acoust Soc Am 57( (suppl 1) ):62, 1975.Crossref 13. Stange G: The effect of sedative agents in psychotropic drugs on acoustically evoked responses . Arch Klin Exp Ohren Nasen Kehlkopfheilkd 201:294-308, 1972.Crossref 14. Galambos R: Suppression of auditory nerve activity by stimulation of efferent fibers to cochlear . J Neurophysiol 14:424-437, 1956. 15. Sohmer H: The effect of contralateral olivo-cochlear bundle stimulation on the cochlear potentials evoked by acoustic stimuli of various frequencies and intensities . Acta Otolaryngol 60:59-70, 1965.Crossref

Meienberg, Otmar;Röver, Jens;Kommerell, Guntram

doi: 10.1001/archneur.1978.00500280049009pmid: 637758

Abstract • In a case of left inferior rectus paresis, it is demonstrated that the lesion must be prenuclear. On downward gaze, the left eye, although it reached the required target with a rapid saccade, drifted back towards the midline immediately afterwards. During the drift, several corrective saccades appeared. A dissociated "gaze paretic" nystagmus resulted. Synchronously, the right eye showed an incyclorotary nystagmus. We suspect a lesion of "tonic" fibers supplying the nuclear region of the left inferior rectus and the right superior oblique muscle. References 1. Lutz A: Ueber die Bahnen der Blickwendung und deren Dissoziierung: Nebst einer Mitteilung eines Falles von Ophthalmoplegia internuclearis anterior in Verbindung mit Dissoziierung der Bogengänge . Klin Monatsbl Augenheilkd 70:213-235, 1923. 2. Smith JL, Cogan DG: Internuclear ophthalmoplegia: A review of fifty-eight cases . Arch Ophthalmol 61:687-694, 1959.Crossref 3. Bielschowsky A: Lectures on motor anomalies: X. Supranuclear paralyses . Am J Ophthalmol 22:603-613, 1939. 4. Lessell S: Supranuclear paralysis of monocular elevation . Neurology 25:1134-1136, 1975.Crossref 5. Jampel RS, Fells P: Monocular elevation paresis caused by a central nervous system lesion . Arch Ophthalmol 80:45-57, 1968.Crossref 6. Metz HS, Scott AB, O'Meara D, et al: Ocular saccades in lateral rectus palsy . Arch Ophthalmol 84:453-460, 1970.Crossref 7. Kirkham TH, Bird AC, Sanders MD: Divergence paralysis with raised intracranial pressure . Br J Ophthalmol 56:776-782, 1972.Crossref 8. Theopold H, Kommerell G: Phasische und tonische Funktion der Augenmuskeln: Untersuchungen an Patienten mit Oculomotorius-oder Abduzens-Paralyse . Albrecht von Graefes Arch Klin Exp Ophthalmol 192:247-254, 1974.Crossref 9. Yee RD, Cogan DG, Zee DS, et al: Rapid eye movements in myasthenia gravis: II. Electrooculographic analysis . Arch Ophthalmol 94:1465-1472, 1976.Crossref 10. Büttner U, Büttner-Ennever JA, Henn V: Vertical eye movement related unit activity in the rostral mesencephalic reticular formation of the alert monkey . Brain Res 130:239-252, 1977.Crossref 11. King WM, Fuchs AF, Magnis M: Einzelzellaktivität im Mittelhirn von wachen Affen während vertikaler Augenbewegungen , in Kommerell G (ed): Disorders of Ocular Motility, Neurophysiological and Clinical Aspects . Munich, Germany, JF Bergmann, 1978. 12. Warwick R: Oculomotor organization , in Bender MB (ed): The Oculomotor System . New York, Hoeber Medical Division, 1964, pp 173-202. 13. Szentágothai J: Pathways and synaptic articulation patterns connecting vestibular receptors and oculomotor nuclei , in Bender MB (ed): The Oculomotor System . New York, Hoeber Medical Division, 1964, pp 205-223. 14. Carpenter MB: Central oculomotor pathways , in Bach-y-Rita P, Collins CC, Hyde JE (eds): The Control of Eye Movements . New York, Academic Press, 1971, pp 67-103. 15. King WM, Lisberger SG, Fuchs AF: Responses of fibers in medial longitudinal fasciculus (MLF) of alert monkeys during horizontal and vertical conjugate eye movements evoked by vestibular or visual stimuli . J Neurophysiol 39:1135-1149, 1976. 16. Robinson DA, Pola J: The conversion of signals in the vestibulo-ocular reflex , in Kommerell G (ed): Disorders of Ocular Motility, Neurophysiological and Clinical Aspects . Munich, Germany, JF Bergmann, 1978. 17. Fuchs AF, Evinger LC, King WM, et al: Die unterschiedliche Rolle des hinteren Längsbündels bei horizontalen und vertikalen willkürlich und vestibular ausgelösten Augenbewegungen: Einzelfaserableitungen und Läsionsstudien beim Affen , in Kommerell G (ed): Disorders of Ocular Motility, Neurophysiological and Clinical Aspects . Munich, Germany, JF Bergmann, 1978.

Kotsias, Basilio A.;Muchnik, Salomon

doi: 10.1001/archneur.1978.00500280052010pmid: 637759

Abstract • The effect of dantrolene sodium on twitch tension in skeletal muscle of the rat was studied in short- and long-term experiments. The twitch tension is reduced to 50% of the control values within 20 to 30 minutes of drug administration. The recovery phase is considerably slower than the effect observed on the addition of dantrolene sodium, having a half time of 10 hours. Twenty-four hours after the drug injection, the twitch tension in the treated muscles is indistinguishable from that in the controls. It is shown that the reduction in the magnitude of the twitch produced by dantrolene sodium is slowly and completely reversible. References 1. Snyder HRJ, Davis CS, Bickerton RK, et al: 1(5-Aryl-furfurylidene amino) hidantoine: A new class of muscle relaxants . J Med Chem 10:807-810, 1967.Crossref 2. Chyatte SB, Birdsong JH, Bergman BA: The effects of dantrolene sodium on spasticity and motor performance in hemiplegia . South Med J 64:180-185, 1971.Crossref 3. Gelenberg AJ, Poskanzer DC: The effects of dantrolene sodium on spasticity in multiple sclerosis . Neurology 23:1313-1315, 1973.Crossref 4. Basmajian JW, Super GA: Dantrolene sodium in the treatment of spasticity . Arch Phys Med Rehabil 54:60-64, 1973. 5. Chipman M, Kaul S, Lambie M: Efficacy of dantrolene sodium in the treatment of spasticity . Dis Nerv Syst 35:427-431, 1974. 6. Dykes MHM: Evaluation of a muscle relaxant: Dantrium (dantrolene sodium) . JAMA 231:862-864, 1975.Crossref 7. Herman R, Mayer N, Mecomber SA: Clinical pharmaco-physiology of dantrolene sodium . Am J Phys Med 51:296-311, 1972. 8. Ladd H, Oist C, Jonsoon B: The effect of Dantrium on spasticity in multiple sclerosis . Acta Neurol Scand 50:397-408, 1974.Crossref 9. Schmidt RT, Lee RH, Spehlmann R: Comparison of dantrolene sodium and diazepam in the treatment of spasticity . J Neurol Neurosurg Psychiatry 39:350-356, 1976.Crossref 10. Harrison GG: Control of the malignant hyperpyrexia syndrome in MHS swine by dantrolene sodium . Br J Anaesth 47:62-65, 1975.Crossref 11. Kurihara T, Brooks JE: Excitation-contraction uncoupling . Arch Neurol 32:92-97, 1975.Crossref 12. Putney JW, Bianchi CP: Site of action of dantrolene in frog sartorius muscle . J Pharmacol Exp Ther 189:202-212, 1974. 13. Hainaut K, Desmedt JE: Effect of dantrolene sodium on calcium movement in single muscle fibres . Nature 252:728-730, 1974.Crossref 14. Close R: Dynamic properties of fast and slow skeletal muscle of the rat during development . J Physiol 173:74-95, 1964. 15. Kotsias BA, Muchnik S: Muscle mechanical changes following denervation and their modification by the use of an inhibitor of RNA synthesis . Life Sci 17:1277-1286, 1975.Crossref 16. Lietman PS, Haslam RHA, Walcher JR: Pharmacology of dantrolene sodium in children . Arch Phys Med Rehabil 55:388-392, 1974. 17. Monster AW, Tamai Y, McHenry J: Dantrolene sodium: Its effect on extrafusal muscle fibres . Arch Phys Med Rehabil 55:355-362, 1974. 18. Heald DE, Matsumoto Y: Inhibition of contraction of frog muscle by dantrolene sodium . Fed Proc 30:778, 1971. 19. Honkomp LJ, Halliday RP, Wessels FL: Dantrolene, 1(5-(P-nitrophenyl) furfurylidine) amino hydantoin: A unique skeletal muscle relaxant . Pharmacology 12:301, 1972. 20. Zorychta E, Esplin DW, Capek R, et al: The action of dantrolene on extrafusal and intrafusal striated muscle . Fed Proc 30:669, 1971. 21. Moulds RFW: A comparison of the effect of sodium thyocianate and dantrolene sodium on a mammalian isolated skeletal muscle . Br J Pharmacol 59:129-133, 1977.Crossref 22. Ellis KO, Carpenter JF: Mechanism of control of skeletal muscle contraction by dantrolene sodium . Arch Phys Med Rehabil 55:362-369, 1974. 23. Hollifield RD, Conklin JD: Determination of dantrolene sodium in biological specimens containing drug-related metabolites . J Pharm Sci 62:271-274, 1973.Crossref 24. Morgan KG, Bryant SH: The mechanism of action of dantrolene sodium . J Pharmacol Exp Ther 201:138-147, 1977. 25. Van Winkle WB: Calcium release from skeletal muscle sarcoplasmic reticulum: Site of action of dantrolene sodium? Science 193:1130-1131, 1976.Crossref