Stapedius reflex in multiple sclerosis

The stapedius reflex (StR) was studied in humans by impedance audiometry. Ipsilateral and contralateral reflexes, obtained from 48 multiple sclerosis (MS) patients and 26 controls, were analysed. MS patients showed smaller reflex amplitudes, longer onset latencies and higher contralateral reflex thresholds. Using onset latencies, 33% of all MS patients had at least two abnormal ipsi- and/or contralateral StRs. If the diagnosis was MS of the definite type, this figure was 39%. The StR is therefore a useful tool for detecting a subclinical lesion in the brainstem and can contribute to the early diagnosis of MS.

Preserved stenography reading in a patient with pure alexia. A model for dissociated reading processes

A proficient stenographer who had had cerebral metastases suffered from pure alexia for normal print but could still read stenography with ease. It is suggested that especially the visuospatial properties of stenography made possible "alternative" reading, most likely via the right hemisphere.

Effects of BAY l 5240, a fixed combination of low dose nifedipine and acebutolol on hypertension: comparison with standard dose nifedipine

116 patients from 4 clinics participated in a double blind study to assess the efficacy of (BAY l 5240), a nifedipine-acebutolol fixed combination (10 mg + 100 mg), as compared to nifedipine 20 mg in essential hypertension. During the 10 week study, the mean recumbent blood pressure decreased 1 to 3 h after treatment from 175.5/105.2 to 148.3/88.0 mmHg in the BAY l 5240 group and from 174.3/102.9 to 150.3/86.5 mmHg in the nifedipine group. The results also showed a comparable decrease in the mean systolic (SBP) and diastolic (DBP) blood pressures before treatment (24 h after last tablet) and after physical exertion before and after either drug given for 4 weeks. Doubling of the dose for 4 additional weeks produced a moderate and similar additional decrease in blood pressure. The results show the possibility of treating essential hypertension with a low dose of a beta-adrenergic blocking agent in combination with 10 mg nifedipine. Both regimens were well tolerated. One patient in the BAY l 5240 group and 2 in the nifedipine group, all treated by the same investigator, were withdrawn from the study because of headache during the nifedipine pre-period.

Rotational testing in patients with bilateral peripheral vestibular disease

We performed quantitative low and high frequency rotational testing in 17 patients with bilateral peripheral vestibular deficits. A characteristic pattern of decreased gain and increased phase lead at low frequencies of sinusoidal stimulation and decreased time constant to impulsive stimulation was observed in most patients. The results of caloric testing correlated with the results of low frequency rotational testing but not with the results of high frequency testing. Only 2 patients complained of oscillopsia at the time of testing and both of these had decreased vestibulo-ocular reflex gain at low and high frequencies of sinusoidal rotation.

Changes in the human vestibulo-ocular reflex after loss of peripheral sensitivity

Quantitative rotational testing was used to study changes in the vestibulo-ocular reflex of patients with unilateral and bilateral peripheral vestibular lesions. Compared with normal subjects, the patients exhibited a characteristic pattern of decreased gain and increased phase lead at low frequencies of sinusoidal stimulation and decreased time constants on impulsive stimulation. By contrast, gain and phase measurements on high-frequency-low-amplitude sinusoidal stimulation were often normal. In the patients with bilateral lesions, the results of caloric testing correlated with the results of low-frequency rotational testing but not with the results of high-frequency testing. There are two main clinical implications of these findings. First, patients with absent response to caloric stimulation (unilateral or bilateral) may have a normal response to high-frequency sinusoidal rotation (i.e., the frequencies that constitute most natural head movements). This probably explains why such patients do not report oscillopsia. Second, low-frequency sinusoidal rotational testing and caloric testing are more sensitive than high-frequency sinusoidal or impulsive rotational testing for detecting early loss of vestibular sensitivity due, for example, to ototoxic drugs.

Cerebral cysticercosis: treatment with praziquantel. Report of two cases

Two patients with cerebral cysticercosis are described: one with a long-standing infection with multiple intracerebral calcifications, and one who had become infected only recently. Treatment with praziquantel 50 mg/kg body weight daily for 14 days resulted in clinical and radiological improvement in the first patient, although she obviously still harbored a number of viable non-calcified parasites. The second patient was completely cured by the same praziquantel regimen. Both patients needed temporary corticosteroid treatment to suppress development of intracranial hypertension. Computerized tomographic scanning and regular measurement of serum antibody titers against cysticercal and echinococcal antigen seem appropriate methods for follow-up of the effect of chemotherapy.

Counterdrifting of the eyes: additional findings and hypothesis

Electro-oculograms for monitoring eye movements and eye positions were performed in patients having a prolonged episode of acute peripheral vestibulopathy. During the course of such illness counterdrifting eye movements have been observed. Counterdrifting is defined as slow eye movements which develop in the direction opposite to the primary drift (i.e. the slow phase of spontaneous nystagmus), that occur when lateral gaze is attempted in the dark at eye positions on the side ipsilateral to the vestibulopathy. Counterdrifting appears always to be accompanied or followed by some recovery of labyrinthine function on the side of vestibular failure, and in 2 patients it was associated with so-called recovery nystagmus. It has not been observed after vestibular neurectomy. The hypothesis is put forward that counterdrifting could be an oculomotor phenomenon--centripetal drifting--similar to that underlying Alexander's modification of acute vestibular spontaneous nystagmus.

[Follow-up studies on benign paroxysmal posture vertigo]

In a prospective study, 47 out of 55 patients with benign paroxysmal positional nystagmus (BPN) were reexamined after 3-41/2 years. In a third of these patients head injury was found to be the cause of positional nystagmus. In a few patients BPN was found to be directly connected with non-traumatic labyrinth affection, intermittent vertebro-basilar insufficiency, or anaesthesia. In a quarter of the patients no causative factors were found. In 44% of the patients nystagmus disappeared in an average of 8.6 months. In the follow-up a quarter of the patients (28%) still suffered regularly from positional nystagmus. Finally, in another quarter of the patients (28%), episodic nystagmus occurred over years and averaged 3.6 episodes per patient. The course of BPN is therefore more resistant and less predictable than was previously believed. However, most patients learn to adjust to the symptom and are only mildly handicapped by BPN.

Low and high frequency sinusoidal rotational testing in patients with peripheral vestibular lesions

We found a consistent pattern of response to low and high frequency sinusoidal rotational testing in patients with chronic compensated unilateral and bilateral peripheral vestibular lesions. Gain (peak slow phase eye velocity/peak chair velocity) was decreased and phase lead increased at low frequencies but both measurements approached normal at high frequencies. Asymmetries in gain, when present, were approximately the same in the low and high frequency range. These changes can be explained by a simple first order linear model of the vestibulo-ocular reflex if one assumes that the goal of the compensation process is to maintain gain in the high frequency range.

The influence of patient-practitioner agreement on outcome of care

A previous study suggested that patient-practitioner agreement and follow-up in ambulatory care facilitates problem resolution as judged by patients. In this study in another medical practice, practitioner-patient agreement on what problems required follow-up was associated with greater problem resolution as judged by the practitioners regardless of the severity of the problems. In this study, patients did not judge problems mentioned only by themselves to be less improved than problems mentioned by both them and their practitioners. However, in this study more of the problems mentioned only by patients were mentioned in the note of the visit contained in the medical record. Patients expected less and reported less improvements of problems that were neither mentioned by the practitioner nor written in the medical record than was the case for problems listed both by patients and practitioners. The findings of this study confirm those of the previous study in suggesting that practitioner-patient agreement about problems is associated with greater expectations for improvement and with better outcome as perceived by patients. In addition, they indicate that practitioners also report better outcome under the same circumstances.