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Kim S, Choi S, Nah S, Han S. Multiple Cerebral Infarctions and Rhabdomyolysis After Sildenafil Citrate (Viagra®) Intoxication: A Case Report. J Emerg Med 2023; 64:624-627. [PMID: 37032204 DOI: 10.1016/j.jemermed.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/14/2023] [Accepted: 02/17/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Sildenafil citrate (Viagra®) is used to treat male erectile dysfunction; however, little is known about the effects of sildenafil overdose and intoxication. We report a patient who presented with cerebral infarction and rhabdomyolysis after intentional sildenafil intoxication. CASE REPORT A 61-year-old man visited the Emergency Department complaining of dysarthria about 1 h after taking more than 30 sildenafil tablets with the intention to commit suicide. Dysarthria and dizziness were observed, but there were no other neurological symptoms. The creatine kinase level was elevated to 3118 U/L, and the patient was diagnosed with rhabdomyolysis. Brain magnetic resonance imaging revealed multiple scattered acute cerebral infarctions in both midbrain artery branches. At 4 h post-intoxication, the dysarthria had improved and we initiated dual antiplatelet therapy for cerebral infarction. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be able to anticipate and treat complications like cerebral infarction and rhabdomyolysis after sildenafil intoxication.
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Affiliation(s)
- Sechan Kim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sungwoo Choi
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea; Department of Emergency Medicine, Armed Forces Yangju Hospital, Yangju, Republic of Korea
| | - Sangun Nah
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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Bahrami Z, Salimi M, Ostovan VR. Severe Hyperkalemia Masquerading as Acute Ischemic Stroke: A Case Report. Iran J Med Sci 2022; 47:608-611. [PMID: 36380974 PMCID: PMC9652496 DOI: 10.30476/ijms.2021.91382.2253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/18/2021] [Accepted: 08/28/2021] [Indexed: 11/25/2022]
Abstract
Severe hyperkalemia usually presents as cardiac or neurologic manifestations. We report a case of a 63-year-old Caucasian woman, who was admitted to Namazi Hospital, affiliated with Shiraz University of Medical Sciences (Shiraz, Iran) in August 2019. The patient suffered from left-sided weakness and slurred speech for one hour prior to admission. Initially, the patient was treated for acute ischemic stroke, and an intravenous recombinant tissue plasminogen activator (IV-rTPA) was prescribed. However, further investigations showed severe hyperkalemia. Hemiparesis and slurred speech improved significantly with appropriate management of hyperkalemia. To the best of our knowledge, this is the first case of hyperkalemia masquerading as acute ischemic stroke without evidence of concomitant central nervous system malignancies, large vessel atherosclerosis, or recreational drug abuse. Stroke mimics due to hyperkalemia should be considered in any patient with simultaneous sudden onset of focal neurologic deficits and tall peaked T waves, particularly in the context of renal failure and a history of potassium-sparing drug use.
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Affiliation(s)
- Zahra Bahrami
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Salimi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Reza Ostovan
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Pi Y, Zhang LL, Li JC. Anti-IgLON5 disease with distinctive brain MRI findings responding to immunotherapy: A case report. Medicine (Baltimore) 2021; 100:e24384. [PMID: 33530233 PMCID: PMC7850656 DOI: 10.1097/md.0000000000024384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/29/2020] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Anti-IgLON5 disease was first described as a progressive antibody-associated encephalopathy, with multiple non-specific clinical symptoms including sleep dysfunction, bulbar symptoms, progressive supranuclear palsy-like syndrome, cognitive impairment, and a variety of movement disorders. This newly discovered disease presents with unremarkable or unspecific brain magnetic resonance imagings (MRI), and have poor responsiveness to immunotherapy. PATIENT CONCERNS In this case, a 37-year-old man presented with 4-day history of gait instability, dysarthria, and oculomotor abnormalities. The initial neurologic examination revealed mild unsteady gait, subtle dysarthria, and left abducent paralysis. DIAGNOSIS The patient was diagnosed with anti-IgLON5 disease, based on clinical features and positive anti-IgLON5 antibodies in serum. INTERVENTIONS Initially, the patient was treated with high dosages of methylprednisolone and immunoglobulins.Outcomes: The symptoms of patient rapidly improved after high-dose intravenous methylprednisolone and immunoglobulins. CONCLUSIONS In this paper, we report a new case of anti-IgLON5 disease with major symptoms of gait instability, dysarthria, and oculomotor abnormalities, with distinctive brain MRI findings, and responsive to immunotherapy.
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Affiliation(s)
| | - Laura Chiesa
- 3rd Division of Internal Medicine, Spedali Civili, Brescia, Italy
| | - Andrea Giustina
- Endocrinology and Metabolism, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy.
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Marecos C, Duarte S, Alonso I, Calado E, Moreira A. [GNAO1: a new gene to consider on early-onset childhood dystonia]. Rev Neurol 2018; 66:321-322. [PMID: 29696620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- C Marecos
- Hospital de Dona Estefania, Lisboa, Portugal
| | - S Duarte
- Hospital de Dona Estefania, Lisboa, Portugal
| | - I Alonso
- Universidade do Porto, Porto, Portugal
| | - E Calado
- Hospital de Dona Estefania, Lisboa, Portugal
| | - A Moreira
- Hospital de Dona Estefania, Lisboa, Portugal
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Chu SY, Barlow SM, Lee J, Wang J. Polar-phase indices of perioral muscle reciprocity during syllable production in Parkinson's disease. Int J Speech Lang Pathol 2017; 19:616-627. [PMID: 28425760 DOI: 10.1080/17549507.2016.1265587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 11/21/2016] [Indexed: 06/07/2023]
Abstract
PURPOSE This research characterised perioral muscle reciprocity and amplitude ratio in lower lip during bilabial syllable production [pa] at three rates to understand the neuromotor dynamics and scaling of motor speech patterns in individuals with Parkinson's disease (PD). METHOD Electromyographic (EMG) signals of the orbicularis oris superior [OOS], orbicularis oris inferior [OOI] and depressor labii inferioris [DLI] were recorded during syllable production and expressed as polar-phase notations. RESULT PD participants exhibited the general features of reciprocity between OOS, OOI and DLI muscles as reflected in the EMG during syllable production. The control group showed significantly higher integrated EMG amplitude ratio in the DLI:OOS muscle pairs than PD participants. No speech rate effects were found in EMG muscle reciprocity and amplitude magnitude across all muscle pairs. CONCLUSION Similar patterns of muscle reciprocity in PD and controls suggest that corticomotoneuronal output to the facial nucleus and respective perioral muscles is relatively well-preserved in our cohort of mild idiopathic PD participants. Reduction of EMG amplitude ratio among PD participants is consistent with the putative reduction in the thalamocortical activation characteristic of this disease which limits motor cortex drive from generating appropriate commands which contributes to bradykinesia and hypokinesia of the orofacial mechanism.
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Affiliation(s)
- Shin Ying Chu
- a Faculty of Health Sciences, Speech Sciences Programme , Universiti Kebangsaan Malaysia , Kuala Lumpur , Malaysia
| | - Steven M Barlow
- b Department of Special Education and Communication Disorders, Biological Systems Engineering, Center for Brain, Biology and Behavior , Communication Neuroscience Laboratories, University of Nebraska , Lincoln , NE , USA
| | - Jaehoon Lee
- c College of Education , Institute for Measurement, Methodology, Analysis and Policy (IMMAP), Texas Tech University , Lubbock , TX , USA , and
| | - Jingyan Wang
- d Communication Neuroscience Laboratories , University of Nebraska , Lincoln , NE , USA
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Page AD, Siegel L, Jog M. Self-Rated Communication-Related Quality of Life of Individuals With Oromandibular Dystonia Receiving Botulinum Toxin Injections. Am J Speech Lang Pathol 2017; 26:674-681. [PMID: 28654948 DOI: 10.1044/2017_ajslp-16-0098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/29/2016] [Indexed: 06/07/2023]
Abstract
PURPOSE In this preliminary study, we examined self-rated communication-related quality of life (CR-QoL) of 10 control participants and 10 individuals with oromandibular dystonia (OMD) and dysarthria receiving therapeutic botulinum toxin (BoNT-A) injections. METHOD Participants with OMD and associated dysarthria self-rated CR-QoL pre- and post- BoNT-A injection using the American Speech-Language-Hearing Association's Quality of Communication Life Scale (ASHA QCL; Paul et al., 2004). Control participants self-rated CR-QoL during a single experimental visit. RESULTS Significant differences were found between control participants and participants with OMD on ratings of CR-QoL across all 5 domains and subdomains of the ASHA QCL. No significant differences in CR-QoL were found over the course of the BoNT-A treatment cycle. CONCLUSIONS CR-QoL was rated lower by participants with OMD as compared with control participants across all ASHA QCL domains/subdomains with "socialization/activities" and "confidence/self-concept" having the largest effect sizes. No differences in CR-QoL were found over the course of the treatment cycle. We advocate for outcome measures that include patient report. The use of patient-reported outcome measures in conjunction with objective or impairment-based outcome measures can help inform meaningful clinical indicators of treatment success. This study adds novel information that may aid our understanding of the experience of living with OMD in this underserviced clinical population.
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Affiliation(s)
- Allyson D Page
- School of Communication Sciences and Disorders, Western University, London, ON, CanadaHealth and Rehabilitation Sciences, Western University, London, ON, Canada
| | - Lauren Siegel
- Health and Rehabilitation Sciences, Western University, London, ON, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
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Pinto S, Cardoso R, Sadat J, Guimarães I, Mercier C, Santos H, Atkinson-Clement C, Carvalho J, Welby P, Oliveira P, D'Imperio M, Frota S, Letanneux A, Vigario M, Cruz M, Martins IP, Viallet F, Ferreira JJ. Dysarthria in individuals with Parkinson's disease: a protocol for a binational, cross-sectional, case-controlled study in French and European Portuguese (FraLusoPark). BMJ Open 2016; 6:e012885. [PMID: 27856480 PMCID: PMC5128890 DOI: 10.1136/bmjopen-2016-012885] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Individuals with Parkinson's disease (PD) have to deal with several aspects of voice and speech decline and thus alteration of communication ability during the course of the disease. Among these communication impairments, 3 major challenges include: (1) dysarthria, consisting of orofacial motor dysfunction and dysprosody, which is linked to the neurodegenerative processes; (2) effects of the pharmacological treatment, which vary according to the disease stage; and (3) particular speech modifications that may be language-specific, that is, dependent on the language spoken by the patients. The main objective of the FraLusoPark project is to provide a thorough evaluation of changes in PD speech as a result of pharmacological treatment and disease duration in 2 different languages (French vs European Portuguese). METHODS AND ANALYSIS Individuals with PD are enrolled in the study in France (N=60) and Portugal (N=60). Their global motor disability and orofacial motor functions is assessed with specific clinical rating scales, without (OFF) and with (ON) pharmacological treatment. 2 groups of 60 healthy age-matched volunteers provide the reference for between-group comparisons. Along with the clinical examinations, several speech tasks are recorded to obtain acoustic and perceptual measures. Patient-reported outcome measures are used to assess the psychosocial impact of dysarthria on quality of life. ETHICS AND DISSEMINATION The study has been approved by the local responsible committees on human experimentation and is conducted in accordance with the ethical standards. A valuable large-scale database of speech recordings and metadata from patients with PD in France and Portugal will be constructed. Results will be disseminated in several articles in peer-reviewed journals and in conference presentations. Recommendations on how to assess speech and voice disorders in individuals with PD to monitor the progression and management of symptoms will be provided. TRIAL REGISTRATION NUMBER NCT02753192, Pre-results.
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Affiliation(s)
- Serge Pinto
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
| | - Rita Cardoso
- Campus Neurológico Sénior (CNS), Torres Vedras, Portugal
- Faculty of Medicine, Instituto de Medicina Molecular (IMM), University of Lisbon, Lisbon, Portugal
| | - Jasmin Sadat
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
| | - Isabel Guimarães
- Faculty of Medicine, Instituto de Medicina Molecular (IMM), University of Lisbon, Lisbon, Portugal
- Speech Therapy Department, Escola Superior de Saude do Alcoitão, Alcabideche, Portugal
| | - Céline Mercier
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Neurology Department, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Helena Santos
- Campus Neurológico Sénior (CNS), Torres Vedras, Portugal
| | - Cyril Atkinson-Clement
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
| | - Joana Carvalho
- Campus Neurológico Sénior (CNS), Torres Vedras, Portugal
| | - Pauline Welby
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
| | - Pedro Oliveira
- Faculty of Medicine, Instituto de Medicina Molecular (IMM), University of Lisbon, Lisbon, Portugal
- Centre of Linguistics, School of Arts and Humanities, University of Lisbon, Lisbon, Portugal
| | - Mariapaola D'Imperio
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
| | - Sónia Frota
- Centre of Linguistics, School of Arts and Humanities, University of Lisbon, Lisbon, Portugal
| | - Alban Letanneux
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
| | - Marina Vigario
- Centre of Linguistics, School of Arts and Humanities, University of Lisbon, Lisbon, Portugal
| | - Marisa Cruz
- Centre of Linguistics, School of Arts and Humanities, University of Lisbon, Lisbon, Portugal
| | - Isabel Pavão Martins
- Neurology Department, Faculty of Medicine, Language Research Laboratory, University of Lisbon, Lisbon, Portugal
| | - François Viallet
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
- Neurology Department, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Joaquim J Ferreira
- Campus Neurológico Sénior (CNS), Torres Vedras, Portugal
- Faculty of Medicine, Instituto de Medicina Molecular (IMM), University of Lisbon, Lisbon, Portugal
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Goodwin SJ, Carpenter AF. Successful treatment of paroxysmal ataxia and dysarthria in multiple sclerosis with levetiracetam. Mult Scler Relat Disord 2016; 10:79-81. [PMID: 27919504 DOI: 10.1016/j.msard.2016.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/12/2016] [Accepted: 09/05/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Paroxysmal ataxia and dysarthria (PAD) is a relatively rare symptom in Multiple Sclerosis patients. PAD involves transient dysfunction in control, coordination and initiation of speech and/or limb movements. OBJECTIVE To describe the successful use of levetiracetam for the treatment of PAD. METHODS Case report. RESULTS A 37-year-old woman with MS developed PAD approximately 3 months after a multifocal MS relapse. Brain MRI showed a lesion in the posterior aspect of the midbrain as well as in the right posterior internal capsule, both of which were adjacent to the red nucleus. Attack frequency was reduced after starting levetiracetam at a dose of 500mg twice daily, and attacks stopped completely once the dose was increased to 750mg twice daily. CONCLUSIONS Given its advantages (in terms of side effects, safety profile and ease of use compared to other anticonvulsants), we suggest that levetiracetam be considered for management of PAD, and perhaps for other paroxysmal MS symptoms as well.
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Affiliation(s)
- Shikha J Goodwin
- Department of Neurology, University of Minnesota Medical School, Minneapolis, MN, United States; Brain Sciences Center, VA Medical Center, Minneapolis, MN, United States
| | - Adam F Carpenter
- Department of Neurology, University of Minnesota Medical School, Minneapolis, MN, United States; Brain Sciences Center, VA Medical Center, Minneapolis, MN, United States.
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Muñoz A, López-Méndez P, Hervás-García M, Ruano A, García-Rodríguez JR. [Foix-Chavany-Marie syndrome presenting as multiple sclerosis]. Rev Neurol 2015; 61:332-333. [PMID: 26411278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Abián Muñoz
- Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Espana
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Canneti B, Mosqueira AJ, Gilo F, Carreras T, Barbosa A, Meca-Lallana V, Vivancos J. [CLIPPERS syndrome with atypical distribution of lesions in magnetic resonance imaging of the brain]. Rev Neurol 2013; 57:354-358. [PMID: 24081890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION CLIPPERS syndrome (chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids) is an inflammatory process of the central nervous system whose distinguishing features are the enhancing punctiform lesions in the brainstem that appear in the magnetic resonance images. Clinically, it is accompanied by dysarthria, ataxia and diplopia, and usually responds to treatment with corticoids. Pathologically, T lymphocytes appear infiltrated in the perivascular spaces of the brainstem. CASE REPORT We report the case of a 40-year-old woman with an initial subacute clinical picture of binocular diplopia, ataxia and dysarthria. The magnetic resonance brain scan revealed T2 hyperintense punctiform lesions in the stem, cerebellum, diencephalons and cortico-subcortical areas of both hemispheres, which were enhanced with contrast. An aetiological study was performed to rule out any underlying infectious, neoplastic or inflammatory origin, the results being negative. The patient was treated on two occasions with methylprednisolone, with a gradual lowering of the dosage, the response being favourable. CONCLUSIONS Diplopia and ataxia, as in our case, are practically always present. The MR findings consist of punctiform enhancing lesions located in the pons extending towards the cerebellum, basal ganglia and corpus callosum, the enhancement gradient becoming lower as the distance increases rostrally away from the cortex, and caudally towards the spinal cord. In the case of our patient, this gradient is not respected, and the density found was similar to that of lesions at the supratentorial level. The differential diagnosis is wide-ranging and justifies an extensive diagnostic study with, in certain cases, a biopsy study of brain tissue. The disease courses in a relapsing-remitting pattern and the earlier steroid therapy is established and the more prolonged it is, the better the prognosis will be.
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Chohan G, Barnett Y, Gibson J, Reddel SWR, Barnett MH. Langerhans cell histiocytosis with refractory central nervous system involvement responsive to infliximab. J Neurol Neurosurg Psychiatry 2012; 83:573-5. [PMID: 21856693 DOI: 10.1136/jnnp-2011-300575] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Valentino P, Nisticò R, Pirritano D, Bilotti G, Del Giudice F, Sturniolo M, Quattrone A. Lamotrigine therapy for paroxysmal dysarthria caused by multiple sclerosis: a case report. J Neurol 2011; 258:1349-50. [PMID: 21264473 DOI: 10.1007/s00415-011-5901-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 12/23/2010] [Accepted: 01/03/2011] [Indexed: 11/27/2022]
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Abstract
UNLABELLED Research has found that speaking rate has an effect on voice onset time (VOT). Given that Parkinson disease (PD) affects speaking rate, the purpose of this study was to examine VOT with the effect of rate removed (VOT ratio), along with the traditional VOT measure, in individuals with PD. VOT and VOT ratio were examined in 9 individuals with PD (before and after taking medication), along with 9 matched controls. Place of articulation and vowel height had significant effects on VOT and VOT ratio for all groups, and there were no PD versus control differences. PD medication had a greater effect on VOT than VOT ratio, reflecting a rate-related VOT change rather than a pure VOT change. These data support the usefulness of examining both VOT and VOT ratio with individuals with PD, as this allows for dissociation between rate-related VOT changes and true VOT changes. LEARNING OUTCOMES The reader will be able to understand and describe: (1) voice onset time (VOT) and VOT ratio; (2) how VOT and VOT ratio are affected in individuals with Parkinson disease; and (3) the effect of medication on VOT and VOT ratio.
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Affiliation(s)
- Emily Fischer
- Department of Communication Sciences and Disorders, 200 Health Center Building, Bowling Green State University, Bowling Green, OH 43403-0149, USA.
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Totah A. Thrombolysis, fluctuations, and protocol expansions. Arch Neurol 2009; 66:418-419. [PMID: 19273768 DOI: 10.1001/archneurol.2008.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Prakash S, Mathew C, Bhagat S. Locked-in syndrome in snakebite. J Assoc Physicians India 2008; 56:121-122. [PMID: 18472515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Two young patients are described who made complete recovery from locked-in syndrome (LIS) after snakebites. LIS was a presenting feature in a patient of presumed snake bite who showed complete response to polyvalent Anti-snake venom (ASV). This case suggests that elapid snake bite should be suspected in unresponsive patient found in early morning in endemic areas of snake bite in monsoon season. The second case was admitted in complete LIS state with history of rapidly progressive ptosis, diplopia, ophthalmoplegia, bulbar symptoms and quadriparesis, 6 hours after snake bite. Complete improvement by ASV in second patient highlights the need of differentiation of complete LIS from coma and brain death in patient of snake bite, as former have good prognosis.
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Affiliation(s)
- S Prakash
- Department of Neurology, Medical College, Baroda, Gujarat
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De Letter M, Santens P, Estercam I, Van Maele G, De Bodt M, Boon P, Van Borsel J. Levodopa-induced modifications of prosody and comprehensibility in advanced Parkinson's disease as perceived by professional listeners. Clin Linguist Phon 2007; 21:783-91. [PMID: 17882694 DOI: 10.1080/02699200701538181] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The prosodic aspects of hypokinetic dysarthria in Parkinson's disease (PD) have been the focus of numerous reports. Few data on the effects of levodopa on prosody, more specifically on the effects on the variability of prosodic characteristics such as pitch, loudness and speech rate, are available in advanced PD. The relation between these characteristics and comprehensibility is currently unknown. These topics are the focus of the present report. Ten patients with advanced PD were evaluated, with and without medication, by four speech-language pathologists during a reading task. A significant improvement of variability in pitch and loudness was demonstrated after medication intake. Comprehensibility improved following medication administration. Results are compared with previous studies.
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Affiliation(s)
- Miet De Letter
- Department of Oto-Rhino-Laryngology, Centre of Speech and Hearing Disorders, Ghent University Hospital, Ghent, Belgium.
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Abstract
PURPOSE OF REVIEW We review recent important papers pertaining to acquired aphasia, apraxia of speech and dysarthria with special attention to clinically significant work published in the last 12 months. RECENT FINDINGS The role of the contralateral inferior frontal gyrus in language recovery after stroke is controversial, but is an area of active research, particularly in functional imaging studies. Recent treatment studies in poststroke aphasia have shown that intensity of language therapy may be more important than the method of therapy. Some studies have indicated that amphetamines, piracetam and repetitive transcortical magnetic stimulation may be effective adjuncts to speech and language therapy. Treatment studies for poststroke dysarthria indicate that speech supplementation strategies may be effective and deserve further study. SUMMARY Recent studies of aphasia provide clues regarding language recovery poststroke, but further studies of the role of the ipsi and contralateral inferior frontal gyrus are necessary, and should be longitudinal. There are relatively few recent studies on the treatment of acquired disorders of speech and language, other than poststroke aphasia.
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Affiliation(s)
- Lori C Jordan
- Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Vasconcelos MG, Fiorot JA, Sarkovas C, Pinto APM, Barsottini OGP, Gabbai AA. [Intermediary form of Foix-Chavany-Marie / Worster-Drought syndromes associated to involuntary movements: neuropsychological and phonoaudiological features]. Arq Neuropsiquiatr 2006; 64:322-5. [PMID: 16791379 DOI: 10.1590/s0004-282x2006000200029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The Foix-Chavany-Marie syndrome (FCMS) is characterized by apraxia of speech associated to bilateral central facio-linguo-velo-pharyngeal paralysis, with automatic-voluntary dissociation. In Worster-Drought Syndrome (WDS), dysarthria is remarkable. We report an 18-year-old female, with clinical and radiological findings of intermediary form of FCMS/WDS, and showing involuntary movements, an unusual fact.
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21
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Bankar RN, Köhnke A. An elderly man with dysphagia and dysarthria. Indian J Med Sci 2005; 59:458-60. [PMID: 16272683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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22
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Abstract
The authors describe a patient who showed paroxysmal dysarthria and right-limb ataxia after midbrain infarction. SPECT imaging showed marked hypoperfusion in the left parietal lobe while the patient was having frequent paroxysmal attacks. After treatment with phenytoin, the symptoms and hypoperfusion in SPECT imaging improved. The authors conclude that dysfunction of the cerebellothalamocortical pathway after midbrain infarction may cause paroxysmal dysarthria and ataxia.
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Affiliation(s)
- M Matsui
- Department of Neurology, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyoku, Kyoto 606-8507, Japan.
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23
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Abstract
Legionnaires' disease is often associated with neurological findings. Despite such findings, computed tomography and neuropathological investigations are typically normal. This report describes a reversible lesion of the corpus callosum identified on magnetic resonance imaging (MRI) in a patient with legionnaires' disease. MRI may show previously undocumented neuropathology in acute legionnaires' disease. Legionella pneumophila infection should be included in the differential diagnosis of conditions associated with reversible lesions of the corpus callosum.
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Affiliation(s)
- J C Morgan
- Department of Neurology, Medical College of Georgia, Augusta, Georgia, USA
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24
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Abstract
A 5-year-old boy presented with typical clinical and electrophysiologic features of benign rolandic epilepsy. His neurodevelopment, language, and behavior prior to the onset of epilepsy were appropriately normal. He demonstrated marked deterioration of language and cognitive function during the course to a mild and then a moderate disability range. Serial sleep electroencephalographic recordings initially showed continuous and bilateral rolandic discharges with evolution to localized left rolandic spikes. Language and cognitive improvements were subsequently seen. Educational support and evolution of the electroencephalogram to a localized focus could have been contributory. It is anticipated, however, that he will have significant long-term problems in complex language.
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Affiliation(s)
- Anna G Berroya
- Department of Neurology, Sydney Children's Hospital, Randwick, New South Wales, Australia
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25
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Abstract
OBJECTIVES To describe a case of an isolated hypoglossal nerve palsy in a patient with a spontaneous internal carotid artery dissection (ICAD). This condition is a well-recognized cause of cerebral ischemic stroke in patients younger than 45 years of age. Isolated cranial nerve neuropathy is a rare presentation. More common manifestations include incomplete hemiparesis, hemicrania, Horner syndrome, cervical bruit, pulsatile tinnitus, and multiple cranial nerve palsies. METHODS A comprehensive literature search (Ovid, MEDLINE) for the presentation, diagnostic evaluation, treatment, and outcome of patients with internal carotid artery dissection was performed. RESULTS A 43-year-old man presented with a 3-week history of mild dysarthria. There was no history of craniocervical trauma. The physical examination revealed an isolated left hypoglossal nerve paresis. Magnetic resonance imaging and angiography findings were consistent with a left skull base ICAD. The patient was successfully treated with anticoagulation therapy. The current rate of cranial nerve involvement is estimated at 10% of all ICADs. This is the second report of isolated hypoglossal nerve palsy without hemicrania in a case of atraumatic ICAD. CONCLUSIONS Patients with an ICAD infrequently present to the otolaryngologist because of its head and neck manifestations. It is crucial to recognize atypical findings and to perform an accurate and prompt diagnostic evaluation. The foundation of treatment is aggressive anticoagulation, with surgical or radiologic intervention reserved for cases demonstrating life-threatening progression.
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Affiliation(s)
- Fred W Lindsay
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center, San Diego, CA 92134, USA
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26
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Pellecchia MT, Criscuolo C, Longo K, Campanella G, Filla A, Barone P. Clinical presentation and treatment of Wilson's disease: a single-centre experience. Eur Neurol 2003; 50:48-52. [PMID: 12824712 DOI: 10.1159/000070858] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2002] [Accepted: 02/25/2003] [Indexed: 11/19/2022]
Abstract
Thirty patients with Wilson's disease (WD) were observed at a movement disorder clinic between 1970 and 2000. Disease onset was at the mean age (SD) of 14.5 (+/-5.9) years. Presentation with hepatic disease occurred in 12 of 30 patients and with neurologic disease in 15. Three patients were asymptomatic at the time of diagnosis. The mean (SD) delay to diagnosis was 5.9 (+/-5.7) years. Five patients diagnosed in an advanced stage of disease died before initiating treatment. Eighteen patients were followed and treated with D-penicillamine alone or in combination with zinc sulphate. Treatment improved most of neurological symptoms. Dystonic postures, behavioural disturbances and dysarthria were the most resistant neurological signs. 'Pseudo-sclerotic' neurologic involvement predicted a good outcome, whereas hepatic onset and 'classic' neurologic involvement were associated with a poorer prognosis. Two of the 18 treated patients died of hepatic failure due to voluntary discontinuation of therapy. Both D-penicillamine and zinc sulphate were well tolerated. No teratogenic effect of D-penicillamine was observed throughout 5 pregnancies. Our results suggest that D-penicillamine or a combination of D-penicillamine and zinc sulphate is a safe and effective long-term treatment in patients with WD.
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Affiliation(s)
- M T Pellecchia
- Department of Neurological Sciences, University Federico II, Naples, Italy.
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27
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Abstract
The purpose of this paper was to examine the effects of speech therapy and various pharmacological treatment approaches on the voice and speech of persons with Parkinson s disease (PD). Approximately 80% of PD patients have voice and speech problems including reduced vocal intensity, reduced vocal pitch, monopitch and monoloudness, and imprecise articulation. Research prior to 1970's had not demonstrated significant improvements following speech therapy. However, recent research has shown that speech therapy (when persons with PD are optimally medicated) has proven to be the most efficacious therapeutic method for improving voice and speech function. Across research studies, pharmacological methods of treatment in isolation do not appear to significantly improve voice and speech function in PD. In a single subject study, however, the dopamine agonist Mirapex was shown to have beneficial effects on vocal intensity. Possible explanations for the differential responses to treatment are discussed. It is suggested that the goal of future studies should be investigations of the effects of combined treatment approaches.
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Affiliation(s)
- Geralyn M Schulz
- Department of Speech and Hearing Sciences, The George Washington University, Room 425 Funger Hall, 2201 G. Street, NW, Washington, DC 20052, USA.
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28
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Abstract
The vocal symptoms of spastic dysarthria and spasmodic dysphonia have many similar features. Botulinum toxin has been used effectively to treat spasmodic dysphonia. This study was designed to determine what vocal changes occur in an individual with spastic dysarthria following Botulinum toxin A injection into the thyroarytenoid muscles. Measures were obtained preinjection and three times postinjection. Acoustic and aerodynamic results were comparable to those reported for individuals with spasmodic dysphonia. The most marked change was increased DC airflow. Despite persistent breathiness, the participant reported great satisfaction with the result, particularly because of her more appropriate loudness. In addition, everyday listeners perceived significantly less listener burden and more relaxed and pleasant vocal quality postinjection.
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29
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Abstract
UNLABELLED The effect of Permax (pergolide mesylate), a dopamine agonist, was assessed in an individual with traumatic brain injury. The participant evidenced symptoms of hypokinetic dysarthria. His performance on and off Permax was evaluated in a BABA design. Measures were obtained across physiological systems. There were few differences in the on and off conditions. In the on condition, he evidenced an abnormally large velopharyngeal orifice area, dysfluencies in stimulus sentences, and less precise articulation. However, listeners perceived him to be more animated in the on condition. In addition, he reported better performance in the on condition. The study highlights potential discrepancies among participant report, listener perception, and objective measures. LEARNING OUTCOMES As a result of this activity, the participant will be able (1) to recognize the effect of dopamine agonists as an adjunct to other pharmacological interventions and (2) to determine potential discrepancies among participant report, listener perception and objective physiological and acoustic measures.
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Affiliation(s)
- M McHenry
- Transitional Learning Center, Department of Communication Disorders, University of Houston, TX 77204-6018, USA.
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30
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Lee CC, Su WW, Hunder GG. Dysarthria associated with giant cell arteritis. J Rheumatol 1999; 26:931-2. [PMID: 10229420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Over a one month period, a 74-year-old man developed typical features of giant cell arteritis (GCA) including visual changes, headache, scalp tenderness, and an elevated erythrocyte sedimentation rate. In addition, he had reproducible painless dysarthria that was precipitated by chewing or prolonged talking and was relieved by resting the jaw. The dysarthria with chewing along with the other classical symptoms of GCA subsided with treatment. To our knowledge this is the first report of painless dysarthria associated with GCA.
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Affiliation(s)
- C C Lee
- Department of Rheumatology and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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31
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Cahill LM, Murdoch BE, Theodoros DG, Triggs EJ, Charles BG, Yao AA. Effect of oral levodopa treatment on articulatory function in Parkinson's disease: preliminary results. Motor Control 1998; 2:161-72. [PMID: 9644287 DOI: 10.1123/mcj.2.2.161] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
To quantify lip function in 16 patients with Parkinson's disease, a computerized semiconductor lip pressure transducer system was used prior to subjects being administered oral levodopa and at approximately 0.5 hr, 1.5 hr, and 3.0 hr postmedication. Two blood samples were taken from each subject at varying times during the levodopa dosage interval, and the exact time and dosage of levodopa were noted. Lip function measurements were expressed as percentage changes from baseline and were plotted for each subject against time and levodopa concentrations to determine the effects of levodopa therapy on articulatory function. The results supported the effectiveness of levodopa therapy in improving lip function. In particular, lip pressures recorded during both speech and nonspeech tasks tended to improve after levodopa administration, the lip measures improving somewhat in parallel with the rise and fall of blood plasma levodopa concentrations. Evidence of a hysteresis effect was noted.
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Affiliation(s)
- L M Cahill
- Motor Speech Research Unit, Department of Speech Pathology and Audiology, The University of Queensland, Australia, 4072
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32
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Abstract
Hereditary paroxysmal ataxia is a rare dominantly inherited disorder characterized by recurrent attacks of cerebellar ataxia, dysarthria, and nystagmus. Each attack lasts from several minutes to few hours or days. Usually there are no motor difficulties between attacks. We report a patient who had had recurrent ataxic episodes since early childhood. Four members of the family over two generations had similar attacks. There were no abnormalities in the laboratory studies including plasma amino acid, lactate, pyruvate, and EEG. Treatment with acetazolamide resulted in complete abolition of the attacks. Because of its dramatic response to acetazolamide, the recognition of this rare disorder is important.
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Affiliation(s)
- H J Kim
- Department of Neurology, College of Medicine, Seoul National University, Korea
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33
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Müller J, Landgraf F, Trabert W. [Schizophrenia-like symptoms in the Westphal-Strümpell variation of Wilson disease]. Nervenarzt 1998; 69:264-8. [PMID: 9565982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Wilson's disease is a rare, autosomal recessive disorder of copper metabolism due to low serum ceruloplasm, resulting in increased copper deposition, especially in the liver and basal ganglia in the brain. The pseudosclerotic type of Wilson's disease, also known as the Westphal-Strümpell form, is distinguished by positional tremor, ataxia and dysarthria as the main symptoms. We use the example of a 23-year-old patient whose neurological symptoms were preceded by a long history of a schizophrenic-like disorder. Clinical symptoms are presented. MRI, SPECT and PET images are illustrated. Therapy and outcome are discussed.
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Affiliation(s)
- J Müller
- Universitätsnervenklinik Psychiatrie-Psychotherapie, Homburg/Saar
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Abstract
An auctioneer is described in whom focal dystonia of the jaw developed as an occupational symptom, occurring solely and predictably when he commenced his selling "patter" and resolving quickly on stopping. He responded well to treatment with intramuscular botulinus toxin.
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Affiliation(s)
- N J Scolding
- National Hospital for Neurology and Neurosurgery, London, England
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35
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Abstract
Herpes simplex encephalitis in adults and young patients carries a high mortality and morbidity. Its presentation may be nonspecific, sometimes hampering early diagnosis. Two young children are reported with herpes simplex encephalitis in whom the operculum syndrome was an outstanding feature. This syndrome is caused by focal, bilateral cortical damage to the anterior opercular regions resulting in anarthria and impairment of mastication and swallowing. After initiation of treatment with acyclovir in the early stage of the disease, the outcomes in both patients were characterized by good general recovery with persistence of deficits of speech, mastication, and swallowing, more pronounced in the patient who was comatose during the illness. Early recognition of the operculum syndrome as a presenting feature of herpes simplex encephalitis may expedite the diagnosis and thereby improve the prognosis.
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Affiliation(s)
- J C van der Poel
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
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36
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Svensson P, Henningson C, Karlsson S. Speech motor control in Parkinson's disease: a comparison between a clinical assessment protocol and a quantitative analysis of mandibular movements. Folia Phoniatr (Basel) 1993; 45:157-64. [PMID: 8406265 DOI: 10.1159/000266243] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Nine individuals with Parkinson's disease (PD) and nine normal control subjects, matched for sex and age, were compared on a standardized assessment protocol for dysarthria. Simple measures of hand and gait motility were also obtained. A kinematic analysis of vertical jaw movements during speech was performed by using an optoelectronic technique. The PD subjects were examined during both induced off L-dopa and on L-dopa states, and their performance was compared between the two conditions. Significant group differences were found for all kinematic measures during a syllable repetition task, as well as for the total dysarthria test scores and certain individual test items. Implications and clinical usefulness of the kinematic approach to the study of oral motor functions are discussed.
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Affiliation(s)
- P Svensson
- Department of Logopedics and Phoniatrics, University of Göteborg, Sweden
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37
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Abstract
Sixteen patients with motor neuron disease received RX77368, a TRH analogue, IV, repeatedly over 1-12 weeks (median 2 weeks). Slight to moderate improvement in bulbar function, particularly speech, was reproduced or persisted with repeated infusions in 8 of 12 responders over a median of 18 days (range 14-90) during the period of study. Cramps (5/9) and spasticity (5/8) improved for a median of 14 days (range 7-35) and 7 days (range 2-14) respectively. The highest benefit/side effect ratio was seen with 0.2 mg/kg (0.15 mg/kg in those with severe bulbar palsy) every 3-4 days. Long term studies with this analogue in MND are indicated.
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Affiliation(s)
- H Modarres-Sadeghi
- Department of Neurology, Charing Cross and Westminster Medical School, Westminster Hospital, London, UK
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38
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Abstract
We studied the effect of clonazepam in a double-blind trial on 12 parkinsonian patients with hypokinetic dysarthria. Speech samples were judged on 14 of the dimensions used in the Mayo Clinic dysarthria study. Of the 11 patients who completed the study, 10 showed improvement. The effective dosage of clonazepam was 0.25 to 0.5 mg/d with higher dosage than that less effective. Clonazepam has a definite role in the management of parkinsonian dysarthria.
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Affiliation(s)
- N Biary
- Department of Neurology, University of Illinois at Chicago 60612
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39
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Hirabayashi S, Kanda H, Tsuno T, Akabane T, Oguchi K, Yanagisawa N. [Effects of high-dosage trihexyphenidyl on symptomatic dystonia in a case of Wilson disease]. No To Hattatsu 1985; 17:571-6. [PMID: 4084421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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