1/40. Impairment of depth perception in multiple sclerosis is improved by treatment with AC pulsed electromagnetic fields.multiple sclerosis (MS) is associated with postural instability and an increased risk of falling which is facilitated by a variety of factors including diminished visual acuity, diplopia, ataxia, apraxia of gait, and peripheral neuropathy. Deficient binocular depth perception may also contribute to a higher incidence of postural instability and falling in these patients who, for example, find it an extremely difficult task to walk on uneven ground, over curbs, or up and down steps. I report a 51 year old woman with secondary progressive MS who experienced difficulties with binocular depth perception resulting in frequent falls and injuries. Deficient depth perception was demonstrated also on spontaneous drawing of a cube. Following a series of transcranial treatments with AC pulsed electromagnetic fields (EMFs) of 7,5 picotesla flux density, the patient experienced a major improvement in depth perception which was evident particularly on ascending and descending stairs. These clinical changes were associated with an improvement in spatial organization and depth perception on drawing a cube. These findings suggest that in MS impairment of depth perception, which is encoded in the primary visual cortex (area 17) and visual association cortex (areas 18 and 19), may be improved by administration of AC pulsed EMFs of picotesla flux density. The primary visual cortex is densely innervated by serotonergic neurons which modulate visual information processing. Cerebral serotonin concentrations are diminished in MS patients and at least some aspects of deficient depth perception in MS may be related to dysfunction of serotonergic transmission in the primary visual cortex. It is suggested that transcranial AC pulsed applications of EMFs improve depth perception partly by augmenting serotonergic transmission in the visual cortex.- - - - - - - - - - ranking = 1keywords = perception (Clic here for more details about this article) |
2/40. Quantitative proton magnetic resonance spectroscopy of focal brain lesions.The diagnostic value of single-voxel proton magnetic resonance spectroscopy (2 T, stimulated echo acquisition mode, TR = 6,000 ms, TE = 20 ms, 4-5 mL volumes-of-interest) was assessed for a differentiation of focal brain lesions of unknown etiology in 17 patients 1-14 years of age. Absolute metabolite concentrations were compared with age-matched control subjects and an individual control region. Most of the brain tumors were characterized by strongly reduced total N-acetylaspartyl compounds and marked increases of myo-inositol and choline-containing compounds, consistent with a lack of neuroaxonal tissue and a proliferation of glial cells. Lactate was elevated in only four patients. When using this pattern for a metabolic discrimination of brain tumors from other focal lesions, proton spectroscopy correctly identified 14 of 17 abnormalities, as confirmed by histologic examination after neurosurgical intervention. One false-positive tumor diagnosis was a severe reactive gliosis mimicking a typical tumor spectrum. Two inconclusive cases comprised an astrocytoma with moderately elevated myo-inositol but reduced choline-containing compounds and a patient with an abscess leading to a marked reduction of all metabolites but strong contributions from mobile lipids. In summary, quantitative proton spectroscopy has considerable clinical value for preoperative characterization of focal brain lesions.- - - - - - - - - - ranking = 0.21928811815657keywords = discrimination (Clic here for more details about this article) |
3/40. optic neuritis in children.PURPOSE: To describe the clinical characteristics of optic neuritis in children, including final visual acuity and development of multiple sclerosis (MS). methods: charts were reviewed of all patients < 15 years of age who presented with optic neuritis to the Bascom Palmer eye Institute or the Miami Children's Hospital between 1986 and 1998. RESULTS: Fifteen patients were identified. There was a slight female predilection in the study group (60%), with a mean age of 9.8 years at presentation. A preceding febrile illness within 2 weeks of visual symptoms was reported in 66% of patients. Initial visual acuity ranged from 20/15 to no light perception. Involvement was bilateral in 66% of patients, and disc swelling was present in 64% of involved eyes. Of the patients who underwent magnetic resonance imaging, 33% had focal demyelinating lesions in the brain, and 63% of affected nerves were enlarged or enhanced with gadolinium. Eleven patients were treated with intravenous steroids. Final visual acuity was > or = 20/40 in 58.3% of eyes. Thirty percent of the patients had vision of finger counting or worse. Four (26%) patients developed MS. The mean age of patients with MS was 12 years, compared with 9 years in children who did not develop MS. patients with unilateral involvement had an excellent visual prognosis (100% > 20/40), but a higher rate of development of MS (75%). Two patients had positive serology for lyme disease. CONCLUSIONS: optic neuritis presents differently in children than in adults. Children typically have bilateral involvement with papillitis following an antecedent viral illness. Although visual prognosis is poorer in children than adults, the development of MS is less common in children. Children who present with unilateral involvement have a better visual prognosis; however, they also develop MS at a greater frequency than children with bilateral involvement. patients who developed MS were, on average, older at presentation with optic neuritis than those who did not develop MS.- - - - - - - - - - ranking = 0.083333333333333keywords = perception (Clic here for more details about this article) |
4/40. Disruption of thermal perception in a multiple sclerosis patient with central pain.OBJECTIVE: To investigate integrative thermal perception in a patient with multiple sclerosis. DESIGN: Quantitative thermosensory testing was used to evaluate pain and other sensations produced by heat, cold, and the thermal grill pain illusion. PATIENT: The authors report on a 43-year-old patient with central pain manifest most strongly in her left arm and hand, contralateral to an upper cervical spinothalamic lesion due to multiple sclerosis. OUTCOME MEASURES AND RESULTS: Quantitative thermosensory testing showed that the patient had heat hypalgesia (no pain with stimuli of 45-50 degrees C) and cold allodynia (pain with innocuous cool temperatures, 25-10 degrees C). Whereas healthy subjects rated 20 degrees and 40 degrees C as nonpainful, but the thermal grill (intermixed 20 and 40 degrees C stimuli) as painful, the patient rated the thermal grill as less painful than 20 degrees C. CONCLUSIONS: The absence of thermal grill-evoked pain is consistent with the hypothesis that in some cases of central pain the loss of the thermosensory pathway results in disruption of the normal cold inhibition of burning pain.- - - - - - - - - - ranking = 0.41666666666667keywords = perception (Clic here for more details about this article) |
5/40. Partial and significant reversal of progressive visual and neurological deficits in multiple sclerosis: a possible therapeutic effect.A 24-year-old woman developed over 18 months fluctuating and progressively increasing visual and cerebellar deficits, due to multiple sclerosis. The minimum visual acuities were 3/19 on the right and the perception of finger movement at 1 m on the left. She became able to walk only with a wide base and with support. Her condition deteriorated despite the use of methylprednisolone, prednisone and interferon beta-1b, so these were ceased. azathioprine, 25 mg daily increasing to 100 mg daily, reducing following abnormal liver function tests to 50 mg daily, and glatiramer acetate 20 mg daily were commenced. The visual acuities two months later were 3/7.5 on the right and 3/6 on the left and after 4 months 3/4.5 on the right and 3/3 on the left. She was able after 2 months to walk unaided on a narrow base and after 4 months to jog half a kilometre without difficulty. Progressive multiple sclerosis has been held to be irreversible. The response in the present case therefore raises the possibility of a drug effect. It indicates the need for trials of combined immunomodulatory and immunosuppressive therapies in progressive multiple sclerosis.- - - - - - - - - - ranking = 0.083333333333333keywords = perception (Clic here for more details about this article) |
6/40. Paroxysmal ataxic dysarthria.This report reviews 13 cases in which a dysarthria appeared, remitted, and reappeared within seconds. The speech pattern of each case was characteristic of ataxic dysarthria. A cinefluorographic film for one of the subjects provided a rare opportunity to study the articulatory dynamics of this disorder. multiple sclerosis either was given as a diagnosis or was strongly suspected in each case, and carbamazepine has been an effective treatment. Speculations concerning the origin of the paroxysmal and ataxic character of the dysarthria are presented along with a preliminary checklist for identifying the disorder.- - - - - - - - - - ranking = 0.034499631770863keywords = speech (Clic here for more details about this article) |
7/40. Otoacoustic emissions, audiometric sensitivity loss, and speech understanding: a case study.The clinical measurement of otoacoustic emissions can assist in differentiating between peripheral and central explanations for deficits in speech understanding. We present audiometric and distortion-product emission data in a case with sensorineural hearing loss and a deficit in speech understanding. The presence of evoked emissions argues against attributing the speech audiometric loss to cochlear defect.- - - - - - - - - - ranking = 0.24149742239604keywords = speech (Clic here for more details about this article) |
8/40. Two women with multiple sclerosis and their caregivers: conflicting normative expectations.It is not uncommon that nurses are unable to meet the normative expectations of chronically ill patients. The purpose of this article is to describe and illustrate Walker's expressive-collaborative view of morality to interpret the normative expectations of two women with multiple sclerosis. Both women present themselves as autonomous persons who make their own choices, but who also have to rely on others for many aspects of their lives, for example, to find a new balance between work and social contacts or to find work. We show that their narratives of identity, relationship and value differ from the narratives that others use to understand and identify them. Since identities, relationships and values give rise to normative expectations, in both cases there is a conflict between what the women expect of their caregivers and vice-versa. The narratives also show that two similar persons with multiple sclerosis may need very different care. This implies that nurses caring for such persons should listen carefully to their stories and reflect on their own perceptions of self.- - - - - - - - - - ranking = 0.083333333333333keywords = perception (Clic here for more details about this article) |
9/40. aphasia in multiple sclerosis.In a 17-year-old woman, motor aphasia developed during her second bout of multiple sclerosis, characterized by absent spontaneous speech, paraphasias in naming and repetition, and marked orofacial apraxia, with relative preservation of written language and intact auditory comprehension. A mild right hemiparesis was associated. Bilateral cerebral lesions were demonstrated on a computerized tomographic brain scan. The aphasia remitted over 1 month.- - - - - - - - - - ranking = 0.034499631770863keywords = speech (Clic here for more details about this article) |
10/40. diabetes insipidus in a patient with suspected multiple sclerosis.A 53-year-old man developed spastic ataxia associated with diabetes insipidus. The patient experienced frequent attacks of stiffness and numbness of the four limbs accompanied by difficulty of speech. During an eight years' follow-up a progressive deterioration of the motor function was observed but no extracerebral manifestations were noticed. The association of spastic ataxia is generally considered as diagnostic of histiocytosis X. In the present case, however, multiple sclerosis seems a more likely diagnosis in view of the late onset and the highly characteristic brain stem seizures.- - - - - - - - - - ranking = 0.034499631770863keywords = speech (Clic here for more details about this article) |
| | Next -> |