Cases reported "Multiple Sclerosis"

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1/51. 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.
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ranking = 1
keywords = electromagnetic
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2/51. Macro square wave jerks.

    Quantitative eye movement recordings in a patient with multiple sclerosis who had both macro square wave jerks and an internuclear ophthalmoparesis supported the concept of an internal brain-stem monitor that mediates corrective eye movements. A brain-stem model of this monitor illustrates the patient's motility disorder and the normal function of providing synergistic version and vergence corrections for dysmetric eye movements. Thus, the careful study of pathologic disturbances provides information relevant to the normal operation of the ocular motor system.
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ranking = 5.060027164201E-7
keywords = wave
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3/51. Clinical exacerbation of multiple sclerosis following radiotherapy.

    BACKGROUND: radiation of the central nervous system in patients with demyelinating disease may have deleterious effects. OBJECTIVE: To describe a 30-year-old woman with multiple sclerosis who developed an attack of demyelination 2 months following radiotherapy for a parotid malignancy. RESULTS: magnetic resonance imaging demonstrated new hyperintense lesions that corresponded to both the localization of the patient's symptoms and to the area defined by the 50% isodose radiation field. CONCLUSION: radiation treatment likely triggered an exacerbation of multiple sclerosis.
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ranking = 2.8665830206999E-8
keywords = radiation
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4/51. Distinct supratentorial lesions mimicking cerebral gliomas.

    BACKGROUND: Various supratentorial pathological conditions can mimic neoplastic cerebral lesions clinically as well as radiologically. Analysis of the neuroradiological findings, the clinical history, laboratory and other paraclinical data mostly help to narrow down the diagnosis of cerebral pathologies. Sometimes, however, histopathological analysis of the operative specimen after surgery reveals unexpected findings. patients AND FINDINGS: In a series of 197 operative procedures performed for glioma surgery between August 2000 and August 2002 we found six distinct cases mimicking supratentorial tumours. Clinicoradiological findings had suggested a neoplastic gliomatous process in all cases. But histopathological examination revealed that in reality one patient had been affected by a stroke, two by hypertensive encephalopathy, and one by radiation necrosis; multiple sclerosis was the underlying pathology in two patients. INTERPRETATION: Conditions which show features similar to those of neoplastic cerebral lesions require advanced magnetic resonance imaging (MRI). The benefit of such sophisticated imaging in relation to the costs is an important issue in this context. Further research in the field of modern image modalities is necessary to evaluate these noninvasive techniques for specification of intracerebral lesions.
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ranking = 2.8665830206999E-8
keywords = radiation
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5/51. Neurogenic vestibular evoked potentials using a tone pip auditory stimulus.

    OBJECTIVES: To obtain neurogenic vestibular evoked potentials (NVESTEPs) with surface scalp recording using a tone pip auditory stimulus. methods: Fourteen neurologically normal volunteers (Age range 26-45 years, 10 females and 4 males), and two patients with sensorineural hearing loss and possible multiple sclerosis respectively, were examined. Two channel recordings were obtained, the first channel being P3 referred to Fpz, and the second channel being P4 referred to Fpz. A 1 kHz tone pip stimulus with two cycles was delivered via headphones monoaurally with contralateral masking noise. RESULTS: A consistent negative wave with a mean absolute latency of 4.72 msec was obtained, which we have named N5. 25% of the ears tested had better responses at the ipsilateral parietal electrode. In the patient with bilateral sensorineural hearing loss, NVESTEPs was present, suggesting that the NVESTEP is not a cochlear response. In the patient with possible multiple sclerosis, an abnormal NVESTEP response and a normal BAEP response were found. CONCLUSION: Use of a tone-pip rather than a click auditory stimulus allows a lower click intensity to be used in the production of NVESTEP responses, leads to a shorter testing time, and is therefore more comfortable for the patient. This study adds to our impression that the NVESTEP may be a physiological response that can be used to assess the vestibular system and is different from the BAEP response. Further testing in patients with symptoms of dizziness and with disorders specific for the vestibular nerve is required.
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ranking = 1.0120054328402E-7
keywords = wave
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6/51. A case of multiple sclerosis with homonymous hemianopia examined by positron emission tomography.

    BACKGROUND: To demonstrate the efficacy of positron emission tomography (PET) for examining multiple sclerosis (MS) patients with hemianopia. CASE: A 20-year-old man visited us with a complaint of left homonymous hemianopia and headache. OBSERVATIONS: The patient's visual acuity was 1.2 (n.c.) OD and 0.9 (1.0) OS. magnetic resonance imaging (MRI) showed a mass in the temporoparietal lobe. A pathological diagnosis of MS was made by brain biopsy. Low glucose metabolism in the lesion and visual cortex was observed by PET with (18)F-fluorodeoxy glucose. PET with (11)C-flumazenyl revealed a reduction of (11)C-uptake in the demyelinated optic radiation, and only a slight reduction of (11)C-uptake in the primary visual cortex. The results of (11)C-flumazenyl PET suggested a slight reduction of neuronal density. In 2 years, the visual field recovered to the normal state. CONCLUSION: PET can be a useful tool for estimating the visual outcome of patients with hemianopia in MS.
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ranking = 2.8665830206999E-8
keywords = radiation
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7/51. Symptomatic retrochiasmal lesions in multiple sclerosis: clinical features, visual evoked potentials, and magnetic resonance imaging.

    We have studied 18 patients with relapsing-remitting multiple sclerosis (MS) who had symptomatic visual field defects due to retrochiasmal lesions. In 17, the lesion responsible was identified by magnetic resonance imaging (MRI), computed x-ray tomography (CT), or both. The lesion responsible involved the posterior optic radiations in eight cases, the optic tract and lateral geniculate nucleus in six, and the posterior limb of the internal capsule in three. The prognosis for recovery of the field defect was good; complete recovery occurred in 14 patients, and only two showed no recovery at all. The striking characteristic of the lesions was that most were unusually large; indeed, many were detectable on CT as well as MRI. Half-field asymmetries of either amplitude or latency of the visual evoked potentials (VEPs), consistent with a postchiasmal lesion, were present in only five out of 13 patients acutely. In only three of these did the abnormality persist at follow-up. We conclude that only large postchiasmal lesions are likely to cause symptomatic homonymous field defects in MS, usually characterized by rapid recovery. Hemifield VEPs have a low sensitivity for the detection of postchiasmal as compared with prechiasmal abnormalities.
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ranking = 2.8665830206999E-8
keywords = radiation
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8/51. Bilateral homonymous visual field defects as initial manifestation of multiple sclerosis.

    Symptomatic suprageniculate lesions in multiple sclerosis expressed as a visual field defect are infrequent. The present case developed a bilateral homonymous defect as the initial and unique symptom of the disease. It was confirmed by nuclear magnetic resonance imaging, which disclosed extensive demyelinating areas in both optic nerve radiations. The mode of onset, perimetric findings, and unusual presentation of this condition are briefly discussed.
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ranking = 2.8665830206999E-8
keywords = radiation
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9/51. magnetic resonance imaging and posttraumatic Lhermitte's sign.

    Two patients developed Lhermitte's sign after cervical spine fractures. The patients were otherwise without evidence of spinal cord dysfunction. Both patients were studied with magnetic resonance scans of the cervical spine. The magnetic resonance scans were normal. The possible etiology of Lhermitte's sign in these patients is discussed. The differential diagnosis including cervical spondylosis, combined systems degeneration, multiple sclerosis, neoplasm, and radiation myelopathy is reviewed. These patients should be carefully evaluated clinically, and flexion/extension lateral cervical spine films as well as a complete blood count and peripheral smear should be obtained. Magnetic resonance scanning may have an important role in evaluating these patients. Magnetic resonance is exquisitely sensitive in detecting demyelination; therefore, we speculate that subarachnoid scarring may be responsible for this symptom. gadolinium-enhanced magnetic resonance scanning may confirm the presence of such scarring in the future.
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ranking = 2.8665830206999E-8
keywords = radiation
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10/51. Effect of cannabinoids on spasticity and ataxia in multiple sclerosis.

    The chronic motor handicaps of a 30-year-old multiple sclerosis patient acutely improved while he smoked a marihuana cigarette. This effect was quantitatively assessed by means of clinical rating, electromyographic investigation of the leg flexor reflexes and electromagnetic recording of the hand action tremor. It is concluded that cannabinoids may have powerful beneficial effects on both spasticity and ataxia that warrant further evaluation.
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ranking = 0.2
keywords = electromagnetic
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