Kagansky and colleagues review studies related to hyperglycemia and acute stroke. A consensus emerges describing the deleterious effect of early hyperglycemia, especially in patients with nonlacunar focal or global ischemia. Clinical trials of intensive insulin treatment are urged. Practical measures to avoid excessive hyperglycemia are recommended.
de Groot and colleagues review their experience with 128 patients with generalized Wegener granulomatosis. Their vast experience with peripheral nervous system as well as central nervous system complications is reviewed, and prompt initiation of immunosuppression therapy is italicasized. This difficult area in patient management is put into critical perspective in an editorial by David Pleasure, MD.
Alegret and colleagues investigate the effects of subthalamic deep brain stimulation as a means to improve motor function in patients with Parkinson disease. Concern has been raised regarding the neuropsychological functions in this mode of therapy. In 15 consecutive patients treated with subthalamic stimulation, Alegret et al found that motor symptoms improved without any clinically relevant neuropsychological deterioration. These are reassuring findings that should be of value to physicians considering this therapeutic approach.
Lipton and colleagues describe their clinical-neuropathologic correlative experience with frontotemporal dementias. They find a trend for an association between synapse loss and lateralizing neuropsychologic and neurobehavior deficits in their cohort of patients. Anatomical-functional correlations of this type are needed to better appreciate the phenomenological features seen in this emerging area of clinical dementia.
Mungas and colleagues have studied the rate of cognitive decline in Alzheimer disease (AD) when associated with concurrent cerebrovascular disease. Of note, they found that in patients aged 80 years or older, dementia progressed more rapidly in AD patients with cerebrovascular disease declined faster than in AD patients without associated cerebrovascular pathological conditions. The emerging role of vascular disease complicating the dementia associated with AD needs increased attention and offers new therapeutic possibilities.
Dabby and colleagues describe the clinical and electrophysiological features of patients with inclusion body myositis that may mimic motor neuron disease. The characteristic features of these clinical disorders are contrasted and compared. Muscle biopsies and quantitative electromyographic analysis are indicated in patients with atypical motor neuron disease.
Etchebehere and colleagues have utilized brain single-photon emission computed tomographic (SPECT) imaging and magnetic resonance imaging (MRI) for the evaluation of patients with Machado-Joseph disease (MJD). Their concern is longitudinally to evaluate functional vs structural features of this autosomal dominant cerebellar degenerative disease longitudinally. They found a unique and characteristic SPECT pattern in discrete regions of the temporal lobes, basal ganglia, and cerebellar hemispheres, while MRI identified more abnormalities in the pons and superior portions of the frontal lobes. These imaging findings provide new insights into the neurodegenerative basis of this complex system disorder.
McCabe and colleagues evaluated patients with intractable frontal lobe seizures utilizing combination therapy with valproic acid (divalproex sodium) and lamotrigine. Ten of 17 patients who completed the study on this regimen became completely free of seizures. Divalproex-lamotrigine combination therapy is a reasonable alternative in intractable frontal lobe epilepsy.
Yilmaz and colleagues describe their experience with 20 adult and pediatric angiographically diagnosed patients with moyamoya. Ischemic stroke or transient ischemic attacks were the predominant initial presentations in their patients. Overall, 5 of their patients received medical treatment, and 15 had surgical revascularization. In general, they found a more benign natural history of disease in their cohort of patient as compared with Asian populations.
Von Giesen and colleagues have studied patients who were seropositive for HIV-1 who had minor motor disorders by assessing their psychomotor speed and metabolic alterations in the basal ganglia using proton magnetic resonance spectroscopy. They found that altered metabolic spectra were indicative of glial proliferation in this group of patients. These findings may be useful in the clinical evaluation of patients with motor deficits and may provide a quantitative measure for initiating anitviral therapy.
This Month in Archives of Neurology. Arch Neurol. 2001;58(8):1198-1199. doi:10.1001/archneur.58.8.1198