Clinical and experimental neurology
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Because sensory neuropeptides improve survival of critical skin and muscle flaps in rats, skin nociceptive sensory nerve function in blister healing was examined. Sensory nerve ablation by unilateral hindlimb denervation or cutaneous axon reflex enhancement by 14 days systemic nicotine treatment (5 mg kg-1 day-1) decreased and increased, respectively, peripheral motor functions of nociceptive (peptidergic) skin nerves. Effects on nociception were measured by a radiant heat tail-flick test. ⋯ Finally, resting substance P release from blisters, after direct cutaneous nerve stimulation, appears to be enhanced in nicotine-treated rats. Thus nociceptive innervation appears critical for inflammation and rapid healing of blisters in rat skin. The data signal a possible important role for neuropeptides in these processes and question the function of nicotinic receptors on sensory nerves.
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Basilar artery occlusion developed in a 34 year old woman 2 months after adopting unusual neck postures during yoga practice. On angiography, her basilar artery was filled with intraluminal clot while the vertebral arteries were normal. We postulate that a severe reduction in blood flow and possibly an intimal tear triggered thrombosis of the vertebral artery and that the final stroke mechanism was artery-to-artery embolism.
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The diagnosis of median nerve compression neuropathy at the carpal tunnel is usually confirmed by clinical electrophysiology. The classical findings of a significantly slowed median nerve conduction velocity for both sensory and motor fibres, with a prolonged distal motor latency and a reduced amplitude compared to age-related norms are unambiguous, but these criteria are often present only in part. In such cases another quantitative indicator of compression neuropathy would be extremely helpful. ⋯ Further, although both thermal thresholds at the wrist were normal, those on the palm were elevated, cold being significantly raised (P less than 0.02) compared both to warm and to age-matched controls. Correlation of the nerve conduction velocity findings and thermal sensory acuity did not yield significant covariance of the positive and negative findings. Overall the results suggest that detection of preferentially elevated cold perceptual threshold (ie reduced cold sensory acuity) on the skin of the palm may aid in the diagnosis of putative carpal tunnel compression in patients with minimal or ambiguous electrophysiological data and provide a functional index of recovery after decompression.
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Severe spasticity is a major problem in the rehabilitation of patients with dysfunction of the spinal cord or cerebral hemispheres. Oral baclofen is often effective. ⋯ Over the past 5 years we have developed a program for the use of intrathecal baclofen for severe spasticity, and in relation to this discuss patient assessment, practical aspects of drug administration, complications of therapy and patient benefits. Continuous intrathecal baclofen is a safe and effective adjunct to physical therapy in the management of patients with severe spasticity.
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A revised EEG grading scale in coma has been introduced previously. This scale is based on the internationally accepted 5 grade scale but also contains uncommon patterns such as spindle, alpha and theta pattern comas. By defining 15 separate grades and subgrades it was possible to reduce the number of patterns of uncertain prognostic significance for survival to 4 out of the 15 possible patterns. ⋯ Four suggested scale subdivisions did not occur in the material studied but these subdivisions are more common in traumatic encephalopathies. This study shows that an EEG performed 24 to 36 hours after cardiac arrest provides significant information for the prediction of survival. No specific patterns of microscopic changes in the brain were found to correlate with individual EEG abnormalities in fatal anoxic encephalopathies.