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Biomedical subjects

A Vighetto

Publications and source records attributed to A Vighetto.

At least 55 records · Page 3Linked to original sources
PubMed1997

Buspirone, a 5-hydroxytryptamine1A agonist, is active in cerebellar ataxia. Results of a double-blind drug placebo study in patients with cerebellar cortical atrophy.

OBJECTIVE: To establish the antiataxic effect of buspirone hydrochloride, a serotonergic 5-hydroxytryptamine1A (5-HT1A) agonist, in a homogenous group of patients characterized by the same well-defined single condition, cerebellar cortical atrophy. SETTING: University ataxia research center. METHODS: Double-blind randomized study of buspirone vs placebo during a 4-month period. PATIENTS: Nineteen patients met the inclusion criteria; all completed the study. Of these 19 patients, 9 were treated with placebo and 10 were treated with the drug. MAIN OUTCOME MEASURES: A semiquantitative scale for kinetic and static ("postural") cerebellar functions; quantitative clinical measurements measuring time in standard tests that evaluated stance, speech, writing, and drawing; and posturographic analysis of the sway path and sway area of the center-of-foot pressure. The primary end point was improvement of the posttherapeutic change of one of the semiquantitative ataxic scores. The secondary end points were modification of the changes of quantitative measures--clinical or posturographic. RESULTS: In intention-to-treat analysis, a significant improvement of the primary end point, ie, the posttherapeutic change of the ataxic kinetic score, was shown. Among secondary end points, the maximum time of standing with feet together also was significantly improved. CONCLUSIONS: Buspirone is active in cerebellar ataxia of patients with cerebellar atrophy. These results confirm the data suggested by open-label studies with buspirone. However, the effect is partial and not clinically major. These pharmacological results might be due to serotonergic mechanisms and confirm a possible link between cerebellar ataxia and the metabolism of serotonin.

Adult↗
PubMed1997

Brain pathology, eye movement disorders, and basic science of ocular movement.

Diagnosis of eye movement disorders is an important step in evaluation of patients with developmental or acquired brain lesions. A better understanding of the various pathologies requires both a detailed clinical examination and the analysis of eye movement recordings (nystagmus of various types, saccade, and pursuit anomalies). Basic science studies help to interpret these eye movement disorders.

Brain↗
PubMed1997

[Leber "plus" disease: optic neuropathy, parkinsonian syndrome and supranuclear ophthalmoplegia].

A 34-year-old right handed man presented with a bilateral subacute optical neuropathy associated with cervical dystonia, parkinsonism and supranuclear ophtalmoplegia. Magnetic resonance imaging showed in T2 increased intensity of signal in the dorsal mesencephalum and pons as well as in dorsal part of striata. The 3,460 mutation of mitochondrial DNA was found in a blood sample. This observation adds to the variability of presentation of Leber's "plus".

Adult↗
PubMed1996

Room tilt illusion. A central otolith dysfunction.

BACKGROUND: We report a sudden 90 degrees room tilt illusion (RTI) following vestibular stimulation in 3 patients with persistent skew deviation caused by a brain stem lesion. Room tilt illusion is a transient tilt perception of the visual surrounding, on its side or even upside down, that is often reported with brain stem lesions. Although its pathophysiologic cause is not well known, the RTI suggests an impairment of otolith pathways, as reported in skew deviation. METHODS: The 3 patients with brain stem lesions were reexamined as part of a follow-up of patients with signs of otolith dysfunction. A registration of vestibular function was performed with a rotatory chair, including earth-vertical axis rotation for canal stimulation and off-vertical axis rotation (OVAR) for otolith stimulation. Measurement of the subjective visual vertical (SVV) was also performed. RESULTS: The otolith-ocular reflex registered by OVAR was impaired in the 3 patients with skew deviation and the SVV in 2 patients. After each direction of OVAR stimulation, the 3 patients reported an RTI as the room was illuminated. CONCLUSIONS: The coexistence of otolith oculomotor (skew deviation and impaired otolith-ocular reflex) and perceptual (tilt of SVV and RTI) disorders suggests a common otolith dysfunction. However, an RTI occurred specifically after vestibular stimulation and when the room was illuminated. We thus suggest that RTI reflects a dynamic visuo-otolith mismatch.

Adult↗
PubMed1995

[Multiple (visceral and neurologic) tumors].

OBJECTIVES: We studied the frequency, histology, epidemiological features and delay between tumours with one localization in the central nervous system. We searched for an association between neurological and visceral neoplasia and tried to establish a guideline when central nervous system tumours appear after a visceral tumour. METHODS: From January 1973 to December 1993, we archived all patients admitted for neurological tumours or who had tumours discovered in our ward. Both neurological and non-neurological and malignant and non-malignant tumours which appeared simultaneously or after a delay were recorded. We retained only patients who had one neurological and one or more visceral tumours (n = 11). Multiple neurological or visceral tumours and phacomatosis were excluded. RESULTS: The association between neurological and visceral tumours is an uncommon but not exceptional finding as multiple tumours were seen in 1% of the cases admitted during the study period with a neurological or a visceral tumour. Meningioma and glioma were the most frequent histological type of central nervous system tumours (10 cases out of 11). Malignant melanoma was particularly frequent among the systemic tumours (3 out of 13 tumours). The classical association between meningioma and malignant breast neoplasia was absent in our study but an association of malignant melanoma and tumours of the central nervous system was found in 3 patients. Age and sex were similar for neurological and visceral tumours. The delay separating the discovery of the two tumours was shorter when the first tumour was a neurological tumour. CONCLUSIONS: These findings demonstrate the frequency of associated neoplasia. We did not find the classical association between breast cancer and meningioma but did find one between malignant melanoma and tumours of the central nervous system. This short study emphasizes the usefulness of having histological proof (when possible) before considering a cerebral tumour as a metastasis of a visceral tumour.

Adult↗
PubMed1995

[False negative results by X scanners in intracranial tumors in adults].

We report a cohort of 34 cases, collected between 1978 and 1992, presenting with symptomatic intracranial tumours with a first negative CT scan. Subsequently, the tumours was revealed with a second CT scan or with an another neuroradiological technique (MRI or angiography). These "false negatives" represented 5% of all intracranial tumours seen during the same period of time in the same institution. Gliomas were observed in 67.7% of cases (a majority of them with a high grade). Initially, seizure was the most common clinical presentation (61.8%). Mean delay between the first scan and the definitive diagnosis was 13.4 months. The localization was supra-tentorial in 79.4% and infra-tentorial in 20.6%. This study leads us to discuss the attitude when a first CT scan is normal, more particularly in cases presenting with seizures, and the different factors that can explain the normality of this first CT scan.

Adult↗
PubMed1993

Saccades in internuclear ophthalmoplegia: are abduction disorders related to interocular disconjugacy?

We studied horizontal saccades by direct-current electro-oculography in 18 patients with internuclear ophthalmoplegia (INO), and in 16 healthy, age-matched subjects. The occurrence of abducting signs, i.e. overshoot and dissociated nystagmus, was related to an increase of interocular dissociation (measured by the ratio of abduction and adduction peak velocities). The amplitude of abduction hypermetria was strongly correlated with the intensity of adduction slowing. These findings support the idea of an adaptive mechanism underlying the overshoot and nystagmus of abduction saccades in INO.

Adult↗
PubMed1993

Idiopathic intracranial hypertension after ofloxacin treatment.

We report the occurrence of idiopathic intracranial hypertension in a patient treated with ofloxacin, a fluoroquinolone antimicrobial agent, for 16 months. The withdrawal of ofloxacin and acetazolamide therapy were followed by a complete recovery of visual function.

Acetazolamide↗
PubMed1993

Ophthalmic results in patients with macroprolactinomas treated with a new prolactin inhibitor CV 205-502.

Macroprolactinomas are pituitary tumours which have been effectively treated medically since the introduction of bromocriptine. The visual function of 13 patients treated with a new prolactin (PRL) inhibitor CV 205-502 (Sandoz Basle), a potent and selective dopamine D2 receptor agonist, was evaluated. This is the first detailed ophthalmic report of the use of this drug in macroprolactinomas. Patients were enrolled from June 1988 to July 1990 (mean follow up 30 months). Visual function including visual acuity, ocular pressure, and visual fields was regularly controlled. Visual fields (VF) were tested with Goldmann and automatic static perimetry (Vision Monitor). Treatment was globally effective. No modifications of the visual function were observed in nine patients (six normal, three previous VF losses after surgery). In four other patients, visual function dramatically improved (regression of a III paresis, one case; disappearance of a chiasmatic syndrome, three cases). A pituitary necrosis was observed in one case and successfully cured. CV 205-502 seems to be an effective and well tolerated treatment of macroprolactinomas.

Adult↗
PubMed1993

[Arnold-Chiari malformation in adults. Development of diagnostic conditions since the availability of MRI].

We reviewed retrospectively 47 patients with a Chiari malformation (CM) who had been admitted to the Clinique de Neurologie of Lyon from 1971 to 1991. The purpose of this report is to assess the possible influence on the frequency and the clinical pattern at presentation of CM since 1985 when Magnetic Resonance Imaging (MRI) became available to us. A diagnosis of CM was made for 21 patients before 1985 (group 1) and for 26 patients thereafter (group 2), i.e., a 2.5 increase of incidence of CM frequency (1.5 patients/year before 1985 vs 3.7 patients/year thereafter). This increase was even more striking for cases without syringomyelic symptoms and signs (SSS) (42.9% in group 1, vs 76.9% in group 2). The accuracy of clinical diagnosis was 68.1% for the total surveyed period (90.5% before 1985 and 50% thereafter). For cases with SS at presentation, a syringomyelic cavity was radiologically demonstrated in 80% of the cases in the pre-MRI period and 90.9% of the cases since MRI was available. On the other hand, when a syringomyelic cavity was radiologically demonstrated, there was a related clinical SS in 70% of group 1 patients and 50% of group 2 patients.

Adolescent↗
PubMed1992

[Painful sequelae of Wallenberg's syndrome].

Twenty-seven out of 45 patients who had Wallenberg's syndrome were re-examined as out-patients. Nineteen were complaining of pain on the side opposite to that with loss or temperature and pain sensations or trigeminal deficit. The follow-up showed that pain was both intense and disabling and its treatment was disappointing. The most striking finding was the high frequency of painful sequelae to Wallenberg's syndrome, since they affected almost one out of two patients. The occurrence of these painful symptoms, usually after lesion of the spinothalamic tract, is difficult to explain.

Arm↗
PubMed1992

[Meningioma with pseudo-vascular disclosure].

In a retrospective study of 125 case reports of intracranial supratentorial meningiomas, the authors have isolated 10 patients whose meningioma had been revealed by pseudo-vascular syndromes. Mean age and sex ratio were the same in this group of patients as in those patients whose meningioma had been more classically disclosed by an epileptic seizure, a motor or a progressive sensorimotor deficit. The site of the tumour exerted an influence on the nature of clinical manifestations. There was no correlation between the size of the tumour and the transient or prolonged course of the pseudo-vascular syndrome. The pathogenesis of these disorders is discussed.

Adult↗