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Biomedical subjects

D J Werring

Publications and source records attributed to D J Werring.

23 records · Page 2Linked to original sources
PubMed1998

Proteus syndrome: diagnosis in adulthood.

We describe a 24-year-old woman with many of the classical features of the Proteus syndrome. In childhood she had undergone bilateral forefoot amputations because of massive bilateral cerebriform hypertrophy of the feet. Other features include abnormally large fingers on one hand, a lymphangioma circumscriptum, an epidermal naevus, prominent venous varicosities and scattered lipomas. The disorder occurs sporadically and is thought to be secondary to a postzygotic mutation that survives by mosaicism.

Adult↗
PubMed1998

The structural and functional mechanisms of motor recovery: complementary use of diffusion tensor and functional magnetic resonance imaging in a traumatic injury of the internal capsule.

OBJECTIVES: Recovery from focal motor pathway lesions may be associated with a functional reorganisation of cortical motor areas. Previous studies of the relation between structural brain damage and the functional consequences have employed MRI and CT, which provide limited structural information. The recent development of diffusion tensor imaging (DTI) now provides quantitative measures of fibre tract integrity and orientation. The objective was to use DTI and functional MRI (fMRI) to determine the mechanisms underlying the excellent recovery found after a penetrating injury to the right capsular region. METHODS: DTI and fMRI were performed on the patient described; DTI was performed on five normal controls. RESULTS: The injury resulted in a left hemiplegia which resolved fully over several weeks. When studied 18 months later there was no pyramidal weakness, a mild hemidystonia, and sensory disturbance. fMRI activation maps showed contralateral primary and supplementary motor cortex activation during tapping of each hand; smaller ipsilateral primary motor areas were activated by the recovered hand only. DTI disclosed preserved structural integrity and orientation in the posterior capsular limb by contrast with the disrupted structure in the anterior limb on the injured side. CONCLUSIONS: The findings suggest that the main recovery mechanism was a preservation of the integrity and orientation of pyramidal tract fibres. The fMRI studies do not suggest substantial reorganisation of the motor cortex, although ipsilateral pathways may have contributed to the recovery. The initial deficit was probably due to reversible local factors including oedema and mass effect; permanent damage to fibre tracts in the anterior capsular limb may account for the persistent sensory deficit. This study shows for the first time the potential value of combining fMRI and DTI together to investigate mechanisms of recovery and persistent deficit in an individual patient.

Adult↗
PubMed1998

Improving the quality of life of patients with multiple sclerosis: diagnosis.

Multiple sclerosis (MS) is the commonest neurological cause of disability in young adults. The clinical course is extremely variable, but typically a relapsing-remitting phase of variable duration is followed by a gradual progression in disability. However, the diagnosis of MS may have an impact that reaches beyond the physical disabilities into many other aspects of life, including career and family. The time of diagnosis is one of the most important in the course of the illness and the way in which investigations are conducted, the timing and manner of imparting the diagnosis, and subsequent support and education may have far-reaching consequences. The diagnostic phase thus presents a difficult management challenge for the neurologist and other health workers attempting to address these issues. This review considers the steps involved in reaching the diagnosis, together with ways in which the overall quality of life of the patient may be maximized during this period.

Journal Article↗