Biomedical subjects

I Milanov

Publications and source records attributed to I Milanov.

47 records · Page 3Linked to original sources

PubMedDate not supplied

Differential diagnosis of amyotrophic lateral sclerosis and similar syndromes.

The aim of this investigation was to re-evaluate the electromyographic findings in patients with ALS and with localised lesions of the spinal cord and to find some clues for differentiation. Two hundred and sixteen patients took part in this investigation. They were subdivided into two groups. The first group consisted of 168 patients with data for amyotrophic lateral sclerosis. The second group consisted of 48 patients with syndrome of amyotrophic lateral sclerosis caused by cervical myelopathy. Detailed neurological and electromyographic examinations were performed to all patients. In conclusion the electromyographic findings in patients with ALS are not different than the abnormalities in muscles innervated by the affected segments in patients with localised lesions which compress the anterior portion of the spinal cord. The only clues for differentiation are the clinical signs and the distribution of electromyographic abnormalities.

Adult↗

PubMedDate not supplied

Clinical and electromyographic examination of tremor in patients with thyrotoxicosis.

Tremor is a well-known symptom of thyrotoxicosis, yet no detailed clinical and electromyographic (EMG) examination of it has been published. The aim of this investigation was to establish the clinical and EMG pattern of tremor in patients with thyrotoxicosis and to compare it with the well-known pattern of enhanced physiological tremor caused by anxiety. Twenty-six patients with thyrotoxicosis and tremor and 30 patients with tremor and generalised anxiety disorder were investigated. Tremor was scored clinically in all possible limb positions. EMG examination of tremor activity from antagonist hand muscles was performed. A postural and kinetic tremor with characteristics of an enhanced physiological tremor was found in patients with thyrotoxicosis and generalised anxiety disorder. Tremor involved only the upper limbs in all patients. In conclusion, tremor in thyrotoxicosis and generalised anxiety disorder is an enhanced physiological tremor which cannot be separated clinically or by EMG measurement. Both types of tremor have similar mechanisms and can be distinguished only by the circumstances responsible for their occurrence. Despite only a moderate correlation between tremor intensity and thyroid hormone levels, successful treatment of thyrotoxicosis results in a dramatic improvement of tremor.

Adolescent↗

PubMedDate not supplied

Differential diagnosis of myasthenic syndromes.

Myasthenia-like symptoms and Eaton-Lambert myasthenic syndrome have been reported in patients with polymyositis. On the other hand, the muscular involvement in myasthenic patients is well established. Thus difficulties in the differentiation of patients with polymyositis and myasthenic syndrome and myasthenia with myopathy may arise. The aim of this investigation was to re-establish the clues for distinguishing between different types of myasthenic syndromes. One hundred and twenty five patients took part in this investigation. According to the electromyography, biopsy and serum levels of creatine kinase data, the patients were subdivided into three groups. The first group consisted of 35 patients with data for chronic polymyositis. The second group consisted of 46 patients with myasthenia. The third group consisted of 44 patients with myasthenia and myopathy. Our data confirm the more often onset of myasthenia with ptosis and of myasthenic syndromes in polymyositis-from lower limbs. The bulbar involvement is more rare, while the autonomic nervous system involvement and decreased tendon reflexes are more common in patients with Eaton-Lambert myasthenic syndrome as compared to patients with myasthenia. Bulbar involvement is more typical for myasthenia, while four limbs involvement is more common in patients with myasthenia and myopathic changes. There are no differences in the typical decrementing response between patients with polymyositis, myasthenia or myasthenia with myopathic involvement. The Eaton-Lambert myasthenic syndrome is quite different and is found only in a small part of polymyositis patients. In conclusion the differential diagnosis between myasthenic syndromes in polymyositis and myasthenia with muscular involvement is not possible only by electromyography.

Action Potentials↗

PubMedDate not supplied

The trigemino-cervical reflex in normal subjects.

There are only few reports on the trigemino-cervical reflex in humans and there is debate over the best method of reflex examination. The aim of this study was, comparing different methods, to provide a reproducible method for evaluating the trigemino-cervical reflex. The trigemino-cervical reflex was studied in 32 healthy volunteers. The stimulation was applied to the supraorbital, infraorbital or mental nerve. Recordings were performed bilaterally from the sternocleidomastoid and trapezius muscles at rest. The reflex was also examined during maximal voluntary contraction of the sternocleidomastoid muscle after supraorbital nerve stimulation. It presented as a two-component reflex if recorded from a tonically active muscle and as a one-component reflex if recorded from a relaxed muscle. The most reproducible reflex responses were obtained from the resting sternocleidomastoid muscle after stimulation of the supraorbital nerve. In conclusion, the trigemino-cervical reflex may be most easily obtained from the relaxed sternocleidomastoid muscle after supraorbital nerve stimulation.

Adult↗

PubMedDate not supplied

Clinical and electromyographic examinations of patients with psychogenic tremor.

The diagnosis of psychogenic tremor is difficult, as it is based on exclusion of all possible causes for organic tremor. The aim of this examination was to evaluate some typical clinical and electromyographic features of the psychogenic tremor. Twenty-nine patients with psychogenic tremor were examined and followed up for more than 36 months. Surface electromyographic recordings of the most involved limb in all positions were performed. The tremor was assessed also during different distractive methods. We found that typical symptoms are the sudden onset from more than one limb and in more than one limb position and the lack of progression. Tremor was accompanied by muscle contraction of both agonistic and antagonistic muscles. EMG recorded tremor was with alternating pattern and variable amplitude and frequency. In conclusion there are typical clinical and EMG symptoms that are useful for the early diagnosis of psychogenic tremors, while with the progression of the disease these symptoms are no more evident.

Adult↗

PubMedDate not supplied

Neurographic studies in hemiplegic patients.

The aim of this investigation was to re-establish the nature of the involvement of the peripheral nervous system after lesions of the central nervous system. An examination of 120 patients with spastic hemiparesis after stroke was performed. The motor conduction velocities, M-response latencies and amplitudes, as well as F-wave latencies were evaluated in median, ulnar, peroneal and tibial nerves. The minimal latency of soleus H-reflex was obtained. Our results revealed normal motor conduction velocities, and distal M-response and H-reflex latencies on the involved side. However the amplitudes of the M-responses were decreased and the latencies of the F-waves prolonged on the spastic side. In conclusion primary axonal degeneration with secondary segmental demyelination, involving predominantly proximal parts of the peripheral nerves, occurs after central nervous system injury.

Aged↗

PubMedDate not supplied

Alcohol withdrawal tremor.

It is well known that during the withdrawal period after chronic alcohol intake, tremor is one of the symptoms that disturb patients. Alcohol withdrawal tremor might be a variant of enhanced physiological tremor, most often caused by anxiety or emotional stress. The aim of this investigation was to establish the EMG pattern of alcoholic tremor and to compare it with the well known pattern of enhanced physiological tremor caused by anxiety or emotional stress. Forty patients 20-43 years old were investigated by a neurologist and psychiatrist 1-10 days after acute alcohol withdrawal. They all met the criteria for chronic alcoholism. Thirty three patients 26-43 years old with the complaint of tremor and anxiety or emotional stress were also investigated. An electromyographic investigation was performed to evaluate the pattern, frequency and amplitude of tremor. Results revealed that both groups of patients had 8-12 Hz low amplitude postural tremor with synchronous activity in antagonist muscles. Patients with alcohol withdrawal tremor had significantly higher amplitude tremor compared with patients with anxiety and emotional stress. No other clinical or electromyographic differences existed between both groups. In conclusion alcohol withdrawal tremor is a variant of enhanced physiological tremor. Both types of tremor could be distinguished only by the circumstances responsible for tremor occurrence.

Adult↗

PubMedDate not supplied

Spasmodic torticollis and tremor due to multiple sclerosis: a case report.

Different forms of symptomatic dystonia have been reported in patients with multiple sclerosis, but the appearance of spasmodic torticollis is extremely rare. We present the case of a 24-year-old man with postural and intentional left hand tremor and leftward spasmodic torticollis. The duration of the disease is 6 years, without remissions. The cerebrospinal fluid examination revealed oligoclonal (two bands) hypergammaglobulinemia. Auditory and visual evoked potentials showed altered sensory afferentation. On magnetic resonance imaging brain scan, multiple T2 high signal lesions involving the white matter of both cerebral hemispheres, mainly the periventricular regions, were found. There were also multiple lesions in the brain stem and some in the cerebellar hemispheres. Thus the diagnosis of multiple sclerosis could be considered as definite. In conclusion, extremely rarely, multiple sclerosis may appear with progressive spasmodic torticollis and rubral tremor.

Adult↗

PubMedDate not supplied

Scapuloperoneal muscular atrophy: Davidenkow's syndrome. Family report.

The nosology of scapuloperoneal syndrome remains controversial. Is it a variant of Charcot-Marie-Tooth's disease, a form of myopathy, or of spinal muscular atrophy is still unknown. A family with a scapuloperoneal syndrome caused by anterior horn cell involvement is described. Data for sensory involvement were also found. In addition one member of the family had motor nerves and corticospinal tract involvement. The distribution of weakness and muscle wasting was unusual--only lower limbs were involved. However, electromyographic data for both upper and lower limbs involvement were evident. The combination of scapuloperoneal syndrome with sensory loss has been described by Davidenkow, but was not proved by neurographic investigation. Later only one case with proved sensory disturbances was reported. Patients with motor nerves involvement in addition were reported, but not received satisfactory explanation. Probably in some patients the disease could be manifested only with anterior horn cell involvement, while in other both motor and sensory nerves could be involved. In conclusion we suppose that the scapuloperoneal muscular atrophy is a form of spinal muscular atrophy which could be manifested by different symptoms.

Adolescent↗

PubMedDate not supplied

Distal muscular dystrophy. Case reports.

The distal muscular dystrophy has been described in 1902 by Gowers. Since then a lot of cases with different mode of inheritance, clinical involvement and morphological findings have been described. Obviously distal myopathies are not a single entity. We describe four new cases of distal myopathy. Although we suppose that they are from the adult-onset Welander's form, they are different in some points. Two cases were with onset in the lower limbs and autosomal dominant inheritance, the third one was sporadic with onset in the lower limbs and the last one was sporadic with onset in the upper limbs. The distal muscles were markedly, while the proximal were slightly involved. Sternocleidomastoid, neck or facial muscles wasting were also found in three cases. The serum creatine kinase in all patients was in nearly normal limits. The electromyographic findings were consistent with chronic myopathy, although fibrillation potentials and positive sharp waves were found in three cases. Muscle biopsy data confirm the myopathic involvement in all patients. We have described patients, which confirm the variability of distal myopathies, regarding the age of onset, initial symptoms, clinical picture, electromyographic and muscle biopsy findings.

Adult↗

PubMedDate not supplied

Differential diagnosis of chronic idiopathic polymyositis and neuromyositis.

The term neuromyositis indicates a very rare type of polymyositis where, beside the usual muscular manifestations, there are signs of peripheral neuropathy. Although a lot of patients with neuromyositis has been published, it is a very controversial entity. There may be considerable difficulty in distinguishing chronic polymyositis from neuromyositis, even with the aid of electromyographic and muscle biopsy examinations. The aim of this investigation was to re-establish the clues for distinguishing chronic polymyositis from neuromyositis. Fifty-seven patients took part in this investigation. They were subdivided into two groups according to EMG and muscle biopsy data. First group consisted of 29 patients with chronic polymyositis and second group consisted of 28 patients with chronic neuromyositis. Our data confirm the existence of neuromyositis as an entity with different clinical, electromyographic and biopsy findings than polymyositis. The differentiation between chronic polymyositis and neuromyositis is a difficult task on purely clinical ground. Electromyographic recordings with widespread myopathic features, some large potentials and spontaneous activity could be found in both diseases. The most common and important electromyographic findings in patients with neuromyositis are prolonged sensory and motor nerve conduction velocities. In conclusion electromyography and muscle biopsy may be useful in the differential diagnosis of polymyositis and neuromyositis.

Adult↗