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Biomedical subjects

L A Rolak

Publications and source records attributed to L A Rolak.

At least 19 recordsLinked to original sources
PubMed1992

Clinical features of Todd's post-epileptic paralysis.

Two hundred and twenty nine patients with generalised tonic-clonic seizures were prospectively evaluated. Fourteen were identified who had transient focal neurological deficits thought to be Todd's post-epileptic paralysis (PEP). Eight of these 14 patients had underlying focal brain lesions associated with the postictal deficits. All patients with PEP were weak, but there was wide variation in the pattern (any combination of face, arm, leg), severity (plegia to mild), tone (spastic, flaccid, or normal), and reflexes (increased, decreased, or normal). Significant sensory loss occurred in only one patient. The only other signs of PEP were aphasia (in five patients all with underlying lesions) and gaze palsy (in four patients). Post-epileptic paralysis persisted from half an hour to 36 hours (mean of 15 hours). Post-epileptic paralysis may occur with the first seizure or after many years of seizures and does not appear after every seizure. The clinical features of PEP are thus heterogeneous.

Electroencephalography↗
PubMed1991

Literary neurologic syndromes. Alice in Wonderland.

Many neurologic syndromes are named for literary characters. For example, the "Alice in Wonderland" syndrome of altered body perceptions, usually caused by migrainous ischemia, is so called because of the resemblance of its symptoms to the fluctuations in size and shape that plague the main character in Lewis Carroll's 1865 novel Alice in Wonderland. The medical symptoms of distorted body images match the literary description so precisely that illustrations from the original book depict them very accurately. Because Lewis Carroll suffered from classic migraine headaches, scholars have speculated that he may have experienced this syndrome himself.

Cartoons as Topic↗
PubMed1990

Headaches and multiple sclerosis: a clinical study and review of the literature.

Whether multiple sclerosis (MS) can cause headaches is controversial. To clarify the association between headaches and MS we prospectively analyzed 104 consecutive MS patients using detailed headache evaluations. Fifty-four patients (52%) reported headaches, compared with 5 of 35 (14%) patients initially suspected to have MS but subsequently proven to have other disorders, and 18 of 100 (18%) matched general neurology patients. The MS patients had tension headaches or vascular headaches of the migraine type; there was no distinctive "MS headache." Seven of these patients had headaches with their first MS symptoms, but in only one did headaches recur with disease activity. Headaches did not correlate with any clinical features of MS. We conclude that an association between headaches and MS may exist.

Adolescent↗
PubMed1990

Low yield in the diagnostic evaluation of transient ischemic attacks.

Among 163 patients presenting with the clinical features of a TIA, extensive testing identified only 2 patients with nonatherosclerotic causes. We conclude that most patients with a TIA have atherosclerotic vascular disease and that screening tests for other etiologies have a low yield.

Algorithms↗
PubMed1988

Psychogenic sensory loss.

One hundred consecutive patients complaining of hemifacial numbness were tested for two features commonly thought to indicate psychogenic sensory loss: a) exact splitting of the midline to pinprick, and b) diminished vibratory sensation on the affected forehead. Twenty patients had purely psychogenic complaints, while 80 had organic lesions. Sensory loss split the midline in four patients (20%) with psychogenic complaints but also in six patients (7.5%) with structural lesions (p = NS). Vibration was diminished in 19 patients (95%) with psychiatric disease but also in 69 patients (86%) with organic lesions (p = NS). Contrary to popular beliefs, these "nonphysiologic" findings do not distinguish psychogenic from organic sensory loss.

Conversion Disorder↗
PubMed1986

Immunosuppressive drug therapy in myasthenia gravis.

We reviewed the records of 37 patients with myasthenia gravis treated with azathioprine (n = 10) or cyclophosphamide (n = 27). All patients had received prednisone and anticholinesterase therapy, and most had undergone thymectomy prior to immunosuppressive therapy. Thirty patients (81%) responded to treatment. Both azathioprine and cyclophosphamide were found to be effective in the treatment of myasthenia gravis. The degree of improvement was more pronounced in patients with thymoma.

Adolescent↗
PubMed1986

Spastic pure motor monoparesis.

Pure motor hemiplegia (PMH) is, in most cases, caused by a lacunar infarction. However, pure motor monoparesis (PMM), i.e., isolated motor involvement with spasticity in one limb, has drawn little attention. We studied prospectively 5 patients with PMM and found that it was always due to a mass lesion in the contralateral superficial cerebral hemisphere. Our observation suggests that PMM should not be regarded as simply a variant of PMH.

Aged↗
PubMed1986

Magnetic resonance imaging in moyamoya disease.

Magnetic resonance imaging of the brain in a patient with moyamoya disease demonstrated multiple scattered white matter lesions, but was not sufficiently specific to confirm the diagnosis without other techniques.

Arterial Occlusive Diseases↗
PubMed1986

Arteriovenous malformation presenting as hemidystonia.

Two men, aged 25 and 33 years, had progressive hemidystonia and an arteriovenous malformation (AVM) in the contralateral cerebral hemisphere. One patient with an AVM in the posterior basal ganglia of the right hemisphere had an older brother with severe generalized dystonia. The second patient had an AVM in the left cortical and subcortical parietal area with no obvious lesion in the basal ganglia. Unlike generalized dystonia, a focal lesion is commonly found in patients with unilateral dystonia. The association of AVM-induced hemidystonia and family history of dystonia suggests that genetic predisposition may be important in some patients with hemidystonia.

Adult↗
PubMed1986

Silent myocardial infarction and diabetic cardiovascular autonomic neuropathy.

Seventy-three consecutive diabetic adults with symptomatic peripheral neuropathy were evaluated for the presence of cardiovascular autonomic neuropathy and electrocardiographic evidence of myocardial infarction (MI). Twenty-five (34.2%) patients demonstrated cardiovascular autonomic neuropathy, and ten (13.7%) patients had electrocardiographic evidence of MI. Of the ten MI identified, seven were asymptomatic (silent) by history. The incidence of silent MI was significantly higher (P less than .04) in patients with cardiovascular autonomic neuropathy. It is postulated that sudden death in diabetic patients with cardiovascular autonomic neuropathy may be due to silent MI.

Adult↗
PubMed1985

The flight of colors test in multiple sclerosis.

Flight of colors (FOC), the rapidly changing series of colored afterimages perceived when a bright light briefly strikes the eye, is impaired or absent in patients with lesions affecting central visual fields, especially optic neuropathies (ONs). The effectiveness of a bedside test of FOC using a pocket flashlight was compared with that of pattern-reversal visual evoked responses (PRVERs) in examining 74 subjects): 20 controls, seven patients with ON not due to multiple sclerosis (MS), 26 patients with MS, and 21 patients with possible MS and no clinical ON. The FOC test correctly identified 95 of 99 normal eyes and 45 of 49 eyes with ON, and accurately diagnosed 140 (95%) of 148 eyes overall. In 84 eyes examined by PRVER and FOC, the results agreed in 73 cases (87%), including those of subclinical ON.

Adult↗
PubMed1985

The hot bath test in multiple sclerosis: comparison with visual evoked responses and oligoclonal bands.

We studied 50 patients with definite, probable, and possible multiple sclerosis (MS), prospectively (20 patients) and retrospectively (30 patients), to determine the value of the hot bath test for diagnosing MS and to compare it to visual evoked responses and oligoclonal bands. The hot bath test was abnormal in 8 of the 23 patients with definite MS (35%), and 4 of the 27 patients with probable or possible MS (15%). Only one patient with an abnormal hot bath test did not also have other evidence of definite multiple sclerosis. Our results suggest that the hot bath test seldom adds diagnostic information, especially when tests for evoked responses and oligoclonal bands are available.

Adult↗