Search PubMed⌕ Search

Biomedical subjects

M E Drake

Publications and source records attributed to M E Drake.

At least 91 records · Page 5Linked to original sources
PubMed1987

Paroxysmal kinesigenic choreoathetosis in hyperthyroidism.

Paroxysmal kinesigenic choreoathetosis is an unusual movement disorder often triggered by attempts to use the limbs, and has sometimes been associated with diffuse or focal brain injury. We report its occurrence in hyperthyroidism, with which choreoathetosis has rarely been described in the past without known cause. Choreoathetosis has also occurred with other metabolic and toxic disorders, and the mechanism is uncertain. The development of involuntary movements activated by limb motion during hyperthyroidism suggests an influence by thyroid hormone or metabolic state on motor neurone excitability or motor system organization.

Athetosis↗
PubMed1987

Asterixis after lacunar infarctions.

Asterixis is usually encountered in metabolic encephalopathy but has rarely been reported with thalamic and midbrain lesions. We report bilateral extremity asterixis as a novel manifestation of basal ganglia lacunar infarction.

Cerebral Infarction↗
PubMed1987

Peripheral neuropathy in multiple sclerosis.

Evidence suggests that the spectrum of multiple sclerosis (MS) may extend to peripheral nerve dysfunction. The author describes a patient with MS whose peripheral nervous system was involved.

Female↗
PubMed1987

Spasmodic torticollis after closed head injury.

Spasmodic torticollis, once thought to be psychogenic, is now recognized as an extrapyramidal movement disorder. A patient with onset of classical torticollis after closed head injury and intracranial hypertension is described. The patient had no clinical or radiologic evidence of brain stem dysfunction, but brain stem auditory evoked potentials suggested pontomesencephalic conduction disturbance ipsilateral to head and neck movements. This finding accords with some previous clinical and experimental evidence that pontomesencephalic structures ipsilateral to the movements may be involved in torticollis. The observation suggests that spasmodic torticollis may develop as a sequel to trauma in head-injured patients and should be differentiated from posttraumatic seizures.

Adult↗
PubMed1987

Disturbed sleep and somatic complaints.

We investigated sleep patterns in 20 patients with multiple vague but persistent somatic complaints, not due to any identifiable medical or neurologic disorder, and in whom psychiatric consultations had failed to identify a psychiatric diagnosis. Afternoon naps were recorded in 20 patients and in 10 controls without medical or psychiatric problems. Three-hour postprandial nap recordings were made of submental electromyogram, electrooculogram, and EEG with drowsiness, stages 1-4 NREM, and REM sleep, sleep latency (minutes), sleep efficiency (percent), and number of arousals with return of alpha activity compared in patients and controls by one-tailed t-test. No stage IV or REM sleep occurred in naps. Patients with multiple somatic complaints had less stage III and stage II sleep, and more wakefulness. Arousals were more frequent in the patient group; sleep latency was shorter but sleep efficiency was reduced in patients with multiple somatic complaints compared with controls. The findings suggest that patients with multiple somatic complaints not otherwise explicable by medical or psychiatric problems may have disturbed sleep, improvement of which may ameliorate somatic complaints. Sleep histories should be elicited in such patients, and sleep recordings may be of value in their evaluation; afternoon naps may be a cost-effective way of screening for remediable sleep disturbances in patients with persistent physical complaints of undeterminable cause.

Adult↗
PubMed1987

Sleep and waking disturbances in epilepsy.

We compared sleep parameters during three-hour postprandial nap recordings in 10 normal controls and 28 seizure patients. Patients had significantly less sleep, longer sleep latency, more wakefulness, less drowsiness and lighter nonREM sleep, and lower sleep efficiency than controls. Generalized seizure patients had longer sleep latency, more arousals, and more (but very little) stage III sleep. Those with partial seizures had more stage II sleep and greater sleep efficiency. Patients on polypharmacy and phenobarbital therapy slept more, phenytoin patients had very short sleep latency but more wakefulness and less sleep efficiency; those taking clonazepam were also awake more and had lower sleep efficiency, while arousals during sleep were more frequent in patients on valproate and carbamazepine. The findings suggest that disturbed sleep, possibly related to aberrant arousal occasioned by generalized epilepsy or epileptogenic foci, is common in seizure patients, and may be related to interictal behavioral and cognitive symptoms. Polypharmacy may have an additive effect on sleep to prolong and disrupt it, while sedative anti-epileptic drugs may increase sleep and other anti-epileptic medications may have alerting effects or interfere with falling asleep. Generalized and partial seizure patients may have sleep disturbances of a different character, possibly reflecting generally altered cerebral excitability by afferent stimuli in the former situation, and the more localized effects of limbic or cortical hyperactivity in the latter.

Adolescent↗
PubMed1987

A case of parasomnia at REM sleep onset.

A case is reported of dyssomnia at the onset of REM sleep with thrashing, shouting, and urinary incontinence throughout the night. The attacks did not respond to, and may have been worsened by, antiepileptic drugs and diazepam, and the patient had microsleeps and brief apneas during a night of severely fragmented sleep. The case underscores the value of differentiating REM and NREM disorders in patients with atypical nocturnal attacks.

Adult↗
PubMed1987

Spindle coma in viral encephalitis.

Our patient's EEG evolved from the spindle coma pattern to normality in parallel with his clinical improvement. This clinical and EEG evolution has been described previously, and emphasizes the heterogeneity of the spindle pattern. The initial focal asymmetry implied focal cerebral abnormality, and was one of the clinical findings favoring HSV encephalitis in the absence of radiologic or pathologic support. The ability of partially-damaged cerebral cortex to express spindle activity is well-described with various cerebral lesions, as is the spindle coma pattern after intoxication. We are not aware of a previous report with HSV or other encephalitis, but an infectious etiology could be suspected in two patients of Hansotia et al. and is conceivable in the three comatose patients of Britt in whom no diagnosis could be established. In such cases, the pathophysiology of the spindle coma pattern is likely to involve an aberrant cortical response to normal reticular formation input and thalamic spindle pacemakers.

Adolescent↗
PubMed1986

Jactatio nocturna after head injury.

Nocturnal head banging or body rocking often occurs in childhood in relation to sleep, and is generally considered a developmental or behavioral disorder. A few cases of jactatio nocturna have been considered manifestations of sleep disorder, and an analogy to somnambulism and pavor nocturnus has been suggested. We observed episodes of jactatio nocturna in a patient with global encephalopathy and frontal lobe dysfunction after closed head injury, and successfully treated these with imipramine. Sleep disorders are increasingly recognized after head injury; jactatio nocturna must be differentiated from post-traumatic seizures, and may represent partial or defective arousal during light non-REM sleep, analogous to the parasomnias of deeper sleep and possibly representing dysfunction of frontal arousal mechanisms.

Adolescent↗
PubMed1986

Long-latency auditory event-related potentials in epilepsy.

Long latency auditory event-related potentials have been shown to change in patients with cerebral dysfunction. Some seizure patients with no evidence of brain damage or mental retardation show altered interictal cognitive and memory function. Long-latency auditory event-related potentials to tone stimulation were recorded in nineteen control subjects and seventeen patients with complex partial or partial and secondarily generalized seizures who had no evidence of brain damage, retardation, or drug intoxication, and whose seizures were controlled when studied. The latencies of N2 and P3 components were significantly longer in seizure patients than control subjects, and the P3 waveform was significantly greater in amplitude in epileptics. These findings suggest that cognitive event-related potentials are affected by partial epilepsy. The changes may be related to the recently reported involvement of the hippocampus in ERP generation, or to loss or alteration of modulatory functions, possibly cholinergic in nature, in the temporal lobe consequent upon epileptogenesis.

Adult↗
PubMed1986

Late onset of myoclonic epilepsy of Janz.

Myoclonic epilepsy of Janz is an essentially benign disorder with excellent response to valproic acid. The onset of myoclonic seizures in a patient at the age of 47 years, with normal mental status and a normal neurological examination, is reported. The electroencephalogram showed typical 3- to 5-Hz polyspike and wave complexes, some associated with myoclonic jerks but without loss of consciousness. The patient responded well to divalproex sodium, which controlled her seizures. A discussion of the condition and a review of the literature are included.

Age Factors↗
PubMed1986

Paroxysmal hyperventilation responses in the adult electroencephalogram.

Hyperventilation (HV) is an important activating procedure in clinical EEG. Paroxysmal HV slowing is associated with hypoglycemia and is common in children. Paroxysmal slowing in adults is sometimes interpreted as indicating cerebral instability or paroxysmal tendencies. We investigated the clinical correlates of paroxysmal HV slowing in 100 consecutive EEGs recorded in 1984 and compared these to 100 controls (age-matched normal EEGs recorded since 1982). Twenty-eight percent of patients over 15 with paroxysmal HV slowing not due to hypoglycemia had headaches, 80% of them vascular. Ten percent had syncope, 15% acute behavioral changes possibly representing seizures, 9% psychiatric disorders, 5% assorted complaints of obscure etiology, 20% had clinically definite seizures, 10% assorted neurologic disorders other than epilepsy, and 3% mental retardation. Fewer patients with HV paroxysms had epilepsy than did control individuals (p less than 0.05), while neurologic disorders of other kinds were more often found in those with HV paroxysms (p less than 0.025). Specific psychiatric diagnoses were less frequent in the paroxysmal HV group, but the difference was not significant. Paroxysmal HV responses in non-hypoglycemic adults may identify individuals prone to syncope, vascular headaches, or other autonomic dysfunction. They are not correlated with epilepsy however, and should not be considered abnormal.

Adult↗
PubMed1986

Acute urinary retention precipitated by ethchlorvynol overdose.

A 75-year-old woman developed acute urinary retention after ingestion of 20 100 mg ethchlorvynol tablets in a suicide attempt. To the authors' knowledge acute bladder dysfunction has not been previously ascribed to ethchlorvynol, but has been described often with therapy with various psychotropic medications. The mechanism of such bladder dysfunction may be direct action on bladder muscle, or parasympathetic cholinergic blockade, but has not been clarified. The risk of acute bladder dysfunction and the possibility of underlying bladder disorder must be considered in all patients receiving sedative-hypnotic drugs, particularly the elderly.

Aged↗
PubMed1986

EEG and brainstem auditory evoked potentials in brain-injured patients with rage attacks and self-injurious behavior.

Attacks of rage and self-injurious behavior are often encountered in brain-injured individuals. Clinical and experimental evidence suggests that brainstem centers may be involved in such behavior. We compared brainstem auditory evoked potentials in 10 normal controls, 10 patients with rage attacks, and 10 individuals with self-injurious behavior. The two patient groups had significantly longer group means for I-V and III-V interpeak latencies than controls. EEGs showed no specific features within or between the two groups. The findings suggest that the EEG may add little to the evaluation of such patients, except of course evidence of epilepsy or encephalopathy, while BAEPs may be a useful tool in the study of rage or self-injurious behaviors, in which brainstem centers may play an important role, possibly through abnormal or diminished reticular formation output.

Adolescent↗
PubMed1986

Manic state with carbamazepine therapy of seizures.

A 40-year-old man developed an acute state of manic exultation when given carbamazepine for complex partial seizures. The symptoms subsided when carbamazepine was discontinued, but recurred when the drug was inadvertently given again. This observation does not accord with previous evidence of a beneficial psychotropic effect for carbamazepine in some epileptic patients and of some effect in the treatment of mania. Carbamazepine has been shown to have complex actions on multiple neurotransmitter and neuromodulator systems, and it is possible that paradoxical effects of this nature may occur in susceptible individuals, as has been found with other sedative and anticonvulsant agents. The patient recalled brief euphoric periods after seizures, which may suggest that carbamazepine exacerbated or prolonged preexisting cerebral dysfunction.

Adult↗
PubMed1985

Electroencephalographic abnormalities in children with congenital heart disease.

Ninety-eight consecutive patients with clinically suspected congenital heart disease were prospectively studied with electroencephalographic (EEG) recordings before cardiac catheterization. Twenty-five patients had abnormal EEGs. Fifty-five patients had acyanotic heart disease and normal neurologic examination results, of whom 15 had abnormal EEGs. Thirteen had spikes or spike and wave discharges and two had mildly abnormal EEGs. Twenty-seven patients had cyanotic heart disease and normal neurologic examination results, of whom four had abnormal EEGs. Seven patients (8%) had abnormal neurologic examination results, of whom four had abnormal EEGs. There was a higher incidence of seizures with increasing age. Based on their medical history two children with acyanotic heart disease had had seizures without EEG abnormalities. Five children with normal catheterization findings and four children with Down's syndrome (two with abnormal EEGs) were excluded from the total of 98. These findings suggest that subclinical nervous system involvement may occur in congenital heart disease.

Brain↗