Biomedical subjects
Publications and source records attributed to R E Cull.
Forty-nine patients with Bell's palsy were studied neurophysiologically within 10 days of the onset of symptoms and the results analysed according to the clinical outcome. Electroneuronography was not helpful in predicting outcome at this stage. The presence of a blink reflex was a good prognostic sign and all patients with an intact blink reflex recovered well.
Two cases of Lambert Eaton syndrome unassociated with an underlying malignancy are described. Both had mild autonomic symptoms but markedly abnormal autonomic function tests. These results are suggestive of a widespread defect in cholinergic transmission in addition to that at the skeletal neuromuscular junction.
The relative merits of 24-hour ambulatory EEG/ECG monitoring and routine EEG recording have been compared in a group of 62 patients attending a neurological clinic because of episodes of loss of consciousness. Overall, ambulatory EEG abnormalities were detected in 21 cases (34%) compared with 16 cases (26%) for routine EEG. Ambulatory EEG mainly improved the detection of generalised paroxysmal activity, but in some cases lateralised abnormalities were detected which were not present on the routine record. Patients who reported clinical attacks once a week or more frequently showed an improved yield of diagnostic abnormalities on ambulatory EEG, but the technique did not prove superior to routine EEG if attacks were less frequent. The indications for, and limitations of, ambulatory EEG monitoring are discussed.
The presenting features, clinical course and outcome of 19 patients with a diagnosis of CNS sarcoidosis are described. In two-thirds of the patients the initial features of sarcoidosis were neurological; half of them had an acute monophasic illness and half a chronic progressive or relapsing course. A favourable outcome was recorded unexpectedly during a study period of one to 16 years for two-thirds of the patients. The course of the disease in four patients suggested multiple sclerosis thus emphasising the importance of considering the possibility of CNS sarcoidosis in patients with suspected demyelinating disease.
Cough syncope is a well-recognized syndrome in which loss of consciousness follows a bout of prolonged coughing. The pathophysiology of this syndrome has been attributed to lowered cerebral perfusion pressure consequent on an increased intrathoracic pressure, which lowers cardiac output (by a Valsalva mechanism) and impairs cerebral venous return. We report a case of cough-induced syncope in which ECG monitoring showed that coughing produced paroxysmal atrioventricular block with ventricular asystole. Such a case has not previously been documented.
A brother and sister suffering from hyperostosis corticalis generalisata familiaris (van Buchem's disease) are described. Both presented in early adult life with signs and symptoms of raised intracranial pressure and underwent partial craniectomy. Following surgery normal intellectual function was maintained and both survived to old age. In later life one showed cerebellar deficit due to bony encroachment of the posterior cranial fossa, while the other had a spastic paraparesis due to spinal cord compression. Several other siblings were affected by this disease which appears to be transmitted as an autosomal recessive gene.
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In a group of 166 patients who had received electroconvulsive therapy more than one year previously the prevalence of epilepsy did not differ significantly from that found in the community as a whole. The findings suggest that a kindling process is not a clinical hazard following repeated electrically induced seizures.
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A case of hemiplegia in a 46 year old woman is described. Total occlusion of the right internal carotid artery was discovered at angiography. Because of persistent elevation of the ESR, and characteristic plasma protein abnormalities, biopsy of the temporal artery was carried out and demonstrated the typical features of giant cell arteritis.
Synaptic boutons on the somata of rat hypoglossal neurones have been stained with Zinc Iodide-Osmium, and counted using light microscopy. Two weeks after Silastic cuffs containing colchicine or vinblastine were applied to the hypoglossal nerve, the number of boutons on parent nerve cell bodies was significantly lower than controls. These drugs inhibited retrograde axonal transport of horseradish peroxidase, but did not affect neuromuscular conduction or the number of axons in the nerve trunk. Cuffs containing lignocaine did not affect boutons or axonal transport significantly.
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The clinical features and peripheral somatic and autonomic nerve function were studied in 10 diabetic subjects (nine men, one woman; mean age 59 yr, range 41-68 yr; mean duration of diabetes 20 yr, range 8 mo to 33 yr) with generalized small muscle wasting of the hands. Five patients were insulin-dependent and five non-insulin-dependent. Nine had retinopathy (two proliferative, seven background), five nephropathy, two ischemic heart disease, and seven peripheral vascular disease. Nine patients had clinical evidence of sensory peripheral neuropathy and absent reflexes in the lower limbs. Eight patients had distal sensory impairment and/or absent reflexes in the upper limbs. Seven had two or more symptoms of autonomic neuropathy. Nerve conduction measurements in the median, ulnar, and lateral popliteal nerves showed that all patients had moderate to severe polyneuropathy affecting both motor and sensory fibers. Nine had one or more abnormal cardiovascular autonomic function tests. Electromyography of affected muscles in the hands showed changes of chronic partial denervation and collateral reinnervation in all cases.