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Biomedical subjects

R J Guiloff

Publications and source records attributed to R J Guiloff.

At least 55 records · Page 3Linked to original sources

Neurological presentations of AIDS--when to test for HIV.

Nine of 122 patients dead from AIDS in central London presented with neurological disease, confirmed pathologically in seven. Seven had no other major systemic manifestations. AIDS needs to be considered in the differential diagnosis of meningitis, dementia, diffuse and focal encephalopathies, brainstem syndromes, myelopathy, visual failure and peripheral nerve syndromes. As AIDS becomes more widespread there will be an increasing need for diagnostic HIV testing in many neurological syndromes.

AIDS Dementia Complex↗

Chronic basal meningitis and vasculitis in acquired immunodeficiency syndrome. A possible role for human immunodeficiency virus.

We describe the clinical and postmortem findings in a 57-year-old man with human immunodeficiency virus who presented with neurologic symptoms attributed to stroke. In addition to multiple foci of ischemic necrosis, pathologic examination of the brain showed chronic basal meningitis and vasculitis. No microorganisms were found. The association of meningitis and vasculitis in patients with acquired immunodeficiency syndrome is unusual and the possibility that these conditions may be due to primary human immunodeficiency virus infection is raised.

Acquired Immunodeficiency Syndrome↗

Short-term stability of single motor unit recordings in motor neuron disease: a macro EMG study.

Thirty five individual macro EMG motor unit potentials in 13 patients with motor neuron disease were recorded every 15 minutes during a 2 hour period. No significant change in amplitude or area was seen in 15 control units in nine patients or in 20 units in 11 patients receiving RX77368 0.2-0.3 mg/kg. The findings provide no evidence for an action of this long acting TRH analogue on the peripheral territory of motor units in motor neuron disease.

Adult↗

Limb pain in migraine and cluster headache.

Upper limb pain occurred in close temporal association with attacks of migraine, cluster headache and cluster-migraine in 22 cases. Seven had also lower limb pain. Limb pain was usually ipsilateral to the headache but could alternate sides and behaved like other accepted migraine accompaniments. It was always ipsilateral to the associated paraesthesiae/numbness (9 cases) and weakness (6 cases). The distribution and restricted localisations of limb pain were similar to those of the sensory symptoms and could not be accounted for by primary dysfunction of the peripheral or autonomic nervous systems. A central origin for limb pain is postulated. A temporary dysfunction in the somatosensory cortex, and/or its thalamic connections, during migraine or cluster headache attacks, might mediate such pain in a number of patients.

Adolescent↗

Subacute administration of a TRH analogue (RX77368) in motorneuron disease: an open study.

Sixteen patients with motor neuron disease received RX77368, a TRH analogue, IV, repeatedly over 1-12 weeks (median 2 weeks). Slight to moderate improvement in bulbar function, particularly speech, was reproduced or persisted with repeated infusions in 8 of 12 responders over a median of 18 days (range 14-90) during the period of study. Cramps (5/9) and spasticity (5/8) improved for a median of 14 days (range 7-35) and 7 days (range 2-14) respectively. The highest benefit/side effect ratio was seen with 0.2 mg/kg (0.15 mg/kg in those with severe bulbar palsy) every 3-4 days. Long term studies with this analogue in MND are indicated.

Activities of Daily Living↗

Nature, incidence and prognosis of neurological involvement in the acquired immunodeficiency syndrome in central London.

Clinical neurological involvement at various times throughout the illness was recorded in 52% of 122 patients seen in central London who died from acquired immunodeficiency syndrome (AIDS). Various metabolic encephalopathies, dementias, focal encephalopathies, retinopathies and peripheral nerve pathology were the most frequent manifestations. Seven of 9 patients with a neurological presentation had no other major systemic illness. The median time from diagnosis of AIDS to death was 9 months and from onset of neurological symptoms to death 4 months. Human immunodeficiency virus dementia, central nervous system opportunistic infections, presence of Kaposi sarcoma, neurological presentations and minor symptoms were not associated with major change in survival time.

Acquired Immunodeficiency Syndrome↗

Controlled acute trial of a thyrotrophin releasing hormone analogue (RX77368) in motor neuron disease.

Twenty five patients with motor neuron disease completed a double blind randomised cross over trial of RX77368, a stabilised TRH analogue, iv over 2 hours against saline. Temporary improvement in bulbar symptoms including speech, respiratory parameters, tongue movements and swallowing were seen. Fasciculations increased and spasticity decreased. Change in muscle force with drug was different from placebo but both increase and decrease in force were seen and did not result in detectable changes in function. Side effects were clinically significant in 50% of the patients and cleared within 12 hours. Prolonged rise of thyroxine and an increase in plasma levels of prolactin, thyroid stimulating hormone and growth hormone were seen and followed characteristic patterns.

Adult↗

Elevated cerebrospinal fluid vasopressin in motor neuron disease.

CSF vasopressin levels were significantly elevated in eight patients with motor neuron disease (2.5 +/- 0.4 pmol/l) compared with controls (0.7 +/- 0.1 pmol/l). CSF oxytocin and plasma vasopressin concentrations were similar in the two groups. This finding may be a primary part of the disease process or an epiphenomenon related to increased autonomic and descending pathway activity secondary to abnormal function and/or loss of anterior horn cells.

Aged↗

Cerebellar syndrome in sarcoidosis.

A 63 year old woman who presented with a cerebellar syndrome was shown to have sarcoidosis of the central nervous system, skin and liver with no pulmonary involvement.

Cerebellar Diseases↗

Observations on the clinical assessment of patients with motor neuron disease. Experience with a TRH analogue.

The need for improved assessment techniques in order to monitor the action of substances active in upper and lower motor neuron systems in motor neuron disease is discussed. A long-acting TRH analogue is shown to have detectable acute effects on bulbar symptoms, particularly speech, tone, fasciculations, and muscle force. Endocrine surveillance is essential in studies with TRH and analogues.

Clinical Trials as Topic↗

Mini-mental state examination in neurological patients.

The Mini-Mental State examination has been found to be a quick and valuable test for simple bedside screening, and for serial assessment of cognitive function in a population of 126 neurological patients. Amongst those with cognitive impairment, there was a close relation between the Mini-Mental State examination and the conventional Weschler Adult Intelligence Scale (WAIS). However, the Mini-Mental test was not a sensitive indicator of focal versus diffuse hemisphere disease. Further refinement in the areas of language and visuo-spatial function may improve its value.

Adolescent↗

Morton's metatarsalgia. Clinical, electrophysiological and histological observations.

In an attempt to improve the accuracy of diagnosis, 16 patients suffering from Morton's metatarsalgia were investigated clinically and electrophysiologically. The histological findings were related to these observations. The precise aetiology of Morton's metatarsalgia remains obscure, but the findings are compatible with an entrapment syndrome. Nerve conduction studies have a place in the investigation of patients with atypical presentation of pain in the foot. Further refinement of the electrophysiological technique should be possible.

Action Potentials↗