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Biomedical subjects

R L Gilmore

Publications and source records attributed to R L Gilmore.

At least 37 records · Page 2Linked to original sources
PubMed1995

Anosognosia for hemiplegia: test of the personal neglect hypothesis.

OBJECTIVE: To test the personal neglect hypothesis of anosognosia for hemiplegia (AHP) using selective anesthesia of the right hemisphere. BACKGROUND: Although AHP most commonly follows right-hemisphere injury, the mechanism responsible for this hemispheric asymmetry has not been entirely elucidated. Because denial of ownership of parts on the contralesional side of one's body (personal neglect) also more commonly follows right-hemisphere damage, personal neglect might account for AHP. DESIGN/METHODS: AHP and personal neglect were assessed in 20 patients during right intracarotid barbiturate infusion. With vision restricted to the central field, patients were randomly presented with either their own hands or those of examiners matched for size, gender, and race. Patients were asked to read numbers placed on the hands to establish that hemianopia did not confound hand recognition. RESULTS: All subjects correctly read the numbers on all trials. Only 4 of 20 subjects misidentified their hands and denied awareness of left hemiplegia. All errors occurred for the left hand, indicating personal neglect. However, the 16 subjects without personal neglect also demonstrated AHP. CONCLUSION: Because AHP and personal neglect are dissociable, personal neglect cannot completely account for AHP.

Adult↗
PubMed1995

Anosognosia during intracarotid barbiturate anesthesia: unawareness or amnesia for weakness.

Previous studies have demonstrated asymmetric hemispheric contributions to deficit awareness during hemisphere inactivation with intracarotid barbiturate infusion (Wada studies). These observations provide insight into the neuropsychological basis of anosognosia for hemiparesis (AHP), arguing against earlier explanations based upon psychological denial, global cognitive disturbance, or emotional indifference. Although prior Wada studies equated AHP after the procedure with AHP during the period of deficit, a selective memory failure could also account for these findings. We, therefore, assessed the occurrence of AHP during and after right-hemisphere inactivation in a group of epilepsy patients undergoing preoperative Wada testing. Because aphasia obscures assessment of deficit awareness during left carotid studies, we compared the frequency of AHP between right- and left-hemisphere inactivation only after recovery. As noted in earlier reports, AHP was present significantly more often after right- than left-hemisphere inactivation. The proportions of subjects with AHP during right-hemisphere anesthesia compared with the proportion of subjects with AHP after the procedure were statistically equivalent, suggesting that the AHP observed after right-hemisphere anesthesia results from true failure of deficit awareness rather than inability to recall the deficit.

Amnesia↗
PubMed1995

Electroencephalographic findings in Hashimoto's encephalopathy.

Hashimoto's encephalopathy (HE) is a steroid-responsive relapsing disorder that frequently presents with seizures and diffuse EEG abnormalities. We report the EEG findings in seven patients with encephalopathy, seizures, or both, associated with elevated antithyroid antibodies. There were several combinations of findings within the same patient and between patients. The EEGs of five patients had generalized slowing or frontal rhythmic slowing; two also had triphasic waves and one had periodic sharp waves. Three had focal left temporal slowing. HE is heterogeneous clinically and electrographically. A high level of suspicion is necessary to establish the diagnosis.

Adult↗
PubMed1995

Apraxia during Wada testing.

Apraxia is the loss of the ability to perform learned skilled movements correctly. In right-handers, apraxia and aphasia are most frequently associated with left-hemisphere lesions. When they are dissociated, however, aphasia is more common in the absence of apraxia than vice versa. There are two hypotheses that can account for this discrepancy: (1) in right-handers, praxis is more likely than language to be mediated by the right hemisphere, or (2) the left-hemisphere network that mediates language is either more widely distributed than the network that mediates praxis or is more likely to be in the middle cerebral artery distribution. We studied apraxia in a group of right-handers undergoing selective hemispheric anesthesia, or Wada testing. All nine subjects had language lateralized to the left hemisphere, and seven of the nine had praxis lateralized to the left hemisphere. Two of the subjects had praxis bilaterally represented. Although our data suggest that speech and praxis functions tend to be lateralized to the left hemisphere in most right-handers, praxis appears to be more distributed between the hemispheres than speech-language functions. Furthermore, an analysis of the types of errors made during praxis testing suggests differential roles of the hemispheres in praxis functions.

Adolescent↗
PubMed1994

Meperidine neurotoxicity after organ transplantation.

Meperidine neurotoxicity, characterized by recurrent convulsions, myoclonus, and asterixis, was diagnosed in an organ transplant recipient. Aside from cyclosporine toxicity, the literature regarding neurologic complications of transplantation contains limited reference to the neurotoxicity of therapy. The case reported illustrates how pharmacokinetic factors might render transplant patients particularly vulnerable to the neurotoxic side effects of certain medications, such as meperidine.

Adult↗
PubMed1993

Intraventricular alpha interferon therapy for Rasmussen's syndrome.

A 4-year-old boy developed Rasmussen's syndrome and was treated with alpha interferon intraventricularly. An improvement in the epileptic and neurologic syndrome was noted for several weeks following interferon. No adverse side effects were encountered. Since hemispherectomy is the only established therapy in Rasmussen's Syndrome, further studies are needed to establish if intraventricular alpha interferon may halt the clinical progression of the syndrome.

Atrophy↗
PubMed1992

Anosognosia during Wada testing.

Anosognosia, the verbally explicit denial of hemiplegia, is more often reported after right- than left-hemisphere lesions. However, this asymmetric incidence of anosognosia may be artifactual and related to the aphasia that often accompanies left-hemisphere lesions. Anosognosia has been attributed to psychological denial and the emotional changes associated with hemispheric dysfunction. Eight consecutive patients undergoing intracarotid barbiturate (methohexital) injections as part of their presurgical evaluations for intractable epilepsy were assessed for anosognosia after their hemiplegia and aphasia had cleared. After their left-hemisphere anesthesia, all subjects recalled both their motor and language deficits. However, after right-hemisphere anesthesia, none of the eight patients recalled their hemiplegia. These results suggest that anosognosia is more often associated with right- rather than left-hemisphere dysfunction and that it cannot be attributed to either psychological denial or the emotional changes associated with hemispheric dysfunction.

Agnosia↗
PubMed1991

Sleep-disordered breathing in Möbius syndrome.

Möbius syndrome is a complex neurologic disorder characterized by congenital bilateral facial paralysis associated with lateral gaze paralysis. The syndrome has variable manifestations and several variants, some with somatic stigmata. In 1990, Möbius syndrome is conceptualized as a spectrum of clinical caudal brain-stem signs. Some deficits are manifested by laryngeal paralysis and aspiration. Sleep-disordered breathing syndromes have not been previously reported in association with Möbius syndrome. We report two children with Möbius syndrome and sleep-disordered breathing. Based on known pathologic findings and clinical manifestations, we believe that sleep-disordered breathing may be a common complication of Möbius syndrome and should be sought, since potential outcomes of such complications include serious morbidity.

Child↗
PubMed1989

SSEP and F-wave studies in acute inflammatory demyelinating polyradiculoneuropathy.

Somatosensory evoked potentials (SSEPs) and F-wave responses were compared after tibial (PTN) and median (MN) nerve stimulation in patients with acute inflammatory demyelinating polyradiculoneuropathy (AIDP). Nineteen patients were evaluated within 2 weeks of AIDP onset. Each had F-wave and PTN-SSEP studies; 18 had MN-SSEP studies. Ten patients had absent or prolonged MN-SSEP latencies, whereas 16 had abnormal MN F-wave studies. Seventeen patients had an abnormal PTN-SSEP while 12 had abnormal PTN F waves. Every patient with an abnormal MN-SSEP also had an abnormal PTN-SSEP. The most common PTN-SSEP findings were an absent or prolonged latency of N8 or N22. All patients had either an abnormal MN F wave or PTN-SSEP.

Adolescent↗
PubMed1989

Comparative impact of paraclinical studies in establishing the diagnosis of multiple sclerosis.

We prospectively examined 58 patients with suspected or confirmed multiple sclerosis (MS) to evaluate the impact of paraclinical studies (evoked potentials (EPs) and magnetic resonance imaging (MRI] in the diagnostic evaluation of these patients. All patients had cranial MRI studies, brain-stem auditory (BAEP), visual (VEP), posterior tibial (PTN-SSEP) and median somatosensory (MN-SSEP) EPs. Patients were categorized according to criteria of Poser et al. initially without knowledge of paraclinical studies. On the basis of clinical history, neurological examination and CSF chemical analysis, there were 18 (31%) clinically definite (CD). 10 (17%) laboratory supported definite (LSD), 13 (22%) clinically probable (CP) MS cases; 17 (29%) cases could not be classified. By providing electrophysiological and/or anatomical evidence for a 'second lesion,' paraclinical studies permitted 25 patients to move from one diagnostic category to another, reflecting an increased certitude of the diagnosis. Twelve moved to CDMS by either MRI or one EP study. Four moved to CDMS on the basis of MRI only, and four moved to CDMS by VEP only. Five moved from an unclassified status to either LSDMS or CPMS by PTN-SSEP (2), by PTN-SSEP or MRI (1), by MRI or VEP (1) and by VEP only (1). Thus, the diagnosis of MS was refined in 28% of the patients (7/25) by incorporation of EPs alone whereas cranial MRI by itself increased the diagnostic certainty in only 16% (4/25). In the remaining 56%, the diagnosis was refined by use of either EPs or MRI. Overall, EP provided evidence for a 'second lesion' in 36% of the patients (21/58) and MRI 31% (18/58). While MRI may ultimately prove the single most useful paraclinical study in the diagnosis of MS. VEPs, and PTN-SSEPs by assessing areas currently not imaged by MRI, remain essential in patient evaluation. Changes in EPs and MRI technology will undoubtedly redefine the role of these diagnostic techniques.

Adolescent↗
PubMed1988

High-dose lorazepam therapy for status epilepticus in a pediatric patient.

This report details the management of status epilepticus with high-dose lorazepam in a 14-year-old patient who was receiving oral clonazepam, ethosuximide, and phenobarbital for an intractable seizure disorder. Although respiratory depression is a frequently cited potential complication of therapy, it did not occur in this patient despite an extraordinarily high total dose of lorazepam, possibly because of tolerance associated with benzodiazepine-receptor down-regulation in this patient's chronic clonazepam therapy. Aggressive dosing of a benzodiazepine may be required for patients receiving chronic benzodiazepine therapy.

Adolescent↗
PubMed1988

Acoustic nerve conduction abnormalities in Guillain-Barré syndrome.

We recorded brainstem auditory evoked potentials (BAEPs) in two patients with Guillain-Barré syndrome (GBS). One patient was acutely deaf with total absence of BAEP waveforms indicative of acoustic nerve conduction block. Hearing improved during early convalescence, and there were prolonged wave I latencies. Normal BAEPs were recorded on recovery. A second patient had bilaterally prolonged wave I latencies. These BAEP findings suggest that acoustic nerve conduction abnormalities from demyelination may occur in GBS.

Adult↗
PubMed1988

Seizures and antiepileptic drug use in transplant patients.

Seizures may occur as an isolated manifestation of an acute encephalopathy or, less frequently, recur as a manifestation of epilepsy in transplant patients. Determining which of these is the case will lead to appropriate treatment. The selection of the antiepileptic drug (AED) will depend on the patient's type of seizure, general medical condition, and transplant type and also depend on the consideration of potential adverse effects of individual AEDs.

Anticonvulsants↗
PubMed1987

Sleep-disordered breathing in healthy aged persons: possible daytime sequelae.

We assessed the overnight sleep and breathing as well as daytime medical, sleep, and psychological status of a group of 34 healthy older persons. Analyses indicated that sleep-disordered breathing (SDB) was not related to any aspects of daytime functioning as measured in this study and that persons with an apnea + hypopnea index (AHI) greater than or equal to 5 (M AHI = 14.6) were not significantly impaired relative to those with lower levels of SDB (M AHI = 1.0) on any aspect of daytime performance. We conclude that SDB occurring in healthy aged persons is probably not of immediate concern and that the use of a cutting score of AHI greater than or equal to 5 for diagnosis of sleep apnea syndrome is not indicative in healthy aged persons. However, these results may not be applicable to older persons who are not in the excellent state of health that was required for participants in our study.

Aged↗
PubMed1986

Neonatal paralytic poliomyelitis. A case report.

Neonatal poliomyelitis, which was rare even when poliomyelitis was widespread, has not been reported in the United States since use of live oral poliovirus vaccine (Sabin's vaccine) became widespread. We report a child who became symptomatic with apnea at 18 days of age and who subsequently developed a permanent monoparesis. Serologic and cultural evidence indicated the virus as poliovirus vaccine type. Another infant who received live oral poliovirus vaccine was probably the source of the infecting virus. Recognition that poliovirus infection can still occur in the United States and an understanding of the serologic, cultural, and typing tests required to substantiate this diagnosis are needed so that such patients will be accurately diagnosed.

Humans↗
PubMed1985

Developmental assessment of spinal cord and cortical evoked potentials after tibial nerve stimulation: effects of age and stature on normative data during childhood.

Somesthetic information from lower extremities is processed by cerebral cortex after traversing the sensory pathways of peripheral nerve, spinal cord, brain-stem and thalamus. Clinical utility of somatosensory evoked potentials (SSEPs) during human development requires systematic analysis of normative data acquired during various stages of body growth and nervous system maturation. Accordingly, SSEPs after tibial nerve stimulation were studied in 32 normal awake children (1-8 years old) and compared with values obtained in young adults (18-40 years old). Potentials were recorded from the tibial nerve (N5), first lumbar spinous process (N14), seventh cervical spinous process (N20) and from the scalp, 2 cm behind the vertex (P28). In all children studied, the N5, N14 and N20 latencies were positively correlated with age and height yielding a predictive nomogram. An extremely variable electropositive cortical SSEP was recorded from Cz' which did not show a highly predictable linear relationship in association with a relatively poor correlation coefficient for height and age. It may be concluded that between 1 and 8 years of normal postnatal development, latencies reflecting peripheral nerve and lumbar spinal cord vary directly with height and age and can be represented by a simple cable model of a lengthening myelinated pathway. In contrast, the latency of the cortical SSEP reflects asynchronous maturation of elongating polysynaptic pathways and apparently requires a more complex model for prediction in order to enhance its clinical utility.

Adolescent↗