Biomedical subjects
Publications and source records attributed to R Sandyk.
Treatment of 27-year-old Black man with writer's cramp with a combination of sodium valproate (Epilim) and baclofen (Lioresal) resulted in dramatic improvement of symptoms and signs. The possible mechanism of action of these drugs is discussed. This combination should be tried in the initial management of this syndrome.
Explore the source record for details and available documents.
The restless legs syndrome is a condition of unknown aetiology characterized by nocturnal paraesthesiae in the lower limbs, an irreversible tendency to move the limbs, pain in the distribution of the paraesthesiae, and psychiatric disturbances. The syndrome may occur at any age and in either sex and usually runs a course over many years with spontaneous improvements and exacerbations. An association with iron deficiency has been suggested but in most cases no apparent cause has been found, and treatment at present is symptomatic with analgesics and sedatives. The differential diagnosis includes phenothiazine-induced akathisia and meralgia paraesthetica.
Explore the source record for details and available documents.
A case of parkinsonism associated with neurosyphilis, which improved markedly after appropriate treatment, is described. Although neurosyphilis is a rare cause of parkinsonism, it should be considered when parkinsonism appears in the 30-50-year age group, particularly if other anomalous neurological findings are present. Adequate therapy may improve the patient's condition and prevent further progression.
The Tolosa-Hunt syndrome, or painful ophthalmoplegia, is a rare condition caused by a granulomatous nonspecific process at the level of anterior cavernous sinus, superior orbital fissure and orbital apex. The syndrome is characterized by pain behind, above or around the eye, involvement of the cranial nerves which pass through the cavernous sinus, spontaneous remissions and exacerbations, and a favourable response to steroid therapy. Recognition of this condition is important because administration of steroids may prevent residual damage.
A 48-year-old hypertensive man with signs and symptoms of pseudobulbar paralysis was ultimately found to be suffering from the operculum syndrome. Recognition of this syndrome is important in that: (a) it may be caused by a localized cortical lesion amenable to treatment; (b) some of the symptoms carry a good prognosis as opposed to those in pseudobulbar paralysis; and (c) the operculum syndrome usually has a more favourable prognosis since there is no associated mental impairment or sphincter disturbances.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The association of orthostatic hypotension with signs of progressive neuronal degeneration of the central nervous system particularly affecting the autonomic nervous system is known as the Shy-Drager syndrome. The pathological hallmark of the disease is cell loss in the intermediolateral column of the spinal cord, which is responsible for the major element in the autonomic failure. There is also evidence that widespread involvement of the dopaminergic system may be responsible for the autonomic as well as the parkinsonian features encountered.
The Eaton-Lambert syndrome is a non-metastatic manifestation of oat-cell carcinoma of the bronchus, although it has been reported in patients with carcinoma at other sites. The clinical picture is usually one of subacute muscular fatiguability with weakness and wasting affecting the proximal parts of the limbs and trunk, but occasionally the external ocular and bulbar muscles are involved. The weakness is often myasthenic, but it has been observed that muscle power may in fact increase after brief exercise. The pathogenesis, diagnosis, electrophysiological features and some aspects of therapy are reviewed.
Explore the source record for details and available documents.
Subcortical arteriosclerotic encephalopathy is a chronic vascular dementia with hydrocephalus characterized clinically by: (i) subacute focal neurological deficit; (ii) acute strokes; (iii) dementia; (iv) motor signs and pseudobulbar palsy; (v) hydrocephalus; (vi) persistent hypertension and systemic vascular disease; and (vii) a lengthy course. The pathogenesis is most probably ischaemic change related to subacute hypertensive encephalopathy. The pathological changes include severe central nervous system disease characterized by loss of white matter with gliosis, and arterial and arteriolar sclerosis of small penetrating cerebral blood vessels. The differential diagnosis includes vascular pseudobulbar palsy, multi-infarct dementia and senile dementia (Alzheimer's disease). Treatment includes blood pressure control as well as management of other factors known to affect vascular disease (diabetes mellitus).
Explore the source record for details and available documents.
A 56-year-old woman with a 2-year history of recurrent attacks of paroxysmal expressive dysphasia mimicking transient ischaemic attacks was subsequently found to have a cerebral neoplasm. It is suggested that recurrent paroxysmal neurological deficit does not necessarily imply a vascular cause, but may be a feature of cerebral neoplasm, and that these patients should, in addition to other noninvasive diagnostic procedures, undergo computed tomography to exclude potentially treatable conditions.
Explore the source record for details and available documents.
A 48-year-old man presented with signs of pseudobulbar palsy. On computed tomography (CT) he was found to have extensive tissue loss in the region of the sylvian fissure and insula bilaterally. This appearance on CT represents the radiological correlate to anatomic descriptions of the operculum syndrome, and is useful in distinguishing the condition from pseudobulbar palsy.
Three cases of rapidly fatal encephalopathy associated with Shigella flexneri infection are reported. There was a lack of severe intestinal involvement and absence of metabolic derangement. In all 3 patients, areas of necrosis were present throughout the brains; and in one case pontine haemorrhages and demyelination were seen. This report supports the evidence of a particular neurotoxic effect in shigellosis.