Biomedical subjects
Publications and source records attributed to R Sandyk.
A man who presented with lumbar backache subsequently developed signs of meningitis. The causative organism was proved to be Klebsiella pneumoniae. Despite treatment with chloramphenicol and amikacin, the condition progressed until cefotaxime was added to the treatment regimen. The patient made a good recovery. This is the first report of the use of cefotaxime in klebsiella meningitis.
Hemichorea developed several weeks after evacuation of a traumatic extradural haematoma. The abnormal movements were confined to arm and leg on the side opposite the surgery. No other causes of chorea were found. The connection between the extradural haematoma and the late onset hemichorea is not well understood; mechanical pressure on basal ganglia structures, vascular disturbances of the anterior choroidal artery as well as biochemical alterations are all possible mechanisms.
Hemifacial spasm developed in a 47-year-old man with tuberculous meningitis. The spasms ceased completely following vigorous antituberculous treatment. A selective compression of the facial nerve root along its exit at the brainstem by a localised inflammatory process is the most tenable explanation for the development of the hemifacial spasm.
A 31-year-old man on phenytoin for post-traumatic epilepsy developed transient hemiparesis contralateral to the injury. This appeared to have been precipitated by phenytoin intoxication. A possible mechanism for focal neurological deficit occurring in brain-damaged patients on phenytoin is discussed.
Neurologic deficits complicating celiac disease are well-described in adults. Here we report a 12-year-old girl in whom isolated ocular myopathy was the presenting feature of biopsy-proven celiac disease; the process was apparently reversed by a gluten-free diet and vitamin supplementation.
The authors describe the case of a 38-year-old woman who presented with parkinsonian syndrome associated with chronic subdural hematoma. Gradual disappearance of the symptomatology followed removal of the hematoma. Chronic subdural hematoma may in rare instances cause a parkinsonian syndrome, probably by a pressure effect on basal ganglia structures or by altering the function of neurotransmitters.
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Motor performance in 8 bradykinetic parkinsonian patients and 8 controls matched for age and sex was studied using measurement of the successive reaction time (SRT) with and without an external warning stimulus. The difference between the SRTs with and without warning was used as a measure of arousal. In both groups a warning stimulus reduced the SRT from a peripheral muscle. Motor performance in the control group following external arousal was significantly better than that in the parkinsonian group. These results suggest that parkinsonian bradykinesia is partially caused by an arousal defect of the 'exo-evoked' attentional system of the ascending reticular formation of the brainstem and that a defect in catecholamine turnover in these structures plays an important role in the mechanism of impaired arousal in these patients.
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