RESUMEN
Motor perseverations are commonly thought to be a sign of frontal lobe lesions, although they may also occur following lesions outside the frontal lobes. Moreover, differences in the type and frequency of motor perseverations between the two cerebral hemispheres have been suggested. Recurrent perseverations (repetition of a previous response to a subsequent stimulus) and continuous perseverations (abnormal prolongation of a current activity) are two different aspects of motor intentional disorders. The former have been associated with left hemispheric lesions, and the latter with right hemispheric lesions. To test this hypothesis, we examined 42 patients with single cerebral lesions of different locations: 22 right hemispheric (7 frontal and 15 extrafrontal) and 20 left hemispheric lesions (8 frontal and 12 extrafrontal), and healthy controls with a graphic task, allowing for analysis of these two types of motor perseverations. We found that (i) both types of perseverations increased significantly for all groups of patients compared to normal controls, except for recurrent perseverations in patients with right posterior lesions, (ii) there was no significant dissociation between the type of perseverations and the side of lesions, and (iii) there was a significant interaction between the type of perseveration, frontal versus extrafrontal location, and the side of a lesion, which is based on the tendency for recurrent perseverations to be increased in left posterior and right frontal lesions, and decreased in left frontal and right posterior lesions, as compared to continuous perseverations. These findings cast doubt about the predominant role of the frontal lobes for motor perseverations, but support the idea of hemispheric specialization in motor control which is, however, more complex than previously thought.
Asunto(s)
Trastornos Cerebrovasculares/complicaciones , Trastornos Cerebrovasculares/fisiopatología , Lóbulo Frontal/fisiopatología , Trastornos de la Destreza Motora/etiología , Trastornos de la Destreza Motora/fisiopatología , Adulto , Anciano , Análisis de Varianza , Trastornos Cerebrovasculares/diagnóstico , Lateralidad Funcional , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Trastornos de la Destreza Motora/diagnóstico , Pruebas Neuropsicológicas , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To investigate the change in systolic blood pressure (SBP) induced by meals and to compare their impact on the orthostatic SBP response in elderly Parkinson's disease with that in control patients. DESIGN: Ten elderly patients suffering from Parkinson's disease were compared with 10 age-matched elderly control patients. METHODS: The postprandial SBP change was measured by means of ambulatory blood pressure monitoring with the patient in the supine position. Orthostatic SBP responses were measured the next day by means of active standing and passive head-up tilting tests performed before and after the patients had their lunch. RESULTS: In Parkinson's disease patients, a postprandial SBP drop of 27 mmHg in the supine position was found compared with a drop of 8 mmHg in controls. In Parkinson's disease patients, that drop was moderately correlated to the orthostatic SBP responses and significantly correlated to the preprandial supine baseline SBP level. The orthostatic fall in SBP was greater with passive than with active standing and with both it was greater in Parkinson's disease patients than in the control subjects. The fall in orthostatic blood pressure was reduced by a previous meal. In contrast, there was no difference in orthostatic heart rate responses between the patients and the controls. CONCLUSIONS: Parkinson's disease patients demonstrated a significant postprandial drop in SBP and a tendency towards orthostatic hypotension, which was not worsened by the meal, probably owing to a stronger sympathetic activation. Postprandial supine SBP change and orthostatic SBP responses were only moderately associated in Parkinson's disease patients. In addition to autonomic dysfunction, an increased baseline SBP level might contribute to both phenomena.
Asunto(s)
Envejecimiento/fisiología , Presión Sanguínea , Ingestión de Alimentos/fisiología , Hipertensión/fisiopatología , Enfermedad de Parkinson/fisiopatología , Anciano , Anciano de 80 o más Años , Femenino , Hemodinámica , Humanos , Hipotensión Ortostática , Masculino , Postura , SístoleRESUMEN
We describe a 28-year-old man who developed a mononeuropathy with a conduction block of the median nerve in the forearm, during the acute stage of a polyarteritis nodosa. Sequential studies show progressive disappearance of the conduction block (together with the clinical symptoms), without signs of axonotmesis.
Asunto(s)
Nervio Mediano/irrigación sanguínea , Neuritis/fisiopatología , Poliarteritis Nudosa/fisiopatología , Transmisión Sináptica/fisiología , Adulto , Axones/efectos de los fármacos , Axones/fisiología , Ciclofosfamida/administración & dosificación , Potenciales Evocados Somatosensoriales/efectos de los fármacos , Potenciales Evocados Somatosensoriales/fisiología , Dedos/inervación , Humanos , Masculino , Nervio Mediano/efectos de los fármacos , Neuritis/diagnóstico , Neuritis/tratamiento farmacológico , Poliarteritis Nudosa/diagnóstico , Poliarteritis Nudosa/tratamiento farmacológico , Prednisona/administración & dosificación , Transmisión Sináptica/efectos de los fármacosRESUMEN
A case of tongue anesthesia after removal of the lower third molar was observed. This type of lingual nerve injury is often unrecognized by the neurologist. Good knowledge of the anatomy and examination techniques are necessary to help the surgeon in the management of the patient.