RESUMEN

OBJECTIVE: To determine the efficacy of 20, 40 and 60 mg methylprednisolone injections in patients with the carpal tunnel syndrome. METHODS: Included were patients with signs and symptoms of carpal tunnel syndrome of more than 3 months duration confirmed by electrophysiological tests. Patients were in a double blind trial randomised to treatment consisting of injections proximal to the carpal tunnel with 20, 40 or 60 mg methylprednisolone. Primary outcome was improvement of symptoms requiring no further treatment. These patients were followed for one year. RESULTS: There were no significant differences in the treatment response between the three randomised groups at one-year follow-up (log rank analysis 1.51, 2 df, 0.4711). In the 20, 40 and 60 mg treatment groups, 56%, 53% and 73% of the patients respectively were free of important symptoms at six months follow-up. Of the patients treated with one or two injections 22% were finally referred to surgery within one year of the first treatment. No side effects were recorded. CONCLUSION: A single local injection of methylprednisolone 20, 40 or 60 mg results in long lasting improvement in approximately half of the patients. There is a trend in favour of the highest dose. A second injection may further reduce the number of patients requiring surgery.

Asunto(s)

RESUMEN

OBJECTIVE: To assess the effect of a 40 mg methylprednisolone injection proximal to the carpal tunnel in patients with the carpal tunnel syndrome. DESIGN: Randomised double blind placebo controlled trial. SETTING: Outpatient neurology clinic in a district general hospital. PARTICIPANTS: Patients with symptoms of the carpal tunnel syndrome for more than 3 months, confirmed by electrophysiological tests and aged over 18 years. INTERVENTION: Injection with 10 mg lignocaine (lidocaine) or 10 mg lignocaine and 40 mg methylprednisolone. Non-responders who had received lignocaine received 40 mg methylprednisolone and 10 mg lignocaine and were followed in an open study. MAIN OUTCOME MEASURES: Participants were scored as having improved or not improved. Improved was defined as no symptoms or minor symptoms requiring no further treatment. RESULTS: At 1 month 6 (20%) of 30 patients in the control group had improved compared with 23 (77%) of 30 patients the intervention group (difference 57% (95% confidence interval 36% to 77%)). After 1 year, 2 of 6 improved patients in the control group did not need a second treatment, compared with 15 of 23 improved patients in the intervention group (difference 43% (23% to 63%). Of the 28 non-responders in the control group, 24 (86%) improved after methylprednisolone. Of these 24 patients, 12 needed surgical treatment within one year. CONCLUSION: A single injection with steroids close to the carpal tunnel may result in long term improvement and should be considered before surgical decompression.

Asunto(s)

Asunto(s)

RESUMEN

A 49-year-old Moroccan man was admitted to hospital with chest pain and dyspnoea. The next day he had paresis of the left arm and because of respiratory arrest he was transferred to the intensive care unit. A fast-progressive neurological illness developed with flaccid tetraparesis, areflexia and a lowered level of consciousness. He died 11 days after admission. The strong clinical suspicion of rabies was confirmed by very high antibody titres in serum and CSF and by positive immunofluorescence in mice inoculated with the patient's CSF. This was the first case of rabies in the Netherlands since 1963.

Asunto(s)

RESUMEN

In a series of patients with unilateral supratentorial ischemia, clinical scores and parameters derived from computer analysis of the EEG and from measurement of the CBF were determined in the first several weeks after the stroke. Seventeen of these patients underwent a carotid-endarterectomy and 15 a STA-MCA bypass operation. Matched control patients were selected from the remaining cases. All patients, including the controls, were eligible for vascular surgery. The measurements were repeated respectively 3 months and 3 years after the first examination. Clinical improvement occurred in all groups. The degree of these clinical changes was similar for operated and non operated cases. EEG changes indicated more improvement in the cases without surgery. Finally, the CBF was remarkably stable in all patients. The overall effects of reconstructive vascular surgery on the recovery after cerebral ischemia appeared to be negligible.

Asunto(s)

RESUMEN

In 43 patients suffering from unilateral supratentorial ischaemia the changes over an interval of 3 years in clinical score, quantified EEG (using the neurometric method) and CBF (Xenon inhalation method) were studied. The patients were examined 3 times: shortly after the onset of ischaemia and respectively 3 and 36 months after this first measurement. Three patients died from causes not related to cerebral ischaemia. In the surviving patients the EEG and clinical score improved, often dramatically; the CBF values did not change significantly. Most of the changes occurred in the first 3 months after the stroke. For the evaluation of the prognostic value of the various parameters, 2 sub-groups of patients with different outcome but comparable initial clinical scores were studied. A persistent neurological deficit was predicted by a low CBF at the first measurement. The neurometric parameters obtained from the initial EEG had no value in this respect.

Asunto(s)

RESUMEN

Follow-up studies over a period of 3 months were carried out on 100 patients with a unilateral ischaemia in the territory of the middle cerebral artery. Twenty-six patients underwent an STA-MCA bypass operation and 23 patients, a carotid endarterectomy. Fifty-one unoperated patients served as a reference group. A clinical examination, quantitative electroencephalogram (qEEG) and cerebral blood flow study (CBF) were performed before, 2 weeks after and 3 months after surgery. In the unoperated patients these examinations were carried out shortly after admission, 3 weeks later and 3 months thereafter. In the unoperated group, a highly significant improvement of clinical score and qEEG was found, but there were no changes in CBF values. The bypass patients showed a transient deterioration of clinical score and qEEG after surgery. Further, over the 3 month post-operative period, the bypass patients and the endarterectomy patients showed no improvement in CBF and qEEG. Thus, a beneficial effect of reconstructive surgery over the period studied could not be demonstrated.

Asunto(s)

RESUMEN

Xenon 133 inhalation CBF studies of one hundred patients with ischemic cerebrovascular disease in the territory of the carotid artery were compared in an attempt to gain more insight into the collateral capacity, especially in those with a stenosis or occlusion of one of the major arteries. Asymmetry of the ISI values for the two hemispheres was expressed as a ratio. High ratios (greater ISI asymmetries) were found for patients with an occlusion of the internal carotid or middle cerebral artery, especially--but not exclusively--those with the more severe clinical symptoms. It also appeared that even when the patient is in a good clinical condition, an elevated ratio reflects insufficiency of the collateral supply to the affected side. The ISI values for individual patients seem to be less useful, partly due to the variable age dependency of this flow parameter.

Asunto(s)

RESUMEN

The 'neurometric' method, as developed by John, was used for the study of patients with one-sided supratentorial ischaemia. The results of a reference group of 64 normal volunteers were compared with those of a group of 94 patients. This patient group included 54 patients with permanent neurological deficit (completed stroke or partial non-progressive stroke) and 40 patients with transient neurological symptoms (reversible ischaemic neurological deficit or transient ischaemic attacks). In 90% of all patients the neurometric method indicated that the EEG had to be considered as abnormal (compared with 3% of false positives in the reference group). A significant overall asymmetry was found in 82% of all patients compared with 2% in the reference group. During the follow-up period of 3 months there was a significant improvement of the EEG (as indicated by 3 neurometric parameters) as well as an improvement in clinical condition. In 57.5% of the EEGs, both the neurometric score and the visual assessment of the EEG indicated that some abnormality was present. In 6.6% of the cases both methods failed to indicate any abnormality. In 34.0% the neurometrics method revealed an abnormality in the EEG which was not found by visual assessment. In only 1.9% of the patients did visual assessment suggest abnormalities which could not be confirmed by neurometrics. In the group of EEGs which were considered as normal by visual assessment, the neurometrics method revealed abnormalities in 84%. The neurometric method is at the moment the most sensitive approach for detecting abnormalities in the EEG of patients with unilateral cerebral ischaemia. However, the method seems not very accurate for lateralization or localization of the lesions.

Asunto(s)

Asunto(s)

RESUMEN

The CBF measurements (Xenon-133, inhalation technique) and quantified EEG (qEEG) recordings of 20 patients with cerebrovascular disturbances due to an unilateral internal carotid artery occlusion were evaluated. One of the advantages of the inhalation method is the possibility of the simultaneous CBF measurement of both hemispheres. Special attention is paid to the difference in flow between the two hemispheres. The results of this investigation are compared with the findings of the qEEG studies. Furthermore the relationship between these results and the clinical state of the patient was studied. Although computer analysis revealed EEG abnormalities in 80% of the cases no correlation could be found between the grade of EEG abnormalities and the clinical data of the patient and/or the CBF parameters. A correlation was found between the asymmetry as well as the absolute values of the hemispheric flow and the clinical state. The question whether CBF measurements can provide a better insight into the pathophysiology of the blood flow pattern in patients with unilateral internal carotid artery occlusions was considered as well.

Asunto(s)

Asunto(s)