Letters to the Editor

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65933/1/j.1528-1157.1995.tb00479.x.pd

Impaired Upper Limb Coordination in Alcoholic Cerebellar Degeneration

BACKGROUND: Alcoholic cerebellar degeneration (ACD) is a disorder resulting from severe chronic alcoholism and malnutrition and is characterized by cognitive disturbances, ataxia of gait, and truncal instability, with generally preserved coordination of the upper extremities. OBJECTIVES: To determine whether cognitive deficits in patients with ACD are the same as those seen in patients with severe chronic alcoholism without ACD and to determine whether upper limb motor coordination is different in the 2 groups. DESIGN: We examined cognitive function and upper limb coordination in 56 patients with severe chronic alcoholism, 13 with ACD and 43 without ACD, who had comparable levels of total alcohol intake. Neuropsychological and motor function was measured using an expanded Halstead-Reitan Neuropsychological Test Battery, including the Tactual Performance Test and Grooved Pegboard Test. RESULTS: Neither group had impaired coordination of upper limb function on clinical neurological examination. Both groups had impaired performance on neuropsychological tests involving executive function, but the patients with ACD had greater impairment of upper limb coordination than the patients without ACD as measured by the Tactual Performance Test and Grooved Pegboard Test. CONCLUSIONS: The findings suggest that these 2 groups have similar cognitive deficits but that upper extremity motor functions are more significantly impaired in the ACD group and that quantitative tasks of motor function reveal these impairments

Management of intractable chronic cough during awake craniotomy: illustrative case.

BACKGROUND: Chronic cough is a common but challenging clinical condition that can adversely affect the safety of awake surgical endeavors such as awake craniotomy (AC). This case lesson highlighted a patient with severe refractory chronic cough undergoing AC for resection of a recurrent left frontal, insula, anterior temporal anaplastic ependymoma of the eloquent cortex. OBSERVATIONS: The patient was successfully managed using a multifaceted medical treatment regimen combined with preoperative and intraoperative cough suppression therapy with a speech-language pathologist. The patient coughed only once intraoperatively and had a positive outcome. LESSONS: Chronic cough is often multifactorial and requires a multifaceted treatment approach. Despite this challenge, select patients can successfully be navigated through AC with appropriate treatment for their condition. A review of neurogenic cough and modern treatments, which were used in this patient and would be helpful to neurologists or neurosurgeons, are also discussed.http://deepblue.lib.umich.edu/bitstream/2027.42/191979/2/Management of intractable chronic cough during awake craniotomy illustrative case.pdfPublished versionDescription of Management of intractable chronic cough during awake craniotomy illustrative case.pdf : Published versio

Effects of abstinence and relapse upon neuropsychological function and cerebral glucose metabolism in severe chronic alcoholism

Prolonged excessive consumption of alcohol has been associated with a variety of cognitive disorders accompanied by neuropathological and neurochemical abnormalities of the brain, particularly in the frontal lobes. Studies with positron emission tomography (PET) have shown decreased local cerebral metabolic rates for glucose (ICMRglc) in frontal regions, with correlated abnormalities on neuropsychological tests sensitive to executive functioning. This investigation was designed as a pilot study to examine the effects of abstinence and relapse in patients with severe chronic alcoholism studied longitudinally with PET and with neuropsychological evaluation to assess both general and executive functioning. Six patients, including 4 who remained relatively abstinent and 2 who relapsed following their initial evaluation, were studied twice, with inter-evaluation intervals ranging from 10 to 32 months. The patients who remained abstinent or who had minimal alcohol use showed partial recovery of ICMRglc in two of three divisions of the frontal lobes and improvement on neuropsychological tests of general cognitive and executive functioning, whereas the patients who relapsed had further declines in these areas. These results, although based upon a relatively small number of subjects, provide preliminary support for at least partial recovery of metabolic and cognitive functioning in individual patients who abstain from alcohol

Psychological Factors and Pet Measured Glucose Metabolism in Olivopontocerebellar Atrophy

We compared 29 olivopontocerebellar atrophy (OPCA) patients on psychiatric rating scales, cognitive tests, and positron emission tomography to 12 normal volunteers with similar age and sex distributions. The patients were generally comparable to normals in cognitive function, but poorer on psychomotor tasks. They had significantly different scores on formal self-report scales than the normals, indicating a greater degree of self-complaint. Analyses of the components of self-complaint suggested that illness-related concerns accounted for most of the differences between the groups. The magnitude of self-complaint was significantly and specifically correlated with the level of glucose metabolism in the frontal cerebral cortex of OPCA patients. These results may be attributed to a combination of biological and experiential factors. The level of patient complaint may be influenced by organic brain dysfunction reflected in metabolism and emotional disturbance, whereas the content of complaint may be specific to the individual's situational experience.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67170/2/10.1177_1073191196003003013.pd

Effects of Disulfiram on Positron Emission Tomography and Neuropsychological Studies in Severe Chronic Alcoholism

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65363/1/j.1530-0277.1996.tb01149.x.pd