Clinical characteristics of multiple system atrophy in Serbian population

Background/Aim. Mulstiple system atrophy (MSA) is a neurodegenerative central nervous system disorder, characterized by any combination of extrapyramidal, cerebellar, pyramidal or autonomic disturbance. The aims of our study were to define clinical characteristics of MSA patients in our population, to account for neuroradiological and electrophysiological profile of the disease and to evaluate one-dose levodopa response. Methods. We have diagnosed 29 patients as MSA, with disease duration from the first symptom 5 years on average on examination. The examinating procedure included an anamnesis and complete neurological investigations, as well as neurootological and neuroradiological examinations. The study included the patients of the Institute of Neurology of the Clinical Center of Serbia in the period of 1996-2001, who completed both clinical and diagnostic criteria for a possible and probable MSA. Results. Autonomic disturbances were documented in 93.1%, whereas extrapyramidal symptoms were seen in additional 89.3% with symmetrical onset in 60%. Levodopa response was poor or moderate. Cerebellar signs were present in 63%, while pyramidal signs occured in 78.7%. There was no a cognitive deterioration (MMSE > 24). CT scan and MRI showed cerebellar and brainstem atrophy, as well as diffuse cortical atrophy. Conclusion. Failure of additional diagnostic procedures to distinguish MSA patients required a precise understanding of their clinical specificities. Our results support this statement

Korelacija vestibularne i kohlearne funkcije kod novorođenčadi

This paper examines the correlation between vestibular and cochlear responses, obtained in newborns immediately after birth, for the purpose of improving procedures of early detection of possible hearing and vestibular impairment. A group of reflexes which indicate whether the vestibular apparatus is already realizing its function were tested in 100 healthy, full-term newborns from regular pregnancies, on the third day upon birth. At the same time, hearing ability in all newborns was examined by transient otoacoustic emission (TEOAE). Testing each reflex in newborns, was carried out in three attempts by trained medical staff, whereas the examiner performed instructing, observation and data recording. The obtained data were recorded by means of a digital camera, then scored and statistically and descriptively processed. For each examinee in the sample, data on gender and body size on birth, body weigh (BW), body length (BL) and head circumference (HC), were recorded. Research results indicate that 91% of babies have normal TEOAE finding bilaterally, whereas in 9% of newborns TEOAE was absent on both sides or just on one ear (bilaterally 3%, on the left side 4% and on the right side 2%). In the examined sample, maximal presence of reflexes in total (MOR+ATRV+VOR+LRIG) was established in 7% of newborns, while minimal presence was recorded just in 1%. Absence of these four reflexes together, was not established in any of the newborns. Reflexes in total were significantly more developed in babies with normal TEOAE results bilaterally, then in babies whose TEOAE findings were bilaterally or unilaterally absent (p<0.01). It was also confirmed that a significant part of variance (13.8%) about presence of reflexes in total, can be established on the basis of TEOAE results. Absence of these four reflexes together, was not established in any of the newborns. BW, BL, HC and gender of infants, do not have significant influence on the presence of reflexes in total, regardless of the fact whether it is an isolated influence of the mentioned variables, their reciprocal interaction, or their interaction with TEOAE results. Giving instructions for recognition and further monitoring of newborns with delayed maturation of vestibular pathways is of special significance in practice. This is particularly important because of the possible associated disturbance of vestibular and cochlear function.U radu se ispituje povezanost vestibularnih i kohlearnih odgovora dobijenih kod beba neposredno po rođenju, u cilju usavršavanja procedure rane detekcije mogućeg oštećenja slušne i vestibularne funkcije. Kod stotinu zdrave, terminske novorođenčadi iz urednih trudnoća, trećeg dana po rođenju, ispitana je grupa refleksa koji ukazuju da li vestibularno čulo već ostvaruje svoju funkciju. Istovremeno, funkcija kohlee kod novorođenčadi ispitana je putem tranzijentne otoakustičke emisije (TEOAE). Testiranje refleksa kod beba izvodilo je iz tri pokušaja obučeno medicinsko osoblje, dok je ispitivač vršio instruiranje, opservaciju i beleženje podataka. Dobijeni podaci su dokumentovani digitalnom kamerom, potom bodovani, statistički i deskriptivno obrađeni. Za svakog ispitanika iz uzorka, uzeti su podaci o polu kao i o telesnoj težini (TT), telesnoj dužini (TD) i obimu glave (OG) na rođenju. Rezultati istraživanja su ukazali da je obostrana prolaznost na TEOAE testu unutar ispitanog uzorka, utvrđena kod 91% novorođenčadi. Kod 3% beba TEOAE odgovor je obostrano izostao, dok je 6% ispitanika palo TEOAE test samo sa jedne strane (4% levo i 2% desno). Maksimalna prisutnost refleksa ukupno (MOR+ATRV+VOR+LRIG) utvrđena je kod 7% novorođenčadi, dok je samo 1% ispitanika ove reflekse imalo minimalno prisutne. Odsutnost sva četiri refleksa, nije utvrđena ni kod jednog novorođenčeta. Svi refleksi su značajno prisutniji kod beba koje su imale obostrano uredan nalaz TEOAE u odnosu na bebe kod kojih TEOAE odgovora obostrano ili samo sa jedne strane nije bilo (p<0.01). Takođe, utvrđeno je da se značajan deo varijanse (13.8%) o prisutnosti refleksa ukupno, može odrediti na osnovu rezultata TEOAE testa. Pol, TT, TD i OG novorođenčadi nemaju značajan uticaj na prisutnost ispitivanih refleksa, bilo da se radi o pojedinačnom uticaju tih varijabli, o njihovoj međusobnoj interakciji ili interakciji sa rezultatima TEOAE testa. Poseban značaj za praksu je u uputstvima prema kojima bi se novorođenčad sa zakasnelom maturacijom vestibularnih puteva, izdvajala i pratila zbog mogućnosti postojanja udružene smetnje vestibularne i kohlearne funkcije

Korelacija vestibularne i kohlearne funkcije kod novorođenčadi

This paper examines the correlation between vestibular and cochlear responses, obtained in newborns immediately after birth, for the purpose of improving procedures of early detection of possible hearing and vestibular impairment. A group of reflexes which indicate whether the vestibular apparatus is already realizing its function were tested in 100 healthy, full-term newborns from regular pregnancies, on the third day upon birth. At the same time, hearing ability in all newborns was examined by transient otoacoustic emission (TEOAE). Testing each reflex in newborns, was carried out in three attempts by trained medical staff, whereas the examiner performed instructing, observation and data recording. The obtained data were recorded by means of a digital camera, then scored and statistically and descriptively processed. For each examinee in the sample, data on gender and body size on birth, body weigh (BW), body length (BL) and head circumference (HC), were recorded. Research results indicate that 91% of babies have normal TEOAE finding bilaterally, whereas in 9% of newborns TEOAE was absent on both sides or just on one ear (bilaterally 3%, on the left side 4% and on the right side 2%). In the examined sample, maximal presence of reflexes in total (MOR+ATRV+VOR+LRIG) was established in 7% of newborns, while minimal presence was recorded just in 1%. Absence of these four reflexes together, was not established in any of the newborns. Reflexes in total were significantly more developed in babies with normal TEOAE results bilaterally, then in babies whose TEOAE findings were bilaterally or unilaterally absent (p<0.01). It was also confirmed that a significant part of variance (13.8%) about presence of reflexes in total, can be established on the basis of TEOAE results. Absence of these four reflexes together, was not established in any of the newborns. BW, BL, HC and gender of infants, do not have significant influence on the presence of reflexes in total, regardless of the fact whether it is an isolated influence of the mentioned variables, their reciprocal interaction, or their interaction with TEOAE results. Giving instructions for recognition and further monitoring of newborns with delayed maturation of vestibular pathways is of special significance in practice. This is particularly important because of the possible associated disturbance of vestibular and cochlear function.U radu se ispituje povezanost vestibularnih i kohlearnih odgovora dobijenih kod beba neposredno po rođenju, u cilju usavršavanja procedure rane detekcije mogućeg oštećenja slušne i vestibularne funkcije. Kod stotinu zdrave, terminske novorođenčadi iz urednih trudnoća, trećeg dana po rođenju, ispitana je grupa refleksa koji ukazuju da li vestibularno čulo već ostvaruje svoju funkciju. Istovremeno, funkcija kohlee kod novorođenčadi ispitana je putem tranzijentne otoakustičke emisije (TEOAE). Testiranje refleksa kod beba izvodilo je iz tri pokušaja obučeno medicinsko osoblje, dok je ispitivač vršio instruiranje, opservaciju i beleženje podataka. Dobijeni podaci su dokumentovani digitalnom kamerom, potom bodovani, statistički i deskriptivno obrađeni. Za svakog ispitanika iz uzorka, uzeti su podaci o polu kao i o telesnoj težini (TT), telesnoj dužini (TD) i obimu glave (OG) na rođenju. Rezultati istraživanja su ukazali da je obostrana prolaznost na TEOAE testu unutar ispitanog uzorka, utvrđena kod 91% novorođenčadi. Kod 3% beba TEOAE odgovor je obostrano izostao, dok je 6% ispitanika palo TEOAE test samo sa jedne strane (4% levo i 2% desno). Maksimalna prisutnost refleksa ukupno (MOR+ATRV+VOR+LRIG) utvrđena je kod 7% novorođenčadi, dok je samo 1% ispitanika ove reflekse imalo minimalno prisutne. Odsutnost sva četiri refleksa, nije utvrđena ni kod jednog novorođenčeta. Svi refleksi su značajno prisutniji kod beba koje su imale obostrano uredan nalaz TEOAE u odnosu na bebe kod kojih TEOAE odgovora obostrano ili samo sa jedne strane nije bilo (p<0.01). Takođe, utvrđeno je da se značajan deo varijanse (13.8%) o prisutnosti refleksa ukupno, može odrediti na osnovu rezultata TEOAE testa. Pol, TT, TD i OG novorođenčadi nemaju značajan uticaj na prisutnost ispitivanih refleksa, bilo da se radi o pojedinačnom uticaju tih varijabli, o njihovoj međusobnoj interakciji ili interakciji sa rezultatima TEOAE testa. Poseban značaj za praksu je u uputstvima prema kojima bi se novorođenčad sa zakasnelom maturacijom vestibularnih puteva, izdvajala i pratila zbog mogućnosti postojanja udružene smetnje vestibularne i kohlearne funkcije

Benign Paroxysmal Vertigo in Childhood

The aim of the paper is to describe the clinical picture of benign paroxysmal vertigo (BPV) in childhood. BPV in childhood often goes unrecognized in spite of the fact that vertigo and balance disorders are not uncommon in children. Four cases are described with clinical examination findings between the attacks

Correlation between Balance Ability and Speech-Language Development in Children

The longitudinal study was conducted in order to establish whether the success rate of refl exes related to maintaining balance at birth is in correlation with the success rate of maintaining balance in early childhood, as well as to examine the correlation of a certain level of speech and language development with the ability of maintaining balance at birth and at the age of 5. The main study group included 54 children of both genders, aged 5.0 to 5.4, whose balance ability and speech and language status were evaluated based on the battery of standardized tests, whereas the group of refl exes related to the function of the vestibular sense was clinically tested on the 3rd day upon birth, within the same sample of children. The data at birth and at the age of 5 were recorded by means of a digital camera, then scored and statistically and descriptively processed. The research results indicated a statistically signifi cant correlation between the achieved level of balance ability in the newborns and fi ve-year-olds, as well as between balance skills and a certain level of speech and language development in children at the age of 5. The importance of this research lies in new knowledge in the domain of maturation of vestubular function immediately after birth, given that this segment of physiology of a newborn has not so far been processed in such a way, as well as in the recognition of function of the vestibular sense as another parametre of a child’s maturation

Subjective visual vertical test: Normative values in healthy population

INTRODUCTION Subjective Visual Vertical test (SVV test) can be applied to measure one of the functions of the vestibular apparatus, its afferent pathways and nuclei within the brain stem. The test is based on the subjective assessment of verticality. The possibility of perceived visual vertical in healthy subjects can show deviation with accuracy of ±2° at most. OBJECTIVE The goal of the study is to present the results of the SVV test developed at our department. METHOD Two kinds of testing procedures were applied; the static test during which the subjects evaluated the verticality on a static background; the dynamic test during which the subjects evaluated the verticality after 20 seconds of rotation of the background to the right or to the left. Ninety-five healthy subjects aged between 21 and 79 years were tested. The whole group was divided into smaller groups according to age criterium. RESULTS The results showed statistically significant bigger SVV tilt in the subjects aged over 45 years than in the younger subjects. The arithmetic mean of the tilt to the left or tilt to the right in the group younger than 45 years was 0.42 degrees during the static test and 0.49 degrees during the dynamic test. The arithmetic mean for the group older than 45 years was 0.67 during the static test and 0.68 during the dynamic test. CONCLUSION The testing indicated that SVV perception showed a bigger tilt according to age. This should be taken into consideration in individual testing and evaluation of functional ability