Morphological differences in Parkinson's disease with and without rest tremor

Background : Rest tremor is a hallmark of Parkinson's disease (PD), but its pathogenesis remains incompletely understood. Nigro-striatal dopamine deficiency correlates best with bradykinesia, but not with tremor. Oscillating neurons in one or multiple localizations within the basal gangliathalamo-cortical loop may cause rest tremor, and an active contribution of the cerebellum and the cerebello-thalamo-cortical projections has been postulated. Objective : To compare the pattern of grey matter volume in PD patients with and without tremor to identify structural correlates of rest tremor. Methods : Voxel-based morphometry (VBM) of a high-resolution 3 Tesla, T1-weighted MR images, pre-processed according to an optimized protocol using SPM2, was performed in 24 patients with mild to moderate PD comparing local grey matter volume in patients with (n = 14) and without rest tremor (n = 10). Results : Grey matter volume is decreased in the right quadrangular lobe and declive of the cerebellum in PD with tremor compared to those without (PFDR < 0.05). Conclusions : These results demonstrate for the first time morphological changes in the cerebellum in PD patients with rest tremor and highlight the involvement of the cerebellum and cerebello- thalamo-cortical circuit in the pathogenesis of parkinsonian rest tremo

Simultaneous Bedside Assessment of Global Cerebral Blood Flow and Effective Cerebral Perfusion Pressure in Patients with Intracranial Hypertension

Background: We examined a bedside technique transcerebral double-indicator dilution (TCID) for global cerebral blood flow (CBF) as well as the concept of effective cerebral perfusion pressure (CPPeff) during different treatment options for intracranial hypertension, and compared global CBF and CPPeff with simultaneously obtained conventional parameters. Methods: Twenty-six patients developing intracranial hypertension in the course of traumatic brain injury or subarachnoid hemorrhage were prospectively analyzed using a combined assessment during elevated ventilation (n=15) or osmotherapy (hypertonic saline or mannitol). For calculation of global CBF, injections of ice-cold indocyanine green boluses were performed and temperature and dye concentration changes were monitored in the thoracic aorta and the jugular bulb. CBF was then calculated according to the mean transit time principle. Estimation of CCP, the arterial pressure at which cerebral blood flow becomes zero, was performed by synchronized registration of corresponding values of blood flow velocity in the middle cerebral artery and arterial pressure and extrapolation to zero-flow velocity. CPPeff was calculated as mean arterial pressure minus critical closing pressure (CPPeff=MAPc−CCP). Results: Elevated ventilation causes a decrease in both ICP (P<0.001) and CBF (P<0.001). While CPPconv increased (P<0.001), CPPeff decreased during this observation (P=0.002). Administration of osmotherapeutic agents resulted in a decrease of ICP (P<0.001) and a temporary increase of CBF (P=0.052). CPPconv and CPPeff showed no striking difference under osmotherapy. Conclusion: TCID allows repeated measurements of global CBF at the bedside. Elevated ventilation lowered and osmotherapy temporarily raised global CBF. In situations of increased vasotonus, CPPeff is a better indicator of blood flow changes than conventional CP

Cerebral perfusion in sepsis

This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855

Reflexões sobre a prática docente na perspectiva etnomatemática

Este artigo tem como objetivo relatar a experiência vivida pelos autores no desenvolvimento de minicursos propostos ao longo do ano de 2010. Tais atividades tiveram por objetivo discutir a prática docente interagindo com os saberes discentes e a cultura cotidiana, assim como os princípios esperados numa formação dentro da perspectiva etnomatemática. O artigo foi construído a partir da análise das respos-tas de um questionário de avaliação proposto aos participantes ao final das atividades