Transient febrile Broca's aphasia during salmonella infection: a case report

Si riporta un caso di afasia di broca in paziente di 40 anni con infezione da salmonella typhi tale complicanza è presente nel 7,4% dei casi di tifo nel bambino mentre nell’adulto sono stati descritti solo due casi. Restano tutt’ora sconosciuti i meccanismi patogenetici responsabili di tale complicanza neurologica in corso di infezione da salmonella typhi

Benign acute childhood myositis: a case report.

La miosite acuta benigna del bambino è una rara complicanza dell’infezione del virus influenzale. Descritta per la prima volta nel 1957 da Lundeberg si manifesta con debolezza e dolore agli arti inferiori, tali da indurre significative difficoltà nella deambulazione. I valori di CPK risultano elevati. Si riporta qui il caso di un bambino di 9 anni: l’esame EMG risultava positivo per danno miogeno; la CPK era elevata. Dieci giorni dopo la prima osservazione il paziente risultò asintomatico ed i valori di CPK erano ritornati nella norma. L’esame EMG si normalizzò dopo circa 40 giorni ed il paziente recuperò completamente il deficit motorio

Collet-Sicard syndrome secondary to a chemodectoma: a case report

La sindrome di Collet-Sicard si manifesta con interessamento dei nervi cranici IX- X-XI e XII. Si tratta di una rara sindrome neurologica associata a patologie della carotide interna, a malattie sistemiche, a polineuropatie craniali idiopatiche ed a tumori della base cranica. Si descrive qui un caso di sindrome di Collet-Sicard in una paziente che presentava interessamento dei quattro nervi cranici suddetti e risultò affetta da chemodectoma del glomo giugulare. Il trattamento neurochirurgico risolse parzialmente il quadro clinico

Gabapentin treatment for muscle cramps: An open-label trial

To evaluate the efficacy and safety of gabapentin in the treatment of muscle cramps, we engaged an open-label trial with a group of 30 patients with frequent (>5 cramps/week), stable, long-lasting cramps, associated with different diseases. Gabapentin was effective in reducing the frequency and severity of muscle cramps and associated sleep disturbances (clinical outcome measures) within the first 2 weeks of medication at 600 mg/d. At the 1 month control (mean dosage, 825 +/- 35 mg), almost every patient had responded to treatment and two thirds experienced a total remission of symptoms. After 3 months of therapy (mean dosage, 892 +/- 180 mg), cramps disappeared in 100% of patients and this benefit persisted as long as 6 months. Additionally, we evaluated in 10 patients the Cramps Threshold Frequency (CTF) (neurophysiological outcome measure) before and during gabapentin treatment. Gabapentin significantly increased the CTF, returning it to normal values. With the limitation of an open-label methodology, our clinical and neurophysiologic experience suggests that a gabapentin dose of 600-1200 mg/d would be helpful in the treatment of muscular cramps

Effects of a selective serotonin reuptake inhibitor escitalopram on the cutaneous silent period: A randomized controlled study in healthy volunteers

The cutaneous silent period (CSP) involves a transient inhibition of the electromyographic (EMG) activity in the hand muscles induced by a painful electrical stimulation of the digital nerves. The neurotransmitters potentially involved in mediating the CSP have not been completely elucidated thus far. However, few studies suggest that the monoaminergic system may play a role in the CSP. We elicited CSPs in the first dorsal interosseous muscle of the right hand before and 3 h after administration of a single oral dose of the selective serotonin reuptake inhibitor escitalopram (20 mg) or placebo. The two experimental sessions (drug and placebo) were performed in a random order at >= 1-week intervals. All recordings were numbered anonymously and analysed offline in a blind manner by one investigator. A significant increase in the CSP duration was observed 3 h after escitalopram administration (p = 0.01), and no changes were observed in the reflex latency and subjective pain sensation (p > 0.05). No significant changes were observed in the CSP duration in subjects who received the placebo (all, p > 0.05). Our results indicate that escitalopram increases the central disposition of serotonin and increases the activity of the spinal inhibitory interneurons on the alpha-motoneurons of the hand muscles. Thus, our results indicate the involvement of the monoaminergic system in controlling the spinal pain mechanisms by supraspinal descending pathways, originating from the brainstem neural structures. (C) 2014 Elsevier Ireland Ltd. All rights reserved

L-Dopa decreases cutaneous nociceptive inhibition of motor activity in Parkinson's disease

OBJECTIVES: To estimate changes in motor inhibitory mechanisms at the spinal level in Parkinson's disease (PD) patients by measuring cutaneous silent responses to nociceptive stimuli in the course of L-Dopa therapy. MATERIALS AND METHODS: Fourteen patients with idiopathic PD (Group 1) and 13 patients with other forms of parkinsonism (Group 2) participated in the study. The cutaneous silent period (CSP) from the hand and clinical scores (UPDRS, part III) were measured "off" therapy (T0), after a single dose of L-Dopa (T1) and 3 months after the beginning of L-Dopa daily therapy (T2). RESULTS: At T0 the duration of the CSP was significantly prolonged in Group 1 and Group 2. At T1 and T2 the mean duration of the CSP significantly decreased in Group 1 (P < 0.05) and a significant correlation was found between the shortening of the CSP and the improvement of rigidity and bradikynesia in the upper limb. CONCLUSIONS: Our findings show that L-Dopa decreases the cutaneous nociceptive inhibition of motor activity in PD patients. CSP may be useful to assess L-Dopa responsiveness during the clinical course of PD

Afterdischarge activity in neuropathic patients with frequent muscle cramps

Objectives - To evaluate the presence of the afterdischarge activity following M- and F-waves in patients with peripheral neuropathies with or without muscle cramps. Material and methods - Ten patients with peripheral neuropathies complaining of frequent muscle leg cramps (Group 1) and 14 patients with peripheral neuropathies without muscle cramps (Group 2) participated in our study. The afterdischarge was evaluated through a repetitive stimulation of the peroneal and tibial nerves. Results - An abnormal afterdischarge activity following F-wave was identified below 5 Hz only in Group 1. On high frequency of stimulation (> 5 Hz), this activity was present in every patient in Group 1. Moreover, it was particularly present in the muscle affected by cramps. Conclusion - Since the afterdischarges following F-waves have been considered to be the result of a hyperactive 'bistable' state of alfa-motor neurons, our findings are indicative of an impairment of motor neuron excitability. Thus, it is hypothesizable that either peripheral and central mechanisms may together contribute in producing muscle cramps