The clinical relevance of a long-duration response (LDR) to levodopa therapy in Parkinson's disease (PD) has not been widely recognized. In 25 patients with moderate PD, we measured LDR on motor function after short periods of treatment with levodopa (subacute tests). Each subacute test lasted 15 days and consisted of the oral administration of levodopa at various interdose intervals (IDIs) of 48, 24, 12, 8, 6, and 5 hours. The goal for a subacute test was to achieve a satisfactory antiparkinsonian effect before the last levodopa dose (day 15), i.e., an LDR greater than 50% of the maximal response following an acute levodopa test (LDR-endpoint). Twenty-one patients (84%) reached the LDR-endpoint. The IDI at which levodopa was administered clearly differentiated patients who were otherwise clinically indistinguishable when evaluated at baseline off medication or after an acute levodopa test. The IDI schedule that produced a satisfactory LDR was specific for each patient, since longer DIs failed to produce the required LDR, and a shorter IDI schedule (resulting in larger cumulative dosage of levodopa) did not significantly enhance the response. Also, the LDR decay rate after discontinuation of treatment was individual for each patient and independent of the cumulative amount of levodopa administered. Both the IDI schedule and the LDR decay rate may reflect the ability of nigrostriatal neurons to store and to release dopamine formed from the exogenous precursor. The assessment of the LDR to levodopa by subacute tests is useful for establishing the appropriate dose of the drug, as well as for developing levodopa sparing strategies in PD patients.
Headache is one of the leading symptoms often associated with brain tumours. Secondary headaches attributed to intracranial neoplasias have been included in subchapter 7.4 of the third edition of the International Classification of Headache Disorders (ICHD-3). According to ICHD-3, the headache may be attributed to a brain tumour if it has developed in close temporal relation with the development of the neoplasia, has significantly worsened in parallel with the worsening of the tumour, and/or has significantly improved following the successful treatment of the neoplasia. Brain tumour headache was traditionally thought to display some specific clinical characteristics, including worsening in the morning and/or when lying down, being aggravated by Valsalva-like manoeuvres and accompanied by nausea and/or vomiting; however, the studies performed after the advent of modern neurodiagnostic techniques have pointed out that the “classic” brain tumour headache is uncommon, particularly at the time of clinical presentation. Therefore, it becomes critical to seek some specific factors associated with the presence of an intracranial mass (the so-called “red flags”) that can guide the physician to establish an accurate diagnosis.
Cluster Headache (CH) is a primary disorder defined by the International Headache Society (IHS) classification (1) as severe, unilateral orbital, supra-orbital, or temporal pain lasting 15-180 min if untreated and associated to signs of dysfunction of the autonomic nervous system such as conjunctival injection, nasal congestion, lacrimation, Horner's sign, and rhinorrhea. The attack frequency is ranged from one every other day to eight per day. In recent years several cases have been described concerning patients having cluster-like syndromes associated with intracranial pathologies, usually showing atypical manifestations with respect to the above mentioned diagnostic criteria (2). We report the case of a female patient affected by cluster-like headache completely fulfilling IHS diagnostic criteria, at least at presentation, who during the course of the illness presented clinical and neuro-imaging aspects of an organic brain lesion, e.g. a cavernous sinus metastasis. Case historyA 60-year-old woman presented with a 3-week history of daily headache. The attacks occurred once daily during the night at the same hour (about 0400h) awakening the patient, and lasted 30-90 min. The pain was severe or excruciatingly severe and strictly localized on the left side and in the temporal region. The attacks were accompanied by ipsilateral lacrimation, conjunctival injection, rhinorrea and, occasionally, ptosis. Prior to the onset of the symptoms the patient was otherwise well, had never suffered from headache and did not take any medication. No familial history of headache disorder was reported.On the initial neurological examination, the only finding was a mild left eyelid ptosis, interpreted as a partial Bernard-Horner sign, frequently recurring in CH patients during the active period (3). The physical examination was unremarkable. In particular, a tender superficial temporal artery was not found and neck movement were within the normal range. Blood-count, ESR, glycaemia, TSH and antinuclear antibodies were normal or negative. A brain and orbit CT with administration of contrast material was required because of the relatively advanced age of the patient, and the result was normal. A diagnosis of cluster headache was made and the patient was administered prednisone, 50 mg/daily. Two weeks later the patient reported the almost complete remission of the pain. Nevertheless intermittent diplopia developed and eyelid ptosis was more pronounced. Furthermore, a few days earlier the patient had started to suffer from low-back pain. Neurological examination discovered a slight left midriasis and a paresis of left medial right muscle, in addition to the previous left eyelid ptosis. A brain MRI disclosed a iso/hyperintense area in the anterior aspect of left cavernous sinus, significantly enhanced by contrast material, consistent with a possible metastatic lesion (Fig. 1). In a few days ptosis became complete and the low back pain worsened. The patient was admitted to hospital. Spine X-ray and total-body CT scan disclosed the presence ...
The authors present the CT findings in their personal series of 77 cases of neurofibromatosis, 34 cases of tuberous sclerosis, and 16 cases of Sturge-Weber disease. These findings are extensively illustrated and compared with those reported in the literature.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.