The Effect of Ischaemia on Vibration Sense in Hypo- Or Hypercalcaemia and in Demyelinated Nerves

SUMMARY A quantitative assessment ofpost-ischaemic paraesthesiae has been made in 50 pellagrins and 20 healthy identical controls. The results show a highly significant diminution of the paraesthetic response in pellagrins. In pellagrins having peripheral neuropathy the depression of paraesthesiae was more marked than in those without peripheral neuropathy. There was no consistent relationship between severity of peripheral neuropathy and degree of depression of paraesthetic response.Post-ischaemic paraesthesia has been used in the evaluation of peripheral nerve function in many diseases including intoxication, vitamin deficiencies, alcoholism, malignant disease, and diabetes mellitus (Poole, 1956b); chronic liver disease (Seneviratne and Peiris, 1970); uraemia (Christensen and 0rskov, 1969); and motor-neurone disease (Shahani and Russell, 1969). However, in pellagra. where neurological manifestations are quite common, no such study is available. MethodsFifty patients with pellagra admitted to the General Hospital, Udaipur and 20 healthy control subjects of identical age and sex were studied. The diagnosis of pellagra was made on clinical grounds and was confirmed by decreased 24 hour urinary excretion of N' methyl nicotinamide (less than 2 mg). The N' methyl nicotinamide was estimated by the technique of Sarett (1943 In all subjects vascular occlusion was effected by rapid inflation of an ordinary sphygmomanometer cuff to a pressure of 60 mmHg above the resting systolic blood pressure. This was maintained for 20 minutes and then the cuff pressure was released. All subjects were instructed at the beginning of the vascular occlusion to report the time of onset, nature, and time of cessation of any subjective sensations that they experienced during the ischaemic and post-ischaemic periods. During the post-ischaemic period they were reminded at regular intervals of the need to report the details of any paraesthesiae experienced, special attention being paid to the 'pins and needles' type of postischaemic paraesthesia.A quantitative assessment of the 'pins and needles' paraesthesia was made by determining a post-ischaemic paraesthesiae (PIP) index (Seneviratne et al., 1973). For calculating the PIP index a PIP score was determined depending upon the intensity of paraesthesiae as described below and then this score was multiplied by the duration in minutes of 'pins and needles' paraesthesia. The reasons for selecting 'pins and needles' paraesthesia alone for determining the PIP score were its easy recognition, constancy, reliability, and reproducibility.

Section: Resultssupporting

confidence: 73%

Post-ischaemic paraesthesia in pellagrins.

Bomb¹,

Bedi²,

Bhatnagar³

1977

“…Further evidence that the resistance of a nerve to ischaemia is determined by the ionic microenvironment of the axon is provided by the observations of Gregersen and Pilgaard (1971). They recognized that the serum calcium ion concentration was also a factor determining the resistance of nerve to ischaemia; hypercalcaemic states being associated with an increase of inactivation time.…”

Section: Discussionmentioning

confidence: 99%

“…The pathogenesis and nature of this change are quite unknown. Although segmental demyelination of peripheral nerve is commonly associated with the increased resistance of nerve to ischaemia, the experimental observations of Seneviratne and Peiris (1968b) and Gregersen and Pilgaard (1971) show that increased resistance to ischaemia does not necessarily follow demyelination and, conversely, that nerves which exhibit no clinical or conventional electrophysiological evidence of dysfunction may exhibit increased resistance to inactivation by ischaemia. This view is supported by the results of this study which show no consistent relationship between the presence of neuropathy and diminution of the paraesthetic response.…”

Section: Discussionmentioning

confidence: 99%

Post-ischaemic paraesthesiae in diabetes mellitus

Seneviratne

Senanayake

Nimalasuriya

1973

SUMMARY A quantitative assessment of post-ischaemic paraesthesiae has been made in 50 diabetic subjects and in a group of healthy age-matched controls. The results show a highly significant diminution of the paraesthetic response in the diabetic subjects. The degree of depression of the paraesthetic response was associated with the duration of the disease and the severity of the metabolic abnormality as determined by the degree of insulin dependence. Diabetics with the juvenile onset type of the disease were more adversely affected than those with the maturity onset type. There was no consistent relationship between the degree of depression of the paraesthesiae and the presence of peripheral neuropathy. The significance of these results is discussed in relation to the factors which determine the composition of the ionic micro-environment of myelinated nerve and the level of electrical excitability of the nerve fibre.

“…This was shown in diabetic patients for vibratory perception (Steiness, 1959), and has later been demonstrated for touch and pain as well (Gregersen, 1968). The phenomenon has also been demonstrated in patients with uraemia (Christensen and 0rskov, 1969), chronic hepatic failure (Seneviratne and Peiris; 1970), and hypercalcaemia (Gregersen and Pilgaard, 1971). In a previous study, we reported that vibratory perception was abnormally preserved during ischaemia in 18 out of 33 patients (540 %) with severe hepatic failure .…”

mentioning

confidence: 79%

“…However, previous studies have shown that an abnormal glucose tolerance was not a precondition for increased ischaemia resistance, neither in uraemia (Christensen and Orskov, 1969) nor in chronic hepatic failure (Seneviratne and Peiris, 1970;Kardel and Nielsen, 1974). (2) The increased ischaemia resistance in patients with hypercalcaemia has been referred to a calcium-ion dependent decrease of the sodium permeability through the ischaemic axon membrane (Gregersen and Pilgaard, 1971). This mechanism is hardly relevant in patients with chronic hepatic failure where the ionized calcium concentration is normal or slightly decreased (Moore, 1971).…”

Section: Discussionmentioning

confidence: 99%

Delayed decrement of the nerve impulse propagation during induced limb ischaemia in chronic hepatic failure.

Nielsen¹,

Kardel²

1975

SYNOPSIS Sensory thresholds for vibrations and electrical shocks and the sensory nerve conduction velocity (median nerve) were measured during 30 minutes of induced limb ischaemia in 10 normal subjects and 15 patients with chronic hepatic failure. Sensory action potentials were recorded simultaneously at the wrist and the elbow. Seven patients (group A) had a normal perception time for vibrations. As in normal subjects, the potential amplitude decreased from the onset of ischaemia, more pronounced at the elbow than at the wrist, and the conduction velocity became reduced more rapidly in the wrist-elbow than in the first digit-wrist segment, indicating impulse propagation with decrement. Eight patients (group B) had a markedly prolonged perception time for vibrations. The reduction of potential amplitude and conduction velocity was considerably delayed, and the impulse propagation showed no evidence of decrement for 20-25 minutes of ischaemia. A rise of the threshold for electrical shocks was absent or very delayed. As in the two other groups, the rise was abrupt and occurred at the moment when the potential below the occluding cuff (elbow) was extinct. In both groups of patients there was an increasing temporal dispersion of action potentials and in patient group A a desynchronization of the late phase of the potential took place early in the course of ischaemia. Differences between groups A and B could not be predicted from the pre-ischaemic nerve conduction data.Peripheral nerve function during ischaemia is sometimes better preserved in patients with certain metabolic disorders than in normal subjects. This was shown in diabetic patients for vibratory perception (Steiness, 1959), and has later been demonstrated for touch and pain as well (Gregersen, 1968). The phenomenon has also been demonstrated in patients with uraemia (Christensen and 0rskov, 1969), chronic hepatic failure 1970), and hypercalcaemia (Gregersen and Pilgaard, 1971). In a previous study, we reported that vibratory perception was abnormally preserved during ischaemia in 18 out of 33 patients (540 %) with severe hepatic failure . The present paper further extends this study by an