Report from a Consensus Conference on the treatment of Ménière's disease with betahistine: rationale, methodology and results.

Ménière's disease is a disorder of the inner ear that causes vertigo, tinnitus, fullness and hearing loss. Although several treatments are available, the success rate is reported to be around 70%, similar to placebo. Betahistine, a weak H1 receptor agonist and an effective H3 receptor antagonist, is frequently prescribed for Ménière's disease, especially to reduce recurrent vertigo attacks.

Cross-cultural adaptation and validation of the Italian version of the patient-rated wrist/hand evaluation questionnaire.

An Italian version of the patient-rated wrist/hand evaluation (PRWHE) questionnaire was obtained through the standardized process of cross-cultural adaptation. The PRWHE-Italian (IT) was tested on 63 patients in order to evaluate comprehension, reliability and validity as correlated to the validated version of the disabilities of the arm shoulder and hand (DASH)-IT and SF-36. No patients had difficulty completing the PRWHE-IT questionnaire.

Novel three-stage ascertainment method: prevalence of PD and parkinsonism in South Tyrol, Italy.

Background: A number of community-based studies on the prevalence of PD have been conducted worldwide, but they are often extremely costly and time consuming.

Objective: To assess the prevalence of PD and parkinsonism for the population aged between 60 and 85 years in South Tyrol, Northern Italy, using a novel population-based three-stage ascertainment method.

Methods: Seven hundred fifty persons aged 60 to 85 years from South Tyrol received a validated screening mail questionnaire for parkinsonism.

Validation of a mail questionnaire for parkinsonism in two languages (German and Italian).

As part of a larger epidemiological study [Neuro-Epidemiology Project South-Tyrol (NEPT)], we investigated the accuracy of a mail questionnaire for parkinsonism in two languages (German and Italian). We administered the instrument to 40 randomly selected subjects with parkinsonism (Italian-speaking, n = 20; German-speaking, n = 20), attending our Parkinson's disease clinic regularly. Each patient was matched by age, sex and language with a subject without parkinsonism residing in the same South-Tyrol Province in Northern Italy.

Correlation of segmental carpal tunnel pressures with changes in hand and wrist positions in patients with carpal tunnel syndrome and controls.

We investigated pressures at 1 cm intervals along the carpal tunnel in 39 patients with carpal tunnel syndrome (CTS) and 12 controls. Pressures were measured for relaxed and gripping hand positions in combination with neutral, extended, and flexed wrist positions. Patient pressures exceeded control pressures, were below the previously reported 30 mmHg threshold for four of five locations in the relaxed neutral position and were typically greater in extension than in flexion.

Serial overnight recordings of intracarpal canal pressure in carpal tunnel syndrome patients with and without wrist splinting.

In 15 carpal tunnel syndrome patients pressure was measured during the day and at 2-hourly intervals from midnight to 6 a.m., via a catheter introduced into the carpal canal, using the constant infusion technique.

Compartment syndrome of the scapula. Definition on clinical, neurophysiological and magnetic resonance data.

Compartment syndromes of the scapula and pelvic girdle have received scant attention in the literature. In 1938, Comolli first described a clinical sign which he considered specific to fracture of the scapula. We report data on two patients, one presenting with prolonged pressure on the posterior surface of the scapula and the other with symptoms associated with scapular fracture.

Neurophysiological assessment of the early phases of carpal tunnel syndrome with the inching technique before and during operation.

In 14 patients with early carpal tunnel syndrome, the diagnostic sensitivity of the measurement of the segmental sensory nerve conduction velocity at 1 cm. steps ("inching") was compared with the distal sensory latency and the pre-operative wrist-digit and wrist-palm S.C.

Carpal tunnel syndrome: correlations between pressure measurement and intraoperative electrophysiological nerve study.

In 19 carpal tunnel syndrome (CTS) patients and 4 control subjects a catheter was introduced into the carpal tunnel and slowly retracted in 5 mm steps. Pressure was measured with the continuous infusion technique. In the same group of patients and controls, median nerve antidromic sensory action potential (aSAP) was detected intraoperatively stimulating proximally (S1), in the center (S2), and distally (S3) to the carpal tunnel and recording from the third finger (R).

Influence of occupational styrene exposure on memory and attention.

Short-term memory, perceptual speed, attention and psychomotor function were studied in 55 workers professionally exposed to styrene. The subjects were grouped according to their urinary styrene metabolites. Those with higher styrene exposure showed a significant impairment of short-term memory only.

Carpal-tunnel pressure.

Using the constant infusion technique, we have measured the pressures within the carpal tunnel in 30 hands in patients with carpal tunnel syndrome and in 4 hands in control subjects. The mean pressure in the normal, control subjects was 13 mmHg and in the carpal tunnel syndrome patients 26 mmHg. In the normal subjects the pressures did not change along the canal, whereas in the patients the values in the middle section were 50 percent higher than the mean.

Parkinsonism in the presence of intracranial extracerebral haematomas.

Bilateral Parkinsonism has been observed in a 60-year-old female with a chronic subdural intracranial haematoma. Scattered, poorly marginated, hypodense areas within the ipsilateral pallidus and putamen were evident on the preoperative CT scans. The rapid neurological improvement following the surgical drainage of the subdural clot and the evolution of the densitometric features of the nuclear lesions, which became clear-cut, though smaller, in the following months, suggest a cause-and-effect relation between the haematoma and the clinical symptomatology.

Assessment of sensory nerve conduction in carpal tunnel syndrome before, during and after operation.

Sensory conduction velocities of the median nerve before, during and after operation were compared in nine patients with carpal tunnel syndrome and four controls, in order to evaluate the prognostic value of the pre-operative and intra-operative findings. Sensory conduction velocity was higher after operation than before in all patients (mean difference 31.33%), but not in control subjects.

Anxiety and depression after mild head injury: a case control study.

Thirty-five patients and corresponding matched controls were investigated between 5 and 17 months from mild head trauma using the Self Rating Depression Scale and the State-Trait Anxiety Inventory. The findings indicate that compared with an appropriate control group mild head injured patients are at risk of developing depression, whereas their liability to anxiety is not increased. Our results strongly suggest that all head injured patients should be screened for depression.

Prognostic value of auditory brain-stem responses for late postconcussion symptoms following minor head injury.

Minor head injury is frequently followed by a subjective postconcussion syndrome. Brain-stem auditory evoked responses (BAER's) were found to be pathological in different small series of patients with a postconcussion syndrome who were examined months after sustaining a slight cranial or cervical trauma; abnormal BAER's have also been reported in larger groups of patients examined early after minor head injury. A relationship between these findings and late subjective symptoms has never been demonstrated.

Longitudinal study of auditory brain-stem response in patients with minor head injuries.

In a longitudinal study of 119 patients with minor head injuries, 13 had abnormal auditory brain-stem responses (ABRs) within 48 hours after trauma. At follow-up examination one month later, ten patients had abnormal ABRs. The ABRs remained stable in most patients; in nine patients they normalized.

[Value of neuropsychologic tests and acoustic evoked brain stem potentials in the prognosis of subjective complaints in patients with brain concussion].

Neuropsychological impairment and pathologically delayed Acoustic Brain stem Responses (ABR) have been found in patients examined after minor head injury. The relation of these alterations with the emergence of post-concussional symptoms is unknown. In this study 27 patients were examined with ABR within 48 hours of a clearly defined head injury and with a complete neuropsychological test battery one month after the trauma.

Neurophysiological and CSF immunological study of 19 patients affected by acute idiopatic optic neuritis.

We studied 19 patients affected by acute idiopatic optic neuritis (ON), with neurophysiological tests: visual (VEP), somatosensory (SSEP), acoustic (ABR) evoked potentials and study of the blink reflex (BR), and with cerebrospinal fluid (CSF) examination, in order to detect "silent" lesions in the central nervous system (CNS) and/or immunological alterations, suggestive of multiple sclerosis (MS). The percentage of cases with at least one altered CSF IgG parameter (IgG index, IgG synthesis/day and IgG oligoclonal bands) has been higher than that of cases with one or more altered neurophysiological tests, regardless of the apparently intact eye VEP. If we also included this last test, the 2 percentages become identical.

Muscle CT, biopsy and EMG in diagnosis of neuromuscular diseases.

The diagnostic value of EMG and muscle biopsy has been compared with muscle CT in 53 patients with neuromuscular diseases. CT concordance with clinical diagnosis was found in 62% of myopathies and was highest in Duchenne PMD and scapulo-peroneal myopathy and very low in metabolic and inflammatory myopathies. In neurogenic diseases muscle CT agreed with clinical diagnosis in 63% of patients: the highest concordance was found in acquired polyneuropathies.

Lumbosacral herpes zoster myelitis.

We present a case of herpes zoster (HZ) with some uncommon features, namely lumbar localization and muscle weakness with a distribution different from the site of cutaneous eruptions and sensory deficits. Spread of HZ virus from sensory ganglion to anterior horn cells seems the only possible explanation of these clinical features. Urinary retention and CSF data confirm the hypothesis of HZ myelitis.

Auditory brain stem responses in the prognosis of late postconcussional symptoms and neuropsychological dysfunction after minor head injury.

Thirty patients suffering from minor head injury were examined with auditory brain stem responses (ABR), neuropsychological tests for assessment of higher nervous functions, and a questionnaire on postconcussional symptoms. Comparison of the 6 patients with altered ABR with the other 24 showed no statistical difference in either the number of long-lasting postconcussional symptoms or the scores on neuropsychological tests. Subclinical brain stem involvement as shown by ABR does not seem to correlated with impaired mental function or symptoms of the postconcussion syndrome.

[Post-traumatic amnesia in the evaluation of minor cranial injuries].

Quantitative assessment of brain damage is a primary condition for studies in neurotraumatology. Scored clinical evaluation, neurophysiological and neuroimaging techniques are usefully applied in highly disabled or comatose patients. In minor head injury (MHI), where focal neurological signs are excluded by definition, quantification of brain dysfunction is still uncertain.