Developing functional outcome measures for unilateral neglect: a pilot study.

Stroke patients may develop personal neglect, peripersonal neglect or both. Four new measures were tested in a sample of 42 right-handed inpatients (25 male; 17 female, median age 72 years). Participants removed keys from a rack, identified grocery items, washed their face, and cleaned a tray.

Uncovertebral joint injury in cervical facet dislocation: the headphones sign.

The purpose of our study is to demonstrate the uncovertebral mal-alignment as a reliable indirect sign of cervical facet joint dislocation. We examined the uncovertebral axial plane alignment of 12 patients with unilateral and bilateral cervical facet joint dislocation (UCFJD and BCFJD, respectively), comparing its frequency to the reverse hamburger bun sign on CT and MR axial images. Of the seven cases with BCFJD, five clearly demonstrated the diagnostic reverse facet joint hamburger bun sign on CT and MR images, but in two cases this sign was not detectable.

Infections and Kawasaki disease: implications for coronary artery outcome.

Objective: We sought to determine the effect of coincident infection, at time of diagnosis of Kawasaki disease (KD), on treatment response and coronary artery outcome.

Methods: A single-center, retrospective study of 129 consecutive patients diagnosed with typical KD between January 1997 and December 1998 was performed. Standardized clinical assessments, laboratory, microbiology, and imaging test results plus treatment regimens were reviewed.

The effectiveness of treating juvenile dermatomyositis with methotrexate and aggressively tapered corticosteroids.

Objective: Childhood dermatomyositis (DM) is often a chronic disease, lasting many years. It has traditionally been treated with long-term corticosteroid therapy; side effects are often seen. For more than a decade, methotrexate (MTX) has been safely used for the treatment of juvenile arthritis.

A randomised phase II study of interleukin-1 receptor antagonist in acute stroke patients.

Objectives: The cytokine interleukin (IL)-1 mediates ischaemic brain damage in rodents. The endogenous, highly selective, IL-1 receptor antagonist (IL-1ra) protects against ischaemic cerebral injury in a range of experimental settings, and IL-1ra causes a marked reduction of cell death when administered peripherally or at a delay in transient cerebral ischaemia. We report here the first randomised, double blind, placebo controlled trial of recombinant human IL-1ra (rhIL-1ra) in patients with acute stroke.

Interleukin-1 and neuronal injury.

Interleukin-1 is a pro-inflammatory cytokine that has numerous biological effects, including activation of many inflammatory processes (through activation of T cells, for example), induction of expression of acute-phase proteins, an important function in neuroimmune responses and direct effects on the brain itself. There is now extensive evidence to support the direct involvement of interleukin-1 in the neuronal injury that occurs in both acute and chronic neurodegenerative disorders. This article discusses the key evidence of a role for interleukin-1 in acute neurodegeneration - for example, stroke and brain trauma - and provides a rationale for targeting the interleukin-1 system as a therapeutic strategy.

Chance-type flexion-distraction injuries in the thoracolumbar spine: MR imaging characteristics.

Purpose: To evaluate retrospectively the magnetic resonance (MR) imaging features of Chance-type flexion-distraction injuries.

Materials And Methods: The authors' institutional review board does not require its approval or patient informed consent for retrospective studies. Imaging data were reviewed retrospectively for 24 patients (15 male, nine female; mean age, 28 years; range, 9-71 years) who had sustained radiographically typical Chance-type flexion-distraction injuries.

Angiography-negative primary central nervous system vasculitis in children: a newly recognized inflammatory central nervous system disease.

Inflammatory central nervous system (CNS) diseases in childhood comprise a wide spectrum of heterogeneous conditions. We studied 4 children with primary CNS vasculitis in whom results of magnetic resonance imaging studies were abnormal but results of conventional angiography were normal. We determined that angiography-negative, biopsy-confirmed primary small-vessel CNS vasculitis is a previously unrecognized distinct disease entity in children.

Feline immunodeficiency virus diagnosis after vaccination.

Prior to the widespread use of vaccination for the control of feline immunodeficiency virus (FIV) infection, diagnosis was made by the detection of antibodies against FIV. A number of commercial animal side tests perform quite well for this determination, with positive predictive values between 91 and 100% and negative predictive values between 96 and 100%. Furthermore, results of these tests could be confirmed by western blot analysis of FIV test-positive sera.

Follow-up imaging of the urinary tract in spinal injury patients: is a KUB necessary with every ultrasound?

Study Design: Prospective study of 100 consecutive patients.

Objectives: To evaluate the diagnostic usefulness of the urinary tract (KUB) radiograph routinely performed as part of spinal injury patient urinary tract screening with ultrasound (US) and the KUB radiograph.

Setting: Orthopaedic and District General Hospital with spinal injuries unit, UK.

Reliability of a semi-automated technique of cerebral infarct volume measurement with CT.

Background: A reliable method of infarct volume measurement is needed if infarct volume is to be used as an outcome measure in clinical stroke trials. We investigated the reproducibility of a semi-automated method of computed tomography (CT) infarct volume measurement amongst three stroke research fellows with no formal neuroradiology training and two consultant neuroradiologists.

Methods: CT brain scans for volumetric analysis were performed at 5 to 7 days in 34 patients with acute ischaemic stroke, of which 28 scans showed visible recent infarction.

Awareness of dysphagia by patients following stroke predicts swallowing performance.

Patients' awareness of their disability after stroke represents an important aspect of functional recovery. Our study aimed to assess whether patient awareness of the clinical indicators of dysphagia, used routinely in clinical assessment, related to an appreciation of "a swallowing problem" and how this awareness influenced swallowing performance and outcome in dysphagic stroke patients. Seventy patients were studied 72 h post hemispheric stroke.

Peak plasma interleukin-6 and other peripheral markers of inflammation in the first week of ischaemic stroke correlate with brain infarct volume, stroke severity and long-term outcome.

Background: Cerebral ischaemia initiates an inflammatory response in the brain and periphery. We assessed the relationship between peak values of plasma interleukin-6 (IL-6) in the first week after ischaemic stroke, with measures of stroke severity and outcome.

Methods: Thirty-seven patients with ischaemic stroke were prospectively recruited.

An early and sustained peripheral inflammatory response in acute ischaemic stroke: relationships with infection and atherosclerosis.

Central nervous system and peripheral inflammation is important in the responses to ischaemic stroke, and may also predispose to its development. We aimed to identify (1) the extent to which a peripheral inflammatory response is activated in patients following acute stroke, and (2) whether there was evidence for preexisting peripheral inflammation. Thirty-six patients with ischaemic stroke within 12 h of onset of symptoms had serial blood samples taken up to 12 months for analysis of markers of inflammation.

Inflammation and infection in clinical stroke.

Stroke has enormous clinical, social, and economic implications, and demands a significant effort from both basic and clinical science in the search for successful therapies. Atherosclerosis, the pathologic process underlying most coronary artery disease and the majority of ischemic stroke in humans, is an inflammatory process. Complex interactions occur between the classic risk factors for atherosclerosis and its clinical consequences.

The diagnostic accuracy of MR imaging in osteoid osteoma.

Objective: To analyse the MR imaging appearances of a large series of osteoid osteomas, to assess the ability of MR imaging to detect the tumour, and to identify potential reasons for misdiagnosis.

Design And Patients: The MR imaging findings of 43 patients with osteoid osteoma were reviewed retrospectively and then compared with other imaging modalities to assess the accuracy of MR localisation and interpretation.

Results: The potential for a missed diagnosis was 35% based solely on the MR investigations.

Magnetic resonance imaging assessment for unicompartmental knee replacement: a limited role.

The purpose of this study was to see if MRI has a role in pre-operative assessment of patients for unicompartmental knee replacement. Until now, surgeons have been unable to predict whether a patient is suitable until the operation itself when the anterior cruciate ligament is inspected. We found that 33% of patients with anteromedial osteoarthritis had a degenerate anterior cruciate ligament according to magnetic resonance imaging, compared to only 13% on surgical inspection.

MRI detection of unsuspected vertebral injury in acute spinal trauma: incidence and significance.

Objective: Multilevel spinal injury is well recognised. Previous studies reviewing the radiographs of spinal injury patients have shown an incidence of 15.2% of unsuspected spinal injury.

Dementia with Lewy bodies studied with positron emission tomography.

Objective: To report a case initially fulfilling the clinical criteria for probable Alzheimer disease, although later clinical features suggested dementia with Lewy bodies. Oxygen 15-labeled positron emission tomograms revealed a pattern of hypometabolism characteristic of Alzheimer disease. At post mortem, there was no evidence of the pathological features of Alzheimer disease, but diffuse cortical Lewy bodies were seen in the pigmented brainstem nuclei and cerebral cortex.

Post stroke shoulder pain: more common than previously realized.

Stroke is a common disease often requiring rehabilitation, which may be prolonged by shoulder pain. The true incidence of post stroke shoulder pain has not been fully evaluated. In order to establish this, we undertook a prospective study of 123 consecutive patients with a diagnosis of acute stroke during a 6-month period.