High prevalence of major neurological disorders in two Albanian communities: results of a door-to-door survey.

Background: There are few epidemiological studies on neurological disorders in Albania.

Methods: A door-to-door survey was undertaken in two geographical areas (Tirana and Saranda) with different socioeconomic backgrounds. Two random samples of the local population underwent a structured interview to ascertain headache, epilepsy, dementia, parkinsonism, multiple sclerosis, polyneuropathy, stroke and cerebral palsy.

Spinal subarachnoid bleeding of unknown etiology. Case reports.

Spinal subarachnoid bleeding of unknown etiology is extremely rare. It has been suggested that these lesions have to be divided into two subtypes with different behaviour and prognosis according to their location around the spinal cord. The dorsally located bleeding would invariably cause severe spinal cord compression while the ventral lesions would have a very benign course in the absence of remarkable neurological deficit.

Local versus central assessment of venographies in a multicenter trial on the prevention of deep vein thrombosis in neurosurgery.

Venography is the diagnostic method of choice for end-point measurement in multicenter trials on the prevention of postoperative deep vein thrombosis (DVT). The aim of the study was to determine the inter-observer agreement between the local and central assessment of venographies in a multicenter trial comparing enoxaparin and placebo in the prevention of DVT after elective neurosurgery. The study was run in seven centers experienced in venography trials on DVT prevention.

High prevalence of antiphosphatidylinositol antibodies in young patients with cerebral ischemia of undetermined cause.

Background And Purpose: Anticardiolipin antibodies (aCL) are associated with thrombotic phenomena including cerebral ischemia in young adults. Although aCL are directed to a neoepitope formed by phospholipid and beta2-glycoprotein I (beta2-GPI), immunoassays based on cardiolipin as target antigen are widely used. We previously demonstrated that 47% of aCL-negative systemic lupus erythematosus (SLE) patients had antiphospholipid antibodies (aPL) to epitopes other than cardiolipin, and we found an association between aPL to noncardiolipin antigens and thrombosis.

Special types of periodic lateralized epileptiform discharges associated with confusional state in cerebral circulation insufficiency.

A peculiar type of periodic lateralized epileptiform discharges (PLEDs) was recorded on 22 EEGs performed in 11 patients. They were characterized by bursts of sinusoid activity around 7-9 Hz, usually followed by a slow wave, lasting less than 500 ms, with a period less than 2 s, and these sequences could be continuous over several days. We propose to name this pattern 'periodic sinusoid paroxysmal activity' (PSPA).

Brain stem abscess treated successfully by medical therapy.

A case of a solitary brain stem abscess in a 55-year-old man is presented. The computed tomographic scan and clinical picture allowed the presumptive diagnosis to be made. The abscess resolved completely after treatment with chloramphenicol, vancomycin, and ceftazidime administered intravenously.

Chronic-relapsing polyneuropathy in the course of cryoglobulinemia. Clinical aspects and plasmapheretic treatment.

During the last 3 years we have observed 7 cases (4.1%) of cryoglobulinemia-associated polyneuropathy out of 167 patients with demonstrated cryoglobulinemia. Nerve involvement in the course of cryoglobulinemia is usually symmetrical, affecting the distal portions of the limbs and has a chronic or chronic-relapsing evolution.

A critical approach to therapeutic apheresis in the management of inflammatory dysimmune polyneuropathies.

Data concerning 37 patients with inflammatory dysimmune polyneuropathy treated by discontinuous flow centrifugation, membrane plasma separation and cascade filtration are presented. Plasmapheresis was combined with immunosuppressants in patients with chronic or relapsing neuropathy (8 patients), cryoglobulinemic (6 patients) and paraneoplastic disease (2 patients), whereas 21 patients with acute Guillain-Barré syndrome (GBS) underwent exclusively plasmapheresis. Most patients were treated during the onset or progression of their disease and excellent or satisfactory clinical results were obtained in 18 patients with GBS, 6 with cryoglobulinemia, 2 with paraneoplastic disease and 4 with chronic relapsing polyneuropathy.

Plasmapheresis combined with lymphocytapheresis and cytotoxic drugs as a therapeutic modality in neuroimmunological diseases.

Rebound after plasmapheresis is thought to be due to enhanced antibody and/or immune complex production. To prevent rebound a combination of steroids and immunosuppressive drugs has been used: lymphocytapheresis was employed in most patients, for not more than 10 sessions. 50 patients with myasthenia gravis, inflammatory myopathy, chronic dysimmune polyneuropathy and immune complex polyneuropathy have been treated and long-lasting benefits obtained in 35 patients.

Plasma-exchange in neurological diseases.

This paper summarizes experience with plasma-exchange therapy for neurological diseases at the Saronno hospital. Most treatments were performed by discontinuous flow centrifugation, but membrane plasma separation and cascade filtration were also employed. Eighty-five patients with demyelinating diseases of the peripheral nervous system (Guillain-Barré syndrome, immune complex polyneuropathies, paraneoplastic polyneuropathies), demyelinating diseases of the central nervous system (multiple sclerosis, subacute sclerosing panencephalitis), dermatopolymyositis and myasthenia gravis have been treated so far.

Plasma exchange combined with cytotoxic drugs and lymphocytapheresis for myasthenia gravis.

20 patients with myasthenia gravis (MG), refractory to anticholinesterase and steroid therapy, underwent plasma exchange therapy combined with immunosuppressive drugs and lymphocytapheresis. In all these patients an apparent clinical improvement was obtained since their first exchange session. During a follow-up of 8-18.

Plasmapheresis in the treatment of four cases of Guillain-Barré syndrome (acute form).

Four patients with GBs were treated by PE. In all cases the treatment was successful in that it halted the progression of the disease, induced regression of the signs of bulbar impairment, ventilatory failure and cranial nerve paralysis and improved motility. In all instances the response was quicker for the nerves affected last.

[The predictive value of serial scintigraphy and computerized tomography in the diagnosis of brain lesions (author's transl)].

Six characteristic initial clinical neurological patterns were defined and their incidence was determined in one year caselist of patients hospitalized in the Neurology Department of the General Hospital of Saronno. Since the predictive value of a diagnostic procedure depends not only on sensitivity and specificity but also on the prevalence of disease in the population sampled, the prevalence of surgical brain lesions was evaluated retrospectively in this caselist for each of the clinical patterns previously defined, in order to evaluate the predictive value of serial brain scintigraphy and of brain computerized tomography. In this caselist the most frequent clinical patterns (stroke, skull trauma) show a low prevalence of surgical lesions, unlike it happens in the Neurosurgery Department of another hospital chosen as reference.

Plasma exchange as a therapy for Guillain-Barré syndrome with immune complexes.

Small volume plasma exchange (PE) was evaluated in 6 patients with acute Guillain-Barré syndrome (GBS) and in 1 with its chronic relapsing type. Patients were treated during the onset or progression of their neurologic involvement and no other combined therapy was provided. 6 of our patients had clear benefit following the first session.

Plasma exchange in the management of patients with multiple sclerosis: preliminary observations.

Since humoral factors have been implicated in the pathogenesis of multiple sclerosis (MS) and previous attempts at therapeutic intervention have not met with uniform success, plasma exchange (PE) was recently proposed for the management of this disease. We are currently investigating the possible effectiveness of PE in the treatment of MS, and to date 6 patients have been entered into the study. At least 4 of our patients who did not respond to conventional therapy have shown unequivocal, moderate to marked improvement following the first session of PE.

Successful treatment by plasma exchange in Guillain-Barré syndrome with immune complexes.

A 18-year-old woman in the 7th month of pregnancy had a mild enteritis followed within 8 days by a typical Guillain-Barré syndrome with respiratory failure requiring ventilatory support and bulbar palsy. After induction of delivery and discouraging results with steroid therapy, she was treated by plasma exchange. After 2 sessions on alternate days, a recovery of motility was observed and respiratory failure was abolished.