1/11. Discrepancy between dysmetric centrifugal movements and normometric centripetal movements in psychogenic ataxia.A method to unravel an aberrant motor behaviour in psychogenic ataxia is reported. The kinematic features of fast reaching movements in the vertical plane are described in a patient presenting a psychogenic ataxia. The procedure compared centrifugal and centripetal movements. Path ratios were computed for each phase, as well as the ratios of the paths for centrifugal and centripetal directions. Trajectories of centrifugal phases were erratic but centripetal movements were very regular, whereas both centripetal and centrifugal movements were irregular in patients presenting an organic cerebellar syndrome. A similar incongruity between movements in opposite directions is also shown for a second patient exhibiting psychogenic ataxia. Discrepancies between the centrifugal phase and the centripetal phase of multi-joint reaching movements support the diagnosis of a psychogenic movement disorder.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
2/11. Immune mediated chorea encephalopathy syndrome in childhood.We report four previously healthy female children, aged between 3 and 8 years, who presented with encephalopathy and an extrapyramidal movement disorder (chorea n=4, rigidity n=2, oculogyric crisis n=2). In addition, an acute behavioural disturbance occurred in two patients and mutism in two others. seizures heralded the onset of the illness in three patients. Acute MRI was either normal or initially normal with later generalized cerebral atrophy. All infective (including streptococcus), biochemical, and metabolic investigations were normal, although all four patients had oligoclonal bands in the (CSF) but not the serum, indicating intrathecal immunoglobulin synthesis. All four children made an apparently full recovery within four months of the onset.We suggest that these patients represent an immune-mediated movement disorder and encephalopathy syndrome.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
3/11. Delayed postanoxic encephalopathy after carbon monoxide poisoning.Delayed postanoxic encephalopathy causes deterioration and relapse of cognitive ability and behavioural movement a few weeks after complete recovery from initial hypoxic injury. A case is reported of delayed postanoxic encephalopathy after carbon monoxide poisoning, which was diagnosed with diffusion weighted magnetic resonance imaging. The literature is also reviewed.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
4/11. Failure of metacontrol: breakdown in behavioural unity after lesion of the corpus callosum and inferomedial frontal lobes.A right-handed man suffered aneurysmal haemorrhage with lesions of the genu and body of the corpus callosum and the inferomedial frontal lobes bilaterally (right more than left). He exhibited remarkable breakdown in behavioural unity characterized by conflict between the two sides of the body, actions inconsistent with verbalizations, and internal conflict over control of the left hand. A major feature of the deficit was its temporal variability. This is interpreted as reflecting intermittent failure of metacontrol processes, which are neural mechanisms for maintaining behavioural unity. Medial frontal structures and their interconnections through the corpus callosum appear particularly important in the maintenance of metacontrol.- - - - - - - - - - ranking = 6keywords = behaviour (Clic here for more details about this article) |
5/11. diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism.low back pain (LBP) is a very common but largely self-limiting condition. The problem arises however, when LBP disorders do not resolve beyond normal expected tissue healing time and become chronic. Eighty five percent of chronic low back pain (CLBP) disorders have no known diagnosis leading to a classification of 'non-specific CLBP' that leaves a diagnostic and management vacuum. Even when a specific radiological diagnosis is reached the underlying pain mechanism cannot always be assumed. It is now widely accepted that CLBP disorders are multi-factorial in nature. However the presence and dominance of the patho-anatomical, physical, neuro-physiological, psychological and social factors that can influence the disorder is different for each individual. classification of CLBP pain disorders into sub-groups, based on the mechanism underlying the disorder, is considered critical to ensure appropriate management. It is proposed that three broad sub-groups of CLBP disorders exist. The first group of disorders present where underlying pathological processes drive the pain, and the patients' motor responses in the disorder are adaptive. A second group of disorders present where psychological and/or social factors represent the primary mechanism underlying the disorder that centrally drives pain, and where the patient's coping and motor control strategies are mal-adaptive in nature. Finally it is proposed that there is a large group of CLBP disorders where patients present with either movement impairments (characterized by pain avoidance behaviour) or control impairments (characterized by pain provocation behaviour). These pain disorders are predominantly mechanically induced and patients typically present with mal-adaptive primary physical and secondary cognitive compensations for their disorders that become a mechanism for ongoing pain. These subjects present either with an excess or deficit in spinal stability, which underlies their pain disorder. For this group, physiotherapy interventions that are specifically directed and classification based, have the potential to impact on both the physical and cognitive drivers of pain leading to resolution of the disorder. Two case studies highlight the different mechanisms involved in patients with movement and control impairment disorder outlining distinct treatment approaches involved for management. Although growing evidence exists to support this approach, further research is required to fully validate it.- - - - - - - - - - ranking = 2keywords = behaviour (Clic here for more details about this article) |
6/11. Nuclear magnetic resonance in adrenoleukodystrophy: report of a case.The nuclear magnetic resonance images obtained in a case of adrenoleukodystrophy are presented. The areas of demyelination are clearly seen. The T1 values of the affected areas are not specific and coincide with those previously recorded in the lesions of multiple sclerosis or cerebrovascular disease. A diagnosis of adrenoleukodystrophy should be considered in younger male patients presenting with behavioural disturbances, especially when these are associated with abnormalities of vision or gait. There may be no clinical evidence of the associated adrenocortical insufficiency.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
7/11. Further observations on the "bobble-headed doll syndrome".Two patients are presented with a head-bobblng "tic" classically associated with a suprasellar cyst. The first of these showed hypothalamic, neuroendocrinological and limbic abnormalities not previously described, although with a classic arachnoidal suprasellar cyst. The second of these patients showed head-bobbling behaviour during the first years of life as a manifestation of one out of many episodes of ventricular shunt obstruction. This case is therefore the first reported whose head bobbling was observed with an acute lesion.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
8/11. iron deficiency in two adolescents with conduct, dysthymic and movement disorders.Enquiry into a marginally subnormal hemogram in two adolescents with complex conduct, dysthymic and movement disorders uncovered a striking iron deficiency and prompted a trial of replacing psychotropic medication with iron therapy. The rationale of iron therapy for behavioural disturbance was examined from the clinical, neurochemical and psychopharmacological points of view. Although further study is required to confirm the therapeutic efficacy and to define the precise nature of iron deficiency in conduct disorder, the weight of the evidence suggests that correcting the nutrient deficit may be an essential step toward a refinement of therapeutic strategies. The presence of a borderline hemogram, hypermenorrhea and malnutrition should alert clinicians to the possibility of iron deficiency, and laboratory screening for hypoferremia should be considered when assessing conduct disorder.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
9/11. Global spatial disorientation. Clinico-pathologic correlations.Two patients presenting with the acute onset of bilateral parietal lobe damage showed initially the features of Balint's syndrome. After most of its manifestations had cleared, both patients exhibited severe disorders of spatial orientation: acoustic ataxia, inability to localize objects in space. In addition, 1 patient showed a topographical disorientation and abnormalities of whole body movements. This patient came to post-mortem examination, which revealed bilateral and fairly symmetrical old and recent infarctions of the superior parietal lobules. In the light of these observations and previous reports, it is suggested that the reported abnormalities of whole body movements can be explained on the basis of a visuo-motor intrahemispheric disconnection due to the bilateral lesion of the dorsal parietal lobe. In addition, the global spatial disorientation is analysed and is thought to be the manifestation of a derangement of a specific function centered in the parietal lobe. Moreover, it is pointed out that topographic disorientation does not require the concomitant failure of oculomotor mechanisms for its production. The topography of the anatomical lesion is considered in relation to current concepts on brain damage after severe hypotension and cardiac arrest. It is concluded that this group of patients is most likely at risk of developing behavioural abnormalities akin to the ones here reported.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
10/11. REM sleep behaviour disorder in the elderly.REM sleep behaviour disorder is a recently described parasomnia characterized by a history of excessive motor activities during sleep and is associated with pathological absence of muscle atonia during REM sleep. There is very limited literature on the condition. Two out of 349 elderly patients referred to a psychogeriatric unit were identified to have REM sleep behaviour disorder. These two patients are presented to illustrate the clinical features of the condition. Both of them showed a good response to clonazepam treatment.- - - - - - - - - - ranking = 6keywords = behaviour (Clic here for more details about this article) |
| | Next -> |