eLetters

620 e-Letters

  • Lacunar stroke: on the threshold of a paradigm shift?
    Vinod K Gupta

    Dear Editor,

    Professor Wardlaw has crafted an inspiring critique on the clinico- pathological spectrum of lacunar stroke that is a delight to read.[1] In elucidating the pathophysiology of lacunar stroke, it is, however, particularly difficult to break out of our mindset that is moulded on the pattern of the ischemic stroke model, particularly given the concurrence of small cortical infarcts with the lacunar syndr...

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  • Electrophysiological characteristics in seronegative MG
    Shin J Oh

    Dear Editor,

    Nemoto et al. reported that jitter was abnormal in 93% of seropositive patients but only in 46% of seronegative patients. This finding is quite different from our previous reports.[1-2] Our study showed that abnormality in the SFEMG was almost equal on both groups, being 91% in seropositive and 92% in seronegative groups.[2] However, clearly all of parameters in SFEMG were worse in seropositive gro...

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  • Authors' reply
    Ryuji Sakakibara

    Dear Editor,

    Anatomical textbook in humans shows us that 11th cranial nerve originates from lower medulla to C5/6 anterior cell column, innervating the trapezius (caudal column) and sternocleidomastoideus muscle (rostral column). There also exist anterior cell columns innervating the cervical muscles. Platysma muscles are innervated by both the facial nucleus and high cervical cord in mammals. Our patient also h...

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  • Parkinsonism after a single head trauma
    Yong Chern Lee

    Dear Editor,

    We read with interest the report by Kuoppamäki et al. on their case of a young man with bilateral globus pallidus lesions and signs of parkinsonism [1]. We have recently come across a patient with similar clinical and MRI findings following a single head trauma. We propose that lesion in this brain region regardless of causes can produce features of parkinsonism.

    Five years ago, this 60...

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  • A breif comment
    Iskandar M I Basal

    Dear Editor,

    If the platysma is innervated from the high spinal cord, I think this will be through the XI cranial nerve; in this case there should be also weakness of shoulder elevation.

    I wonder about the sensory loss in the onion or Dejerine pattern, particularly close to the forehead, ear, and chin areas as it may result from lesion to caudal spinal tract of the V and about the respiratory function. Als...

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  • Response to van Vliet et al.
    Roberta B Shepherd

    Dear Editors,

    Regarding the article by van Vliet et al. [1] reporting the results of an outcome study comparing two 'approaches' to physiotherapy following stroke:

    The authors make a common error in assuming that an outcome study provides evidence of effectiveness of an intervention. It does not, as Herbert [2] has recently pointed out - "outcome measures measure outcome. They do not measure the effects...

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  • Authors' Reply
    Ralf W. Baumgartner

    Dear Editor,

    We thank J. Kwan for his interest in our article. As he mentioned, we studied 203 patients aged 16 to 45 years using a standard protocol including blood tests, CT and/or MRI, 12 lead electrocardiography, and ultrasound examination of the brain supplying arteries. Additional investigations to rule out the presence of patent foramen ovale, vasculitis, cardiac arrhythmias, cervical artery dissections, et...

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  • MIBG is useful, but not absolute, in clinical practice
    Hiroshi Nagayama

    Dear Editor,

    We are grateful to Dr. Braune for his comments regarding our recent paper [1], and appreciate the opportunity for further discussion. The most important thing in our paper was that MIBG scintigraphy was carried out in the largest number of parkinsonian patient-series to verify the usefulness of the examination in clinical routine. Since all of them were outpatients, only clinical diagnosis was av...

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  • ICP and cerebral oedema at high altitude.
    Richard G Fiddian-Green

    Dear Editor,

    In my earlier eLetter I wrote, "Increasing blood flow to the brain by increasing pCO2 may do much more metabolic harm than good. Indeed in upregulating oxidative phosphorylation and down regulating ATP-dependent enzymatic activity... keeping the intracerebral pH abnormally low could reduce the need for blood flow to abnormally low levels". Is this statement compatible with the effects of high altitud...

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  • Sinus venous thrombosis or arachnoid granulation?
    Ansgar Studer

    Dear Editor,

    We read the report of Deus Silva et al. [1] with great interest. The authors describe a patient with right ear pain, fever and diffuse pulsatile headache, who later developed pancerebellar symptoms. Cerebrospinal fluid (CSF) examination revealed pleocytosis (138 cells, predominantly lymphocytes) and elevated protein. CT and MR-imaging revealed an "unusual empty delta sign" and thrombosis of the lat...

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