Sitting, standing, and walking

Apraxia of gait- or apraxia of postural transitions?

"Apraxia of gait" is not a useful concept and freezing of gait should also not be considered an apraxia. The concept of apraxia may, however, be applied to distortions of postural transitions that can accompany fronto-parietal lesions.

Response to Some Stimulant and Depressant Drugs of the Central Nervous System

Nearly one hundred years ago, Anstie (1864) wrote: “Among the too frequent instances which are to be found in medical nomenclature, of confusion and uncertainty in the application of descriptive terms, there is none, perhaps, more striking than is occupied by the words Narcotic and Stimulant.” Both classes of substance embrace drugs of antiquity. Thus of the depressants, alcohol dates from the time of the Thracian god, Dionysus, while the earliest use of stimulants such as caffeine and xanthine is lost in the obscurity of the past (Goodman and Gilman, 1955a). Even today, there exists no systematized codification of response to the two classes of drug, although it is implicitly assumed that stimulants and depressants are invariably and mutually antagonistic in their effect on the central nervous system. Advantage was therefore taken of phenomena arising during drug intoxications to categorize abnormal features in the central nervous system common to each of the two classes of intoxicant and to essay a comparison, the one with the other.

[Orthostatic tremor]

Orthostatic tremor (TO) is a recently described new type of a high frequency irregular tremor which affects antagonistic sets of muscles in the lower limbs only since the erect posture is maintained. We describe two other cases of this peculiar kind of tremor which may be not so uncommon as up to now realized and emphatize its main diagnostic and semeiological characteristics. TO may share some basic pathophysiological mechanism with tremors of the classical heredofamilial essential variety.

The management of drop attacks

From the preceding it is evident that drop attacks can result from a myriad of causes. As in all situations, the patient's history and the clinical picture are the most important factors in arriving at the appropriate diagnosis. However, understanding the neurophysiologic basis of posture should prove significantly helpful in this endeavor.

The drop attack: a common geriatric symptom

While the "drop attack" has been described in the British literature as a classic geriatric syndrome accounting for as many as one-quarter of all falls in their elderly population, it is rarely acknowledged in discussions of falls by physicians in the United States. Is the drop attack a distinct entity that has been overlooked and under-investigated in this country, or is it perhaps a symptom of a spectrum of diseases? This paper reviews the original descriptions of the drop attack for its characteristic features, and focuses on the epidemiology, etiology and clinical management of this common, but infrequently recognized, event.

Cryptogenic drop attacks: an affliction of women

A drop attack was defined as falling without warning, not apparently due to any malfunction of the legs, not induced by change of posture or movement of the head, and not accompanied by vertigo or other cephalic sensation. All 33 patients attending a neurological clinic with a primary complaint fulfilling these criteria were women, and a further seven examples were found by questioning 200 consecutive patients at a gynaecological clinic. No affected male was found.In all but one patient, falls occurred only when walking. They were not due to wearing high-heeled shoes. The average age at onset was 44.5 years and in younger women onset was often during pregnancy. The accepted causes of drop attacks were not found with certainty in any of these patients. The sex incidence and the circumstances of the falls suggest that the cause may lie in differences between the two sexes in the mechanism of walking rather than in any central disturbance. Drop attacks in women commonly occur as an isolated symptom for many years, and although distressing have no serious prognostic implications.

THE "SUBCLAVIAN STEAL" SYNDROME: REPORT OF A CASE WITH SURGICAL CORRECTION

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Ruptured posterior fossa aneurysms and their surgical treatment

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