B

Parametric Ki maps of 18F -dopa PET scans of (A) a healthy control person (B) a patient with probable MSA-P coregistered to the individual MRI (horizontal section) showing almost completely reduced Ki values in the caudate and putamen of the MSA patient. discriminated from PD patients and normal controls showing reduced striatal (19) or putaminal (11) D2 binding. MSA putaminal D2 binding correlated with locomotor scores in one study (19). Similar results have been obtained with the D2...

Neuropsychiatric Symptoms In Corticobasal Degeneration

CBD is characterized pathologically by neurodegeneration of frontal and parietal cortices, sub-stantia nigra, and several basal ganglia nuclei including subthalamic nucleus, striatum, and pallidum. Other brainstem nuclei, including locus ceruleus, raphe nucleus, and midbrain tegmentum, are also involved, with marked reductions of noradrenaline and serotonin in addition to the nigrostriatal dopamine deficiency (81). Tau protein-positive inclusions and achromatic neurons are found. Sev eral...

Transgenic Mice Expressing Ftdp17associated P301l Mutant Tau Transgenes

Overexpression of wild-type tau transgenes has had only limited success in modeling the pathology observed in the human tauopathies. As a result, several groups have generated mice that express human tau containing FTDP-17-associated mutations in an attempt to accelerate the development of neurofibrillary inclusions and other tau-related pathology. Lewis and coworkers (24) reported a tau (P301L) transgenic mouse that expresses at about one- to twofold above endogenous levels the shortest 4R tau...

Alsparkinsonism Dementia Complex Of Guam

A high incidence of neurodegenerative disease is found within the Chamorro population of the Western Pacific island of Guam, and includes parkinsonism, dementia, and amyotrophic lateral sclerosis (ALS), each of which may occur in isolation but are more commonly combined (121). The cause is unknown but a toxic or viral etiology has been postulated (122-124). The histopathology is dominated by the presence of numerous NFTs (125,126), with similar immunohistochemical, biochemical, and...

Introduction

In many neurological diseases the topography of the lesion, whatever its nature, determines the clinical signs, whereas the nature of the lesion (vascular, inflammatory, degenerative, etc.) whatever its topography, determines the time course. According to J. P. Martin (1), this general principle cannot be simply applied to diseases of the basal ganglia since the nature of the lesions directly influence the clinical signs. Chorea, for instance, is associated with atrophy of the caudate nucleus...

Multiple System Atrophy

MSA is an uncommon, sporadic (nonfamilial), and distinct neurodegenerative condition that is characterized by varying combinations of parkinsonism, cerebellar ataxia, spasticity, and autonomic dysfunction (43). Its onset is usually in the sixth to seventh decade, with a duration range of 1-18 yr and median survival of about 9 yr (44,45). Recognizing MSA as distinct from PD is important because prognosis, counseling, and treatment of the communication problems of people with PD and MSA differ....

Progressive Supranuclear Palsy

PSP is a degenerative disease of later life characterized by abnormal vertical saccades the early appearance of falls, usually within a year of onset, owing to disturbance of tone and posture difficulties with swallowing and speech and mental slowing (48). Median survival time is about 6 yr. The disturbance of eye movements is usually present early in the course, but occasionally develops late, or is sometimes not noted by the patient's physicians (49). Patient may complain of blurred vision,...

Classification Of Visuospatial Disorders

Visuospatial activities have been classified according to different criteria. O'Keefe and Nadel (1) divided them on the basis of the sensorimotor responses of persons moving in their own environment, classifying them as position (or egocentric) responses when subjects use their body as a reference, as cued responses when movements are guided by external cues, and as place responses when movements are guided by relationships between external references. Grusser (2) classified the space around...

Metabolic Causes Of Parkinsonism

Important metabolic causes of parkinsonism include hypothyroidism and parathyroid dysfunction. Patients with hyperparathyroidism have clinical presentation identical to that of idiopathic PD, but the syndrome is levodopa resistant. The symptoms, however, may be relieved after resolution of the parathyroid dysfunction by surgical removal of the parathyroid adenoma. Hypoparathyroidism may also cause levodopa unresponsive parkinsonism (69,70). Bilateral striopallidodentate calcinosis, also known...

Imaging

MRI scanning of patients with MSA often, but not always, reveals atrophy of cerebellar vermis and, less marked, of cerebellar hemispheres (52). There is also evidence of shrinkage of pons as well as middle cerebellar peduncles (27), differentiating MSA-C from cortical cerebellar atrophy (CCA). The pattern of infratentorial atrophy visible on MRI correlates with the pathological process of OPCA affecting the cerebellar vermis and hemispheres, middle cerebellar peduncles, pons, and lower...

The 3 and 4R Tauopathies

We turn now to a set of disorders in which tau protein that makes up the inclusions is a various mix of 3R and 4R isoforms. Alzheimer's disease belongs to that category and because of its frequency is the first disorder to be considered in this chapter. Alzheimer's-type pathology is the only detectable lesion in a significant proportion of cases in which the diagnosis of IPD has been made premortem (20,164,165). This observation raises the possibility that Alzheimer's disease, in the absence of...

References

Criteria for diagnosing Parkinson's disease. Ann Neurol 1992 32(Suppl) S125-127. 2. Jankovic J. Parkinsonism-plus syndromes. Mov Disord 1989 4(Suppl 1) S95-S119. 3. Foster NL, Wilhelmsen K, Sima AA, Jones MZ, D'Amato CJ, Gilman S. Frontotemporal dementia and parkinsonism linked to chromosome 17 a consensus conference. Conference Participants. Ann Neurol 1997 41 706-715. 4. Pickering-Brown S, Baker M, Yen SH, et al. Pick's disease is associated with mutations in the tau...

Clinical Features Of Dementia With Lewy Bodies

The central feature of DLB is a progressive cognitive decline of sufficient magnitude to interfere with normal social or occupational function, whereas core clinical components comprise fluctuating cognition, recurrent and persistent visual hallucinations, and extrapyramidal signs (EPS). Supportive features may increase diagnostic sensitivity, though exclusion criteria also need to be considered (Table 1). Depression and REM sleep behavior disorder (RBD) have been suggested as additions to the...

Prospects For Future Research

In research on atypical parkinsonian disorders, MR investigations can be expanded in at least two main directions. One implies the collection of large series in multicentric studies, particularly regarding the less common disorders such as CBD or DLB, so that the sensitivity and specificity of the MRI findings can be reliably established. However, in order to make them widely and reliably applicable, the study protocols should be carefully planned, taking into account the existing knowledge of...

Psychiatric Aspects Of Dementia With Lewy Bodies

DLB is characterized clinically by dementia, visual hallucinations, and fluctuating consciousness in addition to parkinsonism. Neuropathological characteristics include alpha-synucleinopathy, such as Lewy bodies and Lewy neurites in the brainstem, particularly the substantia nigra, subcortical structures, limbic cortex, and neocortex. Some amyloid deposition is also found in most patients. Neurochemically marked cholinergic deficits are reported in addition to a moderate nigro-striatal...

Hemiparkinsonismhemiatrophy

Hemiparkinsonism-hemiatrophy (HPHA) syndrome was first described by Klawans in 1981 (87), who described four individuals with known hemiatrophy with narrow extremities on one side who developed delayed-onset hemiparkinsonism between ages 31 and 40 with tremor on the same side as the hemiatrophy along with rigidity, akinesia, and dystonia, but no evidence of hypomimia, or abnormal posture or lack of postural reflexes. Their symptoms remained unilateral between 5 and 35 yr after onset of illness....

Parkinsonism Owing To Toxin Exposure

Several studies have explored the role of various environmental causes of parkinsonism, especially exposure to industrial toxins, organic solvents, pesticides, and other putative toxins (35,36). Population studies have shown a link between risk of PD, and chronic (more than 20 yr) exposure to manganese, lead-copper combinations, and iron-copper (37). Mercury exposure has also been linked to PD, but no firm evidence exists for mercury-induced parkinsonism. In the case-control study from...

Infectious Causes Of Parkinsonism

The association of human immunodeficiency virus (HIV) infection and movement disorders has been recognized since the first descriptions of neurological complications of HlV-associated AIDS (58). Secondary parkinsonism has been reported by various authors as case reports, but Mattos et al. (59) have reported movement disorders in 28 HIV patients of whom 14 patients had parkinsonism. The mean age at onset of parkinsonism was 37.2 yr (range 25-63). They report mean Hoehn and Yahr scale of 2.5...

School Disw

According to Kosaka (34,35), the topography of the Lewy bodies is organized in three different distributions. An X rectangle means presence of Lewy bodies. The brainstem type is commonly found in Parkinson's disease. The diffuse type is usually associated with DLB. In the transitional type, cognitive symptoms are common they may be primary or complicate IPD. The borders between the three types may be difficult to draw. It has been shown that even in cases of apparently uncomplicated IPD, the...

Investigations

The diagnosis of MSA still rests on the clinical history and neurological examination. Attempts have been made, however, to improve diagnostic accuracy through analysis of cerebrospinal fluid (CSF) and serum biomarkers, autonomic function tests, structural and functional neuroimaging and neurophysiological techniques. Red Flags Warning Features of MSAa Orofacial dystonia Atypical spontaneous or L-dopa-induced dystonia predominantly affecting orofacial muscles, occasionally resembling risus...

Dementia With Lewy Bodies

DLB is a clinically identifiable dementing illness that often includes parkinsonian features (68). The average ages at onset is 75 yr, and mean survival is about 3.5 yr, with a range of 1-20 yr (69). The central feature of DLB is progressively disabling dementia, but its core features, of which two out of three are necessary for a probable diagnosis, include fluctuating cognition, visual hallucinations, and motor signs of parkinsonism. Additional problems that may support the diagnosis include...

Info

Facial reflex responses to median nerve stimulation in a patient with IPD (A), and in a patient with PSP (B). Note the absence of orbicularis oculi response in the patient with PSP even though the mentalis muscle response (lower traces) is similar in both patients. Fig. 3. Facial reflex responses to median nerve stimulation in a patient with IPD (A), and in a patient with PSP (B). Note the absence of orbicularis oculi response in the patient with PSP even though the mentalis muscle...

The Tauopathies

A large group of neurodegenerative diseases (including Alzheimer's disease, PSP, CBD, argyro-philic grain disease, Pick's disease, PDC, PEP) are characterized by the accumulation of tau protein. Tau is a phospho-protein that is normally involved in the regulation of tubulin assembly. Tau accumulation is always intracellular and gives rise to inclusions with a variety of shapes, depending on the disease in which they occur. This diversity in the morphology of the inclusions is not understood at...

Magnetic Resonance Spectroscopy

MRS provides chemical information on tissue metabolites (3,4). The molecules that can be studied by MRS in human brain tissue are hydrogen 1 ( H) and phosphorus 31 (31P). Magnetic resonance sensitivity is far greater for protons than it is for phosphorus (3). Therefore, most commercial MR scanners are capable of only proton MRS. Spectra are usually obtained from localized brain regions. The brain region is defined on a single slice by placing a small voxel, on the order of 1 or 2 cm2, in the...

Neuropsychiatric Symptoms In Multiple System Atrophy

MSA is clinically characterized by the variable combination of autonomic failure, parkinsonism, cerebellar ataxia, and pyramidal signs, and includes the previously called striatonigral degeneration (parkinsonian features predominate), sporadic olivopontocerebellar atrophy (OPCA) (cerebellar features predominate), and the Shy-Drager syndrome (autonomic dysfunction predominates). Histologically, all subtypes of MSA show glial cytoplasmic inclusions in oligodendrocytes of the cerebral white...

Parkinsonism With Atypical Postures

Charcot studied muscle tone extensively and established that most Parkinson's disease subjects showed a flexed posture with the shoulders hunched forward, neck bent down toward the chest, and the arms held in partial flexion at rest. In contrast, he found a small number of parkinsonian patients Fig. 1. Tremor recording machine used by Charcot to separate cases of typical rest tremor from those with postural tremor and action-induced tremor. Early studies focused on the differentiation by tremor...

Clinicopathologic Heterogeneity

Although the early literature on CBD suggested it was a distinct clinicopathologic entity, numerous case reports and small series clearly indicates considerable clinicopathologic heterogeneity in the CBS and CBD-the disease. An updated review of this heterogeneity from one institution (43,90) is shown in Tables 6 and 7. Thus, the following disorders can underlie the CBS CBD, AD, Pick's disease, PSP, dementia lacking distinctive histopathology, and Creutzfeldt-Jakob disease (43), as well as...

Dysautonomia

Dysautonomia is characterized by urogenital and or orthostatic dysfunction. Orthostatic hypotension is defined by an orthostatic fall in blood pressure by 20 mmHg systolic or 10 mmHg diastolic, but a 30-mmHg systolic or 15-mmHg diastolic is required for the consensus diagnosis criteria by Gilman 11 . Although this is considered to be a frequent and early sign in the disease 12,13 , it is rarely symptomatic syncope or faintness , and autonomic nervous system testing may not distinguish MSA from...

Structural Lesions Causing Parkinsonism

A variety of structural lesions can cause parkinsonism. Siderowf et al. 93 argue that the first described case of PSP in a patient with progressive opthalmoparesis and postural instability, and structural lesion with a tumor in the right cerebral peduncle is not idiopathic PSP. Brainstem astrocytoma was reported to be the cause of unilateral parkinsonian symptoms the symptoms resolved after resection of the tumor 94 . A frontal meningioma can sometimes present with rest tremor without other...

Case Study

Parkinson Disease Nursing Study

The following case study illustrates some of the essential components of our movement disorders program at our institution for a patient with an APD. MG is an 89-yr-old male who reported progressive worsening of gait and increased frequency of falls. He was started on L-dopa carbidopa several months prior to admission by his primary neurologist, who suspected the patient had idiopathic PD. It was not clear that medication produced an improvement in function. His past medical history was...

Parkinsonism Without Prominent Rest Tremor

Early neurologists recognized resting tremor as the most distinctive feature of typical Parkinson's disease, and placed patients who had unusual, intermittent tremor patterns or no tremor into the clinical category termed Parkinson's disease without tremor 3,4 . Some of these cases actually had tremor, but the movements were mild in severity or intermittent and primarily induced with emotion or action 3 . It is possible that myoclonus, a feature frequently seen in corticobasal degeneration, and...

Vascular Parkinsonism

Although the concept of vascular parkinsonism, proposed by Critchley in 1929, was almost abandoned for many years, it has once more come to the fore. The prevalence and incidence of vascular parkinsonism is variable in different series. Diagnosis of vascular parkinsonism is usually suggested by acute onset or other signs of cerebrovascular disease, but needs to be confirmed by imaging studies 72 . This is the form of parkinsonism that frequently can be diagnosed by CT, without requiring MRI to...

Visuospatial Disorders In Parkinson Disease

Visuospatial abnormalities have often been reported in PD patients. Early in 1964, Proctor et al. 105 demonstrated that PD patients have difficulty in determining when a rod is vertical if they are in a darkened room. Later, this abnormality was confirmed both in patients seated in a chair that is tilted either to the right or to the left 13 , and in patients who are upright 106 . Subsequently, as we have already documented, a number of authors reported that PD is associated with...

Corticobasal Degeneration

This clinicopathological entity was first described under the name corticodentonigral degeneration with neuronal achromasia 68 and early reports stressed the characteristic movement abnormalities, which often include akinetic rigidity 69 . More recently, however, a number of postmortem studies have found abnormalities of higher mental function, such as language disturbance and dementia, to be a common and sometimes predominant feature in patients with corticobasal degeneration CBD pathology...

Autonomic Function Tests

Autonomic function tests are a mandatory part of the diagnostic process and clinical follow-up in patients with MSA. Findings of severe autonomic failure early in the course of the disease make the diagnosis of MSA more likely, although the specificity in comparison to other neurodegenerative disorders is unknown in a single patient. Pathological results of autonomic function tests may account for a considerable number of symptoms in MSA patients and should prompt specific therapeutic steps to...

Prevalence of PSP and MSA

Measures of the prevalence of PSP vary from 0.97 to 6.54 per 100,000 eight studies and for MSA from 2.29 to 39.3 per 100,000 five studies Table 1 . A study from Sicily 8 reported one of the highest rates of 28.6 per 100,000 but this was for unspecified parkinsonism, so this category may have included cases other than MSA and PSP. The results presented in Table 1 are simple crude rates for the whole population rather than age-standardized rates. Though some studies do report such standardized...

Reference

The significance of the Lewy body in the diagnosis of idiopathic Parkinson's disease. Neuropathol Appl Neurobiol 1989 15 1 27-44. 2. Perl DP, Olanow CW, Calne D. Alzheimer's disease and Parkinson's disease distinct entities or extremes of a spectrum of neurodegeneration Ann Neurol 1998 44 3 Suppl 1 S19-S31. 3. Hardy J, Duff K, Hardy KG, Perez-Tur J, Hutton M. Genetic dissection of Alzheimer's disease and related dementias amyloid and its relationship to tau. Nat Neurosci...

Other Genetic Diseases Occasionally Presenting With Atypical Parkinsonism

Huntington's disease HD is an autosomal-dominantly inherited disorder, usually characterized by a hyperkinetic movement disorder, personality changes, and dementia. It is caused by the pathologic expansion of a CAG-trinucleotide repeat sequence in the gene for Huntingtin on chromosome 4 94 . The fact that particularly cases of early onset frequently present with dystonia and parkin-sonism, rather than with chorea, has long been recognized 95 . In addition, the widespread use of molecular...

Druginduced Parkinsonism And Oculogyric Crisis

Drug intoxications, especially with phenothiazines such as the butyrophenones, may produce a parkinsonian picture with slowing of saccades and an akinetic mutism picture. A distinct syndrome is oculogyric crisis, which was once a common feature of postencephalitic parkinsonism, but is now a side effect of drugs, especially neuroleptic agents 87 . Oculogyric crises may also rarely be a feature of Wilson's disease 88 , and disorders of amino acid metabolism aromatic L-amino acid decarboxylase...

Further Research In Neurophysiology Of

There is a large amount of possibilities for research in neurophysiology of parkinsonism and of movement disorders in general. Neurophysiology offers the advantage of a good temporal resolution of events and should bring further understanding of what is wrong in the CNS that leads to motor dsyfunction. The research in clinical neurophysiology will probably continue until the pathophysi-ological mechanisms of the diseases are well understood. However, meaningful information can only be obtained...

Laboratory

Grey Matter Loss Parkinson Disease

There are no laboratory markers for the diagnosis of PSP but ocular motor studies, electrophysi-ological studies, MRI, magnetic resonance spectroscopy, and positron emission tomography PET scans may be helpful to support the diagnosis or exclude other disorders. In general the sensitivity and specificity of these techniques in distinguishing patients with clinically equivocal or early PSP from other conditions has not been assessed. For this reason this techniques are not yet considered...

Clinical Features And Differential Diagnosis

The most important features that characterize and differentiate PSP from other disorders are presented in Table 1 and described in more detail in the subheading that follows. Postural instability manifested as nonexplained and unexpected falls or tendency to falls is the most frequent symptom presentation in PSP 7-14 . In the National Institutes of Neurological Disorders and Stroke NINDS study 10 , 96 of 24 PSP patients had gait disorder and postural instability 83 history of falls at the first...

Motor Disorder

Because the results of drug treatment for the motor disorder of MSA are generally poor, other therapies are all the more important. Physiotherapy helps maintain mobility and prevent contractures, and speech therapy can improve speech and swallowing and provide communication aids. Dysphagia may require feeding via a nasogastric tube or even percutaneous endoscopic gastrostomy PEG . Occupational therapy helps to limit the handicap resulting from the patient's disabilities and should include a...

Irene Litvan md

Atypical Parkinsonian Disorders Clinical and Research Aspects, edited by Irene Litvan, 2005 Psychiatry for Neurologists, edited by Dilip V. Jeste and Joseph H. Friedman, 2005 Status Epilepticus A Clinical Perspective, edited by Frank W. Drislane, 2005 Thrombolytic Therapy for Acute Stroke, Second Edition, edited by Patrick D. Lyden, 2005 Parkinson's Disease and Nonmotor Dysfunction, edited by Ronald F. Pfeiffer and Ivan Bodis-Wollner, 2005 Movement Disorder Emergencies Diagnosis and Treatment,...

Marie Vidailhet Frdric Bourdain and Jean Marc Trocello

The current chapter was prepared to help clinicians examine patients with parkinsonian syndromes and to detect clinical signs and clues that should alert to the appropriate diagnosis. For the main clinical diagnosis criteria of various parkinsonian syndromes Parkinson's disease PD , multiple system atrophy MSA , progressive supranuclear palsy PSP , corticobasal degeneration CBD , and dementia with Lewy bodies DLB , , the semiology will be detailed. The validity and reliability of these criteria...

Abc

Corticobasal Degeneration Mrt Flair

Serial axial FLAIR MR images in a patient with features of frontotemporal dementia at age 79 A , which then evolves to include nonfluent aphasia at age 81 B and corticobasal syndrome findings at age 82 C . matter, most often in superior frontal gyrus, superior parietal gyrus, pre- and postcentral gyri, and striatum Fig. 17 . Tau oligodendroglial coiled bodies are also common Fig. 18 . While achromatic, ballooned neurons that are immunoreactive to phosphorylated neurofilament or...

Mptp Intoxication

Some intravenous drug addicts who use a synthetic heroin-like drug meperidine develop chronic parkinsonism as a result of contamination by MPTP 193 . MPTP is metabolized in the brain to 1-methyl-4-phenylpyridinium MPP 194 and is selectively transported into dopaminergic cells, which it kills by inhibiting mitochondrial function 195 . Human postmortem studies reveal severe depletion of pigmented neurons in the substantia nigra without LBs 196 . The presence of active gliosis and microglial...

Major Points

Opalski Cells

Parkinsonism may be associated with a variety of underlying pathologies. Most of the conditions that cause parkinsonism have damage of the striatonigral system as the anatomicopathological substrate. The most common causes of parkinsonism are neurodegenerative diseases, each of which has a defining pattern of neuropathology, often characterized by the abnormal accumulation of protein in the form of a cellular inclusion. For many of these conditions, recent molecular genetic findings have...

Test Stimuli For Audiotaped Samples

Boston Aphasia Picnic

You wish to know all about your grandfather. Well, he is nearly 93 years old, yet he still thinks as swiftly as ever. He dresses himself in an old black frock coat, usually several buttons missing. A long beard clings to his chin, giving those who observe him a pronounced feeling of the utmost respect. Twice each day he plays skillfully and with zest upon a small organ. Except in the winter when the snow or ice prevents, he slowly takes a short walk in the open air each day. We have often urged...

Onset And Progression

Msa Antecollis

MSA usually manifests in middle age the median age of onset is 53 , affects both sexes, and progresses relentlessly with a mean survival of 6-9 yr 13,19,20 . MSA patients may present with akinetic-rigid parkinsonism that usually responds poorly to levodopa. This has been identified as the most important early clinical discriminator of MSA and PD 11,21-23 , although a subgroup of MSA patients may show a good or, rarely, excellent, but usually short-lived, response to levodopa 24-26 . Progressive...

Postanoxic Parkinsonism

Parkinsonism can rarely result from hypoxic ischemic injury. Different movement disorders including chorea, tics, athetosis, dystonia, and myoclonus have been reported. Patients can develop parkinsonism with or without dystonia weeks to months after the ischemic event 74 . MRI findings include T1 hyper intensities in the basal ganglia bilaterally, indicative of ischemia or gliosis. In the case described by Li et al. 74 , the clinical findings included mainly an akinetic rigid syndrome with...

Madhavi Thomas and Joseph Jankovic

Idiopathic Parkinson's disease PD is the most common cause of parkinsonism, accounting for about 75 of all cases. Other causes of parkinsonism include multiple system atrophy MSA , progressive supranuclear palsy PSP , corticobasal degeneration CBD , and a variety of other neurodegenerative disorders in which rest tremor, bradykinesia, rigidity, and other parkinsonian features are present. Since these disorders are often associated with other neurological deficits, such as dysautonomia in MSA ,...

Other Neurodegenerative Conditions

Many other common idiopathic neurodegenerative conditions have parkinsonism as an inconsistent or minor clinical feature. Extrapyramidal symptoms are very common in AD and may take the form of true parkinsonism 135-137 . Many patients with a clinical diagnosis of AD and parkin-sonism are found to have coexisting LB pathology at autopsy, either restricted to subcortical structures or also involving the cerebral cortex 35,136,138 . The correct terminology for these cases is uncertain, because of...

Hemiplegic Parkinsons Disease

Corticobasal Degeneration

Early neurologists considered Parkinson's disease to be a bilateral condition, but often commented on the mild asymmetry of tremor, especially in the early years of disease. Within the context of this asymmetric but bilateral archetype, they distinguished another form of Parkinson's disease that was highly asymmetric with prominent disability in the involved upper extremity beyond that expected with bradykinesia alone 3 . Collectively termed hemiplegic Parkinson's disease, these cases form a...

Pathophysiology Diagramatic Ptesentstion Ofanorectal Malforation

Anorectal Malformation Pathophysiology

Plots summarizing important dynamic properties of saccades. A Plot of peak velocity vs amplitude of vertical saccades. Data points are saccades from 10 normal subjects. The data are fit with an exponential equation also plotted are the 5 and 95 prediction intervals. The indicate vertical saccades from a patient with PSP, which lie outside the prediction intervals for normals. B Plot of duration vs amplitude. The data from 10 normal subjects are fit with a power equation. The indicate...