Rivista di patologia nervosa e mentale最新文献

A case of permanent global amnesia resulting from a bilateral hippocampal lesion is reported, remarkable for its typical clinical picture and prolonged period of observation with repeated neuropsychological testing. No tendency toward spontaneous recovery was noted, even though extra-mnesic cognitive functions remained undamaged. No differences were observed between this amnesic syndrome and the neuropsychological picture during an acute episode of transient global amnesia.

A 64 year-old man, who had been ingesting 20 g of licorice daily for about five months, developed a progressive, diffuse muscle weakness, with myoglobinuria, severe hypokalemia and elevated serum muscle enzymes. Electromyography and muscle biopsy results were consistent with a necrotizing myopathy. Following licorice withdrawal and appropriate electrolyte administration, complete clinical recovery was observed within about ten days. Previous reports of similar cases are reviewed and causative factors of this kind of myopathy are discussed.

The Authors present two brothers suffering from proximal progressive muscular atrophy arising in adulthood and describe its clinical, bioptic and electromyographic characteristics. Electromyographic and bioptic examinations demonstrate the neurogenic nature of the amyotrophy and localize the causal lesion at the level of the anterior horns of the spinal medulla. With regard to the differential diagnosis, the nosographic position of the disorder in question is described, and the hypothesis advanced that it may represents the late onset variety of Wohlfart-Kugelberg-Welander disease.

Foix-Chavany-Marie syndrome is characterized by diplegia involving the face, the pharynx, the tongue and the masticatory muscles, with automatic-voluntary dissociation due to vascular damage of both operculi. The prognosis is usually good for life expectancy. The authors describe a 46-year-old man in whom one operculum was destroyed because of a birth trauma, the other one was injured by an ischemic infarct in the territory of the middle cerebral artery. The clinical correlations to the site of the lesions are discussed. They confirm the diagnostic value of CT scan in evaluating this syndrome.

The concentration of PG D2 (a prostanoid with demonstrated vasoconstrictor activity on human cerebral arteries was studied in the cerebrospinal fluid of 7 patients admitted for subarachnoid aneurysmal hemorrhage. CSF samples were sequentially obtained at different intervals following the hemorrhage and the PG D2 concentration was detected with radioimmunological assay. Four patients developed vasospasm leading to neurological deterioration. PG D2 concentrations varied from 0.21 to 1.09 mg/ml. The highest CSF PG D2 concentrations were seen 24-48 hours after the hemorrhage in three patients, who subsequently died due to resumption of bleeding. In the four cases with angiographically demonstrated vasospasm a peak in PG D2 concentration could be observed corresponding to the clinical appearance of neurological deterioration. In the three cases without a neurological finding of vasospasm, PG D2 concentrations tended to be stable. Serial monitoring of arachidonic acid metabolites having different vasoactive actions on the cerebral arterial wall could be of great interest as a clinical and biological marker useful in the management of subarachnoid hemorrhage.

Normal subjects and chronic alcoholics without clinical evidence of memory disorders have been compared on two tasks of verbal learning of a word list, one administered with the classical procedure and the other with the "selective reminding" technique developed by Bushke. Results showed that the selective reminding technique has the same discriminative power as the classical procedure: both brought out a remarkable learning deficit in chronic alcoholics. The selective reminding procedure is easier to administer and can distinguish between storage and retrieval deficits; it seems therefore preferable for diagnostic purposes. Practical criteria to distinguish a normal from pathologic performance on this test are suggested. Alcoholics were also inferior on Raven Progressive Matrices. The scope of the impairment produced by chronic alcohol consumption is wider than suggested by clinical observations and deserves careful assessment.

The term "neurosis", although is no longer used in the recent American classification, is still considered valid and firmly established in our learning even with its etymological and semantic inexactitudes. So in this 5th coordinated and systematical study on the nosography of neurosis the Authors observe its less known and less described aspects in literature, such as short-dated neurosis forms with acute course. These situations of acute neurosis can be explained as unspecific answers to stress situations, that is to say as reactions to conscious or removed biological and psychological events. They are disorders of adaptation with a single pathogenetical mechanism and their aspect suggests the approach to alarm-reactions for unspecific stressors. This neurotic reaction of adaptation, conditioned by the subject's cognitive interpretation, has the characteristics of an exaggerated and disorderly alarm-reaction with particular polymorphism of its symptomatology. The Authors elaborate a model of the symptomatology and they examine the differential diagnosis of these reactions. Regarding the evolution and the course of this disorders they assert that the prognosis is good, but in some cases there may be the passage to a form of structured neurosis or the evolution to a depressive syndrome; they interpret this as a decompensation due to the exhaustion of fitting mechanisms. At the end of the study the authors illustrate the therapy.

Recent studies of the literature indicate that arteriosclerotic lesions located in the remnants of bifurcation and proximally to an occluded internal carotid artery can represent sites for the origin of emboli. Through the collateral circulation, these emboli can reach the homolateral cerebral territories producing further ischemic events. Two groups of patient, with angiographically proven internal carotid artery occlusion, one with, and another without irregular arteriosclerotic lesions (IAL) in the stump and/or external carotid artery, were followed up in order to determine the frequency of delayed post-occlusion ischemic events in each group. Ipsilateral events occurred more frequently when there was a stump associated with IAL in the remnants of bifurcation and signs of ophtalmic collateral circulation. This association may have prognostic value and should be considered before performing bypass procedures.

Increased neuromuscular excitability with varying clinical and EMG features were also observed during KCl administration in both cases. The findings are discussed on the light of the membrane ionic gradients current theory.