Rivista di patologia nervosa e mentale最新文献

In order to test the hypothesis that age of onset of manic-depressive psychosis may be associated with family history, the authors investigated 479 clinical records of patients suffering from affective disorders and admitted to Hospital during the period 1966-1981. Given the retrospective nature of the study, standardized diagnostic criteria were not possible. A positive family history of psychopathological disorders has been found associated with an early age of onset in comparison with a negative family history; the bipolar type has been found associated with an early age of onset in comparison with the unipolar type. Nevertheless, both these variables and their interaction appeared to be insufficiently predictive. The possible influence of other variables such as sex, marital status, years of education, migration, residence have been investigated, but none of them gave any significant result. This suggests the presence of other more predictive variables, which have not considered in this paper.

Paroxysmal kinesigenic choreoathetosis is a rare disease of unknown origin, considered by some authors a reflex epilepsy, by some an extrapyramidal disorder and related recently to brainstem atrophy. Two patients, father and son, aged 52 and 22 years, are described suffering from this disease starting at age 40 and 13. In both patients the attacks consisted in slow flexion and extention movements starting in the foot and extending to the knee and the arm and were usually monolateral, but in the son some attacks were bilateral causing him to fall and involved also face muscles. In both patients neuroradiological investigations were normal. Neurophysiological studies including blink reflex, short latency somatosensory evoked potentials and brainstem acoustic evoked potentials did not show any involvement of the brainstem. In one case carbamazepine therapy, at low dosage, was tried and cured the patient.

A survey was made of 161 patients with a diagnosis of MND during the years 1965-1979 at the Neurological Clinic of Padova University. The results of a clinical and electromyographical reassessment is reported in 8 cases, selected out of the 24 surviving patients. Among this group, 3 patients had a moto-neuron disease, characterized by an exceptionally benign course, while in the remaining 5 the previous diagnosis was found to be inaccurate. The misleading clinical and EMG findings (at times encountered in the differential diagnosis of MND) are discussed: among them are previous illnesses such as poliomyelitis or radiculitis, inadequacy of both EMG techniques and the evaluation of fasciculations.

The authors describe two patients who died during hyperthermic reaction following the administration of MAO inhibitors and tricyclic antidepressants in therapeutic doses. In both cases, there was a high increase of temperature, rigidity of skeletal muscles and impairment consciousness with some analog with the syndrome following an overdose of the same drugs taken simultaneously, or with an acute intoxication by MAO inhibitors. The pharmacological aspects point out the synergistic mechanism between drugs of the two groups and the possible onset of the syndrome, not only after simultaneous administration, but also when the tricyclic antidepressants are prescribed without an adequate interval following a therapeutic cycle with MAO inhibitors. The possible professional responsibility is discussed and the authors emphasize that the pharmacological association must be used with caution and only after establishing the inefficacy of one single drug, starting anyhow with low doses, constantly looking after the patient and avoiding the parenteral administration.

Diffuse encephalitis occurred in a 2 year old girl, with activation of a chorioretinitis, which on clinical and serological grounds was taken to be caused by toxoplasma infection. The small patient presented clinically not only typical ocular lesions (bilateral chorioretinitis) but also neurological complications with status comatosus with some archaic reflexes, diffuse and marked hyperkinesis, right hemiparesis, and frequent epileptic seizures. The encephalitis and the acute ocular inflammation were partially resolved by treatment with spiramycin and cortisone. This is, presumably, an example of reactivation of congenital cerebral toxoplasmosis. A similar course of events was reported--as far as we know--in only two children.

The optic facial reflex (ofr) has been studied in a group of subjects affected by multiple sclerosis (ms) and compared with the trigemino-facial reflex (tfr) as well as clinical data. From the literature it appears that the afferent pathway of the ofr, after the optic chiasma crosses the midbrain tegmentum and from there goes directly to the pons. The ofr was impaired in 14 subjects out of 20 (70%), the tfr only in 7 (35%). This difference is attributed to the fact that the visual pathways are frequently affected by demyelinating processes. The ofr in contrast with the tfr, because of anatomophysiological differences, does not supply the exact localization of the damage. In our series of patients affected by ms the data from ofr reflected exactly the signs of optic nerve lesions. When these were not found, ofr abnormality was attributed to lesions located behind the chiasma or in the midbrain. A close correspondence between data supplied from the ofr and the diagnosis of ms according to Mc Alpine is emphasized: this makes the ofr a very useful diagnostic test of ms. The combined use of ofr and tfr, in addition to fulfilling the criteria of detecting multiple sites of demyelination, can be useful to investigate the brain stem.

The reactions of father and/or mother at the time of the birth of the first son are here analysed (post partum "blue", "couvade", paternal acting and neurotic depressions). These manifestations are considered as masked depressive states. Analogies between the freudian concept of the mourning work and the work of becoming parents are seen as an internal process for both parents to consider all their losses (the role of the son, the privileged role of the pregnant woman, the exclusive relationship with the partner . . .). Two aspects are emphasised which correspond to different levels of involvement and to different clinical manifestations. An incapacity to establish a dual relationship is expressed in both father and mother with psychosis as an escape from the work of parenthood; problems and failures in such work are expressed as depressive manifestations which testify the obstacles to this elaboration.

The authors describe two cases of "reading epilepsy" followed for nine and seven years respectively. In the first case the seizures consisted in an alexic aura followed by secondary tonic clonic convulsion; in the second case the seizures consisted in jaw clenching followed by loss of consciousness. In both patients neuroradiological studies including C.T. were negative and in both the seizures were controlled by anti-epileptic treatment. Clinical and electro encephalographic features tended to differ in the two cases and the authors review the literature on the subject. These observations led to recognise three groups of reflex epilepsy as follows: the first group includes focal secondary generalised seizures with parieto-occipital spikes and spikes and waves in parieto-occipital lobes; the second group includes seizures starting with jaw clenching corresponding with bursts of posterior sharp-waves; the third group consists of endogenous cases which can not be included in the other two groups.

The possibility of aphasic disorder caused by thalamic lesions has been supported by anatomo-clinical findings, stereotaxic surgery and more recently by radiological investigations with new techniques, i.e. ct and brain scan. A case of thalamic aphasia investigated with these techniques and the Luria's neuropsychological test is reported in this paper. The case concerns a 50 years old woman who developed a sudden right hemiplegia with marked motor aphasia. C.T. and radioisotope brain scan revealed a left capsular haemorrhage with involvement of thalamic structures. Later, when this patient's aphasia decreased, Luria's test showed reduction of spontaneous speech, anomia, paraphasic and disarthric disorder, distractibility without impairment of comprehension and repitition. These findings are similar to those reported by some AA. in left thalamic lesions and similar to aphasic syndromes caused by cortical lesions. Another important observation was the presence of widespread cortical functional disorder involving the left fronto-temporo-parietal region without evidence of cortical anatomical alteration. The above data and those reported in the literature suggest a very close relationship between thalamic structures, other central nuclei and cortical areas particularly in the control of speech.

The therapeutic efficacy of tiapride in chronic headache (300 mg/day orally during 30 days) was studied in a doubleblind trial in a group of 50 patients, 40 of them with so-called "mixed headache", and 10 with classical migraine. The results were subjected to statistical analysis. 65% of treated patients had clinical benefit in the intensity and frequency of headaches. The mode of action of this drug is discussed, together with the involvement of several monoaminergic systems in the genesis of headache. The action of tiapride appears to be indirectly dopaminomimetic as it operates by a blockade of dopaminergic inhibitors receptors.