Neurologia-Neurocirugia Psiquiatria最新文献

Recent advances in the understanding of the asymmetrical functions of the cerebral hemispheres provide new insight to the mechanisms underlying the developmental language disorders. It is probable that learning to read depends in part upon the ability to establish an association between a seen object (customarily perceived within the right hemisphere) and a verbal symbol (mediated by the left). It is possible that as the reading skill develops, verbal symbol recognition may also become a left hemisphere function. A complex interaction between the two developing hemispheres is involved. A clue to the nature of this problem is that developmental dyslexia is six times more common in boys than in girls. Studies defining differences in cerebral dominance in boys and girls will be reviewed in this context.

In an attempt to describe epidemiologic features to generate etiological hypotheses and to study natural history, 121 cases of childhood CNS neoplasms under 15 years of age, occurring during 1950-66 in Manitoba, were analyzed. The incidence of CNS neoplasms in childhood (2.4/100 000 per annum) ranks second only to leukemia in Manitoba. For both sexes somewhat elevated incidences were noted for both extreme age groups; i.e. 0-4 and 10-14. Such peaks were more prominent for gliomas, which may indicate differential factors operation in the genesis of gliomas between early and late childhood. The former may be related to genetic and/or perinatal environmental factors and the latter, to environmental factors, in early childhood. Excess occurrences of gliomas among Irish, Scottish and Icelandic offsprings were observed, which possibly indicates the importance of either genetic or environmental factors peculiar to these ethnic groups. There was no evidence of time clustering (i.e. season and year) by estimated conception or by birth. Further investigation into the relative role of genetic and environmental factor in the genesis of childhood gliomas are in order.

Child psychotherapy has limited use in an institution. Through play one can appreciate the conflicts and suggest solutions, either verbally or through the play itself. As a framework one can use a dynamic concept of development and learning, and an educational approach. First one must elaborate a clinical history, do a physical examination and apply psychological tests in order to make a good diagnosis. The approach and treatment should be interdisciplinary. The institutional difficulties for this type of work are mentioned.

At the ISSSTE, a community psychiatry program was created and is being developed in two areas: the population of beneficiaries who attend two clinics and groups of employees of those same clinics at their respective places of work. The main purpose is to carry out prevention in mental health. In this report only the work in the first session of eight employee operative groups is reported. The method, the difficulties and the characteristics of the groupings are explained. Some theoretical aspects are shown. Results showed: 1. Little correspondence between the internal reality of the beneficiaries. 2. Difficulties in communication which produce differences of criteria with the clinic. 3. Difficulties in the internal distribution of power. 4. Unnecessary expenditure of energy. 5. Suggestions to solve the problems handled in the group. 6. Resistance against responsibilities.

Programmed teaching of neurologic semiology, charted in agreement to subsequent learning in clinical neurology, is conceived. The basis of the pedagogic system consists of respecting the systems that bind physiologically among themselves. The goal is the creation of areas of comprehension, dramatizing common functions and signology. To know "all" is of less validity than to posses an engram prepared by key information. The anatomic physiology memory, previous to the course and the weekly partial evaluation, is considered useful. The problematic of the competitive test is analyzed and its negative and positive criterions are exposed. Anatomy, physiology, semiology and clinical neurology spun together are estimated to favor pedagogic goals redundantly.

Theiler's encephalomyelitis virus (TMEV) in mice represents one of the few existing animal models of virus-induced demyelination and may provide further information about the human disease, Multiple Sclerosis. An inbred strain of mice (SJL/j) employed in the present ultrastructural study, develops a life-long neurologic illness characterized by profound spasticity after intracerebral inoculation of TMEV. Anesthetized animals were sacrificed sequentially by total body perfusion with gluteraldehyde from 7 days to 9 months after infection. An intense mononuclear inflammatory infiltrate appeared in the leptomeninges and white matter of spinal cord by 15 days and persisted for as long as one year. These infiltrates contained numerous plasma cells, and perivascular demyelination could be found in almost every 1 micron section. Vesiculation and stripping of myelin by mononuclear cell processes were seen as mechanisms of myelin break-down. However, virions were not found in cells in grey or white matter and the integrity of oligodendrocytes was maintained. At one year, active demyelination was still seen in areas containing naked and remyelinated axons. The relevance of these ultrastructural findings to postulated mechanisms of virus-induced demyelination will be discussed.

This paper justifies the consideration of epilepsy as a social problem and an important public health problem in Latinamerica. It comments on the lack of proper statistical studies and the particular composition of the Latinamerican population where epilepsy has no clear differences according to age, in reference to mortality. It considers the labor structure of the population with low income and exposed to morbility and malnutrition for different causes, making notice that the social problems of epilepsy are by and large going along with the economic deficits and the unequal social system. The article mentions the problem of neonatal anoxia and other perinatal hazards so much influenced by poor hygiene and ignorance, going along with other poorly understood or non existing hygienic prevention problems. Among other points it touches on human and material resources in relation to epilepsy.

Histoplasma meningitis (HM) has been reported to occur primarily in association with disseminated histoplasmosis (DH). We report a case of histoplasma meningitis occurring in a patient with common variable hypogammaglobulinemia (CVH) in which no manifestations of DH were observed. L. L., a 66-year-old Caucasian male, clerical worker, developed occasional episodes of dizziness and tinnitus in mid-1971. During 1972, increasing frequency of these episodes and gradually progressive confusion were noted. In January 1973, vomiting, forther confusion, obnubilation, and a left central facial paresis developed and he was hospitalized. Physical examination revealed no pulmonary abnormalities, lymphadenopathy or hepatosplenomegaly. Over the ensuing 6-week evaluation, there was occasional fever to 38.5 degrees C. Chest roentgenogram was normal. Cerebral angiography suggested a mass in the left cerebellar hemisphere. EEG was diffusely slow. Multiple CSF examinations revealed: Glucose 7-18 mg/with a normal blood glucose, protein 109-256 mg/and cells 66-140 (95 + % mononuclear). Histoplasma capsulatum was cultured from CSF but not from sputum, urine, blood or bone marrow. Skin tests for PPD, histoplasmosis, coccidiodomycosis, blastomycosis, mumps, dinitrochlorobenzene and streptokinase-streptodornase were negative then and 6 months later. Histoplasma serum antibody was absent. Immunoglobulin analysis revealed IgG 430 mg %, IgA 46 mg %, and IgM 35 mg %, which with the history and skin test results suggested CVH. Treatment with 2.51 gm of amphotericin B given intravenously over a 3-month period resulted in complete reversal of all neurologic signs and clearing of the confusion. The remission has been maintained for two years. This case represents a primary infection of the CNS by histoplasma. The relationship between the HM and the CVH will be discussed.

Accidents are the cause of some 50 deaths per 100 000 population each year in the US; some 3% of these are from traumatic spinal cord injury alone. Traumatic spinal cord injury in socioeconomically advanced countries, has a probably annual incidence rate of 3 per 100 000 population. Males are affected five times as often as females, and in the US, Negroes have twice the rates of whites. Half the cases are due to motor vehicle accidents, 1/4 to falls, and 1/10 to sports injuries. Maximal ages at risk are 15 to 34; only for cord damage due to falls do this risk differ, and here elderly are the more prone. Associated injuries are common in traumatic cord injury, and head injury and pulmonary dysfunction are frequent causes of the acute deaths in traumatic SCI which is why complete quadriplegia has a high early case-fatality ratio. Late deaths in SCI are principally the direct or indirect result of the neurogenic bladder. With treatment in comprehensive spinal cord injury centers, more than 4 of 5 traumatic SCI patients will survive ten years with an average of almost 18 years. Median survival may be almost 14 years for complete quadriplegia, 17 for complete paraplegia, 19 for incomplete quadriplegia, 20 for incomplete paraplegia and 28 for cauda equina lesions. Prevalence is likely to be some 50 per 100 000 population with about 20 per 100 000 completely paralyzed (3 quadriplegic and 19 paraplegic). Some 4 out of 5 survivors of traumatic SCI should be able to live at home and perform gainful work after such treatment.