Bulletin of the Los Angeles neurological societies最新文献

In the quest for the elusive cure of human neoplasms, considerable effort has been expended over the course of the past 10 years to define the immune system as it relates to the development and evolution of cancer in man. At this time thera is ample evidence for, but incomplete of, the existence of a multifactorial immunosurveillance system that is important in the production and control of neoplasms. The framework for this system has been defined and its modification, with the development and progression of various neoplasms, has been studied with great detail. These studies have been undertaken with the hope of harnessing immune mechanisms and altering their response in favor of the host's defenses related to the evolving tumor. This paper will review the major principles and concepts that have evolved.

The management of pituitary apoplexy with reference to both diagnosis and operative sequelae remains a major challenge. Acute onset of retro-orbital headache in association with visual loss and ophthalmoplegia are the cardinal symptoms; however, obtundation and signs of subarachnoid hemorrhage also may be present. Good quality plain skull radiographs and complete angiography prove sufficient for preoperative radiographic studies. Preoperative endocrine preparation focuses on supplemental glucocorticoids since these patients must be presumed deficient in cortisol reserve. Residual visual deficit appears to be more a function of the extent of damage at the time of ictus rather than rapidity of decompression. Our experience indicates that transsphenoidal decompression in appropriate cases offers an ideal opportunity to minimize mortality and morbidity. The acute onset of severe retro-orbital headache in association with stupor and ocular palsies would alert most physicians to the potential diagnosis of spontaneous subarachnoid hemorrhage. The association of complex ophthalmoplegias and visual defects in this constellation of symptoms should, in addition, alert one to the possibility of an acute intrasellar or parassellar expansile process. During the past two years, we have had the opportunity to care for 8 such patients with confirmed diagnoses of acute hemorrhagic infarction of the pituitary enabling us to formulate diagnostic and therapeutic schemata with reference to management of this problem.

A selective loss of language resulting from left hemisphere cerebral lesions is familiar to all neurologists but only rarely does such a deficit allow preexisting extraordinary capabilities of the right hemisphere to emerge. A retrospective case history of French composer Maurice Ravel demonstrates such a right-sided cognitive system. At 58, Ravel was struck with aphasia, which quelled any further artistic output. Most strikingly, he was able to think musically but unable to express his ideas in either writing or performance. Hemispheric lateralization for verbal (linguistic) and musical thinking offers an explanation for the dissociation of Ravel's ability to conceive and to create. What makes Ravel's history interesting to the public as well as to physicians is not only the tragic toll exacted in this composer's personal and creative life but also the resultant loss of the output of one of the 20th century's towering musical geniuses.

Gas myelography is not a new technique, but its acceptance in neuroradiologic diagnosis has been relatively recent. Previously reported series have emphasized the benign nature of this technique and the lack of significant accompanying complications. From a series of 174 gas myelograms performed during a four-year period, two reports are presented wherein transient exacerbation of neurologic deficit followed exchange of cerebrospinal fluid and gas under pressure by the lumbar route. One patient with cervical spondylotic myelopathy experienced an increase in paresis, while another was found to have marked fasciculations. Speculation regarding possible mechanisms involved with these complications is presented. It is suggested that exchange of cerebrospinal fluid and gas under pressure via the lumbar route be used with caution in those patients with compromised cervical spinal cords.

The widespread availability of eye movement recording systems has added a new dimension to our ability to accurately describe nystagmus. Electrooculography (EOG) is the simplest and most readily available system. With EOG the effect of loss of fixation (either with eyes closed, or eyes open in darkness) can be accurately assessed and quantitative evaluation of nystagmus speed, frequency and amplitude is easily made. Of equal importance, it provides a permanent record that can be compared with nystagmus recorded in other patients. By comparing clinical observation with paper recordings, both students and experienced clinicians can become more efficient in recognizing different varieties of nystagmus.

A series of four articles on the "other side" of the brain has been published in this journal by Dr. Joseph Bogen and his colleagues (1, 2, 3, 4). The first three of these are rapidly becoming minor classics for those of us interested in hemispheric specialization. However, the fourth article reports a combination of sociologic and neurologic observations which, in our opinion, are misinterpreted. This misinterpretation stems primarily from the use of inappropriate statistical procedures and the misleading characteristics of a variable which is comprised of a ratio of two other variables (i.e. the A/P ratio). In short, we argue that the sociologic data presented (4) are not consistent with the constant sum model of hemisphericity discussed in that paper. An alternative model is discussed.