Bulletin of the Los Angeles neurological societies最新文献

This study was designed to determine whether immunological examination of carcinoembryonic antigen (CEA) levels in blood serum and cerebrospinal fluid would be helpful in detecting central nervous system tumors. Forty patients with tumors of the central nervous system were compared with 108 control patients. The findings suggest that: 1) CEA determinations are not helpful as a screening test in detecting preclinical central nervous system tumors; 2) Serum CEA determinations may be useful in determining the presence of a malignant tumor in patients with a circumscribed uptake on brain scan or a nonspecific mass lesion at cerebral angiography; 3) Cerebrospinal fluid CEA determinations were of no value in detecting central nervous system tumors; 4) Further study on a larger population of malignant central nervous system tumors is warranted.

Two cases in which medially placed retro-orbital tumors were approached transfrontally have been presented. The computerized tomographic scanner was important in the localization of both lesions. Although of different histologic types, both tumors were friable and vascular. This friability and vascularity would have caused severe difficulties in removal had it not been for the facility with which a cryoprobe froze and grasped tumor tissue. The importance of this instrument, previously unemphasized, has been pointed out.

A patient is described with severe intention myoclonus which was made worse by treatment with L-Dopa and improved by clonazepam. Family history and examination of several siblings suggested the diagnosis of Huntington's disease. Subsequent to improvement of the myoclonus the patient appeared to have the rigid form of Huntington's disease. This case represents a unique expression for an otherwise well defined genetic abnormality. Stimulus activated myoclonus in a common feature of a number of disorders of the nervous system. Intention, or action myoclonus has been the subject of increasing interest because of its association with the syndrome of post-anoxic encephalopathy (1), although it may occur with other disorders as well. Many abnormal movements have been reported in Huntington's disease, but myoclonus is a relatively uncommon feature of this disorder and to our knowledge intention myoclonus has not been reported as a major symptom. We recently have evaluated a patient with disabling intention myoclonus and examined several members of his family who have typical Huntington's disease. We therefore report this case, a unique presentation of an otherwise well described movement disturbance.

Four patients with clinical features of Goldenhar-Gorlin syndrome who showed facial paralysis on clinical examination are presented. The fourth case died following surgery for cleft lip. Autopsy revealed hypoplasia of the right facial nerve in its intracranial segment, with small right facial nucleus in the brain stem. Nosological aspects of the Goldenhar-Gorlin syndrome are discussed. Peripheral facial paralysis, as a part of this syndrome, is reviewed in the light of clinical and pathological findings and in its relationship to cardiac anomalies. It is suggested that Goldenhar-Gorlin syndrome is a part of a so-called cardiofacial syndrome.

Four diabetic patients are presented with alternating facial palsy. The term alternating is meant to imply facial nerve paralysis, the onset of which occurs at different points in time on both sides of the face. Clinical findings are presented and a short review of the literature is summarized. The authors conclude that alternating facial palsy is often associated with diabetes mellitus. Alternating facial palsy is an infrequent finding. This is in marked contrast to the unilateral form. Approximately every 13 minutes someone in the United States incurs idiopathic facial paralysis or Bell's palsy (20 persons per 100,000 per year). It is apparent that the majority of unilateral facial palsies fall into the idiopathic category. The alternating form of facial paralysis, however, appears to be an unusual finding in a symptom complex of several diseases which will be discussed. It is the diagnostic significance of this alternating facial paralysis and its occasional association with diabetes mellitus that prompts this report.

The advancement of surgical techniques has enabled the neurosurgeon to undertake a continually more aggressive approach toward lesions within the fourth ventricle. Laboratory and clinical observations have enabled us to conclude that (1) exploration of the fourth ventricle is feasible without anatomical disruption of the vermis, (2) controlled ventilation during such explorations is physiologically most desirable, and (3) irrigation of neural structures must consider acid-base and ionic parameters in order to maintain physiologic stability.

A method for accurate localization of intracranial lesions on CT scans is described, using a marker wire and a radiograph exposed by the CT scanner.

Phenytoin was given in full dosage to eight patients with thalamic pain and two others with intractable pain resistant to other forms of treatment. Serum levels were monitored and correlated with dosage levels. Three patients improved markedly, two improved only minimally, two were unchanged, and three were worse. Those patients who had improved noted return of original pain on stopping phenytoin. The results indicate the need for a further study of the drug in thalamic and other chronic pain states.

The gate theory of pain is criticized at three levels: (1) at the dorsal horn "gate", where pre-synaptic inhibition in the primary afferent endings may go beyond mere reduction of synaptic power at the afferent endings and induce antidromic impulses (dorsal root reflexes) that may modulate peripherally by blocking; (2) central to the "gate", where postsynaptic neuronal repetitive (epileptiform) firing is believed to be an important underlying mechanism in clinical chronic pain syndromes; and, (3) in the periphery, where there is more to input coding than a balance between the ratio of large and smaller fiber inputs. Contrary to the belief of many sensory neurophysiologists, the present authors contend that pattern theory is viable; and that specificity, while important and not to be ignored, should be considered as only a partially evolved refinement superimposed on a basic underlying spatial and temporal patterning of input that probably requires central decoding, which begins in the dorsal horn.