State of the art: deep brain stimulation in Parkinson's disease.

Surgical therapy for Parkinson's disease has a long history beginning in the 1930s with empirical exploration of different brain targets, such as resection of the primary motor cortex or extirpation of the caudate. Recently, there has been a renaissance of functional neurosurgery for the treatment of advanced Parkinson's disease, particularly deep brain stimulation (DBS). To date, DBS of the globus pallidus interna and subthalamic nucleus has been reported to relieve motor symptoms and levodopa-induced dyskinesia in patients with advanced Parkinson's disease. DBS also has different advantages over pallidotomy and subthalamotomy, including reversibility, decreased risk of reoperation and decreased morbidity. In addition to well-experienced neurologists and neurosurgeons, a multidisciplinary team approach is fundamental and critical to ensure success in the DBS procedure in individual patients. With the advances in neuroimaging, neurophysiology and localization techniques, it is increasingly likely that there will be more surgical targets in the future that can also improve cardinal features of Parkinson's disease, or even nonmotor manifestations of this condition.

Huntington's disease in Thailand: a case report.

The first documented case of Huntington's Disease (HD) in Thailand is reported. The patient presented with classical clinical picture, clinical course and family history. Although hereditary chorea is most frequently associated with HD, other hereditary basal ganglion diseases, Syndenham's chorea, and other causes of abnormal movements were considered and excluded by clinical profiles and investigations. Various recent aspects of HD are briefly mentioned.

Increased intracranial pressure associated with spinal cord astrocytoma: a case with CSF dynamic study.

The case of an astrocytoma of the cervical cord associated with signs and symptoms of increased intracranial pressure in a 14-year-old girl is reported. Several possible etiological factors responsible for producing this syndrome are presented. The impairment of CSF absorption at the convexity proven by CSF dynamic study is the main factor for the increased intracranial pressure and the neoplastic inflammatory reaction appears to be the causative mechanism for poor CSF absorption in this patient.

Intermittent exophthalmos.

A 28-year-old woman is reported with intermittent exophthalmos and acute orbital hemorrhage which developed after a warning symptom of recurrent positional headache. The cause was proven to be a primary orbital varix. Conservative measure was considered in this case. The characteristics of the primary orbital varix are presented and the problems of diagnosis and treatment are discussed.

Vogt-Koyanagi-Harada syndrome.

Clinical analysis was done in 7 cases of Vogt-Koyanagi-Harada syndrome. Nearly all of the patients were Thai women. The most common manifestation was headache and blurred vision. CSF pleocytosis without meningeal irritation signs were encountered in every cases. Ophthalmological, neurological and otological findings responded, in 2-4 weeks, to the systemic administration of high dose corticosteroids.

A report of three cases of AIDS in Thailand.

Acquired immune deficiency syndrome (AIDS) has been rarely reported as occurring primarily in Asia. We report here on first three cases of AIDS diagnosed at Chulalongkorn Hospital Medical School. One case was an American who had been in Thailand for two years; the other two were Thai. The American and one of the Thai patients were male homosexuals but they had no connection with one another. The latter Thai male homosexual had sexual contact with a German man who showed no evidence of the disease. The other Thai patients was the mistress of the male Thai patient, which underlies the importance of heterosexual transmission of the disease. The two male patients had opportunistic infections whereas the female patient had only generalised lymphadenopathy (Pre-AIDS). Delayed type hypersensitivity response, T-cell subsets enumeration and the in vitro T-cell mitogen response served as diagnostic tools when combined with the clinical history. The diagnosis was made even before the results of tests to determine the presence of antibodies to HTLV-III were known. The presence of anti-HTLV-III simply confirmed our diagnosis.