Computed Tomography of Japanese Encephalitis with Clinical Correlation

The computed tomographic (CT) and clinical findings in 9 patients with serologically confirmed Japanese encephalitis were reviewed. In 6 patients with prominent pyramidal and extrapyramidal symptoms and signs, the main CT finding was low density areas in the thalamus, internal capsule, basal ganglia, and midbrain. Low density areas were compatible with the anatomical distribution of pathologic lesions in Japanese encephalitis. Diffuse low density in the periventricular white matter was evident in 5 of 6 cases, with ventricular compression in 2 cases, between the 1st and 7th day of illness. There was enlargement of the third and lateral ventricles and cortical sulci dilatation in 3 cases on or after the 21st day of illness. In once CT scan obtained on the 10th day of illness, diffuse low density in the periventricular white matter was observed with enlargement of lateral ventricles and cortical sulci dilatation. Gyral enhancement was noted in 3 of 4 cases within 4 days after the onset of symptoms. There was a limited correlation between the clinical and CT findings.

A Clinical Study on Guillain-Barr'e Syndrome

Authors reviewed clinical recordings of 102 patients who were diagnosed as Guillain-Barre syndrome from 1979 to 1983 at Seoul National University Hospital. Among them, eighty-five cases were selected for the clinical study of Guillain-Barre syndrome through application of strict diagnostic criteria. And the following results were obtained. 1) There was a male preponderance (2.5:1) and an apparent predilection for the first and the second decades in this series. 2) Seasonal predilection was in summer and fall over five years. As judged from the uneven monthly incidence rate in each year, some epidemic tendency is likely to be in Guillain-Barre syndrome. 3) Sixty cases (71%) of this series had a history of antecedental events. The onset of neuritic symptoms occurred within one week from the preceding events in twenty-nine cases and one to two weeks in twenty cases. 4) The neuritic symptoms started from lower limbs in fifty cases (59%), upper limbs in eighteen (21%), cranial nerve distribution in six (7%) and developed nearly simultaneously in eleven (13%). 5) Most of the disabilities of the patients were devided into flaccid paralysis of limbs, cranial nerve dysfunction, autonomic dysfunction, respiratory difficulty and sensory abnormalities (paresthesia and myalgia). Autonomic dysfunction was observed in nine cases (11%), respiratory difficulty in thirty-one (37%), sensory abnormality in thirty-two (38%), and cranial nerve dysfunction in forty-seven (55%). 6) Authors devided the crainal nerve dysfunction into facial diplegia which was the most frequent form, bulbar palsy the next, masticatory muscle weakness the third, and ocular paresis the least. 7) There were two cases of Fisher syndrome (2.4%), three cases of polyneuritis cranialis (3.5%), and two cases of recurrence (2.4%) in this series. 8) Two cases (2.4%) died of respiratroy and bulbar dysfunction. Five cases (6%) had residual disability in motor function till six months follow-up.