Aphasia in Multiple Sclerosis

Aphasia as clinical manifestation of cerebral multiple sclerosis is a rarity. We report here a clinical case of multiple sclerosis complicated by striking motor aphasia. A 11 year old male was admitted with sudden onset of aphasia and quadriparesis following appendectomy under the general anesthesia. A few hour after operation, above symptoms and bilateral pyramidal signs were developed. These findings were fluctuated but slowly remitted. Two weeks later second bout of multiple sclerosis developed, characterized by absent spontaneous speech, quadriparesis, multiple cranial nerve palsies internuclear ophthalmoplegia and bilateral pyramidal signs. The finding of E.E.G. disclosed paroxysmal slow waves in high amplitude on frontal region. Patient was treated with steroids and conservative management. Eleven weeks later, he was discharged with relatively good results.

Ependymoblastoma Associated with Massive Intracerebral Hemorrhage

The patient is a 17 month old girl admitted to the Korea General Hospital with histories of irritability, walking disturbance and right sided weakness. On admission, she had seizure followed by coma. Skull x-ray showed widely separated all cranial sutures. A left carotid angiogram revealed a space occupying lesion in the left frontotemporoparietal region with shifting of the midline to the right. At operation, a darkish hemorrhagic tumor with relative clear demarcation was explored after evacuation of massive intracerebral hematoma. The tumor was extended to the midline. The main mass was removed with difficulty. Additional fragments of the necrotic tumor tissue infiltrated in the surrounding structures were also removed. It was not directly connected to or have invaded the ventricular wall. On microscopic examination, the tumor was largely made up of solid sheets and cords of round or ovoid cells with darkly stained nuclei. In areas, typical ependymal rosettes as well as pseudorosettes, gliomatous features and occasional formation of tubule are presented. We think the tumor represents those rare tumors called ependymoblastoma of Rubinstein.

Bitemporal Hemianopsia Caused by Head Injury

Visual field defects being associated with severe closed head injury is well known. The nature and frequency of these association have been reported in a few literatures. Some hypotheses have been advanced to explain the field defects, but no prospective pathological study of the visual pathways in a large number of cases with closed head injury has been made. These hypotheses as to why vision is impaired after head injury have not explained most cases, if not at all. Authors have experienced a case of traumatic, complete bitemporal hemianopsia associated with macular sparing on the right and macular splitting on the left eye in 29 year old man. The patient had a head injury with traffic accident, which caused fractures of the frontal bone and orbital roofs. The various pathogenic possibilities of the chiasmal damage and consequent visual field defects are discussed.