Case report of a patient with complex partial frontal lobe seizures as a complication of bifrontal lobotomy.

This case report describes an 85 year-old woman who underwent a bilateral frontal lobotomy for presumed schizophrenia 50 years ago. The patient presented with sudden alterations of consciousness accompanied by motionless staring and speech and movement arrest. After 5 to 10 seconds, contact recovered briskly. As there was electrophysiological evidence for a frontal epileptic focus, these fits were classified as complex partial frontal lobe seizures with impairment of consciousness at onset. An aetiological link with the bifrontal lobotomy is probable. At the occasion of this case report, complications of frontal lobotomy are reviewed.

Superoxide dismutase activity in cerebrospinal fluid of patients with dementia and some other neurological disorders.

Data on superoxide dismutase (SOD) activity in the cerebrospinal fluid (CSF) of patients suffering from dementia (n=32) as compared with a control group (n=58), a Parkinson disease (PD) patient group (n=12), and a group of individuals suffering from epilepsy (n=13) are presented. SOD activity was determined by electron spin resonance spectrometry using the spin trap method. No significant correlation was found between CSF SOD activity and age in the control group. In addition, CSF SOD activity was not gender dependent. One-way analysis of variance showed a highly significant between-groups effect for the CSF SOD activity and specific CSF SOD activity of the four major groups (p=0.0008). Post hoc comparison (Fisher PLSD test) revealed significant differences between the control group and the total dementia group (p < 0.001), between the dementia group and the epilepsy group (p < 0.01), and between the dementia group and the PD group (p < 0.05). The CSF of patients with PD or epilepsy showed a similar SOD activity as the CSF of control patients. In addition, CSF SOD activity levels were significantly lower in the total dementia group (p=0.002) and in the group with dementia of the Alzheimer type (DAT) (p=0.001) than in the dementia age-matched control group. No significant difference was found for CSF SOD activity levels between the control group and the non-DAT dementia group. This result corresponded with a reduction of CSF SOD activity in the total dementia group, DAT subgroup, and non-DAT subgroup of 37, 43, and 22%, respectively. No significant correlation between the Mini-Mental State Examination score and CSF SOD activity was found in DAT. The lowered CSF SOD activity in Alzheimer disease, as demonstrated here, may reflect impaired radical defense mechanisms and may have possible pathophysiological significance.

Discriminative use of SPECT in frontal lobe-type dementia versus (senile) dementia of the Alzheimer's type.

UNLABELLED: Dementia of the Alzheimer's type [(S)DAT] and dementia with frontal features (FLD) are nosological entities with different prognoses and presumed pathophysiology. There is a need for noninvasive differential diagnostic tools. To evaluate whether SPECT perfusion imaging could discriminate between these neurodegenerative disorders, we performed a comparative study. METHODS: SPECT scans using 99mTc-hexamethylpropylene amine oxime (99mTc-HMPAO) of 21 patients with FLD were compared with those obtained in a group of 19 age- and severity-matched patients suffering from (S)DAT. Brain SPECT perfusion deficits were scored by visual qualitative analysis with respect to location, lateralization and severity. A total severity score of cerebral hypoperfusion (maximal value = 18) was calculated by adding all severity scores (scored between 0 and 3; 0 = no perfusion deficit; 1 = 13%-30% hypoperfusion; 2 = 30%-50%, hypoperfusion and 3 = > 50% hypoperfusion including breaching of the cortex) for right and left frontal, parietal and temporal lobes. Moreover, bifrontal hypoperfusion (Fa) was scored, yielding a value between 0 and 6 by adding the two frontal severity scores. RESULTS: No significant correlation was found between MMSE scores and total severity scores on SPECT. A statistically significant correlation was found between the Middelheim frontality score and frontal severity score. Statistically more significant bilateral hypoperfusion of the parietal lobes was found in the (S)DAT group. Conversely, bifrontal hypoperfusion was found more in the FLD group. Stepwise logistic regression analysis identified the severity of bifrontal hypoperfusion as the most significant contributing parameter to correctly classifying (S)DAT versus FLD on SPECT. The probability of predicting (S)DAT based on the SPECT scan is calculated with the following formula: [equation: see text] Using this equation, a value above 0.5 was predictive for (S)DAT and a calculated value under 0.5 was predictive for FLD. Using this model, 81% of the FLD group and 74% of the (S)DAT were correctly classified. CONCLUSION: Technetium-99m-HMPAO SPECT may help in discriminating FLD from (S)DAT. Bifrontal hypoperfusion was found to be the most powerful predictor of clinical classification. Further validation of the presented logistic regression model is warranted.

Focal neurocognitive dysfunctions in abstinence delirium: a case report.

Due to abrupt interruption of hidden benzodiazepine-use, a 68-year-old woman developed a full-blown abstinence delirium characterized by epileptic seizures and progressive focal neurocognitive symptoms. The evolution of such rare neuro-linguistic phenomena as an echoism, palilalia and glossomania associated with a progressive visuo-perceptive syndrome and a visual hallucinosis are for the first time reported within the context of withdrawal. Notwithstanding the lack of any neuroradiological evidence for a morphological lesion in the clinically expected brain regions, the anatomo-clinical hypothesis of a focal frontal and parieto-occipital dysfunction was explicitly corroborated by repeated 99mTc-HMPAO SPECT findings.

Bilateral infarction in the anterior cerebral artery vascular territory due to an unusual anomaly of the circle of Willis.

BACKGROUND: Bilateral infarction in the anterior cerebral artery vascular territory is rare and usually results from rupture of an aneurysm of the anterior communicating artery. In the case of an anomaly of the anterior part of the circle of Willis, thrombosis also may lead to bilateral infarction. CASE DESCRIPTION: A 73-year-old right-handed man presented with a complete loss of communicative behavior and an almost complete quadriplegia. 99mTc-hexamethylpropyleneamine oxime single-photon emission-computed tomography (HMPAO SPECT) of the brain showed a "horseshoe" image, reflecting bilateral perfusion defects in areas supplied by the anterior cerebral arteries. Postmortem examination of the brain revealed an unusual anomaly of the circle of Willis in which the postcommunicating part of the right anterior cerebral artery was absent. CONCLUSIONS: In our patient a unique developmental anomaly of the circle of Willis indirectly contributed to bilateral infarction in the territory of the anterior cerebral artery. The patient's neuropsychological profile, dominated by akinetic mutism, was highly suggestive of involvement of the receptive language modalities. For the first time, 99mTc-HMPAO SPECT of the brain revealed a horseshoe image in bilateral infarction in the territory of the anterior cerebral artery.

Repeat thallium-201 SPECT in cerebral lymphoma.

The authors report on the contribution of Thallium-201 brain SPECT in the diagnosis and follow-up of a non-immunosuppressed patient, presenting with primary cerebral lymphoma. The tumoral process was at first not diagnosed on CT-scan, but Thallium-201 SPECT suggested a tumoral invasion. During corticosteroid treatment the tumor volume on CT-scan decreased, while on Thallium-201 SPECT there was an enhancement of the accumulation and an increasing tumor to non-tumor ratio. These scintigraphical findings more closely reflected the clinical course and the postmortem results.

Some controversies about type and nature of aphasic symptomatology in Landau-Kleffner's syndrome: a case study.

The syndrome of acquired aphasia and convulsive disorders in childhood has received ample discussion since the initial description by Landau and Kleffner in 1957. Despite numerous investigations considering the linguistic and epileptic phenomena of the syndrome, the symptomatology still remains of a puzzling nature. Two aspects of the syndrome, the acquired nature of the aphasia and the type of linguistic symptomatology, have not been discussed thoroughly. In our case not only a history of developmental language pathology was present but language symptomatology also revealed a predominantly motor aphasia during a language deterioration phase. A careful review of the literature as presented here yields data in agreement with our findings. First we found further evidence in the literature that Landau-Kleffner's syndrome is not exclusively a primarily receptive language disturbance. Secondly, evidence in favour of a developmental type of Landau-Kleffner's syndrome was found in 25 additional cases. In this group of children with developmental language disturbances at least two distinct types seem to emerge. A group in which the already existing developmental language disturbances did not fluctuate during the course of the illness and a group in which a considerable deterioration of the developmentally disturbed language functions took place. The different patterns of language evolution not only seem to suggest the possibility of an acquired language pathology within a context of developmental language disturbances but also a congenital onset of the syndrome of Landau-Kleffner as the probable cause of developmental language pathology.

Clinical and pathophysiological aspects of neurological complications in renal failure.

A review of the neurological complications presenting in uremia and an account of their presumed pathophysiology is given. With the introduction of different dialytic procedures during the last twenty years, the incidence and severity of neurological complications have declined. Nevertheless, some disturbances related to the uremic syndrome fail to respond to dialytic therapy and these therapeutic measures may even be responsible for the appearance of some new abnormalities. The clinical manifestations of uremic encephalopathy and polyneuropathy are presented. The review of the presumed pathophysiology of these syndromes illustrates the still existing controversies. Nevertheless, some promising new lines of research are reviewed. In addition, some complications of uremic treatment, including dialysis disequilibrium syndrome and dialysis encephalopathy are presented.

A case of idiopathic palatal myoclonus: treatment with sodium valproate.

We describe a case of idiopathic palatal myoclonus with normal CT and NMR results, especially of the region of the inferior olive. The effective treatment with sodium valproate is reported and its relation with GABA is discussed.