Central pontine myelinolysis after liver transplantation.

Eight adults and 3 children out of 85 patients who had neuropathologic examination after death following orthotopic liver transplantation showed central pontine myelinolysis (CPM). Four patients also had extrapontine myelinolysis. Eight patients had significant serum sodium changes. In 5, the fluctuation occurred perioperatively and 4 had a clinical picture consistent with CPM, although no patient had this as an antemortem diagnosis. We emphasize the role of hepatic dysfunction as a cause of CPM and recommend careful monitoring of electrolytes in the perioperative period of patients undergoing liver transplantation.

Limbic system symptomatology associated with colloid cyst of the third ventricle.

The clinical manifestations of olfactory and gustatory hallucinations are commonly attributed to temporal lobe involvement. The case is presented of a 46-year-old man with prolonged episodes of olfactory and gustatory hallucinations, who was found to have a colloid cyst of the third ventricle. Exhaustive electroencephalographic and radiological studies were negative except for the cyst. Stereotaxic aspiration of the cyst resulted in immediate cessation of all symptomatology with a follow-up of 14 months.

Neurologic complications of liver transplantation.

The clinical and neuropathologic findings of 55 adults and 30 children who received liver transplants were reviewed. Encephalopathy was the most common clinical neurologic syndrome and was usually caused by metabolic or anoxic causes. (Alzheimer type astrocytes were present in 73 per cent of patients, and evidence of diffuse hypoxic damage was present in 40 per cent of children and 25 per cent of adults.) Cerebrovascular lesions were a common finding with infarcts or hemorrhages present in 30 per cent of patients. CNS infections were documented in 34 per cent of patients. Seizures were present in a third of patients. Central pontine myelinolysis was present in 12 per cent of patients and was more common in adults than in children. Antemortem diagnosis of neurologic complications was more often based on clinical presentation rather than specific radiologic or laboratory tests.

Effect of water pH and salinity on the survival of eggs and larvae of the euryhaline teleost, Gasterosteus aculeatus L.

The effect of water acidification and salinity on the survival of the eggs and larvae of the euryhaline teleost, Gasterosteus aculeatus, was studied using tap water that was low in calcium and high in total aluminium as the basic medium. The survival of eggs from fertilisation to hatching increased with an increase in pH from 4.5 to 6.5. Survival was higher at a given pH at higher salinities (equivalent to 5% and 10% seawater) than in tap water. The salinity experienced by the female prior to spawning also had an effect on egg survival. Survival for 7 days after hatching was high except at the lowest pH levels. The salinity experienced by the female had no significant effect on larval survival.

The electroencephalogram after resuscitation of cardiocirculatory arrest.

Fifty-two EEGs of 31 patients were studied after resuscitation from cardiac arrest. Examples of patients with normal or mildly abnormal (category I) and severely abnormal (category II) EEGs are presented. All patients in category II died. In the patients of category I, EEGs showing no improvement or worsening indicated a fatal prognosis and possibly reflected deteriorating cardiac function caused by the basic disease process.

Reappraisal of alcoholic myopathy. Clinical and biopsy study on chronic alcoholics without muscle weakness or wasting.

To determine if alcoholic neuropathy which causes denervation of the distal muscles of chronic alcoholics also produces a subclinical myopathy of their proximal muscles, we studied 11 chronic alcoholics who had no muscular weakness or wasting. Six patients demonstrated distal hyporeflexic (ankle jerks) sensory neuropathy on clinical examination. Four patients, one of whom was asymptomatic, had slow peroneal motor nerve conduction velocities. Patterns of neuropathy were present in the electromyograms of the proximal muscles of two patients. Muscle biopsy studies with enzyme histochemistry indicated denervation atrophy and myopathic changes in the contralateral quadriceps muscles of eight patients. As denervation atrophy was present, we concluded that these myopathic changes represented the effects of denervation of these muscles. We conclude, therefore, that the proximal subclinical alcoholic myopathy, previously described as primary by ourselves and others, is the result of denervation due to the well-known alcoholic neuropathy.

Subacute necrotizing encephalomyelopathy. Its relationship to central pontine myelinolysis.

Clinical and neuropathological features of a case of subacute necrotizing encephalomyelopathy are discussed and compared with the features of central pontine myelinolysis. A hypothesis is offered relating the two diseases to a common aetiological factor.