Neuroradiological features of intracranial and intraorbital meningeal haemangiopericytomas.

The neuroradiological features of six intracranial and one intraorbital haemangiopericytomas (HP) are reviewed. CT was performed before and after IV contrast medium in 5 patients. In 2 patients MRI was performed before and after contrast medium; in another, only unenhanced images were obtained. Five patients were studied by selective external and internal carotid artery angiography. Women constituted 5 of the 7 patients, and the mean age was 50.5 years, thus the sex and age distribution did not differ from that of typical meningiomas. Contrary to previous reports, calcification was present in two of the intracranial HP, and bone erosion was clearly seen in one intracranial HP and the orbital lesion. On MRI the tumours showed no differences from angioblastic meningiomas. All 6 intracranial HP were aggressive: all recurred following treatment and extracerebral metastasis occurred in one case.

Early clinical and imaging (high-field MRI) diagnosis of Hallervorden-Spatz disease.

In a 10-year-old girl, with progressive motor disturbance since the age of seven years and dominant pyramidal signs, MRI revealed marked overall low signal from the globus pallidus on each side, with central zones of high signal. There was also strikingly low signal in the zona reticularis of the substantia nigra, indicative of Hallervorden-Spatz disease (HSD).

Migraine and epilepsy with infantile onset and electroencephalographic findings of occipital spike-wave complexes.

An EEG finding of temporo-occipital or temporo-parieto-occipital spike-wave complexes, suppressed by eye opening, coexisting with classical migraine, was observed in 14 children; in 13 of these patients, seizures were present. Classical migraine, visual phenomena and seizures coexisted in different clinical patterns.

Increased reactivity to a met-enkephalin analogue in the control of autonomic responses in migraine patients.

The effects of naloxone and a met-enkephalin analogue on head pain, vascular responses, and autonomic-associated symptoms were studied in 24 migraine patients, 12 patients suffering from tension-type headache, and 24 normal subjects in whom headache was induced by intravenous injections of increasing doses of histamine (histamine test). A hypersensitivity to histamine was found in migraine patients. Naloxone slightly increased the intensity of pain in migraine and tension-type headache sufferers. The met-enkephalin analogue did not affect the intensity of pain in migraine patients, tension-type headache patients, and normal subjects, but it reduced the intensity and duration of facial flushing (p less than 0.001) and the autonomic symptoms (p less than 0.001) in migraine patients when the pretreatment was not given shortly before histamine. In migraine patients, there seems to be an increased reactivity (receptor supersensitivity?) to the met-enkephalin analogue at the level of systems that inhibit facial vasodilatation and autonomic symptoms.

Idiopathic and symptomatic trigeminal pain.

The trigeminal reflexes (corneal reflex, blink reflex, masseter inhibitory periods, jaw-jerk) and far field scalp potentials (nerve, root, brainstem, subcortical) evoked by percutaneous infraorbital stimulation were recorded in 30 patients with "idiopathic" trigeminal neuralgia (ITN) and 20 with "symptomatic" trigeminal pain (STP): seven postherpetic neuralgia, five multiple sclerosis, four tumour, two vascular malformation, one Tolosa-Hunt syndrome, and one traumatic fracture. All the patients with STP and two of those with ITN had trigeminal reflex abnormalities; 80% of patients with STP and 30% of those with ITN had evoked potential abnormalities. The results indicate that 1) trigeminal reflexes and evoked potentials are both useful in the examination of patients with trigeminal pain, and in cases secondary to specific pathologies provide 100% sensitivity; 2) in "symptomatic" and "idiopathic" paroxysmal pain the primary lesion affects the afferent fibres in the proximal portion of the root or the intrinsic portion in the pons; 3) primary sensory neurons of the A-beta fibre group are involved in both paroxysmal and constant pain, but in the latter the damage is far more severe.

Regression of an internal carotid artery pseudoaneurysm after therapeutic embolization of a post-traumatic carotid-cavernous fistula secondary to gunshot injury.

A case is reported of a 53-year-old woman who was hit by a bullet which penetrated the skull base and caused a left carotid-cavernous fistula of the direct type and a pseudoaneurysmal dilation of the high cervical portion of the left internal carotid artery. The fistula was successfully embolized by positioning a balloon into the fistula itself by means of the Debrun technique: unexpectedly the size of the pseudoaneurysm decreased after the embolization; the possible explanations for this event are discussed.

Polymicrogyria: a case detected by MRI.

We report a 3-year-old child affected by severe encephalopathy, partial seizures with early onset and microgyria whom polymicrogyria was detected by means of magnetic resonance imaging (MRI). We believe that MRI first allow an early and confident in vivo diagnosis of this severe and probably not so rare condition.

Migraine and other clinical syndromes in children affected by EEG occipital spike-wave complexes.

Twenty EEG recordings obtained in children showed temporo-parieto occipital or temporo-occipital spikes or spike-wave complexes suppressed by eye-opening. Patients showed different neurological syndromes: classic migraine, vertebrobasilar migraine, visual phenomena, epilepsy, psychomotor retardation. Thirteen subjects were affected by epileptic seizures, which were preceded by visual phenomena in 12 cases. In 6 cases, a combination of classic migraine, visual phenomena and seizures was found. In one case of vertebrobasilar migraine, seizures occurred 5 years after the first episode of migraine. Follow-up data indicate a non-benign evolution of occipital epilepsy: partial or generalized seizures persisted in 13 treated cases. Moreover, the EEG finding of occipital spike-wave complexes seems to extend to different neurological syndromes.

Spasmophilia: a clinical neurophysiopathological and biochemical study.

Spasmophilia is a problem much debated as regards its nosographic location. Its paroxysmal onset in a "neurotic" patient has confined spasmophilia within a psychiatric syndromic complex for many years. In the present study, strict clinical criteria used in selecting a population of spasmophilic patients included clinical, neurophysiological, biohumoral and psychological evaluations, providing further information about the real organic features of this syndrome. Moreover, on the basis of an organic pathogenetic hypothesis, all patients were administered medical therapy which resulted in clinical amelioration in a significant number of cases.

Nuclear magnetic resonance imaging in the aging brain.

43 patients aged over 55 years with different clinical diagnoses but with the common aspect of impairment of the cognitive functions underwent a 0.5 Tesla magnetic resonance imaging (MRI) investigation in order to obtain further information about the pathological causes underlying the clinical syndromes. The occurrence of white matter signal alterations (periventricular lucency) and of multifocal ischemic areas represented the most frequent and atypical finding. Independently of the clinical focal symptomatology, these data might well represent a marker of a diffuse tissue sufferance due to a chronic mild cerebral hypoperfusion. The incidence of similar findings in 'normal' elderly subjects must be assessed before giving them a definite relevance in the evaluation of the pathological aging.

A multicenter double-blind controlled trial comparing lidamidine HCl and loperamide in the symptomatic treatment of acute diarrhoea.

The efficacy of 1-(2,6-dimethylphenyl)-3-methyl-amidinourea hydrochloride (lidamidine HCl, WHR-1142 A) an aryl-substituted amidinourea recently synthesized, was compared with that of loperamide in 32 patients with acute diarrhoea. The results of the study show that lidamidine HCl and loperamide had comparable effects in the pharmacological treatment of acute non-specific diarrhoea. Lidamidine HCl was also shown to be well tolerated; side-effects were generally minor and self-limiting.

Flunarizine-pizotifen single-dose double-blind cross-over trial in migraine prophylaxis.

The results of a double-blind cross-over clinical trial involving 27 patients with classical or common migraine are described to compare the prophylactic effect of the calcium entry blocker flunarizine with that of pizotifen. Duration of the treatment was two months, with an evening single-dose administration of both drugs. For most parameters, there was no definite difference between flunarizine and pizotifen in migraine prophylaxis. It has been demonstrated previously that pizotifen is an effective drug in migraine prophylaxis, and these results suggest that flunarizine is effective, too. Weight gain as a side effect was less frequent and less severe with flunarizine than with pizotifen; other side effects showed the same incidence with both drugs.

Rolandic paroxysmal epilepsy: a long term study in 150 children.

150 children with Rolandic paroxysmal epilepsy (RPE) aged 3 to 12 years were followed up clinically and by EEG for 16 years. Antiepileptic drugs were administered initially for 2 years and then suspended for 6-12 months. Treatment was resumed in the 29 patients who had seizures during the drug-free interval and was maintained for a further 5 years. 80.6% of all patients were in clinical remission after the 2-year treatment period. Some patients had seizures while on drugs, others during the drug-free interval. Seizure frequency declined with age. No seizures occurred after the age of 14 or in the 8 years following final discontinuation of drug therapy. The need for prolonged drug treatment is therefore questioned.

Can antigliadin antibody detect symptomless coeliac disease in children with short stature?

Duodenal biopsy and tests for antigliadin antibodies were done in 108 children with short stature unassociated with gastrointestinal symptoms. Other investigations for causes of growth failure were also carried out. In 88 patients, the cause of short stature could not be determined (group I). In 9 patients (8.3%) biopsy showed total villous atrophy, indicating probable coeliac disease (group II), while 7 patients had mild partial villous atrophy (group III). 4 patients (3.7%) had complete growth hormone deficiency. Antigliadin antibodies detected by immunofluorescence (IFL-AGA) were positive in 8 of the 9 group II patients. Symptomless coeliac disease is therefore a commoner cause of short stature than is hypopituitarism; by use of the IFL-AGA test it is possible to select patients for biopsy, thereby identifying most of the coeliac patients. If duodenal biopsies had been limited to IFL-AGA positive patients, 18 biopsies would have been carried out and coeliac disease would have been diagnosed in 8 of the 9 patients.

[Double-blind clinical study: flunarizine versus pizotifen in a single nightly dose in hemicrania patients]. / Studio clinico in doppio cieco: flunarizina contro pizotifene in un'unica somministrazione serale in pazienti emicranici.

In this double-blind clinical trial we compared the prophylactic efficacy of the calcium-entry blocker flunarizine (15 mg nocte) with that of pizotifen (1,5 mg nocte). In 30 patients affected by classical and common migraine. During a two months treatment both drugs showed a good efficacy. Flunarizine tended to more markedly suppress severity of pain and duration of attacks than pizotifen. Daytime drowsiness and weight gain occurred with both drugs; the first side effect was more evident in the group treated with flunarizine, the second one in the group treated with pizotifen.

Trigeminal control of cranio-facial vasomotor response: I. Histamine test in patients with unilateral gasserian ganglion lesions.

It has been hypothesized that the trigeminal system may control vasomotor changes and pain in vascular headaches. In this study, headache was induced by an intravenous injection of histamine in 37 patients with trigeminal rhizotomy and in 12 controls. The vasomotor response to histamine was studied with facial telethermography. The headache in patients with trigeminal lesions differed, in a prevalence of unilateral localization contralaterally to the operated side (21 patients), from that in controls. No relationship was found between the hypoesthesia caused by the operation and the prevalence of unilateral headache. A statistically significant correlation (p less than 0.001) was found between unilateral absence of headache and decreased vasomotor response on the operated side. These reactions occurred more in patients who underwent thermocoagulation than in patients who underwent retro-gasserian rhizotomy. Thus the gasserian ganglion seems to control the cranio-facial vasomotor response and the headache through a vascular pathway, acting on cerebral arteries, which differs from the sensory pathway.

[Neurotransmitter control of pupillary motoricity in man]. / Controllo neurotrasmettitoriale della motricita 'pupillare nell'uomo.

The pupillary responses to different agonists and antagonists of the sympathetic and parasympathetic systems have been studied in normal volunteers. The eyedrops were instilled unilaterally and the responses were evaluated by measuring the changes in diameter of the pupils (in millimeters). All the eyedrops induced an unilateral response on the instilled side. The mydriatic substances (phenylephrine, thropamide, tyramine) showed an evident and lasting action. Phenylephrine 1% was found to be a threshold dose to acquire the mydriatic effect. The beta blocking agent (timolol) induced a short mydriatic response, while methaproterenol did not change the pupillary diameter. Clonidine caused an unilateral mydriasis. The alpha blocking agent and the parasympathetic system stimulation agent induced miotic effects The results are discussed with particular reference to the possible mechanism of the pupillary response to timolol and clonidine.