ABSTRACT
Report with complementary clinical examinations and detailed neuropathological findings of a case of subacute progressing "thalamic dementia", interpreted as combined systemic degeneration of the dorsal and medial thalamic nuclei. For the development of the EEG changes, which were followed from beginning of the disease, a slowly advancing reduction of the function of the meso-diencephalic activating system proved responsible. The inferior olives were symmetrically atrophied and the fasciculus tegmenti centralis was on both sides completely degenerated. It is to be considered that the inferior olives are directly subordinated to the medial thalamic nuclei by the way of the fasciculus tegmenti centralis. In the cerebellum nerve cell groups and fiber bundles, which are closely connected with the reticular system, are degenerated. The systemic medial degenerations of the thalamus belong to the abiotrophies in the sense of Gowers original conception.
Subject(s)
Dementia/pathology , Thalamic Diseases/pathology , Adult , Alpha Rhythm , Arousal/physiology , Atrophy , Brain Stem/pathology , Cerebellum/pathology , Cerebral Cortex/physiopathology , Dementia/physiopathology , Electroencephalography , Female , Humans , Nerve Degeneration , Thalamic Diseases/physiopathology , Thalamus/physiopathology , Theta RhythmABSTRACT
34 EEG records of 9 patients with verified necrotizing-herpes-encephalitis permit the following statements concerning the electroencephalographic findings. 1. The EEG is always severely affected in the acute stage. This is characterized by a progressive slowing and disorganization, almost constantly coexistent with focal signs or pronounced asymmetries. 2. The preferential site in the temporo-insular, hippocampal and orbitofrontal regions of the pathological process is almost invariably reflected by the uni- or bilateral fronto-temporal local slow-wave abnormality. Even bilateral processes may show asymmetries, which correspond to the different expansion of the process in the hemispheres. 3. Periodic complexes, if present differ from those seen in Creutzfeldt-Jakob disease and in subacute sclerosing panencephalitis. They are highly suggestive of the diagnosis of herpes encephalitis but do not indicate always a poor prognosis. 4. Local slow wave abnormality may be followed by local flattening indicating a necrosis of large cortical areas. 5. Epileptiform discharges present in only 7 of the 34 records were always focal or lateralized. 6. In a case followed up to 46 months the EEG became temporarily normalized although severe neurologic deficits were present at the same time.
