Aetiology of diabetic neuropathy - abstract

The diverse disorder of diabetic neuropathy seems to be due to a plethora of factors. No one factor seems to be solely reposible. There is a spectrum of probabilities which include mechanical and environmental factors as well as the milieu interieur which embraces chemical, genetic, metabolic, biochemical, toxic and vascular entities. This paper attempts to explore these probabilities with a view to their relevance to the pathogenesis of diabetics neuropathy (AU)

Subacute sclerosing panencephalitis

The case is described of a 13-year-old Jamaican boy with subacute sclerosing panencephalitis. There have been no previous reports of this condition in Jamaica. Review of the literature has shown that the measles virus involved in the pathogenesis of this disorder (AU)

Neurosyphilis in Jamaica - abstract

This report reviews 105 consecutive cases of neurospyphilis seen at the Kingston Public Hospital over the past 10 years. The diagnostic criteria used were the clinical picture, blood and CSF serology and the lange colloidal gold curve. There were 51 males and 54 females with ages ranging from 17 to 84 years. Only 7 cases (6.6 percent) occurred before the age of 30 years. Syphilis serology was positive in blood in 65.7 percent and in CSF in 45.7 percent of cases, in 23.8 percent there was negative blood serology, in 51.4 percent negative CSF serology, while blood and CSF were negative in 20.9 percent of cases. In the 22 cases with negative blood and CSF serology 19 had a paretic lange curve. In the series as a whole, 62.8 percent had a paretic curve, 3.8 percent a tabetic curve and 33.3 percent were non-reactive. There was a strong correlation between a wide range of neuroluetic manifestations and a positive Lange curve. It also appeared that the best indices of neuroluetic activity were a reactive Lange curve, hyperproteinaemia lymphocytosis and a positive CSF serology. Among the neuroluetic manifestations found were personality changes, spastic paraplegia, hemiplegia, speech disturbances, ocular disturbances, epilepsy, headaches and subarachnoid haemorrhage. It is noted that epilepsy was a presenting feature in 17 percent of cases and the headaches which occurred in 14 cases closely resembled those seen in other clinical situations such as hypertension, anxiety states and migraine. Subarachnoid haemorrhage occurred in 17 percent of cases and 55 percent of these were under 55 years of age. On the basis of the present series 4 clinical groups emerge. They are (a) the catastrophic (b) the acute, (c) the chronic, (d) the remittent (AU)

Subacute sclerosing encephalitis: a case report

Dawson in 1934 and Ludo Van Boegart in 1945 independently described a progressive and uniformly fatal, degenerative disease of the central nervous system in childhood. The main clinical characteristics of the conditions are progressive intellectual decay, deterioration of personality and behaviour, motor seizures, myoclonus, and incoordination, on the downhill march to quadraplegia, immobility, and death. This is a disease of the first 2 decades of life. It is rare, only 1 or 2 cases being diagnosed annually at large neurological centres. A case is described in a 13 year-old boy who is in the early stages of the disease. Reliable clinical diagnosis at this stage is based upon symptomatology, CSF changes, and the diagnostic EEG studies. The electrical studies and their significance are discussed in detail, as are the various clinical stages. Measles antibodies studies are not available locally. Their significance and recent serological and electron miscroscopic studies, incriminating the Measles virus as aetiological are described (AU)

The migraine equivalents - abstract

The purpose of this paper is to underline the importance of the migraine equivalents, clinical conditions which simulate classical migraine but are unlike it in essential clinical characteristics. There is often considerable diagnositic confusion when the clinician is not aware of them. The differential diagnoses are discussed. The similarity between migraine and the migraine equivalents is based on the deranged patho-physiology, namely vasoconstriction followed by vasodilatation, affecting the vertebro-basilar system and the internal carotid territory of supply. These areas of vascular involvement are outlined and suitably illustrated. The related migraine equivalents are discussed in detail as they affect the motor, parietal, occipital, temporal and other significant areas of localisation. The common and rare forms of the migraine equivalents are tabulated for quick appraisal. Reference is made to personal cases. The relevant literature is reviewed. Therapy is briefly discussed (AU)

Facial palsy: a multifactorial entity

Facial Palsy is not a common condition in Kingston, Jamaica, only 21 cases being treated at the Kingston Hospital between 1958 and 1968. Statistical problems arise as a result of sampling distortion consequent on omission from the diagnotic records because of other overwhelming conditions, no attention being sought for the condition, or the patient being lost to follow-up. The age range is wide. Men were more commonly affected than women and at an older average age. A seasonal incidence has been demonstrated, some 71 percent (15/21) of the cases occurring in the warm season of the year (April to October). Older patients are more commonly affected during the warm months, raising the possibility of a vacular ischaemic process. Other aetiological factors such as exposure to cold, infections of viral or non-viral type, diabetes, and trauma are discussed. Trauma accounting for some 20 percent (4/21) of the cases seemed a particularly high percentage in this Jamaican series. The recovery rate in those followed up was favourable. Onset in summer and early spring appeared to exert a favourable prognostic effect (Summary)

Apert's syndrome

Apert's syndrome is a rare condition characterized by a tetrad of features: acrocephaly, facial deformities, ocular proptosis with visual defect, and syndactyly. The patient in the case described is a 13 year old girl without a family history of similar anomalies. (AU)

Primary hepatoma - abstract

Primary hepatoma is not a common condition, being found in only 4 cases of a personal series of admissions to the wards between 1958 and the present. The series confirms the predelection of the condition for the young adult male. The clinical presentation and findings conform to a characteristic pattern, a triad of symptoms and a tetrad of signs being typical of this series. The main laboratory and autopsy findings are discussed. Current views on aetiology are briefly explored(AU)

Myasthenia gravis in Kingston, Jamaica

Myasthenia Gravis has been described as a complete clinical entity only within the last 90 years, although there have been references to it as early as 1672. A brief historical review has been given. The condition is not common in Kingston, Jamaica, there being only 12 proven cases out of a total admission of 6,000 patients to two medical wards at the Kingston Public Hospital between January 1st, 1959 and December 31st, 1964. The clinical behaviour of these cases is reported in detail (AU)

Carcinomatous neuropathy

Carcinomatous neuropathy has become defined and the object of universal clinical attention during the last 20 years. The more obscure an entity and the more varied its clinical presentation, the greater the speculation as to its aetiology and the stimulus to its documentation. This is the first report of this condition from the Kingston Hospital. A series of personal cases seen during the last eight years is briefly outlined. The varied clinical pictures are described and correlated with a suggested clinical classification. Current aetiologic concepts are reviewed. The literature is briefly discussed and the principal differential diagnoses are examined (AU)

A pattern of convulsions in childhood

Convulsions were a common cause of admission to hospital in patients under 16 years of age. During the period 1958-1961 there was a total of 447 such patients admitted to Kingston Public Hospital, the peak age was 1 to 5 years and there was a male dominance. Febrile respiratory infections were a major factor indicating the need for early, effective, treatment. Fever of undetermined origin affected about 18 per cent of the cases. Non-respiratory infections, cerebral damage and helminthiasis were infrequent causes of convulsions. Noteworthy was the absence of tumours, syphilis, hypertensive encephalopathy and heredity as aetiological factors. Reasons are also adduced for the probable mis-diagnosis of petit mal and psycho-motor epilepsy (AU)

Myxedema coma

Only once was this condition found in over 5,500 admissions during a five year period. This case report commented on the clinical features, the laboratory findings as well as the response to thyroid extract (AU)