Spinal subarachnoid hemorrhage due to a filum terminale ependymoma.

We present a case of spinal subarachnoid hemorrhage due to an ependymoma of the filum terminale in a 23-year-old male. Clinical signs indicating a spinal origin of the subarachnoid hemorrhage are discussed. Subarachnoid hemorrhages are only rarely caused by an intraspinal tumor, most of which are located in the cauda equina. Our findings in this case proved the value of MRI examination in tumors of the cauda equina.

Biochemical parameters of bone turnover during ten days of bed rest and subsequent mobilization.

Immobilization is associated with increased bone resorption. To investigate the early onset of increased bone resorption, we evaluated 14 patients who were immobilized for 10 days because of lumbar disc protrusion. The fasting urinary hydroxyproline/creatinine ratio increased significantly after four days (P less than 0.01), reached a peak after 10 days (16.4 +/- 3.3 mumol/mmol, 27.6 +/- 8.8 mumol mmol, P less than 0.01) and returned slowly to baseline values after mobilization. The fasting urinary calcium creatinine ratio followed a similar pattern. Serum calcium and phosphate increased during immobilization (P less than 0.01). Serum 1,25-dihydroxyvitamin D decreased significantly during immobilization (98 +/- 33 pmol/l vs. 79 +/- 36 pmol/l, P less than 0.05), and reached a nadir one week after mobilization (P less than 0.01). We conclude that there is an early significant increment in resorption parameters, with a slow return during the mobilization period. Serum 1,25-dihydroxyvitamin D is suppressed as a result of the increased serum calcium and serum phosphate levels.

A Dutch family with autosomal dominant pure spastic paraparesis (Strümpell's disease).

Families with "pure" hereditary spastic paraparesis of late onset have rarely been reported. Since the original article by Strümpell in 1880, many "complicated" forms of the disorder have been reported, and the question as to whether a "pure" form exists still arises from time to time. We present a Dutch family with "pure" hereditary spastic paraparesis, involving 15 affected members in three generations. The mode of inheritance was autosomal dominant, with onset of clinical signs in the fourth or fifth decade. Severity of the disease was mild; only a few of them became chairbound in the end. There were no sensory symptoms. Mild sphincter disturbances were mentioned by six patients. A review of the reports on Dutch families is given and arguments in favour of the existence of "pure" hereditary spastic paraparesis are discussed.

A case of progressive aphasia without dementia: "temporal" Pick's disease?

We report a patient who suffered from progressive aphasia for nine years, before developing mild behavioural disturbances. Sequential computed tomography (CT) scanning and magnetic resonance (MRI) imaging showed progressive bilateral temporal atrophy. The case is thought to be a temporal form of Pick's disease, in which isolated progressive aphasia was the only symptom over many years.

The functional recovery of stroke: a comparison between neuro-developmental treatment and the Brunnstrom method.

The relative efficacy of Neuro-Developmental Treatment (N.D.T.) versus the Brunnstrom method was studied from the perspective of the functional recovery of stroke patients. An alternating treatment design (B-C-B-C) was used. Each intervention phase lasted 5 weeks. The functional recovery of the patients was assessed every week by using the Barthel Index and the Action Research Arm test, by registering walking velocity, and by performing gait analysis. At the start and at the end of each intervention phase, neurological and neuropsychological assessments took place. Time series analysis indicated that for one patient only, walking speed progressed more during the Brunnstrom phases than the N.D.T. phases. This result did not generalize towards other parameters or patients studied. For upper extremity function and maximum walking speed, a high correlation was found between the week post stroke in which the patient showed the first signs of recovery and the end condition after 20 weeks.

[A patient with botulism caused by Clostridium botulinum type B]. / Een patiënt met botulisme veroorzaakt door Clostridium botulinum type B.

A case of botulism type B acquired in The Netherlands is presented. The diagnosis was made on clinical grounds and positive mouse bio-assay. The patient was a man aged 37 years. Additional evidence was obtained by electromyography, single fibre electromyography and autonomic function tests. Antitoxin was administered without side effects. The clinical outcome was good.

Observations on the lesion site in the Miller Fisher syndrome: presentation of a case including CT and MRI.

Debate about the lesion site in the Miller Fisher syndrome is still going on. We studied a patient with features of the Miller Fisher syndrome in whom arguments for both central and peripheral nervous system dysfunction were found.

Contrast enhanced magnetic resonance imaging of the brain using gadolinium-DTPA.

This report concerns a clinical trial with gadolinium-DTPA (Gd-DTPA) as an intravenous contrast medium for magnetic resonance imaging (MRI) in patients with disorders of the central nervous system. Fifty patients, 30 females and 20 males, were examined without and with Gd-DTPA. The contrast medium was well tolerated by all patients. The results of MRI scanning without and with Gd-DTPA and those obtained with computed tomography (CT) using intravenous contrast enhancement were compared. This investigation comprised mainly patients with intracranial tumors, multiple sclerosis, and nasopharyngeal tumors. The results may be summarized as follows: 1) MRI with Gd-DTPA (MRI+) gave better results than MRI without Gd as regards delineation of the lesion, blood vessels and edema in cerebral tumors, pituitary adenomas and acute forms of multiple sclerosis (MS). 2) MRI+ was better than CT in 32 of the 50 cases examined; with intracerebral tumors it was better in 15 out of 18 cases. 3) MRI+ was always better than CT in patients with MS. In 3 out of 7 cases MRI demonstrated the acute MS lesions. 4) MRI+ seemed to have advantages also in nasopharyngeal tumors as ascertained from this limited experience.

Gadolinium-DTPA in magnetic resonance imaging of the brain.

This report concerns a clinical trial with Gd-DTPA as an intravenous contrast medium for MRI in patients with neurological disorders. 50 patients (30 female, 20 male) were examined without and with Gd-DTPA and the results of CT scanning and MR scanning without and with Gd-DTPA were compared. All patients tolerated the contrast medium very well. In the various patient groups, Gd-DTPA often added to the information. This was especially true in the tumor group, where better delineation of tumor, blood, and edema was obtained.

Iohexol 240 mgr I/ml and metrizamide 240 mgr I/ml in lumbar myelography. Report from a randomized double blind study.

A parallel, double blind, randomized study, comparing iohexol 240 mg I/ml and metrizamide 240 mg I/ml in lumbar myelography was carried out. Fifty patients were admitted to the study, and 1 patient was excluded after entry. Of the 49 patients included, 28 were males and 21 females, aged between 18 and 72 years. A dose of 10.5 ml of contrast medium was administered. A detailed neurological examination, and measurement of blood pressure and heart rate were performed before and 24 h after myelography. EEG was recorded in 37 patients. All patients were observed for adverse reactions for 48 h. Adverse reactions were reported in 14 of 26 patients examined with iohexol, and in 13 of 23 patients examined with metrizamide. EEG changes were observed in 7 patients examined with metrizamide, no changes were observed in patients examined with iohexol. The image quality was judged good or excellent in all cases, with the upper level of contrast medium brought to the level of L1 in the majority of cases.