The birth of American neurology and highlights from the first 100 years of the Philadelphia Neurological Society, 1884-1984.

The Philadelphia Neurological Society was founded 100 years ago by Charles K. Mills, together with Wharton Sinkler, J.T. Eskridge, and Francis X. Dercum. S. Weir Mitchell was the first president and served for 5 additional years. American neurology was born in Philadelphia at the Orthopedic Hospital and the Infirmary for Nervous Diseases. The growth in neurology in this country is reflected in the activities of the Philadelphia Neurological Society.

The transient global amnesia-migraine connection.

Twelve patients with transient global amnesia (TGA) were studied. Seven (58%) of the 12 had a headache during their attack; five (42%) of the 12 were migraineurs. Measurement of regional cerebral blood flow (rCBF) by the xenon Xe 133 inhalation method showed similar patterns of flow in five of the seven patients tested. The rCBF abnormalities were impaired vasomotor response in the watershed area between the middle cerebral artery and posterior cerebral artery territories, and/or focal ischemia in the inferior part of the temporal lobe. These rCBF abnormalities differed from those seen in patients with carotid transient ischemic attacks (TIAs) and vertebrobasilar TIAs. We speculate that the vasomotor phenomena in migraine may play a major role in the cause of TGA.

Cerebral angiographic and clinical differences in carotid system transient ischemic attacks between American Caucasian and Japanese patients.

Cerebral angiographic findings of 32 Japanese patients with carotid system TIA's were compared with those of an equal number of age and sex matched American Caucasians. The end points included irregularity, ulceration, stenosis or occlusion of the carotid artery appropriate to the side of TIA. Atherosclerotic changes were found in 27 patients (84.4%) of the Japanese and 30 patients (93.7%) of the American patients. Mild lesions (49% stenosis and below) were similar in either frequency of topography between both groups; namely 25 intracranial and 17 extracranial lesions in Japanese as well as 29 intracranial and 10 extracranial in Caucasian patients. There was, however, an extra-intracranial difference in severe lesions (50% stenosis and above) between American Caucasian and Japanese patients; 10 of 12 severe lesions in Japanese were located intracranially, while 17 of 20 severe lesions present in the American group occurred in the extracranial portion of the internal or common carotid arteries.

Comparison of the effects of intravenous papaverine hydrochloride and oral pavabid HP capsulets on regional cerebral blood flow in normal individuals.

A single-blind study was conducted in 13 right-handed normal male subjects to compare the effects of oral and i.v. papaverine on regional cerebral blood flow (rCBF). Six xenon-133 inhalation rCBF measurements were performed on each subject; three tests--baseline, placebo, and drug evaluations--were carried out on each of two separate days. The oral and i.v. drugs were randomized for first-day administration. rCBF, measured as flow gray (FG), increased significantly (p less than or equal to 0.001) from baseline with both drug forms. Increases of 10.53% and 13.94% (left and right hemispheres, respectively) were demonstrated 90 min after a single 600-mg dose of oral papaverine. Increases of 5.09% and 8.69%, respectively, were recorded immediately after a single 100-mg dose of i.v. papaverine. FG also increased significantly (p less than or equal to 0.001) for both drug forms when compared to that of placebo. Placebo produced only a slight increase (not significant) with both the oral and i.v. groups. The data show increasing rCBF in normal subjects.

Convergence spasm--treatment by amytal interview. A case report.

Convergence spasm is manifest by intermittent occurrence of ocular convergence, accommodative spasm, and miosis. It is usually due to hysteria but can have an organic basis. Treatment has included various ophthalmologic interventions. An amytal interview was used successfully to establish a nonorganic basis for the gaze palsy and, more importantly, concomitant narcosuggestion proved to be effective treatment.

Cerebellar syndrome following neuroleptic induced heat stroke.

We report a patient in whom extreme hyperthermia, rhabdomyolysis, acute renal failure and a residual pancerebellar syndrome occurred while taking a combination of perphenazine and amitriptyline. We postulate that impaired thermoregulation due to psychotropic drugs was responsible for the development of heat stroke and that the cerebellar syndrome resulted directly from the elevated temperature.

Cranial computerized tomography in carotid artery transient ischemic attacks.

32 of 45 (71.1%) patients with carotid artery distribution transient ischemic attacks had normal cranial computerized tomography (CCT). 9 (20%) had cerebral atrophy. Incidental abnormalities were found in 3 (6.6%) patients, while a hypodense lesion corresponding to the site of neurological dysfunction was seen in only 1 (2.2%) patient. The latter showed a persistent abnormality in follow-up studies on the 8th and the 23rd day after the initial event. Our clinical CCT correlation did not demonstrate the frequency of hypodense lesions reported by some authors. Furthermore an increased incidence of cerebral atrophy was found compared to the one reported previously.