Coma vigil masquerading as psychiatric illness.

A patient is described who had the hyperpathic variety of akinetic mutism (coma vigil), which was mistaken for a dissociative state. The case discussion emphasizes the importance of differentiating neuropsychiatric syndromes from those which are purely psychiatric in nature in order that appropriate treatment may be given.

Psychiatric disturbances seen in primary care: when to treat and when to refer.

Recent advances and changes in diagnosis and treatment of various psychiatric disturbances have both increased cooperation between psychiatrists and primary care physicians and better integrated psychiatry with the remainder of medicine. With increasing emphasis on the holistic approach to patient care and more appreciation of emotional components of various physical illnesses, the primary care physician now finds it incumbent upon himself to both understand and use various pragmatic psychiatric concepts. To the benefit of the patient, the primary care physician, and the psychiatrist, this integration of psychiatry with medicine appears to be growing. Thus an overview of the major psychiatric disturbances seen by the primary care physician, as well as guidelines in when to treat and when to refer these problems, should be useful.

Alternating painful ophthalmoplegia.

The ultimate evolution of our case and its atypical features of unilateral blindness, bilateral involvement, and extensive involvement of the trigeminal nerve revealed the pathogenesis of this case of alternating painful ophthalmoplegia resembling the Tolosa-Hunt syndrome to be that of a parasellar pituitary adenoma. Similar cases of painful recurrent ophthalmoplegia should alert the clinician to the strong possibility of a parasellar syndrome involving a mass, even if the patient carries the clinical diagnosis of Tolosa-Hunt syndrome.

An overview of neuropsychiatric disturbances in the elderly.

In no other period of life than old age do neurophysiologic alterations seem to affect behavior and cognition so significantly. Consequently, the relationship between neurology and psychiatry remains substantial when attempts are made to understand and deal with the many problems of aging. This study concerns improvement in the organization of such an approach to the neurologic and psychiatric problems of the elderly and to various interdisciplinary factors. Special consideration is given to changes in the central nervous system with aging, and to the differential diagnosis of dementia and pseudodementia.

Prosopagnosia and the Capgras syndrome.

The Capgras syndrome is an unusual psychiatric disorder which has attracted much attention in recent years because of its striking nature and controversial etiology and pathogenesis. The question of whether some cases of Capgras syndrome are an expression of a perceptual disorder of facial recognition, i.e., prosopagnosia, is addressed in this report. Careful testing for a possible prosopagnosia revealed that in 2 newly identified cases of Capgras syndrome, the deficit was present. A deficit of facial recognition could not be appreciably detected in a group of normal female and schizophrenic controls.

The Klüver-Bucy syndrome in man.

It is apparent that the importance of the limbic system is essentially for survival. The inability to discriminate enemy from friend as well as loss of the proper affective response to what is dangerous or safe to the organism may be thought of as more central to survival than what is described as "other higher intellectual functions." The case described is a dramatic expression of such a transient limbic dementia originally described by Klüver and Bucy in their syndrome. Since Klüver and Bucy originally described their syndrome, the structural and functional understanding of the limbic system has been greatly increased. Although a rare occurrence in man, the Klüver-Bucy syndrome serves as a demonstration of an unusual brain syndrome whose theoretical and experimental basis has been greatly enlarged since first described.

Leptospirosis: a neglected cause of nonbacterial meningoencephalitis.

Two cases of leptospirosis with different clinical presentations are presented. The importance of recognizing mild, nonicteric and meningoencephalitic forms in order to identify vectors and contaminated areas and prevent further infections is emphasized. Cerebrospinal fluid (CSF) findings in reported cases of leptospirosis are reviewed and possible prognostic implications of CSF xanthrochromia, hypoglycorrhachia, persistent polymorphonuclear leukocytosis, and increased intracranial pressure are discussed.