Magnetic resonance imaging in cerebral sinus thrombosis. Report of a case.

We report the entire course of a case of thrombosis of the venous sinuses, very probably caused by contraceptive pill use, documented by MR imaging. MRI appears to be the examination of choice in such cases.

Gadolinium-DTPA-enhanced MR imaging in the diagnosis of spinal epidural haematoma. Report of a case.

A case of spinal epidural haematoma diagnosed by means of Gadolinium-DTPA-enhanced MR imaging is described. The sensitivity of this recent technique is underlined.

Disconnection Syndrome and Verbal, Spatial and Tactile Amnesia following a Tumor of the Splenium of the Corpus Callosum.

A patient with a severe amnesic syndrome following a glioma of the splenium of the corpus callosum is reported. The long-term memory deficit involved anterograde as well as retrograde events dating back to 40 years and causing topographical disorientation. Short-term memory test performance was in the normal range, with the exception of tactile memory which was severely impaired.The patient also showed disconnection symptoms, due to severing of occipito-parietal and parieto-temporal connections, while parieto-parietal connections were undamaged.

Diagnostic investigations in MS: which is the most sensitive?

In an attempt to establish the efficacy of the different diagnostic tests, 41 multiple sclerosis (MS) patients at different stages of the disease were studied by means of visual evoked potential (VEP) recording, T-lymphocyte subset determination cerebrospinal fluid (CSF) analysis and magnetic resonance (MR) imaging. MR and CSF oligoclonal bands (OB) were the most sensitive techniques for the diagnosis of MS, being positive in 88% of patients, while VEP and helper/suppressor (H/S) T-cell ratio were altered in 54% and 46% of patients respectively. Low significant agreement coefficient were found among the 4 tests and the major value, even though "fairly" significant, was between MR and OB.

Pseudotumor cerebri: clinical features and evolution.

Risk factors, neurological, neuroradiological and ophthalmological features of 13 cases of acute pseudotumor cerebri were studied. After a 53-month period of mean follow-up, ophthalmological complications were taken into consideration: one patient (8%) showed unilateral optic atrophy with complete loss of vision, another subject complained of visual field constriction, and a third one of transient horizontal diplopia. Papilledema, which was present in 100% of the patients in the acute phase, persisted in 62%.

[Risk factors and short-term prognosis in ischemic and hemorrhagic attacks: review of 503 patients admitted to the Neurologic Clinic of Modena]. / Fattori di rischio e prognosi a breve termine nell'ictus ischemico ed emorragico: revisione di 503 pazienti ricoverati presso la Clinica Neurologica di Modena.

Cerebrovascular risk factors, characteristics of the lesion (ischaemia or haemorrhage in the carotid or vertebro-basilar area) and mortality in the acute phase were studied in 503 patients admitted for first stroke. Seventy-five per cent of the patients had an ischaemic lesion and 25% a hemorrhagic one. Most of the ischaemic lesions occurred in patients aged 71-80 years, while haemorrhagic strokes hit subjects aged 61-70 years. Hypertension favors haemorrhage and heart disease and the older age favors ischaemia. Coma at onset negatively influences prognosis; mortality is more frequent among older patients, subjects in coma or with haemorrhagic lesions. Twelve per cent of the patients died in the first three weeks post-onset.

Epidemiology of amyotrophic lateral sclerosis in the province of Modena, Italy. Influence of environmental exposure to lead.

A retrospective study of all admissions to the University of Modena Neurological Department from 1976-1986; 51 cases of amyotrophic lateral sclerosis (ALS) were found. ALS mean annual incidence was 0.78/100,000 inhabitants, while prevalence was 2.35/100,000. Mean age at onset was 61.43 years, mean and median duration of illness were, respectively, 28.83 and 24.5 months, and survival at 5 years post-onset was 24.4%. A tendency to higher incidence and prevalence of ALS in the ceramic district, when compared with those of the rest of the province was found. However, the small number of cases did not allow any conclusive statistical correlation between environmental exposure to lead and frequency of ALS.

The incidence of aphasia and global aphasia in left brain-damaged patients.

Two hundred and twenty three right-handed patients consecutively admitted to the wards in a 21-month period for a left-sided cerebrovascular disease were examined 15 to 30 days after the stroke for the presence of aphasia. Twenty-seven of them could not be assessed. Of the remaining 196, 108 (55.1%) were aphasic. The incidence of global aphasia (43%) in the latter group was higher than in previous studies. Based on CT-scan data it was associated in 32% of patients with a deep lesion and only in 53% with an antero-posterior cortical-subcortical lesion, contrary to what is traditionally assumed. There was no sex difference in the incidence and distribution of aphasia.

[Subclinical deficit in the memory of chronic alcoholics. Comparison between 2 learning tests]. / Deficit subclinici di memoria negli etilisti cronici. Confronto fra due test di apprendimento.

Normal subjects and chronic alcoholics without clinical evidence of memory disorders have been compared on two tasks of verbal learning of a word list, one administered with the classical procedure and the other with the "selective reminding" technique developed by Bushke. Results showed that the selective reminding technique has the same discriminative power as the classical procedure: both brought out a remarkable learning deficit in chronic alcoholics. The selective reminding procedure is easier to administer and can distinguish between storage and retrieval deficits; it seems therefore preferable for diagnostic purposes. Practical criteria to distinguish a normal from pathologic performance on this test are suggested. Alcoholics were also inferior on Raven Progressive Matrices. The scope of the impairment produced by chronic alcohol consumption is wider than suggested by clinical observations and deserves careful assessment.

Modality-specific and supramodal mechanisms of apraxia.

This study investigated the relation of apraxia to the nature of the stimulus which is given to elicit the gesture. Patients were required to perform a movement imitation test and to demonstrate the use of the same ten objects, once on verbal command, once with the object shown but not handled, and once with the object handled but not seen. One set of comparisons concerned the performance on two tasks involving the visual modality, movement imitation and use of objects presented visually. Although the majority of left brain-damaged patients either failed or passed both tests, there were at least 13 patients who showed an exceedingly poor performance on demonstration of use as compared to imitation. We infer that the distinction between ideational and ideomotor apraxia is warranted. Another set of comparisons concerned the performance on the use of objects presented in the verbal, visual and tactile modalities. A greater percentage of patients failed on the verbal or visual modalities than on the tactile modality. Out of 64 left brain-damaged patients who were diagnosed as apraxic in at least one modality, 23 had an exceedingly poor score on one test as compared to their score on either or both other tests. Fourteen patients selectively failed on verbal presentation, 14 on visual presentation and 2 on tactile presentation. These findings are viewed as supporting the hypothesis that apraxia results from the disconnection between the areas where information is processed and the areas where the movement is programmed.

The differential contribution of the verbal code in the course of visual learning: evidence from hemisphere-damaged patients.

Control patients and patients with hemispheric lesion were given a paired-associate memory test made up of meaningful figures and their performance was compared on two measures: number of errors over the first three trials and trials to criterion. Impairment on the former measure was associated with left brain damage and found to be related to the degree of aphasic deficit, suggesting the involvement of the verbal code in the early stages of the learning process. However, analysis of trials to criterion showed that a defective performance was confined to patients of either hemispheric group having posterior lesions and bore non relationship to measures of language impairment. It is inferred that, as the learning process consolidates, the aid provided by verbal mediation to recognizing visual images progressively recedes.

[Clinical study of disorders of eye movements (voluntary and following) after acute vascular accidents involving the cerebral hemispheres (author's transl)]. / Studio clinico sui disturbi della motilità oculare volontaria e di guida conseguente ad incidenti vascolari acuti degli emisferi cerebrali.

Voluntary eye movements and following movements have been assessed on a 3 point scale in 33 cerebrovascular patients, examined immediately after the stroke and in 52 patients examined 6-9 days after the stroke. The two types of movements were found to be impaired to the same extent in the majority of patients, especially those with severe neurological deficits. The "agreement index" between them, though high, was significantly inferior to 1. This suggests that voluntary and following movements are subserved by adjacent, but not identical neuronal structures. The available neuro-radiological evidence points to the parieto-temporal cortex as the area critically involved in eye movement disorders.

[Neuropsychological study of long-term cerebral complications of eclampsia (author's transl)]. / Analisi neuropsicologica delle complicanze cerebrali a lungo termine dell'eclampsia.

A review of the literature shows that long-lasting neurological complications of eclampsia are rare, but that, when present, they frequently involve visual function. Two patients are reported, whose symptomatology suggested damage to the posterior region of both cerebral hemispheres. The first patient showed a Balint's syndrome with complete inability to perceive more than one object at a time, erratic gaze movements and optic ataxia. After a year and half a marked improvement was observed. The second patient presented with severe of dyscalculia, spatial memory disorders, constructional apraxia and mild aphasia. She recovered completely in one year. This symptomatology might result from ischemic lesions in the watershed area between the territories of the middle and posterior cerebral arteries, the underlying mechanism being the compression of the posterior cerebral artery against the tentorium, caused by edema.