A large intracranial xanthoma in familial hypercholesterolemia.

Intracranial xanthomata occurring in patients with familial hypercholesterolemia are very rare. We present a young woman with a large intracranial xanthoma. The patient was treated for a familial hyperlipoproteinemia type IIa. MRI and morphological features are shown and discussed on reviewing the literature.

Positron emission tomographic study of postinfarction seizures.

Positron emission tomography (PET), using the steady-state technique with (15)O, was performed in 18 patients 4-14 months after a thromboembolic stroke in the territory of the middle cerebral artery. Eight patients developed seizures 2-12 months after infarction. The patients with and without late-onset epilepsy were comparable according to age, etiology, and location of the stroke, and the degree of neurological deficit. PET examination showed a more pronounced decrease in regional cerebral blood flow (rCBF) and oxygen consumption (rCMRO2) in the infarcted area in the group with postapoplectic seizures compared to the nonepileptic stroke group. The PET findings were similar in the border areas of the infarcts and in the contralateral hemispheres of both groups. It cannot be determined if the more decreased rCBF and rCMRO2 in the infarcted zone of the group of patients with postinfarction epilepsy is the cause or the consequence of the seizures.

Apraxia of eyelid opening secondary to right frontal infarction.

Apraxia of eyelid opening is the incapacity of voluntarily eyelid opening in the absence of motor dysfunction or blepharospasm. It has mostly been described in extrapyramidal diseases and only very rarely in cortical lesions. We report a right-handed patient with a right frontal infarction exhibiting eyelid opening apraxia.

Brain abscess after esophageal dilatation for stenosis.

The case is presented of a 28-year-old female with a brain abscess after esophageal dilatation for stricture, secondary to an acute necrotizing esophagitis. Other causes of brain abscess were excluded. To our knowledge this is the first documented case of brain abscess after dilatation for esophageal stricture in adult life. Some reports in the pediatric literature have been published previously.

Macro CK type 1 as a marker for autoimmunity in coronary heart disease.

In a group of 3000 hospital patients the prevalence of immunoglobulin bound creatine kinase (macro CK type 1) was 4.3%. The relative frequency was greater in the older age categories. The highest prevalence was found in patients with rheumatic and cardiac diseases. In a group of 556 cardiac patients selected for coronary angiography a prevalence of 13.8% was observed. No significant correlation was obtained between the findings of the coronary angiography and the activity of macro CK type 1. CK MB results determined by ion-exchange or immuno-inhibition techniques in macro CK type 1 positive patients are falsely positive. Macro CK type 1 may be seen as an antigen-antibody complex against CK BB, which originates at least partly from the vascular wall.

Post-cardiac injury syndrome and an increased humoral immune response against the major contractile proteins (actin and myosin).

To better understand the pathogenesis of the post-cardiac injury syndrome (PCIS) 2 models of cardiac injury were studied. One hundred twenty-nine patients who underwent cardiac surgery and 80 patients with acute myocardial infarction (AMI) were prospectively followed and the levels of anti-heart antibodies (AHA), anti-actin antibodies (AAA) and anti-myosin antibodies (AMA) were determined. In the surgical group, PCIS developed in 27 patients (21%) and incomplete PCIS in 36 (28%). In the AMI group, PCIS did not develop in any patient, but incomplete PCIS developed in 11 patients (14%) (p less than 0.001). The surgical group showed a significantly higher humoral immune response than the AMI group when analyzed for AHA and anti-contractile protein antibodies. After cardiac surgery, AHA developed in 59 patients (46%), AAA developed in 33 (26%) and AMA developed in 49 (38%); in the AMI group, significant levels of AHA, AAA and AMA developed in 16 (20%), 7 (9%) and 13 patients (16%), respectively. These studies show a significant correlation between the PCIS clinical classification and auto-antibodies raised against heart contractile proteins.