Creutzfeldt-Jakob disease diagnosable by EEG and cerebrospinal fluid analysis without brain biopsy: a case report.

This case illustrates a classic example of CJD in its clinical presentation and course and the EEG. It also shows dramatically the utility of a newly developed protein assay in the diagnosis of this disease. This assay has the potential of eliminating the need for brain biopsy in most cases, thus providing a safer diagnostic method for both staff and patients. In addition, the case points out that anatomical structural studies such as CT and MRI do not replace the utility of EEG in the comprehensive evaluation of rapid onset dementia, but rather complement the usefulness of EEG.

Neurodiagnostic testing in patients with closed head injury.

This brief review summarizes the current understanding of mild closed head injury with postconcussion syndrome. It is to be emphasized that objective evaluation be performed because it is critical to the assessment of the patient. Increased awareness of patients with symptoms in association with heightened sensitivity and caring will go a long way in helping the millions of patients yearly with mild to moderate head injury. Only with objective scientific data will the understanding of the causes of the varied symptomatology of the postconcussion syndrome be thoroughly understood.

Clinical and laboratory evaluation of patients exposed to neurotoxicants.

For clinicians, toxicologists, and behavioral scientists, the steady contamination of the environment poses dynamic challenges for accurate diagnosis and evaluation of toxic exposure. The purpose of the neurotoxic evaluation is to determine the level of damage a toxic substance has caused to the biochemistry, physiology, and morphology of the central, peripheral, and autonomic nervous systems. A complete clinical neurotoxicologic assessment hinges on a thorough medical and occupational history, physical examination findings, and specific neurologic and neuropsychologic tests as well as laboratory evaluation.

Computed tomographic analysis of bilateral cingulotomy for intractable mood disturbance and chronic pain.

Forty-two patients out of 300 who had undergone bilateral stereotactic cingulotomies were studied by means of computerized tomography (CT). The appearance showed bilateral encephalomalacia, measuring on the average 5 X 7 mm2, located in the cingulate gyrus. These induced lesions had attenuation values similar to cerebrospinal fluid and did not enhance with contrast. CT is a useful technique for initial evaluation, management, and follow up of these patients.

Phenytoin-induced choreoathetosis in infancy: case reports and a review.

Three cases of choreoathetosis which developed during phenytoin therapy in children less than 2 years of age are described. The most striking clinical manifestations included the sudden onset of restlessness and agitation with superimposed choreoathetosis. None of these children had toxic levels of phenytoin in the blood. Discontinuation of phenytoin resulted in prompt cessation of the symptoms. Phenytoin-induced choreoathetosis should be a diagnostic consideration in children with a preexisting CNS insult who manifest violent choreoathetosis during therapy for seizure control. This consideration is especially pertinent in the pediatric intensive care unit, where other more common causes of agitation could be misdiagnosed.

Horner syndrome with causalgia.

A previously healthy man presented with burning pain in the chest wall and arm; there was Horner syndrome on the same side. After extensive investigation, the disorder was attributed to a foraminal osteophyte involving the left T1 spinal root.

Diagnosis of cryptococcal meningitis by cytologic methods: an old technique revisited.

In six patients with cryptococcal meningitis, diagnosis was made by routine cytologic examination of cerebrospinal fluid (CSF). A seventh patient had a false-positive cryptococcal antigen titer, and no organism was seen on SCF examination. The patient had herpes simplex encephalitis on brain biopsy. Cytologic examination is recommended whenever cryptococcal meningitis is suspected.

Cytologic diagnosis of intraventricular hemorrhage in a neonate.

A neonate with autoimmune thrombocytopenia presented with megacephaly and hydrocephalus. The cause remained obscure until hemosiderin-laden macrophages were found in the ventricular cerebrospinal fluid (CSF), indicating prenatal intracranial hemorrhage. The literature on the diagnosis of intraventricular hemorrhage by the cytologic examination of CSF is reviewed and discussed. The cytologic evaluation of CSF may be helpful in cases of central nervous system dysfunction when the cause is obscure.

[Hepatic and renal toxicity of enflurane (author's transl)]. / Atteinte hépato-rénale après anesthésie à l'enflurane.

Enflurane has been implicated with both hepatic and renal toxicity. Others factors associated with similar dysfunction in the post operative period should be ruled out before the drug can be incriminated. We are reporting a case of mild post operative jaundice and transient renal insufficiency associated with enflurane anesthesia, which was eventually treated vigorously and successfully. The exact frequency of this kind of post operative complication is still unknown. Although other types of viral hepatitis cannot be completely ruled out, the anesthesiologist should be aware of the potential hazard of hepatic and renal toxicity attributed to enflurane. He should also be prepared to initiate vigorous treatment of the syndrome as soon as it appears so as to increase the chance for a successful outcome.

A civilian case of fatal meningococcemia due to Neisseria meningitidis, group Y.

The present report is that of a civilian episode of fatal, fulminant group Y meningococcemia in a previously healthy adolescent, who denied prior vaccination against group C meningococcus. The patient suffered abrupt onset of purpura, hypotension and cardiopulmonary arrest. A detailed clinical and pathologic report is included.