Angiopathic parkinsonism: does it exist?

The Authors report on 150 cases of patients suffering from Parkinson's disease. The patients represent 8.3% of total parkinsonian patients and are selected on the basis of clinical and laboratory criteria that allow the diagnosis of "angiopathic parkinsonism" as an autonomous entity. Cerebral blood flow alterations in Parkinson's disease and associated dementing symptoms are also discussed. In conclusion, the Authors emphasize the usefulness of recognizing the "angiopathic parkinsonism" in view of therapeutical implications.

Heatstroke and hyperthermias.

We describe the pathogenesis and the typical clinical and laboratory features of the hyperthermia syndromes that may develop during neuroleptic drug treatment, environmental exposure or following the use of inhalational anesthetics. Since the features are similar and confusion is possible we emphasize the need for prompt diagnosis so that appropriate treatment, can be started without delay. Hyperthermic reactions have common pathophysiological mechanisms and they may be seen as an abnormal individual response to organic and functional stressors.

Sonographic findings in septo-optic dysplasia in the fetus and newborn infant.

A 28-year-old primigravida woman was referred for ultrasound studies at 27 weeks' gestation. Sonographic examination found enlarged cerebral ventricles, communicating lateral ventricles, bilateral cleft lip and palate. A 2500 gm male infant was delivered at 36 weeks' gestation, after which the diagnosis of septo-optic dysplasia was made.

Sonographic diagnosis of agenesis of the corpus callosum in the fetus and newborn infant.

The sonographic findings in nine cases of agenesis of the corpus callosum examined before and after birth are reported. Agenesis of the corpus callosum was suspected in utero due to a typical configuration of the lateral ventricles, which included enlargement of the atria and occipital horns and marked separation of the bodies. In three cases pregnancy was terminated because of severe associated anomalies. In the remaining six cases postnatal ultrasound examination allowed a certain diagnosis by demonstrating the abnormal configuration of the lateral ventricles, varying degrees of enlargement, and upward displacement of the third ventricle and absence of the corpus callosum.

Long-term evaluation of cervical spine disorders following laminectomy.

The Authors report the results obtained by long-term clinical and radiological evaluation of patients who had undergone cervical multiple bilateral laminectomy to relieve the compression exerted on the cord by different diseases (spondylarthrosis, syringohydromyelia, intramedullary and extramedullary tumours, leptomeningeal cysts and extradural tumours). 98 patients were reviewed, the follow-up ranging from 8 to 24 years (mean 14 years). The results demonstrate that the most severe post-laminectomy changes are recorded in patients with intramedullary lesions and when middle-low cervical spine levels (C4-C7) are affected. The significance of spinal deformities such as kyphosis, spondylolisthesis and swan-neck is also discussed.

Pisa syndrome. Report of a case.

Very few cases of Pisa syndrome have been reported. The syndrome consists of dystonic symptoms, namely, tonic flexion of the trunk to one side and its slight rotation. It appears to be a side effect of prolonged antipsychotic therapy. We report on a case of Pisa syndrome in which withdrawal significantly improved the dystonic symptoms. However, a severe exacerbation of schizophrenic symptoms required the immediate resumption of neuroleptic therapy which was followed by the reappearance of dystonic symptoms. Associated anticholinergic medication led to only a slight improvement.

Long-term results of surgically treated congenital intradural spinal arachnoid cysts.

The authors report long-term results in 17 patients with surgically treated congenital intradural spinal arachnoid cysts. Comparison between the immediate and long-term results demonstrates that surgical removal of the cyst allowed a significant neurological improvement in all cases, but clinical worsening of various degrees was observed later. The authors attempt to explain the results in terms of mechanical and vascular factors.

The control mechanisms activated by experimental intracranial hemodynamics changes.

The Authors describe an experimental model (rat) performed in order to evaluate the cerebrovascular changes which occur following the venous outflow impedance increase. This increase was obtained by bilateral occlusion of the external jugular veins at the neck. The rat was chosen because its intracranial and extracranial circulation is very similar to the human one, thus allowing the recording of blood flow velocity changes in the common carotid artery by means of a noninvasive technique such as Doppler ultrasound. Ligature of both the external jugular veins, performed on 35 rats, produced a decrease of common carotid artery blood flow velocity in 2/3 of the animals. The remaining 1/3 presented increased common carotid velocity. These changes were recorded within 15 minutes after ligation of the veins. On the contrary, the epidural pressure, measured in 6 cases, showed a constant increase. The results demonstrate that the different patterns of CBF and EDP do not permit univocal interpretation of the cerebrovascular reactivity control mechanisms, that is, myogenic, metabolic or neurogenic.

Epidural pressure measurement in the rat.

An original device for the epidural pressure measurement in the rat is presented. The reliability of epidural pressure as an index of intracranial pressure is discussed and several possible causes of error are examined. The device has been tested under conditions both of transient and prolonged cerebral blood volume increase, obtained by venous outflow obstruction.

The surgical treatment of congenital hydrocephalus.

The Authors discuss the incidence, the etiology, the pathology and the pathophysiology of congenital hydrocephalus. Furthermore, the problems of intrauterine surgical procedures are in particular discussed. On the light of the experimental and clinical results the Authors believe that the shunting fetal procedures should be considered anything but experimental and, therefore, subject to rigorous limitations. The results of the postnatal surgical procedures in congenital hydrocephalus are also discussed. Owing to the fact that early treatment of hydrocephalus in newborns seems to obtain the most satisfactory results, particular regard is reserved to that diagnostic techniques which could allow to recognize the right and early moment for surgical intervention, such as transfontanelle Doppler ultrasound examination.

Extracranial internal carotid artery occlusion associated with ipsilateral cerebral glioblastoma.

A case of left extracranial internal carotid artery occlusion, associated with ipsilateral parietal glioblastoma, is reported. The clinical and radiological aspects are discussed. The Authors stress the usefulness of a complete investigation in patients with symptoms of cerebrovascular insufficiency.

Ultrasonographic appearance of the mega cisterna magna in the newborn.

The mega cisterna magna is a congenital developmental malformation which in the majority of instances is symptomless and does not require further study or surgical treatment. However, differential diagnosis with other cerebellar diseases is often necessary especially in newborn infants. Ultrasonographic recognition of the mega cisterna magna in a newborn infant is reported. The reported case demonstrates the usefulness of the ultrasonographic technique in the study of the posterior cranial fossa abnormalities of newborn infants.

Long-term results of surgically treated brainstem gliomas.

Long-term results of 16 surgically treated brainstem gliomas are reported. The results have been reviewed with reference to the clinical and pathological criteria defined by Hoffman and co-workers (1980) in the attempt to differentiate a distinct group of benign tumours. A good correlation has been obtained. The usefulness of surgical treatment of brainstem gliomas has been stressed in view of the survival time as well quality of survival.

Evaluation of cerebral blood flow changes by transfontanelle Doppler ultrasound in infantile hydrocephalus.

Doppler ultrasound investigation of cerebral blood flow velocity was performed in hydrocephalic infants through the anterior fontanelle. Systolic (S) and end-diastolic (D) frequency values recorded on the anterior cerebral artery were used to define the pulsatility index (PI) calculated from the equation PI=S-D/S. Comparison between systolic, end-diastolic and pulsatility index values of 50 normal infants and 10 hydrocephalic infants showed a statistically significant difference (P less than 0.05) for systolic and pulsatility index values. However, no significant difference was found for end-diastolic values. The authors believe that the phenomenon could be explained as an increase of the cerebrovascular compliance which counteracts the increase of the perivascular pressure in an attempt to maintain a normal cerebral blood flow. Therefore, the transfontanelle Doppler ultrasound technique may provide a useful and early tool in diagnosing cerebral blood-flow changes in hydrocephalic infants.

[Neurological complications in Behçet's disease]. / Complicanze neurologiche nella malattia di Behçet.

A case of unusual Neuro-Behçet syndrome is reported. Four years of follow-up revealed at beginning later the occurrence of acute meningoencephalitis caractherized by two convulsive fits. CSF examination revealed high albumin and cells contents. CT examination of the head was negative. Incomplete clinical improvement was obtained by using steroids. Differential diagnosis is finally discussed.