Transient recurrent situational insomnia associated with cluster headache.

Headache syndromes are known to occur in association with sleep. Both the clinical and the polysomnographic abnormalities occurring in association with various headache syndromes have been described. We report the occurrence of transient recurrent situational insomnia that occurred in association with chronic cluster headaches and was reversible after the headache cluster subsided. This seems to represent a further degree of sleep disturbance in addition to the previously described insomnia and other abnormal polysomnographic features that may occur in direct association with the headache syndromes.

Sleep and headache syndromes: a clinical review.

The relationship between sleep and headache has been known for over a century. Sleep represents the only well documented behavioral state related to the occurrence of some headache syndrome. Liveing in 1873, wrote about the effect of sleep in terminating an attack of headache. Bing also, noted this relationship when he wrote about early morning headaches. Gans reported a decrease in frequency and severity of migraine attacks following selective 'deep-sleep deprivation.' Dreams leading to headache have been reported. Quite obviously, headache also finds a place in the classification of sleep disorders. This very important relationship between sleep and headache is the subject of this clinical review.

The electroretinogram in preterm infants.

With the hope that the electroretinogram (ERG) in preterm infants could help clarify their vitamin A requirements, a technique for recording the full-field ERG in the neonate is described. One hundred seventy-seven ERGs were performed in 59 preterm and 52 term infants. An ERG was recorded as soon as 7 hours after birth and as early as 30 weeks after conception. In preterm infants the a-wave latency was longer and the amplitude less than in term infants of the same age. The amplitude of the ERG in preterm infants increased with the duration of light exposure. Longitudinal data on 15 preterm infants showed a reduction in a-wave latency. None of the ERG findings correlated with postconceptional age, which suggests that the duration of light exposure is a major determinant of the ERG pattern in preterm infants. Despite low circulating levels of retinol, no correlations with any of the ERG values were found.

Neurological assessment.

Neurological assessment of certain movement disorders is described with emphasis on Parkinson's disease. In addition, abnormal behavior and changes in affect are given. Changes in neurological status, i.e., Bradykinesia, rigidity, gait changes, hand-writing irregularity, postural reflexes are outlined. The differential diagnosis of the disease is also indicated in addition to prognosis and to the biochemical correlates of Parkinson's disease.

Comparison of the offspring of three serial pregnancies during voluntary alcohol consumption in Sinclair (S-1) miniature swine.

The offspring of serial breedings of voluntary alcohol consuming Sinclair (S-1) miniature swine have been evaluated over the past three years. The first and second litters of 12 dams and the third litter of 6 dams were examined. All study animals had been consuming alcohol for at least 18 months prior to the first breeding. Alcohol consumption was continuous throughout the ninth study. Twelve non-alcohol-consuming sows were used as controls. The results of the study revealed a progressive decrease in mean litter size from controls of 6.66 in the control litters to 1.8 piglets per litter in the third litter born to alcohol-consuming dams. Perinatal deaths showed a progressive increase from 10% in the controls to 36.4% in the L3 litter. The birth weight showed a decline from a mean of 719 +/- 186 g in the control group to 467 +/- 122 g in the L3 litter. Abortions were not seen in control, first litter or second litter; however, there were 3 aborted fetuses in the third litter. Observation revealed no additional anomalies beyond the previous reports of anomalies seen in litters of alcohol-consuming S-1 miniature swine dams.

Neurochemical effects of long-term ingestion of ethanol by Sinclair (S-1) swine.

Sinclair (S-1) miniature swine were given access to a mixture of ethanol and beer for three years. Control swine were fed an isocaloric diet with corn starch substituted for ethanol. Both groups had free access to tap water. The alcohol group consumed about 4 g ethanol/kg/day (about 50% of their caloric intake) resulting in plasma ethanol concentrations of about 100 mg/dl. Brain membranes were prepared for analysis of neurotransmitter receptor binding, membrane lipid composition and physical properties. Receptor studies demonstrated an increase in the binding of 3H-GABA to cortical and cerebellar membranes from the alcoholic pigs as compared to control. Binding of 3H-ligands to muscarine cholinergic, beta-adrenergic, alpha-adrenergic, dopamine and benzodiazepine receptors was not changed by chronic ethanol ingestion. These results are similar to those obtained in studies of human alcoholics by other investigators. The cholesterol content of myelin and synaptic plasma membranes was not altered by ethanol consumption. The fluorescence polarization of diphenylhexatriene, a measure of membrane order, did not detect any differences in the membranes from control or alcohol-treated swine either before or after in vitro exposure to ethanol. These results are different from those reported for rodents after short-term ethanol treatments and emphasize the importance of evaluating different models of experimental alcoholism.

Correlation of intraoperative electroencephalography with neurologic deficit after carotid endarterectomy.

In an attempt to prevent morbidity and mortality in carotid endarterectomy, we monitored 47 operations with intraoperative EEG to determine which patients should have a shunt during endarterectomy. The EEG was recorded for up to five minutes during test carotid cross-clamping. When EEG asymmetry between the cerebral hemispheres occurred, the clamp was immediately removed. A shunt was used in all patients who had EEG asymmetry. In the absence of EEG asymmetry, no shunt was used. Of the 38 patients with no EEG asymmetry intraoperatively, one patient had transient deficits postoperatively. Electroencephalographic asymmetry occurred in nine patients during test carotid cross-clamping. Postoperatively, five of these shunted patients awakened neurologically intact and four patients had transient deficit. When the EEG was normal and no shunt was used, patients did well; when the EEG was abnormal and a shunt was used, there was a high incidence of transient neurologic deficit.