Disturbance of central vision after carbon monoxide poisoning.

BACKGROUND: Cerebral achromatopsia is a disturbance of colour perception which may be complete or partial. CLINICAL RECORD: A 28-year-old male patient presented five months after carbon monoxide poisoning with achromatopsia. The achromatopsia was unaccompanied by an inability to recognise faces (prosopagnosia) nor was there any disorder of form or depth perception. RESULTS: Magnetic resonance imaging showed bilateral sharply defied areas of haemorrhagic infarction in the globus pallidus with extensive infarction involving temporal and occipital lobes and with apparent partial sparing of the visual cortex, presumably due to arterial insufficiency. The disturbance of central colour vision resolved spontaneously after a further period of 6 months. CONCLUSION: The symptom of achromatopsia is analysed with particular reference to the recent work of Professor Zeki on disturbance of central colour vision following CO poisoning and the unusual MRI findings.

Angiomatous osteolysis of the skull vault.

A case is reported of angiomatous osteolysis of the calvarium. This condition normally affects long bones and there is only one previous report in literature of massive osteolysis of the skull. The clinical, radiological and pathological implications of this condition are considered.

Cerebral tumour with intracranial angioma.

This paper concerns the simultaneous occurrence of tumours, a meningioma and intracranial angioma, of diverse histological characteristics. Their clinical radiological and pathological implications are discussed.

The surgical management of extracranial cerebrovascular occlusive disease: a review of 200 consecutive surgical cases.

The role of surgery in the treatment of extracranial cerebrovascular disease is essentially a prophylactic one but it should be borne in mind that apart from preventing stroke, such procedures will or should eliminate symptoms. The authors believe that every patient suffering from cerebrovascular insufficiency should be thoroughly evaluated for extracranial cerebrovascular occlusive disease and that arteriograms should be performed on all patients who could be expected to be candidates for surgery. The various indications for surgery have been discussed. The authors believe that people who have severe bilateral disease and who are of an advanced age are probably in a higher risk group. They also believe that surgery should not be offered to people who have a complete stroke and who are in semi-coma or coma, no matter how rapidly they may be transferred to the operating theatre. The authors firmly believe that intra-operative E.E.G. monitoring is an important adjunct to the safe surgical treatment of lesions of the carotid bifurcation, not only to indicate when shunting is necessary but also to indicate how well that shunt is functioning. In spite of the frequent presence of associated heart disease, hypertension and other vascular lesions, operation can be offered with confidence to suitable candidates. Elimination of symptoms can be expected in over 90% of cases. Only one patient has suffered a stroke since leaving hospital and this occurred because of occlusion in his internal carotid artery which was not operated on. Apart from patient selection, the factors which have contributed to the authors' low morbidity and mortality have been the use of intra-operative E.E.G. monitoring, intra-operative heparinisation and the availability of excellent angiographic studies.