[Neurological deficits in patients with primary and secondary anticardiolipin syndrome]. / Powiklania neurologiczne u chorych z pierwotnym i wtórnym zespolem antyfosfolipidowym.

27 patients (22 women, 5 men); age 17 to 56 yr. (mean age 37 yr.) were included in this study, 4 had primary antiphospholipid syndrome and 18 secondary antiphospholipid syndrome in the course of systemic connective tissue disease and in 5 cases increased levels of anticardiolipid antibodies were found which did not meet the criteria necessary for diagnosis of secondary antiphospholipid syndrome. The mean duration of the disease was 8 yrs. Among primary antiphospholipid syndrome patients two had ischaemic stroke, one migraine-like headache and seizures. 18 patients had lupus erythematosus, two mixed connective tissue disease, one rheumatoid arthritis, one Sjögren syndrome, one Behçet disease. In 55% of patients migraine-like headache, polyneuropathies, encephalophaties, stroke, seizures and vision disturbances were present. In 18.5% of patients EEG exam revealed focal lesions with tendency for generalisation. On brain stem auditory evoked potentials examination, in 11.1% of patients conductivity lesions in mesencephalon and pons were found, visual evoked potentials, in 11.1% of patients in visual tracts. In 37% of patients, neuropathy was found on EMG exam. Neurological symptoms are one of the most frequent disorders in systemic connective tissue disease associated with the presence of anicardiolipin antibodies.

Computerized morphometric analysis of the cerebellum in patients with lymphoblastic lymphomas of various survival time.

Post-mortem neuropathological investigations of the cerebellum were carried out in 15 patients deceased due to lymphoblastic lymphoma (LBL). In patients with survival time of LBL longer than 20 months, neuronal structures of the cerebellum appeared to be significantly rarefied. It was especially observed within granular layer, less frequently in Purkinje and dentate nuclei cells. In cases with longer survival time shrinkage and deformation of neurons, especially Purkinje and dentate nuclei cells were observed. The morphometric analysis suggests that the cerebellar neuronal changes might be a consequence of remote effects of LBL on nervous tissue. The longer survival time contribute to the nervous system exposure on remote effects of neoplasm. The dentate nuclei cells are damaged due to remote effect of lymphoma, irrespective of Purkinje cells destruction.

F wave studies after intrathecal methotrexate administration.

Electrophysiological examinations were done on 20 patients aged 40-71 years with recently diagnosed high grade non-Hodgkin's lymphomas. General chemotherapy and intrathecal chemotherapy in order to prevent central nervous system (CNS) involvement were begun. On the first day of chemotherapeutic cycle patients received intrathecally methotrexate (ITMTX) and prednisolone. Electrophysiological study was carried out twice in each subject: before ITMTX injection and a day after injection. The study procedure included: a conventional nerve conduction examination (peripheral conduction velocity and compound muscle action potential amplitude), the F wave latency and amplitude measurement and F ratio (F-M-1/2M) calculation for peroneal and tibial nerve bilaterally. Results of the first and the second examinations were statistically compared by t-Student's test. No significant differences between values of estimated parameters were found. The study revealed no recent alterations in proximal, paraspinal motor conduction and motor neuron excitability due to antidromical activation after single ITMTX administration.

-The evaluation of the effectiveness and tolerance of sumatriptan in abortive treatment of migraine attacks (open multicenter trial). / Ocena skutecznosci i tolerancji sumatryptanu w doraznym leczeniu napadów migrenowych (otwarte badania wieloosrodkowe).

The authors review data on sumatriptan obtained in the results of their own studies performed on 78 patients in 10 Polish neurological centres. In all 154 migraine attacks were treated with 6 mg of subcutaneous sumatriptan. Significant decrease of pain intensity was achieved in 30% of cases after 15 min and 60%--after 30 min. According to the patient's own opinion, 62% of them evaluated the drug as very efficient, 23% of patients--as efficient. Adverse effects were reported by 11 patients (15%), but they were mild and transient. Headache recurred in 16% of patients.

Central nervous system leukostasis in patients with leukemias and lymphomas.

The clinical and neuropathological investigations have been done on 133 autopsied patients died of leukemia or non-Hodgkin's lymphoma of high malignancy. A study was performed to analyse the role of various factors particularly with respect to adhesion and aggregation in the CNS leukostasis development. The findings were also designated to evaluate the distribution of leukostasis in different CNS regions and to recognize its intensity in various CNS vessels. Basing on the studies the authors conclude that the risk of CNS leukostasis increases evidently when the leukocyte counts are elevated above 50 G/l. The adhesion and aggregation of leukemic and lymphomatous cells as well as local anatomical factors in the CNS vessels play and important role in the CNS leukostasis development, which is more intensive in the white matter and leptomeninges. The medium-sized vessels are much involved, whereas cortical capillaries are relatively less affected by leukostasis. The CNS leukostasis appears to be dynamic and reversible phenomenon, which undergoes fluctuations according to the leukocyte counts increase or decrease.

Cavernous angioma of brain stem mimicking multiple sclerosis.

A 14-year-old boy was admitted to our Department due to peripheral palsy of right VII and bilateral of the VI cranial nerves, spasticity, cerebellar symptoms as well as to dysphagia and dysarthria. In general, he was hospitalized 13 times because of the disease of a relapsing-remitting and next progressive course. He died 31 years after onset of the disease. Multiple sclerosis was diagnosed. Brain autopsy revealed tumor involving almost all brain stem structures and a part of right cerebellar hemisphere. Histologically, cavernous angioma was diagnosed.

[Epileptic seizures and alcoholism]. / Napady padaczkowe a alkoholizm.

A high incidence of epilepsy in chronic alcoholics and similar incidence of alcohol abuse in patients with epilepsy are a serious medico-social problems. A relation between seizures and alcohol abuse is discussed in this paper. Epilepsy is the commonest complication of an alcoholism. Pathogenesis of epileptic seizures is multiple and complex. Alcohol-dependent epilepsy is closely related to a problem of alcohol abuse in patients with epilepsy. A criteria of alcohol-dependent epilepsy diagnosis should be clearly defined as they play an important role in therapy selection.

[Degenerative changes in the cerebellum in adult non-lymphoblastic leukemia]. / Zmiany zwyrodnieniowe w mózdzku w bialaczkach nielimfoblastycznych u doroslych.

Neuropathological investigations have been performed on 61 patients of both sexes, aged 17-60 years, deceased owing to nonlymphoblastic leukemias. The cerebellar degenerative changes appeared in 51 percent of cases mainly in the grey matter. Distinct rarefaction or atrophy of the cerebellar granular layer and the dentate nuclei were frequent phenomena. The following classification of the cerebellar granular layer damage was used: I degrees - focal rarefaction, II degrees - diffuse distinct rarefaction, III degrees - focal atrophy, IV degrees - diffuse atrophy. The investigations suggest that polychemotherapy is one of the causes of cerebellar degenerative changes, especially atrophy of the granular layer and dentate nuclei, as well as demyelination. In leukemias of short duration more frequently than in the remaining cases lymphocytic perivenous infiltrations appeared in the white matter. It seems to be a consequence of immunopathological reactions between the neoplasm and the nervous tissue in cases with more dynamic course of the disease.

[Clinical diagnosis of Jakob-Creutzfeldt syndrome--analysis of 6 cases]. / Diagnostyka kliniczna choroby Creutzfeldta-Jakoba--analiza 6 przypadków.

The authors present an analysis of the clinical course of 6 cases of Creutzfeldt-Jakob disease (patients were aged from 27 to 59 years). The diagnosis was established during the life of the patients. In the neurological status dementia and syndromes of pyramidal and extrapyramidal lesions predominated. Neuropathological examinations in 5 cases demonstrated also considerable cerebellar damage, however, clinical signs of this damage were noted in two patients only. EEG findings were of greatest importance among the laboratory investigations.

[The role of leukemic conversion in the development of lymphoma infiltration of the nervous system]. / Rola konwersji bialaczkowej w powstawaniu nacieków chloniakowych w ukladzie nerwowym.

On the basis of neuropathologic studies in 22 patients died from ML it was found that lymphoma cells in the brain and spinal cord were in the form of leukostasis, infiltrations usually limited to perivascular spaces, infiltrations in hemorrhagic foci and their vicinity. In cerebrospinal meninges, spinal roots and peripheral nerves we observed leukostasis and intraparenchymatous infiltrations. It was found that the most important role in the development of lymphoma infiltrations in the nervous system was played by hematogenic metastases whose development in the brain and spinal cord was promoted by leukemic conversion with high leukocytosis. In contrast, marked dissemination of lymphoma cells to peripheral blood is not indispensible for the development of infiltrations in the cerebrospinal meninges and peripheral nervous system.

[Catamnestic studies of patients with reversible ischemic stroke]. / Badania katamnestyczne pacjentów z odwracalnymi udarami niedokrwiennymi.

The authors carried out follow-up examinations of 75 patients with reversible ischaemic strokes suffered by them 6-10 years earlier. The results showed that reversible ischaemic strokes accounted for about 8% of all strokes. The risk of a repeated stroke was about 10.6%. The prognosis in such cases is rather good, but is worsened by coexistence of risk factors, particularly by coincidence of several such factors. In 17.6% of cases death ensued within 6-10 years.

[Physiologic all-night sleep in patients with severe forms of epilepsy]. / Fizjologiczny sen calonocny u chorych z ciezkimi postaciami padaczki.

100 all night sleep records in 90 patients with various forms of epilepsy and 10 patients with syncope were analyzed. There were 10 patients with generalized epilepsy, 41-with partial epilepsy with complex symptomatology and temporal foci, 23--with mixed seizures and frontal focal changes and 16 patients with partial epilepsy with simple seizures and various location of EEG foci. Normal sleep pattern was present in 21% of cases. The most frequent changes of sleep pattern were: prolongation of sleep onset and the latency of the first episode of REM, instability of sleep stages and absence of sleep spindles. Interictal discharges appeared mostly in all sleep stages of NREM. 50% of epileptic patients showed focal spikes in REM. Nocturnal seizures occurred in 18 patients, in several of them very frequently.

[Myoclonic cerebellar dyssynergia (Ramsay Hunt). Description of 2 cases]. / Dyssynergia cerebellaris myoclonica (Ramsay Hunt). Opis 2 przypadkow.

The authors report two cases of dyssynergia cerebellaris myoclonica in siblings. Apart from typical clinical manifestations attention is called to the results of computerized tomography of the brain which demonstrated cerebellar atrophy. This helped in verification of the diagnosis. Comparing these cases with other ones described earlier in the literature the authors conclude that dyssynergia cerebellaris myoclonica is not a separate nosological entity but a syndrome associated with myoclonia.

Appearance of microthrombi in vessels of central nervous system in the course of disseminated intravascular coagulation syndrome in acute leukemias.

In 35 cases out of 37 (88%) microthrombi have been found in CNS. They appeared much more frequently than it could be expected on the basis of the clinical picture of DIC syndrome or changes in the coagulation system. Microthrombi occurred prevalently in white substance of the frontal and occipital lobes as well as in thalamus. In 15 cases the microthrombi were the only evidence of DIC syndrome, besides clinically "mute" one. It should be emphasized that almost in half of the cases we encountered numerous disseminated microthrombi in many regions of CNS. Unequal distribution of microthrombi in CNS points out the significance of the local factor in the pathogenesis of DIC syndrome.

[Effect of different stages of physiological nocturnal sleep on interseizure discharges in patients with various forms of epilepsy]. / Wplyw poszczególnyçh stadiów snu nocnego fizjologicznego na miedzynapadowe wyladowania u chorych z róznymi formami padaczki.

All-night EEG records were obtained in 100 patients aged 14-48 years staying at a neurosurgical centre for various forms of focal epilepsy. In 84 cases discharges were observed during the nocturnal investigation. The morphology of the discharges depended on the phase of sleep during which they appeared. Discharges occurring in phases of light sleep had greater activity and more focal character in relation to the remaining NREM phases. On the other hand, discharges in deep sleep phases had a greater tendency for generalization. In half the cases focal discharges disappeared in the REM sleep phase. Intraseizure changes depended on the phase of sleep, focal or generalized character, and localization of pathological focus. Seiture activity during sleep was never observed in the REM phase of sleep.