"Pure alexia" without hemianopia or colour anomia.

We report a case of "pure alexia" without hemianopia or colour anomia, caused by a small subcortical haematoma in the dorso-lateral part of the occipital lobe, not affecting the splenium of the corpus callosum. It is argued that the reading disorder was due to a visual-verbal disconnection in spite of the fact that this typically is caused by a lesion in the medial part of the left occipital lobe including the splenium.

Detection rate and clinical significance of monoclonal gammopathy in different age groups in the population of Northern Jutland, Denmark.

All serum protein electrophoresis performed in the period 1 May 1979-30 April 1982 in the county of Northern Jutland, Denmark, were studied to find the annual detection rate and the clinical significance of a monoclonal gammopathy (MG) in different age groups. A monoclonal gammopathy was found in 325 persons (185 males and 140 females). The average annual detection rate of MG per 100,000 individuals increased with age in both sexes (p less than 0.01, Kolmogorov test). The lowest and highest detection rate for males/females were 2.8/3.3 (age group less than 50 years) and 236.8/100.3 (age group greater than or equal to 80 years) per 100,000 individuals, respectively. Monoclonal gammopathy was associated with a B-cell malignancy in 28 percent (95% confidence limits 23.9-32.4%) of the persons irrespective of sex and age.

Peripheral neuropathy and paraproteinemia: an immunohistochemical and serologic study.

Four of 132 consequtive patients with paraproteinemia and with an M-component presented exclusively with neurological symptoms. A sural nerve biopsy was performed in all patients. In one case direct immunofluorescence revealed deposition of immunoglobulin corresponding to the M-component along the perineurium. No deposition of immunoglobulin was found along the myelin sheaths and the patient's serum revealed no immunoreactivity towards normal peripheral myelin or other components of normal peripheral nerves. In a second case, deposition of immunoglobulin corresponding to the M-component was found along the myelin sheaths, and this patient's paraprotein showed immunoreactivity towards normal peripheral myelin. Two patients showed no in situ bound immunoglobulin in the nerve biopsies and their sera did not react with any component in normal peripheral nerves. The patient with deposition of immunoglobulin along the perineurium had severe demyelination and severe peripheral sensory-motor neuropathy, while the patient with immunoglobulin deposition along the myelin sheaths had a slight sensory neuropathy which had not progressed for 4 years. Based on these findings the pathogenesis of neuropathy in patients with paraproteinemia is discussed, and it is concluded that although there is evidence for immune-mediated neuropathy in the patients, the histologic, immunohistochemical and clinical data are conflicting and the exact pathogenic pathway is still unknown.

Monoclonal gammopathy in general practice. Associated clinical conditions.

The clinical diagnoses in all 88 cases of monoclonal gammopathy, detected by general practitioners in Northern Jutland during a 3-year period, were investigated: 15% had malignant monoclonal gammopathy, 5% had non-haematologic cancers, and in 80% a benign disorder was found. These results indicate that the finding of a monoclonal gammopathy in general practice deserves attention, but it is rarely accompanied by a grave prognosis. Malignant monoclonal gammopathy should be suspected, but search for another type of cancer is not indicated.

Diffuse cerebral symptoms in convalescents from cerebral infarction and myocardial infarction.

In order to evaluate occurrence and cause of a number of diffuse cerebral symptoms (DCS), such as impaired memory, inability to concentrate, emotional instability, irritability, etc., 44 survivors of cerebral infarction (CI) and 40 survivors of myocardial infarction (MI) were seen 6-26 months after onset for psychometric testing and an interview about DCS. Although surprisingly common in both groups, DCS were significantly more frequent in CI patients than in MI patients. 1/2 of the former and 1/3 of the latter complained of 5 or more symptoms. In contrast, a significant difference in test performance was demonstrated in only 1 of 4 tests. There was no significant correlation between the number of DCS and test performance. In both groups, DCS occurrence was independent of age, whereas in the MI group, but not in the CI group, test performance was inversely related to age. In the CI group, DCS occurrence was not significantly related to size or site of the infarction. The results indicate that an organic brain damage cannot be the sole cause of DCS, and it is suggested that some of the symptoms are manifestations of a stress response syndrome provoked by insufficient coping with the consequences of the disease.