[Balint's syndrome--visual disorientation]. / Balint-syndrom--visuel desorientering.

The three major components of the Balint's syndrome are described: 1) visual disorientation or simultanagnosia, i.e. the inability to perceive the visual field as a whole, 2) ocular apraxia, a deficit of visual scanning and 3) optic ataxia, an impairment of pointing and reaching under visual guidance. Our description of the syndrome is illustrated by three case histories. The complete syndrome is rare, and partial syndromes have been reported more frequently. Sudden and severe hypotension resulting in bilateral borderzone infarction in the occipito-parietal region is reported to be the most frequent cause of complete Balint's syndrome. Lack of awareness of the syndrome may lead to misdiagnosis such as blindness, psychosis, or dementia.

Conservatively treated patients with cerebral arteriovenous malformation: mental and physical outcome.

Twenty five patients with conservatively treated cerebral arteriovenous malformation were followed up for a mean of 10.6 years after diagnosis. The follow up included neuropsychological examination. Bleeding did not occur after the time of diagnosis. Three patients had moderate to severe neurological deficits, five had moderate to severe intellectual impairment. Nineteen had an unaffected occupational status. It is concluded that the outcome in conservatively treated patients may be no worse than in surgically treated patients.

Increased vigilance and dopamine synthesis by large doses of tyrosine or phenylalanine restriction in phenylketonuria.

In a group of 9 patients with classical phenylketonuria (PKU) aged 15-24 years we examined the effect of phenylalanine restricted diet on vigilance, as judged by the continuous visual reaction times, and neurotransmitter synthesis, as judged by cerebrospinal fluid (CSF) homovanillic acid (HVA) and 5-hydroxyindole acetic acid (5-HIAA) levels. HVA and 5-HIAA levels decreased significantly with increase in plasma phenylalanine concentration on free diet (p less than 0.01 and p less than 0.0005 respectively). Vigilance improved on phenylalanine restricted diet in 6 of the 7 patients with abnormally long reaction times on free diet. Addition of tyrosine (160 mg/kg/24 h) to the free diet resulted in an increased CSF in the six patients examined. In 14 patients on free diet supplemented with tyrosine, an improvement in vigilance (reaction times at the 90 percentile) was seen in all 12 patients with values longer than the normal mean (264 msec) (p less than 0.001). Tyrosine treatment may be a therapeutical alternative when phenylalanine restriction is impractical.

Nonsurgical treatment of a traumatic brain abscess in a child.

A large traumatic brain abscess in a 9-year-old white boy was successfully treated conservatively with antibiotics, including metronidazole and ampicillin. No neurological or psychological sequelae, except for unilateral loss of the olfactory sense, were revealed at follow-up 5 years later, and on CT two minor hypodense areas remained in the right frontal lobe. Our treatment protocol includes metronidazole (0.5 g 3 times a day) and ampicillin (1 g 6 times a day) for adults. This seems to be the treatment of choice in cases of intracranial brain abscesses.