Epilepsy: disappearing lesions appearing in the United Kingdom

Objective: - Investigation of spontaneously resolving lesions associated with epilepsy. Design:- Observational study during one year. Setting:- One neurology department. Patients:- 4 cases in patients (one of Indian parents, one African, one white English, and one Afro-Caribbean) resident in the United Kingdom, who presented with transient epilepsy. Main outcome measures:- Findings on computed tomography and on screening for infections. Results:- In all four cases a small mass lesion in one cerebral hemisphere was observed on computed tomography, which resolved after 9, 4, 3 and 1.5 months respectively without surgery. Conclusions:- The number of cases seen in one year suggests that the lesions may be more common in the United Kingdom than previously recognised and that research into their cause is warranted. (AU)

Behaviour of untreated proliferative sickle retinopathy

The development of ocular lesions in 313 patients with sickle cell disease followed up for periods of 1-8 years is described. Proliferative sickle retinopathy (PSR) was present on initial examination in 68 (12 percent) of 567 eyes and developed in a further 46 (8 percent) eyes during the study period. Spontaneous regression (autoinfarction) was present on initial examination in 33 (49 percent) eyes with PSR initially and developed in a further 45 (39 percent) eyes during the study. Development of PSR was common in sickle cell-hemoglobin C (SC) disease, and autoinfarction appeared to occur more commonly in homozygous sickle cell (SS) disease. The two processes were delicately balanced, and some PSR lesions lasted less than a year before undergoing autoinfarction. Although the high prevalence of autoinfartion diminishes the clinical sequelae of PSR, blindness related to PSR occurred in 14/119 (12 percent) eyes. Autoinfarction closes the feeding vessels of PSR lesions more elegantly than, and without the complications associated with, photocoagulation. A greater understanding of factors involved in the progression and regression of PSR is relevant to defining the role of photocoagulation in this condition. (Summary)

Marijuana modified mania

A syndrome seen in four Jamaican patients is described in which increased use of marihuana followed the onset of symptoms of a hypomanic nature. At the time of admission to the hospital the patients exhibited persecutory delusions, auditory hallucinations, withdrawal, and thought disorder. Within three to four days after admission, manic or hypomanic symptoms emerged. It is suggested that these patients had mania and that excess marihuana usage was symptomatic of their illness, leading to a transient, marihuana-induced, schizophreniform phase of their manic illness. A plea is made for a broader approach to the psychiatric implications of marihuana use.(AU)

Cortisone therapy in the nephrotic syndrome: a case report

A three-year old Jamaican boy with the nephrotic syndrome, who showed no response to other forms of therapy, was treated with a nine-day course of intramuscular cortisone acetate. On the third day after the cessation of treatment, diuresis occurred, followed by a clinical remission lasting for some five weeks, but ultimately followed by a replapse (AU)