MR findings in subacute combined degeneration of the spinal cord caused by nitrous oxide anaesthesia--two cases.

Vitamin B12 deficiency causes haematological and neurological diseases. Subacute combined degeneration (SCD) of the spinal cord is characterized by degeneration of the posterior and lateral columns. We report two cases of SCD induced by nitrous oxide (N2O) anaesthesia. In both cases magnetic resonance imaging (MRI) of the spinal cord showed symmetric, reversible changes in the posterior columns, correlating well with patients' symptoms.

Can intravascular lymphomatosis mimic sinus thrombosis? A case report with 8 months' follow-up and fatal outcome.

We report a case of intravascular lymphomatosis of the brain with 8 months' follow-up and fatal outcome. Several MRI investigations revealed variegated, rapidly changing infarct-like lesions and invasion of the walls of the superior sagittal sinus and deep veins. When disturbances of the venous outflow are detected with multifocal infarct-like lesions, intravascular lymphomatosis should be considered in the differential diagnosis. Brain biopsy may ensure the proper diagnosis ante mortem, but failure of biopsy is frequent, as in our case.

Hippocampal malrotation with normal corpus callosum: a new entity?

Among 527 MRI examinations of patients with a suspicion of epilepsy in 5 years, we found 32 cases of hippocampal malrotation (HIMAL). The characteristic features are: incomplete inversion of the hippocampus with and abnormally round shape; unilateral involvement of the whole hippocampus; normal signal intensity and size; blurred internal structure; an abnormal angle of collateral sulcus; abnormal position and size of the fornix; normal size of the temporal lobe; enlargement and particular configuration of the temporal horn, typical of corpus callosum agenesis; and a normal corpus callosum. In 7 cases (22%) HIMAL occurred together with developmental disorders. It was predominantly seen in men. The clinical features were varied. Based on some MRI features, the presence of developmental disorders, the male predominance, the frequently positive family history, and a review of the literature, we think HIMAL may be the consequence of a mild hemisphere developmental disorder. It is probably not the basic cause of epilepsy in such varied clinical setting, but may be a sign of a developmental disorder and can help in selecting patients for more meticulous investigation. It also may give some new understanding of brain development.

Scalp distribution of the dimensional complexity of the EEG and the P3 ERP component in stroke patients.

The use of recently developed techniques allows the quantitative investigation of the non-linear properties of the electrical activity of the brain not only in basic but also in applied research. The point correlation dimension (PD2) was used in this study for the analysis of the electroencephalogram (EEG) recorded in patients with unilateral stroke caused by middle cerebral artery occlusion. The scalp distribution of the PD2 and that of the P3 event-related potential component was mapped and frequency spectra were calculated. Compared to normal controls, asymmetrical PD2 distribution was observed with low values on the side of the stroke, the extension of which depended on recording conditions (level of vigilance) and only partially corresponded to the region characterized by slow frequencies. In one case, ipsilateral reduction of the P3 wave was caused by a small subcortical stroke. The efficacy of the linear and non-linear methods in localizing brain pathology are evaluated and compared.

Assessment of borderzone ischemia with a combined MR imaging-MR angiography-MR spectroscopy protocol.

We attempted to assess whether magnetic resonance imaging (MRI)-MR angiography (MRA)-MR spectroscopy (MRS) measurements can be used in the differentiation of patients in whom severe carotid lesions result in chronically hypoperfused regions and in whom the collateral capacity is sufficient to maintain a normal cerebral blood flow. Sixty-six patients with severe stenosis of the internal carotid artery (ICA) and 19 control subjects underwent MRI, 1H MRS, and MRA. Anaerobic metabolic changes in the middle cerebral artery (MCA) territory were studied by assessing N-acetyl-L-aspartate (NAA)/choline and lactate/ NAA ratios. Quantitative flow was measured in the ICA, in the basilar artery, and in the MCA. Thirty-four patients had borderzone infarcts, 16 patients had territory infarcts, and 16 patients had no infarcts on MRI. Patients with border-zone infarcts had significantly reduced flow in the ICA (P < 0.001) and in the MCA (P < 0.05) and decreased NAA/ choline ratios (P < 0.001) in non-infarcted regions compared with control subjects (P < 0.001) but also compared with patients with territory infarcts (P < 0.05) and patients without infarcts (P < 0.05). Flow measurements in the ICA and MCA and metabolic measurements in the MCA territory can be applied to select patients in whom cerebral perfusion pressure is insufficient to maintain normal cellular integrity.

[The Budapest "stroke data bank" (goals, methods)]. / Budapesti "stroke adatbank" (célkitüzések, metodika).

The Stroke Data Bank initiated by National Institute of Neurological and Communicative Disorders and Stroke (USA) has been adapted and published here in a short form. The original questionnaire has been extended with data of patients' diets and neuropsychology. A suitable computer data basis derived from 1292 questions in 22 groups provides information about the risk factors, etiology, symptoms, signs, diagnosis, prognosis of stroke, and the easy to use follow up of patients.

[Early experience with the use of the Halo device in the treatment of damage to the cervical spine]. / Halo-készülékkel szerzett korai tapasztalataink nyaki gerinckórképek kezelése során.

Authors report on their experiences gained in 5 cases with the Halo device. The method of treatment is described. On the basis of a literary overview the field of indication, the advantages and the disadvantages of the method are described. In the assessment of the method it is stressed that according to their opinion this is the best conservative method of treatment, and the results compete with that of the operative treatment.