Large striatocapsular infarcts: clinical features and risk factors.

We defined large striatocapsular infarcts as subcortical softenings of more than 20 mm in diameter involving the territories of the lateral and medial groups of lenticulostriate arteries. The aim of this study of 56 patients was to compare the clinical features and risk factors of these infarcts with those of cortical and lacunar infarcts. On the whole, our data suggest that both the clinical features and risk factors of large striatocapsular infarcts are similar to those of cortical infarcts, but significantly different from those of lacunar infarcts. The clinical manifestations of large striatocapsular infarcts with a maximum diameter of less than 50 mm may sometimes resemble those of lacunar infarcts because neuropsychological disorders are less frequent; however, our study indicates that, even in these cases, cardioembolic sources and artery-to-artery embolism are significantly more frequent in large striatocapsular than in lacunar infarcts, thus suggesting a different pathogenesis.

Partial Klüver-Bucy syndrome arising from a multicentric glioblastoma: anatomo-clinical study of a case with unusual involvement of CNS.

The authors describe the case of a patient showing clinical symptoms consistent with a partial Klüver-Bucy syndrome. CT-scan, macroscopic and histological findings showed the presence of a multicentric glioblastoma with almost exclusive involvement of subcortical gray nuclei and white matter. The possible anatomo-clinical correlations of these unusual locations in KBS are discussed. In addition, the authors emphasize that KBS can arise not only from lesions located in the temporal cortex and/or amygdala, but also from strategically located subcortical lesions particularly involving striatal nuclei and subcortical white matter in the insular area.

Peripheral nerve vasculitis: a clinico-pathological study.

The clinico-pathological findings of 20 nerve biopsies consecutively performed at the neuropathological laboratory of Verona University Hospital were reviewed in order to establish the most important clinical manifestations of peripheral nerve vasculitis and to determine the role of biopsy in corroborating the diagnosis. Dystal sensori motor polyneuropathy was the most frequent clinical manifestation, confirming previous clinico-pathological studies and suggesting a more widespread pathological process than usually supposed. The biopsy was the basis of the diagnosis since it established or substantially modified the clinical diagnosis. Therefore we suggest that in cases with suspected vasculitis of the peripheral nerve the biopsy makes a useful contribution to diagnosis.

Paraballism associated with anterior opercular syndrome: a case report.

We describe the combination of acute bilateral ballism and anterior opercular syndrome in a 75-year-old female hypertensive patient with bilateral multiple small infarcts involving the basal ganglia, the subcortical white matter and the area of the subthalamic nucleus, detected by CT scan and MRI. These clinical manifestations were accompanied by apathy, somnolence and cognitive changes usually observed in cortical involvement. Pathogenetic mechanisms for this unusual clinical picture are discussed on the basis of CT, MRI, and SPECT findings.

Aphonia as the only speech disturbance from bilateral paramedian thalamic infarction.

We examined a 55-year-old right-handed woman showing transient coma, amnesia, mild right hemiparesis, vertical gaze impairment and aphonia without aphasia. CT-scanning revealed bilateral paramedian thalamic infarction in the territory of the thalamo-subthalamic paramedian arteries. Aphonia may occur as a consequence of thalamic lesions, but until now it has not been described as an isolated speech disturbance.

[Value of visually evoked potentials in lesions of the optic nerve caused by a mucocele]. / Intérêt des potentiels évoqués visuels dans les lésions du nerf optique par mucocèle.

Mucoceles originating in accessory paranasal sinuses with orbit involvement are quite rare. The authors describe two cases of mucoceles, revealed by CT-Scan, the first in the ethmoid-sphenoidal-maxillary sinuses and the other in the ethmoid-frontal sinuses respectively. In both cases Visual Evoked Potentials were most important for assessing optic nerve involvement. They were also useful to check post surgical recovery. These case reports emphasize that early diagnosis of mucoceles involving the optic nerve is very important because prompt surgical treatment may lead to recovery of visual disturbances.

[Infarction of the anterior choroidal territory. Clinical and tomodensitometric study of 11 cases]. / L'infarto nel territorio di irrorazione dell'arteria corioidea anteriore. Studio clinico e tomodensitometrico di 11 casi.

Clinical features of anterior choroidal artery (ACA) territory infarct are hemiplegia, hemi-anaesthesia and homonymous hemianopia. However this syndrome in its complete form is of rare occurrence, since one or more signs or symptoms may be lacking. The Authors describe 11 patients with CT-documented infarctions in the (ACA) territory in order to establish clinical-CT correlations and possible risk factors. Among the investigated risk factors arterial hypertension is the most frequent in these patients. This finding, and the small size of the ischemic lesions make the ACA territory infarctions similar to Lacunar Infarcts. The Authors, emphasize that, as in lacunar infarcts, a thromboembolic mechanism cannot always be ruled out in ACA infarctions. Therefore a cause other than arterial hypertension should be considered in each patient for a better management of this type of infarcts.

[Unilateral cavernous angioma of the thalamus disclosed by transitional disorders in the upward gaze]. / Angioma cavernoso unilaterale del talamo rivelato da transitori disturbi di sguardo verso l'alto.

We describe a case of a cavernous angioma of the right thalamus, identified by MRI, showing transient vertical diplopia in the upward gaze, present only in protracted recumbency. We consider possible pathogenetic mechanisms in an attempt to explain this peculiar disturbances. In addition we emphasize that MRI is the most sensitive procedure for detection of the cavernous angioma.

Proliferative retinopathy: value of the oscillatory potentials.

Oscillatory potentials (OPs) and retinal fluorescein angiography (RFA) were performed in 45 patients with diabetes mellitus. OPs were normal in 28 patients, altered (increased latencies and or inter-peak times) but with normal shape in 9, changes in morphology in 8: none of these patients had normal RFA, 2 had no proliferative retinopathy, 6 proliferative retinopathy (PR). In the authors' opinion OP changes in morphology are nearly always caused by a serious diabetic retinopathy, often by a PR. The authors emphasize the usefulness of OPs for studying the neurophysiologic properties of the retina of diabetic patients, particularly in PR.

[Leucoaraiosis: correlation of arterial hypertension and lacunar infarct (study of 80 patients)]. / Leucoaraiose: corrélations entre hypertension artérielle et infarctus lacunaires (étude de 80 sujets).

We studied 80 patients with lacunar strokes in the attempt to find a relation between lacunar strokes, arterial hypertension and leucoaraiosis. Leucoaraiosis was found in 47 patients (58,75%) on CT-scan. Our findings emphasize that arterial hypertension is the most important risk factor of leucoaraiosis (p less than 0.003); but we did not find a relation between the admission value of systolic or diastolic blood pressure and leucoaraiosis. Our data do not confirm the hypothesis that leucoaraiosis may be the result of a confluence of several lacunar infarcts, although we found that a rarefaction of cerebral white matter was associated with arterial hypertension.

Painful tonic spasms associated with subcortical infarction.

The authors describe the case of a patient in whom painful tonic spasms developed as a consequence of a small infarct involving the lateral aspect of the putamen, the external capsule, and the subcortical white matter of the posterior insular region. Possible pathogenetic mechanisms explaining painful tonic spasms are discussed.

Hemichorea-hemiballism and anosognosia following a contralateral infarction of the caudate nucleus and anterior limb of the internal capsule.

The authors describe a patient who experienced the sudden occurrence of hemicorea-hemiballism on the left side of the body and the contemporary agnosia of it. An unenhanced CT-scan disclosed an ischemic lesion involving the head of the caudate nucleus and of the anterior limb of the internal capsule of the contralateral hemisphere. The authors discuss the possible pathophysiologic mechanisms explaining the rare association of these two symptoms and suggest that the involvement of the pyramidal tract in the internal capsule usually does not allow hyperkinesis to manifest itself.

MRI findings in a patient with a familial form of motor neuron disease.

The authors report the case of a 32-year-old woman who developed symptoms and signs possible manifestations of a familial motor neuron disease with left sided pyramidal signs and marked wasting and weakness in the ipsilateral upper girdle, progressively extended to the contralateral upper limb. The CT-scan showed only frontal cortical atrophy. MRI disclosed a restricted area of increased signal intensity in the centrum semiovale of the subcortical white matter of the right prefrontal cortex. This young woman did not disclose any risk factors for cerebrovascular diseases nor other disorders of the CNS; therefore the authors are of the opinion that the white matter changes observed on MRI are not occasional findings, but are related to the pathologic process occurring in consequence of her neurodegenerative disorder (possible ALS).

Dementia syndrome in patients with postsurgical hypoparathyroidism and extensive brain calcifications.

The authors report the cases of 2 patients with extensive brain calcifications after thyroidectomy, showing behavioral and cognitive changes suggesting a subcortical dementia syndrome. On the basis of clinical, neuroradiologic and SPECT features they discuss the role of the brain calcifications in the pathophysiology of associated cognitive disorders and the putative mechanisms for the observed neuropsychological disorders.

Acute confusional states secondary to infarctions in the territory of the posterior cerebral artery in elderly patients.

Acute confusional states and agitated delirium are among the most common psychopathologic disorders in the elderly. However, they are rarely reported in the course of infarcts in the territory of the posterior cerebral artery. This study involving thirteen patients aged more than 65 years suggests that acute confusional states from posterior cerebral artery infarcts are less rare than usually thought, although the diagnosis may be difficult during the acute phase. The risk factors are no different from those observed for infarcts in other cortical areas, suggesting that this syndrome is due to structural damage of the brain rather than the other, usual causes of confusion in the elderly (intoxications, dysmetabolic diseases or dementia). The recognition of acute confusional states from posterior cerebral artery infarcts and its distinction from other causes of confusion is important in elderly patients because of the different diagnostic, prognostic and therapeutic implications involved.