Brain-stem auditory evoked potentials in human immunodeficiency virus-seropositive patients with and without acquired immunodeficiency syndrome.

Brain-stem auditory evoked potentials were recorded in 35 human immunodeficiency virus (HIV)-seropositive subjects from the Centers for Disease Control groups III and IV, 24 HIV-negative drug abusers, and 62 normal healthy controls. None of the patients had evidence of neurological complications. History of alcohol consumption was an exclusion criterion. The values of central conduction times I-V and III-V showed significant differences between the HIV-seropositive subjects and normal healthy controls, as well as between the HIV-seropositive subjects and HIV-negative drug abusers. Central conduction times I-III showed no differences between groups, except in the left ear of Centers for Disease Control group IV compared with controls. No statistical differences were found in the central conduction times between HIV-negative drug abusers and normal healthy controls. The results suggest a subclinical involvement of the upper brain stem in HIV infection. It could be produced by direct action of the virus on central nervous system structures.

[Neurological complications of Argentinian hemorrhagic fever]. / Complicaciones neurológicas de la fiebre hemorrágica argentina.

The Argentine hemorrhagic fever (AHF) is an infectious disease, endemo-epidemical, of viral etiology, produced by the Junin virus and limited to the Buenos Aires Province, South of Córdoba, East of La Pampa, and South of Santa Fe. It generally assails rural workers at harvest-time, especially during corn-harvest. The incubation period of the disease does not exceed 12 days. A feverish syndrome with asthenia, adynamia, myalgias, migraine, photophobia, epigastralgia etc., appear. The patient has a facial erythema, petechias on the skin, enantema on the palate, conjunctive micropolyadenopaty injection. The laboratory shows a low erytro, leukopenia with aneosinophilia, thrombopenia and a urine with albuminuria and virous cells. After the fourth day, hemorrhage and a neurological case appears. The laboratory tends to normalize and cast appears in the urine. The most striking neurological signs are the following: muscular hypotonia, proprioceptive hyporreflexia or arreflexia, marinesco reflex, shakings, difficulty to stand and walk, oscillations in consciousness level, and ocular disturbances. The cytochemical test of the C.L. Rachis in the usual ways of the AHF is within its normal characteristics; on the other hand there are modifications in the nervous cases: the total proteins are nearly always increased and the cells augmented with a great predominance of mononuclear cells. The electroencephalogrammes were always abnormal, varying from a brief disorganization up to a diffusive and permanent slowness. The half of which additionally presented paroxisms generalized by slow waves. The pathological anatomy over the central nervous system makes us think that the lesion would not primitively neuronal but that the action of the virus would be indirectly done through the capillar wall. This capillar lesion is produced by multiple focuses. The neuronal destruction with necrosis by microinfarcts is minimum. The symptoms and neurological signs are present in 10% of the clinical cases; the death-rate in the nervous clinical cases having reached 50% of them. The premature treatment allows the death-rate to diminish and the cases that survive have not many after effects.

Amnesia global transitoria: respuesta peculiar del hipocampo ante un conflicto prolongado? / Transient global amnesia: hippocampal peculiar response in front of a prolonged conflict?

Se presentan 14 casos de Amnesia Global Transitoria (AGT), asistidos a lo largo de 18 años. Hubo 7 que reunían algunas características comunes: 1) Personalidad minuciosa, responsable, laboriosa. 2) Sufrían prolongadas situaciones conflictivas de carácter familiar o personal.3) Tuvieron factores desencadenantes. En 12 el episodio fue único. Tres tenían antecedentes migrañosos. En 2 se encontraron alteraciones cerebrales. La recuperación fue total en todos y uno solo repitió el episodio. Uno sufrió un infarto protuberancial 3 años después, y otro una demencia senil 6 años después de la amnesia. El objetivo de la presentación es destacar el hallazgo de rasgos comunes de personalidad, conflicto prolongado y factores desencadenantes, en la mitad de los casos, postulando que la AGT debe ser concebida como un síndrome que difícilmente dependa de una sola causa y menos de un simple factor desencadenante emocional. Probablemente se sumen condiciones de constitución, de anatomía cerebral y/o vascular, de personalidad, de circunstancias biográficas y algunas veces desórdenes de patología focal cerebral. La inhibición funcional del hipocampo, en base a un mecanismo como el que fuera descrito en la depresión propagada (Spreading depresion de Leao), surge como propuesta razonable

Siete casos de tuberculoma intracraneano / 7 cases of intracranial tuberculoma

Se presentan siete casos de tuberculoma intracraneano asistidos entre 1979 y 1981. Seis casos eran supratentoriales y el otro pontino. Todos tenían signos neurológicos focales. Cinco casos tuvieron convulsiones parciales y uno generalizadas. Había antecedentes de tuberculosis en cinco pero era activa solamente en tres. Cuatro casos fueron intervenidos con la presunción de tumor cerebral, pero el estudio biópsico demostró granulomas con caseificación en los cuatro y bacilos ácido-alcohol resistentes en uno. Un paciente falleció con diagnóstico de meningoencefalitis tuberculosa, la necropsia evidenció un tuberculoma pontino. Los dos casos restantes se recuperaron con tratamiento tuberculostático. Se enfatiza: 1) la importancia de considerar el diagnóstico de tuberculoma cerebral ante cada caso de masa intracraneana, con o sin antecedentes de patología pulmonar; 2) la importancia del estudio tomográfico contrastado, para llegar al diagnóstico siempre que se relacione al mismo con el cuadro clínico, que no suele ser de rápida evolutividad, pudiendo inclusive ser estático o regresivo, y 3) la escasa utilidad práctica de los restantes medios complementarios de diagnóstico