Severe amnesia after hypoglycemia. Clinical, psychometric, and magnetic resonance imaging correlations.

OBJECTIVE: To determine the correlation between clinical, psychometric, and magnetic resonance imaging (MRI) findings after an episode of hypoglycemic coma resulting in amnesia. RESEARCH DESIGN AND METHODS: Detailed psychometric assessment, especially memory testing, performed with MRI in a man with severe amnesia after hypoglycemic coma. RESULTS: Psychometric testing confirmed impaired immediate recall. MRI findings were consistent with a lesion in the left temporal lobe. CONCLUSIONS: This is the first description of MRI in determining the neurological damage in hypoglycemic coma.

Cerebral histiocytic lymphoma presenting with loss of weight.

An adult man presented with loss of weight and this progressed over several months before the appearance of signs of neurologic disease. Autopsy showed histiocytic lymphoma with extensive meningeal spread and dense infiltration of the hypothalamus. This diencephalic syndrome has been reported with cerebral tumor, leukemia, encephalitis lethargica, multiple sclerosis, and Alzheimer disease, CT of the brain and examination of the CSF may be helpful in diagnosis.

The early diagnosis of multiple sclerosis.

An outline of modern views on the aetiology of multiple sclerosis is followed by a discussion of diagnosis. Examination of the cerebrospinal fluid, visual evoked potentials, and other electrophysiological tests are considered. The special problems of optic neuritis, spastic paraparesis, and psychological disorder receive more detailed attention. It is concluded that while the supplementary tests are valuable the diagnosis remains essentially clinical.

Migraine, head trauma and sport.

In some people an attack of migraine may be provoked by heading a football or a blow on the face in a rugby tackle. The attack is sometimes alarming and clearly cannot be explained on a basis of trauma alone. Some people only have attacks in this particular circumstance but the majority have spontaneous episodes at other times. The presentation is usually in childhood or early adult life. The syndrome is discussed in relation to reports of seven patients to illustrate the variations which include migraine without headache and persistent features after the attack. The condition is benign but may cause the patient to give up playing football.

The Bramwells and neurology in Edinburgh.

An account is given of the life and work of Sir Byrom Bramwell (1847-1931), and his son Professor Edwin Bramwell (1873-1952). They were outstanding as clinical observers and teachers. Byrom Bramwell began his professional work in his father's practice in North Shields. After a brief period of hospital work in Newcastle he moved to Edinburgh. His early struggles in consulting practice were combined with prolific writing of papers and books. He became the leading physician in Scotland. Edwin Bramwell received extensive postgraduate training as a neurologist and returned to practise in Edinburgh. He became Moncrieff-Arnott Professor of Medicine, and was widely known as a clinician, lecturer, and writer on medical subjects. He was particularly active in postgraduate teaching. Both of the Bramwells became, in their turn, President of the Royal College of Physicians of Edinburgh. Edwin Bramwell was also President of the Association of British Neurologists. They shared an interest in angling which was their principal recreation. Their work is reviewed and considered in its historical perspective.

Leptomeningeal gliomatosis.

The diagnosis of leptomeningeal gliomatosis is discussed in relation to a single case studied in detail. Histology showed extensive subarachnoid spread of tumour that seemed to originate in an astrocytoma of the ventricular wall. The spinal fluid was xanthochromic with a high protein content. Reports of primary leptomeningeal gliomatosis are reviewed and the need for detailed histological study of the brain in such cases is emphasised.

Evidence of osteomalacia in an outpatient group of adult epileptics.

A review of 50 adult epileptics who had taken anticonvulsant drugs for 10 or more years showed a decrease in the concentration of serum phosphate and calcium and an increase in the activity of alkaline phosphatase in 22% of the patients. Plasma albumin and gamma-globulin levels were higher than in control subjects. All the patients lived at home and the dietary intake of calcium and vitamin D was often borderline normal or low. Six patients were submitted to bone biopsy and of these, 4 showed histological osteomalacia. Gastrointestinal disease did not appear to be a significant factor. None of the patients had symptoms or signs attributable to osteomalacia which does not seem to be of serious significance. All the patients were taking at least two drugs and it was not possible to assess the relative importance of the various drugs. A prospective study is needed. Measurements of serum calcium, phosphorus, and alkaline phosphatase should be performed at intervals on patients who are receiving anticonvulsant therapy. Treatment with calciferol may be indicated.

Delayed visual evoked potentials with bilateral disease of the posterior visual pathway.

A man of 51 years presented with sudden onset of a confusional state and marked visual deterioration. The computerised transaxial tomogram showed a mass in the corpus callosum which had spread to involve both cerebral hemispheres. The visual evoked potential to pattern stimulus was delayed by about 20 ms. Necropsy confirmed the presence of an astrocytoma of the corpus callosum involving the optic radiation and occipital cortex on both sides. The anterior visual pathway was normal.

Visual function in multiple sclerosis.

126 patients with multiple sclerosis and normal visual acuity were submitted to a battery of tests of visual function. The investigation included visual evoked potential, contrast sensitivity by three methods, and a segment of the Farnsworth-Munsell 100 Hue test. 22 of the patients gave a history of unilateral acute optic neuritis and in these the abnormalities were greater in degree. Contrast sensitivity emerged as the most useful test and was abnormal in 92.2% of eyes. Visual evoked potential was delayed in 35.6% and colour vision was abnormal in less than a third. In general, contrast sensitivity was depressed at all frequencies and most of the abnormalities could be identified by testing at a single frequency of 4 cycles/degree.