Pathological laughter and crying in patients with pontine lesions.

Pathological laughter and crying (PLC) has been widely documented in the medical literature in association with various pathological processes in the brainstem, particularly infarction. However, it remains poorly understood. The authors present a case report and analyze all the cases in the literature to try to localize a putative faciorespiratory center. This 13-year-old girl developed a pontine abscess subsequent to sphenoid sinusitis. This increased in size despite antibiotic treatment, and she developed PLC. The abscess was then stereotactically aspirated, with resolution of the symptoms. A PubMed search of the term "pathological laughter and crying" was performed. From these papers all reported cases of PLC were identified. Cases without neuroimaging were excluded. The remaining cases were categorized as small lesions permitting accurate localization within the pons, or large nonlocalizing lesions. All images of localizing lesions were magnified to the same size and placed on a grid. From this an area of maximal overlap was identified. The authors identified 7 cases of small localizing lesions with adequate imaging. The area of maximal overlap was in the region of the anterior paramedian pons. All the lesions involved this region of the pons. There were 28 further reports of large lesions that either resulted in gross compressive distortion of the pons or diffusely infiltrated it, and thus, although implicating involvement of a pontine center, did not allow for localization of a specific region of the pons. The authors report a case of PLC caused by a pontine abscess. Symptoms were reversible with stereotactically assisted aspiration and antibiotic administration. Analysis of the lesions reported in the literature showed a pattern toward a regulatory center in the pons. The most consistently involved region was in the anterior paramedian pons, and this may be the site of a faciorespiratory center.

Nocardiosis in a teaching hospital in the Central Anatolia region of Turkey: treatment and outcome.

Predisposing factors, antimicrobial susceptibility patterns, treatment and outcome were analysed for nine consecutive patients with nocardiosis. Predisposing factors were identified in six (67%) of the nine patients. Clinical syndromes of nocardial infection were pulmonary infection (three patients), cerebral infection (five patients) and disseminated infection (one patient). The predominant (60%) species was Nocardia farcinica rather than the Nocardia asteroides complex. Treatment was started empirically, modified according to the antimicrobial susceptibility pattern, and then continued for 6-12 months. Overall mortality was 33%, with death being caused by the Nocardia infection in two cases.

Pyogenic brain abscess following haematogenous seeding of a thalamic haemorrhage.

We report the rare occurrence of a pyogenic brain abscess at the site of a preceding intracerebral haemorrhage in a 58-year-old man. The diagnosis was based on clinical observations, isolation of Staphylococcus aureus from blood cultures, and characteristic cerebrospinal fluid and cerebral computed tomography findings. The patient had a favourable response to antibiotic therapy.

Discrimination of brain abscess and cystic tumor by in vivo proton magnetic resonance spectroscopy.

Proton magnetic resonance (MR) spectroscopy was evaluated for the differentiation of brain abscesses and cystic brain tumors. Proton MR spectroscopy was performed in vivo in two patients with brain abscess and eight patients with various cystic brain tumors (anaplastic astrocytoma, glioblastoma, and metastatic brain tumor). MR imaging with contrast medium demonstrated ring-like enhanced mass lesions in all patients. The various resonance peaks in proton MR spectra were assigned to metabolites according to chemical shifts. Treatment of the cystic brain lesions was based on the information from proton MR spectroscopy. Aspirated pus from one patient with brain abscess was examined using ex vivo proton MR spectroscopy. The in vivo spectra of brain abscess contained resonance peaks attributed to acetate, lactate, alanine, amino acids, and lipids in both cases, and an additional peak of succinate in one case. In vivo spectra of the neoplasms contained resonance peaks corresponding to lactate, lipids, choline, creatine, and N-acetyl aspartate. Proton MR spectroscopy is useful for discriminating brain abscess from cystic tumors with similar neuroimaging appearance, which is very important for determining the treatment strategy.

Solitary histoplasmoma of the thalamus: case report and literature review.

Only nine cases of solitary thalamic abscess have been reported. All were of bacterial origin, and three were successfully treated by surgical drainage and antibiotic therapy. The authors present the history of a patient with a histoplasmoma of the thalamus. As is often the case with solitary thalamic lesions, this lesion was initially assumed to be a tumor and was first treated with radiotherapy. Despite the sensitive location of the lesion, tissue diagnosis and decompression was safely accomplished with the aid of ultrasonic localization. Appropriate antifungal treatment was given, and the patient made a good recovery.

[Morphofunctional features of the hypothalamo-hypophyseal system in experimental cerebral abscess]. / Morfofunktsional'nye osobennosti gipotalamo-gipofizarnoi neirosekretornoi sistemy pri éksperimental'nom abstsesse golovnogo mozga.

The morphological characteristics of the hypothalamo-pituitary neurosecretory system (HPNS) were studied in 123 rats with an experimental abscess in the temporal area of the brain. It was found that changes in the HPNS in this pathology ran 2 stages corresponding to the periods of the development of the pyoinflammatory process in the cerebral tissue. In the first period (at the 3rd-10th day of the development of a cerebral abscess) the functional activity of the HPNS was inhibited: a decrease in both synthesis and excretion of neurohormones was evident. The mortality rate at this period was the highest (21 of 23 rats). At the second period (the 15th-30th day of experiment) there was an increase in the activity of neurosecretory nuclei and a decrease in the mortality rate (2 rats). It is suggested that the absence of NPNS activation was one of the causes of the high mortality rate at the first period of the experiment which was related to the direct damaging action of the abscess localized in the cerebral portions having the direct impact on the neurosecretory system.