RESUMO
The cerebellum is classically linked with control of motor function, such as coordination, balance, and regulation of movement. There is an increasing awareness, now, of the non-motor functions of the cerebellum, and the occurrence of behavioral anomalies with cerebellar disorders. We present the first report of Schmahmann syndrome (cerebellar cognitive affective syndrome [CCAS]) occurring secondary to posterior fossa meningioma excision. A 35-year-old lady with a posterior fossa meningioma developed an infarct of the right posterosuperior cerebellar hemisphere and ipsilateral superior vermis, following suboccipital craniotomy and tumor resection. Few days after the surgery, she presented with aggressive and emotional behavior, irrelevant talk, and emotional lability. The CCAS scale was administered, and she scored poorly on almost all parameters. A neuropsychological evaluation was also done. The occurrence of CCAS, posterior fossa syndrome (PFS), and behavioral abnormalities like abnormal pathological laughter/crying provides further clinical evidence of the "affective" functions of the cerebellum, modulated mainly by the posterior lobe and vermis of the cerebellum.
Assuntos
Doenças Cerebelares , Neoplasias Meníngeas , Meningioma , Adulto , Doenças Cerebelares/complicações , Doenças Cerebelares/psicologia , Cerebelo/patologia , Feminino , Humanos , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/cirurgia , Meningioma/complicações , Meningioma/patologia , Meningioma/cirurgia , Testes Neuropsicológicos , SíndromeRESUMO
BACKGROUND: Symptomatic peritumoral edema (PTE) is a known complication after radiosurgical treatment of meningiomas. Although the edema in most patients can be successfully managed conservatively with corticosteroid therapy or bevacizumab, some medically refractory cases may require surgical resection of the underlying lesion when feasible. Laser interstitial thermotherapy (LITT) continues to gain traction as an effective therapeutic modality for the treatment of radiation necrosis where its biggest impact is through the control of peritumoral edema. CASE DESCRIPTION: A 56-year-old woman with neurofibromatosis 2 presented with a symptomatic, regrowing left frontotemporal lesion that had previously been radiated, then resected with confirmed recurrence of grade I meningioma, and subsequently radiated again for lesion recurrence. Given her history of 2 prior same-side craniotomies, including a complication of wound infection, she was not a candidate for further open surgical resection. Having failed conservative management, she underwent LITT with intraoperative biopsy demonstrating viable grade I meningioma. Postoperatively, she demonstrated radiographic marked, serial reduction of PTE and experienced resolution of her symptoms. CONCLUSIONS: This case demonstrates that LITT may be a viable alternative treatment for patients with meningioma with symptomatic PTE who have failed medical therapy and require surgical intervention.
Assuntos
Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/cirurgia , Edema/etiologia , Edema/terapia , Hipertermia Induzida/métodos , Terapia a Laser/métodos , Meningioma/complicações , Meningioma/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/terapia , Radiocirurgia/efeitos adversos , Craniotomia , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neurofibromatose 2/complicações , Infecção da Ferida Cirúrgica/complicações , Infecção da Ferida Cirúrgica/terapia , Resultado do TratamentoRESUMO
Brain tumors are generally associated with cognitive changes. Little is known about cognition in patients with meningioma - a lesion that usually shifts and compresses the brain parenchyma with a low probability of infiltrate it. We investigated the cognitive functioning in a consecutive series of 46 patients with a meningioma in the sensorimotor area in the left (LH, N = 27) or in the right (RH, N = 19) hemisphere. All the patients underwent a pre-operative neuropsychological assessment and structural MRI. Clinical symptoms varied between LH and RH meningioma patients. Impaired performance was seen in naming (19.23% noun and 35% verb naming), short-term (18.18%) and working (14.24%) memory in the LH group, and in visuo-spatial tasks (25% neglect, 21.42% visuospatial planning) in the RH group. Both groups were impaired on a sensorimotor mental imagery task (LH, 66.66% of the LH 70% of the RH meningioma patients), while only the RH meningioma group was impaired on the visuo-spatial mental imagery task. The lesion MRI maximum overlap occurred in the postcentral and paracentral lobules. Edema was maximally localized on the left superior longitudinal fasciculus and the superior part of the right superior corona radiata. We found that only the meningioma mass, and not the edema, is a predictive variable in determining patients' performance. Patients with meningioma could present with cognitive alterations at pre-surgical evaluation even if the meningioma occurs in sensorimotor areas. In the present series, a large meningioma vs. a large edema is more relevant for cognitive performance.
Assuntos
Edema Encefálico/patologia , Disfunção Cognitiva/fisiopatologia , Neoplasias Meníngeas/patologia , Meningioma/patologia , Córtex Sensório-Motor/patologia , Substância Branca/patologia , Adulto , Idoso , Disfunção Cognitiva/etiologia , Feminino , Humanos , Imaginação/fisiologia , Imageamento por Ressonância Magnética , Masculino , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico , Meningioma/complicações , Meningioma/diagnóstico por imagem , Pessoa de Meia-Idade , Testes Neuropsicológicos , Córtex Sensório-Motor/diagnóstico por imagem , Substância Branca/diagnóstico por imagemRESUMO
BACKGROUND: Pathologic laughter is inappropriate, involuntary, and unmotivated laughter episodes that may or may not be associated with mirth or amusement. Although associated with many diffuse brain pathologies, its association with intracranial focal mass lesions causing ventrolateral brainstem compression, like petroclival meningioma, is very rare. The exact pathophysiology of this interesting and unusual clinical symptom is unknown, but probably involves disinhibition and release of the so-called coordination center located in the upper brainstem due to compression by the tumor. CASE DESCRIPTION: A 26-year-old woman presented with recurrent episodes of inappropriate and involuntary laughter, which significantly affected her quality of life, for 2 years. These episodes did not resolve, and a magnetic resonance imaging of the brain showed a giant petroclival meningioma causing upper brainstem compression. Near-total excision of the tumor was done using an extended middle fossa approach. To our surprise, the pathologic laughter subsided immediately after surgery. CONCLUSIONS: Pathologic laughter may be the only symptom of a focal mass lesion causing ventrolateral upper brainstem compression, like petroclival meningioma, well before other neurological sign/symptoms appear. Tumors causing ventral brainstem compression must be ruled out before the patient is sent for a psychiatric evaluation.
Assuntos
Riso , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Adulto , Tronco Encefálico , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Feminino , Humanos , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/cirurgia , Meningioma/complicações , Meningioma/cirurgiaRESUMO
BACKGROUND: Craniosacral therapy (CST) is a commonly used but under-researched therapeutic approach. This case study explores the implementation of CST in the integrative inpatient treatment of sequelae of postoperative meningioma and traumatic brain injury. CASE: A 50-year-old woman was admitted for 2 weeks of integrative inpatient treatment following meningioma resection and traumatic brain injury. In addition to the integrative treatment approach, which included conventional as well as complementary and alternative medicine, she received five sessions of CST for refractory headaches, vertigo, and cervicobrachial syndrome during this time. At discharge, the reported intensity of her headaches on a 10-cm visual analogue scale decreased from 6-9 cm to 2-4 cm and her level of vertigo decreased from 6-10 cm to 2 cm. Her cervical mobility and muscle tension, sleep quality, and general well-being also improved. The attending physicians saw CST as having contributed greatly to this improvement alongside use of phytotherapy and hyperthermia. CONCLUSION: Implementation of CST in integrative inpatient care could benefit patients with headache and vertigo from intracranial injuries.
Assuntos
Lesões Encefálicas/complicações , Cefaleia/terapia , Massagem/métodos , Meningioma/complicações , Vertigem/terapia , Feminino , Cefaleia/etiologia , Humanos , Pessoa de Meia-Idade , Vertigem/etiologiaRESUMO
Los meningiomas son tumoraciones eminentemente benignas procedentes de las meninges, correspondiendo al 15-25% de las tumoraciones intracraneales en el adulto, cuya expresividad clínica viene representada por la compresión de estructuras vecinas quedando representada predominantemente por cefalea, alteraciones del comportamiento, y déficit neurológicos. Presentamos un caso donde el cuadro constitucional constituye la primera y principal manifestación de un meningioma intracraneal pontocerebeloso (AU)
Meningiomas are basically benign tumours arising in the meninges and account for 15-25% of intracranial tumours in adults. It is clinically signs are due to compression of the neighbouring structures, with the main symptoms being migraine, behavioural changes, and neurological deficits. We present a case where constitutional syndrome was the first and principal manifestation of an intracranial cerebellopontine meningioma (AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Diagnóstico Constitucional/métodos , Ângulo Cerebelopontino/patologia , Ângulo Cerebelopontino , Imageamento por Ressonância Magnética/instrumentação , Imageamento por Ressonância Magnética/métodos , Ângulo Cerebelopontino/cirurgia , Meningioma/complicações , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Neurocirurgia/métodosAssuntos
Adenoma Oxífilo/diagnóstico por imagem , Lobo Frontal/diagnóstico por imagem , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Segunda Neoplasia Primária/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Sestamibi , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Imagem Corporal Total , Adenoma Oxífilo/radioterapia , Adenoma Oxífilo/cirurgia , Edema Encefálico/etiologia , Edema Encefálico/patologia , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/secundário , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/cirurgia , Terapia Combinada , Diagnóstico Diferencial , Feminino , Humanos , Achados Incidentais , Radioisótopos do Iodo/uso terapêutico , Neoplasias Renais/cirurgia , Imageamento por Ressonância Magnética , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/patologia , Meningioma/complicações , Meningioma/patologia , Pessoa de Meia-Idade , Nefrectomia , Cintilografia , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/cirurgia , TireoidectomiaRESUMO
Neuropathic facial pain can be a debilitating condition characterized by stabbing, burning, dysesthetic sensation. With a large range of causes and types, including deafferentation, postherpetic, atypical, and idiopathic, both medicine and neurosurgery have struggled to find effective treatments that address this broad spectrum of facial pain. The authors report the use of motor cortex stimulation to alleviate 3 distinct conditions associated with intractable facial pain: trigeminal deafferentation pain following rhizotomy, deafferentation pain secondary to meningioma, and postherpetic neuralgia. Functional MR imaging was used to localize facial areas on the precentral gyrus prior to surgery. All 3 patients experienced long-lasting complete or near-complete resolution of pain following electrode implantation. Efficacy in pain reduction was achieved through variation of stimulation settings over the course of treatment, and it was assessed using the visual analog scale and narrative report. Surgical complications included moderate postsurgical incisional pain, transient cerebral edema, and intraoperative seizure. The authors' results affirm the efficacy and broaden the application of motor cortex stimulation to several forms of intractable facial pain.
Assuntos
Terapia por Estimulação Elétrica , Dor Facial/terapia , Córtex Motor/fisiopatologia , Dor Intratável/terapia , Adulto , Idoso de 80 Anos ou mais , Dor Facial/etiologia , Feminino , Herpes Zoster da Orelha Externa/complicações , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/cirurgia , Meningioma/complicações , Meningioma/cirurgia , Pessoa de Meia-Idade , Córtex Motor/patologia , Dissinergia Cerebelar Mioclônica , Dor Intratável/etiologia , Resultado do TratamentoRESUMO
Propionibacterium acnes (P. acnes) is emerging as a pathogen in postneurosurgical infections. A case of cranial bone flap infection due to P. acnes successfully treated with daptomycin is presented. This case demonstrates the potential of daptomycin as an option in the treatment of P. acnes.
Assuntos
Antibacterianos/uso terapêutico , Daptomicina/uso terapêutico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Osteomielite/tratamento farmacológico , Propionibacterium acnes , Crânio/patologia , Infecção da Ferida Cirúrgica/diagnóstico , Ciprofloxacina/uso terapêutico , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/patologia , Humanos , Masculino , Meningioma/complicações , Meningioma/patologia , Meningioma/cirurgia , Procedimentos Neurocirúrgicos , Osteomielite/microbiologia , Osteomielite/patologia , Seio Esfenoidal/patologia , Seio Esfenoidal/cirurgia , Retalhos Cirúrgicos , Infecção da Ferida Cirúrgica/microbiologia , Adulto JovemRESUMO
A 59-year-old woman with a 5-year history of right lower limb pain is reported. Symptoms developed initially when walking and progressively became bilateral, appeared at rest and involuntary movements of the toes became evident. A diagnosis of painful legs and moving toes was made. As several drug therapies proved unsuccessful, a therapeutic test with a tetrapolar epidural lead to stimulate the spinal cord dorsal tracts was performed. Due to the marked improvement the device and generator were implanted and she has responded satisfactorily to this therapy for the past 13 months.
Assuntos
Terapia por Estimulação Elétrica/métodos , Transtornos dos Movimentos/terapia , Manejo da Dor , Medula Espinal/fisiologia , Eletromiografia , Feminino , Humanos , Imageamento por Ressonância Magnética , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/patologia , Meningioma/complicações , Meningioma/patologia , Pessoa de Meia-Idade , Transtornos dos Movimentos/etiologia , Transtornos dos Movimentos/patologia , Condução Nervosa , Dor/etiologia , Dor/patologia , Células do Corno Posterior/fisiologia , Dedos do PéRESUMO
We present a patient who developed acute visual loss and light flashes at retrobulbar anesthesia for cataract extraction. Vision improved only slightly after cataract surgery. Although traumatic optic neuropathy was suspected, the patient was diagnosed one year later with an optic nerve sheath meningioma (ONSM). ONSM is a rare, slow growing, benign tumour with highly variable clinical features. Diagnosis is often delayed. This case report demonstrates the diagnostic difficulty of this tumour.
Assuntos
Anestesia Local/efeitos adversos , Extração de Catarata/efeitos adversos , Meningioma/diagnóstico , Neoplasias do Nervo Óptico/diagnóstico , Transtornos da Visão/etiologia , Idoso , Humanos , Masculino , Meningioma/complicações , Neoplasias do Nervo Óptico/complicaçõesRESUMO
In a retrospective case study of a patient with a right-sided cerebellopontine angle mass lesion, transient evoked otoacoustic emissions were robustly present despite a severe to profound sensorineural hearing loss and abnormal auditory brainstem response. These results were interpreted as suggestive of a neural site of lesion, and the potential for planned, preserved, or improved hearing by a suboccipital surgical craniotomy was considered. A gross total resection was successful. Three years postoperatively, the patient has normal hearing sensitivity and word recognition ability.
Assuntos
Estimulação Acústica/métodos , Neoplasias Cerebelares/patologia , Neoplasias Cerebelares/cirurgia , Ângulo Cerebelopontino/patologia , Ângulo Cerebelopontino/cirurgia , Cóclea/fisiopatologia , Perda Auditiva Neurossensorial/diagnóstico , Meningioma/patologia , Meningioma/cirurgia , Cuidados Pré-Operatórios , Adulto , Neoplasias Cerebelares/complicações , Potenciais Evocados Auditivos do Tronco Encefálico , Feminino , Perda Auditiva Neurossensorial/etiologia , Humanos , Imageamento por Ressonância Magnética , Meningioma/complicações , Período Pós-Operatório , Índice de Gravidade de DoençaRESUMO
Human erythropoietin in concert with intraoperative hemodilution, tumor embolization, and surgical staging was used to manage a red blood cell mass in an anemic Jehovah's Witness patient with a hypervascular meningioma. Erythropoietin (3000 U thrice weekly) and oral iron (1300 mg daily) were given for 1 month prior to surgery, raising the hemoglobin level from 11.8 to 14.1 gm/100 ml. A posterior fossa craniectomy combined with a temporal craniectomy was then performed so that partial petrosectomy, section of the transverse sinus, incision of the tentorium, and exposure of the lesion could be carried out. The first stage of the surgery was terminated immediately prior to tumor mobilization. Isovolemic hemodilution was initiated just before the skin incision. Postoperatively, the hemoglobin concentration dropped to 11.5 gm/100 ml. The erythropoietin dose was doubled and administration of oral iron continued, leading to a hemoglobin level of 14.0 gm/100 ml at 1 month after the first operation. The tumor was embolized using superselective catheterization. The next day, at the second stage of the surgery, the tumor was extirpated, again employing isovolemic hemodilution. By the 4th postoperative day, the hemoglobin level had dropped to 9.4 gm/100 ml. The patient made an uncomplicated recovery. Erythropoietin therapy contributed substantially to the successful outcome of this case. Since erythropoietin has the potential to augment all other forms of autologous banking, its role in elective neurosurgery may become increasingly important in an era of heightened concern about heterologous transfusion.
Assuntos
Craniotomia , Epilepsia/cirurgia , Eritropoetina/uso terapêutico , Hemodiluição , Transfusão de Sangue Autóloga , Cristianismo , Fossa Craniana Posterior , Embolização Terapêutica , Epilepsia/etiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/terapia , Meningioma/complicações , Meningioma/terapia , Pessoa de Meia-IdadeRESUMO
A 66-year-old man developed progressive visual field loss in the inferior arcuate region of the right eye with normal central visual acuity. Intraocular pressures were normal on all but one occasion. The right optic disk showed extensive glaucomalike cupping; the left optic disk was normal. Magnetic resonance imaging revealed a tumor of the right medial sphenoid wing impinging upon the intracranial portion of the right optic nerve. It was resected via a frontotemporal craniotomy. Histopathologic examination revealed a meningothelial meningioma. The visual field and optic disk cupping remained unchanged postoperatively. To our knowledge, this is the first report in which both glaucomalike cupping and visual field loss occurred as the result of a compressive lesion of the anterior visual pathway.
Assuntos
Glaucoma/diagnóstico , Síndromes de Compressão Nervosa/diagnóstico , Doenças do Nervo Óptico/diagnóstico , Idoso , Fundo de Olho , Humanos , Pressão Intraocular , Imageamento por Ressonância Magnética , Masculino , Neoplasias Meníngeas/complicações , Meningioma/complicações , Síndromes de Compressão Nervosa/etiologia , Disco Óptico/patologia , Doenças do Nervo Óptico/etiologia , Acuidade Visual , Campos VisuaisRESUMO
In a prospective trial anthropometric and biochemical data of 24 neurosurgical patients with primary intracranial tumors were measured to assess preoperative malnutrition in this special group of patients. In spite of starving because of invasive diagnostic procedures, high-dose dexamethasone therapy of peritumoral edema, and changes in food intake because of psychical alterations and repeated vomiting resulting from elevated intracranial pressure no abnormalities were found in the data measured. The authors conclude that in general preoperative malnutrition is absent in neurosurgical patients and preoperative nutrition to improve postoperative outcome is not indicated in this group.
Assuntos
Neoplasias Encefálicas/complicações , Estado Nutricional , Desnutrição Proteico-Calórica/etiologia , Adulto , Aminoácidos/sangue , Astrocitoma/complicações , Proteínas Sanguíneas/metabolismo , Estatura , Peso Corporal , Neoplasias Encefálicas/cirurgia , Creatinina/sangue , Feminino , Glioma/complicações , Humanos , Masculino , Neoplasias Meníngeas/complicações , Meningioma/complicações , Pessoa de Meia-Idade , Oligodendroglioma/complicações , Estudos Prospectivos , Desnutrição Proteico-Calórica/sangueRESUMO
Angina-like phenomena of CNS etiology were studied. Data were collected and analyzed from clinical cases of cerebral hematoma, concussion, and tumors in which cardiological disturbances were observed consequent to compressive brain lesions or surgical brain manipulations. The cases in which the disturbances were largely angina-like and without ectopic beats or arrhythmias were chosen for study. The brain region most significantly related to this phenomenon seemed to be the hypothalamus. Experiments conducted in cats and monkeys showed that stimulation of specific sites in the hypothalamus resulted in angina-like manifestations with no other cardiac changes. These data support our working hypothesis that a cerebrally induced syndrome that is conspicuously angina-like must be related to hypothalamic involvement. In the awake monkey hypothalamic stimulation caused angina-like ECG changes and behavior suggestive of referred pain. In some cases, repetitions of the stimulations or irritations in all of the species resulted in permanent pathological myocardial changes, mostly bleeding into the myocardium. In some animals there were minute hemorrhagic necroses that were subepicardial in distribution. It is significant that the most severe or permanent pathological changes were found in cases in which the angina-like ECG alterations were persistent. There were also cases, however, with persistent angina-like ECG changes that showed no such pathology.
Assuntos
Angina Pectoris/etiologia , Neoplasias Encefálicas/complicações , Hipotálamo , Adolescente , Animais , Encefalopatias/complicações , Gatos , Hemorragia Cerebral/complicações , Modelos Animais de Doenças , Eletrocardiografia , Ependimoma/complicações , Feminino , Humanos , Masculino , Meningioma/complicações , Pessoa de Meia-Idade , Saimiri , Especificidade da EspécieRESUMO
Seventeen of 27 patients studied before and after surgical operations for basal meningioma frequently showed forms of cardial sinusal arythmia, sinusal tachycardia and ventricular extrasystolia. These pathological changes in cardiac rhythmics appeared and were aggravated during the postoperational period. Their possible pathophysiological mechanisms, due to the effect of the tumor and operative injury to the hypothalamo-diencephalic apparatus are discussed.
Assuntos
Arritmias Cardíacas/etiologia , Hipotálamo/fisiopatologia , Neoplasias Meníngeas/complicações , Meningioma/complicações , Adulto , Arritmia Sinusal/etiologia , Neoplasias Ósseas/complicações , Neoplasias Ósseas/cirurgia , Complexos Cardíacos Prematuros/etiologia , Eletrocardiografia , Eletroencefalografia , Feminino , Humanos , Masculino , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Pessoa de Meia-Idade , Osso Occipital , Período Pós-Operatório , Sela Túrcica , Taquicardia/etiologiaAssuntos
Síndromes de Compressão Nervosa/etiologia , Quiasma Óptico , Doenças do Nervo Óptico/etiologia , Acromegalia/radioterapia , Adenoma Cromófobo/complicações , Adenoma Cromófobo/radioterapia , Adulto , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/radioterapia , Neoplasias do Ventrículo Cerebral , Criança , Craniofaringioma/complicações , Craniofaringioma/radioterapia , Humanos , Hipotálamo , Meningioma/complicações , Meningioma/radioterapia , Metástase Neoplásica , Síndromes de Compressão Nervosa/radioterapia , Quiasma Óptico/diagnóstico por imagem , Nervo Óptico/diagnóstico por imagem , Doenças do Nervo Óptico/radioterapia , Pinealoma/complicações , Pinealoma/radioterapia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/radioterapia , Radiografia , Radioterapia/efeitos adversosRESUMO
Recently, the presence of thalamic neuronal cytoplasmic inclusions in patients with myotonic dystrophy has been reported. At the ultrastructural level, the inclusions were described "containing a fibrillar material within a limiting membrane studded on its outer surface with ribosomes". We have studied the brain of a 48-year-old woman with myotonic dystrophy. Many neuronal inclusion bodies were found within the thalamus, and examined in the electron microscope. Inclusions were found to have an electron density resembling that of nuclear chromatin, were not membrane-bound, and had an internal structure composed of parallel alternating dark and pale lines. We confirm the previously-reported existence of cytoplasmic thalamic neuronal inclusions in myotonic dystrophy, but differ in our observations of their ultrastructural appearance, and note that these inclusions bear no resemblance to previously described inclusion bodies.