Spinal cord ischemia and left atrial myxoma.

A 62-year-old man had an acute, transient, flaccid paraplegia. Examination showed a primary cardiac tumor with emboli to major branches of the aorta. A myxoma was removed from the left atrium, and normal function returned. Left atrial myxoma should be suspected as a cause for embolism to the CNS.

Movement disorders of familial neuroacanthocytosis syndrome.

Characteristic movement disorders were observed in two siblings who had neuroacanthocytosis syndrome with normal serum lipoprotein levels. The disorders included orolingual tic-like movements associated with vocalization, biting of the lip and tongue, peculiar dysphagia with bird-like drinking, and postural lapse with abrupt buckling of the knees. In addition, subtle features of parkinsonism and chorea were observed. These movement problems are strikingly similar to those described in cases of neuroacanthocytosis syndrome in several other familial and sporadic cases. Careful observations of these unusual movement disorders may provide a clue to the diagnosis of this rare syndrome.

Delta waves in the EEGs of patients with intracerebral hemorrhage.

Localized polymorphic delta wave activity appears ipsilaterally in patients with intracerebral hematoma without a shift of midline structures, regardless of the location of hematoma. Appearance of delta wave slowing after thalamic bleeding is quite variable, however, and may produce localized slowing or unilateral diffuse polymorphic delta wave activity. Unilateral diffuse polymorphic delta wave activity is seen in patients with larger hematomas of 30 mL or more, which cause a shift of the midline structures. The shift of midline structures, including the hypothalamus and surrounding structures, is thought to be one of the main factors responsible for the production of unilateral responsible for the production of unilateral diffuse polymorphic delta wave slowing.

The syndrome of posterior thalamic hemorrhage.

In six patients with CT evidence of posterior thalamic hemorrhage, we found the following signs: saccadic hypometria away from the lesion; defective pursuit toward the lesion with corresponding opticokinetic abnormalities; mild ipsilateral ptosis; ipsilateral miosis; unilateral sensory neglect; and sensorimotor hemiparesis. This distinct syndrome has a benign course and satisfactory recovery. It differs from the classic picture of thalamic hemorrhage, and can be called "the syndrome of posterior thalamic hemorrhage."

Changes of auditory brainstem responses in electrolyte-induced myelinolysis in rats. Role of hyponatremia and hypernatremia.

Electrolyte-induced myelinolysis was produced in rats to evaluate electrophysiological derangement in the brainstem. Auditory brainstem responses (ABRs) were used to assess the brainstem function. Rats treated with hypertonic saline for 2 days had normal interpeak latencies in ABRs. Rats treated with vasopressin-induced hyponatremia alone and those with hypertonic saline after 3 days of hyponatremia had significantly prolonged interpeak latencies between waves II-III and III-IV in ABRs. These prolongations indicate electrophysiological derangement of the upper pons and mesencephalon in hyponatremic rats as well as in rats with hyponatremia followed by hypernatremic myelinolysis. In view of these data, hyponatremia may be a prerequisite for electrolyte-induced myelinolysis and electrolyte derangements such as hyponatremia, and rapidly correcting hypernatremia may be the cause of electrolyte-induced myelinolysis in rats.

Intramedullary spinal cord metastasis associated with pencil-shaped softening of the spinal cord: case report.

A 57-year-old man presented with a pulmonary mass and subacute onset of paraplegia. Laboratory examination revealed an increased protein content in the cerebrospinal fluid and a normal myelogram. Autopsy disclosed epidermoid carcinoma in the left lower lobe of the lung, intramedullary metastasis at the midthoracic level, and a central pencil-shaped softening above and below the metastatic lesion. The pencil-shaped softening was an ischemic infarct rather than of hemorrhagic or congestive origin. The pathogenesis of this rare association may be explained by the hypothesis of a tumor embolus in the arterial circulation that feeds the center of the cord, producing metastasis. This embolus was followed later by a second embolus to a radicular artery, causing the pencil-shaped softening of the spinal cord.

[Neuroradiological studies of Wilson's disease by computed tomography and magnetic resonance imaging].

Three cases of Wilson's disease were imaged by computed tomography and magnetic resonance. They were characterized by common findings. CT scan showed atrophy of cerebral cortex, caudate head, midbrain and cerebellum, and areas of low absorption in the caudate head, putamen, globus pallidus, posterior limb of internal capsule, thalamus and midbrain. The T2-weighted MRI imaging demonstrated marked hyperintensity in the putamen, retrolenticular part of internal capsule, thalamus and midbrain. In 2 patients, these high intensity areas were decreased by chelating therapy. Improvement of the increased intensity on T2-weighted images led to the suggestion that the area of marked hyperintensity area might be edema or demyelination rather than neuronal loss or cavitation.

Epileptic seizures in a patient with mitochondrial myopathy, encephalopathy, lactic acidosis and strokelike episodes (MELAS).

This study reports a case of MELAS with epileptic seizure, and reviews the characteristics of seizures in patients with this syndrome. They are characterized by: (1) generalized and/or partial seizures, (2) frequent association with visual symptoms and hemiparesis, and (3) posteriorly predominant EEG abnormalities.