Percutaneous cervical cordotomy: a review of 181 operations on 146 patients with a study on the location of "pain fibers" in the C-2 spinal cord segment of 29 cases.

The authors present a review of 146 patients who underwent 181 percutaneous cervical cordotomies for intractable pain. In addition, an anatomical-clinical correlation was carried out for 29 of these patients. It was found that the fibers subserving pain sensation in the C-2 segment lie in the anterolateral funiculus between the level of the denticulate ligament and a line drawn perpendicularly from the medial angle of the ventral gray-matter horn to the surface of the cord. The best analgesic results have been obtained by creating lesions that extend 5.0 mm deep to the surface of the cord and destroy about 20% of the hemicord. There is a somatotopic organization with sacral fibers running ventromedially and cervical fibers running dorsolaterally. The authors believe that the ascending fibers subserving the distinct sensations of pain induced by tissue damage and pinprick, although mixed (overlapping) in the anterolateral funiculus of the spinal cord, are physiologically distinct from one another. Whereas some cordotomies, both in the current series and as reported in the literature, may affect these functions differentially, optimum pain relief seems to be obtained only when pinprick sensation is also abolished in the affected segments. Evoked pain sensation is not abolished by cordotomy, but its threshold is greatly raised. When pathological pain is completely abolished, so is pinprick sensation. However, in a number of cases where pathological pain was only partially alleviated, pinprick sensation remained intact. The significance of these and other cases reported in the literature is discussed. The importance of clinically distinguishing between pain caused by tissue damage and pinprick sensation is emphasized, as well as that between return of pre-existing or new tissue-damage pain and painful dysesthesia.

Trichloroethylene cranial neuropathy: is it really a toxic neuropathy or does it activate latent herpes virus?

The mechanism of the cranial neuropathy associated with heavy exposure to trichloroethylene (or dichloroethylene) is unknown. In severe cases there is destructive spread of the neuropathic process from the Vth cranial nerve nuclei up and down the brain stem in a manner that is difficult to explain on accepted neurotoxicological principles. However, there is a close association reported of this form of trigeminal neuropathy with reactivation of orofacial herpes simplex that suggests the possibility that the chemical, which readily gains entrance into the nervous system, may be responsible for reactivating the latent virus. This novel hypothesis is discussed in the light of current understanding of latency in herpes simplex infection in nervous tissue.

An intrasellar pituitary tumour producing metastases in liver, bone and lymph glands and demonstration of ACTH in the metastatic deposits.

We report the history, laboratory and histological findings in a man who presented with Cushing's disease. Despite removal of the primary pituitary tumour, his disease progressed and after bilateral adrenalectomy, he became pigmented and plasma ACTH levels remained elevated. He had further pituitary surgery and radiotherapy, to relieve compression of the optic chiasma. Plasma ACTH levels remained elevated. He developed liver, bone and lymph gland metastases and after an acute paraparesis due to spinal metastases he died. Immunoperoxidase staining techniques demonstrated ACTH in the pituitary recurrence and metastases. The combination of bone, liver and lymph node metastases has not previously been reported, nor has ACTH been reported before in metastases from a primary intrasellar tumour.

Intracranial malignant teratoma.

A case of malignant teratoma arising near the third ventricle in an adult is reported. It represented a true teratoma containing elements of all three germ layers of which two, namely the mesenchymal and endodermal elements have undergone malignant change. It was characterized by rapid recurrences after two operations with death occurring shortly after the second operation.

Measles virus and subacute neurological disease: an unusual presentation of measles inclusion body encephalitis.

A 20-year-old girl developed a subacute neurological illness characterized by seizures and epilepsia partialis continua, which resulted in her death within 10 weeks of her first symptom. Although she had a history of unusual reactions to viral infections, there was no evidence of any underlying disorder resulting in immunosuppression. Histopathology demonstrated the presence of dense infection with measles virus. The unusual clinical features of this cases suggest that measles virus may be responsible for a wide spectrum of neurological disease ranging from measles inclusion body encephalitis on the one hand to subacute sclerosing panencephalitis on the other.

Lactate production in McArdle's disease.

A case of McArdle's disease in a man is described in detail and a less complete study of his family is reported. This patient showed the classical features of McArdle's disease and the diagnosis was confirmed by muscle biopsy. Unlike other reported cases of this disorder, this case showed a normal rise in blood lactate levels on ischaemic exercise. This apparently paradoxical finding is discussed. It is suggested that a normal rise in the level of blood lactate on ischaemic exercise should not exclude myophosphorylase deficiency.

Gowers' syringal haemorrhage.

The second case of Gowers' syringal haemorrhage, successfully treated by surgery, and the first such case in a child, is described. It is suggested that the very slow development of haematomyelia within an existing hydrosyringomyelia may originate from a torn intraspinal vein, deprived of its normal neural and glial support.

Myositis in father and daughter.

The occurrence of myositis in a father and his daughter is reported. The daughter's illness resembled childhood dermatomyositis and progressed to systemic involvement and death less than four years from the onset of symptoms. In the case of the father the illness followed the course of adult polymyositis and there was little evidence of systemic involvement. The immunological and genetic significance of the two cases is discussed.

Myophosphorylase deficiency (McArdle's disease) in two interrelated families.

The clinical and laboratory findings are presented of three patients (two affected sisters and their male cousin) with myophosphorylase deficiency in two interrelated families. Nine unaffected relatives were also investigated. Although the three patients demonstrated the characteristic features of the disease, their unaffected relatives showed no clear evidence of a heterozygous state. The genetic findings support the hypothesis that the disease is inherited as a rare autosomal recessive. A possible sex-limited mode of inheritance is discussed.