Positron emission tomography in vascular dementia.

BACKGROUND: Vascular dementia (VaD) is an ill-defined entity. It is not known how acute brain failure related to stroke becomes chronic leading to dementia. PURPOSE: The present study investigates whether positron emission tomography (PET) can detect different metabolic patterns in VaD. PATIENTS AND METHODS: Four groups of stroke patients were selected. The PET findings of 14 stroke patients with multiple large infarcts and dementia (MID) and 14 without dementia (MS) were compared. Sixteen stroke patients with lacunes, leukoaraiosis and dementia (LD) were assessed against nine without dementia (LS). The PET examination utilised the 15-O-steady-state technique in order to determine regional cerebral blood flow (rCBF), regional oxygen extraction rate (rOER) and regional cerebral metabolic rate for oxygen (rCMRO2) in different pre-established cortical, subcortical and cerebellar regions. RESULTS: Decreased coupled mean rCBF and rCMRO2 with comparable rOER values were observed in all cerebral regions except in the cerebellum of the MID compared to the MS group. In the LD group mean rCBF and rCMRO2 were decreased with increased rOER in all cerebral regions except in the cerebellum compared to the LS group. CONCLUSIONS: The PET findings in demented patients with multiple large infarcts are in agreement with the concept of multi-infarct dementia. In demented patients with lacunes and leukoaraiosis, the PET pattern suggests a state of misery perfusion not only in the deep structures but also in the whole cerebral cortex. The present PET study argues that there are at least two possible mechanisms that can explain the occurrence of VaD in stroke patients.

Invasion of a subcutaneous Aspergillus abscess into the brain.

We present the case of a 57 year old woman with contiguous infection by Aspergillus fumigatus. The lesion started subcutaneously, forming an abscess. Seventeen days later we observed an intracranial abscess, infection of the frontal sinus and destruction of the frontal bone between the subcutaneous abscess and the sinus.

Candida parapsilosis vertebral osteomyelitis.

A case of culture verified Candida parapsilosis lumbar spondylodiscitis, with infectious involvement of an aortic prosthetic graft, presented with a lumbar radicular pain syndrome. Only 33 Candida infections of the spine are described in the literature. Candida parapsilosis was cultured in three cases. Considering the poor general condition of the patient, a conservative treatment with bedrest, casting and amphotericin B, hydrocortisone and itraconazol was given. The patient died 28 months after onset from intercurrent pneumonia.

Higher prevalence of atrial septal aneurysms in patients with ischemic stroke of unknown cause.

Atrial septal aneurysms (ASA) are frequent findings on transesophageal echocardiographies. Whether they are more frequent in patients with cerebral ischemia of unknown cause remains unclear. We investigated this question in 154 consecutive patients with an ischemic stroke or transient ischemic attack. The 16 patients with ASA were younger, less likely to have arterial hypertension and more likely to have a patent foramen ovale (PFO) or an unknown cause of stroke, but they did not differ for number and side of infarcts, other demographic data and vascular risk factors. Patients with ASA unassociated to PFO were also more likely to have an unknown cause of stroke. These findings lead to the hypothesis that ASA might be sources of cerebral emboli.

Borderzone infarct subtypes: preliminary study of the presumed mechanism.

Whether watershed infarcts and internal junctional infarcts have different mechanisms remains unknown. Of 493 consecutive patients with ischemic stroke or transient ischemic attack, 26 had 1 watershed infarct or more (8 anterior and 21 posterior) and 18 had 1 internal junctional infarct or more. Patients with watershed infarcts were more likely to have arterial hypertension [95% confidence intervals of odds ratio (CIOR): 1.04-6.15] and internal carotid artery stenosis > 50% (95% CIOR: 1.03-7.12) than patients without borderzone infarcts. Patients with internal junctional infarcts were more likely to have heart diseases than patients without borderzone infarcts (95% CIOR: 1.46-10.52). This preliminary study suggests that both subtypes of borderzone infarcts probably have different mechanisms.

Intrathoracic meningocele.

We present the case of a 63-year-old woman and review the literature. The incidence of intrathoracic meningocele is rare, even in known cases of Von Recklinghausen's neurofibromatosis. Cases of isolated intrathoracic meningocele or multiple meningoceles without neurofibromatosis are even more uncommon. The majority of intrathoracic meningoceles have been discovered by chance or after nonspecific symptoms. Although diagnosis by CT scan and MRI has been documented, we are convinced that myelography is still of great value. There is no agreement about the etiology of intrathoracic meningocele. Treatment is also discussed.

Altitudinal hemianopia; a clinical and anatomical entity or a mere coincidence? Case report and review of literature.

Many lesions along the visual pathway from the retina to the occipital cortex can cause a horizontal hemianopia. The anatomy of the visual pathway is reviewed in an attempt to clarify how and where this visual field defect develops. A case is presented in which two ischemic occipital infarcts caused a bilateral inferior horizontal hemianopia and complex visual hallucinations. Previous cases of occipital lesions resulting in an altitudinal hemianopia are reviewed.

Explosion of the orbital roof due to electrical current.

Prolonged contact with high voltage electricity can cause severe damage to the brain. Contact with the skull can produce heating of the brain and the cerebrospinal fluid, which may result in an explosion of the orbital roofs with downward displacement of the brain into both orbits.

Thrombosis of a giant aneurysm of the basilar artery.

Thrombosis of a giant aneurysm of the basilar artery appears on computed tomographic scan as a well-delineated, prepontine, hyperdense mass.

Acid maltase deficiency in adults. A study of five cases.

Five adult patients with the myopathic form of acid maltase deficiency are described. In three, the clinical onset dates back from youth with progressive proximal weakness while in the other two, the first symptoms occur after the age of 20 years. Respiratory insufficiency is a direct cause of death in one young adult male and plays an accessory role in the death of an older female patient with an interauricular septal defect. A unilateral diaphragm paralysis is noted in a third patient. A vacuolar myopathy is easily detected in the young adult patients but minimal or moderate lesions are encountered in other muscles or in the older patients. Electron microscopy of muscle and skin biopsies and the assay of acid maltase on muscle completed by the action of antibodies directed against acid maltase represent much more reliable criteria which will confirm the diagnosis. Therefore, when dealing with the heterogeneous group of limb-girdle myopathies, it is necessary to use all adequate diagnostic methods in order to avoid false negative results. The importance of making a correct diagnosis stems from the fact that the respiratory insufficiency should be recognized in order to try to avoid severe complications.

Locked-in syndrome with bilateral ptosis: combination of bilateral horizontal pontine gaze paralysis and nuclear oculomotor nerve paralysis.

A patient with a classical locked-in syndrome is described, in whom bilateral ptosis was observed on the 2nd day. On the 4th day, ophthalmoplegia was complete with the exception of a voluntary downward movement of the right eye. The syndrome can be explained by the association of bilateral horizontal pontine gaze palsy and a unilateral nuclear oculomotor nerve palsy, and approximates the "total locked-in syndrome".

Linear cutaneous lesions and neurological deficit. A case report.

A patient with subdural hygroma in the perinatal period developed into a right hand sided spastic hemiplegia with epileptic seizures and intellectual deficit. On the age of 17 years a linear dermatosis that proved to be a naevus unislateris was remarked. The combination of linear nevi and neurological deficit is known as the epidermal nevus syndrome.

[The EEG in hypercalcemia]. / Das Elektroenzephalogramm bei Hyperkalzämie.

When a patient with hypercalcemia presents symptoms of encephalopathy, then also the EEG shows some abnormal characteristics; triphasic waves are mentioned. Both the clinical and electroencephalographical disturbances are grave, nevertheless they are specific. As well the clinical as the electroencephalographic symptoms have a tendency to disappear when the calcemia bends to normal values; there exists a certain latency. The reason for hypercalcemia usually cannot be properly cured, so an encephalopathy due to hypercalcemia mostly includes bad prognosis.

[The serial CSF lactate and pyruvate levels as a guide to prognosis after severe head injury (author's transl)]. / La détermination du lactate et du pyruvate dans le LCR comme moyen de pronostic en cas de traumatismes cranio-cérébraux graves.

We have studied the lactate-level in the CSF of 40 patients with a severe head injury. After a first group of 20 patients we concluded that those levels were usefull for predicting the outcome of those patients. After receiving new informations about the normal metabolism of lactate in the CSF of man and animals, we became more suspicious. Therefore we have studied a new group of 20 patients. The levels of lactate, pyruvate, pH, pC02 and p02 were checked both in the CSF and in the blood for a longer period. An own coma-scale was used. The results are discussed.

Intracranial fibromuscular dysplasia and stroke in children.

Fibromuscular dysplasia (FMD) is an arterial lesion of unknown origin which may sometimes affect intracranial arteries. In recent years a few rare cases, mostly involving younger people, have been described. The present case concerns a child of 8 years in whom the finding of hemiplegia led to a diagnosis of intracranial fibrodysplasia which was proven by arteriography and biopsy. This arterial lesion is described within the context of stroke in children.