Lateralizing significance of head and eye deviation in secondary generalized tonic-clonic seizures.

We studied 92 secondary generalized tonic-clonic seizures (SGTCS) in 29 patients with a clearly lateralized seizure focus using video-EEG telemetry. An examiner, blind to the EEG, reviewed direction and type (forced versus nonforced) of head/eye deviation (HD). Forced HD consisted of sustained, unnatural tonic or clonic movements. Nonforced HD consisted of sustained deviations that were neither tonic nor clonic and were similar to volitional head movements. Eighty-three of the 92 SGTCS (26 of 29 patients) had lateralized and sustained HD. The direction of HD was contralateral in over 90% of seizures when the movement either (1) continued as the seizure generalized, or (2) occurred in the 10 seconds prior to generalization. The direction of HD was ipsilateral in over 90% of seizures if the movement ended before the seizure began to generalize (in all cases, the movement ended more than 10 seconds before generalization). HD occurring within the first 10 seconds after seizure onset was not of lateralizing significance. Forced HD was 89% contralateral, while nonforced HD was not of lateralizing significance. HD in SGTCS provides information on seizure focus lateralization.

Tethered hindbrain. Case report.

The authors present the case of an 11-year-old boy with symptomatic tethering of the hindbrain related to a Chiari Type III malformation repaired at birth. Surgical release of the cord resulted in functional improvement.

Neodymium:YAG laser posterior capsulotomies performed by residents at a Veterans Administration Hospital.

PURPOSE: To assess the initial efficacy of neodymium:YAG (Nd:YAG) laser posterior capsulotomies performed by residents at a teaching institution and to evaluate the associated complications over an extended follow-up. SETTING: Department of Ophthalmology, Edward Hines, Jr. Veterans Administration Hospital, Hines, Illinois, USA. METHODS: This retrospective noncomparative case review comprised 212 pseudophakic eyes having Nd:YAG laser posterior capsulotomies from April 1992 through March 1995. Evaluated were postoperative changes in best corrected visual acuity (BCVA), intraocular pressure (IOP) elevations, and complications related to the procedure. RESULTS: In all 212 eyes, Snellen visual acuity was obtained at least 1 week after the capsulotomy. The BCVA in 96 eyes (45.3%) improved by 3 or more lines, in 43 (20.3%) by 2 lines, and in 51 (24.1%) by 1 line. Nineteen eyes (9.0%) did not improve by 1 or more lines, and 3 eyes (1.4%) had decreased Snellen acuity. All but 4 eyes with less than 1 line of improvement had underlying ocular pathology or a previous incomplete capsulotomy. For evaluation of postoperative complications, long-term follow-up was available for 133 of 212 eyes (62.7%). The mean follow-up for this group was 3.18 years. Postoperative complications were found in 14 of these eyes (10.5%). Nine (6.8%) had a rise in IOP greater than 10 mm Hg after the capsulotomy. One eye (0.8%) developed a persistent iritis, 2 (1.5%) had vitreous prolapse into the anterior chamber, and 2 (1.5%) developed rhegmatogenous retinal detachments. CONCLUSION: Postoperative Snellen acuity results and complication rates compare favorably with those in previous studies. The results indicate that Nd:YAG laser posterior capsulotomies performed by residents with attending supervision are safe, effective, and carry a low associated complication rate over a long follow-up.

Recurrent nocardial brain abscesses treated by repeated stereotactic aspirations.

A case of a 61-year-old diabetic patient who had a new onset simple partial seizure is presented. Past medical history was remarkable for pulmonary sarcoidosis for which the patient was on chronic steroid therapy. Computed tomography scan demonstrated a postcentral abscess which was aspirated under stereotactic guidance. Nocardia asteroides was identified. The patient was placed on intravenous trimethoprim and sulfamethoxazole. He required two further stereotactic aspirations of recrudescences until symptoms resolved. The use of repeated stereotactic aspiration in place of an open surgical procedure is advocated for the treatment of nocardial abscesses.

Strategies for object identification and confidence: influence of appearance, amount of context, and familiarity.

In an experimental study of the everyday, what-is-this? perceptual encounter, the strategies subjects used to identify a focal object were influenced by the object's physical appearance, the amount of context in which it was displayed, and subjects' familiarity with the object. These factors also affected subjects' confidence in the accuracy of their identifications. The results appear to support the contention that visual processing is a middle-out rather than either a top-down or bottom-up sequence.

Social character of materialism.

Scores for 170 undergraduates on Richins and Dawson's Materialism scale were correlated with scores on Kassarjian's Social Preference Scale, designed to measure individuals' character structure. A correlation of .26 between materialism and other-directed social character suggested that an externally oriented reference system guides materialists' perceptions, judgments, acquisitions, and possessions.

Memory structure in the processing of advertising messages: how is unusual information represented?

Two models of memory structure--schema-copy-plus-tag (Graesser & Nakamura, 1982; Schmidt & Sherman, 1984) and associative-network/depth-of-processing (Craik & Lockhart, 1972; Hastie & Kumar, 1979)--were tested in a 2 x 2 between-subjects design. Type of argument (typical vs. atypical) and measurement interval (immediate vs. 2-day delay in recognition and recall) were manipulated in a print-advertising context. Results indicated that atypical arguments (unusual information) prompt deeper processing of the entire message (implying an associative-network memory structure) rather than some part of the message (as would be hypothesized by the schema-copy-plus-tag formulation) and that this effect prevails under both immediate- and delayed-measurement conditions.

Malignant non-Hodgkin's lymphoma of the cranial vault: a case report.

We present the case of a 19-year-old patient who was admitted with a subcutaneous scalp lump associated with bilateral papilloedema. CT demonstrated a large heterogeneous vault lesion destroying the right parietal bone. The mass was hyperdense and enhanced slightly with contrast. An important intracranial epidural extension was also demonstrated. The mass was completely removed through a parietal craniectomy and histological examination was characteristic for a B-cell non-Hodgkin's lymphoma. Staging revealed other bony lesions and neoplastic cells were also found in the CSF. Systemic and intrathecal chemotherapy were administered. This report discusses both the clinical differential diagnosis of scalp masses and the radiological diagnosis of skull lesions.

Aggressive behavior following exposure to cholinesterase inhibitors.

The authors report four instances of significant, essentially unprovoked aggressive behavior, including two homicides, following exposure to cholinesterase inhibitors. No subject had a history of violent behavior, antisocial personality, or major psychiatric or neurologic disorder. After anticholinesterase exposure ceased, all showed sincere remorse for their actions, and none has since engaged in aggressive or psychopathologic behavior. Well-controlled experimentation in animals suggests that enhanced activation of hypothalamic cholinergic receptors may underlie aggressive behavior in humans exposed to cholinesterase inhibitors. A relationship between cholinesterase inhibitors and aggression has important implications for public health, raising the possibility of unappreciated neurotoxic influences on behavior.

Spontaneous involution of a diencephalic astrocytoma.

We present the case of a child with a symptomatic diencephalic astrocytoma which involuted after needle biopsy without any adjuvant therapy. A tendency for certain childhood astrocytomas to regress after partial resection has been previously suggested. However, some authors have doubted whether or not such regression actually occurs. Our case radiographically documents the spontaneous involution of a low-grade astrocytoma.

Shaveless brain surgery: safe, well tolerated, and cost effective.

Neurosurgeons perform operations every day, many of which involve the scalp. There is evidence supporting similar or decreased wound infection rates in the unshaven scalp. Patients with standard scalp incisions were assigned to either shave or shaveless preparations (n = 20). The timing of preparation and skin closure was recorded for both groups as were infectious complications. All of the patients have been followed for an average of 10 months. There were no cases of infection. The timing of scalp preparation and closure was not significantly different between the two groups (P < .05). We have previously suggested that shaving the scalp is not a critical step in the prevention of infection. We confirm that the timing of this technique is not prolonged over that of standard preparations.