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We investigated the relationship of neurologic, neuropsychological, and social interaction impairments to the work status of a large sample of penetrating head-injured patients wounded some 15 years earlier during combat in Vietnam. Extensive standardized testing of neurologic, neuropsychological, and social functioning was done at follow-up on each head-injured patient (N = 520), as well as on a sample of uninjured controls (N = 85). Fifty-six percent of the head-injured patients were working at follow-up compared with 82% of the uninjured controls. Seven systematically defined impairments proved to be most correlated with work status. These were post-traumatic epilepsy, paresis, visual field loss, verbal memory loss, visual memory loss, psychological problems, and violent behavior. These disabilities had a cumulative and nearly equipotent effect upon the likelihood of work. We suggest that a simple summed score of the number of these seven disabilities can yield a residual "disability score" which may prove to be a practical tool for assessing the likelihood of return to work for patients in this population and perhaps in other brain-injured populations. These findings may also help to focus rehabilitation efforts on those disabilities most likely to affect return to work.
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PMID:Residual impairments and work status 15 years after penetrating head injury: report from the Vietnam Head Injury Study. 842 17

The authors present 27 cases of cerebral hydatid cyst (CHCy) treated between 1980 and 1992. These cases of CHCy represent 2.8% of all cases of expansive nontraumatic lesions in children. Most of the patients were between 6 and 10 years of age. There was a substantial prevalence of male patients-18 cases (66.6%). Most of the children with CHCy were from rural areas. The cysts were all located in the cerebral hemispheres (none in the posterior fossa). Usually two or three lobes were affected and the cysts were most often retrorolandic. Only 8 patients (29.6%) also had pulmonary or hepatic infestation. All patients were operated on immediately the diagnosis was established. Operative mortality was very low (1 patient died immediately after surgery). There have been 11 cases of recurrence; all these patients have been reoperated on. Neurological sequelae were mainly partial and general seizures. Epilepsy developed postoperatively in five patients. Paresis, which usually disappears in time, was the most common motor disturbance. Two other important postoperative complications were subdural effusion and ventricular dilatation (six cases). There have been five cases of multiple recurrences (four of these patients have since died). Treatment with albendazole was used in three cases without significant results.
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PMID:Cerebral hydatid cyst in children. Experience of 27 cases. 875 Sep 49

The therapeutical results such as recoveries or substantial improvements obtained by neurovascular decompressive functional morpho-corrective rhino-skull base surgery on 2124 cases of primary headaches (migraine with aura, migraine without aura, cluster headache, chronic paroxysmal hemicrania, tension-type headache) obliges a thorough review of the classical chapter on "rhinogenous headaches" (Bonaccorsi, Novak, Blondiau, Bisschop, Hoover, Clerico). In fact all those headaches seemingly "primary", but having a "central-peripheral" etiopathogenesis proved by a well documented (CT) volumetric reduction of "ethmoidosphenoidal subcribriform chamber" according to hemoangiokinetics purposes of endo-exocranial anastomotic circulation of this area, should be included in the chapter of "rhinogenous headaches". This endo-exocranial anastomotic circulation is considered a "functional unit" owing to the continuity of rhino-ophthalmic-encephalic trigeminal-vegetative and vascular circuits (Hannerz, Hardebo, Moskowitz). These morphological abnormalities of the rhino-skull base osteo-vascular-mucous structures acquire physio-pathological significance only in patients with "low pain threshold and elevated central integrative capability", modulated and timed by the neurogenic biorhythms. It is described the surgery of rhino-skull base by "neurovascular decompressive septo-ethmoidosphenoidectomy" procedure, either conservative or radical till the III grade monolateral with trigeminal and vegetative selective neurotomy that permits to save olfaction and to remove even the controlateral pain decompressing the circulation and eliminating stasis even on the opposite side. Further, it is emphasized that the neurological deficit or central irritative symptomatology (visual aura, sensory-motor paresis, epilepsy) disappears after surgical removal of the "peripheral rhinogenous trigger". It demonstrates a cause and effect relationship that is the central peripheral functional interdependence, even if it's included in the neuro-transmissive, biochemical, neuro-endocrine, constitutional background which is controlled by the psychical, vegetative and dysnociceptive biorhythms.
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PMID:[Decompressive neurovascular nose and skull-base surgery in primary headache with a rhinogenic trigger]. 875 Nov 91

At least three types of ictal atomic phenomena can be seen in partial seizures. Focal atomic seizures are partial seizures with ictal paresis or paralysis of one or more body parts preceding or independent of any convulsive activity. A diagnosis may be difficult without simultaneous EEG recording supplemented by video monitoring or polygraphy. Epileptic negative myoclonus manifests as brief lapses in tone in one or more muscle groups that interferes with motor coordination and postural control. Drop attacks can also occur in partial seizures, as have been well documented in patients with temporal or frontal lobe epilepsy. Different mechanisms may underlie these three phenomena. Focal atonic seizures probably result from relatively circumscribed seizure activity in one or more cortical areas that contribute to the elaboration and execution of motor functions. Whether this represents inactivation or interference in motor integration, or activation of inhibitory system, remains unresolved. The pathophysiology of epileptic negative myoclonus, like that of its positive counterpart, is probably to be found at a more local level, possibly from transiently enhanced local inhibition in the motor cortex. Drop attacks in partial seizures may be close in mechanism to that also seen in generalized seizures, possibly related to ictal activation of descending inhibitory pathways in the brainstem.
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PMID:Atonic phenomena and partial seizures. A reappraisal. 884 76

The atypical clinical course of a young male with encephalopathy due to right hemispheric cortical dysplasia (pachygiria) is described. From the first months of life the course of the disease was a static encephalopathy with left hemiparesis, epilepsy and mild mental retardation. When he was 14 years old a subacute pseudobulbar palsy, dystonia and spread of the paresis to the right side occurred. Epileptic seizures, paroxysmal EEG abnormalities and drug ingestion were excluded. Neuropsychological studies showed a low level of cognitive functions, probably related to the malformative encephalopathy and expressive language deficit due to the pseudobulbar paresis. We speculate that this case could be an atypical case of delayed onset dyskiesia.
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PMID:[Late onset of pseudobulbar paralysis and dystonia in a case of hemispheric cortical dysplasia]. 924 18

Arachnoid cysts in the middle cranial fossa usually present with skull deformity, intracranial hypertension, epilepsy, focal symptoms and delayed mental development. Some cases, however, have neither symptoms nor signs. We have encountered a patient with an arachnoid cyst of the middle cranial fossa with extraocular muscle paresis and who was treated with cyst wall fenestration with good results. An 11-year-old boy presenting with double vision was diagnosed as having an arachnoid cyst in the middle cranial fossa with extraocular muscle paresis. He had no signs of increased intracranial pressure. This patient underwent a cyst membranectomy. Postoperatively this symptom rapidly subsided. Double vision disappeared two months postoperatively. To our knowledge, if those cases associated with increased intracranial pressure signs are excluded, this is the first case reported so far of a middle cranial fossa arachnoid cyst with extraocular muscle paresis. This report illustrates that extraocular muscle paresis can be caused by an arachnoid cyst in the middle cranial fossa and that knowledge of this could be helpful in its early diagnosis and treatment.
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PMID:[Arachnoid cyst of the middle cranial fossa with extraocular muscle paresis: case report]. 926 65

In a family with two sets of dizygotic twins, three, possibly all four, siblings were affected by the same disorder. The parents were unrelated and the illness seemed limited to one generation. Onset was in the early to mid-20s with tics and choreiform movements, dysarthria, and dysphagia. Two twins had epilepsy. There was a marked dyscoordination of bulbar musculature reminiscent of pseudobulbar paresis. Involuntary movements were prominent during the first years, but then disappeared and were replaced by an akinetic-rigid parkinsonian appearance in the late stage. The intellect remained largely intact. Tendon reflexes were reduced. Varying degrees of peripheral nerve changes were seen. Two patients died after 22-24 years from causes indirectly related to the main illness. Marked degenerative changes were found in the caudate nucleus and putamen. Acanthocytes in significant numbers could not be detected in peripheral blood. Lipoproteinelectrophoresis was normal. Creatine kinase levels were moderately raised in one patient, normal in the others. Although certain clinical resemblances exist with neuroacanthocytosis, the exact nosologic status of the disorder has not been determined.
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PMID:Progressive pseudobulbar paresis, early choreiform movements, and later rigidity: appearance in two sets of dizygotic twins in the same family. 961 54

Insular epilepsy has been rarely reported and its clinical and electrographic features are poorly understood. The electrographic study of the insula is difficult since it is hidden from the brain surface by the frontal and temporal lobe. A 48 years-old woman started having simple partial autonomic and complex partial seizures with automatisms and ictal left arm paresis 8 years prior to admission. Seizure's frequency was 1 per week. Pre-operative EEG showed a right temporal lobe focus. Neuropsychological testing disclosed right fronto-temporal dysfunction. MRI showed a right anterior insular cavernous angioma. Intraoperative ECoG obtained after splitting of the sylvian fissure showed independent spiking from the insula and temporal lobe and insular spikes that spread to the temporal lobe. The cavernous angioma and the surrounding gliotic tissue were removed and the temporal lobe was left in place. Post-resection ECoG still disclosed independent temporal and insular spiking with a lower frequency. The patient has been seizure-free since surgery. Insular epilepsy may share many clinical and electroencephalographic features with temporal lobe epilepsy.
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PMID:Insular epilepsy. Similarities to temporal lobe epilepsy. Case report. 968 34

The study included 22 patients with poststroke epilepsy (group 1) and 30 patients with stroke without epilepsy (group 2). A bilateral decrease of the time of central conduction (TCC) through pyramidal path (both on the paretic and intact side) was revealed in group 1. This was not observed in patients of group 2 with similar gravity of motor disorders (p < 0.01). Tendency to TCC decrease was also observed in patients without epileptic disorders by day 5-6 after ischemic stroke. However, TCC values were increased in such patients by day 10-14. Low indices persisted for a long time in patients with poststroke. There was also an increase of delta index of facilitation (the difference between TCC in rest and in muscle effort). It was also found that motor disorders in the group of patients with poststroke epilepsy were characterised by higher muscular tone than in poststroke patients with the same degree of the paresis.
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PMID:[Clinical neuropsychological aspects of motor disorders in patients with post-CVA epilepsy]. 972 69

Spasticity, mental retardation, macrocephaly and distinct craniofacial appearance: confirmation of a new subtype of complicated spastic paraplegia?: In this report, we describe a 30-year-old female with mental retardation, spastic paresis, epilepsy, macrocephaly and distinct craniofacial appearance. Probably, she suffers from the same condition as the two sibs described by Fryns et al., in 1994 (2).
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PMID:Spasticity, mental retardation, macrocephaly and distinct craniofacial appearance: confirmation of a new subtype of complicated spastic paraplegia? 977 44


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