Characterization of the intermediate filament apparatus in skin fibroblasts from patients with giant axonal neuropathy: effect of trypsin

Skin fibroblasts from two siblings with giant axonal neuropathy (GAN) were examined by both biochemical and immunocytochemical studies. The presence of intermediate filaments (IF) characteristic of these cells was affected by the growth conditions. Immediately after plating and during the following 24 hours the majority of the cells contained an IF "bundle"; however, after 4-6 days in culture only a minority of the cells retained this structure. We present evidence that trypsinization but not serum concentration is likely to influence the formation of the "bundle." The results indicate that the formation of the "bundle" may result from a defective association or relationship between the cytoskeleton and the plasma membrane.

Aperiodic alternating nystagmus: report of two cases and treatment by baclofen

We report two cases of non periodic alternating nystagmus, one of vascular origin (ischemia of the vertebrobasilar territory) and a second of traumatic origin (whiplash injury) with otoneurological signs, typical of lesions in posterior cranial fossa and in particular of vestibulum-cerebellum and brainstem: gaze paretic nystagmus, rebound nystagmus, saccadic dysmetria, vestibular hyperreflexia and impaired visual suppression test. In one case it was possible to give baclofen therapy, which yielded positive results. Suspension of drug administration resulted in the worsening of clinical signs. The mechanism of action of the drug will be discussed.

Exercise-induced bilateral anterior tibial compartment syndrome without pain

We report the case of a 41 year old man who complained of a severe bilateral deficit of the anterior tibial compartment two hours after prolonged exercise. On admission there was no spontaneous or evoked pain, no objective sensory deficit but total loss of dorsiflexion of feet and toes. Electrophysiological investigation showed no voluntary or evoked electrical activity in tibial and extensor digitorum muscles; while peroneus longus and gastrocnemius muscles showed a near-normal pattern. On the other hand a weak motor response was obtained by direct stimulation of the anterior tibial muscle belly. An early bilateral fasciotomy was followed by almost complete recovery of the spontaneous and evoked motor activities of the tibial anterior muscles. On the basis of these findings we discuss the possible pathogenetic role of a neuroapraxic block of the deep peroneal nerve where it crosses the anterior fibular septum and supply a possible interpretation of the absence of pain.

Sensory and motor peripheral neuropathy in olivopontocerebellar atrophy

We report the findings of an electrophysiological study in 9 patients affected by olivopontocerebellar atrophy, 4 with a dominant form and 5 with a sporadic form. Superficial peroneal nerve biopsy was obtained from 2 patients. The electrophysiological alterations were signs of collateral reinnervation and loss of motor units, decrease in sensory potential amplitude and increase in distal motor latency. Only a slight reduction in motor and sensory conduction velocity was observed in some cases. Nerve biopsy showed slight reduction of the number of myelinated fibres. In the first case, fibre diameter distribution was unimodal, due to reduction of myelinated fibres of large diameter, in the second case there was no significant alteration of the fibre distribution. In both cases short internodes were present with no signs of segmental demyelination, remyelination or axonal degeneration. The alterations observed in the peripheral nervous system are probably secondary to a lesion of the posterior root ganglion and the anterior horn cell in the spinal cord.

Atypical phenotype of Refsum's disease: clinical, biochemical, neurophysiological and pathological study

The authors describe the clinical, biochemical, electrophysiological and ultrastructural study of a case of Refsum's disease whose phenotype suggested other hereditary ataxias. Due to the presence of Babinski sign and optic atrophy and the absence of retinitis pigmentosa, this case can be considered atypical. Electrophysiological and ultrastructural findings confirm the variability of peripheral lesions in this hereditary polyneuropathy.

Familial Richner-Hanhart syndrome: genetic, clinical, and metabolic studies

The genetic, clinical, and metabolic studies of two familial cases of Richner-Hanhart syndrome (type II hypertyrosinemia are described and the findings compared with other familial cases of palmo-plantar keratoderma. The clinical pictures are identical except that in the latter there are not ocular symptoms and the tyrosine levels are not raised. One of the two patients examined was treated with a diet low in tyrosine and phenylalanine with immediate improvement in clinical symptomatology and complete disappearance of the dendritic keratitis.

Cervical myelopathy secondary to ossification of the posterior longitudinal ligament (a case report)

A case of ossification of the posterior longitudinal ligament, documented by spinal X-ray, myelography and CT scanning of the spinal cord is reported. The patient underwent decompressive laminectomy by posterior approach, which was successful. The case is discussed in the light of recent published data.

Impairment of human brain development: glycoconjugate and lipid changes in congenital athyroidism

The brain glycoconjugates, glycosidases and lipids have been studied in a case of human congenital athyroidism never treated with hormonal replacement. Increase of membrane-bound mucopolysaccharides has been found in the grey matter. Total lipids in the white matter, and phospholipids, and total glycolipids and cholesterol in both white and grey matter were reduced. Sialic acid (NeuNAc) and hexosamines in the cytosol grey matter were significantly raised, while they were reduced in the membrane-bound grey fraction. These biochemical findings confirm impairment of the myelination process in human hypothyroidism as is well established in experimental hypothyroidism. The significant changes in the carbohydrate moieties of the brain glycoproteins focus attention on complex alterations of structure and function of the cell plasma membranes.

Anderson-Fabry's disease: neuropathological and neurochemical investigation

A clinical, neuropathological and neurochemical study of a case of Anderson-Fabry's disease is described. The clinical course mainly consisted of repeated ictus with major involvement of the CNS. The neuropathological examination is dominated by severe alterations in the cerebral vessels due to glycolipid deposits on the walls, with reduction or occlusion of the lumen. This is correlated with secondary ischaemic foci scattered throughout the cortex as well as through the white matter. In addition, the cells of the cerebral cortex, thalamus, basal ganglia, amygdala, cerebellar and olivary nuclei show a marked accumulation of lipofuscin. Biochemical examination reveals a threefold increase in galactolipids due to the specific alpha-galactosidase deficiency. Cholesterol is reduced secondarily to ischaemic myelin damage. Glycosaminoglycans uronic acid is increased in cytosol and membrane-bound fractions which could be related to reactive gliosis. Glycoprotein sugars show a decrease in N-acetyl-neuraminic acid and fucose as well as an increase in hexosamines and hexoses in membrane-bound fraction, while in cytosol fraction all sugars are increased. This suggests that the alpha-galactosidase deficiency can alter not only the glycolipid but also the glycoprotein metabolism, resulting in a higher presence of hexosamines and hexoses-rich glycoproteins.

Familial lead poisoning from contaminated wine

Three members of a family were found be suffering from lead poisoning of nonindustrial origin, the causative agent being the home-produced wine left to ferment in a glazed earthenware vat. The clinical and neurophysiological features are discussed in the light of similar cases in the literature. Correct diagnosis and early treatment of nonindustrial lead polyneuropathy are often extremely difficult because of the elusive nature of the exposure.

Sanfilippo B syndrome (MPS III B): case report with analysis of CSF mucopolysaccharides and conjunctival biopsy

A case of a child with Sanfilippo B syndrome (MPS III B), born of a consanguineous marriage, is reported. Urinary mucopolysaccharide analysis showed an abnormal excretion mainly of heparan sulphate. N-acetyl-a-glucosaminidase activity was absent in the patient but was present in the heterozygous range in parents and siblings. CSF mucopolysaccharides were also abnormally high. In fibrocytes from conjunctival biopsy and CSF cells numerous vacuoles containing storage material were found. The presence of vacuoles in fibrocytes from conjunctival biopsy and/or in CSF cells can be useful in the diagnosis of many suspected lysosomal storage disorders.

Brain glycosidases in Creutzfeldt-Jakob disease

Several glycosidase activities were measured in frontal gray matter of 4 brains from subjects affected by Creutzfeldt-Jakob disease. The changes of N-acetyl-beta-glucosaminidase, N-acetyl-beta-galactosaminidase, beta-glucosidase, alpha-fucosidase and alpha-mannosidase were not statistically significant but significant increases of beta-glucuronidase and beta-galactosidase activities were found. These results are in accordance with several reports on brain glycosidases in scrapie and Semliki Forest virus-infected brain and could explain some changes in brain glycoconjugate content previously observed in human and experimental Creutzfeldt-Jakob disease.

Macular cherry-red spot and myoclonus syndrome. Juvenile form of sialidosis

Macular cherry-red spot, myoclonus and progressive mental deterioration are described in a man of 16 years. Morphological examination of the liver, bone marrow and fibroblasts showed numerous vacuoles containing storage material in the cytoplasm of the cells. Twelve different oligosaccharides were isolated from urine and their structures were determined. All have N-acetylglucosamine in a reducing end and (2--3) and 2--6) neuraminic acid in the terminal position. This abnormal urinary oligosaccharide excretion is due to absence of (2--6) neuraminidase which was not detected in fibroblast culture. This case is discussed in relationship to other cases with macular cherry-red spot, myoclonus and oligosaccharide urinary excretion.

Neurochemical changes in Creutzfeldt-Jakob disease

A biochemical study of a case affected by Creutzfeldt-Jakob disease is reported. Changes were found in soluble and insoluble proteins, glycoproteins and mucopolysaccharides and in total lipids, glycolipids, phospholipids and gangliosides. Also CNPase, choline acetyltransferase, 5'-nucleotidase and several glycosidases have an altered activity. All these data give a complete neurochemical pattern of the changes underlying the morphological and functional alterations in this disease.

Behçet's disease: an unusual case with bilateral obliterating retinal panarteritis and ischemic optic atrophy

Report of an unusual case of Behçet's disease with bilateral obliterating retinal panarteritis and ischemic optic atrophy. The rarity of the primary optic nerve involvement and chiefly the exceptional full acute bilateral occlusion of the retinal arteries are emphasized. This ophthalmoscopic picture is further clinical evidence for the major importance of the vascular involvement in the pathogenesis of Behçet's disease.

Urinary glycosaminoglycans in patients with progressive myoclonus epilepsy

Urinary GAGs analysis in Progressive Myoclonus Epilepsy (PME) showed an accumulation of uronic acid in the fraction eluted by 1 M NaCl and 3 M NaCl. As analogous changes were found in other myoclonic and epileptic patients receiving large doses of anticonvulsant drugs, these alterations in the GAG urinary pattern were not considered a primary disturbance of PME.

Glycosaminoglycans and glycoproteins in metachromatic leucodystrophy

A study is reported of the brain glycoproteins and the glycosaminoglycans in a case of infantile metachromatic leucodystrophy, associated with a ponto-cerebellar systemic atrophy, verified by autopsy. The glycosaminoglycan concentrations in the grey matter were within the normal range, while in the white matter they were slightly increased. The glycopeptides from the soluble and insoluble glycoproteins of white matter were altered not only in their quantity but also in their composition. In the grey matter a decrease of all sugars except the NaNa was detected in the insoluble fraction while in the soluble no change was detected, except for a threefold increase of fucose. The relationship was discussed of soluble to insoluble glycoproteins, and a mechanism for their derangement in MLD was suggested.

[Cerebrospinal fluid immunoglobulins and neurological diseases]

Then is reported a new inexpensive and easy method to analyse the CSF concentration of immunoglobulins in some neurologic disease (in particular in the multiple sclerosis). The obtained data were in according with similar results of other Author, which used more sophisticated techniques. The increase of IgG in multiple sclerosis (72,7%) suggested us to consider this analysis now very useful for a correct diagnosis. The reason of CSF IgG increase in multiple sclerosis is discussed.

[Multiple sclerosis. Etiopathogenetic review]

This is a synthetic report about multiple sclerosis: there is described the neuropathology (by optic and electronic microscopy) of this disease, the changes in the protein metabolism, above all in basic protein content, in lipids, in enzymes of the plaques and of the apparently normal white and gray matter. There are afterwords described the relationship between viruses and multiple sclerosis, the probable action mechanism of the virus-determined demyelination, and the changes of the immunitary system (increase of gamma-globulins, serum myelotoxicity, lymphocitary changes).

[Oculopharyngeal myopathy. Histochemical observation of the muscles and concentration of immunoglobulins in the serum of an Italian family]

We reported the first Italian family with oculopharyngeal myopathy. Five of six brothers, aged 60 to 76, showed to a different degree ptosis of the eyelids, ophtalmoparesis, hypomimic face, troubles in chewing, swallowing and speaking, some wiggling gait, and a widespread, mainly proximal, muscular hypotrophy and weakness. Characteristic of this disease are its hereditary transmission of dominant autosomic type, its late appearance also after 50 years of age and its slow progression without periods of improvement. Electromyography, histologic and histochemical study of extra-ocular muscles were performed in two patients and showed clear changes of myopathic type. Besides, we found in 3 patients increased serum immunoglobulins, chiefly IgG, as first Russe, Busey and Barbeau demonstrated in a large French-Canadian family.