The spectrum of Jansky-Bielschowsky disease

A series of five patients with a variant type of Jansky-Bielschowsky disease is presented. The disease initiated between four and a half and seven years with mental and slight motor symptoms. The additional neurological symptoms and signs, i.e. visual failure, retinal degeneration, ataxia, myclonia and epilepsy developed in all children before the age of ten years. The present series differs from our previous series of 16 cases especially in regard of neurophysiological findings (photic spikes, high visual evoked potential, VEP and high somatosensory evoked potential, SEP). VEP became abnormally high between 8.0 and 9.5 years instead of being an early finding as in the previous series. Photic spikes appeared also later in the present series. Electromicroscopic investigation revealed cytosomes with fingerprint profiles (FP) in the autonomic ganglion cells and cytosomes with both FP and curvilinear (CP) profiles in many extraneural cells including smooth muscle, Schwann cells, capillary endothelium and macrophages. In the light of our 21 Finnish patients and the literature, the spectrum of Jansky-Bielschowsky disease seems to be much wider than previously assumed. The diagnosis should be based on clinical, ophthalmological, neurophysiological and ultrastructural findings. Repeated neurophysiological studies may be necessary.

Single-photon emission computed tomography of brain perfusion: analysis of 60 paediatric cases

Sixty-nine brain perfusion single-photon emission computed tomography (SPECT) scans were performed on 60 paediatric patients with various neurological diagnoses. SPECT was abnormal more frequently in degenerative brain diseases (82 per cent), than in epilepsy (63 per cent), encephalitis (62 per cent), cerebrovascular disease (43 per cent), or other brain disorders (43 per cent). SPECT was more sensitive than EEG, CT and MRI results. SPECT was of considerable value for diagnosis in many cases. It was a decisive aid in two cases, but misleading in another two, so SPECT must be related to findings obtained by clinical and other laboratory methods.

Brain perfusion defect size in SPECT predicts outcome in cerebral infarction

The results of previous reports on the usefulness of brain perfusion single photon emission computed tomography (SPECT) in predicting the outcome of patients with acute cerebral infarction are conflicting. We therefore studied brain perfusion in 64 patients with a single supratentorial infarction. Contradictory to previous results the perfusion defect volume estimated from transversal and coronal slices correlated significantly with both presenting clinical findings and outcome. Although the clinical status at admission also correlated well with outcome, there was a subgroup of patients in which the favourable outcome was predicted only by SPECT and not by physical or any other examination at admission.

Nephropathia epidemica encephalitis

A case of serologically proven Nephropathia epidemica (NE) with encephalitis is described. Follow up of serum and CSF antibody titres demonstrated NE virus antibody production in the CNS concomitantly with clinical encephalitis. Decrease of initially high CSF antibody titres was followed by a simultaneous increase of serum antibody titres corresponding to the clinical picture shifting from encephalitis to nephritis. This suggests that the first replication of NE virus may undertake in the CNS.

Diagnosis of acute herpes simplex encephalitis by brain perfusion single photon emission computed tomography

Brain perfusion was studied in 14 patients with acute encephalitis by use of 123I-iodoamphetamine or 99mTc-hexamethylpropyleneamine oxime and single photon emission computed tomography (SPECT), the first examination being made 4-11 days after onset of encephalitis symptoms. All 6 patients with herpes simplex virus encephalitis (HSVE) had strongly increased accumulation of radiotracer in the affected temporal lobe; in the remaining 8 results were normal. At the time of the first SPECT conventional CT images were normal in all patients. The SPECT abnormality in HSVE gradually converted over 4-10 weeks from increased tracer accumulation to greatly subnormal accumulation. Brain perfusion SPECT may be helpful in the early diagnosis of HSVE.

Dense middle cerebral artery sign: an indicator of poor outcome in middle cerebral artery area infarction

Thirteen patients with a dense appearance of the horizontal part of the middle cerebral artery (MCA) "dense middle cerebral artery sign" in CT scans taken within 24 hours after onset of ischaemic stroke had considerably poorer prognosis than controls with stroke, but without the sign. A hyperdense appearance of the MCA is known to be associated with thromboembolism, but dense middle cerebral artery sign is also an early warning of a large infarction, brain oedema and poor prognosis in infarction in the MCA area.

Localization of melanoma with radiolabelled monoclonal antibody fragments and iodoamphetamine

In two melanoma patients, metastases accumulated both 99mTc-labelled monoclonal anti-tumor F(ab')2 fragments and N-isopropyl-p-(123I)-iodoamphetamine. Small metastatic deposits were localized only by labelled antibody, for which a higher target-to-nontarget ratio was observed than for radioiodoamphetamine, indicating that immunoscintigraphy may be the more sensitive method. In these two patients positive immunohistochemical staining for the antibody used was observed, whereas in a third patient, with no concentration of labelled antibody, the staining result was negative showing the specificity of the immunoscintigraphy findings. It is possible that the accumulation of radio-iodoamphetamine is due to binding to melanin but this is not certain as tissue samples from one of the two patients with positive scintigrams did not contain stainable melanin.

Isolated angiitis of the central nervous system

Two adults with isolated angiitis of the central nervous system (CNS) are described and the diagnostic criteria of the disease are evaluated. The diagnosis was based on carotid angiogram showing segmental narrowing (a "beaded" appearance) with or without microaneurysms or arterial obstruction, and on clinical observations excluding other underlying diseases. The clinical picture consisted of progressing or fluctuating symptoms and signs of CNS origin. Although the primary etiology of this rare condition remains unknown, treatment with corticosteroids and cyclophosphamide is rewarding. Thus, isolated angiitis of the CNS is treatable, contrary to some earlier assumptions. Therefore, the early diagnosis of isolated angiitis of the CNS is emphasized.