Pallidonigral pigmentation and spheroid formation with multiple striatal lacunar infarcts

A 72-year-old hypertensive man had focal seizures and mild memory loss. At autopsy, there were many lacunar infarcts, particularly in the neostriatum. Rust-brown discoloration and spheroid formation within the globus pallidus and pars reticulata of the substantia nigra resembled Hallervorden-Spatz disease, in which more detailed analysis of the striatum may be worthwhile.

Familial dementia of adult onset with pathological findings of a 'non-specific' nature

A family is described in which 4 of 10 siblings developed a dementing illness that culminated in death within five to six years of onset. The pathological findings in 3 members were strikingly similar, and consisted of widespread nerve cell loss and astrocytosis within the cerebral cortex, status spongiosus within the outer cortical layers and, in 2, nerve cell loss and astrocytosis within the dorsomedial nucleus of the thalamus. It is concluded that the disorder described in this report does not conform precisely to any of the currently recognized categories of familial dementing disease.

The neuropathology of rheumatoid disease

Patients with active rheumatoid disease may develop encephalopathy, myelopathy, peripheral neuropathy, and myopathy through a variety of tissue mechanisms. Brain involvement is usually characterized by the formation of rheumatoid nodules or by the development of vasculitis or its complications, and there is evidence to suggest that the trapping of immune complexes within the choroid plexus may be important in pathogenesis. Structural damage to the spinal cord and lower brain stem, on the other hand, most commonly results from narrowing of the bony canal, leading either to direct compression of neural tissue or to compromise of its vascular supply. The appearance of peripheral neuropathy generally signifies the presence either of inflammatory epineurial arterial disease or entrapment by neighboring anatomical structures. Skeletal muscle dysfunction may be due to vasculitis, myositis, or denervation atrophy. Both systemic and local anatomical factors, therefore, are of importance in determining the manner in which different parts of the nervous system may be affected in rheumatoid disease.

Chorea gravidarum. Report of a fatal case with neuropathological observations

In a 23-year-old primigravida with no prior history of rheumatic fever, choreiform movements developed late in the third trimester, and she died in a state of hyperthermia 14 days later. Results of neuropathological examination showed, as the basis for the chorea, nerve cell loss and astrocytosis within the striatum (especially the caudate nucleus). Anaylsis of the case in conjunction with a review of the literature strongly suggests that chorea gravidarum should be regarded as a syndrome rather than a specific disease entity.

Heat stroke. Report of three fatal cases with emphasis on findings in skeletal muscle

Three fatal cases of heat stroke were encountered in the central New York area over a two-month period. Although in each instance one or more predisposing factors were identified, exertion clearly played a role in its development in only one case. In addition to laboratory and postmortem findings indicative of dysfunction of many organ systems, there was morphological evidence of widespread damage to skeletal muscle.

Rheumatoid disease with encephalopathy

A 63-year-old woman developed progressive rheumatoid disease complicated by a confusional state as well as persistent cerebrospinal fluid pleocytosis and hypoglycorrhachia. Neuropathological examination revealed extensive rheumatoid lesions in the cranial dura, falx, and choroid plexus. The choroid plexus has not been affected in any of the 16 previously reported cases of pathologically verified rheumatoid disease of the central nervous system. The findings in this patient support the observations of others regarding the role of the choroid plexus in development of CNS manifestations in systemic immune complex disease.