[Indirect cardiac massage as a cause of pulmonary fat embolism]

55 cases of non-traumatic death with preterminal treatment by indirect heart massage showed fat pulmonary embolism in 42 per cent. Cases with thoracal fractures caused by massage were positive in 67 per cent. Controls were represented by a group of traumatic deaths with multiple fractures (80 per cent positivity) and a group of non-traumatic deaths without application of massage (6 per cent positivity).

A herpes simplex virus type 1 variant, deleted in the promoter region of the latency-associated transcripts, does not produce any detectable minor RNA species during latency in the mouse trigeminal ganglion

In peripheral sensory ganglia latently infected with herpes simplex virus type 1 (HSV-1) transcription is restricted. A set of viral latency-associated transcripts, the LATs, have been characterized by Northern blotting and in situ hybridization. These transcripts have previously been mapped to a 3 kb region of the viral genome within the repeat long region. However, transcription from adjacent regions of the genome can be detected by in situ hybridization, which cannot be detected by Northern blotting. These RNAs are termed minor LATs or m-LAT. In this study we show that in ganglia latently infected with the HSV-1 variant 1704, which is deleted in one complete copy of the LAT gene and in the promoter and 5' portion of the other copy, m-LATs are not detected by in situ hybridization. Furthermore, the levels of DNA in nervous system tissue latently infected with the parental and the 1704 variant virus are similar. Thus we propose that the sequence elements necessary for initiating transcription or stabilizing m-LATs are within the region deleted in variant 1704 that codes for the promoter and the 5' end of the LATs.

A herpes simplex virus type 1 mutant containing a nontransinducing Vmw65 protein establishes latent infection in vivo in the absence of viral replication and reactivates efficiently from explanted trigeminal ganglia

Vmw65, a herpes simplex virus type 1 (HSV-1) tegument protein, in association with cellular proteins, transactivates viral immediate early genes. In order to examine the role of Vmw65 during acute and latent infection in vivo, a mutant virus (in1814), containing a 12-base-pair insertion in the Vmw65 gene, which lacks the transactivating function of Vmw65 (C. I. Ace, T. A. McKee, J. M. Ryan, J. M. Cameron, and C. M. Preston, J. Virol. 63:2260-2269, 1989) was examined in mice. Following corneal inoculation, the parental virus (17+) and the revertant (1814R) replicated effectively in eyes and trigeminal ganglia with 30 to 60% mortality. At either equal PFU or equal particle numbers, in1814 did not replicate in trigeminal ganglia and none of the infected mice died. Although in1814 did not replicate following corneal inoculation, it established latent infection in trigeminal ganglia. HSV-1 in1814 reactivated at explant as efficiently and rapidly as did 17+ and 1814R. Even low amounts of inoculated in1814 (10(2) PFU) were sufficient to establish latent infection in some animals. Since infectious in1814 was not detected at any time in mouse trigeminal ganglia, in1814 provided a unique opportunity to determine how soon after primary infection latency begins. Latent in1814 infection was detected shortly after virus reached the sensory ganglia, between 24 to 48 h postinfection. Thus, though Vmw65 may be required for lytic infection in vivo, it is dispensable for the establishment of and reactivation from latent infection. These data support the hypotheses that the latent and lytic pathways of HSV-1 are distinct and that latency is established soon after infection without a requirement for viral replication. However, the levels of Vmw65 reaching neuronal nuclei may be a critical determinant of whether HSV-1 forms a lytic or latent infection.

In ovo infection with the avian retrovirus RAV-1 leads to persistent infection of the central nervous system

The ability of an avian retrovirus to cause central nervous system (CNS) disease was investigated in chickens infected in ovo with Rous associated virus-1. Viral envelope and core proteins and mature virions were found throughout CNS parenchyma, with the highest amounts localized in the granular layer of the cerebellum, in blood vessel endothelium, and the choroid plexus. This distribution was established by the time of hatching and persisted throughout the 14 weeks of observation. The highest levels of integrated proviral DNA and viral mRNA, were present in the cerebellum, consistent with the distribution of viral antigens. Mononuclear cell infiltrates were evident throughout the CNS, consistent with an inflammatory process. However, demyelination or vacuolar changes, as observed in other retroviral-induced CNS diseases, were not detected. Clinical symptoms of progressive neurologic dysfunction, i.e., weakness or paralysis of the hindlimbs, imbalance, and ataxia, were present in 7 of 38 infected chickens before termination of the experiment at 14 weeks posthatch. Viral antigens or lymphocyte infiltration were not detected in peripheral nerves. These findings suggest that the avian system may provide a valuable model to analyze the mechanisms governing retroviral induced CNS disease.

[Arrhythmogenic dysplasia of the right ventricle]

The authors describe a case of sudden death of a 22-year-old man where on necropsy arrhythmogenic dysplasia of the right ventricle was found. The authors describe the clinical and morphological picture of this recent nosological unit. They discuss its relationship with Uhl's anomaly. Attention is drawn to concurrent affection of the left ventricle.

[Cardiomyopathy of the right ventricle]

Right ventricular cardiomyopathy (arrhythmogenic right ventricular dysplasia) is a recently described entity characterized morphologically either by an absence of the right ventricular myocardium (Uhl's anomaly; parchment heart), or by replacement of the myocardium by adipose tissue (lipomatous cardiomyopathy). Three cases of the disease are presented. The simultaneous involvement of the left ventricle is stressed.

Effects of lipofuscin on in situ hybridization in human neuronal tissue

In situ hybridization is a highly sensitive technique for detecting nucleic acid sequences within tissues, and is frequently employed in neurovirology. However, this technique requires many appropriate controls in order to recognize and avoid potential artifactual hybridization. We have encountered abundant reaction to lipofuscin in neurons in human peripheral and central nervous systems, using various DNA probes, which could be misinterpreted as positive signals. This pseudohybridization reaction was resistant to treatment with RNase or DNase and was also present in tissue sections treated with hybridization mixture or nuclear autoradiographic emulsion in the absence of any radioactive probes. Characteristics used to distinguish between authentic in situ hybridization and the reaction to neuronal lipofuscin include cellular localization, color, margins and granular appearance, sensitivity to treatment with nucleases and the effect of exposure time on signal intensity. These guidelines should be used to avoid potential misinterpretation of in situ hybridization results with human tissue.

The yield of sural nerve biopsy in the evaluation of peripheral neuropathies

The diagnostic yield of sural nerve biopsy was evaluated in 120 peripheral neuropathy patients. In 58 (48%) a final diagnosis was reached without biopsy, while 14 (11.5%) remained undiagnosed. Nerve biopsy contributed to the final diagnosis in 20 of the 53 biopsies (38%). In patients with motor conduction velocity below 30 m/s, sural nerve histology was helpful in 65% of biopsies. In patients with milder reduction in conduction biopsy contributed in only 11%. It is concluded that in general neurological population, nerve biopsy is of limited value as a routine diagnostic procedure. However, in patients with marked slowing of conduction velocity, in whom the diagnosis is not immediately apparent, sural nerve biopsy is indicated.

Herpes simplex virus type 1 latency-associated transcripts are evidently not essential for latent infection

The herpes simplex virus type 1 (HSV-1) transcripts that can be detected during latent infection by Northern blot analysis in human and experimental animal sensory ganglia are encoded by diploid genes. To investigate their role in latent infection we studied HSV-1 variant 1704, which has deleted most of the IRL copy of the coding region of these RNAs and has a 1.2-kb deletion that is immediately upstream of the coding region of the TRL copy. During primary infection, 1704 replicated in trigeminal ganglia with kinetics similar to the parent virus (17+) and established latent infection. However, while explant reactivation of latent HSV-1 from trigeminal ganglia was detected in 100% of 17+ infected mice within 7 days, the reactivation of 1704 was significantly delayed, and 31 days elapsed before eight out of nine mice became virus positive. The recognized HSV-1 latency-associated RNAs were not detected during the latent state of 1704 by Northern blot analysis or in situ hybridization, which implies that the 1.2-kb deletion may contain the promoter or other important regulatory elements. The data indicate that detectable levels of these latency-associated transcripts are not required for viral replication, establishment, or maintenance (greater than 6 weeks) of HSV-1 latency in trigeminal ganglia, but suggest a role in reactivation.

Muscle cramps in cancer patients

We prospectively evaluated 50 cancer patients with new complaints of muscle cramps. Neurologic examination and laboratory evaluation identified disorders related to neural, muscular, or biochemical abnormalities in 41 (82%) patients. Abnormalities were confined mainly to the peripheral nervous system and included peripheral neuropathy in 22 patients, root and plexus pathology in 17 patients (six with leptomeningeal metastases), and polymyositis in two patients. Hypomagnesemia accounted for muscle cramps in only one patient. Identifiable causes of muscle cramps were related mostly either to metastatic or nonmetastatic complications of the underlying malignancy (14 patients) or to complications of its treatment (21 patients). Cramps, or rather complaints of cramps, were the presenting symptom of recognizable and previously unsuspected neurologic dysfunction in 64% (27 of 42) of the identified causes. Therefore, we conclude that muscle cramps in cancer patients may not be a benign complaint and that they usually mark the presence of an identifiable neurologic disorder. The use of simple clinical and laboratory measures is rewarding in the evaluation of these patients and leads to diagnosis in the majority of them.

[Comparison of the degree of chronic gastritis in the resected gastric body with histologic findings in postoperative gastric biopsy]

In resected portions of the stomach we find chronic atrophic gastritis of the corpus only in 10% of the patients with duodenal ulcers, and chronic inflammatory changes are, contrary to patients with a gastric ulcer, less marked. The difference is statistically significant. Consistent with some other authors, we find that great progression of chronic inflammatory changes occurs in patients operated on account of duodenal ulcers in the course of the first three years after operation. From six cases of regression of chronic inflammatory changes after operation, in two cases undetected atrophic gastritis was involved which was present in a severe form in the body of the resected portion beyond the vicinity of the gastric ulcer. According to the author's findings regression of atrophic gastritis is possible. The high score of chronic inflammatory changes in the antrum of gastric resectates (3.54) and in the close vicinity of gastric ulcers (4.0) confirms the frequency of severe antral gastritis in peptic ulceration and the intensity of the focal inflammation in the vicinity of gastric ulcers.

Intraventricular interferon treatment for subacute sclerosing panencephalitis

Three children with subacute sclerosing panencephalitis (SSPE) were treated with alpha-interferon. Medication was administered via an Ommaya reservoir into the cerebral ventricular system over a period of 13 to 24 months in increasing amounts up to 1.0 x 10(6) IU twice weekly. Mild clinical improvement in two children and a stable course in the third were associated with improvement of electroencephalographic recordings in all patients and a decrease in antimeasles antibodies in the cerebrospinal fluid of two. The small number of patients does not enable us to determine whether this course was the natural history of SSPE in our patients or whether it was induced by treatment, yet it seems that intraventricular interferon treatment can modify the course of SSPE.

Fulminant subacute sclerosing panencephalitis in association with pregnancy

Subacute sclerosing panencephalitis developed during pregnancy in a 27-year-old woman and immediately after delivery in an 18-year-old woman. In both, disease took an acute and fulminant course culminating in a vegetative state within several weeks. It is suggested that the relative older age of disease presentation and the unusually rapid neurologic deterioration were partially due to immunologic and hormonal alterations of pregnancy.

Latent herpes simplex virus type 1 transcription in human trigeminal ganglia

We studied latent herpes simplex virus type 1 gene expression in human trigeminal ganglia. Two transcripts were mapped to a 3.0-kilobase region within the long repeat region and appeared to be located in neuronal nuclei. These viral RNAs were not abundant during lytic replication and may represent an alternative pattern of herpes simplex virus type 1 gene expression involved in the pathogenesis of latent infection.

High-field magnetic resonance imaging of intracranial hematomas

One hundred intracranial hematomas aged 1 day to greater than 4 years old were imaged at 1.5 Tesla using T1- and T2-weighted spin-echo pulse sequences. Characteristic intensity patterns seen in the evolution of hematomas were identical to those preliminarily reported in 20 hematomas. They allow staging of a hematoma into acute (less than 1 week old), subacute (between 1 week and 1 month old), and chronic (several months to several years old). The mechanisms suspected to be responsible for these intensity patterns were confirmed by in vitro nuclear magnetic relaxometry of blood, ferritin and hemosiderotic spleen samples performed on a variable field spectrometer at 0.19 to 1.4 Tesla. High-field magnetic resonance imaging is sensitive and specific for hemorrhage in all of its stages of evolution as well as to the ambient oxygen tension of acute hematomas.

Chronic progressive myelopathy: its relation to the spinal progressive form of multiple sclerosis

The causes and clinical features of chronic progressive myelopathy (CPM) were evaluated in a retrospective study of 107 patients. A special emphasis was put on those in whom no underlying cause for the myelopathy could be determined. Of 76 such, 39 (51%) had oligoclonal immunoglobulins (Ig) in the CSF and were therefore considered as possible MS, while the remainder, without oligoclonal Ig, were designated "myelopathy of unknown origin" (MUO). Our "possible MS" group was similar clinically to reported series of proven spinal MS, and it seems therefore, that the presence of oligoclonal Ig permits the recognition of a group of patients with myelopathy who might be at a greater risk for MS. Patients with MUO differed from possible MS patients in several clinical characteristics, but most significantly in disease course and levels of functional disability which were more benign in the former. Myelopathy in possible MS patients was also of a primary pyramidal and asymmetrical nature. It is therefore suggested that the segregation of patients with CPM of undetermined origin into 2 separate groups based on the presence or absence of oligoclonal Ig might be of prognostic significance.

Sensory peripheral neuropathy of vitamin B12 deficiency: a primary demyelinating disease?

In five patients with peripheral neuropathy due to vitamin B12 deficiency, electrodiagnostic studies demonstrated severe reduction in sensory nerve conduction velocities compatible with a demyelinating disorder affecting sensory nerve fibres. It is suggested that in some patients lack of vitamin B12 may cause primary sensory demyelinating neuropathy.

Antibiotic therapy for infected Ommaya reservoir systems

The major complication of prolonged use of a permanently implanted Ommaya reservoir system is bacterial infection, encountered in 3 to 15% of patients. The best therapeutic approach to ventriculitis and meningitis occurring in the presence of this device is still a subject of debate. We reviewed our experience in 66 consecutive patients receiving intraventricular therapy via the Ommaya reservoir for leptomeningeal metastases or for subacute sclerosing panencephalitis. Eight episodes of infection occurred during the period of treatment, and all of them responded to systemic antibiotics with or without intraventricular treatment. Removal of the Ommaya reservoir was avoided, and therapy via the device for the underlying disease was resumed as soon as the infection was controlled. No relapse of infection occurred during a minimal follow-up of 40 days. On the basis of our experience and review of the literature, we challenge the concept that the Ommaya device, as a foreign body, must be removed to treat such infections successfully.

The prevalence of isolated atrial amyloid

The frequency of isolated atrial amyloid (IAA), a form of 'senile' cardiac amyloidosis, was determined in younger age groups. For the detection of amyloid the Sirius red staining technique was used. IAA first appears in the fourth decade; its prevalence increases roughly linearly by 15-20 per cent with each subsequent decade, reaching 95 per cent in the 81-90 years age group. The prevalence is higher in females than in males.

Substitution of Co alpha-(5-hydroxybenzimidazolyl)cobamide (factor III) by vitamin B12 in Methanobacterium thermoautotrophicum

Methanobacterium thermoautotrophicum grown on mineral medium contains 120 nmol of Co alpha-(5-hydroxybenzimidazolyl)cobamides (derivatives of factor III) per g of dry cell mass as the sole cobamide. The bacterium assimilated several corrinoids and benzimidazole bases during autotrophic growth. The corrinoids were converted into factor III; however, after three transfers in 5,6-dimethylbenzimidazole (200 microM)-supplemented mineral medium, derivatives of factor III were completely replaced by derivatives of vitamin B12, which is atypical for methanogens. The total cobamide content of these cells and their growth rate were not affected compared with factor III-containing cells. Therefore, the high cobamide content rather than a particular type of cobamide is required for metabolism of methanogens. Derivatives of factor III are not essential cofactors of cobamide-containing enzymes from methanogenic bacteria, but they are the result of a unique biosynthetic ability of these archaebacteria. The cobamide biosynthesis include unspecific enzymes, which made it possible either to convert non-species-derived corrinoids into derivatives of factor III or to synthesize other types of cobamides than factor III. The cobamide biosynthesis is regulated by its end product. In addition, the uptake of extracellular cobamides is controlled, and the assimilated corrinoids regulate cellular cobamide biosynthesis.

Familial progressive neuronal disease and chronic idiopathic intestinal pseudo-obstruction

Chronic idiopathic intestinal pseudo-obstruction (CIIP) is characterized by recurrent episodes of bowel obstruction without mechanical cause. In five members of two Jewish-Iranian families, CIIP was associated with progressive neuronal disease, starting before age 30, with ophthalmoplegia, sensorimotor peripheral neuropathy, and hearing loss. There was no evidence of CNS involvement. The pattern suggested autosomal recessive inheritance.

Familial intestinal pseudoobstruction dominated by a progressive neurologic disease at a young age

Chronic neuropathic intestinal pseudoobstruction is a rare entity, characterized by recurrent episodes of bowel obstruction without a mechanical obstructive cause. We report five members of two Jewish-Iranian families in whom chronic neuropathic intestinal pseudoobstruction was associated with an identical and unique progressive severe neuronal disease. It appeared within the first two decades of life. The disease consisted of external ophthalmoplegia, ptosis, and severe sensory and motor peripheral neuropathy. Three patients also had neuronal hearing loss. There was no evidence of central nervous system involvement and all patients were mentally intact. The combined disease was confirmed by radiologic, electrophysiologic, and histologic studies. Specific nutritional deficiencies, toxic elements, and systemic diseases affecting both the gastrointestinal tract and the nervous system were ruled out. It seems that these patients suffer from an autosomal recessive, presently unrecognized variant, of chronic neuropathic intestinal pseudoobstruction. In a patient with severe peripheral neuropathy of unknown etiology associated with symptoms suggestive of intestinal obstruction, the possibility of chronic neuropathic intestinal pseudoobstruction has to be considered.

Late-onset progressive radiculomyelopathy in patients with cervical athetoid-dystonic cerebral palsy

Three patients with severe athetoid-dystonic type of cerebral palsy involving the neck musculature developed in their fourth to fifth decade progressive cervical radiculomyelopathy associated with vertebral spondylarthrotic compressive lesions in addition to their long-standing neurological syndrome. It is likely that the late-onset myelopathy is linked to continuous torsion, compression and 'wear and tear' of the cervical spinal cord, induced by the involuntary movements. In 2 patients decompressive cervical spinal surgery was ineffective, suggesting irreversible damage.

Central neurogenic hyperventilation in a patient with medulloblastoma

Central neurogenic hyperventilation is a rare but important cause of the frequently observed phenomenon of hyperventilation. Its diagnosis demands that primary respiratory or metabolic causes, as well as cerebrospinal fluid abnormalities, be ruled out. We hereby describe a patient whose attacks of hyperventilation were the presenting sign of her disease and might be consistent with the central neurogenic mechanism. This patient suffered from a medulloblastoma which compressed the pons. After removal of the tumor the hyperventilation attacks ceased.

Non-linear CT windows

The display of computerized tomographic (CT) data requires data compression because of the limited shades of grey which the eye can differentiate. This may lead to information loss which can be minimized by a more efficient utilization of the available levels of grey than that afforded by conventional linear windows. Automated histogram equalization for grey level assignment has not been satisfactory because of the underlying assumption that the information content at any given CT level is proportional to the number of pixels at that level. For four different anatomic regions; the lumber spine, abdomen, brain and chest, an empiric graph of the clinical information content vs CT levels was integrated to yield the shape of a graph assigning shades of grey vs CT level i.e. a non-linear window. This non-linear window curve was utilized in the same manner as the linear window, namely the window center and width were under the direct control of the observer through the window center and width knobs. Each non-linear window was implemented on images of its anatomic region and interactively optimized on the screen till a maximal display of information was obtained. These optimal non-linear windows compared favorably with linear windows in most cases. This method provides the means to display more information on a CT image with no extra processing time, additional equipment or special training.

Appearance of Guillain-Barré syndrome in patients during corticosteroid treatment

Three patients developed acute Guillain-Barré syndrome while on steroid treatment. The first patient suffered from ulcerative colitis and developed Guillain-Barré syndrome when the steroid dosage was being tapered. Another patient with long-standing multiple sclerosis received steroids during relapse and the Guillain-Barré syndrome appeared while treatment was reduced. The third patient, with aqueductal stenosis and ventriculoatrial shunt, who received steroids when malfunction of the shunt was suspected, developed Guillain-Barré syndrome while steroids were being tapered. Based on the putative immune pathogenesis of inflammatory demyelinating polyneuropathy, the occurrence of the syndrome in these patients could have been due to a selective effect of low-dose steroids on a specific, maybe suppressor lymphocyte subpopulation.

Isolation and analysis of bacterial cobamides by high-performance liquid chromatography

Cyanocobamides were extracted from diverse bacterial species, purified by XAD-4 and neutral aluminum oxide column chromatography, and separated by isocratic reversed-phase high-performance liquid chromatography (HPLC). Retention times are given for seven cobamide types: dicyanocobinamide (factor B), Co alpha-(alpha-benzimidazolyl)-Co beta-cyanocobamide, Co alpha-(5-hydroxybenzimidazolyl)-Co beta-cyanocobamide (factor III), Co alpha-(5-methoxybenzimidazolyl)-Co beta-cyanocobamide (factor IIIm), Co alpha-(5-methylbenzimidazolyl)-Co beta-cyanocobamide, cyanocob(III)alamin (vitamin B-12) and Co alpha-(naphthimidazolyl)-Co beta-cyanocobamide. Other Co beta-ligandyl-cobamides such as hydroxycobamide and the light-sensitive methyl-, acetyl-, propyl-, and adenosylcobamides were separated by HPLC in a gradient mode. The recovery of total cell cobamide after extraction, purification, and separation was 75-80%. The method was useful in preparative and analytical work. Less than 10 ng cyanocobamide was detectable.

[Calcification of the heart]

A case of chronic calcific constrictive pericarditis in a 39-year-old Ugandan is presented. According to recent views this condition is only rarely caused by tuberculosis.

Metatarsal-slide lengthening without bone grafting

Brachymetatarsia is a condition of premature closure of the epiphyseal plate of a metatarsal. The authors present a case of brachymetatarsia of the second metatarsal. Utilizing a review of the literature, various surgical procedures are discussed. Treatment in this case consisted of a metatarsal-slide lengthening osteotomy, a modification of the Giannestras step-down procedure.

Guillain-Barré syndrome after epidural anesthesia: direct nerve root damage may trigger disease

Guillain-Barré syndrome (GBS) appeared in four patients 1 to 2 weeks after epidural anesthesia. In all patients, clinical diagnosis was confirmed by CSF findings and nerve conduction velocity studies. Although epidural anesthesia has not been listed as an antecedent event in GBS, evidence for the relationship has been previously reported. Interaction between the anesthetic agents and peripheral nervous system myelin or local trauma to roots may initiate a cascade of immunologic events that result in the demyelinating neuropathy.

[Calcification in the heart. IV. Calcification of the pulmonary valve]

A case is described of a 12-year-old girl suffering from Fallot's tetralogy whose atretic pulmonary valve was massively calcified. This appears to be the first case described of this condition in childhood.

Guillain-Barré syndrome: a possible extraintestinal manifestation of ulcerative colitis

In two elderly patients with ulcerative colitis, acute Guillain-Barré syndrome developed while the inflammatory bowel disease was in remission. The patients were treated with corticosteroids and recovered. Since both disorders are relatively uncommon, we suggest that the Guillain-Barré syndrome may have been causally related to the preexisting chronic inflammatory bowel disease. Guillain-Barré syndrome may be regarded as a possible extraintestinal complication of chronic ulcerative colitis.

[Calcification in the heart. I. Spontaneous coronary embolism due to calcified material]

Thirty-one hearts with advanced calcification of one or both left heart valves were investigated for the presence of spontaneous "calcific" emboli. X-ray (mammography) showed coronary emboli in 14 cases, that is in 45% of the whole series. A total of 265 "calcific" emboli (205 intracoronary and 60 in the left ventricular cavity) was demonstrated. The embolisation occurred most frequently and most extensively in association with postrheumatic mitral valve disease. Coronary "calcific" embolisation must be considered in the differential diagnosis of symptoms of ischemic heart disease in patients suffering from valvular heart lesions.

Features of brain atrophy in Parkinson's disease. A CT scan study

Multiple parameters for brain volume and mass were studied in 85 parkinsonian patients and in 149 normal controls aged 24 to 84 using CT scanning. In controls there was reduction in brain substance with advancing age. Increased brain atrophy in patients with Parkinson's disease (PD) was mainly observed in the younger age group of 24 to 49. This included parameters evaluating the size of the lateral and third ventricles (P less than 0.05 and P less than 0.01 respectively) and the size of the subarachnoid space in the frontal interhemispheric and Sylvian fissures (P less than 0.005 and P less than 0.01). With computed canonical correlation analysis a formula was obtained which expressed the tendency of the atrophic process in PD to involve the areas surrounding the third ventricle and the mesial aspect of the frontal lobes more than during normal aging.

Progressive brain atrophy during normal aging in man: a quantitative computerized tomography study

We quantitatively evaluated the computerized tomograms (CT) of 148 neurologically intact subjects, aged 28 to 84 years, to examine the effect of normal aging on the integrity of brain mass. Ten parameters were measured in each CT scan as indices for brain volume, including size of lateral, third and fourth ventricles, width of the sylvian and interhemispheric fissures, cortical sulci and the prepontine cistern. Most of these measurements showed that advancing age is associated with progressive loss of brain substance. Data show that the atrophy of brain during normal aging is both cortical and central and is not limited to the older population, but begins at a young age. These normative measurements may serve for comparison with data obtained from CT scans of patients with various neurological disorders.

Immediate spasticity with acute hemiplegia is a sign of basal ganglia hemorrhage

Acute appearance of hemiparesis or hemiplegia with initial marked spasticity was observed in 8 stroke patients. All had intracerebral hematomas and in 7 it was located in the region of the basal ganglia. By contrast, none of 121 hemiplegic patients with hemispheric ischemic stroke hospitalized during the same period had increased muscle tone in the involved limbs at stroke onset. Study indicates that association of hemiplegia with immediate spasticity at stroke onset is a clinical clue to a possible deeply located intracerebral hematoma.