Comparative neuroimaging with pathologic correlates in Alexander's disease

We describe a case of pathologically confirmed Alexander's disease in which serial cranial ultrasound studies demonstrated unique findings of enlarging subependymal cysts with evolving periventricular hyperechogenicity. Computed tomographic scan of the head showed low attenuation of the periventricular white matter and centrum semiovale. Magnetic resonance imaging (MRI) demonstrated diffuse, confluent high signal predominantly in frontal white matter. These imaging modalities, particularly cranial ultrasound and MRI, may be useful tools in the diagnostic evaluation of children with degenerative neurologic disease, megalencephaly, and suspected Alexander's disease.

Gaze-evoked involuntary movements

Voluntary gaze may evoke a number of neurological phenomena such as vertigo, tinnitus, blepharoclonus, eyelid nystagmus, "facial nystagmus," involuntary laughter, and seizures. We report two patients in whom eccentric gaze evoked facial twitching and arm movement. Electroencephalograms remained unchanged during these movements. The pathogenesis of these movements is unclear but may involve ephaptic transmission.

Epilepsia partialis continua in multiple sclerosis

Epilepsia partialis continua (EPC) in multiple sclerosis is extremely rare. We report a case of a patient with clinically definite multiple sclerosis who developed EPC. Magnetic resonance imaging (MRI) depicted high signal in subcortical white matter and basal ganglia. A combination of lesions may be important in the generation of EPC.

Prevalence of dystonia in veterans on chronic antipsychotic therapy

The prevalence of dystonia was studied in 125 veterans on chronic antipsychotic therapy using a detailed and systematic examination. Twenty-seven out of 125 had dystonic manifestations. The most common areas involved were hands and jaw. There was no relation between the presence or absence of dystonia, and duration of neuroleptic therapy. There was a tendency for tardive akathisia to occur more frequently in patients with dystonia than in those without it (Fisher's exact probability test, p = 0.0656). Tardive dystonia in its milder forms may be more common than currently believed.