Confusional states with periodic lateralized epileptiform discharges (PLEDs): a peculiar epileptic syndrome in the elderly

The histories of seven patients over the age of 60 years are reported. They all suffered from recurrent and prolonged episodes of confusional state associated with psychic and neurologic manifestations. All episodes were accompanied by the occurrence of periodic lateralized epileptiform discharges (PLEDs) on the EEG, which became normal when the ictal episodes subsided either spontaneously or after administration of diazepam i.v. Although PLEDs may correspond to severe hemispheric lesions, serial computed tomography (CT) scan and laboratory investigations detected significant abnormalities in only one case, that of a patient with a progressive dementing outcome. In the other six patients, follow-up neuropsychological controls indicated moderate impairment of higher cortical functions according to the hemisphere involved by PLEDs. Administration of carbamazepine (CBZ) proved rather effective in preventing the recurrence of the ictal episodes. For its clinical, EEG, and prognostic features, this condition may represent a peculiar nonconvulsive status epilepticus in the elderly.

[Myxoma of the mitral leaflet. Apropos of a case]

This case of an intracardiac myxoma observed in a 15 year old girl had several points of interest: the mode of presentation: the clinical signs were exclusively systemic and articular; the mode of diagnosis: 2D echocardiography demonstrated an immobile, dense mass about the size of a walnut implanted on the ventricular surface of the posterior mitral leaflet along the whole of its base and seemingly adherent to the ventricular wall; the intraventricular location of the tumour (exceptionally rare) and its mitral valve origin. The site of the tumour imposed mitral valve replacement but we were able to discuss the surgical approach using the results of echocardiography before surgery and a bioprosthesis was inserted to protect the maternal future of the patient.

Hematocrit and stroke. A case-control study

A case-control study was undertaken to evaluate the role of hematocrit (Hct) level in the pathogenesis of stroke. Hct was determined in 110 subjects with acute ischemic stroke and compared with the values obtained in 110 subjects, matched for age and sex, admitted to our Division of General Medicine because of other diseases. Statistical analysis of the results by means of the McNemar test for pairs did not confirm the hypothesis that Hct values in stroke patients differ significantly from the control values.

Cluster headache: remission following ascending aorta/innominate artery bypass surgery. Case report

A 51-year-old man with cluster headache has been free from cluster attacks for over two years following ascending aorta/innominate artery bypass surgery for correction of an atherosclerotic narrowing at the origin of the innominate artery. Surgery may have been a causal factor in the remission of these attacks.

[Epidemiological study on tremor in the aged]

203 hospitalized old-aged patients were examined for the presence of tremor. This physical sign was found in 58.6% of cases. By far the largest diagnostic category resulted that of essential tremor: 46.7% of all patients investigated and 77.8% of all cases of tremor. The frequency of this type of tremor was found to increase proportionally to age. The conclusion is drawn that also tremor, as well as other neurological signs frequently demonstrable in "normal" old people (for example, the so-called primitive reflexes), should be inscribed in the group of the phenomena due to the ageing process itself.

[Juvenile cerebral infarct. Retrospective analysis of risk factors in 78 cases]

THe records of 78 young adults, who had suffered cerebral infarction, were reviewed with regard to possible pathogenetic mechanisms. Atherosclerosis risk factors appeared to play a major role between the age of 40 and 50, especially in males. Non atherosclerotic factors of cerebral ischemia were found predominant among females under 40, owing to contribution of migraine, oral contraceptive use and pregnancy/puerperium. In 18% of the patients no etiology could be identified.

[Carotidynia]

The clinical definition of carotidynia is not a controversial one, whereas how its etiology should be interpreted is still uncertain. The study of the clinical features and the therapeutical results in 12 patients suffering from carotidynia reveals a marked resemblance to migraine. In particular, the case history reported points out a significant incidence of migraine as a familial disease, its special localization and the type of pain, the possible presence of a prodromal stage and the favourable response to the drugs that are known to be effective in migraine treatment. The theory that carotidynia should be ascribed to the group of vascular headaches is therefore suggested.

[Complicated migraine]

Three cases of complicated migraine are reported. A few days after neurological accidents, one patient showed an angiographic evidence of diffuse cerebral vasospasm. This finding possibly bears out vasomotor hypothesis of migraine.