Drawing ability in four young children with congenital unilateral brain lesions

The drawings of four 5-yr-old children, two with left and two right hemisphere congenital brain injury, were compared with those of 20 normal 3.5-5 yr-olds. Two types of drawings were evaluated: copied geometric forms and free drawings. The children with left hemisphere injury showed normal development in both copying and free drawing. The children with right hemisphere injury were developmentally impaired in the copying task. In addition, their free drawings lacked configurational coherence; they included the elements of the figures but failed to arrange them in spatially organized ways. This failure to organize spatially elements is consistent with the descriptions of spatial cognitive disorders found in the drawings of adults with right parietal brain lesions.

Bereitschaftspotential preceding speech after holding breath

Cerebral potentials prior to speaking were recorded in 36 healthy righthanded subjects. Subjects began holding breath at irregular intervals prior to the voluntary onset of speech. This was done in order to avoid respiration-related potential shifts. The Bereitschaftspotential (BP) or readiness potential started already 2 s prior to the onset of speaking and was present over either hemisphere. During the last 100 to 200 ms of preparation period, the BP became significantly lateralized towards the left hemisphere. The close temporal relation to speech onset characterized this hemispheric lateralization to be an indicator of the final motor mechanisms for speech. Still, the BP was a bilateral phenomenon, i.e. it was also present over the right hemisphere, indicating involvement of the non-dominant hemisphere as well. The data are compatible with the view of an early bihemispheric motor preparation for speech followed by a late left hemisphere preponderance as the final common pathway.

Empty sella syndrome in childhood

The empty sella syndrome is common in middle-aged women, usually presenting with headache, and only occasionally associated with endocrine or visual abnormalities. It is rare in childhood. Childhood cases tend to present either with endocrine disturbances, visual symptoms, or with craniofacial syndromes. We present three cases of complete empty sella with childhood onset, each discovered unexpectedly during evaluation of endocrine or visual dysfunction.

Oral immunisation with killed Haemophilus influenzae for protection against acute bronchitis in chronic obstructive lung disease

Fifty patients with chronic obstructive lung disease were randomly allocated to three groups, to assess whether an oral vaccine containing non-typable Haemophilus influenzae protected against acute bronchitis. The double-blind prospective study over a three-month winter period included two placebo groups and one test group. Oral immunisation with H influenzae induced a tenfold reduction in the incidence of infection (p less than 0.001). During the subsequent winter, without further immunisation, protection by the vaccine was no longer statistically significant. There was no clear correlation between clinical protection and either carriage of H influenzae or the level of antibody to H influenzae antigen in saliva.

Progressive dyskinesia due to internal cerebral vein thrombosis

A 9 1/2-year-old boy developed a progressive dyskinesia 7 years after an angiographically demonstrated internal cerebral vein thrombosis. CT revealed bilateral thalamic lesions, more severe on the side contralateral to the movement disorder, without striatal involvement. This is a rare example of survival after internal cerebral vein thrombosis in a child and demonstrates that movement disorders may be delayed consequences of childhood stroke.

Increased intraventricular pressure without ventriculomegaly in children with shunts: "normal volume" hydrocephalus

Five patients with shunt-dependent hydrocephalus were observed to have apparently normal ventricular size despite marked increases in ventricular pressure after shunt malfunction. Elastance (dP/dV) was determined in four of these patients by removing increments of cerebrospinal fluid and measuring the resulting pressure. These patients without ventricular enlargement and with markedly increased ventricular pressure had high elastance. This group of patients with "normal volume" hydrocephalus had distal shunt occlusions, in contrast to previously reported patients with cephalic shunt obstructions after ventricular decompression. Initial shunting in early infancy, prolonged shunt dependency, and lack of recent shunt revision were common factors in these patients. Markedly elevated pressure with normal volume is a threatening clinical entity, requiring prompt surgical intervention