European neurology
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Twenty-five children with post-hemiconvulsive hemiplegia, who had had epileptiform discharges on EEG, were followed for over 5 years. Twenty-two of them developed the hemiconvulsion-hemiplegia-epilepsy syndrome. The computed tomographic (CT) findings were: marked hemispheric atrophy in 13 cases; moderate or slight hemispheric atrophy in 4; focal atrophy or porencephaly in 4, and a normal scan in 4. ⋯ Epileptiform discharges on EEG were found on the ipsilateral side (the damaged hemisphere) in 13 cases, the contralateral side (the undamaged hemisphere) in 9, and on both sides in 3. As to the correlation between CT and EEG abnormalities, 8 of 13 cases with marked hemiatrophy on CT had contralateral epileptiform discharges on EEG, and the converse was more pronounced: 8 of 9 cases with contralateral epileptiform discharges had marked hemiatrophy on CT. Contralateral epileptiform EEG abnormalities were observed in the patient with severe hemispheric brain damage.
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A sensory disturbance limited to the hand or fingers and the corner of the mouth both on the same side constitutes the cheiro-oral syndrome (COS). Six patients with typical COS are described; in 5 of them a well-circumscribed lesion was found at different brain sites. ⋯ The pathogenetic explanation of this peculiar sensory symptom complex is a matter of debate and a new hypothesis is formulated. We advocate that when COS is encountered, especially if a history of migraine is lacking, a thorough neurological workup is called for.
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The case of a patient with a cauda syndrome without sensory deficits following radiation therapy to the lumbosacral cord is reported. This patient received a total dose of 38 Gy to the lumbar vertebrae because of bone metastases of a carcinoma of the breast. ⋯ No definite ischemic lesions were detectable. This is the first case report on neuropathological findings in lumbosacral radiation myelopathy.
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The authors themselves studied 26 patients. The EEGs were classified in terms of increasing severity in 5 categories. Incorporating over 400 cases from the literature, the authors correlated the initial EEG findings with the clinical outcome following cardiac arrest. ⋯ A complete remission can be expected in most cases. Grade II (dominant theta-delta activity with detectable normal alpha) and grade III (dominant theta-delta activity without detectable normal alpha) findings have no definite prognosis. Grade IV [low-voltage delta, possibly with short isoelectric intervals; dominant, monomorphic, non-reactive alpha-activity (alpha coma); periodic generalized phenomena (spikes, sharp waves, slow waves with very low background activity)] and grade V (very flat to isoelectric EEG) findings have a very serious prognosis.
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In the recent literature about neurosyphilis, several publications have mentioned more atypical presentations of neurosyphilis. Inadequate penicillin therapy and improved serological methods are supposed to be responsible for these findings. In contrast with this proposition the present retrospective study of two groups of neurosyphilitic patients (518 patients during the period 1930-1940 and 121 during 1970-1984) reveals no marked differences in clinical data of these groups. Besides the fall in incidence of syphilis and neurosyphilis and the shift in the male/female ratio, conforming to modern literature, there is an increase in the cases of asymptomatic neurosyphilis, due to development of the immunological techniques to detect the diagnosis 'neurosyphilis' earlier.