This is a report of a series of patients who suffered major cerebral hemorrhage or infarction complicating industrial head injuries. The variable importance of trauma and of pre-existing vascular disease is exemplified. Accuracy of assessment of such complex problems is facilitated by modern applied neuroscientific techniques.

Eleven patients with transient paralytic attacks of obscure nature are described. Paralysis could involve face or leg alone, face and hand, or face, arm and leg. The duration varied from two minutes to one day. Four patients had brain tumors, six probably had brain infarcts, and one a degenerative process. The differential diagnosis included TIAs, migraine accompaniments, and seizures. In the absence of good evidence for the first two, the cases are discussed from the standpoint of possibly representing nonconvulsive seizure paralysis (ictal paralysis, inhibitory seizure paralysis or somatic inhibitory seizure). Because of the difficulty in defining seizures as well as TIAs and migraine in their atypical variations, a firm conclusion concerning the mechanisms of the spells was not attained. Two cases of the hypertensive amaurosis-seizure syndrome have been added as further examples of ictal deficits.

An automated system, incorporating the ANOPS-101 mini-computer, has been used to analyse the EMG. The vastus medialis (VM) and biceps brachii (BB) muscles were studied in 28 controls, 16 patients with myopathies, and in 26 patients with denervating disorders. For each muscle mean values were computed for the durations and numbers of phases of muscle action potentials; the mean density and amplitude of the deflections in the interference pattern were also measured. A higher incidence of abnormalities could be detected in myopathic than in neuropathic disorders; for both conditions the incidence was significantly greater in BB than in VM. For the diagnosis of denervation the most useful measurement was that of potential duration; for the detection of myopathies amplitude determinations were also very useful. The present results have been compared with those of other published studies in which automatic EMG analysis has been employed.

Spinal curves may be produced in fetal lambs with three surgical techniques. These procedures vary from mere exposure of the costo-vertebral junction of three ribs through a paravertebral incision, to resection of the head and part of the adjacent shaft of three ribs. The fetal age varies from forty-nine to seventy-three days. The degree of curvature present at birth seems to increase in severity with decreasing fetal age at the time of surgery, but the type of surgical procedure does not appear to influence the severity of the curve, suggesting that the mechanical presence of the ribs does not prevent the development of scoliosis in these animals.

Histological studies of the m. longissimus dorsi at the apices of the curves reveal two main types of abnormality in the muscle fibers. Both Type I and Type II fibers were significantly reduced in size in the biopsies taken from the side on which the surgery was performed, and there was marked alteration in the proportion of one fiber type to the other in most biopsies taken from both operated sides when compared with biopsies from unoperated twin animals.

The fetal age and amount of surgical trauma appeared to play no role in the degree of muscle alteration, suggesting that even minimal surgical trauma to the paraspinal region at any fetal age between 49–73 days is sufficient to produce significant muscle fiber abnormality and spinal curvature.

A parallel is drawn between these muscle findings and those in a number of human musculoskeletal diseases, and suggests the possibility of a developmental defect in the pathogenesis of these diseases.

Transit (conduction) times from the wrist to the seventh cervical spinous process (C7) were measured by using the F-wave response (TA) and the cervical somatosensory response (SEPC). The mean values obtained in 25 controls were 10.1 ± 0.9 s-3 and 10.9 ± 1.0 s-3 respectively. The 0.8 ± 1.0 s-3 difference between the two methods represents central delay of SEPC, possibly at the level of the dorsal root ganglion. The mean onset latency of the cortical somatosensory response (SEPA) evoked by median nerve stimulation in the same subjects was 15.5 ± 1.0 s-3. Transit time from C7 to the cortex (TB) given by either SEPA - TA or SEPA - SEPC - 0.8, where 0.8 is the necessary corrective factor for central delay of SEPC, was 5.3 ± 1.0 s-3. These techniques were applied to 10 patients suspected of having multiple sclerosis, but without clinical evidence of involvement above C7. Six of the 10 cases showed prolongation of TB. In 4 of these, this could only be calculated by the F-wave method since SEPC was absent. It is concluded that transit times derived from either the F-wave or SEPC are equally valid and interchangeable. The absence of one response allows for its replacement by the other.

An adaptation of cellulose acetate electrophoresis for studying concentrated cerebrospinal fluid is described. Two hundred and twenty-one patients have been studied, and the specificity for multiple sclerosis and sub-acute sclerosing panencephalitis is discussed. This has been positive for oligoclonal banding (OB) in 79% of patients with clinically definite multiple sclerosis.

Seventy six regional cerebral blood flow (rCBF) studies were conducted on 32 patients who had a total of 39 aneurysms. Twenty three of these patients were studied pre- and post-operatively. Normal values were obtained from a control group of 33 subjects, each of whom underwent one rCBF study. Flow was reduced following subarachnoid hemorrhage (SAH); it increased significantly postoperatively. Lower flows were associated with poorer clinical grades. There was a greater variation in regional distribution of flow immediately following SAH than in normals or in patients who had recovered from the acute phase. rCBF studies correlated with CT scans demonstrated that a progressive increase in ventricular size was accompanied by a progressive reduction in flow. In addition, intraventricular hemorrhage (IVH) was associated with a significant reduction in cerebral blood flow (CBF). No significant correlation between CBF and spasm was demonstrable.

Memory deficits in demented patients were studied by applying a computerized system to titrate individual memory performance. Two delayed matching to sample tasks were used. ABA1 involved random visual shapes used as a measure of visual memory. ABA 2 involved nonsense syllable trigrams used as a measure of verbal memory. A Human Test System panel with a display screen was utilized. This screen was a rear view projection window divided into four independent 3 x 2 sections arranged in a 2 x 2 matrix. The sample stimulus appeared on the upper left window for one second. The delay interval between stimulus sample and choices varied by 7 seconds dependent upon patient performance per trial. A Iso utilized was a color distractor task. Task parameters, data acquisition, retrieval, and graphic print-outs were all computerized. Individual titration levels reflected the severity of neurological impairment. Computerized assessment enabled subtle changes in memory performance to be readily identified. Implications for use of the system as a screening device in the assessment of mental changes in the elderly are apparent.

Visual evoked responses (VER) to four geometric shapes (a square, circle, el and omega) were recorded from multiple scalp locations in twelve subjects. Significant differences were found between the occipital VERs to the square and el and between the VERs to the circle and omega. Consistent differences could not be demonstrated between the responses to the square and circle or to the el and omega.

The differences between the responses were quantified by three different methods, including measurement of peak latencies and amplitudes, computation of a ratio index called λ, and the performance of discriminant functions derived by Stepwise Discriminant Analysis Program (SWDA) in classifying other single trial responses. The amplitudes (but not the latencies) of a negative peak at approximately 150 msec, and a positive one at 220 msec, latency were found to be different in the pairs of shapes described. SWDA was able to separate these same pairs and classify from 63 to 68% of new trials correctly. The latency points chosen to make up the discriminant functions correlated partly with the and components that were found to be significantly different in amplitude.

It is suggested that the VER differences in the earlier part of the wave-form are related to the physical properties of the stimuli, including the contrast densities in the central 1.5° of the visual field and/'or the spatial frequencies contained in the stimuli. Differences demonstrated in later parts of the VERs may reflect differences in symbolic meaning of the stimuli.

A 28 year old woman with multiple sclerosis has been followed for 10 months with serial brain scans on 5 admissions. The correlation between the clinical picture and the brain scans was clearly demonstrated.

Various examples of foreign body embolization of cerebral arteries, usually followed by serious consequences, have been reported (Lindberg et al, 1961; Chason et al, 1963; Steele et al, 1972; Wetli et al, 1972). However, a shotgun pellet entering the left atrium of the heart through a gunshot wound of the chest with subsequent embolic occlusion of one of the carotid arteries appears to be unique. It is the subject of this short communication.

The case is reported of a woman with a mucin producing lobular carcinoma of the breast with metastases to many bone sites, whose terminal neurological illness was the result, not of cerebral metastases, but of cerebral infarcts. These were caused by emboli of mucin and emulsified fat, originating in bone metastases.

The pathogenesis of this embolism is compared with that of traumatic fat embolism. Attention is drawn to this process because emboli of this type have never been reported and because this distant nonmetastatic effect of carcinoma may have been overlooked in other cases. It is suggested that this mechanism should be considered in the diagnosis of otherwise obscure cerebral infarction.

Trigeminal neuralgia was the presenting symptom in two patients with aqueduct stenosis, hydrocephalus, and raised intracranial pressure. Treatment of the hydrocephalus resulted in the remission of pain in both patients.