In 1896 Flechsig was still under the influence of Hermann Munk (1890) who had assumed that the cortex consisted of sensory centers, each equipped with efferent descending projection systems — olfactory, visual, auditory and — anterior to the last, the somatic sensory sphere (“Körperfühls-phäre”). This sphere also contained the kinaesthetic images of motor action induced by efferent fibers in the subcortical ganglia which, from Burdach (1819-26) until the time of Meynert, had been widely regarded as the highest motor centers. In 1905a, however, Flechsig had shed most of the influence of Munk. By then he had taken cognizance of the research of Grunbaum and Sherrington (1902, 1903) and realized that “in the highest anthropoid all stimulable points of the type of Fritsch and Hitzig are concentrated within one gyrus, namely the precentral gyrus, so that we can call this the motor gyrus … in man, too, the motor centers of the type of Fritsch and Hitzig are restricted to the precentral gyrus and the immediately adjacent part of the first frontal convolution. The central sulcus here too is the posterior boundary of the motor zone … Occasionally a larger or smaller part of the motor centers, especially of the fingers, gets into the postcentral convolution, but, according to my own embryological studies, only exceptionally. As a rule we have to assume that all voluntary motor impulses leave the cortex from the precentrai gyrus …”

An experimental model for the study of porphyric neuropathy is presented. Injection of either tetraphenylporphinesulfonate (TPPS), hematoporphyrin derivative (HpD), or delta-aminolevulinic acid (ALA) into mice resulted in markedly decreased motor nerve conduction velocity (MNCV). The MNCV returned to normal within one week following the injection of large doses of A LA, and within three weeks following the injection of close to lethal doses of HpD. hut there was no recovery of nerve function within 60 days following injection of substantially smaller doses of TPPS. Ultrastructural examination of motor nerves at various times following TPPS injection revealed the gradual development of structural abnormalities. Ultrastructional examination of the same nerves after a single dose of either A LA or Hp D failed to demonstrate any abnormalities.

The present observations call for precaution as to the use of TPPS as photosensitizer in human cancer treatment.

Extraneural spread of a cerebral glioma has been described infrequently. The present case provides an example of this unique mode of metastasis.

The computed tomographic (CT) examinations of one hundred and sixty patients with a clinical diagnosis of cerebral infarction were reviewed. A characteristic CT pattern was noted. Infused scans and follow-up studies allowed for considerable accuracy in diagnosis.

Fifty-five subjects undergoing carotid endarterectomy were grouped according to side of operation, i.e. right, left and bilateral. These subjects were administered a comprehensive neuropsychological battery prior to and six months following surgery. The performance of these subjects was compared with a control group undergoing surgical procedures that did not in volve the brain or cerebral vasculature, and a second control group composed of patients with cerebrovascular symptoms who were not operated. It was found that as a group the endarterectomy subjects improved on a greater percentage of measures. When various subgroups were examined, it was found that the right operated stroke patients improved on significantly more measures than any other group. The difference between right and left stroke patients was significant, but there was no difference between right and left TIA patients in the extent of improvement. These findings were discussed in terms of possible underlying mechanisms.

Four cases are described illustrating the clinical features of positional vertigo and nystagmus due to posterior fossa tumors and a case of obstructive hydrocephalus. In these cases positional vertigo was the first and only presenting symptom of central nervous system disease. One case of subependymoma of the fourth ventricle and one with hydrocephalus had characteristic symptoms of benign positional vertigo; each showed positional nystagmus of the benign paroxysmal type.

Renal function studies were performed in seventeen patients, under metabolic ward conditions, before the initiation of therapy with levodopa. These studies were repeated during the first two to three weeks of treatment and, again, after one to two years of chronic therapy. There were no significant differences between the results of pre- and post-therapy studies, except that the blood urea nitrogen was slightly, but significantly, elevated in the nine patients who had been on the drug for one to two years. During the early weeks of treatment, there was an insignificant trend towards hypotension and increased excretion of sodium. This did not persist in those patients followed for one to two years after the initiation of treatment. Glomerular filtration rate, as measured by an endogenous method, was unchanged by chronic therapy with levodopa. These results are in contrast to the acutely increased glomerular filtration rate, as measured by an exogenous method, and the increased sodium excretion following a single dose of levodopa or dopamine.

Antibodies directed against glial cells may be involved in autoimmunity in multiple sclerosis (MS). Using a tissue culture system, the presence of glial cell antibodies in MS-patient serum was detected through immunofluorescent technique. Thirty one of 73 MS-sera were strongly positive for anti-glial cells, 13 were equivocal and 29 were negative. The antibody staining was either cytoplasmic or associated with cell surface membrane, and involved IgG type of antibody.

A 52 year old female with polymyositis presenting with distal and asymmetrical weakness is presented. Similar reported cases are reviewed. These patients respond favorably to steroids. Increased awareness of this unusual distal polymyositis should avoid delay in diagnosis.

Three cases of suhacutely progressive spinal paraparesis had myélographie evidence of spinal cord swelling suggesling the diagnosis of intramedullary tumour. The diagnosis of multiple sclerosis (MS) was made in each case with the aid of CSF protein electrophoresis, evoked responses and CT scan. Because acute MS may produce cord swelling simulating tumor or syrinx, these additional investigations may he necessary to make a correct diagnosis.

A case is described thai illustrates the difficulties involved with the interpretation of postoperative posterior fossa CT scans. The reasons for the difficulties are discussed and the pertinent literature reviewed.

A 54-year-old man died following a 20-year course of intermittent neurologic symptoms. He carried a diagnosis of multiple sclerosis, with most severe involvement thought to be in the spinal cord. At autopsy, two neurenteric (enterogenous) cysts were found to indent the anterior spinal cord — at the T4 and Tl I cord levels. Partial diplomyelia was present in the lumbosacral cord. These findings represent a unique combination of congenital abnormalities. Their embryogenesis and pathogenesis are discussed.

The first case of Pasteurella Multocida subdural empyema is reported. This was secondary to hematogenous spread from the pharynx to a chronic subdural hematoma. Positive cultures were obtained from the primary source, the blood and the subdural space. The patient was discharged with no neurological deficit following surgical drainage and parenteral antibiotics. The incidence, predisposing factors, clinical features, bacteriology, diagnostic procedures, treatment and mortality of subdural empyema are briefly discussed.

Dopamine (DA) uptake by platelets from 41 patients at risk to develop Huntington’s chorea was assayed and compared to controls. The DA uptake was significantly higher in the at risk group. However, the at risk group did not separate into two distinct subgroups. which reduces the usefulness of the assay as a disease prognosticator.

Five myasthenia gravis patients with post-thymectomy residual ocular signs were treated with plasmapheresis. Despite a significant reduction in AChR antibody titer, there was no clinical improvement. Subsequently, there was a dramatic response to prednisone. The AChR antibody titer did not correlate with the clinical state of the individual patient. It is suggested that plasmapheresis may operate by removing a thymic factor and that prednisone acts by a different mechanism.

Filamentous axonalmasses, similar to the abnormal enlargements found in the ventral horns, were found in Clarke’s nucleus in six cases of sporadic A LS. Clarke’s nucleus is generally thought to be normal in sporadic A LS, but the present findings, in conjunction with distal spinocerebellar degeneration which is often described, suggest that this system is also pathologically involved.

Anoxic tonic seizures are reported as a complication of severe asthma in two adults. The nature of these attacks can be misinterpreted. They do not indicate the presence of a recurrent seizure problem unconnected to the episodes of anoxia caused by asthma. These attacks do not respond to antiepileptic medication, but cease if the asthma can be controlled. One of our patients developed an anoxic encephalopathy and the other died. The need for prompt diagnosis and appropriate treatment is emphasized.

The authors report a single case of Huntington’s chorea associated with a unilateral focus of ectopic gray matter. The patient’s symptoms began at age 45 and included typical involuntary jerking movements of all extremities and face. Mental deterioration may have proceeded the choreiform movements. The family history was positive for Huntington’s chorea. Pneumoencephalogram showed atrophy of the caudate nuclei bilaterally early in the disease. The patient improved transiently with haloperidol therapy.

The major pathologic features included mild generalized cerebral atrophy with marked atrophy of the caudate nuclei and putamen. Within the white matter of the left frontal lobe, there were irregular nodules of ectopic gray matter with an overall diameter of 2 cm.

The rarity of either unilateral ectopia or Huntington’s chorea alone, makes it impossible to judge if the two lesions might be linked by a common pathologic mechanism. The significance such a linkage might hold is discussed in light of several currently postulate pathologic mechanisms.