Bennett Blumenkopf

Preferential neuronal loss in layer III of the entorhinal cortex in patients with temporal lobe epilepsy

We report a characteristic pattern of neuropathological change in the entorhinal cortex (EC) from four patients with temporal lobe epilepsy. Specimens of the EC were obtained during the surgical treatment of intractable partial seizures and were studied by light microscopy in Nissl-stained sections. A distinct loss of neurons was observed in the anterior portion of the medial EC in the absence of apparent damage to temporal neocortical gyri. Cell loss was most pronounced in layer III, but also noticed in layer II, particularly in the rostral field. A similar pattern of neurodegeneration in the EC was found in all specimens examined though the degree of neuronal loss varied between cases. These observations provide neuropathological evidence for an involvement of the EC in temporal lobe epilepsy. Since the EC occupies a pivotal position in gating hippocampal input and output, our results further support previous suggestions that dysfunction of this region may contribute, either independently or in concert with Ammons horn sclerosis, to epileptogenesis in humans.

Meningeal neurosarcoidosis mimicking convexity en-plaque meningioma

A 34-year old man presented with headaches. Computed tomography scanning revealed an enhancing subdural mass extending from the skull base to the convexity, thought to represent an en-plaque meningioma. Pathologic study revealed extraaxial subdural granulomatous inflammation consistent with neurosarcoidosis.

Thoracic intervertebral disc herniations: diagnostic value of magnetic resonance imaging

Thoracic disc herniation is relatively rare and frequently poses a challenge in clinical diagnosis. These protrusions have been categorized into two major anatomical types and three main clinical syndromes. A number of characteristic radiographic features have been reported. Recently, magnetic resonance imaging (MRI) has gained popularity as a neurodiagnostic imaging tool. A series of nine cases of thoracic intervertebral disc herniation is reported. The clinical aspects of the cases are discussed, and the potential value of spine MRI for thoracic disc herniation diagnosis is emphasized.

Comparison of subjective and objective analgesic effects of intravenous and intrathecal morphine in chronic pain patients by heat beam dolorimetry

&NA; The pain tolerance latencies of 10 chronic pain patients were evaluated by heat beam dolorimetry (stimulus intensity 15.33 mW · cm−2 · sec−1) prior to and following administration of morphine by intrathecal (n = 5) or intravenou Patients not undergoing opiate withdrawal evinced increased baseline pain tolerance latencies prior to drug administration compared with normal volunteers. Two patients undergoing the opiate withdrawal syndrome at the time of test experienced reduced pain tolerance latencies compared with normal volunteers, most probably corresponding to the hyperesthesia symptom of the syndrome. Intravenous morphine infusion (30 mg) induced a time‐dependent increase in cutaneous pain tolerance with peak effect occurring 1–2 h after administration. This persisted for up to 4 h and thereafter declined. The time course of subjective pain self‐report by visual pain analog scale (VPAS) measurements corresponded to the time course of increasing cutaneous pain tolerance latency assessed by dolorimetry. Pain self‐reports following intrathecal morphine infusion (2.25 or 1 mg) followed a similar though slower onset to that reported by patients receiving intravenous morphine and was of lesser degree. In contrast, heat beam dolorimetric evidence of increased cutaneous pain tolerance (which was of lesser degree than following i.v. morphine) did not reach its maximum during the 4 h measuring period. A dissociation was noted therefore between the self‐reported relief of endogenous pain and dolorimetrically measured cutaneous analgesia following intrathecal morphine administration. Linear regression correlation analysis characterized this phenomenon as a positive correlation between cutaneous pain tolerance and pain relief self‐report following intravenous morphine infusion and a negative correlation following intrathecal administration. We propose that the phenomenon may be due to intrathecal morphine acting via two separate compartments: one spinal and one supraspinal. We further propose that the prolonged segmental action of intrathecal morphine is continued through supraspinal processes, which induce dolorimetrically measurable elevation of pain tolerance level.

Chronic pain assessment using heat beam dolorimetry

&NA; The heat beam dolorimeter (HBD) was developed to evaluate cutaneous pain thresholds in humans. In the present study, the hypothesis that a patients underlying pain status affects his pain tolerance to an incident HBD stimulus was tested. Twenty‐seven chronic pain patients with a variety of clinical problems unresponsive to conventional algological therapy were scheduled for neurosurgical procedures. These patients were evaluated pre‐ and postoperatively by the HBD procedure. On initial testing, drug‐free pain patients showed significantly higher pain tolerance thresholds than normal volunteers (P < 0.02, Mann‐Whitney U test). Postoperatively, incident pain tolerance thresholds in the HBD test were reducedfrom pre‐surgical levels in these patients and were indistinguishable from the second evaluation latencies of volunteers (P > 0.05). Twenty‐four of the 27 patients reported significant pain relief following surgery. Our results show that, in chronic pain patients, endogenous pain significantly affected incident pain perception in the HBD test when compared with the responses of normal pain‐free volunteers. Consequently, HBD may be useful in objectively assessing chronic pain and its relief by neurosurgical procedures.

Tuberous sclerosis and multiple intracranial aneurysms: case report.

A 6-year-old girl with tuberous sclerosis was found to have multiple intracranial fusiform arterial aneurysms. This represents the fifth reported case of this association. The concepts of an arterial dysplasia being present in cases of tuberous sclerosis and of developmental defects being the cause of some intracranial aneurysms are discussed. The need for a prospective study to assess the prevalence of intracranial aneurysms in patients with tuberous sclerosis is suggested.

Primary leptomeningeal gliomatosis and "numb, clumsy hands": a case report.

A 48-year-old man presented with the numb, clumsy hand syndrome. Evaluation revealed a high cervical cord lesion. Surgical exploration discovered leptomeningeal gliomatosis with no discernible intraparenchymal component. The clinical features of the case, the neuroimaging studies including magnetic resonance scanning, and the most unusual pathological nature of the lesion are discussed.

Computed tomography detection of cervical spinal cord hemangioblastoma: a case report

Hemangioblastomas of the spinal cord are uncommon, accounting for 1.6% and 2.1% of all spinal cord tumors (1). Until recently these vascular lesions were best evaluated angiographically. Several cervical hemangioblastomas have been studied by computed tomography with intravenous contrast medium enhancement (2-4). This report illustrates the use of computed tomography with combined intravenous and intrathecal contrast medium enhancement, which permitted preoperative diagnosis and treatment planning of an intramedullary hemangioblastoma.

Ocular bobbing with ruptured giant distal posterior inferior cerebellar artery aneurysm

A patient presented comatose with an intraventricular hemorrhage of unknown etiology, and manifested the unusual clinical phenomenon of ocular bobbing. Further evaluation revealed a giant aneurysm of the distal posterior inferior cerebellar artery, which was successfully treated surgically. The pathophysiology of ocular bobbing is discussed as well as the association of this unusual sign with a rare aneurysm.

Percutaneous minidose metrizamide endomyelographic computed tomography in syringomyelia.

Two patients presented with syringomyelia, each unusual. After neuroradiographic diagnosis with delayed metrizamide computed tomography (CT) or magnetic resonance imaging (MRI), an interesting diagnostic question arose. A percutaneous minidose metrizamide endomyelographic CT (PMDMECT) study clarified each situation and directly affected the neurosurgical approaches. The features of each case, the technique of PMDMECT, and postoperative follow-up data are reported.