Donald R. Bennett

Cranial CT appearance of acute multiple sclerosis

In acute multiple sclerosis, cranial computerized tomography (CT) may show periventricular and deep white matter contrast-enhanced lesions that are easier to see using 8 mm rather than 13 mm cranial CT sections. Follow-up studies show that the lesions evolve either to areas of density similar to the surrounding white matter or to low-density lesions. We presume they represent foci of active demyelination with extravasation of iodine through an altered blood-brain barrier. Enhanced cranial CT studies may be helpful in diagnosing acute multiple sclerosis and in following the course of the white matter lesions.

Clinical and EEG manifestations of an unusual aphasic syndrome in children.

Three cases of acquired aphasia in childhood associated with marked spike-wave discharges with temporal lobe predominance are described. The degree of aphasia paralleled the EEG abnormalities; spike-wave discharges were almost continuous when the language disorder was at its peak. Improvement in the language disorder coincided with reduction in the number of paroxysmal discharges or with a change to focal origin. The aphasia appears to be the result of an underlying pathophysiology causing the abnormal EEG activity, and not the result of a gross structural lesion.

On national needs for neurologists in the United States

Estimates of the number of neurologists needed in the United States have been widely divergent. For direct patient care needs alone in a US population of 243.5 million, the Joint Commission on Neurology (ANA-AAN) estimate was 14,000 neurologists, the Delphi Panel median (Battelle/GMENAC) 11,200, and the Advisory Panel (Battelle/GMENAC) 6,200; our review suggests a need for 12,600. Total needs for clinical neurologists including faculty were 8,400 (Advisory Panel), 14,500 (Delphi Panel), and 16,500 (ours) for respective rates of 3.44, 5.96, and 6.76 neurologists per 100,000 population.

Neurologists in the United States—past, present, and future

Neurologists in the United States were enumerated for each year from 1935 to 1984 on two bases: board certification (including Child Neurology and Psychiatry and Neurology) and completion of PG4 neurology residency training. The annual incidence of new neurologists was calculated at less than 200 until 1970; then it rose steadily to 380 in 1980, and plateaued thereafter at 385. The estimated number of neurologists present at one time (prevalence) was 1,500 in 1950, 2,400 in 1970, 4,600 in 1980, 8,100 in 1990, and 11,000 in 2000. These numbers for total neurologists will plateau at 12,200 by about 2010, at which time the number of certified neurologists will also plateau at 9,900. Both numbers are notably less than our prior estimate of needs: 16,500 neurologists by 1990, 19,100 in 2010.

Primary amenorrhea secondary to noncommunicating hydrocephalus. Case report.

ENDOCRINOLOGICAL DYSFUNCTION in hydrocephalus of early onset may occur more frequently than is realized. In Guillaume and RogB’s series of 15 young patients with hydrocephalus evaluated because of primary neurological complaints, there were 4 cases of small stature, 1 of gigantism, 4 of “obesity,” 4 of delayed puberty, 2 of absent secondary sexual characteristics, 3 of menstrual irregularity, 2 of glycosuria, and 1 of diabetes insipidus and sleep disturbance.l The purpose of this paper is to report a case of primary amenorrhea secondary to pressure on the pituitary gland from an enlarged third ventricle (chronic noncommunicating hydrocephalus), with spontaneous menstruation following ventriculojugular shunt.

Neurology residency training programs in the United States

A survey of 127 neurology residency training programs (124 approved by the Accreditation Council for Graduate Medical Education; 3 by the American Osteopathic Association) in the United States indicated that 80% were sponsored by medical schools. Of the 2,700 MD neurology faculty in 1982, 3/5 were full-time. As of 1982, there were 1,300 neurology trainees, including 334 fourth-year postgraduates (PG4s); 21% were women, and 3% held DO degrees. From 1980 through 1983, about 6,000 PG4s were produced, and for 1984 through 1990 the program directors estimated that this lumber will be about 3,000; our own projection, however, was only 2,400.