Edgar A. Kahn

Korsakoff's syndrome associated with surgical lesions involving the mammillary bodies

THE MENTAL MANIFESTATIONS of Korsakoff‘s syndrome-amnesia, confabulation, and disorientation-are familiar to most physicians. Delay1 in 1942 and Barbizet’ in 1963 coilsidered them to be defects in memorizing with possible involvement of the hippocampi and mammillary bodies. It had been thought earlier that lesions were invariably present in the mammilhry bodies. A comprehensive monograph on the subject was published by Delay and Brion3 in 1969. There has been considerable confusion about the syndromes of Korsakoff and Wernicke. Wernicke’s syndrome is almost always due to alcoholism or at least to a thiamine deficiency and usually has an apoplectic onset, hemorrhages being found in the mamillary bodies and midbrain. The mental symptoms of Korsakoffs syndrome are present but to these are added ophthalmoplegias. Gamper,4 in 1928, showed the similarity of the pathological processes in the two syndromes. In a detailed study of the brains of 16 alcoholics, there were lesions extending from the thalamus and hypothalamus to the brainstem, and the mammillary bodies were involved in all the cases. There were no consistent changes in the cerebral cortex. I t is well known that Korsakoffs syndrome can have etiologies other than chronic alcoholism. The syndrome has been described with lesions in the hippocampi5.6 and the septa1 area718 and with tumors pressing upon the mammillary bodies.o--12 We are describing 5 cases which showed the syndrome of Korsakoff as a result of retrochiasmal craniopharyngiomas iiivolving the mammillary bodies. In 4 cases the symptoms disappeared soon after removal of the tumor. The anatomical bases for the development of Korsakoffs symptoms will be discussed in the light of clinical cases.

Chronic Neurological Sequelae of Acute Trauma to the Spine and Spinal Cord: The Significance of the Acute-flexion or "tear-drop" Fracture-dislocation of the Cervical Spine

The acute-flexion or tear-drop fracture-dislocation associated with injuries of the cervical spinal cord warrants special attention. It is characterized by the separation and downward and forward displacement of the anterior inferior margin of the involved vertebral body. The posterior inferior margin of this same vertebral body is displaced posteriorly into the spinal canal. Acute injuries of this type may be associated with the syndrome of damage to the anterior aspect of the cervical cord. This syndrome may be due to either destruction of this portion of the cord or to compression by displaced bone or disc material. If due to compression, this may be relieved by a surgical procedure. In these cases surgical exploration with the patient in traction and section of the dentate ligaments are indicated, if neurological signs are present. Spine fusion should then be performed at the primary operation, or at a secondary procedure. This will prevent See Images in the PDF file instability of the spine, and the fractured cervical vertebrae will heal in good alignment without the formation of a bony bulge posteriorly. Such bulging may cause chronic compresion of the anterior portion of the cervical spinal cord with neurological sequelae. If the tear-drop fracture is present without neurological signs, spine fusion without laminectomy should be performed after spinal re-alignment by cervical traction.

The effects of splanchnicectomy on the blood pressure in hypertension; a controlled study.

The effect of supradiaphragmatic splanchnicectomy on the blood pressure of 294 hypertensive patients followed for 10 to 18 months after surgery is compared with the effects of nonspecific medical management in a control group of 79 patients similarly studied. The data are presented in simple graphic form. It is concluded that 29 per cent of the hypertensive patients had reductions in blood pressure outside the range of spontaneous variation, that the vascular complications of hypertension decreased the likelihood of a good result, and that extension of the sympathetic ganglionectomy upward appeared to increase the frequency of good results without requiring a two-stage operation or producing significant postoperative orthostatic hypotension.

Considerations on the surgical treatment of slipped epiphysis with special reference to nail fixation.

Conservative treatment of slipped epiphysis has now been superseded by surgical procedures. If the slipping is slight or moderate, bone-pegging or fixation in situ with a nail is indicated. In our series of 185 nailed hips, the complications which occurred in the patients operated upon were: driving away of the epiphysis, bending of the guide wire, perforation of the cortex of the femoral head, gliding of the nail, femoral fracture, and necrosis of the femoral head. Only in one patient had complicating necrosis of the femoral head any permanent effect on the hip. The frequency of complications was lower following the use of blunt three-flanged nails. Wedge osteotomy of the femoral neck performed on patients in the series of eighty-four hips was followed by necrosis in 27 per cent and it is questionable whether this method is justified.

Certain Afferent Cortical Connections of the Rhinencephalon

Publisher Summary Afferent connections from various cortical areas to the hippocampal gyrus and the hippocampus are traced in Marchi preparations following suitable lesions. The projection of the cingulate gyrus to the inferior temporal gyrus and the hippocampal gyrus and, in less amount, directly to the hippocampus and the amygdala are demonstrated. The connections of the orbital surface of the frontal lobe with the hippocampal gyrus and the hippocampus, as well as with the inferior temporal cortex, are described from a clinical case in which there was a lesion in the orbital cortex. The results exhibit that the anterior temporal lobe syndrome (involving the rostral end of the temporal lobe, the rostral end of the hippocampus, and the hippocampal gyrus and the amygdala of the anatomists) may be equally well obtained from irritating lesions in frontal cortex or cingulate cortex without any direct inclusion of the rostral temporal or rhinencephalic fields in the lesion. The typical anterior temporal lobe syndrome includes deja vu phenomena, olfactory aura, micropsia and macropsia, and sometimes auditory hallucinations.

Acute Injuries of the Cervical Spine

Care of the patient with spinal cord injury is stressed. Successive steps in management are presented beginning at the scene of injury and proceeding to the emergency room and then to the hospital ward. Diagnostic procedures are discussed, and emphasis is placed on prevention of pressure sores, initial treatment of the paralytic bladder and bowel, and prevention of deformities.

Introductory remarks concerning neural factors in essential hypertension.

The vasoconstrictor effect of neural stimuli from frontal and hypothalamic centers to the blood vessels, including the renal arterioles, is reviewed. Such a theory of the pathogenesis of hypertension is probably deficient, since humoral or atherogenic factors also play a part. Nevertheless, splanchnicectomy may sometimes alleviate superimposed vasoconstriction and help in treatment of the patient.