Helio Lemmi

The Utility of the REM Latency Test in Psychiatric Diagnosis: A Study of 81 Depressed Outpatients

To examine the utility of the REM (rapid eye movement) latency test in identifying outpatient primary depressions, 81 consecutive referrals to a sleep disorders center were evaluated in a phenomenologic, sleep polygraphic, and psychometric study. Modified Feighner (St. Louis) diagnoses were definite primary depression (n = 19), probable primary depression (n = 30), depression chronologically secondary to preexisting psychiatric disorders (n = 19), and nonaffective psychiatric disorder (n = 13). There were 18 nonpsychiatric controls. REM latency less than 70 minutes on 2 consecutive nights detected 62% of primary depressions, discriminating them from the other diagnostic groups with 88% specificity. There were no false positives among controls. These data provided a 90% confidence for the diagnosis of primary depression in this outpatient sample. Requiring 2 consecutive nights of shortened REM latency appears to improve significantly the specificity of a test previously considered to have high sensitivity but relatively low specificity for depressive disorders.

Subacute sclerosing panencephalitis Correlation of clinical, neurophysiologic and neuropathologic findings

Clinical, neurophysiologic and neuropathologic findings were correlated in five cases of subacute sclerosing panencephalitis (SSPE). In the early stages, the disease chiefly affects the occipital areas, then spreads to the anterior portion of the cerebral hemispheres. Subcortical structures, brain stem, and spinal cord are involved later. Involvement of the brain stem by intranuclear inclusion bodies appears to be an almost constant finding. The EEG complexes typical of early SSPE indicate relative preservation of the cortex. Later, when marked cortical damage occurs, these EEG changes disappear. Neuropathologic findings—neuronaI abnormalities, gIial and inflammatory changes, demyelination, and inclusion bodies—most likely are dependent on the clinical stage at the time of brain biopsy or autopsy.

Neuromyelitis optica (Devic's syndrome) in two sisters.

Neuromyelitis optica (Devics syndrome) typically occurs in a sporadic pattern. We studied the disorder in two sisters, ages 6 and 10 years, who presented with sudden loss of vision at age 3 years, followed 5 months later by a transverse myelopathy. The older girl had only light perception in either eye, persistent paraparesis and progressive scoliosis; her sister had a visual acuity of 20/200 in both eyes and mild spinal cord dysfunction. Results of electrodiagnostic tests correlated well with the severity of clinical neurologic deficits and provided objective estimates of the extent of tissue damage in both the optic nerves and the spinal cord. The presence of Devics syndrome in these two sisters could be coincidental; however, the possibility of a shared genetic factor(s) should be considered.

Electroencephalographic Findings in the Noonan Syndrome

In 1963 Noonan and Ehmke (1) described a series of male and female children with pulmonic stenosis and associated anomalies. The spectrum of anomalies was subsequently delineated more fully and the constellation designated the Noonan syndrome ( 2 7 ) . The phenotype bears some similarities to the Turner syndrome but is clinically separable and in the Noonan syndrome no abnormality of the sex karotype exists. Table 1 lists for clarification the various terminologies related and unrelated to the Noonan syndrome. A distinction between this syndrome and the Turner syndrome was outlined by Summitt (5 -7 ) who compiled a list of the most common features of the Noonan syndrome (Table 2). Figure 1 shows a patient with some of the outstanding clinical features of this syndrome, namely the characteristic craniofacial abnormalities, deformity of the neck and lymphedema. Although evidence exists that cerebral involvement is a common part of this syndrome, as indicated by the fact that over 50% of patients are mentally retarded, to date no electroencephalographic (EEG) studies have been published.

Apnéia obstrutiva durante o sono: avaliação clínica e poligráfica de 150 casos

Obstructive sleep apnea is one of the most common causes of excessive daytime sleepiness. In our sample, clinical evaluation generally suggested this diagnosis by daytime sleepiness (90.6%) and loud snoring (92.0%). Respiratory pauses and inspiratory gasps were frequently reported (12.6%). The age of presentation was after the fourth decade in 87.2%. Polysomnography was characterized by numerous obstructive or mixed apneas, with mean apnea index 37.1; frequent arousals following the apneas; reduction or abscence of stages 3 and 4; reduction of sleep efficiency; hypoxemia and EEG arrhythmias during the respiratory pauses. Tracheostomy was performed in 45 cases, uveopalatopharyngoplasty in 43 and both surgeries in 5, as treatment of choice.Obstructive sleep apnea is one of the most common causes of excessive daytime sleepiness. In our sample, clinical evaluation generally suggested this diagnosis by daytime sleepiness (90.6%) and loud snoring (92.0%). Respiratory pauses and inspiratory gasps were frequently reported (12.6%). The age of presentation was after the fourth decade in 87.2%. Polysomnography was characterized by numerous obstructive or mixed apneas, with mean apnea index 37.1; frequent arousals following the apneas; reduction or abscence of stages 3 and 4; reduction of sleep efficiency; hypoxemia and EEG arrhythmias during the respiratory pauses. Tracheostomy was performed in 45 cases, uveopalatopharyngoplasty in 43 and both surgeries in 5, as treatment of choice.

Valor da linha bimastóidea de Fischgold e Metzger para o diagnóstico radiológico da impressão basilar

With the purpose of establishing the normal figure of the distance between the odontoid tip and the Fischgold-Metzgers bimastoid line - a useful reference for the radiological diagnosis of basilar impression - the authors make the statistical study of the measurements on 127 craniograms of patients without occipito-cervical malformations and on 11 cases of basilar impression diagnosed clinical and radiologically. The correlations of that distance with age and with the distance from the odontoid tip to the McGregors basal line are studied. The authors conclude that: 1) Above 10 years of age, the average distance from the odontoid tip to the bimastoid line is normally +0.56 ± 5.79 mm., the fiducial limits being -10.79 and +11.91 mm. Therefore, figures above 12 mm. must be considered as radiological index of basilar impression. 2) Correlation was observed between the distances from the odontoid tip to McGregors and Fischgold-Metzgers lines, in 120 normal cases, above 10 years of age. 3) There was no difference between sexes in relation to the distance from the odontoid tip to the bimastoid line. 4) At least until 20 years of age there is correlation between this distance and age. Therefore, under that age, the diagnosis of basilar impression must be made in presence of lesser figures of this distance, the upper normal limit being around +8 mm. 5) In cases of basilar impression, the average distance from the odontoid tip to the bimastoid line was +21.09 ± 10.03 mm., significantly greater than the average of cases without occipito-cervical anomalies. 6) There was no correlation between the degree of basilar impression and the age and between the distances from the odontoid tip and McGregors and Fischgold-Metzgers lines in the cases of basilar impression.

NCPAP for the treatment of obstructive sleep apnea.

Nasal continuous positive airway pressure (NCPAP) represents a real advance in the management of obstructive sleep apnea (OSA). Our data show that except for awakenings, all sleep and respiratory parameters were significantly improved (p less than 0.05) in favor of the group treated with NCPAP. A main problem with NCPAP is the acceptance by the patient; it also may disturb the sleep, at least, on short term basis and, in a small number of patients, it does not correct the apneas. In our patients series, males responded better to NCPAP than females.

IX reunião da American Academy of Neurology

Este congresso, realizado em Boston entre 22-27 abril 1957, teve grande sucesso conforme se depreende dos seguintes dados: inscreveram-se mais de 700 congressistas; foram apresentados 132 trabalhos, sendo que 32 se referiam à neuroquímica; nos cursos especiais feitos em paralelo com o certame inscreveram-se 422 candidatos. Para possibilitar a apresentação de todos os trabalhos foram realizadas várias sessões simultâneas, tornando difícil uma apreciação de conjunto. Um neurologista paulista remeteu as notas abaixo contendo suas impressões sobre alguns dos trabalhos mais importantes cuja exposição pôde ouvir.