James Q. Miller

Transient Global Amnesia Associated With Cardiac Arrhythmia and Digitalis Intoxication

A 54-year-old woman with transient global amnesia (TGA) was found to have digitalisinduced bradyarrhythmia with atrioventricular dissociation. The amnesia cleared only upon resolution of the arrhythmia. Cardiac arrhythmia has been postulated as a cause, but TGA in the setting of cardiac arrhythmia has not been documented previously. Cardiac arrhythmia should be excluded in patients with TGA, and TGA, a syndrome diagnosed on clinical grounds alone, must be recognized as one possible manifestation of treatable, potentially serious cardiac or cerebrovascular disease.

Dandy‐Walker syndrome diagnosed in utero by ultrasonography

Fetal ultrasonography during evaluation of a pregnancy complicated by acute polyhydramnios suggested the presence of a Dandy-Walker cyst. At autopsy, the classic posterior fossa anomalies associated with that syndrome were present. In addition, the right vagus nerve was deformed by the cyst wall, suggesting that fetal dysphagia led to the polyhydramnios.

Tolosa-Hunt syndrome A radiation responsive syndrome

The Tolosa-Hunt syndrome is a clinical entity characterized by retro-orbital pain and variable involvement of the third, fourth, fifth and sixth cranial nerves related to inflammation in the cavernous sinus. Typically, this syndrome is responsive to steroids and most attacks are self-limited. However, occasional patients will have prolonged courses and become steroid dependent. A case is presented in which the patient developed significant toxicity from chronic steroid dependency. Because of the similarities between the Tolosa-Hunt syndrome and orbital pseudotumor, a course of low-dose radiation therapy was prescribed which allowed the patient to be withdrawn from steroids. The rationale for the treatment of selected patients with the Tolosa-Hunt syndrome with low-dose radiotherapy is discussed. This is the second reported case in the worlds literature of the Tolosa-Hunt syndrome being successfully treated with radiotherapy.

Clinical findings of the phakomatoses: Sturge–Weber syndrome

The dermatologic hallmark of Sturge–Weber syndrome (SWS) is the nevus flammeus (port-wine stain, PWS), a angiomatous lesion usually distributed in the region innervated by the ophthalmic branch of the trigeminal nerve1 caused by lack of normal regression of embryonic vascular plexus of the cephalic neural …

Clinical findings of the phakomatoses Hypomelanosis of Ito

Hypomelanosis of Ito (HI, incontinentia pigmenti achromians, pigmentary mosaicism-Ito type) is a multisystem disorder with unilateral or bilateral hypomelanotic whorled, streaked, or reticulated macules distributed along Baschko lines. Extracutaneous congenital abnormalities present in 75% of cases of HI and usually involve the brain; mental retardation is present in 60%, epilepsy in 50%, and autism in 10%. Dysmorphia (hemihypertrophy or hemiencephalomegaly), dental, cardiac, gastrointestinal, …

The Human Nervous System: Introduction and Review, 4th Ed.

This book is described by the editor as “current research work of more than 40 internationally renowned researchers in the field of treatment resistant depression. The chapter topics range from issues of etiology, nosology, and classification to some of the most provocative new strategies for treating this difficult syndrome.” However, in most chapters the actual questions of nosology, psychopathology, and dynamics of refractory depression seem to be dealt with as an afterthought. There is no common thread in this book. It seems more like a potpourri of papers on various aspects of affective disorders. This is really not surprising since there is very little known or written specifically on the topic of refractory depression. A further caution must be voiced for this book because i t is partially supported by a grant from a drug company and the Jack Warsaw Fund for research in biological psychiatry. This may explain the blatant lack of any exploration of personality Axis I1 issues and concepts, such as demoralization in the elderly, which are known as significant factors in refractory depression. Nevertheless, there are several chapters that are of interest to someone wanting to learn more about depression and its biological treatment. Chapter 2, by F. Sulser, addresses the complex issue of the cascade signal transduction by the 5HT-NE-glucocorticoid receptor system. This takes us far beyond the simplistic biogenic immune theories of depression. Chapter 10 is an excellent presentation by S. Montgomery on the selectivity of antidepressants and the difficulty in identifying this clinically because it is usually overshadowed by a general antidepressant effect. This is of special significance with the arrival of a completely new group of antidepressants led by fluoxetinenamely the selective serotonin reuptake inhibitors. Chapter 15 by Kukopoulos has an interesting discussion on nosology of bipolar disorders based on the sequence of depression mania and euthymic interval and how treatment responses vary depending on the sequence of the phases of affective disorders. Chapter 17 puts to rest the issue of stimulants such as Ritalin in the treatment of depression. Chapter 20 gives some interesting insights into the theory of kindling and the chaotic system theory, which explain how small, simple changes of a psychobiological nature can precipitate a complex behavior such as mania. There is also a chapter on depressive disorders in children, which doesn’t address the issue of refractory depression but gives a good overview of child studies with antidepressants. A case is presentedto clearly show the great problems of comorbidity of behavioral components and how difficult a diagnosis of major depressive disorders in children is. The specific discussions of multiple antecdotal drug treatment protocols make this book unsuitable to gain an overview of the treatment of refractory depression. The chapters mentioned in this review are potentially useful to individuals interested in the specific topics discussed. However, because of the lack of cohesiveness and a true common focus, I am unable to recommend this book to any specific group of mental health professionals or neurologists.