Oscar Reinmuth

The dissolution of language in Pick's disease with neurofibrillary tangles: A case study

This paper is a detailed retrospective history of a patient who began to have difficulty with speaking and comprehension in 1967, and whose neuropathological examination at time of death 12 1/2 years later was consistent with a diagnosis of Picks disease, complicated by neurofibrillary tangles. It follows the deteriorating course of his language abilities in the context of relatively less-impaired general cognitive abilities, using two sources of information. The first is his own written record of his deteriorating abilities, shown in letters and notes he wrote over this period. The second is through an oral history obtained from the patients family. The purpose of this report is to illustrate in detail the course of a degenerative condition and to suggest the utility of such descriptional records in increasing understanding of language deterioration in dementia.

Clinical experience with the use of xenon-enhanced CT blood flow mapping in cerebral vascular disease.

Cerebral blood flow mapping with the xenon-enhanced/CT method has become a useful clinical tool in the management of patients with occlusive cerebral vascular disease. Studies involving 4-5 minutes of inhaling a xenon/oxygen mixture (=£ 35%) can now be performed routinely with acceptable patient tolerance and compliance. Four cases with acute and chronic ischemlc injuries are reported here to illustrate the manner in which this method has been used to characterize flow pattern in such patients and the relevance of this flow information to clinical patient management. Stroke Vol 15, No 3, 1984

Serum autoantibodies in patients with Alzheimer's disease and vascular dementia and in nondemented control subjects.

Background and Purpose In this study we sought to evaluate the clinical significance of serum autoantibodies to dementing processes. Methods We assessed 40 age-matched subjects: 10 patients with probable Alzheimers disease, 10 with possible Alzheimers disease with cerebrovascular disease, 10 with vascular dementia, and 10 nondemented control subjects. Serum from each subject was tested for the presence of antithyroglobulin antibody, thyroid antimicrosomal antibody, gastric anti-parietal cell antibody, anti-smooth muscle antibody, antinuclear antibody, rheumatoid factor, antineuronal antibody, and anticardiolipin antibody. In addition, we investigated the sera of these patients for the presence of an antivascular antibody directed against the vascular basement membrane proteoglycan antigen and for circulating immune complexes. Results Autoantibodies were present in 100% of the patients with possible Alzheimers disease with cerebrovascular disease, 80% of those with vascular dementia, 40% of those with probable Alzheimers disease, and 30% of the nondemented control subjects. The highest number of autoantibodies was observed in patients with vascular dementia and possible Alzheimers disease with cerebrovascular disease. Antinuclear antibody was present in 60% of vascular dementia patients and antineuronal antibody in 50% of these patients. However, no individual autoantibody could differentiate Alzheimers disease from cerebrovascular disorders. Immune complexes were detected in the serum of 20-30% of each patient group. Neither the patient nor the control sera was found to contain antiendothelial antibody. Conclusions Despite the relatively small number of individuals examined in each category, the elevated number of autoantibodies associated with possible Alzheimers disease with cerebrovascular disease and vascular dementia indicates a possible link between the presence of autoantibodies and cerebrovascular disorders in dementia.

Predictors of electromechanical dissociation during cardiac arrest

ECG patterns observed during cardiac arrest were analyzed in 261 comatose cardiac arrest survivors. Forty-seven patients (18%) exhibited electromechanical dissociation (EMD) at some point before restoration of stable spontaneous circulation. These patients had a higher mortality (P = .05) and a lower rate of cerebral recovery (P = .01) during the one-year follow-up than study patients who did not exhibit EMD. Patients who developed EMD subsequent to defibrillation had better outcome than patients presenting with EMD. Multivariate analysis revealed that age more than 70 years old (P = .007), pulmonary disease (P less than .001), diabetes (P = .013, in-hospital arrests only), and prearrest hypoxemia (P = .013, outside-hospital arrests only) were independently predictive of the occurrence of EMD. Although the generalizability of these findings is limited, they may offer new clues to the pathophysiology of EMD.

An international collaborative clinical study mechanism for resuscitation research

Recent experimental and clinical studies of cardiac arrest, suggesting a brain damage ameliorating effect of thiopental loading, stimulated the development of an international randomized clinical trial of brain resuscitation. Twelve collaborating hospitals in 9 countries are testing the efficacy of post-cardiac arrest thiopental loading (30 mg/kg body wt). The methodology for assessing insult and outcome data, as well as risk and benefit monitoring, is described. This clinical trial will be completed in 1983 and is expected to provide valuable data about the efficacy of thiopental loading. The study mechanism is now well-established and ready for the evaluation of future promising brain resuscitation therapies.