Philip R. Dodge

Epilepsy in Cerebral Vascular Disease

As the mean age of our population rises, the problems of cerebral vascular disease assume increasing importance. Moreover, the prolongation of life in these patients by more effective general medical therapy is resulting in increasing opportunities to study the natural history of the disease process. In an excellent article on cerebral vascular disease, A d a m and Vander Eecken ( 1953 1 have reviewed critically much of our present knowledge on this subject. We have become interested in one of the aspects of cerebral vascular disease, namely, its relationship to the development of seizures in adult life. In the past this has been the subject of much speculation and discussion, yet the available studies and reports have left many of the fundamental questions still unanswered. One of the defects in our knowledge arises from the lack of studies using series of consecutive cases with pathological verification and acceptable controls. It is the purpose of this report to present data on the incidence of seizures in 104 patients who on post mortem examination were found to have cerebral infarction and/or hemorrhage and to compare this incidence with that in a control group of 74 patients of comparable mean age who had cerebral arteriosclerosis but no evidence of cerebral infarction or hemorrhage. It is intended also to analyze and to correlate the various clinical and pathological data and to compare our findings with those from the medical literature. Finally, it is hoped to discuss the results in the light of current concepts of cerebral vascular disease and cf convulsive disorders.

Experimental herpes simplex encephalitis Electroencephalographic, clinical, virologic, and pathologic observations in the rabbit

Abstract Herpes simplex virus was instilled in the conjunctival sac of six rabbits; four of these animals developed clinical evidence of encephalitis within 6–10 days and died of their disease within 1–4 days. In these animals EEG tracings showed the development of seizure discharges occurring on a background of irregular slow waves. These EEG changes appeared before definite clinical evidence of encephalitis in every animal. In the two animals which survived, no such changes were seen over a 6 week period following inoculation of virus.

Unilateral pupillary dilatation during and immediately following seizures

All cases of epilepsy and head trauma :idniitted to the neurological and neurosurgical services and all neurological consultations at the Massachusetts General Hospital for the years 1963 to 1965 were retrieved using an IBM sorter. (Identifying data, including diagnoses, are recorded routinely on IBM cards for every neurological and neurosurgical admission and for every neurological consultation. ) Approximately one thousand cases were reviewed for observations on pupiIlary size during and following seizures. Six examples of transient anisocoria related to seizures were found in this manner. Six additional cases had been observed a t various other times by one of the authors. These twelve cases form the basis of this report.

THE DISTRIBUTION AND FATE OF SUBDURALLY INSTILLED HUMAN SERUM ALBUMIN IN INFANTS WITH SUBDURAL COLLECTIONS OF FLUID.

IN RECENT YEARS it has been clearly demonstrated that albumin is the principal protein constituent of subdural effusion fluid of infants.1,’ A factor postulated as contributing to the persistence and enlargement of the effusion has been the effective osmotic or oncotic pressure created by this albumin-rich fluid. Support for the concept that the albumin is derived from blood and enters the subdural fluid by way of the thin-walled vessels of the outer subdural membrane was provided by a prior investigation in which intravenously injected 1131labeled albumin appeared rapidly in the subdural fluid of a 5-month-old infant with a traumatic effusion.2 The data from this study also were consistent with an exchange of labeled for unlabeled albumin molecules between plasma and subdural fluid and permitted calculation of the albumin turnover time. In the present study the distribution and fate of labeled albumin injected directly into the subdural space of 2 infants with chronic subdural effusions were investigated. Labeled albumin appeared in the blood soon after injection, and from its rate of disappearance from the subdural space, the turnover times, turnover rates, and turnover were calculated, confirming the concept of an active exchange

Non-fatal Submersion

Requests for reprints may be forwarded to the Editorial Director, John P. Connelly, M.D., Chief, Ambulatory Division, Children’s Service, Massachusetts General Hospital, Boston, Massachusetts 02114. * The opinions, or assertions made by Captain J. Imburg, MC, USN, contained herein are his own and are not to be construed as official, or reflecting the views of the Navy Department or the Naval Service at large. Dr. Keating: The day of admission, this 15year-old boy dove from a power boat into the

GASTROINTESTINAL ENDOSCOPY IN INFANTS AND CHILDREN

Thirty children ranging from 2 to 17 years of age have undergone 32 gastrointestinal endoscopic procedures. A variety of flexible fiberoptic instruments were utilized. The recently available Olympus GIF-P (tip diameter 7.2 mm) appears to be a significant advancement for upper gastrointestinal endoscopy. Preparation and anesthesia for the cases varied with the age of the child and the nature of the procedure. A definitive diagnosis was made solely by upper gastrointestinal endoscopy in 6 of 6 procedures performed for upper gastrointestinal bleeding, 2 of 6 for ulcer-type pain, 0 of 2 for gastric outlet obstruction, 1 of 4 for possible esophagitis, and each procedure performed for single cases of dysphagia, pre-pyloric mass, possible esophageaI varices, and antral deformity in a patient with regional enteritis. A definitive diagnosis was made solely by colonoscopy in 1 of 5 patients with possible inflammatory bowel disease and 0 of 1 patient with lower gastrointestinal bleeding; 4 of 4 polypectomies were successful. Non-diagnostic or normal examinations almost invariably yielded valuable information. There were no significant complications. Our experience suggests that gastrointestinal endoscopy is a safe and valuable procedure which offers promise as a sensitive diagnostic tool in infants and children.