Central neurofibromatosis

Two patients with central form of neurofibromatosis are reported. Bilateral acoustic neuromas were diagnosed by computerized tomography (CT) scan in one and at autopsy in the other patient. The clinical and radiologic features in the first patient indicated associated bilateral optic nerve gliomas. The autopsied case in addition had multiple meningiomas and numerous nontumorous glial hamartomas. The clinical, pathologic and biochemical basis for classification of neurofibromatosis into central and peripheral forms are discussed.

Adult aqueductal stenosis with Recklinghausen's neurofibromatosis

A 28-year-old man with von Recklinghausen's neurofibromatosis was first seen with a spastic-ataxic gait and epileptic seizures of recent onset. computerized tomographic scan established the diagnosis of aqueductal stenosis, rarely reported in patients with von Recklinghausen's disease. The value of computerized tomography in the etiological diagnosis of hydrocephalus in von Recklinghausen's disease is emphasized and the pathogenesis of aqueductal narrowing in neurofibromatosis is discussed.

Vascular changes in leprosy and its role in the pathogenesis of leprous neuritis

The arteriographic pattern of left hand vessels was studied in 20 patients in leprosy by percutaneous brachial arteriography. Arteriographic abnormalities noted consisted of occlusion, narrowing, tortuosity, dilatation, irregularity and incomplete filling of the lumen by contrast medium. Such abnormal findings were seen in all the arteriograms studied and more than one vessel involvement was noted in over 50 percent cases. This study clearly demonstrated that arterial involvement in leprosy was frequent. No correlation was found between motor weakness and vascular abnormalities. There was no difference in arterial lesions between the patients with and without trophic changes. There was also no correlation between the severity of vascular changes and decline in motor nerve conduction. Degree of histopathological abnormalities in the sural nerve biopsy from these patients showed no features of micro angiopathic neuropathy. It is concluded that the observed vascular abnormalities do not contribute significantly in the genesis of neurological deficit in leprosy.

Migraine with interparoxysmal sharp complexes in the EEG: clinical features and response to anticonvulsant drugs

The clinical profile and therapeutic response of 25 patients with migrainous headaches with interparoxysmal electroencephalographic (EEG) abnormalities in the form of sharp complexes are discussed. The clinical features of these patients consisted of male preponderance, early age of onset in males, long history of illness in females, very low incidence of aura and family history of migraine, frequent severe paroxysms, poor response to routine anti-migraine drugs and good response to anti-convulsant drugs. It is speculated that the EEG abnormalities in migraine may have a congenital basis which finds expression in vasomotor instability through hypothalamus and autonomic nervous system.

Meige's syndrome: clinical, pharmacological and radiological observations

The clinical pharmacological, and neuroradiological observations in six patients with spontaneous blepharospasm-oromandibular dystonia (Meige's) syndrome are recorded. This group consisted of five males and one female, mean age at onset being 50.3 years. The duration of symptoms ranged from three months to 12 years, three patients having had symptoms for over four years. The dyskinesia was arrhythmic and asymmetrical in the orbicularis oculi and masseter muscles electrophysiologically. Pharmacological studies evinced no consistent response to parenteral physostigmine, no response to oral levodopa and no significant improvement in the dyskinesia following oral haloperidol. Lumbar air encephalogram was done in five patients, and showed frontal cortical atrophy without ventricular dilation in three. It is concluded that Meige's syndrome is a distinct nosological entity, and that physostigmine test is unlikely to be helpful in the differential diagnosis from neuroleptic-induced tardive dyskinesia. Neurotransmitter imbalance in the basal ganglia in this disorder remains to be established, and at present there is no satisfactory drug treatment for this progressively disabling movement disorder.

Multiple sclerosis in North-West India

Fifty-four patients, with multiple sclerosis from North-West India are described. This included two pathologically proven cases of multiple sclerosis. Five patients conformed to the definition of neuromyelitis optica (Devic's syndrome). This study is in agreement with the other series reported from Asia regarding the special clinical features of multiple sclerosis described from this part of the world. There is more common occurrence of visual impairment at onset, predominant involvement of optic nerves and spinal cord and higher incidence of classical neuromyelitis optica. There is no relationship of any or all cerebro spinal fluid abnormalities with the type of multiple sclerosis, duration of an attack and disability, except for the possible relation between the type of colloidal gold reaction pattern and the type of multiple sclerosis.

Trigeminal Trophic Syndrome Following Herpes Zoster Ophthalmicus

A case of trigeminal trophic syndrome presenting with painless ulceration of the scalp following herpes zoster ophthalmicus is presented. The pathogenesis of neurotrophic changes in the trigeminal territory is reviewed.

Cardiac dysautonomia in leprosy

Responses to various tests of cardiovascular reflexes were studied in 15 patients with leprosy. Heart rate was continuously monitored by electrocardiogram and blood pressure was recorded simultaneously. Three patients showed evidence of cardiac dysautonomia, showing involvement of both the sympathetic and parasympathetic systems. These three patients belonged to the bacilliferous group.