[24-hour blood pressure determination in Shy-Drager syndrome. A case report]

The case history is presented of a 57 year-old male patient suffering from the Shy-Drager syndrome. This syndrome was first described by G. M. Shy and G. A. Drager in 1960. The clinical manifestations are extrapyramidal, with Parkinsonian features, combined with severe orthostatic hypotension and failure of the autonomic nervous system. Apart from the standard clinical investigations in this condition, namely the orthostasis test and polygraphic recording of the EEG, ECG, breathing and blood pressure on the tilting table, additional non-invasive long-term determination of the blood pressure was carried out. This method allows simultaneous measurement of blood pressure and heart rate without appreciably interfering with the patient's daily activities.

Hexa-methyl-propylene-amine-oxime (HMPAO) single photon emission computed tomography (SPECT) in epilepsy

Twenty-eight normal volunteers and 74 seizure patients were investigated with hexa-methyl-propylene-amine-oxime (HMPAO) brain single photon emission computed tomography (SPECT). Fifty-four patients suffered from partial seizures and 20 patients had generalized seizures. Indices describing regional tracer distribution (RIs) were calculated in all investigated subjects. Regions whose RI exceeded the mean normal RI +/- 3 SD were defined as abnormally perfused. In normals a significant interhemispheric asymmetry of HMPAO deposition was found, with higher RI values in the right frontal, parietal, temporal and occipital regions. In 59.3% of partial seizure patients abnormal RIs were found. Low RIs were detected predominantly in the frontal and temporal cortex, while elevated RIs were observed predominantly in the anterior basal ganglia. Only in 20% of the cases with generalized seizures, abnormal RIs were found. In one patient an ictal and 3 follow-up SPECT studies were obtained. Here SPECT results indicated transient rCBF changes between the ictal and seizure free state. EEG and SPECT foci were ipsilaterally located in 69.2% of the partial seizure cases. The results indicate that HMPAO brain SPECT is valuable for the detection of rCBF abnormalities in seizure patients and that patients with partial seizures have mostly several abnormally perfused areas in their brains.

Influence of long-term anticonvulsant treatment on liver ultrastructure in man

In 35 patients on long-term anticonvulsant treatment (7-35 years, means = 19.6 years), various liver enzymes were measured. In 32 cases (91.4%), elevated levels of serum-gamma-glutamyl-transpeptidase (GGT) were found. Liver biopsy was performed in five of 13 patients with GGT levels of greater than 60 U/l (75-257, means = 123 U/l). Light microscopy showed a minimal steatosis and fine granular appearance of hepatocytes in two cases, and a slight portal fibrosis in one case. Two cases showed an unremarkable histology. Electron microscopy revealed signs of enzyme induction as overall swelling of the smooth endoplasmic reticulum and additionally a dilatation of the rough endoplasmic reticulum in all five specimens. No signs of liver damage or disturbance of liver function could be observed.

[The Steel Richardson Olszewski-syndrome. A report on 3 further cases (author's transl)]

In this report we are describing 3 further cases of progressive supranuclear palsy, all displaying the typical clinical features (first described by Steele, Richardson and Olszewski, 1964): Ophthalmoplegia (affecting chiefly vertical gaze), pseudobulbar palsy, dysarthria, dystonic rigidity of the neck and upper trunk and dementia. Clinical symptoms started between 49 and 51 years of age with slow progression during 2 to 4 years. One patient died 2 years after the first clinical symptoms began. The purpose of this paper is, to describe a further group of 3 cases of progressive supranuclear palsy and to point out in detail the clinical symptoms, that all correspond to supranuclear localisation of this disease and to report about some differences in the development of the disease and the fully developed disorder. The use of treatment with Adamantin and Akineton was not (very) satisfying.