Painful tonic spasms caused by putaminal infarction.

Lacunar infarcts in the basal ganglia are known to cause various movement disorders, such as chorea, focal dystonia, and hemichorea-hemiballismus. We report here a case of putaminal lacunar infarction which presented with "painful tonic spasms" of the contralateral limbs. This consisted of paroxysmal brief, painful, flexor contractures of the upper, and occasionally the lower limb.

Abnormal facial movements. Guide to differential diagnosis.

Spontaneous facial movements are disturbing to those who have them, yet some such movements are benign and cause no more than cosmetic embarrassment. Other abnormal facial movements, however, are more serious and can be associated with neurologic disorders such as multiple sclerosis, brainstem tumor, peripheral neuropathy, and Guillain-Barré syndrome. Occasionally, an abnormal movement of the face is the first sign of such an underlying disorder.

Isolated facial myokymia and facial contracture: computed tomography and magnetic resonance imaging correlation.

Isolated facial myokymia with contracture can be the earliest manifestation of intrinsic lesions of the brainstem. We report a case of facial myokymia with contracture occurring as the result of a pontine glioma, as depicted on cranial computed tomography and magnetic resonance imaging studies. The rostral location of the tumor supports the supranuclear disinhibition hypothesis of facial myokymia.

Ethical issues in the treatment of patients with a remitting vegetative state.

A case of remitting vegetative state is presented illustrating the need to draw a distinction between persistent and remitting vegetative states in brain-damaged patients. Standard ethical considerations regarding dying patients cannot be universally applied to remitting vegetative states, which are best handled in a context of an ethics of discretion, rather than an ethics of rules. Ethical obligations towards such persons are presented.

Serial CT scans in Haemophilus influenzae meningitis of childhood.

Eleven children admitted to hospital with H. influenzae meningitis had computerized tomographic head scans during the acute stage of the illness. 10 of the 11 had at least one other scan between two weeks and 30 months later.

Spinal cord involvement in acute bacterial meningitis.

A 25-month-old boy had the development of respiratory arrest and quadriplegia with a T-10 sensory level during the acute phase of Haemophilus influenzae meningitis. The sequelae of spinal cord involvement of bacterial meningitis are reviewed. A possible mechanism of the spinal cord involvement in this case is discussed with reference to known pathology of H influenzae meningitis.

Interhemispheric subdural hematoma.

The clinical presentation and surgical management of an interhemispheric subdural hematoma, a rare entity, is presented and the literature reviewed. Either hemiparesis, worse in the lower than the upper extremity, or lower extremity monoparesis is characteristic of this lesion. Computerized tomography (CT) is the preferred diagnostic procedure.

Situs inversus, subaortic and subpulmonic stenosis, ventricular septal defect, and single coronary artery.

The unusual occurrence of situs inversus totalis, ventricular septal defect, hypertrophic subaortic and subpulmonic stenosis, and single coronary artery in a 38-year-old man is presented. The clinical course was remarkably mild, as documented by data from 23 years of study including four cardiac catheterizations. At age 35 years, however, syncope, chest pain, and marked elevation of right ventricular pressure prompted complete surgical repair of the left and right ventricular outflow tract obstructions and closure of the septal defect.

Myasthenia gravis associated with wasp sting.

A clinical picture indistinguishable fro, but not therefore identical with, myasthenia gravis (ocular form) developed within 24 hours of a wasp sting. Because of the close temporal association of events, operative mechanisms may be either an immediate hypersensitivity reaction to some components of wasp venom or a direct toxic effect of these substances on acetylcholine synthesis, release, or degradation. Theoretical considerations from the literature and the lack of immunologic abnormalities in the patient suggest that the latter may be correct.

Myasthenia gravis: An embryologic and phylogenetic perspective.

Myasthenia gravis is a rare disease with unique clinical features. These include (1) progressive fatigue on exertion, most evident clinically in the muscles of the head and neck (2) a definite relationship of the disease to the thyroid, parathyroid and thymus glands. A hypothesis is advanced with correlates these facts on the basis of a common embryologic origin of these glands and the branchial arch muscles.