Several subjects who tell their depression and play a part of it in front of the doctor without being really depressed are reported. Some of them try to hide the symptoms (irritability or erethism, ceremonials of obsessive neurosis, shunning of phobia) which, in their opinion, might be detrimental to their reputation. Others neglect to describe some of the symptoms of their polymorphous clinical picture only underlining the depressive signs. Some others play a part of depression because they have believed to recognize themselves in persons presented by mass media, because it seems to them a duty to show an adequate depression in case of mournful event, or because they "convert" their problem into a depression. Some others use depression as a blackmail, or to obtain an advantage from doctor's conviction about their illness. The reason for the high frequency of similar cases in the present time are examined: the scientific divulgation and the acceptance of depression by the modern society are among the most important ones. The peculiar semantic vicissitudes of the word depression are also reviewed. A widening of the boundaries of depression has contributed to an increase in the number of the cases. Finally, in addition to patients who are depressed without being aware of it, the authors focus the inverse possibility: patients who believed or try to make their doctor believe (playing the part of depression in front of them) that they are depressed.
Thirteen patients affected by either dominant or recessive and/or sporadic olivopontocerebellar atrophy were studied. All patients were subjected to auditory evoked potential recordings including early and long latency components, CT scans, vestibular and EMG-ENG examinations. In nine patients somatosensory evoked potentials were also recorded. Clear-cut abnormalities in brainstem auditory evoked potentials were observed in only two patients while a slight reduction of the IV-V/I amplitude ratio was found in seven cases. N85 was increased in two patients. The main feature of somatosensory evoked potentials abnormalities was a delayed N20 in association with prolonged N13-N20 central conduction time (five patients). For all patients the CT scan varying degrees of cerebellar and brainstem atrophy. There was no clear correlation between the abnormalities revealed by neurophysiological and neuroradiological investigations and the severity and duration of the illness. It is noteworthy that auditory and/or somatosensory evoked potential changes were found in all dominant olivopontocerebellar atrophy patients.
58 patients suffering from anxiety neurosis were divided into two groups, matched for age, sex, marital status and symptomatology. In a double-blind trial of 4 weeks' duration one group (28 patients) received alprazolam 0.75-3 mg/day and the other (30 patients) received lorazepam 3-12 mg/day. Both groups showed a steady and significant reduction in anxiety levels as measured by Hamilton Anxiety Rating Scale and Clinical Global Impression scores at 0, 1, 2 and 4 weeks. However, there was no significant difference in measured anxiety levels between the two groups at any stage. Fewer side effects were reported in the alprazolam treatment group, with the mental confusion symptom occurring significantly less often.
A case of hypokalemic periodic paralysis, is reported, characterized by a positive family history and by repeated attacks of transient motor weakness since the age of 14 involving one all limbs. An induction test under ECG and EMG monitoring, carried out by infusing glucose and insulin when the patient was symptom-free, provoked motor paresis comparable to the spontaneous attacks and confirmed the diagnosis.
An unusual case of Chiari type I malformation is presented. The only symptom was a "drop attack" during sneezing or coughing. The possible pathogenetic mechanisms are briefly reviewed and the good results of the surgical therapy are stressed.
A case of intracranial multiple aneurysms associated with a giant arteriovenous malformation is reported. Three aneurysms were found arising from the arteries feeding the malformation. The patient could not be operated because of his age, neurological condition and the size of the arteriovenous malformation. Previously reported cases of cerebral aneurysms associated with arteriovenous malformation are reviewed. Our case well illustrates the possible role of hemodynamic stresses induced by the malformation on the development of the aneurysms.
A case of unusual Neuro-Behçet syndrome is reported. Four years of follow-up revealed at beginning later the occurrence of acute meningoencephalitis caractherized by two convulsive fits. CSF examination revealed high albumin and cells contents. CT examination of the head was negative. Incomplete clinical improvement was obtained by using steroids. Differential diagnosis is finally discussed.
A prospective study of head injury patients was carried out in the city of Ravenna in 1984. A complete record was completed for all patients admitted for hospital care. More than 50 clinical and diagnostic variables were evaluated to investigate risk factors on patients admitted to a Non-Neurosurgical Unit with CT facilities. Our report deals with 578 cases and shows some interesting findings: The mortality in the entire trauma-group was 42 cases; 35 (83%) of these died immediately after the accident or while being transported to the hospital. The number of patients hospitalized (42%) was much higher than that in previous reports concerning hospital admission of head injury patients. 9 cases were sent from the First Aid to Regional Neurosurgical Centre (Bellaria Hospital, Bologna). Among the other patients admitted to the Non-Neurosurgical Centre, 12 showed cerebral lesions on the CT (1 extradural haematoma). Risk factors were evaluated by comparing EEG, skull fractures and poor clinical condition with the presence of cerebral lesions. Our data show a peculiar situation here in Italy: a large number of hospital admissions for minor head injuries, of whom relatively few patients are at risk of intracranial post-traumatic haematoma.
Auditory and somatosensory evoked potentials were recorded from 10 patients suffering from Friedreich's ataxia. All patients were subjected to audiological tests and EMG-ENG study. Acoustic evoked potentials recordings included brainstem acoustic evoked potentials and long latency components. Peripheral and central components of somatosensory evoked potentials were obtained by stimulating the median nerve at the wrist and elbow. Various abnormalities of the cortical components were observed in all patients for both acoustic and somatosensory evoked potentials. Analysis of brainstem acoustic evoked potentials and of the early components of somatosensory evoked potentials showed a different incidence of abnormalities. The main feature of brainstem acoustic evoked potential changes was the frequent absence of one or more waves; the greatest abnormalities occurred in patients whose disease was of long duration. Long latency components (N85) were significantly prolonged in all but one patient. There was often an absence or reduction of early somatosensory evoked potentials with normal or near normal latencies, even though cortical responses were markedly prolonged. The sensory conduction velocity between stimulation sites at wrist and elbow was normal in all patients. Clinically brainstem acoustic evoked potentials may prove to be a reliable means of monitoring the progression of the disease, while long latency components and somatosensory evoked potentials could be used as complementary procedures in early diagnosis.
The author describe a patient with bilateral giant aneurysms of the internal carotid artery in the region of the ophthalmic artery. These lesions are very rare and can be mistakenly diagnosed as intracranial tumors on the basis of the clinical presentation and CT findings alone. The correct diagnosis is made via cerebral panangiography and a successful surgical treatment for this pathology is often available.
In a 21 year-old man suffering from a post-traumatic neurotic syndrome, the cranial CT scan revealed an arachnoid cyst in the left Sylvian fissure, which had been completely asymptomatic before. The surgical emptying of the cyst modified neither the CT finding nor the neurotic syndrome. The latter disappeared once the insurance controversy was resolved. After a review of the etio-pathogenesis of arachnoid cysts, our patient's malformation was identified as the so-called "Temporal Lobe Agenesis Syndrome". On that basis, any medico-legal correlation between the head injury and the cystic malformation was excluded.
Three cases of tardive myelopathy were identified among more than one thousand patients treated for tumors by X-rays at the Institute of Radiology of the University of Florence during the period 1974-83. In two of these, the clinical picture was that of a partial Brown-Séquard syndrome while in the third case it corresponded to a transverse myelitis. The myelopathy of the former patients can be attributed to the total radiation dose, which was very close to the tolerance limit. The third patient's disturbance, instead, involved additional factors of individual hypersensitivity of connective vascular tissue in response to the X-ray treatment. These cases, while few in number and lacking pathological investigation, call attention to this iatrogenic disorder which, though rare now thanks to progress in limiting radiation exposure, has not yet disappeared.
A through review of the literature relating to the schizoaffective psychoses was undertaken; the considerable variety of criteria used for diagnosis accounts for the diversity of the results obtained by various researchers. In order to identify a homogeneous group of schizoaffective patients, four parameters, on which the literature is in agreement were formulated. These have enabled us to isolate 27 schizoaffective subjects and to compare them with two control groups: 25 cases of schizophrenia and 26 cases of maniac-depressive psychosis. On the basis of the symptomatological and social variables considered (age of onset, cultural level, social adaptation, family history, early and recent events, response to short-term pharmacological treatment, symptomatology during the observation period), we believe that we are able to distinguish schizoaffective subjects from both schizophrenic and dysthymic subjects.
A right-handed patient with no family history of either neurological disorders or of left-handedness was affected by crossed aphasia due to a focal hemorrhagic lesion in the right hemisphere at the level of the basal ganglia. The CAT-scan revealed the site of the brain change. Our case is uncommon in that the aphasia. Assessed by neuropsychological tests, was associated with impairment of right functions such as visual and spatial cognition. Thus he does not fit the classic description of crossed aphasia, exhibiting instead language disorders similar to those following deep brain lesions. Various hypotheses were considered in attempting to explain the pathogenesis of our neurological data, none of which proved adequate to account for all the reported findings.
An EEG and CT study was carried out on 79 patients affected by dementia (24 SDAT and 55 MID). The EEG and CT patterns were compared with those of an age-matched control group. Statistical analysis of the CT findings between the demented and normal subjects showed significant differences only for severe atrophy. As far as EEG findings are concerned, no EEG pattern indicative of a specific type of dementia was observed even though a greater number of abnormal EEGs occurred in demented patients than in the control group. Finally, a poor EEG-CT correlation was found in demented patients.
Groups of left-hemisphere damaged patients, right-hemisphere damaged patients and controls were given the facial recognition test of Benton and Van Allen. Educational level was found to be relevant with regard to the performance of the brain damaged groups, such that a difference between left and right hemisphere-damaged groups became apparent only in patients with higher (greater than 5 years) schooling. The implications of the results are discussed.
The Schalling--Sifneos Personality Scale was administered to several groups of subjects (patient suffering from chronic hepatitis or from ulcerative colitis, patients undergoing chronic periodic haemodialysis, encephalopathic patient and healthy subjects) in order to assess the presence of alexithymia in healthy subjects, in patients suffering from chronic organic pathologies and in psychosomatic patients. The results obtained permit one to distinguish the psychosomatic patients from other groups of subjects: compared to healthy subjects, patients suffering from ulcerous rectocolitis obtained higher average scores, while compared to patients suffering from other organic pathologies their scores showed a wider scatter. A distinction is therefore proposed between primary alexithymia, of a distinctive cognitive-affective kind which predisposes towards psychosomatic pathology, and secondary alexithymia which is associated with stressful situations, such as illness, and which is essentially defensive in origin.
The case of a 64-year-old patient with a severe cerebellar ataxia of unknown origin, dating back at least three years, is described. The patient was diagnosed as suffering from hypothyroidism and after one month of replacement therapy with thyroxine there was complete remission both of the myxedema symptoms and of the cerebellar syndrome. The possible association between cerebellar ataxia and myxedema was thus confirmed. The writers stress the importance of identifying this uncommon clinical entity especially in view of the excellent results of thyroxine treatment.
Intracranial tuberculomas have become uncommon in industrial nations, while they still have a high incidence in underdeveloped countries. Four cases of intracerebral supratentorial tuberculomas are reported in this paper. Clinical findings suggestive of tuberculosis were present in only one case. The other cases were thought to be gliomas or metastases and the diagnosis was made only after surgery. The CT scan provided a good image of the lesions whose characteristics, however, were diagnostically confusing. When a tuberculoma is suspected, medical therapy alone should be administered initially. Surgery should be resorted to in cases of markedly increased intracranial pressure.
