Although the major complication of the 1957 pandemic of influenza was pneumonia, cases of neurological disorder were reported to accompany or to follow the initial respiratory infection. The brunt of the insult was borne at any level of the nervous system, giving rise to a varying combination of clinical symptoms and signs. One of these was the Guillain-Barre syndrome. Despite the occurrence of fatal cases and the opportunity for pathological study, this syndrome remains a clinical concept, although, since its first description in 1916, 16 the ambit of its diagnostic use has been greatly extended, particularly in the literature of Scandinavia, America, and the British Commonwealth. By the outbreak of World War II, Guillain 14 himself had accepted several varieties of the syndrome, and in his most recent communication 15 (1953) he allotted 3 of his series of 19 cases to a sixth variety, which had been described nearly 20
Hyperosmolarity is characterized by an increase in the solute concentration of body fluids brought about by loss of water, inadequate water intake, or administration of large amounts of hypertonic solutions. When the osmolar concentration of the extracellular fluid is increased, transfer of water from cells to extracellular fluid exceeds that in the opposite direction. Net water movement is thus out of the cells, with resultant dilution of extracellular fluid and concentration of the fluid within cells themselves. If the solute which increases the extracellular fluid osmolarity is one which is in the main excluded from intracellular fluid, such as sodium and chloride ions, this disturbance in water distribution cannot be mitigated by movement of solute into cells. Hence, the ultimate effect of hypernatremia is dehydration of cells. This physicochemical disorder is most frequently encountered in infants and children with severe diarrhea and vomiting, but it also occurs in adults. Schmidt,
Reversible figures are drawings in which figure and ground appear to alternate on continued inspection (e. g., the Rubin vase, Fig. 1A), or in which perspective appears to shift (e. g., the Necker cube, Fig. 1B); in yet a third type, a moving pattern, such as the vanes of a windmill, seems to reverse the direction of its movement. The neural mechanisms underlying these apparent fluctuations remain obscure, despite numerous investigations involving such aspects of the patterns as size (Washburn, Mallay, and Naylor34; Cohen5), "complexity" (Donahue and Griffitts7; Washburn, Reagan, and Thurston35), or brightness (Mull, Ord, and Locke19). That retrochiasmal processes are involved, however, is suggested by two facts: (a) In figures with reversible perspective or movement, rate of apparent change (RAC) increases with continued fixation (Köhler15; Brown3; Cohen5), and (b) inspection of a reversible figure with one eye causes an
The proper management of intracranial arterial aneurysms has been the object of considerable controversy. In an effort to evaluate various methods of treatment, we have compared the results of these methods in 115 patients treated under similar conditions by the same surgeons. Before the evolution of modern neurosurgical techniques, intracranial aneurysms were curiosities, usually discovered at autopsy. In 1923 Symonds'1presentation of the criteria for the diagnosis of a ruptured intracranial aneurysm gave impetus to further study of this subject. Richardson and Hyland,2Walsh and King,3Dandy,4and numerous others have contributed much to the increasing frequency of diagnosis and successful treatment of aneurysms. Recently a more complete study by Hamby5has brought the entire subject into focus with a survey of the previous publications and an analysis of his own material. The mortality rate of ruptured intracranial aneurysms is known to be high, ranging
In the course of our studies of the neuropathology of alcoholism, which were begun at the Neurological Unit, Boston City Hospital, and have continued in the laboratories of the Neurology Service, Massachusetts General Hospital, two of us (R. D. A. and M. V.) observed three, perhaps four, cases in which the myelin sheaths of all the nerve fibers in the central part of the basis pontis had been destroyed in a single, large, symmetric focus. The nerve cells and axis cylinders were spared for the most part, and the blood vessels were patent and unaffected. There were no signs of inflammation in or near the lesion. The disease had occurred on a background of alcoholism and malnutrition; in the two cases with the largest lesions, it had manifested itself clinically by a pseudobulbar palsy and quadriplegia, leading to death in about 13 and 26 days. In the other two cases
In a previous publication1it was reported that the disturbing experience of being introduced into a strange and potentially dangerous place or of being subjected to an anxiety-evoking psychiatric interview raised the plasma level of the adrenal cortical hormone, hydrocortisone, in a group of anxious patients 40% and 28%, respectively. The increase in hormone level following the interview was also associated with a significant increase in emotional responses.2The present study is intended to extend the earlier work in two directions: to investigate response to another type of psychological stimulus and to make a comparison of normal subjects and psychiatric patients, which was not possible in the earlier experiment. We shall here compare the response of two groups differing considerably in anxiety-proneness to the same situation, and also two groups of the same (high) level of anxiety in response to two different stress procedures. The experimental condition used
The striking mental changes induced by the diethylamide of lysergic acid (hereafter referred to as LSD) have been studied extensively in Europe,* Great Britain,† and the United States.‡ In minute doses (20γ to 120γ) LSD induces a peculiar mental state characterized by anxiety, signs of autonomic dysfunction, perceptual distortion (chiefly visual), alterations in mood and affect, synesthesias, feelings of depersonalization, and hallucinations. The drug is apparently the most effective and safest agent for inducing an experimental, but reversible, psychosis in nonpsychotic subjects. Various interpretations have been placed on the mental state produced by LSD. Some European authors refer to it as a "toxic psychosis of the exogenous reaction type" or a "diencephalosis,"§ presumably because the autonomic signs suggest effects on the hypothalamus. The resemblance of some of the psychic manifestations which follow LSD to symptoms of the major psychoses has been stressed by others.∥ The LSD reaction has been referred
The relationship of increased cerebral venous pressure to ventricular enlargement and hydrocephalus has never been satisfactorily worked out. The interdependence of intracranial pressure and cerebral venous pressure has been recognized both in clinical problems and in experimental studies, but the possibility of cerebral venous pressure as a primary cause of ventricular enlargement has remained a controversial issue. Dandy 2 stated that the occlusion of the vein of Galen would cause hydrocephalus. Others have tried this and other types of experimental venous occlusions, with varying results. Russell, 4 in her monograph on hydrocephalus, reviewed much of this work, including some experimental work of her own, and concluded that, while hydrocephalus had apparently been produced in some instances, the results were, in general, equivocal. These experimental attempts to produce hydrocephalus from increased venous pressure were all based upon local occlusion of a cerebral vein or dural sinus. This allowed the possibility that
Primary sarcoma of the brain is rare, having been estimated to comprise only 0.25% of all intracerebral neoplasms.1The relative paucity of recorded cases, as well as the uncertain nosologic position of some glial cells, has apparently impeded their precise classification. The various appellations utilized for some intracerebral sarcomas with similar morphologic features and biologic behavior have further complicated the study of this group of neoplasms. The recent studies of Feigin and associates2,3have satisfactorily demonstrated the vascular origin of that form of sarcomatous growth observed in some glioblastomas. However, much debate has occurred concerning that form of malignant mesoblastic cerebral neoplasm most commonly referred to as microglioma, or reticulum-cell sarcoma. Since the studies of Hortega4and, subsequently, Dunning and Furth5have indicated that the microglial cells represent the reticuloendothelial elements of the central nervous system, it would appear that much of the controversy concerning this
Introduction At the time of our last publication on glutamic acid treatment, in 1951, accurate appraisal of its effectiveness was difficult because of controversial findings as to degree and nature of changes following therapy. Since we had stressed intellectual aspects of improvement, it was natural for early investigators to follow that trend and to try to duplicate our results. Success or failure of therapy was usually judged in terms of point gains or losses on psychological retest, with emphasis upon group statistics rather than upon individual clinical change. Several studies appeared, nevertheless, showing the value of glutamic acid in cerebral functioning (regardless of alteration or lack of change in intelligence following therapy), results of which suggested that further investigation of the drug was warranted. As early as 1948, for example, Waelsch1reported on the global effect of glutamic acid in a biochemical consideration of mental deficiency. It seemed that
Although electroshock is a useful treatment, we are not uniform in our thinking about it, and are often in doubt as to when and how to employ it. While certain criteria for its use have been established with respect to diagnosis, symptomatology, and chronicity, it remains difficult to predict accurately the response of any individual patient to it. This state of affairs may well be traceable to our failure to consider, in the design of studies bearing on the effectiveness of EST, the host of variables pertaining to the patient, the therapist recommending and administering EST, and the relationship of the doctor and the patient. Over the past 15 years many workers experienced in the use of the somatic therapies have been impressed with the influence of factors other than the three enumerated above on the effectiveness of EST in any given case. These factors broadly fall into two categories:
Introduction The present study was undertaken in order to determine the anatomical structures of the circle of Willis,27with the purpose of learning its normal configuration, the frequency of deficient or incomplete circles, and, if possible, how these findings can be correlated with the clinical problems of vascular disease, such as infarcts, aneurysms, and vascular anomalies. There are many problems in vascular disease of the brain which make desirable an intimate knowledge of variants in the anatomy of the circle of Willis. The state of the circle becomes important in determining the adequacy of the brain circulation in operations for cerebral aneurysm and in ligation of the carotid artery. The possibility of bypassing or shunting effects in occlusion of one of the cerebral vessels and the adequacy of recovery or lack of recovery after vascular occlusion might be explained in part by variations in the anatomy of the circle
Although the major complication of the 1957 pandemic of influenza was pneumonia, cases of neurological disorder were reported to accompany or to follow the initial respiratory infection. The brunt of the insult was borne at any level of the nervous system, giving rise to a varying combination of clinical symptoms and signs. One of these was the Guillain-Barré syndrome. Despite the occurrence of fatal cases and the opportunity for pathological study, this syndrome remains a clinical concept, although, since its first description in 1916,16the ambit of its diagnostic use has been greatly extended, particularly in the literature of Scandinavia, America, and the British Commonwealth. By the outbreak of World War II, Guillain14himself had accepted several varieties of the syndrome, and in his most recent communication15(1953) he allotted 3 of his series of 19 cases to a sixth variety, which had been described nearly 20
The psychological examination of the brain-injured patient is now being introduced more and more routinely as an integral part of the general diagnostic procedure in neuropsychiatric clinics. 1,3,18 The usual testing tools applied are visual designs tests (Bender, 4,9,15,26 Ellis, 11 Benton 6,8 ), the tests designed by Goldstein and his co-workers, 12 Wechsler's Intelligence Scale, 17, 25,31 the Marble Board test, 30 Rorschach's technique, 2,16,19,20-22,27 and Goodenough's Draw-a-Man test. 5,7,13 Important and helpful as all those tests are, they do not easily lend themselves to quantification. The present paper presents a combined test, relatively short (administration and scoring takes about 10 minutes), which lends itself to objective scoring and to qualitative analysis as well. * The plan of presentation is as follows: (1) First, the test will be described; (2) a validating study will be reported, and (3) the qualitative aspects of the test and the interpretation of positive test findings
