A. M. A. archives of neurology

<h3>Introduction</h3> In Far Eastern countries, particularly Japan, Korea, China and Taiwan (Formosa), and the Philippines, the habit of eating raw crabs and other crustaceans is responsible for an endemic infection with the lung fluke Paragonimus westermani. The fluke, after leaving the cyst, pierces the intestinal wall to enter the abdominal cavity, whence it may perforate the diaphragm and penetrate the lung, either becoming encysted there or being carried to other organs. As a result of the pulmonary infection, the commonest symptom is hemoptysis. This is so common in these eastern countries that it is considered lightly. The diagnosis may be made in patients with a chronic cough and rusty-brown expectoration by a demonstration of the ova in the sputum. Paragonimus infection of the brain, first reported by Otani,10of Japan, in 1887, is a frequent manifestation of the disease. Of 201 cases exhibiting extrapulmonary involvement, 93 had signs

S. K. KIM

A M A Archives of Neurology

Cerebral Paragonimiasis

脑并殖吸虫病

Stroke, apoplexy, and cerebral vascular accident are clinical terms applied to the situation resulting from a sudden major injury to the brain due to disease of the cerebral blood vessels and/or alteration of the cerebral circulation. Pathologically, the cerebral lesion in such circumstances is an infarct or a hemorrhage. The infarct, an area of necrosis due to ischemia, may be associated with a varying degree of hemorrhage in the form of isolated or confluent petechiae, and this hemorrhage may be minimal, moderate, or severe in degree. Even when the extravasation of blood into an infarct is severe, such hemorrhagic infarct should be distinguished fundamentally from a cerebral hemorrhage. The latter is characterized by a gross extravasation of blood into the cerebral tissues without obvious necrosis, except at the periphery of the hemorrhage, where the necrosis may be secondary to compression of the tissues or of the associated vessels. The separate

IRWIN FEIGIN

Hypertensive Fibrinoid Arteritis of the Brain and Gross Cerebral Hemorrhage

脑部高血压性纤维素样动脉炎与大量脑出血

The concept of spasm of the cerebral arteries is of particular importance as regards its relationship to ruptured intracranial aneurysms. Vasospasm has long been suspected as a cause of cerebral ischemia in a variety of conditions, but proof of its occurrence in the human subject has been particularly difficult to obtain, for reasons that are obvious. The uncritical use of the term "vasospasm" as an explanation of cerebral ischemia in vascular disease of the brain has been rightly criticized by Denny-Brown1and others. Pickering2was of the opinion that true spasm is a rare condition. However, since the advent and widespread usage of cerebral angiography in the diagnosis of subarachnoid hemorrhage, it has become evident that spasm of the major cerebral arteries not infrequently occurs after the rupture of an intracranial aneurysm. Direct observation of the constricted vessels at surgery has been reported with increasing frequency since

THOMAS M. FLETCHER

Cerebral Vasospasm in Angiography for Intracranial Aneurysms

颅内动脉瘤血管造影中的脑血管痉挛

It is known that even in expanding lesions that cause fatal rises in intracranial pressure, the Kocher-Cushing guides6,7,14for diagnosing severely high intracranial pressure are often absent. These guides are slowing pulse and respirations and steadily rising blood pressure. If the high intracranial tension is not relieved, the pulse begins to rise, blood pressure falls, and respiration stops. Our purpose was to determine the circumstances under which alterations of these signs may prove helpful in the diagnosis of rapidly expanding brain lesions and in the management of patients suffering from them. We attempted also to clarify the mechanism by which the Kocher-Cushing changes occur. We used new techniques21,22to produce gradually increasing intracranial pressure and to measure pressure within and around the animal brain tissue. To test the results of these experiments, they were correlated with a study of 43 patients suffering from acutely high intracranial pressure.

M. TARLOV

Acute Intracranial Hypertension

急性颅内高压

The principle of neurosecretion and the understanding of the hypothalamohypophysial interrelationship, although recently developed, are already well established and of great importance to several medical disciplines. Our knowledge about the function of this system is growing rapidly, but there is still much to be learned about the histology of the neurosecretory hypothalamic nuclei. The generally recognized concept of neurosecretion (Scharrer and Scharrer,1Bargmann,2Heller3) postulates that the neurosecretory hormones are produced by the nerve cells of the hypothalamic nuclei (supraoptic, paraventricular, and infundibular) and descend to the neurohypophysis along their neuraxes, which form the hypothalamohypophysial tract. The neurohypophysis has the mechanism for storage and the regulation of the release of this hormone.4-6 The histological visualization of the neurosecretory substance was made by previous investigators with chrome alum-hematoxylin-phloxine and aldehyde-fuchsin stains, which were developed by Gomori. This neurosecretory material, frequently referred to as the Gomori-positive

LEOPOLD LISS

Morphology of the Neurosecretory Substances

神经分泌物质的形态学

In a previous communication11the results of a study of electroencephalographic (EEG) activation in 37 normal subjects by the use of inhalation of a mixture of 7% oxygen and 93% nitrogen were presented. In this paper the results of the test in 26 subjects suffering from various types of epilepsy will be reported. In all subjects the arterial oxygen saturation and alveolar carbon dioxide concentration (CO2) were continuously recorded with the EEG, and the effects of hypoxia were compared with other activation procedures, such as hyperventilation, breath holding, and, in some subjects, ocular compression.3The effects of breathing 7% CO2and oxygen mixtures, of breathing 100% oxygen, and of intravenous injection of sodium bicarbonate on induced seizure discharges were also evaluated. Before we proceed with a detailed account of the methods and results of the present study, the history of the use of hyperventilation and

JOHN S. MEYER

Arterial Oxygen Saturation and Alveolar Carbon Dioxide During Electroencephalography

脑电图期间动脉血氧饱和度与肺泡二氧化碳水平

Papilledema is not always indicative of a cerebral or an intracranial lesion. In rare instances, disease of the spine1or tumor of the spinal cord may produce choked discs. In a review of the literature, 12 cases have been recorded,1-9including 1 from this institution. The rarity of such a condition warrants this report, with a brief analysis of the recorded cases. <h3>Report of Case</h3> A 32-year-old man was admitted to the Kaiser Foundation Hospital on May 29, 1959, because of frequent episodes of blurred vision, vertigo, and headache for two weeks. During these two weeks he vomited four to six times. For three years he had had pain in the lower back, at times radiating down both lower extremities. At another clinic, he was told that he had a herniated lumbar intervertebral disk. One week before admission, he noted black spots before both eyes. There was

PAUL TENG

Giant Ependymoma of the Spinal Cord Associated with Papilledema

脊髓巨大室管膜瘤伴视乳头水肿

An investigation of the usefulness of induced hypoxia as an activation technique in electroencephalography will be reported in this and in following communications. Arterial oxygen saturation and, in most instances, alveolar carbon dioxide content (CO2) have been recorded concurrently with the EEG in 108 human subjects during induction of hypoxia by means of the inhalation of gas mixtures low in oxygen. Observations in normal subjects will be reported in this paper. Subsequent papers will present observations in subjects suffering from various types of epilepsy21and cerebrovascular disease.22 A comparison of the EEG effects of hypoxia and other commonly used activation techniques was undertaken in this group of subjects for a number of reasons. Cerebral hypoxia induced by breath holding has been reported to be a useful activation technique by several investigators,2,11,17,27but many patients are unable to hold their breath sufficiently long to induce EEG changes.

Patients with clinical evidence of cerebral vascular insufficiency frequently relate that a particular head position may precipitate their symptoms. Usually, extension of the head, as in looking upward, or lateral rotation, as in looking over the shoulder, is mentioned. In a previous study1we found that many such patients tolerated compression of a carotid artery when their heads were face forward but quickly developed signs and symptoms of insufficiency when carotid compression was repeated after the head had been turned to one side. In the past, those2,3who have recognized this influence which head position can have upon response to carotid compression have usually attributed it to stimulation of a carotid sinus reflex mechanism or to local anatomical factors which permit more effective compression of the sinus when the head is rotated. In this paper we suggest that a more important factor may be change in blood flow

JAMES F. TOOLE

Influence of Head Position upon Cerebral Circulation

头部位置对脑循环的影响

Myoclonus, colloquially known as jerks, has remained an enigmatic clinical entity for more than 70 years, despite the frequent use of this term by neurologists. During this time, little emphasis has been placed on this symptom with regard to its clinical implications and prognostic signifiicance. It is the purpose of this paper to review the records of patients exhibiting myoclonus, exclusive of patients with the rhythmic type involving the velum palatinum and the pharynx, and to report on follow-up studies on these patients. The pertinent literature will be reviewed, and the clinical and prognostic significance of myoclonus will be elaborated. Definition Myoclonus may be defined as an involuntary, repetitive, desultory, instantaneous, irregular contraction of a group of muscles or, occasionally, a single muscle. Such contractions must be differentiated from the fasciculations seen clinically and in electromyographic studies. It may be difficult to recognize this clinical symptom, and the diagnosis

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A. M. A. archives of neurology

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Cerebral Paragonimiasis

Hypertensive Fibrinoid Arteritis of the Brain and Gross Cerebral Hemorrhage

Cerebral Vasospasm in Angiography for Intracranial Aneurysms

Acute Intracranial Hypertension

Morphology of the Neurosecretory Substances

Arterial Oxygen Saturation and Alveolar Carbon Dioxide During Electroencephalography

Giant Ependymoma of the Spinal Cord Associated with Papilledema

Arterial Oxygen Saturation and Alveolar Carbon Dioxide During Electroencephalography

Influence of Head Position upon Cerebral Circulation

Myoclonus