Biomedical subjects
Publications and source records attributed to A A DeMaria.
This report of a woman with positional dizziness is apparently the first to describe position-dependent vertebral artery compression shown by magnetic resonance angiography. This noninvasive technique may be helpful in the differential diagnosis of positional dizziness.
In 17 patients with cough syncope, electroencephalograms showed normal interictal recordings in 12 patients, minimally abnormal recordings in 4, and a moderately abnormal recording in 1. Fourteen episodes of cough syncope (six patients) were recorded, with the EEGs showing diffuse theta and delta slowing during the episodes. These findings were similar to those seen during other types of syncope. Although eight patients had rhythmic or clonic-like movements during the episodes, no epileptiform activity was seen. The exact mechanism of cough syncope is not known, but the vigorous coughing probably increases CSF pressure enough to impair intracranial circulation, causing syncope due to cerebral ischemia.
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A 38-year-old hypertensive woman presented with acute onset of cranial nerve and long tract signs referable to a lesion in the right dorsolateral pons. A hemorrhage in the suspected area was demonstrated by CT. Although brain stem hemorrhage was previously thought to be only rarely compatible with survival, our patient survived and recovered sufficiently to go home. CT indicates a more favorable prognosis for brain stem hemorrhage than has been previously suspected.
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I recently observed two patients with adrenoleukodystrophy who had similar, distinctive CT scans of the head. The first patient also had a characteristic nuclear brain scan; the second patient was initially thought to have subacute sclerosing panencephalitis until the CT scan was obtained. Classification of leukodystrophies has been controversial and ambiguous. CT and nuclear brain scanning promise to be helpful in nosology of these disorders, as well as the clinical management of the patients.
A patient with the clinical and electroencephalographic features of dialysis encephalopathy exhibited dramatic improvement with the initiation of diazepam therapy. Although improvement was sustained for a period of several weeks, her clinical condition eventually deteriorated despite continued treatment with diazepam and dialysis. Dialysis encephalopathy in this patient is compared with other cases recently reported in the medical literature as having a similar dramatic response to diazepam. It is concluded that diazepam transiently reverses a component of the dialysis encephalopathy syndrome, but it does not appear to change the ultimate prognosis for patients with this condition.