Five patients were examined suffering from bilateral paramedian thalamic infarction, caused by occlusion of the posterior paramedian thalamo-subthalamic arteries, when they begin from one single pedicle. All cases began with obnubilation or transitory coma, followed by hypersomnia. Four patients showed vertical gaze paralysis, and the fifth vertical nystagmus. In three cases, nuclear lesion of the III cranial nerve was observed along with alteration of the photomotor reflexes, and there was miosis in one case. All were suffering from weakness in one or another limb or facial paresis and generalised acute hypotonia: only one patient had hemihypostesia. All five had dysarthria, ataxy and dysmetria, one had asterixis and two spasmodic crying. Between 5 and 12 months later, one had akinetic mutism and vertical gaze paralysis as the most noteworthy signs. The neuroradiological images show a bilateral ischemic lesion in the paramedian thalamic region, which extends in some cases to the anterior nucleus and in one case to the pulvinars; the lesion continues through the subthalamic regions and the medial part of the mesencephalic tegmentum, with a clear extension to the medial region of the cerebral peduncles in three cases and to the tectum in one case.

Adult↗

PubMedDate not supplied

[Clinical diagnosis of dementia associated with cortical Lewy bodies].

8 cases of dementia associated with cortical Lewy bodies are dealt with, that were diagnosed in 1993 in examinations for dementia, using the Nottingham's clinical criteria. They make up 15.4% of primary degenerative dementias diagnosed in this examination. All developed a predominantly cortical dementia with variable bradiphrenia and a parkinsonian syndrome which was predominantly of the rigid-bradikinetic type. The dementia established itself rapidly -between 1 and 3 weeks- in 3 cases (37.5%). 50% of patients (4 cases) showed marked psychiatric symptoms. In 2 cases stiffness was predominantly axial and another had supranuclear paralysis of vertical gaze. 3 patients had no tremor, and 2 of the 5 remaining patients showed postural tremor. CT and axial MR images of the encephalon were similar to those observed in dementia of the Alzheimer type. The coronal MR carried out on 3 patients revealed less atrophy of the hypocampus than is normally observed in patients with dementia of the Alzheimer type who are at the same stage of development.

Aged↗

PubMedDate not supplied

[The hostility complex and myocardial infarct].

Several studies have associated the hostility complex (part of type A personality) to the development of coronary atherosclerosis. The complex is composed by aggressive behavior, frequent rage outbursts, intolerance to waiting lines and sense of urgency. To investigate the occurrence of this behavioral trait, 50 post-myocardial infarction men were compared against 50 normal male subjects of the same age. In all of them sphygmomanometric blood pressure was obtained, total blood cholesterol was measured and hostility was quantified by means of the Cook and Medley's questionnaire and an arbitrary ad hoc scale. Diastolic blood pressure was significatively higher in post-infarction patients (82 +/- 10 vs 77 +/- 9, p < 0.001), as well as the cholesterol level (231 +/- 55 vs 197 +/- 43, p < 0.001). Also, hostility score was higher in the post-infarcted men (16 +/- 4 vs 13 +/- 5, p < 0.001). The hostility score showed correlation with the occurrence of myocardial infarction (p < 0.02). These results establish that post-myocardial infarction patients express more hostility than control subjects. It was not possible to establish the true nature of the relationship among hostility and diastolic blood pressure, total cholesterol and the occurrence of coronary events. Nevertheless, this study confirms that the hostility complex is frequently present in atherosclerotic patients.

Adult↗