Biomedical subjects
Publications and source records attributed to H H Morris.
We report five patients who experienced delayed patchy hair loss after prolonged EEG monitoring. The location of the patches corresponded to the electrode sites in four. The hair loss was temporary and most probably was due to traumatic noncicatricial alopecia. The frequency of hair loss was approximately 2% of monitored patients.
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We compared the etiologic factors and clinical characteristics of 30 patients with unitemporal vs those of 30 patients with bitemporal independent (minimum 20% from one side) interictal epileptiform discharges on extracranial electroencephalograms. Febrile seizures occurred significantly more frequently in the unitemporal (40%) than in the bitemporal (17%) group. Mass lesions were more common in the bitemporal group, and seven of 10 patients with mass lesions showed bitemporal interictal epileptiform discharges. There were no statistically significant differences in age at onset, frequency of seizures, duration of epilepsy, and history of central nervous system infection or trauma between the two groups. A history of febrile seizures or central nervous system infection that may be expected to cause diffuse cerebral injury does not appear to be the major factor predisposing to the development of bitemporal interictal epileptiform discharges.
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Experimental design effects and range effects may have influenced previous studies on motor response processing (Grice & Hunter, 1964; Grice, Nullmeyer, & Schnizlein, 1979; Poulton, 1973). This investigation was conducted concurrently with two experiments. First, Erlebacher's (1977) more powerful analysis of variance (ANOVA) model, which allows for the testing of the independent variable (stimulus intensity effect), the experimental design effect (between-subjects [BS] vs. within-subjects [WS]), and the important interaction between independent variable and experimental design was utilized to clarify if the nature of the experimental design (BS, WS) biases motor response processing. Second, Erlebacher's (1977) ANOVA model was used to determine if motor response processing was affected by stimulus intensity and experimental design when different ranges of auditory stimuli were compared. Results indicate motor response processing was inversely affected by increasing stimulus intensity. Experimental design effects and range effects did not appear to bias motor response processing. We conclude stimulus intensity effects on motor response processing appear to be the result of true neuromotor functioning and not artifacts of experimental design or of range effects.
Language interference was elicited by electrical stimulation of the dominant basal temporal region in 8 out of 22 cases and in none of 7 cases with subdural electrodes implanted over the nondominant temporal lobe. Language interference was elicited by stimulation of electrodes placed over the fusiform gyrus 3-7 cm from the tip of the temporal lobe. Electrical stimulation of the basal temporal language area produced a global receptive and expressive aphasia with speech arrest at high stimulus intensities. Other higher cortical function, for example copying complex designs or memory of nonverbal information was intact, in spite of the total inability to process verbal information. At lower stimulus intensities partial aphasias with a predominant receptive component occurred. Surgical resection of the basal temporal language area produces no lasting language deficit.
We studied the eye movements (EM) elicited by electrical stimulation of the frontal lobe in 19 awake patients evaluated with subdural electrodes for epilepsy surgery. All patients had only contralateral conjugated EM. They were saccadic in 16 patients (84%). Head version, always following the eye deviation, occurred in 11 patients (58%). We also determined the eye field somatotopic distribution analyzing the responses obtained from the electrodes adjacent to the eye fields. All patients had motor cortex contiguous to the eye fields. In 17 patients (90%) the eye fields were located in front or at the level of the motor representation. There was no silent cortex between the motor strip and the eye fields.
Supplementary motor seizures (SMS) are among the group of frontal lobe seizures that may often be misdiagnosed as pseudoseizures (PS). We designed this study to determine the value of clinical phenomena in distinguishing between the two. In a series of patients with SMS, we identified those with symptoms mimicking PS and compared the clinical phenomena with those of clinically similar PS. We found that SMS are short in duration, stereotypic, tend to occur in sleep, and often present with a tonic contraction of the upper extremities in abduction. This sign was specific for SMS, particularly when occurring at the onset. Conversely, PS are long in duration, nonstereotypic, and occur in the awake state. We conclude that clinical phenomena may be useful in distinguishing PS from SMS, although the final diagnosis must be documented by neurophysiologic means.
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Twenty-seven patients with complex partial seizures were studied electrographically utilizing a large number of closely spaced scalp electrodes around the epileptogenic focus. Skull roentgenograms were made with the electrodes in place in order to relate the electrode positions to underlying brain anatomy. Field distribution maps were constructed from reference montages employing the closely spaced electrode set. Electrodes other than 10-20 were maximal most often and the single electrodes most often maximal were D9-D10, anterior temporal in location. This method of localization is of help in the evaluation of patients with complex partial seizures who may be surgical candidates.
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A patient with X-linked hypogammaglobulinemia developed chronic meningoencephalitis. ECHO virus type 5 was repeatedly cultured from cerebrospinal fluid (CSF). Infusions of high-titer, specific plasma resulted in clinical improvement, but failed to eradicate the virus. After more intensive plasma infusions, the virus could not be cultured from the CSF. The patient died 8 months after institution of intensive therapy. The cause of death was unknown. Autopsy showed persistence of perivascular and meningeal inflammation. Specific anti-ECHO-virus-5 plasma was shown to be more effective in lowering CSF ECHO-virus titers than was plasma without anti-ECHO-virus antibody.
An elderly man had focal motor status epilepticus secondary to a frontal lobe hematoma. Phenytoin, phenobarbital, and diazepam did not stop the seizures. Intravenous lidocaine by bolus injection and continuous infusion rapidly controlled the seizures.
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Electrophysiologic measurements in a 9-year-old girl with tick paralysis demonstrated a prolonged distal latency and a decremental response to 30 Hz stimulation. The nerve conduction determinations became normal after clinical recovery. The pathophysiologic process of this disease seems to be within the peripheral nerve although a central site of action of tick toxin cannot be completely excluded. Tick paralysis should be considered in the individual who develops ascending paralysis.
A 65-year-old woman had intermittent episodes of blindness. Although severe atherosclerotic changes were documented angiographically, definite radiographic evidence of arteritis also was present. A temporal artery biopsy was diagnostic for giant cell arteritis. Despite high-dose corticosteroid treatment, the patient became blind. A Westergren sedimentation rate of greater than 40 mm/hr in a patient over age 50 with headache, constitutional complaints, or visual symptoms is presumptive evidence of giant cell arteritis and demands further investigation. Prompt treatment with prednisone in high doses may prevent visual loss. At times angiography may be helpful in diagnosis of this illness or in selection of a biopsy site.
Leukocyte peroxidase deficiency has been demonstrated in a confirmed case of neuronal ceroid-lipofuscinosis with guaiacol, o-dianisidine, and p-phenylenediamine used as hydrogen donors in the peroxidase assay system. Nitroblue tetrazolium (NBT) reduction values in the leukocytes of the patient were also found to be significantly higher than those of normal controls, indicating the impaired hydrogen peroxide catabolism. When the patient was given a daily dose of vitamin E (400 I.U.), vitamin C (1 gm), and methionine (1 gm.) along with a weekly intramuscular injection of vitamin B12, the leukocyte peroxidase values of the patient returned to normal levels in about 7 weeks. NBT reductions values also decreased to normal levels. The regenerated enzyme in the patient's leukocytes was shown to have similar chromatographic and electrophoretic properties as the leukocyte peroxidase of normal controls. After about 28 weeks of therapy, the peroxidase levels in the leukocytes of the patient returned to original low levels, with concomitant increase in the NBT reduction values. The effect of vitamin therapy on normal control subjects was, at least in some cases, an increase of leukocyte peroxidase. A significant increase in the peroxidase levels of the patient's leukocytes during vitamin therapy remains unexplained, and the possibility of peroxidase deficiency being a secondary manifestation rather than the primary defect in Batten's disease cannot be ruled out.