Occlusion of the carotid arteries for 5 minutes in the Mongolian gerbil results in selective necrosis of CAI pyramidal neurons. In the present experiments we studied whether intraventricular infusion of acidic fibroblast growth factor (aFGF) could attentuate this damage. Intraventricular infusions of bovine serum albumin (BSA-10 ng/h) or aFGF (1, 10 or 100 ng/h) were started 2 days prior to 5 minutes of bilateral carotid occlusion and continued for 5 days post-ischemia. The brains were perfused and fixed at 5 days post-ischemia and histological assessment of CAI damage was made. Animals receiving intraventricular infusions of 10 or 100 ng/h aFGF showed a significant reduction of CA1 neuronal damage in comparison to no treatment ischemic controls (no treatment − 8 + 1 ; aFGF 10 ng/h − 147 ± 28; aFGF 100 ng/h − 168 ± 35 cells/mm CAI; P < 0.05 for both aFGF groups). The results indicate that aFGF infusion can attenuate the severity of ischemic neuronal necrosis in the gerbil hippocampus.

This review describes some characteristics of patients with cerebellar lesions, including limb movements, changes in motor planning and disturbances in time-dependent perception. The delay in movement initiation can be explained by a delay in onset of movement-related discharge of neurons in motor cortex. Disorders of movement termination (hypermetria) are accompanied by asymmetric velocity profiles and by prolonged agonist and delayed antagonist EMG activity necessary to brake the movement. During complex movements in three-dimensional space, the cerebellum contributes to timing between single components of a movement, scales the size of muscular action, and coordinates the sequence of agonists and antagonists. The basic structure of motor programs is not generated exclusively within the cerebellum and patients with cerebellar lesions can use precuing information to improve their motor performance. Time-dependent perception in the auditory and visual domains are disturbed in patients with cerebellar lesions.

There are 60 pediatric neurologists in Canada. Replies were received from 56 in response to a survey regarding the use and perceived value of antiepileptic drug (AED) levels. AED levels are frequently ordered and influence clinical care. There were, however, discrepancies among pediatric neurologists regarding the upper and lower limits of the “therapeutic ranges” and the clinical application of levels. We suggest that both the value and use of AED levels needs further study.

Five patients with evidence of focal encephalopathy are reported. In each case, evidence of mycoplasma pneumoniae infection was detected. No patient improved with conventional antibiotic therapy, but in three subjects, rapid and complete recovery did occur contemporaneously with the administration of high dose steroid therapy. It is suggested that focal as well as diffuse cerebral or cerebellar lesions may occur as manifestations of auto-immune disease complicating mycoplasmal infections in young people and that this illness may be designated as acute mycoplasma-associated encephalopathy.

The incidence of vestibular schwannoma (acoustic neuroma) in Manitoba, Canada was reviewed. From 1987 through 1991, 71 tumors were diagnosed in 69 patients. The overall annual incidence rate for both sexes was 1.27/100,000 with male and female annual incidences of 1.31/100,000 and 1.24/100,000 respectively. For males, there was an early peak in the age group 30 - 39 years (2.1/100,000). Following the fifth decade, the incidence for males plateaued (2.7 - 3.6/100,000). For females, the incidence increased with age up to age 60 - 69 years (4.1/100,000). This was followed by a progressive decline in the incidence. Although the incidence of vestibular schwannoma was relatively high, the clinical features were not unlike those previously reported in the literature.

Synaptic plasticity plays a role in the learning capability of brain tissues. Long-term depression (LTD) of parallel fiber synapses in cerebellar Purkinje cells occurs when these synapses are activated in conjunction with climbing fiber synapses. Signal transduction mechanisms underlying LTD have recently been investigated extensively. It has also become apparent that climbing fiber signals encode errors in the motor performance of an animal. It is therefore hypothesized that learning proceeds in cerebellar tissues in such a way that error signals of climbing fibers act to depress by LTD those parallel fiber synapses responsible for the errors. The cerebellum contains a large number of corticonuclear microcomplexes. Each microcomplex is connected to an extracerebellar system and is presumed to endow the system with learning capability. The hypothesis accounts for the adaptation of the vestibuloocular reflex and probably also for other forms of motor and cognitive learning.

A large sample of Canadian adults was surveyed by telephone to determine the prevalence and characterization of headache, and the effects of headache on life-style, consulting behaviours and medication use. We reported prevalence and characterization in a previous issue; here, we detail the effects of headaches on sufferers. Sixteen and one-half percent of adult Canadians experience migraine and 29% tension-type headaches. In over 70% of headache sufferers interpersonal relationships are impaired. Regular activities are limited in 78% of migraine attacks and 38% of tension-type headaches. Despite this, only 64% of migraine and 45% of tension-type headache sufferers had ever sought medical attention, and of these only 32% returned for ongoing care. Fourteen percent of migraine and 8% of tension-type headache sufferers had used emergency departments. Most headache sufferers take medication, primarily over-the-counter varieties. Measures to reach the headache population are needed, as are safe effective treatment options that will encourage them to participate in their medical care.

In this study the ability of iron chelators to attenuate hypoxic-ischemic brain damage was assessed in hyperglycemic rats that were exposed to 1% carbon monoxide and right carotid occlusion. The animals received deferoxamine (50 mg/kg), manganese-deferoxamine (50 mg/kg) or vehicle i.p. 0.5 h prior to hypoxemic-ischemic exposure and at 0.5, 3 and 24 h post-exposure; with subsequent histological examination of the brain at 7 days recovery. The area of cerebral infarction was measured at three levels using video imaging methods. The mean percentage of total hemisphere that was infarcted in the three groups was: vehicle — 28.5 ± 5.0; deferoxamine — 31.7 ± 12.1; and manganese deferoxamine — 30.6 ± 6.8 (p - n.s.). The results as obtained in this preliminary study indicate that aggressive pre- and post-treatment with iron chelators has no ability to attenuate cerebral infarction in this model.

The objective of our prospective study was to assess the role of contact thermography in children with migraine. Contact thermograms were done in 54 children aged 4.2 - 16.5 years (median 10.5 years), who were seen for headache and on 10 age-matched controls, between July and December 1991. Thermograms were interpreted as definitely normal, equivocally normal, equivocally abnormal, and definitely abnormal by a radiologist who was blinded to clinical information. Forty-eight children had the test between headaches; of these, four out of 26 patients (15%) who had migraine without aura and 3 out of 14 children (21%) who had migraine with aura had definitely abnormal thermograms. Nine out of 10 normal controls had definitely normal thermograms. The sensitivity of contact thermography in the diagnosis of childhood migraine, when done between headaches, was low in our study.

Four patients presented with hemiballism-hemichorea as a clinical manifestation of white matter ischemia. These patients illustrate “positive” motor phenomena rather than limb weakness as a consequence of cerebral ischemia. In each patient, the involuntary movements disappeared following worsening of paresis. Subcortical white matter infarction in three patients and hemodynamic hypo-perfusion in the cerebral hemisphere contralateral to dyskinetic movements were possible causes. Neuroradiologically, none had pathological changes in the vicinity of the subthalamic nucleus. We presume from these observations that ischemia of the subcortical white matter, without involvement of the basal ganglia or the subthalamic nucleus, may cause hemiballism-hemichorea

Walker-Warburg syndrome is a well delineated clinical entity with characteristic brain and eye anomalies. Recent diagnostic surveys have revealed that muscular dystrophy is an obligatory feature of this syndome. We report a patient with an inflammatory myopathy that preceded dystrophic changes. While reports of parental consanguinity and multiple affected sibships strongly suggest an autosomal recessive genetic basis for this syndrome, previous pathological analyses of the CNS have suggested an inflammatory process. Our case supports both the notion of an aberrant inflammatory process that is likely under genetic control or etiologic heterogeneity (phenocopies) underlying this syndrome.

By applying vibratory stimulation to patients suffering from pain, it is possible to set up an inhibitory control on the pain pathways which is based on the activation of large-sized afferent fibres. The exact mechanisms responsible for these analgesic effects still remain to be determined, however. For this purpose, we investigated in the present study whether or not the analgesic effects were accompanied by a decrease in the CSF substance P-like immunoreactivity levels (SPLI) of seven patients suffering from chronic pain, who were fitted with a ventriculo-peri-toneal drain. The SPLI levels were determined before and after 30-min vibratory stimulation sessions. The results show that the SPLI levels decreased as the result of the vibration, but this decrease seems to be too slight to account for the pain relief obtained.

Cervical myelopathy consequent on ossification of posterior longitudinal ligament (OPLL) is very rare in Caucasians. A 65-year-old Anglo-Saxon woman developed progressive gait disturbance, paresthesia in both legs and urinary urge incontinence. Radiological examination showed OPLL from fifth to seventh cervical vertebral level; the dense OPLL was graphically displayed by three-dimensional computerized tomography. Medial corpectomy, C5 to C7, and removal of OPLL, with subsequent fusion C4 to Tl using a free fibula graft resulted in clinical improvement. Three dimensional computerized tomographic imaging is a valuable diagnostic procedure in OPLL.

The circuitry of the cerebellum is quite well understood. The computation takes place in the cerebellar cortex, which functions in synchronized strips to provide excellent timing signals to the cerebral cortex and the spinal cord. The cerebellar cortex is also the site where error signals from other parts of the central nervous system are incorporated. For voluntary limb movements the cerebellular cortex is important for the timing of the innervation of the agonist and antagonist anterior horn neurons. It is also important for the temporal order of and precision in the execution of motor programs. As will be apparent, the cerebellum is not only a computer taking care of motor programs.

A single-blind study of dystrophin staining in skeletal muscle was performed in 13 biopsies from carriers of Duchenne Muscular Dystrophy (DMD) and controls. The results indicate that immunohistochemical analysis of dystrophin staining is a valuable diagnostic test for DMD carriers when DNA for testing is unavailable from critical family members or is uninformative, when creatine kinase (CK) values are conflicting or when CK values must be used in isolation.

A 4-year-old boy developed Rasmussen’s syndrome and was treated with alpha interferon intraventricularly. An improvement in the epileptic and neurologic syndrome was noted for several weeks following interferon. No adverse side effects were encountered. Since hemispherectomy is the only established therapy in Rasmussen’s Syndrome, further studies are needed to establish if intraventricular alpha interferon may halt the clinical progression of the syndrome.