Hyperkinetic children: Early indicators of potential school failure

Hyperkinetic children are identified as a population-at risk upon admission to kindergarten. The etiology of hyperkinetic behavior is controversial. Organic driveness, hyperkinetic behavior disorder, postencephalitic behavior, brain damage with behavioral and conceptual deficit, Strauss syndrome, have all been used to label essentially similar symptom constellations. Bypassing the area of controversy, a study is reported that demonstrates that children who were identified as hyperkinetic (using behavioral criteria developed in an earlier study) were (1) absent from school more frequently, and (2) did remarkably less well on standardized tests of school readiness than their peers rated nonhyperkinetic. The implications are discussed and suggestions made for the development of intervention programs.An earlier version of this paper was presented at the Annual Meeting of the American Orthopsychiatric Association, March, 1967.     

Genealogic study of patients with admission diagnosis of functional psychosis

Summary The results are reported of a genealogic study of 313 patients (171 males and 142 females) consecutively admitted to the psychiatric department of the Medical School of Charles University in Prague, Czechoslovakia. Patients suffering from psychosis were selected and divided into five groups: schizophrenia, bipolar psychosis, unipolar depressive psychosis, schizoaffective psychosis and unspecified disorder (the diagnosis of psychosis suspected but not yet certain at the time of investigation). A total of 1086 first degree relatives (parents and siblings) were ascertained and one or more first degree relatives of each proband were interviewed. The total morbidity risk of psychiatric disorder for parents and siblings was 12.6% for schizophrenic probands, 17.8% for bipolar probands, 10.7% for unipolar probands, 12.0% for schizoaffective probands and 12.6% for probands with unspecified psychosis. A striking increase of the frequency of affective disorders was found among secondary cases of schizoaffective probands.Heterogeneity between schizophrenia and primary affective disorders was tested and demonstrated.The pros and cons of the study design was discussed.     

Relationship of maternal parenting behaviors to preschool children's temperament

Mothers of 182 preschool nursery school children rated their own parenting responses on a Parent's Report questionnaire. At the same time the mothers responded to the Behavior Style Questionnaire (BSQ) from which scores were determined for nine categories of temperament. On the basis of category scores the children were grouped into one of five temperament clusters i.e. easy, difficult, slow to warm up, high intermediate, low intermediate. The children's membership in BSQ clusters was independent of sex, age, birth order, and mothers employment status but there was a significantly higher ratio of easy children from higher socioeconomic classes I and II. Mothers of children grouped in either the difficult or slow to warmup clusters were more likely to use guilt inducing and temper-detachment parenting styles than mothers of children grouped in the easy cluster.     

The immorality of morality

The psychiatrist cum humanist wonders aloud why euthenics is almost as dirty a word as eugenics—with special emphasis on the psychiatric establishment.For example: Unlike the complaint bureaus of commerical establishments, mental health services operate on the basis that the customer is always wrong.This article is a revision of a longer paper delivered at the 49th Annual Meeting of the American Orthopsychiatric Association in 1972.     

Clinical and Human Resource Planning for the Downsizing of Psychiatric Hospitals: The British Columbia Experience

Riverview Hospital, B.C.'s only and Canada's largest remaining provincial psychiatric hospital began a formal planned downsizing process in 1992. This initiative was an important element in the Province's strategic plan to shift to a more community-focused mental health system and to bring tertiary psychiatric services closer to home by redeveloping Riverview Hospital on three sites. The paper summarizes the literature pertaining to the downsizing of psychiatric hospital services in relation both to clinical and human resource planning. It describes the mental health system in B.C. and the service system context in which this exercise is occurring. It is based on the first three years of experience in identifying the major challenges and the strategies developed to meet these challenges. It draws some conclusions about the effectiveness of these strategies and it speculates about the likely future challenges as the downsizing process continues.     

Clinical Evaluation of Attention-Deficit Hyperactivity Disorder by Objective Quantitative Measures

This study assessed the diagnostic potential of the actigraph, the Continuous Performance Test, and the Matching Familiar Figures Test in diagnosing attention-deficit hyperactivity disorder (ADHD). Twenty boys previously diagnosed with ADHD and 52 controls were examined. By these measures the boys with ADHD were differentiated from the controls with sensitivity and specificity above 75%. We were able to classify ADHD into eight subtypes by combining the scores of the actigraph and the CPT: hyperactive-impulsive, hyperactive-inattentive, impulsive-inattentive, hyperactive, impulsive, inattentive, mixed, and unspecified type. These classifications may be useful in diagnosing ADHD.     

Quality of life in multiple sclerosis: The disability and impact profile (DIP)

Seventy-three Dutch and Flemish patients with definite multiple sclerosis (MS) were assessed by means of the Disability and Impact Profile (DIP), which is a 2 × 39 item, self-administered questionnaire with parallel questions aboutdisabilities and their importance for orimpact on the patient, resulting in a profile of weighted scores. It was designed as a tool for clinical assessment of quality of life (QoL) domains in MS patients. Group data showed more than 50% loss on weighted scores for walk, clean home, work and worry about deterioration. In individual patients a median of 7 (range 0–23) major disruptions of quality of life (MD-QoL: loss on weighted score more than 50%) was found. Prevalence of MD-QoL in more than 10% of the patients was found for as many as 31 disabilities and > 50% for 3 (clean home, work and worry about deterioration). Results in the MS group were compared with available data from 25 patients with rheumatoid arthritis (RA) and 25 patients with a spinal cord lesion (SCI). Weighted scores of read, memory and concentration were significantly lower in the MS group than in the RA and SCI groups. Significantly lower weighted scores in both the MS and RA groups compared with the SCI group were found for worry about deterioration, physical endurance, clean home, work, see and write. In conclusion, major disruptions in many domains of QoL were found in MS patients. Weighted score profiles for MS were in accordance with clinical manifestations. Unlike Kurtzke's Extended Disability Status Scale, DIP assesses a wide range of potentially MS-affected human activities, and also takes into account the subjective perception of disabilities.     

Intestinal neurohormones in protein-deficient rats

Summary The levels of noradrenaline, adrenaline, and serotonin in the jejunum and ileum of weanling rats fed protein-free (deficient) and high-protein (control) diets were analyzed. The concentration of noradrenaline of the deficient rats was markedly increased, both in the jejunum (0.430±0.039g/g vs. 0.188±0.019g/g in the control animals, +228%, P<0.001) and in the ileum (0.492±0.041g/g vs. 0.212±0.014g/g in the control rats, +232%, P<0.001). However, the levels of adrenaline and serotonin were unaltered in deficient rats as compared to controls, both in the jejunum (0.049±0.009g/g of adrenaline and 1.233±0.178g/g of serotonin vs. 0.047±0.006g/g of adrenaline and 1.364±0.131g/g of serotonin in the controls) and in the ileum (0.027±0.005g/g of adrenaline and 0.902±0.150g/g of serotonin vs. 0.038±0.006g/g of adrenaline and 1.118±0.192g/g of serotonin in the controls). In view of these results, it can be speculated that the abdominal distension and the reduced intestinal motility usually seen in the states of protein malnutrition could be caused, at least in part, by the accumulation of noradrenaline in the intestine.     

Attitudes toward authority and mental health in adolescent college students

In all instances, those subjects holding negative perceptions of authority scored in less favorable mental health directions. The author cautions, however, that in potentially creative college students, such negative attitudes (perhaps even negative behavior) may not be as ominous from the mental health/personality development point of view as might otherwise be the case.     

A Qualitative Research Study of the Evolution of Symptoms in Individuals Identified as Prodromal to Psychosis

Because schizophrenia is difficult to treat and exacts large personal and societal costs, there is an effort underway to identify adolescents and young adults at high risk for psychosis. Theory-derived criteria of subthreshold positive symptoms identify a prodromal or clinically at-risk population who have conversion rates to psychosis of 40 to 50% within one to two years. However, further characterization of the psychosis prodrome by qualitative research methods could increase the predictive value of the prodromal designation. We conducted open-ended interviews with 20 parents of prodromal adolescents that focused on changes observed. The narratives fell into two thematically distinct subgroups, identified as declining and never normal. The prodromal adolescents described as declining had a higher subsequent rate of conversion to psychosis than did the never normal group. Although preliminary, these results suggest that a trajectory of change in personality, relationships, and behavior from an essentially normal baseline may be consistent with increased risk for psychosis among prodromal adolescents.     

Prevalence of known and hidden alcoholism in the revisited lundby population

Summary Using the new data from a second followup of the Lundby 1947 cohort, the aim of the present paper has been to analyze some relationships between known and hidden alcoholism in a Swedish general population sample. Information was collected by psychiatrists trough free, exploratory field interviews checked against documentary records. Alcoholism was medically defined for present purposes. Information was obtained for 98% of the 952 men surviving the cross-section date July 1, 1972. The distribution of alcoholism and other psychiatric disorders in the total population and in age subgroups was analyzed epidemiologically. The true prevalence of alcoholism in the adult men was 9.5%, comprising 7.2% known and 2.3% hidden. The proportion of hidden to known cases was 0.301 (Temperance Boards 0.871, Psychiatric Agencies 0.961, Drinking and driving offences 4.31). The main finding that about 70% of male alcoholics in Lundby appears to be known to the agencies is at variance with current views that there is an iceberg under the tip, though consistent with Rubington's suggestion that so-called hidden alcoholism is not totally but partially invisible in welfare societies.     

Cytoplasmic and axoplasmic density variations in relation to hyperactivity

Summary The density of the cytoplasm and axoplasm of the anterior horn cell in rats was determined by X-ray microradiography. The average density of the cytoplasm of more than 400 cells from control rats was 0.31 g/³, while that of over 600 cells from rats fed IDPN (- iminodipropionitrile) was 0.43 g/³.Hyperactivity developed during the first 5 weeks and was associated with a gradual increase in cytoplasmic density to 0.51 g/³.At 6 weeks there was a drop in density to 0.36 g/³ which coincided with the appearance of axonal balloons having a density of 0.17 g/³.During the 7–12th week on the diet, the cytoplasmic density showed a gradual increase to 0.59 g/³ and the balloons to 0.29 g/³.The volume of the nerve cells remained fairly constant. The density increases were discussed in relation to hypertrophy, dystrophy, and hyperactivity.

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Zusammenfassung Die Dichte des Cytoplasmas und Axoplasmas der Vorderhornzellen von Ratten wurde durch Röntgenmikroradiographie bestimmt. Die mittlere Dichte des Cytoplasmas von mehr als 400 Zellen der Kontrollratten war 0,31 g/³, während die mittlere Dichte von mehr als 600 Zellen der Ratten, die mit IDPN (- iminodipropionitrile) gefüttert waren, 0,43 g/³ war.Hyperaktivität entwickelte sich während der ersten 5 Wochen und war mit einer progressiven Zunahme der Cytoplasmadichte bis auf 0,51 g/³ verbunden.Nach 6 Wochen sank die Dichte auf 0,36 g/³. Diese Tatsache traf mit dem Auftreten der Axonauftreibungen zusammen, die eine Dichte von 0,17 g/³ hatten.Nach 7–12 Wochen zeigte die Cytoplasmadichte eine progressive Zunahme auf 0,59 g/³ und die der Auftreibungen eine Zunahme auf 0,29 g/³.Das Volumen der Nervenzellen blieb ziemlich konstant.Die möglichen Zusammenhänge zwischen Zunahme der Dichte, Hypertrophie, Dystrophie und Hyperaktivität werden dargestellt.

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Supported by U. S. Public Health Grant NB 1305.     

Pelizaeus-Merzbacher disease

Summary A girl of non-Jewish origin, with non-contributory family history, at the age of 3 developed progressive mental deterioration, an ataxic-spastic syndrome and died in a decerebrate state at the age of 18 10/12 years. Neuropathological examination disclosed severe discontinuous-subtotal demyelination and diffuse sclerosis of the cerebral and cerebellar white matter with some small myelin islets and sparing of the subcortical arcuate fibres as well as of the deeper myelinated regions. There were remarkably sparse residua of orthochromatic myelin breakdown chiefly of the fixed type. The axons were preserved. Additional atrophic lesions of the thalamus and cerebellar folia were considered to be of anoxic origin. This sporadic case is suggested to represent a transitional form between the classical and the co-natal (Seitelberger) type of Pelizaeus-Merzbacher Disease.

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Zusammenfassung Ein Mädchen aus gesunder, nicht-jüdischer Familie erkrankte im 3. Lebensjahr mit schubförmig-progressiver psychischer Retardierung, cerebellar-spastischem Syndrom und starb mit 18 10/12 Jahren in einem Decerebrationszustand. Neuropathologisch fand sich eine schwere diskontinuierlich-subtotale Entmarkung und Sklerose im Groß- und Kleinhirn mit wenigen erhaltenen Markinseln, intakten U-Fasern und tiefen Markstrukturen bei nur diskretem fixen orthochromatischen Abbau. Eine symmetrische Thalamusatrophie und Kleinhirnläppchensklerose wird als Anoxieschaden aufgefaßt. Die sporadische Beobachtung wird der Übergangsform zwischen klassischem und konnatalem Typ der Pelizaeus-Merzbacherschen Krankheit zugeordnet.

     

Are VEP abnormalities in optic neuritis (ON) dependent on plaque size? A reappraisal of the physiopathology of ON based on improved MRI and multiple-lead recordings

Twenty patients with optic neuritis (ON) described in the previous study [23] underwent serial VEP recordings (using multiple electrode arrays) for two years. The VEPs could be correlated with the lesions revealed by MRI, Visual Field tests and other clinical findings. On the basis of their scalp distribution, they were classified as really delayed VEPs and pseudo-delayed VEPs.Real delays could be recorded at the onset of ON or shortly afterwards, and their appearance indicated the recovery of visual function and a good prognosis.Pseudo-delays indicated an alteration in the visual field and, unless a breakthrough of normal or delayed components appeared in the first three months, following acute ON, indicate a poor prognosis for the recovery of visual function.The pseudo-delayed VEPs were mainly observed in patients with longer lesions revealed by means of LTE-STIR MRI [23]; there was no correlation between VEP latency and the length of plaques.Our findings contradict previous theories on the timing of conduction alterations in ON and multiple sclerosis.

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Sommario I 20 pazienti affetti da Neurite Ottica (NO), descritti nel precedente lavoro [23] sono stati sottoposti a registrazioni seriali multicanali dei Potenziali Evocati Visivi (PEV), per un periodo di 2 anni dall'esordio della NO. I PEV potevano correlare con le lesioni evidenziate con la Risonanza Magnetica, con le alterazioni campimetriche e con altri reperti clinici. Basandoci sulla loro distribuzione in mappa, i PEV sono stati classificati come realmente ritardati e pseudo-ritardati. PEV realmente ritardati potevano essere registrati all'esordio, o precocemente dopo l'episodio di NO, e la presenza del ritardo stava ad indicare un recupero della funzione visiva e, quindi, una prognosi fausta.Gli pseudo-ritardi indicavano un'alterazione del campo visivo a prognosi non favorevole per un recupero della funzione visiva, a meno che entro i primi 3 mesi dalla NO si fosse verificata una ricomparsa di componenti normali o ritardate.Gli pseudo-ritardi erano rilievi caratteristici nei pazienti con lesioni maggiormente lunghe alle immagini LTE-STIR MRI [23]. Nessuna correlazione è stata trovata tra latenza dei PEV e lunghezza delle placche.I nostri rilievi sono in disaccordo con precedenti teorie relative ai tempi di instaurazione-recupero delle alterazioni di conduzione nella NO e nella Sclerosi Multipla.

     

An ultrastructural analysis of remyelination following segmental demyelination

Summary Electron microscopic observations were made of early remyelination after segmental demyelination in experimental allergic neuritis (EAN) and experimental diphtheritic neuropathy. In EAN 71% of axons which had been demyelinated were invaginated each within a single Schwann cell; remyelination associated with this cellular relationship was in accordance with the spiral myelin concept, 29% of demyelinated axons in EAN were initially enveloped each by several Schwann cell processes and the associated mechanism of remyelination was by tunication resulting in a transient irregular distribution of myelin lamellae around the axon circumference. In diphtheritic neuropathy regeneration more closely paralleled development in ontogeny. 88% of demyelinated axons were invaginated each within one Schwann cell, only 12% of axons were each enveloped by more than one Schwann cell process. Early remyelination by tunication was not observed in diphtheritic neuropathy. Additional loosely associated Schwann cell processes lying within the old Schwann cell basement membrane occurred frequently in both experimental conditions. Schmidt-Lanterman clefts, redundant myelin, and desmosomes were observed in the sheaths of incipient remyelination.     

Administrative influences on psychiatric diagnosis

Summary In order to cut expenditure on mental health care in Brazil, the national authority responsible for the financing of health care imposed in 1977 the following two restrictions on reimbursement: a) the costs for inpatient treatment under the diagnoses neurosis and alcoholism would be paid only for a maximum length of hospital stay of 30 days and b) the costs for inpatient treatment under the diagnoses oligophrenias and epilepsies would no longer be paid. We studied the effects of these administrative measures upon the yearly frequencies of diagnoses and the mean lengths of hospital stay in 27377 treatment episodes between 1975 and 1982. We found significant decreases in both variables for the above mentioned diagnoses after 1977. At the same time the frequencies of the diagnoses alcoholic psychoses, psychoses associated with other cerebral conditions and other psychoses increased significantly. These findings can probably not be attributed to true changes in morbidity, but are rather the results of changes in diagnostic habits in response to administratively imposed austerity measures.     

Zur Frage der Randzonensiderose des Zentralnervensystems

Zusammenfassung Unsere Experimente sollten einen Beitrag zur Klärung der Ätiologie der Randzonensiderose des Gehirns geben. Bei cisternaler Eiseninjektion gleichen die morphologischen Befunde denen der Randzonensiderose des Gehirns. Nach i.v. Eiseninjektion entsprechen die Eisenablagerungen in der Organverteilung den Befunden bei allgemeiner Hämosiderose.Durch enterale massive Eisenzufuhr wurde eine in der Stärke den i.v. Injektionen vergleichbare Eisenanreicherung in den Organen beobachtet.Die Organverteilung von suboccipital und i.v. bzw. enteral verabreichten Eisenverbindungen ist somit den Versuchen mit sauren Vitalfarbstoffen vonGoldmann undSpatz vergleichbar.Die Randzonensiderose des Gehirns — als Sektionsbefund beim Menschen — halten wir für einen Folgezustand chronischer subarachnoidaler Blutungen. Sie unterscheidet sich grundsätzlich von dem typischen Befund am Gehirn bei der Hämochromatose, bei der eine Plexussiderose im Vordergrund steht. Daneben finden sich geringe Eisenablagerungen in der Area postrema und in den paraventrikulären hypothalamischen Geibeten.Eine Hämochromatose ist experimentell durch i.v. Zufuhr sehr großer Eisenmengen nicht zu erzeugen.Ein Durchbrechen der Blut-Hirnschranke selbst mit hohen Eisendosen ist vom Blut her nicht möglich.Eine Randzonensiderose infolge von Ferrosulfatvergiftung, wie sie vonPentschew beschrieben wurde, ließ sich nicht erzeugen.

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Summary The aim of our investigation has been a contribution to the clarification of the etiology of the marginal siderosis of CNS. The morphological findings after cis-ternal injection of Fe-compounds are comparable with those of the marginal siderosis. After intravenous Fe-injection the distribution of Fe-deposits in the the organs corresponds to the findings in general hemosiderosis.After massive enteral administration a Fe-concentration, which corresponds to that after intravenous injections, was observed.The distribution of suboccipitally and intravenously as well as enterally administered Fe-compounds within the organs is, therefore, comparable to the vital staining experiments byGoldmann andSpatz.The autoptic finding of marginal siderosis of CNS in men is considered as a condition resulting from chronic subarachnoid hemorrhages. In principal marginal siderosis can be differentiated from the typical hemochromatosis of the brain, whereby the latter is characterized by siderosis of plexus. Furthermore slight Fe-deposits occur within the area postrema as well as within the paraventricular hypothalamic areas. Hemochromatosis cannot be produce experimentally by intravenous administration of high Fe-doses.Break down of the blood brain barrier, even by high Fe-concentration in the blood, is not possible.Marginal siderosis, caused by a ferrous sulfate poisoning—as described byPentschew—could not be produced.

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Mit 5 Textabbildungen     

Electroconvulsive therapy in Parkinsonian patients with the “on-off” syndrome

Summary Marked, abrupt and disabling oscillations in motor performance—the on-off phenomenon-frequently occur in the course of long-term levo-dopa therapy for Parkinson's disease. Although these fluctuations are usually refractory to available medications it has recently been suggested that electroconvulsive therapy (ECT) may be beneficial.Five Parkinsonian patients with incapacitating and unpredictable on-off changes who were free of significant depression were given conventional bilateral ECT while usual drug regimens were maintained. While ECT was well tolerated, after a total of six treatments no significant improvement in Parkinsonian disabilities or on-off changes were seen.     

An Operationalized Multisymptomatic Model of Neuroses (OMMON): Toward a reintegration of diagnosis and treatment in behaviour therapy

Summary Experimental results from a sample of 216 patients with four different symptom-neuroses show that 65% to 90% of these patients have different combinations of multiple symptomatology.With a background of these data, we present an Operationalized Multisymptomatic Model of Neuroses (OMMON), based on self-rating assessment of these patients on 4 symptom scales. Individual ratings on each scale are dichotomized into (+) or (-) results with regard to defined cut-off points and the model is derived from their 16 mathematically possible combinations. Subsequent analysis of these data (from a single test application) with our Varying Cut-Off Point Assessment (VACOPA) leads to hypotheses regarding causal symptom interactions and prediction of symptom changes over time, easily evaluated by repeated test application.In treatment research the model seems suitable to: (a) build more homogeneous diagnostic groups; (b) operationalize varying degrees of neurotic disturbance, from normal via client to patient—independently of existing illness theories; (c) support prognoses of individual developments within and without treatment; (d) specify treatment aims and optimal sequences of interventions; (e) monitor predicted outcome; (f) reconsider earlier apparently contradictory outcome studies; (g) evaluate theoretical concepts regarding neurotic symptom formations in neuroses, psychoses, and psychosomatic disturbances.For treatment purposes, OMMON should only be used together with clinical hypotheses; its prognostic potential can be increased by additional application of our Operationalized Multivariate Model of Motivation (OMMOM).All three diagnostic approaches may be used for mutual evaluation.Different sections of this paper have been presented to:1. International Congress of Behaviour Therapy, Trondheim/Norway, 19.–22. 8. 19812. The 1st European Conference on Psychotherapy Research, Trier/Federal Republic of Germany, 18.–20. 9. 19813. 2. Kongreß für Klinische Psychologie und Psychotherapie, Berlin, 14.–19. 2. 1982We wish to thank the patients and the Allgemeines Krankenhaus Ochsenzoll for their cooperation, and Profs. F. Kanfer and R. Liberman for valuable comments on a first draft (May 1981) of this paper.     

Lesions of the brain in hyaline membrane disease of infants

Summary A pilot study to determine the character, topography and frequency of lesions in the brains of infants who died of hyaline membrane disease (respiratory distress syndrome) is reported. The series consisted of 21 children who died of this disease, 4 who died of other diseases, and 2 stillborn infants.Marked decrease or absence of Purkinje cells, particularly in babies of more than 30 weeks gestation, appeared to be the most significant finding. This was not considered to be a normal state at birth, nor was it commonly observed in babies who died of causes other than the respiratory distress syndrome. The Purkinje cell reduction also appeared unrelated to birth injury and postnatal biochemical abnormalities. It is suggested that the Purkinje cells in babies with hyaline membrane disease either never developed normally in prenatal life or underwent rapid cellular disintegration in utero due to some as yet unidentified metabolic disturbance. Cerebral cortical laminar pallor probably due to anoxemia also was frequently noted but was considered to be of less significance than the cerebellar lesion.

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Zusammenfassung Bericht über die Ergebnisse einer vorläufigen Untersuchung an Gehirnen von Säuglingen mit hyalinen Membranen der Lungen (Respiratory Distress Syndrome). 21 Fälle dieser Erkrankung wurden untersucht, außerdem 4 Fälle mit anderen Erkrankungen und 2 Totgeborene.Der Hauptbefund, besonders bei Säuglingen mit einer Schwangerschaftsdauer von mehr als 30 Wochen, war zahlenmäßige Verminderung oder völliger Ausfall der Purkinje-Zellen. Man hatte nicht den Eindruck, daß dieser Befund etwas Normales beim Neugeborenen darstellt, oder daß er bei Tod nach anderen Erkrankungen häufig vorkommt. Ein Zusammenhang mit Geburtstrauma oder postnatalen chemischen Störungen wurde nicht festgestellt. Es wird vermutet, daß die Purkinje-Zellen bei Säuglingen mit hyalinen Membranen sich entweder überhaupt nicht normal entwickelt haben, oder daß sie im Uterus rasch zerstört wurden, und zwar im Zusammenhang mit einer noch nicht völlig geklärten Stoffwechselstörung. Schichtförmige Erbleichungen der Großhirnrinde durch Anoxaemie wurden häufig beobachtet, sie waren aber weniger charakteristisch als die Kleinhirnveränderungen.

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With 4 Figures in the Text