Benign encephalopathy of pregnancy Preliminary clinical observations

A survey of 67 pregnancies in 51 professional women (physicians, psychologists, nurses, administrators, etc.) revealed the occurrence of symptoms of cognitive dysfunction such as forgetfulness, disorientation, confusion and reading difficulties in 28 pregnancies occurring in 21 women. These were unrelated to such factors as age of delivery, percentage weight gain, the baby's sex or birth weight, alcohol consumption, smoking, a history of migraine or allergy or other symptoms occurring during pregnancy such as sleepiness and lack of concentration, irritability, loss of interest in job or nightmares. Nor was there any correlation with hypertension, proteinuria, glycosuria, ketonuria, anemia, or morning sickness. Furthermore, these cognitive disturbances were not related to depression or sleep deprivation. Despite these symptoms, none of the women suffering from them were forced to interrupt their professional activities during pregnancy. The syndrome of benign encephalopathy of pregnancy should be recognized so that simple precautions can be taken to prevent any interference with professional or other activities. The etiology of the syndrome is unknown.     

Hypertensive brainstem encephalopathy: clinical and radiographic features

Reversible posterior leukoencephalopathy syndrome associated with hypertension rarely presents with predominant involvement of the brainstem and relative sparing of the supratentorial regions. We describe the clinical and neuroimaging features of three patients with reversible hypertensive brainstem encephalopathy. Headache and confusion in the setting of severe hypertension, with a relative paucity of brainstem signs and symptoms, despite extensive neuroimaging abnormalities in the brainstem support the diagnosis. The clinical findings and neuroimaging abnormalities resolve with treatment of the hypertension, further distinguishing this syndrome from brainstem infarction.     

15例放射性脑病临床分析

本文对15例鼻咽癌放疗后，引起放射性脑病进行了临床分析，结果发现，放射性脑病发生在放疗后1～5年内占73．3％，5年以后者占26．8％。临床表现：有脑干症状占86．7％，伴颅内压升高占20％。通过应用肾上腺糖皮质激素配合支持营养治疗，早期治疗效果较好。     

Ultrastructural study of three cases of encephalopathy with hypsarrhythmia

Summary We report a morphological study of three cases of infantile hypsarrhythmia. The cerebral cortex lesions consisted of a diffuse neuropile microspongiosis, corresponding ultrastructurally to vacuolized and enlarged neuronal processes, particularly postsynaptic bags. The morphological aspects and the high cell fusion index in one case resemble those described in transmissible subacute spongiform encephalopathies.     

Symmetrical necrosis in the gray matter of the brainstem and spinal cord. Two adult cases of anoxic encephalopathy]

We describe distinctive necrosis in the brainstem of two adult patients of anoxic encephalopathy. The patients were a 75-year-old man and an 82-year-old woman, who were resuscitated after cardiac arrest that lasted about 20 minutes and artificially ventilated. The first patient remained comatose without recovery of brainstem reflexes and had persistent hypotension requiring continuous infusion of catecholamine until death that occurred two weeks after the onset of illness. In the second patient, her general circulation recovered on the next day resuscitation, and traces of brainstem reflexes reappeared thereafter, while her consciousness was severely disturbed throughout the three weeks' clinical course. Both of the patients failed to regain spontaneous respiration and required the ventilatory support. On general autopsy, the first patient had small cell carcinoma of the lung with metastasis to the pleura, hilar lymph nodes and liver. In the second patient, an old myocardial infarction and pneumothorax were found. The neuropathological findings in the two patients were similar, varying only in their severity, except for the presence of the degenerative changes compatible with those of progressive supranuclear palsy in the second patient. There were laminar necrosis in the cerebral cortex and severe ischemic changes in the basal ganglia, thalamus and cerebellum. The cerebral white matter, however, exhibited only myelin pallor without apparent destruction. There was no herniation in the brain. In the first patient, fresh hemorrhages were noted in the bilateral globus pallidus. In the brainstem, symmetrical necrosis was present exclusively in the gray matter: the superior and inferior colliculi, periaqueductal gray matter, substantia nigra and the several cranial nuclei including the spinal nucleus of the trigeminal nerve, solitary and vestibular nuclei. In the second patient the symmetrical necrotic foci were also found in the substantia gelatinosa of the lower lumbar and sacral cords which were available for examination. Around these sharply demarcated necrotic lesions of the brainstem and spinal cord were there rarefaction and pronounced astrogliosis. Unlike the cases of neonates or infants, symmetrical necrosis in the brainstem has been reported to be exceptional in adult patients of anoxic encephalopathy. Now that the medical technology of resuscitation is well advanced, the adult patients exhibiting the pathology presented here may be encountered more frequently than previously thought.     

Clinical features and course of 5 cases with HIV encephalopathy]

Clinical features and courses of 5 cases with HIV encephalopathy were reported. The subjects were among the patients registered as HIV patients at the Nagoya Medical Center, between 1996 and 2005. There were 458 patients with HIV infection including 127 cases of AIDS. All patients suffered from severe immunological deficiency when HIV encephalopathy developed. Other opportunistic infections had also occurred in three patients. HIV encephalopathy was one of the presenting manifestations of HIV infection in four patients, and no patients had received antiretroviral therapy. HAART improved motor disturbance and their ADL became independent except for one case. Improvements in neuropsychological examination scores were noted in all cases. Recovery from psychiatric symptoms, however, was incomplete. Four patients could not work, and 3 needed psychological treatment due to behavioral abnormalities. HIV encephalopathy is not a lethal disease but the functional prognosis was very poor. New therapy is needed for HIV encephalopathy.     

A case of hypertensive encephalopathy with prominent brainstem presentation

A 39-year-old woman developed severe arterial hypertension associated with brainstem hyperintensity in T2-weighted images and hyperintense lesion in the left basal ganglia. Clinical findings were a sudden loss of consciousness, confusion, nausea, vomiting and headache. Rapid treatment of hypertension resulted in clinical and radiological improvement. Rapid identification and appropriate diagnostics are essential, as prompt treatment usually results in reversal of symptoms; permanent neurologic injury or death can occur with treatment delay.     

Hepatic encephalopathy: study of 50 cases

The authors present a retrospective study of 50 patients with hepatic encephalopathy treated at the University Hospital, Faculty of Medicine of Ribeir?o Preto since 1959 and discuss clinical, laboratory and anatomo-pathologic aspects. The diagnoses of the different types of liver disease as well as the factors that triggered the episodes of hepatic coma and pre-coma are reported and the role of the measurement of arterial blood gases in establishing the diagnosis is emphasized.     

Two cases of hemorrhagic shock and encephalopathy syndrome]

A 10-month-old male infant (case 1) and another male infant aged 1 year and 11 months (case 2) were admitted to our department because of fever, watery diarrhea and convulsion. On admission, they were unconscious and showed rigidity of the limbs. Laboratory examination revealed a marked increase in GOT and GPT, a decrease in platelet and antithrombin III and an increase in FDP. Metabolic acidosis was found by blood gas analysis. Brain CT showed an extensive area of low density in case 1, and low density centering on the cerebral basal ganglia and brainstem in case 2. Rotavirus was detected in case 2 by fecal examination. The clinical pictures in these cases closely resembled those of hemorrhagic shock and encephalopathy (HSE) reported by Levin et al. in 1983. The etiology of this disease is currently unknown, and its prognosis is poor. The relationship between this disease and rotavirus should be examined in future studies.     

A longitudinal study of clinical and electroencephalographic findings in a female infant with early myoclonic encephalopathy]

We reported a female infant with early myoclonic encephalopathy (EME). She was diagnosed on the basis of clinical and laboratory features including electroencephalographic and magnetic resonance image (MRI) findings. Frequent erratic myoclonic seizures appeared since 28 days after birth and EEG showed a typical suppression-burst pattern. We administered a high-dose pyridoxal phosphate, thyrotropin-releasing hormone analogue (TRH), and then ACTH, but could not control the seizures at all. With seizure types, we observed the change from erratic myoclonus to tonic spasms in series, with concomitant EEG change to hypsarhythmia at the age of 6 months. Cranial MRI revealed delayed myelination in the white matter but no brain malformation. We administered ACTH to her again and succeeded partially in the decrease of the seizure frequency, and significantly in the improvement of EEG findings. It is supposed that the responsiveness to ACTH treatment changed with age as the seizure patterns developed from erratic myoclonus to tonic spasm.     

脑干卒中患者的认知障碍研究

目的研究急性孤立性脑干卒中患者认知功能与正常对照之间的差异,探究脑干卒中对认知功能的影响及其主要受损的认知域。方法选取符合入组标准的、性别、年龄和受教育年限匹配的首次发病的急性孤立性脑干卒中患者29例和正常对照20例,分别进行艾登布鲁克斯认知检测(ACE-Ⅲ)、蒙特利尔认知评估量表(MoCA)、数字符号转换测验(SDMT)、韦氏数字广度测验(DS)、连线测验(TMT)、Stroop词色测验等量表评测及事件相关电位P300检测。结果脑干卒中患者MoCA量表和ACE-Ⅲ量表总体评分与对照组相比显著降低(P=0.012,P=0.004),其中受损的认知域主要为语言功能(P=0.024)及视空间功能(P=0.004)。SDMT、DS、TMT和Stroop等量表完成度欠佳,与对照组相比,均未见显著差异(P0.05)。P300检测结果显示脑干卒中患者较对照组存在显著的波幅降低(P=0.022)及潜伏期延长(P=0.033)。ACE-Ⅲ与MoCA显著正相关(P0.001),而与P300潜伏期显著负相关(P=0.006)。结论急性孤立性脑干卒中患者存在一定的认知功能障碍,受损的认知域主要为注意力、语言及视空间能力。