Biomedical subjects
Publications and source records attributed to P Delaney.
Of 40 reported cases of solitary brain stem metastasis, only two patients had medullary lesions. We have presented a third case, suggesting that this infrequent occurrence may be due to the mid-brain and pons having a more abundant blood supply, with increased potential for metastatic deposits, and being larger targets for metastases than the medulla.
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A compromised cellular immunity associated with an increased frequency of tumors and fatal opportunistic infections has recently been reported in homosexual men. We studied a homosexual man with fatal CNS toxoplasmosis to emphasize the value of CT in CNS toxoplasmosis and to alert neurologists to potentially curable opportunistic infections.
Nervous system dysfunction occurs in 50 to 75 percent of patients with systemic lupus erythematosus and is a common cause of morbidity and mortality. This may be a direct effect of the disease or an indirect effect of associated infection, metabolic derangement or therapy. Though the pathogenesis is poorly understood, steroids are still the mainstay of therapy. Since the family physician is often the first to encounter the patient with SLE, an awareness of the associated neurologic complications may facilitate early recognition and treatment.
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The neurotoxicity of the Vinca alkaloids vincristine and vinblastine is well recognized. Less recognized is laryngeal nerve paralysis induced by these chemotherapeutic agents. This potentially dangerous paralysis is usually reversible when the drug is withdrawn, but other causes of hoarseness in a cancer patient must be considered. I add two cases to 19 previously documented.
Of 100 consecutive cases of dementia, 23 were found to be of treatable or reversible causes. Many of these patients had been labeled as having "senile dementia" and some were en route to chronic care facilities. The implications of overlooking a treatable cause of dementia are obvious but cannot be overemphasized. An evaluation of dementia with emphasis on the potentially correctable causes is outlined.
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The diagnosis is often elusive, but the high morbidity and mortality of unrecognized chronic meningitis make diagnosis and therapy imperative. The family physician is likely to be the first to encounter a patient with chronic meningitis. Meningeal signs, changes in mentation, seizures or cranial nerve palsies may occur. Cerebrospinal fluid protein is elevated and there is a lymphocytic pleocytosis. Tuberculous and fungal infections are the most common causes, but metastatic carcinoma is being seen with increasing frequency.
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Intracranial hemorrhage (ICH) occurred in a drug abuser soon after self-administration of amphetamine. Other reported cases indicate a consistent clinical picture, sometimes fatal or causing permanent neurologic disability.
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