Biomedical subjects
Publications and source records attributed to P Haller.
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The clinical test was carried out in extracranial carotid occlusions and acute peripheral paralysis with sympathetic lesions. The measurements obtained were compared with those of the infrared thermovision. Both in the technical and in the clinical tests, the device proved to be very suitable. The practical procedure of temperature measurement (cerebral ischemia and lesions of the sympathetic trunk) is described.
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Kearns' syndrome, a rare cause of chronic progressive ophthalmoplegia was observed in three patients aged 15 to 54 years. Apart from the chronic progressive external ophthalmoplegia the syndrome consists of retinal changes and cardiac conduction defects in all cases, as well as other signs indicating damage to the nervous system. High tone deafness and vestibular damage as well as an increase in CSF protein are common. Endocrine disorders and skeletal anomalies may occur. The cause is unknown. The ophthalmoplegia may be of neurogenic origin. Adams-Stokes attacks following disturbances of cardiac rhythm may be prevented by timely implantation of a cardiac pacemaker.
The diagnosis of brain tumour could not be made in 91 cases at the first investigation in a group of 1155 brain tumours. Slowly growing gliomas causing only epileptic fits and no other symptoms are especially difficult to diagnose. Of 21 personal observations of tumour seizures, in which the diagnosis of the neoplasm was missed at the first investigation in hospital, 9 were oligodendrogliomas, 5 astrocytomas, 3 glioblastomas, 2 spongioblastomas, 1 gangliocytoma and 1 a metastasis. They were all located in the frontal or centroparietal region. In most cases the seizures appeared during the third or fourth decade. The average interval between the first epileptic fit and the tumour diagnosis was 8.2 years in cases of oligodendrogliomas and 2.2 years in astrocytomas. 5 patients had major seizures, 2 had psychomotor attacks and all the others suffered from partial epilepsy. Anticonvulsive therapy was often successfull; either the frequency of the fits diminished or, in 2 cases, the character of the seizures changed. 18 patients had a normal neurostatus at time of the first investigation. Only 3 patients had a slight difference of physiological reflexes, but no other pathological signs. In none of the patients did investigation of the CSF, skull X-rays, brain scanning, pneumencephalography or cerebral angiography first lead to the diagnosis of a brain tumour. The EEG alone showed focal signs corresponding to the location of the tumour in about 50% of the cases.
In a 59-year-old man in complete health a pure motor polyneuropathic syndrome with quadruplegia, swallowing and respiratory paralysis developed over a few hours. A few days later he died with the clinical picture of septicaemia. In a 59-year-old woman who had been investigated and treated for a suspected carcinoma for several months a predominantly distal sensomotoric polyneuropathy syndrome developed. The further course of disease was completely misleading as regards the diagnosis due to an acutely occurring transection syndrome with flaccid paraplegia, loss of reflexes, and bladder and rectal paralysis. Due to the very unusual neurological symptoms panarteritis nodosa was only diagnosed at autopsy and by histology in both cases. Panarteritis nodosa must be considered as a differential diagnosis in Landry-type polyneuropathy as well as in an acute spinal transection syndrome. The first patient demonstrates toxic damages, the second vascular damages of the nervous system which in general determine the neurological symptomatology of this vascular disease.
Cerebral metastases are the most common intracranial tumors next to the malignant glioblastoma multiforme. The clinical aspects are described in summary with reference to 191 cases. At least 1/3 of the cerebral metastases are already multiple on diagnosis. The daughter tumors most frequently colonize in the cerebrum - in the centroparietal region in particular - and much more seldom in the cerebellum. Bronchial and mammary carcinomata are the most important primary tumors; melanomas and hypernephromas come next in frequency. The primary tumor escapes clinical detection relatively frequently. The first symptoms are most frequently signs of cerebral pressure. Of the local symptoms of cerebral metastases, the hemi-syndrome occupies first place.
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In 322 cases of lumbar PID proved by myelography the radiologically recognizeable malalignment of the lumbar spine was related to site and direction of the prolaps. Scoliosis towards the side of the prolapse was seen in about 70 per cent. Scoliosis convex towards the normal side was significantly more common with right-sided than with left-sided prolapses. Scoliosis was the more pronounced the higher the site of prolapse. The degree of lumbar lordosis, too, appeared to depend on the level of prolapse. The lower the prolapse the less the lordosis. In the individual case one cannot draw any conclusions as to site or direction of a prolapse from radiologically detectable malalignment.
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