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Show LIILI\i\TURf ABSTRACTS Childhood Chiasmal Gliomas: Update on the Fate of Patients in the 1969 San Francisco Study. In1('s R". Hoyt WF. Hr/l)/,/,1!1I1111/ol IYHh;70:17Y-H2 (Mar). II\l'print rt'ljul'S!s tll W. F. Iloy!, M.D., ROlllll M-H7/l. J)q',lrtnll'nt lit l )phth,lll1l11l11gV. Uni\' ersil\' of C,llifllrni,l, S,lll h,lllCisCll, San Frilnciscll, C/\ lJ-lI-lJ.1 This is ,1 review of the current status of 2H piltients wllll presl'nll'd with chiasmill glioma 'lnd who were rl'portL'd in )YhY by Hoyt and Baghdass, uian. This repllrt represents the longest followup n.'view of p,ltil'nts with chiasmal glioma yet repl1rted the med ium follow-u p period bei ng 20 years from diagnosis. Sixteen of 28 patients are dead. Howl'ver, only five of them died from their chiasmaI glioma. Four of the deaths from chiasmal glioma occurred within 3 years of diagnosis; this emphasizes that the risk of death from these lesions is greatest during the early follow-up period. Patients with neurofibromatosis may be at greater risk of death from nonchiasmal tumor than from their chiasmal glioma. Apparently, visual function of affected patients has not changed appreciably since diagnosis. Except for hypothalamic effects on growth and body habitus, most of the surviving reported patients are considered normal, and seem to be well adjusted in their life socially. However, prognosis for survival in patients with chiasmal glioma is felt to be not as good as it was thought to be in 1969. Al'illoam B. Safrall, M.D. Mydriatic Response to Topical Naloxone in Opiate Abuse. Ghobse AH, Bewley TH, Kearney MK, Smith SE. Br I Psychiatry 1986;148:44-6 (Jan). [Reprint requests to S. E. Smith, Department of Applied Pharmacology and Therapeutics, St. Thomas Hospital Medical SchooL UMDS, London SE1, 7EH, England]. Use of naloxone eyedrops may be a diagnostic test of current opioid effects, and possibly of physical dependence. In 36 of 47 opiate addicts on methadone maintenance treatment, naloxone hydrochloride eyedrops (1 mg/ml) dilated the pupilS. This effect was not seen in healthy unmedicated subjects. In addicts, response was attenuated by certain ancillary treatments and by withdrawal of methadone treatment. Al'illoam B. Safrall, M.D. I Cl1II NCIITll-(l/,llllm!lI/ol. V"t 6. No.4. 1980 Oculographic Diagnosis of Hemineglect in Patients with Homonymous Hemianopia. Meienberg 0, Harrer M, Wehren C. I Neural 1986; 233:97-101 (Jan). [Reprint requests to Dr. 0. Meienberg, Neurologische UniversiUitsklinik, Kantonsspital, CH-4031 Basel, Switzerland.] Patients with hemineglect demonstrate no or only few spontaneous searching saccades crossing the midline, no reaction after disappearance of fixated target, inefficient searching saccades on command, no prediction of target, missing part of lines upon reading, and no or insufficient pursuit of target towards the hemineglected side. This is in contrast with the ocular motor pattern occurring in patients with isolated homonymous hemianopia who demonstrate many spontaneous saccades crossing the midline, immediate reaction with searching movements upon disappearance of fixated target, prediction of target, some initial difficulties in finding beginning of lines with left hemianopia, increased number of reading steps when reading with right hemianopia, and finally ability of target pursuit to extreme positions, including onhemianopic side. Importance of electrooculographic recording was emphasized in the paper of Meienberg et al. for diagnosing hemineglect in patients showing hemianopia, with objective and quantitative methods. Al'illOl1!1l B. Safrall, M.D. Peripheral Neuropathy Associated with the Sicca Syndrome. Kennett RP, Harding AE. I Nt'llrol Neurtlsllrs Psychiatry 1986;-19:90-2 (Jan). [Reprint requests to Dr. R. Kennett, Department of Clinical Neurology, Institute of Neurology, Queen Square, London, WClN 3BG, England]. In case of chronic sensory axonal neuropathy, particularly when proprioceptive loss is prominent and pupillary abnormalities as well as trigeminal involvment are present, investigations should include autoantibody studies and salivary gland bIOPSY, This was indicated in a study of three patients with the sicca syndrome, and demonstrating chrome sensory neuropathy. In two of them, neuropathy was the presenting clinical feature of the disorder. Sensory impairment in the trigeminal nerve territory was noted in two patients. These two patients also showed tonic pupils, with evidence of parasympathetic denervation. All three reported patients suffered from chronic peripheral urU~ArUR[ ABSTRACTS Eight patients with clinical features of myastlwnia gravis, in whom no serum antibody against .H:l'tykhlliine receptor nluld Ill' dl'teded, were sho~Yn tll h.lVl' ,1 Illv,lstlll'nic disorder that is c.Hlsed bv ,1ntibodies 1'0 dl'lermin,lnts ,1t the neuroIlluscul,; r junctil1ns otlll'r than thl' antibodil's ,1g,linst ,lCl'lvlcholine receptor. These patients pril11. uilv il',ltured Wl',lklll'SS of bulbar, rl'spiratory, lH lll:ubr l11uscll's. TIll' my,lsthenic kature of thymic hyperpl,]Si,l W,lS ,1bsent in thl' two patients wilo unl1erwent thVIl1l'ctllmy before immunosup- . . pressive drug treatment was started. This obser-vatil) n raises the question of whether thymectomy is ,lppropriate in this group of patients, considering that in some (but not all) reports the response tll thymectomy is positively correlated with the degree of hyperplasia in the thymus. Precise site of action at the neuromuscular junction of these patients' antibodies still needs to be defined. In addition, therapeutic means for treating this type of myasthenia were felt to need further evaluation. Api/lOalll B. Safral/, M.D. Optic Neuropathy and Chronic Cyanide Toxicity (letter). Freeman AG. Lancet 1986;1:441-2 (Feb). [Reprint requests to Anthony G. Freeman, Meadow Rise, 3, Lake Side, Swindon, Wiltshire SN3 IQE, England.] Incidence of chronic cyanide neurotoxicity rose sharply among people who, in the 1969 Nigeria civil war, fled into the bush and lived on uncooked and unprepared cassava roots and leaves. A similar phenomenon was also reported in Mozambique in 1981. Clinical features included bilateral optic neuropathy and nerve deafness, myopathy, and sensory ataxia. A rise in plasma cvanocobalamin levels and in plasma and urin~ry thiocyanate levels was found (i.e., product of cyanide detoxification). This supported the assumption that the dietary source of cyanide in cassava and in other vegetables contributed to the pathogenesis of these neurological manifestations of chronic cyanide toxicity. AlJil/oalll B. Safran, M.D. Parkinsonism, Tardive Dyskinesia, Akathisia, and Depression Induced by F1unarizine. Chouza I Clill Neuro·ophtllCllmof, Vol. b, No.4, 1986 C, Scaramelli A, Caamano JL, De Medina 0, AIjanati R, Romero S. Lancet 1986;1:1303-4 Oun). IReprint requests to C. Chouza, Instituto de Neurologia, Hospital de C1inicas, Montevideo, Uru-guayl · Administration of flunarizine was observed to induce extrapyramidal motor signs, including orofacial tardive diskinesia, in 12 subjects. One affected wuman still presented symptoms 20 months after stopping flunarizine, while other patients showed partial or complete improvement after withdrawal of the drug. Flunarizine is a calcium- entry blocker, and is widely prescribed for a number of conditions, including cerebral bloodflow disturbances, migraine prophylaxis, and epileptic seizures. Flunarizine has a piperazine radical that links it to neuroleptics and antihistamics, and it is conceivable that side effects may be related to the blockade of postsynaptic dopaminergic receptors b~' f1unarizine. Al'inoalll B. Safran, M.D. Detection of Optic Nerve Lesions in Optic Neuritis with Magnetic Resonance Imaging (letter). Miller DH, Johnson G, McDonald WI, MacManus D, DuBoulay EPGH, Kendall BE, Moseley IF. Lane!'! 1986;1:1490-1 Oun). [Reprint requests to D. H. Miller, Institute of Neurology, London WCl, England.) In most sequences of magnetic resonance imaging (MRI), orbital images are dominated by the signal arising from orbital fat. Using an inve~sion recovery sequence with a short inversion time of 100-150 ms (STIR sequence) allows us to obtain images in which orbital fat gives little signal, and other orbital structures, including optic nerve and extraocular muscles, are highlighted against the fat. In turn, demyelinated plaques, with long T1 relaxation times, should provide a higher signal than normal optic nerve when using this sequence. Eighteen patients with optic neuritis and 15 controls were scanned (using the STIR technique) on a Picker 0.5 T superconducting system. A surtace coil specially designed for orbital imaging was used to obtain 5-mm coronal and longitudinal slices. Ten of 14 patients who presented WIth an acute unilateral optic neuritis 18 n:onths be~ore the examination showed a high SIgnal area m the appropriate optic nerve. Four pa- |
