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Show ]. Clin. Neuro-ophthalmol. 3: 275-276, 1983. Abstracts Australian Association of Neurologists' Annual Scientific Meeting-1983 ISLA M. WILLIAMS, MD. The Annual Scientific Meeting of the Australian Association of NeurologistS-1983 was held in Perth, Western Australia. Eleven papers of interest to neuro-ophthalmologists will be reviewed briefly. 1. (*t) Drs. G. Selby and J. Fryer reported Fatal Migraine in a 58-year-old woman who had a past history of classic migraine since youth. She experienced sudden blurred vision and flexor spasms of her left hand, followed by a right hemicrania and photophobia, similar to previous attacks of migraine. Within a few hours a progressive left hemiplegia and paralysis of left conjugate gaze developed. Severe right hemicrania continued. CT brain scans showed a progressing large right parietotemporal infarct. Her level of consciousness declined and she died 10 days after admission to the hospital. The autopsy showed a large infarct in the area of supply of the right middle cerebral artery, associated with edema and with a shift of midline structures to the left, cingulate, and right hippocampal herniation. There was secondary midbrain hemorrhage. Recent secondary hemorrhagic infarction was present in the left calcarine cortex. The carotid arteries in the neck showed only minimal atheromatous change and were patent; the cerebral arteries were remarkably free of atheroma, but the right middle cerebral artery contained red thrombus. Histologically, the cerebral infarction antedated the middle cerebral artery thrombus by several days, supporting arterial spasm as the cause of infarction. The thrombosis was considered to be a secondary phenomenon. 2. Prof. M. Anthony reported Arrest of Bouts of Cluster Headache by Chemical Occipital Neurectomy. Nine patients were given an injection of 120 mg of Methylprednisolone acetate in polyethelene glycol (Depo-Medrol) into the region of the greater occipital nerve on the same side as the headache during a bout of cluster headache. All patients noted arrest of the headache attacks for periods ranging from 5 to 56 days. He demonstrated that this result suggests that disturbances in the upper cervical spine or irritation of the occipital nerve playa significant role in initiation of attacks of such headaches. December 1983 3. (t) Drs. J. L. Morris, C. L. Lim, and J. A. Lee reported that The Distribution of Sweat Loss on the Face in Horner's Syndrome may be useful in localizing the site of the lesion. In those whose lesion was proximal to the bifurcation of the common carotid artery, the loss of sweating involved the whole of the side of the face; in those with the lesion distal to that site, loss of sweating was confined to the medial aspect of the forehead and side of the nose. Of 26 patients studied, facial sweating was normal in four patients with avulsion injuries of the brachial plexus, and in two patients with a lateral medullary syndrome. Abnormalities of sweating were less clearly defined in patients with only a partial Horner's syndrome. 4. (t) Drs. A. Fisher, M. Gresty, B. Chambers, and P. Rudge in their paper Primary Position Upbeating Nystagmus: The Effects of Tilt and its Significance, discussed the interaction between the otolithic apparatus and convergence in studies of 11 patients with primary position upbeating nystagmus. 5. (t) Drs. I. Williams, D. Gee, E. Cooper, P. Dickinson, T. Sandeman, and A. Sum in Myasthenia Gravis with Thymic Seminoma (Germinoma), described a 27-year-old man who presented with symptoms of ocular myasthenia. An enlarged thymus gland was detected by computed tomography and at operation an enlarged thymus, with multiple cystic areas and a 5-cm hard mass, was excised completely together with adjacent pericardium. Pathological examination revealed lymphoid (follicular) hyperplasia and, in the wall of one cyst, a nodule comprising lymphoid hyperplasia with an interfollicular distribution of seminoma (germinoma) cells, some infiltrating germinal centers. The authors are unaware of a patient with a primary mediastinal seminoma having been reported presenting with symptoms of myasthenia gravis. Distinction between a primary thymic seminoma and a thymoma is important because a primary thymic seminoma, if infiltrating, responds readily to radiation and the prognosis is usually excellent. A thymoma, if infiltrating, and associated with myasthenia gravis, has a 275 Australian Abstracts poor prognosis. 6. Drs. D. G. Milder, C. F. Elliott, and W. A. Evans in their paper Neuro-pathologic Findings in a Case of Co-existent Progressive Supranuclear Palsy and Alzheimer's Disease, described a 66year- old man first seen for increasing forgetfulness and frequent falls. Following investigation the cause was presumed to be senile dementia of the Alzheimer type. Impaired vertical gaze, nuchal rigidity, and dysarthria developed subsequently and a diagnosis of progressive supranuclear palsy was made. Neuropathological examination revealed changes characteristic of progressive supranuclear palsy and also of Alzheimer's disease. 7. (t) Drs. S. R. Hammond, G. Danta, P. Dowling and B. S. Gilligan in The Mechanism of Reading Epilepsy, reviewed 18 patients with reading epilepsy which they concluded is cortical rather than central in origin and is generated by a fault in language processing. Of interest were the findings that typical clinical episodes and spike and wave activity may be induced by visual recall of reading material. Individual letters, numbers, and designs read sequentially will trigger episodes. Spike activity during reading was frequently found to be focal within the left hemisphere. Neuropsychological testing revealed that the majority had impaired verbal memory. 8. Drs. J. L. Black, J. N. De Roach, and S. M. Kay in their paper Pattern Reversal Visual Evoked Potentials in Normal and Dyslexic Children, reported that they measured monocular visualevoked responses for a group of 29 dyslexic children and a comparative group of 39 children of similar ages, but with normal reading ability. For each group, 70 quantitative parameters characterizing the VER were analyzed statistically. Small, but significant, differences occurred between the two groups of subjects for some parameters, including P100 latency, response shape similarity from opposing lateral electrode sites, and median frequency. Variations of parameters as a function of age and subjective reading ability were presented. 9. (t) Drs. J. I. Manson, A. Bourne, G. LeQuesne, and L. Sheffield in A Case of Joubert's Syndrome: Clinical, Electrophysiological, Neuroanatomical, and Genetic Aspects, described a first-born male infant who was transferred to the Adelaide Children's Hospital at the age of 7 weeks with a neurologic syndrome consisting of severe hypotonia, unresponsiveness to stimuli, abnormal nystagmoid vertical and rotary, eye movements, and episodic attacks of apnea and hyperpnea. These features had been present from time of birth. The ocular movements and the respiratory irregularities were shown by polygraphic studies to be nonepileptic. CAT scan and ultrasound scan confinned agenesis of the cerebellar vermis, with a prominent posterior and rostral extension of the fourth ventricle. The infant died at the age of 12 weeks. Autopsy examination revealed agenesis of the cerebellar vermis, and prominent dysplasia of both dentate nuclei. The clinical constellation of ataxia, abnormal eye movements, episodic hyperpnea, and mental retardation, associated with agenesis of the cerebellar vermis, was first described by Joubert in 1969. Recognition of this rare syndrome is important from the point of view of genetic counseling, as the condition appears to be of autosomal recessive inheritance, and the enlarged fourth ventricle has been recognized by prenatal echoencephalography at 21 weeks gestation. (Personal communications Prof. Stuart Campbell, Kings College Hospital, London, 1982.) 10. (t) Drs. W. M. Carroll, G. L. Thickbroom, F. L. Mastaglia, and H. D. Davies, presented their paper entitled "The Scalp Topography of the Visual Evoked Potential Resulting from Pattern- Reversal in One Half-Field." They pointed out that their findings may elucidate some of the problems of waveform alteration encountered presently in the interpretation of clinical recordings. 11. Drs. G. Thickbroom and F. L. Mastaglia in their paper Scalp Potentials Associated with Saccadic Eye Movements, described their findings in normal subjects, in a small number of subjects with an ocular prosthesis, in a patient who had undergone a hemispherectomy and in patients with extraocular muscle palsy. The next decade will probably establish the clinical value of techniques described in the latter two papers. Notes * To be published in full in Clinical and Experimental Neurology, Vol. 20. t To be published in full in journals elsewhere. Journal of Clinical Neuro-ophthalmolog' |