.*3tKT COLLEGE A Journal of Neurology 1967 Volume 90 Part IV Defective Autonomic Control of Blood Vessels in Idiopathic Orthostatic Hypotension. Roger Bannister, Leslie Ardill and Peter Fentem .. .. The Circle of Willis—the Incidence of Developmental Abnormalities in Normal and Infarcted Brains. S. K. Battacharji, E. C. Hutchinson and A. J. McCall Intracerebral Microaneurysms and Small Cerebrovascular Lesions. F. M. Cole and Peter Yates Cerebral Effects of Rewanning following Prolonged Hypothermia: Significance for the Management of Severe Cranio-cerebral Injury and Acute Pyrexia. Maurice Bloch A Pharmacological Investigation of Cerebro-spinal Fluid from Patients with Migraine. Margaret Barrie and Alison Jowett .. .. .. .. Experimental Porphyria and its Relationship to the Human Disease. T. Lehoczky, J. Sos, L. Selmeci and Margit Halasy .. .. .. .. Clinical, Biochemical and Histopathological Findings in a Family with Muscular Dystrophy. L. J. Hurwitz, Nina A. J. Carson, Ingrid V. Allen, T. F. Fannin, J. A. Lyttle and D. W. Neill Nemaline Myopathy: Report of a Fatal Case, with Histochemical and Electron Microscopic Studies. S. A. Shafiq, Victor Dubowitz, Hart de C. Peterson and A. T. Milhorat The Brain in Multiple Neurofibromatosis (von Recklinghausen's Disease): a Suggested Neuropathological Basis for the Associated Mental Defect. N. Paul Rosman and John Pearce .. .. .. .. .. .. "Infantile Hydranencephaly"—a Report of Five Cases of Infarction of both Cerebral Hemispheres in Infancy. Richard Lindenberg and Phillip D. Swanson Ataxia and other Neurological Disorders as Sequels of Severe Hypoglycaemia in Childhood. T. T. S. Ingram, G. D. Stark and Ivy Blackburn .. .. Progressive Multifocal Leukoencephalopathy: Electron Microscope Study of Four Cases. M. A. Woodhouse, A. D. Dayan, J. Burston, I. Caldwell, J. Hume Adams, D. Melcher and H. Urich .. .. .. .. .. Geographical Considerations in Multiple Sclerosis. Uri Leibowitz, David Sharon and Milton Alter Spinal Segmental and Long-loop Reflexes on Spinal Motoneurone Excitability in Spasticity and Rigidity. C.-B. Yap The Effect of Undernutrition and Subsequent Rehabilitation on the Growth and Composition of the Central Nervous System of the Rat. J. W. T. Dickerson and Ann L. Walmsley .. .. .. .. .. .. Notices of Recent Publications .. .. .. .. .. .. .. Index 725 747 759 769 785 795 799 817 829 839 851 863 871 887 897 907 915 MACMILLAN (JOURNALS) LTD, LITTLE ESSEX STREET, LONDON, W.C.2 Advertisements EDITOR IN CHIEF Dr. Denis Williams, C.B.E. EDITORIAL BOARD Prof. John Cumings Dr. Bryan Matthews Prof. Brodie Hughes Dr. Peter Nathan Prof. William McMenemey Prof. Charles Phillips, F.R.S. ADVISERS Dr. D. E. Broadbent Prof. Roger Gilliatt Dr. R. T. C. Pratt Prof. David Whitteridge, F.R.S. Dr. J. W. D. Bull Dr. Ronald Henson Dr. J. D. Spillane Prof. John Cavanagh Mr. Valentine Logue Prof. P. D. 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If wrapper, title and renumbering of pages are desired, authors must specify the same when ordering. Price 20s. net. Subscription 84s. net Entered u Second Class Matter, April 24, 1929, at the Pott Office at Boston, Mass., under the Act of March 3,1197 (Sec. 397, P.L. and R.). Printed in Great Britain. vt •• •fv Management of the manic phase of a manic-depressive illness* 'He was surprisingly unresentful about his stay in the 'secure' ward. So long as he had plenty of paper and pencils, he was happy re-planning the world and would rush up to any visitor anxious to expound his latest theories. He admitted to hallucinations of sound and sometimes acted under their instructions — once when he hit a nurse . . . The threat of physical exhaustion and unpredictable violence made it vital to control the illness with speed, and intramuscular 'Stelazine' was given eighthourly starting with a dose of 4 mg. as he was a big man, and then adjusting the dose between 1 mg. and 3 mg. according to his state. Within 48 hours he was taking nourishment normally and catching up on sleep.' 'Oral medication with 'Stelazine' 10 mg. twice a day, plus an anti-Parkinsonism drug, was then given. Though major problems of nursing soon passed, he remained grandiose and without insight for several weeks, and absconding was feared. E.C.T. was even considered, but proved unnecessary. Frequent reassuring visits of his wife helped, and awareness as to how abnormally he had behaved slowly dawned on him.' 'After two weeks in a convalescent villa and a couple of successful weekends at home, he was discharged on a daily maintenance regimen of one 15 mg. 'Stelazine Spansule' Capsule at night.' * Excerpts from a case narrative prepared by a consultant psychiatrist, based on actual patient records. Certain minor details have been changed to protect individuals. in psychiatry many symptoms respond to the major tranquillizer with the invaluable alerting action Now available as 'Spansule' Capsules 10 mg. and 15 mg.: also Tablets 5 mg., Concentrate in 114 ml. (4 fl. oz.) bottles containing 10 mg. 'Stelazine' per ml., and Ampoules 1 mg./ml. Literature giving full prescribing information available o n request. SMITH KLINE A N D FRENCH LABORATORIES LTD W E L W Y N GARDEN CITY, HERTFORDSHIRE 'Stelazioe' (brand or trifluoperazioe dihydrochloride) and 'Hpausule' are trade marlu. BZ: PA 128 mmm "...and well have you right in next to no time" (a rapid response is characteristic with 'Concordin'-10) 'All 56 patients who improved on protriptyline did so within the first 2 weeks and 23 of them (41 per cent) showed initial improvement during the first 7 days. None of the 54 improved imipramine cases showed initial improvement by the end of the first week; 27 (50 per cent) showed it during the second week, 26 (48.1 per cent), during the third week and 1 patient (1.9 per cent) required 3 weeks. This was observed uniformly in all the diagnostic categories.' From a paper presented at the IVth World Congress of Psychiatry, Madrid. September 5-11. 1966. 'A particularly notable feature was the rapid onset of action following the administration of protriptyline. In 30 of the 47 patients in whose clinical condition lack of drive predominated, a distinct improvement was observed during the first three days. By the end of the fifth day of treatment, eight other patients reported an improvement, and only in 9 of the 47 patients did it take longer to affect the lack of drive favourably.' Med.Klin.A 966,61,1876 (25 Nov) CONCORDIN-10 Protriptyline hydrochloride a powerful antidepressant Rapid improvement Response is often seen within a week the patient improves early in treatment, doctor-patient rapport is enhanced. Highly effective Frequently successful even when patients fail to benefit from other antidepressants. Versatile Suitable for both in-patients and out-patients; dosage is simple and 'Concordin' is usually well tolerated. Essentially free from sedative activity Since drowsiness is rare, normal daily activities can be performed — an important consideration when prescribing for out-patients. No dietary restrictions Not a monoamine oxidase inhibitor —the patient can enjoy full freedom in choice of food. Suitable for use with many other agents Can be used concurrently with other psychotherapeutic agents, such as tranquillisers and amitriptyline, if desired (but not with monoamine oxidase inhibitors). Can be used concurrently with ECT Usually reduces the number of shock treatments necessary for the patient. Note: 'Concordin' is available as 'Concordin'-10. containing 10 mg protriptyline hydrochloride. and also as 'Concordin'-5 containing 5 mg protriptyline hydrochloride. In moderate to severe depression, 'Concordin'-10 is generally the more appropriate dosage form. It is therefore important to specify 'Concordin'-10 when this is required. Detailed information is available to physicians on request. Merck Sharp & Dohme Limited Hoddesdon, Hertfordshire Telephone, Hoddesdon 67123 Advertisements VI ANNUAL REVIEW OF PSYCHOLOGY Volume 18 February 1967 Editors: P. R. Farnsworth, O. McNemar, Q. McNemar Contents: 606 pages Perception, D. E. Johannsen Visual Sensitivity, F. A. Mote Comparative Psychology and Ethology, / . P. Scott Developmental Psychology, H. W. Stevenson Educational Psychology, R. C. Anderson Projcctive Methodologies, S. Fisher Personnel Selection, R. M. Guion Test Theory, / . A. Keats Value: Behavioral Decision Theory, G. M. Becker and C. G. McClintock Group Dynamics, H. B. Gerard and N. Miller Psychotherapy, D. H. Ford and H. B. Urban Classification of the Behaviour Disorders, /. Zubin Audition, J. J. Zwislocki Organizational Psychology, R. P. Quinn and R. L. Kahn Personality, G. S. Klein, H. L. Barr, and D. L. Wolitzky Other medical REVIEWS of interest: • MEDICINE, Vol. 18 (May 1967) • BIOCHEMISTRY, Vol. 36 (July 1967) • MICROBIOLOGY, Vol. 21 (October 1967) • GENETICS, Vol. 1 (October 1967) For complete information on the topics, authors, and prices of the various publications of Annual Reviews, Inc., a nonprofit corporation, please write for a free copy of our 1968 Prospectus. REPRINTS of all articles published in the Annual Review of Psychology from Vol. 12 may now be purchased at a uniform price of 8.95 each. A descriptive REPRINT BROCHURE, in which the reprints are listed both by author and by subject, is available on request. Publisher: ANNUAL REVIEW OF PHYSIOLOGY Volume 29 March 1967 Editors: V. E. Hall, A. C. Giese, R. R. Sonncnschein Contents: 652 pages Prefatory Chapter, M. Kleiber Transport Through Biological Membranes, E. Heinz Growth and Differentiation, R. M. Gaze Comparative Physiology: Metabolism, / . Awapara and J. W. Simpson Respiration, L. Bernstein Gastric Juice and Secretion: Physiology and Variations in Disease, G. E. Farrar, Jr., and R. J. Bower Comparative Physiology: Invertebrate Excretory Organs, L. B. Kirschner Lymphatics and Lymphoid Tissues, L. Allen Systemic Circulation, A. A. Rovick and W. C. Randall Heart, fV. Schaper The Adenohypophysis and Its Hypothalamic Control, R. Guillemin Parathyroid Hormone, C. D. Arnaud, Jr., A. M. 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World Medical Literature now contains over 400 references to Orbenin. leumonia • Lung Abscess • Tonsillitis • Pharyngitis • Acute bronchitis ipticaemia )ils • Carbuncles • >teomyelitis • Infected dermatoses Osteitis >st-operative wound infections • Burns • Skin graft protection :ute endocarditis aphylococcal enterocolitis • Staphylococcal urinary tract infections • )sage iu/ts 500mg (2 capsules) four times daily. i0mg (1 vial) by intramuscular injection, four les daily. lildren Under 2 years—quarter adult dose. 10 years—half adult dose. iditional information is available on request. Staphylococcal meningitis Contra-indications Orbenin should not be given to patients with a penicillin allergy or administered by subconjunctival injection. Side-effects As with other penicillins. Orbenin (Regd) (cioxaciiim sodium BP) is a product of British research at Beecham Research Laboratories originators of the new penicillins. Brentford, England, Advertisements via (1RITIJH POSTORADUATE MEDICAL FEDERATION—UNIVBRtlTY OF LONDON) INSTITUTE OF NEUROLOGY (QUEEN SQVARE, LONDON, W.C.I) ASSOCIATED W I T H THE N A T I O N A L U O I P I T A L , Q U E E N I Q U A R B , H O S P I T A L FOR N E R V O U S D I S E A S E S , H A I D A V A L B . A N D THE The Institute provides postgraduate training in the various departments of Neurology. The Out-Patient Practice is open at 10 o'clock at QUEEN SQUARJE every day (except Saturday). A fee of 5 gns. per month is charged for attending the Out-patient Department only. The In-Patient Practice at Queen Square and Maida Vale is open at 10 a.m. and a limited number of clinic clerks are appointed at both Hospitals. Fees: three months, £62 10 0; six months, £125. Whole-time courses of instruction are given during the Autumn, Winter and Summer terms. 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LIVINGSTONE LTD., 15-16-17 TEVIOT PLACE, EDINBURGH Advertisements IX EPILEPSY CAN LIMIT OPPORTUNITY ZARONTIN EPANUTIN CELONTIN enable the epileptic to play a useful part in the community in petit ma/ ... ZARONTIN* (ethosuximide, Parke-Davis) in grand ma/ and temporal lobe epilepsy ... EPANUTIN* (phenytoin sodium B.P. Parke-Davis) in temporal lobe epilepsy and petit mat... CELONTIN* (methsuximide, Parke-Davis) Detailed information on Zarontin, Epanutin and Celontin is available on request PARKE DAVIS HOUNSLOW • LONDON • TELEPHONE: 01 570 2361 * Trade mark (ODI!) Advertisements BRAIN RESEARCH International Multidisciplinary Journal devoted to Fundamental Research in the Brain Sciences Forthcoming articles: The evolution of the primate brain: Some aspects of quantitative relations (R. L. Holloway, Jr., New York, N.Y., U.S.A.) Central nervous system-thyroid interrelationsships (D. H. Ford, Brooklyn, N.Y., U.S.A.) Telencephalo-diencephalic aspects of sleep mechanisms (P. L. Parmeggiani, Bologna, Italy) Biochemical-physiological correlations in studies of the y-aminobutyric acid system (E. Roberts, K. Kuriyama, Duarte, Calif., U.S.A.) Functional organization of group I activated neurones in the cuneate nucleus of the cat (I. Rosen, Lund, Sweden) Unresponsive cells in cerebral cortex (J. S. Kelly, K. Krnjevi6, C. K. W. Yim, Montreal, Que., Canada) Hyperpolarizing increase in membrane conductance in hippocampal neurons (D. P. Purpura, S. Prelevic, M. Santini, New York, N.Y., U.S.A.) Heart rate changes following selective deprivation of rapid eye movement (REM) sleep (V. Karadzic, W. C. Dement, Palo Alto, Calif., U.S.A.) Habituation of the flexor reflex in spinal rats, and in rats with frontal cortex lesions followed by spinal transection (J. P. Griffin, J. A. Pearson, London, Great Britain) Shivering and panting during sleep (P. L. Parmeggiani, C. Rabini, Bologna, Italy) Effect of hallucinogenic anticholinergic agents on D-amphetamine toxicity for aggregated mice (C. D. Proctor, L. G. Ashley, J. L. Potts, B. A. Denefield, Nashville, Tenn., U.S.A.) Effects of bilateral eye enucleation upon single-unit activity of the lateral geniculate body in free behaving cats (H. Sakakura, K. Iwama, Osaka, Japan) Acetylcholine release from the cerebral cortex: its role in cortical arousal (J. W. Phillis, Clayton, Victoria, Australia) lntracellular recording from cat spinal interneurons during acute asphyxiation (A. Niechaj, A. Van Harreveld, Pasadena, Calif., U.S.A.) Publication and Subscriptions Brain Research is published monthly. During 1968 5 volumes are scheduled to appear. Subscription price for 1968: £36 Os. Od., Dfl. 360.00 or USS100.00 plus postage 24s., Dfl. 12.00 or USS3.35. Subscriptions should be sent to: ELSEVIER PUBLISHING COMPANY 335, JAN V A N GALENSTRAAT, P.O. BOX 211, AMSTERDAM, THE NETHERLANDS Meningitis-the role of PENBRITIN 'Ampicillin appears to be an excellent drug for the treatment of acute meningitis due to D. pneumoniae, N. meningitidis, and H. influenzae in children.'1 Bactericidal. Highly active against the common meningeal pathogens, Penbritin kills, rather than merely inhibits bacteria. Adequate Concentrations. T/M Penbritin crosses the blood-brain barrier when the meninges are inflamed, producing adequate concentrations in the C.S.F.1 Effective. Two controlled comparisons confirm that intravenous and intramuscular Penbritin is not only as effective as other conventional therapy, but has distinct advantages: CONTROLLED TRIAL 1963-1965 CONTROLLED TRIAL 1964-1965 Treatment Groups: 192 patients were assigned to the Penbritin group, 261 to the control group who were treated with the conventional penicillin G/ chloramphenicol regime. Treatment Groups: 28 patients were assigned to the Penbritin group; 25 matched patients to the control group who were treated initially with penicillin G, chloramphenicol and sulphadiazine, discontinuing the unnecessary antibiotics later. Results of treatment: 79.2% of the Penbritin patients were discharged from hospital with no apparent defect, compared with 77.5% in the control group. Authors' conclusions: 'the advantages of a single drug, and the absence of significant toxicity suggest that this agent (Penbritin) be considered as the drug of choice for the initial treatment of meningitis in patients more than 2 months of age.'2 Results of treatment: 61 % of the Penbritin group responded satisfactorily, compared with 48% in the control group. Authors' conclusions: Penbritin 'is as safe and effective as conventional triple therapy, and in addition hasthefollowing advantages: (1) simplicity of administration, and (2) apparent freedom from hematologic and renal complications encountered with chloramphenicol and sulphonamides respectively.'1 C h i l d r e n ' s D o s a g e . First 48 hours—150 mg./kg./day by 4-hourly intravenous injections or by continuous drip. From 3rd day onwards—100 mg./kg./day 4-hourly intramuscular injections. Intrathecal therapy when necessary: infants and young children—5 mg. once daily. 10 years and above—10 mg. once daily. These concentrations of Penbritin in the C.S.F. do not cause any local or cerebral irritation A d u l t D o s a g e . 750 to 1000 mg. 4-6 hourly by intramuscular injection. Intrathecal therapy when necessary—10 to 40 mg. daily. C o n t r a - i n d i c a t i o n : Penicillin allergy. S i d e - e f f e c t s : as with other penicillins. References. 1. Journal of Paediatrics, (1966), 69,343. 2. Antimicrob. Agents & Chemother., (1965), p. 610. Further information is available on request from the Company's Medical Department. Penbritin (ampicillin B.P.) is a product of British research at Beecham Research Laboratories Brentford, England originators of the new penicillins. xii Advertisements Pitman Medical The Basal Ganglia and Posture James Purdon Martin, MA, MD, FRCP (Lond) In this book the author presents his clinical and pathological investigations into the function of the Basal Ganglia. The guiding principle throughout the research was to discover the functions which were lost or otherwise disturbed, in the conditions in which the Basal Ganglia were known to be diseased. The early chapters deal with the search for the deficiences of function in a group of 130 cases of post-encephalitic Parkinsonism. It was observed that the principal 'negative' or deficiency symptoms were attributable to the loss of postural reflexes; a special study of the defects of locomotion demonstrated that they were due to faults of postural controlling mechanisms, and a study of the patients' reactions to tilting revealed still further postural defects. These chapters on 'negative' phenomena are followed by studies of certain 'positive' symptoms of Basal Ganglia disease. The conclusion is that the Basal Ganglia as a group are concerned with the reflex control of posture, other than support of the body against gravity, and that the globus pallidus is a major centre for postural reflexes. The text is particularly well presented and is amplified by half-tone illustrations. Contents PART I The Basal Ganglia Introduction NEGATIVE PHENOMENA Negative symptoms in basal ganglia disease (Post-encephalitic Parkinsonism)—Locomotion and the Basal Ganglia—Tilting Reactions and Disorders of the Basal Ganglia—Negative Symptoms in Idiopathic Parkinson's Disease—Loss of Postural Reflexes in Wilson's Disease—Loss of Postural Reflexes in Huntington's Chorea—Anatomical Background to the Loss of Postural Reflexes POSITIVE PHENOMENA Hemichorea of Sudden Onset (Hemiballism)—The Caudate Nuclei and Locomotion—Curvature of the Spine in Post-encephalitic Parkinsonism—Post-encephalitic Parkinsonism with Severe Rigidity—A Note on Intention Tremor—Interpretation and Conclusions PART II Posture and its Central Nervous Control Posture and Postural Reflexes—Posture and Movement Bibliography Index 1st edition 1967 152 pages 146 illustrations 80s net Pitman Medical Publishing Company Ltd 46 Charlotte Street, London, Wl DEPRESSION: a prison of the mind Depression makes a dungeon of the skull-an oubliette in which the mind may languish through a wearisome toll of eternities. For many depressed patients, 'Aventyl' may be the key that opens the door to the normal world again. 'Aventyl' has a true antidepressant action, with a concomitant eftect on associated anxiety when this is present. Its action is rapid—most responding patients improve within ten days. The beneficial effect of 'Aventyl' is not likely to be marred by troublesome side-effects; the drug is not a MAO inhibitor and exhibits less anticholinergic activity than other tricyclic antidepressants. This simplifies management, especially after the patient's discharge from hospital. 'AVENTYL' liberates the depressed mind \\veni\T inortriptylitu- as the hydrochloridc) is presented as "l'ulvulcs' ol'25mi{. lull proscribing information on request. Jiu From the series 'Carceri d'lnvenzione' (Imaginary Prisons) by Piranesi. 1720-1778. The violence and hopelessness of these works has led to the speculation that Piranesi was a manic-depressive. 'Aventvl' is.i trade mark ELI LILLY & COMPANY LIMITED BASiNGSTOKE ENGLAND AVJ2. 05341 XIV Advertisements SPRINGERVERLAG BERLIN-HEIDELBERG NEW YORK Schiefer/Kazner Klinische Echo-Encephalographie In KQrze erscheint: Von Prof. Dr. med. Wolfgang Schiefer und Dr. med. Ekkehard Kazner, Erlangen Mit einer Einfuhrung in die akustischen GrundJagen von Dr. phil. Werner Guttner, Erlangen Mit 174 Abbildiuigen in 280 Einzeldarstellungen, davon 2 farbige Operationsbilder Etwa 230 Seiten 4°. 1967 Gebunden DM 68,—; US 8 17.00 • Bitte Prospekt anfordem! Die Ultraschalluntersuchung des Gehirns in Form der eindimensionalen Echo-Encephalographie hat in den letzten Jahren zunehmende Bedeutung erlangt, da sie ohne GefShrdung des Patienten in kurzester Zeit Einblicke in die rilumlichen VerhSltnisse innerhalb der Schadelkapsel zulSflt. In dieser Monographic werden zunachst die physikalischen Voraussetzungen, soweit sie fur das Verstandnis des Ultraschall-Echoimpulsverfahrens am Schadel erforderlich sind, beschrieben. Nach ausfuhrlicher Erdrterung der Untersuchungstechnik, des normalen und des pathologischen Echo-Encephalogramms legen die Autoren an Hand von flber 9000 Einzeluntersuchungen bei 2747 Patienten den Wert der Methode eingehender dar. Im speziellen Teil werden besonders die echo-encephalographischen Befunde bei supra- und infratentoriellen Hirntumoren, cerebralen Massenblutungen, Enveichungen und beim kindlichen Hydrocephalus demonstriert. Einen groBeren Raum nimmt die Darstellung der Anwendung des Verfahrens beim SchSdel-Hirntrauma und seinen Komplikationen ein. Auf diesem Gebiet ist die Methode bereits heute unentbehrlich geworden und hat zu einer Verbessening der diagnostischen und damit auch der therapeutischen Ergebnisse gefOhrt. AJle Kapitel sind durch 'eine ausfQhrliche Kasuistik belegt, wobei die neuroradiologischen Befunde den Echogrammen gegeniibergestellt werden. Instruktive Abbildungen, schematische Darstellungen sowie tabellarische Obersichten gestatten eine rasche Orientierung. Ein besonders ausfuhrliches Literaturverzeichnis bietet dem Leser die Mdglichkeit, sich auch in Einzelfragen weiter einzuarbeiten. Das vorliegende Werk gibt erstmals einen Gesamtuberblick uber die klinische Anwendung der eindimensionalen Echo-Encephalographie. AUe diagnostischen Mbglichkeiten des Verfahrens sind erschopfend dargestellt. FOr denjenigen, der sich mit der Echo-Encephalographie befaBt, ist dieses Standardwerk nicht nur empfehlensw«rt, sondern unentbehrlich. Interessenten: Neurologen, Neurochirurgen, Neurophysiologen, Radiologen, insbcsondere Neuroradiologen, Chirurgen, insbesondere Unfallchirurgen, Kinderarzte, ferner Internisten, Otologen, Ophthalmologen, Gutachter.
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