.*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
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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
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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)
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March 1967
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Transport Through Biological Membranes, E. Heinz
Growth and Differentiation, R. M. Gaze
Comparative Physiology: Metabolism, / . Awapara
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The Adenohypophysis and Its Hypothalamic
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Parathyroid Hormone, C. D. Arnaud, Jr., A. M.
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Reproduction, R. V. Short
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Martin and J. L. VeaJe
Central Nervous System: Afferent Mechanisms and
Perception, P. O. Bishop
Hearing, /. Schwartzkopff
Visual Processes in the Limulus Eye, M. L. Wolbarsht and S. S. Yeandle
Higher Functions of the Central Nervous System,
A. M. Laursen
Central Nervous System: Motor Mechanisms,
E. Eldred and J. Buchwald
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BRAIN RESEARCH
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The evolution of the primate brain: Some aspects of quantitative relations (R. L. Holloway, Jr.,
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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,
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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
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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
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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
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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.