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Four infants had bilateral hippocampal sclerosis by magnetic resonance scans, including oblique coronal fast spin echo images of the temporal lobes; [18F]fluorodeoxyglucose-positron emission tomographic scans, done in 2 infants, showed isolated bilateral anterior temporal lobe hypometabolism. All had epilepsy with episodes of status epilepticus. Despite adequate motor and sensory functions, all failed to develop language (or lost attained language), social skills, and complex purposive or adaptive activity, even after epilepsy was controlled. Bilateral hippocampal dysfunction in early life appears to be associated with a profound failure of cognitive capacities, including language learning and learning of complex social and adaptive skills in general. The deficits correspond to the cognitive deficits of severe infantile autism. Hippocampal function, or more generally medial temporal lobe function, appears necessary for language learning in the infant, as well as for complex social and adaptive learning.

Congenital anomalies of the vertebral artery, including aneurysms and fenestrations, or partial duplication of the extracranial vertebral artery are rarely seen. Presented here is an unusual case of bilateral congenital anomalies of the extracranial vertebral arteries. The right vertebral artery demonstrated an aneurysm and the left a partial duplication. The aneurysm was felt to be the source of the embolic phenomenon to the posterior circulation. This was treated with detachable balloon catheter placement.

Preoperative suspicion of brain abscess is extremely important. Failure to anticipate it may, on intervention, lead to a possibly catastrophic, gross contamination of the ventricular system and the meninges. It is well established that massive edema, particularly in the white matter, frequently accompanies brain abscess on postmortem examination. The purpose of this paper is to call attention to the association, first noted by Dr. Juan Taveras (14), of marked perifocal edema in the diagnosis of brain abscess by arteriography; the emphasis of the paper is on effects secondary to swelling at a considerable distance from the central focus. In the past (8), the clinical diagnosis of brain abscess has been emphasized in those patients having fever, a primary source of infection, or congenital heart disease which could lead to embolization of the brain with either subacute bacterial endocarditis or paradoxical embolus in right-to-left shunts. We have noted, however, that a significant number of patients with br...

Correlation between isotope cisternography and traditional neuroradiological procedures was investigated in 130 patients with dementia or significant ventricular dilatation. In all patients with positive cisternograms, the results of the radiological procedures were either diagnostic or consistent with a diagnosis of obstructive hydrocephalus. The longer the duration of subarachnoid block, the less favorable the prognosis. Low-pressure shunt valves are preferred for surgical improvement of hydrocephalus patients.

A patient with progressive supranuclear palsy demonstrated a region-specific decrease in T2 signal during high-field-strength brain magnetic resonance imaging. At autopsy the T2-signal hypointensity was found to correspond topographically to increased deposition of ferric iron. The potential clinical, radiologic, and pathophysiologic implications of these findings are discussed.

Four patients with spontaneous aseptic thrombosis of the superior sagittal sinus and cerebral veins are reported. These cases illustrate the variable clinical and angiographic features at different stages and severity of this disease.Cerebral vein thrombosis, particularly when localized and unaccompanied by dural sinus thrombosis, probably occurs much more frequently than it is diagnosed.With proper angiographic technique and interpretation, we believe that it sometimes is possible to make a diagnosis of cerebral vein thrombosis without thrombosis of the superior sagittal sinus.

The authors describe a new technique of gas myelography based on (a) a lateral C1–2 puncture which permits a one-needle CSF-gas exchange and (b) a tilt-table and Trendelenburg position to keep gas below the level of the foramen magnum. Evaluation of the entire spinal canal is made possible, including the cervicomedullary junction and the posterior fossa. Flexion and extension views are obtained readily and without significant discomfort. Indications include cervical spondylotic myelopathy and/or disk herniation, cervical trauma, hydromyelia, intramedullary tumors, congenital and developmental anomalies.

I. Introduction IT IS WELL KNOWN that many non-neoplastic disease entities may give symptoms and signs which mimic those of an expanding intracranial lesion. None of our diagnostic procedures, including cerebral angiography, is always definitive in diagnosis of the entities. They include: congenital lesions such as aneurysm,1and arteriovenous malformation2; focal inflammatory and infectious diseases such as brain abscess3; intracranial hemorrhage, infarct formation or edema formation secondary to cerebrovascular disease4; and trauma.4Leukoencephalopathy of the hemorrhagic type, one form of demyelinating disease, has been reported to present as an intracranial mass lesion, in which the mass effect is related to hemorrhage.5It is the purpose of this paper to report a case with demyelinating disease without hemorrhage in which the clinical symptoms and cerebral angiograms were interpreted as indicating an expanding intracranial lesion and led to the presumptive diagnosis of brain tumor.