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To the Editor: We read with interest the report by Treib et al.1 on a careful retrospective study of 44 patients followed up for 4.2 ± 1.2 years after standard treatment for neuroborreliosis. The study points out that a significant proportion of the patients developed signs of persistent infection and CNS involvement, represented by persistence of serum IgM on Western blot analysis (but not ELISA) in 80% (35/44) and by appearance of symptoms related to chronic fatigue syndrome in 32% (14/44). To detect signs of persistent or rather new CNS involvement, only objective quantitative evaluation of memory, headache, and concentration according to psychological and neuropsychological batteries provides convincing evidence of a change with time. In addition, appearance of memory and concentration “problems” (without quantification) after 4.2 ± 1.2 years in 14 of 44 patients originally age 55.7 ± 15.3 years may well be consistent with other causes not associated with neuroborreliosis, including cerebrovascular, depressive, and neurodegenerative disorders. In this regard, previous reports support the view that …

To the Editor: White et al. [1] describe a patient with acute multifocal motor neuropathy with conduction block (MMNCB) after a Campylobacter jejuni (CJ) enteritis who recovered within 6 weeks after immunoglobulin treatment. We report a case of MMNCB, with a chronic relapsing course lasting 3 years after a CJ enteritis. [2] A 52-year-old man was admitted with a 15-day history of acute weakness of the lower extremities. He had a history of 7 days of acute diarrhea 2 weeks before admission. Neurologic examination revealed only minimal symmetric weakness with extension of both feet with loss of ankle jerks. CSF was normal. Needle EMG showed fibrillations and a reduced interference …

A young male patient affected with Lafora’s disease and concomitant mental deterioration, myoclonic jerks and epileptic seizures is reported. A cerebral biopsy showed round PAS-positive myoclonus bodies in nerve cells and neuropile. A tendency to periodic recurrence of paroxysmal activity in the EEG tracings, an unusual finding in Lafora’s disease, is briefly discussed.

In a case of loss of consciousness presenting diagnostic difficulties, the syncopal nature was determined only with the help of combined polygraphy and closed circuit television recording.

Fifty-one brains showing lacunae and 30 with cribriform cavities have been identified out of 191 examined brains. A histologic and immunohistochemical study with the peroxidase-antiperoxidase method for glial fibrillary acidic protein has been carried out in selected cases. The number, site, associated arterial lesions and the microscopic appearance of lacunae and cribriform cavities are reported. Lacunae are small cavities usually, but not always due to softenings; cribriform cavities are dilatations of the perivascular space. Two types of cribriform cavities have been identified, according to the histological appearance of the surrounding tissue: type 1 with normal and type 2 with rarefied and abnormally gliotic surrounding nervous tissue. Sixteen cases showing a cribriform state in the basal ganglia exhibited a pseudobulbar palsy or extrapyramidal rigidity. Pseudobulbar palsy of striate form or parkinsonism may be ascertained in some cases only by histological and immunohistochemical examination.

We studied a case of focal status epilepticus with aphasia as the sole manifestation, lasting 21 days. A 77-year-old woman developed aphasic seizures followed by aphasic status epilepticus 10 months after a left temporo-occipital hemorrhage. The diagnosis was made only after EEG, and seizures were stopped by anticonvulsant medication. Aphasic status epilepticus may be only a reflection of cerebral irritability, suggesting the possibility of a functional etiology for prolonged language disorders also in adults.

The estimated annual mortality rate of Creutzfeldt-Jakob disease in the Genoa area during the six year period 1974 through 1979 was 0.93 per million inhabitants.

Resume Les EEG repetes de 12 cas de maladie de Creutzfeldt-Jakob ont ete examines. Dans la moitie des cas au periode prodromique le premier EEG montre des alterations constituees par des ralentissements non specifiques du rythme de base au des decharges lateralisees periodiques. Au cours de l'evolution de la maladie nous avons observe la conversion des alterations focalisees non specifiques en PLD et apres en traces periodiques generalises. Cette evolution et la correlation entre les PLD et les manifestations epileptiques focales suggerent la nature corticale des decharges.

Large numbers of neurofibrillary tangles and neuritic plaques were found in a cerebral biopsy from a 52-year-old woman suffering from subacute dementia with early myoclonus and quasiperiodic EEG changes. This case, which appeared to be an example of non-familial Alzheimer's disease, is commented in the context of possible relation of Alzheimer's disease to transmissible dementia.

Non-communicating syringomyelia (NCS) can be associated with different disease processes such as arachnoidytis, trauma or tumor. Approximately 12 cases, documented radiographically, of the association of non-communicating syringomyelia and multiple sclerosis (MS) have been described but their relationship remains obscure. In 3 patients with laboratory supported MS spinal magnetic resonance imaging (MRI) revealed a central cystic cavity. In 2 patients lesions on the spinal cord above the cavity were demonstrated. At 3-year follow-up in 1 patient, no change in the cavity was detected. Although 3 cases are insufficient for providing a definitive conclusion on the relationship between these two diseases, we suggest that demyelinating lesions have to be regarded as possible causes of spinal, asymptomatic cavities.

A 50-year-old man with minimal risk factors for cerebrovascular disease had a pure motor hemiparesis due to a pontine infarction. Syphilis serology and CSF findings indicated a previously unrecognized meningovascular syphilis as the cause of the stroke. At variance with the majority of recently reported cases, no prodromal syndrome preceded the cerebrovascular event, and there was no HIV coinfection. Treatment with erythromycin and minocycline was followed by clinical improvement and normalization of main CSF parameters including VDRL; oligoclonal bands and local IgG synthesis, however, were still detectable in post-treatment CSF.

To the Editor.— In the recent article by Dubin et al (1983;249:60) on the differentiation in the emergency department of organic brain syndrome from functional psychiatric illness (ie, organic v functional acute psychosis), the authors do not mention the EEG, a rapid and inexpensive investigation. Pro and Wells, 1 in a review on the EEG and delirium, concluded that, in their opinion, the EEG is a useful and often ancillary procedure in the differential diagnosis of delirium, but they complain about the lack of evidence to "label EEG a luxury or a necessity" in the diagnosis of psychotic patients. In a study of 114 patients consecutively referred to us with acute or subacute confusional state, we were able to find normal EEG recordings in 15 of 18 patients (83%) with psychiatric illness and only in eight of 96 patients (8%) with acute confusional state from organic, intracranial, or extracranial disorders