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In recent years the incidence of primary cerebral lymphomas has increased. Diagnosis by imaging techniques (CCT, angiography, MRT) and stereotactic biopsy are considered as reliable diagnostic tools. Therapeutically a combination of radio-, steroid- and chemotherapy is recommended. We report a case of space-occupying CNS lesion in which the radiopaque enhancing process completely disappeared after biopsy and steroid therapy. A year later the tumor recurred on the other side and again regressed after steroid therapy. The first biopsy showed signs of a papillar tumor, so a choroid plexus papilloma was suspected. On examination of the treatment history, however, this diagnosis had to be revised. A primary CNS lymphoma seems most probable. The phenomenon of a tumor remission under steroid administration and the problems related to the differential diagnosis are discussed.

A 45 year old woman is reported who initially presented with a cerebellar syndrome, severe ataxia, and dysarthria. She rapidly deteriorated to coma vigile with bilateral myoclonic jerks, flexion rigidity, and immobility necessitating complete nursing. Her EEG showed generalised slow activity and periodic biphasic and triphasic waves. The CSF concentration of neuron specific enolase was very high. Consequently the diagnosis of Creutzfeldt-Jakob disease was established. Eight months later she died of respiratory complications. Thirty years earlier the patient had undergone corneal transplantation for keratoconus. Review of the organ donor's hospital records showed that death was caused by intercurrent pneumonia subsequent to subacute spongiform encephalopathy confirmed by necropsy. In view of two previous case reports in the literature it is presumed that the cadaveric cornea was the source of transmission of Creutzfeldt-Jakob disease in this patient.

Background: The Chiquitano tribe lives in the southern Amazonas region in Bolivia, remote from larger towns. Data on the epidemiology of neurological disorders are completely lacking., Methods: A combined prospective-retrospective study was designed to determine the prevalence and annual incidence of major neurological diseases. In an one-year prospective study 1514 individuals (total population 5652) who consulted the general practitioner were interviewed and examined for neurological disturbances. These histories were analysed retrospectively by a neurologist and classified according the diagnosis key of the DGN., Results: During a one-year period (April 1995-March 1996), 139 patients suffering from neurological diseases were seen (one-year incidence and prevalence 2.45%). Cervical and lumbosacral pain syndromes were the most common neurological problems; these were caused by sleeping in hammocks, and by hard agricultural labour. Tropical myositis (12.9%) was very frequent and the most frequent muscle disease. Epilepsy was found in 11 patients and extrapyramidal syndromes in 2 patients. Regarding epilepsy, a high dark rate is assumed because of social and cultural traditions. Strokes are rare, since many risk factors are not present. All cases of meningitis were lethal and clearly demonstrated infrastructural problems. Patients with social diseases (AIDS, drug- and alcohol addiction, injuries caused by violence) were rarely seen., Conclusion: In a shrinking world, and with the development of "Tropical Neurology" as a specialised discipline neuroepidemiological data are increasingly important for two reasons. First of all, they sensitise neurologists to this topic, and secondly, they can be used to estimate the need for neurologists serving the Third World's minority populations.

History and Clinical Findings: A 56-year-old woman with hepatitis C had symptoms of a polyneuropathy with asymmetrical distal pareses and painful sensory disturbances in the limbs., Investigation: In addition to positive serology for hepatitis C cryoglobulins were demonstrated and complement C4 was reduced. Biopsy of the sural nerve showed a vasculitic neuropathy., Treatment and Course: The multiple neuropathy (cryoglobulinaemia neuropathy), associated with hepatitis C, was treated with corticosteroids (starting with 60 mg/d prednisolone) and the neurological abnormalities regressed well., Conclusion: Vasculitis associated with hepatitis C should be included in the differential diagnosis of peripheral neuropathy.

Background: Diagnosis of bacterial meningitis is due to granulocytic pleocytosis of CSF. In developing countries and in hospitals without continuous availability of a clinical laboratory a bedside-method of diagnosing meningitis is desired., Methods: 75 CSF samples were tested for granulocytes and protein with reagent strips and the results were compared with those obtained from the clinical laboratory., Results: All 48 samples with normal cell count were correctly diagnosed negative using reagent strips. Twenty-five samples of 27 samples with granulocytic pleocytosis were correctly recognised as right positive (sensitivity 92.6%; specificity 100%). All 48 samples with normal protein were correctly tested normal. Twenty-one samples of 27 samples with elevated protein were correctly diagnosed right positive (sensitivity 77.8%; specificity 100%)., Conclusion: Testing CSF for granulocytes and protein with urine reagent strips is a bedside-method which allows a rapid and reliable decision whether CSF is normal or granulocytically pleocytotic.

Objective: The reliable diagnosis of brain death is a precondition of organ removal for subsequent transplantation. As demographic data, information on the underlying cause and written consent to organ removal from brain-dead patients are largely unknown; protocols relating to the determination of brain death were analysed to obtain these data., Patients and Methods: The study was based on an examination of the protocols of 547 consecutive and unselected patients who between 1984 and 1994 had been examined for possible brain death by experienced members of the Neurological Department of Erlangen University, in consequence of the establishment of a consultation service for this purpose to hospitals in the region of North Bavaria. The criteria of brain death were those established by the Federal German Doctors' Chamber, all the data in the written protocol being analysed retrospectively., Results: Brain death was confirmed in 521 patients (319 males, 202 females; mean age 40.1 [1.5 - 84] years). 473 patients (86.5%) had been examined at the Erlangen University Clinic or the Municipal Hospital in Nuremberg, the remainder in regional hospitals. The most common causes were trauma to the head/brain (43.5%), subarachnoid haemorrhage (18.6%), generalised hypoxaemia (9.5%), cerebral infarction (7.3%) or other conditions (4.5%). 33 patients (6%) had committed suicide. Organs were removed in 244 of 413 patients (59.1%) for whom there data on possible organ removal: seven patients had carried donor cards, relatives' consent was obtained in 237. No consent was given in 90 cases (21.8%), while 79 (19.2%) were excluded for medical reasons., Conclusion: If brain death is suspected, an experienced neurological consultant should be called in as soon as possible to assess the patients survival chances and evaluate possible organ removal for subsequent transplantation.

The recognition of handwriting is a specific achievement of the brain which need not be connected to understanding the written text itself. The goal of this study was to determine how this ability is impaired in patients with left- or right-sided lesions. Seventeen aphasic patients with lesions in the left hemisphere, 16 patients with lesions in the right hemisphere, and 15 normal controls (without CNS illness or damage) were investigated. They were asked to recognize the handwriting of a person well-known to them among a sample of ten different handwritten texts. The aphasic patients were able to recognize the handwriting of the familiar person either immediately or after some delay in 96%, the non-aphasic patients in only 44%, and the healthy controls in 100% of the cases. Results indicate that the recognition of handwriting represents a specific achievement which is independent of other verbal and lexical tasks. It is a task which involves the recognition of figural, geometric spatial patterns and, thus, an achievement of the non-dominant hemisphere.