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We have developed the Thermocross, a simple device for rapid assessment of thermal sensitivity, tested it on healthy subjects and diabetic patients and evaluated its use in identifying patients whose sensation loss may expose them to the risk of neuropathic foot injury. Thermal discrimination deteriorated with age (P less than 0.001) in healthy subjects, but all the controls could detect a temperature difference less than or equal to 10 degrees C. In diabetic patients, the deficit in thermal sensation detected by the Thermocross paralleled the decline of nerve conduction. Thermocross thermal sensation was impaired in 87% of 38 ulcerated feet of 26 diabetic patients. We conclude that the Thermocross is a suitable tool for screening for sensation loss and that diabetic patients with impaired thermal sensation are vulnerable to ulceration. The Thermocross could also serve a useful educational purpose, the implications of reduced thermal sensation probably being more meaningful to patients and health care personnel than those of a reduction in the traditionally tested vibration sensation.

A unique case of sustained, rhythmical contractions of both orbicularis oculi induced by voluntary eye closure is described. It was observed in a 25-year-old man who had suffered a severe head trauma. The lid phenomenon was synchronous with macro square-wave jerks. Sustained blepharoclonus upon eye closure is likely to be related to dysfunction in the cerebellar system.

Acroparesthesias may develop as a result of various pathological processes which affect the nerves of the hand. Usually the diagnosis can be made from the history and the clinical findings. If objectifiable neurological findings are lacking, electrographic investigations must be carried out. If several diseases are present, electrography (stimulation and myography) is particularly important for diagnosis and therapy. In compression of the median nerve in the carpal tunnel, the speed of sensory conduction is delayed in about 85%, an anomalous motor latent duction is delayed in about 70%. A distal motor latency of the median nerve of more than 8 m/sec is an absolute indication for a surgical intervention. Signs of denervation of the thenar muscles also required operative treatment.

The effect of subcutaneously injected gangliosides on diabetic peripheral neuropathy was assessed in 26 diabetic patients with neuropathy, 20 of whom received 100 mg daily 5 days per week for 12 weeks in a randomised single-blind cross-over placebo-controlled study and six of whom, with painful neuropathy, received the same quantity of gangliosides for the same length of time but no placebo. Subjective symptoms of lower limb neuropathy improved on gangliosides but not on placebo (P = 0.01). The amplitude of the peroneal nerve muscle action potential increased on gangliosides and declined on placebo (P = 0.05), but no other significant changes were observed in nerve conduction or in any other measurable sign of lower limb somatic nerve function or of cardiovascular autonomic function.