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Objectives:To compare the microbiological efficacy, turnaround time, cost, convenience, and patient and user tolerance of Tristel Trio Wipes, PeraSafe solution and Cidex OPA solution for the high-level disinfection of flexible nasendoscopes.Methods:Flexible nasendoscopes were used in routine clinical encounters. They were then disinfected with one of the three disinfectant methods. Surveillance cultures were taken before and after each disinfection process. Data relating to each of the study parameters were recorded.Results:Positive bacterial cultures were discovered on nasendoscopes disinfected with PeraSafe and Cidex OPA. Tristel Trio Wipes have no capital outlay cost, the lowest running cost, the greatest convenience and the fastest turnaround time. PeraSafe had a faster turnaround time than Cidex OPA, and lower running costs.Conclusion:Tristel Trio Wipes are equal to PeraSafe and Cidex OPA in terms of microbiological efficacy. Turnaround time and cost are dramatically reduced when using Tristel Trio Wipes compared to the other disinfectant methods.

Investigations of the elemental and phase composition, microstructure, microhardness and tribological properties of AISI M2 steel subjected to nitrogen and carbon plasma-immersion ion implantation (PIII) at different regimes are presented. Elemental composition was studied by Auger electron spectroscopy (AES) and X-ray microanalysis. Phase composition was identified by means of conversion electron Mossbauer spectroscopy (CEMS) and X-ray diffraction (XRD). Using these methods it was established that nitrogen PIII at a target temperature of 380°C resulted in phase transformations: from α′-Fe(C,M)+M 6 C+MC (M: Fe,Cr,W,Mo) to e-(Fe,M) 2+ x (N,C)+M 6 (C). With increasing temperature up to 500°C in nitrogen PIII the retained martensite, in addition to e-(Fe,M) 2+ x (N,C), was observed. Joint nitrogen and carbon PIII leads to the formation of e-(Fe,M) 2+ x C and (Fe,M) 7 C 3 (M:Cr,W,Mo) carbides. Theoretical analysis of the distribution of thermoelastic stresses during PIII demonstrated the essential increase in the mass transport process of implanted atoms into the target volume. On the basis of the estimations conducted, it has been shown that migration processes of nitrogen into steel during PIII have a complicated character and can be described with the help of mechanisms stimulated by the reaction of a crystal lattice under the impulse influence.

According to the definition we will use here, a chemical species represent ’expressis verbis’ the molecular arrangement of a particular metal or metal compound. This may include free aquated ions, distinct chemical compounds (such as dissolved insorganic salts and acids, or solid oxides, sulfides, and carbonates), as well as thermodynamically unstable aggregates (like dissolved and solid organic complexes, colloids or coprecipitates) either naturally available or as a result of man’s activity.

This is a report on two male patients aged 22 and 43 years, respectively, who developed a fatal progressive demential syndrome that lead to the death of one after 16 months and of the other patient after 25 months and that presented with the typical clinical pattern of "subcortical dementia". In both the cases, the hospital had suspected Creutzfeldt-Jacob's disease but this was not confirmed by microscopy of the tissue; the typical form of manifestation was absent. Instead, microscopy of the brain revealed a marked symmetric degeneration of the thalamus with special preference given to the anterior and media nuclear groups. Predilection for the neothalamic against the palaeothalamic and archithalamic structures produced a very strong impression of a system-related thalamic degeneration process of the type occasionally discussed on the basis of similar observations. Parallel to the atrophic process there were also degenerative changes that were less pronounced, in the rubro-olivo-cerebellar system and in one case a moderately pronounced involvement of the second motor neuron. Both observations of a "thalamic dementia" are discussed against the background of relevant literature published so far on the subject.

The incidence of cardiac embolic events in stroke patients has often been underestimated. Recent research has shown that it ranges from 15% to 35% (1, 11, 14, 17). In most cases, the diagnosis of cardiac embolism can be established by using clinical criteria along — for example, the presence of atrial fibrillation, valvular disease, cardiomyopathy or rheumatic heart disease (3, 6, 8). A direct positive detection of intracardiac thrombi is, however, not to be expected often, even when using two-dimensional echocardiography (2, 7, 10, 13). The diagnostic techniques mentioned above including chest-ray, ECG and echocardiography provide the means of splitting the patient population into groups with a high risk of cardiac embolism, with a low risk of cardiac embolism and with heart diseases without an enhanced risk or cardiac embolism.

The case history is presented of a man who died at the age of 38 years and had been suffering from severe torsion dystonia and a hypokinetic-rigid motor disturbance since the age of 10. The pathological findings were isolated pallidal degeneration with demyelination and moderate neuronal loss, iron pigment accumulation and spheroid bodies in both pallidal nuclei. In addition the zona reticularis of the substantia nigra was hypoplastic and not affected. The red nucleus, the dentate nucleus and the zona reticularis of the substantia nigra showed iron depigmentation. The rare condition of non-familial Hallervorden-Spatz syndrome, without involvement of the zona reticularis and the cerebral cortex, was considered to be the diagnosis.

We report on the results obtained by means of directional continuous-wave Doppler sonography in 33 patients with superficial temporal-to-middle cerebral artery anastomoses. Recurrent transient ischaemic attacks or a recent mild neurological deficit were considered as justification for bypass surgery in cases of angiographically proven occlusions of one or both internal carotids, severe intracranial carotid artery disease, or stenoses and occlusions of the M-1 segment of the middle cerebral artery. The efficiency of the anastomosis was evaluated by the modified Pourcelot indices (relative end-diastolic flow velocity) of the preauricular superficial temporal artery and of the bypass-supplying branch at the edge of the burr-hole. The influence of intermittent compression of the bypass-supplying branch on the modified Pourcelot index of the ipsilateral common carotid was used as a further criterion for sonographic evaluation. All efficient anastomoses, defined by a modified Pourcelot index of at least 0.20 at the edge of the burr-hole, exhibited an average reduction of 0.08 in the relative end-diastolic flow velocity in the common carotid during compression. In the 18 patients with unilateral occlusion of the internal carotid, bypass surgery was predominantly efficacious (by the above criterion) in those patients who showed a reduction in the sum of the modified Pourcelot indices of the remaining brain-supplying arteries of at least 10% as compared with age-matched controls. The subgroups of existing and absent collaterals through the ophthalmic artery did not show any differences with respect to the percentage of efficient anastomoses.(ABSTRACT TRUNCATED AT 250 WORDS)

We examined the CT-scans of 310 patients with epilepsy and found a cerebellar atrophy (CA) in 56 cases. 8 of them concerned the cerebellar hemispheres and 48 the vermis. The CA was predominantly observed in patients treated with phenytoin, who had experienced one or more phenytoin intoxications. The combination of phenytoin and carbamazepine resulted in a high risk of acquiring a CA. The CA did not depend on the age of the patients or on the presence of major generalised tonic-clonic seizures.

Using directional continuous-wave Doppler sonography of the vertebral arteries, we have investigated 1,540 patients during the past 5 years. On the basis of unilateral and bilateral retrograde brachial angiograms in the same patients (a total of 1,989 angiograms) we have developed sonographic criteria for demonstrating a significant increase in the peripheral resistance of both distal vertebral arteries and/or the basilar artery. All 11 cases of basilar artery stenosis of at least 60% reduction in lumen diameter (as shown by angiography) exhibited an approximately 40% or higher reduction in the sum of the modified Pourcelot indices of both vertebral arteries with respect to age-matched controls. All 3 stenoses of less than 60% reduction in lumen diameter were not detected by sonography. Even a good collateral circulation through rete mirabile anastomoses did not normalize the modified Pourcelot indices. One case of a persistent primitive trigeminal artery with thin-calibered vertebral arteries was also detected by sonography. The high percent of patients with one hypoplastic vertebral artery in the group with basilar artery stenoses indicates an increased risk for atherosclerosis of the basilar and/or distal vertebral artery in these patients. All 14 angiographically verified occlusions of the basilar artery were detected by sonographic criteria independent of the occlusion localization. Thus, we believe that directional continuous-wave Doppler sonography is a reliable technique for detecting basilar artery stenoses of at least 60% reduction in lumen diameter and basilar artery occlusions.

The chronological development of environmental pollution in the Western Baltic Sea for the past hundred years was investigated in dated sediment cores. An artificial radionuclide (137Cs), nutrients, heavy metals, chlorinated hydrocarbons (PCB, DDT, Lindane) and plasticizers (phthalate esters) show characteristic distribution patterns within the various cores. They can be related to the production and use of specific chemicals and goods, to emissions associated with the increased combustion of coal parallel to industrialization and —in the case of 137Cs — to emissions associated with atomic weapons tests in the high atmosphere. Characteristic trends in the general development of pollution may be superimposed by specific emissions from local sources.

Immunohistochemical examinations were carried out in a case of thromboangiitis obliterans. A 26-year-old man developed 4 brain infarctions which could be demonstrated by CAT scan. He suffered from a left-sided hemiparesis, major epileptic seizures, and an ischemic optic neuritis. Immunologic studies supported a diagnosis of cerebral thromboangiitis obliterans (CTAO). The serum anti-elastin titer as well as IgE were considerably increased and a biopsy of the temporal artery showed immunohistochemical signs of an acute inflammatory vessel disease. After the diagnosis of CTAO had been made, the patient was treated with azathioprine and dexamethasone. In cases of young stroke patients, a temporal biopsy is important in confirming the diagnosis.

We have investigated 6,587 patients with directional continuous-wave (c-w) Doppler sonography of the carotid arteries during the last 33 months, and have developed criteria for the diagnosis of a significant increase in peripheral resistance of the internal carotid artery in conjunction with 1,671 retrograde brachial and direct carotid angiograms. We distinguished stenoses proximal (15 cases) and distal (4) to the origin of the ophthalmic artery, supraclinoid internal carotid artery occlusions (8), stenoses (2) and acute occlusions (10) of the middle cerebral artery. Stenoses in the carotid siphon (proximal or distal to the origin of the ophthalmic artery) of at least 60% reduction in lumen diameter showed a reduction of the relative end-diastolic flow velocity (modified Pourcelot's index) of more than 40%; additionally, stenoses proximal to the origin of the ophthalmic artery exhibited a variable alternating flow, or flow reversal, in the supratrochlear artery. Stenoses distal to the origin of the ophthalmic artery rarely revealed the theoretically expected increase in orthograde flow velocity in the supratrochlear artery. Stenoses of the middle cerebral artery consisting of more than atherosclerotic irregularities proved to be an exception. Supraclinoid occlusions of the internal carotid artery were reliably demonstrated by Doppler sonography. However, the majority of acute occlusions of the middle cerebral artery could not be detected by this means, probably due to anastomoses between the anterior and the middle cerebral arteries, which were detected by angiography. Thus, we believe that c-w Doppler sonography is a reliable tool to detect stenoses of the carotid siphon of more than 60% reduction in lumen diameter and and supraclinoid carotid artery occlusions.(ABSTRACT TRUNCATED AT 250 WORDS)

Es wird uber drei Kranke mit traumatischen Thrombosen im oberen Abschnitt der extrakraniellen Arteria carotis interna und A. vertebralis berichtet, bei denen sich die verletzungsbedingten Veranderungen im Kontroll-Angiogramm weitgehend zuruckbildeten. Die Bedeutung dieses Befundes fur die Differentialdiagnose gegenuber der fibromuskularen Dysplasie wird diskutiert.

Platelet scintigraphy was performed on 62 patients with cerebral ischaemia. Pathological scintigraphic images were obtained in 29 of the 62 patients. In 79.3% of these 29 patients the scan was abnormal in the vessel clinically affected. Platelet scintigraphy was abnormal in 21 of 34 patients with normal angiogram or only slight atherosclerosis. In patients undergoing antiplatelet therapy, platelet scintigraphy was less often positive than in untreated patients. It is suggested that platelet scintigraphy could be an appropriate technique for detecting small mural thrombi of the carotid artery, which are the source of arterio-arterial emboli, and for controlling the efficiency of antiplatelet therapy.

A new dual isotope scintigraphic (DISC) examination of the carotid arteries consisting of simultaneous injections of 111In-labeled platelets and 99mTc-labeled red cells was performed on eight male patients suffering from amaurosis fugax attacks. In concordance with the angiographically proven high percentage of significant extracranial carotid disease in patients with amaurosis fugax, six of the eight patients examined had an increased platelet accumulation in the carotid artery clinically affected. In one patient with normal angiography and one amaurosis fugax attack the platelet scintigraphy even revealed a pathological platelet accumulation in the ipsilateral carotid artery. These findings confirm the hypothesis that most amaurosis fugax attacks are due to arterio-arterial emboli originating from atherosclerotic plaques of the carotid bifurcation.

Antikoagulantien haben auch nach Einfuhrung der Thrombozytenaggrega-tionshemmer ihren Wert in der Hirninfarktprophylaxe nicht verloren, da sich die Wirksamkeit der Antiaggregantien moglicherweise auf bestimmte noch nicht klar abgrenzbare Untergruppen von Patienten mit fluchtig gen zerebralen Ischamien beschrankt und Hinweise vorliegen, das Antikoagulantien im direkten Vergleich den Thrombozytenaggregationshemmern uberlegen sind. Auf der anderen Seite schreckt viele die Erfahrung, das unter Antikoagulantien-Therapie todliche Hirnblutungen vorkommen. Die von der Mayo-Gruppe 1963 beobachtete und oft zitierte Zahl von 7% intrazerebralen Hamatomen mit todlichem Ausgang unter Langzeitantiko-agulation ist hinreichend bekannt. Nach spateren Beobachtungen der gleichen Untersuchergruppe sollen jedoch die Antikoagulantien-induzierten Hirnblutungen so gut wie ausschlieslich bei Langzeitantikoagulation von mehr als 12 Monaten Dauer vorkommen, so das als Hirninfarktprophylaxe bei Patienten mit Ischamieattacken und reversiblen ischamischen Insulten eine Art abgestufter Gerinnungshemmung zunachst mit Antikoagulantien und anschliesend Thrombozytenaggregationshemmern empfohlen und praktiziert wird.

Elastin stellt die extrazellulare Matrix der Venen und Arterien dar. Antikorper gegen Elastin sind in niedrigen Titerstufen physiologisch (4). Erhohte Konzentrationen von Anti-Elastin-Antikorpern (AE-AK) lassen sich jedoch bei verschiedenen Gefaskrankheiten nachweisen. So fanden Horsch et al. (2) im Vergleich mit einem Normalkollektiv bei Patienten mit dem klinischen Verdacht auf eine Thrombangiitis obliterans (TAO) v. Winiwarter-Burger signifikant erhohte AE-AK-Titer. Aufgrund dieser und weiterer Befunde schlos Bollinger (1) auf eine Immunpathogenese des TAO. Dies konnte von Kessler et al. (3) bestatigt werden, immunologisch fanden sich bei Patienten mit dem klinischen Verdacht auf eine zerebrale Form der TAO neben signifikant erhohten AE-AK-Titern Komplement und IgG-Ablagerungen in den Vas vasorum der A. temporalis. Mit der Fragestellung, inwieweit die AE-AK-Titerbestimmung bei Schlaganfallpatienten Hinweise auf eine entzundliche Gefaserkrankung oder eine generalisierte schwere Verlaufsform der Arteriosklerose geben kann, untersuchten wir die AE-AK-Titer bei 4 6 Normalpersonen und 40 Schlaganfallpatienten.

Three patients with ischemic cerebrovascular disease suffered attacks of transient dyskinesias, consistent with hemiballism. Angiographically all of them showed occlusive disease of the cerebral arteries. Two patients had lesions in different cerebral arteries, but showed signs and symptoms of insufficiency of the carotid artery contralateral to the dyskinesias, which was occluded in one patient and severely stenosed in the other. The third patient had frank occlusion of the basilar artery. The blood supply of the nucleus subthalamicus receiving contributions from the carotid and vertebral arterial system as well would explain transient hemiballism as a symptom of the insufficiency of both arterial systems and would further be one of the possible explanations for the low frequency of this symptom. On the other hand the appearance of transient hemiballism should be regarded as indicative of significant occlusive disease of the cerebral arteries.

In a randomised double-blind longterm study the value of acetylsalicylic acid in prophylaxis against relapse was investigated against placebo in 58 patients with transitory ischemic attacks of prolonged reversible insults. During the 24 months of observation, significantly fewer relapses of cerebral ischemia occurred in patients with carotid transient ischemia attacks under acetylsalicyclic acid than in the control group. The recurrences usually took the form of transitory ischemic attacks. Of the 5 cerebral infarcts, 4 occurred in the control group, 3 patients died. Patients with vertebrobasilar insufficiency showed no response. On account of the relatively small number of patients the result of the study is to be regarded rather as a confirmation of the results of a larger series of investigations in the USA and Canada than solely a proof of the efficacy of acetylsalicylic acid.

In the past 5 years we have investigated 29 patients with symptomatic basilar artery stenoses (14 cases) and occlusions (14) and a patent primitive trigeminal artery with thin-calibered basilar and vertebral arteries (1) using directional continuous-wave Doppler sonography of the vertebral arteries. A total of 19 patients survived, and 17 of them were clinically and sonographically reexamined after 40.4 ± 15.8 months (mean ± SD). Among the 8 patients with basilar stenoses, 6 — with no further transient ischemic attacks (TIAs) in the interval — exhibited an increase in the summed modified Pourcelot indices (relative end-diastolic flow velocities) of the vertebrals by 0.18 ± 0.16; the other 2 showed a decrease by 0.26 each, in 1 case temporally related to a TIA, in the 2nd case without further clinical deterioration. In the 8 survivors with basilar occlusions, 5 remained — by sonographic criteria — unchanged with summed modified Pourcelot indices of the vertebrals of 0.00, while 3 patients exhibited a slight increase in the summed modified Pourcelot indices of 0.13 ± 0.03. While the difference between the outcome of subsets of patients treated with regimens of 30,000–40,000 units heparin/day or phenprocoumon and less radical drugs were statistically not significant, the former regimen appeared clinically more efficacious in preventing further deterioration in approximately two-thirds of the patients affected. Due to the potential recurrence of neurological symptoms, a treatment period with phenprocoumon of 6 months after discharge from hospital appears justified. Due to these therapeutic efforts, approximately half of the patients initially affected survived with no or only a mild neurological deficit. Directional continuous-wave Doppler sonography is, in our opinion, a reliable technique for examining the short- and long-term changes in peripheral vascular resistance.

Obwohl nach den Ergebnissen der EC-IC Bypass Study Group [1] keine Praventivwirkung gegenuber ischamischen Hirninfarkten durch einen Bypass — berucksichtigt werden hier nur Temporalis superficialis-Cerebri media-Anastomosen -nachgewiesen wurde, bleibt zu prufen, ob sich nicht Patientenuntergruppen definieren lassen, die von einer Bypass-Operation langfristig profitieren konnen. In der vorliegenden Studie berichten wir uber die Doppler-sonographischen Funktionsprufung nach Bypass-Operation und entwickeln mogliche sonographische Kriterien, die praoperativ als Indikator fur eine wahrscheinliche Wirksamkeit des geplanten Bypass eingesetzt werden konnen.

Using covered thermoelements, the authors determined in 26 non-dermopathic volunteers the changes in skin temperature produced by the application of Unguentum emulsificans aquosum SR, Unguentum emulsificans cum 50% aqua, Linimentum aquosum SR, Lotio Zinci oxydati SR, Lotio Zinci oxydati aethanolica SR and water. Lotio Zinci oxydati aethanolica SR had the strongest cooling effect, followed by Lotio Zinci oxydati SR and, with some reservations, Unguentum emulsificans aquosum SR. The two other external remedies are unsuitable as cold creams.

We have reviewed 29 cases of patients who suffered from basilar impression and had undergone hospital treatment since 1969. 12 of these patients were reexamined. The predominant symptoms were lesions of the long tracts while the ,,classical signs" such as headache and nystagmus occurred less frequently than expected. Only a quarter of our patients showed a marked deterioration during follow-up. The outcome for four patients who underwent operation is reported.

Platelet scintigraphy (PSC) with indium-111 labelled platelets has been confirmed as an adequate method for the detection of intracardiac thrombi in patients with heart disease. We performed PSC of the heart and the neck vessels in 27 stroke patients with suspected cardiac embolism and as control on 10 patients with atherosclerotic lesions of the carotid arteries without evidence of heart disease. The carotid PSC was positive in 6 of 10 patients with carotid disease, and twice in the 27 with suspected cardiac embolism. In these 27 the PSC of the heart indicated pathological conditions 13 times. Pathological platelet accumulations could be visualized in 3 cases in the atrial space, in 9 cases in the region of the left ventricle, and once at the aortic valve. Scintigraphy was negative in all 10 patients with atherosclerosis of the neck vessels. The two-dimensional echocardiography revealed pathological findings in 8 of the 13 patients with positive heart PSC (3 with intraventricular thrombi, 3 with valvular disease, 2 with decreased ventricular contractility) and was normal in the 10 control patients. Open-heart surgery was performed in 2 patients with pathological PSC and revealed an intracardiac thrombus. Three of 4 patients with positive atrial PSC showed mitral or aortic valve disease. These results suggest that PSC can provide a valuable method for detecting cardiac thrombi in stroke patients.

In six patients with ischemic lesions of the visual pathways above the lateral geniculate body, the pupil light reflex was investigated under perimetric conditions. The size of the lesions--in four cases caused by lateralized cerebral infarction, in two cases by complicated migraine attacks--was certified by neurological examination and by angiography or computerized tomography respectively. The recordings were done with a portable pupillograph measuring the infrared light reflected from the iris. A Tübinger perimeter served as stimulator. All patients except one, whose visual fields recovered quickly and completely, showed parallel tracings concerning the sensory and the pupillographic profiles, in the older lesions as well as in the recent ones.

Die von Aaslid et al. (1982) eingefuhrte transkranielle Doppler-Sonographie der basalen Hirnarterien bietet wie alle auf Ultraschall basierenden Untersuchungs-methoden den grosen Vorteil der nahezu beliebigen Wiederholbarkeit. Als Methode, die bei der Diagnose arterieller Stenosen von Funktionsstorungen auf morphologische Veranderungen zuruckschliest, ist sie allerdings erheblichen Stor- bzw. Fehlerquellen ausgesetzt, die die Aussagekraft der gewonnenen Untersuchungsergebnisse mindern. Wir haben uns bei der hier vorgestellten Studie die Aufgabe gestellt, den Einflus einiger technischer Parameter auf die Reproduzierbarkeit der transkraniellen Doppler-Messungen zu bestimmen. Im einzelnen wurde fur die A. cerebri media, die A. cerebri anterior und die A. basilaris sowie jeweils fur systolische und diastolische Werte getrennt untersucht: — die Streuung der Meswerte bei wiederholten Untersuchungen durch gleiche Untersucher, — die Streuung der Meswerte bei Kontrolluntersuchungen durch wechselnde Untersucher, — der Einflus der vom Frequenzanalysator bestimmten Hullkurve (Abb. 1) auf die Reproduzierbarkeit der Messungen, — die Streuung der Ablesungen verschiedener Untersucher an identischen Kurven.

A 52 year old female with an anterior interosseous nerve syndrome is reported, which probably was caused by an unusual mechanical stress--transport of a case with the left hand for a prolonged period. With insertion of pronator quadratus muscle by a needle electrode as far as radial and distal as possible we received a distinctly prolonged latency of 9.8 ms on the afflicted side by stimulation of median nerve in the bend of elbow; the corresponding value on the healthy side was 5.9 ms. The described technic seems recommendable for proofing of diagnosis and controlling the course of this illness in cases without complete denervation of the muscles innervated by the anterior interosseous nerve.

Die kardiale Hirnembolie als Folge von Vorhofflimmern, Myokardinfarkt und Klappenvitium ist eine haufige Ursache von zerebralen Durchblutungsstorungen (5,12,15,16). Die Diagnose eines intrakardialen Thrombus bringt schwerwiegende therapeutische Konsequenzen wie Langzeitan-tikoagulation oder Herzoperation mit sich. Bis jetzt wurde hierfur vorwiegend die Echokardiographie eingesetzt, welche zwar uber den Zustand der Herzklappen und die Kontraktilitat des Myokards gute Informationen liefern kann, jedoch beim direkten Nachweis von intrakardialen Thromben oft nur unsichere Ergebnisse zeigt (1,2,7,11,13). Nachdem Stratton et al. (14) mit Hilfe von 111In-markierten Blutplattchen im Tiermodell szintigraphisch intrakardiale Thromben nachweisen konnten, untersuchten Ezekowitz et al. (3,4) Patienten nach Myokardinfarkt und Mitralklappenvitien plattchenszintigraphisch und konnten in uber 70% der Falle pathologische Plattchenanreicherungen im Bereich des linken Herzens nachweisen. Alle szintigraphisch positiven Befunde wurden intraoperativ oder autoptisch bestatigt, die Plattchenszintigraphie erwies sich hinsichtlich der Nachweisgenauigkeit der Echokardiographie zum Teil uberlegen.

Four cases with isolated cerebral infarction near the occipital pole resulting in homonymous hemianopic paracentral scotoma showed loss of pupillomotor sensitivity within the scotomatous defects. This supports previous similar findings in patients with homonymous hemianopia due to larger infarctions in the posterior cerebral artery territory.

Three cases of post-traumatic thrombosis of the distal extracranial internal carotid artery and vertebral artery are reported. Control angiograms showed considerable recession of changes caused by injury. Discussed is the significance of these findings for differentiation between post-traumatic artery changes and fibromuscular dysplasia.

We examined the CT-scans of 310 patients with epilepsy and found a cerebellar atrophy (CA) in 56 cases. 8 of them concerned the cerebellar hemispheres and 48 the vermis. The CA was predominantly observed in patients treated with phenytoin, who had experienced one or more phenytoin intoxications. The combination of phenytoin and carbamazepine resulted in a high risk of acquiring a CA. The CA did not depend on the age of the patients or on the presence of major generalised tonic-clonic seizures.

We have investigated 6,972 patients with directional continuous-wave Doppler sonography within the last three and a half years, and have derived criteria for the sonographic diagnosis of basilar artery occlusion or tight stenosis in conjunction with 1,071 retrograde brachial angiograms. By sonographic patterns, we have suspected obstruction of the basilar artery or of both distal vertebral arteries in nine cases. Either bilateral sonographic silence or the absence of a diastolic flow component of the vertebral arteries served as criteria in the sonographic evaluation. Angiography of the vertebro-basilar system, performed in eight cases, showed near or complete occlusion in the distal vertebrals or in the proximal basilar artery. Degrees of stenosis less than an 80 percent reduction in lumen diameter could not be detected sonographically. Two further basilar artery occlusions were detected by means of angiography despite negative Doppler sonography: one of these patients showed an extensive collateral circulation between the posterior inferior and the superior cerebellar arteries, and one patient had an occlusion only of the middle and rostral thirds of the basilar artery, the proximal third and the anterior inferior cerebellar arteries being widely patent. Thus, we believe that directional CW Doppler sonography is very useful in the diagnosis of near or complete occlusion of both distal vertebral arteries or of the proximal basilar artery.

Pathological nystagmus may be spontaneous, positional, or gaze-evoked. Peripheral vestibular nystagmus is usually rotatory, the horizontal component being most prominent. It is - in contrast to a central vestibular nystagmus - strongly inhibited by fixation. Spontaneous congenital nystagmus is also prominent with fixation, but it can usually be distinguished from acquired fixation nystagmus based on its long duration, atypical waveforms and high frequency. Two general types of positional nystagmus can be identified on the basis of nystagmus regularity: static and paroxysmal. The most common variety of positional nystagmus is the so-called benign paroxysmal positional nystagmus, which in the majority of cases occurs as an isolated symptom of unknown cause. Gaze-evoked nystagmus, prominent with fixation, includes dissociated, rebound and gaze-paretic nystagmus forms. Symmetrical gaze-evoked nystagmus is most commonly produced by ingestion of certain drugs. Phenomena related to nystagmus include: amblyopic, voluntary, and convergence-retraction nystagmus, ocular dysmetria, ocular flutter, opsoclonus, ocular bobbing, and ocular myoclonus.