Faculty Bibliography

A 45-year-old man awoke with numbness and paresthesias on the right side of his face, scalp, ear, and tongue. CT and MRI demonstrated a focal hemorrhage in the dorsolateral right pontine tegmentum. Cerebral angiography was negative for vascular malformation or aneurysm. CT performed 1 month later showed complete resolution of the pontine hematoma, with residual minimal lateral pontine atrophy.

A 67-year-old woman had experienced exquisite focal pain and tenderness for more than 1 year in the distal forearm 4.5 cm proximal to the distal wrist crease. Surgical exploration showed a venous fibrovascular band adherent to and transversing the epineurium of the median nerve precisely at the point of maximal tenderness. Resection of the fibrovascular band completely relieved the symptoms of focal pain and tenderness.

In 1976 a 28-year-old Ecuadoran male suffered paraparesis after a kick to his back. Iophendylate myelography was followed by thoracic laminectomy with incomplete resolution of the paraparesis. One year later, worsening of the paraparesis was managed by further thoracic laminectomy without improvement. In 1978 a spinal cord stimulator was implanted via low thoracic laminectomy as a measure to counter his spasticity. In 1984 metrizamide myelography and computed tomography scanning were performed for increasing spastic paraparesis that disclosed an intramedullary lesion at the T-4 level. Exploration and myelotomy revealed an intramedullary cysticercal cyst, which was totally removed.

A 74-year-old male attorney developed rapidly progressive weakness of the fourth and fifth digits of the right hand with impairment of his grip and ability to perform cursive writing. Lancinating pain occurred spontaneously and was triggered by pressure along the ulnar border of the forearm about 5 cm proximal to the wrist crease. Nerve conduction studies revealed a complete electrical block to stimulation at a point 5 cm proximal to the wrist crease when recording from the abductor digiti minimi. Distal to this point, responses of normal amplitude and latency were recorded. Surgical exploration disclosed two fibrovascular bands coursing from the ulnar artery to the distal belly of the flexor carpi ulnaris, entrapping and grooving the ulnar nerve. Release of these bands resulted in reversal of the electrical block, complete relief of pain, and a full neurologic recovery during the ensuing six months.

A 35-year-old man experienced sudden spontaneous arterial bleeding from his left ear. Arteriography demonstrated a left petrous carotid aneurysm. The bleeding was initially controlled with packing and ultimately by left common carotid ligation and transection.

This report describes a case of paroxysmal alexia which progressed to a persistent syndrome of alexia without agraphia. The sequence of symptoms beginning with a sensation of eyeball movement followed by blurred vision in the affected eye, alexia and diminished awareness strongly implicates an ictal mechanism. Anatomical, physiological and psychological considerations suggest that the syndrome arose from functional disruption between the visual cortex and the dominant inferior parietal cortex.

Two patients with structural lesions had illusions of eye movement as the earliest manifestation of their seizures. One patient had a right occipitoparietal arteriovenous malformation and the other had a tentorial meningioma encroaching on the left occipital lobe. Symptoms were controlled by anticonvulsants and subsequent surgery in both cases. The characteristic feature of this rare form of seizure onset is a unilateral sensation of eye movement in the absence of oscillopsia.

A one-month-old male infant with hydrocephalus, aqueductal stenosis and congenital clasped thumbs is reported. Electromyographic evaluation supported the hypothesis that the clasped thumbs were a consequence of flexion-extension imbalance, with subsequent muscle contracture secondary to hypoplasia or aplasia of the thumb extensors.