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Recent anatomoclinical and neuroimaging studies have suggested a possible relation between obsessional compulsive disorders (OCD) and some brain damage, such as frontolenticular lesions, basal ganglia cavitations and local glucose metabolism impairment. A poor frontocaudal regulation of the left hemisphere and an autonomic nervous system dysfunction in OCD patients have been supposed. To absess these morphofunctional abnormalities, an electrophysiological approach has been performed in 100 consecutive neurotic patients, screened with various neuropsychological tests and divided in two groups, 50 with OCD and 50 with anxious neurosis (ANX). Patients were submitted to EEG spectral analysis and BAEP studies and comparated with 25 age-matched normal controls. The mean alpha power in occipital regions was significantly higher in OCD patients and reduced in ANX patients. A significant reduction of the beta activity was recorded in frontal regions in both patient groups as compared to controls. A slight (p < 0.11) increase in I-V interpeak latency (IPL) vs. control group was observed in BAEP from left ear. A significant increase of the same IPL in OCD vs. controls (p < 0.025) was observed in BAEP from right ear. A slight n.s. reduction in III wave amplitude in OCD patients was observed in BAEP from left ear, whereas a highly significant reduction in the same wave amplitude from BAEP from right ear was observed in OCD patients. The above findings cold be account for both a frontotemporal and brainstem dysfunction with a probable involvement of serotoninergic central pathways, with a significant impairment of pontine segment in ANX patients and of mesencephalic region in OCD patients.

The hypothesis that alpha-adrenergic receptor blockade accounts for the ability of ergotamine to stop migraine attacks was tested, in migraine patients, in an experimental migraine model based on nitroderivative- induced attacks. In a preliminary single blind, placebo controlled study, thymoxamine, a prevalently post-synaptic alpha adrenergic receptor antagonist, was able to abort migraine attack in 9 out of 10 patients, as opposed to 2 out of 10 by placebo (p < 0.005 Fisher's exact test). In a subsequent randomized, crossover, placebo controlled double blind study, the ability of a selective alpha-1 adrenergic receptor agonist, methoxamine, to block ergotamine antimigraine effect was studied. In 26 patients migraine was induced in two separate tests and then ergotamine was administered once after methoxamine pretreatment and once after placebo; methoxamine was significantly more effective than placebo in blocking antimigraine effect of ergotamine (p = 0.0055 Fisher's exact test). These results support the hypothesis that ergotamine alpha-1 adrenolytic properties may account for its antimigraine effect suggesting that this action takes place outside the blood-brain barrier, since methoxamine can cross it very poorly. Ergotamine target structure could be the trigeminal innervation of the extracranial and/or dural vessels.

In 22 migraine patients and 5 healthy controls an investigation has been performed on lymphocyte subsets in basal conditions and 90 minutes after sublingual isosorbide dinitrate (IDN) administration. In all patients the drug assumption induced a typical migraine attack with increase in all examined lymphocyte subsets with except of NK cells. A statistically significant increase (p < 0.05) in T lymphocyte subsets we found during the crisis, whereas in healthy controls neither a migraine attack nor any modification in lymphocyte subsets could be observed. These results seem to confirm the immune alteration we have previously found in migraineous patients and suggest the possible role of IDN-stimulated endothelium not only in vasodilatation but also in production of substances responsible of the observed immune modifications.

Forty-six patients with myasthenia gravis (MG) underwent transternal thymectomy between 1975 and 1991 and were observed over a long term follow up period (mean 6 years). Surgery was well tolerated and was followed in 32.6% of patients by remission of symptomatology. The severity of symptoms according to the Osserman scale was significantly reduced: slight forms of myasthenia increased soon after thymectomy more frequently than moderate and severe forms. Response to thymectomy at 3 months, according to the Hankins scale, was found to be positive (remission or amelioration of symptoms) in 31/41 patients, and worse in patients with thymoma. Probability of clinical remission and death were both significantly correlated with clinical response at three months after thymectomy. No other preoperatory clinical factor (onset age, sex, initial severity of MG, interval from symptom onset to thymectomy) was found to predict the response to treatment. Preoperatory mediastinic CT had a good reliability (> 85%) in diagnosing thymona, but was rarely able to distinguish between thymic hyperplasia and atrophy.

The case of a slight epileptic 30-year-old woman with heterotopic gray matter diagnosed by TC and NMR is described. The seizures of left jacksonian type begun at the age of 3, and stopped at the age of 12. In 1986 the seizures of atonic-akinetic type reappeared and continued until now at an average of 2 for year without obstacle for her job of employer. Cerebral computed tomography and magnetic resonance imaging showed a neuronal migration anomaly with nodular masses of gray matter in the right temporo-parietal area, characteristic image of gray matter heterotopia.

Serum levels of tumor necrosis factor (TNF)-alpha/cachectin have been evaluated in 20 patients with Migraine without Aura (MwA) versus 17 patients with Chronic Type Tension Headache (CTTH). Results show an exaggerated release of TNF-alpha/cachectin in sera of patients affected by MwA, while in CTTH patients TNF serum concentration is comparable to that observed in normal donors. Some hypotheses are formulated in order to clarify the TNF-alpha/cachectin spontaneous production and its biological significance in patients with MwA.

Different classes of drugs are used in the pharmacological treatment of headache, both during migraine crisis and migraine prophylaxis. How these drugs exert their therapeutical effect in migraine is not clearly understood. Hypothetical mechanisms of action are discussed by the Authors in regard to the different pathogenetical events relevant to migraine. It is proposed that different pathological events can be modified by one drug and, conversely, one mechanism of action may be common to different drugs.

The case of 38-year-old woman bearer of a congenital giant naevus "en pélerine" with numerous neurofibromas and other satellite naevi was reported: the patient was afflicted by spastic tetraparesis, more pronounced on the right side. MRIscan of the spine revealed the presence of a cervical spinal tumor shown histologically to be a psammomatous meningioma. The skin picture was consistent with neurocutaneous melanosis; the rarity of its association with neurofibromatosis and spinal meningioma is discussed in the light of embryologic arguments.

Central nervous system diseases occur frequently in patients with AIDS. From 20 to 40% of all these patients develop neurological symptoms and in about 10% of AIDS patients the onset of the disease is characterized by neurological symptoms. These may be related to primary HIV infection or to any of a large number of opportunistic viral and non-viral infections. Moreover, the observation of multiple central nervous system infections is frequent, making the diagnosis difficult. AIDS-related opportunistic infections of the central nervous system are discussed, presenting both a review of the literature and several case reports.

Acute transverse myelitis and monolateral optic neuritis developed within a few weeks of each other in a 68-year-old woman. CSF findings consisted of elevated protein, pleocytosis, increased IgG and presence of one oligoclonal band in the electrophoresis. MRI investigation revealed diffusely increased signal on the T2-weighted images in the cervical and thoracic tracts of the spinal cord. Notwithstanding an intense steroid therapy, the patient died after 6 weeks. Despite the absence of post-mortem examination, clinical, laboratory and neuroimaging findings are consistent with the diagnosis of neuromyelitis optica (NO) related to multiple sclerosis. This case serves to document that NO can occur initially at an advanced age.

A 73-year-old man presented a progressive neurologic syndrome with impairment of multiple cranial nerves, ataxia and limb weakness. Neuroradiological evaluation showed multiple supra and infratentorial lesions, which completely disappeared after steroid treatment on two occasions. These neuroradiological modifications were closely correlated with clinical picture and CSF findings. Post-mortem examination showed multifocal primary CNS immunoblastic large cell lymphoma. Immunohistochemistry showed that the tumor was of B-cell origin.