Bilateral pallidal DBS is safe and efficient in patients who have levodopa-responsive parkinsonism with severe fluctuations. Major improvements in motor score, ADL score, and off time persisted beyond 2 years after the operation, but signs of decreased efficacy started to be seen after 12 months.

No abstract

deductions concerning the cortical representation of the superior visual field in man, our case provides further insight in the understanding of the role of the lingual and fusiform gyri in complex visual processing. Case reportA 73 year old man with chronic arterial hypertension, atrial fibrillation and insulin-independent diabetes was admitted after he had an episode of bilateral leg weakness associated with rotatory vertigo and nausea which lasted 30 minutes. Three days before, he had experienced throbbing bilateral temporal headaches associated with lightning phenomena in the left visual hemifield, followed by intermittent blindness in the upper visual field on both sides.On admission, he was well-oriented and collaborated well with the examiner. Blood pressure was 160/100 mm Hg, with an irregular pulse suggesting atrial fibrillation (60/min).There were no carotid or subclavian bruits and no heart murmur. The ophthalmological and visual findings are described below. The remainder of the cranial nerves did not show any abnormality. The tendon reflexes were normally brisk and symmetrical. The abdominal reflexes were absent bilaterally. The plantar reflexes were downgoing. In the limbs, no abnormality of tone, strength and coordination was found. Tactile, pain, temperature, posture and vibration senses were normal. The gait was unremarkable.

SUMMARY The study of 3 personal cases and 5 published cases of unilateral infarct limited to the territory of the tuberothalamic artery suggests that this syndrome should be differentiated from the other thalamic syndromes. The onset is usually sudden, with moderate contralateral weakness. Sensory changes may be present but remain mild. The patients are apathetic, show perseverations and may be disoriented. In left-sided infarcts, transcortkal aphasia, verbal and visual memory impairment and sometimes acalculia are found. In right-sided infarcts, hemispatial neglect, visual memory impairment and disturbed visuospatial processing are common. A decreased level of consciousness, disturbed ocular movements, severe motor weakness and delayed abnormal movements do not occur. Involvement of the ventral lateral and dorsomedial nucleus with sparing of the intralaminar nuclei, posterolateral formation and upper midbrain may explain this picture. The fact that the tuberothalamic artery arises from the posterior communicating artery, which often receives its supply from the carotid system, further justifies considering unilateral tuberothalamic infarcts as a syndrome.

We describe a patient who had sequential strokes in both hemispheres with a severe unilateral spatial neglect after a first right-sided parietal infarct and abrupt disappearance of the neglect after a second left-sided frontal infarct. The first lesion involve the caudalmost right angular gyrus (area 39), whereas the second lesion involved the left frontal eye field (area 8) and surrounding cortex. Those two cortical areas are assumed to have a pivotal role in modulating both shifts of attention within extrapersonal space and saccadic eye movements through their connections with subcortical structures, in particular, superior colliculi and thalamic nuclei. Our case supports the existence of a distributed anatomic-functional network in subserving directed spatial attention.