Acute right hemiplegia and transient expressive aphasia occurred in a 7-year-old girl a few days after nonspecific constitutional symptoms and the appearance of a large right submandibular lymph node. Biopsy of this node and lack of other evident cause suggested a diagnosis of cat-scratch disease. Carotid arteriography showed a localized arteritis of the supraclinoid part of the left internal carotid artery and the left middle cerebral artery, involving also some lenticulostriate vessels. Computerized tomography demonstrated infarction in the left internal capsule. The size of this infarct and the angiographic abnormalities improved 6 weeks after onset, and coincided with clinical recovery. Cat-scratch disease may have caused the localized arteritis.

SUMMARY Two cases of intracranial dissemination of primary intramedullary spinal cord gliomas are reported, with a review of the literature. One patient had a post mortem confirmation and in the second, cerebral CT scan and CSF examination demonstrated the occurrence of intracranial dissemination. CSF protein was elevated on both patients and malignant cells were found late in only the one patient. Both patients had raised intracranial pressure. The mechanisms of dissemination and of raised intracranial pressure are discussed. Such dissemination may be more common than previously realised.Dissemination of spinal cord gliomas into the cranial cavity has been reported infrequently while spread from intracranial glial tumours to the spinal subarachnoid space is not uncommon. We report two cases in young women which were seen within one year of each other and speculate on the mechanism of the extensive ventricular seeding that occurred. Case reports Case IIn December 1981, a 38-year-old woman presented with a six weeks history of right leg weakness and left leg paraesthesiae. There was no sphincter disturbance. Examination revealed mild weakness of right hip flexors, brisk knee jerks, flexor plantar responses and impaired appreciation of pinprick below T1 1 on the left. Neurological examination was otherwise normal. A myelogram to T3 was normal. CSF revealed no malignant cells but many lymphocytes and macrophages and total protein was raised to 0-65 g/l. IgG/Albumin ratio was normal. A diagnosis of possible transverse myelitis was made.In late January 1982 the patient re-presented with sudden onset of severe headache, vomiting and neck stiffness. Neurological examination was unchanged apart from increased weakness of right leg. Examination of CSF revealed no white blood cells, 222 red blood cells with no xanthochromia, protein of 18-8 g/l and glucose of 2-2 mmol/l. The headache was rapidly relieved by lumbar puncture. Headache and vomiting soon recurred and florid (fig 1), while a repeat cerebral CT scan showed mild ventricular dilatation.

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