Many patients with Alzheimer's disease (AD) develop parkinsonian symptoms, suggesting an overlapping between AD and Parkinson's disease (PD). However, pathologic and neurochemical studies indicate that the involvement of the dopamine system may be different in the two conditions. Using single photon emission tomography, we determined the relative specific striatal uptake (striatum to cerebellum ratio) of the D2 receptor ligand [123I]-IBZM in 15 AD patients without overt extrapyramidal symptoms (three subjects presented mild rigidity and bradykinesia) and nine age-matched controls. Mean specific activity in striatal regions of AD patients (1.35 +/- 0.09) was significantly reduced from control mean (1.59 +/- 0.03). Because such changes were evident even in the absence of overt parkinsonian symptomatology, our data indicate that alterations of striatal D2 receptors may be part of the pathologic abnormalities of AD. In addition, the mechanisms underlying extrapyramidal symptoms in AD (decline of postsynaptic striatal dopamine receptors) appear different from the prevalent presynaptic nigrostriatal alterations typical of PD.

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Hypertensive encephalopathy is a syndrome consisting of headache, seizures, visual changes, and other neurologic disturbances in patients with elevated systemic blood pressure. The purpose of this study was to analyse the clinical and neuroradiological findings in nine patients with hypertensive encephalopathy, observed in five years.CT (n = 13), and MR (n = 12), examinations performed in these patients before and after resolution of symptoms were reviewed. Six had the preeclampsia-eclampsia syndrome, and three had hypertensive encephalopathy due to other causes. CT and MR findings in all patients having these examinations were indicative of oedema in the cortex and subcortical white matter in the occipital lobes. Two of the nine patients also had similar findings in the cerebellum and frontal lobes.The findings on the CT and MR studies resolved on follow-up examinations performed after the hypertension was corrected.Our results suggest that the radiological findings associated with hypertensive encephalopathy in the appropriate clinical setting are very useful to achieve an early diagnosis. Encefalopatia ipertensivaQuadro clinico e neuroradiologico RIASSUNTO -L'encefalopatia ipertensiva e una sindrome neurologica subacuta causata da un aumento delta pressione arteriosa, che perdura per uno o piu giorni. Tale aumento puo essere anche modesto e!o intermittente. Essa risulta frequente nelte pazienti che vadano incontro net periodo finale delta gestazione a sindrome pre-eclamptica-eclamptica. I sintomi sono progressivi e comprendono cefalea, diminuzione delta vigilanza, segni cerebrali focali, crisi epilettiche, disturbi visivi fino alla cecita corticale. La sintomatologia regredisce completamente se vi e una riduzione precoce e rapida della pressione arteriosa, altrimenti rimangono dei danni irreversibili, prima fra tutti la cecita, ma vi puo essere anche la morte. La TC e soprattutto la RM contribuiscono, quando positive, alla diagnosi. Esse evidenziano un oedema della sostanza bianca, ma anche della grigia corticale, soprattutto nelle regioni parieto-occipitali. Tale reperto puo generare problemi diagnostici, superati oggi in parte con le tecniche di RM di diffusione.Gli Autori riportano la toro esperienza in 9 casi osservati in 5 anni, con particolare riguardo alle possibilita di diagnosi precoce clinico-radiologica ed alla reversibilita del quadro sintomatologico e neuroradiologico.

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Trans-ethmoidal encephalo-meningocele is an extremely rare event among the adult population. It mainly affects young people who have previously reported a head injury. Even though early treatment is mandatory to avoid septic complications, the diagnosis is usually late because of the misleading symptomatology. We describe the unusual clinical history of an adult patient with a giant trans-ethmoidal encephalo-meningocele. A 61-year-old woman presented progressively more intense headache and rhinorrhea. No trauma was reported. We learned that she had a history of misunderstood spontaneous rhinorrhea beginning two years before, followed one year later by a lateral sinus thrombosis which worsened the cerebrospinal fluid leakage. Some months after stroke a new cerebral magnetic resonance scan revealed a giant trans-ethmoidal encephalo-meningocele. The brain herniation was surgically removed by a subfrontal intradural approach through a frontal craniotomy. Even rare, giant naso-ethmoidal encephalo-meningocele has to be considered in adult patients presenting with rhinorrhea even without a history of meningitis or neurological defects. Venous stroke can affect patients in whom prolonged CSF leakage occurs because of misunderstood cerebrospinal fistula. These patients must be monitored after stroke for the possible onset of an encephalo-meningocele.