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MRI of the lumbar spine at L3 level (left); enhancement of the cauda equina roots after gadolinium (right). The roots remain discrete.clotting function which was corrected with fresh frozen plasma. The CSF was turbid with 6000 white cells per mm3, 90% of which were polymorphonuclear cells, and a protein concentration of 0-6 g/l. Antibiotic treatment with cefotaxime and benzylpenicillin was instituted with the benzylpenicillin alone being continued when both blood and CSF cultures showed Neisseria meningitidis.By the fifth day he had persistent headache but was oriented. He complained of lumbar backache and leg pain with unsteadiness, and failed a trial without a urinary catheter because of urinary retention. He was unable to stand for more than a few seconds and could not walk at all; he was also faecally incontinent. Examination on the 12th day of his illness showed him to be confined to bed, afebrile, alert, and fully oriented without signs of meningism. He had no papilloedema and no cranial nerve signs. Apart from a depressed left triceps reflex he had no signs in the arms. There was a severe flaccid asymmetric leg weakness, worse on the left, with all tendon reflexes, except for that at the right knee, being absent even with reinforcement.Both plantar responses were flexor. There was impaired pinprick sensation from L4 to S5 bilaterally. Proprioception was impaired in the right toes and in the right ankle.

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This paper reports the results of botulinum toxin A treatment in 13 children with cerebral palsy. All patients except one d i t e d dynamic deformities in one hand or foot and changes in muscle tone of corticospinal and extrapyramidal origin. The primary purpose of the treatment was to improve the impaired W e d movements which resulted from dystonic limb posture and were the most disabling symptoms in the group studied.The study showed that the botulinum toxin treatment produced a sigruScant improvement in functional disabhty in terms of amelioration of skilled hand movements and foot posture Op c 0.01). The injections took effect a few days 'after dystonic muscle infiltration, and the mean dmation of improvement was 3.1 months (2.0 -4.0 months). Side effects were n&g&le and transient; transitory muscle weakness was the most frequent.Botulinum toxh A provides a safe and effective adjuvant treatment of dystonic skilled movements and gait disorders in children with d r a l palsy.

The number of venous narrowings is higher in more disabled patients. A significant improvement in clinical disability in the relapsing-remitting group was observed.