The blink reflex, ordinarily elicited only in the orbicularis oculi and not in other facial muscles, can be used to detect synkinetic movements objectively. In 26 of 29 patients tested at least 4 months after facial nerve degeneration, an aberrant blink reflex was recorded in the orbicularis oris on the affected side. Of the remaining three, one had injury to only a peripheral branch of the facial nerve and experienced a return of function with no evidence of synkinesis; in the other two, the affected side of the face was totally paralyzed in the absence of facial nerve regeneration. Synkinetic movements ultimately will occur in nearly all cases following facial nerve degeneration provided that the facial nerve regenerates from a proximal site.

✓ Warning signs prior to major hemorrhage were analyzed in 112 cases of single intracranial aneurysm. Fifty-four of 112 patients (48.2%) showed such signs, and the incidence for women was slightly higher (49.2%) than that for men (46.6%). Incidence decreased as patient age advanced, more steeply for men than women. Incidence and characteristics of warning signs varied according to location of aneurysm. Nineteen different signs occurred in 97 instances for 54 patients (average 1.76), and were placed into three groups according to possible etiologies: Group 1, vascular origin due to expansion of aneurysm and adjacent artery; Group 2, minor bleeding; and Group 3, ischemic lesion, arterial spasm, or occlusion. The average time interval from onset of warning sign to major hemorrhage was 20.7 days: 110.5 days for Group 1, 10.4 days for Group 2, and 21.0 days for Group 3. Therefore, signs in Group 2 suggest the necessity of most urgent medical attention. Results of treatment clearly suggested the group with warning signs fared better than the others. Possible reasons for this are discussed.

Two unusual cases of neurocutaneous melanosis are presented. Both patients had congenital giant hairy nevi and both developed hydrocephalus, seizures, and myelopathy. The first patient displayed multicentric cerebral and spinal cord melanosis, as opposed to the more commonly described basilar leptomeningeal involvement. The second patient had total spinal leptomeningeal involvement, and ventriculoperitoneal shunting for hydrocephalus produced peritoneal metastasis of melanoma. An individual born with a congenital giant hairy nevus or marked generalized cutaneous pigmentation should be closely observed for the development of malignant melanoma of the nervous system.

Two cases of lymphocytic hypophysitis are reported, in which hypothalamic involvement causing diabetes insipidus was a prominent clinical feature. In one case, a man had clinical and radiological evidence of the involvement of the cavernous sinus. This represents the second reported case of a man with lymphocytic hypophysitis. A transsphenoidal biopsy established the diagnosis in both cases. Neither the involvement of the cavernous sinus nor permanent diabetes insipidus has been reported previously. A review of the literature is provided.

Abstract:Vertebral Artery Occlusion Following Hyperextension and Rotation of the Head• This is a case report of a lateral medullary syndrome of Wallenberg following occlusion of one vertebral artery and stenosis of the opposite artery precipitated by combined motion of hyperextension, rotation, and lateral flexion of the head within physiological limits. Sufficient duration of such head position appeared to initiate thrombus formation following stenosis or occlusion of the vertebral artery at the level of the atlanto-occipital joint. Propagation of this thrombus obstructed the posterior inferior cerebellar artery causing infarction of the lateral medullary region. The pathogenesis of this mechanism is discussed. Additional Key WordsWallenberg syndrome vertebral artery thrombosis posterior inferior cerebellar artery atlanto-occipital joint However, the mechanism of arterial occlusion, thrombosis, and infarction has not been clarified from postmortem or clinical findings. 6This article presents a description of a lateral medullary syndrome following sustained physiological hyperextension, rotation, and lateral flexion movements of the head for a period of several hours. The angiographical survey demonstrated complete obstruction of the right vertebral artery associated with severe stenosis of the vertebral artery on the left. The clinical course and angiographical abnormalities provide an interesting sequence of events which suggest a probable mechanism of progression for this type of vascular occlusion. Case ReportA 43-year-old left-handed male draft designer experienced occasional nonvertiginous dizziness for two years. On March 21, 1974, he painted the ceilings of two rooms in his home, beginning in the early morning and finishing in the late afternoon. While painting, he used a roller or brush in his left hand. Therefore, his head was maintained in hyperextension, rotated to the left, and tilted to the right. Occasionally he used his right hand while his head remained hyperextended, rotated to the right, and tilted to the left. During that afternoon, he noted occasional dizziness as he used his right hand. The remainder of the day was not unusual and he was in no particular distress. The next morning, From the Division of Neurosurgery, Department of Neurology, University of Iowa College of Medicine, Iowa City, Iowa 52242. however, on March 22, 1974, he experienced an abrupt onset of severe headache, unsteadiness, numbness of the right side of his face, difficulty swallowing, and loss of taste on the right side of the tongue. As he attempted to climb into bed, he fell to the floor with marked loss of balance, but noted no change in level of consciousness. On March 23rd he was admitted to a local hospital where his ataxia and headache increased gradually. On admission to University of Iowa Hospitals on March 28th, examination revealed an alert and well-oriented man with a blood pressure of 140/80 mm Hg. The cranial nerve examination revealed absence of corneal reflex, and marked impairment of sensation to touch ...