SUMMARY The long-term clinical and CT-outcome of 53 conservatively treated patients with spontaneous intracerebral hematomas (ICH) was studied in relation to the acute findings.The acute mortality of ICH was 27%. Determinant for the immediate prognosis was the level of consciousness and the volume of the hematoma. The crucial size was 50 ml with a mortality of 90% for hematomas larger and 10% for hematomas smaller than that. Intraventricular hemorrhage was a bad prognostic sign only in the ganglionic-thalamic hematomas.At follow-up at a median of 4!/j years after ICH, 30% of the total series had a completely normal neurological examination and 28% had resumed work. Thirteen per cent had minor neurological deficits and 17% had debilitating sequelae. During the follow-up period 7 patients had died, which indicates an excess mortality for ICH survivors.The CT findings at follow-up consisted of low density areas smaller than the original hematomas, focal atrophy, calcifications and porencephalic cysts. In 10% the CT scan revealed no trace of the previous hematoma.Stroke Vol 15, No 6, 1984 BEFORE THE ADVENT of cranial computer tomography (CT) the acute mortality of intracerebral hematomas (ICH) varied from 51% to 92%.'" 3 The longterm prognosis was evaluated in surprisingly few studies. Six months after ICH McKissock et aJ 1 of a total of 91 patients found that 51 % were dead ,12% had returned to full work, 22% were partially disabled and 15% were totally disabled. Out of 138 patients who had survived ICH Felger et al 4 after an observation period of 3 to 7 years found that 35% had died, 14% had recovered completely and 43% and 8% respectively were partially and totally disabled.After CT has become available the diagnosis of ICH is made more frequently and with greater accuracy.5 " 7As a probable effect of diagnosing smaller hematomas the overall acute mortality of ICH has declined to about 30%. The resolution of the hematomas as visualized by CT during the first weeks and months has been described in several studies. 38 "" The long-term outcome after 6-29 months of CT verified ICH has been evaluated in clinical studies, 12 " 16 which however, did not include concomittant follow-up CT studies.The purpose of the present paper was to study the long-term clinical and CT outcome of conservatively treated spontaneous ICH as related to the acute findings. Patients and MethodsThis series of CT-verified ICH was collected from the neurological and neurosurgical departments at Rigshospitalet, Denmark, over the years 1974 to 1982. The clinical data concerning the acute phase were compiled retrospectively from the charts. After exclusion of patients with ICH known to be due to trauma, ruptured arterial aneurysm and to hemorrhage into tumors a total of 108 patients were diagnosed as having a spontaneous ICH. Neurosurgical evacuation of the hematoma was performed in 55 patients. The remaining 53 patients who were conservatively treated for spontaneous ICH formed the object of the present study. The material is not representativ...

Article abstract-We performed proton magnetic resonance spectroscopy ('H-MRS) in patients with motor neuron disease (MND) to determine the absolute in vivo concentrations in the brain of the metabolites N-acetyl aspartate (NAA), choline (Cho), and creatine (CrPCr). We examined the spectra acquired from a 20 X 20 X 20-mm3 voxel placed in the motor cortex and in the cerebellum from seven patients with clinically probable or definite amyotrophic lateral sclerosis (ALS) according to the El Escorial criteria, from three patients with suspected ALS (progressive muscular atrophy), and from eight normal control subjects. We estimated the concentrations of the metabolites using the water signal as an internal standard. The concentrations of Cho and Cr/PCr in both brain regions, a s well as the concentration of NAA in the cerebellum, were unaltered in the MND patients compared with the controls. Only MND patients with both upper and lower motor neuron signs had a significantly decreased concentration of NAA (9.13 5 0.28 mM, mean t SEM) in the primary motor cortex when compared with healthy controls (10.03 2 0.22 mM). In conclusion, the slightly decreased concentration of NAA in the primary motor cortex from ALS patients may represent a loss of neurons in this region.

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Charts from patients admitted from April 1976 to March 1986 to the departments of neurology, neurosurgery, ophthalmology and pediatrics serving a population of 615,000 inhabitants in Copenhagen County were surveyed. We then examined patients with coexisting headache and ophthalmoplegia at follow‐up. Many diseases may mimic a single attack of ophthalmoplegic migraine. We found 4 cases of ophthalmoplegic migraine, i.e. an annual incidence of 0.7 per million inhabitants. We added another 4 cases from the same area, but diagnosed before or after the study period. Only in 2 of the 8 cases did the ophthalmoplegic episodes fulfil criteria for pain and associated symptoms required for migraine without aura (common migraine). In contrast, the clinical characteristics of the attacks are typical of the Tolosa‐Hunt syndrome. When this inflammatory disease strikes a migraineur it is likely to elicit headache with migrainous features. We postulate that such cases have been diagnosed as ophthalmoplegic migraine, whereas the proper diagnosis of Tolosa‐Hunt syndrome has been made in non‐migraineurs.