Bilateral Symmetrical Necrosis of the Corpora Striata

Hawke, Wm. A.; Donohue, Wm. L.

doi:10.1097/00005053-195101000-00002

Cited by 35 publications

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“…Necropsy disclosed severe neuronal necrosis bilaterally in putamen and caudate nuclei with only mild changes in globus pallidus and patchy laminar necrosis of the cerebral cortex. Hawke and Donohue (1951) described a child with bilateral necrosis of the caudate nucleus, putamen, and globus pallidus developing during the course of otitis media without any known episode of anoxia. During two months of survival the child neither spoke nor responded to commands, although she would occasionally cry and withdraw from a painful stimulus.…”

Section: Discussionmentioning

confidence: 99%

Akinetic mutism and bilateral anterior cerebral artery occlusion

Freemon

1971

Journal of Neurology, Neurosurgery & Psychiatry

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A 68 year old retired depressed white male was admitted to the surgical service because of a self-inflicted minor gunshot wound to the chest. The only significant past history was a myocardial infarction 13 years previously. After successful treatment of his chest wound the patient was transferred to the psychiatric service because of continued suicidal thoughts and statements. One morning a week later he awoke feeling unusually 'groggy' as he told his room-mate. On his way to the bathroom the patient fell and could not arise. When he was examined his eyes were open but he could not speak or follow commands. The doll's head manoeuvre showed extraocular movements to be full. Pupils were equal and reactive to light. Gag reflex was present as were corneal reflexes. A slight plastic rigidity was present in all limbs. The only move-.r K.1 ment elicitable was a slight withdrawal of each limb to deep pain stimulation. However, if the patient's arm was held over his face and allowed to drop, it usually fell in such a way as to miss his face. Tendon reflexes were bilaterally symmetrical and hyperactive, particularly in the lower extremities with sustained clonus at both ankles. Bilateral Babinski signs were present, as were snout and grasp reflexes. The patient would look at the examiner and would follow him with his eyes. Several attempts to communicate with the patient using eye movements or eye blinks as signals were entirely unsuccessful. Within an hour after the insult, an electroencephalogram was performed which showed low voltage 2-2i Hz generalized activity. A lumbar puncture showed an opening pressure of 140 mm CSF and a closing pressure of 120 mm CSF; glucose was 77 mg and protein 45 mg/100 ml. There were no cells in the CSF and there was no xanthochromia. The next morning the patient had lost his superficial appearance of alertness. His eyes were closed and his musculature was flaccid unless he was stimulated at which time he became rigidly opisthotonic with extension of legs and arms, with flexion at the wrists. He had CheyneStokes respiration with an apnoeic period of 20 seconds. At this time the pupils remained equal and reactive, extraocular movements were intact as estimated by the doll's head manoeuvre, and caloric examination showed conjugate tonic deviation of the eyes toward the side of the cold water. The patient died 10 days later.NEUROPATHOLOGICAL FINDINGS External examination revealed bilateral softening from the frontal pole to the inferior occipital region with slight clouding and thickening of the overlying meninges. Coronal sections showed severe infarction on the left, involving the entire frontoparietal and temporal cortex extending through subcortical white matter to the basal ganglia, including the head of the caudate nucleus but sparing the thalamus.

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Section: Discussionmentioning

confidence: 99%