Philadelphia Neurological Society

Abstract

Dr. William H. Everts: In reply to Dr. Riley's question about improve¬ ment of the central nervous system: First, the time element during which we had to observe these patients was too short, but I may say there was pronounced im¬ provement in strength and in the numbness of the feet and legs, as well as in the vision of some of them. The acuity of vision which they had remained, but there was practically no improvement in the central scotomas. The period of observa¬ tion, during which the diets were better, was about seven weeks. For the first four weeks we did not see them. They had food dropped by airplane, and the diet was thus improved; but, according to many, it was not adequate. In the hospital the regimen was adequate, but neither the scotomas nor the symptoms referable to the cord improved during the time of observation. As I was observing them, I felt that the improvement recorded on many of the charts was purely that of general strength, of the peripheral nervous system, and not that of the central nervous system at all. In the course of a few weeks these men were ready to get up and be on their way, and they hiked off to the ships of the British army and to our ships without too much trouble. That was not so with the men who were serevely ill, and I think they will be permanently crippled. The literature relating to the value of pneumoencephalography in the differ¬ ential diagonsis of the presenile dementias was reviewed. The report of Flügel indi¬ cating that the extracortical air is distributed as large, confluent masses over the frontal lobes in cases of Pick's disease and as broad stripes over the convexity in cases of Alzheimer's disease was shown to be based on rather tenuous evidence.Nine cases were reported, in all of which pneumoencephalograms had been made and in 8 of which autopsy had been performed. The pathologic observations were compared with the pneumoencephalographic findings, and it was pointed out that the lack of clearcut pathologic distinction between Pick's and Alzheimer's disease vitiates the value of air studies in the differential diagnosis. Uniform or asym¬ metric ventricular dilatation without displacement was found in all the 9 cases reported. In these cases the appearance of the extracortical air was of little or no value in differentiating the two conditions. It was concluded that the pneumoencephalogram is a valuable diagnostic aid in distinguishing the presenile de¬ mentias from other conditions, but that it is of little or no value in differentiating the various members of the presenile group. discussion Dr. Walter Freeman, Washington, D. O: Dr. Chodoff might do well to bring out in his final discussion that pneumoencephalographic examination in these cases is not always without risk. I recall a patient, not in this series, who after pneumoencephalographic examination went into profound shock and was saved only by heroic efforts, including a blood transfusion and oxygen inhalations. Another patient, who probably had unrecognized septicemia at the time the pro¬ cedure w...