Seventy-five patients were treated between March 1976 and June 1980 for classical idiopathic tic douloureux. Fifty-five patients underwent percutaneous trigeminal rhizotomy (PTR) and twenty-four had posterior fossa microvascular decompression (M VD) of the trigeminal nerve. Four patients had both procedures. In the PTR group. 4% were immediate failures, 42% had a delayed recurrence of pain, while 54% remained totally pain free with an average follow-up of 30 months. In the MVD group, 12% were immediate failures, 17% had a delayed recurrence of pain, and 71% have remained free of pain with an average follow-up of 28 months. Neither procedure can be regarded as ideal surgical treatment for patients with pain refractory to medical treatment. Percutaneous rhizotomy has an established place because of its safety, particularly in elderly patients. A high rate of recurrent pain is to be expected. Microvascular decompression has appeal in younger patients because of its non-destructive nature but the long term efficacy of the procedure is not known.

Our previous studies of cerebrovascular permeability in angiotensin-induced acute hypertension demonstrated that the principal mechanism resulting in increased permeability is enhanced pinositose. In order to exclude the possibility that the enhanced pinositose was a direct effect of exogenous angiotensin, cerebrovascular permeability alterations were studied in nonpharmacologically induced acute hypertension.

Rats receiving horseradish peroxidase (HRP) intravenously, were sacrificed 2½ minutes after the onset of hypertension induced by placing a clip on the abdominal aorta. These animals showed the same pattern of permeability alterations as had been observed previously in animals with angiotensin-induced acute hypertension. Focal segments of penetrating arterioles in the temporal and parietal cortex showed increased permeability to HRP. Permeable vessels showed increased numbers of pinocytotic vesicles and the interendothelial junctions revealed no alterations. Enhanced pinocytosis appears to be the principal mechanism resulting in increased cerebrovascular permeability in this model as well suggesting that the alterations of cerebrovascular permeability observed previously in angio-tensin-induced acute hypertension occur due to the hypertensive state and are not a direct drug effect of exogenous angiotensin.

Somatosensory evoked potentials (SEPs) were recorded following trigeminal nerve stimulation in 25 normal subjects. Mucosal stimulation of the lip resulted in a reduced stimulus artefact. The three initial peaks, N13, P19, and N30, measured respectively 12.8 ± 0.9 S−3, 19.3 ± 1.4 S−3 and 28.6 ± 1.7 S−3. Blink reflex studies were also performed in most of these subjects. In 41.4% of 29 patients with established or suspected multiple sclerosis, the trigeminal SEP was abnormal. Additional use of the blink reflex raised the overall incidence of trigeminal nerve dysfunction to 51.7%. None of the patients had clinical evidence of fifth nerve involvement either historically or on examination. Four of seven patients with progressive spinal MS and two patients whose only deficit was that of optic neuritis, had abnormal trigeminal SEPs. It is concluded that occult involvement of the pontine fifth nerve structures occurs frequently in MS despite the rarity of corresponding clinical findings. The trigeminal SEP is a useful additional neurophysiological method.

Some multiple sclerosis patients with 20/20 acuity complain of poor vision. In a previous report we accounted for this in our patient group by showing that multiple sclerosis had caused a depression of contrast sensitivity while sparing visual acuity. In this study we investigated whether some of this measured depression might be due to abnormally rapid or severe adaptation during the test procedure rather than a true permanent loss. Our finding was opposite to this supposition: adaptation was abnormally slight and/ or slow.

Depressed contrast sensitivity was not well correlated with abnormal adaptation to contrast. In patients whose contrast sensitivity losses were restricted to a band of spatial frequencies, we found no evidence that abnormalities of contrast adaptation were restricted to this same spatial frequency band. Further evidence of dissociation between abnormal contrast sensitivity and abnormal contrast adaptation is that some patients with normal contrast sensitivity showed abnormally small adaptation.

Our finding of abnormally slow or abnormally small contrast adaptation in MS patients seems to conflict with Enoch et al’s (1978) report of abnormally great adaptation after inspecting a bright stimulus. This apparent disagreement may be due to their use of prior dark adaptation, very bright adapting stimuli and patients in the acute stage of retrobulbar neuritis.

Regional cerebral blood flow (rCBF) during internal carotid artery (ICA) occlusion for endarterectomy can be measured without inconvenience using the probe holder illustrated.

When mean ipsilateral hemispheric CBF exceeds 20 ml/100 gm/min, an intraluminal bypass is not necessary (63% of patients), except in patients with extensive cerebrovascular disease in whom rCBF should also exceed 20 ml/100 gm/min in all areas. ICA “stump” pressure is falsely high in about 20% of patients, and is therefore not a dependable criterion for selecting patients who need shunting.

While intraoperative shunting is capable of restoring pre-occlusion CBF levels, it does not eliminate the risk of intraoperative ischemic neurological deficit of probable embolic origin.

Visual function is usually considered to be normal in papilledema. We report previously undescribed abnormalities in the electroretinograms (ERG) and visual evoked potentials (VEP) of two patients with chronic papilledema. The steady-state latencies of the ERG and VEP were calculated using time-difference analysis. The ERG was abnormal under both scotopic (slow) and photopic (fast) flicker conditions, but the VEP was abnormal only to fast flicker photopic stimulation. This may indicate a relative vulnerability of a high frequency signal system under conditions of raised intracranial pressure. The abnormalities resolved rapidly once the intracranial pressure had been normalised. The cause of the V EP and particularly the ERG abnormalities remains unknown.

An experiment was conducted to evaluate the effect of 1-Hz or direct current brain stimulation on kindling behavior induced by 60-Hz sine wave stimulation. The effective threshold intensity to elicit a convulsion was determined on four separate occasions with 5 days of daily trials between determinations. On each day one group of experimental rats was stimulated with 1-Hz sine wave current before and after stimulation with 60-Hz sine wave current (1-60-1 group). Another group received direct current stimulation and 60-Hz current (D-60-D group). A third group received only 60-Hz stimulation. Suppression of kindling behavior usually induced by the 60-Hz stimulation occurred with 1-Hz stimulation; the mean threshold value increased on each successive determination. Suppression was most pronounced for the direct current group; it appeared after a single trial and persisted for 32 days after the last threshold determination. In contrast, most of the rats in the 1-60-1 group had recovered from the suppression after the 32 day period of nonstimulation. A second phase of the experiment indicated that the increase in threshold values for the D-60-D group occurred after a single DC stimulation. These results are consistent with the hypothesis generated by previous research that suppression following 1-Hz stimulation is not due to tissue damage.

The anticonvulsant activity of the ethyl esters of the major valproic acid metabolites was assessed against minimal pentylenetetrazol seizures in adult male ICR mice. The ethyl ester 3-hydroxy-propylpentanoic acid was found to possess significant anticonvulsant activity.

Two children, age seven and 16 years, are described with the abrupt onset of a pure motor hemiplegia as the initial manifestation of a brain stem neoplasm. Subsequent rapid neurological deterioration localized the lesion to the brain stem and glioblastoma multiforme was diagnosed by surgical biopsy. It is suggested that brain stem gliomas with this unusual presentation are likely to be highly malignant and prone to rapid bulbar deterioration.