Clinical Neuroscience

[Data for the diagnosis and differential diagnosis of intracranial space-occupying processes in the elderly Part II]

GÁTAI György

DECEMBER 01, 1963

Clinical Neuroscience - 1963;16(12)

[More than 2000 cases (1690 intracranial space-occupying processes and 320 other brain diseases) were studied to determine the diagnostic results, sources of error and characteristics of intracranial space-occupying processes in the elderly. I. The diagnostic results for age-related intracranial space narrowing are unsatisfactory and worse than average. The incidence of misdiagnosis ranges from 34% to 86%, depending on the definition. II. The most common causes of diagnostic errors : 1. Neurological symptoms in elderly individuals, based on advanced age, are attributed ab ovo by the examiner to involutional-vascular lesions, without considering the possibility of a partial constriction process and the need for such studies. 2. Recognition of symptoms of intracranial narrowing processes is complicated by advanced senile involutional lesions. The investigator's attention is not drawn to changes in the nature and progression of the process. 3. Overestimation of the absence of a congestive papilla, failure to recognise that intracranial space-occluding processes are not associated with congestion in the fundus in 1/3 of cases on average, and in 4/5 of cases in older age. 4. The general symptoms of intracranial hypertension, partly due to the absence of a congestive papilla, are not recognised by the investigator and are thought to be the result of a vascular involution process. III. Diagnostic features of intracranial constriction in the elderly : 1. Progression depends on the nature of the constrictive processes. In the majority of cases, the course of malignant tumours is typical (relatively rapid and steady deterioration). The course of the less frequent benign constrictive processes is atypical compared with younger ones: progression is very slow, with late or no progression of pressure-induced symptoms - The coexistence of senile involution and intracranial constrictive processes may be characterised by a biphasic progression: after the initial multisegmental, undulatory symptoms, unilocularity and steady worsening become increasingly dominant. 2. Intracranial constrictive processes also lead to spatial disproportion in older age. The latter is usually affected by senile involution (not only in rare benign spatial constrictive processes). Accordingly, the general symptoms of pressure intensification, with the exception of congested papilla, are only slightly less frequent in older people, and can be assessed diagnostically in a similar way as in younger age. 3. in older age, congestive papillae are typically less frequent, and their presence or absence, or severity, is even less representative of intracranial pressure increase than in younger age groups. The absence of congestion in older age appears to be due partly to localised distribution of constrictive processes and partly to sclerotic vascular wall lesions. 4. Intracranial constrictive processes in old age seem to be characterised by a predominance of focal seizure type and absence of centrencephalic epilepsy on the one hand and a reduced generalisation tendency on the other. 5. The prevalence of psychiatric disorders in terms of spatial constrictive processes in older age cannot be evaluated. Their prevalence is not specific to the constrictive processes but to age. 6. Intracranial constrictive processes in old age are characterised by more frequent and more pronounced protein secretion in CSF. Negative CSF is more valuable against space-occupying processes, with protein levels above 60 mg per cent in space-occupying processes than in younger age. ]



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PÉTER Ágnes, SCHMIDT M. Rudolf

[1 The authors performed qualitative CSF analysis in 30 patients with cerebrovascular disease. They compared the lesions found in patients with soft tissue foci and diffuse cerebral lesions. 2. In apoplectic patients with early post-ictal stage a or a, y globulin accumulation and monocyte rectio along with pathologic cell forms were found. 3. In chronic anapoplegia, qualitative pathologic cell pattern or pherograms were observed in diffuse cerebral blood flow disturbance with nodal symptoms. 4. In vascular encephalopathies without apoplexy, the CSF pherogram was found to be normal, with CSF cell intact usually showing monocyte reactivity. In these cases, only in cases of long-standing disease or periodic cerebral circulatory insufficiency were pathological cell forms or abnormalities in CSF protein fractions detected. 5 Authors have reported that in cerebro-vascular disease, CSF electrophoresis and CSF differential cell pattern varies according to the severity and duration of clinical symptoms, consistent with circulatory failure. ]

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[Meningioma patients with some electrographic characteristics]


[Authors present EEG data from 122 meningioma patients. Of these, all but 6 were diagnosed by surgery or dissection. Locally, significant nodal activity was mainly provided by tumours with frontal location, followed by those with olfactory, occipital and temporal localisations. In contrast, the EEG abnormalities of centro-parietal, parasagittal meningiomas are mild but often diffuse and bilateral. No correlation was found between the background activity of electrical activity and the increase in brain pressure expressed by congestion in the orbital floor. Nor can the degree of relaxation of cerebral electrical activitas be used to infer surgical prognosis. Localisation diagnosis based on EEG was completely or approximately accurate in 75% of cases. However, in 14 cases the EEG opinion was insufficient or negative. The majority of these cases were centro-parietal parasagittal, posterior scalar or deep tumours. In 74% of patients with nodal activity before surgery, a significant reduction of nodal lesions was observed on the catamnestic curve, but complete negativity was observed in only a few cases. In contrast, excitatory or epileptiform activitas after surgery became appreciably more pronounced with a significant reduction of the slow foci in the majority of cases. ]

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