of the lumbar spinal cord resulting from temporary occlusion of the thoracic aorta [31. O u r findings suggest that localized spinal cord ischemia distant from the site of injury can occur in patients with traumatic quadriplegia. T h e mechanism of the ischemia may be difficult to assess in humans but should be amenable to experiments. Selective anterior horn necrosis has recently been reported in patients suffering from severe anoxia [ 11. However, the lesions were diffuse throughout the cord rather than confined to a cervical segment, as in our patient, and the posterior horns were frequently involved. In addition, contrary to our findings, the brain in these cases showed severe anoxic changes. References Azzarelli B, Roessmann U: Diffuse “anoxic” myelopathy. Neurology (Minneap) 27: 1049- 1057, 1977 Doppman J L The mechanism of ischemia in anteroposterior compression of the spinal cord. Invest Radio1 10:543-551, 1975 Schneider H, Dralle J: Ultrastructural changes in the rat spinal cord after temporary occlusion of the thoracic aorta. Act Neuropathol (Berl) 26:301-315, 1973
Cysticercosis and Spinal Cord Compression Jacqueline B. McDonald, MD, Paul T. Turner, MD, and Alden H . Miller, M D Involvement of the spinal cord by cysticercus is a rarely encountered phenomenon, even in countries where cysticercosis is common [ 11. W e have observed this unusual cause of spinal cord compression and wish to emphasize its potential for becoming an intraspinal mass [3], as well as to demonstrate the unique myelographic picture that results when contrast material is inadvertently injected into the cyst.
A 53-year-old man had experienced progressive weakness of his lower limbs for one month. O n admission he was unable to walk, his bladder was distended, and he complained of numbness and dysesthesias of his lower body. The patient was a frequent visitor to Chihuahua, Mexico. Neurological examination revealed flaccid paresis of the legs. Pinprick sensation was diminished below the inguinal ligaments, and there was a band of similar hypalgesia in the midthoracic area. The white blood count was 8,400/mm3 with no eosinophils. At myelography the puncture (L3-4 level) was unusual; upon removal of the stylet, several mil~~
From the Departments of Surgery and Radiology, The University of New Mexico and the Veterans Administration Hospital, Albuquerque, NM. Accepted for publication May 18, 1979. Address reprint requests to Dr Turner, Division of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM 87131.
Composite roentgenogram showing upper and lower margins of cyst (arrows) in both head-up and head-down positions; 3 cc of Pantopaque was introduced at the L3-4 level during the puncture.
Miters of clear fluid rapidly spewed out, then flow ceased. Pantopaque, 3 cc, was introduced (Figure). At laminectomy the cauda equina was shown to be bound by diffuse arachnoiditis. Three cysts were identified and excised; the largest of these had been punctured by the myelogram needle, and it contained Pantopaque. Pathological examination showed a typical three-layered cyst wall of racemose cysticercosis. The patient was treated with prednisone, 40 mg per day. Six months after admission he was able to walk with a cane and had bowel and bladder control, but complained of lower limb dysesthesias.
Notes and Letters
367
The myelographic findings in almost all previously reported cases demonstrated variable intradural filling defects 121, most of them characteristic of diffuse arachnoiditis. We know of only 1 report of an isolated cyst without surrounding arachnoiditis 141. If one recognizes the uncommon phenomenon of puncturing an intraspinal cyst at myelography, the correct diagnosis may be suggested, especially if the patient has been in an endemic area such as Mexico or Eastern Europe. The realization that a cyst has been punctured should begin when one encounters the cerebrospinal fluid dynamics of unusually rapid egress of fluid without subsequent flow. Sequential roentgenograms after introduction of contrast material may suggest the interior of a cyst.
R efirences I . Dixon HBF, Lipscomb FM: Cysticercosis: an analysis and followup of 450 cases, series 299 (Medical Research Council Special Report). London, H e r Majesty's Stationery Office, 1961 2. Dorfsman J: Radiological aspects of spinal cysticercosis. Acta Radio1 [Diagnl (Stockh) 5:1003-1006, 1966 3. Firemark H . Spinal cysticercosis. Arch Neurol 35:25O-25 1, 1978 4. Santin G, Vargas J: Roentgen study of cysticercosis of central nervous system. Radiology 86:520-527, 1966
Clinical Similarity of Alzheimer and Creutzfeldt-Jakob Disease C. P. Watson, MD Ehle and Johnson 1 1J pointed out that the clinical and electroencephalographic distinction between Alzheimer disease and Jakob-Creutzfeldt disease may be difficult, and sometimes requires pathological examination. The following case illustrates that rapidly progressing dementia, myoclonus, and periodic complexes on the electroencephalogram may all be features of Alzheimer disease. A 5 5-year-old woman developed dementia and myoclonic jerking of the upper extremities ten months before death. An EEG showrd diffuse slow activity in the 3 to 4 cps range. A tentative diagnosis of Jakob-Creutzfeldt disease was made. We examined t h e p a t i e n t three months prior to death. H e r dementia had progressed. She had pseudobulbar palsy and bilateral hyperreflexia of the limbs with upgoing toes and sustained clonus. Symmetrical myoclonic jerking ot all four extremities occurred every few minutes and was exaggerated by intentional movements An EEG
Accepted tor publication May 17, 1979. Address reprint Dr Watson, 3025 ~~~~~~~i~ St, Suite 5 0 4 , Mississauga, Ont, Canada L5A 2H1.
368 Annals of Neurology Vol 6 No 4 October 1079
showed diffuse slowing of background activity with intermittent projected slow activity, suggesting a widespread disturbance of function. Periodic low-amplitude, sharp transients and medium-amplitude sharp waves ant1 spikes were seen, diffusely and synchronously distributed to all head regions and separated by 4 t o 8 seconds o f lowamplitude activity. Myoclonic jerks had n o electrophysiological accompaniment except for movement artifact. Jakob-Creutzfeldt disease was helieved t o be the most likely diagnosis. The patient died three months later. At autopsy the main finding was hronchopneuriionia bilaterally. The brain weighed 1,100 gm and showed moderate ventricular dilatation with no cortical atrophy o n sectioning (Fig 1). Microscopic examination showed generalized neuronal degeneration in the cerebral hemispheres with senile plaques and neurofibrillary tangle fornm;xion (Fig 2). Granulovacuolar degeneration was prominent in the hippocampus. No morphological evidence of JakobCreutzfeldt disease was present. The pathological diagnosis was Alzheimer disease. Ehle and Johnson 5 patient had subacute dementia without myoclonus, with EEG changes rc-sembling chow of Jakob-Creutzfeldt disease. One previous case of quasiperiodic EEG abnormalities in Alztieinier disease was reported by Jacob 131. Faden and Townsencl 121 have reported 2 cases of myoclonus associatecl with Alzheimer disease. The findings i n our patient reemphasize the clinical
Cysticercosis and Spinal Cord Compression Jacqueline B. McDonald, MD, Paul T. Turner, MD, and Alden H . Miller, M D Involvement of the spinal cord by cysticercus is a rarely encountered phenomenon, even in countries where cysticercosis is common [ 11. W e have observed this unusual cause of spinal cord compression and wish to emphasize its potential for becoming an intraspinal mass [3], as well as to demonstrate the unique myelographic picture that results when contrast material is inadvertently injected into the cyst.
A 53-year-old man had experienced progressive weakness of his lower limbs for one month. O n admission he was unable to walk, his bladder was distended, and he complained of numbness and dysesthesias of his lower body. The patient was a frequent visitor to Chihuahua, Mexico. Neurological examination revealed flaccid paresis of the legs. Pinprick sensation was diminished below the inguinal ligaments, and there was a band of similar hypalgesia in the midthoracic area. The white blood count was 8,400/mm3 with no eosinophils. At myelography the puncture (L3-4 level) was unusual; upon removal of the stylet, several mil~~
From the Departments of Surgery and Radiology, The University of New Mexico and the Veterans Administration Hospital, Albuquerque, NM. Accepted for publication May 18, 1979. Address reprint requests to Dr Turner, Division of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM 87131.
Composite roentgenogram showing upper and lower margins of cyst (arrows) in both head-up and head-down positions; 3 cc of Pantopaque was introduced at the L3-4 level during the puncture.
Miters of clear fluid rapidly spewed out, then flow ceased. Pantopaque, 3 cc, was introduced (Figure). At laminectomy the cauda equina was shown to be bound by diffuse arachnoiditis. Three cysts were identified and excised; the largest of these had been punctured by the myelogram needle, and it contained Pantopaque. Pathological examination showed a typical three-layered cyst wall of racemose cysticercosis. The patient was treated with prednisone, 40 mg per day. Six months after admission he was able to walk with a cane and had bowel and bladder control, but complained of lower limb dysesthesias.
Notes and Letters
367
The myelographic findings in almost all previously reported cases demonstrated variable intradural filling defects 121, most of them characteristic of diffuse arachnoiditis. We know of only 1 report of an isolated cyst without surrounding arachnoiditis 141. If one recognizes the uncommon phenomenon of puncturing an intraspinal cyst at myelography, the correct diagnosis may be suggested, especially if the patient has been in an endemic area such as Mexico or Eastern Europe. The realization that a cyst has been punctured should begin when one encounters the cerebrospinal fluid dynamics of unusually rapid egress of fluid without subsequent flow. Sequential roentgenograms after introduction of contrast material may suggest the interior of a cyst.
R efirences I . Dixon HBF, Lipscomb FM: Cysticercosis: an analysis and followup of 450 cases, series 299 (Medical Research Council Special Report). London, H e r Majesty's Stationery Office, 1961 2. Dorfsman J: Radiological aspects of spinal cysticercosis. Acta Radio1 [Diagnl (Stockh) 5:1003-1006, 1966 3. Firemark H . Spinal cysticercosis. Arch Neurol 35:25O-25 1, 1978 4. Santin G, Vargas J: Roentgen study of cysticercosis of central nervous system. Radiology 86:520-527, 1966
Clinical Similarity of Alzheimer and Creutzfeldt-Jakob Disease C. P. Watson, MD Ehle and Johnson 1 1J pointed out that the clinical and electroencephalographic distinction between Alzheimer disease and Jakob-Creutzfeldt disease may be difficult, and sometimes requires pathological examination. The following case illustrates that rapidly progressing dementia, myoclonus, and periodic complexes on the electroencephalogram may all be features of Alzheimer disease. A 5 5-year-old woman developed dementia and myoclonic jerking of the upper extremities ten months before death. An EEG showrd diffuse slow activity in the 3 to 4 cps range. A tentative diagnosis of Jakob-Creutzfeldt disease was made. We examined t h e p a t i e n t three months prior to death. H e r dementia had progressed. She had pseudobulbar palsy and bilateral hyperreflexia of the limbs with upgoing toes and sustained clonus. Symmetrical myoclonic jerking ot all four extremities occurred every few minutes and was exaggerated by intentional movements An EEG
Accepted tor publication May 17, 1979. Address reprint Dr Watson, 3025 ~~~~~~~i~ St, Suite 5 0 4 , Mississauga, Ont, Canada L5A 2H1.
368 Annals of Neurology Vol 6 No 4 October 1079
showed diffuse slowing of background activity with intermittent projected slow activity, suggesting a widespread disturbance of function. Periodic low-amplitude, sharp transients and medium-amplitude sharp waves ant1 spikes were seen, diffusely and synchronously distributed to all head regions and separated by 4 t o 8 seconds o f lowamplitude activity. Myoclonic jerks had n o electrophysiological accompaniment except for movement artifact. Jakob-Creutzfeldt disease was helieved t o be the most likely diagnosis. The patient died three months later. At autopsy the main finding was hronchopneuriionia bilaterally. The brain weighed 1,100 gm and showed moderate ventricular dilatation with no cortical atrophy o n sectioning (Fig 1). Microscopic examination showed generalized neuronal degeneration in the cerebral hemispheres with senile plaques and neurofibrillary tangle fornm;xion (Fig 2). Granulovacuolar degeneration was prominent in the hippocampus. No morphological evidence of JakobCreutzfeldt disease was present. The pathological diagnosis was Alzheimer disease. Ehle and Johnson 5 patient had subacute dementia without myoclonus, with EEG changes rc-sembling chow of Jakob-Creutzfeldt disease. One previous case of quasiperiodic EEG abnormalities in Alztieinier disease was reported by Jacob 131. Faden and Townsencl 121 have reported 2 cases of myoclonus associatecl with Alzheimer disease. The findings i n our patient reemphasize the clinical
