Archives of Neurology

CHAPMAN, LORING F.;RAMOS, ARMANDO O.;GOODELL, HELEN;SILVERMAN, GERALD;WOLFF, HAROLD G.

doi: 10.1001/archneur.1960.00450030001001pmid: 13809242

Abstract During the painful phase of attacks of vascular headache of the migraine type there is dilatation of the large and small blood vessels of the head both intra- and extracranially, often more on one side than the other.1-3 In most attacks, however, the pain stems chiefly from the large subsurface cranial arteries and their branches. Aching pain is experienced when these vessels are distended, pulled upon, or displaced. Yet dilatation of these vessels, for instance that induced by immersion of the body in hot water, is not usually painful and does not induce other focal features of the migraine attack, i.e., edema, tenderness on pressure, and heightened vulnerability of tissue to injury. These observations led to the hypothesis that in addition to vasodilatation, a local sterile inflammation occurs. Also a substance (or substances) accumulates in the walls of the arteries and in the adjacent perivascular, areolar, and supporting tissues References 1. Graham, J. R., and Wolff, H. G.: Mechanism of Migraine Headache and Action of Ergotamine Tartrate , A. Res. Nerv. & Ment. Dis., Proc. 18:638, 1937. 2. Wolff, H. G.: Headache and Other Head Pain , New York, Oxford University Press, 1948. 3. Wolff, H. G.: Headache Mechanisms , Internat. Arch. Allergy 7:210, 1955. 4. Goodell, H.; Bigelow, N. H., and Harrison, J. B.: Unpublished observations, 1942 5. cited by Hardy, J. D.; Wolff, H. G., and Goodell H.: Pain Sensations and Reactions , Baltimore, Williams & Wilkins Company, 1952. 6. Wolff, H. G.; Tunis, M. M., and Goodell, H.: Evidence of Tissue Damage and Changes in Pain Sensitivity in Subjects with Vascular Headaches of the Migraine Type , A.M.A. Arch. Int. Med. 92:478, 1953. 7. Ostfeld, A. M.; Chapman, L. F.; Goodell, H., and Wolff, H. G.: Studies in Headache: Summary of Evidence Concerning a Noxious Agent Active Locally During Migraine Headache , Psychosom. Med. 19:199, 1957. 8. Armstrong, D.; Jepson, J. B.; Keele, C. A., and Stewart, J. W.: Pain-Producing Substance in Human Inflammatory Exudates and Plasma , J. Physiol. 135:350, 1957. 9. Rocha e Silva, M.; Beraldo, W. T., and Rosenfeld, G.: Bradykinin, a Hypotensive and Smooth Muscle Stimulating Factor Released from Plasma Globulin by Snake Venom and by Trypsin , Am. J. Physiol. 156:261, 1949. 10. Frey, E. K.; Kraut, H., and Werle, E.: Kallikrein: Padutin , Stuttgart, Ferdinand Enke, 1950. 11. Lewis, G. P.: Formation of Plasma Kinins by Plasmin , J. Physiol. (London) 140:285, 1958. 12. Chapman, L. F.; Goodell, H., and Wolff, H. G.: Neurohumoral Features of the Axon Reflex , Fed. Proc. 18:95 ( (March) ) 1959. 13. Chapman, L. F.; Goodell, H., and Wolff, H. G.: Increased Inflammatory Reaction Induced by Central Nervous System Activity , Tr. A. Am. Physicians 72:84, 1959. 14. Chapman, L. F.; Ramos, A. O.; Goodell, H., and Wolff, H. G.: Neurokinin; a Polypeptide Formed During Neuronal Activity in Man , Tr. Am. Neurol. A. , 1960. 15. Chapman, L. F., and Wolff, H. G.: A Property of Cerebrospinal Fluid Indicating Disturbed Metabolism Within the Central Nervous System , Tr. A. Am. Physicians: , 1958. 16. Wolff, H. G.: Personality Features and Reactions of Subjects with Migraine , Arch. Neurol. & Psychiat. , 37:895, 1937.

ORBACH, J.;MILNER, B.;RASMUSSEN, T.

doi: 10.1001/archneur.1960.00450030008002pmid: 14428979

Abstract In 1899 Bechterew3 demonstrated a case of bilateral softening of the gyrus uncinatus and cornu ammonis before members of the St. Petersburg Clinic and drew attention to the prominent memory disturbances. Over 50 years later, Glees and Griffith8 described an instance of dementia with bilateral destruction of the hippocampus and hippocampal gyrus in which recent memory impairment was an early and prominent symptom. They concluded on the basis of the necropsy material that the integrity of the region of the hippocampus is necessary for the maintenance of recent memory. Since then, a series of clinical studies has provided corroborative evidence and has extended these findings. In 1954, Scoville35 reported a grave loss of recent memory in one epileptic and one psychotic patient after bilateral surgical removal of the uncus, hippocampus, and hippocampal gyrus. Formal memory and intelligence testing of eight similar patients again indicated impairment in recent References 1. Dr. William Scoville demonstrated this approach and carried out the bilateral hippocampectomy. 2. A film was prepared illustrating some of these categories of behavior. 3. As described elsewhere,22 the essential element of the Snooperscope is an infrared image converter tube which transforms infrared rays to light within the visible range. This tube has a cathode which emits electrons in proportion to the amount of infrared light falling on it. No complex scanning device is necessary. Controls have been used to assure that the monkeys are not sensitive visually to infrared light. 4. A more recent study by Stepien et al.,37 using a delayed matching-from-sample technique developed by Konorski, has demonstrated learning and retention deficits in the monkey that are not modality specific, after bilateral amygdala-hippocampus resections. 5. Allen, W. F.: Effect of Ablating the Frontal Lobes, Hippocampi, and Occipitoparieto-Temporal (Excepting Pyriform Areas) Lobes on Positive and Negative Olfactory Conditioned Reflexes , Am. J. Physiol. 128:754-771, 1940. 6. Bard, P., and Mountcastle, V. B.: Some Forebrain Mechanisms Involved in Expression of Rage with Special Reference to Suppression of Angry Behavior , A. Res. Nerv. & Ment. Dis. Proc. 27:362-404, 1948. 7. von Bechterew, W.: Demonstration eines Gehirns mit Zerstörung der vorderer und innerer Theile der Hirnrinde beiden Schläfenlappen , Neurol. Centralbl. 19:990-999, 1900. 8. Brady, J. V.; Schreiner, L.; Geller, I., and Kling, A.: Subcortical Mechanisms in Emotional Behavior: The Effect of Rhinencephalic Injury upon the Acquisition and Retention of a Conditioned Avoidance Response in Cats , J. Comp. & Physiol. Psychol. 47:179-186, 1954. 9. Chow, K. L.: Lack of Behavioral Effects Following Destruction of Some Thalamic Association Nuclei in Monkey , A.M.A. Arch. Neurol. & Psychiat. 71:762-771, 1954. 10. Chow, K. L.: Conditions Influencing the Recovery of Visual Discrimination Habits in Monkeys Following Temporal Neocortical Ablations , J. Comp. & Physiol. Psychol. 45:430-437, 1952. 11. Feindel, W., and Penfield, W.: Localization of Discharge in Temporal Lobe Automatism , A.M.A. Arch. Neurol. & Psychiat. 72:605-630, 1954. 12. Glees, P., and Griffith, H. B.: Bilateral Destruction of the Hippocampus (Cornu Ammonis) in a Case of Dementia , Monatsschr. Psychiat. u. Neurol. 123:193-204, 1952. 13. Hebb, D. O.: The Effects of Early and Late Brain Injury upon Test Scores and the Nature of Normal Adult Intelligence , Proc. Am. Phil. Soc. 85:275-292, 1942. 14. Hunt, H. F., and Diamond, I. V.: Some Effects of Hippocampal Lesions on Conditioned Avoidance Behavior in the Cat, Proc. XVth Internat. Cong. Psychol., Brussels, pp. 203-204, 1959. 15. Jacobsen, C. F.: Functions of Frontal Association Area in Primates , Arch. Neurol. & Psychiat. 33:558-569, 1935. 16. Jasper, H.; Gloor, P., and Milner, B.: Higher Functions of the Nervous System , Ann. Rev. Physiol. 18:359-386, 1956. 17. Kling, A.; Orbach, J.; Schwartz, N. B., and Towne, J.: Chronic Disturbances Following Massive Limbic Resections in Cats , Arch. Gen. Psychiat. , to be published. 18. Klüver, H.: Behavior Mechanisms in Monkeys , Chicago, University of Chicago Press, 1933. 19. Klüver, H., and Bucy, P. C.: Preliminary Analysis of Functions of the Temporal Lobes in Monkeys , Arch. Neurol. & Psychiat. 42:979-1000, 1939. 20. Milner, B.: Psychological Defects Produced by Temporal Lobe Excision , A. Res. Nerv. & Ment. Dis. Proc. 36:244-257, 1956. 21. Mishkin, M.: Visual Discrimination Performance Following Partial Ablations of the Temporal Lobe: II. Ventral Surfaces vs. Hippocampus , J. Comp. & Physiol. Psychol. 47:187-193, 1954. 22. Mishkin, M., and Pribram, K. H.: Visual Discrimination Performance Following Partial Ablations of the Temporal Lobe: I. Ventral vs. Lateral , J. Comp. & Physiol. Psychol. 47:14-20, 1954. 23. Mishkin, M., and Pribram, K. H.: Analysis of the Effects of Frontal Lesions in Monkey: I. Variations of Delayed Alternation , J. Comp. & Physiol. Psychol. 48:492-495, 1955. 24. Olszewski, J.: The Thalamus of the Macaca Mulatta: An Atlas for Use with the Stereotaxic Instrument , Basel, S. Karger (American agent— Albert J. Phiebig, White Plains, N.Y.), 1952. 25. Orbach, J.: "Functions" of Striate Cortex and the Problem of Mass Action , Psychol. Bull. 56:271-292, 1959. 26. Orbach, J., and Chow, K. L.: Differential Effects of Resections of Somatic Areas I and II in Monkeys , J. Neurophysiol. 22:195-203, 1959. 27. Orbach, J., and Fantz, R. L.: Differential Effects of Temporal Neocortical Resections on Overtrained and Non-Overtrained Visual Habits in Monkeys , J. Comp. & Physiol. Psychol. 51:126-129, 1958. 28. Orbach, J., and Fischer, G. L.: Bilateral Resections of Frontal Granular Cortex , A.M.A. Arch. Neurol. 1:78-86, 1959. 29. Penfield, W.: The Permanent Record of the Stream of Consciousness, Proc. 14th Internat. Cong. Psychol., pp. 47-69, 1954. 30. Penfield, W., and Milner, B.: Memory Deficit Produced by Bilateral Lesions in the Hippocampal Zone , A.M.A. Arch. Neurol.& Psychiat. 79:475-497, 1958. 31. Peters, R. H.; Rosvold, H. E., and Mirsky, A. F.: The Effect of Thalamic Lesions upon Delayed Response-Type Tests in the Rhesus Monkey , J. Comp. & Physiol. Psychol. 49:96-104, 1956. 32. Pribram, K. H., and Bagshaw, M.: Further Analysis of Temporal Lobe Syndrome Utilizing Fronto-Temporal Ablations , J. Comp. Neurol. 99:347-375, 1953. 33. Pribram, K. H., and Kruger, L.: Functions of the Olfactory Brain , Ann. New York Acad. Sc. 58:109-139. 1954. 34. Rosvold, H. E.: Physiological Psychology , Ann. Rev. Psychol. 10:415-454, 1959. 35. Rosvold, H. E., and Delgado, J. M. R.: The Effect on Delayed-Alternation Test Performance of Stimulating or Destroying Electrically Structures Within the Frontal Lobes of the Monkey's Brain , J. Comp. & Physiol. psychol. 49:365-372, 1956. 36. Rosvold, H. E.; Mirsky, A. F., and Pribram, K. H.: Influence of Amygdalectomy on Social Behavior in Monkeys , J. Comp. & Physiol. Psychol. 47:173-178, 1954. 37. Rosvold, H. E.; Mishkin, M., and Szwarcbart, M. K.: Effects of Subcortical Lesions in Monkeys on Visual Discrimination and Single Alternation Performance , J. Comp. & Physiol. Psychol. 51:437-444, 1958. 38. Schreiner, L., and Kling, A.: Behavioral Changes Following Rhinencephalic Injury in Cat , J. Neurophysiol. 16:643-659, 1953. 39. Scoville, W. B.: The Limbic Lobe in Man , J. Neurosurg. 11:64-66, 1954. 40. Scoville, W. B., and Milner, B.: Loss of Resent Memory After Bilateral Hippocampal Lesions , J. neurol. Neurosurg. & Psychiat. 20:11-21, 1957. 41. Stepien, L.; Cordeau, J. P., and Rasmussen, T.: The Effect of Temporal Lobe and Hippocampal Lesions on Auditory and Visual Recent Memory in Monkeys , Brain , to be published. 42. Teuber, H-L., and Mishkin, M.: Judgment of Visual and Postural Vertical After Brain Injury , J. Psychol. 38:161-175, 1954. 43. Thomas, G. J., and Otis, L. S.: Effects of Rhinencephalic Lesions on Conditioning of Avoidance Responses in the Rat , J. Comp. & Physiol. Psychol. 51:130-134, 1958. 44. Weiskrantz, L.: Behavioral Changes Associated with Ablation of the Amygdaloid Complex in Monkeys , J. Comp. & Physiol. Psychol. 49:381-391, 1956. 45. Weiskrantz, L., and Wilson, W. A.: The Effect of Ventral Rhinencephalic Lesions on Avoidance Thresholds in Monkeys , J. Comp. & Physiol. Psychol. 51:167-171, 1958.

LEMMI, HELIO;LITTLE, SAMUEL C.

doi: 10.1001/archneur.1960.00450030030003pmid: 14415604

Abstract Introduction As early as 1828 Ménière1 described clinical syndromes associated with lesions of intracranial venous structures, and the following year Tonnelle2 reported additional studies. In spite of these early reports and the subsequent detailed studies of others,3-6 clinical conditions attributable to lesions of intracranial venous structures are seldom reported in the literature or recognized clinically. We were unable to find any comprehensive report on the electroencephalographic findings in these conditions at the time this study was begun but subsequently the article by Severini7 gave the EEG studies considerable emphasis.In most of the cases reported in the present series the diagnosis was based upon the congruence of the patient's clinical picture with the well-recognized syndromes associated with occlusion of the intracranial venous structures.For the description of the details of the intracranial venous structures and venous circulation the reader is referred to standard text books References 1. Ménière, P.: Observations et réflexions sur l'hémorrhagie cérébrale, considérée pendant la grossesse, pendant et après l'accouchement , Arch. gen. méd. 16:489-522, 1828; cited by Frenckner.33 2. Tonnelle, M. I.: Mémoire sur les maladies des sinus veineux de la dure-mére , J. hebd. méd. 5:337-403, 1829. 3. Holmes, G., and Sargent, P.: Injuries of the Superior Longitudinal Sinus , Brit. M.J. 2:493-498 ( (Oct. 2) ) 1915.Crossref 4. Martin, J. P.: Thrombosis in Superior Longitudinal Sinus Following Childbirth , Brit. M.J. 2:537-540 ( (Oct. 18) ) 1941.Crossref 5. Martin, J. P.: Lesions veineuses cérébrales sans infection , Rev. Neurol. 80:433-439, 1948. 6. Stevens, H.: Puerperal Hemiplegia , Neurology 4:723-728 ( (Oct.) ) 1954.Crossref 7. Severini, P.: Le tromboflebiti cerebrali , Riv. neurol. 27:493-553, 1957. 8. Stuart, E. A.; O'Brien, F. H., and McNally, W. J.: Cerebral Venous Thrombosis: Its Occurrence; Its Localization; Its Sources and Sequelae , Ann. Otol. Rhin. & Laryng. 60:406-438 ( (June) ) 1951. 9. Carrie, A. W., and Jaffe, F. A.: Thrombosis of Superior Sagittal Sinus Caused by Trauma Without Penetrating Injury , J. Neurosurg. 11:173-182 ( (March) ) 1954. 10. Smith, J. C.: Primary Cerebral Thrombophlebitis , J.A.M.A. 148:613-616 ( (Feb. 23) ) 1952. 11. Hyland, H. H.: Intracranial Venous Thrombosis in the Puerperium , J.A.M.A. 142:707-710 ( (March 11) ) 1950. 12. Dennis, E. J.: Postpartum Cerebral Venous Thromnosis: A Case Report , J. South Carolina M.A. 3:91-92 ( (March) ) 1957. 13. Martin, J. P., and Sheehan, H. L.: Primary Thrombosis of Cerebral Veins (Following Childbirth) , Brit. M.J. 1:349-353 ( (March 8) ) 1941. 14. Kendall, D.: Thrombosis of Intracranial Veins , Brain 71:386-402 ( (Dec.) ) 1948. 15. Mead, S.: Thrombophlebitis Migrans with Involvement of Both Lateral Sinuses , Am. J. Med. 5:916-918 ( (Dec.) ) 1948. 16. Prick, J. J.: The So-Called Spontaneous (Sive Primary) Thrombosis of the Sinus Longitudinalis Superior and of Its Tributary Pial Veins , Folia psychiat. neerl. 58:259-276 ( (Aug.) ) 1955. 17. Silbermann, M., and Fishman, R. A.: Primary (Idiopathic) Thrombosis of Superior Longitudinal Sinus , Tr. Am. Neurol. A. 76:164-167, 1951. 18. Martin.5 19. Beck, D. J. K., and Russell, D. S.: Experiments on Thrombosis of Superior Longitudinal Sinus , J. Neurosurg. 3:337-347 ( (July) ) 1946. 20. Owens, G.; Stahlman, G.; Capps, J., and Meirowsky, A. M.: Experimental Occlusion of Dural Sinuses , J. Neurosurg. 14:640-647 ( (Nov.) ) 1957. 21. Bailey, O. T., and Hass, G. M.: Dural Sinus Thrombosis in Early Life: The Clinical Manifestations and Extent of Brain Injury in Acute Sinus Thrombosis , J. Pediat. 11:755-771 ( (Dec.) ) 1937. 22. Hirsch, E. F.: Symmetric Hemorrhagic Necrosis of Cerebrum Following Primary Thrombosis of Superior Longitudinal Sinus , Arch. Path. 26:210-215 ( (July) ) 1938. 23. Dekaban, A. S., and Norman, R. M.: Hemiplegia in Early Life Associated with Thrombosis of Sagittal Sinus and Its Tributary Veins in One Hemisphere , J. Neuropath. & Exper. Neurol. 17:461-470 ( (July) ) 1958. 24. Benda, C. E.: Developmental Disorders of Mentation and Cerebral Palsies , New York, Grune & Stratton, Inc., 1952. 25. Denny-Brown, D.; Horenstein, S., and Fang, H. C. H.: Cerebral Infarction Produced by Venous Distension , J. Neuropath. & Exper. Neurol. 15:146-180 ( (April) ) 1956. 26. Dowman, C. E.: Thrombosis of the Rolandic Vein , Arch. Neurol. & Psychiat. 15:110-112 ( (May) ) 1926. 27. Waggoner, R. W.: Thrombosis of a Superior Cerebral Vein: Clinical and Pathological Study of a Case , Arch. Neurol. & Psychiat. 20:580-584 ( (Sept.) ) 1928. 28. Merwarth, H. R.: The Syndrome of Rolandic Vein , Am. J. Surg. 56:526-544 ( (June) ) 1942. 29. Swanson, H. S., and Fincher, E. F.: Experiences Involving Superior Longitudinal Sinus and Rolandic Veins , Neurology 4:801-810 ( (Nov.) ) 1954. 30. Ray, B. S., and Dunbar, H. S.: Thrombosis of Superior Sagittal Sinus as Cause of Pseudotumor Cerebri: Methods of Diagnosis and Treatment , Tr. Am. Neurol. A. 75:12-17, 1950. 31. Symonds, C.: Intracranial Thrombophlebitis: Otolaryngology Lecture , Ann. Roy. Coll. Surgeons England 10:347-356 ( (June) ) 1952. 32. Ray, B. S.; Dunbar, H. S., and Dotter, C. T.: Symposium: Intracranial Vascular Abnormalities; Dural Sinus Venography as Aid to Diagnosis in Intracranial Disease , J. Neurosurg. 8:23-37 ( (Jan.) ) 1951. 33. Frenckner, P.: Sinography: Method of Radiography in Diagnosis of Sinus Thrombosis , Acta otolaryng . 25:441-452, 1937. 34. Farrior, J. B., and Hart, W. W.: Sigmoid Sinus Thrombosis: Report of a Case , New Orleans M. & S.J. 100:20-23 ( (July) ) 1947. 35. Woodhall, B.: Variations of the Cranial Venous Sinuses in the Region of the Torcular Herophili , Arch. Surg. 33:297-314 ( (Aug.) ) 1936. 36. Discussion: Intracranial Thrombophlebitis , Proc. Roy. Soc. Med. 48:391-404, 1955. 37. Ford, F. R.: Diseases of the Nervous System in Infancy, Childhood and Adolescence , Ed. 2, Springfield, Ill., Charles C Thomas, Publisher, 1944.

LIN, TUNG HUI;DIERSSEN, GUILLERMO;MINGRINO, SALVATORE;COOPER, IRVING S.

doi: 10.1001/archneur.1960.00450030045004pmid: 14417017

Abstract The importance of preoperative selection of patients for achievement of better postoperative results in basal ganglia surgery has been repeatedly emphasized in the past publications.1-4 It is the purpose of this paper to substantiate the empirically formulated conceptions concerning the selection of Parkinsonian patients for surgery and also to study the factors influencing the outcome of surgical treatment. Design of Study Four groups of patients were selected for this study, and their surgical results were compiled and compared. The first group were the patients with tremor, rigidity, and motor dysfunction confined to extremities of one side. They were called unilateral Parkinsonism, though some of them could not so be designated in a strict sense, owing to the facioaxial symptoms. The second group were patients who had mild Parkinsonian symptoms or those with moderate symptoms either unilateral or bilateral, but fully self-sufficient and actively employed. All of the patients in References 1. Cooper, I. S.: The Neurosurgical Alleviation of Parkinsonism , Springfield, Ill., Charles C Thomas, Publisher, 1956. 2. Cooper, I. S.: Neurosurgical Alleviation of Parkinsonism , Bull. New York Acad. Med. 32:713-724, 1956. 3. Cooper, I. S., et al.: Chemopallidectomy and Chemothalamectomy for Parkinsonism , Geriatrics 13:127-147, 1958. 4. Cooper, I. S.: Implication of a Five-Year Study of 700 Basal Ganglia Operations , Neurology 18:701-707, 1958.Crossref 5. Lin, T. H., and Cooper, I. S.: Results of Chemopallidectomy and Chemothalamectomy: A Study of 100 Cases of Parkinsonism with Ages Over 60 , A.M.A. Arch. Neurol. 2:188-193, 1960.Crossref

ECKER, ARTHUR;PERL, THEODORE

doi: 10.1001/archneur.1960.00450030049005pmid: N/A

Abstract Injection of the thalamus through a cranial bur hole is performed for rigidity and tremor,1-3 spasticity,4 intractable pain,5,6 dystonia musculorum deformans,7 or hemiballismus.8 Some of the more precise stereotaxic methods take several hours. With the cannula and balloon technique, there is a mortality rate of 2.4%, and an additional complication rate (usually hemiplegia) of 3%.2 Furthermore, only about one out of three Parkinsonians are accepted for the procedure.9 We had had previous experience with radiologically planned and controlled percutaneous placement of a needle through the foramen ovale into the region of the Gasserian ganglion and subsequent injection of procaine, followed by alcohol.10,11 We report here a similar approach to making lesions in the thalamus, thalamolysis, primarily to relieve contralateral rigidity and tremor of Parkinsonism. The target (a mathematical point) in the ventrolateral nucleus of the thalamus is determined by measurement from the References 1. Bravo, G. J., and Cooper, I. S.: A Clinical and Radiological Correlation of the Lesions Produced by Chemopallidectomy and Thalamectomy , J. Neurol. Neurosurg. & Psychiat. 22:1 ( (Feb.) ) 1959. 2. Cooper, I. S., and Bravo, G. J.: Chemopallidectomy and Chemothalamectomy , J. Neurosurg. 15:244 ( (May) ) 1958. 3. Spiegel, E. A., and Wycis, H. T.: Stereoencephalotomy: Principles and Methods, in Premier Congrés Internationale de Neurochirurgie, Brussels, 1957, p. 91. 4. Spiegel, E. A.; Wycis, H. T., and Baird, H. W., III: Long-Range Effects of Electropallido Ansotomy in Extrapyramidal and Convulsive Disorders , Neurology 8:734 ( (Aug.) ) 1958. 5. Wycis, H. T.; Folkerts, J. F., and Spiegel, E. A.: Treatment of Post-Herpetic Trigeminal Neuralgia by Mesencephalotomy or Combined Mesencephalothalamotomy , Zentralbl. Neurochir. 18:188, 1958. 6. Hassler, R.: Functional Anatomy of the Thalamus, VI Congr. Latino-Americano de Neurocirurgia, Montevideo, 1955, p. 754. 7. Cooper, I. S.: Dystonia Musculorum Deformans Alleviated by Chemopallidectomy and Chemopallidothalamectomy , A.M.A. Arch. Neurol. & Psychiat. 81:5 ( (Jan.) ) 1959. 8. Martin, J. P., and McCaul, I. R.: Acute Hemiballismus Treated by Ventrolateral Thalamolysis , Brain 82:104 ( (March) ) 1959. 9. Cooper, I. S.: Personal communication to the authors, 1958. 10. Ecker, A., and Perl, T.: Alcoholic Gasserian Injection for Relief of Tic Douloureux , Neurology 8:461 ( (June) ) 1958. 11. Perl, T., and Ecker, A.: Radiologically Controlled Placement of a Needle in the Trigeminal Root for the Treatment of Tic Douloureux , Am. J. Roentgenol. 82:830 ( (Nov.) ) 1959. 12. Spiegel, E. A., and Wycis, H. T.: Stereoencephalotomy (Thalamotomy and Related Procedures) , New York, Grune & Stratton, Inc., 1952, pp. 55, 123, 127. 13. Riley, H. A.: An Atlas of the Basal Ganglia, Brain Stem, and Spinal Cord Based on Myelin-Stained Material , Baltimore, Williams & Wilkins Company, 1943, pp. 264, 270, 516. 14. Schwab, R. S.: England, A. C., and Peterson, E.: Akinesia in Parkinson's Disease , Neurology 9:65 ( (Jan.) ) 1959. 15. Monnier, M.: Les résultats de la coagulation du thalamus chez l'homme (noyau ventroposterior), in Röntgendiagnostische Probleme bei intrakraniellen Geschwülsten , Acta Neurochir ., (Suppl. 3) , 1955, p. 291. 16. Gerstmann, J., and Schilder, P.: Über organisch bedingte Tics , Med. Klin. 19:896 ( (June 30) ) 1923. 17. Clauss, J. L., and Balthasar, K.: Zur Kenntnis der generalisierten Tic-Krankheit (maladie des tics, Gilles de la Tourette'sche Krankheit) , Arch. Psychiat. 191:398, 1954. 18. Hess, W. R.: Hypothalamus und Thalamus , Stuttgart, Georg Thieme Verlag, 1956, p.47.

LOCKE, SIMEON;FOLEY, JOSEPH M.

doi: 10.1001/archneur.1960.00450030057006pmid: N/A

Abstract Ever since the attempt of Pierre Marie to incorporate four families with ataxia into a single clinical syndrome, the cerebellar and spinocerebellar degenerations have proved a source of nosologic difficulty. Two major tendencies of classification have become manifest. One has been to establish separate groupings for each family that showed some slight variation of symptoms. The other has been to regard all familial neurologic illness as representative of differing manifestations of a broad spectrum of disease which includes the myopathies, peripheral neuropathies, hereditary spinal degenerations, spinocerebellar ataxias, and cerebellar degeneration.1,2 Optic atrophy, retinitis pigmentosa, congenital deafness, congenital heart disease, polycystic kidneys and congenital hereditary hematuria have been reported in patients, or relatives of patients, with underlying neurologic disorder3-7 and similar conditions have been observed in animals in both the hereditary and sporadic forms.8-13 The opportunity for detailed clinical study of a patient with evidence of a familial References 1. Spillane, J. D.: Familial Pes Cavus and Absent Tendon-Jerks: Its Relationship with Friedreich's Disease and Peroneal Muscular Atrophy , Brain 63:275, 1940.Crossref 2. Spiller, W. G.: Friedreich's Ataxia , J. Nerv. & Ment. Dis. 37:411, 1910. 3. Denny-Brown, D.: Hereditary Sensory Radicular Neuropathy , J. Neurol. Neurosurg. & Psychiat. 14:237, 1951. 4. Matthews, W. B.: Familial Ataxia, Deaf Mutism, and Muscular Wasting , J. Neurol. Neurosurg. & Psychiat. 13:307, 1950. 5. Reyersbach, G. S., and Butler, A. M.: Congenital Hereditary Hematuria , New England J. Med. 251:377, 1954. 6. Roth, M.: On a Possible Relationship Between Hereditary Ataxia and Peroneal Muscular Atrophy, with a Critical Review of the Problem of "Intermediate Forms" in the Degenerative Disorders of the Central Nervous System , Brain 71:416, 1948. 7. Case Records of the Massachusetts General Hospital, Case 43511 , New England J. Med. 257:1231, 1957. 8. Russell, J. S. R.: Defective Development of the Cerebellum in a Puppy , Brain 18:523, 1895. 9. Russell, J. S. R.: Defective Development of the Central Nervous System in a Cat , Brain 18:37, 1895. 10. Herringham, W. P., and Andrewes, F. W.: Two Cases of Cerebellar Disease in Cats with Staggering , St. Barth. Hosp. Rep. 24:241, 1888. 11. Schut, J. W.: Olivopontocerebellar Atrophy in a Cat , J. Neuropath. & Exper Neurol. 5:77, 1946. 12. Mettler, F. A., and Goss, L. J.: Canine Chorea Due to Strio-Cerebellar Degeneration of Unknown Etiology , J. Am. Vet. M.A. 108:377, 1946. 13. Finley, K. H.: An Anatomical Study of Familial Olivo-Ponto-Cerebellar Hypoplasia in Cats , Koninklijke Akademia Van Wetenschappen Te Amsterdam 38:922, 1935. 14. Holmes, G.: An Attempt to Classify Cerebellar Disease with a Note on Marie's Hereditary Cerebellar Ataxia , Brain 30:545, 1907. 15. Marie, P.: Sur l'hérédo-ataxie cérébélleuse , Semaine méd . 13:444, 1893. 16. Brown, S.: On Hereditary Ataxy, with a Series of 21 Cases , Brain 15:250, 1892. 17. Meyer, A.: The Morbid Anatomy of a Case of Hereditary Ataxy , Brain 20:276, 1897. 18. Barker, L. F.: A Description of the Brains and Spinal Cords of 2 Brothers Dead of Hereditary Ataxia: Cases XVIII and XX of the Series in the Family Described by Dr. Sanger Brown , Tr. A. Am. Physicians 18:637, 1903. 19. Klippel, M., and Durante, G.: Contribution a l'étude des affections nerveuses familiales et héréditaires , Rev. méd. 12:745, 1892. 20. Holmes, G.: A Form of Familial Degeneration of the Cerebellum , Brain 30:466, 1907. 21. Greenfield, J. C.: The Spino-Cerebellar Degenerations , Springfield, Ill., Charles C Thomas, Publisher, 1954. 22. Wilson, S. A. K.: Neurology , edited by A. N. Bruce, Ed. 2, Baltimore, Williams & Wilkins Company, 1955. 23. Déjerine, J. J., and Thomas, A.: L'atrophie Olivo-ponto-cérébelleuse , Nouv. Icon. Salpêtriére , 13:330, 1900.

LOGOTHETIS, JOHN;HARNER, RICHARD

doi: 10.1001/archneur.1960.00450030068007pmid: 14417977

Abstract Introduction The effect of various steroid hormones upon the electrical activity of the mammalian brain has been the subject of many investigations in the past. Cortisone and corticotropin (adrenocorticotrophic hormone) have been reported to exert convulsive effect in animals1 and humans,2,3 although these steroids have recently been used with some success in the treatment of patients with hypsarhythmia.4,5 Desoxycorticosterone has also been found to exert electrical and clinical anticonvulsant effect in humans6 and to increase the seizure threshold in animals.1,7 Other steroids with anticonvulsant properties in animals are progesterone and certain androgenic hormones.1,7We have been unable to find previous reports dealing with the direct effect of estrogens on cerebral electrical activity, although several studies indirectly suggest that ovarian hormones augment convulsive discharge in man and animals. For example, ovariectomy has been reported to give relief of seizures in humans8-10 and to prevent References 1. We also presented Experiment 6(b) elsewhere.16 2. We also presented Experiment 3 elsewhere.16 3. Costa, P. J., and Bonnycastle, D. D.: The Effect of DCA, Compound E, Testosterone, Progesterone and ACTH in Modifying "Agene-Induced" Convulsions in Dogs , Arch. Internat. Pharmacodyn. 91:330, 1952. 4. Geppert, L. J.; Dietrick, A. C.; Johnston, E. H., and Lind, C. J.: Fatal Convulsive Seizures Associated with Cortisone Therapy: Report of a Case , A.M.A. Am. J. Dis. Child. 84:416, 1952. 5. Dorfman, A.; Apter, N. S.; Smull, K.; Bergenstal, D. M., and Richter, R. B.: Status Epilepticus Coincident with Use of Pituitary Adrenocorticotrophic Hormone: Report of 3 Cases , J.A.M.A. 146:25, 1951.Crossref 6. Sorel, L., and Dusaucy-Bauloye, A.: A Propos de 21 cas de hypsarhythmia de Gibbs: Son traitement spectaculaire par l'ACTH , Acta neurol. et psychiat. belg. 58:130, 1958. 7. Stamps, F. W.; Gibbs, E. L.; Rosenthal, I. M., and Gibbs, F. A.: Treatment of Hypsarrhythmia with ACTH , J.A.M.A. 171:408, 1959.Crossref 8. Aird, R. B., arid Gordon, G. S.: Anticonvulsive Properties of Desoxycorticosterone , J.A.M.A. 145:715, 1951.Crossref 9. Spiegel, E., and Wycis, H.: Anticonvulsant Effects of Steroids , J. Lab. & Clin. Med. 30:947, 1945. 10. Everke, C.: Uber ovarielle Epilepsie , Monatsschr. Geburtsh. u. Gynäk. 61:256, 1923. 11. Russel, A. W.: Epileptische Anfälle der doppelseitigen ovarial Tumor , Zentralbl. Gynäk. 33:1044, 1905. 12. Rebattu, Mollon, and Sêdaillean: Epilepsie et fonctions ovariennes , Lyon méd . 131:1028, 1922. 13. Longo, V.: Epilessia sperimentale e glandole endocrine: influenza dell' attività delle glandole sessuali sulla predisposizione del cane all'epilessia riflessa da eccitamenti afferenti , Riv. pat. nerv. 57:432, 1941. 14. Morrell, F., and Florenz, A.: Modifications of Freezing Technique for Producing Experimental Epileptogenic Lesions , Electroencephalog. & Clin. Neurophysiol. 10:187, 1958. 15. Sandler, B.: Personal communications to the authors, 1959. 16. Christiansen, E. G.: Correlation Between Variation in Amount of Estrogen and Cholinesterase Activity in Human Serum, Thesis, Copenhagen, 1956. 17. Reynolds, S. R. M.: Cholinergic Action of Oestrin , Science 87:537, 1938. 18. Logothetis, J.; Harner, R.; Morrell, F., and Torres, F.: The Role of Estrogens in Catamenial Exacerbation of Epilepsy , Neurology 9:352, 1959.

PASIK, PEDRO;PASIK, TAUBA;BENDER, MORRIS B.

doi: 10.1001/archneur.1960.00450030076008pmid: 14430699

Abstract The role of the primate cerebral cortex in oculomotor function has been extensively investigated with electrical stimulation techniques. Recent experiments have demonstrated that deviational (horizontal and vertical), and centering eye movements may be elicited upon stimulations from almost every point on the cortex or subcortex. In the alert preparation, such as monkeys with cervical transection or chronically implanted electrodes,12,22 the evoked ocular movements are usually of the deviational type. As a rule the binocular movement is horizontal and contralateral in direction. In the occipital lobe, vertical or oblique movements are more frequently obtained than from other areas of the brain.20 Electrical stimulation in the anesthetized preparation, in contrast, induces more of eye centering; horizontal movements are less frequent, and vertical are rare.11 These observations suggest that the entire cerebrum influences oculomotor function. In man, there seems to be some cortical specificity for ocular responses. Electrical stimulations elicit References 1. Bender, M. B.: The Eye-Centering System , A.M.A. Arch. Neurol. & Psychiat. 73:685, 1955. 2. Bender, M. B.: Functions and Dysfunctions of Vertical Eye Movements , J. Nerv. & Ment. Dis. , to be published. 3. Bender, M. B.; Pasik, T., and Pasik, P.: Effect of Collicular Lesions Upon Certain Ocular Functions in Monkeys , Tr. Am. Neurol. A. 82:19, 1957. 4. Berman, A. J.; Knapp, H. D., and Rabiner, A. M.: Recovery of Function Following Massive Unilateral Cerebral Ablations in the Monkey , Tr. Am. Neurol. A. 82:82, 1957. 5. ter Braak, J. W. G.: Untersuchungen über optokinetische Nystagmus , Arch. néerl. physiol. 21:309, 1936. 6. Dandy, W. E.: Physiological Studies Following Extirpation of the Right Cerebral Hemisphere in Man , Bull. Johns Hopkins Hosp. 53:31, 1933. 7. Henderson, J. W., and Crosby, E. C.: Experimental Study of Optokinetic Responses , A.M.A. Arch. Ophth. 47:43, 1952. 8. Karplus, J. P., and Kreidl, A.: Über Totalexstirpationen einer und beider Grosshirnhemisphären an Affen (Macacus rhesus) , Arch. anat. physiol. (Physiol. Abt.) , p. 155, 1914. 9. Kennard, M. A.: Reactions of Monkeys of Various Ages to Partial and Complete Decortication , J. Neuropath. & Exper. Neurol. 3:289, 1944. 10. Kennard, M. A., and Ectors, L.: Forced Circling in Monkeys Following Lesions of the Frontal Lobes , J. Neurophysiol. 1:45, 1938. 11. Krieger, H. P.; Wagman, I. H., and Bender, M. B.: Changes in State of Consciousness and Patterns of Eye Movements , J. Neurophysiol. 21:224, 1958. 12. Lilly, J. C.; Hughes, J. R., and Galkin, T. W.: Gradients of Motor Function in the Whole Cerebral Cortex of the Unanesthetized Monkey , Fed. Proc. 15:119, 1956. 13. Mettler, F. A.: Extensive Unilateral Cerebral Removals in Primate; Physiologic Effects and Resultant Degeneration , J. Comp. Neurol. 79:185, 1943. 14. Pasik, P.; Pasik, T., and Krieger, H. P.: Effect of Cerebral Lesions upon Optokinetic Nystagmus in Monkeys , J. Neurophysiol. 22:297, 1959. 15. Penfield, W., and Boldrey, E.: Somatic Motor and Sensory Representation in the Cerebral Cortex of Man as Studied by Electrical Stimulation , Brain 60:389, 1937. 16. Santos, S. P., and Correa, A.: Funçao cócleo-vestibular após hemisferectomías cerebrais; apresentação de dois casos , Arq. brasil. med. nav. 18:58, 1957. 17. Spiller, W. G.: The Importance in Clinical Diagnosis of Paralysis of Associated Movements of the Eyeballs Especially of Upward and Downward Associated Movements , J. Nerv. & Ment. Dis. 32:417, 497, 1905. 18. Travis, A. M., and Woolsey, C. N.: Motor Performance of Monkeys After Bilateral Partial and Total Cerebral Decortications , Am. J. Phys. Med. 35:273, 1956. 19. Volk, D., and Bruell, J. H.: Eye Movements in an Adult with Cerebral Hemispherectomy , Am. J. Ophth. 42:319, 1956. 20. Wagman, I. H.; Krieger, H. P., and Bender, M. B.: Eye Movements Elicited by Surface and Depth Stimulation of the Occipital Lobe of Macaque Mulatta , J. Comp. Neurol. 109:169, 1958. 21. Wagman, I. H.; Shanzer, S., and Bender, M. B.: Interaction Between Motor Responses of Brainstem and Cerebrum , Tr. Am. Neurol. A. 83:104, 1958. 22. Wagman, I. H.; Shanzer, S., and Bender, M. B.: Interaction Between Motor Responses of Brainstem and Cerebrum , Tr. Am. Neurol. A. 83:104, 1958. 23. Wagman, I. H.; Werman, R.; Feldman, D. S.; Sugarman, L., and Krieger, H. P.: The Oculomotor Effects of Cortical and Subcortical Stimulation in the Monkey , J. Neuropath. & Exper. Neurol. 16:269, 1957. 24. Walker, A. E., and Fulton, J. F.: Hemidecortication in Chimpanzee, Baboon, Macaque, Potto, Cat and Coati: A Study in Encephalization , J. Nerv. & Ment. Dis. 87:677, 1938. 25. White, R. J.; Schreiner, L. H.; Hughes, R. A.; MacCarty, C. S., and Grindlay, J. H.: Physiologic Consequences of Total Hemispherectomy in the Monkey , Neurology 9:149, 1959.

ULLMAN, MONTAGUE;ASHENHURST, EDWARD M.;HURWITZ, LEWIS J.;GRUEN, ARNO

doi: 10.1001/archneur.1960.00450030084009pmid: 13840288

Abstract The difficulty in discerning the difference between capacity and motivation, as recently emphasized by David Levy,1 is pertinent to the problems posed by patients with anosognosia. He defines capacity as the nonmotivational aspects of behavior, namely, the individual's ability, fitness, and endowment. "As contrasted with motivation it (capacity) refers to what the individual can do rather than what he intends to do." Recent contributions2-5 to the subject of denial of hemiplegia reflect differing opinions concerning the role of motivational factors as compared with structural damage. In the effort to arrive at a unified point of view concerning the symptomatology of these patients two somewhat separate approaches can be identified. The first is concerned with the discovery of the specific structural factor involved and the analysis of the resultant functional deficit. This is best exemplified by the work of Denny-Brown and his associates4 and their concept of amorphosynthesis. References 1. In addition, Dencker and Lofving20 present evidence showing that the organization of cognitive functions in the brain-damaged person is different from that in normals, thus reenforcing the concept (Footnote continued on next page) of altered level of functioning with cerebral dysfunction. Various neurological mechanisms (aside from pure destruction of cortical tissue) have been advanced by Klein and Krech 21 and Bruner 22 which would account for such changed functioning. Bruner in particular suggests that anything that will change the rules for the utilization of stimulus relationships may change resulting percepts (perceptions) even though the stimulus remains the same. The work on sensory interaction in the Soviet Union23 also suggests that any intrusion in any sensory modality will alter the subsequent nature and level of sensory responses. In this respect Naruse and Obonai24 have shown how under conditions of altered mental states (like drowsiness) mental images follow laws leading to their decomposition rather than synthesis. This again suggests that alterations in levels of brain functioning lead to changes in the level of conceptual organization, namely, away from synthesis and toward dedifferentiation. The resulting "primitivity" of mental organization seems akin to the concrete character of mental organization described by Werner 25 in the case of children and primitive men, and the autistic thinking of children investigated by Piaget.26 2. Levy, D.: Capacity and Motivation , Am. J. Orthopsychiat. 27:1-8, 1957.Crossref 3. Critchly, M.: The Parietal Lobes , Baltimore, The Williams & Wilkins Company, 1953. 4. Sandifer, P. H.: Ansognosia and Disorders of Body Scheme , Brain 69:122-137, 1946.Crossref 5. Denny-Brown, O.; Meyer, J. S., and Horenstein, S.: The Significance of Perceptual Rivalry Resulting from Parietal Lesions , Brain 75:433-471, 1952.Crossref 6. Weinstein, E. A., and Kahn, R. L.: Denial of Illness: Symbolic and Physiological Aspects , Publication No. 249, American Lecture Series, Monograph in Bannerstone Division of American Lectures in Neurology, edited by C. D. Aring, Springfield, Ill., Charles C Thomas, Publisher, 1955. 7. Weinstein, E. A., and Kahn, R. L.: The Syndrome of Anosognosia , Arch. Neurol. & Psychiat. 64:772-791, 1950. 8. Scheerer, M.: An Experiment in Abstraction , Confinia neurol . 9:232-254, 1940. 9. Goldstein, K.: The Organism , New York, American Book Company, 1939. 10. Bolles, M.: The Basis of Pertinence: A Study of the Test Performance of Aments, Dements and Normal Children of the Same Mental Age , Arch. psychol. 212, 1937. 11. Gelb, A., and Goldstein, K.: Über Farbennamenamnesie , Psychol. Forsch. 6:127, 1924. 12. Goldstein, K., and Scheerer, M.: Abstract and Concrete Behavior , Psychol. Monog. 53:1941. 13. Hanfmann, E.: Analysis of the Thinking Disorder in a Case of Schizophrenia , Arch. Neurol. & Psychiat. 41:568-579, 1939. 14. Hanfmann, E.; Rickers-Ovsiankina, M., and Goldstein, K.: Case Lanuti: Extreme Concretization of Behavior Due to Damage of the Brain Cortex , Psychol. Monog. 57:1-75, 1944. 15. Nadel, A.: A Qualitative Analysis of Behavior Following Cerebral Lesions Diagnosed as Primarily Affecting the Frontal Lobes , Arch. psychol. 224, 1938. 16. Weigl, E.: Zur Psychologie sogenannter Abstraktionsprozesse: I. Untersuchungen über das "Ordnen," Ztschr. Psychol. 103:1, 2-45, 1927. 17. Bender, B., and Teuber, H.: Psychopathology of Vision , in Progress in Neurology and Psychiatry , edited by E. A. Spiegel, New York, Grune & Stratton, Inc., 1949. 18. Semmes, C.; Weinstein, S.; Ghent, L., and Teuber, H.: The Performance on Complex Tactual Tasks After Brain Injury in Man: Analyses by Locus of Lesion , Am. J. Psychol. 67:220-240, 1954. 19. Teuber, H.; Battersby, W., and Bender, M.: Performance of Complex Visual Tasks After Cerebral Lesions , J. Nerv. & Ment. Dis. 114:413-429, 1951. 20. Teuber, H., and Weinstein, S.: General and Specific Effects of Cerebral Lesions : Am. Psychologist 10:408-409, 1955. 21. Denker, J., and Lofving, B.: A Psychometric Study of Identical Twins Discordant for Closed Head Injury , Acta Psychiat. et Neurol. scandinav. (Supp. 122) 33:1-50, 1958. 22. Klein, S., and Krech, D.: Cortical Conductivity in the Brain-Injured , J. Personality 21:118-148, 1952. 23. Bruner, S.: Neural Mechanisms in Perception , Psychol. Rev. 64:340-358, 1957. 24. London, D.: Research on Sensory Interaction in the Soviet Union , Psychol. Bull. 51:531-568, 1954. 25. Naruse, O., and Obanai, T.: Decomposition and Fusion of Mental Images in the Drowsy and Post-Hyponotic Hallucinatory State , Jap. J. Psychol. 22:175-188, 1952. 26. Werner, H.: Comparative Psychology of Mental Development , Chicago, Follett Publishing Company, 1948. 27. Piaget, J.: The Language and Thought of the Child, London, Routledge and Kegan Paul, Ltd.

WELLS, CHARLES E.

doi: 10.1001/archneur.1960.00450030097010pmid: 13843897

Abstract Though the brain of man normally requires for its maintenance approximately 15% of the resting cardiac output and 20% to 25% of the total oxygen utilized by the resting subject,1 knowledge of the mechanisms and regulation of its blood flow remains incomplete. Nevertheless, studies have appeared in increasing numbers during recent years giving a much more complete picture of normal cerebral blood flow and withal explanations for a variety of previously poorly understood observations. The essay in no ways aims to review all studies of cerebral circulation, but rather to present those recent advances in knowledge which may aid the physician in the management of patients with cerebral vascular disorders and broaden his comprehension of the associated clinical phenomenology. As Sir Russell Brain2 has recently noted: "The striking feature which emerges from the recent increases in our knowledge of the cerebral circulation is the complexity and the multiplicity References 1. Scheinberg, P., and Stead, E. A., Jr.: The Cerebral Blood Flow in Male Subjects as Measured by the Nitrous Oxide Technique: Normal Values for Blood Flow, Oxygen Utilization and Peripheral Resistance, with Observations on the Effect of Tilting and Anxiety , J. Clin. Invest. 28:1163-1171, 1949.Crossref 2. Brain, R.: Order and Disorder in the Cerebral Circulation , Lancet 2:857-862, 1957.Crossref 3. Kramer, S. P.: On the Function of the Circle of Willis , J. Exper. Med. 15:348-364, 1912.Crossref 4. Hoff, E. C., and Grenel, R. G.: Circulation Through the Brain , in Howell, W. H.: A Textbook of Physiology , Ed. 16, edited by J. F. Fulton, Philadelphia, W. B. Saunders Company, 1949, pp. 779-780. 5. Forbes, H. S., and Wolff, H. G.: Cerebral Circulation: III. The Vasomotor Control of Cerebral Vessels , Arch. Neurol. & Psychiat. 19:1057-1086, 1928. 6. Wolff, H. G.: The Cerebral Circulation , Physiol. Rev. 16:545-596, 1936. 7. Fulton, J. F.: Observations upon the Vascularity of the Human Occipital Lobe During Visual Activity , Brain 51:310-320, 1928. 8. Gerard, R. W., and Serota, H.: Localized Thermal Changes in the Brain , Am. J. Physiol. 116:59, 1936. 9. Schmidt, C. F.: The Cerebral Circulation in Health and Disease , Springfield, Ill., Charles C Thomas, Publisher, 1950. 10. Kety, S. S., and Schmidt, C. F.: The Determination of Cerebral Blood Flow in Man by the Use of Nitrous Oxide in Low Concentrations , Am. J. Physiol. 143:53-66, 1945. 11. Kety, S. S., and Schmidt, C. F.: The Nitrous Oxide Method for the Quantitative Determination of Cerebral Blood Flow in Man: Theory, Procedure and Normal Values , J. Clin. Invest. 27:476-483, 1948. 12. Kety, S. S., and Schmidt, C. F.: The Effects of Active and Passive Hyperventilation on Cerebral Blood Flow, Cerebral Oxygen Consumption, Cardiac Output, and Blood Pressure of Normal Young Men , J. Clin. Invest. 25:107-119, 1946. 13. Kety, S. S., and Schmidt, C. F.: The Effects of Altered Arterial Tensions of Carbon Dioxide and Oxygen on Cerebral Blood Flow and Cerebral Oxygen Consumption of Normal Young Men , J. Clin. Invest. 27:484-492, 1948. 14. Kety, S. S.; Hafkenschiel, J. H.; Jeffers, W. A.; Leopold, I. H., and Shenkin, H. A.: The Blood Flow, Vascular Resistance and Oxygen Consumption of the Brain in Essential Hypertension , J. Clin. Invest. 27:511-514, 1948. 15. Sensenbach, W.; Madison, L., and Ochs, L.: A Comparison of the Effect of 1-Norepinephrine, Synthetic 1-Epinephrine, and U.S.P. Epinephrine upon Cerebral Blood Flow and Metabolism in Man , J. Clin. Invest. 32:226-232, 1953. 16. King, B. D.; Sokoloff, L., and Wechsler, R. L.: The Effects of 1-Epinephrine and 1-Nor-Epinephrine upon Cerebral Circulation and Metabolism in Man , J. Clin. Invest. 31:273-279, 1952. 17. Sokoloff, L.: Relation of Cerebral Circulation and Metabolism to Mental Activity , in Progress in Neurobiology: I. Neurochemistry , edited by S. R. Korey and J. I. Nurnberger, New York, Paul B. Hoeber, Inc. (Medical Book Department of Harper & Brothers), 1956, pp. 216-229. 18. Fazekas, J. F.; Thomas, A.; Johnson, J. V. V., and Young, W. K.: Effect of Norepinephrine on Cerebral Hemodynamics in Severe Hypotension , A.M.A. Arch. Neurol. 2:305-308, 1960. 19. Fazekas, J. F.; Thomas, A.; Johnson, J. V. V., and Young, W. K.: Effect of Arterenol (Norepinephrine) and Epinephrine on Cerebral Hemodynamics and Metabolism , A.M.A. Arch. Neurol. 2:435-438, 1960. 20. McDonald, D. A., and Potter, J. M.: The Distribution of Blood to the Brain , J. Physiol. 114:356-371, 1951. 21. Willis, T.: Practice of Physick , translated by S. Pordage, London, 1684, Pt. 6, p. 59, cited by Kramer.3 22. Alpers, B. J.; Berry, R. G., and Paddison, R. M.: Anatomical Studies of the Circle of Willis in Normal Brain , A.M.A. Arch. Neurol. & Psychiat. 81:409-418, 1959. 23. Vander Eecken, H. M., and Adams, R. D.: The Anatomy and Functional Significance of the Meningeal Arterial Anastomoses of the Human Brain , J. Neuropath. & Exper. Neurol. 12:132-157, 1953. 24. Pool, J. L.: Cerebral Vasospasm , New England J. Med. 259:1259-1264, 1958. 25. Meyer, J. S.; Fang, H. C., and Denny-Brown, D.: A Polarographic Study of the Cerebral Collateral Circulation , A.M.A. Arch. Neurol. & Psychiat. 72:296-312, 1954. 26. Meyer, J. S., and Denny-Brown, D.: Studies of Cerebral Circulation in Brain Injury: I. Validity of Combined Local Cerebral Electropolarography, Thermometry and Steady Potentials as an Indicator of Local Circulatory and Functional Changes , Electroencephalography & Clin. Neurophysiol. 7:511-528, 1955. 27. Meyer, J. S., and Denny-Brown, D.: The Cerebral Collateral Circulation: I. Factors Influencing Collateral Blood Flow , Neurology 7:447-458, 1957. 28. Denny-Brown, D., and Meyer, J. S.: The Cerebral Collateral Circulation: II. Production of Cerebral Infarction by Ischemic Anoxia and Its Reversibility in Early Stages , Neurology 7:567-579, 1957. 29. Denny-Brown, D.: Recurrent Cerebrovascular Episodes , A.M.A. Arch. Neurol. 2:194-210, 1960. 30. Abbie, A. A.: The Morphology of the Fore-Brain Arteries, with Especial Reference to the Evaluation of the Basal Ganglia , J. Anat. 68:433-470, 1934. 31. Moossy, J.: Development of Cerebral Atherosclerosis in Various Age Groups , Neurology 9:569-574, 1959. 32. Hultquist, G. T., cited by Fisher.33 33. Fisher, M.: Occlusion of the Internal Carotid Artery , A.M.A. Arch. Neurol. & Psychiat. 65:346-377, 1951. 34. Fisher, M.: Occlusion of the Internal Carotid Arteries: Further Experiences , A.M.A. Arch. Neurol. & Psychiat. 72:187-204, 1954. 35. Samuel, K. C.: Atherosclerosis and Occlusion of the Internal Carotid Artery , J. Path. & Bact. 71:391-401, 1956. 36. Adams, R. D.: Mechanisms of Apoplexy as Determined by Clinical and Pathological Correlation , J. Neuropath. & Exper. Neurol. 13:1-13, 1954. 37. Hutchinson, E. C., and Yates, P. O.: The Cervical Portion of the Vertebral Artery: A Clinico-Pathological Study , Brain 79:319-331, 1956. 38. Hutchinson, E. C., and Yates, P. O.: Carotico-Vertebral Stenosis , Lancet 1:2-8, 1957. 39. Holman, R. L., and Moossy, J.: Natural History of Aortic, Coronary and Cerebral Atherosclerosis, Symposium on Cerebrovascular Disease, Houston Neurological Society, to be published; cited by Moossy.31 40. Kubik, C. S., and Adams, R. D.: Occlusion of the Basilar Artery—A Clinical and Pathological Study , Brain 69:73-121, 1946. 41. Siekert, R. G., and Millikan, C. H.: Studies in Cerebrovascular Disease: II. Some Clinical Aspects of Thrombosis of the Basilar Artery , Proc. Staff Meet. Mayo Clin. 30:93-100, 1955. 42. Millikan, C. H., and Siekert, R. G.: Studies in Cerebrovascular Disease: I. The Syndrome of Intermittent Insufficiency of the Basilar Arterial System , Proc. Staff Meet. Mayo Clin. 30:61-68, 1955. 43. Schneider, R. C., and Crosby, E. C.: Vascular Insufficiency of Brain Stem and Spinal Cord in Spinal Trauma , Neurology 9:643-656, 1959. 44. Ford, F. R., and Clark, D.: Thrombosis of Basilar Artery with Softenings in the Cerebellum and Brain Stem Due to Manipulations of the Neck , Bull. Johns Hopkins Hosp. 98:37-42, 1956. 45. Ford, F. R.: Syncope, Vertigo, and Disturbances of Vision Resulting from Intermittent Obstruction of the Vertebral Arteries Due to Defect in the Odontoid Process and Excessive Mobility of the Second Cervical Vertebra , Bull. Johns Hopkins Hosp. 91:168-173, 1952. 46. Tatlow, W. F. T., and Bammer, H. G.: Syndrome of Vertebral Artery Compression , Neurology 7:331-340, 1957. 47. Duffy, P. E., and Jacobs, G. B.: Clinical and Pathological Findings in Vertebral Artery Thrombosis , Neurology 8:862-869, 1958.Crossref 48. Weiss, S., and Baker, J.: The Carotid Sinus Reflex in Health and Disease , Medicine 12:297-354, 1933.Crossref 49. Gurdjian, E. S.; Webster, J. E., and Martin, F. A.: Studies of Compression of the Carotid Bifurcation by Cinematography , Tr. Am. Neurol. A. , pp. 66-68, 1956. 50. Gurdjian, E. S.; Webster, J. E., and Lindner, D. W.: On the Non-Existence of the Cerebral Form of "Irritable Carotid Sinus," Tr. Am. Neurol. A. , pp. 49-51, 1958. 51. Gurdjian, E. S.; Webster, J. E.; Hardy, W. G., and Lindner, D. W.: Nonexistence of So Called Cerebral Form of Carotid Sinus Syncope , Neurology 8:818-826, 1958.Crossref 52. Engel, G. L.: On the Existence of the Cerebral Type Carotid Sinus Syncope , Neurology 9:565-568, 1959.Crossref 53. Toole, J. F.: Stimulation of the Carotid Sinus in Man, I. The Cerebral Response. II. The Significance of Head Positioning , Am. J. Med. 27:952-958, 1959.Crossref 54. deKleyn, A. and Versteegh, C.: Über verschiedene Formen von Ménières Syndrom , Deutsche. Ztschr. Nervenh. 132:157-189, 1933.Crossref 55. Toole, J. F., and Tucker, S. H.: The Influence of Head Position upon Cerebral Circulation Studies on Blood Flow in Cadavers , A.M.A. Arch. Neurol. 2:616-623, 1960Crossref 56. Sugar, O.: Editorial note, in The Yearbook of Neurology, Psychiatry and Neurosurgery (1958-1959 Series) , edited by R. P. Mackay, S. B. Wortis, and O. Sugar, Chicago, The Year Book Publishers, Inc., 1959, p. 550. 57. Adams, R. D., and Vander Eecken, H. M.: Vascular Diseases of the Brain , Ann. Rev. Med. 4:213-252, 1953.Crossref 58. Taveras, J. M.; Pool, J. L., and Fletcher, T. M.: The Incidence and Significance of Cerebral Vasospasm in 100 Consecutive Angiograms of Intracranial Aneurysms , Tr. Am. Neurol. A. , pp. 100-102, 1958. 59. Mackay, R. P., in discussion of Taveras et al.58 60. Ecker, A., and Riemenschneider, P. A.: Arteriographic Demonstration of Spasm of the Intracranial Arteries , J. Neurosurg. 8:660-667, 1951.Crossref 61. Ecker, A., and Riemenschneider, P. A.: Arteriographic Evidence of Spasm in Cerebral Vascular Disorders , Neurology 3:495-502, 1953.Crossref 62. Johnson, R. J.; Potter, J. M., and Reid, R. G.: Arterial Spasm in Subarachnoid Hemorrhage: Mechanical Considerations , J. Neurol. Neurosurg. & Psychiat. 21:68, 1958. 63. Potter, J. M.: Redistribution of Blood to the Brain Due to Localized Cerebral Arterial Spasm , Brain 82:367-376, 1959. 64. Sokoloff, L.: The Action of Drugs on the Cerebral Circulation , Pharmacol. Rev. 11:1-85, 1959. 65. Gurdjian, E. S., and Thomas, L. M.: Observations on Distention and Contraction of Cerebral Blood Vessels , Tr. Am. Neurol. A. , pp. 100-102, 1959. 66. Gurdjian, E. S.; Webster, J. E.; Martin, F. A., and Thomas, L. M.: Cinephotomicrography of the Pial Circulation , A.M.A. Arch. Neurol. & Psychiat. 80:418-435, 1958. 67. Forbes, H. S.: Regulation of the Cerebral Vessels—New Aspects , A.M.A. Arch. Neurol. & Psychiat. 80:689-695, 1958. 68. Ingvar, D. H.: Extraneuronal Influences upon the Electrical Activity of Isolated Cortex Following Stimulation of the Reticular Activating System , Acta physiol. scandinav. 33:169-193, 1955. 69. Ingvar, D. H.: Cortical State of Excitability and Cortical Circulation , in Reticular Formation of the Brain , edited by H. H. Jasper, L. D. Proctor, R. S. Knighton, W. C. Noshay, and R. T. Costello, Boston, Little, Brown & Company, 1958, pp. 381-408. 70. Shanbrom, E., and Levy, L.: The Role of the Systemic Blood Pressure in Cerebral Circulation in Carotid and Basilar Artery Thromboses , Am. J. Med. 23:197-204, 1957. 71. McMurrey, J. D.; Bernhard, W. F.; Taren, J. A., and Bering, E. A., Jr.: Studies on Hypothermia in Monkeys: I. The Effect of Hypothermia on the Prolongation of Permissible Time of Total Occlusion of the Afferent Circulation of the Brain , Surg. Gynec. & Obst. 102:75-86, 1956. 72. Rosomoff, H. L.: Hypothermia and Cerebral Vascular Lesions I. Experimental Interruptions of the Middle Cerebral Artery During Hypothermia , J. Neurosurg. 13:332-343, 1956. 73. Rosomoff, H. L., and Holaday, D. A.: Cerebral Blood Flow and Cerebral Oxygen Consumption During Hypothermia , Am. J. Physiol. 179:85-88, 1954. 74. Bering, E. A., Jr.; Taren, J. W.; McMurrey, J. D., and Bernhard, W. F.: Studies on Hypothermia in Monkeys: II. The Effect of Hypothermia on the General Physiology and Cerebral Metabolism of Monkeys in the Hypothermic State , Surg. Gynec. & Obst. 102:134-138, 1956. 75. Stone, H. H.; Donnelly, C., and Frobese, A. S.: The Effect of Lowered Body Temperature on the Cerebral Hemodynamics and Metabolism of Man , Surg. Gynec. & Obst. 103:313-317, 1956. 76. Meyer, J. S., and Hunter, J.: Effects of Hypothermia on Local Blood Flow and Metabolism During Cerebral Ischemia and Hypoxia , J. Neurosurg. 14:210-227, 1957. 77. Howell, D. A.; Stratford, J. G., and Posnikoff, J.: Prolonged Hypothermia in Treatment of Massive Cerebral Hemorrhage , Canadian M.A.J. 75:388-394, 1956. 78. Millikan, C. H.; Siekert, R. G., and Whisnant, J. P.: Intermittent Carotid and Vertebral-Basilar Insufficiency Associated with Polycythemia , Neurology 10:188-196, 1960. 79. Siekert, R. G.; Whisnant, J. P., and Millikan, C. H.: Anemia and Intermittent Focal Cerebral Arterial Insufficiency , Arch. Neurol. , to be published. 80. Meyer, J. S.: Localized Changes in Properties of the Blood and Effects of Anticoagulant Drugs in Experimental Cerebral Infarction , New England J. Med. 258:151-159, 1958. 81. Meyer, J. S., and Waltz, A. G.: Effects of Changes in Composition of Plasma on Pial Blood Flow: I. Lipids and Lipid Fractions , Neurology 9:728-740, 1959. 82. Meyer, J. S., and Waltz, A. G.: Effects of Changes in Composition of Plasma on Pial Blood Flow: II. High Molecular Weight Substances, Blood Constituents, and Tonicity , Neurology 9:815-825, 1959. 83. Swank, R. L.: Blood Viscosity in Cerebrovascular Disease , Neurology 9:553-560, 1959. 84. Sibley, W. A.; Morledge, J. H., and Lepham, L. W.: Experimental Cerebral Infarction: Effect of Dicumarol , Am. J.M. Sc. 234:663-667, 1957. 85. Moyes, P. D.; Millikan, C. H.; Wakim, K. H.; Sayre, G. P., and Whisnant, J. P.: Influence of Anticoagulants on Experimental Canine Cerebral Infarcts , Proc. Staff Meet. Mayo Clin. 32:124-130, 1957. 86. Wood, M. D.; Wakim, K. H.; Sayre, G. P.; Millikan, C. H., and Whisnant, J. P.: Relationship Between Anticoagulants and Hemorrhagic Cerebral Infarction in Experimental Animals , A.M.A. Arch. Neurol. & Psychiat. 79:390-396, 1958. 87. Whisnant, J. P.; Millikan, C. H.; Sayre, G. P., and Wakim, K. G.: Effect of Anticoagulants on Experimental Cerebral Infarction , Circulation 20:56-65, 1959. 88. Carter, A. B.: The Immediate Treatment of Cerebral Embolism , Quart. J. Med. 26:335-348, 1957. 89. Wells, C. E.: Cerebral Embolism: The Natural History, Prognostic Signs, and Effects of Anticoagulation , A.M.A. Arch. Neurol. & Psychiat. 81:667-677, 1959. 90. Carter, A. B.: Immediate Treatment of Cerebral Infarction , Lancet 1:345-351, 1960.