OCCASIONAL SPECIMENS of scarred, atrophic brain removed for the relief of focal cerebral seizures at the Montreal Neurological Institute have shown striking perivascular collections of round cells, particularly in less severely damaged areas of these specimens. In the past this perivascular cuffing has been attributed to the effect on the brain of recurring seizures, with recognition, however, that this was a rather unsatisfactory explanation since the great majority of surgical specimens removed from patients with equally frequent focal seizures do not show this change. Histologic studies of surgical specimens from three children recently operated upon for intractable focal seizures suggest that this microscopic picture may indicate the presence of an unsuspected, more or less localized, chronic encephalitis that has smoldered along over a period of years. The clinical and histologic data on these three children will be reported in some detail.The most complete study from the pathologic standpoint was made in the last of the three patients to appear. This case will be discussed first, since it seems to clarify interpretation of the train of events in the other two. M.D.Remooal of the left frontal lobe, carded out six months after the onset of seizures in a fruitless attempt to stop them, proofded an oppoctunity to compare the miczoscopic picture at that time with that shown at autopsy three and a half months later.Birth and early development of this child were normal, and there were no signscant illnesses until April 1955 at 18 months of age, when the parents noted a scratch behind the right ear. The following day swelling in this region was noted and the temperature rose to 104" F. The tempefature subsided the next day after administration of penicillin, but the swelling behind the ear continued to discharge bloody fluid for one week.The child seemed entirely well for two months, but in July he became unusually irritable one day and vomited the followin mornin . That afternoon he seemed dizzy an% soon aifer was noted to stare and salivate; he then developed clonic movements of the right side of the body.persisted for an hour before the convulsion was stopped by administration of chloroform. A similar attack occurred a month later in August 1955, and from then on milder right-sided seizures recurred several times daily. During the next three months his usual quiet, pleasant bebehavior changed and he became somewhat irritable and destructive. During this period his parents felt that his speech was becoming somewhat less clear than it had been.In November the right arm became completely useless and hung limply by his side for three days.From the department of neurology and neurosurgery.

No abstract

No abstract

No abstract

No abstract