Summary: Purpose: To acquire normative data of the hippocampus and its postnatal growth in SO children (age, 1 month to IS years) without epilepsy.Methods: Morphometry of the hippocampus was carried out by using a spoiled FLASH 3D sequence (sagittal orientation), whereas the volume of the brain was assessed with a TIweighted spin-echo sequence (transverse orientation). The volume of the hippocampus and the brain was determined by following Cavalieri's principle. Growth curves of the brain and hippocampus were fitted to a nonlinear Boltzmann sigmoidal equation.Results: lntra-tinterobserver coefficient of variation was 2.01 4.9% for hippocampal volume measurements and 2.0/2. I % for brain volumetry. A significant difference in volume was noted between the right and left hippocampus (p < 0.001), with the right side being larger on average by 0. I0 cc. Correlation coefficients of growth curves ranged between 0.71 and 0.94. Growth curves demonstrated a faster development of the hippocampus in girls. A steeper slope of hippocampal growth as compared with brain growth was found in girls, whereas in boys, the slope of brain growth was steeper.Conclusions: Our findings will be of help in evaluating vulnerable phases of the hippocampal formation with accelerated growth, thereby leading to a better understanding of the development of hippocampal sclerosis in early childhood.

We report a 35-year-old man with hereditary cerebroretinal vasculopathy (CRV) characterized by retinal microvascular changes and a right frontal intracerebral mass lesion that suggested a brain tumor. Histopathologic analysis of the patient's brain lesion as well as reviewed specimens of the patient's mother, who had reportedly died of a brain tumor, showed no neoplasia but did show cerebral microvasculopathy. CRV should be considered as a differential diagnosis for patients with intracerebral mass lesions, retinal vascular changes, and a positive family history of "brain tumors."

Vascular malformations are a common cause of spontaneous brain-stem hemorrhage in young normotensive individuals. These lesions are no longer cryptic. Magnetic resonance (MR) imaging has renewed interest in the treatment of this disorder because of the precise accuracy in diagnosis and localization of these lesions that it affords. The MR image demonstrates characteristic findings of multiple hemorrhages of varying ages surrounded by a hypointense peripheral zone of hemosiderin. Five cases of vascular brain-stem malformation diagnosed with MR imaging are described. The vascular malformations could be demonstrated as "flow void" areas in three cases. Three patients were treated surgically and vascular malformations were confirmed: all three patients improved postoperatively. Two patients were treated nonsurgically; one of these recovered from a second hemorrhage and the other experienced neurological deterioration after a single hemorrhage. High-energy radiotherapy was not effective for the one vascular malformation treated by this method. This experience suggests that surgical exploration should be considered for vascular brain-stem malformations when the diagnosis is confirmed by MR criteria and the clinical course and lesion are both progressive in character.

We investigated whether ictal single photon emission computed tomography (SPECT) with 99Tcm-ethyl cysteinate dimer (ECD) could differentiate between temporal (TE) and extratemporal epilepsy (ETE) in 30 consecutive patients (n = 21 for TE, n = 9 for ETE), all of whom had excellent postoperative seizure control (class I according to Engel's classification). Ictal SPECT showed isolated temporal hyperperfusion in 90% (19 out of 21) of the TE patients and normal perfusion in two patients. All the ETE patients had ictal SPECT findings consistent with extratemporal seizure onset. The sensitivity of ictal ECD-SPECT for correct localization of the seizure onset zone was 80% in all patients, 86% in TE patients and 66% in ETE patients. Although ictal ECD-SPECT has a lower sensitivity in ETE than in TE, it can be used to clearly distinguish between TE and ETE. It provides non-invasive imaging information for use in further diagnostic and treatment strategies in patients with drug-resistant focal epilepsy.

A patient with proven borrelial infection of the central nervous system (CNS) and progressive weakness of the arms was treated with antibiotics. Although the initially elevated CXCL13 concentration in the cerebrospinal fluid decreased, indicating effective treatment of the infection, weakness progressed. Investigation revealed multiple nerve conduction blocks and the presence of GM1 antibodies, suggesting a multifocal motor neuropathy; the patient improved on treatment with intravenous immunoglobulins. This report of an autoimmune-mediated polyneuropathy in a patient with borrelial CNS infection indicates that such patients might respond to immunomodulatory therapy if antibiotic treatment is not effective.

Proper treatment and counseling of women with epilepsy, with due attention to aspects that are specific to women patients, can reduce the limitations to which they are subject in everyday life.

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A case of an extradural spinal meningioma presenting with a separate intradural meningioma at the same cord level is reported. Review of the English literature on spinal epidural meningiomas reveals a high incidence of concurrent intradural tumors in patients with epidural meningiomas. This leads to the conclusion that the intradural space should be evaluated carefully when an epidural meningioma is encountered.