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SCIENTIFIC MEETING OF THE NETHERLANDS SOCIETY OF NEUROLOGY HELD IN U rRECHT ON SEPTEMBER 8, 1979

METASTASIS INTO THE SPINAL CORD

D. MOFFIE and s. S’TEFANKO (Amsterdam)

Dissemination of malignant turnouts into the spinal cord is rare. However, it is quite possible that this dissemination is more frequent than is usually thought, as a spinal symptomatology may be masked by

symptoms of cerebral metastases. Most intramedullary metastases are found in the middle and lower thoracic spinal cord. A description is given of four cases of metastasis into the spinal cord; in three of these the localisation was in the middle and lower part of the thoracic cord, in one case the metastasis was found in the medulla oblongata with extension into the upper part of the cervical cord.

Antemortem diagnosis is rare. The diagnosis is suspected in a patient, known with a malignancy (breast. lung) and a rapidly progressing transverse lesion of the spinal cord, generally without radicular symptoms. X-rays of the spine are normal. On lumbar punction the pressure of the CSF is normal as well as the manomatric tests and myelography. In most of the cases there is a pronounced increase of the total protein content in the CSF with a normal cell-count and an absence of tumour-cells. It is thought that this dissemination is haematogenous. The localisation in the thoracic and thoraco-lumbar spinal cord is probably due to metastasis in the area supplied by the great anterior radicular artery (Adamkiewicz).

THE PROGNOSIS OF INTRAVENTRICULAR HAEMORRHAGE

A. w. DE WEERD (Wassenaar)

In a series of 40 patients with blood in the cerebral ventricular system demonstrated with computerized tomograpby 19 patients survived, of which 12 had no significant residual disability. Even in patients with blood in 611 ventricles including the 4th ventricle survival without significant handicap was possible. Our data sug&t that the better the clinical condition on admission the greater the chance that the patient will survive and will regain a useful life.

Patients with intraventricular haemorrhage most likely due to hypertension had a grave prognosis: 12 out of 17 patients died. In contrast 8 out of 1 I patients with an aneurysm or arteriovenous malformation

ruptured into the ventricular system survived. The results suggest that the clinical condition of the patient on admission, origin and site of the ruptured

intracerebral haematoma and possibly age of the patient play an important role in predicting the outcome. rather than rupture into the centricular system by itself. as always has been assumed.

PREPARATION FOR THE EXECUTION OF A MOVEMENT

c. H. M. BRUNIA (Tilburg)

Preparation for the execution of a movement in man can be investigated, using EEG and EMG recordings. The movement studied in a series of experiments was a plantar flexion of the foot to press a button. following th? presentation of a visual stimulus S2. Four seconds before S2, a tone was presented as a warning signal SI. The use of a foreperiod (the time between Sl and S2) in reaction time experiments causes a shortening of the mean reaction time. This is due to preparatory processes during the foreperiod. Electrophysiological indication of these processes can be found, using the recording techniques mentioned above: _ The late wave of the Contingent Negative Variation (CNV) shows a larger amplitude, when preceed-

ing a shorter reaction time. _ Amplitudes of monosynaptic reflexes evoked in the m.triceps surae, increase systematically during the

second half of the foreperiod. It was suggested that the motorpotential is related to the very steep increase of reflex amplitudes, found after the presentation of S2 and before the onset of the movement.