The effect of the experimental undernutrition on the early development of the brain has been extensively studied by several investigators. It has been usually found that the greatest vulnerable period coincides with the time of rapid growth of brain, and at that time even mild undernutrition will cause severe and permanent reduction of the weight and size, RNA, protein and lipid contents, and cell number and size in the brain. Undernutrition causes the irreversible deficiencies in these substances of the brain if the fully rehabilitation is not given the underfed animals during the periods concomitant with the vulnerable ones. The ability of the underfed animals to recover from undernutrition is dependent upon the number of factors, the number and the types of cells, the time of start of rehabilitation and the extent of feed restriction. It is noted that undernutrition during early life of the developing rat caused deficit in weight and DNA in cerebellum most severely. The close relationships between this deficit and the marked high rate of cell formation in cerebellum during postnatal periods has been described. In human studies, retardation in mental development appears to im plicate undernutrition as the cause. Up to now much work has been done, but the data are becoming more and more complicate, each study has its own particular fault and faults are not the same. More available informations will be obtained in future.
Fourteen cases of infantile hydrocephalus resulting from purulent meningitis were presented, out of which five cases were associated with lumbosacral meningccele. There have been many problems for the surgical treatments of postmeningitic hydrocephalus, which is quite different from those of congenital hydrocephalus, because of the presence of infection and increased protein content in the cerebrospinal fluid. It is also one of the most important factors to determine the period of the surgical procedure. In our clinic, the following prccedure is carried out for the treatment of postmeningitic hydrocephalus. The first: ventricular tap or drain age is performed at situations which culture of the CSF is positive and hydrocephalus is progessive. In addition, antibiotic therapy is maintained as long as persistent fever or evidence of cellular reaction in the CSF remains. The second: ventriculo-peritoneal shunt should be performed after the culture of the CSF was negative for more than three weeks and total protein content in the CSF dropped down to less than 500mg/dl. The third: if v-p shunt is ineffective for reducing increased intracranial pressure, it should be replaced to the ventriculo-atrial shunt.
The authors have experienced eleven cases of surgical treatment for spina bifida cystica during last eight years. Redical operation was performed in ten cases, one of which died of post-operative meningitis. Five cases who had hydrocephalus underwent ventriculoatriostomy with favorable results. The advantage of our operation method to combine upper laminectomy with ordin ary radical operation for spina bifida was the case of direct surgery of structural aspect of spina bifida which enabled to avoid untoward nervous damage during surgery, to perform the suture of the dura easily and consequently to prevent post operative infection. The neurological status of 8 cases 2 to 8 years following surgery were as follows: ( a ) Mental activities were normal in all cases. ( b ) Physical activities were normal in four cases. ( c ) One case had occasional incontinence only. ( d ) The other three cases had slight gait disturbance with incontin
This study is based on 156 cases with grand mal epilepsies, which have shown more than five times of attacks during the period over one year after the first attack, and which were observed at our department for the last six years. These 156 cases were classified into the three groups, i. e. “awakening”, “sleep” and “diffuse” epilepsies, according to the Janz' classification. The 51 cases (33%) out of them were awakening epilepsies with attacks only while waking, the 55 cases (35%) were sleep epilepsies with seizures mainly after falling asleep and/or before waking in the morning, and the 50 cases (32%) were diffuse epilepsies with attacks occuring while waking as well as sleeping without particular regularities. This report consists of the surveys of the ages at the onset, the etiology, the com bination with other types of minor attacks, the frequencies of the attacks, the precipitating factors, the abnormalities of the neurological examination, the mental disturbances, the characters, the EEG-findings, and the effects of the anticonvulsant for the three groups and the relevant discussions. It was suggested that the awakening epilepsy is a prototy pe of the genuine epilepsy, the diffuse epilepsy is that of the symptomatic one, and the sleep epilepsy is the intermediate between them.
Cloth on the face test and parachute response were examined in three hundred and five mentally retarded children and investigated the correlation of the age of the first positive reaction with their motor development. The r esults of the studies showed that the age of positive cloth on the face test and parachute response were not dependent on their ages, but related with their motor development: ramely cloth on the face test mostly correlated with about the time of sitting, and parachute response mostly correlated with that of standing up. Possible reasons of delaye d motor development in mentally retarded children were delayed neurological maturation and retarded mentallity (lack of will, poor surroundings interest etc. ). Cloth on the face test seems more dependent on mentallity and parachute respose, automatic and equilibrium reaction, seems more dependent on neurological maturation rather than mentallity. Our results showed that the etiology of the delayed motor development in mentally retarded children concerned with both poor neurological maturation and retarded mentallity and more complexity one.
Electroencephalographic examinations were repeatedly performed in a 12 year old girl with EPC before the onset of, during and after the subsidence of continuous localized twitchings which were cofined to the left foot, involving at times a variable extent of the lower and upper extrimities. At 6 years of age the patient had an episode of several generalized or left-sided c onvulsions over a period of 10 days. EEG showed attenuation cif the right parieto-occipital and posterior temporal area 10 days and 2 months after the initial episode subsided. Four months later, EEG showed moderate degree of slow wave dysrhythmia, which was more marked in the right parietoocipital area. Ten months later, basic rhythm was more and more disorganized with appearance of sporadic spikes in the right centroparietal area.1 1/2 years later, EEG showed marked slow wave dysrhythmia, more conspicuous in the right hemisphere with sharp waves, spike and wave discharges in the right centroparietal and midtemporal area. These seizure discharges became more and more marked to be continuous when EPC appeared. The course of epileptogenesis outlined above suggests an important role played by the cortex in the genesis of EPC, together with the findings obtained in the all night polygraphic EEG recording: Continuous muscular twitchings and seizure discharges were reduced during sleep and reached the lowest intensity during the REM stage. Although becoming least frequent, seizure discharges in EEG persited considerably during the REM stage.
Follow-up of 2 cases of hydrocephalus treated by shunt operation within 2 months of age were reported. Case 1 is a 4-year-old boy with noncommunicating hydrocephalus who has become shunt dependent. He was treated by ventriculo-atrial shunt at the age of 9 weeks, although there was no marked dilatation of lateral ventricle. Since 3 months after the 1 st ventriculo-atrial shunt, he has been suffering mainly from frequent occlusions of shunting tube. PVG showed that the lateral ventricles reduced markedly in size and changed in shape. Skull x-ray also revealed disappearance of the coronal suture and microcephalic appearance. As the result of occlusion of shunting tube, rapid intracranial hypertension occurred and revisions of shunt have to have been performed 21 times. This means that this child may need ventricular shunt completely and permanently in his long life. Case 2 is a 5-year-old girl with hydroencephalodysplasia who has come to arrested hydrocephalus. She was treated by cyst-atrial shunt at the age of 8 weeks. Since 2 months after the 1 st shunt operation, revision of the shunt had been performed 4 times for the past 2 years and 6 months. Because she had been suffering mainly from meningitis and/or sepsis, she has been treated conservatively. Clinical course of 2 years' duration has showed neither increase of cranial circumference nor intracranial hypertension. It is thought that the arrested hydrocephalus may have occurred in this case clinically.
An instrument for visual perception test in infants was made by modifying Fantz's procedure. The procedure is to place an infant face up in a bed room, and the stimulus targets such as various figures and colors are exposed one after the other for a fixed time. The experimenter observes the infant's eye through a magnifying glass in the chamber ceiling, and records the fixation time by a stop watch. The measurement of the fixation times in healthy infants proved to be longer in the complicated figures such as fretwork and concentric circle than the simple figures such as circle and triangle. The exposure of several targets with different colors showed the longest fixation time in the red target. The average fixation time for several figures and colors in healthy infants of each months of age showed serial elongation, and especially a striking developmental change was demonstrated between two and three months of age. On the other hand, in seven of eight infants with suspected brain damage including cerebral palsy the fixation times were shorter even after five months of age than those of healthy infants in three months of age. These results suggest that the visual perception test is valuable for early detection of brain damage.