Abstracts from Current Literature ACUTE CIRCUMSCRIBED EDEMA AND RELATED CONDITIONS. H. QuiNCKE, Med. Klin. 17:675 (June 5) 1921. In this rather extensive article the author reviews the subject of angio- neurotic edema and allied conditions. It is his belief that the disease is not as uncommon as usually supposed, owing to the fact that the usual case is transient, not serious, and rarely requires the services of a physician. Quincke has observed from sixty to seventy cases. In the last thirty-six cases 50 per cent, occurred in males and 50 per cent, in females. The more complicated and atypical cases appeared in the females. The youngest patient was 13, the oldest 68. The majority of patients had their first attack when between 21 and 30 years of age. The average duration of the disease was five years, the minimum a single attack, the maximum thirty years. The length of the single attack varied from a few hours to six days, but usually lasted a day and a half. The eruption may be so fleeting as to go unobserved. The length of intervals between attacks varies greatly—from twenty-four hours to years. At times the attacks occur at irregular intervals. They may occur in series with a long period of remission. Two such cases are briefly reported, the first patient having had two attacks in twenty-one years, the second patient two attacks in four years, the last attack consising of a series occurring daily, usually most severe between the hours of 7 and 11 p. m. In another case the interval was twenty-six and eighteen years, respectively. Usually with increasing age the attacks of edema become lighter and more infrequent, or may stop entirely. Periodicity is common; the attacks occur not uncommonly at certain times of the month, on certain days, on rising in the morning, after the noon-day meal, etc. A close relation to migraine, epilepsy, hydrops genu intermittens. certain colics, types of erythema and neuralgias is noted in the paroxysmal type of the attacks. The etiology of the disturbance is not yet clear. Menstruation, psychic excitement, fatigue, loss of blood, heavy meat consumption, constipation, articles of diet, such as strawberries, chemicals, such as caffeine, aspirin, etc., are mentioned. One patient gave the cause as sea-bathing, two as warm baths, three as pressure or other mechanical measures ; excessive sunshine is also mentioned. Climatic conditions are also referred to, but usually the associated change in the diet plays a more important part. In one of the cases reviewed by the author the cause of the edema was thought to be due to the absorption of toxins as the result of a cholecystitis, the edema dis¬ appearing on the removal of the gallbladder. As a rule, patients having an angioneurotic edema appear healthy. During an attack, except for the local discomfort, little disturbance is noted. In only three cases were any febrile signs noted. In 39 per cent, of the cases general nervousness was present ; 13 per cent, showed a familial tendency to urticaria or acute edema. The majority of patients were anemic and sedentary and reacted well to change in mode of living and exercise. Robust out-of-door persons were, however, also affected. In Quincke's edema, the swellings vary from 2 to 10 cm. in diameter. The margin is not sharply defined, but blends into the surrounding skin. The Downloaded From: http://archneurpsyc.jamanetwork.com/ by a University of Pennsylvania User on 06/13/2015 color may be unchanged or slightly red, there being no increase in local heat. The edema is firm and does not pit; the patient usually complains of a feeling of fulness, occasionally burning, rarely itching. Besides the skin, the subcutaneous tissue may be involved. Any grade of hyperemia may be present up to a distinct wheel formation with temperature, itching and pain, but no proportional constitutional symp¬ toms. At times there may be local tenderness before the appearance of the edema. Quincke's edema and urticaria, while usually very distinct conditions, may show any possible admixture. In four cases, urticaria had existed for years prior to the appearance of the circumscribed edema. Urticaria is fre¬ quently seen as an associated condition in the familial type of edema. The edema may also be associated with erythema multiforme, erythromelalgia. and Raynaud's disease. Frequency of involvement of various parts is given : face, 80 per cent. ; eyes, 64 per cent.; lips, 53 per cent.; legs, 44 per cent.; hands, 41 per cent.; arms, 25 per cent. ; tongue, 22 per cent. ; prepuce and scrotum, 20 per cent. ; thighs, 19 per cent; pharynx, 17 per cent.; mouth, 8 per cent.; gastro-intestinal organs, 5 per cent.; esophagus, 3 per cent., and periosteum. 5 per cent. Occasionally symmetrically situated parts are affected one after the other. There is no rule, however, as any or all of the areas mentioned may be affected in one attack or in succeeding attacks. In no case in this series was the larynx involved ; rarely the mouth, pharynx, stomach or intestines are involved, and, if so, only in association with some other region. Ten cases are cited by the author to illustrate the unusual distribution which the edema may take. Several atypical cases are also reviewed. In one interesting case in this series, the patient, a female, had for months a swelling of the eyelids, first one, then the other, usually occurring in the morn¬ ing. Finally, under calcium lactate treatment, the condition cleared away. Another case was that of a patient who had swelling of the face for eight months, first diagnosed as erysipelas. Migraine was found to be frequently associated with Quincke's edema (seven cases). In some cases the headache precipitated the attack, in others no apparent relation was present. In one case of severe migraine which had existed from the age of 10 to 50, there developed at the latter age, with prac¬ tically every headache, a swelling of the face and lips, or an edema occurred without headache. Quincke is of the opinion, as is also Biirgi, that migraine is a manifesta¬ tion of meningeal edema, exactly as angioneurotic edema is a swelling of the skin or mucous membranes. On this basis Quincke believes that one is able to explain the great variety of cases of migraine, and also the numerous cerebral focal signs, as edema of the meninges may occur anywhere as it may on the skin. In a case of left-sided headache noted by the author, in which the head¬ ache lasted for three days, there was an associated twitching of the right side of the face and right arm with weakness, lasting several days., but always passing away. Cases of hemiplegia with migraine have been observed, and Quincke has seen two patients with monoplegias. These cases he believes are due to edema of the pia with pressure or possible associated cortical involvement. Hydrops genu intermittens, edema of the bursae and tendon sheaths are also discussed by the author. Cerebrospinal fluid exudates are also noted, and the author reports three cases in which, associated with the menstrual period, there occurred a serous meningitis. Downloaded From: http://archneurpsyc.jamanetwork.com/ by a University of Pennsylvania User on 06/13/2015 Recurrent neuralgias are mentioned as a possible result of edema. One case of recurring sciatica, according to Quincke, was due to localized edema of the lumbar plexus. Recurring myalgias are also due to this cause. In some of the studied cases colloid changes in the muscle were thought to be the cause, but Quincke personally believes that the condition is due to an edema of the intermuscular connective tissue fibers. Various other types of edema are mentioned by the author under the heading of circumscribed edema. In one case reported by Neuda and Gagstatter, edema of the mucous membrane of the bladder was noted. Edema due to other causes, such as nephritis, cardiovascular conditions, mechanical reasons, etc., is reviewed by the author. In discussing the physi¬ ology of this condition the author reviews several theories based on ion concentration. The transitory character, the periodicity and the location point to a nervous origin, as do also the usual history of nervousness, familial tendency, psychic emotions and the known similarity to migraine and epilepsy. Under the heading of treatment the author has little new to offer, diet, hygiene, etc., playing the usual important rôle. Other therapeutic measures are mentioned but none that has been used with uniform success. Moersch, Rochester, Minn. THE ANATOMICAL AND CLINICAL SYNDROMES OF THE CORPUS STRIATUM. J. Lhermitte, Neurol. Bull. 3:163 (May) 1921. The author presents a comprehensive study of this important structure. He insists clearly and logically that there is no evidence to justify the assump¬ tion that the corpus striatum is in any sense regressive in structure or function. We have come to our present knowledge of this subject by the anatomicoclinical route; physiologic investigation has been misleading and practically barren of constructive result. The anatomoclinical syndromes are grouped under three headings : those in which the lesion involves the corpus striatum in its entirety; those which affect the striatum (putamen and caudate nucleus) ; and those which impli¬ cate the pallidum. The pallidum includes not only the two internal seg¬ ments of the lenticular nucleus, but also, according to Ramsey Hunt, the large-celled neurons scattered over the putamen and caudate nucleus. The pallidal syndrome would appear to be determined not only by destructive or degenerative alterations affecting the globus pallidus, but also by those that reach the pallidal element carried to the interior of the striatum along with the purely striate neurons (striopallidal system).