MEDICAL MEMORANDA Bilateral Renal Carcinoma associated with Polycystic Kidneys

Creutzfeldt disease and of hepatic coma is probably also due to a compensating action in the presence of a disordered dopaminergic system. Taken together, these findings suggest that triphasic waves occurring repetitively and regularly in an E.E.G. are caused by a disturbance of the dopaminergic system. The question arises whether the hyperkinesia and the coma are caused by disorders of two separate dopaniinergic systems. The following considerations support such a view. (1) In the early stages of Jakob-Creutzfeldt disease of the Jones-Nevin type the triphasic wave E.E.G. picture may occur in association with myoclonus but without a disturbance of consciousness. (2) In some cases of slowly developing cerebral infarction myoclonus is an early feature but there is no loss of consciousness. Myoclonus disappears when the patient becomes hemiparetic, which is understandable when it is remembered that Parkinsonian tremor may disappear when a lesion of the internal capsule occurs. (3) Triphasic waves may appear in a case of rapidly developing hemiplegia without loss of consciousness and disappear after the administration of antadine. More supporting evidence is needed before this concept of the cause of triphasic E.E.G. waves can be accepted, and it is to be hoped that this communication will stimulate further investigations.