Are the preservatives sodium bisulfite and ethylene diaminetetraacetate free from neurotoxic involvement?
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Animals↗
Biomedical subjects
G Budzilovich
Publications and source records attributed to G Budzilovich.
Lumbar subarachnoid ethylenediaminetetraacetate induces hindlimb tetanic contractions in rats: prevention by CaCl2 pretreatment; observation of spinal nerve root degeneration.
Disodium ethylenediaminetetraacetate (Na2EDTA) has replaced sodium bisulfite as the antioxidant in 2-chloroprocaine, Nesacaine CE. This study was undertaken to determine whether this new formulation has neurotoxic effects when administered in the subarachnoid space. Sprague-Dawley rats receiving subarachnoid injections of 1.5 mM or higher concentrations of Na2EDTA immediately initiated a circling behavior that was followed by the development of tetanic contractions of the hindlimbs lasting for 15-20 min. The tetanic contractions were followed by a brief period of hindlimb paralysis. Pretreatment of rats by subarachnoid injections of 1 mM CaCl2 prevented the development of tetanic contractions and paralysis of the hindlimb. Histologic examination of animals receiving Na2EDTA revealed moderate to severe focal degenerative changes in spinal nerve roots. Control rats receiving subarachnoid injections of normal saline solution did not develop tetanic contraction nor pathological changes on light microscopy. These results suggest that the preservative used in Nesacaine-MPF may be neurotoxic.
Animals↗
Supraophthalmic intracarotid infusion of BCNU for malignant glioma.
We treated five patients with 11 supraophthalmic infusions of BCNU at 200 mg/m2 every 2 months. All three patients with residual tumors showed marked CT response after one infusion. Two patients with bilateral tumors had no response on the contralateral side. All four evaluable cases showed evidence of BCNU neurotoxicity. CT findings superficially resembled tumor recurrence, but white matter changes, nonspecific gyral enhancement, and delayed calcification were more indicative of neurotoxicity. There were no procedure-related complications. One autopsy suggested that direct parenchymal damage might be responsible for delayed neurotoxicity. Supraophthalmic BCNU infusion, at this dosage, is too toxic for cerebral tissue.
Adult↗
Retinal and optic nerve findings in Goldenhar-Gorlin syndrome.
Involvement of the posterior segment of the eye in Goldenhar-Gorlin syndrome is more common than is generally appreciated. We examined seven patients with this syndrome. Abnormalities included diminished visual acuity, tilted optic disc, optic nerve hypoplasia, tortuous retinal vessels, macular hypoplasia and heterotopia, microphthalmia and anophthalmia. In one case, pathologic study showed agenesis of the optic nerve. It is proposed that retinal, optic nerve and craniofacial abnormalities in this condition may reflect an asynchrony in the migration of the neural crest cells in the early stages of embryonal development.
Adolescent↗
Cerebellocele and associated central nervous system anomalies in the Meckel syndrome.
Three cases with the Meckel syndrome were autopsied and found to have: arhinencephaly , polymicrogyria , aqueductal stenosis, heterotopia of glial tissue, hypoplasia or agenesis of the cerebellar vermis, cranium bifidum associated with large occipital ventriculocele and others. The anomalies at the level of posterior fossa in this condition are classified as those belonging to the Chiari type III group of anomalies. This unusual set of anomalies which forms pathogenetic link between the Dandy-Walker and Chiari-Arnold group of anomalies in the posterior fossa seems to be very frequent in the Meckel syndrome. The therapeutic emphasis is on genetic counseling in view of the recessive inheritance of the syndrome.
Abnormalities, Multiple↗
Neural defects in Say-Gerald (VATER) syndrome.
The Say-Gerald (VATER) syndrome consists of vertebral defects, anal atresia, tracheoesophageal fistula, radial dysplasia and renal defects. 2 children with Say-Gerald (VATER) syndrome were autopsied: the first child was found to have hydrocephalus, aqueductal stenosis and probable craniosynostosis, and the second child had hypoplasia of the nerve roots and anterior and posterior horns of the spinal cord, corresponding to the hypoplastic limb. It is suggested that the Say-Gerald syndrome is a multifocal developmental disorder in which central nervous system anomalies may be found. The children with Say-Gerald syndrome should have a complete neurological examination in order to rule out a potentially treatable central nervous system defect.
Abnormalities, Multiple↗
Intracranial lipomas, hydrocephalus and other CNS anomalies in oculoauriculo-vertebral dysplasia (Goldenhar-Gorlin syndrome).
13 cases of Goldenhar-Gorlin syndrome are presented in which numerous central nervous system anomalies have been found. These include occipital encephalocele, hydrocephalus, aqueductal stenosis, agenesis of corpus callosum, multiple congenital lipomas and many others. Pertinent literature has been reviewed. It is concluded that any part of the central nervous system can be involved in this condition and that careful evaluation is indicated in order to rule out a treatable intracranial anomaly.
Adolescent↗
Encephalocele (cerebellocele) in the Goldenhar-Gorlin syndrome.
A patient with unilateral preauricular appendages and occipital mass is described who died on the fifth day of life. An autopsy demonstrated congenital megabladder and megaureters and dysplastic kidneys. The neuropathological examination revealed cranium bifidum in the occipital region, defective posterior arch of the C1 vertebral body, agenesis of vermis and a large cerebellocele. It is suggested that some patients with the Goldenhar-Gorlin syndrome may have prominent central nervous system involvement in spite of only relatively slight facial involvement.
Cerebellar Diseases↗
Intracerebral toxoplasmosis in patients with acquired immune deficiency syndrome.
The acquired immune deficiency syndrome (AIDS) is a recently described T-cell deficiency predisposing patients to a spectrum of opportunistic infections. Kaposi's sarcoma, and other neoplasms. It appears primarily among homosexual males and intravenous drug abusers, but is now being observed in other groups as well. The authors describe six adult patients with AIDS who developed intracranial toxoplasmosis. In four patients, diagnosis was made by brain biopsy, and in one by serology. These patients received a 90-day course of therapy with sulfadiazine, pyrimethamine, or both when tolerated, and improved neurologically. In one patient, the brain biopsy was nondiagnostic and the organism was identified at autopsy. On computerized tomographic and pathological follow-up studies the organism appeared to be eradicated by therapy. Early aggressive diagnostic study and prompt institution of therapy are imperative for reversal of neurological deficits. Despite cure of toxoplasmosis, the prognosis in patients with AIDS is poor; the mortality in this series was 67%. Isolation precautions should be taken by those caring for such patients.
Acquired Immunodeficiency Syndrome↗
Iniencephaly: a neuropathologic study.
Five cases of iniencephaly are reviewed. Numerous central nervous system malformations were found at all levels, including microencephaly, polymicrogyria, heterotopic glial tissue in the leptomeninges, atresia of the ventricular system, marked disorganization of the brain stem, vermian agenesis, large cerebellar cyst, and disorganization of the spinal cord tissue. The cerebellum was normal in one case. Numerous skeletal anomalies were found as well as marked retroflexion of the craniocervical junction. We concluded that cerebral anomalies, although severe, are not specific for iniencephaly. Cerebellar anomalies, on the other hand, were considered to share some morphologic features between Dandy-Walker and Arnold-Chiari, i.e., Chiari type II and Chiari type III, malformations.
Abnormalities, Multiple↗
Intracerebral metastasis of esophageal carcinoma: case report.
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Brain Neoplasms↗
Atypical computed tomography features of intracranial meningioma: radiological-pathological correlation in a series of 131 consecutive cases.
While most intracranial meningiomas have characteristic computed tomographic (CT) findings, a significant number produce atypical images that may lead to a spurious histopathological diagnosis. The authors reviewed 131 consecutive, previously untreated cases of meningioma, all confirmed pathologically. Nine cases (7%) were misdiagnosed initially as malignant lesions based on CT findings alone. Features such as irregular areas of nonenhancing mass and well defined regions of persistent low density were the reasons for misdiagnosis. Close correlation with pathological findings of tumor necrosis, hemorrhage, scarring, and cystic change was noted. An unexpectedly high incidence of necrosis in untreated meningioma is noteworthy.
Adult↗
Benign osteoblastoma of a thoracic vertebra. Case report.
A patient with osteoblastoma of the T-11 vertebral body presented with symptoms of spinal cord compression. Six weeks after an emergency laminectomy and subtotal removal, spinal computerized tomography disclosed residual tumor, which was totally removed via a combined anterior transthoracic approach and posterior laminectomy.
Adult↗
Malignant cardiac myxoma with cerebral metastases.
Two cases of cardiac myxoma with secondary involvement of the brain and death are reported. In one case, tumor emboli to the middle cerebral artery caused massive cerebral infarction, while in the other case true cerebral metastasis developed in the cerebrum and cerebellum, with rapid demise ensuing in both patients. It is emphasized that an emergency exists in cases ihat prompt echocardiography and computerized tomography of the brain are indicated. The second case represents the only instance of cardiac myxoma behaving as a true malignant neoplasm with actual invasion of the neural tissues recorded in the literature.
Brain Neoplasms↗
Anaplastic neuronal tumors of brain.
A multicentric neuronal tumor of brain with unique morphologic features is described. It is compared with four other markedly anaplastic brain tumors containing neoplastic neurons. Demonstration of axon processes, which must be carefully distinguished from other similarly stained structures, is essential for the recognition of such tumors. Recent experience suggests that anaplastic neuronal tumors are more frequent than is generally realized. It is suggested that axon stains should be more widely employed in the investigation of atypical or highly pleomorphic gliomas.
Adult↗
Congenital ophthalmoplegia in oculoauriculovertebral dysplasia-hemifacial microsomia (Goldenhar-Gorlin syndrome). A clinicopathologic study and review of the literature.
Two patients with Goldenhar-Gorlin syndrome showed paralysis of one or more extraocular eye movements on neurologic examination. At autopsy, a third patient showed unilateral agenesis of trochlear and abducens nerves and corresponding brain stem nuclei. Congenital ophthalmoplegia is not infrequent in Goldenhar-Gorlin syndrome and may be due to hypoplasia or agenesis, or both, of extraocular muscles, extraocular nerves, and brain stem nuclei.
Abducens Nerve↗
Congenital facial neuropathy in oculoauriculovertebral dysplasia-hemifacial microsomia (Goldenhar-Gorlin syndrome).
Four patients with clinical features of Goldenhar-Gorlin syndrome who showed facial paralysis on clinical examination are presented. The fourth case died following surgery for cleft lip. Autopsy revealed hypoplasia of the right facial nerve in its intracranial segment, with small right facial nucleus in the brain stem. Nosological aspects of the Goldenhar-Gorlin syndrome are discussed. Peripheral facial paralysis, as a part of this syndrome, is reviewed in the light of clinical and pathological findings and in its relationship to cardiac anomalies. It is suggested that Goldenhar-Gorlin syndrome is a part of a so-called cardiofacial syndrome.
Abnormalities, Multiple↗
Cystic pituicytoma of the neurohypophysis in a Siamese cat.
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Animals↗