Biomedical subjects
Publications and source records attributed to H H Itabashi.
A patient with Parkinson's disease who had undergone bilateral adrenal to caudate implantation by stereotactic technique came to autopsy. The implantation was shown to have produced minimal trauma and to have been well placed. Minimal surviving adrenal medullary tissue remained in the implanted coil, and no outgrowth of tissue into the striatum occurred.
Two patients had upward nystagmus on forward gaze before they died with acute caudal brainstem dysfunction. Bilateral dorsal paramedian damage in the rostral medulla, involving the perihypoglossal nuclei, was probably the critical lesion responsible for upbeat nystagmus.
This article describes the neuropathologic findings in a woman who died suddenly at the age of 48 after having had symptoms of narcolepsy for 1 1/2 years. Gross examination of the brain showed an arachnoid cyst. The significant light microscopic findings consisted of focal gliosis of the ventrolateral caudal pons and the periventricular anterior hypothalamus. Although cases of symptomatic narcolepsy have been previously reported, to our knowledge structural brain changes in idiopathic narcolepsy have not been previously described. In the present case, there is no evidence that the narcoleptic symptoms were secondary to any other disorder, including the arachnoid cyst. This patient's symptoms may be related to the pontine and hypothalamic gliosis, the etiology for which is unknown.
A 28-year-old man had a chronic locked-in syndrome following tentorial herniation caused by an epidural hematoma. Postmortem examination revealed bilateral corticospinal tract degeneration caudal to the midbrain, with infarction of the right internal capsule just rostral to the cerebral peduncle and pressure necrosis of the pyramidal portion of the left cerebral peduncle.
We studied a 69-year-old man with multiple brain infarcts who died 8 days after being studied with positron emission tomography and (F-18)-fluorodeoxyglucose. Metabolic abnormalities were greater than structural changes in size and extent. They were found in areas with no gross pathologic abnormalities. Remote metabolic effects were attributed both to degeneration of fiber tracts with disconnection of remote structures, as demonstrated by hypometabolism in the left frontal cortex associated with an infarct in the genu of the left internal capsule, and to microscopic infarcts not apparent on gross examination but manifested as hypometabolic regions.
One month before death, a 63-year-old man with known lung carcinoma manifested a left third-nerve palsy and crossed ataxia. The oculomotor involvement began with a dilated left pupil and progressed to a complete left oculomotor nerve palsy, with the exception of nearly normal lid function. Pathologic examination revealed a solitary midbrain metastasis involving the left third-nerve nucleus and rootlets, with the exception of the caudal central oculomotor subnucleus and its outflow fibers.
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A 27-year-old woman who had undergone extensive small bowel resection at age 14 months developed kyphoscoliosis, ocular palsies, constricted visual fields, retinitis pigmentosa, progressive ataxia, muscular weakness, nearly absent vibration and impaired position sense, areflexia, extensor plantar responses, and macrocytic anemia. Her condition closely resembled Bassen-Kornzweig disease, but lipoprotein electrophoresis was normal. Mild fat malabsorption, lactic acidosis, and severe deficiency of vitamins A and E and carotene were documented. Serum B12 and folic acid levels were normal. During vitamin A and E therapy sufficient to elevate serum levels to the normal range, there was improvement of visual fields and visual acuity in dim light, lactic acidosis, and red cell volume. Progression of symptoms was halted during vitamin replacement therapy, and her gait improved. This syndrome is the human counterpart to vitamin E deficiency in experimental animals.
Spongy degeneration of white matter localized to basis pontis was found in a 47-year-old woman with hepatic encephalopathy. In this clinical setting, the lesion resembled those changes described by Victor et al and found primarily in cerebral cortex, subcortical white matter, and putamen. Isolated involvement of the basis pontis and ventral midline tegmentum of pons has not, to our knowledge, been previously reported. The morphologic appearance and distribution distinguish this lesion from central pontine myelinolysis. The possible vascular cause of this localized interstitial edema is discussed.
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The pathology of CNS cysticercosis is dependent upon the route of infection, the larval form, its predilection for certain anatomic sites, and the host reaction. Clinicopathologic correlates are illustrated.
Drechslera spicifera is a dematiaceous fungus which occurs widely in nature but only rarely has been implicated in animal and human infections. Previous infections have occurred in superficial and subcutaneous sites or were encountered in immunologically compromised hosts. This report documents a case of granulomatous encephalitis due to Drechslera spicifera in an immunologically competent woman with no known underlying disease, from whom the fungus was isolated. Animal pathogenicity studies in mice reproduced the histopathologic features, and the fungus was reisolated from the animals.
A premature infant who died of early-onset group B streptococcal meningitis was found to have cerebritis with direct bacterial infection of the basal ganglia. Although the organism was sensitive to penicillin by in vitro testing, it was not eradicated from the cerebrospinal fluid after 48 h of antibiotic treatment. These findings illustrate that suppurative extension with cerebritis of the basal ganglia as a complication of group B streptococcal meningitis may be one of the factors responsible for treatment failure.
A group of 1,700 cases of head trauma were reviewed to determine the incidence of posterior fossa injuries and to assess the value of computed tomography (CT) in their diagnosis and management. In 57 cases (3.3%), the most significant and primary injuries were within the posterior fossa. These included epidural hematoma (EDH), acute and chronic subdural hematoma (SDH), and parenchymal hemorrhage and contusion of the cerebellum and brainstem. The prognosis varies with the location and severity of the injury. Brainstem injuries are associated with a high mortality rate. Computed tomography proves particularly useful in the early recognition of brainstem injury. The demonstration by CT of obliteration of the cisterns surrounding the brainstem is a reliable sign of a grave prognosis in brainstem injury. Contrast enhancement is useful in demonstrating whether the dural sinuses are displaced, thus differentiating EDH from SDH. Except in the rare case of vascular injury unassociated with EDH, CT correlated with the neurological examination is an accurate method of determining the nature, location, and extent of significant posterior fossa injury. Scans of high quality are mandatory, and frequent supplementary contrast studies are recommended.
Cranial computed tomography (CT) scans of 1,600 head trauma patients, 67 of which demonstrated evidence of brainstem injury, were reviewed. CT diagnosis of brainstem injury was based on direct and indirect evidence. Direct signs, which include focal hemorrhage, significant intraparenchymal contrast enhancement, hemorrhagic contusion, and edema of the brainstem, appear as areas of high density, mixed density, and low density on the CT scan. Indirect signs are obliteration of the pontine, cerebellopontine angle, and perimesencephalic cisterns. Mortality and morbidity rates after brainstem injury are 2-3 times greater than for head trauma with descending transtentorial herniation, but without brainstem injury.
Proteins were extracted at pH 2.5 from carefully washed brain homogenates of patients with subacute sclerosing panencephalitis. Immunoglobulin G was isolated from the extracts by gel filtration and immunoadsorbent chromatography and was 125I radioiodinated. The labeled immunoglobulin G was reacted with purified measles virus antigens by crossed immunoelectrophoresis and utilized to identify antigens in measles-infected cell cultures and hamster brain tissue subjected to treatment corresponding to that used for elution of immunoglobulin G. The method described is useful in identifying the specific nature of antibodies as well as antigens in tissue-associated immune complexes.
We describe an autopsy-proven case of central pontine myelinolysis (CPM) with premortem computerized tomographic (CT) visualization of the lesion on two scans, performed with an interval of 2 weeks. This case demonstrates the capability of CT to support the clinical diagnosis of central pontine myelinolysis. Identification of the condition should facilitate prompt initiation of aggressive supportive care.
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