Biomedical subjects
J B Kirkpatrick
Publications and source records attributed to J B Kirkpatrick.
Spinal intramedullary ependymal cyst. Report of three cases.
Three cases of spinal intramedullary ependymal cyst, two at the thoracolumbar junction and one in the cervical spinal cord, are reported in women in their fifth to seventh decades. Neurological signs and symptoms were extremity dysesthesias, paresthesias, and weakness. Plain cervical and lumbothoracic x-ray films were normal for the patients' age. Magnetic resonance (MR) imaging demonstrated a rounded cystic intramedullary mass at the thoracolumbar junction in two cases and at C3-7 in one case. The signal intensity of the cyst contents approximated that of cerebrospinal fluid on T1- and T2-weighted images. Upon administration of gadolinium-diethylenetriaminepenta-acetic acid (Gd-DTPA), MR imaging showed no enhancement in the cyst wall or cavity. Myelotomy and cyst drainage were performed in each case, and the neurological status of each patient improved. The lining of the cyst was biopsied in one of the three patients undergoing surgery and was composed of a single layer of cuboidal cells supported by glial tissue. Periodic acid-Schiff staining of the tissue did not reveal a basement membrane. The findings in these cases suggest that the Gd-DTPA-enhanced MR imaging appearance of intramedullary spinal ependymal cyst is consistent and allows for accurate preoperative diagnosis with or without biopsy.
Demonstration of Epstein-Barr virus in primary central nervous system lymphomas by the polymerase chain reaction and in situ hybridization.
Primary lymphomas of the central nervous system (CNS) account for 0.3% to 1.5% of all intracranial neoplasms. Several reports have noted a coincidence between this neoplasm and serologic evidence of Epstein-Barr virus (EBV) infection, but in only a few instances has the EBV genome been demonstrated in these tumors. To further evaluate the frequency of this occurrence, we analyzed primary CNS lymphomas using nucleic acid hybridization methods and the polymerase chain reaction (PCR). In situ hybridization was used in selected cases. Sequences of EBV were found in two of nine cases by PCR and in situ hybridization. Southern blot hybridization of genomic DNA from these samples was negative for EBV. Both tumors arose in patients with conditions shown to produce secondary immunodeficiency, namely, chronic alcohol abuse and diabetes mellitus. We conclude that the association of EBV and CNS lymphoma is not restricted to patients with severe primary immune deficiency, and that PCR can be applied successfully to paraffin-embedded tissue for the detection of low-abundance viral sequences.
Position and vibration sensations: functions of the dorsal spinocerebellar tracts?
Clinical evidence is presented which establishes for the first time that position and vibration sensations may be carried in the dorsal spinocerebellar tracts. We present a patient who incurred a spinal cord infarction eight months prior to death that caused a Brown-Séquard syndrome with loss of position and vibration senses in the right lower extremity. The infarction spared the right fasciculus gracilis and thus supports the recent observations in human beings (and animals) that conscious proprioception is not a function of the dorsal columns. The vibratory and position losses were best correlated with the portion of the lesion involving the right dorsal spinocerebellar tract. Arguments are furnished based on physiological experiments in animals that conscious proprioception may be carried by Morin's spinocervicothalamic pathway, which forms part of the dorsal spinocerebellar tract in the spinal cord.
Trigeminal neuralgia and multiple sclerosis: demonstration of the plaque in an operative case.
Trigeminal neuralgia is unique to humans. The most common cause seems to be an injury to the myelin of the trigeminal nerve root entry zone as it extends for several millimeters lateral to the pons. Jannetta has developed an elegant retromastoid microsurgical approach to this region. He has identified a compression-distortion phenomenon of this nerve root entry zone, usually from an anomalous position of the superior cerebella artery. Trigeminal neuralgia can also occur in association with multiple sclerosis, when the plaque lies in this same location. The historical evidence for this explanation is reinforced by the electron microscopic demonstration of the plaque in this region in a patient with multiple sclerosis who was suffering from tic douloureux. (Neurosurgery, 5: 711--717, 1979).
Pathogenesis of calcification of necrotic brain tissue.
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Clinical studies of intrathecal autologous lymphocyte infusions in patients with malignant glioma: a toxicity study.
The feasibility and toxicity of intrathecal lymphoid cell infusions in patients with glioma were examined in this study. Blood rich in lymphoid cells was obtained using the Haemonetics Model 30 cell separator; the lymphoid cells extracted were further purified on Ficoll-Hypaque gradients. Four patients received a total of eighteen autologous lymphoid cell infusions, with between 1 X 10(6) and 5 X 10(9) lymphoid cells being infused on each occasion. No toxicity was observed, but the CSF glucose declined in 2 patients. In 1 patient examined at autopsy the lymphoid cells appeared to have gained access to the tumor bed as well as to the rest of the subarachnoid space.
Anatomic and pathologic correlations with computerized tomography.
Material familiar to the pathologist is reviewed from the view point of confirming and extending the diagnostic utility of computerized tomography. Pathological examples of variations in ventricular shape, acute hydrocephalus and obstruction of arachnoid villi are cited. Calcification in basal ganglia and periventricular leukomalacia are illustrated. Acute traumatic hemorrhage and hemorrhagic necrosis of the visual cortex are shown.
The blood-brain barrier: its role in contrast studies.
The concept of a blood-brain barrier includes overlapping control mechanisms which work together to produce a constant microenvironment. Most important is the barrier to macromolecule passage located in cerebral capillary endothelium. Many drugs bound to proteins cannot pass this obstruction. Also important are membrane properties shared by all living cells. Lipid soluble molecules pass cell membranes easily; water soluble and ionized molecules do not. Other components include selective ion regulation, facilitated sugar transport, and resorption by the choroid plexus. The bulk flow of cerebrospinal fluid washes all solutes, and even particulate debris, from the system.
White matter of the cerebellum demonstrated by computed tomography: normal anatomy and physical principles.
Although computed tomography (CT) delineation of normal white matter of the cerebral hemispheres has been well documented, there has been no description of white matter within the cerebellum. Through the use of phantom studies, CT number correlations between cerebellum and cerebral hemispheres, and anatomic correlation with in vitro specimens, the ability to visualize cerebellar white matter is demonstrated. Thin sections decrease volume averaging and enable consistent imaging of these structures. Size and shape of the corpus medullaris on CT scan may vary with the scan angle and level of section. Representative examples of various normal appearances are illustrated.
Fatal cerebral injury in the elderly.
A medical examiner's series of 71 elderly patients with fatal internal cerebral injuries demonstrated age differences with respect to the type of cerebral lesion and the causal incident. The elderly showed relatively fewer severe cerebral contusions than did a young group, but a higher incidence of subdural and intraparenchymal hematomas. Falls, the most common cause of injury in the elderly, were often precipitated by physical illness or ingestion of alcohol. Consumption of alcohol was also a prominent factor in the fatal assault cases.
Civilian gunshot wounds of the brain.
The authors report on 42 fatal gunshot wounds to the brain in civilians. The firearms used were those commonly available to civilians, ranging from a .22 revolver to a .45 semiautomatic pistol. Missle tracks were measured and the volume computed. The relatively low-velocity missles produced by these weapons to not create the devastation that characterizes wounds from high-velocity military firearms. Instead, there is much variation in the size of the missle tracks, and they cannot be directly related to caliber. Pressure marks and contusions, impaction of bone chips, internal richochet, and cerebral edema occurred frequently. The missle passed through the brain completely in very case but was retained by the skull or soft tissues in a large percentage of cases. The mechanism of death may be acute pressure on the brain stem from the passage of the missle through the brain.
Visceral neuropathology.
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Cerebellar hypoplasia in Werdnig-Hoffmann disease.
The case of an infant with Werding-Hoffmann disease, who died at the age of 4 1/2 days, is reported. At autopsy there was severe cerebellar hypoplasia, associated with degenerative changes in the brain-stem nuclei. This case supports the concept that cerebellar hypoplasia may develop as a manifestation of the neuronal abiotrophy of Werdnig-Hoffmann disease. A similarity has been noted between the cerebellar lesion found in the child reported here and that produced by viral infection in experimental animals.