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Two cases of fatal neurogenic pulmonary oedema are depicted. The hemodynamic study failed to document any hypertensive crisis or pulmonary hypertension. By contrast, the low values of pulmonary capillary wedge pressures and the high protein concentration in tracheal fluid suggest a pulmonary capillary wall lesion.
The effects of short reversible cooling of the dentate nucleus in two groups of 3 and 4 cebus monkeys, with two different types of ipsilateral elbow movements, have been studied. One group was trained to turn a moving handle back and forth rapidly between two mechanical stops, while the second group was trained to move the handle between two target zones. Brief blocking of the dentate nucleus caused a delayed termination of contraction of the agonistic muscles (hypermetria) near the mechanical stop for very rapid, ballistic, alternating arm movements and, consequently, delayed initiation of the antagonistic return movement. The resulting increase of the duration of a single movement was not caused by a reduction of the peak acceleration of the movement. For the slower target movements, dentate nucleus cooling caused shortening of agonistic muscular contraction (hypometria) with corresponding, saccadic movement corrections. The frequency of the "movement tremor" lay between 3 and 5 Hz. The average velocity maxima during dentate cooling did not change. The findings indicate that different types of movements exhibit different disturbances of the movement pattern during the period of functional elimination of the same anatomical structure. The results indicate that the dentate nucleus and cerebellar hemispheres take part in preprogramming movement duration (Kornhuber) for rapid ballistic movements. In slower target movements, the dentate nucleus may be involved in sectional preprogramming of step movements.
Clinical and neuropathological data of a 50-year-old woman with an unusual multisystem degeneration are presented. Clinically the illness was characterized by progressive ataxia with ophthalmoplegia and multiple cranial nerve palsies. Neuropathological investigation showed a severe and selective degeneration of the dentato-rubral system, of the posterior columns and of several cranial nerve nuclei. The problems of differential diagnosis and classification are discussed.
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We describe a woman with paraneoplastic cerebellar degeneration associated with para-ovarian adenocarcinoma, who had a circulating antibody with a corresponding antigen not only in cerebellar Purkinje cells but also in neurons located in the molecular layer of the human and rat cerebellum. The antigen was also present in neurons in the cerebral cortex, brain stem, anterior horn cells, dorsal root ganglia, intestinal autonomic neurons, retinal ganglion cells, Schwann cells of the peripheral nerve and epithelial cells of the renal glomerulus in rats. Immunoelectron microscopy revealed immunoprecipitates in the smooth and rough endoplasmic reticulum and polyribosomes in human and rat cerebellar Purkinje cells and other neuronal cell bodies as well as Schwann cells of the peripheral nerve. Even though patients with this disorder manifest primarily with cerebellar and some extracerebellar signs, the antigen also exists in many neurons other than cerebellar Purkinje cells and even in non-neuronal cells. The clinicopathologic significance of the observed immunologic reaction in diverse neurons remains to be determined.
The normal course and appearance of the veins draining the tectum mesencephali proper are described in detail on the basis of the anatomical radiological study. These specific veins, the quadrigeminal veins, were constantly present on autopsy study. There are two types of variations of these quadrigeminal veins. They have a close anatomical and angiographic correlation with the quadrigeminal plate proper, and also outline the posterior aspects of the quadrigeminal plate. The whole structure of the mesencephalon may be delineated by these veins in combination with the other veins of the mesencephalon. They may be of diagnostic value in the early recognition of the brain stem lesions.
The clinical and roentgenographic findings in ten patients with infratentorial retrocerebellar cysts are presented. An approach to the neuroradiological evaluation of retrocerebellar cysts and their differential diagnosis are discussed.
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Seven patients with facial and scalp capillary hemangiomas with associated and nonvascular intracranial malformations are presented. All patients were female. The most important anomalies include: Dandy-Walker disease, cerebellar hypoplasia, arterial angiomas, and abnormal origin and intracranial distribution of some of the principal cerebral arteries.
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Intraneuronal accumulation of cytosomes with the fluorescent and tinctorial properties of ceroidlipofuscin occurred in the C.N.S. of a fully matured dog with signs of slowly progressive cerebellar disease. Ultrastructural study revealed various membrane-bound inclusions in addition to typical lipofuscin granules. The clinicopathologic findings in this case were contrasted with those occurring in English Setters with juvenile neuronal ceroid-lipofuscinosis, and compared with those reported in Kufs' disease in man.
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One of the clinical oculomotor hallmarks of lateral medullary infarction (Wallenberg's syndrome) is the so-called saccadic lateropulsion. In man and in animals, cerebellar lesions lead to dysmetric saccades and underline the importance of cerebellar control on saccadic accuracy. In order to study the lesion site responsible for saccadic lateropulsion we prospectively examined 12 patients with Wallenberg's syndrome who did not show a cerebellar lesion on CT or MRI. All patients consistently showed hypermetric saccades to the ipsilateral side and hypometric contralateral saccades comparable with the effects of cerebellar lesions in monkeys on saccadic accuracy. Based on the most recent experiments involving recordings from saccade-related neurons in the deep cerebellar nuclei of monkeys (oculo-motor region of fastigial nucleus), we hypothesize that saccadic lateropulsion in lateral medullary infarction is essentially identical with cerebellar saccadic dysmetria and results from a disruption of afferent olivocerebellar climbing fibres that gives rise to functional disinhibition of the cerebellar cortex and to increased inhibition of the deep cerebellar nuclei.
This prospective study investigates the frequency of patent foramen ovale (PFO), venous air embolism (VAE) and paradoxical air embolism (PAE) by transoesophageal echocardiography (TOE) in neurosurgical patients operated on in the sitting position. The risk of PAE after exclusion of PFO is assessed. A PFO was identified by pre-operative TOE and VAE and PAE by continuous intraoperative TOE. Sixty-two patients were divided into two groups, 22 patients were studied in group 1 (posterior fossa surgery) and group 2 (cervical surgery) contained 40 patients. Pre-operative TOE demonstrated a PFO in 5 of the 22 patients in group 1 (23%). Patients with proven PFO were excluded from the sitting position. Two further patients of this group (12% of 17 patients), in whom a PFO had been excluded pre-operatively, nevertheless had PAE, air occurring in all cavities of the heart. In group 2 the incidence of PFO was 4 out of 40 patients (10%). No PAE was observed in this group. Three morphological types of VAE with different haemodynamic and ventilation changes were demonstrated. VAE was observed in 76% of all posterior fossa operations and in 25% of cervical laminectomies. We conclude that a pre-operative search for PFO is mandatory considering its incidence of 23% in group 1 and of 10% in group 2, and the risk of PAE. If a PFO is detected, the sitting position should be avoided. A residual risk for PAE remains despite exclusion of PFO because the reliability of TOE is limited. TOE is the method of choice for detecting VAE and PAE.