The authors describe the magnetic resonance (MR) imaging appearance of the head of the right caudate nucleus in patients who have undergone adrenal medullary transplant surgery for Parkinson disease. All four patients examined showed some clinical improvement after surgery. The MR images acquired 4-6 months postoperatively showed no evidence of caudate atrophy. Three of the four patients showed some increase in size of the operated caudate head relative to preoperative studies. Neither cavitation nor high signal intensity on T2-weighted images was evident within the caudate head. The one patient studied after administration of gadopentetate dimeglumine showed no abnormal enhancement. These images provided a description of the transplant site and also suggested that the clinical improvement seen was not due to simple ablation of caudate tissue or to postoperative inflammation. The increase in size of the caudate head also suggested that some implanted tissue may have remained in these patients at the time the MR images were acquired.

Adrenal Medulla↗

PubMedDate not supplied

Microsurgical operations in the treatment of trigeminal neuralgia.

Three neurosurgical procedures to aid patients suffering from intractable, medically resistant tic douloureux are described: (1) the Sweet-Nugent transcutaneous radiofrequency neurolysis of the gasserian ganglion, (2) the Gardner-Rand suboccipital arterial decompression or rhizotomy of the trigeminal root, and (3) the Rand subtemporal transtentorial retrogasserian arterial decompression or rhizotomy of the trigeminal root. Each procedure has its indications, and the neurosurgeon should adjust his approach to the circumstances of the individual case. The clinical results with follow-up evaluations over a 10-year period for each of these operations are approximately the same. Ninety percent or more of patients suffering from intractable tic douloureux were completely relieved. Anesthesia dolorosa was not observed in more than 300 patients treated by these three operations, even though on rare occasions total anesthesia occurred following radiofrequency neurolysis. There was no operative mortality in the radiofrequency neurolysis series, and the operative morbidity and mortality rates were less than 4% for both the suboccipital and subtemporal craniotomy procedures.

Humans↗

PubMedDate not supplied

Complex partial seizures of hippocampal and amygdalar origin.

We studied the first clinical manifestations of 72 complex partial seizures (CPS) in 17 drug-resistant patients. CPS were indicated to be of hippocampal-amygdalar origin by scalp and depth EEG. We asked: (a) Do all CPS of hippocampal-amygdalar origin start with an initial motionless stare and/or oroalimentary automatisms? (b) If not, what other clinical manifestations appear at onset of the CPS? Results showed that approximately 39% of CPS begin with motionless staring, 25% with nonfocal discrete movements, 21% with oroalimentary automatisms, 10% with perseverative stereotyped automatisms, and 6% with vocalizations. Nonfocal discrete movements and oroalimentary automatisms were identified as the most common second and third clinical sequential manifestations during a CPS. We conclude that although approximately 60% of CPS of hippocampal-amygdalar origin start with motionless staring or oroalimentary automatisms, 40% do not.

Amygdala↗

PubMedDate not supplied

Scanning electron microscopic appraisal of a new micro T-tube.

A new micro T-tube, 0.6 mm in outer diameter, has been constructed. Use of this tube has allowed 1-mm common carotid artery (CCA) bypass ofr periods of time up to 22 minutes. After bypass, scanning electron microscopic observation of sutured CCA endothelium showed widespread destruction, scattered attached platelets and other formed blood elements, as well as microthrombi both at suture lines and in areas in contact with T-tubes. Despite microthrombi, 41 of 42 CCAs were patent after anastomosis. Silicone cuffs and 8-0 ties secured T-tubes inside vessels with no apparent difference in underlying endothelial destruction.

Animals↗