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PubMed1981

[Frontal pseudoataxia, discussion on its mechanism (author's transl)].

We presented a rare care who had right frontal lobe infarction, with left side pseudoataxia, and the mechanism, causing pseudoataxia, was considered. The patient, a 51 year-old, righ-handed male, was admitted on August 9, 1980, complaining of left-side pseudoataxia. About p.m. 7:00, July 29, 1980, he suddenly noticed numbness of the left foot, and he found himself difficulty in standing in the next morning. He had a mild paresis and tactile-tactile of the left side including the face, which was rapidly improved. However, there was pseudoataxia of the left extremities, which had not been improved. On physical examination, dysarthria, aphasia, finger agnosia, difficulty in right left orientation or muscle weakness was not recognized, and there was no sensory disturbance except for slight impairment of stereognosis, two point discrimination and vibratory sense. Demonstrable impairment of tactiletactile from was observed in the left hand. Notable dysmetria, terminal tremor and dysdiadochokinesia were seen in the left limbs, which were remarkably worsened with eyes closed. However, tapping and line-drawing tests were normal. Babinski-Weil's test disclosed typical compass gait. There was marked swaying in Romberg position. Tandem gait was impossible with a tendency to decline the left. Deep reflexies were normal except for mildly hyperactive radial reflex in the left. Carotid and vertebral angiographies revealed neither evidence of vascular occlusion nor displacement of vessels CT scan demonstrated a low density area, which included the right inferior and middle frontal gyri, the head of the right caudate nucleus and a part of anterior crus of right internal capsule. There was enlargement of anterior horn of the right lateral ventricle. Caloric test, electronystagmography, eye tracking test or optokinetic nystagmus test disclosed no abnormalities. Vibration induced falling, which is the postural reaction to muscle vibration during standing (Ekuland, G., 1972), was not recognized when the left Achiles' tendon was stimulated. Pseudoataxia of this patient differed from the typical cerebellar or vestibular ataxia. From a review of the literatures concerning frontal pseudoataxia, almost all cases had no distinct cerebellar signs, and showed positive Romberg's sign. The impairment of tactile-tactile form and postural reaction to vibratory stimulation to the left leg, appeared in this case, could be hardly explained by the lesion of parietal lobe or deconnection syndrome. Sensory perception of parietal lobe and pyramidal motor system were thought to be almost normal in this case. Therefore, these findings should be due to impairment of integration center between sensory and motor systems. The pseudoataxia in frontal lesion seems to occur as the results of involvement of this center, in which caudate nucleus maybe has important role, but not as the results of disturbances in the front-ponto-cerebellar or front vestibular pathway.

Ataxia↗
PubMed1981

[Asymptomatic multiple sclerosis - 3 cases (author's transl)].

Multiple Sclerosis (MS) cases found at autopsy in patients who had died from other diseases and in whom no sign or symptom could be related to MS are called "asymptomatic". Three cases are reported. The first patient was a 62 year old man who presented with a slowly progressive disturbance of gait, incontinence and deterioration of intellectual function. A falx meningioma was surgically removed. The patient died 3 years later with an acute respiratory illness. Examination of the brain disclosed evidence of the operation and numerous old plaques disseminated through the cerebral hemispheres (centrum semi-ovale, periventricular regions, internal thalamus and junction between cortex and white matter) and in the brain stem. The second case, a 77 year old woman with diabetes mellitus and hypertension, presented with cortical blindness and disturbances of memory of acute onset. She died one year later. Examination of the brain showed multiple infarcts involving the territories of both posterior cerebral arteries and the left middle cerebral artery. Numerous old plaques were seen in the periventricular regions, in the corpus callosum and in the left middle cerebellar peduncle. The third case, a 60 year old woman with mitral and aortic stenosis, presented with cortical deafness and transient right hemiparesis. She died 5 years later. Brain examination showed infarcts involving both middle cerebral artery territories. There was also many old plaques in the periventricular areas, thalamus, internal capsule, centrum semi-ovale, brain stem and right nucleus dentatus. In the 3 cases, the optic tracts were normal. The spinal cord, examined only in the first case, was also normal. The asymptomatic character of these MS cases can be explained first by the location of the plaques and the lack of spinal cord and optic tract involvement. It could also be due to the small size of the plaques and to axonal preservation. Such features are rare since our 3 observations have been selected from a pathological collection of 125 MS cases and 9,300 general neuropathological records. Six other cases have been previously reported by other authors.

Aged↗
PubMed1980

Embryonal and fetal development of capillaries: microangiographic investigations. II. The telencephalon.

The development of the intracerebral capillaries of the telencephalon was studied by the combined techniques of microangiography and histology in embryos and fetuses of cattle and pigs. In the telencephalic colliculi ganglionares, vascularization starts during the 4th week of gestation and leads to the formation of a peripheral and a central arterial system separated by the internal capsule. Capillary development within the pallium occurs 3 weeks later and consists in the formation of longitudinal arteries, concentrically arranged rings of deviations and bifurcations, and a periventricular capillary network.

Angiography↗
PubMed1980

[318 cases of intracerebral hemorrhage. A pathologic study (author's transl)].

The systemic analysis of cerebral hemorrhages (large single and multiple hematomas and small slit-hemorrhages) has been practiced in 318 patients. The emphasis is put on the site of the bleeding and the etiological data. Single hematomas were situated: 1) in 127 cases in the basal ganglia region (26 were medial, 44 intermediate, 48 lateral, 8 quadrilateral and one subthalamic), 2) in 67 cases in cerebral lobes (24: front; 22: temporal; 21 parietal) and 3) in 33 cases in the posterior fossa (19: cerebellum; 14: brain stem). Large hematomas in 71 cases and slit-hemorrhages in 20 others were multiple. In more than one case out of three, lateral hematomas extended into the temporal lobe and in one case out of two, the internal capsule was affected. The incidence of high blood pressure is significantly higher in patients with intermediate haematomas and slit hemorrhages. This factor is often found in lateral or cerebellar hematomas. Anticoagulant therapy is more frequent in lobar hematomas. In 43 cases without any proved etiology, the patients' mean age of death is inferior to that of the whole studied population. These findings are discussed in relation with the literature data.

Aged↗
PubMed1994

Subplate pioneers and the formation of descending connections from cerebral cortex.

The adult cerebral cortex extends axons to a variety of subcortical targets, including the thalamus and superior colliculus. These descending projections are pioneered during development by the axons of a transient population of subplate neurons (McConnell et al., 1989). We show here that the descending axons of cortical plate neurons appear to be delayed significantly in their outgrowth, compared with those of subplate neurons. To assess the possible role of subplate neurons in the formation of these pathways, subplate neurons were ablated during the embryonic period. In all cases, an axon pathway formed from visual cortex through the internal capsule and into the thalamus. In half of all cases, however, cortical axons failed to invade their normal subcortical targets. In the other half, targets were innervated normally. Subplate neurons are therefore likely to provide important cues that aid the process by which cortical axons grow toward, select, and invade their subcortical targets.

Afferent Pathways↗
PubMed1995

Dopaminergic microtransplants into the substantia nigra of neonatal rats with bilateral 6-OHDA lesions. I. Evidence for anatomical reconstruction of the nigrostriatal pathway.

Reconstruction of the nigrostriatal pathway by long axon growth derived from dopamine-rich ventral mesencephalic (VM) transplants grafted into the substantia nigra may enhance their functional integration as compared to VM grafts implanted ectopically into the striatum. Here we report on a novel approach by which fetal VM grafts are implanted unilaterally into the substantia nigra (SN) of 6-hydroxydopamine (6-OHDA)-lesioned neonatal pups at postnatal day 3 (P3) using a microtransplantation technique. The results demonstrate that homotopically placed dopaminergic neurons survive and integrate well into the previously 6-OHDA-lesioned neonatal SN region. Moreover, the tyrosine hydroxylase (TH)-positive neurons extended axons rostrally along the white matter tract of the internal capsule closely following the course of the original nigrostriatal pathway. The graft reestablished a TH-positive axon terminal network in the ipsilateral caudate-putamen, with the highest density in the medial and central parts. Retrograde labeling with Fluoro-Gold from the host striatum demonstrated that most of the transplant neurons giving rise to the graft-derived fiber outgrowth were TH-positive, but revealed also a small proportion of projecting neurons which were TH-negative. Amphetamine-induced striatal Fos expression was normalized in the caudate-putamen ipsilateral to the intranigral VM grafts, showing hyperexpression in some areas of the striatum, and the apomorphine-induced Fos expression seen in the 6-OHDA-lesioned animals was completely reversed on the grafted side. These findings indicate that the graft-derived dopaminergic reinnervation of the striatum is functional. The microtransplantation strategy may provide new avenues for the exploration of morphological and functional integration of fetal dopamine neurons in the nigrostriatal system and give new insights into the mechanisms controlling long-distance axon growth in the brain.

Amphetamine↗
PubMed1975

[A case of primary reticulum cell sarcoma of the brain with uveitis (author's transl)].

In 1972, Neault and his co-workers reported seven cases of uveitis associated with intracranial reticulum cell sarcoma. Recently we have experienced a similar case for the first time in Japan. A 32-year-old woman registered on March 10, 1971, complaining of blurred vision in the left eye for about two weeks. By ophthalmic examination, left posterior uveitis was diagnosed but the etiology was unknown. Treatment with corticosteroids was begun, but her left eye continued to fail in spite of the treatment. In August, 1971, she complained of weakness of left arm and leg, and in October, she suffered from severe headache and vomiting. At that time, uveitis appeared in the right eye too. Neurological findings and carotid angiogram indicated a right cerebral lesion. On November 5, 1971, a right frontoparietal craniotomy was performed but no tumor was found. Since then her neurological and eye symptoms had been progressively worse. The patient died on July 12, 1972. Postmortem examination revealed the tumor infiltrating in the bilateral diencephalon, left internal capsule, left lenticular nucleus, left temporal lobe, midbrain, pons, left dentate nucleus, optic chiasma and intracranial portion of the optic nerves. But no tumor was found at any other parts of the body. Histologically the tumor was a reticulum cell sarcoma. The eyeballs were not examined histologically, but the uveitis in this case was thought to be closely related to the intracranial reticulum cell sarcoma. If the uveitis is resistant to the treatment, we must consider a possibility of reticulum cell sarcoma of the brain.

Adult↗
PubMed1976

Early and late histologic effects of stereotactic neurosurgery.

The histologic lesions produced in the brain by stereotactic chemosurgery and cryosurgery are reviewed in four patients who died from 25 days to 15 years postoperatively. Three of four patients had damage to the internal capsule and died of pulmonary emboli. The early lesions are histologically nonspecific, but the old lesions of chemopallidectomy and chemothalamectomy in one patient contained metaplastic bone. Lesions produced by freezing are more discrete than those made by chemical means.

Adult↗
PubMed1995

[Infarction in the area of the right anterior choroidal artery and minor hemisphere syndrome: clinical and metabolic study using positron-emission tomography].

A 72 year-old right handed woman had a right sided anterior choroidal artery infarction. She presented the triad of hemiplegia, hemianaesthesia, and homonymous hemianopsia, as well as complete non-determinant hemisphere syndrome that combined: disorientation for place and time, anosognosia, hemiasomatognosia, left spatial neglect, constructional apraxia and spatial fabulation concerning both the present time and the weeks that preceded the vascular event. Language and verbal memory were normal. Spatial memory could not be studied because of the severity of the neglect. The clinical course was poor: when tested one and a half year post-onset, the hemiplegia, the hemianaesthesia, and the hemianopsia as well as left spatial neglect remained severe. Vestibular caloric stimulation, carried out with left ear cold water irrigation, resulted in brief but clear-cut alleviation of the spatial neglect. An MRI with both axial and coronal slices showed a right-sided infarct affecting the whole posterior limb of the internal capsule including the genu, the posterior part of the globus pallidus, the anterior third of the cerebral peduncle and the amygdala but sparing the thalamus and the corona radiata. This crescent-shaped lesion transected entirely the thalamo-cortical connection fibers which resulted in a "thalamic exclusion". The measurement of brain glucose utilisation with (18F)-Fluoro-2-Deoxy-D-Glucose and positron emission tomography performed in the chronic phase (3 months post-onset) showed an exceptionally severe and widespread hypometabolism of the right hemisphere, relative to the left hemisphere, which correlated with both the unusual, severe and protracted non-dominant hemisphere syndrome. All the brain regions on the right side were hypometabolic relative to the left including the temporal region (mostly medial temporal), the left cerebellar lobe, the frontal lobe (mostly prefrontal region), the occipital region and the thalamus. The hypometabolism of the basal ganglia, the sensorimotor area and the parietal cortex was less severe. This most uncommon clinical-metabolic presentation presumably reflects a global thalamo-cortical disconnection inducing a diffuse dysfunction of the whole hemisphere.

Aged↗
PubMed1995

[Deficiency in the reproduction and learning proper names after left tubero-thalamic ischemic lesion].

Predominant impairment or preservation of category-specific naming and comprehension is not rare in aphasics. Much less frequent is a selective inability to generate proper names. To our knowledge, only one such case has been reported after a left thalamic lesion, located in the ventral anterior nucleus, the mamillo-thalamic tractus and the genu of the internal capsule. We report a new case of selective inability to generate proper names after a left tubero-thalamic infarct. A 65-year old right-handed man presented with a selective impairment in producing proper names, both from photographs or descriptions and on tests of verbal fluency. The deficit was obvious both for persons names and for geographical names. The rest of the neuropsychological testing was remarkable only for a mild verbal amnesia, affecting only serial material (list of words), a reduced fluency for flowers, fruits and musical instruments, difficulties in learning of new words, and a dissociation between preserved learning for words on a test of learning of words and occupations (Cohen, 1990). This anomia for proper names could result from an indirect frontal-lobe dysfunction, preventing voluntary activation of the phonological representation of proper names.

Aged↗
PubMedDate not supplied

White matter changes associated with feline GM2 gangliosidosis (Sandhoff disease): correlation of MR findings with pathologic and ultrastructural abnormalities.

PURPOSE: To establish changes on MR of the brain in a feline model of Sandhoff disease in order to develop standards by which this model may be used in future noninvasive studies. METHODS: Five affected felines and six age-matched, littermate controls were evaluated. T1- and T2-weighted images were obtained once or twice for each of four affected and five control animals at 4 1/2 to 12 weeks of age, for a total of 15 MR examinations. Images were evaluated qualitatively for the pattern of myelination and the size of the ventricular system. After the animals were killed, pathologic specimens of the brain were examined with light and electron microscopy, and pathologic changes were correlated with MR. RESULTS: Compared with control animals, affected animals showed MR evidence of delayed myelination, manifested by white matter signal hypointensity on T1-weighted images and signal hyperintensity on T2-weighted images. This finding was corroborated by histopathologic findings of decreased myelin in the subcortical and internal capsule regions. White matter abnormalities were not detected ultrastructurally in the animals examined. CONCLUSION: Although GM2 gangliosidosis is primarily a neuronal disease, MR imaging can show changes in myelination of white matter tracts that may be secondary to the neuronal damage. This provides a noninvasive method of in vivo monitoring as therapeutic strategies are developed in this animal model.

Age Factors↗
PubMed1993

Modifications of the distribution of substance P-like immunoreactivity in the cerebral basal nuclei of the cat after electroacupuncture.

The distribution of Substance P in the fibrillar structures of the basal nuclei of the cat brain, and its modification with low frequency electroacupuncture (EA) stimulation, have been studied using the indirect immunocytochemistry technique. An increase in the immunoreactivity of Substance P (IR-SP) after stimulation with EA has been observed in the nucleus caudatus and nucleus putamen, in the globus pallidus, and in the amygdaloid complex. Abundant IR-SP fibres have also been seen in some areas of the internal capsule. These observations place the said IR-SP modifications in the basal nuclei of the cat brain, when subjected to low frequency EA.

Animals↗
PubMed1993

[The detection of corticoliberin in the neurosecretory cells of additional Gomori-positive centers in the rat hypothalamus].

The experiments were carried out in male Wistar rats in which deafferentation of the mediobasal hypothalamus was performed or colchicine (75 micrograms/10 microliters of saline) was inoculated into the III ventricle cavity. Using the PAP-method, the presence of corticoloberin was determined immunohistochemically in neurosecretory cells of additional groups (AG) of the hypothalamus: circular, perifornical (PFG), dorsolateral, ventrolateral, as well as extrahypothalamically located group (the internal capsule area). The intact rats were shown to have no corticoliberin-immunoreactive (CL-IR) cells in any of AG. After experimental treatments, CL-IR cells appeared in PFG only but not in any other AG. In the experimental rats, two types of CL-IR cells were demonstrated in PFG. The first type consisted of cells of 15-20 microns in diameter with processes, similar to those found in the paraventricular nucleus. The second type consisted of large cells (40-50 microns in diameter) with morphological features of nonapeptidergic ones whose cytoplasm gave a weak reaction with antiserum to corticoliberin. Thus, among AG of various localizations PFG alone contained CL-IR cells which indicated the involvement of this group into realization of the stress reaction.

Afferent Pathways↗
PubMed1995

Deep brain stimulation for the relief of chronic pain.

Deep brain stimulation analgesia is an effective method of treating otherwise intractable chronic pain, with few side-effects, and long-term good or better results in 50% to 80% of patients, depending on etiology and stimulation site. In general, the best results are in deafferentation pain with internal capsule stimulation and somatic pain with periventricular stimulation.

Brain↗
PubMed1995

Increased brain water self-diffusion in patients with idiopathic intracranial hypertension.

PURPOSE: To investigate changes in brain water diffusion in patients with idiopathic intracranial hypertension. METHODS: A motion-compensated MR pulse sequence was used to create diffusion maps of the apparent diffusion coefficient (ADC) in 12 patients fulfilling conventional diagnostic criteria for idiopathic intracranial hypertension and in 12 healthy volunteers. RESULTS: A significantly larger ADC was found within subcortical white matter in the patient group (mean, 1.16 x 10(-9) m2/s) than in the control group (mean, 0.75 x 10(-9) m2/s), whereas no significant differences were found within cortical gray matter, the basal nuclei, the internal capsule, or the corpus callosum. Four of 7 patients with increased ADC in subcortical white matter also had increased ADC within gray matter. CONCLUSION: Measurement of diffusion coefficients in vivo demonstrated increased local water mobility within subcortical white matter in 7 patients with idiopathic intracranial hypertension that otherwise appeared normal on conventional MR imaging. Further studies are necessary to assess the clinical significance of these observations.

Adolescent↗
PubMed1994

[Transcranial magnetic stimulation].

The technique of transcranial magnetic stimulation of the motor cortex is a new neurophysiological examination of the central motor pathways. In clinical application a reduced MEP/M wave amplitude ratio had a higher correlation with hyperreflexia than did a delayed MEP onset latency. The inhibitory period (IP) which is a transient suppression of muscle action potentials following motor evoked potentials (MEP) by magnetic cortical stimulation is caused primarily by inhibitory process in the motor cortex, because the duration of IP did not depend on the amplitude of MEPs, MEP distribution over the motor cortex or severity of voluntary contraction. Furthermore, the IP was shorter and the amplitude of MEP was increased when ipsilateral motor cortex stimulation to the thenar muscle preceded the contralateral cortex stimulation. C response in a patient with familial essential myoclonus was significantly suppressed by the magnetic stimulation of the sensory cortex locally and during the IP. The uncrossed pyramidal tract was proved by motor cortex stimulation in a patient with hemorrhage in the right thalamus and internal capsule who showed a right hemiparesis. The enhancement of cortical SEP amplitudes (P23 and N30) were noted when the median nerve was stimulated at 50 msec following magnetic stimulation over the sensory cortex locally. SEPs by twin coil stimulation at thoracic and lumbar root levels are useful in detecting the lesions of spinal cord or roots. Sympathetic skin responses and sudomotor potentials are recorded easily by the neck magnetic stimulation, and are useful method for evaluating sympathetic nerve function.

Cerebral Cortex↗
PubMed1995

[Infarcts in the brain areas supplied by the posterior cerebral artery. Clinical aspects, pathogenesis and prognosis].

The clinical and neuroradiological features of 127 patients with ischemia of the posterior cerebral artery (PCA) and a positive CT scan (n = 122) or pathological angiography findings (n = 63) were analyzed. Unilateral headache was the most common presenting symptom (50%), making complicated migraine an important differential diagnosis. Clinical findings were visual field deficits (93%), sensory (29%), motor (28%), and neuropsychological deficits (25%). Infarcts, including the thalamus (n = 27), were mostly associated with sensory and slight motor deficits. Our findings suggest that motor deficits in PCA ischemia, particularly if minor and reversible, are likely to be due to ischemia-induced edema in the internal capsule adjacent to an associated thalamic infarct. Based on angiography, stroke etiology was considered embolic in 83/127 (65%), atherothrombotic in 20/126 (16%), and probably migrainous in 4 (3%) patients. In the remaining 20 patients (16%), the etiology was uncertain. Prognosis of PCA infarcts is usually good.

Adolescent↗
PubMed1994

[Bilateral infarction of the caudate nuclei].

We report the case of a 57-year-old right-handed woman, with a history of hypertension, who, in February 1990, suddenly developed behavioral and cognitive abnormalities. Prior to the onset of her illness she had been normal. On examination, neuropsychological testing (Wechsler Mental Test, Wechsler Adult Intelligence Scale Revised, Knox Cube Test) elicited attention abnormalities, decreased recent memory, apathy, reduced spontaneity and initiative and left hemiparesia. CT scan showed small low density areas in the head of both caudate nuclei and right internal capsule, indicating infarction. Two years later, the deficit had partially resolved. Apathy persisted; psychometry showed an IQ of 57. Bilateral damage to the head of the caudate nuclei disrupt cortical-subcortical connections. The caudate nucleus is an essential component of basal ganglia-thalamo-cortical circuitry and its contribution to cognitive functions and behavior appears to be important.

Caudate Nucleus↗

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