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[Current and future aspects of mitochondrial diseases].

Though mitochondria have been a major source of energy production in eukaryotae since 15-20 billion years previously, existence of disorders due to primary abnormalities of their DNA has not been known until very recent years. In 1962, Luft et al reported the first case of such myopathy, and another case reported in 1967 by Shy et al was also the first case of generalized disorder with mitochondrial abnormalities. Since then, many case reports have followed including MELAS and other encephalomyopathies. Finally, in 1989, deletion of mitochondria DNA was found by Folt et al. Today, these disorders were able to be classified as follows: 1) LHON and A1555G type deafness as strictly limited non-syndromic type, 2) encephalomyopathies and their incomplete forms due to common and other deletions of mitochondria DNA, 3) encephalomyopathies and their incomplete forms including MIDD, diabetes mellituis, cardiomyopathy, deafness due to point mutations of mitochondria DNA related MELAS and others, 4) Neurodegenerative types including Parkinson's disease, Alzheimer's disease, cerebellar degeneration, and amyotrophic lateral sclerosis, or neurologic disorders mimic to such diseases, 5) Mitochondrial involvement not due to primary abnormalities of mitochondria DNA. Possible mechanisms were discussed, but sufficient knowledge is lacking so far to clarify pathophysiology of these disorders and the role of deleterious DNA in aging. Possible effective therapeutic strategies were also discussed, but further development of research works on these disorders in the 21st century are needed to answer these questions.

Female↗

Neuronal intranuclear hyaline inclusion disease with progressive cerebellar ataxia.

Neuronal intranuclear hyaline inclusion disease is a progressive, fatal neurologic condition characterized by eosinophilic inclusions in neurons of the central, autonomic, and peripheral nervous systems. The clinical and pathologic findings of a 4-year-old boy who presented with a rapidly progressive cerebellar ataxia and seizure disorder that had begun 2 years earlier are described. Although intraneuronal inclusions were identified in neurons of cortex, basal ganglia, brainstem, cerebellum, and spinal cord, clinical signs were restricted to cerebellar ataxia, internuclear ophthalmoplegia, and cognitive delay. Predominant cerebellar atrophy, early age of onset, and short clinical course distinguishes it from previously reported patients.

Atrophy↗

Legionnaires' disease with profound cerebellar involvement.

An acute febrile illness with pulmonary infiltration and severe cerebellar deficit developed in a woman. The diagnosis of Legionnaires' disease was confirmed by indirect fluorescent antibody tests. Legionnaires' disease should be considered as a diagnostic possibility in patients with pneumonia and cerebellar dysfunction.

Cerebellar Diseases↗

Saccadic dysmetria induced by transient functional decortication of the cerebellar vermis [corrected].

Saccadic dysmetria is seen in patients with cerebellar diseases as well as in monkeys whose vermis and fastigial nucleus are experimentally lesioned. We investigated the oculomotor signs of the vermis by blocking cerebellar impulses with bicuculline injections into the fastigial nucleus. The oculomotor abnormalities associated with the bicuculline treatment (in effect, functional as well as reversible, unilateral decortication of the vermis) were hypometric saccades toward the injection side and gaze deviation toward the opposite side. These oculomotor signs disappeared with the withdrawal of the bicuculline effect.

Animals↗

Cerebellar cortical abiotrophy in a beagle.

A beagle puppy was presented with clinical signs indicative of a cerebellar disease. Histopathological evaluation of the cerebellum revealed a diffuse degenerative cortical lesion. The clinical history and the histopathological findings are consistent with a neonatal cerebellar abiotrophy. Furthermore, the breeding history supports the hypothesis of an inherited genetic disorder that is, most likely, an autosomal recessive trait.

Animals↗

Essential tremor and cerebellar dysfunction: abnormal ballistic movements.

BACKGROUND: Clinical characteristics reminiscent of cerebellar tremor occur in patients with advanced essential tremor. Ballistic movements are known to be abnormal in cerebellar disease. The hypothesis was proposed that ballistic movements are abnormal in essential tremor, reflecting cerebellar dysfunction. OBJECTIVE: To elucidate the role of the cerebellum in the pathophysiology of essential tremor. METHODS: Kinematic parameters and the triphasic electromyographic (EMG) components of ballistic flexion elbow movements were analysed in patients assigned to the following groups: healthy controls (n = 14), pure essential postural tremor (ET(PT); n = 17), and essential tremor with an additional intention tremor component (ET(IT); n = 15). RESULTS: The main findings were a delayed second agonist burst (AG(2)) and a relatively shortened deceleration phase compared with acceleration in both the essential tremor groups. These abnormalities were most pronounced in the ET(IT) group, which had additional prolongation of the first agonist burst (AG(1)) and a delayed antagonist burst (ANT). CONCLUSIONS: Abnormalities of the triphasic pattern and kinematic parameters are consistent with a disturbed cerebellar timing function in essential tremor. These abnormalities were most pronounced in the ET(IT) group. The cerebellar dysfunction in essential tremor could indicate a basic pathophysiological mechanism underlying this disorder. ET(PT) and ET(IT) may represent two expressions within a continuous spectrum of cerebellar dysfunction in relation to the timing of muscle activation during voluntary movements.

Adult↗

Tuberous sclerosis: differences between cerebral and cerebellar cortical tubers in a pediatric population.

BACKGROUND AND PURPOSE: Histologic evidence of cortical tubers is pathognomonic of tuberous sclerosis (TS) disease. Cerebellar tubers, however, are uncommonly found. Our objective was to evaluate the prevalence and characteristics of cerebellar tubers in a large series of pediatric patients with TS studied with MR imaging. In particular, their relationship with volume loss and age will be analyzed. METHODS: MR images of 34 children with TS and cortical tubers were reviewed. There were 17 female and 17 male patients. The mean age was 8.9+/-4.5 years (mean +/- SD), with a range from 2 to 14 years. The number and location (supratentorial, infratentorial) of tubers and volume loss of the underlying parenchyma were recorded. The relationship between tuber location, patient age, and number of tubers was studied using the Student's t test for independent samples. The relationship between tuber location and presence of volume loss was established using the Pearson chi2 test. RESULTS: The mean number of cortical tubers was 14.3+/-8.5. Fifteen (44.1%) patients had cerebellar tubers associated with cerebral lesions. Patients with cerebellar and cerebral tubers had significantly more global cortical lesions than did patients with isolated cerebral tubers (17.9+/-8.9 versus 11.4+/-7.2 tubers, P = .026). Patients with cerebellar tubers were significantly older than those with isolated supratentorial tubers (11.3+/-3.4 versus 7.1+/-4.4 years, P = .005). In only four (11.8%) patients were tubers associated with focal parenchymal volume loss. The tubers in all of these cases were located in the cerebellum-indicating a significant relationship with volume loss (Pearson chi2 test, P = .017). CONCLUSION: In this series, cerebellar tubers were frequent and were always present in association with cerebral cortical tubers. They were seen in older children with a larger total number of tubers. Cerebellar tubers may be associated with focal volume loss.

Adolescent↗

Brain metastases from ovarian cancer.

Brain metastasis from ovarian carcinoma is a relatively rare phenomenon. At NYU Medical Center five patients were treated for this entity from 1982 to 1985. The stage at presentation ranged from stage I to stage III, and all patients had received or were receiving chemotherapy. Two patients had active disease elsewhere at diagnosis of brain metastasis, but three patients were otherwise NED. Three patients had solitary cerebellar disease, and two patients had multiple lesions. All patients were treated with whole brain radiotherapy to 3,000 cGy, with neurological improvement in three of the five patients. The central nervous system may need special consideration for prophylactic treatment in those patients with ovarian cancer who receive adjuvant chemotherapy.

Adenocarcinoma↗

Cerebellar voice tremor: an acoustic analysis.

Patients with cerebellar disease may exhibit tremulous phonation as part of their dysarthria. The results of an acoustic analysis of cerebellar voice tremor in a patient with hereditary ataxia and presenting with a purely cerebellar syndrome are reported. Analysis included computation of speech intensity contours, fundamental frequency contours, and spectral parameters from sustained productions of vowels and voiceless fricatives. Fundamental frequency contours during sustained phonation of vowels showed rhythmic oscillations at a rate of about 3 Hz. No concomitant periodicity could be detected for the parameters characterising voiceless fricative production. The results indicate an impairment of phonatory control in relation to the maintenance of a constant isometric activity of the internal laryngeal muscles. Cerebellar voice tremor may therefore be classified as a form of postural tremor.

Cerebellum↗

Typical features of cerebellar ataxic gait.

BACKGROUND: Although gait disturbance is one of the most pronounced and disabling symptoms in cerebellar disease (CD), quantitative studies on this topic are rare. OBJECTIVES: To characterise the typical clinical features of cerebellar gait and to analyse ataxia quantitatively. METHODS: Twelve patients with various cerebellar disorders were compared with 12 age matched controls. Gait was analysed on a motor driven treadmill using a three dimensional system. A tandem gait paradigm was used to quantify gait ataxia. RESULTS: For normal locomotion, a significantly reduced step frequency with a prolonged stance and double limb support duration was found in patients with CD. All gait measurements were highly variable in CD. Most importantly, balance related gait variables such as step width and foot rotation angles were increased in CD, indicating the need for stability during locomotion. The tandem gait paradigm showed typical features of cerebellar ataxia such as dysmetria, hypometria, hypermetria, and inappropriate timing of foot placement. CONCLUSIONS: Typical features of gait in CD are reduced cadence with increased balance related variables and an almost normal range of motion (with increased variability) in the joints of the lower extremity. The tandem gait paradigm accentuates all the features of gait ataxia and is the most sensitive clinical test.

Disability Evaluation↗

Synaptic neurochemical alterations associated with neuronal degeneration in an inherited cerebellar ataxia of Gordon Setters.

Canine Inherited Ataxia (CIA) is an autosomal recessive cerebellar disease of Gordon Setters associated with degeneration of Purkinje and granule cells. To define specific biochemical correlates of neuronal loss, synaptic neurochemical parameters were measured in three cerebellar regions (vermis, "pars intermedia," and hemisphere) at early and late stages of this disease. At one and a half years of age, affected dogs showed the most severe lesions in the "pars intermedia," with a 39% decrease in the number of Purkinje cells and a 29% decrease in granule cells. Neurochemical measurements demonstrated decreased [3H]muscimol binding and elevations in norepinephrine concentration (248% above control) and [3H]glutamate receptor binding (118% above control). At five years of age, reduction of Purkinje cells in the three cerebellar regions ranged from 65 to 91% while loss of granule cells was between 13 and 53%. [3H]Muscimol binding remained low throughout the cerebellum (38 to 59% of control) and norepinephrine concentration and [3H]glutamate binding were markedly reduced from the levels observed at one and a half years. Glutamate decarboxylase activity, [3H]QNB binding and GABA concentration were relatively unaffected. Our results indicate that neurochemical parameters associated with cerebellar neuronal systems demonstrate specific alterations in a chronic degenerative disorder. This study also indicates the importance of evaluating neurochemical measurements with regard to both spared and degenerating neuronal systems and emphasizes the role of compensatory neurochemical alterations in cerebellar degenerative disorders.

Animals↗

Eales' disease with neurological involvement. Part 2. Pathology and pathogenesis.

Detailed neuropathologic examination was carried out on 1 case of Eales' disease with CNS involvement, in the form of retinal vasculopathy, followed first by signs of brain stem and cerebellar disease and then by a myelopathy, with death 4 years later from retinal infection. There was mild chronic inflammation in the retina, and sub-total demyelination of one optic nerve. The brain stem and cerebellum showed extensive vasculopathy, with various stages of venous change extending from proliferation and dilatation to haemorrhage, or to thickening with hyalinisation. The perivenular brain tissue, particularly of the cerebellum, often showed demyelination, with relative axon preservation, but no inflammation. Similar, but less pronounced venopathy was seen in the dorsal cord. There was ascending degeneration of Goll's columns and descending degeneration of the lateral columns.

Adult↗

Eye-head co-ordination in patients with Parkinsonism and cerebellar ataxia.

Eye-head co-ordination of patients with Parkinsonism and cerebellar ataxia was investigated and compared with that of normal subjects. In Parkinsonian patients eye-head co-ordination was of the same pattern as normals, with an accurate and stable gaze. Reaction times for both eyes and head, however, were prolonged. It was also noted that the contribution of head movements to gaze shift was abnormally large and that the gaze accuracy was decreased when the head was immobilised. In patients with cerebellar ataxia, gaze was dysmetric, often hypermetric, and was unstable during head movements. The contribution of head movements to gaze was also large. It is concluded that Parkinsonism and cerebellar diseases influence eye-head co-ordination differently.

Adult↗

Coeliac disease presenting with cerebellar degeneration.

A case of rapidly progressive cerebellar degeneration with bilateral sixth nerve palsies is described in whom investigation revealed the presence of unsuspected coeliac disease. In spite of treatment with a gluten free diet, rapid fatal deterioration occurred. Coeliac disease should be considered in patients with encephalopathy of obscure origin.

Abducens Nerve↗

Oculomotor studies of cerebellar function in autism.

Histopathological, neuroimaging and genetic findings indicate cerebellar abnormalities in autism, but the extent of neurophysiological dysfunction associated with those findings has not been systematically examined. Suppression of intrusive saccades (square wave jerks) and the ability to sustain eccentric gaze, two phenomena requiring intact cerebellar function, were examined in 52 high-functioning individuals with autism and 52 age- and IQ-matched healthy subjects during visual fixation of static central and peripheral targets. Rates of intrusive saccades were not increased in autism during visual fixation, and foveopetal ocular drift was also not increased when subjects held an eccentric gaze. The absence of gross disturbances of visual fixation associated with cerebellar disease in individuals with autism, such as increased square wave jerk rates and foveopetal drift when holding eccentric gaze, indicates that the functional integrity of cerebellar--brainstem networks devoted to oculomotor control is preserved in autism despite reported anatomic variations. However, increased amplitude of intrusive saccades and reduced latency of target refixation after intrusive saccades were observed in individuals with autism, especially when subjects maintained fixation of remembered target locations without sensory guidance. The atypical metrics of intrusive saccades that were observed may be attributable to faulty functional connectivity in cortico-cerebellar networks.

Adolescent↗

Characteristic alterations of long-loop "reflexes" in patients with Friedreich's disease and late atrophy of the cerebellar anterior lobe.

Sudden tilting of a platform around the axis of the human ankle joint causes a regular pattern of short and medium latency EMG responses in the stretched triceps surae muscle and a long latency response in its antagonist, the anterior tibial muscle. This paper reports alterations of these EMG responses in 41 patients with cerebellar lesions. Patients with anterior lobe atrophy exhibited normal latencies of all EMG responses, but an increase in duration and amplitude of the long latency response. This may at least partially explain the 3 Hz postural tremor, which can be evoked in these patients through a toe-up tilt of the platform. Patients with lesions restricted to the vestibulocerebellum and to the cerebellar hemispheres exhibited normal latencies of all EMG responses. The most specific finding in all of the patients suffering from Friedreich's ataxia (affecting spinal afferents) was the massive delay of the stabilising response of the anterior tibial muscle. The fact that the patients with lesions restricted to the cerebellum invariably exhibited normal latencies of postural "reflexes" indicates that the exact "timing" of these responses is independent of the cerebellum. The duration and amplitude of the long latency response of the antagonist, however, seems to be controlled by the cerebellum.

Afferent Pathways↗

Transient cerebellar eye closure and mutism after cerebellar tumor surgery: long-term clinical follow-up of neurologic and behavioral disturbances in a 14-year-old girl.

Transient cerebellar eye closure (TCES) is a complication of cerebellar tumor surgery in children and is almost exclusively observed in the context of the syndrome of mutism and subsequent dysarthria. As knowledge about the course of transient cerebellar eye closure is absent, we describe in detail the clinical picture in a 14-year-old girl. The process of improvement of TCES is characterized by four distinct phases, can last more than 1 month and may be associated with severe persistent cerebellar dysfunction.

Adolescent↗