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PubMed1994

Neurosonographic abnormalities in neonates with hypoxic ischemic encephalopathy.

Pattern of neurosonographic (NSG) abnormalities in 150 term newborn infants with hypoxic ischemic encephalopathy (HIE) was studied. Sonographic abnormalities, presumably indicating cerebral edema and or ischemia, were observed in 86% (n = 129) cases. Obliteration of the ventricles occurred as the sole abnormality in 30 (20%) cases. Eighty (53%) patients had diffusely increased echogenicity of the brain parenchyma (DPE) in addition to the compression of the ventricles, sulci and the interhemispheric fissure. Focal parenchymal echodense (FPE) lesions occurred in nine (6%) neonates with HIE. Ten (6.6%) patients, however, had increased periventricular echogenicity (PVE). Two patients, one with focal parenchymal lesions and the other with PVE had obliterated ventricles in addition. Regarding temporal sequence earliest NSG abnormalities were DPE or slit like ventricles that were observed on day-1 itself. Focal or periventricular echogenic lesions, however, made their first appearance on day-3 of life. Twenty one patients had normal scans. Fifty patients with abnormal scans died. None of the infants with normal scans, however, died (p < 0.001). At 4 weeks of age, scans performed in 100 survivors revealed no abnormality in 51 cases. Others showed development of cerebral atrophy (n = 21), multicystic encephalomalacia (n = 2), porencephalic cyst (n = 1), or persistence of PVE without cystic changes (n = 4). The results of this study highlight the diagnostic efficacy of neurosonography in cases of HIE. We suggest that it should be incorporated in the routine evaluation of patients with hypoxic brain injury.

Asphyxia Neonatorum↗
PubMed1994

Cranial ultrasonic assessment of infants with acute bacterial meningitis.

A prospective study was performed on 44 patients (newborn to one year old) with acute bacterial meningitis. Sonograms were obtained within 72 hours of diagnosis, and repeated on 7th, 14th or at an early date, if required. The spectrum of sonographic features of meningitis included normal scan (35.4%), echogenic sulci (63.7%) and parenchyma (29.5%), ventriculomegaly (59%), ventriculitis (35%), pseudo-porencephalic cyst (4.4%), extra axial fluid collection (4.4%), encephalomalacia (2.2%) and cerebral abscess (2.2%) in patients.

Acute Disease↗
PubMedDate not supplied

Intracranial calcification in children on computed tomography.

Pathological intracranial calcifications detected on computed tomography of 83 children during a six-year period were reviewed. The common causes in our series were tuberous sclerosis and intracranial tumors. Other conditions associated with calcification were Sturge-Weber syndrome, neurofibromatosis, Cockayne's syndrome, hypoparathyroidism, arteriovenous malformations, vein of Galen aneurysm, encephalomalacia, cerebral infarcts, subdural hematoma, cerebral infections, birth asphyxia and dihydropteridine reductase deficiency. In two cases (2%), calcifications were idiopathic. The distribution and location of the calcifications in these conditions are discussed.

Adolescent↗
PubMed1993

Cerebral infarcts in newborns and infants with cyanotic cardiac anomalies.

Neuropathological examination of six brains of newborns and infants who died in the course of congenital cyanotic cardiac anomalies showed focal brain lesions. The material included five cases from two weeks to two months of age, and one two-year-old infant. In two of them, the periventricular ischemic infarcts were found, in one multifocal encephalomalacia due to multiple vascular occlusions, and in three the necrotic foci corresponded to the supply of large cerebral arteries. The character and topography of severe brain lesions, particularly within the hemispheric white matter, were clearly influenced by the immaturity of the cerebral structures.

Astrocytes↗
PubMed1976

[Cortisone in non-hemorrhagic stroke. An anterospective comparative study (author's transl)].

In an open, randomized anterospective, comparative study on encephalomalacias it was shown that with regard to the parameter of rehabilitation progress in the degree of paralysis, the patients treated with cortisone had a significantly better performance at the 5% level. The main point of attack of cortisone appears to be in the early phase of the insult (first 5 days). It seems unlikely that edema control is the only active principle. More probably this is an additional effect on cell metabolism. From these results it seems logical to continue to follow up the acute treatment of cerebral insult with cortisone and search for an optimal dosage and better confirmation.

Aged↗
PubMed1993

Surveillance for lesions of bovine spongiform encephalopathy in U.S. cattle.

The appearance of bovine spongiform encephalopathy (BSE) as a new disease of cattle in 1985-1987 increased worldwide interest in various aspects of human and animal spongiform encephalopathies. In the United States, a part of the surveillance effort has been directed toward prospective examination of bovine brain specimens for lesions of BSE. One focus area has been to obtain specimens from cattle that (1) are two years of age or older, (2) have documented signs of neurologic disease, and (3) have received protein supplement as a substantial part of the i.v. ration. Another focus area has been to examine rabies-suspect cases that were rabies-negative. A third area has been to obtain the results of bovine neuropathology examinations being conducted at other state and regional laboratories. Specimens have been obtained by direct submission and by referral from other public health and veterinary diagnostic laboratories. Many of the cases have been classified as having (1) inflammatory lesions such as listeriosis, pseudorabies, brain abscesses and inflammation of undetermined cause, (2) degenerative lesions such as polio-encephalomalacia, lead poisoning, Wallerian degeneration, siderocalcinosis, and lipofuscinosis, (3) neoplastic lesions such as meningioma and Schwannoma, and (4) no significant findings. Other case results were reported as inflammation or no significant findings. Of the 459 cases reported here none has contained lesions with the characteristics and distribution typical of BSE.

Animals↗
PubMed1993

[A growing skull fracture: a case report].

A case of growing skull fracture was reported with some considerations on the literature. At the age of 1 year, the patient fell down stairs and struck the right occipital region, but did not receive any treatment at that time. At the age of 19 years, he suffered from several epileptic attacks and was admitted to our ward. Plain craniograms showed a right occipital bone defect measuring 7 x 3 cm in size. CT scan demonstrated a cystic lesion just beneath a membranous substance existing at the bone defect. MRI revealed cystic encephalomalacia underlying the cyst very clearly. At the operation the bone defect was found to be replaced by the granulation tissue which was examined microscopically. Under the granulation tissue, a cyst filled with yellowish fluid and surrounding gliotic brain was found. The dural tear was noticed to be much wider than the bone defect. A dural plasty with LYODURA and a cranioplasty with methacrylic resin were performed. Microscopic examination revealed the granulation tissue to be a fibroglial cicatrix. According to these findings, we concluded that the contused and swollen brain tissue which had herniated through the dural tear had enlarged the skull fracture and formed a fibroglial cicatrix with subcutaneous tissue. It is emphasized that MRI combined with CT scan is an indispensable procedure for diagnosis of growing skull fracture, and microscopic examination contributes to an understanding of its pathogenesis.

Adult↗
PubMed1993

[Acute psychosis in a patient with a combination of sickle cell disease and hemoglobin-C disease].

A 35-year-old negroid patient, known to have sickle cell-haemoglobin C disease, after heavy exercise developed an acute thrombotic crisis localised mainly in the brain. The clinical manifestations were those of an acute psychosis with severe confusion, aggressiveness, unco-operative behaviour and incontinence for faeces and urine. With adequate therapy he recovered after a few days. This so-called cerebral sickle cell crisis, confirmed by multiple small encephalomalacia lesions on the MRI which are typical of this disease, is a rare complication and difficult to diagnose.

Acute Disease↗
PubMed1996

[Perinatal brain injury in infants with depressed EEG activities immediately after birth].

We investigated the developmental outcome and features of brain imaging in 33 infants with moderate or severe depression of background EEG activities immediately after birth. Lesions due to perinatal injury were observed in 25 infants on neonatal ultrasonography and/or childhood MRI. These findings strongly correlated with their gestational age. Periventricular leukomalacia and posthermorrhagic porencephaly were observed in preterm infants. On the other hand, perinatal injury of mature brain type, such as multicystic encephalomalacia, parasagittal infarct, bilateral basal ganglia/thalamic lesion, and subcortical leukomalacia, were observed in full-term infants. Periventricular leukomalacia rather correlated with moderate depression of EEG activities than severe depression like observed in full-term neonates who have brain lesions due to perinatal asphyxia.

Asphyxia Neonatorum↗
PubMedDate not supplied

[Vein of Galen malformation: prenatal diagnosis and noninvasive procedure].

In two fetuses a vein of Galen aneurysmal malformation was prenatally diagnosed causing cardiac failure and hydrocephalus associated with marked encephalomalacia. Blood flow in the vena prosencephalica measured by Doppler ultrasonography was extremely high (1290 and 1500 ml/min maximum). In a interdisciplinary council a strictly noninvasive pre- and postnatal procedure was proposed. After adequate information both parents agreed with this approach. The neonates died immediately after birth.

Cerebral Veins↗
PubMedDate not supplied

Magnetic resonance imaging in symptomatic/cryptogenic partial epilepsies of infants and children.

In order to identify the brain lesions of symptomatic/cryptogenic partial epilepsies (S/CPEs) in infants and children, magnetic resonance imaging (MRI) studies, thorough encephalographic (EEGic) studies, and detailed clinical and neurologic evaluations were obtained in 300 infants and children who were diagnosed to have S/CPEs with onset before the age of 13 years during the past 7 years. The overall detection rate of brain lesions by MRI was 41.7% (125/300). Congenital malformations (18 cases), vascular malformations (9 cases), neurocutaneous syndromes (13 cases), and space-taking lesions (20 cases) constitute a large percentage of SPEs in infants and children. A variety of insults such as infection, ischemia, hemorrhage, trauma and metabolic disorders can result in destructive parenchymal loss lesions including porencephaly, focal atrophy, hemiatrophy, and diffuse brain atrophy (20 cases). Major etiologic factors leading to infarction, encephalomalacia, leukomalacia, included trauma, hvpoxicischemic encephalopathy (HIE), systemic lupus erythematosus (SLE), encephalitis, vasculitis, venous thrombosis, vasculopathies, and heart problems (22 cases). Mesial temporal sclerosis (MTS) could be evidenced in around 20% (18/95) of cases with temporal lobe epilepsy (TLE), which was strongly associated with past histories of febrile seizures and encephalitis complicated by status epileptics. However, cases with porencephaly, global atrophy or delayed myelination of unilateral temporal lobe on MRI were more related to HIE. With the advent of neuroimaging techniques, particularly MRI, a wide variety of underlying pathology can be detected as a cause of symptomatic partial epilepsies in pediatric patients. The occurrence of S/CPE indicates the presence of localized brain dysfunction, and many of the causes are potentially treatable. An orderly and thorough clinical and laboratory investigations, as well as neuroimaging studies should be made to diagnose and treat any underlying conditions.

Adolescent↗
PubMed1977

[Neoplastic alveolitis complicating chronic pneumonia].

The author describes two observations on cancerous alveolitis and bronchiolitis developed in the foci of chronic (interstitial) pneumonia under squamous metaplasia and anaplasia of epithelial cells of alveoli and bronchioli. Two cases were diagnosed by roentgenologists, one case was found pathoanatomically; in the first two cases the patients died due to grave hypoxia and cardiopulmonary insufficiency, in the third case-due to encephalomalacia in ischemic brain disease. Cancerous alveolitis and bronchiolitis made 2.4% to all lung cancer, the disease shows an acute course, the duration of the lesion-4-6-months.

Carcinoma, Squamous Cell↗
PubMed1977

[Therapy of staphylococcal endocarditis].

It is reported on the therapy with antibiotics of 5 patients with staphylococcal endocarditis with linkomycin--streptomycin. 2 patients were cured, 2 patients died after disappearing of fever and clinically unequivocally controlled septicaemia of typical complications of ulcerous endocarditis. One patient continued fevering to the exitus letalis when negative blood cultures were present, whereby at post-mortem examination an encephalomalacia with fresh haemorrhage was found to be the cause.

Adolescent↗
PubMed1997

[Neuropathology of refractory epilepsy in children].

INTRODUCTION AND OBJECTIVES: The pathological findings in surgical material from children with refractory epilepsy has not offered yet a clear understanding of its role in this condition. The objective of this paper is to report our findings to further expand our knowledge about refractory epilepsy in children. MATERIAL AND METHODS: Results of microscopic examination of the surgical specimen obtained from 80 children, ages 12 or younger, who had surgery for intractable epilepsy at Miami Children's Hospital between 1990 and 1996 were reviewed. RESULTS: Examination was normal only in one. The rest revealed ectopic neurons (1), dysplastic cells with ectopic neurons (2), dyslamination with large neurons (7), dyslamination with ectopic neurons (18), dyslamination with dysplastic cells (10), pachygyria (2), encephalomalacia (9), gliosis with ectopic neurons (10), gliosis without ectopic neurons (3), developmental ectodermal tumor (6), ganglioglioma (2), tumors (3), and Rasmussen encephalitis (4). Lesions were located to the temporal lobe in 34 children. CONCLUSIONS. Extratemporal lesions are more frequent than temporal one, including hyppocampal sclerosis. Ectopic neurons, the most frequent pathological findings, rather than a cause of seizure may be a marker other highly epileptogenic cortical malformations.

Brain↗
PubMedDate not supplied

[The morphology of the vascular spasm in cerebral aneurysm rupture].

The vessels of the basis cerebri were histologically examined in 45 patients who had died from arterial aneurysmal rupture. Angiography had made at the clinic detected cerebral vasospasm of varying severity and extent. All autopsies showed ischemic encephalomalacia in specimens. The findings indicated that arteriostenosis angiographically identified as vasospasm, by causing ischemic events was induced by morphological changes in the arterial wall. The arterial structural changes found were characterized by subsequent changes in the intima, elastic membrane, and medial layer.

Adult↗
PubMed1997

Nutritional metabolic diseases of poultry and disorders of the biological antioxidant defence system.

Deficiencies or disturbances of nutrition cause a variety of diseases and can arise in different ways. The amount of a particular nutrient in the diet may be insufficient to meet the requirements, the diet may contain substances that inactivate the nutrient or inhibit its absorption/utilisation, or metabolism may be upset by the interaction of dietary and environmental factors. Peroxidation of lipids or oxygen free radical generation in general is a physiological process important for cell metabolism, division and differentiation and also for the biosynthesis of hormones and prostaglandins. Free radicals generated through these processes are effectively scavenged by the antioxidant defence system. Uncontrolled lipid oxidation caused by disturbances of that system may play a crucial role in some important poultry diseases and toxicoses. The first route of lipid peroxide loading of the organism is via the feed, such as through oxidised lipids. Oxidised fatty acids are absorbed from the intestine mainly in the form of unsaturated keto compounds and initiate lipid peroxidation in the tissues. The second problem is the insufficient amount of antioxidants in the feed, e.g. vitamin E deficiency. Nutritional encephalomalacia is a problem in poultry production which depends both on the actual vitamin E supply and the dietary amount of polyunsaturated fatty acids. In young birds the primary target of vitamin E deficiency is the brain because it contains low amounts of vitamin E, and the vitamin E content of the liver acting as store decreases rapidly during the first week of life. Besides vitamin E, other components of the antioxidant system, e.g. the antioxidant enzymes (catalase and glutathione peroxidase) also have low activity in the brain as compared to other major tissues. The brain is highly susceptible to oxidative stress because of the accumulation of polyunsaturated fatty acids. The third source of free radical generation is the toxic level of different feed ingredients, e.g. toxicoses caused by vitamin A, selenium, and ionophore antibiotics. Other important aspects of antioxidants (e.g. vitamin E and selenium) in poultry are stimulation of the immune response (e.g. in the case of vaccination) and reduction of the risks of free radical formation as a result of macrophage function.

Animals↗
PubMed1998

Inversion-recovery echo-planar MR in adult brain neoplasia.

PURPOSE: A T1-weighted multishot inversion-recovery (IR) echo-planar MR imaging (EPI) sequence was developed to improve intracranial tissue differentiation; its diagnostic utility was compared with that of conventional axial T1-weighted spin-echo and axial T2-weighted turbo spin-echo sequences. METHODS: Eighteen patients with known or suspected primary or metastatic brain neoplasia were imaged in a 1.5-T unit with IR-EPI sequences. Three observers measured gray/white matter contrast-to-noise ratios and subjectively compared IR-EPI sequences with T1-weighted spin-echo and T2-weighted turbo spin-echo sequences for gray/white matter discrimination, visibility of intracranial and vascular structures, overall lesion conspicuity, size of lesion(s), and presence and severity of artifacts. RESULTS: Twenty-four lesions (including neoplasia, infarction, treatment-associated encephalomalacia, nonneoplastic white matter signal abnormalities, and basilar artery dolichoectasia) were detected in 12 patients. Basilar artery dolichoectasia was not included in subsequent statistical analysis. Pulsatile flow artifacts were markedly reduced on IR-EPI sequences relative to those on T1-weighted spin-echo sequences. Gray/white matter contrast was greater on IR-EPI images than on T1-weighted spin-echo images. Periaqueductal gray matter, basal ganglia, optic tracts, cranial nerve V, and claustrum were seen better or as well on IR-EPI images as compared with T1-weighted spin-echo images. IR-EPI was more sensitive to magnetic sensitivity effects, with resultant decreased visibility of cranial nerves VII and VIII and the orbital portion of the optic nerves. For noncontrast sequences, lesion conspicuity was better on IR-EPI images than on T1-weighted spin-echo images in 16 (70%) of 23 lesions and was equal on the two sequences in seven (30%) of 23 lesions. Lesion size, including surrounding edema, was greater on IR-EPI images than on T2-weighted turbo spin-echo images in two (9%) of 23 cases and equal in 21 (91%) of 23 cases. Hyperintense foci of methemoglobin were more conspicuous on T1-weighted spin-echo images. CONCLUSION: Multishot IR-EPI is superior to conventional T1-weighted spin-echo imaging for parenchymal tissue contrast and lesion conspicuity, and is equal to T2-weighted turbo spin-echo imaging in sensitivity to pathologic entities.

Adult↗