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PubMed1998

[Endovascular treatment using platinum coil of a peripheral artery aneurysm associated with moyamoya disease: case report].

A 47-year-old man presented with the sudden onset of severe headache and left hemiplegia. CT showed a large hematoma in the right thalamus and internal capsule with intraventricular hemorrhage. Right carotid angiography disclosed occlusion of the terminal portion of the right internal carotid artery with moyamoya vessels and a small aneurysm at the perforator of the right anterior choroidal artery. The follow-up angiography 17 days later disclosed definite enlargement of the aneurysm. The aneurysm corresponded to the lateral portion of the hematoma on CT and was considered to be the source of bleeding. Endovascular embolization was performed using a platinum coil, and the aneurysm was completely occluded with preservation of the parent artery. No change in the patient's neurological status was seen during and after the procedure. The management of peripheral artery aneurysms associated with moyamoya disease is controversial. We suggest that surgical intervention should be considered if the aneurysm is thought to be the source of bleeding, and that endovascular embolization using platinum coils may be a useful therapeutic alternative for these aneurysms.

Aneurysm↗
PubMed1988

Carotid angiography in patients with lacunar infarction. A prospective study.

We prospectively studied the results of carotid angiography in 45 patients with transient or nondisabling neurologic deficits caused by lacunar infarction in the internal capsule or corona radiata and demonstrated by computed tomography. An ipsilateral stenosis at the bifurcation of the internal carotid artery was found in 14 patients (31%, 95% confidence limits 18-47%), seven of whom also had stenosis of the contralateral internal carotid artery. In previous studies an average of 65% of patients with transient hemispheric deficit had internal carotid artery stenosis or occlusion. Hypertension and hypertensive retinal vasculopathy assessed by fundus photographs were found in most patients, but not significantly more often in the patients without internal carotid artery stenosis. Our findings support the notion that small vessel disease rather than emboli from the carotid bifurcation is the most common cause of lacunar infarction.

Adult↗
PubMed2001

Radiation-induced apoptosis of oligodendrocytes in the adult rat brain.

Although radiation injuries to the brain are well documented, immediate early histological changes in the brain remain to be defined. The present study characterizes glial injury provoked in adult rat white matter within 24 h after a single irradiation of the whole brain (10 or 20 Gray). Irradiated brains were histologically and histochemically analyzed. TUNEL-positive cells exhibiting apoptotic morphology were counted in five representative regions of the white matter. Glial cell death was further evaluated by glial cell density 24 h after irradiation, which induced both dose (p < 0.0001)- and time- (p < 0.0001) dependent apoptosis in these cells. The overall apoptotic rate in the white matter peaked within 8 h after irradiation. Total glial cell density decreased significantly in the white matter 24 h after irradiation. TUNEL-positive cells were immunohistochemically negative for GFAP, a marker for astrocytes, but positive for CNP, a marker for oligodendrocytes. The apoptotic rate was highest in the external capsule (p < 0.0001), followed by the fimbria and genu of the corpus callosum (p < 0.0001). The rates were lowest in the internal capsule and cerebellum. These data indicated that brain irradiation induces rapid apoptotic depletion of the oligodendroglial population, which may participate in the development of radiation-induced pathological conditions.

Age Factors↗
PubMed1999

[A case of hypertensive intracerebral hemorrhage associated with ipsilateral internal carotid artery occlusion].

We report a case of intracerebral hemorrhage associated with ipsilateral internal carotid artery occlusion. The patient was a 54-year-old man, who developed a small cerebral hemorrhage in the left internal capsule. He was admitted with mild right hemiparesis to out hospital. Left carotid angiography showed an occlusion at the origin of the internal carotid artery. Right cerebral angiography revealed the slow filling of cerebral arteries of left hemisphere by the cross flow. He was treated conservatively. Two days after admission, the neurological examination revealed no notable abnormalities. The etiology of hemorrhage of this case is presumed as the arterial necrosis due to hypertension. There has been no report on the intracerebral hemorrhage associated with ipsilateral internal carotid artery occlusion. Our case suggests that the volume and enlargement of cerebral hemorrhage may be influenced by cerebral perfusion pressure.

Carotid Stenosis↗
PubMed2003

Denaturation of demineralized bone matrix significantly reduces bone formation by guided tissue regeneration.

AIM: To examine in a discriminating capsule model whether denaturation of demineralized bone matrix (DBM) by heating may influence bone formation. MATERIALS AND METHODS: DBM was produced from the long bones of rats. Half the portion of DBM was denatured by heating in distilled water for 20 min at temperatures between 70 degrees C and 90 degrees C. Prior to the study, the destruction of the osteoinductive properties of the DBM was confirmed in three rats following intramuscular implantation. Thirty, 4-month-old, male albino rats of the Wistar strain were used in the study. Following surgical exposure of the mandibular ramus, a hemispherical Teflon capsule (internal diameter = 5.0 mm) was placed, with its open part facing the lateral aspect of the ramus. On one side (test side), the capsule was loosely packed with denatured DBM, while on the contralateral side, serving as control, the capsule was loosely packed with the same amount of non-denatured DBM. After healing periods of 30, 60, and 120 days, groups of 10 animals were killed and 40-70 microm thick undecalcified sections of the capsules were produced. Three sections from each specimen, representing the mid-portion of the capsule, were subjected to histological analysis and computer-assisted planimetric measurements. RESULTS: Increasing amounts of newly formed bone were observed in both test and control capsules during the experimental period. At 4 months, the new bone formed in the control capsules occupied 46.7% of the cross-sectional area of the capsules, while it was only 19.1% in the test capsules (P<0.05). CONCLUSION: Denaturation of DBM by heating significantly reduces bone formation by guided tissue regeneration.

Animals↗
PubMed2001

Delayed onset of hemidystonia and hemiballismus following head injury: a clinicopathological correlation. Case report.

The authors report the case of a young man who suffered multiple injuries in a motor vehicle accident, the most significant of which arose in the brain, creating an unusual clinical syndrome. After experiencing an initial coma for several days, the patient was found to have a right-sided homonymous hemianopsia and a right hemiparesis, which was more marked at the shoulder and was accompanied by preservation of finger movement. Dystonic movements appeared 2 months later and progressed, along with increased spasticity on volition, to severe uncontrolled arm movements at 2 years postinjury. This motor disorder continued to worsen during the following 6 years prior to the patient's death. At autopsy, the left side of the brain was observed to have marked atrophy of the optic tract, a partial lesion of the posterior portion of the medial segment of the globus pallidus (GP), and a reduction in the size of the internal capsule at the level of the GP, suggesting impaired circulation to these areas at the time of injury. The isolated lesion of the internal segment of the GP was the presumed cause of the dystonia, acting through an alteration in thalamic inhibition. The atrophic subthalamic nucleus was the probable cause of the hemiballismus. The authors speculate that this and other delayed and progressive features of this case were the result of an active, but disordered, adaptive process that failed to compensate and, instead, caused even greater problems than the original injury.

Adult↗
PubMedDate not supplied

Pre- and postoperative MR evaluation of stereotactic pallidotomy.

PURPOSE: Stereotactic pallidotomy, which has evolved as a result of technological advances in high-resolution MR imaging and microelectrode electrophysiological recording, is becoming a major form of treatment for patients with Parkinson disease in whom medical therapy has failed. We describe the location and appearance of the pallidotomy lesion on high-resolution MR images. METHODS: MR images in 83 patients (60 men and 23 women) who underwent stereotactic pallidotomy were reviewed retrospectively. The prepallidotomy screening study included standard spin-echo and gradient-echo sequences. After placement of a stereotactic headframe, volume-acquisition T1-weighted spoiled gradient-echo images were acquired for target localization in the posteroventral internal globus pallidus. One to three days after the pallidotomy, volume-acquisition T1-weighted and standard spin-echo sequences were obtained. In 16 patients, turbo spin-echo inversion recovery images also were obtained before and after surgery. The diameter, signal intensity, and location of the lesions relative to the midcommissural point and the intercommissural line were noted. RESULTS: The average lesion volume was 118 mm3 while that of the lesion-edema complex was 420 mm3. The midportion of the lesion was located on average 3.5 mm anterior to the midcommissural point, 21 mm lateral to the middle of the third ventricle, and 1.2 mm inferior to the intercommissural line. Signal intensity of the lesions varied, but all had a rim of edema. Forty-two patients had edema extending into the optic tract, four had increased signal in the ipsilateral basal ganglia on T2-weighted images, and seven had hemorrhage involving the ipsilateral caudate, internal capsule, and putamen. All patients experienced some improvement in contralateral bradykinesia, rigidity, and dystonia. CONCLUSION: The acute pallidotomy lesion is invariably located within the posteroventral internal globus pallidus, is usually hyperintense centrally on T1-weighted and turbo spin-echo inversion recovery MR images, and has a thin rim of edema. Edema extending into the ipsilateral optic tract was a common finding, but this series of patients evinced no visual changes.

Adult↗
PubMed1999

Bilateral caudate infarct--a case report.

Caudate strokes comprise only a small proportion of all subtypes of strokes. Bilateral caudate infarcts are even rarer and only a few cases have been reported in the literature. We report an 86-year-old woman with bilateral caudate infarcts. She had no past medical history of note. She presented with headache for several days and drowsiness on day of admission. Clinical examination revealed abulia, inability to comprehend or verbalize (acute mutism), right-sided neglect and right-sided hemiparesis. Computed tomographic (CT) scan brain revealed decreased attenuation in both heads of both caudate nuclei with extension across the anterior limb of both internal capsules to involve the lentiform nuclei. Echocardiography showed aortic valve sclerosis, mild mitral and aortic regurgitation and normal left ventricular function. Carotid ultrasound revealed mild stenosis of proximal right internal carotid and left distal common carotid and adjacent proximal internal carotid arteries. She showed initial improvement in the first week, but subsequently had a progressive downward course despite rehabilitation and died 44 days after her stroke. A patient with bilateral caudate infarcts is likely to have poor prognosis for rehabilitation and survival.

Aged↗
PubMed1989

[Fibromuscular dysplasia with cerebral infarction in children. Case report].

A 15-year-old boy suddenly developed a headache, followed by progressive weakness of the right extremities. A computed tomographic scan obtained on admission showed a low-density area in the left putamen extending to the internal capsule. No neurological deficits were observed other than slight dysarthria and right hemiparesis. Left carotid angiography showed the characteristic "string of beads" deformity of fibromuscular dysplasia (FMD) extracranially and complete occlusion of the internal carotid artery at the C2 portion. The right carotid artery and both vertebral arteries were normal. Anastomosis of the left superficial temporal and middle cerebral arteries was performed 1 month after the onset. The patient recovered quickly from the hemiplegia and was discharged with no neurological deficits. Angiograms obtained 3 months later showed not only patency of the bypass, but also recanalization of the intracranial internal carotid artery. Cervico-cephalic FMD mainly affects middle-aged women, and is uncommon in children; only nine childhood cases have been reported. This disorder may play an important role in the genesis of strokes among children.

Adolescent↗
PubMed1990

Compartmental origins of the striatopallidal projection in the primate.

The organization of striatopallidal projection neurons in the primate was studied by injecting horseradish peroxidase conjugated with wheat germ agglutinin and fluorescent markers (latex microspheres, Fluorogold, Diamidino Yellow or Nuclear Yellow) into the globus pallidus of 20 adult squirrel monkeys (Saimiri sciureus). Single injections of horseradish peroxidase conjugated with wheat germ agglutinin were placed so as to involve predominantly either one or both pallidal segments. In the double-tracer experiments, fluorescent tracer injections were centered in the external pallidum and deposits of horseradish peroxidase conjugated with wheat germ agglutinin were made in the internal pallidum. In control cases, injections were made in nearby parts of the internal capsule or striatum. Distributions of retrogradely labeled neurons in the striatum were analysed in relation to its striosomal architecture as demonstrated by histochemistry and immunohistochemistry. Three principal findings emerged. (1) Both the external and the internal segments of the primate pallidum receive input from both the caudate nucleus and the putamen, but different sets of striatal cells within these nuclei project to the two segments. (2) The striatopallidal projection in the primate originates mainly in the extrastriosomal matrix, although striosomes in the fields of labeling almost always contain some labeled neurons. (3) Heterogeneous groupings of striatopallidal projection neurons exist in the matrix and appear to be parts of three-dimensional projection-neuron arrays. We conclude that in the primate, separate lines of conduction lead from the striatum to the external and the internal pallidal segments, and raise the possibility that the cells of origin of these pathways form a mosaic in the extrastriosomal matrix.

Animals↗
PubMed1995

Simultaneous occurrence of aneurysmal subarachnoid hemorrhage and remote intracerebral hemorrhage--case report.

A 77-year-old female presented with a rare aneurysmal subarachnoid hemorrhage accompanied by a remote hypertensive intracerebral hemorrhage. With a past history of hypertension, she suddenly developed right hemiparesis followed by delayed loss of consciousness. Left carotid angiography demonstrated a left internal carotid-posterior communicating artery aneurysm. The intracerebral hematoma was located in the posterior limb of the internal capsule ipsilateral to the ruptured aneurysm. The aneurysm was clipped with a fenestrated clip 3 weeks after the onset. The rise in blood pressure at the onset of intracerebral hemorrhage probably caused the rupture of the internal carotid-posterior communicating artery aneurysm.

Aged↗
PubMed1976

Development of a liposarcoma out of the capsules of a hygroma.

We treated a patient who had a very rare finding: the development of a malignoma out of the capsules of the subdural hygroma covering the right occipitotemporal brain. Lumbar encephalography and arteriography confirmed the fact that surgery was necessary. A subdural-auricular shunt was performed and revised 2 years later. During the second operation, the external and internal capsules were removed in addition to the shunt. 3 years later the hygroma and large capsules were removed again and a ventricular-subdural drainage performed. 1 year later once more a subdural-auricular shunt was performed. 10 months later a tumour was found to be a pseudomucinous liposarcoma with large hyperchromatic nuclei and oval cells with large vacuoles of neutral fat. Renewed growth of the tumour led to the child's death. The histological and macroscopic findings of the capsules suggest the development of a malignoma within the last 3 years.

Brain Neoplasms↗
PubMed1989

In vivo evaluation of hydrophobic and fibrillar microporous polyetherurethane urea graft.

Mitrathane hydrophobic and fibrillar microporous prosthesis was implanted as infrarenal arterial substitute in dogs; it was evaluated in terms of patency rates, healing characteristics and biostability. Segments of grafts were implanted in duplicate for a period of implantation of 24 h, 1 wk, 1 month and 6 month. Two control grafts from the Ontario Research Foundation were implanted: one for 1 month, the other for six month. All except the two Mitrathane grafts implanted for 6 month were patent at death. The Mitrathane grafts showed kinking at one and 6 month post-implantation. The ORF graft implanted for 1 month was found crinkled in its mid-section and the external capsule was ruptured in the graft implanted for 6 month, without crinkling. Histological studies showed fibrin deposits on the flow surface and infiltration of blood elements into the wall of the Mitrathane grafts implanted for 24 h and 1 wk. A thin internal capsule was present on the graft flow surface of both types of graft tested 1 month post-implantation; scanning electron microscopy revealed the presence of endothelial-like cells on the luminal surface, particularly in the vicinity of the anastomoses. At 6 month, the Mitrathane grafts were occluded by a thick thrombus originating from the anastomoses, while the ORF graft showed infiltration of collagen through the polyurethane fibrillar structure of the wall with an endothelial-like lining covering the flow surface in the vicinity of both anastomoses.

Animals↗
PubMed1992

[Infarcts in the region of the middle cerebral artery. Study of 501 cases in 484 patients].

We report a study of 501 infarcts in the middle cerebral artery (MCA) territory, in 484 patients. All cases had an appropriate low-density area on computed tomography. The basal (perforators) territory was involved in half the cases and the motor pathways either in the pre-rolandic area or in the internal capsule in 90%. In all locations, except for watershed infarcts, the main cause was cardiac embolism. Atrial fibrillation accounted for 59%, the two other main causes were myocardial infarction and paradoxical embolism. Atherosclerosis accounted for less than one third of the cases. Among 102 internal carotid artery occlusions less than one half were due to atherosclerosis, cardiac embolism and dissecting aneurysms accounted for 22% each. None of 34 MCA occlusions were due to atherosclerotic thrombotic occlusion. Transient ischemic attacks were recorded in 22% of the cases. Stroke-in-progression with a mean duration of 6-8 hours in hospital, was noted in nearly half the cases. In a small group of MCA infarcts paralysis began and predominated on the lower limb, fifteen contralateral old MCA infarcts were silent. Ten of these were on the right side. The 15 patients with silent infarcts were all right-handed.

Adolescent↗
PubMedDate not supplied

The spatial distribution of MR imaging abnormalities in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy and their relationship to age and clinical features.

BACKGROUND AND PURPOSE: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a condition causing recurrent subcortical strokes. MR imaging, which shows focal lacunar infarcts and leukoaraiosis, plays a central role in the diagnosis and evaluation. We studied MR imaging abnormalities in a large prospectively recruited cohort of CADASIL patients to describe the spatial distribution of abnormalities, determine how this distribution alters with age, and identify any correlations with the clinical features of the disease. METHODS: In this study, 112 CADASIL subjects from 64 families were prospectively recruited. MR imaging scans were graded by a single neuroradiologist, by using the modified Scheltens scale, to quantify the severity of high-signal-intensity changes in different brain regions. RESULTS: Lesion load increased progressively with age. Scores were maximal in the frontal, parietal, and anterior temporal cortex, and the external capsule; intermediate in the pons; and relatively low in the corpus callosum, caudate, globus pallidus, cerebellum, midbrain, and medulla. Anterior temporal pole involvement was common at all ages and, when present, usually confluent, but this was absent in 33% of patients 20-29 years of age. A history of stroke correlated with total Scheltens score and internal capsule and pontine scores. Dementia correlated with total Scheltens score and subcortical white matter score, whereas depression correlated with subcortical white matter score but not total Scheltens score. CONCLUSIONS: There is a characteristic pattern of MR imaging abnormalities in CADASIL that aids in differential diagnosis; however, some characteristic features, such as anterior temporal pole involvement, can be absent. MR imaging lesion load correlated with some clinical features including stroke and dementia, whereas depression is more common in individuals with deep white matter changes.

Adult↗
PubMedDate not supplied

[Effect of gutimine on the electroencephalogram and cerebral blood supply of cats with intracerebral hemorrhage].

It was shown in experiments on conscious cats 1-2 days after intracerebral hemorrhage (administration of 2 ml autogenous blood in the internal capsule of the right hemisphere) that intravenous injection of 50 mg/kg gutimin led to an increase in the brain blood supply. The increased local blood flow was recorded in the cortex, thalamus of the affected hemisphere, particularly in the midbrain reticular formation. Experiments in vitro demonstrated that gutimin had a direct dilatatory action on isolated strips of the cat internal maxillary artery, with this action being determined by inhibition of the metabolism of exo- and intracellular calcium.

Animals↗