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PubMed1991

[Mediterranean boutonneuse fever disclosed by severe neurological involvement].

The authors report a case of mediterranean boutonneuse fever disclosed in a 6 year-old child presenting with severe neurological disorder, coma, hypotonia, sphincteral disorders, rash and eschar at the site of bite. Rise of antibodies detected by indirect immunofluorescence test (1/80----1/320) confirmed the diagnosis. Visualization of ischemic internal capsules at cerebral CT scan brought evidence of vascular lesions in rickettsial disease.

Boutonneuse Fever↗
PubMedDate not supplied

[Usefulness of neuropsychological studies in the documentation of functional damage in a case of deep frontal lesion].

A case of patient with deep frontal brain haemorrhage is reported. The lesion is in the striato-caudate region extended to the anterior arm of the internal capsule. The neuropsychological survey is reported: it shows an impairment in functions implying the central processing while not so markedly spoiled are functions classically considered depending on the damaged areas. A SPECT investigation shows an extension of the functional impairment corresponding to the neuropsychological data.

Caudate Nucleus↗
PubMed1991

[Deformation of brain and stress distribution caused by putaminal hemorrhage--numerical computer simulation by finite element method].

Deformation and stress distribution caused by putaminal hemorrhage in two-dimensional model brain were analyzed by computer simulation using finite element method. The model brain was composed of cerebral cortex, white matter, caudate nucleus, lenticular nucleus, thalamus and lateral ventricle. Young's modulus of gray and white matter was assumed to be 0.08 and 0.04 kgf/cm2, respectively, and Poisson's ratio was 0.47 for both of them. Bleeding of 100 mmHg pressure was represented by 4 vectors of force directing anterior, lateral, posterior and medial direction from the middle portion of putamen. Calculation of finite element method was carried out by a 16-bit personal computer. The calculated deformation of brain presented a hematoma cavity elongated from anterior to posterior direction at the lenticular nucleus. Mass effect of hematoma was noted from displacement of the anterior horn of the lateral ventricle and the internal capsule. Distribution of stress vector revealed the stress concentration at the lenticular nucleus while small stress was noted all over the model brain. Strength of principal stress was presented by contour-line and took the shape of concentric circles with a center at the putamen. This study suggested that the computer simulation by finite element method would be a useful technique to analyze the physical phenomenon of brain suffered from intracerebral hemorrhage.

Basal Ganglia Diseases↗
PubMed1991

[Arterial vascularization of the amygdaloid body in man].

The arterial supply of the amygdaloid body was studied on 20 brains of adult individuals of both sexes. The middle cerebral and anterior choroidal artery were selectively injected with a mixture of India ink and 5% gelatin solution. By injecting the middle cerebral artery, we filled the blood vessels of the putamen, the lateral part of globus pallidus, the internal capsule, claustrum, insular cortex and the cortex of the convex side of the hemisphere, whereas the blood vessels of the amygdaloid body remained unfilled by the mixture. By injecting the anterior choroidal artery, the blood vessels of the medial part of globus pallidus and of the amygdaloid body were filled, except in one case, when the blood vessels were filled only in it's posterior part. Based on the results obtained, a conclusion may be drawn that the branches of the anterior choroidal artery play the main role in the amygdaloid body arterial supply.

Amygdala↗
PubMed1991

[Anterior choroidal artery syndromes].

Three cases of anterior choroidal artery territorial infarction, diagnosed by computerized tomography, with the triad of hemiplegia, hemianaesthesia and hemianopia, pure motor stroke and ataxic hemiparesis are described. Major and minor (lacular) infarctions in the territory of the anterior choroidal artery involve almost exclusively the basal segment of the posterior limb of the internal capsule and manifest themselves by symptoms of long pathway lesion. Based on the published case reports and the authors' own observations, the complete capsular syndrome characterized by the triad of hemiplegia, hemianaesthesia and hemianopia was differentiated from partial capsular syndromes including the following forms: pure motor stroke, pure sensory stroke, sensorimotor stroke, sensory stroke with hemiataxia, ataxic hemiparesis, dysarthria and/or clumsy hand, and homonymous hemianopia (quadrantanopia or sectoranopia). The characteristic features of the above types of capsular syndromes were analyzed. Distant symptoms of territorial infarctions involving the anterior choroidal artery are transcortical sensory or motor aphasias and construction apraxia in the dominant hemisphere, left side perception failure and visual-construction apraxia in the non-dominant hemisphere, and cerebellar hemiataxia. These distant symptoms are a manifestation of distant cortical or cerebellar metabolic depression due to the mechanism of diaschisis.

Adolescent↗
PubMed1991

[CT-guided stereotaxic evacuation of hypertensive intracerebral hematomas].

CT-guided stereotaxic evacuation of hypertensive intracerebral hematomas was performed in 50 patients. Hematoma was found in the basal ganglion in 36 cases in the internal capsule in 23, in external capsule in 6, in thalamus in 7, in subcortex in 6 in cerebellum, in 6 and in brain stem in 2. The volume of these hematomas was less than 10 ml in 2 patients, 20-50 ml in 21, 51-100 ml in 16 and over 100 ml in 11. The liquid hematoma was totally aspirated by stereotaxic technique in 9 patients. Similarly, more than 80% of clots of hematoma was evacuated in 28 patients and about 60-80% of clots was evacuated in 13. Good operative results were obtained in 14 patients (28%). Mild neurological disability was seen in 16 patients (32%) and marked disability in 15 (30%). Five patients (10%) died.

Adult↗
PubMed1991

Delayed oculogyric crises associated with striatocapsular infarction.

Oculogyric crises are dystonic, usually upward, conjugate eye deviations. We describe an 11-year-old girl who developed oculogyric crises 3 1/2 years after infarction of the right caudate, putamen, and internal capsule. Her abnormal eye movements responded to anticholinergic agents. This is the first reported association between oculogyric crises and striatocapsular infarction.

Benztropine↗
PubMed1991

[Diffuse axonal injury (DAI) in an autopsy case of head trauma with long survival].

The authors reported a clinico-pathological case survived 11 months after a traffic accident. A 41-year-old man had been hit by a motor car and was found in a state of semicoma. On admission, his consciousness level was III-100 to 200 (Japan Coma Scale). Pupils were isocoric; light reflex was present. Linear fracture of occipital bone was disclosed by Skull X-ray and subarachnoid hemorrhage was revealed on CT scan. This comatose state, lasting 24 hours, slowly improved and eventually he presented the so-called Korsakoff's syndrome until his death. He could not recognized his relatives, only uttered some meaningless words. He was unable to obey simple verbal orders. The patient was incontinent and right pyramidal sign was positive. On repeated CT scans, cerebral ventricles gradually increased in size; especially the enlargement of the fourth ventricle was remarkable. He expired of septic shock caused by bed sores. At autopsy brain weighed 1190 g. Old gloss contusional scars were observed on the bilateral frontal lobes including the orbital area and on the left temporal pole. Gliding contusions were revealed in the subcortical white matter beneath the left superior frontal convolution. Fibrillary gliosis was noted in this region, the deep white matter underlying the left temporal pole and the tissue surrounding the anterior horn of the left lateral ventricle. Nerve fibers were fragmented and lacerated at corpus callosum, anterior commissure and posterior limb of the left internal capsule. Bilateral pyramidal tracts showed mild myelin pallor at the brainstem. Loss of Purkinje cells were observed. This case would correspond to mile type of diffuse axonal injury proposed by Adams and Gennarelli. (ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗
PubMed1991

Bioartificial polymeric materials obtained from blends of synthetic polymers with fibrin and collagen.

A new class of biomaterials, called "bioartificial polymeric materials", was prepared blending a segmented polyurethane (PU) with fibrinogen (FBNG); and poly(acrylic acid) (PAA), poly(acrylamide) (PAAM), poly(vinyl alcohol) (PVAL), with collagen (CLG), respectively. The PU-FBNG material was processed through a spraying, phase-inversion technique to fabricate porous tubular conduits. FBNG was subsequently converted into covalently cross-linked fibrin (FBN) through the action of thrombin (Th), fibrin-stabilizing factor (FSF), and calcium ions. Differential scanning calorimetry (DSC) showed the cross-linked blend was more stable than native cross-linked FBN. Tensile behaviors of the PU-FBN materials closely matched those of a natural artery on varying the ratio PU/FBN. Implantation experiments in the rat model showed a mature internal capsule and good tissue organization of PU-FBN (50%) grafts in the regenerated arterial wall. However, 50% of FBN did not assure adequate mechanical resistance, and aneurysmal changes were seen in some grafts. DSC of CLG-based materials, processed by casting, showed that the synthetic component offered definite advantage compared to the CLG denaturation temperature, particularly noticeable for CLG-PAA and CLG-PVAL blends. Material advantages and drawbacks are discussed.

Animals↗
PubMed1991

CT-guided stereotactic evacuation of hypertensive intracerebral hematoma.

From January 1986 to June 1989, the CT-guided stereotactic evacuation was performed in 38 cases of hypertensive intracerebral hematoma with satisfactory result. 24 patients were male and 14 female. The age ranged from 37 to 78 years, with an average of 55. 24 cases had their hematoma in internal capsule, 7 in cerebellum, 5 in subcortex, and 2 in brain stem. The interval between the occurrence of hemorrhage and evacuation of hematoma was 24 hours or less in 18 cases, 2-3 days in 14 and 4-7 days in 6. The volume of hematoma was estimated by CT scanning being more than 100 ml in 6 cases whereas much less in 2 cases of the brain stem.

Adult↗
PubMed1991

[P3 portion aneurysm of the posterior cerebral artery; a case report].

A case was reported of surgically treated saccular aneurysm located at the right posterior temporoparietooccipital artery junction (P3 portion of PCA). An aneurysm of this portion is said to be rare, and only 7 cases have been described so far. A 74-year-old female was transferred to our clinic, after 3, 5 months of sustaining aneurysmal rupture, for surgical treatment. The patient had been treated conservatively because of her severe condition in the early stage. She was in nearly apallic state with left hemiparesis at the time of admission to our clinic. During the acute stage of her illness, moderate hematoma in the right ambient cistern without hydrocephalus, and an aneurysm at P3 portion of the right posterior cerebral artery with marked arteriosclerosis were delineated by CT, and by right vertebral angiography respectively. However, in the CT taken 3, 5 months after the onset, moderate hydrocephalus and a low density area in the right internal capsule were detected. Aneurysmal neck clipping was performed using the right posterior subtemporal approach, without any deformity of the parent arteries. Occlusion of the right parietooccipital artery occurred, however, probably on the 2nd postoperative day. Despite the newly developed left homonymous hemianopsia, general condition, including consciousness level, improved postoperatively particularly after the ventriculo-peritoneal shunt was carried out.

Aged↗
PubMed1991

[Clinical and CT correlative researches in deep infarction of cerebral hemispheres].

Clinical and CT correlative researches in 172 patients with deep infarction of cerebral hemisphere were reported. The lesions are classified into eight types according to their location. Lateral of the central part of lateral ventricle was most frequently, and putamen, posterior limb of internal capsule, lateral of the anterior horn of lateral ventricle were subsequently. Only a few deep infarctions were watershed infarction possibly. The question of low perfusion in the peripheral of the lesion were discussed.

Adult↗
PubMed1991

[Analysis of hemiparesis with homolateral ataxia by single photon emission CT].

Case 1. A 46-year-old man suddenly developed mild gait disturbance and left hemiparesis. On examination, gross strength was slightly reduced in the left extremities. The finger-to-nose and heel-to-knee tests disclosed moderate dyssynergia and dysmetria on the left side that could not be explained by the muscular weakness. Deep tendon reflexes were more brisk in the left extremities. There was no Babinski sign. Magnetic resonance imaging showed a region of high signal intensity in the right posterior limb of internal capsule with extension into lateral thalamus. The lesion involved the cortico-ponto-cerebellar pathway and partly the dentato-rubro-thalamo-cortical pathway. No lesions were seen in the brainstem. Single photon emission CT with 123I-IMP showed left cerebellar hypoperfusion termed crossed cerebellar diaschisis by Baron et al. Case 2. A 65-year-old female developed weakness of the left extremities and gait disturbance. On examination, there was a horizontal nystagmus on lateral gaze to each side. She showed dysarthria, mild left hemiparesis and slight left hypesthesia. The finger-nose and heel-knees tests revealed moderate dysmetria and dyssynergia on the left side. Deep tendon reflexes were hyperactive in the left extremities with left Babinski sign. CT showed a low density area in the right basis pontis at about middle level. Intravenous digital subtraction angiography revealed a slight stenosis of right vertebral artery, but no other abnormality. The lesion involved the cortico-ponto-cerebellar pathway. Single photon emission CT with 123I-IMP showed left cerebellar hypoperfusion. The right cerebellar blood flow was normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Progression of experimental infantile hydrocephalus and effects of ventriculoperitoneal shunts: an analysis correlating magnetic resonance imaging with gross morphology.

Although previous ultrasonographic studies did monitor ventricular enlargement successfully in experimentally-induced models of feline hydrocephalus, the resolution of neuroanatomic detail was relatively poor after placement of a ventriculoperitoneal (VP) shunt because the skull had ossified over the coronal sutures. Therefore, the present study employed magnetic resonance imaging to follow the progression of ventriculomegaly more accurately, as well as to evaluate the compensatory effects of VP shunting. Hydrocephalus was induced in kittens between 7 and 10 days old by injection of kaolin into the cisterna magna. Age-matched controls received similar injections of saline. At 9 to 14 days after the kaolin injection, the hydrocephalic animals received VP shunts. Anesthetized kittens were scanned at various intervals before and after shunt placement and were killed for morphological correlation. The features observed on the magnetic resonance imaging scans were consistent with the gross morphological changes that accompanied ventricular enlargement. The lateral ventricle began to enlarge as early as 1 day after the kaolin injection, and within 3 days, both the occipital and temporal horns, along with the 4th ventricle, showed signs of moderate dilatation. By 5 days, a bilateral communication had been established through the septum pellucidum. Continued expansion of the ventricular system occurred from 6 to 20 days after injection, to the point where the cerebral cortex was reduced to less than 25% of its original thickness. The internal capsule was stretched and edematous, the caudate nucleus was compressed ventrolaterally, and the cerebellar hemispheres were eroded and/or compressed. Animals in which shunts were successfully placed demonstrated a dramatic improvement in behavior, and a reduction of about 50% in the size of the lateral ventricles within 2 days. In some cases, the lateral ventricles became slit-like within 1 week. When they were killed, about half of the animals that received shunts exhibited mild to moderate ventriculomegaly. These results indicate that magnetic resonance imaging is an excellent method for visualizing the morphological changes associated with this animal model, that these alterations occur soon after the onset of hydrocephalus, and that VP shunting can successfully reduce ventriculomegaly.

Animals↗
PubMed1991

[Clinical aspects of silent cerebral infarction--MRI findings and its distribution].

High-field MR scans have often showed patchy incidental findings especially in the elderly. We examined 91 patients, without episodes of cerebrovascular disorders previously, who had silent cerebral lesions noted by the 1.5 tesla superconductive system T2 weighted magnetic resonance imaging. They were divided into three subtypes by the localization of foci. The 23 subjects (25%) showed confined lesions to thalamus and/or internal capsule and/or basal ganglia (the basal ganglia type). The 39 subjects (43%) had lesions predominantly in cerebral cortex and/or subcortical white matter and/or cerebellum (the diffuse subcortical type). Finally, the 29 subjects (32%) had both features of above-mentioned two groups (the mixed type). These subtypes were correlated with age, sex and some of the other risk factors, such as systolic blood pressure, diastolic blood pressure, serum total cholesterol and uric acid, for stroke. The mean age of the basal ganglia type was significantly younger than that of the diffuse subcortical type (p less than 0.001) and than that of the mixed type (p less than 0.001). The diffuse subcortical type consisted of 11 men and 28 women. In the mixed type, it was composed of 21 men and 8 women. These two subtypes had the significant sex differences (the diffuse subcortical type, p less than 0.05 and the mixed type, p less than 0.025). Systolic and diastolic pressures of the basal ganglia type were lower than those of the diffuse subcortical type (systolic, p less than 0.001 and diastolic, p less than 0.025) and than those of the mixed type (systolic, p less than 0.001 and diastolic, p less than 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Double athetosis with Bielschowsky bodies--their histological features and distribution in the lateral pallidum].

This report analyzes a rare case of double athetosis with Bielschowsky bodies. These bodies are pleomorphic intra-neuronal PAS positive deposits mainly found in the lateral palladium of both sides. Clinically the patient was diagnosed as "double athetosis" and mild mental retardation. In her childhood she went through seizure attacks several times. The degree of athetosis was more severe in the upper extremities than in the lower ones. At the age of 25 she died from suffocation. Post-mortem findings: The brain weighed 1520 g. The cerebral cortex and cerebellum were not atrophic and externally not remarkable. Microscopically the most remarkable finding was PAS positive intra neuronal inclusions mainly restricted to the lateral pallidum, which are known as "Bielschowsky bodies." They varied in size and shape, and divided into 2 types according to their structural features. One is rather round type mostly in the intra-neuronal perikarya, and the other is small round but sometimes sausage-like in shape which is thought to be intra-axonal. We investigated the distribution of these deposits in and around the lateral pallidum. The distribution was different between these 2 types, that is, small and intra-axonal inclusions were seen "diffuse" all over the lateral pallidum and a little were in medial lamina which lies between lateral and medial pallidum, while large intra-perikaryal type were strictly restricted in the lateral pallidum and dominantly found near the internal capsule. This patient experienced generalized convulsion several times in her childhood but severe ischemic change was not seen in cerebral structures, especially in the hippocampus. Electron microscopically these bodies consisted of the accumulation of irregular fine fibrils.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Crossed aphasia in right handed patients].

The very rare aphasia following damage to the right cerebral hemisphere in right-handed subjects is described, with a survey of the views on this problem and presentation of two cases of this so-called crossed aphasia in right-handed subjects. On one of these cases the lesion was cortico-subcortical in a part of the frontal lobe, temporal lobe and a part of the occipital lobe, with sparing of the deep structures of the right hemisphere and with clinical pattern resembling that of Broca aphasia. In the second case the lesion involved the subcortical and deep structures with destruction of the lentiform nucleus, anterior part of the internal capsule and part of the head of the caudate nucleus, and the clinical pattern resembled that of Wernicke aphasia.

Aged↗
PubMedDate not supplied

Canavan disease: CT and MR imaging of the brain.

Canavan disease (spongy degeneration of the brain) is a rare lethal neurodegenerative disorder of infancy; fewer than 100 cases have been reported. We describe a series of nine patients with enzymatic defects and clinical features consistent with Canavan disease; in two patients the disease was proved by biopsy. All patients were examined with CT and seven with MR. In every instance, both CT and MR showed white-matter disease, sometimes sparing the external and internal capsules, the corpus callosum, and the deep cerebellar white matter. Atrophic changes were found in six patients; the changes were marked in one and slight in five. There was no obvious correlation between the severity of the white-matter disease and the clinical presentation--one patient with severe white-matter disease was clinically normal. The CT and MR findings in Canavan disease are nonspecific and somewhat nonuniform: its preautopsy diagnosis relies primarily on biochemical findings.

Brain↗