bluuebunny/crossref_metadata_2025 huggingface dataset:
Noradrenalin, serotonin, and the dorsal horn
Authors: Hodge Charles J. , Woods Charles I. , Delatizky Jonathan
Published: May 2009

✓ There is anatomical, pharmacological, and physiological evidence that descending systems from the brain stem using noradrenalin and serotonin (5-hydroxytryptamine, 5-HT) participate in the control of segmental sensory processing. Study of these systems is described in this paper. L-dopa was given intravenously to cats to cause the release of noradrenalin and 5-HT. The resultant effects on the responses of dorsal horn cells to innocuous and noxious thermal stimulation of skin were determined. Using the catecholamine cell neurotoxin, 6-hydroxydopamine, the dopamine α-hydroxylase inhibitor, fusaric acid, and the tryptophan hydroxylase inhibitor, parachlorophenylalanine, the available central stores of noradrenalin or 5-HT were altered, thus allowing separation of the effects of noradrenalin and 5-HT release on dorsal horn cells. The results indicate that noradrenalin facilitates the responses of dorsal horn cells to innocuous cutaneous stimuli, and has an inhibitory effect on the responses to noxious stimuli. Serotonin inhibits the responses of dorsal horn cells that respond to noxious stimuli, to both innocuous and noxious stimuli. The results are discussed in light of current developments concerning aminergic control of segmental sensory processing.
Antiepileptic drug distribution in cerebral cortex, Ammon's horn, and amygdala in man
Authors: Sironi Vittorio A. , Cabrini Gianpiero , Porro Maria G. , Ravagnati Luigi , Marossero Franco
Published: May 2009

✓ Significant correlations in the concentrations of phenobarbital, phenytoin, and carbamazepine in the brain, plasma, and cerebrospinal fluid were found in 12 surgically treated epileptic patients. These findings confirm the clinical reliability of monitoring anticonvulsant drug plasma levels as part of the routine management of epilepsy. Phenobarbital, phenytoin, and carbamazepine are uniformly distributed in the gray and white matter in different brain areas (except for a higher concentration of phenobarbital in the rhinencephalic structures in comparison with the corresponding temporal neocortex) and in normal and scar tissue. In these 12 patients, all of whom were medically resistant, molar cortex concentration of phenobarbital and phenytoin was at “therapeutic” levels or even higher. These data suggest that in therapy-resistant patients, despite cerebral drug concentrations of the same therapeutic level as, or higher than, those present in medically controlled patients, anticonvulsant drugs are pharmacologically ineffective.
Isodense subdural hematoma presenting with paraparesis
Authors: Shields Christopher B. , Bodley Stites T. , Garretson Henry D.
Published: May 2009

✓ Computerized tomography (CT) has replaced cerebral angiography in many institutions as the diagnostic test of choice in cranial trauma. However, isodense subdural hematomas can be a source of false-negative results on CT scans, resulting in omissions in therapy. The authors report a patient with bilateral isodense subdural hematomas who presented with paraparesis but was otherwise alert and fully oriented. The CT findings caused an initial diagnostic dilemma before being resolved.
Intramedullary spinal cord metastasis associated with pencil-shaped softening of the spinal cord
Authors: Hirose Genjiro , Shimazaki Kohei , Takado Matsuhei , Kosoegawa Hiroshi , Ohya Nobuo , Mukawa Akio
Published: May 2009

✓ A 57-year-old man presented with a pulmonary mass and subacute onset of paraplegia. Laboratory examination revealed an increased protein content in the cerebrospinal fluid and a normal myelogram. Autopsy disclosed epidermoid carcinoma in the left lower lobe of the lung, intramedullary metastasis at the midthoracic level, and a central pencil-shaped softening above and below the metastatic lesion. The pencil-shaped softening was an ischemic infarct rather than of hemorrhagic or congestive origin. The pathogenesis of this rare association may be explained by the hypothesis of a tumor embolus in the arterial circulation that feeds the center of the cord, producing metastasis. This embolus was followed later by a second embolus to a radicular artery, causing the pencil-shaped softening of the spinal cord.
Congenital inclusion dermoid cyst located over the region of the anterior fontanel in adult Nigerians
Authors: Ojikutu Nosiru A. , Mordi Victor P. N.
Published: May 2009

✓ Two cases of a congenital inclusion dermoid cyst located over the region of the anterior fontanel are described in adult Nigerians, aged 28 and 32 years. In both cases, the cystic lesion was noticed at birth over the anterior fontanel as a small soft lump, and was carried on the head from infancy into adult life. The clinical, radiological, and the operative findings revealed no intracranial extension. The two lesions were histologically verified as dermoid cysts. Surgical excision was curative.
Tapia's syndrome caused by a neurofibroma of the hypoglossal and vagus nerves
Authors: Andrioli Giancarlo , Rigobello Luca , Mingrino Salvatore , Toso Vito
Published: May 2009

✓ Tapia's syndrome is characterized by unilateral paralysis of the tongue and vocal cord, and is caused by a lesion of the 10th and 12th cranial nerves below the nodose ganglion, without involvement of the pharyngeal branches of the 10th nerve. The authors report the case of a 25-year-old man who presented with a 4-year history of progressive glossolaryngeal paralysis. Operation through the right laterocervical region allowed complete removal of a neurofibroma involving the 10th and 12th nerves at their crossing below the nodose ganglion.
A simple, inexpensive technique for accurate mass localization by computerized tomography
Authors: Moseley John I. , Giannotta Steven L. , Renaudin Justin W.
Published: May 2009

✓ A simple wire template is placed on the patient's head during computerized tomography scanning, and the results of the scan are later reproduced on the scalp prior to surgery. Measurements of the distance between the wires and the relationship of the mass provide the key to accurate localization of the mass on the scalp surface.
Irrigating sucker dissector
Authors: Bleasel Kevin , Harrison John
Published: May 2009

✓ The authors describe an irrigating sucker that can be regulated to provide a clear field for dissection or
coagulation under saline irrigation and has a single visible sucker end.
Relationship of cerebral blood flow to cardiac output, mean arterial pressure, blood volume, and alpha and beta blockade in cats
Authors: Davis Dudley H. , Sundt Thoralf M.
Published: May 2009

✓ The relationship among cerebral blood flow (CBF), blood volume, cardiac output (CO), and mean arterial blood pressure (MABP) at varying levels of arterial CO2 tensions (PaCO2) were studied in 70 normal cats. The CBF was measured from the clearance curve of xenon−133 and CO with a thermal dilution catheter placed in the pulmonary artery. The CBF, CO, and MABP values varied appropriately with changes in PaCO2, confirming the reliability of the preparations and the presence of normal autoregulatory responses. Moderate hypovolemia that did not change MABP did, nevertheless, significantly decrease CO and CBF. In an effort to determine if this decrease in CO and CBF were coupled responses, the effects of beta stimulation, hypervolemia, and alpha and beta blockade were investigated. Propranolol, in a dosage insufficient to change MABP, decreased both CO and CBF. This agent abolished the CO response to elevations in PaCO2 but not the CBF response, making it unlikely that this CBF reduction resulted from impaired cerebral autoregulation. Isoproterenol, which, in contrast to propranolol, does not cross the normal blood-brain barrier, alone or in combination with phenoxybenzamine, produced a 38% and 72% increase in CO, respectively, without a change in CBF. Alpha blockade (no major change in CO) and beta blockade (major decrease in CO) did not significantly effect cerebral autoregulation to changes in MABP from angiotensin. The ability of the brain to resist increases in MABP and CO and maintain normal CBF is explained by normal cerebral autoregulation. However, its vulnerability to modest decreases in blood volume, which cannot be attributed to variations in perfusion pressure, is unexplained but obviously has important therapeutic implications. This may be related to reduction in CO, changes in autonomic activity, or a decrease in the size of the perfused capillary bed.
Stereotaxic occlusion of 22 consecutive anterior communicating artery aneurysms
Authors: Alksne John F. , Smith Randall W.
Published: May 2009

✓ The authors review 22 consecutive cases of anterior communicating artery aneurysms treated by stereotaxic iron-acrylic occlusion. There was no mortality and no rebleeding in this series. The morbidity was low, and 16 of the 22 patients have returned to work. The patients whose aneurysms could be treated transsphenoidally enjoyed the best outcome.
Stereotaxic computerized tomography with a GE 8800 scanner
Authors: Boëthius Jörgen , Bergström Mats , Greitz Torgny
Published: May 2009

✓ A stereotaxic system is described that uses computerized tomography scanning for target localization. This system is unique in that the stereotaxic localization may be carried out using the scanner computer without the addition of any extra software. The hardware of the system is built up around a base plate which is fastened to the scanner's patient table. The head is positioned and fixed to the base plate with aluminum bars, which are fixed to the calvaria with screws. Various stereotaxic devices may be fastened to the base plate. The system has been in clinical use for 4 months at the time of writing. Its main application has been in tumor biopsies, but it has also been used for functional operations.
Intervertebral disc surgery
Authors: Long Charles J. , Brown Douglas A. , Engelberg Jerry
Published: May 2009

✓ Eighty patients with severe back or leg pain were assessed by a battery of psychological tests. Functional factors (that is, psychological and behavioral characteristics) thought to be contributing to the patient's pain experience were analyzed, and the patient's response to surgery was predicted. Patients were selected for the study on the availability of good follow-up data at 6 months or longer after surgery. The results reveal that the presence of functional factors was not of substantial consideration in the decision for surgical treatment. However, when both the clinical predictions and the subject's response to surgical treatment were rated on the same 0 to 5 scale, it was found that response to surgery could be predicted with 84% accuracy based upon functional data. Few single scores significantly discriminated between success or failure of surgery, and the basis for discrimination was made upon clinical judgment of an array of findings obtained by the functional pain assessment. The results are discussed with regard to a pain model which assumes the presence of an organic-functional pain continuum.
Spinal cord glioma after multiple fluoroscopies during artificial pneumothorax treatment of pulmonary tuberculosis
Authors: Steinbok Paul
Published: May 2009

✓ A patient is reported who developed multiple basal-cell carcinomas of the skin, a breast carcinoma, an astrocytoma of the spinal cord, and a bronchial carcinoid tumor following multiple fluoroscopies during artificial pneumothorax treatment for pulmonary tuberculosis. A review of the literature revealed no previously documented cases of radiation-induced gliomas of the spinal cord.
Absence of limitation of straight leg raising in proved lumbar disc lesion
Authors: Ramamurthi B.
Published: May 2009

✓ The absence of the classical clinical sign of limitation of straight leg raising is reported in one patient and summarized in 14 others who had all the other clinical signs of disc protrusion and in whom the disc lesion was proved by myelography and at surgery. It is postulated that the absence of this important sign may be explained by the daily habits of patients who stoop and bend to perform their household duties. Such posture leads to an elongation of the nerve roots, which permits a full range of straight leg raising. It is worth remembering that this sign may be absent in some patients with a disc lesion.
Identification of a brain stone as calcified hemangioma
Authors: Kasantikul Vira , Wirt Timothy C. , Allen Vaughan A. , Netsky Martin G.
Published: May 2009

✓ A 71-year-old woman with progressive hemiparesis had a large cerebral calculus (brain stone) removed from the temporal lobe. Her condition thereafter improved remarkably. The differential diagnosis and specific methods to determine the angiomatous nature of this almost acellular mass are discussed. Reticulin impregnation, elastic tissue stain, and electron microscopy were of greatest value.
Anterior surgery for cervical disc disease
Authors: Lunsford L. Dade , Bissonette David J. , Zorub David S.
Published: May 2009

✓ The results of anterior cervical surgery for treatment of cervical spondylotic myelopathy (CSM) are assessed 1 to 7 years postoperatively in 32 patients. At follow-up review, 50% were improved after surgery and 50% were unimproved or had deteriorated in spite of surgery. The results could not be statistically linked to the patients' age, duration of symptoms, severity of myelopathy, cervical canal size, or the performance of single- or multiple-level operations. Various anterior surgical techniques were used, but none proved to have superior results. The results in this series failed to surpass the results obtained by others for conservative treatment alone. In many cases, symptoms of CSM progressed despite the intervention of anterior cervical surgery.
Epsilon-aminocaproic acid and recurrent subarachnoid hemorrhage
Authors: Shucart William A. , Hussain S. K. , Cooper Paul R.
Published: May 2009

✓ A clinical trial of epsilon-aminocaproic acid (EACA) in preventing recurrent hemorrhage from intracranial arterial aneurysms is reported. Previous reports were reviewed, and their results concerning antifibrinolytic agents were inconclusive in establishing their efficacy. One hundred patients with documented ruptured intracranial aneurysms were admitted to this study within 48 hours of the initial hemorrhage: 45 patients received 36 gm of EACA/day, with 11 documented rebleeds and one suspected rebleed; 55 patients did not receive EACA, and there were four documented rebleeds and one suspected rebleed. No benefit was seen from the use of EACA.
Scanning electron micrographic study of vascular lesions caused by microvascular needles and suture
Authors: Pagnanelli David M. , Pait T. Glenn , Rizzoli Hugo V. , Kobrine Arthur I.
Published: May 2009

✓ The authors studied the damage to blood vessels 1 to 2 mm in diameter caused by the most commonly used types of microvascular needle. Excluding variables introduced by anastomosis, the study focused specifically on lesions attributable only to the needle and suture. Scanning electron microscopy revealed four distinct types of lesion. A theory is proposed to explain the mechanisms whereby these lesions were produced, and a needle design is recommended that may aid in minimizing vascular trauma.
Preliminary characterization of vasocontractile activities in erythrocytes
Authors: Cheung Shu T. , McIlhany Michael P. , Lim Ramon , Mullan Sean
Published: May 2009

✓ The vasocontractile activities of washed red cell preparations hemolyzed by various methods were studied in vitro using isolated canine basilar arteries. Significant contractions were induced by each preparation. The maximum strength of contraction attained by the various preparations was similar. The contractile activity appeared to be dose-related, and molecular exclusion chromatography demonstrated that the activity migrated with the fraction of approximately 40,000 to 45,000 molecular weight. The vasocontractile effect of the active fraction was sustained in vitro when tested against basilar artery, but was inactive in peripheral arterial preparations. Preliminary biochemical characterization indicates that the contractile activity resides in a protein. Enzymatic digestion of the crude fraction appears to enhance the contractile activity significantly, and this observation suggests a possible mechanism for the delayed onset of ischemic symptoms encountered in the clinical situation.
Pain and tryptophan
Authors: King Robert B.
Published: May 2009

✓ Tryptophan, the precursor for serotonin, was given to five patients with recurrent pain and diminished sensory deficits following rhizotomy and cordotomy. Their sensory deficits for both touch and pinprick reexpanded to the maximum extent initially recorded after their operative procedures. Their pain was again relieved. No clear understanding of the mechanisms responsible for these changes can be proposed at this time. It is speculated that a metabolic modulation of neurotransmitter functions is responsible for these clinical observations.
Dimethyl sulfoxide in experimental brain injury, with comparison to mannitol
Authors: Brown Frederick D. , Johns Lydia M. , Mullan Sean
Published: May 2009

✓ The effects of dimethyl sulfoxide therapy were studied in rhesus monkeys following a standardized occipitofrontal missile injury. This therapy resulted in substantially higher blood pressure, cerebral perfusion pressure, blood flow, and oxidative metabolism than those of a group of monkeys that had been treated similarly with mannitol, and than those of an untreated group.
Treatment of autochthonous rat brain tumors with fractionated radiotherapy
Authors: Steinbok Paul , Mahaley M. Stephen , Raymond U , Varia Mahesh A. , Lipper Stan , Mahaley Jane , Dalzell Juanita G. , Bigner Darell D.
Published: May 2009

✓ The avian sarcoma virus-induced glioma model in rats was used to evaluate radiation dose response (survival curves), giving fractionated treatments to the whole head. Groups of 14 to 20 rats received total doses of 2300, 4600, or 5750 rads over 2, 4, or 5 weeks, respectively. Median group survival times were compared to controls and to each other. All doses of radiation significantly prolonged survival with reference to control. The 4600- and 5750-rad doses were significantly more effective than the 2300-rad dose. In another series of experiments, BCNU chemotherapy (10 mg/kg) was combined with 2300 and 4600 rads radiation therapy. Synergism of therapies was demonstrated. Methylprednisolone acetate (2 mg/kg twice weekly over 4 weeks) alone did not affect survival curves, and its combination with 4600 rads radiation therapy negated the prolongation of survival achieved with 4600 rads alone.
True traumatic aneurysm of the vertebral artery
Authors: Paul Gordon A. , Shaw Cheng-Mei , Wray Linda M.
Published: May 2009

✓ A patient is reported in whom a true aneurysm of the vertebral artery developed following head trauma. The histology of the aneurysm and parent vessel is presented, and its implications regarding the mechanism of formation of posttraumatic true aneurysms are discussed.
Bone erosion of the cervical vertebrae secondary to tortuosity of the vertebral artery
Authors: Cooper Daniel F.
Published: May 2009

✓ A case of “hangman's fracture” is presented, with erosion of the cervical vertebrae by tortuosity of the vertebral artery. The necessity for vertebral angiography in the evaluation of cervical bone-destructive lesions is stressed.
Moyamoya disease in monovular twins
Authors: Yamada Hiroshi , Nakamura Shigetoshi , Kageyama Naoki
Published: May 2009

✓ The first reported instance of identical twins with moyamoya disease is presented. The involved portions of the main intracranial arteries were similar, but the formation of the moyamoya vessels was somewhat different. The cause of obstructive changes in large intracranial arteries remains obscure, but the frequent familial occurrence suggests that the initial stages of this disease and the formation of the moyamoya vessels occur in the prenatal period.
Intraorbital and intracranial glial hamartoma
Authors: Vaquero Jesús , Cabezudo José M. , Leunda Guillermo , Carrillo Rafael , Bravo Gonzalo
Published: May 2009

✓ A case is reported of a glial hamartoma located in the orbital fossa, with an extradural extension to the middle fossa. This location of a glial hamartoma has not previously been reported.
Giant pituitary cavernous hemangioma
Authors: Sansone Maria Elena , Liwnicz Boleslaw H. , Mandybur Thaddeus I.
Published: May 2009

✓ A large cavernous hemangioma of the pituitary was an incidental finding at the autopsy of a 72-year-old woman who died as a result of metastatic breast carcinoma. This lesion did not cause any overt clinical problems.
A nobleness of purpose
Authors: Eugene Stern W.
Published: May 2009

✓ In the annual address, the President of the American Association of Neurological Surgeons reviews the responsibilities and the continued dedication of the members of the Society to the goals of excellence in patient care, education, and investigation. Insistence upon first-class standards of training has not waivered despite cynical impugnment of our motivation. Dividends of advantage to the general welfare can come from assistance in the design of enlightened legislation, in the assessment of the scientific basis and therapeutic value of various procedures, and in the support of rigorous training for neurosurgeons, fostering the development of excellent clinicians as well as investigators.
Follow-up study with computerized tomography and clinical evaluation 5 to 10 years after surgery for pituitary adenoma
Authors: Muhr Carin , Bergstrom Kjell , Enoksson Paul , Hugosson Rune , Lundberg Per Olov
Published: May 2009

✓ This study was based on 24 consecutive patients operated on for pituitary adenoma with suprasellar extension, and treated postoperatively with radiotherapy. The follow-up period was 5 to 10 years. A clinical examination, endocrine evaluation, perimetry, computerized tomography (CT) and sellar roentgenography were performed in 19 of 20 surviving patients. The CT scans revealed four recurrences, while perimetry only showed an increased visual field defect in one patient. Plain sellar films were of no value for diagnosis of recurrence. Prolactin determinations seemed to have a limited value in recurrence diagnosis, but very high levels spoke in favor of a recurrence. Thus, CT was found to be the superior method of diagnosing recurrences. It is proposed that CT be used regularly in the follow-up study of patients operated on for a pituitary adenoma.
Chronic cerebellar stimulation for cerebral palsy
Authors: Penn Richard D. , Myklebust Barbara M. , Gottlieb Gerald L. , Agarwal Gyan C. , Etzel Mary E.
Published: May 2009

✓ The effects of chronic electrical stimulation of the cerebellum in patients with cerebral palsy have been studied using objective tests of joint compliance, and standardized assessments of developmental reflexes and motor skills. Of 14 patients studied prospectively for 1 to 44 months, 11 showed improvement in motor function. A double-blind test of 10 patients off and on stimulation for an average 8-week period showed no significant changes. Thus, we have no proof that the functional improvements seen with long-term stimulation are the result of cerebellar stimulation.
Brain elasticity changes with ventriculomegaly
Authors: Sklar Frederick H. , Diehl Jan T. , Beyer Chester W. , Clark W. Kemp
Published: May 2009

✓ The pressure-volume relationship of brain elasticity was determined in 32 patients during servo-controlled variable-rate lumbar infusions to measure net cerebrospinal fluid (CSF) absorptive capacity. Several indices were used to estimate ventricular size from computerized tomography scans. The results show a linear relationship between ventricular size and the elasticity slope which relates the natural logarithm of pressure to volume. It follows that a hydrocephalic patient should show a greater intracranial pulse amplitude at a given pressure than does a patient with normal-sized ventricles. Although these elasticity changes may simply be the result of the ventriculomegaly, it seems possible that the pressure-volume elasticity relationship may be of etiological importance in disorders of the CSF system.
The effects of cold-induced brain edema and white-matter ischemia on the somatosensory evoked response
Authors: Sutton Leslie N. , Bruce Derek A. , Welsh Frank
Published: May 2009

✓ The electrophysiological effects of cold-lesion edema and white-matter ischemia were studied in cats by reference to the short-latency somatosensory evoked response. The primary cortical waves were found to be considerably delayed following a period of white-matter ischemia; however, cold-lesion edema appeared to have no significant effect on the evoked response. The authors conclude that vasogenic edema does not interfere with axonal functioning by an ischemic mechanism.
Causes of spontaneous subarachnoid hemorrhage in Thai infants and children
Authors: Visudhiphan Pongsakdi , Chiemchanya Surang , Somburanasin Racha , Dheandhanoo Dhanit
Published: May 2009

✓ The authors report 56 cases of spontaneous subarachnoid hemorrhage in Thai infants and children. The causes were: hemorrhagic disorders in 22 cases, arteriovenous malformations and aneurysms in 18, gnathostomiasis in nine, bleeding tumors in four, hypernatremia in one, and undetermined causes in two cases. Coagulation studies and cerebrospinal fluid examination for eosinophils are recommended before further invasive studies in such cases.
Cerebral vasodilation and prostacyclin
Authors: Chapleau Charles E. , White Richard P. , Robertson James T.
Published: May 2009

✓ The effects of aspirin and meclofenamic acid on the diphasic responses produced by prostacyclin in isolated canine basilar arteries were compared. Meclofenamate enhanced the relaxant action of prostacyclin in low concentrations (10−8M to 10−6M) and also significantly inhibited the contractions caused by the highest concentration (10−6M) of this prostaglandin. Aspirin had no such effects. The results indicate that some drugs classified as prostaglandin synthetase inhibitors can directly enhance the vasodilator action of prostacyclin on cerebral arteries, and suggest that this enhancement could be of value in the clinical applications of prostacyclin.
Modal DNA content of human intracranial neoplasms studied by flow cytometry
Authors: Mørk Sverre J. , Laerum Ole D.
Published: May 2009

✓ The relative DNA content in 56 human intracranial tumors was investigated by flow cytometry and correlated to their histological type. Tumors with a modal DNA content within the diploid value (2c) ± ½c were divided from those with heteroploidy. Of the “benign non-neuroepithelial tumors,” the meningiomas (five), neurilemomas (two), pituitary adenomas (three), and one hemangioblastoma had a unimodal diploid/neardiploid DNA content. The “malignant non-neuroepithelial tumors” were both heteroploid (two metastatic carcinomas) and diploid/near-diploid (three meningeal fibrosarcomas and one primary malignant lymphoma). Of the neuroepithelial tumors, the highly differentiated gliomas all had a diploid/near-diploid DNA mode except one recurrent oligodendroglioma. The majority of the poorly differentiated gliomas also presented near-diploid DNA modes. Heteroploidy of primary brain tumors was not correlated with a more malignant clinical/biological behavior in the individuals in this study.
A simple method for distal catheter lengthening of ventriculoatrial shunts
Authors: Pritz Michael B.
Published: May 2009

✓ A simple technique to lengthen the distal catheter of ventriculoatrial shunts is described in eight children. This method, which uses a Swan-Ganz introducer set, has proved successful even when a guide wire by itself has been inadequate to gain access to the right atrium.
Histopathological changes following removal of the perineurium
Authors: Nesbitt John A. , Acland Robert D.
Published: May 2009

✓ Using microsurgical techniques, the perineurial sheath was stripped off the sciatic nerves of rats over a 0.5 cm length at a point where the nerve consists of a single fascicle. The nerves were excised 0 to 84 days after the injury, and were examined in semi-thin transverse section. A new sheath, closely resembling normal perineurium, became organized during the first 10 days; it appeared uniformly over the length of the injured segment. The new perineurial sheath was probably formed by endoneurial fibroblasts migrating from within the fascicle. In undamaged specimens, the axons immediately beneath the excised perineurium underwent no degenerative changes.
Teratoma in the pineal region in two brothers
Authors: Wakai Susumu , Segawa Hiromu , Kitahara Shigemi , Asano Takao , Sano Keiji , Ogihara Riuji , Tomita Shin
Published: May 2009

✓ The occurrence of pineal teratoma in two brothers is described, and the pathogenesis of this type of tumor is discussed. This is the first report of familial occurrence of pineal teratoma in two siblings.
Pontine gaze paresis due to traumatic craniocervical hyperextension
Authors: Klingele Terence G. , Schultz Robert , Murphy Michael G.
Published: May 2009

✓ Pontine gaze paresis is frequently due to tumor of the brain stem. Occasionally it may be caused by inflammation or ischemia. Two cases are reported, each with pontine gaze paresis and other signs of lower brain-stem injury, basal skull fractures, and second cervical vertebra fractures. This pattern of injuries is believed to be the result of craniocervical hyperextension with stretch injury to the brain stem at the junction of the medulla and pons.
Cerebral cysticercosis with aqueductal obstruction
Authors: Poon Tung Pui , Arida Edward J. , Tyschenko Wolodymyr P.
Published: May 2009

✓ The authors report a case of cerebral cysticercosis which presented with generalized nonspecific neurological signs and symptoms attributed to acute aqueductal obstruction, with concomitant intracranial hypertension. These were characteristic intracranial calcifications along with angiographically demonstrated signs of hydrocephalus. Contrast encephalography clearly demonstrated aqueductal obstruction. Pathologically, the aqueductal obstruction was shown to be due to parasitic invasion of the brain stem with compression of the aqueduct. The presence of typical intracranial calcification in conjunction with either obstructive or normal-pressure hydrocephalus should alert the observer to the possibility of cerebral cysticercosis.
A multipurpose all-angle clip applier for aneurysm surgery
Authors: Sano Keiji
Published: May 2009

✓ A newly designed aneurysm clip applier is described, which has a pair of sockets in the tip that can be rotated in any desired angle. The applier can be used for placement of three types of spring clips that are currently in use.
Preliminary report of a hollow-centered balloon for intravascular occlusion of intracranial aneurysms or arteriovenous fistulas
Authors: Heifetz Milton D. , Hieshima Grant B. , Mehringer C. Mark
Published: May 2009

✓ A doughnut-shaped balloon has been designed that can be inserted intravascularly by catheter to occlude the orifice of an intracranial berry or giant aneurysm or arteriovenous fistula. The blood in the parent artery can continue to flow uninterrupted through the hole in the balloon. In a preliminary study, an arteriovenous fistula was successfully obliterated in a dog. The technique for placing the balloon is described.
Arteriovenous malformations
Authors: Parkinson Dwight , Bachers Gary
Published: May 2009

✓ One hundred cases of macroscopic supratentorial arteriovenous malformations are studied, along with the significant literature. On the basis of morphology, they are subdivided into straight-line, single-unit, multiple-unit, intra- and extracranial, venous-wall types, and one other of questionable type. The study does not confirm a relationship of pregnancy to bleeding. It does confirm the absence of vasospasm in association with these lesions, the increasing tendency of the lesion to bleed the smaller it is, the equal sex distribution, the peak incidence in the patient's fourth decade, the lack of significance of family history, and the lack of associated vascular lesions. The study stresses the advantages of preoperative three-dimensional angiography, surgical magnification, and intraoperative serial angiography. It is emphasized again that the fistula itself must be removed or obliterated.
Embolism from intracranial aneurysms
Authors: Sakaki Toshisuke , Kinugawa Kazuhiko , Tanigake Tatsuo , Miyamoto Seiji , Kyoi Kikuo , Utsumi Shozaburo
Published: May 2009

✓ Embolism from an aneurysm is one of the mechanisms involved in the pathogenesis of ischemic symptoms associated with intracranial aneurysms. Four cases are reported in which aneurysms of the internal carotid arteries and middle cerebral arteries were the source of emboli resulting in cerebral infarction. In the treatment of these aneurysms, it is best to clip the neck of the aneurysm with great care to avoid embolism due to extrusion of clot into the distal artery.
Prediction of late ischemic complications after cerebral aneurysm surgery by the intraoperative measurement of cerebral blood flow
Authors: Pickard John D. , Matheson Margaret , Patterson James , Wyper David
Published: May 2009

✓ The response of cerebral blood flow (CBF) to drug-induced hypotension was measured in 20 patients who underwent craniotomy for clipping of a cerebral aneurysm following subarachnoid hemorrhage. A modified intravenous xenon-133 injection technique was used to monitor CBF. In 15 patients, CBF increased significantly with hypotension, and only one developed a late neurological deficit. In five patients, CBF fell with halothane-induced hypotension, and four developed delayed neurological deficits. Measurement of the intraoperative CBF response to halothane-induced hypotension may reveal those patients at greatest risk of developing late neurological deficits and who require more intensive postoperative monitoring and early use of the induced hypertension technique.
Mechanism of cerebral arterial contraction induced by blood constituents
Authors: Toda Noboru , Shimizu Koichiro , Ohta Tomio
Published: May 2009

✓ In helically cut strips of cerebral, coronary, mesenteric, and renal arteries from dogs, a test solution containing hemoglobin (Hb) and soluble constituents, obtained by exposure of blood clot to distilled water, produced a dose-related contraction. The contraction of cerebral arteries was greater than that of the other arteries. Methemoglobin (metHb) caused only a slight contraction. The contractile response of cerebral arteries to the Hb-containing test solution was attenuated by aspirin (10−5 to 2 × 10−4 M), polyphloretin phosphate (PPP, 3 × 10−5 gm/ml), a prostaglandin (PG) antagonist, and cinanserin (10−7 M), a serotonin antagonist. Combined treatment with these antagonists suppressed the response to the test solution, but only slightly attenuated contractions induced by K+. Phentolamine was ineffective. Contractions of mesenteric arterial strips induced by the test solution were potentiated by aspirin, but were attenuated by PPP and cinanserin. Serum also produced contractions of cerebral and mesenteric arteries, which were attenuated by treatment with cinanserin or PPP. Contractile responses to Hb-containing solution and serum obtained from dogs pretreated with reserpine were weaker than those to the solutions obtained from control dogs. It may be concluded that the Hb-containing test solution releases vasoconstricting PG's from the cerebral arterial wall but vasodilating PG's from mesenteric arteries. The test solution appears to contain vasoconstricting PG's and serotonin. Serum-induced contractions appear to be mediated mainly by serotonin.
The long-term results of stereotaxic surgery and L-dopa therapy in patients with Parkinson's disease
Authors: Kelly Patrick J. , Gillingham F. John
Published: May 2009

✓ Sixty patients with Parkinson's disease underwent stereotaxic surgery in Edinburgh between 1965 and 1967, and were examined every 2 years for a total follow-up period of 10 years. Although stereotaxic surgery had been extremely effective in treating tremor and rigidity, the other manifestations of Parkinson's disease were noted to progressively affect more patients at each follow-up examination. L-dopa therapy was instituted in 36 patients after 1968. The effect of L-dopa on bradykinesia was remarkable, but the long-term benefit on the other manifestations of Parkinson's disease was negligible. Furthermore, in most cases L-dopa became progressively ineffective for bradykinesia after 3 to 5 years. L-dopa-induced tremor and involuntary movements were less frequently noted in limbs contralateral to the side of a previous stereotaxic procedure. It was concluded that in patients presenting with tremor and rigidity as the major problem in their parkinsonian syndrome, the most effective form of palliative therapy is stereotaxic surgery, and that L-dopa should be reserved for the management of bradykinesia.
Electrophysiological evaluation of phrenic nerve function in candidates for diaphragm pacing
Authors: Shaw Richard K. , Glenn William W. L. , Hogan James F. , Phelps Mildred L.
Published: May 2009

✓ The electrophysiological status of phrenic nerve function has been determined by an assessment of the conduction time and diaphragm muscle action potential in patients who were being evaluated as candidates for diaphragm pacing, or who were being studied for suspected phrenic nerve injury or disease. The conduction time and muscle action potential were evoked by transcutaneous phrenic nerve stimulation or by stimulation with a permanently implanted diaphragm pacemaker. In normal volunteers, the conduction time was found to be 8.40 msec ± 0.78 msec (SD). Transcutaneous phrenic nerve stimulation was successful in predicting phrenic nerve viability in 116 of 120 nerves studied. The four false negatives were due to technical difficulty in locating the nerves in obese or uncooperative subjects. In patients who were selected for implantation of a diaphragm pacemaker, a conduction time that was prolonged (10 to 14 msec) preoperatively did not preclude successful diaphragm pacing. Postoperatively, a prolonged (> 10 msec) conduction time was associated with severe systemic disease or local nerve injury caused by trauma or infection. The elucidation of phrenic nerve function by such electrophysiological studies serves as a valuable adjunct to the selection and management of patients undergoing diaphragm pacing.
Carcinoembryonic antigen in patients with intracranial tumors
Authors: Suzuki Yasuo , Tanaka Ryuichi
Published: May 2009

✓ Carcinoembryonic antigen (CEA) in plasma, cerebrospinal fluid (CSF), and tumor cyst fluid obtained from patients with a variety of intracranial tumors was determined by radioimmunoassay. Slightly elevated levels of plasma CEA, ranging from 2.6 to 3.8 ng/ml, were noted in six (4%) of 161 patients with primary brain tumors: in three gliomas, two pineal tumors, and one acoustic neurinoma, respectively. On the other hand, 17 (37%) of 46 patients with metastatic brain tumors showed a definite elevation, and most of them had values higher than 5.0 ng/ml. Of 37 patients with primary brain tumors, only one with a pineal germinoma showed a significant elevation of CEA in CSF, whereas eight (44%) of 18 patients with metastatic brain tumors showed high values of CEA in CSF. All six patients with leptomeningeal carcinomatosis showed elevated CEA in CSF. Levels of CEA in tumor cyst fluid were determined in 17 patients with intracranial tumors, including 12 gliomas, two craniopharyngiomas, two metastatic tumors, and one meningioma; elevation of CEA in tumor fluid was noted in two craniopharyngiomas and one metastatic tumor. Sequential determination of CEA in plasma or CSF revealed that the CEA levels were well correlated with the activity of brain tumors. Consequently, the determination of CEA in plasma or CSF is valuable for the differential diagnosis between primary and metastatic brain tumors and for the management of CEA-producing tumors.
Spinal cord energy metabolism following compression trauma to the feline spinal cord
Authors: Anderson Douglas K. , Means Eugene D. , Waters Thomas R. , Spears Crate J.
Published: May 2009

✓ The purpose of this study was to determine the spinal cord metabolic state for 24 hours after compression trauma to the feline spinal cord. Cats were anesthetized with pentobarbital and injured by placing a 190-gm weight on the spinal cord for 5 minutes. Biochemical analysis of the injured segment revealed a significant depletion in the levels of adenosine triphosphate (ATP), phosphocreatine (P-creatine), and total adenylates for the entire 24-hour recovery period. Glucose levels initially declined, but by 1 hour had normalized, and at 8 and 24-hours were significantly supranormal. The lactate/pyruvate ratio and tissue lactate concentrations increased four and five and a half times, respectively, for the first 4 hours after injury. Between 8 and 24 hours, lactate levels remained elevated, whereas the lactate/pyruvate ratio declined to control levels as the result of a significant rise in the tissue pyruvate concentration. This sequence of metabolic changes suggested that metabolism was probably not homogeneous throughout the injured segment, and that tissue metabolic rate was depressed for the initial 4 hours after trauma then increased in metabolically active tissue for the remainder of the 24-hour recovery period. This model of spinal cord trauma results in a severe, prolonged ischemia and metabolic injury to the affected tissue. Whether these metabolic changes result from or cause the tissue damage and irreversible paraplegia associated with this type of spinal cord injury remains to be determined.
Cerebellar stimulation for chronic extensor-flexor rigidity and opisthotonus secondary to hypoxia
Authors: Sukoff Michael H. , Ragatz Robert E.
Published: May 2009

✓ Two patients with chronic hypertonus (in a decerebrate state) as a result of hypoxia are described. Long-term cerebellar stimulation markedly modified their extraordinarily severe extensor-flexor rigidity phenomena that had resulted in chronic opisthotonus.
Vertical cleft through the superior articular process of the lumbar spine: fracture or anomaly?
Authors: Miki Takaaki , Oka Masanori , Hama Hiromichi , Shima Mitsuhiro , Hirofuji Eikazu , Tanaka Seizuke
Published: May 2009

✓ A case is reported in which roentgenograms of the lumbar spine showed a vertical cleft in the superior articular process of the L-5 vertebra. The cleft seemed to be of no clinical significance.
Super giant globoid intracranial aneurysm in an infant
Authors: Ventureyra Enrique C. G. , Choo Sin H. , Benoit Brien G.
Published: May 2009

✓ The incidence of intracranial aneurysms in infancy is less than 1%. Intracranial arterial aneurysms are very rare in patients under 1 year of age. This 6-month-old baby girl presented with progressive macrocephaly and anemia. Computerized tomography and cerebral angiography demonstrated a giant globoid aneurysm, 8 × 9 cm in size, arising from an anomalous posterior cerebral artery. The aneurysm was successfully clipped and excised in two stages. The child made an uneventful recovery. The congenital nature of the aneurysm is discussed, and the literature concerning intracranial aneurysms in patients under 1 year of age is reviewed.
Hemodynamic aspects of cerebral arteriovenous malformations
Authors: Nornes Helge , Grip Arne
Published: May 2009

✓ Local hemodynamics were studied in 16 patients undergoing total extirpation of cerebral arteriovenous malformation (AVM). Directional Doppler technique was used for the registration of blood velocities in vessels feeding and draining the AVM. Calculated flow in single feeding arteries ranged from 3 to 550 ml/min (average, 180 ml/min). An estimation of total AVM flow was possible in nine patients, and ranged from 150 to more than 900 ml/min (average, 490 ml/min). Pressure recordings were made from feeding arteries at their entrance to the AVM. This pressure was well below the systemic arterial blood pressure in all cases, and ranged from 40 to 77 mm Hg (average, 56 mm Hg). On temporary occlusion, this stump pressure instantly rose to from 55 to 95 mm Hg (average, 76 mm Hg). Draining vein pressure before occlusion ranged from 8 to 23 mm Hg (average, 15 mm Hg), and fell to zero in all patients when the AVM was occluded. These data and other clinical observations are discussed with regard to adjacent brain-tissue perfusion, and with special emphasis on the circulatory breakthrough that can follow the occlusion of these high-capacity shunts.
Carotid ligation for recurrent ischemia due to inaccessible carotid obstruction
Authors: Countee Roger W. , Vijayanathan Thurairasah , Hubschmann Otakar R. , Chavis Pamela
Published: May 2009

✓ Experiences with a patient with symptomatic obstruction to the carotid artery in its petrous segment are described. In spite of the severe stenosis of this vessel, complete cerebral arteriography demonstrated excellent perfusion of the symptomatic eye and hemisphere and an ample collateral reserve. Funduscopy confirmed the clinical impression that recurrent retinal and hemispheric ischemia in this patient was the result of microembolism rather than intracranial hemodynamic insufficiency. Consequently, extracranial-intracranial (EC-IC) bypass was believed to offer little benefit to this patient. Abrupt ligation of the internal carotid artery in the neck proved to be an effective method for arresting the embolic discharge from this vessel's inaccessible obstruction, and resulted in prompt and complete relief of ischemic symptoms. It is concluded that identifying the mechanism(s) responsible for recurrent ischemia past uncorrectable carotid obstructions is of paramount importance in order to establish the most appropriate treatment(s). Carotid occlusion is an effective surgical remedy for terminating microembolism from this vessel when it is diseased and incompletely obstructed, and should be considered in selected patients. The importance of angiographic evaluation of naturally occurring EC-IC anastomotic connections in addition to the assessment of intracranial collateral reserves in cases of carotid occlusion is also emphasized.
Oncotic pressure of subdural fluids
Authors: Weir Bryce
Published: May 2009

✓ The oncotic pressure of fluid from subdural heatomas and subdural hygromas was compared to that of simultaneously drawn venous blood in 20 patients. There was no significant difference in the oncotic pressure of fluid from subdural hematomas and venous blood; however, the oncotic pressure of fluid from subdural hygromas was significantly less than that of blood. This finding fails to support the Zollinger and Gross modification of Gardner's theory, that chronic subdural hematomas grow and produce symptoms after a latent interval because they attract fluid from the blood via dural vessels.
Systems analysis of intracranial pressure
Authors: Chopp Michael , Portnoy Harold D.
Published: May 2009

✓ Systems analysis is explored as a method of evaluating intracranial pressure (ICP). The intracranial cavity is characterized by a transfer function that is evaluated by the blood pressure pulse acting as the system input and the ICP pulse acting as the output. A comparison is made of the ability of systems analysis, volume-pressure test (VPT), and cerebrospinal fluid-pulse amplitude analysis (CSFPAA) to distinguish between an epidural balloon inflation (EBI) and an intraventricular infusion (IVI) at various steady state levels of ICP. The VPT could not distinguish between EBI and IVI at any level of ICP, and above 30 mm Hg the volume-pressure response decreased. Spectral analysis was able to distinguish EBI from IVI above 30 mm Hg, and CSFPAA was demonstrated to be a simplified spectral analysis. Changes in ICP waveform generated during each cardiac cycle appear to be related to changes in vasomotor reactivity and may have value in the clinical monitoring of ICP.