bluuebunny/crossref_metadata_2025 huggingface dataset:
Castleman's disease of the leptomeninges
Authors: Severson Gregory S. , Harrington Douglas S. , Weisenburger Dennis D. , McComb Rodney D. , Casey John H. , Gelber Benjamin R. , Varet B. , Abelanet R. , Rappaport Henry H.
Published: May 2009

✓ Castleman's disease is a rare, benign lymphoproliferative disorder that usually arises in lymph nodes, most commonly in the mediastinum. The authors report the clinical and pathological features of three patients with localized Castleman's disease of the leptomeninges. There were two women, aged 63 and 82 years, and one 25-year-old man. Two patients had progressive focal motor seizures of 3 and 24 months' duration, and the third patient presented acutely with generalized seizures. The clinical diagnosis was meningioma in each case, based on computerized tomography scans, cerebral arteriography, and the operative findings. All three lesions arose in the leptomeninges, compressed the underlying cerebral cortex, and infiltrated the overlying dura to a variable extent. Surgical excision of the tumor resulted in marked clinical improvement in all three patients. Histologically, two cases were classified as the hyaline-vascular type and one as the plasma cell type. Immunohistochemical stains of the latter case revealed a monoclonal population of mature plasma cells. Only a few scattered polyclonal plasma cells were seen in the other two cases. The authors conclude that Castleman's disease involving the leptomeninges is a rare disorder that may mimic meningioma clinically and radiographically.
Pineoblastoma with an unusually long survival
Authors: Uematsu Yuji , Itakura Toru , Hayashi Seiji , Komai Norihiko
Published: May 2009

✓ The authors report a case of pineoblastoma with a 9-year follow-up period after stereotaxic biopsy, a shunting procedure, and radiotherapy. Light and electron microscopic studies of biopsy and autopsy specimens revealed no cell differentiation of the pineoblastoma. The possible factors predisposing to long survival are discussed in comparison with the course in patients with medulloblastoma.
Leptomeningeal spread of intramedullary spinal cord tumors
Authors: Bell William O. , Packer Roger J. , Seigel Kathy R. , Rorke Lucy B. , Sutton Leslie N. , Bruce Derek A. , Schut Luis
Published: May 2009

✓ Three patients with intramedullary spinal cord tumors and secondary leptomeningeal spread of their tumors are presented. Two patients had astrocytomas and one had a ganglioglioma. Two tumors were located in the cervical spinal cord and one within the thoracic spinal cord. Review of the past and recent literature shows leptomeningeal dissemination of spinal cord tumors to be relatively rare, but it should be suspected and investigated in any patient whose condition deteriorates following removal of a spinal cord neoplasm.
The stereotaxic retractor in computer-assisted stereotaxic microsurgery
Authors: Kelly Patrick J. , Goerss Stephan J. , Kall Bruce A.
Published: May 2009

✓ The authors describe a cylindrical retractor that is attached to a standard stereotaxic frame. This retractor provides a route for stereotaxic procedures and exposure of and a reference structure for the computer-assisted removal of deep-seated intracranial lesions defined stereotaxically by computerized tomography and magnetic resonance imaging.
Management of elderly patients with aneurysmal subarachnoid hemorrhage
Authors: Inagawa Tetsuji , Yamamoto Mitsuo , Kamiya Kazuko , Ogasawara Hidenori
Published: May 2009

✓ A total of 299 patients with aneurysmal subarachnoid hemorrhage (SAH) were classified into three age groups, that is, those aged 59 years or younger (Group 1: 159 patients, 53%), those aged 60 to 69 years (Group 2: 85 patients, 28%), and those aged 70 years or older (Group 3: 55 patients, 18%). A comparison was made of the surgical indications and their overall management outcome in these age groups.

The overall outcome at 1 year after SAH of Group 3 was significantly poorer than that of Group 1 (p < 0.01) or Group 2 (p < 0.01), but no significant difference could be demonstrated between Groups 1 and 2. Overall, 104 of the 299 patients died, for a mortality rate of 35%. The mortality rate by age group was 29% for Group 1, 33% for Group 2, and 55% for Group 3. Surgery was performed on 122 patients (77%) in Group 1, 56 (66%) in Group 2, and 25 (45%) in Group 3. The overall operative outcome at 1 year after SAH in Group 3 was significantly poorer than that of Group 1 (p < 0.01), but no significant difference was observed in this regard between Groups 1 and 2. The operative mortality rate of the patients in Groups 1 , 2, and 3 who were preoperatively in Hunt and Hess Grades I and II was 1%, 7%, and 22%, respectively (no significant difference). By life-table analysis the 5-year survival probability was 65% for Group 1, 60% for Group 2, and 37% for Group 3. The rate of patients surviving in good condition or in a disabled but independent condition at 1 year after SAH was 93% and no statistically significant difference in survival probability was observed among the three age groups.
Diagnosis and treatment of vertebral aneurysms
Authors: Yamaura Akira
Published: May 2009

✓ The intracranial vertebral artery and its branches are a common site of aneurysms in the posterior fossa. Ninety-four aneurysms in 86 patients were analyzed for their clinical manifestation, diagnosis, and treatment. There were three distinct varieties of aneurysm in this group: 56 (60%) saccular aneurysms, 26 (28%) dissecting aneurysms, and 12 (13%) atherosclerotic fusiform aneurysms. Of the 26 dissecting aneurysms, 81% bled and 24% of these rebled. None of the atherosclerotic fusiform aneurysms bled. Angiographic differentiation between dissecting aneurysms and atherosclerotic fusiform aneurysms was difficult. The dissecting aneurysms were characterized by a “narrowed segment” proximal and/or distal to a “fusiform dilatation” of the affected artery and by the presence of contrast medium in the intramural false lumen until the late phase. Poor postoperative outcome and the lateral medullary syndrome were seen only in dissecting aneurysms. Small atherosclerotic fusiform aneurysms seemed to be benign lesions that do not require any surgical treatment.
Cell kinetics studies of human brain tumors by in vitro labeling using anti-BUdR monoclonal antibody
Authors: Nishizaki Takafumi , Orita Tetsuji , Saiki Masahide , Furutani Yasuhiro , Aoki Hideo
Published: May 2009

✓ Since the development of a specific monoclonal antibody against the thymidine analogue bromodeoxyuridine (BUdR), many investigators have used intravenous infusion of BUdR to estimate the proliferative potential of human brain tumors. However, side effects such as the induction of cell mutation, latent virus promotion, or inhibition of cytodifferentiation cannot be ignored, and thus many workers hesitate to use it in patients, especially those with hepatic disease or of reproductive age. Furthermore, if BUdR remains in the deoxyribonucleic acid of tumor cells after injection, analysis of the effect of chemical and radiation therapy may not be evaluated correctly. In this report,in vitroBUdR labeling with an anti-BUdR antibody is compared with thein vivomethods described by previous authors. This method appears to be useful for determining the S-phase fraction of human brain tumor. It was more rapid, and was simple, safe, and reproducible as compared to the intravenous infusion method.
The acute-phase response of the brain-injured patient
Authors: Young A. Byron , Ott Linda G. , Beard David , Dempsey Robert J. , Tibbs Phillip A. , McClain Craig J.
Published: May 2009

✓ The acute response to injury and infection is manifested by increased synthesis of acute-phase proteins by the liver, an increased white blood cell count, fever, a negative nitrogen balance, and altered serum mineral levels (zinc, iron, and copper). This response is thought to be partially mediated by cytokines such as interleukin-1, but has not been well studied in head-injured patients. In this study, 25 patients were studied for evidence of the acute-phase response extending from hospital admission up to 21 days postinjury. The patients were divided into two groups to determine if severity of injury influenced the response. Group 1 consisted of nine patients with admission peak 24-hour Glasgow Coma Scale (GCS) scores of 4 or less; Group 2 consisted of 16 patients with admission peak 24-hour GCS scores of 8 or greater. All patients demonstrated some evidence of the acute-phase response. Serum alpha-1 acid glycoprotein, ceruloplasmin, and C-reactive protein levels were elevated on admission and throughout the study. Serum albumin and zinc levels were depressed on admission; zinc levels gradually normalized by Day 21 in both groups, but hypoalbuminemia was observed throughout the study period. Serum copper levels were normal on admission but increased to above normal in both groups by Day 11 postinjury. Urinary urea nitrogen excretion was elevated in both groups and peaked on Day 7 for Group 1 and Day 11 for Group 2 patients. The patients with admission GCS scores equal to or less than 4 had overall higher temperatures than were seen in those with GCS scores greater than or equal to 8 (p = 0.009). All patients but one had an elevated white blood cell count on admission. It is concluded that braininjured patients with admission GCS scores of 3 to 4 and 8 to 14 demonstrate an acute-phase response which lasts for at least 3 weeks postinjury. It is speculated that this response is at least partially mediated by increased intraventricular interleukin-1 activity.
Enhanced specificity of prognosis in severe head injury
Authors: Choi Sung C. , Narayan Raj K. , Anderson Randy L. , Ward John D.
Published: May 2009

✓ Data from 523 patients admitted to the Medical College of Virginia with severe head injury and known 6-month outcomes were analyzed in order to determine the optimal combination of early-available prognostic factors. Twenty-one prognostic indicators noted in the emergency room at admission were used to predict outcomes into four categories: good, moderately disabled, severely disabled, or vegetative/dead. A combination of the patient's age (in years), the best motor response (graded in the usual six-point scale), and pupillary response (in both eyes) was found to be the most accurate indicator. The model correctly predicted outcome into one of the four outcome categories in 78% of cases (“specifically accurate predictions”). If predictions into an outcome category adjacent to the actual outcome were accepted, this model was accurate in 90% of cases (“grossly accurate predictions”). A set of three simple graphs based on this model can be used for rapid early estimation of probable outcome in a severely head-injured patient at admission.
Mechanisms and implications of hypoalbuminemia in head-injured patients
Authors: McClain Craig J. , Hennig Bernhard , Ott Linda G. , Goldblum Simeon , Young A. Byron
Published: May 2009

✓ Severely head-injured patients are hypermetabolic/hypercatabolic and exhibit many aspects of the postinjury acute-phase response. These patients have hypoalbuminemia, hypozincemia, hypoferremia, hypercupria, fever, and increased synthesis of acute-phase proteins such as ceruloplasmin and higher C-reactive protein levels. It has been suggested that increased interleukin-1 (IL-1) in the ventricular fluid may be responsible, at least in part, for these metabolic abnormalities. In the present study, serum albumin levels were evaluated throughout an 18-day study period in 62 head-injured patients receiving aggressive nutritional support. Hypoalbuminemia (mean ± standard error of the mean 3.10 ± 0.2 gm/dl; normal value 3.5 to 5 gm/dl) was observed upon hospital admission; these albumin levels continued to decrease until 2 weeks postinjury, despite aggressive nutritional support. This hypoalbuminemia may be mediated via altered endothelial permeability properties due to endothelial cell dysfunction caused by cytokines such as IL-1. Transendothelial movement of albumin was assayed using a pulmonary artery endothelial cell culture system. Both a crude macrophage supernatant derived from a murine P388D cell line having IL-1 activity (mIL-1) and human recombinant IL-1 (rIL-1) were tested. The amount of albumin transferred was time- and concentration-dependent, with maximal transfer at 24 hours and 20 U of mIL-1 per 0.5 ml of culture medium. Endothelial permeability changes observed after incubation with mIL-1 were confirmed using rIL-1. Compared to control cultures, 20 U of rIL-1 and 20 U of mIL-1 increased albumin transfer across endothelial monolayers 205% and 459%, respectively. These findings suggest that the mechanism of hypoalbuminemia seen after severe head trauma can be explained in part by IL-1-induced endothelial cell injury, resulting in enhanced endothelial permeability to albumin.
Bromodeoxyuridine: a comparison of its photosensitizing and radiosensitizing properties
Authors: Raffel Corey , Deen Dennis F. , Edwards Michael S. B.
Published: May 2009

✓ The photo- and radiosensitizing properties of bromodeoxyuridine (BUdR) were assessedin vitrousing the 9L rat brain tumor cell line. Pretreatment of 9L cells with 10µM BUdR for 24 hours followed by irradiation with ultraviolet (UV) light resulted in a dose-enhancement ratio of 3.8:1 compared with UV radiation alone. X-radiation of BUdR-pretreated cells produced a dose-enhancement ratio of 1.7:1. Alkaline elution analysis of deoxyribonucleic acid (DNA) from cells treated with BUdR and UV irradiation showed the presence of DNA single-strand breaks and DNA-protein cross-links. Analysis of DNA from cells treated with BUdR and then x-irradiated showed no increase in DNA single-strand breaks compared with cells treated with x-radiation alone; no DNA-protein cross-links could be detected. The possible clinical relevance of these findings is discussed.
Sequelae of the osmotic blood-brain barrier opening in rats
Authors: Suzuki Michiyasu , Iwasaki Yuzo , Yamamoto Teiji , Konno Hidehiko , Kudo Hiroko
Published: May 2009

✓ Histopathological sequelae of the osmotic blood-brain barrier opening were studied in 69 adult Wistar rats sacrificed between 2 minutes and 6 days after infusion of 1.6 M mannitol into the unilateral internal carotid artery. The results were correlated with immunohistochemical localization of autologous albumin in the brain parenchyma on paraffin sections. Extravasation of serum albumin was evident in all rats, and the albumin immunoreactivity, commonly localized to the territories of the ipsilateral anterior, middle, and posterior cerebral arteries and contralateral anterior cerebral artery, showed maximum intensity in the rats sacrificed 30 minutes after infusion. The albumin immunoreactivity remained macroscopically visible in the brain parenchyma for 24 to 48 hours, and then gradually faded out. Serum extravasation was accompanied by widening of the perivascular space and focal edema, which largely subsided within 48 hours as the albumin immunoreactivity of the tissue diminished. Although no overt neurological sequelae were seen in the present experiment, minute but definite foci of infarction with focal accumulation of albumin were found in 23 (38%) of 61 rats surviving more than 30 minutes. In addition, ischemic neuronal death of delayed onset was encountered among neurons in the CA-1 region of the hippocampus, in the cerebellum, and in the thalamus in five (25%) of 20 rats sacrificed between Days 4 and 6. Thus, care should be exercised in the practice of this procedure.
Infection-related spontaneous atlantoaxial dislocation in an adult
Authors: Clark W. Craig , Coscia Michael , Acker James D. , Wainscott Keith , Robertson James T.
Published: May 2009

✓ This paper reports the third described case of infection-related atlantoaxial subluxation in an adult. Like most of the similar cases seen in the pediatric literature, this case was associated with a parapharyngeal β-hemolytic streptococcal abscess. Based upon this experience, the authors advocate intravenous antibiotic therapy and 1) immediate reduction followed by application of a halo brace; 2) immobilization in a halo brace for at least 3 months; and 3) a C1–2 wiring and fusion procedure for patients who fail this trial of conservative therapy.
Limiting artifact in CT stereotaxic periventricular procedures
Authors: Maciunas Robert J. , Juneau Patrick
Published: May 2009

✓ One potential source of computerized tomography image artifact during stereotaxic data acquisition is scatter from standard steel-tipped fixation pins as supplied for use with the Brown-Roberts-Wells stereotaxic headframe. In some cases, this can hinder selection of periventricular targets. Replacement of the steel-tipped pins with aluminum-tipped pins, which produce less artifact, helps to facilitate stereotaxic intervention.
Low morbidity and mortality of carotid endarterectomy performed with regional anesthesia
Authors: Lee K. Stuart , Davis Courtland H. , McWhorter Joe M.
Published: May 2009

✓ Various anesthetic and surgical techniques have been recommended with or without cerebral function monitoring in attempts to reduce the risk of carotid endarterectomy, but there is no consensus as to the ideal method for performing this procedure. General anesthesia is now the most common anesthetic technique used, but of 337 carotid endarterectomies performed by the authors' service from 1981 through 1985, 305 (91%) were conducted with regional anesthesia. This paper presents the morbidity and mortality rates for those patients. There were two perioperative transient ischemic attacks (0.66%), two perioperative strokes (0.66%), and two perioperative deaths (0.66%). No patient in the series suffered a myocardial infarction within 30 days after endarterectomy. This series demonstrates that carotid endarterectomy can be performed with good results using regional anesthesia, which facilitates intraoperative cerebral function monitoring. Regional anesthesia is associated with a very low incidence of postoperative hypertension and perioperative myocardial infarction.
Symptomatic arterial luminal narrowing presenting months after subarachnoid hemorrhage and aneurysm clipping
Authors: Kondziolka Douglas , Bernstein Mark , Spiegel S. M. , ter Brugge Karel
Published: May 2009

✓ The authors describe three cases of clinical cerebral ischemia associated with angiographic evidence of cerebral arterial luminal narrowing presenting 7, 14, and 52 weeks after subarachnoid hemorrhage (SAH) and aneurysm clipping. Delayed vasospasm, in its usual time setting 1 or 2 weeks after hemorrhage, did not occur symptomatically in these patients. No evidence for aneurysm clip migration or rebleed was present. All patients responded favorably to volume expansion and elevation of blood pressure. This unusual occurrence of a very delayed vasospasm may further the understanding of the vasospastic process. The symptomatic onset of arterial luminal narrowing months after SAH may suggest that a proliferative vasculopathy more accurately explains the observed vessel narrowing, rather than conventional active constriction of vascular smooth muscle.
Madreporic coral: a new bone graft substitute for cranial surgery
Authors: Roux François X. , Brasnu Daniel , Loty Bernard , George Bernard , Guillemin Geneviève
Published: May 2009

✓ Since 1985, the authors have been using madreporic coral fragments (genera Porites) as a bone graft substitute. Of the 167 coral grafts implanted, 150 were coral “corks” used to obliterate burr holes (diameter 10 mm), five were large implants (length 20 to 40 mm) to repair skull defects, and 12 were coral blocks to reconstruct the floor of the anterior cranial fossa. Previous experimental studies suggested that coral grafts would be well tolerated and become partially reossified as the calcific skeleton was resorbed. The authors describe their experience and detail the main biological properties of these materials, which appear to be very promising for use in cranial reconstructive surgery.
The effect of intracerebral hematoma location on the risk of brain-stem compression and on clinical outcome
Authors: Andrews Brian T. , Chiles Bennie W. , Olsen Walter L. , Pitts Lawrence H.
Published: May 2009

✓ The clinical findings and computerized tomography (CT) brain scans of 45 patients with supratentorial intracerebral hematomas were evaluated to determine the effect of hematoma location on the clinical course and outcome of the disease. The lesions were frontal in 18 patients, temporal or temporoparietal in 17, and parieto-occipital in 10. No patient with a frontal or parieto-occipital hematoma had clinical signs of transtentorial herniation at admission or subsequently, whereas seven (41%) of those with temporal or temporoparietal lesions had signs of herniation (p < 0.05); three of these seven patients had an abnormal mental status, ipsilateral anisocoria, and lateralizing motor findings at admission, and four developed these signs within 12 hours after admission, necessitating urgent surgical intervention. The mean volume of the lesions estimated from the CT scans was similar in the three groups (frontal 47 ± 28 cc; parieto-occipital 53 ± 26 cc; temporal/temporoparietal 41 ± 21 cc). None of the six patients with temporal or temporoparietal hematomas smaller than 30 cc had signs of tentorial herniation, compared with seven (64%) of 11 patients with larger hematomas (p < 0.05); in six of these seven cases, the hematoma was caused by head injury. Patients with a temporal or temporoparietal hematoma had a worse outcome than those in the other two groups, and no patient with signs of tentorial herniation had a good outcome. Patients with temporal or temporoparietal hematomas appear to be at greater risk of brain-stem compression, especially if the lesion is larger than 30 cc and caused by head injury, than are those with hematomas in other sites. In such cases, prompt surgical intervention should be considered.
Suprasellar meningiomas: the effect of tumor location on postoperative visual outcome
Authors: Andrews Brian T. , Wilson Charles B.
Published: May 2009

✓ The authors reviewed 38 cases of suprasellar meningioma to determine the correlation between tumor site and postoperative visual outcome. Progressive visual loss, the most frequent initial complaint (94.7%), occurred over a mean of 24½ months, was most often unilateral (18 patients) or bilateral but asymmetrical (14 patients), and was severe (20/200 vision or worse) in 23 patients; 24 patients had visual field abnormalities. Computerized tomography or magnetic resonance studies clearly delineated the lesions but did not appear to permit earlier diagnosis. Eleven patients had tumors limited to the tuberculum sellae; the tumor extended from the tuberculum sellae onto the planum sphenoidale in nine patients, into one optic canal in eight, onto the diaphragma sellae in seven, and onto the medial sphenoid wing in three. Patients with tumors affecting the optic canal had severe unilateral visual loss more often than those with tumors at other sites. Tumors limited to the tuberculum sellae were most often completely resected; postoperative recovery of vision was also most frequent in patients with tumors at this site. Tumors involving the diaphragma sellae or the medial sphenoid wing were least often completely removed and most likely to be associated with postoperative visual deterioration. Overall, 42% of patients had improved vision postoperatively, 30% remained unchanged, and 28% were worse. After a mean follow-up period of 38 months, 24 patients are doing well, four have significant visual disability, and three are blind or doing poorly. Two patients died of causes unrelated to their tumor. Three patients have had tumor recurrence.
Appearance of venous malformations on magnetic resonance imaging
Authors: Rigamonti Daniele , Spetzler Robert F. , Drayer Burton P. , Bojanowski W. Michel , Hodak John , Rigamonti K. Hoenig , Plenge K. , Powers M. , Rekate Harold
Published: May 2009

✓ The magnetic resonance (MR) imaging appearance of venous malformations, all angiographically verified, was evaluated in 11 patients. A venous malformation is characteristically depicted as a tubular area of decreased signal intensity in the white matter of the brain. In one patient, a histologically verified cavernous malformation was also present with a characteristic mixed signal-intensity core on the T2-weighted MR images. Care should be used when evaluating venous angiomas to exclude the presence of a lesion with associated prominent venous drainage, such as a glioma.
Parietal cephalocele: clinical importance of its atretic form and associated malformations
Authors: Yokota Akira , Kajiwara Hidehiko , Kohchi Masato , Fuwa Isao , Wada Hidetaka
Published: May 2009

✓ In this study of atretic cephaloceles, the authors have considered the pedunculated or sessile type of cephalocele and also small nonpedunculated scalp defects developing in the vertex midline. Parietal cephaloceles were found in 15 infants (10 boys and five girls), and accounted for 37.5% of all cephaloceles. They consisted of four encephaloceles, six meningoceles, and five atretic cephaloceles. The clinical and morphological characteristics of parietal cephaloceles were investigated and compared with those arising at other locations. Parietal cephaloceles carried a much less favorable prognosis than those in the occipital region, regardless of the type of cephalocele; they were associated with cerebral malformations more frequently and were more severe than occipital cephaloceles. Grave congenital anomalies were found in 87% of patients with parietal cephalocele, and only two patients (neither of whom had any other malformation) attained normal development. Brain malformations were closely related to the site from which the cephalocele issued, and dorsal cyst malformation was found in eight patients with parietal cephalocele.

Two types of atretic cephaloceles were found, each in a different location. The first type was an alopecic lesion occurring in the parietal midline; all five patients with this type had dorsal cyst malformations and none developed normally. The second type was a nodular lesion developing at the occipital midline, not associated with cerebral anomalies; all five patients with this type showed normal development. The pathogenesis of atretic cephaloceles and their associated intracranial malformations are discussed.
Quantification of thermal asymmetry
Authors: Uematsu Sumio , Jankel William R. , Edwin David H. , Kim Won , Kozikowski Joseph , Rosenbaum Arthur , Long Donlin M.
Published: May 2009

✓ Temperature differences between the lower extremities were measured using a computerized thermometric scanning system in order to compare the degree of thermal asymmetry in 144 patients with low-back pain. The patients displayed highly significant thermal asymmetries, with the involved limb being cooler (p < 0.001). When asymmetries exceeded 1 standard deviation from the mean temperature of homologous regions measured in 90 normal control subjects, the positive predictive value of thermometry in detecting root impingement was 94.7% and the specificity was 87.5%. These values indicate that calculation of temperature asymmetry is particularly effective in evaluating reported pain in psychosocially affected patient populations in whom the chance of positive myelography or impaired root function is low. In this group of patients, thermometric study provides physicians with important information for proper decision making. The test can be performed to avoid more invasive and probably less revealing diagnostic or exploratory surgical procedures.
Effects of treatment with U-74006F on neurological outcome following experimental spinal cord injury
Authors: Anderson Douglas K. , Braughler J. Mark , Hall Edward D. , Waters Thomas R. , McCall John M. , Means Eugene D.
Published: May 2009

✓ The compound U-74006F is one of a series of 21-aminosteroids that lack glucocorticoid or mineralocorticoid activity. These potent inhibitors of lipid peroxidation have been specifically developed for the acute treatment of central nervous system trauma and ischemia. This study evaluated the dose-response characteristics and capability of U-74006F to promote functional recovery in cats subjected to compression trauma of the upper lumbar (L-2) spinal cord. Thirty minutes following injury, randomized and investigator-blinded treatment was initiated with the intravenous administration of either vehicle (citrate-buffered saline) or one of eight doses of U-74006F. Initial doses of U-74006F ranged from 0.01 to 30 mg/kg. Subsequent doses consisted of intravenous bolus injections followed by a continuous 42-hour intravenous infusion. Over the 48-hour treatment period, cats received total U-74006F doses ranging from 0.048 to 160 mg/kg. The animals were evaluated weekly for neurological recovery based upon an 11-point behavioral scale. With the exception of two cats in one group, the animals receiving accumulated doses of U-74006F (ranging from 1.6 to 160.0 mg/kg/48 hrs) exhibited nearly 75% of normal neurological function by 4 weeks after injury. Lower total doses of 0.16 and 0.48 mg/kg/48 hrs were associated with approximately 50% return of normal function, which was not significantly better than the recovery in the vehicle-treated control group. The lowest total dose tested (0.048 mg/kg/48 hrs) gave results indistinguishable from those in vehicle-treated cats, which had recovered only 20% of their preinjury neurological function by 4 weeks. These findings demonstrate that over a 100-fold range of doses, U-74006F has a remarkable capacity to promote functional recovery in spinal cordinjured cats.
Reduction of cellular energy requirements
Authors: Zager Eric L. , Ames Adelbert
Published: May 2009

✓ Protection of the brain and spinal cord against ischemia is a goal of vast clinical importance. One approach to this objective is to reduce the tissue's functional activity in order to preserve energy for the metabolic processes that are essential to viability. Experiments to explore ways of reducing function-related energy demands were performed on isolated rabbit retina, a well-characterized model of organized adult mammalian central nervous system (CNS) tissue. The retina was maintained in a nearly physiological state in a miniature “heart-lung” apparatus. Energy metabolism (oxygen consumption and glycolysis) and electrophysiological function (determined by electroretinogram) of thein vitroretina were monitored, and their responses to a series of agents that may reduce energy requirements were determined.

Large reversible reductions in O2consumption, glycolysis, and electrophysiological function were seen in response to mild hypothermia ( −3° to −6°C), phenytoin (Dilantin, 100 to 200 mg/kg), chlordiazepoxide (Librium, 200µM), lithium (1 to 4 mM), Mg++(6 to 20 mM), strophanthidin (0.15 to 0.25µM), CO2(25% to 30%), 2-amino-5-phosphonovaleric acid (APV, 500µM), amiloride (1 mM), and dantrolene (1 mM). One retina was exposed simultaneously to a combination of six of these agents, which reduced its oxidative and glycolytic metabolism to less than 50% of the control level. The retina recovered metabolic and electrophysiological function after a 2½-hour exposure period. Other agents tested (diphenhydramine, midazolam, nifedipine, nimodipine, and quercetin) had effects on energy metabolism and electrophysiological function that were poorly reversible. Surprisingly little effect was seen in response to general anesthetic agents (thiopental and Althesin) and other CNS depressants (chlorpromazine, ethanol, lidocaine, paraldehyde, valproic acid, and baclofen). The presumed mechanisms through which these agents reduce cellular energy requirements, as well as their potential roles in the treatment of CNS ischemia, are discussed.
Flow cytometric determination of modal DNA population in relation to proliferative potential of human intracranial neoplasms
Authors: Cho Kyung G. , Nagashima Tadashi , Barnwell Stanley , Hoshino Takao
Published: May 2009

✓ Paraffin-embedded specimens of brain tumors from 256 patients who had received an intravenous infusion of bromodeoxyuridine (BUdR) at the time of craniotomy were analyzed retrospectively by flow cytometry to determine the modal deoxyribonucleic acid (DNA) population. A single G1 peak was considered to represent a unimodal DNA population; two or more G1 peaks indicated a multimodal population. Most of the pituitary tumors and moderately anaplastic astrocytomas had unimodal DNA populations, whereas a higher percentage of other slow-growing tumors, such as meningiomas, ependymomas, and neurilemomas, had multimodal populations (46.2%, 50.0%, and 60.0%, respectively). A relatively high percentage of the rapidly growing or highly malignant brain tumors, including highly anaplastic astrocytomas, glioblastomas multiforme, metastatic tumors, and medulloblastomas, also had multimodal populations (52.9%, 48.7%, 57.1%, and 66.7%, respectively). In most tumor groups, however, the percentage of tumors with a multimodal DNA population did not correlate with the BUdR labeling index or with the percentage of BUdR-labeled S-phase cells. Thus, modal DNA analysis by flow cytometry may provide information about the degree of heterogeneity and the biological behavior of individual brain tumors, but the results do not necessarily correlate with the rate of tumor growth or the prognosis in individual patients.
Bilirubin and the induction of intracranial arterial spasm
Authors: Duff Thomas A. , Feilbach John A. , Yusuf Qaiser , Scott Grayson
Published: May 2009

✓ Although a number of substances which participate in the physiological control of vascular caliber have been proposed to play a causative role in cerebral vasospasm, none of these has been shown to induce the profound, sustained degree of constriction or the vasculopathy that characterize this disorder. The present study was undertaken to determine whether bilirubin, a hemoglobin breakdown product with detergent-like activity, accrued in incubated blood or in intracranial hematoma and whether topical application of bilirubin altered the caliber or morphology of cerebral arteries. As a model of blood residing in the subarachnoid space, sterile vials of cat blood and of human blood were incubated in vitro at 37°C. The concentration of bilirubin in the supernatant of cat blood increased from a value of 0.27 ± 0.3 mg% (mean ± standard error of the mean) on Day 0 to a value of 9.57 ± 2.4 mg% on Day 10; the respective values for human blood were 0.53 ± 0.02 mg% and 13.4 ± 5.4 mg%. Samples of intracranial hematoma that had been surgically removed from three patients between 4 and 11 days after hemorrhage yielded bilirubin levels from 2.1 to 15.2 mg%. Application of a bilirubin suspension of 5, 10, or 20 mg% in buffered Ringer's solution to cat basilar artery in vivo led to progressive and sustained constriction; at 4 hours the mean decrease in the width of the blood column was 34% ± 2.1%. Ultrastructural analysis of these vessels showed widespread pathological changes similar to those associated with cerebral vasospasm. Application of a 10-mg% bilirubin suspension to the basilar artery of two baboons produced similar alterations. Minimal changes in diameter or morphology were observed in cat arteries bathed in buffer solution alone. These findings in animal models indicate that bilirubin may play a central role in the development of cerebral vasospasm.
Rupture of cavernous carotid artery aneurysm causing subdural hematoma and death
Authors: Hodes Jonathan E. , Fletcher William A. , Goodman Daniel F. , Hoyt William F.
Published: May 2009

✓ Aneurysms of the intracavernous portion of the internal carotid artery may become very large, but they very rarely rupture. A case is described in which rupture of such a lesion resulted in a lethal massive subdural hematoma with transtentorial herniation. This is the second reported case of substantiated intracranial rupture from a wholly intracavernous carotid artery aneurysm.
Suprasellar craniopharyngioma associated with hyperprolactinemia, pituitary lactotroph hyperplasia, and microprolactinomaCase report
Authors: Cusimano Michael D. , Kovacs Kalman , Bilbao Juan M. , Tucker William S. , Singer William
Published: May 2009

✓ A case with the coexistence of a microprolactinoma and suprasellar craniopharyngioma lactotroph hyperplasia is presented. Loss of inhibitory hypothalamic dopaminergic input may have played a role in hyperprolactinemia and the proliferation of pituitary lactotrophs. This is believed to be the first published case of suprasellar craniopharyngioma with this association.
Hemophilic pseudotumor of the spinal canal
Authors: Liu Shih Sing , White William L. , Johnson Peter C. , Gauntt Charles
Published: May 2009

✓ Hemophilic pseudotumor is an uncommon complication among hemophiliacs. Most of these lesions are located in the long bones and the pelvis. The authors describe a case of hemophilic pseudotumor in a patient who presented with symptoms of L-5 radiculopathy and evidence of a destructive lesion on computerized tomography scans. Histologically, the lesion consisted of an organizing hematoma with reactive fibrosis. The diagnosis requires a high index of suspicion. Surgery is recommended for symptomatic patients.
The role of MR imaging in the diagnosis and treatment of anterior sacral meningocele
Authors: Lee K. Stuart , Gower David J. , McWhorter Joe M. , Albertson David A.
Published: May 2009

✓ Anterior sacral meningoceles are rare. This report describes familial anterior sacral meningoceles in a father and daughter who underwent magnetic resonance imaging as part of the preoperative evaluation. Magnetic resonance imaging showed a pelvic teratoma in the daughter and confirmed the absence of abnormal tissue in the father — findings not clearly provided by ultrasound studies, myelography, or contrast-enhanced computerized tomography. It is believed that MR imaging is the most useful preoperative diagnostic technique available in establishing a treatment plan for anterior sacral meningocele.
A comparative study of brain-stem auditory evoked potentials and blink reflexes in posterior fossa tumor patients
Authors: Zileli Mehmet , İdiman Fethi , Hiçdönmez Tufan , Övül İzzet , Tunçbay Erdem
Published: May 2009

✓ Brain-stem auditory evoked potentials (BAEP's) and blink reflexes (BR's) were recorded from 40 patients with clinical and radiological evidence of posterior fossa tumors. They were examined in three groups according to the anatomical location of the lesion: Group A included 15 patients with midline tumors; Group B included 14 patients with cerebellar hemispheric tumors; and Group C included 11 patients with cerebellopontine angle (CPA) tumors. More of the 40 patients had BAEP abnormalities (32) than BR abnormalities (24). All of the 11 patients with CPA tumors had some kind of BAEP and BR abnormalities. The 14 patients with cerebellar tumors showed the next most frequent abnormalities: 12 related to the BAEP's and seven to the BR's. The 15 patients with midline tumors showed the least number of abnormalities: nine related to BAEP's and six to the BR's.

In the analysis of BAEP wave latencies and interpeak latencies, a wave III latency delay occurred in all groups; latencies of waves IV and V were more significantly delayed in patients with CPA and cerebellar hemispheric tumors, and the interpeak latencies of waves III–V and I–V were markedly prolonged only in patients with CPA tumors (p < 0.01).

In all tumor groups, early response (R1) of BR's was significantly delayed in comparison to a healthy volunteer control group (p < 0.01), but R1 was more pronounced in cases of CPA tumors when compared with the other tumor groups. Although significant delays in direct and consensual late reflex components (R2) of BR's were noted in comparison to the control group, this delay could not differentiate one tumor group from another.

It can be concluded that, while these tests reflect the functions of different cranial nerves and brain-stem tracts, BAEP monitoring is more sensitive than BR testing for the detection of brain-stem involvement in posterior fossa tumors. Cerebellopontine angle tumors almost always cause severe abnormalities in both tests. Cerebellar hemispheric tumors and midline tumors cause fewer changes in both BAEP's and BR's.
Differentiation of aseptic and bacterial meningitis in postoperative neurosurgical patients
Authors: Ross Donald , Rosegay Harold , Pons Vincent
Published: May 2009

✓ The differentiation of bacterial from aseptic meningitis in postoperative neurosurgical patients has traditionally been based on the clinical setting, a recent history of steroid administration, and cerebrospinal fluid (CSF) studies, including the total and differential leukocyte counts, Gram stain, glucose, and total protein. Recent reports questioning both the validity of a relative CSF lymphocytosis in excluding bacterial meningitis and the usefulness of standard CSF testing prompted the authors to reevaluate these standard criteria. The type of operation, the presence of a foreign body, use of steroids, postoperative day on which symptoms developed, altered mental status, neck stiffness, headache, and nausea were not helpful in the differential diagnosis. High fever, new neurological deficits, an active CSF leak, and elevated leukocyte counts in the CSF and peripheral blood favored a bacterial etiology. The CSF glucose level and the differential leukocyte count were less helpful. No criterion or combination of criteria was sensitive and specific enough to reliably differentiate aseptic from bacterial meningitis in the majority of patients. The possibility of improving diagnostic accuracy with newer tests, such as CSF lactate, ferritin, total amino acids, C-reactive protein, and amyloid-A, should be assessed.
Effect of subarachnoid hemorrhage on intracranial pulse waves in cats
Authors: Cardoso Erico R. , Reddy Kesava , Bose Deepak
Published: May 2009

✓ The influence of vasoconstrictors of intracranial arteries on the amplitude and configuration of the intracranial pulse wave (ICPW) was investigated. Continuous pressure recordings from the descending aorta (systemic arterial pressure) and the third cerebral ventricle (intracranial pressure) were obtained from anesthetized cats. Computerized analysis of the configuration, amplitude, and frequency spectrum of ventricular wave (ICPW) and aortic pulse wave (SAPW) was performed. Artificial cerebrospinal fluid (CSF), blood, or 5-hydroxytryptamine (5-HT) was injected intracisternally. In 24 control cats, 2 ml artificial CSF was injected into the cisterna magna. This produced a significant increase in amplitude of the ICPW but no change in the SAPW. Ten animals received 14 intracisternal injections of 2 ml autologous blood which caused narrowing of the amplitude of the ICPW as well as of all its components (P1, P2, and P3), with no significant change in the SAPW's. Eight animals were also subjected to cisternal injection of 2 ml of a 10−4-M solution of 5-HT, resulting in findings similar to those produced by autologous blood. Frequency spectrum of the intracranial and aortic pulse waves showed a high degree of correlation between wave amplitudes and height of the fundamental wave in the FFT record.

These results suggest that the cerebral vasospasm that follows cisternal injections of blood and 5-HT in cats can be diagnosed by analysis of the ICPW. This method may allow early diagnosis and continuous monitoring of cerebral vasospasm in humans.
Creutzfeldt-Jakob disease probably acquired from a cadaveric dura mater graft
Authors: Thadani Vijay , Penar Paul L. , Partington Jonathan , Kalb Robert , Janssen Robert , Schonberger Lawrence B. , Rabkin Charles S. , Prichard James W.
Published: May 2009

✓ A case of Creutzfeldt-Jakob disease (CJD) is reported in a 28-year-old woman who had received a cadaveric dural graft 19 months earlier after resection of a cholesteatoma. The circumstances of the case point to the graft as the most likely source of the disease. Cadaveric dura should be added to the list of materials that may transmit CJD, and it must be very carefully screened if it is used at all for grafting. Autologous tissue should be considered whenever possible.
Cervical spinal intramedullary myxoma in childhood
Authors: Paşaoğlu Aydin , Patiroğlu Tahir E. , Orhon Cem , Yildizhan Ahmet
Published: May 2009

✓ A unique case is reported of a cervical intramedullary myxoma in an 18-month-old boy who presented with torticollis and monoparesis. Radical removal of the tumor by a planned two-stage procedure was curative.
Mycotic vasculitis with repeated intracranial aneurysmal hemorrhage
Authors: Venger Benjamin H. , Aldama Alfonso E.
Published: May 2009

✓ A case of repeated intracranial aneurysmal rupture occurring despite successful treatment of infective endocarditis is reported. While the valvular source of emboli was eradicated and serial angiograms documented no further aneurysms after resection of the primary lesion, the formation and rupture of multiple septic aneurysms occurred 9 months later in the opposite hemisphere. A relationship to damage of the cerebral vasculature by immune complexes is suggested as one possible explanation for this unusual occurrence. This implies that some patients with infective endocarditis may be at permanent risk for the formation and rupture of mycotic intracranial aneurysms, despite successful treatment of the primary cardiac lesion.
Intracranial malignant fibrous histiocytoma with abscess-like tumor necrosis
Authors: Berry Allen D. , Reintjes Stephen L. , Kepes John J.
Published: May 2009

✓ A case of a malignant fibrous histiocytoma (MFH) in the right temporal lobe of a 75-year-old man is reported. The tumor involved the brain and the overlying dura as one continuous mass and had undergone extensive liquefaction necrosis of its center that had a gross appearance similar to that of an abscess. The preoperative computerized tomography scan with injection of contrast material showed the lesion to have central and peripheral enhancement suggestive of metastatic tumor, glioblastoma multiforme, or abscess. Microscopically, the tumor showed the typical features of a MFH with marked acute inflammation in the areas of necrosis. No extracranial sources for this tumor were found clinically. This is the 15th reported case of MFH involving the central nervous system as a primary neoplasm and the first case with gross pathological and radiological features resembling in many respects those of an abscess.
Primary intracranial plasma-cell granuloma
Authors: Cannella Dominic M. , Prezyna Anthony P. , Kapp John P.
Published: May 2009

✓ The authors report the fourth case of primary intracranial plasma-cell granuloma. The patient was a 16-year-old girl who presented with loss of vision as the major clinical feature. The tumor resembled a meningioma both preoperatively and grossly at surgery. Because the tumor did not respond to steroid treatment following subtotal surgical excision, radiation therapy was administered to the affected area. Major considerations in the differential diagnosis of this neoplasm are discussed.
Signet-ring cell lymphoma of the central nervous system
Authors: Pappas Conrad T. E. , Johnson Peter C. , Sonntag Volker K. H.
Published: May 2009

✓ Signet-ring cell lymphoma is a rare tumor described in the lymph nodes, skin, tonsils, thyroid, salivary gland, and ocular orbit. This is the first case report of a B-cell signet-ring cell lymphoma in the central nervous system with Dutcher and Russell bodies, signet-ring nuclei, intracisternal crystalline inclusions, and immunoglobulin M positivity. The patient is doing well 2 years after surgery and postoperative radiation therapy. No definitive prognostic characteristics have been elucidated. This disease entity can only be suspected on histological grounds and confirmed by immunocytochemical and ultrastructural studies.