[An autopsy case of bilateral cavities in the temporal white matter and the striatum (author's transl)]

A 24-year-old female developed high fever and unconsciousness for several days at the age of 3. She was said to have meningitis. Subsequently her verbal development was markedly retarded so that she was kept at a deaf-and-dumb institute. At the age of 19, she was transfered to the mental hospital because she occasionally became very wild without any reasons. She suddendly died at the age of 24 due to paralytic ileus. Her autopsy showed bilateral cavities in the white matter of the anterior portion of the temporal lobes and the striatum. Microscopically, the tissues around the cavities were necrotic and devastated with loss of neurones. Glio-mesodermal reaction was mild. Besides marked thickening of meninges and micropolygyria of the cerebellar hemispheres were demonstrated.

Hypokalemic myopathy due to chronic alcoholism

A patient with hypokalemic myopathy occurring in the context of chronic alcoholism was reported. A 56-year-old male patient, heavy drinker for 20 years, complained of marked weakness and acutely developing pains in his limbs. The principal clinical findings were weakness and tenderness of the proximal limbs and girdle muscle. He was unable to lift his head or any extremities from the bed. Deep tendon reflexes were diminished, but not absent. There was no sensory disturbance except for muscle tenderness. These clinical manifestations disappeared gradually by abstinence from drinking, and potassium administration therapy, and the patient recovered completely on the 26th day after onset. On the day after admission (8th day), serum potassium value was 2.2 mEq/L, and serum CPK activity was 4270 IU. The ECG pattern was consistent with a diagnosis of low potassium content in serum, and the EMG pattern was consistent with a diagnosis of myopathy. These electrophysiological findings had a tendency to recover from this pattern to normal range correspondingly with clinical improvement. The repeated muscle biopsies showed that vacuolation, hyaline degeneration and significant phagocyte infiltration were observed in the muscle on the 9th day after the onset of muscle weakness, and that these pathological findings disappeared almost completely three weeks later. The frequently repeated examinations of potassium content and CPK activity in sera showed that there was a close correlation between these biochemical abnormalities and clinical improvement. The pathogenesis of alcoholic myopathy and significance of CPK abnormality in chronic alcoholism were discussed.

Frequency of Alzheimer's neurofibrillary tangles in the cerebral cortex in progressive supranuclear palsy (subcortical argyrophilic dystrophy)

The frequency of Alzheimer's neurofibrillary tangles was studied, employing large sections of the cerebral hemispheres, in the cerebral cortex in 2 cases of progressive supranuclear palsy. The majority of the neurofibrillary tangles were found in the smaller nerve cells of the third layer. The typical triangular form was rare, and most of them showed argyrophilic neurofibrillary filaments which coiled around the well-preserved nucleus. We concluded that their occurrence in the cerebral cortex is one of the morphological manifestations of the disease process.

[Experimental study on epilepsy using a "kindling preparation". Correlation between septal seizure development and psychomotor seizure]

The seizure development was investigated in seven septal kindled cats for examining a participation of septal area in psychomotor epilepsy. Daily electrical stimulation (mean: 33.5 days) of septal area could lead to the "kindled" generalized convulsion. Six stages of behavioral seizure development were distinguished: 1) attention reaction, 2) the above and immobility, 3) the above and autonomic manifestation, 4) the above and facial twitching, head nodding, 5) the above and tonic extension of contralateral forepaw, 6) the above and generalized clonic convulsions. Self-sustained after-discharge and independent interictal spike discharge appeared in the hippocampus in stage 2 or 3, in the amygdala and the globus pallidus in stage 3 or 4, and also in the ventromedial hypothalamic nucleus in stage 5. Positive transference phenomenon was confirmed in bilateral hippocampus, amygdala and globus pallidus. These findings show the progressive dissemination of secondary epileptogeneses in these secondary brain structures during the septal seizure development. Electrographic and behavioral seizure development mentioned above were completely identical to those in the hippocampal seizure that we have reported previously. It is concluded that psychomotor epilepsies may not only be triggered by the hippocampal and amygdaloid foci but by the septum and its related structuresfoei.

[Correlation between seizure susceptibility and brain catecholamine levels. An experimental study using a kindling preparation]

Correlation between the kindled seizure susceptibility and brain monoamine levels was investigated in the hippocampal and amygdaloid kindled cats. Increase of interictal discharge (IID) frequency and morphological change of IID into self-sustained discharge appeared following reserpine administration. alpha-MPT also increased the IID frequency. These changes in reserpine- and alpha-MPT-treated cats were suppressed completely by the administration of L-DOPA, suggesting that depletion of norepinephrine and dopamine exacerbate the kindled seizure susceptibility. In a second experiment, the assay study of brain catecholamine showed significant and parallel depletion of both norepinephrine and dopamine in the hippocampal kindled cat brain. It is concluded that catecholamine may play an inhibitory role in the establishment and neurohumoral control of the kindled seizure susceptibility.

Frequency of Alzheimer's neurofibrillary tangles in the basal ganglia and brain-stem in Alzheimer's disease, senile dementia and the aged

The authors studied the frequency of neurofibrillary tangles in the basal ganglia and brain-stem of two cases with Alzheimer's disease (average 55 years of age), six cases with senile dementia (average 82 years) and ten cases with cerebral softening and arteriosclerosis in old age (average 79 years). The distribution pattern of ANC was almost the same in Alzheimer's disease and senile dementia, i.e. plenty of ANC were found in the nucl. dorsalis raphe, nucl. centralis superior, nucl. mamilloinfundibularis and nucl. basilaris, but in senile dementia ANC were much fewer in the thalamus and lenticular nuclei. In the aged with cerebral softening and arteriosclerosis, a negligible number of ANC in the brain-stem made a marked contrast to a large quantity of ANC in the cases with senile dementia. Hence, as far as ANC in the brain-stem is concerned, no continuum seems to exist between normal senility and senile dementia.

Distribution of Alzheimer's neurofibrillary tangles in the basal ganglia and brain stem of progressive supranuclear palsy and Alzheimer's disease

The authors studied the distribution of neurofibrillary tangles in the basal ganglia and brain stem of progressive supranuclear palsy and Alzheimer's disease, with the result that almost no similarity in the distribution and frequency of neurofibrillary tangles exists between both diseases. In two cases with progressive supranuclear palsy, neurofibrillary tangles were found most numerously in the subthalamic nucleus. Next in order came the globus pallidus, reticular formation of midbrain, pons and medulla oblongata, pontine nuclei, locus coeruleus, red nucleus, substantia nigra, periaqueductal grey matter and olivary nuclei. Neurofibrillary tangles were rare in the thalamus. In two cases with Alzheimer's disease, neurofibrillary tangles were found most numerously in the nucleus mamilloinfundibularis, nucleus basilaris, nucleus dorsalis raphe, nucleus centralis superior, and next in order came the thalamus. They were found scarcely in the lenticular nuclei and reticular formation of the pons. In both diseases, almost no neurofibrillary tangles were found in the nucleus supraopticus, nucleus paraventricularis, nuclei tuberales and nuclei corporis mamillare.

Double-blind comparison of lithium carbonate and imipramine in treatment of depression

The effect of lithium carbonate therapy on patients with depression is still unconfirmed. Our past studies have shown a favorable response to the drug in patients with depression of mild or moderate severity. Therefore, we performed a controlled double-blind study of lithium carbonate and imipramine hydrochloride in 64 patients with depression. No significant differences were noted in the overall therapeutic response, depression scale scores, or clinical effects between the two drug groups.

Effects of various cerebral metabolic activators on glucose metabolism of brain

The effects of various metabolic activators on the glucose metabolism of the perfused cat brain have been investigated. (1) When the perfusion is done with the blood containing cytidine monophosphate, the glucose metabolism of the brain is enhanced, as compared to the perfusion with the blood without cytidine monophosphate. There is no marked change in the cerebral metabolic rate and in the contents of intermediate metabolite of glucose in the brain. (2) Citicoline enhances the incorporation of blood glucose into the brain and its metabolism in the brain. It increases slightly the cerebral blood flow rate and decreases the accumulation of lactate in the brain. (3) Either Pyrithioxin or Meclophenoxate has no effect on the glucose metabolism of the brain nor on the cerebral metabolic rate.