Neuronal ubiquitin and neurofilament expression in different lysosomal storage disorders

We studied various lysosomal storage disorders such as Tay-Sachs' disease, Niemann-Pick's disease, and Hunter's disease for their immunoreactivity with antibodies against ubiquitin (Ub) and neurofilaments (NF). We found that in all cases, irrespective of the nature of the storage material or disorder, only a minor proportion of neurons (20-30% at most), as a rule, moderately reacted with the Ub antibody, while the majority of the distended neurons neither expressed Ub nor NF epitopes. These findings suggest that the UB dependent proteolytic pathway may play a secondary role in the lysosomal storage disorders, at least in the advanced stages which are observed at autopsy. It seems that the Ub expression of a minor proportion of neurons should be regarded as an unspecific epiphenomenon rather than as a mechanism of major significance in the basic metabolism of these disorders, in which the inclusions consist of membrane-bound lipid material.

Primitive neuroectodermal tumors after prophylactic central nervous system irradiation in children. Association with an activated K-ras gene

Three patients had supratentorial malignant brain tumors 7 to 9 years after prophylactic central nervous system (CNS) treatment for acute lymphocytic leukemia or malignant T-cell lymphoma. Therapy was administered at the age of 3 to 8 years and included cranial irradiation (total dose, 1800 to 2400 cGy) and intrathecal methotrexate. The brain tumors had histologic and immunohistochemical features of primitive neuroectodermal tumors (PNET), including neuroblastic rosettes, rhythmic arrangement of tumor cells, and immunohistochemical expression of glial, and in one patient neuronal, marker proteins. Using polymerase chain reaction-mediated DNA amplification from paraffin-embedded tissues and subsequent DNA sequence analysis, an activating point mutation was detected in the K-ras protooncogene in one tumor. This mutation was a G to A transition in position 2 of codon 12, substituting aspartate (GAT) for glycine (GGT). This type of mutation has not been observed before in human brain tumors, but it is frequent in radiation-induced murine lymphomas. These observations suggest that PNET can be induced after completion of the embryonal and fetal development of the human CNS. Oncogene-activating point mutations may represent a pathogenetic mechanism involved in the genesis of radiation-induced brain tumors.

[Aspergillosis of the central nervous system in glioblastoma multiforme]

A 45 year-old male with a butterfly glioma received stereotactic biopsy for histologic confirmation of the clinical diagnosis. Microscopically, the results were controversial since some biopsy specimens showed distinct inflammatory changes, while others displayed typical features of a malignant glioma. The patient died four days after the stereotactic approach due to therapy-resistant intracranial pressure rise. In addition to a large butterfly glioblastoma originating from the frontal part of the corpus callosum, neuropathologic examination revealed a mycotic encephalitis with formation of numerous fungi-containing inflammatory foci in all parts of the brain and in the glioma. General autopsy disclosed pulmonary aspergillosis as the source of the inflammatory spread. A previous steroid medication over several weeks for treatment of increased intracranial pressure may be considered as an important factor in the origin of the pulmonary aspergillosis complicating the butterfly glioma.

Alternative splicing of the beta A4 amyloid gene of Alzheimer's disease in cortex of control and Alzheimer's disease patients

An S1 nuclease protection assay was designed to study the splicing pattern of the alternatively spliced beta A4 amyloid gene (APP gene) of Alzheimer's disease (AD). We determined the splicing pattern of the APP gene in fetal, adult, aged adult and AD human cortex. The results suggest that alternative splicing of the APP gene in AD is not significantly different from age-matched controls, but distinct from the developing fetal brain.

Dissection of the anterior and middle cerebral artery with fatal ischemia following kicks to the head

A 19-year-old male received kicks to his head in the course of a fight with other young people. On admission to hospital he became drowsy and developed a hemiparesis and a facial paralysis on the right. After 3-4 days of continuous improvement the patient suddenly fell unconscious again and died on the seventh day after the trauma due to an increase of the intracranial pressure. Neuropathologic examination revealed an extensive dissection of the wall of the left anterior and middle cerebral artery. The age of the recurring infarction in the dependent areas of blood supply corresponded to the biphasic clinical course.

[Primary degeneration of the thalamus with dementia--2 cases with family background]

This is a report on two male patients aged 22 and 43 years, respectively, who developed a fatal progressive demential syndrome that lead to the death of one after 16 months and of the other patient after 25 months and that presented with the typical clinical pattern of "subcortical dementia". In both the cases, the hospital had suspected Creutzfeldt-Jacob's disease but this was not confirmed by microscopy of the tissue; the typical form of manifestation was absent. Instead, microscopy of the brain revealed a marked symmetric degeneration of the thalamus with special preference given to the anterior and media nuclear groups. Predilection for the neothalamic against the palaeothalamic and archithalamic structures produced a very strong impression of a system-related thalamic degeneration process of the type occasionally discussed on the basis of similar observations. Parallel to the atrophic process there were also degenerative changes that were less pronounced, in the rubro-olivo-cerebellar system and in one case a moderately pronounced involvement of the second motor neuron. Both observations of a "thalamic dementia" are discussed against the background of relevant literature published so far on the subject.

Malignant intracerebral granular cell tumor reacts positively with anti-alpha-1-antichymotrypsin and the MB2 antibody: a clue to the histogenesis of the brain granular cell?

A 50-year-old man developed a granular cell tumor (GCT) of the right hemisphere (parieto-occipital) with visual deterioration and headache. Two months after surgery the tumor relapsed with diffuse infiltration of the right hemisphere, the corpus callosum and the adjacent left hemisphere. Subsequently, radiotherapy (5000 rads) was applied. Controls two and four months after the radiotherapy did not show any signs of the tumor in the computerized tomogram (CT). Light- and electronmicroscopy showed typical type I (small) and type II (large) granular cells with irregularly rounded or oval nuclei, abundant cytoplasm and PAS positive granules. Immunohistochemistry was positive with anti-alpha-1-antichymotrypsin (ACT) and the MB2 antibody. A survey of the relevant literature is given with special emphasis on the impact of the results of immunohistochemistry on the histogenesis of the CNS granular cell. Finally, some aspects of the therapy of GCTs will be discussed.

Distribution and immunoreactivity of cerebral micro-hamartomas in bilateral acoustic neurofibromatosis (neurofibromatosis 2)

Bilateral acoustic neurofibromatosis (neurofibromatosis 2, NF2) accounts for less than 10% of all cases of neurofibromatosis and manifests itself with bilateral acoustic schwannomas, multiple schwannomas of spinal nerve roots, meningiomas, glial tumors and hamartomatous CNS lesions. We have observed dysplastic foci of immature neuroectodermal cells in the cerebral cortex and basal ganglia of six patients afflicted with neurofibromatosis 2, ranging from occasional clusters of immature, dysplastic cells to numerous, confluent lesions. These cells, although often polymorphic and multinuclear did not show mitotic activity or a tendency for neoplastic transformation. To determine the histogenesis of these foci, extensive immunocytochemical reactions were carried out with antibodies to a variety of glial, neuronal and non-neural cell lineages. With the exception of S-100 protein, no immunoreactivity was detectable. S-100 was consistently expressed in these foci, irrespective of their size, location, and degree of polymorphism. On the basis of cytological appearance, distribution and immunoreactivity we tentatively designate these foci as glial micro-hamartomas. Although we did not systematically analyze the CNS of patients with von Recklinghausen neurofibromatosis (neurofibromatosis 1, NF1), the present study strongly suggests that these micro-hamartomas constitute a morphological hallmark of bilateral acoustic neurofibromatosis (NF2).

Incidence of late radiation necrosis with transient mass effect after interstitial low dose rate radiotherapy for cerebral gliomas

Late radiation necroses constitute a hazard in low dose rate interstitial irradiation for inoperable gliomas. An incidence of 40% (8/20 patients) was found after permanent implantation of Iodine-125 seeds. This finding may even underestimate the real frequency, because follow-up of unaffected patients was shorter than in patients with radiation necrosis. The necrotic reactions caused a transient mass effect, which lead to a significant deterioration of performance scores. Further manifestations of late delayed radiation damage were observed in two patients. The occurrence of radiation necrosis was correlated with total radiation dose, amount of implanted radioactivity, and with velocity of tumour shrinkage. A mechanism underlying the development of radiation necrosis is proposed: A rapid shrinkage of tumour after interstitial Iodine-125 implantation may cause a significant irradiation of surrounding brain tissue, which was initially lying outside the target volume. Since most patients affected by radiation necrosis were children or adolescents, the risk of radiation damage should be minimized. This could probably be achieved either by reduction of irradiation dose, or by using temporary implants of Iodine-125.

Diagnostic value of the stereotactic approach to focal lesions in the deep brain of children and adolescents

Since it is relatively harmless, stereotactic biopsy has become in recent years a useful method for the diagnostic assessment of lesions deep in the brain, which are not accessible to open surgery. With the aid of stereotaxis, focal lesions only a few millimeters in diameter can be approached in every location in the brain with high precision. Since stereotaxis does not require general anesthesia, or at most requires only a very shallow anesthesia, it can also be applied to young infants or persons of advanced age. Experience with stereotactic biopsy exploration of lesions of various kinds in the deep brain of 74 children and adolescents, out of a sample of 260 patients of all age groups who received stereotactic biopsy, is reported. Our aim is to demonstrate and discuss the advantage of this contemporary method for child neurology and neurosurgery. In many medical centers in the world where stereotactic tumor biopsy has been established, it has become an important criterion for the choice of treatment.

"Angiodysgenetic necrotizing encephalopathy" and its different manifestations. Survey of age-related forms and clinico-pathological appearances

Various observations of diffuse meningo-cerebral angiomatoses, which cannot be satisfactorily classified with the common phakomatoses, have been reported. They may occur at any age, with familial accumulation or sporadically. Divry and van Bogaert were the first to draw attention to such conditions in adults, where meningo-cerebral angiomatoses seemed to be combined with sudanophilic leukodystrophy. However, subsequently the latter was considered to be due to hypoxic damage to the white matter. In other observations, the severe damage to the grey matter was more evidently of hypoxic origin. Observations on two newborn individuals, sporadic examples of diffuse meningo-cerebral angiomatosis and with severe necrotic changes in the grey and white matter, are reported and discussed. Published reports on the various age-related forms are summarized and a general designation is suggested, which includes the various observations under a general heading. A parallel will be drawn between the meningo-cerebral angiomatosis and Foix-Alajouanin's disease.

[MR tomography in intracranial meningiomas]

The typical findings of intracranial meningiomas seen in 24 patients are described. The signal intensities at different acquisition parameters are analysed and optimal pulse sequences derived from these data. In 90% of the patients MR-tissue parameters were measured and correlated with the histological findings. Marked prolongation of T2-times was found in tumours showing regressive changes.

Differential transcription of the repetitive R-element in various mouse cell types

Clones that contain R-elements separated from the rest of the L1-repeat have been isolated from a mouse genomic DNA library. Spot hybridization of DNA from various species (from mammals to plants) with one representative and well characterized mouse DNA clone shows that at least this sequence hybridizes only with mouse DNA. In addition, we demonstrate that the R-element repeat is transcribed differentially in various tissues or cell types. Furthermore, the amount of R-transcripts is regulated at varying rates in the different cell types of a tissue as shown by in situ hybridization.

Numerical grading of astrocytomas

Ninety-three astrocytomas from biopsy material including glioblastomas ('astrocytomas grade 4') were graded according to Kernohan (1949) by light microscopy. Feulgen sections were subjected to an automated microscopic analysis to obtain morphometric-densitometric data of the tumour cell nuclei. These quantitative and reproducible data showed a significant correlation with malignancy expressed in terms of Kernohan and prove automated image analysis to be a valuable tool in the grading of gliomas. This is in particular true if the nuclear parameters determined by image analysis are completed by histologic features which were recorded semiquantitatively by subjective light microscopic evaluation as is usual in clinic pathologic diagnosis of brain tumours. A quadratic discriminant analysis of morphometric-densitometric data of tumour cell nuclei and semiquantitative microscopic data gave a 94% agreement with subjective grading.

[Diagnosis and therapy of Churg-Strauss allergic granulomatosis]

Three cases of allergic granulomatosis (Churg-Strauss syndrome) are reported. The patients all presented 2-10 years after the onset of pulmonary symptoms with a mononeuritis multiplex, accompanied by sharp pain in the extremities involved. In one patient, the neurological findings improved under treatment with corticoids and cyclophosphamide; the other two patients responded to treatment with thioguanine and cytarabine. In the first patient, the diagnosis was confirmed by a biopsy specimen of the sural nerve.

Characterization of cloned sequences complementary to F9 cell double-stranded RNA and their expression during differentiation

In a cDNA library prepared from the RNA of cultured murine F9 teratocarcinoma cells, we identified sequences exhibiting strong hybridization to double-stranded RNA (dsRNA) of F9 cells but weak hybridization to mouse liver dsRNA. Northern-blot hybridization of RNA extracted from F9 cells with or without treatment with retinoic acid revealed differences in the expression of some of these sequences in undifferentiated and differentiated cells. As shown by Southern-blot hybridization experiments, these differences of expression were not related to a gross rearrangement of the corresponding genomic DNA sequences of the differentiated cells. When RNA from F9 cells was used, one of the cloned dsRNA-related sequences selected mRNA which was translated in vitro to a polypeptide with an Mr of 24,000; the level of this mRNA was reduced in F9 cells that had been treated with retinoic acid. Our results show that the differentiation of F9 cells induced by retinoic acid results in the differential expression of some middle-repetitive sequences.

Transcription of repetitive DNA in condensed plant chromatin

Polyadenylated transcripts homologous to highly repetitive DNA were found in root tips of Vicia faba by Northern blot hybridization. Electron microscope autoradiography using [3H]uridine as a probe revealed transcription of condensed chromatin in various higher plants. This is consistent with the general rule that highly repetitive DNA is located within condensed chromatin, but it is new that this chromatin fraction is active in RNA synthesis to a considerable amount. Semi-quantitative comparison of the intensity of transcription in species with widely differing 2C DNA contents by means of light microscope autoradiography revealed an inverse relationship between the amount of 2C DNA (and condensed chromatin), and the rate of RNA synthesis.

Familial occurrence of amyotrophic lateral sclerosis, parkinsonism, and dementia

We report here on a 59-year-old man from southwest Germany who died after a 14-year course of an illness characterized by progressive dementia, parkinsonism, and amyotrophic lateral sclerosis. Postmortem examination revealed Alzheimer's neurofibrillary tangles in the substantia nigra, innominata, locus ceruleus, parahippocampal gyrus, and less frequently in the hippocampus and the cerebral cortex. Investigation of the patient's pedigree back to the 17th century revealed nine additional family members who had exhibited signs of amyotrophic lateral sclerosis or parkinsonism-dementia or both. The pedigree suggests that a recessive trait with genetic epistasis is responsible for the disorder.

Multicystic encephalopathy--a polyetiologic condition in early infancy: morphologic, pathogenetic and clinical aspects

Eleven observations of severe multicystic encephalopathy ( MCE ) in young infants and in a two-year-old child provide the basis for a summing-up and discussion of the various aspects of this characteristic polyetiologic phenomenon occurring in early infancy. In all cases the triggering causes or underlying disorders were different, although in five cases the common pathogenetic mechanism was a disturbance of circulation and/or respiration (acute respiratory distress syndrome). In two cases the basic disorders were a suppurative and a granulomatous meningoencephalitis. Carbon monoxide poisoning had occurred in one and diffuse meningocerebral angiomatosis in another two cases. In the eleventh case, one of a complicated twin birth, the exact cause of the MCE remained obscure. These cases together with those recorded in the literature demonstrate that the surprisingly constant pattern of damage in MCE , which results from different etiologic conditions, should be due to a specific mode of reaction of the infantile brain to a common pathogenetic mechanism. Anoxia with hypercapnia and the formation of brain edema are discussed as the basic events in the pathogenesis of MCE .

Metastases of malignant neoplasms to intracranial tumours: the "tumour-in-a-tumour" phenomenon

This is a report of two observations of the metastatic spread of carcinomas to meningiomas. A survey of the relevant literature is given.

[Sports accident or natural death? Hematocephalus internus caused by rupture of a choroid plexus angioma]

This is a case report of a young policeman who collapsed in the course of a football game. He died seven days later due to a massive intraventricular hemorrhage that resulted in internal hematocephalus. The source of the bleeding was obviously a bilateral angioma of the choroid plexus of the lateral ventricles.