Acute-onset amnestic syndrome with localized infarct on the dominant side--comparison between anteromedial thalamic lesion and posterior cerebral artery territory lesion

Among 39 cases with acute-onset amnestic syndrome having unilateral localized infarct, 8 cases with anteromedial thalamic infarct ("thalamic" amnesia), and 18 cases with medial temporal lobe infarct including hippocampus in the posterior cerebral artery territory ("PCA" amnesia) were studied in terms of X-CT and MRI findings and neuropsychological examinations. Results were as follows: 7 out of 8 cases with thalamic amnesia (88%), and 15 of 19 cases with PCA amnesia (78%) showed left side lesions on CT scan. All groups showed a prolonged recent memory loss with little loss of immediate recall and remote memory, and disorientation and dyscalculia. In both types of amnesia, patients having a left sided lesion showed recent memory loss with new learning disabilities of verbal materials. Patients having a right sided lesion showed recent memory loss with new learning disabilities of both verbal and visuospatial materials. Judging from the X-CT and MRI findings, the lesions most probably causing amnesia in these cases seemed to be the anterior and dorsomedial nuclei of the thalamus in thalamic amnesia and hippocampus in PCA amnesia. Differential diagnosis in amnestic syndrome with localized infarct is also discussed.

Pontine ataxic hemiparesis studied by a high-resolution magnetic resonance imaging system

Using a high-resolution magnetic resonance imaging system, we studied 3 patients who had exhibited pontine ataxic hemiparesis. In each patient, the ischemic lesions responsible for the contralateral ataxia were located in the dorsomedial basis pontis. The isointensity bands in the ischemic area on T2-weighted images showed the spared transverse fibers originating from the contralateral pontine nuclei, and this may explain the cause of the unilateral ataxia.

Magnetic resonance images of neuro-Behçet syndrome show precise brain stem lesions. Report of a case

Neuro-Behçet syndrome was investigated with magnetic resonance imaging (MRI) showing precise images of brain stem lesions, and therefore suggesting the clinical usefulness of MRI in diagnosis of neuro-Behçet syndrome.

Thalamic tumours invading the brain stem produce crossed cerebellar diaschisis demonstrated by PET

Two cases of thalamic tumour, spreading through the midbrain into the pons ventrolaterally, showed suppression of cerebellar blood flow on the opposite side to the tumour, and also showed reduction of blood flow in the pons on the side of the tumour in positron emission tomographic studies. The pathophysiological mechanism of crossed cerebellar diaschisis may be due to functional suppression of the pontine nuclei by destruction of descending fibres from the cerebral cortex.

Localization of monoamine oxidase (MAO) in the rat peripheral nervous system--existence of MAO-containing unmyelinated axons

Using a new coupled peroxidation method modified by adding nickel ammonium sulfate, we demonstrated the localization of monoamine oxidase (MAO) in the rat peripheral nervous system. MAO was localized in the endothelial cells of endoneurial vessels, in Schwann cell cytoplasm encircling myelinated axons, and in some unmyelinated axons. The morphometric ratio of these MAO-containing axons to the total unmyelinated axons was 10-13%. These MAO-containing unmyelinated axons were assumed to coincide with postganglionic sympathetic noradrenergic ones passing in the sciatic nerve. Histochemical MAO staining may be utilized to identify the postganglionic sympathetic nerves in normal and pathological conditions at the electron microscopic level in particular.

Effects of propranolol on myocardial damage resulting from coronary artery occlusion followed by reperfusion

To evaluate the effects of propranolol on myocardial metabolism after coronary reperfusion, serial measurements of myocardial creatine kinase (CK) and calcium (Ca) contents and CK and lactic acid (LA) concentrations in coronary sinus blood were carried out in 33 open-chest dogs. The left anterior descending coronary artery was occluded for 60 minutes and was then reopened. Twelve of the dogs were given propranolol before occlusion. Reperfusion for 30 minutes in dogs with and without propranolol pretreatment resulted in reduced myocardial CK in the ischemic region and rapidly elevated plasma CK and LA. However, when compared with the control group, the propranolol-treated group showed smaller changes in myocardial CK and plasma LA. Myocardial Ca in the ischemic region was significantly higher than that in the nonischemic region in the control group, but not in the propranolol-treated group. It was concluded that propranolol was protective against myocardial damage resulting from coronary occlusion followed by reperfusion.

Periodic acid-Schiff (PAS)-positive, granular structures increase in the brain of senescence accelerated mouse (SAM)

Abnormal granular structures, which stained positively with periodic acid-Schiff (PAS-positive granular structures; PGS), were observed in the brain of senescence accelerated mouse (SAM). They were small, round to ovoid, homogeneous structures measuring up to 5 microns in diameter and usually grouped in clusters. PGS were localized in the hippocampus, piriform cortices, olfactory tubercle, nucleus of the trapezoid body, and cerebellar cortices. Quantitative analysis revealed that PGS remarkably increased in the hippocampus of SAM-P/8, a substrain of SAM, with advancing age, although a few PGS also appeared in the aged control mice, SAM-R/1 and DDD. Their histochemical nature, morphological features and distribution pattern were different from those of corpora amylacea and other similar bodies. A close anatomical relationship between PGS and glial fibrillary acidic protein-positive astrocytes was inferred from immunohistochemical studies. PGS is considered to be one of the morphological manifestations of senescence in mice brains, and are found to occur more numerously in the brains of learning or memory deficit mice, SAM-P/8.

Active site of intestinal gamma-glutamyltransferase faces luminal side of brush border membrane

Purified gamma-glutamyltransferase from hog small intestine was competitively inhibited by glutathione in vitro when L-gamma-glutamyl-p-nitroanilide was used as a substrate. An S-acetyldextran derivative of glutathione inhibited the enzyme as well as glutathione, although dextran had no inhibitory effect. gamma-Glutamyltransferase in the rat small intestine could utilize in situ L-gamma-glutamyl-p-nitroanilide circulated in the lumen, and was inhibited by the impermeable derivative of glutathione which was on the luminal side. These data suggested that the active site of intestinal gamma-glutamyltransferase faced the luminal side of the brush border membrane.

Serial determinations of serum enzymes following aorta-coronary bypass surgery and acute myocardial infarction

Serial determinations of serum creatine kinase (CK), cardio-specific isoenzyme of CK (CK-MB), glutamic oxaloacetic transaminase (GOT) and alpha-hydroxybutylate dehydrogenase (HBD) were made in 29 consecutive patients undergoing aorta-coronary (AC) bypass grafting, and the results were compared with those in 31 patients with acute myocardial infarction (AMI). Postoperatively, all patients had an uneventful postoperative course and there was no evidence of AMI. The time course of enzyme activity following surgery was characterized by 1) shortening of peak activity time of all enzymes except CK, 2) rapid disappearance of CK-MB, 3) prolonged normalization of GOT and HBD. Peak activities of CK, CK-MB, GOT and HBD in AC bypass patients were 801 +/- 77, 46 +/- 6, 100 +/- 9 and 718 +/- 32 IU (mean +/- SEM), respectively, which were equivalent to 46%, 12%, 22% and 47% of those in AMI. The degree of postoperative CK-MB elevation was influenced by the duration of the operation and the extracorporeal circulation, and the number of grafts bypassed. The peak CK-MB activity did not correlate with the CK peak. The ratio of CK-MB to CK was much smaller in AC bypass than in AMI (6.5 +/- 1.8 vs. 20.1 +/- 1.4%). It was concluded that serum enzyme elevations after AC bypass surgery largely reflected enzyme release from the skeletal muscle rather than the myocardium.

Distribution of the blood flow supplied by the vertebral artery in humans as assessed by emission CT

Though unilateral blood distribution of the vertebral artery has not been studied in humans, it is significant when considering the ischemic events especially embolic occlusion in vertebrobasilar system. To clarify the blood distribution, Krypton-81m was continuously infused into the vertebral arteries of 10 patients. Radioactivity was recorded by a rotating gamma camera. The perfusion images, reconstructed by computer in the transaxial plane, were classified according to whether the distribution was equal, or predominantly unilateral. Overlapping of blood supply from each vertebral artery was studied. In addition, the perfusion from one of the vertebral arteries revealed four distribution patterns with respect to laterality. A) ipsilateral; B) contralateral; C) bilateral; D) mosaic. Images obtained following perfusion of the vertebral artery show less uniformity compared to that of the internal carotid artery, suggesting a complicated vascular supply of the vertebral basilar territory. This complex distribution can be classified by the use of continuous infusion of Krypton-81m.

A study of regional cerebral blood flow and hemodynamics in cerebrovascular diseases by selective continuous infusion of Kr-81m

A tomographic study of regional cerebral blood flow and hemodynamics was performed on 25 patients with cerebrovascular diseases by selective continuous infusion of krypton-81m (Kr-81m). Kr-81m single photon emission computed tomograms were superimposed on X-ray computed tomograms to assess topographically the perfusion of the entire brain. Study of cerebrovascular diseases using this method showed: (1) regional cerebral blood flow change; (2) perfusion distribution change; (3) the route by which blood reached the brain or the obstructed artery proximal to the circle of Willis; (4) development of a collateral system and its actual function; and (5) efficacy of surgical bypass after extracranial-intracranial anastomosis. This method is especially useful in hemodynamic assessment in patients with ischemic cerebrovascular disease.

Superimposition of Krypton-81m single photon emission CT and X-ray CT images for cerebral blood flow evaluation

Selective arteriographic infusion of krypton-81m was used to obtain cerebral single photon emission computed tomograms. These were then superimposed on X-ray computed tomograms to assess topographically the perfusion of the entire brain. This method enhances the detecting capability for abnormal perfusion areas and has been used in 21 patients with various brain diseases.

Sympathetic nerve terminals in the tunica media of human superficial temporal and middle cerebral arteries: wet histofluorescence

In specimens from the superficial temporal artery (STA) and middle cerebral artery (MCA), obtained during STA-MCA anastomosis, green fluorescent varicose fibers of sympathetic nerves were clearly visible with both formaldehyde-glutaraldehyde and sucrose-potassium phosphate-glyoxylic acid wet-histofluorescent techniques. These fibers were fairly thick, were densely packed and had a meshwork-like arrangement. Fluorescent terminals were seen both in the adventitia and in the outer muscular layer of the media in both STA and MCA specimens. They were more often observed in patients with prominent atherosclerosis in these vessels. The present study suggests the possible role of sympathetic nerve terminals in the development of vasospasm and occlusive lesions in cerebral vessels. It may also help to explain the marked constriction and transient occlusion following a STA-MCA bypass procedure.

Krypton-81m single photon emission tomography and the collateral circulation in carotid occlusion: the role of the circle of Willis and leptomeningeal anastomosis

Cerebral perfusion images were investigated in patients with carotid artery occlusion, using single photon emission computed tomography with the infusion of krypton-81m into the internal, common carotid and vertebral arteries. The contribution of the circle of Willis and cerebral cortical anastomoses to the maintenance of adequate blood supply into the involved hemisphere was analysed. It was concluded that the cerebral perfusion image is superior to angiography in evaluating collateral circulation, and in the case of carotid occlusion, the circle of Willis is important in preventing infarction in the territory of the perforating arteries, while the cerebral cortex mainly receives its blood supply through the cortical leptomeningeal anastomoses, illustrating the major role of the leptomeningeal anastomosis as a collateral channel.