[Trauma and tumor: malignant glioma in the area of a traumatic lesion of the brain with metal scales]

Report of a 75 year-old male who sustained severe head injury by shell splinters during the second world war. 38 years later he died due to a malignant glioma which was localized exactly in the left and right frontal areas damaged by the shell. Multiple metal scales were still localized within these areas and the glioma. The reasons for the presumption of a causal relation between the trauma and the tumor will be discussed.

Rapid anaplastic transformation in gliomas of adulthood. "Selection" in neuro-oncogenesis

Rapid change of the phenotypical expression is reported in three adult cases of benign or malignant gliomas. Cases with phenomenologically similar thorough alterations have only infrequently been reported in the literature. In all cases the alteration resulted in uniformly small undifferentiated and aggressive cell populations, which would not have permitted diagnosis of the original tumor. Remnants of the latter and the new undifferentiated portions were blended with each other. In two cases the clinical course was characterized by a rapid deterioration within a few months, following as slowly progressive course or periods with only mild symptoms over many years. In his studies of mammary tumors Foulds (1956) found similar phenomena of circumscribed phenotypical changes, to which he applied the term "focal progression". He outlined progression as a basic mechanism in oncogenesis. Later on it has been interpreted as the result of selection of genetically changed subpopulations of tumor cells with an altered, i.e. enhanced malignant expression. They are favoured due to their less demanding behaviour as to environmental conditions. Thus they gradually or rapidly overgrow the original tumor, changing its phenotype. The author believes that the present observations may be interpreted as examples of rapid focal progression in gliomas in terms of Foulds, with "selection" acting as a basic developmental mechanism.

Acute abdominal rhabdomyolysis after body building exercise: is there a "rectus abdominus syndrome?"

Report of a 19-year-old man who was admitted to the hospital after vigorous exercise with signs of the "acute abdomen" syndrome. Since intestinal reasons for the complaints were excluded, a myocardial infarction was considered. However, the excessively increased serum CK levels indicated a disorder of the voluntary muscles. A biopsy taken from the rectus abdominis revealed typical features of acute rhabdomyolysis, which was obviously restricted to the rectus abdominis. Together with a somewhat later observed autopsy case of a young male with acute abdominal rhabdomyolysis, also restricted to the rectus abdominis, this case gives rise to discuss, whether there exists a "rectus abdominis syndrome" analogous to the anterior tibial syndrome.

Intrinsic laryngeal muscles in oculocraniosomatic syndrome (OCSS). An autopsy study

In a 36-year-old woman who died due to an atypical subacute necrotizing inclusion-body encephalitis with herpes virions, typical clinical symptoms of the oculocraniosomatic syndrome of Kearns and Sayre were substantiated. Her still living daughter suffers from the same disorder. The skeletal muscles taken from various parts of the body of the 36-year-old patient displayed the typical features of a sudanophilic myopathy, including abundant 'ragged-red' fibers and a pleoconial mitochondriosis. For the first time in the literature the intrinsic laryngeal muscles were also found to be significantly involved. Their morphological features are delineated and discussed.

Unusual split of the spinal cord in a caudal regression syndrome with myelocystocele

Report of a newborn infant with a caudal regression syndrome and a large myelocystocele. A small part of the transitional zone between the normal spinal cord and the myelocystocele displayed a triploid cord in cross sections, suggesting a kind of "triastematomyelia," which was, however, finally considered rather to represent a special form of diastematomyelia than a true threefold split of the spinal cord. The probable pathogenetic background of the condition is discussed.

Mixed chemodectoma-ganglioneuroma of the conus medullaris region

Report of a 33-year-old man with a year-long history of low-back pain radiating into the left leg. Neurologic examination upon admission to the hospital revealed a spinal compression syndrome at the level L5. Laminectomy at L 4/5 revealed an encapsulated intradural tumor measuring 4 X 2.5 X 2.5 cm. The tumor was attached to the dorsal root L 4 and extended downward to the conus region. Light and electron microscopy revealed features mostly consistent with a mixed chemodectoma and ganglioneuroma.

An autopsy study of a familial oculopharyngeal muscular dystrophy (OPMD) with distal spread and neurogenic involvement

An 81-year-old man from a family with a history of oculopharyngeal muscular dystrophy (OPMD) involving 6 members over 4 generations is described. The patient first noted drooping of his eyelids at the age of 65. Dysphagia and dysarthria occurred soon thereafter. At age 78, impairment of gait developed and progressive wasting occurred in the limbs with an initial distal distribution. Electromyography of several limb muscles displayed a mixed myopathic and neurogenic pattern with giant potentials. Examination at autopsy revealed slight loss of neurons in the anterior horns of the spinal cord, with scanty ghost cells, neuronophagia, and central chromatolysis. By light microscopy the limb muscles showed moderate small-group atrophy with severe myopathy and target fibers. The viscerocranial muscles, including the ocular, vocal, and tongue muscles, demonstrated only myopathic change with the typical features of progressive muscular dystrophy. Advanced replacement by fibrous connective tissue and fat had occurred in both the viscerocranial and the lower limb muscles. The significance of neurogenic involvement in OPMD is discussed.

Changes in the voluntary muscles and the peripheral nerves in an autopsy case of MPS type II (Hunter)

Skeletal muscles and peripheral nerves obtained at autopsy from a fifteen-year-old boy who had mucopolysaccharidosis type II (Hunter) were examined. The muscles showed severe neurogenic atrophy, chiefly from a distal motor neuropathy due to damage of the intramuscular nerve terminals. There was only a very slight loss of motor neurons in the spinal cord, which itself could not explain the severe atrophy of the muscles. Contrary to former observations in Tay-Sachs disease, in which the telodendra of peripheral nerves had exhibited abundant intraaxonal storage phenomena, similar axonal distensions were not found in the present case.

[Fatal subarachnoid hemorrhage originating from the region of the great vein of Galen following a "fight" (author's transl)]

Report of the case of a 12-year-old boy who had died due to a massive basal subarachnoid hemorrhage after moderate fight with a class mate. Findings at autopsy and by microscopic examination indicated that a lesion in the system of the great vein of Galen and the internal cerebral veins might have been the source of the bleeding. The nature of an underlying pre-existing vascular change favoring a rupture is discussed on the basis of the clinical history and the pathoanatomic findings.

"Inverse Chiari type II syndrome" in untreated hydrocephalus and its relationship to typical Arnold-Chiari syndrome

Two cases of transtentorial upward displacement of the cerebellum in children with untreated hydrocephalus are reported. These cases clearly indicate that the condition is a primary malformation of the hindbrain and not a result of longstanding hydrocephalus treatment, as has been proposed in the past. The second case demonstrates the close relationship of the syndrome to classical Arnold-Chiari malformation.

Peripheral intraaxonal storage in Tay-Sachs' disease (GM2-gangliosidosis type 1

Considerable intraaxonal lipid storage was observed in intramuscular nerve fibres mainly of the extraocular muscles and less frequently in limb muscles of a 3-year-old child, which had suffered from Tay-Sachs' disease. Many axons of the small intramuscular nerve twigs and of the terminal and preterminal nerve endings showed spherical and cylindrical enlargements containing granular storage material of the same staining properties as the material in the central nervous system. The identify of the axonal and the neuronal storage material was further confirmed by electron-microscopical demonstration of typical multilamellated cytoplasmic bodies (MCBs) in both of them. In addition, silver impregnation and electron microscopy revealed dystrophic changes with an increase of argyrophilic filamentous material within some of the axonal distensions, indicating that the latter were probably due to both a lipid storage and an unspecific dystrophic process.

Skeletal muscular atrophy in malignant tumour diseases: neurogenic or unspecific?

Muscles from patients who had died from malignant tumours were examined with regard to changes in the intramuscular nerve twigs and the axon terminals or the motor end-plates, respectively. Three muscles from each of 120 cases were obtained at autopsy and stained with conventional methods. Nineteen cases with pronounced small-group and sometimes large-group atrophy were selected. Myelin and axon preparations displayed various changes of the small nerve branches and the axon terminals. Their significance for the atrophy frequently observed in the muscles of cancer patients is discussed.

Chronic electrical stimulation of the thalamic unspecific activating system in a patient with coma due to midbrain and upper brain stem infarction

Chronic intermittent bipolar electrical stimulation of the left nucleus reticulatus polaris thalami was performed in a patient in a state of subcoma due to ischaemic infarction of wide medial parts of the midbrain, mainly the tegmentum, and the right-sided mediobasal parts of the forebrain. Stimulation immediately resulted in autonomic reactions and behavioural arousal reactions during the periods of stimulation. Longterm effect consisted of a rise in the level of clinical responsiveness for a period of seven weeks. A preexistent severe pneumonia disappeared completely after one week of stimulation and returned after seven weeks. The results are discussed on the basis of the pathoanatomical findings and of the physiological functions of the damaged as well as of the stimulated areas.

Quantitative analysis of the size distribution of target- and targetoid fibres employing the method of Daeves and Beckel for mixed distributions

An analysis of frequency distribution is performed in 250 target and targetoid fibres each from the anterior tibial muscle of a case with rapidly proceeding denervation atrophy. Following plane measurements on cross sections the size data were analysed according to the method of Daeves and Beckel [1] for mixed distributions. Three homogeneous normally distributed populations could thus be extracted from the mixed distributed sample. The largest population represents target fibres with a normal size range, while the second one encloses hypertrophic fibres, and the third and smallest one consists of fibres ranging within atrophic size limits. These findings support the previous presumption that targets predominantly occur in fibres of normal size and can therefore be regarded as manifestations of an early stage of denervation atrophy. The targetoid fibres, on the contrary, are of an atrophic size by 84%, while only a small population of about 15% contains targetoid fibres of a normal size on cross section.

The influence of chronic deep brain stimulation on excitability and morphology of the stimulated tissue

Bipolar electrical stimulations of the rostal hippocampus and of the amygdala were performed at irregular intervals in wakeful unrestrained cats via chronically implanted glass-insulated stainless steel electrodes. The excitability of the stimulated tissue remained unchanged during the whole investigation period of six months up to one and a half years, as was revealed by regularly performed comparisons of shape, latency, and amplitude of evoked potentials elicited by electrical stimulation of the rostral hippocampus and recorded within the ipsilateral mammillary body. The histological examination of the stimulated tissue revealed a fibrillary gliosis due to the trauma caused by the insertion of the electrodes, but no signs of additional tissue damage due to electrical stimulation or chronic mechanical irritation. The results indicate that it is possible to perform therapeutic stimulations of deep brain structures for long periods without inducing relevant changes in morphology or electrical responsiveness of the stimulated tissue. No kindling phenomena are to be expected, if the stimulations are performed at irregular intervals.

Involvement of the larynx in a congenital "myopathy", unilateral aplasia of the arytenoid, micrognathia, and malformation of the brain--a new syndrome?

Neuromyopathic changes were found in various limb muscles and in intrinsic laryngeal muscles of a two month old girl. She had been noted to have micrognathia, arthrogryposis and congenital stridor and died as a result of respiratory insufficiency and aspiration. Autopsy revealed an absent left arytenoid cartilage and severe histogenic abnormalities of the brain. Although the muscles involved showed a mainly myopathic pattern, marked signs of peripheral neurogenic involvement were present. These differed from motor neuron disease or aplasia of anterior horn cells. These findings cast a new light on the discussion of unclassified congenital myopathy resembling the picture of congenital muscular "dystrophy". This is the first case of congenital neuromyopathy in which involvement of intrinsic laryngeal muscles has been demonstrated morphologically.

Cerebral massive hemorrhage in congophilic angiopathy and its medicolegal significance

The principles of a special type of senile cerebromeningeal angiopathy, these days usually named "congophilic angiopathy", are demonstrated on the basis of eight cases, complicated by spontaneous massive intracranial hemorrhages in seven and late traumatic hemorrhage in one of them. The occurrence of massive hemorrhages associated with congophilic angiopathy has until now only rarely been reported. The medicolegal significance of this vascular disease is emphasized by the eighth, traumatic, case, which became forensically relevant; the late massive hemorrhage had to be regarded as significantly favoured by amyloid angionecrosis, which is the main feature of congophilic angiopathy.