[Lipogenesis in the brain under hypoxia]

This study investigated the utilization of some radioactive precursors [2(12)C]-acetate, [1-6(14)]-glucose, [5(14)C]-glutamate) for fatty acids and lipid biosynthesis in the rat brain under normal and hypoxic conditions. In severe hemic hypoxia (30-45 min after the injection of 15 mg of NaNO2/100 g body weight) there was a significant increase in 14C incorporation from glutamate into brain lipids (by 2.8 times) and into fatty acids (by 2.2 times) as compared to the control level. Enhanced lipogenesis from glutamate was demonstrated due to the activation of all alpha-ketoglutarate shunt steps. The higher lipogenesis from glutamate in the brain as a possible mechanism for this excitatory amino acid utilization under hypoxia.

Amnesic syndrome and severe ataxia following the recreational use of 3,4-methylene-dioxymethamphetamine (MDMA, 'ecstasy') and other substances

A 26-year-old woman suffered disseminated intravascular coagulation (DIC) and a brief respiratory arrest following recreational use of 3,4-methylene-dioxymethamphetamine (MDMA; 'ecstasy'), together with amyl nitrate, lysergic acid (LSD), cannabis and alcohol. She was left with residual cognitive and physical deficits, particularly severe anterograde memory disorder, mental slowness, severe ataxia and dysarthria. Follow-up investigations have shown that these have persisted, although there has been some improvement in verbal recognition memory and in social functioning. Magnetic resonance imaging and quantified positron emission tomography investigations have revealed: (i) severe cerebellar atrophy and hypometabolism accounting for the ataxia and dysarthria; (ii) thalamic, retrosplenial and left medial temporal hypometabolism to which the anterograde amnesia can be attributed; and (iii) some degree of fronto-temporal-parietal hypometabolism, possibly accounting for the cognitive slowness. The putative relationship of these abnormalities to the direct and indirect effects of MDMA toxicity, hypoxia and ischaemia is considered.

The neuropathology of heroin abuse

A broad spectrum of neuropathologic changes are encountered in the brains of heroin abusers. The main findings are due to infections, either due to bacterial spread from bacterial endocarditis, mycoses, or from HIV-1 infection. Other complications include hypoxic-ischemic changes with cerebral edema, ischemic neuronal damage and neuronal loss, which are assumed to occur under conditions of prolonged heroin-induced respiratory depression, stroke due to, for example, thromboembolism, vasculitis, septic emboli, hypotension, and positional vascular compression. Myelopathy is believed to be the result of an isolated vascular accident within the spinal cord due to an as yet unknown mechanism. A distinct entity, spongiform leukoencephalopathy, has been described mainly after inhalation of pre-heated heroin. A lipophilic toxin-induced process was considered to be due to contaminants and to be induced or enhanced by cerebral hypoxia, but a definite toxin could not be identified. At the cellular level, abnormalities in signal transduction systems and changes of various receptor densities have been reported. The exact etiology of the different neuropathological alterations associated with heroin abuse is still unclear, but may also be related to additional substances used as adulterants.

Anaesthetic management of a pregnant patient in a persistent vegetative state

Pregnancy in a patient in a persistent vegetative state presents challenging therapeutic questions about the level of supportive management required, the assessment of fetal well-being, the timing and mode of delivery and the anaesthetic management of labour and delivery. We report the case of a 29-yr-old woman who had a favourable fetal outcome despite suffering hypoxic brain damage after a suicide attempt by a drug overdose. She was managed until the onset of labour on an intensive care unit and had a spontaneous vaginal delivery assisted by epidural anaesthesia.

Interactive effects of anoxia and general anesthesia during birth on the degree of CNS and systemic hypoxia produced in neonatal rats

A model of global hypoxia during Caesarean-section (C-section) birth has been widely used to study long-term effects of birth hypoxia on central nervous system (CNS) function. However, the actual degree of CNS and systemic hypoxia produced by the birth insult in this model has never been characterised. Additionally, the way in which the dam is anaesthetised during the C-section procedure may impinge on the degree of hypoxia experienced by the neonate. This study examined how a period of global birth anoxia and isoflurane/N2O anaesthesia interact to affect measures of CNS and systemic hypoxia in neonatal rats born by C-section compared with control, vaginally born animals. A 10-min period of global anoxia just before birth increased blood lactate, a metabolic indicator of systemic hypoxia, increased brain lactate and decreased brain ATP to a similar extent in pups born by C-section from either decapitated, unanaesthetised dams or dams anaesthetised with 2.5% isoflurane. Thus, this model does produce systemic and CNS hypoxia in the neonate. Pups born by C-section with a higher concentration of isoflurane (3.5%), in the absence of added global anoxia, also showed reductions in brain ATP at birth. In addition, 10 min of global anoxia produced greater increases in blood lactate in pups born from dams anaesthetised with the higher concentration of isoflurane. Thus, the concentration of anaesthetic used in this model may affect the degree of CNS or systemic hypoxia experienced by the neonate. Compared with vaginal birth, pups born by C-section with 2.5% or 3.5% isoflurane (and no added global anoxia) showed decreased PO2 and pH, and increased pCO2 in systemic blood taken <30 s after birth. Exposure to global anoxia during C-section birth actually increased systemic PO2 at <30 s after birth, presumably due to ventilatory responses to hypoxemia and hypercapnia; this effect of anoxia was reduced in anaesthetised compared with unanaesthetised pups. Thus, global anoxia acts as a stimulus for rapid recovery of systemic PO2 at birth, and this stimulus is dampened by isoflurane/N2O anaesthesia. These results should aid in understanding how CNS and systemic hypoxia at birth contribute to long-term changes in brain biochemistry and behaviour in this model.

Cytoskeleton mediates inhibition of the fast Na+ current in respiratory brainstem neurons during hypoxia

Whole-cell Na+ currents (INa) were recorded in inspiratory neurons in a medullary slice preparation from neonatal mouse that contains the functional respiratory network. Hypoxia and metabolic poisoning with KCN rapidly inhibited INa by reducing the number of Na+ channels available for opening during depolarization. Application of agents specific for G-proteins, protein kinase C and A, intracellular Ca2+ and pH did not prevent the hypoxic inhibition of INa. The effects of hypo-osmolarity and hypoxia were additive, whereas hyperosmolarity partially prevented a subsequent hypoxic inhibition of INa. Cytochalasin B and colchicine decreased, and taxol or phalloidin increased INa and reduced its hypoxic inhibition. We conclude that cytoskeleton rearrangements during hypoxia are responsible for suppression of a fast INa in brainstem respiratory neurons, which could be mediated by the uncoupling of channel inactivation gates from cytoskeletal elements.

Effects of hypoxia induced by Na2S2O4 on intracellular calcium and resting potential of mouse glomus cells

Isolated and cultured glomus cells, obtained from mouse carotid bodies, were superfused with Ham's F-12 equilibrated with air (mean PO2, 119 Torr; altitude 1350 m). [Ca2+]o was 3.0 mM. In one experimental series, dual cell penetrations with microelectrodes measured intracellular calcium ([Ca2+]i) and the resting potential (Em). In another series, [Ca2+]i was measured with Indo-1/AM, dissolved in DMSO. Normoxic cells had a mean Em of -42.4 mV and [Ca2+]i was about 80 nM (measured with both methods). The calculated calcium equilibrium potential (ECa) was 137+/-0.74 mV. Hypoxia, induced by Na2S2O4 1 mM, reduced pO2 to 10-14 Torr. This effect was accompanied by cell depolarization to -19.1 mV. Hypoxia increased [Ca2+]i to 231 nM when detected with Ca-sensitive microelectrodes, but only to 130.2 nM when measured with Indo-1/AM. Calcium increases were preceded by decreases in [Ca2+]i, which also were more pronounced with microelectrode measurements. CoCl2 1 mM blocked the hypoxic [Ca2+]i increase and exaggerated the decreases in [Ca2+]i. Correlations between DeltaEm and Delta[Ca2+]i during hypoxia were significant (p<0.05) in 19% of the cells. But, in 29% of them significance was at the p<0.1 level. In the rest (52%), there was no correlation between these parameters. Thus, voltage-gated calcium channels are rare in mouse glomus cells. Their activation by depolarization cannot explain the two to threefold increase in [Ca2+]i seen during hypoxia. More likely, [Ca2+]i increase may be due to hypoxic inactivation of a Ca-Mg ATPase transport system across the cell membrane. The blunting of hypoxic [Ca2+]i increase, seen in Indo-1/AM experiments, is probably due to its solvent (DMSO), which also depresses hypoxic cell depolarization.

Extracellular reduced glutathione increases neuronal vulnerability to combined chemical hypoxia and glucose deprivation

In addition to its intracellular antioxidant role, reduced glutathione (GSH) is released by CNS cells and may mediate or modulate excitatory neurotransmission. Although extracellular GSH levels rise in the ischemic cortex, its effect on the viability of energy-compromised neurons has not been defined. In this study, we tested the hypothesis that exogenous GSH would increase the vulnerability of cultured cortical neurons to azide-induced chemical hypoxia combined with glucose deprivation. Thirty minutes azide exposure in a glucose-free buffer was tolerated by most neurons, with release of less than 10% of neuronal LDH over the subsequent 21-25 h. Concomitant treatment with 10-100 microM GSH increased cell death in a concentration-dependent fashion, to 71.6+/-5.1% of neurons at 100 microM; GSH alone was nontoxic. Injury was blocked by the selective N-methyl-d-aspartate (NMDA) antagonist MK-801 but not by the AMPA/kainate antagonist NBQX. The sulfhydryl reducing agent mercaptoethanol (10-100 microM) mimicked the action of GSH; however, the zinc chelator ethylenediaminetetraacetic acid (EDTA) was ineffective. Two GSH analogues that lack a sulfhydryl group, S-hexylglutathione (SHG) and oxidized glutathione (GSSG), were inactive per se but attenuated the effect of both GSH and mercaptoethanol. These results suggest that micromolar concentrations of GSH enhance neuronal loss due to energy depletion by altering the extracellular redox state, resulting in increased NMDA receptor activation.

Hydroxyl radical production in the substantia nigra after 6-hydroxydopamine and hypoxia-reoxygenation

To study the involvement of oxidative stress in 6-OHDA neurotoxicity, we investigated the production of the hydroxyl free radical (OH.) in the substantia nigra (SN) and the striatum (CS) several moments after intranigral injection of the neurotoxin, with or without an added episode of hypoxia (30 min, 95% N2, 5% O2). We utilized the hydroxylation of salicylate to 2,3 dihydroxybenzoic acid (2,3 DHBA) as indication of OH. production. When 2.3 DHBA levels were not modified, the levels of 2,5 DHBA were taken as an indication of cytochrome P450 (CYP 450) metabolism. 6-OHDA alone did not increase the production of 2,3 DHBA in the SN. 2,5 DHBA increased significantly after 120 min and was high up to 24 h. An episode of hypoxia (60 min after 6-OHDA injection) significantly worsened the decrease of dopamine (DA) in the striatum assessed 8 days after injection of 6-OHDA in the SN. Hypoxia performed 60 min and 24 h before or 24 h after 6-OHDA did not show any additional effect on striatal DA levels. Contrary to results obtained after 6-OHDA alone, 2,3 DHBA increased significantly 120 min after the injection, when the hypoxia-reoxygenation was added to the 6-OHDA treatment. Our data are showing a relationship between the increase in OH. production and a concomitant worsening of neuronal degeneration. As a whole, the results support the idea that neurons undergoing 6-OHDA neurotoxicity have their antioxidant defences affected and that oxidative stress is actually an important eliciting factor in 6-OHDA dependant neurodegeneration. However, OH. may not be the main radical species involved in this process. Additionally, 6-OHDA also appeared to provoke a long-term increase in CYP 450 activity.

Extended therapeutic window for caspase inhibition and synergy with MK-801 in the treatment of cerebral histotoxic hypoxia

In rats, striatal histotoxic hypoxic lesions produced by the mitochondrial toxin malonate resemble those of focal cerebral ischemia. Intrastriatal injections of malonate induced cleavage of caspase-2 beginning at 6 h, and caspase-3-like activity as identified by DEVD biotin affinity-labeling within 12 h. DEVD affinity-labeling was prevented and lesion volume reduced in transgenic mice overexpressing BCL-2 in neuronal cells. Intrastriatal injection of the tripeptide, N-benzyloxycarbonyl-Val-Ala-Asp-fluoromethylketone (zVAD-fmk), a caspase inhibitor, at 3 h, 6 h, or 9 h after malonate injections reduced the lesion volume produced by malonate. A combination of pretreatment with the NMDA antagonist, dizocilpine (MK-801), and delayed treatment with zVAD-fmk provided synergistic protection compared with either treatment alone and extended the therapeutic window for caspase inhibition to 12 h. Treatment with cycloheximide and zVAD-fmk, but not with MK-801, blocked the malonate-induced cleavage of caspase-2. NMDA injections alone resulted in a weak caspase-2 cleavage. These results suggest that malonate toxicity induces neuronal death by more than one pathway. They strongly implicate early excitotoxicity and delayed caspase activation in neuronal loss after focal ischemic lesions and offer a new strategy for the treatment of stroke.

Cerebrolysin protects isolated cortical neurons from neurodegeneration after brief histotoxic hypoxia

A brief period of histotoxic hypoxia exhibits certain metabolic features resembling the in vivo situation of ischemia. In this study the neuroprotective effects of the peptidergic nootropic drug Cerebrolysin (Cere) against iodoacetate induced histotoxic hypoxia were investigated. For that purpose isolated cortical neurons from 9 day chicken embryos were precultured with 0 to 6.4 mg.Cere/ml medium. At the 8th day in vitro histotoxic hypoxia was induced by incubation with 0.01 or 0.1 mM iodoacetate. Cells were allowed to recover from toxic stress for 3, 6, 24 or 48 hours. Cere protected neurons dose dependently from delayed neuronal cell death due to 0.01 mM iodoacetate even after a recovery period of 48h. After induction of histotoxic hypoxia by 0.1 mM iodoacetate high concentrations of Cere again led to neuronal protection after the 3 and 6 h recovery period. Moreover the influence of Cere on the cytoskeletal protein MAP2 in neurons submitted to 0.01 mM iodoacetate was investigated. With Western blotting and immunohistochemical techniques it has been demonstrated that the drug clearly increased MAP2 abundance after histotoxic hypoxia. The present study points out that after severe damage of cortical neurons with iodoacetate Cere is able to protect neurons from delayed neuronal cell death maybe by maintaining neuronal plasticity due to avoidance of the cytoskeletal breakdown.

Excitotoxin-induced cerebral hyperemia in newborn piglets: regional cerebral blood flow mapping with contrast-enhanced power Doppler US

PURPOSE

To create regional cerebral blood flow maps with contrast material-enhanced power Doppler ultrasound (US).

MATERIALS AND METHODS

In six anesthetized newborn piglets, cerebral hyperemia was induced after intrastriatal injection of 5 mumol of N-methyl-D-aspartic acid. Coronal power Doppler US was performed with a microbubble-based contrast agent, and cerebral blood flow was determined before and at 15, 30, and 60 minutes after injection. Images were digitized and analyzed for changes in mean pixel intensity. A bolus injection curve was constructed by plotting mean pixel intensity versus time, and the area under this normalized curve was compared with cerebral blood flow.

RESULTS

Hemispheric cerebral blood flow increased from 40 mL/min/100 g +/- 1 (mean +/- standard error) to 90 +/- 12, 86 +/- 8, and 85 +/- 12 at 15, 30, and 60 minutes after injection, respectively (P < .0001 [analysis of variance]). Hemispheric mean pixel intensity at peak contrast also increased from 69 units +/- 5 to 120 +/- 4, 112 +/- 6, and 98 +/- 13 at 15, 30, and 60 minutes after injection, respectively (P < .003). The area under the normalized curve correlated well with changes in hemispheric and striatal cerebral blood flow (r = .73, P = .0001; r = .62, P = .0001, respectively).

CONCLUSION

In the newborn brain, regional blood flow maps can be created accurately with contrast-enhanced power Doppler US.

Estrogen protects against while testosterone exacerbates vulnerability of the lateral striatal artery to chemical hypoxia by 3-nitropropionic acid

Gender differences in the vulnerability of the lateral striatal artery (1STR artery) to systemic intoxication with 3-nitropropionic acid (3-NPA, succinate dehydrogenase inhibitor) were studied. Subcutaneous injection of 3-NPA (20 mg/kg once a day for 2 days) induced striatal selective lesions in half of male rats associated with motor symptoms (rolling, paddling, recumbency, etc) while female rats were resistant. Lesions were located in the lateral striata and characterized by astroglial necrotic cell death, enhanced immunoreaction to factor VIII-related antigen, edema, extravasation of IgG and sometimes bleeding. The motor and histological disturbances were highly sex-dependent and modulated by changes in hormonal levels. Males were more susceptible than females. Castration had little effect but ovariectomy enhanced the vulnerability. Replacement therapy with testosterone increased while estradiol or tamoxifen suppressed the vulnerability in ovariectomized females. Investigation of the arterial architecture of the brain often revealed rectangular and acute angled branchings in the centrolateral striatum where the ISTR artery feeds. A parallel in vitro toxicity study demonstrated that an extreme Ca++ overload and a strong cellular swelling resulted in astrocytic cell death. Data suggest that 1STR artery and astrocytes are highly vulnerable to 3-NPA intoxication in males. The greater vulnerability of the ISTR artery may contribute to the pathogenesis of neurodegenerative diseases, striatal bleeding, etc. Protective effects of estrogen and tamoxifen may mediate gender differences often observed in these disorders and suggest their potential use as therapeutic agents for these disorders.

Cerebral hypoxia after etomidate administration and temporary cerebral artery occlusion

Neurovascular surgical procedures often require temporary cerebral arterial occlusion. Although clinical validation is lacking, etomidate has often been used to attenuate the effects of cerebral ischemia in this setting. The purpose of this study was to evaluate the effects of etomidate and temporary cerebral arterial occlusion on human brain tissue oxygen pressure (PO2), carbon dioxide pressure (PCO2), and pH during intracranial aneurysm surgery. We studied nine patients presenting for cerebral aneurysm surgery. A Paratrend probe was used to determine brain tissue pH and gas tensions. Etomidate was administered to produce electroencephalographic burst suppression before temporary cerebral arterial occlusion. After etomidate administration in nine patients, brain tissue PO2 decreased 30% compared with baseline (P < 0.05). During temporary brain artery occlusion in 8 patients, tissue PO2 decreased 32% below preclip values (P < 0.05) in conjunction with a tissue PCO2 increase of 23% (P < 0.05) and a 0.1-unit decrease in pH (P < 0.05). In patients in whom PO2 decreased below 10 mm Hg during temporary clipping, tissue pH decreased, compared with patients in whom PO2 remained above 10 mm Hg (P < 0.05). These results demonstrate that etomidate administration during cerebral aneurysm surgery decreases tissue PO2 and that in these patients, tissue PO2 does not increase with increases in inspired oxygen concentration. Low tissue PO2 during temporary clipping significantly increases the risk of tissue acidosis.

IMPLICATIONS

Etomidate administration alone resulted in cerebral deoxygenation. Subsequent temporary cerebral artery occlusion resulted in additional tissue deoxygenation and acidosis. These results suggest that etomidate enhances hypoxic risk in the setting of cerebral ischemia.

[Hypoxic brain damage after carbon monoxide poisoning. Visual agnosia, reduced initiative and memory and delayed sequelae]

Four patients with hypoxic brain damage caused by carbon monoxide poisoning are described. Three of these had attempted suicide with car exhaust fumes. Two patients had visual agnosia due to lesions in the parieto-occipital cortex. Three patients had temporary Parkinsonian symptoms. In two of these patients CT and MRI showed lesions in the globus pallidus. They also showed reduced initiative, and in one patient this was combined with minor tics and obsessive symptoms. One patient had impaired memory as the only symptom. The patient with the longest lasting exposure developed delayed sequelae; three weeks after the poisoning he became apathetic and confused, with failing memory, Parkinsonian symptoms, and urinary and faecal incontinence. MRI showed demyelination in the periventricular white matter. His condition started to improve two months after the accident.

[Delayed symptoms of hypoxic brain damage after temporary improvement]

A shipyard worker was doing welding work inside a pipe with argon as cover gas. After taking a break he fainted while controlling the weld, also inside the pipe. He was rescued after 15-20 minutes and regained consciousness after a few hours. Two days later he was discharged from hospital in apparently good health. After a week he returned to the hospital suffering from confusion, failing memory, aphasia, apraxia and urinary incontinence. MR showed elevated signal intensity bilaterally in the caudate nucleus. He improved gradually and six months later was given less demanding work. The course of his illness is consistent with delayed neuropsychiatric sequelae after hypoxia, probably due to displacement of oxygen by argon. Delayed symptoms are caused by demyelination in the subcortical white matter.

Response of tracheal smooth muscle tone to lower brain stem hypoxia in dogs

We examined effects of central hypoxia on tracheal smooth muscle (TSM) tone, phrenic nerve activity (PNA) and blood pressure (BP) in decerebrated, paralysed, and artificially ventilated dogs. Central hypoxia was induced by injection of N2-saturated saline (5 ml; PO, 25-32 torr) through a catheter in the vertebral artery. The effects of central hypoxia were compared with the responses to central chemoreceptors stimulation, namely central hypercapnia induced by intravertebral injection of high CO2 saline (5 ml; PCO2 90-100 torr, PO2 80-120 torr, pH 7.38-7.42) buffered by HCO3-. Central hypoxia caused relaxation of TSM accompanied by depression of PNA and elevation of BP. In contrast, central hypercapnia evoked tracheal constriction along with respiratory excitation and pressor response. The tracheal relaxation in response to central hypoxia occurred with onset and peak latencies similar to those observed in PNA depression and BP elevation. This suggests a common source for the synaptic inputs to three distinct control systems involved in cardiovascular, respiratory and airway functions. Such neuronal substrate is considered to be activated by central hypoxia.

NMDA-antagonists reverse increased hypoxic tolerance by preceding chemical hypoxia

Glutamate antagonists mitigate hypoxic damage upon acute inhibition of energy metabolism. The goal of this study was to investigate their effect on increased hypoxic tolerance induced by preceding chemical inhibition of energy metabolism. While recovery of population spike amplitude (psap) is 30% of onset in slices prepared from control animals (15 min hypoxia, 45 min recovery), recovery exceeds 90% in slices prepared from animals that underwent mild chemical hypoxia in vivo by treatment with 20 mg/kg 3-nitropropionic acid 1 h prior to slice preparation (p-slices). In p-slices perfused for 5 min with D(-)-2-amino-5-phosphonopentanoic acid (APV) (100 microM) 45 min prior to hypoxia, recovery declines to 42 +/- 13% (mean +/- SEM). In contrast, posthypoxic recovery after similar perfusion with 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX) (10 microM) is 72 +/- 15% (P < 0.05). We conclude that increased hypoxic tolerance is abolished by N-methyl-D-aspartate (NMDA)-antagonists but not non-NMDA-antagonists.

Accidental choke-cherry poisoning: early symptoms and neurological sequelae of an unusual case of cyanide intoxication

We report the case of a 56-year-old woman who was accidentally poisoned when she ingested choke cherries whose pulp contained cyanide, and describe the acute clinical picture, the neurological sequelae and the neuroradiological findings. After recovery from coma, the patient showed signs of a parkinsonian syndrome, retrobulbar neuritis and sensory-motor neuropathy. MRI showed abnormal signal intensities involving the basal ganglia. Since no memory deficits were observed, we argue that the parkinsonian syndrome was caused by cyanide intoxication rather than by subcortical damage due to hypoxia.

Delayed post-anoxic encephalopathy

Delayed anoxic encephalopathy, a rare yet clinically and pathologically welldelineated complication of hypoxia with unknown pathogenesis, is described in a 40-year-old man following a drug overdose.

Study on pharmacological effect of bile salts, sodium scymnol sulfate, from Rhizoprionodon acutus. I. Effect of scymnol, chimaerol and sodium scymnol sulfate on cerebral anoxia

The effects of scymnol, chimaerol and sodium scymnol sulfate, prepared from the bile of Rhizoprionodon acutus, on cerebral anoxia were investigated in experimental models of hypoxia, ischemia and histotoxic anoxia in mice. Scymnol, at a dose of 100 mg/kg, showed a significant protective action against cerebral anoxia in all of the models studied and significantly increased the partial oxygen pressure of the arterial blood. The anti-anoxic activity of scymnol was found to be slightly greater than that of idevenone. A similar protective effect of sodium scymnol sulfate was seen at doses higher than 100 mg/kg. The survival time on hypoxia was significantly prolonged in the animals pretreated with chimaerol.