The effect of lesions in the locus coeruleus on the physiological responses of the cerebral blood vessels in cats

The effects of cerebral blood flow (CBF) of lesions placed stereotactically in or near the locus coeruleus were studied in 15 lightly anesthetized cats; 5 control cats in which the electrode was placed but no lesion created, and 10 experimental cats in which a lesion was created. The response of CBF to changes in Paco2 and in mean arterial blood pressure was determined by 133Xe-washout studies 10 days after the stereotactic procedures. The sites of the lesions were studied histologically, and their effects on catecholamine concentrations in the paraventricular hypothalamic nucleus, anterior ventral nucleus of the thalamus, and parietal cortex were determined by radio-chemical assay. Control animals and those with lesions near, but not in, the locus coeruleus had normal Paco2--CBF response curves and normal catecholamine concentrations in the areas of biopsy. Bilateral destruction of the locus coeruleus was confirmed in 3 animals on histological examination and in these animals there were decreased levels of catecholamines in the areas of assay, higher resting CBFs at normocapnia, and significantly abnormal CBF--Paco2 response curves. The autoregulatory response to changes in perfusion pressure was preserved. Thus, noradrenergic neurons originating in the locus coeruleus may contribute to the control of intraparenchymal cerebral vessels and disturbance of this control may be important in the pathology of cerebral ischemia.

A prospective study of nontraumatic coma: methods and results in 310 patients

Neurological signs and outcome are compared in the first 310 patients from a continuing prospective study of coma not caused by trauma or drugs. Sixteen percent of the patients achieved an independent existence within a month; severe disability or the vegetative state developed in 25% of patients comatose for six hours and in 79% of those still in coma after a week. The chance of regaining an independent existence was greater in patients who, by one day, obeyed commands or moved the limbs appropriately in response to noxious stimuli or who had attained any of the following: orienting eye movements, normal responses to oculocephalic or oculovestibular stimulation, or normal muscle tone. Conversely, the chance of regaining an independent existence fell in patients who, after one day, had either extensor responses of the limbs or failed to move them in response to noxious stimuli or who lacked eye opening, pupillary reactions, corneal responses, or any eye movement in response to oculovestibular or oculocephalic stimulation. Beyond these general guidelines, numbers of patients with particular signs are presently too small for confident prediction of outcome.

The relevance of peripheral baroreceptors and chemoreceptors to regulation of cerebral blood flow in the cat

The contribution of neural vasomotor reflexes to the control of cerebral blood flow (CBF) was investigated in 30 cats lightly anesthetized with pentobarbital. CBF was measured both by kinetic analysis and by the intial slope technique of the washout curve of a bolus of 133Xe. Autoregulation (10 cats) and responsiveness to alteration in arterial PCO2 (PaCO2) (10 cats) and arterial PO2 (Pao2) (five cats) were assessed both before and after bilateral intracranial division of the 9th and 10th nerves. In an additional group (five cats), related changes in CBF to alteration of PaCO2 were recorded before and after unilateral section of the 7th and 8th nerves. Autoregulation was preserve after division of the 9th and 10th nerves and there was no significant change in the PaCO2 response curves. Section of the 7th and 8th cranial nerves did not produce conclusive results in the small number of cats studied. A conclusion that the facial nerves are not dominant in responses to hypercapnia seems justified, but a modulating role for these nerves is possible. These studies do not exclude a physiological role for these nerves in the autoregulation of CBF, but do indicate that the cerebral vascular bed apparently is capable of functioning normally after their division.

Cryptococcal meningoencephalitis

A patient was admitted to hospital with an apparent psychiatric disturbance. When she became stuporous the cerebrospinal fluid was cultured but proved sterile. The latex test showed that serum was positive for cryptococcal antigens, and cryptococcal meningoencephalitis was diagnosed. Amphotericin B was given but when she developed a toxic reaction it was replaced by flucytosine. She responded well to flucytosine alone and no side effects appeared on continued treatment. Cryptococcal meningitis may present as a psychiatric disturbance, and serological tests are invaluable aids to diagnosis.

Chronic liver disease and mitochondrial antibodies: a family study

Two sisters had primary biliary disease and associated autoimmune thyroiditis with high titres of mitochondrial and other autoantibodies. Their deceased mother possibly suffered from similar disorders. In the same family two brothers had multiple autoimmune reactions, including mitochondrial antibodies, but liver function tests gave normal results. Ten other close relatives were investigated. Australia antigen was not found in the proband or her relatives.