Cerebral hypoperfusion in the sudden infant death syndrome? Brainstem gliosis and vasculature

Gliosis is increased in the respiratory control area of the brainstem in victims of sudden infant death syndrome (SIDS), as it is in infants who have died of congenital heart disease. In the latter, the lesions appear to result from hypoxia or ischemia, and studies of the brainstem microvasculature of SIDS victims indicated a close relationship between the gliosis and adjacent vasculature. It is postulated that cerebral hypoperfusion may play a role in SIDS.

Cellular reactions to subependymal plate haemorrhage in the human neonate

The most important cause of death in human premature babies at the present time is intraventricular haemorrhage consequent to haemorrhage in the subependymal plate. Lesser degrees of plate haemorrhage can also have serious effects. It was possible to observe the reaction to such haemorrhages in twenty-seven cases whose range of gestational age extended from 23 to 36 weeks and survival from 4 to 59 days. The haemorrhage occurs in the first week of life, usually in the first few days. The earliest reaction at 4 days was the presence of mononuclear phagocytes around the haemorrhage, these evolved to iron pigment macrophages which were present in eighteen of the twenty-two cases in which some reaction was detected. Subependymal astrocytic proliferation was seen at 11 days, related to ependymal disruption, but an astrocytic reaction around the haemorrhage and related to it was not seen until 14 days. Within the subependymal plate this reaction was scanty in fibril production and the cells were thought to be derived from differentiating astrocytes in the plate. In one case a more marked reaction was detected to hypoxic damage in the adjacent thalamus. The source of the phagocytes in these sites and the reasons for the rather slow astrocytic reaction are discussed.

A quantitative histological study of changes in neurons and glia in the Gunn rat brain

The rostral part of the anterior limb of the anterior commissure (RAL) and the indusium griseum of the brains of Gunn rats and Wistar rats were examined quantitatively to assess the effects of hyperbilirubinaemia on the developing nervous system. The number of glia in the RAL was significantly less in Gunn rats than in the Wistar rats. The number of glia in the indusium griseum was similar in both groups but the Gunn rats showed a decrease of about 20% in the number of neutrons in this region. Myelination appeared to be unaffected and apart from an apparent increase in the number of dense bodies in astrocytes and oligodendrocytes there were no obvious morphological changes in either glia or neurons.

Transmissible virus dementia. II. Neurohistology of three, geographically clustered cases of Creutzfeldt-Jakob disease

Histopathological findings in three temporo-spatially linked cases of Creutzfeldt-Jakob disease (CJD) are reported. The patients were males, unrelated and without positive family history. Their mean age at the onset of the disease was 52.3 years. The mean duration of the illness was 6.6 months; the clinical symptomatology differed considerably. Neurohistology revealed in all patients a neuronal loss, intracyoplasmic vacuolation, spongiosis and astrocytosis. Besides the cortical regions, basal ganglia and cerebella were severely affected. All cases were pathologically suggestive of the cortico-striato-cerebella variant of CJD. Attention is drawn to this apparent topical similarity of most pronounced lesions. The possible significance of the pathoanatomical consistency, observed in the cases studied, for the unusual pattern of natural occurrence of CJD is considered.

Arrest of myelination and demyelination in rabbit retina induced by herpes simplex virus infection

Herpes simplex virus was injected into the vitreous of suckling and adult rabbits. In the suckling rabbits the infection caused an arrested myelination of the strip. Further, the infected strips showed degenerative changes with splitting and distension of myelin sheaths which then disintegrated. Ultrastructurally, herpes simplex virus particles were found in both oligodendroglial cells and in astrocytes in the bundles. No increase in intraocular pressure was recorded during the inflammation. The infection spread along optic pathways to the opposite side. Inflammatory cells appeared at the surface and infiltrated the degenerating strip. Especially in the contralateral eye, an extensive inflammatory cell infiltration was seen among bundles of nerve fibres which showed partly well-preserved myelin and partly with signs of demyelination reminiscent of the picture of experimental allergic encephalomyelitis in the epiretinal strip.

Hemochromatosis associated with brain lesions--a disorder of trace-metal binding proteins and/or polymers?

A 68-year-old man, after having been diagnosed as having hepatic disease at about the age of 41 years, had been hospitalized frequently until his death. Blood sugar, iron, and copper had not increased during his illness. Although the diagnosis of liver cirrhosis had been made and he had been receiving therapy, various neurologic symptoms without disturbances of consciousness appeared six months before his death. Autopsy revealed hemochromatosis, liver cirrhosis, and pancreatic fibrosis. A large amount of iron had accumulated in the liver, the pancreas, and the thyroid gland, while considerable numbers of ceroid and lipofuscin pigment granules had accumulated diffusely in the brain. Abnormal astrocytes of the Alzheimer II type were diffusely distributed in the brain and contained no intranuclear glycogen which stained positive with the carmine stain. No spongy changes were seen in the deeper layers of the cerebral cortex. Chemical analyses for trace metals in the brain, liver, and kidneys revealed a large amount of iron and increased copper in the liver, and considerable quantities of copper, manganese, calcium, and mercury in the brain. Because of changes in the erythrocyte sedimentation rate and marked thymol turbidity seen before and after the occurrence of the neurologic symptoms, this man was suspected of having disorders of the trace-metal binding proteins and/or of their polymers.

Encephalopathy associated with lamellar residual bodies in astrocytes (Towfighi, Grover and Gonatas 1975):a new observation

A 7-year-old male patient presented a few episodes of convulsions during the first year of life. The psychomotor development has been normal during that period of time after which a steadily progressive deterioration occurred. Increasingly severe pyramidal signs, optic atrophy, quadriparesis and progressive evolution towards a decorticate state were noted. Skin and neuromuscular biopsies were not contributory. A brain biopsy showed the presence of lamellar inclusions in astrocytes and, to a lesser extent, in neurons. Such features have only been reported once in two siblings by Towfighi et al. (1975). The nosological situation of this disease is discussed.

[Immunocytochemical localization of gliofibrillary proteins (GDAP) in human cerebral tumors. Histological and in vitro studies]

On the basis of studies utilizing antibody to GFAP (glial fibrillary acidic protein) in the indirect immunofluorescent and immunoperoxydase methods we report the presence of GFAP in 5 astrocytomas, 1 ependymoma and 1 medulloblastoma. The GFAP was evidenced on cryostat sections of frozen material and in short-term tissue culture. Five others tumors including 1 oligodendrocytoma, 1 choroid-plexus papilloma, 1 meningioma and 2 secondary sarcomas were negative. Possible applications of antibodies to GFAP for localization and therapy of brains tumors were considered.

Spongy degeneration of the central nervous system (van Bogaert-Bertrand type?) in a newborn infant. A light and electron microscopic study

Autopsy findings on a 5 day old infant with hypotonia from birth showed extensive spongy changes of the myelinating tracts within the cerebrum, cerebellum and brain stem. The spongy changes, similar to Van Bogaert-Bertrand disease, resulted from intramyelinic edema. However, unlike the typical forms of this disease, swollen astrocytes with abnormal mitochondria were not found. The relationship of this case to typical forms of Van Bogaert-Bertrand disease is discussed. This case may represent a very early form of Van Bogaert-Bertrand disease or a new pathological entity.

Glial and neuronal alteration in the corpus striatum or fats with CCl4--induced liver disease. A quantitative morphological study using an electronic image analyzer

The density and size of astrocyte-, oligodendrocyte-and neurone nuclei in corpus striatum were determined in rats with CCl4-induced liver encephalopathy by means of an electronic image analyzer. After 8 weeks of CCl4-administration, the astrocyte number had nearly doubled, and astrocytes with increased nuclear size qppeared. After 20 weeks, a reduction (appr. 25 per cent) was found in the number of nerve cells and oligodendrocytes. The total number of glial cells, however, was unchanged during the experiment; this demonstrates the need of performing differential counts when evaluating gliosis. Probably, a part of the increase in the number of astrocytes was due to a transformation from precursor cells, usually classified as oligodendrocytes. The increased number and size of astrocyte nuclei are probably connected with an enhanced astrocyte metabolic capacity due to alterations in the ammonia and amino acid metabolism.

Number of Purkinje cells and Bergmann astrocytes in rats with CCl4--induced liver disease

The nuclei of Purkinje cells and Bergmann astrocytes were counted on sagittal sections from cerebellum and the length of stratum gangliosum was measured in rats with CCl4-induced liver disease, using an electronic image analyzer. After 8 weeks of CCl4-administration a reduction was found in the number of Purkinje cells, many of which showed homogenizating changes. Ten weeks after termination of the administration period the number of Purkinje cells was reduced by 12 percent. The number of Bergmann astrocytes remained significantly increased after 8 weeks of CCl4-administration (max. 20 per cent). The changes of Purkinje cell and Bergmann astrocyte density developed during the period of severe liver necrosis, whereas only minor changes were found in the ensuing period of liver "cirrhosis". In the perfusion fixed specimens, the Bergmann astrocyte nuclei increased in volume up to 65 per cent and immersion fixed brains showed typical Alzheimer type II nuclear changes. The impact of the increased plasma ammonia concentration on the astrocytes is discussed.

Cerebral "radiation necrosis": vascular and glial features

Glial and vascular abnormalities in brain, simulating intracranial neoplasia, are described in a patient who received radiation to the pituitary region for treatment of an adenoma, 13 months before death. In addition to the expected changes of cerebral radionecrosis, four interesting features are cited: 1. Diffuse hyperplasia of capillaries in the cerebral cortex with marked endothelial hypertrophy; 2. abundant, large multipolar bizarre cells in the perivascular connective tissues; 3. focal astrocytic proliferation with many cells resembling either Alzheimer type I astrocytes or neoplastic cells, and 4. radiation changes in the non-irradiated brain.

Scrapie: a review of its relation to human disease and ageing

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Preclinical lesions and their progression in the experimental spongiform encephalopathies (kuru and Creutzfeldt-Jakob disease) in primates

Creutzfeldt-Jakob disease and kuru were studied in experimental primates. Eight animals with clinical disease lasting from 1/2 to 12 1/2 months were evaluated for histological evidence of progression of the pathological triad of neuronal vacuolation, neuronal loss and fibrous astrocytosis. The first change to appear was neuronal vacuolation, in both the body of neurones and in the neuropil. Fibrous astrocytosis was found subsequent to neuronal damage and necrosis. Neuronal loss was apparent when clinical signs were present. As the clinical disease progressed, so did the severity of neuronal loss and astrocytosis. Five animals, 1 1/2-10 1/2 months after intracerebral inoculation, before they had shown any signs of clinical disease, had histological evidence of neuronal vacuolation and astrocytosis.

Retina subjected to components of ischemia in vitro. Selective vulnerability and minimum lethal exposure of neurons and glia to oxygen and/or glucose deprivation and to loss of exchange with incubating medium

Rabbit retinas were incubated at 37 C in media lacking oxygen, glucose, or both, or sealed in a small compartment without medium to convert them to a "closed system." They were then returned to control medium before being fixed for microscopy. Other retinas were incubated only in control medium and then fixed. Conversion of the retina to a closed system caused irreversible damage to all cell types within 40 minutes. Combined deprivation of oxygen and glucose also irreversibly damaged the neuronal cells within 40 minutes, but Mueller cells,the principal glial cells of the retina, were not irreversibly altered by 90 minutes of the deprivation. Deprivation of oxygen alone caused irreversible damage to receptor cells in 80 minutes, but the cells of the inner nuclear layer, ganglion cells, and Mueller cells retained normal structure for at least 180 minutes. Deprivation of glucose alone damaged receptor cells in 160 minutes and the other neuronal cells in 180 minutes, but did not irreversibly damage Mueller cells by 200 minutes.

Some chemical principles applicable to some silver and gold staining methods for neuropathological studies

Some of the chemical principles involved in some silver and gold staining procedures for neuropathological studies are analyzed in the light of experience with methods for astrocytes, microglia, axons and reticulin fibers. The role of formalin fixation, and of treatment with ammonium bromide or oxidizing agents prior to staining for glial cells or reticulin fibers respectively, is described. The silver staining methods are divided into two fundamentally different groups. One is based on the use of silver diammine solutions with or without other substances such as carbonates or pyridine, and at varying times, gold toning. This group encompasses a great variety of techniques for staining glial cells, reticulin fibers and axons. The second group is based on the use of weak solutions of silver ions, reduction in a photographic developer, treatment with gold chloride, and a second reduction in oxalic acid. This group is represented by methods for staining axons and reticulin fibers. A brief analysis of the gold and mercuric chloride methods for astrocytes is also given.

Alexander's disease presenting as astrocytoma

A case of progressive fibrinoid degeneration of astrocytes is described. Symptoms began with convulsions at the age of 6 weeks and cerebral tumour was suspected because of enlargement of the head, increased intracranial tension, and marked proliferation of astrocytes in the brain biopsy which was interpreted as an astrocytoma. Fibres and granules staining deeply with PTAH are a constant feature of the few cases so far described. The aetiology is unknown but an inherited metabolic defect of astrocytes may be responsible.

Alexander's disease: a report and reappraisal

A boy with juvenile onset of symptoms of Alexander's disease had a clinical picture of pseudobulbar palsy, ataxia, and spastic paraparesis. Pathologic examination of the central nervous system revealed the diffuse presence of Rosenthal fibers and patchy demyelination. This may be the first report of a case with significant neuronal changes and inflammation within the brain stem in this disease. The clinical picture of this entity is varied and age-dependent. Alexander's disease may be a motor system specific entity secondary to astrocytic dysfunction.

[Hereditary spongiform dystrophy in young children (Canavan: van Bogaert-Bertrand)]

Hereditary spongiform dystrophy in young children is characterised by macrocephaly with spasticity, convulsions and ultimately a decerebrate state and diffuse electroencephalographic changes. Histological examination of the brain remains essential for its diagnosis. A review of the ultrastructural studies reported by various authors complements the findings obtained by conventional histology. We have thus endeavoured to determine whether van Bogaert-Bertrand's disease is to be considered as congenital or acquired. The anatomical findings in 3 cases together with the descriptions of other authors lead us to the following conclusions: -that the spongiform changes may be due to an osmolar disequilibrium in which the ATPase-Na/K relation with mitochondrial abnormalities is yet unclear. -that the constant finding of Alzheimer type II cells is certainly an indication of intra-astrocytic malfunction. -that the oedema blocks both myelin synthesis and its coiling into lamellae. Case 1, which showed a long survival compared to others described (about 4 years), enabled us to study terminal lesions. Sub-cortical zones, in both cerebrum and cerebellum, contained neither myelin nor spongiform cavities, but, on the other hand, showed a compact glio-fibrillosis with large vesicles and oligodendroglia of increased density. We have interpreted these lesions, progressively replaced by spongiosis deeper in the cortex, as evidence of retracted scar tissue. Differences found between cerebral weights seem to confirm this hypothesis.

In vitro astrocytic differentiation from embryoid bodies of an experimental mouse testicular teratoma

Astrocytic differentiation in monolayer cultures of ascitic embryoid bodies from the experimental teratoma OTT-6050 was studied by conventional light microscopy and by indirect immunofluorescence with antisera to glial fibrillary acidic (GFA) protein, a protein specific for astorcytes. Primitive neuroepithelial cells were identified in 24-hour cultures. Within 72 hours, two cell types diverged. One cell type, with a flattened epithelial morphology in early cultures, demonstrated delicate GFA protein-positive fibrils within 48 hours. In later cultures, this type progressively displayed more typical stellate astrocytic features, with denser, more compact GFA protein-positive fluorescence in the perinuclear cytoplasm and cell processes. As indicated by GFA protein expression, the appearance of astrocytes of typical morphology therefore was preceded by biochemical differentiation. The second cell type, interpreted as neuroblastic, failed to demonstrate GFA protein and had a small perikaryon with slender bipolar processes that were argyrophilic with Bodian's protargol in late cultures. Divergent neuroepithelial differentiation occurred within mitotically active cell populations and proceeded without apparent tissue relationships to other germ layer derivatives.

Infantile diffuse cerebral degeneration with hepatic cirrhosis

Four children had progressive degeneration of the cerebral cortex, with hepatic cirrhosis. They and four previously described ones, are representative of a distinct form of hepatocerebral degeneration. Onset of the neurological disorder is between ages 1 and 3 years, at times with mild developmental delay. Explosive onset of intractable convulsions, leaving the child in a stuporous and demented state, is characteristic. Generalized hypotonia or hemiparesis were observed in several affected children. Clinical evidences of hepatic disease, including ascites and jaundice, occurred late, if at all. The illness ended fatally within ten months of onset of convulsions. Pathological findings in the brain are neuronal loss and gliosis, in a pattern that is indistinguishable from that in degeneration of the cerebral gray matter in infancy (Alpers disease). The hepatic lesions consist of cirrhosis or of subacute hepatitis, with superimposed fatty infiltration of hepatocytes. The disorder is genetically determined, with recessive inheritance.

Quantitative changes in neuroglia in the white matter of the mouse brain following hypoxic stress

Two experimental and one control group of 70-80 day old mice were used in this study. The two experimental groups were subjected to hypoxia for 2 days in a decompression chamber at 390 mmHg. The animals in one experimental group were killed on removal from the chamber (hypoxic group) while those in the other (recovery group) were allowed to recover at sea-level atmospheric pressure for one week before being killed. Semithin, toluidine blue stained sections from the anterior limb of the anterior commissure were examined to find whether any quantitative changes occurred in the neuroglia with hypoxic stress. The following changes were observed: (1) The percentage of astrocytes in the hypoxic and recovery groups was significantly (P less than 0-005) lower than in the control group. (2) The percentage of oligodendrocytes in the hypoxic and recovery groups was significantly (P less than 0-001) higher than in the control group. (3) The percentage of microglia in the recovery groups was significantly (P less than 0-02) lower than in either of the other two groups. (4) The percentage of astrocytes in the recovery group was slightly (2-1%) higher than in the hypoxic group, and although not statistically significant, this result suggested that a slow return to normal might be occurring. (5) Little change was observed in cell density. The possible significance of these changes is discussed. I should like to express my indebtedness to Dr E.J. Clegg of the Department of Anatomy, Sheffield University, for the use of the decompression chamber, for his advice and help in the preparation of the control and experimental animals, and also for his hospitality throughout the duration of the experiments. Thanks are also due to Mrs Sheila Ramsay for her careful preparation of the perfusing fluids, and to Mrs Dawn Alexander for typing the manuscript.

Edema of the cortical gray matter of the human cerebrum

Five cases of brain tumor are reported in which an extracellular edema of the cerebral cortex was recognized in the form of lakes of eosinophilic, PAS positive material, presumably serum proteins, permeating among the neuronal and glial cells and processes. In three, the astrocytes and their processes were stained in replicate paraffin sections by a gold sublimate technique. The astrocytic changes were variable. Most often, the astrocytes changed from protoplasmic to fibrillary, with long deeply stained processes, the cells sometimes becoming large and distorted. Many became enlarged and smudgy, with short stubby processes. Only a few showed the fragmentation and disintegration of processes. Only a few showed the fragmentation and disintegration of processes which are regularly observed in edematous white matter. The neuronal processes remained essentially normal. In comparison with edema of white matter, edema of the cortex is rare, involves only small portions of tissue, and differs in its effects on astrocytes. The edema in both cortex and white matter is extracellular. We have not been able to recognize a specific intracellular form of edema, grossly or with light microscopic techniques.

Double encephalitis with herpes simplex virus and cytomegalovirus in an adult

A 51-year-old housewife developed symptoms of a cold followed by high fever, delirium, coma, rigidity of extremity muscles, positive Babinski sign and generalized convulsions, while complement-fixing antibody titre to herpes simplex virus in the sera raised over 128 X and declined to 8 X in the course. She finally expired of bronchopneumonia following status epilepticus after 94 days of illness. Severe necrosis with extensive hemorrhage in the white matter was predominant in the temporal, insular and orbitofrontal cortex, thalamus and globus pallidus. Focal rarefaction of the cerebral cortex with a very few eosinophilic intranuclear inclusions in the oligodendroglia and nerve cells, nerve cell destruction in the substantia nigra with glial nodules and perivascular inflammatory cell cuffs were observed. Abundant cytomegalic inclusion cells, originating from hypertrophic astrocytes, were present in the necrotic areas of cerebrum as well as in the rarefied tissue in the subependymal layers of the brainstem and cerebellum. Electron-microscopic study of the cytomegalic cells demonstrated the presence of numerous virions in both nucleus and cytoplasm. Fortuitour infection of the brain by cytomegalovirus with necrotizing encephalitis by herpes simplex virus is unique. The cause of double viral infections and severe lesions by less virulent strains is discussed.

Cerebral biopsy and assessment of brain damage in hydrocephalus

Needle biopsies of the cerebral mantle were taken from 12 hydrocephalic children aged between 14 days and 3 years. 5 children were biopsied twice or more often during subsequent shunting operations. Histological studies of biopsies embedded in epoxy resin for light and electron microscope examination revealed more useful information than those embedded in paraffin wax. There was evidence of axonal degeneration in the white matter of patients with acute hydrocephalus. Progressive gliosis was seen in more chronic hydrocephalus together with signs of cerebral atrophy. No measurable effect of hydrocephalus on myelination was detected. This histological study of needle biopsies taken at shunt operations could be useful in assessing brain damage and thus in predicting future intellectual development in hydrocephalic children.

Hyperplasia of oligodendrocytes in quaking mice

The number of neuroglial cells in selected fiber tracts of 90-day-old quaking and normal mice was determined by a combination of light and electron microscopy. Oligodendrocytes of quaking mice are normal in number in the anterior commissure and corticospinal tract (in the cervical spinal cord) but are increased two- to fourfold in the optic nerve and the fasciculi cuneatus and gracilis (in the cervical spinal cord). The nuclei and perikarya are normal in size or smaller than normal. Those tracts with the greatest hyperplasia of oligodendrocytes also have the greatest content of myelin, suggesting that cell number influences content of myelin. However, the volume of myelin per oligodendrocyte also varies, between 2 and 11% of normal, in the different tracts of the mutant. The hyperplasia of oligodendrocytes in quaking mice may arise as compensation for their decreased production of myelin and reflect a normal plasticity in the processes of myelination. If so, the mutant may be a useful system for study of the regulation of myelogenesis.

Human epileptic brain Na, K ATPase activity and phenytoin concentrations

An abnormal flux of monovalent cations may be related to the epileptogenic process in man. One possible mechanism for deranged electrolyte metabolism in epileptic brain is an abnormality in sodium, potassium-dependent adenosine triphosphatase (Na, K ATPase). We found the activity of Na, K ATPase to be significantly less in epileptic human corfex than in nonepileptic cortex. Histological changes have been simultaneously evaluated in epileptic brain. A second membrane-bound enzyme, acetylcholinesterase (AChE), was also assayed as a marker for neuronal membranes and found not to correlate with the epileptogenicity of human brain. In addition, the concentrations of the anticonvulsant compound phenytoin have been determined in the serum and cerebral cortex of epileptic and nonepileptic patients. The ratio of phenytoin in cortex to serum concentration is significantly lower in epileptic patients than in nonepileptic controls.

Transmission of Creutzfeldt-Jakob disease to the stumptail macaque (Macaca arctoides)

The successful transmission of Creutzfeldt-Jakob disease from both affected human and chimpanzee brain to stumptail macaques has been accomplished. The incubation period of 5 yr was the same for both animals; however, the course of the disease was longer in the animal receiving the human brain. In both cases, initial mild symptoms slowly remitted only to reappear some 4 mo later. Muscle biopsies revealed changes suggestive of a mild neuropathy. In addition, there appeared to be an increased ability to incorporate 3H-thymidine in untreated cultures of lymphocytes from peripheral blood.

[Evolution of the astroglial reaction in the pyramidal pathway after injury of the rat motor cortex]

Investigation of astrocytes in the pyramidal tract of the rat 2 to 100 days after a lesion of the motor cortex indicates that the glial reaction, with increase in size of astrocytes and in affinity for Cajal's gold-sublimate, begins at the lesion and extends to the distal segments of the spinal cord. But this reaction recedes and disappears in lumbar and dorsal cord about 70 days after the operation. It persists in the cervical cord and in the brain. On the other hand, a characteristic increase in activity of glutamate andglucose-6-phosphate dehydrogenases is restricted to the vicinity of the lesion and does not even encroach upon the posterior limb of the internal capsule.

Patterns of proliferation in cerebral lymphoreticular tumours

A study of eighteen cases of primary lymphoreticular tumours in the brain is described. In four of these there were extraneural lesions and in one macroglobulinaema. The use of whole brain sections embedded in celloidin, and of metallic impregnation methods, revealed certain constant patterns of proliferation. The tumours were diffuse and multicentric; the leptomeninges and perivascular spaces especially in the subependymal regions were frequently involved. Mature microglia were active both in infiltrated and in apparently tumour-free regions.