Ependymal changes in experimental hydrocephalus

Elevated diffusion anisotropy in gray matter and the degree of brain compression

OBJECT

For several decades, clinicians have predicted intraparenchymal brain pressure or brain tissue compression indirectly based on the degree of distortion of the midline structures (midline shift) and ventricle wall (ventriculomegaly) observed on conventional MRI. However, this method has several limitations. Diffusion tensor imaging (DTI) is a novel MRI technique that can provide information about the microstructural properties of compressed tissue. In this study, the authors evaluated whether DTI can precisely define the degree of tissue compression in patients with chronic subdural hematoma (CSDH).

METHODS

The study sample consisted of 18 patients (mean age 71 years, 10 men and 8 women) with unilateral CSDH and 12 age-matched volunteers. Diffusion tensor imaging results were acquired before and after the surgical irrigation in the CSDH group. Subdural pressure during the operation was also measured. Fractional anisotropy (FA) values were evaluated at several locations, including the gray matter.

RESULTS

The FA values of the gray matter, especially in the caudate nucleus and putamen, were increased in the patients with CSDH compared with the control group. The change in FA data before and after surgery (ΔFA) correlated with the degree of tissue compression evaluated by measurement of the subdural pressure. Furthermore, the increased FA values in patients with CSDH decreased after surgery.

CONCLUSIONS

These findings indicate that FA values of the gray matter, especially in the caudate nucleus and putamen, may be important markers of tissue compression. The assessment of FA values of the gray matter will result in a new, less-invasive diagnostic technique to evaluate the degree of brain compression.

New ependymal cells are born postnatally in two discrete regions of the mouse brain and support ventricular enlargement in hydrocephalus

A heterogeneous population of ependymal cells lines the brain ventricles. The evidence about the origin and birth dates of these cell populations is scarce. Furthermore, the possibility that mature ependymal cells are born (ependymogenesis) or self-renewed (ependymal proliferation) postnatally is controversial. The present study was designed to investigate both phenomena in wild-type (wt) and hydrocephalic α-SNAP mutant (hyh) mice at different postnatal stages. In wt mice, proliferating cells in the ventricular zone (VZ) were only found in two distinct regions: the dorsal walls of the third ventricle and Sylvian aqueduct (SA). Most proliferating cells were monociliated and nestin+, likely corresponding to radial glial cells. Postnatal cumulative BrdU-labeling showed that most daughter cells remained in the VZ of both regions and they lost nestin-immunoreactivity. Furthermore, some labeled cells became multiciliated and GLUT-1+, indicating they were ependymal cells born postnatally. Postnatal pulse BrdU-labeling and Ki-67 immunostaining further demonstrated the presence of cycling multiciliated ependymal cells. In hydrocephalic mutants, the dorsal walls of the third ventricle and SA expanded enormously and showed neither ependymal disruption nor ventriculostomies. This phenomenon was sustained by an increased ependymogenesis. Consequently, in addition to the physical and geometrical mechanisms traditionally explaining ventricular enlargement in fetal-onset hydrocephalus, we propose that postnatal ependymogenesis could also play a role. Furthermore, as generation of new ependymal cells during postnatal stages was observed in distinct regions of the ventricular walls, such as the roof of the third ventricle, it may be a key mechanism involved in the development of human type 1 interhemispheric cysts.

Evaluation of ventriculomegaly using diffusion tensor imaging: correlations with chronic hydrocephalus and atrophy

OBJECT

Ventriculomegaly is a common imaging finding in many types of conditions. It is difficult to determine whether it is related to true hydrocephalus or to an atrophic process by using only imaging procedures such as MR imaging after traumatic injury, stroke, or infectious disease. Diffusion tensor (DT) imaging can distinguish the compression characteristics of white matter, indicating that increased diffusion anisotropy may be related to white matter compression. In this preliminary study, the authors compared the DT imaging findings of ventriculomegaly with those of chronic hydrocephalus or atrophy to clarify the potential of diffusion anisotropy in the identification of hydrocephalus.

METHODS

Ten patients with chronic hydrocephalus, 8 patients with atrophy (defined by conventional devices and surgical outcome), and 14 healthy volunteers underwent DT imaging. Images were acquired before and after shunting or once in cases without shunting. The fractional anisotropy (FA) values at many points around the lateral ventricle were evaluated.

RESULTS

The FA patterns around the lateral ventricle in the chronic hydrocephalus and atrophy groups were different. Especially in the caudate nucleus, FA was increased in the chronic hydrocephalus group compared with the atrophy group. Furthermore, the FA values returned to normal levels after shunt placement.

CONCLUSIONS

Assessment of the FA value of the caudate nucleus may be an important, less invasive method for distinguishing true hydrocephalus from ventriculomegaly. Further research in a large number of patients is needed to verify the diagnostic ability of this method.

Intracerebroventricular antisense knockdown of G alpha i2 results in ciliary stasis and ventricular dilatation in the rat

BACKGROUND

In the CNS, the heterotrimeric G protein Galphai2 is a minor Galpha subunit with restricted localization in the ventricular regions including the ependymal cilia. The localization of Galphai2 is conserved in cilia of different tissues, suggesting a particular role in ciliary function. Although studies with Galphai2-knockout mice have provided information on the role of this Galpha subunit in peripheral tissues, its role in the CNS is largely unknown. We used intracerebroventricular (icv) antisense administration to clarify the physiological role of Galphai2 in the ventricular system.

RESULTS

High resolution MRI studies revealed that continuous icv-infusion of Galphai2-specific antisense oligonucleotide caused unilateral ventricular dilatation that was restricted to the antisense-receiving ventricle. Microscopic analysis demonstrated ependymal cell damage and loss of ependymal cilia. Attenuation of Galphai2 in ependymal cells was confirmed by immunohistochemistry. Ciliary beat frequency measurements on cultured ependymal cells indicated that antisense administration resulted in ciliary stasis.

CONCLUSION

Our results establish that Galphai2 has an essential regulatory role in ciliary function and CSF homeostasis.

Aging affects choroidal proteins involved in CSF production in Sprague-Dawley rats

Aging is currently associated with progressive declines of cerebral functions. From these, a decreased resistance to dehydration suggested alteration in choroidal control of brain homeostasis and reduced cerebrospinal fluid (CSF) production in old subjects. In the present study, choroid plexuses of 20-month old Sprague-Dawley rats were compared with those of 3- and 10-month old rats. Using ultrastructure analysis and immunodetection of ezrin, a protein associating cytoskeleton to membranes, we showed that progressive loss of microvilli and strong decrease in apical ezrin are evident in 20-month old rats. Using immunolabeling and confocal microscopy, we found reduction in expression of two choroidal proteins, carbonic anhydrase II and aquaporin 1, involved in CSF secretion. In addition, we confirmed previous studies indicating that choroidal Na,K-ATPase decreased with age. In situ hybridization analyses showed that mRNA levels for Na,K-ATPase and aquaporin 1 were significantly lowered in choroid plexus of old rats. These findings are consistent with a reduced secretory activity in choroid plexus and suggest that massive disorders could affect choroidal CSF production in aged rats.

Morphological Changes of Cerebral Ventricular Wall in Traumatic Brain Injury Evaluated via Large Histological Specimens

Large brain specimens were prepared from 50 head-injured and 50 non-head-injured cases that underwent medicolegal autopsy to critically examine the morphological changes in the periventricular tissue caused by injury to the head. Hemorrhagic damage to the ventricular wall was observed in 30 (60%) of the head-injury cases but was not observed in any of the non-head injured cases. Of 14 cases with only wounds to the scalp, five cases (35.7%) had ventricular wall damage. Of 40 cases in which death occurred within 24 h after injury, 25 (62.5%) showed ventricular wall damage. Of five cases of dying more than 24 h post-injury, only one revealed ventricular wall damage. This ventricular wall damage was frequently detected in the posterior (46%) and anterior horns (19%) of the lateral ventricle, near the attachment of the choroid plexus (19%). These morphological changes are considered primary damage, formed at the moment of impact in that concomitant hemorrhagic damage to the ventricular wall was also observed in all immediate death cases. Accordingly, detection of ventricular wall damage is considered a reliable means for deducing the occurrence of traumatic injury even in the cases where death occurs soon after injury.

Ependymal development, proliferation, and functions: a review

A survey of the literature shows that proliferation of ependyma occurs largely during the embryonic and early postnatal periods of development in most species. Differentiation of these cells proceeds along particular regional and temporal gradients as does the expression of various cytoskeletal (vimentin, cytokeratins, glial fibrillary acidic protein) and secretory proteins (S-100). Turnover declines significantly postnatally, and only low levels of residual activity persist into adulthood under normal conditions. Although the reported response of ependyma to injury is somewhat equivocal, only limited regenerative capacity appears to exist and to varying degrees in different regions of the neuraxis. Proliferation has been most often observed in response to spinal cord injury. Indeed, the ependyma plays a significant role in the initiation and maintenance of the regenerative processes in the spinal cord of inframammalian vertebrates. In the human, however, ependyma appears never to regenerate at any age nor re-express cytoskeletal proteins characteristic of immature cells. The functions of ependyma including tanycytes, a specialized form of ependymal cell that persists into adulthood within circumscribed regions of the nervous system, are still largely speculative. Fetal unlike mature ependyma is believed to be secretory and is believed to play a role in neurogenesis, neuronal differentiation/axonal guidance, transport, and support. In the adult brain, mature ependyma is not merely an inert lining but may regulate the transport of ions, small molecules, and water between the cerebrospinal fluid and neuropil and serve an important barrier function that protects neural tissue from potentially harmful substances by mechanisms that are still incompletely understood.

Neuroepithelial and ependymal changes in HTX rats with congenital hydrocephalus: an ultrastructural and immunohistochemical study

To investigate the pathogenesis of congenital hydrocephalus the brains of HTX rats aged between 16 days and 4 weeks and the brains of normal Wistar rats of the same ages were examined. In the fetal HTX rat brains, the lateral ventricles were symmetrically dilated from 20 days of gestation. The neuroepithelium bordering the ventricles showed thinning with cellular disarrangement and deformity. Similar neuroepithelial abnormalities were also found in the lateral ventricles of the HTX rat brain with no macroscopic signs of hydrocephalus at 20 days of gestation. The neuroepithelium showed flattening of the cells, widening of the intercellular spaces, formation of microvilli on the detached lateral cell surfaces, and frequent macrophage infiltration. On the other hand, the neuroepithelial cells of the third ventricle and the aqueduct were affected less severely or showed no significant abnormalities. Immunohistochemically, most of the neuroepithelium and ependyma of the lateral ventricles were positive for vimentin in both prenatal and postnatal hydrocephalic HTX rats, while a small number or none of those in normal control rats were positive. These morphological changes suggested that preferential involvement of the lateral ventricular neuroepithelium might be closely associated with the pathogenesis of congenital hydrocephalus in HTX rats.

Neuropathological changes caused by hydrocephalus

The medical literature concerning neuropathological changes caused by hydrocephalus is reviewed. In both humans and experimental animals the ependyma suffers focal destruction, cerebral blood vessels are distorted and capillaries collapse, there is damage to axons and myelin in the periventricular white matter, and occasionally neurons suffer injury. The damage appears to result from mechanical distortion of the brain combined with impaired cerebral blood flow. If ventriculomegaly develops very early, foci of cortical dysgenesis may be the result. The character and distribution of pathological changes are dependent on the age at which hydrocephalus develops, the rate and magnitude of ventricular enlargement, and the duration of hydrocephalus. Diversionary shunting of cerebrospinal fluid can only incompletely reverse the damage and the potential for reversal diminishes as the duration of hydrocephalus increases.

Subependymal cells provide a faster response to ependymal injury than astrocytes in the hydrocephalic brain

Obstructive hydrocephalus was induced in 12-day-old rats by the infusion of kaolin into the cisterna magna. After 7 days, cortical and ependymal lesions were made with thin wire in non-hydrocephalic brains and in hydrocephalic brains. The wounds were allowed to heal for times ranging from 1 day to 10 days post-lesion, after which the animals were perfused and the brains prepared for histology. Paraffin sections of brain containing the ependymal wound were reacted for glial fibrillary acidic protein by the avidin biotin complex technique. Subependymal cells were associated with the ependymal defect from 1 day in both non-hydrocephalic and in hydrocephalic brains. Reactive astrocytes were identified in hydrocephalic wounded brains on day 3. It was not until day 6 that astrocytes and astrocytic processes were seen in association with the subependymal cells at the wound edge, and astrocytic processes were noted along the needle track in the cortex. The results suggest that the extremely rapid response of subependymal cells to ependymal injury is a mechanism distinct from the astrocytes response for repair in the brain.

Clinical and ultrastructural observations of maturing human frontal cortex. Part I (Biopsy material of hydrocephalic infants)

Three of 30 human cerebral cortex biopsies from infants treated for hydrocephalus by shunt operation are described. The descriptions include an account of their case history, the clinical methods, and the operational procedures. The biopsy specimens were studied in semithin and ultrathin sections. Attention is drawn to normal synapse formation but also to neuronal degenerative changes due to hydrocephalus.

Neuronal effects of experimentally induced hydrocephalus in newborn rats

To determine the effects of increased cerebrospinal fluid (CSF) pressure on neuronal morphology, obstructive hydrocephalus was induced by injecting kaolin into the fourth ventricle and cisterna magna of 1-day-old rats. The animals were sacrificed 10 to 12 days later, at which time severe ventriculomegaly and cortical thinning were apparent in the parieto-occipital region. Tissue from this area was processed by rapid Golgi methods. Well impregnated pyramidal neurons were examined by light microscopy, and their somatic and dendritic features compared to those of age-matched littermate controls. The somata of medium pyramidal neurons were unaffected, but their basilar dendrites had fewer branches and those that remained were shorter. A variable reduction in dendritic spines occurred, such that some branches were totally denuded while others exhibited spine densities similar to those seen in control animals. The most striking alteration was the occurrence of frequent dendritic varicosities. These enlargements of the dendritic shaft separated by extremely thin constrictions gave the affected segment a beaded appearance. Both dendritic spine loss and varicosity formation were most notable on distal portions of individual branches and within regions of the dendritic tree closest to the ventricular and meningeal surfaces. These alterations are consistent with other reports of dendritic changes associated with aging, mental retardation, and alcohol exposure. These observations suggest that hydrocephalus causes dendritic deterioration or retardation of dendritic maturation. The fact that neuronal morphology was not more severely affected may indicate that these effects are reversible.

Human neonatal hydrocephalus. An electron microscopic study of the periventricular tissue

An infant of 43 weeks gestational age with severe congenital hydrocephalus was operated on for removal of a subependymal astrocytoma in the region of the foramen of Monro. A biopsy of periventricular tissue was taken from the lateral ventricle for examination by scanning and transmission electron microscopy. The ependyma was largely denuded, with glial cell processes forming most of the ventricular lining. Many of the attenuated ependymal cells, however, had intact junctional complexes at areas of contact with other ependymal cells. Club-shaped unipolar cells, believed to be a previously undescribed form of immature ependymal cells, were found in the ventricular lining. Cerebrospinal fluid edema was present in the neuropil up to 60 microns from the ventricular lumen, but there was no obvious axonal pathology in the tissues examined.

The pathology of experimental obstructive hydrocephalus. A scanning electron microscopic study

Obstructive hydrocephalus was produced in 14-day old rabbits by injection of kaolin into the cisterna magna. The ependymal lining was studied by scanning electron microscopy. Marked hydrocephalus was present 1 or 2 weeks after the kaolin injection. The ependymal lining adapted remarkably well to the rapid expansion by increasing the surface area of the ependymal cells. No breaks or denudement of the ependymal lining was observed except at the sites of ruptured ventricular synechiae. Generally, these findings confirm previous light and electron microscopic observations on the same model (Torvik et al. 1976; Torvik and Stenwig 1977). The results are discussed in relation to current theories concerning the pathophysiology of acute hydrocephalus.

Ventricular ependyma of normal and hydrocephalic subjects: a scanning electronmicroscopic study

Recent scanning electronmicroscopic studies of the ependymal surfaces of the lateral, third and fourth ventricles of a variety of animals have shown that most areas are covered by numerous cilia. In this paper, the density of the ciliary population in each of the ventricles is illustrated with material taken from human and rat brains. The authors' examination of Hy3 mice with hydrocephalus, and a number of other reports of examinations of animals with genetic and artificially induced hydrocephalus, have shown that the cilia are lost only from the ependymal surfaces covering those parts of the ventricular wall which are stretched and thinned by the raised intraventricular pressure. Thus the loss of the cilia is most probably the result of the hydrocephalus, and not its cause. Theories concerning the functions of the cilia are reviewed, and a new one accounting for why they are present in such large numbers is suggested. It is proposed that the cilia, together with the ventricular system and the cerebrospinal fluid, provide a cooling system for the brain.

Fine structure of ependymal cysts in and around the area postrema of the rat

Peculiar cells forming cysts were observed in the area postrema and sometimes also in the choroid plexus and the tela chorioidea near the area postrema, and were studied in detail by electron microscopy. The cytological features of the cyst cell and its junctional relationship to neighboring cells imply that cyst cells are derived from ependymal and choroid epithelial cells. The cyst cells usually contact directly the perivascular spaces of postremal, choroidal or pial capillaries, where the cytoplasm is often considerably attenuated. The cystic lumen is commonly filled with a flocculent material. The limiting membrane of the cystic lumen, which frequently bears cilia and microvilli, has the same thickness as the surface cell membrane. In many cases the cyst is surrounded by the cytoplasm of a single cell. In some cases, however, two cells participating in the formation of the cyst, although one is only a slender process and joined by a zonula occludens with the main cyst cell. Horseradish peroxidase (HRP) injected into the cerebrospinal fluid (CSF) space failed to enter the cystic lumen. A possible significance of the cyst in relation to the CSF and blood circulation was considered.