Profound hypoxia in Papio anubis and Macaca mulatta--physiological and neuropathological effects. I. Abrupt exposure following normoxia. II. Abrupt exposure following moderate hypoxia

The brain at high altitude

The sport of high-altitude climbing encompasses a number of factors of stress that supersede the usual endurance activities at lower altitudes. The effect of hypoxia on both physical and mental performance can be profound and, therefore, compound the risk. Much is yet to be known, particularly about the brain. Hopefully, a better understanding of the effect of hypoxia on neurotransmitters, the effect of hypoxemia on blood flow to all areas of the brain, and the potential subsequent anatomic changes that may take place are all yet to be discovered. Perhaps the more we know about it, the more appropriate it will be to call climbing a "no-brainer."

Early onset, autosomal recessive muscular dystrophy with Emery-Dreifuss phenotype and normal emerin expression

OBJECTIVE

To describe the clinical and histopathologic picture of a childhood-onset, severe variant of scapuloperoneal MD with rigidity of the spine.

BACKGROUND

Rigidity of the spine is a feature of numerous syndromes, including X-linked Emery-Dreifuss MD, Bethlem myopathy, and the rigid spine syndrome. These are, however, relatively static or very slowly progressive neuromuscular disorders, usually associated with preserved ambulation into adult life.

PATIENTS AND METHODS

Five unrelated children (three boys and two girls) presented in the first 2 years of life with poor neck control, waddling gait, and frequent falls. Early wasting of the distal leg muscles, biceps, triceps, and neck muscles was noted in all patients, and all had contractures and severe rigidity of the spine. The condition progressed rapidly, and all patients lost ambulation before the age of 8 years. Cardiac function was normal in all.

RESULTS

Creatine kinase was moderately elevated in all, and muscle biopsy specimens showed nonspecific dystrophic changes with normal expression of dystrophin, the sarcoglycans, and laminin alpha2, alpha5, beta1, and gamma1 chains. Emerin expression was normal in two of the boys whose tissue was available for study.

CONCLUSIONS

The distribution of weakness, wasting, and contractures of the patients described resembled Emery-Dreifuss MD, but the rapid progression of weakness and contractures and the involvement of both sexes together with normal emerin expression suggest that this form is not X-linked Emery-Dreifuss MD. We suggest that these patients represent a severe MD characterized by early onset distal wasting and severe rigidity of the spine, with probable autosomal recessive inheritance.

The rationale and utility of neurophysiological investigations in clinical monitoring for brain and spinal cord ischaemia during surgery and intensive care

This review concerns the role of neurophysiological monitoring in prevention of damage to the brain or spinal cord from inadequate supply of oxygenated blood during surgery and intensive care. The spontaneous and evoked electrical activity from neurones depends on oxidative metabolism of glucose, the substrate being delivered via the arterial blood supply and not stored locally. In critical situations electrical activity declines as oxygen delivery fails. Since this happens before neuronal death occurs it can provide early warning of risk. Methods for signal processing of EEG for this purpose must include time domain assessment and recognition of burst suppression pattern, as well as frequency domain information, and provide multivariate pattern recognition. Models for monitoring systems require analysis of data sets based on clinical studies where accurate outcome data is available so that valid comparisons between different approaches can be made. Neurophysiological features must be considered in the context of other relevant clinical parameters in the design of effective warning systems for prevention of brain damage due to inadequate oxygen supply.

The effects in vivo of hypoxia on brain injury

To separately analyze the hypoxic component of hypoxic-ischemic encephalopathy, rats were prepared such that their paO2 was maintained at 20 mmHg while maintaining systemic arterial pressures. During the 20-min experiment, brain oxygen concentration and extracellular amino acid concentrations were monitored. At sacrifice, the brains were studied for morphologic evidence of injury by immunocytochemical staining for the non-constitutive stress protein HSP-72 or neuronal death by acid fuchsin staining. Oxygenated rats subjected to global ischemia were prepared for comparison. In these experiment, hypoxia resulted in no increase in extracellular glutamate concentration, and no morphologic injury was detected. Thus, hypoxia without ischemia is well tolerated by brain.

Implantable cardioverter-defibrillator. Evaluation of clinical neurologic outcome and electroencephalographic changes during implantation

During placement of implantable cardioverter-defibrillators, ventricular arrhythmias are induced to test the function of the devices. Although cerebral hypoperfusion and ischemic electroencephalographic changes occur in patients while implantable cardioverter-defibrillators are being tested, no investigation has assessed neurologic outcome in these patients. Nine patients having either implantation or change of an implantable cardioverter-defibrillator underwent neurologic examination and neuropsychometric tests before and after the operation. After induction of general anesthesia and insertion of implantable cardioverter-defibrillator leads (when needed), ventricular fibrillation, ventricular flutter, or ventricular tachycardia, was induced by means of programmed electrical stimulation. Implantable cardioverter-defibrillator testing continued until satisfactory lead placement was confirmed. The intraoperative electroencephalographic recording was analyzed for evidence of ischemic change. In all, an electroencephalogram was recorded during 50 periods of circulatory arrest. Mean duration of the arrest periods was 13.6 seconds. By means of conventional visual inspection of the raw electroencephalogram, high-amplitude rhythmic delta or theta, voltage attenuation, or loss of fast frequency activity was observed in 30 of the arrests. By means of an automated technique of electroencephalographic interpretation based on power spectral analysis, electroencephalographic changes were correctly identified in 26 of the arrests. The incidence of these electroencephalographic changes was dependent on the arrest duration. The mean interval from arrest onset to electroencephalographic change was 7.5 seconds (standard deviation +/- 1.8 seconds). In patients with electroencephalographic changes during multiple arrests, no downward trend in this interval was detected in later arrests and no evidence of persistent ischemic change was observed in electroencephalograms recorded after the conclusion of implantable cardioverter-defibrillator testing. Postoperative neurologic and neuropsychometric testing was completed in eight patients, none of whom exhibited a new neurologic deficit, exacerbation of a preexisting neurologic condition, or significant deterioration in neuropsychometric performance. We conclude that the brief arrest of cerebral circulation induced during insertion of an implantable cardioverter-defibrillator is not associated with permanent neurologic injury.

PET studies of [18F]methyl-MK-801, a potential NMDA receptor complex radioligand

Using positron emission tomography (PET), the potential of 18F-labelled fluoro-methyl-MK-801([18F]FMM) as a radioligand for in vivo studies of the NMDA receptor complex was investigated in baboons. In baseline conditions, there was a slight differential retention of [18F]FMM in cerebral cortex and striatum relative to cerebellum, compatible with specific binding. However, neither pretreatment with pharmacological doses of MK-801 or phencyclidine, nor severe, transient brain hypoxia, were able to clearly alter [18]FMM brain regional kinetics, indicating limited usefulness of this radioligand for in vivo PET investigations of the NMDA receptor.