A New Determinant of Poor Outcome After Spontaneous Subarachnoid Hemorrhage: Blood pH and the Disruption of Glossopharyngeal Nerve–Carotid Body Network: First Experimental Study

New experimental finding of dangerous autonomic ganglia changes in cardiac injury following subarachnoid hemorrhage; a reciprocal culprit-victim relationship between the brain and heart

OBJECTIVE

The vagal, stellate, and cardiac ganglia cells changes following subarachnoid hemorrhage (SAH) may occur. This study aimed to investigate if there is any relation between vagal network/stellate ganglion and intrinsic cardiac ganglia insult following SAH.

MATERIALS AND METHODS

Twenty-six rabbits were used in this study. Animals were randomly divided as control (GI, n = 5); SHAM 0.75 cc of saline-injected (n = 5) and study with autologous 1.5 cc blood injection into their cisterna magna(GIII, n = 15). All animals were followed for three weeks and then decapitated. Their motor vagal nucleus, nodose, stellate, and intracardiac ganglion cells were estimated by stereological methods and compared statistically.

RESULTS

Numerical documents of heart-respiratory rates, vagal nerve- ICG, and stellate neuron densities as follows: 276 ± 32/min-22 ± 3/min-10.643 ± 1.129/mm3-4 ± 1/mm3-12 ± 3/mm3 and 2 ± 1/cm3 in the control group; 221 ± 22/min-16 ± 4/min-8.699 ± 976/mm3-24 ± 9/mm3-103 ± 32/mm3 and 11 ± 3/cm3 in the SHAM group; and 191 ± 23/min-17 ± 4/min-9.719 ± 932/mm3-124 ± 31/mm3-1.542 ± 162/mm3 and 32 ± 9/cm3 in the SAH (study) group. The animals with burned neuro-cardiac web had more neurons of stellate ganglia and a less normal neuron density of nodose ganglia (p < 0.005).

CONCLUSION

Sypathico-parasympathetic imbalance induced vagal nerve-ICG disruption following SAH could be named as Burned Neurocardiac Web syndrome in contrast to broken heart because ICG/parasympathetic network degeneration could not be detected in classic broken heart syndrome. It was noted that cardiac ganglion degeneration is more prominent in animals' severe degenerated neuron density of nodose ganglia. We concluded that the cardiac ganglia network knitted with vagal-sympathetic-somatosensitive fibers has an important in heart function following SAH. The neurodegeneration of the cardiac may occur in SAH, and cause sudden death.Graphical abstract[Formula: see text].

New Evidence for Regulatory Role of Trigeminal Ganglion on the Intraocular Pressure Following Subarachnoid Hemorrhage

BACKGROUND

 Increased intraocular pressure (IOP) likely secondary to an activated oculo-trigeminal reflex network is an important issue following subarachnoid hemorrhage (SAH). The relationship between the IOP and trigeminal ganglion (TGG) following experimental SAH was investigated in this study.

METHODS

 Twenty-three rabbits were used in this study. Five rabbits (n = 5) were used as the control group, another 5 as the sham group (n = 5), and the remaining 13 (n = 13) as the study group. The study group was further divided into two groups of animals with mild (n = 6) and severe (n = 7) TGG degeneration. The IOP values were recorded. After 2 weeks, the animals were decapitated. The mean degenerated neuron density of TGGs was estimated by stereological methods and analyzed statistically.

RESULTS

 The average IOP values were 11.85, 14.12, and 21.45 mm Hg in the control (n = 5), sham (n = 5), and study (n = 13) groups, respectively. The mean degenerated neuron density was 34, 237, and 3,165 mm3 in the control, sham, and study groups, respectively.

CONCLUSION

 According to the findings of this study, the experimental SAH leads to changes in IOP by affecting the TGG. By predicting and preventing IOP elevation in the setting of SAH, our findings will shed light on secondary sequelae such as glaucoma and irreversible blindness.

Could the Cerebral Involvement of COVID-19 Disease be Related to Microstructural Changes that are not Reflected in Conventional MRI Images?

In patients with COVID-19, neurodegeneration may develop before clinical symptoms appear. Diffusion-weighted (DW) MRI is an important technique for analyzing microstructural changes such as gliosis. In this study, a quantitative evaluation of microstructural changes in the brain with apparent diffusion coefficient (ADC) values in patients presenting with a headache after the COVID-19 disease was analyzed and compared. DW MR images of patients of 20 COVID-19 patients (13 females, 7 males) who required imaging due to headache; 20 controls (16 females, 4 males) were retrospectively reevaluated. ADC measurements were taken from 16 regions of the brain, including right and left symmetrical in patients with COVID-19 infections and control groups. All regions of interest (ROIs) were taken from the hypothalamus, parahippocampus, thalamus, corpus striatum, cingulate gyrus, occipital gyrus, dentate nucleus, and medulla oblongata posterior. ADC values in the dentate nucleus right (784.6 ± 75.7 vs. 717.25 ± 50.75), dentate nucleus left (768.05 ± 69.76 vs. 711.40 ± 52.99), right thalamus (731.15 ± 38.14 vs. 701.60 ± 43.65), left thalamus (744.05 ± 39.00 vs. 702.85 ± 28.88), right parahippocampus (789.10 ± 56.35 vs. 754.75 ± 33.78), right corpus striatum (710.00 ± 39.81 vs. 681.55 ± 39.84) were significantly higher than those in the control group. No significant changes were observed in other areas. A significant increase in ADC values at many levels in the brain in patients with COVID-19 disease and headache was observed. Thus, this study indicates that cerebral involvement in COVID-19 disease may be related to microstructural changes that are not reflected in conventional MRI images.

New histopathological evidence for the relationship between hydromyelia and hydrocephalus following subarachnoid hemorrhage: An experimental study

Objectives

Subarachnoid hemorrhage (SAH) is a serious pathology with a high death and morbidity rate. There can be a relationship between hydromyelia and hydrocephalus following SAH; however, this subject has not been well investigated.

Materials and Methods

Twenty-four rabbits (3 ± 0.4 years old; 4.4 ± 0.5 kg) were used in this study. Five of them were used as the control, and five of them as the SHAM group. The remaining animals (n = 14) had been used as the study group. The central canal volume values at the C1-C2 levels, ependymal cells, numbers of central canal surfaces, and Evans index values of the lateral ventricles were assessed and compared.

Results

Choroid plexus edema and increased water vesicles were observed in animals with central canal dilatation. The Evans index of the brain ventricles was 0.33 ± 0.05, the mean volume of the central canal was 1.431 ± 0.043 mm3, and ependymal cells density was 5.420 ± 879/mm2 in the control group animals (n = 5); 0.35 ± 0.17, 1.190 ± 0.114 mm3, and 4.135 ± 612/mm2 in the SHAM group animals (n = 5); and 0.44 ± 0.68, 1.814 ± 0.139 mm3, and 2.512 ± 11/mm2 in the study group (n = 14). The relationship between the Evans index values, the central canal volumes, and degenerated ependymal cell densities was statistically significant (P < 0.05).

Conclusions

This study showed that hydromyelia occurs following SAH-induced experimental hydrocephalus. Desquamation of ependymal cells and increased cerebrospinal fluid secretion may be responsible factors in the development of hydromyelia.

Comparative analysis of MVD and RHZ in the treatment of primary glossopharyngeal neuralgia: A clinical report on 61 cases

Objective

Clinical data on 61 patients (grouped by their treatment with MVD or RHZ) with glossopharyngeal neuralgia were analyzed retrospectively. A summary analysis of the effective rate and surgical complications of MVD and RHZ in the treatment of glossopharyngeal neuralgia was performed to observe the new surgical options for GN.

Method

From March 2013 to March 2020, 63 patients with GN were admitted to our hospital by the professional group of cranial nerve diseases. Two patients diagnosed with tongue and pharynx pain secondary to tongue cancer and upper esophageal cancer, respectively were excluded from the group. The remaining patients all met the diagnosis of GN, some of them were treated with MVD and others were treated with RHZ. The pain relief rate, long-term results, and complications of the patients in the two groups were well-organized and analyzed.

Result

Of the 61 patients, 39 were treated with MVD and 22 were treated with RHZ. In the early-stage patients (the first 23 patients), all of them were operated on with the MVD procedure except one patient without vascular compression. In the later-stage patients, MVD was performed for evident single arterial compression according to the intraoperative situation. And for compression of arteries with greater tension or PICA + VA complex compression, RHZ was performed. It was also performed in cases where vessels with tight adhesions to the arachnoid and nerves could not be easily separated, or where it was easy to damage the perforating arteries after separating the blood vessels, causing vasospasm, which affects the blood supply to the brainstem and cerebellum. RHZ was also performed if there was no clear vascular compression. The efficiency of both groups was 100%. In the MVD group, one case recurred 4 years after the initial operation, and RHZ was performed for reoperation. Complications related to the operation included one case of swallowing and coughing in the MVD group, and three cases in the RHZ group; two cases of uvula not centering in the MVD group, and five cases in the RHZ group. There was 2 patients in RHZ group lost taste in 2/3 of the backing of the tongue, though these symptoms mostly disappeared or decreased after follow-up. One patient in the RHZ group had developed tachycardia by the time of the long-term follow-up, but whether it was related to the surgery is still uncertain. In terms of serious complications, there were two cases of postoperative bleeding in the MVD group. Based on the clinical characteristics of the patients' bleeding, it was judged that the cause of the bleeding was ischemia and was related to an intraoperative injury to the penetrating artery of the PICA artery and vasospasm.

Conclusion

MVD and RHZ are effective methods for the treatment of primary glossopharyngeal neuralgia. MVD is recommended for cases where vascular compression is clear and easy to handle. However, for cases with complex vascular compression, tight vascular adhesions, difficult separation, and without clear vascular compression, RHZ could be performed. Its efficiency is equivalent to MVD, and there is no significant increase in complications such as cranial nerve disorders. There are few cranial nerve complications that seriously affect the quality of life of patients. RHZ helps to reduce the risk of ischemia and bleeding during surgery by reducing the risk of arterial spasms and injury to the penetrating arteries by separating the vessels due to separation of vessels during MVD. At the same time, it may reduce the postoperative recurrence rate.

Does the anesthesia technique of cesarean section cause persistent low back pain after delivery? A retrospective analysis

OBJECTIVE

Cesarean sections (CS) under spinal anesthesia may lead to newly developed low back pain (LBP) after anesthesia. The cause of this pain is still unknown. This subject was investigated.

METHODS

The persistent LBP after the section was retrospectively analyzed in patients who were operated on under spinal or general anesthesia between January 1, 2018, and January 1, 2020.

RESULT

General anesthesia was used in 52 women, but 251 women were operated on under spinal anesthesia. Newly developed persistent LBP was detected in 57 (18,8%) of a total of 303 patients. Of those patients with LBP, general anesthesia was used in 14 of 52 (26,9%) patients, but 43 of 251 (17.1%) patients received spinal anesthesia. Baby weight after CS was the only variable associated with persistent LBP after 3 and 6 months (P < 0.05) in multiple logistic regression analysis. Patient age and anesthesia type were not associated with persistent LBP (P > 0.05).

CONCLUSION

This study shows anesthesia type as spinal or general was not associated with increased persistent LBP. Performing more spinal than general anesthesia in the cesarean section may be false data about the increased rate of LBP after CS.

New Histophatological Finding About Data Destroying Amyloid Black Holes in Hippocampus Following Olfactory Bulb Lesion Like as the Universe

Background: Many infinite theories have been suggested to explain memory loss in neurodegenerative diseases. However, there are clear data that iron-containing neurofibrillary networks can cause neuron death and erase the memory of neurons, just like black holes in space. Objectives: Ths study aimed to investigate the electromagnetic properties of iron-loaded neurofibrillary networks formed in the hippocampus as a result of damage to the olfactory nerves, just like black holes in space, as well as whether they cause neuron death and memory loss. Methods: All rats were tested with star maze performance before, 3 weeks, and 3 months after surgery. The data used in the study were obtained from the subjects in the experimental groups who had been followed up for 3 months with control (GI; n = 5), SHAM (GII; n = 5) with only frontal burr hole, and study (GIII; n = 15) animals with olfactory bulb lesion. All rats were tested with star maze performance before, 3 weeks, and 3 months after surgery. The olfactory bulbs and hippocampus of subjects were examined by stereological methods. Olfactory bulb volumes, degenerated neuron densities of the hippocampus, and numbers of hippocampal black holes were estimated quantitatively, and results were statistically analyzed by a 1-way analysis of variance (ANOVA). The properties of black holes in the brains and the universe were compared theoretically. Results: The mean olfactory bulb volumes, degenerated neuron density, and black holes of the hippocampus were estimated as 4.43 ± 0.22 mm3, 42 ± 9 mm3, and 3 ± 1 mm3 in GI, 4.01 ± 0.19 mm3, 257 ± 78 mm3, and 11 ± 3 mm3 in GII, and 2.4 ± 0.8 mm3, 1675 ± 119 mm3, and 34 ± 7 mm3 in GIII. All animals were tested with star maze performance before, 3 weeks, and 3 months after surgery. Latency, distance, speed, and path efficiency values of all animals were detected. The more diminished olfactory bulb volume (P < 0.00001) causes more apoptotic neurons and black holes in the hippocampus (P < 0.0001) and more memory loss in olfactory bulb lesion (OBL)-applied animals (P < 0.005). Conclusions: Hippocampal black holes, which are similar to black holes in terms of their formation processes, may be responsible for neuronal losses and memory erasures in the brain by acting like black holes in space. These amyloid plaques, which cause neuron death and memory loss, will be called data-deleting amyloid black holes (DADA-Black Holes) in the paper.

Protective Felix-Culpa Effect of Superior Sympathetic Cervical Ganglion Degenerations on Prevention of Basilar Artery Spasm Following Subarachnoid Hemorrhage: A Preliminary Experimental Study

BACKGROUND

Posterior cerebral blood flow is regulated by the basilar arteries (BA). Its vasospasm of basilar arteries (BA) can occur following subarachnoid hemorrhage (SAH). Superior cervical sympathetic ganglia (SCG) fibers have a vasoconstrictor effect on the BA. We aimed to investigate the relationship between the degenerated neuron density of the SCG and the severity of BA vasospasm after experimental subarachnoid hemorrhage.

METHODS

Twenty-four rabbits were used. Five of them were used as the control group, and five of them were used as the SHAM group. Experimental subarachnoid hemorrhages were performed in the remaining fourteen animals (study group) by injecting homologous blood into cisterna magna. After three weeks of injection, neuron densities of SCG and the severity of BA vasospasm index values (VSI) were examined histopathologically and compared statistically.

RESULTS

The mean VSI was 0.669±0.1129 in the control group, 0.981±0.159 in the SHAM group, and 1.512±0.298 in the study group. The mean degenerated neuronal density of SCG was 436±79/mm³ in severe vasospasm (n=3), 841±101/mm³ in moderate vasospasm (n=4), and 1.921±849/mm³ in the less vasospasm detected animals (n=6).

CONCLUSION

This study shows an inverse relationship between the degenerated neuronal density in the SCG and VSI values. This finding indicates a diminished sympathetic input from the superior cervical ganglion (SCG) resulting in a beneficial (the Felix-culpa) effect by dilating the lumen diameter of the basilar artery (BA), so superior sympathetic cervical ganglion degeneration following SAH protects the basilar artery spasm.

Destructive Effects of Acidic Blood on the Intestines: Experimental Study

Objective

This study aimed to investigate the destructive effects of acidic blood on the intestinal structures, which has been reported as the most hazardous biochemical result of vagosympathetic autonomic imbalances in intensive care unit patients with subarachnoid hemorrhage (SAH).

Materials and Methods

In total, 27 hybrid rabbits were used; 5 rabbits were used as a control group, 7 as the SHAM group into whom 1 cc saline was injected into the cisterna magna, and the remaining 15 were used as the study group. These animals received 1 cc of autologous arterial blood injection into the cisterna magna to create the SAH group. Blood pH values were recorded before, during, and after the experimental procedures. Computed tomography was performed to examine the intestinal morphology. Normal and degenerated epithelial cell densities of the intestine were estimated by stereological methods. The relationship between pH values and intestinal tissue changes was analyzed statistically using the Mann-Whitney U test.

Results

The mean blood pH values were 7.364±0.042 in the control group, 7.326±0.059 in the SHAM group, and 7.23±0.021 in the study group. Intestinal epithelial cell injury, desquamation of villus, and cell loss were observed. It is observed that the number of degenerated epithelial cells, fragmented villi numbers, and vacuoles significantly increased in the study group (p<0.05).

Conclusion

Acidotic intestinal injury secondary to blood pH changes following SAH may be considered as a generalized and dangerous complication with their multiorgan insuficiency effect.

First histopathological bridging of the distance between Onuf's nucleus and substantia nigra after olfactory bulbectomy-new ideas about the urinary dysfunction in cerebral neurodegenerative disease: an experimental study

OBJECTIVES

Olfactory bulbectomy (OBX) in experimental studies induces neurochemical, neurodegenerative changes in various parts of the body. But no information is available about how OBX affects the spinal cord in rats. Our study aims to investigate this question.

METHODS

Twenty-eight male rats were used. The rats were divided into three groups: six as the control, six as the SHAM, and 16 as the study group in which OBX was performed. The animals were followed for 10 weeks. After decapitation of the animals, olfactory bulb (OB) volumes, the olfactory glomerulus (OG), and the neuron density of the ON (Onuf nucleus) per cubic centimeter at the L4-S4 level were examined histopathologically and analyzed stereologically.

RESULTS

The mean OB volume, remaining normal OG density, and degenerated neuron density (DND) of the ON was measured as 4.32 ± 0.21/mm³ , 1842 ± 114/mm³ , and 4 ± 1 /mm³ in the control (group I); 3.3 ± 0.14/mm³ , 1321 ± 114/mm³ , and 43 ± 8/mm³ in the SHAM (group II); and 1.672 ± 0.12/mm³ , 852 ± 93/mm³ , and 154 ± 11/mm³ in the study group (group III). There was a statistically significant difference between the SHAM and the study group (P < .05).

CONCLUSIONS

In this study, histopathological bridging between ON-related lower urinary tract symptoms (LUTS) and OBX was shown the first time. According to the findings, LUTS may be reversed by the protection of the affected spinal cord through the correction of olfaction impairment in neurodegenerative disease.

What Are We Missing From Asymmetric Relationship Between the Retinal Nerve Fiber Layer Thickness Profiles and Sphenoid Sinus Volume?

PURPOSE/AIM OF THE STUDY

Detailed analysis of retinal structure such as the retinal nerve fiber layer can be performed by spectral-domain optical coherence tomography (OCT). There are no published studies concerning a relationship between retinal nerve fiber layer and human sphenoid sinus volumes. We investigated this relationship.

MATERIAL AND METHODS

Spectral-domain OCT. The peripapillary retinal nerve fiber layer (RNFL) thickness and sphenoid sinus volume estimation of both sides of sex-matched patients were retrospectively analyzed.

RESULTS

The mean RNFL thicknesses at the left side (91.8 μm) were significantly smaller than the right side (94.5 μm) (P = 0.040). However, the mean left sinus volume (44.5 cm) is larger than the right side, (34.5 mm) (P < 0.005). Left and right differences of both parameters are statistically significant (P < 0.05).

CONCLUSION

There is a negative correlation between mean RNFL thicknesses and mean sinus volumes. To our knowledge, this article is the first report demonstrating the asymmetry relationship between RNFL and sphenoid sinus volumes.

First definition of burned choroid plexus in acidic cerebrospinal fluid-filled brain ventricles during subarachnoid hemorrhage: Experimental study

Blood and cerebrospinal fluid (CSF) acidosis is the most troubling complication in subarachnoid hemorrhage (SAH) if carotid body (CB) networks are disrupted. However, histopathological examination of the choroid plexus (CP) in acidic CSF has not been evaluated so far. In this study, we aimed to investigate the CP in acidic CSF following SAH. Twenty-eight rabbits were used. Five rabbits were used to analyze CB network (control group; n = 5); seven rabbits were injected 1 mL of saline (Sham group; n = 7); and the rest 16 rabbits were given 1 mL of autologous arterial blood inject into the cisterna magna to create SAH (SAH group; n = 16). Blood and CSF pH values were recorded before/during/after the experimental procedures. Nuclear darkening, cellular shrinkage and pyknosis suggested the presence of apoptosis of epithelial cells of CP. The densities of normal and degenerated epithelial cells of CPs were estimated using stereological methods. The relationship between the pH values and degenerated epithelial cell densities of CPs were statistically compared by Mann-Whitney U-test. The pH values of blood were estimated as 7.359 ± 0.039 in the control group, 7.318 ± 0.062 in the Sham group, 7.23 ± 0.013 in the SAH group. CSF pH values were 7.313 ± 0.028 in the control group, 7.296 ± 0.045 in the Sham group, and 7.224 ± 0.012 in the SAH group. Degenerated epithelial cell density of CP was 25 ± 7 in the control group, 226 ± 64 in the Sham group, and 2115 ± 635 in the SAH group. There was a considerable link between CSF pH values and degenerated epithelial cells of CP (P < 0.0001). This study shows that CB insult causes acidosis of CSF as well as cellular degeneration of CP during SAH. This is the first description of this in the literature.

Rationalization of Using the MR Diffusion Imaging in B12 Deficiency

Context:

The structural imaging of brain does not demonstrate any changes in the vast majority of patients with vitamin B12 deficiency, even in the advanced stages.

Aims:

We investigated the microstructural changes in the brain with diffusion imaging among patients with biochemical evidence of B12 deficiency.

Patients and Methods:

We retrospectively analyzed all diffusion-weighted MRI images between the periods 2014–2016 who had biochemical evidence of B12. The age-sex matched controls were chosen from the group with normal B12 levels. Patients with pathological findings in conventional MRI images were excluded from the study.

Results:

About 37 patients were recruited (22 women, 15 men; mean age, 34.1 ± 9.9 years; age range). They were about thirty-four age-and sex-matched controls (with normal B12 levels), which were also included in the study. The mean apparent diffusion coefficient (ADC) value of amygdala (773.8 ± 49.9 vs. 742.2 ± 24.2, P = 0.01), hypothalamus (721.3 ± 39.2 vs. 700.2 ± 38.2, P = 0.02), striate cortex (737.6 ± 77.6 vs. 704.3 ± 58.2, P = 0.04), suprafrontal gyrus (740.7 ± 46.9 vs. 711.6 ± 40.7, P = 0.007) and medulla oblongata-olivary nucleus (787.3 ± 56.4 vs. 759.7 ± 46.2, P = 0.02) were significantly higher in B12 deficiency group compared to controls, whereas ADC values were similar at hippocampus, thalamus, insula, corpus striatum, cingulate gyrus, occipital gyrus, dentate nucleus, cerebral pedicle, tegmentum, pons, and posterior medulla oblongata.

Conclusions:

Our study indicates that a significant increase in ADC values occurs in multiple brain regions in patients with vitamin B12.

Controversy about the protective role of volume in the frontal sinus after severe head trauma: larger sinus equates with higher risk of death

The "crumple zone" hypothesis suggests that the paranasal sinuses protect the brain as a zone to distribute and absorb energy after trauma to the head. We investigated the relation between the size of the frontal sinus and mortality in patients with cranial trauma. All patients with head trauma admitted to the ICU between 1 January 2016 and 20 December 2017 were reviewed retrospectively. They were divided into two groups (according to their outcome) : died and survived. The volumes of the frontal sinuses and other trauma-related variables were assessed on computed tomographs (CT) on admission. Admission CT of 33 patients (24 male, and nine female, aged between 18-92 years, mean 43) were obtained. Male patients had significantly larger frontal sinuses than female (10.24 compared with 6.6cm³). Larger sinuses were significantly associated with a worse outcome (p=0.005). The size of the frontal sinus correlates with mortality after cranial trauma. Our findings do not confirm the "crumple zone" hypothesis, and suggest that the larger the sinus, the greater the risk of death. To our knowledge this is a new finding that warrants further validation.

A New Neuropathologic Mechanism of Blood pH Irregularities After Neck Trauma: Importance of Carotid Body-Glossopharyngeal Nerve Network Degeneration

OBJECTIVE

We created a neck trauma model by injecting blood into the sheath of rabbits' carotid bodies (CBs). Then we determined the relationship between neuronal degeneration of the CB due to hemorrhage of this organ and its clinical effects such as blood pH and heart rhythm.

METHODS

The present study included 24 adult male New Zealand rabbits. The animals were divided into 3 groups: control (n = 5); sham (0.5 mL saline injected into CBs; n = 5); and study (CB trauma model; n = 14). pH values and heart rhythms were recorded before the experiment to determine the values under normal conditions, and measurements were repeated thrice in the days following the experiment. The number of normal and degenerated neuron density of CBs was counted. The relationship between the blood pH values, heart rhythms, and degenerated neuron densities was analyzed.

RESULTS

Heart rhythms were 218 ± 20 in the control group, 197 ± 16 in the sham group (P = 0.09), and 167 ± 13 in the study group (P < 0.0005). pH values were 7.40 ± 0.041 in the control group, 7.321 ± 0.062 in the sham group (P = 0.203), and 7.23 ± 0.02 in study group (P < 0.0005). Degenerated neuron densities were 12 ± 4/mm³ in the control group, 430 ± 74/mm³ in the sham group (P < 0.005), and 7434 ± 810/mm³ in the study group (P < 0.0001).

CONCLUSIONS

A high degenerate neuron density in the CB can decrease blood pH and hearth rhythm after neck trauma, and there might be a close relationship between the number of degenerated neurons and clinical findings (such as heart rhythm and blood pH). This relationship suggests that injury to the glossopharyngeal nerve-CB network can cause acidosis by disturbing the breathing-circulating reflex and results in respiratory acidosis.