The Psychological Science Accelerator's COVID-19 rapid-response dataset

In response to the COVID-19 pandemic, the Psychological Science Accelerator coordinated three large-scale psychological studies to examine the effects of loss-gain framing, cognitive reappraisals, and autonomy framing manipulations on behavioral intentions and affective measures. The data collected (April to October 2020) included specific measures for each experimental study, a general questionnaire examining health prevention behaviors and COVID-19 experience, geographical and cultural context characterization, and demographic information for each participant. Each participant started the study with the same general questions and then was randomized to complete either one longer experiment or two shorter experiments. Data were provided by 73,223 participants with varying completion rates. Participants completed the survey from 111 geopolitical regions in 44 unique languages/dialects. The anonymized dataset described here is provided in both raw and processed formats to facilitate re-use and further analyses. The dataset offers secondary analytic opportunities to explore coping, framing, and self-determination across a diverse, global sample obtained at the onset of the COVID-19 pandemic, which can be merged with other time-sampled or geographic data.

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world. PROTOCOL REGISTRATION: The stage 1 protocol for this Registered Report was accepted in principle on 12 May 2020. The protocol, as accepted by the journal, can be found at https://doi.org/10.6084/m9.figshare.c.4878591.v1.

Romantic relationship distress, gender, socioeconomic status, and inflammation: A preregistered report

Poor quality romantic relationships increase risk for health problems; elevated systemic inflammation is one promising underlying mechanism. This registered report utilized data from 3 publicly available datasets with large sample sizes (Add Health, MIDUS, NSHAP) to test this possibility. An internal meta-analysis across all 3 studies determined that romantic relationship distress was unrelated to inflammation (assessed via C-Reactive Protein levels). In addition, this link was not moderated by gender, socioeconomic status (SES), or the combination of gender and SES.

The Mediating Roles of Hostility and Dissociation in the Relationship Between Sexual Assault and Suicidal Thinking in College Students

Sexual assault and suicide are two serious public health concerns. Research has documented the relationship between sexual assault and suicidal thinking and attempts; however, limited research explores the more multifaceted relationships between posttraumatic stress reactions and suicidal ideation in college students through unsuccessful modulation of emotion. The authors hypothesized a mediation model where the relationship between sexual assault and suicidal ideation is mediated by dissociation and hostility. In total, 1,677 undergraduate students were administered modified versions of the Traumatic Life Events Questionnaire (TLEQ), Symptom Checklist-90-Revised (SCL-90-R), and Peritraumatic Dissociative Experiences Questionnaire (PDEQ). The results revealed both significant partial but equal mediators of hostility and dissociation. However, a portion of the direct effect between sexual assault and suicidal ideation remained unaccounted for by indirect effects. The current model supports previous work on dialectical behavior therapy that says either side of the dialectic between extreme expression and suppression of hostility increases the likelihood of suicidal thinking after sexual assault. With sexual assault survivors, practitioners should use strategies that emphasize both anger expression and healthy avoidance as a way to modulate emotion to potentially reduce suicidal thoughts. Future research should focus on different gender models, additional possible mediators such as alcohol use and guilt, and different forms of sexual assault. Limitations of the correlational, cross-sectional methodology are discussed.

Threats to Belonging, Immune Function, and Eating Behavior: an Examination of Sex and Gender Differences

PURPOSE OF REVIEW

The first goal of this review is to discuss the evidence linking belonging threats to immune function and food intake. The second goal is to evaluate whether the links among belonging threats, immune function, and eating behavior differ based on gender.

RECENT FINDINGS

Threats to belonging are linked to elevated herpesvirus antibody titers, dysregulated appetite-relevant hormones, and increased food consumption. Furthermore, these relationships are largely consistent for both men and women. Threats to belonging are also linked to elevated inflammation. However, some studies showed that these effects were stronger among women, others demonstrated that they were stronger among men, and others determined that the links were consistent for men and women. Understanding why belonging threats are inconsistently linked to inflammation across men and women is an important next step. We conclude the review with four concrete recommendations for researchers studying belonging threats, immune function, and eating behavior.

Does the Prospect of Fulfilling Belonging Affect Social Responses to Rejection? A Conceptual Replication Attempt

Historically, one of the biggest paradoxes in the rejection literature was that rejected people sometimes behaved antisocially and at other times prosocially. Researchers responded to this paradox by demonstrating that the prospect of fulfilling belonging predicted these varied responses. A close inspection of the foundational studies, however, revealed small sample sizes relative to today’s standards. Hence, we conducted a conceptual replication of the prospect of fulfilling belonging hypothesis using a high-powered 2-day preregistered study. On Day 1, we manipulated the prospect of fulfilling belonging through a profile exchange with a confederate. On Day 2, we manipulated rejection using a recall paradigm and then measured prosocial and antisocial responses toward the confederate. Rejected participants who expected the confederate to fulfill belonging showed similar levels of prosocial and antisocial responses compared with those who did not. These results suggest that the prospect of fulfilling belonging hypothesis needs further refinement.

Eating moderates the link between body mass index and perceived social connection

Some studies have demonstrated that heavier people perceive themselves as lacking social connections, whereas others have not. The current study investigated whether eating alters the link between body mass index (BMI) and perceived social connection, providing one explanation for inconsistencies across previous studies. Participants were instructed to refrain from eating or drinking anything except water after 9 p.m. the prior night. Upon arrival at the lab, participants were assigned to the food (n = 63) or no food (n = 110) condition. They also provided a saliva sample that was assayed for ghrelin (an appetite-relevant hormone), and completed a series of questionnaires about their relationships. Participants with a higher BMI felt more socially disconnected than people with a lower BMI, but only among those who had not recently eaten. BMI and perceived social disconnection were unrelated among people who had recently eaten. These results were consistent across multiple measures of perceived social disconnection, and also across the experimental manipulation and continuously measured ghrelin.

[A case of hypertrophic cranial pachymeningitis developed skull lesion]

We report a case of hypertrophic cranial pachymeningitis (HCP) developed skull lesion. A 70-year-old male presented with the symptom of left hemiconvulsion. MRI revealed that the enhanced intraosseous mass infiltrated into the the dura and brain parenchyma under the parasagittal region of the right parietal bone. Histological examination revealed chronic inflammation with lymphoplasmacytic infiltrate and fibrosis of both intraosseous mass and dural invasive lesion. Steroid therapy resulted in improvement of clinical symptoms and enhanced lesion of MRI. Three years later, the patient presented with generalized convulsion and weakness of right upper and lower limbs. MRI revealed dural thickening with gadolinium enhancement in the bilateral parasagittal region and falx. Angiography showed occlusion of the superior sagittal sinus. The cause of relapsing symptoms in this patient may have been related to the occlusion of the superior sagittal sinus, due to HCP. We considered that the incipient intraosseous mass resulted from a response of the marrow by destructive progression of chronic inflammation passed through the fracture crack or the cavity of arachnoid granulation.

[Treatment of spontaneous intracranial hypotension with continuous epidural saline infusion: a case report]

We describe that a 27-year-old woman with a severe postural headache for a month due to spontaneous intracranial hypotension was successfully treated with a continuous epidural saline infusion (CESI). She presented with sudden postural headache and back pain. On admission, CT scans of the head and thoracic spine were normal. Spontaneous intracranial hypotension (SIH) was suspected from her symptoms that her headache was worsen by the erect position and relieved by the supine position. She was treated with intravenous infusion (1000 ml/day), but her headache did not resolve. Three weeks later, MR images showed descent of the brain stem and cerebellar tonsil, effacement of the sulci and cisterns, subdural fluid collections and diffuse meningeal enhancement. A lumbar puncture was performed and yielded an opening CSF pressure of 75 mmH2O in the horizontal position. Radionucleotide cisternography showed early accumulation of nucleotide in the bladder, slow ascent along the spinal axis, less than expected activity over the cerebral convexities and early disappearance of radioactivity. As for the treatment, an epidural catheter was placed at the L 1-2 level and CESI of 15 ml/hour was started. Immediately the postural headache resolved and the next day she could walk. CESI was continued for 5 days. MR images after CESI showed normalization of the sulci and cisterns including spinal subarachnoid space, reelevation of the brain stem and cerebellar tonsil and improvement of meningeal enhancement. She remained headache free during 7 months of follow-up period. We propose this method as a safe and effective treatment for SIH.

[Subependymal giant cell astrocytoma associated with tuberous sclerosis exhibiting rapid regrowth after 17 years: a case report]

A 17-year-follow-up case of subependymal giant cell astrocytoma (SGCA) is reported. In 1979, when aged 28 years, the patient first presented obstructive hydrocephalus caused by a tumor in the right lateral ventricle close to the foramen of Monro. It was partially removed by a transcallosal approach. Pathological examinations showed gemistocytic astrocytoma or SGCA associated with tuberous sclerosis. A ventriculo-peritoneal shunt was carried out and 36Gy of radiation therapy was administered. Eight months later, the patient suffered from an intraventricular hemorrhage originating from SGCA, but he responded to conservative therapy. He was followed-up by CT scans over 17 years. In 1996, because of rapid regrowth of the tumor, total removal was performed by a transcortical approach via the right frontal horn. The pathological diagnosis was SGCA. The greater part of the recurrent tumor was composed of blood vessels. The tumor cells were grouped into two morphological types, large cells and spindle cells. We compared the tumor in 1996 with that in 1979, each revealing immunohistochemical stainability for glial fibrillary acidic protein (GFAP), neuron specific enolase (NSE) and S-100 protein (S-100). The large cells in 1979 were negative for GFAP, NSE and S-100, but were positive for NSE and S-100 in 1996. The spindle cells in 1979 were positive for GFAP, NSE and S-100, but were negative for GFAP in 1996. The pathological origin of SGCA remains a subject of controversy. These results suggest that the origin of SGCA could be variably differentiated cells like the germinal matrix cells.

[Isolated angiitis of the CNS associated with Hashimoto's disease]

In 1987, a 69-year-old female suffering from epilepsy and right hemiparesis was admitted to the hospital and given conservative therapy. During the next three weeks she became a stuporous state. Steroids were then prescribed, and she made a complete recovery. Following hormonal and immunological investigations, a diagnosis of Hashimoto's disease with hypothyroidism was made. Following her discharge, thyroxin and anticonvulsant treatments continued. On May 30, 1989, at the age of seventy-one, the patient was found lying unconscious at home, and taken to our hospital. She had signs of a confused state, and seizures of her right arm on admission. Cranial computed tomography (CT) revealed a low density area in the left parieto-occipital lobe, which was heterogeneously enhanced by contrast medium. Magnetic resonance imaging (MRI) showed a lesion of low signal intensity in T1-weighted images and high signal intensity in T2-weighted images, which was homogeneously enhanced by Gd DTPA. Cerebral angiography disclosed no abnormality. Two weeks later, follow-up CT showed that the lesion had become larger and markedly enhanced. A brain tumor, probably malignant lymphoma, was suspected. On June 14, stereotaxic biopsy of the enhanced lesion was performed. Histopathological examination disclosed dense infiltration of the entire walls of many small parenchymal vessels, both arterioles and venules, by lymphocytes. Treatment for angiitis (betamethasone 16 mg daily) was started on June 20, then gradually tapered, and the lesion diminished on CT. Our case has some features of both isolated angiitis of the central nervous system and encephalopathy in compensated Hashimoto's disease. It is suggested that some common base of the autoimmune diseases exists in this case.

[Diffuse cerebrospinal gliomatosis. Case report]

A 65-year-old male was admitted with memory and gait disturbance. A computed tomography (CT) scan showed bilateral, diffuse, low-density areas with two round, slightly enhanced masses. T1-weighted magnetic resonance image revealed a low-intensity area in the left paraventricular region, which converted to increased signal intensity, extending to the right paraventricular region through the splenium, on T2-weighted images. The tumor was diagnosed as glioblastoma multiforme after needle biopsy and treated by irradiation and chemotherapy. Seven months after admission, a CT scan revealed subependymal infiltration of the tumor with spotty calcification. He died of respiratory complications 11 months after the onset of symptoms. The autopsy showed brain swelling with flattened gyri. Horizontal sections of the brain showed diffuse enlargement of the white matter and basal ganglia with scattered hemorrhage and necrosis. Microscopically, the lesion was far more extensive and diffuse than was suspected from gross examination. Wide glial tumor cell infiltration was observed in the cerebral hemispheres, basal ganglia, brainstem, cerebellum, and even the cervical spinal cord with minimum destruction of the pre-existing architecture. Calcification was found around the thrombosed vessels and necrotic lesions. The clinical diagnosis and histological features of gliomatosis cerebri are discussed with reference to reported cases.

Identification of CSF fistulas by radionuclide counting

A radionuclide counting method, performed with the patient prone and the neck flexed, was used successfully to diagnose CSF rhinorrhea in two patients. A normal radionuclide ratio (radionuclide counts in pledget/radionuclide counts in 1-ml blood sample) was obtained in 11 normal control subjects. Significance was determined to be a ratio greater than 0.37. Use of radionuclide counting method of determining CSF rhinorrhea is recommended when other methods have failed to locate a site of leakage or when posttraumatic meningitis suggests subclinical CSF rhinorrhea.

[Primitive neuroectodermal tumor with peritoneal metastasis through a ventriculoperitoneal shunt. Case report]

A 13-month-old boy admitted with lethargy and hydrocephalus was found to have a right thalamic mass. Ventricular drainage was instituted, and the tumor mass was reduced by partial resection and local irradiation. A ventriculoperitoneal shunt was then placed. However, the tumor recurred 16 months later, with extensive ventricular seeding and peritoneal metastasis through the shunt tube. The child died 22 months after onset. Histological study of surgical specimens of the primary tumor and autopsy specimens of the brain and peritoneal metastatic tumors revealed poorly differentiated, small, round cells with numerous mitotic figures. In addition, autopsy specimens of the brain tumor contained areas of ependymal, oligodendroblastic, and spongioblastic differentiation. On immunohistochemical study, the tumor cells of each specimen were positive for anti-neuron specific enolase and anti-neurofilament antibodies, but negative for anti-glial fibrillary acidic protein antibodies. Electron microscopy revealed some zonulae adherens. These findings strongly suggest that the tumor originated from primitive multipotential cells capable of differentiating into ependymal, glial, and neuronal lines.

[Enlarging skull fracture treated by early surgery. Case report]

The authors report a case in which an enlarging skull fracture was surgically repaired on the fourth day after the initial injury. A 5-month-old boy fell from his father's arms and was hospitalized with a large, irregular protrusion in the left parieto-occipital region and right hemiparesis. Plain skull films showed a diastatic linear fracture with a maximum width of 8 mm, which expanded to 11 mm by the fourth day. Computed tomography (CT) scans revealed a cerebral contusion just beneath the fracture as well as a left subdural effusion. At operation, the contused brain tissue was found to have herniated over the bone defect. Craniotomy revealed a large dural defect, which was repaired with lyophilized dura. The patient was discharged with no neurological deficit. On the basis of a review of 58 recently reported cases of skull fracture, the authors conclude that the following conditions warrant consideration of early surgery: 1) a diastatic skull fracture with a width of at least 4 mm; 2) CT demonstration of a cerebral contusion beneath the fracture; 3) overlying scalp swelling; and 4) a neurological abnormality contralateral to the fracture. Performing surgery before the fracture gap becomes scalloped will result in more rapid neurological recovery and reduce the likelihood of enlargement of the fracture.

[Interaction between neurogenic and metabolic factors upon deterioration in cerebrovascular tonus--experimental study on the etiology of cerebral vasoparesis]

It is widely accepted that a tremendous increase in cerebral blood volume (CBV) due to progressive cerebral vasoparesis is an essential to the development of acute brain swelling. This study was designed to determine whether neurogenic and/or metabolic factors are predominant and how these interact with each other in producing cerebral vasoparesis. Fifty-one awake cats immobilized with pancuronium bromide were divided into 4 groups: group I, control; group II, normocapnic hypoxia (PaO2 = 50 mmHg); group III, normoxic hypercapnia (Pa-CO2 = 70 mmHg), and group IV, increased intracranial pressure (ICP = 40 mmHg) by brain compression. Systemic arterial pressure (BP), CBV (photoelectric method), and ICP (epidural pressure) were continuously recorded. The dorsomedial hypothalamic nucleus (DM) and the reticular formation of the midbrain (MB-RF) were bilaterally coagulated by a stereotaxic technique (3mA, 1 min). Therefore alterations in cerebrovascular tonus created by destruction of the cerebral vasomotor centers were examined in the animals with metabolically induced cerebral vasodilatation to various degree's. In group I, vasomotor center destruction resulted in an immediate and transient decrease in BP (DM; -14.1 +/- 6.7 mmHg, MB-RF; -10.2 +/- 4.8 mmHg) and simultaneous increase in CBV and ICP (DM; 7.6 +/- 7.0 mmHg, MB-RF; 6.0 +/- 5.6 mmHg) for 3 to 4 minutes. Increase in ICP by destruction of vasomotor centers reduced significantly in group II (DM; 2.3 +/- 2.6 mmHg, MB-RF; 1.6 +/- 1.2 mmHg) and reduced slightly in group IV (DM; 7.5 +/- 4.0 mmHg, MB-RF; 4.8 +/- 3.2 mmHg). In these 3 groups, autoregulation of cerebral blood flow and CO2 vasoreactivity were not changed by destruction of vasomotor centers.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of pituitary hyperplasia associated with primary hypothyroidism]

A thirteen-year-old girl was admitted complaining of short stature and anemia. The low titers of her serum T3 and T4 and the abnormally high TSH level represented primary hypothyroidism. Although she had normal sellar size, CT demonstrated an intra- and suprasellar round mass with homogeneous enhancement. With thyroid replacement therapy the enhanced mass diminished on CT within 5 months, and her symptoms regressed. Twelve cases with radiological diminution of pituitary mass or visual field improvement after thyroid replacement therapy are reviewed. They were considered to be pituitary hyperplasia, rather than pituitary adenoma, caused by long-standing untreated hypothyroidism. In four of them, the pituitary mass on CT was diminished after the therapy. Characteristic CT findings of pituitary hyperplasia, including our case, was a round isodensity mass with homogeneous enhancement in the midline of the pituitary region. In the experimental studies, pituitary hyperplasia is based on the feedback mechanism of hypothalamic-pituitary-thyroid axis, and ultimately autonomous pituitary adenoma may occur. Pituitary mass with hypothyroidism, visual field defect, amenorrhea or galactorrhea tend to be mistaken for prolactinoma or non-functioning adenoma with pituitary hypothyroidism. Thorough endocrinological examination must be carried out. The first choice of treatment for this type of pituitary mass should be thyroid replacement therapy. If there is no improvement of visual field, no regression of pituitary mass on CT, or continuing high TSH levels, then pituitary surgery must be considered.

Craniopharyngioma in the third ventricle: necropsy findings and histogenesis

A case of craniopharyngioma confined within the third ventricle with necropsy is reported. A stalk-like structure in this tumour was present in the wall of the third ventricle at its base. It is suggested that this tumour might have arisen from the remnants of Rathke's pouch persisting in the tuber cinereum.

Histopathologic investigation of a case of meningioangiomatosis not associated with von Recklinghausen's disease

A case of meningioangiomatosis not associated with von Recklinghausen's disease is reported. Microscopically, irregularly branched blood vessels extending into the gray matter from the meningeal surface are surrounded by a concentric arrangement of proliferating spindle-formed cells. Ultrastructurally these proliferating cells are composed of elongated heterochromatin-rich nuclei and slender cytoplasm-containing microfilaments, occasionally associated with desmosomal junctions and basal laminalike structures. Judging from these findings, together with a negative immune reaction for S-100 protein, the histogenesis of these proliferating cells is most probably meningothelial in origin.

Agenesis of the left internal carotid artery, common carotid artery, and main trunk of the external carotid artery associated with multiple cerebral aneurysms

A case of agenesis of the left internal carotid artery, common carotid artery, and the main trunk of the external carotid artery with multiple cerebral aneurysms is presented. This case was diagnosed by angiography and computed tomography scanning and confirmed by operation. Correlation between the anomaly of the circle of Willis based on the absence of the internal carotid artery and the development of cerebral aneurysm is discussed on the basis of the reported cases.

[Application of the RI-counting method in CSF rhinorrhea]

Some diagnostic procedures for CSF rhinorrhea have been reported, but they can not always identify and localize CSF leakage. This method, using intranasal cotton pledgets after the intrathecal injection of radioisotope (111In-DTPA) is thought to be reliable, informative and innocuous for localizing the sites of CSF leakage. This technique was named RI-counting method, and applied in two cases that were difficult to diagnose especially with positional-loading. The patients were first in the supine position, then in the sitting position, after the intrathecal injection of radioisotope and the intranasal insertion of cotton pledgets. After exchanging these pledgets, the patients were set in the prone position. After measuring the radioactivity of these pledgets and of 1 ml of blood, the ratios of the radioactivity of the pledgets to that of the blood were calculated. In case 1 the ratios of the left sphenoethmoid recess and the left middle meatus were significantly higher when the patient took the prone position, but in the supine or sitting position the ratios were in the normal range. In case 2 the ratio of right olfactory cleft was significantly higher in the sitting position or neck flexion. Both cases were operated and demonstrated that the location of the CSF leakage was presumable by using RI-counting method, regarding the anatomical relationship between the intranasal sites of pledgets and the opening of the paranasal sinuses. Positional-loading seemed to be essential. We obtained 72 pledgets of patients without CSF rhinorrhea, and the ratios of radioactivity of these pledgets had a mean value (M) of 0.156 and a standard deviation (SD) of 0.107.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of convexity cavernous hemangioma associated with meningioma]

A case of convexity cavernous hemangioma associated with sellar meningioma with parasellar extension is presented. A 61-year-old female who had complained of left blepharoptosis and diplopia was admitted to our hospital. On admission she showed left oculomotor nerve palsy. Plain CT revealed an isodense mass in the sellar and parasellar region. Computed angiotomography demonstrated that this mass was enhanced heterogeneously and filled the sellar turcica and extended superiorly. And homogeneously enhanced mass in the convexity without mass effect was observed. Angiogram revealed no tumor stain in any phase. With these findings, this case was diagnosed as the multiple meningiomas preoperatively. Left frontotemporal craniotomy was carried out, and subtotal removal of sellar and parasellar tumor and total removal of convexity tumor were performed. Pathologically the sellar and parasellar tumor was diagnosed as meningioma, convexity tumor as cavernous hemangioma derived from dura mater. Convexity cavernous hemangioma derived from dura mater is very rare, only one case was reported previously. Only 2 cases of cavernous hemangioma associated with meningioma have been reported in the literature. Correlation between cavernous hemangioma and meningioma is discussed. It is possible to owe this complication to the developmental abnormality concerning with inner factor like genetic factor and so on, because both tumors are mesodermal origin. However it is proper to regard that this complication occurred by chance.

[Agenesis of the left internal carotid artery, common carotid artery and main trunk of the external carotid artery associated with multiple cerebral aneurysms: case report]

A case of agenesis of the left internal carotid artery, common carotid artery and main trunk of external carotid artery with multiple cerebral aneurysms is presented. No similar case has been reported before. A 70-year-old man who had severe headache was admitted to the neurological department of Matsuyama Shimin Hospital. On admission he demonstrated nuchal rigidity and motor aphasia. CT scan revealed subarachnoid hemorrhage with intracerebral hematoma in the left temporal area. Right common carotid angiography, bilateral retrograde brachial angiography and aortography demonstrated an agenesis of the left internal carotid artery, common carotid artery and main trunk of external carotid artery with aneurysms of the anterior communicating artery, left middle cerebral artery and basilar tip. And these revealed that the left middle cerebral artery was fed from the basilar artery via the dilated left posterior communicating artery, and the left ophthalmic artery was originated from the left middle cerebral artery. CT of the base of the skull revealed no carotid canal on the left side. We confirmed these findings by operation. The importance of altered hemodynamic forces on the circle of Willis produced by the agenesis of the internal carotid artery and the embryological considerations are discussed.

Screening and treatment of unruptured cerebral aneurysms

Thirty outpatients with unruptured cerebral aneurysms screened by computed angiotomography have been analysed and followed up in our clinic since 1979. Seventeen were men and the age range was 41 to 74 years old (mean 57.7 years). Patients had no or only mild neurological symptoms, such as headache, sensorimotor or speech impairment and others, which were scarcely related to the unruptured aneurysms themselves. It is important to realize that these first aneurysms which remain unruptured, have a primary significance to the individual in the protective aspect of an initial subarachnoid haemorrhage. Operation was successfully performed in fifteen patients. Transient aggravation of previous diseases, e.g. cerebral infarction, occurred in three after operation. Follow-up studies of fifteen patients without operation revealed no change in eight and some worsening or death due to other or previous diseases in six. One died of aneurysmal rupture in the 5th month after its detection. Because of the low operative risk, we advocate the operative treatment of unruptured aneurysms, following careful selection of the indicated patients.

[Bilateral agenesis of internal carotid arteries]

The authors present angiographic and computed tomographic demonstration of bilateral agenesis of internal carotid arteries. The patient was a seventy-six years old man who had been admitted to our hospital because of right hemisparesis and disorientation. In addition to the left chronic subdural hematoma, computed angiotomography showed the dilated basilar artery and dilated posterior communicating arteries. However, the bilateral internal carotid arteries were not recognized. Burr hole and irrigation were performed, then neurological deficits and symptoms were disappeared. Hematoma was 150 ml. Though axial transverse computed tomograms of base of skull demonstrated the absence of bilateral carotid canals. On aortography, the right common carotid artery and vertebral artery were supplied from the innominate artery and the left common carotid artery and vertebral artery were supplied from the left dilated subclavian artery. Bilateral retrograde brachial angiograms demonstrated the internal carotid circulation, which was supplied through bilateral dilated posterior communicating arteries. Basilar artery was also in a large caliber. Bilateral ophthalmic arteries were opacified from external carotid artery via the middle meningeal artery. Ten cases of bilateral agenesis of internal carotid arteries have been reported previously. The findings of angiograms and computed tomograms on the agenesis of bilateral internal carotid arteries were discussed. This anomaly is important on cerebral hemodynamics and embryology.

[Rapid growth and rupture of a newly originated aneurysm near the clipped middle cerebral artery aneurysm]

A 38-year-old man was admitted to our hospital because of severe headache following reduced level of consciousness on February 13, 1979. He was lethargic and showed neck stiffness. A lumbar puncture revealed bloody cerebrospinal fluid. Left carotid angiography showed a berry aneurysm of 11 mm in diameter at the bifurcation of the middle cerebral artery (MCA). Rebleeding occurred on February 21, and he fell into semicoma. But, his consciousness recovered to lethargy on the next day. On February 26, a direct intracranial operation was performed and a Sugita clip was placed to the aneurysmal neck. The postoperative course was uneventful. But, left carotid angiography on 8th day after operation showed a newly originated aneurysm proximal to the operated aneurysm. On the 12th postoperative day, he suddenly fell into coma. CT showed subarachnoid blood in the basal cisterns and intraparenchymal hematoma in the left temporal lobe. On the same day, left carotid angiography was performed and it showed the enlarged aneurysm. He died on the 19th day after operation. Autopsy was not performed. Three factors have been considered dealing with the recurrence of the operated aneurysm in the previous reports: first, local fragility of the vascular wall due to the clip edge. Secondly, macro- or microscopic residual aneurysmal neck, thirdly, broken or slipped clip. Our case had the following characteristics from the angiographical and operative findings: the orifice of the operated aneurysm was situated on the superior side of the parent artery and the aneurysm protruded posterosuperiorly at an angle of approximately 90 degrees to the long axis of M1.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cystic cerebral tuberculoma--a case report]

A case of cystic cerebral tuberculoma is presented. A 63-year-old man was admitted initially to a sanatorium in May, 1983, for the treatment of pulmonary tuberculosis. He developed headache and vomiting, and suddenly had a right hemiconvulsion on September 27, 1983. Gradually he developed right hemiparesis and motor aphasia. CT scan revealed a well defined, ring-like enhanced mass with multiloculated cysts in the left fronto-parietal lobe. So, he was transferred to our hospital on February 3, 1984. Neurological examination revealed that he had motor aphasia and right hemiparesis. Left carotid angiogram showed light tumor stain in the left fronto-parietal lobe, and 99mTc brain scan detected increased uptake in this area. A left fronto-parieto-temporal craniotomy was performed and a subcortical mass was excised en bloc. The mass had multiloculated cysts containing xanthochromic fluid. Histologically, the mass was cystic cerebral tuberculoma. Cystic cerebral tuberculomas have rarely been reported even before the introduction of antituberculous chemotherapy. The pathogenesis of the cysts in this particular case was considered that the caseous material would have undergone liquefaction by enzymes liberated from degenerated and fragmented inflammatory cells.

Computed angiotomography of unruptured cerebral aneurysms

Twenty-seven unruptured cerebral aneurysms in 25 patients were detected by computed angiotomography. A comparison of the computed angiotomographic features in common aneurysm sites with plain CT and conventional arteriography was carried out. An isodense, round cisternal defect and a calcification or high-density mass in the basal cisterns on plain CT are important findings suggestive of unruptured aneurysms larger than 7 mm in diameter. The identification of the aneurysm, as well as of the afferent and efferent arteries on computed angiotomography is essential for the direct diagnosis of smaller unruptured aneurysms related to the circle of Willis. This is possible in a number of cases when the aneurysms are relatively large. It appears that the aneurysm size must be larger than 3 mm in diameter to permit its recognition on the basis of angiotomography and the avoidance of false-positive findings.

Coronal computerized angiotomography for the diagnosis of isodense chronic subdural hematoma

The authors demonstrate the value of coronal computerized angiotomography for the diagnosis of and screening for isodense chronic subdural hematoma. Specific features of coronal computerized angiotomograms include 1) thick lines of high density with slight convexity; 2) lines of high density parallel with the inner table of the skull; or 3) high-density dotted lines away from the inner table. These high-density lines or dots represent the superficial cerebral veins and cortical branches of the middle cerebral artery, which have been displaced by the hematoma. When these characteristic features are revealed on noninvasive coronal computerized angiotomography, cerebral angiography may be unnecessary.

[The role of brain-stem vasomotor centers on the neurogenic control of the neurogenic control of cerebrovascular tonus. Part 1: In special reference to cerebral blood volume and intracranial pressure]

An increase in cerebral blood volume (CBV) due to a decrease in cerebrovascular tonus has been though to be a major factor in the cause of acute brain swelling. It has been reported that the dorsomedial nucleus of the hypothalamus (DM), one of the brain-stem vasomotor centers, regulates cerebrovascular tonus. The DM and other vasomotor centers, such as the midbrain reticular formation (MBRF) and the reticular formation of the medulla oblongata (MORF), are connected through a series of nerve fibers. This experiment was designed to clarify the neurogenic control of the DM, MBRF, and MORF on cerebrovascular tonus. Using fifty-six cats, unilateral and bilateral DM(A 1.2, L2.0, H-10.0), MBRF (A4.0, L4.0, H0), and MORF (P10.0, L2.5, H-9.0) were coagulated stereotaxically with the condition of 15-10 mA for 1 minute. The lesions in the DM and MBRF were enlarged by increasing the current intensity of electrical coagulation. The effects of the increase on a number of simultaneously coagulated lesions were examined. Changes in systemic blood pressure (BP), intracranial pressure (ICP), and CBV were continuously recorded. Temporary increases in ICP (mean increase 16 mmHg, n = 14) and CBV were observed after unilateral coagulation of the DM. These increases were associated with transient systemic hypotension. The changes lasted only for approximately 5 minutes. The changes that occurred in ICP and CBV as a result of unilateral coagulation in the MBRF were almost the same as those that occurred after coagulation of the DM. In the latter case, the duration of the change was approximately 6 minutes with a mean increase of 12 mmHg (n=12).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute intracranial hypertension and brain-stem blood flow. An experimental study

This study has been carried out to evaluate the effect of supratentorial mass lesions on the local cerebral blood flow (CBF) of the brain stem. Local CBF of the thalamus, inferior colliculus, and medulla oblongata, and supra- and infratentorial pressure were serially measured in 52 cats with intracranial hypertension produced by supratentorial balloon expansion. The mean control local CBF's in the thalamus, inferior colliculus, and medulla oblongata were 37.5, 42.1, and 30.7 ml/100 gm/min, respectively. At 20 to 30 mm Hg of supratentorial pressure, the local CBF of the thalamus started to decrease, and at 20 mm Hg of infratentorial pressure, the local CBF of the inferior colliculus began to decrease. Finally, at 40 to 60 mm Hg of infratentorial pressure, the local CBF of the medulla oblongata was affected. At the beginning of uncal herniation, indicated by anisocoria, the mean local CBF of the inferior colliculus abruptly decreased from 33.7 to 19.6 ml/100 gm/min in 16 cats. The Cushing response was evoked at a mean supratentorial pressure of 93.4 mm Hg and infratentorial pressure of 49.9 mm Hg in 16 cats. When the systemic arterial pressure was increased to the highest level in 13 cats, the mean local CBF of the medulla oblongata did not show significant change (a decrease from 22.8 to 20.9 ml/100 gm/min). The results suggest that at the beginning of uncal herniation, the local CBF of the upper brain stem markedly decreased. During the Cushing response, the local CBF of the medulla oblongata did not change significantly.

Serial observations of brain stem function by auditory brain stem responses in central transtentorial herniation

Changes in auditory brain stem responses were serially investigated in a patient with downward transtentorial herniation due to acute obstructive hydrocephalus to correlate the neurological signs with the results of computerized tomography. Neurological deterioration correlated highly with disruption of auditory brain stem responses, especially with that of the components of waves V to VII. A noninvasive technique, the measurement of auditory brain stem responses is thought to be useful in detecting the severity of downward transtentorial herniation and in estimating the recovery of brain stem function after surgical treatment of intracranial hypertension.