[Amyotrophic lateral sclerosis]

The literature on amyotrophic lateral sclerosis from the years 1995/96 is reviewed including the topics of the World Congress of Neurology in Buenos Aires in September 1997. The problems of a) changed criteria of diagnosis and course of SLA after the time of the first definitions by classical neurological authors, b) the concepts concerning the aetiology and mechanisms of the disease, c) the present studies on drugs and their tentative clinical applications are discussed.

Embryonal carcinoma of the pineal gland with yolk sac tumor differentiation. A case report

Twenty three old male patient was diagnosed as a pineal gland tumor and was operated in neurosurgical ward. He died four weeks later due to pneumonia and respiratory failure. Clinical diagnosis was based on computer tomography (CT) and magnetic resonance image (MRI) examination. Histological study of a biopsy and autopsy specimens showed embryonal carcinoma with yolk sac tumor differentiation. The diagnosis was supported by positive cytokeratin, placental alkaline phosphate and alpha-fetoprotein immunostainings.

[A case of fatal hemolytic-uremic syndrome with central nervous system manifestations]

Twelve years old girl who died from haemolytic uraemic syndrome (hus) on post mortem neuropathological examination showed cerebral purpura and demyelination focus with glial-mesenchymal reaction. The problem with factor is responsible for cerebral lesions, direct allergic reaction causing hus or uraemia in consequence of acute renal failure but also activating allergic processes, is discussed.

[A case of coexistence of meningioma with intracranial aneurysm in a patient with ruptured aortal aneurysm]

Fifty-three-year-old woman was admitted to hospital with tetraplegia symptoms and died two hours later. Clinical diagnosis was: cerebral stroke, hypertension in anamnesis. Postmortem examination showed ruptured dissecting aneurysm of thoracic and abdominal segment of aorta, meningioma of right pontocerebellar angle and saccular aneurysm of left inferior, posterior cerebellar artery. The diagnostic difficulties and hypotheses of formation of multifocal of different changes are discussed.

[Arteriovenous malformation as the most frequent form of cerebral vascular dysplasias]

The purpose of the study was a survey of autopsy and biopsy material from 27 cases of cerebral vascular malformations for establishing the occurrence of various forms of these lesions in relation to that reported from other centres. It was tried also to check in the light of the morphological analysis of our cases the theory of vascular malformation development put forward by Kaplan et al (1961). The material comprised 4 cases of telangiectasia, 11 arteriovenous malformations, 7 cavernous haemangiomas and 5 mixed cavernomas with arteriovenous malformation. Arteriovenous malformations prevailed. The clinical manifestations set in at the age between 15 and 46 years. The analysis rather confirm the concept of Kaplan et al. that dysplasia is derived from disturbances in the development of capillaries in early embryogenesis. All other comparisons and observations were consistent with those reported in literature outside Poland.

[Intravenous treatment with streptokinase of acute myocardial infarction. II. Effect of patency of the artery supplying the infarction area on the infarction size and post-infarction impairement of left-ventricular function]

153 patients with a first acute myocardial infarction underwent the study. 90 of them received 1.000.000 units of streptokinase intravenously, followed by intravenous heparin administration for 5-7 days. The control group consisted of 63 remaining. In all patients serum CK-MB activity was determined every 4 hours for 72 hours: the infarct mass was calculated from the obtained curves. In 118 patients selective coronarography and left ventriculography was performed in the 2-nd or 3-rd week of hospitalisation. Left ventricular ejection fraction (E.F.) and dyssynergy index were calculated from ventriculographic data. Coronarography revealed a patent infarct-related artery in 76.7% of patients treated with streptokinase and in 44.4% of the control group (p less than 0.001). Among patients with a patent infarct-related artery an early peak of serum CK-MB activity (suggesting early recanalisation) occurred in 72.2% of streptokinase patients but in only 42.1% of the control group. Patients with a patent infarct-related artery had a significantly lower infarct mass (45 +/- 28 g vs 56 +/- 30 g), a lower left ventricular dyssynergy index (229 +/- 243 vs 348 +/- 247) and a significantly higher E.F. (63 +/- 12% vs 54 +/- 15%) compared with patients with an occluded artery.

[Neuropathologic analysis of 8 undiagnosed cases of cerebral cysticercosis]

The presented material comprised 17 cases observed in four Warsaw hospitals in a period of 20 years. Nine patients with the pseudotumour syndrome were diagnosed correctly and referred to neurosurgical services. The remaining eight cases died in neurological hospital departments with the following clinical diagnoses: cerebral stroke 3, subarachnoid haemorrhage 1, comatose state preceded by dementia 1, chronic meningoencephalitis 1, status epilepticus 2 cases postmortem investigations demonstrated cerebral cysticercosis in all cases. In four patients with predominant symptoms of cerebrovascular disease lesions were found of the type of residual vasculitis cysticercosa, the sequelae of which might have caused secondary complications independent of concomitant arteriosclerosis. Dementia appeared in a patient with huge hydrocephalus consequent to numerous cysticerci. The patient with the diagnosis of meningoencephalitis had an inflammatory reaction of the ependyma and meninges caused by a cysticercus floating in the IV ventricle. Of the patients dying in status epilepticus attention is called to a 6-year-old girl with a solitary cysticercus localised subcortically in the motor area. The authors suggest that the possibility of cysticercosis should be kept in mind, despite its rarity, in cases with a not completely clear clinical manifestations of cerebrovascular disease, chronic meningoencephalitis and epilepsy or dementia.

Ultracytochemical evidence for endothelial channel-lysosome connections in mouse brain following blood-brain barrier changes

An investigation designed to define relationships between endothelial channels and lysosomes was conducted in the mammalian brain microvasculature. Microvessels from normal and mechanically injured mouse brains were studied ultracytochemically for: (1) transport of horseradish peroxidase (HRP) protein tracer through endothelial channels, and (2) for acid phosphatase (AcP) activity as an enzymatic marker of lysosomes. Following traumatic brain injury for 1 week with 2 h circulation of intravenously injected HRP, selected brain slices were processed for ultrastructural localization of either HRP, AcP, or for both reactions together within the same tissue slices. One week after blood-brain barrier (BBB) damage, the presence of HRP reaction product (RP) was observed within endothelial channels and vesicles of capillaries and arterioles with concomitant increase in lysosomal enzymatic activity of the endothelial cells bordering regions of brain damage. Lysosomes were observed to be directly connected to the endothelial channels. Our observations present cytochemical evidence for endothelial channel-lysosome connections which may suggest intralysosomal modification of blood-born materials before entering the neuropil. Such modification could have important immunological and/or metabolic significance.

Ultrastructural cytochemical studies of cerebral microvasculature in scrapie infected mice

Alkaline phosphatase, 5'-nucleotidase nucleoside diphosphatase and thiamine pyrophosphatase activities were studied by cytochemical method applied to electron microscopy of brain microvasculature in normal and scrapie infected mice. In control mice, the major location of all phosphatases studied was the luminal plasma membrane of the endothelial cells. In scrapie infected mice, changes in activity and distribution of the above mentioned phosphatases manifested themselves in the appearance of the reaction product on the abluminal side of the vessel wall. Our data presents evidence that following scrapie infection, these enzymes change their specific localization along the endothelial cell membranes. These enzymatic changes may serve as useful indicators of some alterations in the mammalian blood-brain barrier following infection by scrapie agent in the mouse.

New ultrastructural evidence for a protein transport system in endothelial cells of gerbil brains

Pathways for transfer of horseradish peroxidase (HRP) across the cerebral microvasculature were studied in Mongolian gerbils after inducing either unilateral carotid-artery ligation or intracarotid air embolism. Electron microscopy on samples from both ipsilateral and contralateral brain hemispheres showed the reaction product (HRP) in the endothelial cytoplasm of capillaries and arteriols in all animals; in the basal lamina, HRP was seen only after long (3--4 h) ischemic periods. HRP was seen within both spherical and tubular structures, with the latter appearing in obliquely or longitudinally sectioned blood vessels. These endothelial channel-like structures are part of a tubulovesicular network which seemingly exists in the normal endothelium of the gerbil brain. The tubules serve as pathways for proteins into the brain; protein transfer becomes enhanced following circulatory injuries such as ischemia.

[Case of Jakob-Creutzfeldt disease with rarely observed location of lesions (the so-called Heidenhain syndrome)]

The authors describe a case of Jakob-Creutzfeldt disease in a 64-year-old women. The peculiarity of the case lay in the fact that besides atrophic lesions of frontal lobes, extensive spongiform degeneration was present in both occipital lobes--corresponding to the so-called Heidenhain syndrome of classical neuropathology. The clinical counterpart of this location of the lesions, apart from dementia, were quadrantic hemianopsia and changes in EEG records.

[Case of multiple sclerosis with Devic's syndrome and secondary cerebellar signs]

The authors describe a 43-year-old woman treated for multiple sclerosis during 11 years in whom at the end of her life tetraplegia, bulbar syndrome and cerebellar syndrome developed. Postmortem examination of the brain disclosed changes compatible with the diagnosis of multiple sclerosis, diffuse sclerosis and neuromyelitis optica. The variability of the demyelinating process is discussed. In this case this variability was responsible for successive appearance of various nosological entities depending on the "balance of power" between the factors damaging myelin and the resistance of the organism.