Spontaneous recovery of function in central nervous system lesions]

A rewiev of the mechanisms responsible for the spontaneous recuperation of function in patients with lesions of the central nervous sistem is made. The spontaneous reorganization theories of the nervous structures and the vicarious function are also referred to. In the last two decades experimental contributions have been accentuated, specially the one conducted by the group of researchers directed by Windle and Guth, who had shown the possibility of regeneration in the central nervous system, as well Lawrende and Kuypers, Brodal, Goldberger and others, which defended the vircarious function as the probable mechanisms of recuperation.     

Diagnostic imaging on inflammatory lesions of central nervous system]

Inflammatory lesions of the central nervous system are divided into infectious and non-infectious diseases. Diagnostic imaging has important roles for understanding the status of diseases, determining the treatment strategy, and assessing the effect of the treatment. This article illustrates diagnostic imaging modalities useful for evaluating inflammatory lesions of the central nervous system and diagnostic strategy which are valuable for differentiating the inflammatory lesions.     

Brain temperature in patients with central nervous system lesions

The knowledge of human brain temperature is still very limited. In this report we investigated the relationship between brain and trunk temperature in neurosurgical patients during normothermia and fever. Another problem addressed was that of possible gradients of temperature within the brain. We carried out direct recordings of temperature in 63 operated, neurosurgical patients with a variety of intracranial pathologies. Flexible, teflon-coated thermocouples were placed intracranially during neurosurgical procedures. Oesophageal, rectal and tympanic temperatures were also monitored. An error of up to 1.3 degrees C is to be expected in single cases if brain temperature is deduced from the rectal or oesophageal temperature. Mean differences between brain temperature and core body temperature measured in the rectum or in the oesophagus, were between 0 to 0.3 degree C. Tympanic temperature (Tty) improved the approximation of brain temperature (Tbr) to within the mean difference between Tbr-Tty close to 0 degree C. Nevertheless Tty also differed from Tbr by as much as 1 degree C in single cases. Brain temperature was the highest body temperature measured, either in normothermia or in fever. Temperature gradients were proved to exist between the warmer brain interior and cooler surface, with maximal differences in temperature reaching 0.6 degree C. This temperature gradient tended to increase along with the rise in intracranial pressure and deterioration of the level of consciousness. Our results suggest that conclusions regarding brain temperature drawn on the basis of other core temperatures, may lead to significant errors, and intracranial temperature measurement is desirable in neurosurgical intensive care. Temperature gradients within the brain may exacerbate its biochemical injury during ischaemia and fever--a combination seen frequently in neurosurgical patients. This may be particularly so, since brain temperature in fever is the highest body temperature in a high proportion of these patients.     

Benign cystic lesions in the central nervous system

A wide variety of benign cystic lesions is known to occur in both adults and children. Recent advances in diagnostic radiology have facilitated meaningful surgical intervention in most instances. It is convenient to classify these cysts into two groups. The first group includes those that arise from defects wholly within the central nervous system. Among these are certain static lesions such as cystic cavities arising from infarcts and other destructive lesions. Some of these are observed to communicate with the subarachnoid space or ventricle. The progressive lesions in this group include arachnoid cysts, ependymal cysts, cystic hemangioblastoma, cystic cerebellar astrocytoma, and certain infectious processes. The second group is constituted by cysts resulting from the intrusion of non-nervous tissue into the neuroaxis, usually in the midline. These are expanding congenital lesions, although some become symptomatic only in the adult. Among these are teratomas, dermoid cysts, epidermoid cysts, craniopharyngiomas, Rathke's cleft cysts, and other epithelial cysts apparently derived from the upper respiratory or the intestinal tract. Colloid cysts of the III ventricle are usually considered to be neuroectodermal in origin, but certain features suggest an endodermal origin.Presented at the 14th Annual Meeting of the Japanese Society of Pediatric Neurosurgery, 27–28 March 1986, Kochi     

Cardiovascular regulation and lesions of the central nervous system

The central nervous system has an important role in the second-to-second regulation of cardiac activity and vasomotor tone. Central lesions that lead to a disturbance in autonomic activity tend to cause electrocardiographic and pathological evidence of myocardial damage, cardiac arrhythmias, and disturbances of arterial blood pressure regulation. To a great extent such cardiovascular disturbances result from alterations in sympathetic activity. Similar alterations in sympathetic activity can occur under conditions of emotional stress and precipitate cardiac arrhythmias that can themselves lead to the syndrome of sudden death. Experimental and clinical evidence suggests that central neural mechanisms may be involved in this important human syndrome, but no central lesion has yet been identified to account for it. Recent experimental evidence, derived from hypertension research, suggests that chemical disturbances in the central nervous system, without accompanying structural lesions, may be found to explain cardiovascular disturbances such as sudden death and hypertension.     

Resolution of chronic inflammatory demyelinating polyneuropathy-associated central nervous system lesions after treatment with intravenous immunoglobulin

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a condition affecting the peripheral nervous system; however, it has been associated with central nervous system (CNS) involvement. The natural history and response to treatment of these CNS lesions are unknown. We report the case of a patient with CIDP which met research criteria for definite CIDP and associated symptomatic CNS lesions. She had resolution of her CNS-based clinical and radiographic findings with intravenous immunoglobulin (IVIG) therapy. IVIG is a reasonable treatment option when symptomatic, CIDP-associated CNS lesions are present.     

Multifocal central nervous system lesions in three patients with trichinosis

Three patients with trichinosis developed central nervous system complications. Cerebral computed tomography showed multifocal hypodense lesions in two patients. The lesions were associated with contrast enhancement and cortical gyral enhancement in the first case, suggesting hypoxia and infarction. In the second patient, magnetic resonance imaging showed multiple high-signal-intensity lesions. Early cerebral computed tomography was normal in the third patient. All patients recovered after treatment with antiparasitic drugs and corticosteroids. We suggest that neurologic complications of trichinosis should be treated by corticosteroids and flubendazole.     

Superficial siderosis of the central nervous system]

We report five cases of superficial siderosis of the central nervous system. All patients developed progressive deafness and cerebellar ataxia associated with pyramidal tract signs or mental deterioration. The cerebrospinal fluid examinations usually revealed an elevated protein level, without other abnormalities. Magnetic resonance imaging typically showed a hypointense rim around the cerebral and cerebellar hemispheres, the brainstem and the spinal cord on T2-weighted images. A definite source of bleeding was only found in two patients. The literature on superficial siderosis is reviewed. The etiologies and the pathogenesis are discussed.     

Myoclonus after 5-hydroxytryptophan in rats with lesions of indoleamine neurons in the central nervous system.

A myoclonic syndrome consisting of tremor, myoclonus, and seizures was produced following the systemic administration of 5-hydroxytryptophan to adult rats previously given intracisternal injections of 5,7-dihydroxytryptamine and systemic desmethylimipramine, but not in their controls. This behavioral response was blocked by pretreatment with the putative serotonin receptor blocking agents methysergide, lysergic acid diethylamide, and bromolysergic and diethylamide, as well as centrally effective doses of the aromatic amino acid decarboxylase inhibitor Ro4-4602. Blockers of receptors of other neurotransmitters had little effect. This neurologic response in the adult rat may be relevant to some forms of clinical myoclonus and may be useful in testing potential agonists and antagonists of serotonin receptors in the mammalian central nervous system.     

以中枢神经系统症状为首发HIV患者的临床特点

目的回顾性分析以中枢神经系统症状为首发表现HIV患者的临床特点。方法对2008年1月1日~2015年12月31日在南京脑科医院住院诊断HIV,具有以中枢神经系统症状为首发表现的39例患者的临床资料,进行回顾性分析研究。结果研究人群的平均年龄为40.9±9.4岁,平均CD4细胞计数为55cells/mm3(QR:25~105)。最常见的临床表现为头痛(87.2%),体重下降(71.8%),发热(66.7%)。弓形虫脑炎(28.2%)、艾滋病痴呆综合征(17.9%)、原发性中枢神经系统淋巴瘤(PCNSL)(15.4%)、不明原因的CNS感染(15.4%)和隐球菌脑膜炎(12.8%)、结核性脑膜炎(12.8%)、不明原因的颅内占位性病变(12.8%)是艾滋病毒相关的中枢神经系统疾病表现的主要病因。结论 HIV-相关的中枢神经系统疾病越来越常见,临床表现复杂多样,易误诊,应提高警惕,留意抗HIV抗体的筛查。     

Antiphospholipid antibodies and the central nervous system]

Among anti-phospholipid antibodies (APA), anti-cardiolipin antibodies and lupus anticoagulants are associated with arterial and venous thrombo-embolic manifestations. Antiphospholipid antibodies can be secondary to numerous diseases, especially systemic diseases, but they are usually encountered in the primary antiphospholipid syndrome. Neurological manifestations associated with APA are most often, if not always, ischemic in nature: large or small subcortical, often multiple, infarcts and transient ischemic attacks are the usual clinical presentations. Several mechanisms can lead to cerebral ischemia in the primary antiphospholipid syndrome, and their diagnosis is probably important for therapeutic choices. A prospective controlled study has started, which should provide data on the prognosis and management of this syndrome.     

Morphological correlates of neural regeneration in the feeding system of Aplysia californica after central nervous system lesions

Morphological techniques were used to study regeneration of central neural pathways involved in feeding behavior following bilateral crushes of the cerebral-buccal connectives (CBCs). Electron microscopic analysis revealed that CBC crushes completely transect axons within the nerve core while leaving a remnant of the nerve sheath intact. Changes in the ultrastructure of the CBCs at the crush site were determined for 1, 7, 14, 21, and 50 days postlesion. At 1 day postlesion, the crush site was no longer compressed, and the nerve core had assumed a circular shape. In addition, several small axon profiles were evident, and large areas of tissue debris and prominent microglial cells were observed. Membranous debris and hemocytes were also present in sinuses that appeared in the sheath adjacent to the crush site. From 7 to 50 days postlesion, the core of the nerve at the crush site increased in size due to the addition of small diameter axons. Initially, the sheath surrounding the crush site exhibited hyperplasia and contained a few small bundles of processes, apparently due to newly sprouted axons that had strayed from the nerve core. By 50 days postlesion, the crush site appeared nearly normal; the nerve core was reacquiring the normal radial pattern of axon profiles with some medium-sized axon profiles covered with glial sheath and exhibiting invaginations typical of the intact CBC. However, there was still a distinct lack of large diameter axons. Cobalt backfills across the crush site revealed neurons in the cerebral ganglion by postlesion day 9. Positions of stained cell bodies were consistent with those observed in controls, although the numbers of stained neurons did not recover to control levels even by postlesion day 63. The changes in the crush site and return of cell body staining with time postlesion are correlated with the recovery of consummatory feeding. J. Comp. Neurol. 387:279–290, 1997. © 1997 Wiley-Liss, Inc.     

Parasitic diseases in the central nervous system]

Along with the drastic decrease of soil-transmitted intestinal helminthiases, parasitic diseases in general are ignored, or considered as the disease of the past, in Japan. However, due to the Japanese food culture of eating raw materials, food-borne parasitic diseases are still present in Japan. The majority of food-borne parasitic diseases are zoonotic, and caused by ectopic migration of parasite larvae. They accidentally migrate into CNS to cause deleterious conditions. Clinicians should always remind about the possibility of parasitic diseases when they make differential diagnosis for CNS diseases.