脊髓,圆锥与马尾损伤分类：附106例胸腰段脊柱与脊髓损伤分析

本文将１０６例胸１０到腰４的脊柱脊髓损伤的病例进行神经损伤的分类：Ｉ型：完全性脊髓损伤；Ⅱ型：完全性脊髓－圆锥损伤；Ⅲ型：不完全性圆锥马尾损伤；Ⅳ型：完全性圆锥损伤，合并部分马尾损伤：Ⅴ型：完全性圆锥马尾损伤；Ⅵ型：单纯圆锥损伤；Ⅶ型：部分马尾损伤．文章论述了每一型损伤的诊断标准，讨论了分类的意义，神经损伤与膀眈功能分级的关系；提出了以感觉、运动及膀胱功能为指标的截瘫量化功能评价的格式．     

超声定位中晚孕期胎儿脊髓圆锥位置的新方法探讨

目的:探索中晚孕期胎儿脊髓圆锥(CM)末端至骶尾部最后一个骨化中心的距离段(CS)内包含完整椎体个数的大致规律.方法:采用二维超声成像及表面三维成像计数19～37孕周胎儿CS段内包含完整椎体的个数,然后采用3D容积存储系统存图、4D View软件离线分析,用Kappa检验二维超声与三维超声在计数CS段内完整椎体个数的结果的一致性.结果:546例中253例二维超声成像与三维表面成像计数的完整椎体个数分布一致性极好(k=1.0).20孕周后CS段内包含完整椎体≥6个,27孕周后均≥7个,34孕周后均≥8个.结论:本研究初步获得了19～37周胎儿各孕周CS段内包含完整椎体个数的参考值范围.三维表面成像可与二维超声相结合来辅助判断胎儿CM位置.     

Primary angiitis of the spinal cord presenting as a conus mass: long-term remission

BACKGROUND: Primary angiitis of the central nervous system (CNS) is a rare vasculitic disorder that typically involves the brain and, less frequently, the spinal cord without involvement of the blood vessels outside the CNS. CASE DESCRIPTION: We present a case of a 52-year-old woman who developed a conus syndrome linked to an enhancing mass of her lower thoracic spinal cord, lumbar cord, and conus. Spinal cord biopsy performed for diagnostic purposes in the setting of progressive neurological deficit confirmed angiitis of the spinal cord. Therapy with steroid and cyclophosphamide was associated with long-term (3 years) clinical and imaging remission of the lesion. CONCLUSIONS: The prognosis of primary CNS angiitis is dismal with most cases progressing to death. Long-term remission is unusual. Aggressive therapy with steroid and cytotoxic agents may improve survival.     

Inhibitory influence of GABA on central serotonergic transmission. Raphe´nuclei as the neuroanatomical site of the GABAergic inhibition of cerebral serotonergic neurons

In order to explore the anatomical nature of the inhibitory GABAergic control of cerebral serotonergic neurons exerted at the level of the anterior raphe´cells in the rat, we have studied the effect of GABA agonist agents (given systematically or infused locally into the raphe´dorsalis or medianus) on cerebral 5-hydroxytryptophan (5-HTP) accumulation after lesion or pharmacological manipulation of various raphe´inputs. Destruction of noradrenergic pathways by local injection of 6-hydroxydopamine in the pedunculus cerebellaris superior or by systemic injection of DSP-4 (50 mg/kg i.p.), or alteration of central dopaminergic transmission (by systemic administration of apomorphine or haloperidol) failed to modify the ability of progabide (400 mg/kg i.p.) or dipropylacetamide (150 mg/kg i.p.) to diminish 5-HTP accumulation in the striatum, hippocampus and substantia nigra. In contrast, electrolytic lesion of the habenular nuclei blocked the ability of these compounds (given systematically) to reduce 5-HTP accumulation both in serotonergic nerve terminal and cell body (raphe´dorsalis and medianus) areas. A similar blockade of the effects of GABA mimetics was seen after ibotenate-induced lesion of the habenula but not after electrolytic lesion of the stria medullaris (which conveys most of the afferents to the habenula). Acute cessation of impulse flow in the habenulo-raphe´tract also prevented the depamide-induced diminution of cerebral 5-HTP accumulation. Finally, interruption of nerve transmission in the habenulo-raphe´pathways (by means of electrolytic lesion of the habenula or fasciculus retroflexus) blocked the ability of GABA (100 μg) or muscimol (50 ng) injected into the raphe´dorsalis or medianus to reduce 5-HTP accumulation in the corresponding serotonergic nerve terminal areas. It is concluded that the GABAergic inhibition of ascending serotonergic neurons exerted in the raphe´dorsalis and medianus depends upon an ongoing neuronal activity in the habenulo-raphe´pathways; GABA may exerts its inhibitory control over serotonergic neurons by tuning down a facilitatory influence on these cells exerted by the habenula.     

The conus demyelination syndrome in multiple sclerosis

Bowel, bladder and sexual dysfunction are common in multiple sclerosis and are generally attributed to the widespread nature of the involvement of the neuroaxis by the demyelinating plaques. Recently we encountered a specific subset of patients within this group who had characteristic clinical complaints of hesitancy, straining and incomplete voiding, perineal hypesthesia on examination, areflexia by cystometry and colonometry and electrophysiological parameters suggesting involvement of the conus medullaris. This heretofore postulated but undocumented mechanism of neurovisceral dysfunction in multiple sclerosis is detailed and discussed in 2 patients in this report.     

Primary spinal yolk sac tumor with brain metastasis: case report and review of the literature

SummaryObject Central nervous system primary germ cell tumors are typically pineal or suprasellar. Primary germ cell tumors of the spinal axis are very rare, with only a few case reports of germinomas and teratomas described in the literature.Methods We present the unique case of a 25-year-old woman with an intradural, extramedullary primary yolk sac tumor (YST) at and below the level of the conus medullaris. The patient was treated with a subtotal resection and within a month had rapid regrowth of her YST. She was subsequently treated with four cycles of chemotherapy (intravenous cisplatin and etoposide), 40-Gy fractionated focal external beam radiation to the spine, and consolidation with four additional cycles of chemotherapy (intravenous carboplatin, vinblastine, etoposide, and bleomycin). Despite an initial reduction in tumor size and clinical improvement in her neurologic exam, she re-presented a year after surgery with gross enlargement of her spinal tumor and CSF dissemination with metastasis to her brain. Despite further chemotherapy and radiotherapy, the patient died from her disseminated YST.Conclusions This case demonstrates that primary YSTs may occur in the spine, and like their intracranial counterparts, are associated with poor prognosis and dissemination through the neuroaxis. When feasible (no evidence of CSF dissemination, metastasis, or multifocal disease), optimal treatment includes as extensive resection of tumor as possible followed by adjuvant chemotherapy and radiation. The authors review the available literature on the treatment of intracranial malignant germ cell tumors, extrapolated to apply to the much rarer spinal lesions.     

Suprachiasmatic nucleus projection to mesencephalic central grey in the woodmouse (Apodemus sylvaticus L.).

The efferent connections of the suprachiasmatic nucleus of the hypothalamus have been studied in the woodmouse using several techniques: the Nauta degeneration method, anterograde axoplasmic transport of tritiated proline, and retrograde transport of horseradish peroxidase or Evans blue. Many degenerating nerve fibres resulting from the destruction of the suprachiasmatic nucleus converge on the ipsilateral ventrolateral segment of the mesencephalic central grey matter. Detailed analysis of autoradiographs after injection of [³H]proline in the suprachiasmatic nucleus agrees with these results. This projection is confirmed by injections of horseradish peroxidase or Evans blue into the mesencephalic central grey matter which result in a retrograde labelling of the suprachiasmatic nucleus. Formed by very thin and diffusely distributed axons, this projection belongs, at least caudally, to the descending periventricular system and is partially mixed with fibres from the medial anterior hypothalamic area.It is suggested that the suprachiasmaticomesencephalic pathway may be the first link in the neuron chain that connects the suprachiasmatic nucleus with the peripheral nervous system.     

The conus medullaris ratio: A new way to identify tethered cord on MRI

Purpose

Approximately 25% of patients with anorectal malformation have tethered cord. The traditional way of determining conus medullaris level on magnetic resonance imaging (MRI) relies on counting vertebrae, which may be challenging due to vertebral numeric variation, segmentation anomalies, as well as transitional vertebral body anatomy. The purpose of this study was to utilize more reliable anatomic landmarks (foramen magnum, conus termination, and the upper limit of the iliac crest) to establish a consistent ratio that may differentiate patients with normal and low-lying conus.

Paediatric ganglioglioma of the conus medullaris

Gangliogliomas of the conus medullaris are very rare, with only 12 patients reported so far. We report a 6-year-old male who presented with a painless numbness of the left lower limb and with bladder dysfunction. MRI revealed an intramedullary lesion at the T11-T12 vertebral levels. The tumour was subtotally removed. Histopathological examination demonstrated ganglioglioma.     

Mapping of somatostatin-28 (1-12) in the alpaca diencephalon

Using an immunocytochemical technique, we report for the first time the distribution of immunoreactive cell bodies and fibers containing somatostatin-28 (1-12) in the alpaca diencephalon. Somatostatin-28 (1-12)-immunoreactive cell bodies were only observed in the hypothalamus (lateral hypothalamic area, arcuate nucleus and ventromedial hypothalamic nucleus). However, immunoreactive fibers were widely distributed throughout the thalamus and hypothalamus. A high density of such fibers was observed in the central medial thalamic nucleus, laterodorsal thalamic nucleus, lateral habenular nucleus, mediodorsal thalamic nucleus, paraventricular thalamic nucleus, reuniens thalamic nucleus, rhomboid thalamic nucleus, subparafascicular thalamic nucleus, anterior hypothalamic area, arcuate nucleus, dorsal hypothalamic area, around the fornix, lateral hypothalamic area, lateral mammilary nucleus, posterior hypothalamic nucleus, paraventricular hypothalamic nucleus, suprachiasmatic nucleus, supraoptic hypothalamic nucleus, and in the ventromedial hypothalamic nucleus. The widespread distribution of somatostatin-28 (1-12) in the thalamus and hypothalamus of the alpaca suggests that the neuropeptide could be involved in many physiological actions.