RESUMEN
We report a case of angioimmunoblastic T-cell lymphoma (AITL) in a 48-year-old Japanese male. Characteristic clinical manifestations of AITL such as fever, weight loss, skin rash, general lymphadenopathy, Coombs test positivity, and polyclonal hypergammaglobulinemia were present. Histopathologically, the nodal architecture was preserved and germinal centers were, if anything, hyperplastic, which was unusual for AITL. Diagnostic clear cells were absent. Intrafollicular tingible-body macrophages were markedly increased. In the interfollicular zone, proliferation of UCHL-1 + immunoblasts was evident, and high-endothelial postcapillary venule-type vessels were increased. The T-cell receptor gene (C beta 1) was clonally rearranged. Based on these findings, a diagnosis of AITL with hyperplastic germinal centers was made. Six courses of CHOP were administered and no signs of relapse were noticed about two years after diagnosis.
Asunto(s)
Centro Germinal/patología , Linfoma de Células T/patología , Diagnóstico Diferencial , Humanos , Linfadenopatía Inmunoblástica/patología , Masculino , Persona de Mediana Edad , Seudolinfoma/patologíaRESUMEN
A 50-year-old male presented with a choroid plexus papilloma in the foramen magnum manifesting as dysesthesia in the right hand and severe headache. Magnetic resonance imaging clearly showed that the tumor was located in the cerebellomedullary cistern, without extension into the fourth ventricle. However, differentiation from hemangioblastoma or foramen magnum tumor was difficult by neuroimaging. Intraoperative observation found the tumor was located extraventricularly and attached to the choroid plexus of the foramen of Magendie. The tumor was grossly totally resected. Histological examination proved the tumor was a choroid plexus papilloma without malignancy. His neurological deficits resolved almost completely.
Asunto(s)
Neoplasias del Plexo Coroideo/cirugía , Glioma/cirugía , Plexo Coroideo/patología , Plexo Coroideo/cirugía , Neoplasias del Plexo Coroideo/diagnóstico , Neoplasias del Plexo Coroideo/patología , Diagnóstico Diferencial , Foramen Magno/patología , Foramen Magno/cirugía , Glioma/diagnóstico , Glioma/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Examen Neurológico , Complicaciones Posoperatorias/diagnósticoRESUMEN
A 20-year-old female presented with dysphasia and slight hemiparesis following a head trauma, who had a non-treated growing skull fracture which had remained asymptomatic for about 18 years, despite an encephalocele in the left parietal region. Neuroimaging demonstrated secondary brain damage and herniated brain resulting in gliosis. Electroencephalography revealed epileptic discharge in the affected region. Dural repair and cranioplasty resolved her neurological deficits. Early corrective surgery should be performed for growing skull fracture to prevent secondary brain damage.
Asunto(s)
Traumatismos Craneocerebrales/complicaciones , Fracturas Craneales/diagnóstico , Fracturas Craneales/etiología , Adulto , Edad de Inicio , Electroencefalografía , Encefalocele/etiología , Femenino , Humanos , Lóbulo Parietal/fisiopatología , Lóbulo Parietal/cirugía , Resultado del TratamientoRESUMEN
A 57-year-old male suffered a fatal subarachnoid hemorrhage due to ruptured infundibular widening of the internal carotid-posterior communicating artery junction, confirmed by autopsy. Infundibular widening is a preaneurysmal or aneurysmal lesion and indicates angiographic follow-up and control of blood pressure when identified.
Asunto(s)
Aneurisma Roto/complicaciones , Aneurisma Intracraneal/complicaciones , Hemorragia Subaracnoidea/etiología , Anastomosis Quirúrgica , Aneurisma Roto/fisiopatología , Arterias Carótidas/fisiopatología , Arterias Carótidas/cirugía , Angiografía Cerebral , Arterias Cerebrales/fisiopatología , Arterias Cerebrales/cirugía , Resultado Fatal , Humanos , Aneurisma Intracraneal/fisiopatología , Masculino , Persona de Mediana Edad , Hemorragia Subaracnoidea/diagnósticoRESUMEN
A 36-year-old male presented with an intramedullary spinal cord arteriovenous malformation with hematomyelia but without subarachnoid hemorrhage, manifesting as lower body sensory impairments and leg weakness. Magnetic resonance imaging was used to localize the lesion. Myelotomy allowed excision of the lesion and his sensory impairments improved.
Asunto(s)
Malformaciones Arteriovenosas/cirugía , Hematoma/cirugía , Médula Espinal/irrigación sanguínea , Adulto , Angiografía , Malformaciones Arteriovenosas/diagnóstico , Hematoma/diagnóstico , Humanos , Imagen por Resonancia Magnética , Masculino , Hemorragia Subaracnoidea/diagnóstico , Hemorragia Subaracnoidea/cirugíaRESUMEN
An aneurysm of the internal carotid artery associated with Marfan's syndrome occurred in a 23-year-old female with a 2-year history of a pulsating lesion in the left neck, which progressively increased in size. Left carotid angiography demonstrated a giant saccular aneurysm at the origin of the internal carotid artery. The aneurysm was excised and end-to-end anastomosis performed without postoperative morbidity.
Asunto(s)
Aneurisma/complicaciones , Enfermedades de las Arterias Carótidas/complicaciones , Síndrome de Marfan/complicaciones , Adulto , Aneurisma/diagnóstico por imagen , Aneurisma/patología , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/patología , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/patología , Femenino , Humanos , RadiografíaRESUMEN
A 47-year-old male presented with a sudden onset of right hemiparesis and numbness of the left face. Magnetic resonance imaging demonstrated a lacunar infarct in the ventral pons. Cerebral angiography demonstrated a persistent trigeminal artery (PTA) anastomosing the left internal carotid artery to the distal basilar artery. Bilateral vertebral arteries and the basilar artery below the PTA junction were extremely hypoplastic. The bilateral posterior communicating arteries were embryonic. The posterior fossa circulation was almost independent from the circle of Willis. The poor vascular supply to the posterior fossa probably caused the brainstem infarct.
Asunto(s)
Tronco Encefálico , Arterias Cerebrales/patología , Infarto Cerebral/etiología , Tronco Encefálico/patología , Infarto Cerebral/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana EdadRESUMEN
A 43-year-old woman with ossifying fibroma of the thoracolumbar vertebrae was presented with a 6-month history of progressive radiculomyelopathy. The symptoms were successfully treated by laminectomy and partial resection of the lesion. This is the first reported case of ossifying fibroma involving the thoracolumbar spine. The clinical significance and management of this rare lesion are discussed with a review of the literature.
Asunto(s)
Fibroma/diagnóstico , Vértebras Lumbares/patología , Osteoma/diagnóstico , Neoplasias de la Columna Vertebral/diagnóstico , Vértebras Torácicas/patología , Adulto , Femenino , Fibroma/cirugía , Humanos , Imagen por Resonancia Magnética , Mielografía , Osteoma/cirugía , Neoplasias de la Columna Vertebral/cirugía , Tomografía Computarizada por Rayos XRESUMEN
A case of brain abscess associated with congenital pulmonary arteriovenous fistula was presented and 52 reported cases were reviewed. The brain abscess was successfully treated with repeated aspiration and drainage, and the pulmonary arteriovenous fistula, located in the right lower lobe, was resected. The arteriovenous fistula occurs as a common pulmonary manifestation of hereditary hemorrhagic telangiectasia; however, no symptoms suggesting these two were noted in this case. Brain abscesses can be an initial clinical manifestation in asymptomatic pulmonary arteriovenous fistula. This possible association should be borne in mind in cases of brain abscesses of unexplained etiology.
Asunto(s)
Fístula Arteriovenosa/congénito , Fístula Arteriovenosa/complicaciones , Absceso Encefálico/complicaciones , Arteria Pulmonar , Venas Pulmonares , Fístula Arteriovenosa/cirugía , Absceso Encefálico/diagnóstico por imagen , Absceso Encefálico/terapia , Humanos , Masculino , Persona de Mediana Edad , Arteria Pulmonar/diagnóstico por imagen , Venas Pulmonares/diagnóstico por imagen , RadiografíaRESUMEN
A series of experiments was conducted to clarify the effect of intravenous administration of lidocaine on brain water content, local cerebral blood flow (lCBF), and neural recovery in brain injury induced by exposure of the cat's cerebral surface to the air. The injury produced ischemia and edema in the cortex and white matter without direct damage of the cortex. Lidocaine (3.0 mg/kg) was given intravenously for 30 minutes immediately after air exposure and thereafter at the rate of 2 mg/kg/hour. Twelve hours after exposure, lidocaine significantly suppressed cortical ischemia and edema; however, it had no effects in the white matter. The electrophysiologic activities of the cortex and white matter which were assessed by the direct cortical response and somatosensory evoked response were significantly preserved by lidocaine compared with nontreated animals. The results of this experiment demonstrate that intravenous lidocaine has a significant beneficial effect on cortical ischemia and electrophysiologic activities of the cortex and white matter in injured brain.
Asunto(s)
Edema Encefálico/tratamiento farmacológico , Encéfalo/fisiopatología , Circulación Cerebrovascular/efectos de los fármacos , Lidocaína/farmacología , Animales , Agua Corporal/análisis , Encéfalo/efectos de los fármacos , Encéfalo/patología , Química Encefálica , Edema Encefálico/etiología , Edema Encefálico/fisiopatología , Gatos , Potenciales Evocados Somatosensoriales , Infusiones Parenterales , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Modelos BiológicosRESUMEN
Local CBF (LCBF) was compared with the corresponding local tissue concentration of ATP, phosphocreatine (PCr), and lactate in anaesthetized baboons subjected to focal ischaemia produced by middle cerebral artery occlusion (MCAO). LCBF hydrogen electrodes were implanted in cortical regions where MCAO had been previously shown to produce severe and penumbral ischaemia and in posterior regions where blood flow is not altered. Metabolites were assayed in small tissue samples collected either by cryoprobe biopsy in the regions where LCBFs were measured (series 1) or by sampling appropriate regions of the rapidly frozen brain (series 2). Subsequent topographical study of brain tissue pH with umbelliferone was performed in this latter series. The results from these two series are compared and discussed in terms of the more appropriate way to perform simultaneous electrode measurements and analysis of tissue samples for studying focal ischaemia in the primate brain. They confirm that the concentrations of ATP and PCr decrease, and that lactate level increases, with decreasing blood flow. These metabolites tended to change more rapidly below a blood flow threshold, rather than showing a steady decrease as the blood flow was reduced, although the variability of the data precluded us from establishing this with confidence. Topographical study of tissue pH often showed sharp boundaries between zones of very low pH and regions with normal pH.
Asunto(s)
Isquemia Encefálica/metabolismo , Encéfalo/metabolismo , Circulación Cerebrovascular , Adenosina Trifosfato/metabolismo , Animales , Isquemia Encefálica/enzimología , Isquemia Encefálica/fisiopatología , Arterias Cerebrales/fisiopatología , Femenino , Concentración de Iones de Hidrógeno , Lactatos/metabolismo , Ácido Láctico , Masculino , Papio , Fosfocreatina/metabolismoRESUMEN
The box method of freezing the brain in situ was assessed in baboons. The cooling rate of the tissue was monitored in several regions located at various depths from the skull surface. These measurements allowed us to examine the time required for the tissue to reach 0 degree C, in relation to its depth measured from the top of the skull. To define brain regions with proven ischaemia, frozen tissue sections were surveyed for areas of decreased pH. In addition, concentrations of ATP, phosphocreatine, and lactate were determined in gray matter located at various depths from the top of the brain surface. Normal tissue pH and low lactate concentration, without any significant decrease in high-energy phosphate levels, were found in regions at a depth less than approximately 10 mm from the brain surface. Deep structures including the inferiomedial aspect of the temporal lobe, the lateral geniculate body, and the limbic system (hippocampus) consistently showed mild tissue acidosis, indicating that these regions were subjected to some degree of ischaemia before they were reached by the freezing front. In some cases, acidosis was also detectable in the thalamus, basal ganglia, and in the deeper part of some sulci. We conclude that, with baboons, in situ freezing using the box method is valid for metabolic studies of the cerebral cortex and structures located at a depth less than approximately 10 mm from the top of the brain surface.
Asunto(s)
Encéfalo/metabolismo , Congelación/métodos , Animales , Masculino , PapioRESUMEN
We studied the changes in amplitude of the first short latency positive potential (2.3 +/- 0.3 msec, mean +/- S.D.) of the direct cortical response (DCR) elicited by surface electrical stimulation of the motor cortex in anaesthetised baboons. Local cortical blood flow, measured by the hydrogen clearance method, was progressively reduced by acute middle cerebral artery occlusion and subsequent hypotension and was related to the amplitude of this potential. With flow levels greater than 25 ml/100 g/min the DCR was essentially unaffected, but it was lost with flows below 20 ml/100 g/min. These results indicate a threshold relationship between the generation of the electrical activity evoked in the cortical elements and local cortical flow, similar to that previously demonstrated for cortical somatosensory evoked potentials.
Asunto(s)
Isquemia Encefálica/fisiopatología , Corteza Motora/fisiopatología , Animales , Circulación Cerebrovascular , Estimulación Eléctrica , Papio , Tiempo de ReacciónRESUMEN
The effect of graded ischaemia on intracranial nerve fibre conduction has not previously been studied quantitatively. We measured pyramidal tract (PT) discharges evoked by electrical stimulation of the ipsilateral motor cortex, together with local blood flow (by hydrogen clearance), in the internal capsule and ventral pons of baboons anaesthetised with alpha-chloralose. Changes in conduction time and amplitude of the motor volley were monitored over this PT segment as it was subjected to progressive ischaemia in controlled stages. Conduction time increased significantly, with attenuation of the volley, at average brain-stem tissue flows below 30 ml/100 g/min. Using paired stimuli, we demonstrated relative refractory and supernormal characteristics of PT conduction. In mild ischaemia, the conduction time of the test response decreased, much more than with single stimulation, and in denser ischaemia it increased, relatively more so at smaller inter-stimulus intervals. The data demonstrate the impairment of conduction in a population of CNS axons with reduced local blood flow and indicate that the transmission of relatively rapid sequences of impulses would be the first aspect of conduction to suffer in ischaemia prior to conduction block.
Asunto(s)
Tronco Encefálico/irrigación sanguínea , Isquemia/fisiopatología , Conducción Nerviosa , Tractos Piramidales/fisiopatología , Animales , Femenino , Masculino , PapioRESUMEN
Central conduction time (CCT) has been monitored in 37 patients undergoing temporary arterial occlusion in aneurysm surgery. 17 patients had internal carotid, 17 had middle cerebral, and 4 had basilar artery occlusion. Internal carotid or middle cerebral artery occlusion lasting less than 12 minutes has not been associated with postoperative morbidity, in any case without appreciable change in CCT after occlusion. Prompt prolongation of CCT was warned the surgeon, but CCT prolongation up to 10 ms could occur without permanent neurological deficit, except in one Grade 4 patient. 10 of 18 patients who lost the N 20 cortical potential showed postoperative neurological deficit, which was promptly recoverable in 7 patients. The speed of loss or recovery of N 20 enabled a patients's prognosis to be predicted. Irrecoverable postoperative deficit is unlikely if the N 20 takes longer than 4 minutes to disappear, to reappears within 20 minutes after recirculation.
Asunto(s)
Potenciales Evocados Somatosensoriales , Aneurisma Intracraneal/cirugía , Ataque Isquémico Transitorio/fisiopatología , Monitoreo Fisiológico , Complicaciones Posoperatorias , Humanos , Aneurisma Intracraneal/fisiopatología , Ataque Isquémico Transitorio/etiología , Conducción Nerviosa , Factores de TiempoRESUMEN
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)
Asunto(s)
Circulación Cerebrovascular , Ataque Isquémico Transitorio/etiología , Animales , Gatos , Dilatación Patológica , Hipercapnia/complicaciones , Hipoxia/complicaciones , Presión Intracraneal , Ataque Isquémico Transitorio/fisiopatología , Enfermedades del Sistema Nervioso/complicaciones , Vasodilatación , Sistema Vasomotor/fisiopatologíaRESUMEN
Recently lidocaine (Ld) has been reported to have beneficial effects on neural suppression caused by experimental cerebral ischemia or spinal cord injury. In this paper, the effects of Ld on brain edema, local cerebral blood flow (lCBF), and neural function in the thalamocortical and cortical structures were experimentally studied. Vasogenic brain edema was induced by exposure of the cat's cerebral surface to the air in the manner of Prados et al. The dura mater over the left cerebral hemisphere was resected, and the brain was exposed to room air for 12 hours. The animals were divided into two groups. In the control group of 31 cats, Ld was not administered. In the treated group of 8 cats, Ld (4.5 mg/kg) was given intravenously immediately after the beginning of the air-exposure and thereafter administered as a drip infusion at the rate of 2 mg/kg/hour. In the untreated group, 12 hours after exposure, the cerebral water content measured by gravimetry in the cortex, white matter and thalamus increased by approximately 1.9, 4.1, 0.7%, respectively, compared to the control values. Local CBF measured by the hydrogen clearance method decreased to about 71, 57 and 56% of the control value, respectively. The latency of the N1 component of the somatosensory evoked response (SER) was prolonged significantly 6 hours after air-exposure. The amplitude of the direct cortical response (DCR) decreased significantly 6 hours after air-exposure, and became approximately 50% of the control 12 hours after exposure.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Edema Encefálico/tratamiento farmacológico , Potenciales Evocados Somatosensoriales , Lidocaína/uso terapéutico , Animales , Encéfalo/irrigación sanguínea , Edema Encefálico/fisiopatología , Gatos , Corteza Cerebral/fisiopatología , Hipotálamo/fisiopatología , Flujo Sanguíneo RegionalRESUMEN
Somatosensory evoked potentials (SEPs) to median nerve stimulation and auditory brainstem evoked potentials (BAEPs) were recorded in 16 comatose patients who had suffered transtentorial herniation (TH) due to intracranial haematoma, hydrocephalus or tumour. An attempt was made to correlate the changes in the N14-P15 component of the central conduction time (CCT) and the I-V interpeak latencies (IPLs) of the BAEP with the clinical severity of TH. The N14-P15 component was not affected in seven patients at the diencephalic or early third-nerve stage, and six of these seven showed normal I-V IPLs. All six patients at the late third-nerve/midbrain stage or worse, however, showed abnormalities in the N14-P15 components. Interestingly, five patients showed dissociation of SEP and BAEP abnormalities suggesting a differential sensitivity of the medial and lateral lemnisci in the brainstem to ischaemia and/or compression. All five patients in whom the P15 potential was absent on either side had a poor outcome and there was a correlation between the electrical failure in the N14-P15 component and the degree of brainstem damage caused by TH as assessed clinically. Reversible loss of the P15 potential by brainstem retraction has been shown in intraoperative SEP monitoring during aneurysm surgery. Prolonged compression of the upper brainstem seems to cause irreversible loss of the P15 which should be regarded as being due to irrecoverable brainstem dysfunction.
Asunto(s)
Tronco Encefálico/fisiopatología , Encefalocele/fisiopatología , Potenciales Evocados Auditivos , Potenciales Evocados Somatosensoriales , Adolescente , Adulto , Anciano , Hemorragia Cerebral/complicaciones , Estimulación Eléctrica , Encefalocele/etiología , Femenino , Hematoma/complicaciones , Humanos , Hidrocefalia/complicaciones , Masculino , Nervio Mediano/fisiología , Persona de Mediana EdadRESUMEN
Both somatosensory (SSEPs) and brain-stem auditory evoked potentials (BAEPs) were recorded in 3 patients with localized lesions in the thalamus or brain-stem. In one patient with a right thalamic cystic tumour there was a significant interhemispheric difference in the central conduction time (CCT), but the N14-P15 interval was not affected on either side and BAEPs showed normal wave latencies and interpeak latencies (IPLs). The second patient had a colloid cyst of the third ventricle in which central herniation had occurred resulting in 'locked-in' syndrome. The P15 peak was absent on one side and markedly prolonged in latency on the other. BAEPs showed neither wave IV nor V on either side. The third patient had compression of the right posterior rostral pons by a metastatic tumour, resulting in significant prolongation of the CCT on the side of the tumour because of increase in the N14-P15 interval. Both I-V and III-V interpeak latencies were significantly prolonged bilaterally without prolongation in I-III IPL in this case. There was a correlation between the electrophysiological abnormalities of P15 and of BAEP wave V. These results suggest that the origin of the P15, which is usually recorded as a far-field potential, may be in the subthalamus or the upper part of the brain-stem.
Asunto(s)
Tronco Encefálico/fisiopatología , Diencéfalo/fisiopatología , Potenciales Evocados Somatosensoriales , Nervio Mediano/fisiología , Conducción Nerviosa , Adulto , Anciano , Encefalopatías/diagnóstico por imagen , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/secundario , Quistes/diagnóstico por imagen , Potenciales Evocados Auditivos , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Changes in the central conduction time (CCT) during the application of temporary clips were studied in 40 patients who had undergone operations for intracranial aneurysms in relation to postoperative neurological outcome. Ten of these 40 patients (25%) showed postoperative morbidity, although promptly recoverable in 5. None of the patients whose CCTs did not change following temporary occlusion of major vessels showed any postoperative morbidity, except in one case of anterior cerebral artery aneurysm. In 6 patients, temporary vascular occlusion caused a considerable transient prolongation in CCT of up to 10 msec. Two of these 6 patients were associated with postoperative neurological deficit (which was recoverable in 1). The cortical response became flat in 15 patients. Seven of these 15 patients showed hemispheric deficits postoperatively, although recoverable in 4. There was a correlation between the change in the somatosensory evoked response and postoperative outcome. Disappearance of the N20 potential following occlusion is regarded as a danger signal, but postoperative, irrecoverable neurological deficit seems to be unlikely if its disappearance takes more than 3-4 minutes. Even if the cortical response disappears, the clinical outcome is expected to be good if the N20 potential recovers within 20 minutes after recirculation.