Severe Neurological Changes Research Articles

Cerebral Cavernous Hemangioma in a Dog

Background: Cerebral cavernous hemangioma is a rare neoplasm of vascular origin in the brain, characterized by abnormally dilated vascular channels surrounded by endothelium without muscle or elastic fibers. Presumptive diagnosis is performed by magnetic resonance or computed tomography (CT) scanning and can be confirmed by histopathology. The prognosis of intracranial cavernous hemangioma is poor, with progression of clinical signs culminating in spontaneous death or euthanasia. The purpose of this paper is to report a case of cerebral cavernous hemangioma in a dog, presenting the clinical findings, tomographic changes, and pathological findings.Case: This case involved a 2-year-old medium sized mixed breed female dog presenting with apathy, hyporexia, ataxia, bradycardia, dyspnea, and seizure episodes for three days. Hemogram and serum biochemistry of renal and hepatic function and urinalysis did not reveal any visible changes. CT scanning was also performed. The scans revealed a hyperdense nodule of 15.9 x 14 mm, with well defined borders, and a hypodense halo without post-contrast enhancement and mass effect in the right parietal lobe was observed in both transverse and coronal sections. Based on the image presented in the CT scans, the nodule was defined as a hemorrhagic brain lesion. The animal died after a seizure. The right telencephalon was subjected to necropsy, which revealed a reddish-black wel-defined nodule 1.7 cm in diameter extending from the height of the piriform lobe to the olfactory trine at the groove level and extending towards the lateral ventricle, with slight compression and deformation of the thalamus but no other macroscopic alterations in the other organs. The histopathology indicated that this nodular area in the encephalus contained moderate, well-delimited but unencapsulated cellularity, composed of large vascular spaces paved with endothelial cells filled with erythrocytes, some containing eosinophilic fibrillar material (fibrin) and others with organized thrombus containing occasional neutrophil aggregates. The endothelial cells had cytoplasm with indistinct borders, elongated nuclei, scanty crust-like chromatin, and cellular pleomorphism ranging from discrete to moderate, without mitotic figures.Discussion: The histological findings characterized the morphological changes in the brain as cavernous hemangioma, and the growth and compression of this neoplasm were considered the cause of the clinical signs of this dog. The main complaint was seizures, although ataxia and lethargy were also noted. These clinical signs are often related to changes in the anterior brain and brainstem. The literature does not list computed tomography as a complementary diagnostic method in cases of cerebral cavernous hemangioma in dogs, but CT scanning was useful in confirming cerebral hemorrhage. The main differential diagnosis for cerebral cavernous hemangioma would be a hamartoma, but what differentiates them histologically is the presence of normal interstices between the blood vessels, since no intervening neural tissue occurs in the case of cerebral hemangioma. Therefore, even in the absence of immunohistochemistry to more confidently confirm a cavernous hemangioma, the clinical signs, CT scans and especially the pathological findings were consistent with a case of cerebral cavernous hemangioma, a benign neoplasm with a poor prognosis due to the severe neurological changes it causes and its difficult treatment.

Psychiatric Disorders in HTLV-1-Infected Individuals with Bladder Symptoms.

BackgroundPrevious studies have reported high rates of depression and anxiety in HTLV-1 infected individuals with the neurological disease and in the asymptomatic phase. No study has investigated the rates in individuals that already show bladder symptoms without severe neurological changes; that is, during the oligosymptomatic phase. The present study investigated patients in this intermediate form on the spectrum of the infection.Methodology/Principal FindingsParticipants answered a sociodemographic questionnaire, the Mini International Neuropsychiatric Interview Brazilian Version 5.0.0 (MINI PLUS) and the Hospital Anxiety and Depression Scale (HADS). Data analysis was performed in STATA statistical software (version 12.0). Depressive disorder was the most frequent comorbidity. Current depressive disorder was higher in the group of overactive bladder subjects (11.9%), and lifelong depression was more frequent in the HAM/TSP group (35%). The three groups had similar frequencies of anxiety disorders. Increased frequency and severity of anxiety and depression symptoms were observed in the overactive bladder group.Conclusion/SignificanceThe results suggest that individuals with overactive bladders need a more thorough assessment from the mental health perspective. These patients remain an understudied group regarding psychiatric comorbidities.

Mechanisms of aluminum-induced neurodegeneration in animals: Implications for Alzheimer's disease1

For four decades the controversial question concerning a possible role for aluminum neurotoxicity in contributing to the pathogenesis of Alzheimer's disease has been debated, and studies by different investigators have yielded contradictory results. The lack of sensitivity to aluminum neurotoxicity in transgenic mouse models of Alzheimer's disease has not allowed the system to be used to explore important aspects of this toxicity. Rabbits are particularly sensitive to aluminum neurotoxicity and they develop severe neurological changes that are dependent on dose, age and route of administration. The most prominent feature induced by aluminum in rabbit brain is a neurofibrillary degeneration that shares some similarity with the neurofibrillary tangles found in Alzheimer's disease patients. In the present review we discuss data from our laboratory and others, on the effects of aluminum on behaviour, neurologic function and morphology, using aluminum administered to rabbits via different routes. Finally, we will examine data on the possible cellular mechanisms underlying aluminum neurotoxicity, and potential neuroprotective strategies against aluminum toxicity.

Effects of intraoperative hyperthermia on peripheral nerves: neurological and electrophysiological studies.

The tolerance of peripheral nerves to heat may limit the heat dose which can be applied to tumours. This may be particularly important in intraoperative hyperthermia (IOHT) for pelvic and retroperitoneal tumours. Furthermore the effects of hyperthermia alone must be known before its effects can be assessed in combination with irradiation. In this study injury to sciatic nerves was evaluated in 30 beagle dogs for 1 year following IOHT. IOHT was performed using a water circulating hyperthermia device with multichannel thermometry system. Neurological and electrophysiological examinations were done before, during and after IOHT treatment. Electrophysiological examinations showed a significant decrease in sciatic nerve conduction velocity and potential amplitude immediately after 60 min of heating for all temperatures. The greatest decrease in conduction velocity was observed for a temperature of 45 degrees C. Full recovery of nerve conduction velocity was observed 3 weeks following hyperthermia for all dogs except for those exposed to 45 degrees C. Neurological findings correlated with electrophysiological results. All five dogs which had nerve exposed to 45 degrees C for 60 min had severe neurological changes, with recovery taking place between 3 and 11 months after treatment. Based on these results it appears that temperatures to the peripheral nerve exceeding 44 degrees C for 1 h are likely to cause significant, but not necessarily permanent, nerve injury.

Atlantoaxial instability in Down's syndrome.

SIR,-Dr Richard A Collacott (18 April, p 988) reviewed atlantoaxial instability in Down's syndrome fully but used the term atlantoaxial instability without specifiying its type. In view of the prevalence of this severe complication, the growing awareness of its morphological classification, and the recent development of guidelines for its operative treatment' I we believe that the natural course and treatment of this disorder should be considered. Anterior atlantoaxial dislocation is secondary to the changes in the collagenous tissue that cause laxity in the cervical spine ligaments.' 2 When the transverse ligaments rupture minimal subluxation is possible.3 When the apical and alar ligaments also become stretched considerable instability occurs between C1 and C2, with amplitudes varying by up to 22 mm.4 Anterior subluxation is the cervical instability usually observed in patients with Down's syndrome. In contrast to anterior atlantoaxial subluxation, where soft tissues play an important part in the pathogenesis, vertical subluxation of the odontoid process seems to be a late development of the disease and is related to bilateral destruction of the articular masses in the atlantoaxial facet joints.3 In addition to these two types of atlantoaxial subluxation, four others should be mentioned: posterior atlantoaxial, lateral atlantoaxial, and rotatory atlantoaxial subluxation and nonreducible head tilt deformities, all ofwhich are late developments of the primary anterior type of atlantoaxial subluxation.3-5 The common failure to report their existence in patients with Down's syndrome may reflect the widespread belief that atlantoaxial instability comprises only one of the above changes. Anterior atlantoaxial subluxation is usually a benign condition, causing C2 nerve related occipitocervical headache and signs indicative of myelopathy, which are usually limited to glove like sensory loss in the hands and increased tendon reflexes.3' 6 It is usually the vertical subluxation of the odontoid process and subaxial subluxations that cause the more severe neurological changes.3'5 In most instances focused lateral view extensionflexion radiographs together with open mouth anteroposterior tomograms are required to detect atlantoaxial instabilities. If multiple level instabilities are suspected cervical myelography, computed tomography, and nuclear magnetic resonance imaging may be used to locate and evaluate the cord compression.35 All patients with Down's syndrome should probably be screened radiographically for cervical spine instabilities, although clinical evaluation is still the priority. Gallie type C1-C2 fusion is effective in the treatment of anterior antlantoaxial subluxation.3-5 Postoperatively, however, there is a risk of later subsequent subluxations below the fused segments as a result of laxity of the longitudinal ligaments and mechanical strain.5 The increasing awareness of the clinical relevance of atlantoaxial subluxations should be accompanied by correct use of the term, including its specifications in relation to the morphological classification in Down's syndrome and other diseases. Sports enthusiasts and athletes with Down's syndrome are not the only group at risk. The deleterious effect of cervical instability should also be considered when tooth extraction, physical manipulation, and the induction of general anaesthesia are performed. YRJO T KONTTINEN

Herniation of the upper lumbar discs.

On the basis of investigations involving 134 patients operated on at the National Institute of Neurosurgery, Budapest, the authors point out that herniations of the intervertebral discs at L 1/2, L 2/3, L 3/4 levels are characterized by more severe neurological changes. Paresis and autonomic disorders occur much more frequently than in lower lumbar disc herniations: paresis was found in 67 cases (50%) and bilaterally in 44 cases (32.8%), with inability to walk in 21 cases (15.7%); autonomic disturbances were noted in 36 patients (26.9%). With clear symptoms of a lumbar disc herniation a raised protein content in the CSF, more than 100 mg%, makes one suspicious of an upper lumbar lesion. In most of the cases the level of the lesion could not be exactly determined on the basis of sensory symptoms alone. The importance of myelography is stressed in determining the level. The more severe neurological changes are attributed to a medial situation of many disc hernias as found at operation, and also to unduly prolonged conservative treatment. The early postoperative results are analysed, most of which show permanent further improvement. According to our classification, the immediate postoperative results were "excellent" or "good" in 124 of the 134 patients. Except for two cases with complications, all of the patients unable to walk because of pain or paresis started to walk again after the operation. In the long-term follow-up period extending from 2 to 20 years the pain continued to improve in most of the cases, with similar, though less marked improvement in motor and autonomic disturbances. In 15 patients the condition deteriorated in the late postoperative period, but among them were 8 patients, in whom the results could be considered satisfactory as compared to the preoperative complaints. In the late postoperative period only 7 patients were unchanged or even in a worse condition than before operation.

The Advantages of Early Spine Fusion in the Treatment of Fracture-Dislocation of the Cervical Spine

This Paper is concerned with the advantages of internal fixation and spine fusion early in the treatment of fracture-dislocations of the cervical spine. It is based on a statistical analysis of eighty-four cases of this entity treated within the clinical experience of the authors. It is important to understand the mechanism of injury in each case in order to treat it intelligently. In the treatment of cervical-spine injuries, first consideration must be given to protection of the neural elements. Relieving all pressure from the spinal cord and nerve roots, and putting them at rest, affords the best opportunity for return of function of the neural elenments. To do this with certainty requires accurate reduction of bone elements, followed by internal fixation for immediate stability and spine fusion to prevent late recurrence. The general routine of skeletal traction, internal fixation, and spine fusion constitutes a method of treatment that needs to be varied but slightly in order to include a large percentage of all serious injuries of the cervical spine. The results in thirty-eight spine fusions and forty-six injuries treated conservatively indicate that the patients in whom fusion was done had less residual deformity and a lower rate of recurrence. In addition less time was spent in the hospital or in uncomfortable casts, and less time was spent away from work. The mechanism of injury in cervical-spine fractures and dislocations is discussed in some detail, with emphasis on the hyperextension types. A new interpretation of the roentgenographic findings in a large group of fracture-dislocations with mild anterior displacement shows that approximately half of them were caused by hyperextension rather than flexion as previously thought. Prior to the recognition of this mechanism, it was difficult to understand the severe neurological changes that were frequently present. Placing these cases in the group of hyperextension injuries makes the neurological damage understandable.

Acute Porphyria with Severe Neurological Changes

Acute Porphyria with Severe Neurological Changes