Development of current problems regarding perinatal CNS lesions from a neuropathologic viewpoint]

Perinatal central-nervous-system lesions may be found in as many as one third of all subjects who died before, during, or after the time of birth. Today, hypoxia is considered to be an essential cause of such lesions; in contrast to views held previously, birth trauma, i.e., physical injury to an infant during its delivery, is of minor pathogenetic importance. Neurohistological studies showed that it is especially prolonged hypoxia - in addition to cerebral hemorrhage, damage to the cerebral parenchyma and medullary substance - which can cause lesion of the brain stem. A relatively frequent occurrence are isolated ischemic cerebrospinal nerve cell lesions. Their prognostic dignity in regard to the possible formation of synapses and the problem of damage to the neuroglia are as yet imperfectly understood.     

Ulnar sulcus syndrome--a contribution to course and prognosis

Of 1028 patients with 1138 peripheral nerve lesions, 142 suffered from an electrophysiologically proven SUS. At follow-up, 93 patients could be restudied. Spontaneous regressions were observed in patients below the age of 40 years and in case of a history under 6 months. So-called late pareses receded in no case without operative displacement of the ulnar nerve. However, if the etiology is unknown, the present results of investigation require reserve towards operative therapy.     

海绵窦区病变外科处理策略

为探讨海绵窦区病变的外科治疗策略,回顾性分析了58例不同性质的海绵窦病变病例的临床资料、治疗方法和治疗效果,发现根据病变的不同性质和不同的生长方式个性化地采用不同的治疗方法可在最大限度治愈病变的同时,保护颅神经的功能,获得良好的治疗效果。     

Inferior olive lesions impair concurrent taste aversion learning in rats.

Taste aversion learning can be established according to two different procedures, concurrent and sequential. For the concurrent task, two different taste stimuli are offered at the same time, one associated with simultaneous intragastric administration of an aversive stimulus and the other associated with physiological saline. This discrimination is learned by sham-lesioned control animals and by animals with lesions in the cerebellar cortex but not by rats lesioned in the inferior olive. At the same time, animals with lesions in the inferior olive and sham-lesioned animals achieve sequential learning when the gustatory stimuli are offered individually during each daily session. The results obtained show that electrolytic lesions in the inferior olive impair acquisition of concurrent learning and are analyzed in terms of an anatomical system consisting of the vagus nerve, inferior olive, and cerebellum, which differentiates between the two modalities of taste aversion learning, concurrent and sequential.     

Lumbale Radikulopathie

Back pain is a common pain syndrome in the general population. The most common cause is lumbar disc disease and only rarely bony degenerative changes of the spine. Other causes of lumbar radiculopathy include local lesions. Inflammatory changes or meningeal carcinomatosis may also lead to lumbar nerve root damage. With pronounced clinical symptoms, motor deficits of the associated muscles can occur, including weakening of muscle reflexes. In addition to thorough education of the patient about the origin, likely duration, and treatment of the disease, a combination of physical therapy and pharmacotherapy is the basis for successful treatment of lumbar radiculopathy. In cases of severe paralysis, bladder and rectal paralysis, and corresponding compression of nerves, urgent spinal surgery is inevitable.     

Effects of selective perirhinal and postrhinal lesions on acquisition and retention of a visual discrimination task in rats

The hippocampal region along with rhinal structures seems to support learning and memory in an important manner. Structures adjacent to the rhinal fissure in the rat have recently been suggested to be divided into the perirhinal and postrhinal cortices. Some effects of perirhinal lesions on cognitive processing are known, whereas effects of postrhinal lesions appear to be unknown. The purpose of the present study was to examine the relative effects of perirhinal and postrhinal lesions in a three-choice visual discrimination test. The results show that both types of lesions impaired acquisition of the task, but only perirhinal lesions impeded subsequent retention. Because the initial phase of acquisition was unaffected by both lesions, it is suggested that the deficits observed may be of mnemonic nature. The apparent differential involvement of the perirhinal cortex and postrhinal cortex in cognition may be associated with differences in anatomical connectivity among these structures.     

A Pastoral Model for Caring for Persons with Diminished Hope

An exegesis of the exchange between Jesus and the paralytic man at the pool in John 5:1-17 serves as the basis for a contemporary model for caring for persons with diminished hope.     

远外侧入路治疗颅颈交界区腹侧病变

探讨远外侧入路在颅颈交界区腹侧病变治疗中的应用。14例患者全部采用远外侧入路显微手术治疗。11例肿瘤全切除7例,次全切除2例,大部切除2例;3例动脉瘤均顺利夹闭;行枕颈融合术3例。术后最常见的并发症是后组脑神经损伤症状;获得随访11例,恢复良好。远外侧入路是治疗颅颈交界区腹侧病变的理想入路,但治疗方案应个体化。     

Perceptual functions in prosopagnosia

Some patients with prosopagnosia may have an apperceptive basis to their recognition defect. Perceptual abnormalities have been reported in single cases or small series, but the causal link of such deficits to prosopagnosia is unclear. Our goal was to identify candidate perceptual processes that might contribute to prosopagnosia, by subjecting several prosopagnosic patients to a battery of functions that may be necessary for accurate facial perception. We tested seven prosopagnosic patients. Three had unilateral right occipitotemporal lesions, two had bilateral posterior occipitotemporal lesions, and one had right anterior-to-occipital temporal damage along with a small left temporal lesion. These lesions all included the fusiform face area, in contrast to one patient with bilateral anterior temporal lesions. Most patients had impaired performance on face-matching tests and difficulty with subcategory judgments for non-face objects. The most consistent deficits in patients with lesions involving the fusiform face area were impaired perception of spatial relations in dot patterns and reduced contrast sensitivity in the 4 to 8 cycles deg(-1) range. Patients with bilateral lesions were impaired in saturation discrimination. Luminance discrimination was normal in all but two patients, and spatial resolution was uniformly spared. Curvature and line-orientation discrimination were impaired in only one patient, who also had the most difficulty with more basic-level object recognition. We conclude that deficits in luminance, spatial resolution, curvature, line orientation, and contrast at low spatial frequencies are unlikely to contribute to apperceptive prosopagnosia. More relevant may be contrast sensitivity at higher spatial frequencies and the analysis of object spatial structure. Deficits in these functions may impair perception of subtle variations in object shape, and may be one mechanism by which the recognition defect in prosopagnosia can extend to other classes of object subcategorization.     

The central nucleus of the amygdala is essential for acquiring and expressing conditional fear after overtraining

The basolateral complex of the amygdala (BLA) is critical for the acquisition and expression of Pavlovian fear conditioning in rats. Nonetheless, rats with neurotoxic BLA lesions can acquire conditional fear after overtraining (75 trials). The capacity of rats with BLA lesions to acquire fear memory may be mediated by the central nucleus of the amygdala (CEA). To examine this issue, we examined the influence of neurotoxic CEA lesions or reversible inactivation of the CEA on the acquisition and expression of conditional freezing after overtraining in rats. Rats with pretraining CEA lesions (whether alone or in combination with BLA lesions) did not acquire conditional freezing to either the conditioning context or an auditory conditional stimulus after extensive overtraining. Similarly, post-training lesions of the CEA or BLA prevented the expression of overtrained fear. Lastly, muscimol infusions into the CEA prevented both the acquisition and the expression of overtrained fear, demonstrating that the effects of CEA lesions are not likely due to the destruction of en passant axons. These results suggest that the CEA is essential for conditional freezing after Pavlovian fear conditioning. Moreover, overtraining may engage a compensatory fear conditioning circuit involving the CEA in animals with damage to the BLA.     

REDUCTIONS IN SELF-INJURY PRODUCED BY TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION

Transcutaneous electrical nerve stimulation is used to reduce pain but also may be useful for self-injurious behavior (SIB). In the current investigation, a microcurrent electromedical device, classified as a transcutaneous electrical nerve stimulator (TENS), was applied with a man with Down syndrome who displayed SIB that persisted in the absence of social contingencies. Although clinically significant results were not maintained, a clear difference in the rates of SIB during active and inactive TENS was observed.     

Partial Kluver-Bucy syndrome: two cases

Kluver-Bucy syndrome (KBS) is a rare neuropsychiatric disorder that may be characterized by visual agnosia, placidity, altered sexual activity, hypermetamorphosis, and hyperorality. Patients with KBS present with a complex behavioral syndrome. KBS is usually associated with lesions of the amygdala or amygdaloid pathways. However, partial KBS may occur in the absence of the classic bilateral temporal lesions. Pharmacologic treatment options have been developed from the results of case reports, which suggest that carbamazepine and antipsychotics may be helpful. We present the cases of two patients with partial KBS who responded favorably to antipsychotic medication.     

Changes in stereotyped central motor patterns controlling vocalization are induced by peripheral nerve injury.

Adult male zebra finches (Taeniopygia guttata), as closed-ended learners, normally crystallize their songs at 90 days of age, and the song remains fixed throughout life (Price, 1979). We show that injuring the tracheosyringeal nerve(s) (each of which innervates the ipsilateral half of the syrinx, the avian vocal organ) results in a short-term deficit in the syllables forming adult male song; this deficit disappears after ts nerve regeneration. However, when adult males were followed for a period of several weeks after unilateral tracheosyringeal nerve injury, long-term changes occurred in the temporal patterning of song. Syllables were deleted, remaining portions of the song were linked, and new syllables were added. Syllables with call-like morphology were less likely to be deleted from and more likely to be added to the song. Deletions were most often contiguous chunks of syllables. Changes in the temporal patterning of song occurred during specific periods following nerve injury, were completed within 100 days after nerve transection, and were not dependent upon regeneration of the ts nerve. The resulting newly formed song patterns were stable, remaining unchanged up to 1 year later. The ability of adult male zebra finches to make specific types of changes to crystallized song indicates that some form of vocal plasticity remains even after song learning is completed, though this plasticity may be restricted to a subset of song characteristics. The limitations on the types of changes that are possible may reflect how song is centrally organized.     

Neuropsychiatry of hypersexuality

Relatively few studies of the psychobiology of hypersexuality have been undertaken. Nevertheless, the literature does suggest the possibility of a neurobiology of hypersexuality. Three cases of hypersexual behavior are presented in the context of neuropsychiatric disorders, and the literature on this phenomenon is briefly reviewed. These case studies and the literature provide evidence that different brain systems may play a role in this disorder. Frontal lesions may be accompanied by disinhibition, including impulsive hypersexual response to external cues, while striatal lesions may be accompanied by repetitive triggering of internally generated response patterns. Temporal-limbic lesions may be accompanied by disturbances in sexual appetite itself, including change in the direction of sexual drive. These case studies demonstrate that a neurobiology of hypersexuality may prove of some heuristic value in the clinic. However, further research is required to consolidate the literature in this area.     

Sudden infant death syndrome and possible relation to vestibular function

Some infants seem to be born with a degree of respiratory centre immaturity which in combination with other problems such as illness, head colds, exposure to cold, air or smoke, may result in cessation of breathing. Vestibular stimulation by rocking has been shown to be beneficial for premature babies in reducing apnea. There also appear to be other benefits, resulting in more rapid maturation of the nerve cells of the cerebellum which is still developing during the first six months of life. The suggestion is made that crib deaths may be reduced by the use of automatically rocking cribs, particularly during the night when most deaths occur.     

自主控制眼跳：实验范式、神经机制和应用

自主控制眼跳是眼跳类型之一。自主控制眼跳实验范式为研究各种脑损伤,神经疾病和精神失调提供了一种新的研究手段,为研究眼跳的神经机制以及反应抑制、空间工作记忆等高级认知功能提供了重要的方法。文章介绍了自主控制眼跳的两种实验范式：反向眼跳和记忆导向眼跳,阐述了自主控制眼跳的神经机制及其实验范式的应用,指出自主控制眼跳实验范式为评定精神分裂症等脑功能失调病人的神经功能状态提供了重要的信息,为研究各种脑功能失调和精神疾病提供了重要的研究方法。今后的研究趋势是眼跳研究与神经成像技术和临床观察相结合     

Sexual dimorphism of auditory activity in the zebra finch song system

While the tracheosyringeal motor neurons of anesthetized male zebra finches fire in response to acoustic stimuli, the same motor neurons in females show no such response. Females masculinized by estradiol implants on Days 1 or 2 after hatching may develop auditory responses in their tracheosyringeal motor neurons; the presence of the response is directly related to the degree of masculinization of the estradiol-treated females' telencephalic song centers. In male zebra finches, neurons in HVc (Hyperstriatum Ventrale pars caudalis) respond to sound, and the HVc is necessary for the tracheosyringeal auditory response. Multiunit auditory activity was demonstrated in the HVc of female zebra finches. A single 20-microA pulse delivered to the male HVc elicits a large volley in the tracheosyringeal nerve; microstimulating the female HVc does not evoke a response in the motor nerve. This failure of both auditory and HVc stimulation to elicit a response in the female tracheosyringeal nerve is attributed to the lack of a functional HVc-nucleus Robustus Archistriatalis projection in females. If, as has been suggested, the tracheosyringeal auditory response may be important for the processing of song, female zebra finches might not process song in the same manner as do males.     

The dorsal tegmental noradrenergic projection: an analysis of its role in maze learning.

The hypothesis that the noradrenergic projection from the locus coeruleus (LC) to the cerebral cortex and hippocampus is an important neural substrate for learning was evaluated. Maze performance was studied in rats receiving either electrolytic lesions of LC or 6-hydroxydopamine (6-OHDA) lesions of the dorsal tegmental noradrenergic projection. The LC lesions did not disrupt the acquisition of a running response for food reinforcement in an L-shaped runway, even though hippocampal-cortical norepinephrine (NE) was reduced to 29%. Greater telencephalic NE depletions (to 6% of control levels) produced by 6-OHDA also failed to disrupt the acquisition of this behavior or to impair the acquisition of a food-reinforced position habit in a T-maze. Neither locomotor activity nor habituation to a novel environment was affected by the 6-OHDA lesions. Rats with such lesions were, however, found to be significantly more distractible than were controls during the performance of a previously trained response. The hypothesis that telencephalic NE is of fundamental importance in learning was not supported. The data suggest that this system may participate in attentional mechanisms.     

The temporal–hippocampal region and retention: The role of temporo-entorhinal connections in rats

Results from previous studies suggest that the entorhinal cortex may be involved in mnemonic processes. The present study was carried out to investigate whether disruption of fibre connections between the temporal cortex and lateral entorhinal area may impair retention of a pre-operatively acquired simultaneous brightness discrimination task. The lesion resulted in a severe impairment in retaining the discrimination task (Experiment 1). The retention deficit could not be traced into the hippocampal formation by making perforant path lesions or hippocampal lesions (Experiment 2). The results indicate that the lateral entorhinal cortex is more crucial for reference memory than the hippocampal formation.     

Wernicke-Korsakoff syndrome following small bowel obstruction

We report a case of a 64-year-old lady who developed clinical features of Wernicke-Korsakoff syndrome following a laparotomy for small bowel obstruction. Following the operation she developed paralytic ileus and required total parenteral nutrition for one month. A suspected history of average 40 units of weekly alcohol consumption prior to the operation could not be confirmed and the patient did not show any sign of alcohol dependence. Within a few months of treatment with a daily oral dose of thiamine 200 mgs supplemented by multivitamins the patient showed subjective evidence of improvement in confusion, confabulation, and anterograde amnesia, although objective tests showed residual deficits in many areas of cognitive functioning, including immediate and delayed recall of verbal and non-verbal materials, planning and switching of attention.