Insular cortical projections to functional regions of the striatum correlate with cortical cytoarchitectonic organization in the primate.

We examined the striatal projections from different cytoarchitectonic regions of the insular cortex using anterograde and retrograde techniques. The shell and medial ventral striatum receive inputs primarily from the agranular and ventral dysgranular insula. The central ventral striatum receives inputs primarily from the dorsal agranular and dysgranular insula. Projections to the central ventral striatum originate from more posterior and dorsal insular regions than projections to the medial ventral striatum. The dorsolateral striatum receives projections primarily from the dorsal dysgranular and granular insula. These results show that cytoarchitectonically less differentiated (agranular) insular regions project to the ventromedial "limbic" part of the ventral striatum, whereas more differentiated (granular) insular regions project to the dorsolateral "sensorimotor" part of the striatum. The finding that the ventral "limbic" striatum receives inputs from less differentiated regions of the insula is consistent with the general principle that less differentiated cortical regions project primarily to the "limbic" striatum. Functionally, the ventral striatum receives insular projections primarily related to integrating feeding behavior with rewards and memory, whereas the dorsolateral striatum receives insular inputs related to the somatosensation. Information regarding food acquisition in the insula may be sent to the intermediate area of the striatum.

[Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes with delayed and decreased cerebral blood flow on cerebral angiography--a case report].

A 9-year-old girl was admitted to our hospital because of fever, headache, vomiting, and convulsive seizures. On admission, she was proved to have homonymous hemianopsia as well as elevated lactate and pyruvate levels in both serum and cerebrospinal fluid. Muscle biopsy study showed scattered ragged-red fibers and strongly succinatedehydrogenase-reactive blood vessels (SSV), suggesting systemic vascular involvement. She had a point mutation at nucleotide pair 3,243 in mitochondrial DNA extracted from muscle and blood samples. Brain CT and MRI showed a large abnormal area mimicking cerebral infarction in the region of the occipital cerebral artery. The cerebral lesion was assumed to be caused by vascular abnormality because of delayed and decreased cerebral blood flow together with vascular changes in her muscle biopsy.

[A case of low grade glioma with Takayasu disease (aortitis syndrome)].

We experienced a rare case of Takayasu disease with low grade glioma. A 36 year-old female had an episode of right hemiconvulsion. On admission, she complained a slight memory disturbance, urination difficulty and motor weakness of right extremities. CT scan demonstrated a low density lesion in the left frontal lobe. MRI showed an inhomogeneous low intense mass on T 1 WI and a homogeneous high intense mass on T2 WI in the same site. No abnormal contrast enhancement was observed in both CT and MRI. Bilateral carotid angiograms demonstrated a filling defect of the left anterior cerebral artery. An aortogram revealed moderate stenosis of the left carotid artery and the brachiocephalic artery, and complete obstruction of the left subclavian artery. CT-guided stereotactic biopsy was performed using BRW stereotactic system and histological diagnosis was astrocytoma grade II. She was followed by interstitial irradiation of 50 Gy at tumor periphery for 10 days. Her neurological symptoms gradually improved, and she is doing well without neurological deficits at the time of this report. The CT scan obtained 13 months after the brachytherapy revealed a decrease in the extent of low density. Brachytherapy seems to be useful for patients with low grade glioma in the eloquent area of the brain.

[Brainstem glioma with supratentorial meningeal dissemination--a case report].

We present a very rare case of 7 year-old-girl who had a pontine glioma with supratentorial meningeal involvement. She complained severe headache with meningeal irritation. She showed fluctuating cranial nerve impairment of the both abducens and glosopharyngeal nerves but no signs of weakness or facial paresis. She also reported two episodes of generalized convulsion with unconsciousness during admission. MRI disclosed a hypointensity intrinsic brainstem mass with an enhancing exophytic component in the prepontine cistern and a sharp contrast uptake is disclosed in the left-meninges of the supratentrial structures. An open biopsy was performed and diagnosed as a high grade astrocytoma.

Facial pain due to brainstem encephalitis. MRI confirmation of the lesion.

A 67-year-old woman developed central pain in the face with bilateral horizontal gaze palsy following brainstem encephalitis. Magnetic resonance imaging demonstrated a lesion in the pontobulbar tegmental area.

Intracranial hemorrhage associated with nontraumatic disseminated intravascular coagulation--report of four cases.

The authors report four cases of intracranial hemorrhage associated with nontraumatic disseminated intravascular coagulation (DIC). Two cases demonstrated a sudden onset of intracerebral hemorrhage. The other two showed chronic subdural hematoma initially, followed by acute multiple intracranial hemorrhages or general hemorrhagic diathesis. The underlying disorders were glioblastoma multiforme, thoracoabdominal aortic aneurysm, acute promyelocytic leukemia, and stomach cancer associated with disseminated carcinomatosis of the bone marrow. All patients died eventually. When the underlying disorder has a rare incidence of DIC as in glioblastoma multiforme or thoracoabdominal aortic aneurysm, the possibility of DIC and the need for immediate initiation of replacement therapy should be recognized, although the mortality is very high because the underlying disorder cannot be eliminated quickly. When the underlying disorder has a high incidence of DIC as in acute promyelocytic leukemia or disseminated carcinomatosis of the bone marrow, it is mandatory to start replacement therapy and treatment for the underlying disorder simultaneously. DIC can be controlled when the treatment for the underlying disorder is effective.

Optic nerve degeneration caused by supraophthalmic carotid artery infusion with cisplatin and ACNU. Case report.

A 28-year-old woman with a left frontoparietal anaplastic astrocytoma was treated postoperatively with a combination of cisplatin and 1-(4-amino-2-methylpyrimidine-5-yl) methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU). The drugs were infused via the left supraophthalmic internal carotid artery in an attempt to avoid ocular toxicity. The patient subsequently developed blindness in the left eye and a right temporal hemianopsia from marked degeneration of the left optic nerve and tract. It is apparent that the placement of a catheter into the supraophthalmic carotid artery does not exclude visual complications.

Coagulation and fibrinolysis in chronic subdural hematoma.

In 19 patients with chronic subdural hematoma, coagulation and fibrinolysis in venous blood taken at the time of surgery and in the hematoma contents aspirated from chronic subdural hematoma were studied. Compared with coagulation results for venous blood, the hematoma contents demonstrated marked prolongation of the recalcification time, prothrombin time, and activated partial thromboplastin time, and marked reduction of clotting factor V, the hepaplastin test, prothrombin, and fibrinogen. Antithrombin III was also decreased, and fibrinopeptide A was increased in the hematomas. Fibrinolytic results demonstrated that both plasminogen and alpha 2-plasmin inhibitor were decreased, and both fibrinopeptide B beta 15-42 and fibrin and fibrinogen degradation products were increased in the hematomas. These findings indicate excessive activation of the clotting system, thrombin generation, and increased fibrinolytic activity occurring in the hematomas. From these results, excessive activation of both the clotting and fibrinolytic systems is emphasized to be the possible etiological factor for the origin and development of chronic subdural hematoma.

Radiological studies of the cheiro-oral syndrome.

Four cases of the cheiro-oral syndrome are reported, with a review of the clinical symptoms and signs and the neuroradiological methods used to demonstrate the responsible lesion. In each case, angiography, computed tomography (CT) and magnetic resonance imaging (MRI) were performed. The lesion was found in the thalamus in three cases and in the pons in one. Infarction had occurred in three cases and haemorrhage in one. Angiography revealed normal findings in all cases. CT at the onset of the symptoms demonstrated a small haemorrhage in the thalamus in one case but was not helpful in the others, and MRI was required to identify infarction. The anatomical sites responsible for the cheiro-oral syndrome have been reported to be in the central gyrus, in the thalamus, and in the brain stem. The clinical symptoms and signs reported in the literature and in our four cases are reviewed to evaluate aetiological factors and clinical features according to the three different sites of lesions causing this syndrome.

Effect of BCG on cytostatic activity of peritoneal macrophages from normal and tumor-bearing rats.

In tumor-bearing rats inoculated intramuscularly with 5 x 10(4) SLC cells, the cytostatic activity of peritoneal macrophages was elevated in the early stage (7 days after transplantation) and decreased in the advanced stage (21 days after transplantation). When BCG was intraperitoneally administered into normal and tumor-bearing rats, peritoneal macrophages showed higher cytostatic activity than the untreated macrophages. This elevated cytostatic activity of the marcophages obtained from BCG-treated tumor-bearing rats was maintained even at an advanced stage.

Effect of 1(4-amino-2-methyl-5-pyrimidinyl) methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU) on Sato lung carcinoma (SLC). Preliminary result of immunochemotherapy for SLC by combination of ACNU and Propionibacterium acnes.

ACNU was highly effective for Sato lung carcinoma transplanted intravenously or intramuscularly by using a large single dose, and the cytotoxic action of ACNU for SLC showed clear dependence upon tumor size. Nonspecific activation of host-defence mechanism by Propionibacterium acnes contributed to the suppression for the regrowth of solid SLC treated by ACNU.

Effect of Propionibacterium acnes or BCG on enzyme activities in spleen lymphocytes of Donryu strain rats.

Immunopotentiated rats, which were injected with Propionibacterium acnes or BCG, had the 50% survival twice as long as those in untreated controls after intravenous inoculation of Sato lung carcinoma (SLC) cells. The amount of labeled tumor cells in the lung of the adjuvant-treated rats decreased significantly in the first 20 hr after intravenous injection of 51Cr-labeled tumor cells compared to that of control animals. The elevated activities of ATPase and acid phosphatase in the whole nucleated spleen cells as well as spleen lymphocytes separated by Ficoll-Conray gradient were also demonstrated in adjuvant-treated groups. These data suggested that the elevation of ATPase and acid phosphatase activities in nucleated spleen cells as well as spleen lymphocytes has an important role for the suppression of tumor growth in adjuvant-treated rats.