Fate of the supraspinal collaterals of cord-projection neurons following upper spinal axonal injury.

In investigating the fate of the cord-projecting CNS neurons following spinal axonal injury, we have demonstrated that surviving rat rubrospinal neurons have altered electrical membrane properties so that their input/output relationship was increased. Further, we found that the synaptic inhibition they received from nearby reticular formation was also reduced following injury. Whether or not these property changes were functional was dependent on the output connections of injured neurons. In the current communication, we examined the supraspinal efferents of the injured neurons recognizing that normal neurons innervate not only spinal but also supraspinal targets. To this end we conducted anterograde tracing on the injured red nucleus 8 weeks following spinal lesion. Results showed that injured rubrospinal neurons still innervated the same supraspinal targets, targeted by normal neurons. We subsequently evaluated the relative intensity of the sustained supraspinal connectivity by examining, in detail, the cerebellar projection of rubrospinal neurons of similarly injured animals using retrograde tracing technique. Here our data revealed that the number, distribution and labeling intensity of rubrospinal neurons projecting to the cerebellum were unchanged following cord injury. In conclusion, although spinal cord injury deprive cord-projecting CNS neurons of their spinal targets, injured neurons survived with altered electrical membrane properties and intact supraspinal projections. The sustained supraspinal connections might allow injured cord-projecting CNS neurons to exert a different weight of influence on higher centers following spinal cord injury.

Variables affecting the accuracy of stereotactic localization using computerized tomography.

Stereotactic localization using computerized tomography (CT) is increasingly employed to guide neurosurgical procedures in crucial areas of the brain such as the brain stem. This technique allows the surgeon to resect a lesion in its entirety while sparing critical areas of the brain. Thus, the parameters used for scanning should be selected for maximum accuracy. While the small pixel size of CT scanners suggests a high degree of precision in localization, there have been few systematic studies of this accuracy. The authors have studied the amount of error in localization created by variables such as CT scan thickness, interscan spacing, size of lesion, and method of computation when using the Brown-Roberts-Wells (BRW) stereotactic system. Over 1000 CT scans were made of a phantom composed of spheres of differing diameter and location. The CT slice thickness was varied from 1.5 to 5.0 mm, and interscan spacing was varied from 0.5 to 3.0 mm. The coordinates of the center of the spheres were calculated independently using the laptop computer supplied with the unit and also by a stereotactic computer which automatically calculates the center of the fiducials. The actual BRW coordinates of the sphere center were obtained using the phantom base and were then compared to the computer-calculated coordinates to determine error in localization. Variables with a significant effect on error included the scan thickness, interscan spacing, and sphere size. The mean error decreased 23% as the scan thickness decreased from 5.0 to 1.5 mm and 45% as the interscan spacing decreased from 3.0 to 0.5 mm. Mean error was greatest for the smallest sphere sizes. The two computational methods did not differ in error. This study suggests that, for critical areas of the brain or for small lesions, a scan thickness of 1.5 mm and interscan spacing of 0.5 mm should be employed.

Correlation of neuromuscular pathology in acquired immune deficiency syndrome patients with cytomegalovirus infection and zidovudine treatment.

Peripheral nerve and skeletal muscle specimens from 115 autopsied adult AIDS patients were examined for types and incidence of histological abnormalities. Focal perivascular chronic inflammatory infiltrates featuring plasma cells were found in 85% of nerve and muscle specimens. These foci were specifically associated with cytomegalovirus (CMV)-infected capillary or venous endothelial cells in neuromuscular specimens of 31/115 patients, with increasing incidence in patients surviving longer with the diagnosis of AIDS. Neuromuscular CMV was identified histologically in 19% of AIDS patients with an AIDS-defining illness for 3 months or less, with the incidence increasing to 46% of patients who had the diagnosis for 2 years or longer. Vascular damage from CMV endothelial infection may result in regional ischemic and/or inflammatory damage to nerves, producing myelinated fiber loss and axonal degeneration, leading to denervation atrophy of myofibers found in skeletal muscle specimens in a majority of the patients. Myelinated fiber loss within the sural nerve was determined by morphometric quantitation for a subset of 50 patients, and correlated with the presence of histologically identifiable neuromuscular CMV, clinical history of zidovudine administration, and chemotherapy for alleviation of Kaposi's sarcoma. CMV infection and zidovudine treatment were both positively correlated with myelinated fiber loss, while Kaposi's sarcoma chemotherapy did not independently increase the incidence of myelinated fiber loss.

Olfactory neuroblastoma mimicking primary intracranial neoplasm.

A case of esthesioneuroblastoma with an unusual clinical and radiographic presentation is reported. The presenting symptoms as well as the computed tomographic examination were compatible with a primary intracranial mass.

Cytomegalovirus in the nervous system of patients with the acquired immune deficiency syndrome.

Clinicopathological features of infection of the nervous system by cytomegalovirus (CMV) in 31 patients with the acquired immune deficiency syndrome (AIDS) are reviewed. Neuropathology was variable, ranging from rare isolated CMV inclusions in brain without associated inflammation or necrosis, to severe necrotizing ependymitis and meningoencephalitis. In 1 patient, CMV had produced a necrotizing meningoradiculitis which presented clinically as ascending paralysis. In the brains and spinal cords of 6 patients, evidence of human immunodeficiency virus (HIV) infection of neural parenchyma was seen in close proximity to CMV infection. Both viruses individually or together were associated with low grade (microglial nodule) encephalitis. In retrospect, the diagnosis of CMV had been a difficult one to make clinically in neurologically impaired patients with AIDS. The results suggest that CMV may also localize in the nervous system without significant clinical sequelae. Imaging studies and analysis of cerebrospinal fluid revealed abnormalities in many patients, but none of them (short of culture of CMV itself in two cases) appeared to be specific to this neurological complication of the immunodeficiency.

Effects of isobutyl 2-cyanoacrylate polymer on cultured cells derived from murine cerebral microvessels.

The initial and delayed effects of isobutyl 2-cyanoacrylate (IBCA) polymer on cells cultured from the wall of mouse cerebral microvessels were examined using a simple cytotoxicity assay. Cell cultured media were conditioned by exposure to IBCA polymer for 24-hr periods over the 15 days following polymerization and the media were then added to confluent endothelial or smooth muscle cell monolayers. The resulting cell detachment was assessed as a measure of cytotoxicity. The results indicated that immediately or a few days after polymerization and at approximately 12-13 days after polymerization, IBCA released material(s) that caused significant cell detachment from cell monolayers. This finding may explain some of the observed toxic effects of IBCA, particularly on vascular lesions within the brain. This simple bioassay may be used to study early and delayed effects of other potential embolotherapy materials on components of the blood vessel wall.

Diagnosis of penicillin allergy by skin testing: the Manitoba experience.

The reliability of skin testing in the diagnosis of penicillin allergy was studied in 86 adults and 167 children with a history of possible hypersensitivity reactions to penicillin. Skin testing was done with the major antigenic determinant of benzylpenicillin and minor determinants of benzylpenicillin, ampicillin, cloxacillin, methicillin and cephalothin. The overall frequency of positive skin reactions was 11.5%. Among the patients with positive skin reactions about half had a history of immediate or accelerated reactions to penicillins, but 2 of 11 adults and 50% of the children in this group had a history of maculopapular rash of delayed onset. There was a low frequency of positive skin reactions when there was a long interval between the times of clinical reaction and skin testing. Of 169 patients reacting negatively to skin testing who received a specific drug challenge only 2 manifested mild urticaria; this indicates the reliability of the skin tests in predicting penicillin allergy. The major and minor determinants of benzylpenicillin were the most useful reagents. One fifth of the patients with penicillin hypersensitivity would have been missed if the major determinant of benzylpenicillin alone had been used for skin testing. The additional use of the minor determinants of other penicillin derivatives, however, did not increase substantially the clinical reliability of the skin testing procedure.

Potassium hydroxide solution 10% for the fast hydrolysis of esters for analysis.

The applicability of a five-minute hydrolysis method with 10% potassium hydroxide in an alcohol-water (80-20) mixture was investigated for the quantitative determination of certain esters (aspirin, benzocaine, benzyl benzoate, methyl paraben, phenyl salicylate, procaine hydrochloride, propyl paraben, salicylanilide and 0-salicylsalicylic acid) and salicylamide. The results indicate that the method is satisfactory for all but methyl paraben and propyl paraben.

Quantitative determination of benzyl benzoate in benzyl benzoate lotion NF.

The development of a simple, shorter and more accurate method than the NF method for the determination of benzyl benzoate in Benzyl Benzoate Lotion NF is discussed. Hydrolyzed benzyl benzoate was measured spectrophotometrically. Interference from other ingredients of the lotion, oleic acid and triethanolamine was almost negligible. The proposed method was completed in approximately 15 minutes, as opposed to the two hours required by the NF procedure.