Decerebrate posturing following traumatic brain injury: MRI findings and their diagnostic value.

AIM: To determine the pathomorphological and clinical background to decerebrate posturing in humans following serious traumatic brain injury. MATERIALS AND METHODS: One hundred and twenty patients who had been unconscious for more than 24 h underwent diagnostic MRI within 8 days after trauma. The presence of decerebrate rigidity as the clinical parameter was correlated to MRI findings, such as traumatic lesions in defined brain areas. Significance was presumed as p < 0.05. RESULTS: On the day of MRI 43 (36%) patients exhibited decerebrate posturing: 19 (23%) cases were unilateral and 24 (77%) bilateral. There was a significant correlation between midbrain lesions and the presence of rigidity. If a midbrain lesion was found in the absence of pontine lesions, decerebrate rigidity could be concluded (p < 0.05). There was no significant correlation to the rigidity in the case of midbrain lesions accompanied by pontine lesions, and no correlation to the rigidity could be detected for other regions of the brain. Both the occurrence of decerebrate posturing and the detection of brainstem lesions at MRI correlated with the Glasgow Outcome Scale. The combination of both parameters improved the probability of predicting the outcome. CONCLUSION: The rate of decerebrate posturing increases significantly in the presence of midbrain lesions. The presence of pontine lesions appears to be of secondary importance. The chances of predicting the Glasgow Outcome Scale are improved by the combination of clinical information (decerebrate posturing) and radiological parameters (type of brainstem lesion).

A filmed hanging without decerebrate and decorticate rigidity: a case report and pathophysiological considerations.

The study of filmed hangings in the recent has reveal a striking similarity in the agonal sequences, with a sequence of rapid loss of consciousness, convulsions, and then a complex pattern of decerebrate rigidity and decorticate rigidity. We report a case of filmed hanging not presenting with decerebrate and decorticate rigidity. A 52-year-old man stepped off a stool, hanging himself in a complete suspension in an upright position. The movement of the body stepping off the stool created a rotary movement around the ceiling's ring and the body of the hanging man immediately started to revolve around the ring. Apart for the rolling around the ceiling's ring, the body stayed motionless for the duration of the movie, without any evidence of decerebrate or decorticate rigidity. A review of the pathophysiology of these reflex posturing gives some insight as to the possible elucidation for their absence in this specific case.

Midbrain and medullary control of postinspiratory activity of the crural and costal diaphragm in vivo.

Studies on brain stem respiratory neurons suggest that eupnea consists of three phases: inspiration, postinspiration, and expiration. However, it is not well understood how postinspiration is organized in the diaphragm, i.e., whether postinspiration differs in the crural and costal segments of the diaphragm and what the influence is of postinspiratory neurons on diaphragm function during eupnea. In this in vivo study we investigated the postinspiratory activity of the two diaphragm segments during eupnea and the changes in diaphragm function following modulation of eupnea. Postinspiratory neurons in the medulla were stereotaxically localized extracellularly and neurochemically stimulated. We used three types of preparations: precollicularly decerebrated unanesthetized cats and rats and anesthetized rats. In all preparations, during eupnea, postinspiratory activity was found in the crural but not in the costal diaphragm. When eupnea was discontinued in decerebrate cats in which stimulation in the nucleus retroambiguus induced activation of laryngeal or abdominal muscles, all postinspiratory activity in the crural diaphragm was abolished. In decerebrate rats, stimulation of the midbrain periaqueductal gray abolished postinspiration in the crural diaphragm but induced activation in the costal diaphragm. In anesthetized rats, stimulation of medullary postinspiratory neurons abolished the postinspiratory activity of the crural diaphragm. Vagal nerve stimulation in these rats increased the intensity of postinspiratory neuronal discharge in the solitary nucleus, leading to decreased activity of the crural diaphragm. These data demonstrate that three-phase breathing in the crural diaphragm during eupnea exists in vivo and that postinspiratory neurons have an inhibitory effect on crural diaphragm function.

Distribution of dendrites from longissimus lumborum motoneurons stained intracellularly with biocytin in adult cats.

The three-dimensional distribution of dendrites from motoneurons innervating longissimus lumborum (Long Motoneurons) in the L4 spinal segment was examined in the adult cat using intracellular staining techniques. Long Motoneurons were electrophysiologically identified, stained with injection of biocytin and reconstructed from serial histological sections. Somas of Long Motoneurons were mainly located in the lateral-ventral area of the ventral horn. The dendritic distribution followed an orderly pattern in all motoneurons examined. Long Motoneurons showed a multi-directional distribution of dendrites, and the dendritic distribution pattern varied depending on the motoneuron. All studied motoneurons distributed dendrites from the spine into the white matter. The most significant morphological characteristic of the Long Motoneurons was the variation in their dendritic distribution. No relationship was observed between the effects of peripheral afferent inputs from the hindlimb and morphological characteristics of motoneurons.

Disruption of cutaneous feedback alters magnitude but not direction of muscle responses to postural perturbations in the decerebrate cat.

Quadrupeds and bipeds respond to horizontal perturbations of the support surface with muscular responses that are broadly tuned and directionally sensitive. Since the discovery of this directional sensitivity, interest has turned toward the critical sensory systems necessary to generate these responses. We hypothesize that cutaneous feedback affects the magnitude of muscle responses to postural perturbation but has little effect on the directionality of the muscle response. We developed a modified premammillary decerebrate cat preparation to evaluate the sensory mechanisms driving this directionally sensitive muscle activation in response to support surface perturbation. This preparation allows us the flexibility to isolate the proprioceptive (cutaneous and muscle receptors) system from other sensory influences. We found that loss of cutaneous feedback leads to a significant loss in background activity causing a smaller muscular response to horizontal perturbations. However, the directional properties of the muscular responses remained intact.

Electromyographic responses from the hindlimb muscles of the decerebrate cat to horizontal support surface perturbations.

The sensory and neural mechanisms underlying postural control have received much attention in recent decades but remain poorly understood. Our objectives were 1) to establish the decerebrate cat as an appropriate model for further research into the sensory mechanisms of postural control and 2) to observe what elements of the postural response can be generated by the brain stem and spinal cord. Ten animals were decerebrated using a modified premammillary technique, which consists of a premammillary decerebration that is modified with a vertical transection near the subthalamic nucleus to eliminate spontaneous locomotion. Horizontal support surface perturbations were applied to all four limbs and electromyographic recordings were collected from 14 muscles of the right hindlimb. Muscle activation was quantified with tuning curves, which compared increases and decreases in muscle activity to background and graphed the difference against perturbation direction. Parallels were drawn between these tuning curves, which were further quantified with a principal direction and breadth (range of directions of muscle activation), and data collected by other researchers from the intact animal. We found a strong similarity in the direction and breadth of the tuning curves generated in the decerebrate and intact cat. These results support our hypothesis that directionally specific tuning of muscles in response to support surface perturbations does not require the cortex, further indicating a strong role for the brain stem and spinal cord circuits in mediating directionally appropriate muscle activation patterns.

Propagation of sinusoidal electrical waves along the spinal cord during a fictive motor task.

We present for the first time direct electrophysiological evidence of the phenomenon of traveling electrical waves produced by populations of interneurons within the spinal cord. We show that, during a fictive rhythmic motor task, scratching, an electrical field potential of spinal interneurons takes the shape of a sinuous wave, "sweeping" the lumbosacral spinal cord rostrocaudally with a mean speed of approximately 0.3 m/s. We observed that traveling waves and scratching have the same cycle duration and that duration of the flexor phase, but not of the extensor phase, is highly correlated with the cycle duration of the traveling waves. Furthermore, we found that the interneurons from the deep dorsal horn and the intermediate nucleus can generate the spinal traveling waves, even in the absence of motoneuronal activity. These findings show that the sinusoidal field potentials generated during fictive scratching could be a powerful tool to disclose the organization of central pattern generator networks.

Caudal brainstem processing is sufficient for behavioral, sympathetic, and parasympathetic responses driven by peripheral and hindbrain glucagon-like-peptide-1 receptor stimulation.

The effects of peripheral glucagon like peptide-1 receptor (GLP-1R) stimulation on feeding, gastric emptying, and energetic responses involve vagal transmission and central nervous system processing. Despite a lack of studies aimed at determining which central nervous system regions are critical for the GLP-1R response production, hypothalamic/forebrain processing is regarded as essential for these effects. Here the contribution of the caudal brainstem to the control of food intake, core temperature, heart rate, and gastric emptying responses generated by peripheral delivery of the GLP-1R agonist, exendin-4 (Ex-4), was assessed by comparing responses of chronic supracollicular decerebrate (CD) rats to those of pair-fed intact control rats. Responses driven by hindbrain intracerebroventricular (fourth i.c.v) delivery of Ex-4 were also evaluated. Intraperitoneal Ex-4 (1.2 and 3.0 microg/kg) suppressed glucose intake in both CD rats (5.0+/-1.2 and 4.4+/-1.1 ml ingested) and controls (9.4+/-1.5 and 7.7+/-0.8 ml ingested), compared with intakes after vehicle injections (13.1+/-2.5 and 13.2+/-1.7 ml ingested, respectively). Hindbrain ventricular Ex-4 (0.3 microg) also suppressed food intake in CD rats (4.7+/-0.6 ml ingested) and controls (11.0+/-2.9 ml ingested), compared with vehicle intakes (9.3+/-2.1 and 19.3+/-4.3 ml ingested, respectively). Intraperitoneal Ex-4 (0.12, 1.2, 2.4 microg/kg) reduced gastric emptying rates in a dose-related manner similarly for both CD and control rats. Hypothermia followed ip and fourth i.c.v Ex-4 in awake, behaving controls (0.6 and 1.0 C average suppression) and CD rats (1.5 and 2.5 C average suppression). Intraperitoneal Ex-4 triggered tachycardia in both control and CD rats. Results demonstrate that caudal brainstem processing is sufficient for mediating the suppression of intake, core temperature, and gastric emptying rates as well as tachycardia triggered by peripheral GLP-1R activation and also hindbrain-delivered ligand. Contrary to the literature, hypothalamic/forebrain processing and forebrain-caudal brainstem communication is not required for the observed responses.

Postural performance in decerebrated rabbit.

It is known that animals decerebrated at the premammillary level are capable of standing and walking without losing balance, in contrast to postmammillary ones which do not exhibit such behavior. The main goals of the present study were, first, to characterize the postural performance in premammillary rabbits, and, second, to activate the postural system in postmammillary ones by brainstem stimulation. For evaluation of postural capacity of decerebrated rabbits, motor and EMG responses to lateral tilts of the supporting platform and to lateral pushes were recorded before and after decerebration. In addition, the righting behavior (i.e., standing up from the lying position) was video recorded. We found that, in premammillary rabbits, responses to lateral tilts and pushes were similar to those observed in intact ones, but the magnitude of responses was reduced. During righting, premammillary rabbits assumed the normal position slower than intact ones. To activate the postural system in postmammillary rabbits, we stimulated electrically two brainstem structures, the mesencephalic locomotor region (MLR) and the ventral tegmental field (VTF). The MLR stimulation (prior to elicitation of locomotion) and the VTF stimulation caused an increase of the tone of hindlimb extensors, and enhanced their responses to lateral tilts and to pushes. These results indicate that the basic mechanisms for maintenance of body posture and equilibrium during standing are present in decerebrated animals. They are active in the premammillary rabbits but need to be activated in the postmammillary ones.

Leptin responsiveness in chronically decerebrate rats.

Peripheral infusions of physiological doses of leptin decrease body fat mass, but it is not known whether this results from direct effects on peripheral tissue or activation of central leptin receptors. In this study, we infused chronically decerebrate (CD) rats, in which the forebrain was surgically isolated from the caudal brainstem, with 60 microg leptin/d or PBS for 14 d from ip mini-osmotic pumps. The CD rats were tube fed an amount of food equivalent to the intake of ad libitum-fed intact controls or 75% of this amount to account for their reduced energy expenditure. Control rats fed ad libitum or tube fed 75, 100, or 125% of their ad libitum intake also were peripherally infused with leptin or PBS. CD rats had a lower serum testosterone, energy expenditure, and lean body mass compared with controls but had increased levels of adiponectin and leptin and were obese. Leptin increased body fat and decreased energy expenditure during the light period in 100%-fed CD rats, but not 75%-fed CD rats. Leptin decreased body fat of ad libitum- and 100%-fed but not 75%-fed or 125%-fed intact controls. Energy expenditure did not change in any control group. These results show that leptin can change body fat independent of a change in food intake or energy expenditure, that the forebrain normally prevents leptin from inhibiting energy expenditure through mechanisms initiated in the caudal brainstem or peripheral tissues, and that the leptin response in both intact and CD rats is determined by the energy status of the animal.

Saccades to the seeing visual hemifield in hemidecorticate patients exhibit task-dependent reaction times and hypometria.

In three patients who had one cortical hemisphere removed surgically (hemidecortication), we studied visually-triggered saccades directed contralateral to the intact cortical hemisphere (i.e., ipsilesional saccades). Both saccade reaction times (SRTs) and accuracy of these saccades have been reported as abnormal in hemidecorticate patients, but not monkeys. One explanation for this difference is that deficits in hemidecorticate patients may not have been directly caused by removal of cortical oculomotor structures themselves, but may have been a manifestation of compensatory strategies used to cope with contralesional hemianopia. We hypothesized that deficits in saccade performance to the ipsilesional (seeing) visual hemifield would be directly linked to how easily patients could localize targets in their blind hemifield with searching saccades. To test this hypothesis, we examined how deficits in our patients varied when targets were: (1) randomly presented to either the seeing or blind hemifield for long durations thereby permitting searching saccades in the blind hemifield; (2) presented as in Experiment 1, but briefly flashed thereby removing visual feedback prior to saccade onset thereby rendering searching saccades useless; (3) briefly flashed as in Experiment 2, but at random locations in only the seeing hemifield (blind hemifield irrelevant). Mean SRTs to the seeing hemifield were 165 ms longer than normal in Experiment 2, but only about 40 ms longer in Experiments 1 and 3. Saccade accuracy was characterized by task-dependent hypometria in all three experiments with a mean undershoot of about twice the amplitude variance. The largest undershoots were in Experiments 2 and 3. Our data suggest that deficits resulted from the direct effects of the lesions themselves coupled with context-dependent strategies used to cope with contralesional hemianopia.

Characteristics and mechanisms of locomotion induced by intraspinal microstimulation and dorsal root stimulation in spinal cats.

Intraspinal microstimulation (ISMS) through a single microelectrode can induce locomotion in cats spinalized at T(13) 1 wk before (untrained) or after 3-5 wk of treadmill training. Here we study the optimal parameters of ISMS and the characteristics of locomotion evoked. ISMS was applied in the dorsal region of segments L(3)-S(1) at different lateralities (midline to 2.5 mm) and after an intravenous injection of clonidine (noradrenergic agonist). Kinematics and electromyographic recordings were used to characterize locomotion. ISMS could induce a bilateral locomotor pattern similar to that obtained with perineal stimulation, and the characteristics of locomotion varied according to the spinal segment stimulated. Mechanisms by which ISMS could evoke locomotion were then investigated by stimulating, inactivating, or lesioning different spinal structures. Dorsal root stimulation (DRS), just like ISMS, could evoke a variety of ipsi- and bilateral nonlocomotor movements as well as locomotor responses. This suggests that sensory afferent pathways are involved in the production of locomotion by ISMS. Microinjections of yohimbine (noradrenergic antagonist) in L(3) and L(4) segments or a complete second spinal lesion at L(3)-L(4) abolished all locomotor activity evoked by ISMS applied at more caudal segments. Progressive dorsoventral spinal lesions at L(3) or L(4) and restricted ventral lesions at L(4) further suggest that the integrity of the ventral or ventrolateral funiculi as well as the L(3)-L(4) segments are critical for the induction of locomotion by ISMS at L(5) to S(1) or by DRS at these caudal segments.

Topography of spinal neurons active during hindlimb withdrawal reflexes in the decerebrate cat.

There exists a spatial organization of receptive fields and a modular organization of the flexion withdrawal reflex system. However, the three dimensional location and organization of interneurons interposed in flexion reflex pathways has not been systematically examined. We determined the anatomical locations of spinal neurons involved in the hindlimb flexion withdrawal reflex using expression of the immediate early gene c-fos and the corresponding FOS protein. The flexion withdrawal reflex was evoked in decerebrate cats via stimulation of the tibial or superficial peroneal nerve. Animals that received stimulation had significantly larger numbers of cells expressing FOS-like immunoreactivity (42.7+/-2.3 cells/section, mean+/-standard error of the mean) than operated unstimulated controls (18.6+/-1.4 cells/section). Compared with controls, cells expressing FOS-like immunoreactivity were located predominantly on the ipsilateral side, in laminae IV-VI, at L6 and rostral L7 segments, and between 20% and 60% of the distance from the midline to the lateral border of the ventral gray matter. Labeled neurons resulting from tibial nerve stimulation were medial to neurons labeled following superficial peroneal nerve stimulation in laminae I-VI, but not VII. The mean mediolateral positions of labeled neurons from both nerves shifted medially as the transverse plane in which they were viewed was moved from rostral to caudal and as the coronal plane in which they were viewed was moved from dorsal to ventral. The mediolateral separation between populations of labeled cells was consistent with primary afferent projections and the location of reflex encoders. This topographical segregation corresponding to different afferent inputs is a possible anatomical substrate for a modular organization of the flexion withdrawal reflex system.

Purkinje cell activity during classical eyeblink conditioning in decerebrate guinea pigs.

Purkinje cells are the sole output from the cerebellar cortex and play a critical role during classical eyeblink conditioning. The present study revealed for the first time a learning-related change in individual Purkinje cell activity during successive eyeblink conditioning in decerebrate guinea pigs which permitted continuous single unit recording from the simplex lobe of the cerebellar cortex. The pair-conditioned group received paired presentation of the conditioned stimulus (CS) and unconditioned stimulus (US) until the frequency of the conditioned response (CR) exceeded 80%. The control group received a comparable number of the CS and US in a pseudorandom fashion. Responses of Purkinje cells to the CS were classified into four types: excitatory, inhibitory, a combination of the two, or no response. Approximately half of the recorded cells from both groups changed their response type at various conditioning stages. The firing frequency of a Purkinje cell to the CS showed a tendency to decrease in the pair-conditioned group, while it had a tendency to increase in the pseudoconditioned group. This learning-related difference in change of response type was attributable to a difference in the change between the no response and the inhibitory response types. Correlation analysis of the temporal pattern between the neural activity and the CR revealed that most of the cells that developed an inhibitory response by paired conditioning acquired the CR-related temporal pattern. These results suggest that the learning-related Purkinje cells gain an inhibitory response with a temporal pattern correlated with the CR topography.

Hypovolemia stimulates intraoral intake of water and NaCl solution in intact rats but not in chronic decerebrate rats.

This experiment tested the hypothesis that afferent signals from cardiac baroreceptors to the caudal brain stem are integrated by hindbrain systems to control ingestive behavior in response to plasma volume deficits in rats. A supracollicular transection was made which should not interfere with the neural signal of volume depletion to the hindbrain. Decerebrate (n=5) and control rats (n=7) were given subcutaneous injections of 30% polyethylene glycol (PEG) to induce hypovolemia or of isotonic saline as a control. Four hours after the injection, either water or 0.1 M NaCl was administered through an intraoral cannula, and intakes were measured. Decerebrate rats did not ingest significantly more water or saline after PEG treatment than after the control treatment, whereas control rats ingested both fluids in significantly larger volumes after PEG treatment. In another test using the same animals, heart rate was monitored after intravenous injections of phenylephrine (to raise blood pressure) and nitroprusside (to lower it). Similar reflexive changes in heart rate were observed in control and decerebrate rats, showing that baroreflex function was not impaired by decerebration. These results indicate that baroafferent signals are processed at multiple levels of the neuraxis, with hindbrain systems mediating autonomic cardiovascular reflexes in response to changes in blood pressure, and midbrain or forebrain systems mediating behavioral responses associated with thirst.

Seizures in Japanese encephalitis.

OBJECTIVE: Although Japanese encephalitis (JE) has been reported to be associated with seizures, there is no report on its frequency, pattern and severity and their correlation with electroencephalography (EEG) and radiological findings. In this communication, the analysis of seizures in 65 JE patients seen during 1991-1999 is presented. METHODS: The diagnosis of JE was based on clinical, radiological and serological criteria. The patients were subjected to a detailed clinical evaluation. Frequency and pattern of seizures and other neurological findings were recorded. Cranial CT scan or MRI was carried out in all the patients. Electroencephalograph was recorded using the 10-20 system of electrode placement. Patients' outcome was defined, on the basis of clinical status for 3 months, into poor, partial and complete recovery. The relationship between seizures and other clinical, radiological and EEG parameters was evaluated by the Z test of proportion using the two-tail approach. RESULTS: The patient's age ranged between 2 and 57 years, 24 were females and 19 were below 13 years of age. Thirty patients had seizures within the first week of encephalitis. The seizures were generalised tonic-clonic in 17 patients and partial motor with secondary generalization in 13 patients. Eleven patients had a single seizure, 8 had two seizures and 11 had multiple seizures. Two patients were presented with status epilepticus. Interictal EEG in the patients with seizures revealed theta to delta slowing in all patients and epileptiform discharges in four patients only. MRI revealed thalamic lesions bilaterally in 24, cortical in 7, basal ganglia in 8 and brainstem in 3 patients out of 26 patients with seizure. In the seizure group, three patients died, nine had poor, eight had partial and nine had complete recovery. Upon comparison of the JE patients with and without seizures, Glasgow coma scale (GCS) score, focal weakness, EEG slowing and cortical and thalamic lesion on CT or MRI were significantly related to the occurrence of the seizures; however, it was not associated with poor outcome. CONCLUSIONS: JE is associated with seizures in 46% of the patients in the acute stage of encephalitis which is easily controlled by monotherapy. Patients with severe encephalitis were associated with higher frequency of seizures.

Decerebration by global ischemic stroke in rats.

In this study we present a fast and simple technique to decerebrate rats. By injecting polyvinylsiloxane (PVS) into both common carotid arteries we occluded the circle of Willis and all cerebral arteries, thereby completely interrupting the blood supply to the cerebrum. High viscosity PVS was used so that it only entered the large arteries, and did not pass into the capillary beds. This procedure reliably resulted in an anemic decerebration, without interfering with the blood supply to the brainstem. Long-term survival was achieved by reducing intracranial pressure by the application of steroids and/or opening the skull.

Changes in fusimotor activity during repetitive lengthening muscle contractions in decerebrate cats.

Responses of fusimotor neurons to lengthening vs isometric contractions have been studied in decerebrate cats. Spike discharges of fusimotor neurons to the medial gastrocnemius muscle were recorded from this muscle nerve filament during sequences of contractions and/or stretches of the lateral gastrocnemius and soleus muscles. The sequences lasted for 250-450s (duty cycle 4:2 s). Isometric contractions were elicited by electrical stimulation (40 Hz, 1.3 times motor threshold) of the muscle nerves. Lengthening contractions were elicited in the same way while the muscles were stretched by 4 mm at a velocity of 1 mm/s. Of 25 fusimotor neurons studied, 23 responded to muscle contractions with an increase in firing rate, subsiding towards the end of the sequence. The increase was either modulated with each subsequent contraction or smooth throughout the sequence. Approximately 64% of fusimotor neurons, responding to muscle contractions, responded in a similar way to the sequences of muscle stretches, applied alone. Responses to sequences of the lengthening contractions were significantly larger, on average, than those to the isometric ones, but smaller than the sum of the responses to the contractions and stretches applied separately. On the other hand, they were also larger in fusimotor units, showing no overt responses to muscle stretches alone.

A clinical conundrum: unilateral decerebrate rigidity.

A case is described in which, following a motorcycle accident resulting in a closed head injury, a young woman was rendered unconscious. On examination she was found to have unilateral decerebrate rigidity. Further clinical and radiological examination revealed that there was no damage to the limbs, vertebral column, or spinal cord. Readers are expected to be able to make an anatomical diagnosis on the basis of the facts presented.