Fever in subarachnoid hemorrhage: relationship to vasospasm and outcome.

OBJECTIVE: To investigate the causes of fever in subarachnoid hemorrhage (SAH) and examine its relationship to outcome. BACKGROUND: Fever adversely affects outcome in stroke. Patients with SAH are at risk for cerebral ischemia due to vasospasm (VSP). In these patients, fever may be both caused by, and potentiate, VSP-mediated brain injury. METHODS: The authors prospectively studied patients admitted to a neurologic intensive care unit with nontraumatic SAH, documenting Hunt-Hess grade, Fisher group, Glasgow Coma Score, bacterial culture data, daily transcranial Doppler mean velocities, and maximum daily temperatures. Patients were classified as febrile (temperature above 38.3 degrees C for at least 2 consecutive days) or afebrile (no fever or isolated episodes of temperature above 38.3 degrees C). VSP was verified by either transcranial Doppler or angiographic criteria. Rankin scale scores on discharge were dichotomized into good (0 to 2) or poor (3 to 6) outcomes. RESULTS: Ninety-two consecutive patients were studied. Thirty-eight patients were classified as febrile. No source for infection was found in 10 of 38 (26%) patients. In a multivariate analysis, three variables independently predicted fever occurrence: ventriculostomy (OR, 8.5 [CI, 2.4 to 29.7]), symptomatic VSP (OR, 5.0 [CI, 1.03 to 24.5]), and older age (OR, 1.75 per 10 years [CI, 1.02 to 3.0]). Poor outcome was related to fever (OR, 1.4 per each day febrile [CI, 1.1 to 1.88]), older age (OR, 1.64 per 10 years [CI, 1.04 to 2.58]), and intubation (OR, 21.8 [CI, 5.6 to 84.5]). CONCLUSION: Fever in SAH is associated with vasospasm and poor outcome independently of hemorrhage severity or presence of infection.

Middle cerebral artery main stem thrombosis in two siblings with familial thrombotic thrombocytopenic purpura.

Idiopathic thrombotic thrombocytopenic purpura (TTP) is frequently complicated by microinfarcts in cerebral cortex and subcortical white matter. We describe two sisters who suffered massive hemispheric infarction due to thrombosis of the middle cerebral artery main stem during exacerbations of TTP. Acute TTP may be associated with intraluminal thrombosis of large-diameter arteries in addition to arterioles and capillaries.

Distribution of metabotropic glutamate receptor mGluR5 immunoreactivity in rat brain.

The receptor mGluR5 is a metabotropic glutamate receptor with messenger RNA abundantly present throughout cortex, hippocampus, and caudate/putamen that is also coupled to phosphatidyl inositide hydrolysis and calcium mobilization. In this study, the distribution of mGluR5 was examined in rat brain by immunocytochemistry. The antibody utilized is highly specific and does not cross react with the most closely related other metabotropic glutamate receptor, as determined by Western blot analysis of nonneuronal cells transfected with metabotropic receptor coding sequences. The receptor mGluR5 is widely expressed with the highest density in olfactory bulb, caudate/putamen, lateral septum, cortex, and hippocampus, as confirmed with both immunocytochemistry and Western blot analysis. Electron microscopic studies in hippocampus and cortex indicate that the labeling is mostly on membranes of dendritic spines and shafts. Light and electron microscopic evidence indicates that some mGluR5 immunoreactivity is located in presynaptic axon terminals, suggesting that mGluR5 may function as a presynaptic receptor.

Analysis of retinotopic maps in extrastriate cortex.

Two new techniques for analyzing retinotopic maps--arrow diagrams and visual field sign maps--are demonstrated with a large electrophysiological mapping data set from owl monkey extrastriate visual cortex. An arrow diagram (vectors indicating receptive field centers placed at cortical coordinates) provides a more compact and understandable representation of retinotopy than does a standard receptive field chart (accompanied by a penetration map) or a double contour map (e.g., isoeccentricity and isopolar angle as a function of cortical x, y-coordinates). None of these three representational techniques, however, make separate areas easily visible, especially in data sets containing numerous areas with partial, distorted representations of the visual hemifield. Therefore, we computed visual field sign maps (non-mirror-image vs mirror-image visual field representation) from the angle between the direction of the cortical gradient in receptive field eccentricity and the cortical gradient in receptive field angle for each small region of the cortex. Visual field sign is a local measure invariant to cortical map orientation and distortion but also to choice of receptive field coordinate system. To estimate the gradients, we first interpolated the eccentricity and polar angle data onto regular grids using a distance-weighted smoothing algorithm. The visual field sign technique provides a more objective method for using retinotopy to outline multiple visual areas. In order to relate these arrow and visual field sign maps accurately to architectonic features visualized in the stained, flattened cortex, we also developed a deformable template algorithm for warping the photograph-derived penetration map using the final observed location of a set of marking lesions.

Laminar organization of acetylcholinesterase and cytochrome oxidase in the lateral geniculate nucleus of prosimians.

Hess and Rockland [Hess and Rockland (1983) Brain Res. 289, 322-325] proposed that the distribution of acetylcholinesterase within the lateral geniculate nucleus might correlate with the daily activity patterns shown by primates. In diurnal primates, the magnocellular laminae show a greater acetylcholinesterase reaction product. In nocturnal primates, the parvocellular laminae are more heavily stained. We have examined the laminar distribution of acetylcholinesterase and cytochrome oxidase in the lateral geniculate nucleus of a series of rare prosimian primates. In all prosimians examined, the most dense acetylcholinesterase reaction product is seen in the parvocellular layers of the lateral geniculate nucleus. Heavy cytochrome oxidase activity is seen in both the magnocellular and parvocellular layers, but not the koniocellular layers of the prosimian lateral geniculate nucleus. We have also employed a polyclonal antibody to choline acetyltransferase to examine the laminar organization or cholinergic activity in the Galago (Bushbaby) lateral geniculate nucleus. We report that choline acetyltransferase immunoreactivity does not correlate with acetylcholinesterase activity in the prosimian lateral geniculate nucleus. Although the lateral geniculate nucleus is more immunoreactive than most other thalamic structures and although the intercalated koniocellular laminae demonstrate somewhat lighter choline acetyltransferase immunoreactivity, no great difference in staining intensity is seen between the parvocellular and magnocellular laminae. In addition, we examined the phenotype of known inputs to assess the laminar specificity of cholinergic projections to the bushbaby lateral geniculate nucleus. Layer VI of primary visual cortex, which is known to be a source of acetylcholinesterase in the parvocellular layers, does not contain cholinergic cells, nor does the pretectal nucleus, which projects mainly to the parvocellular layers. The parabigeminal nucleus is cholinergic; however, this nucleus is known to project to the koniocellular layers, along with the non-cholinergic superior colliculus. Finally, the pedunculopontine tegmental nucleus, which provides a strong input to many regions of the thalamus, including the lateral geniculate nucleus, is cholinergic. The laminar organization of its input to the lateral geniculate nucleus is not known. Increased acetylcholinesterase reaction product within the parvocellular layers of the lateral geniculate nucleus is common to all strepsirhine primates. The pattern is also seen in the only two nocturnal haplorhine primates, Tarsius and Aotus (owl monkey). The relation of this increased acetylcholinesterase activity to cholinergic function remains unclear.(ABSTRACT TRUNCATED AT 400 WORDS)

Organization of long-range inhibitory connections with rat visual cortex.

We have studied the laminar organization of local long-range inhibitory connections within rat primary visual cortex (area 17) by combining retrograde tracing of nerve cell bodies with glutamic acid decarboxylase immunocytochemistry. While most inhibitory connections are confined to within 0.4 mm of the injection site, a subset of neurons at the layer 5/6 border provide long-range (> 1 mm) inhibitory connections within area 17. However, other cell layers that contain similar local long-range horizontal connections, that is, lower layer 2/3, upper layer 5, and lower layer 6 (Burkhalter and Charles, 1990), show a much more restricted distribution of inhibitory connections. This suggests that cells at the layer 5/6 border play a role in the direct inhibition of neurons at a distant point of the topographic map. Similar double labeling studies reveal long-range inhibitory connections between visual areas. Following injections of fluorescent tracers into area 17, in horizontal sections inhibitory connections can be identified that are up to 8 mm long, linking the extrastriate subdivisions 18a and 18b with striate cortex. Conversely, injections of fluorescent tracers into the cytoarchitectonic subdivision 18a reveal local long-range inhibitory connections within 18a, long-range inhibitory connections between 18a and the cytoarchitectonic subdivision 18b, and inhibitory forward connections from area 17 to 18a. These results suggest that the communication between different cortical areas can be influenced by direct inhibitory connections.