Adrenaline (ADR), noradrenaline (NOR) and acetylcholine (ACH) were given intramuscularly to the patients with tremor induced by electrical stimulation of putamen, in order to observe effects of the drugs upon the tremor.In cases of ADR injection, the amplitude of the tremor markedly increased and the threshold of stimulus dicreased.The effects of NOR. were almost similar to those of ADR.In cases of ACH, however, the amplitude of tremor decreased and thereshold of stimulus increased.ADR, NOR and ACH were also given to the patients suffering from tremor of various diseases.In cases with tremor at rest, the amplitude of tremor always increased with ADR and decreased with ACH.That is to say, the effects upon the Parkinsonian tremor were almost the same as those upon induced tremor.On the other hand, in cases with tremor at intention, the effects were not always similar to those in Parkinsonian tremor.In our department of surgery, electrical destruction of V.O.P. in the thalamus was performed in cases with tremor as a way of treatment.The autonomic drugs were administered as a preoperative examination.The forms of tremor were thus classified from the drugs effects.Relationships between the effects of drugs on tremor and those of stereotactic surgical treatments were clarified. Quantitative Measurementof Rigidity and Tremor, especially the Latter One
The method of three-dimensional reconstruction of structures and lesions in the brainstem was developed by using a personal computer to visualize the affected sites in some cranial nuclei and long tracts. Outlines of brainstem structures and lesions were digitalized manually by tracing the atlas of the human brainstem and CT or MR images. Four outlines of the brainstem, the medulla, lower pons, upper pons and midbrain, and the outlines of any parenchymal structures were taken at every point 2 mm in thickness. These were used as the standard visualization of the atlas. The CT and MRI, which show outlines of the lesions, were taken on the vertical planes to the floor of the fourth ventricle, one of which included the fastigium, at every point 3 to 5 mm in thickness. These two kinds of outlines, taken from the atlas and the CT/MRI, were reconstructed three-dimensionally with commercial 3-D software. It took only 20 to 25 minutes for the digitalization and the 3-D reconstruction. Three-dimensional display of small structures, which were difficult to identify on CT or MRI, and lesions would enable the visualization of their anatomical relations and make possible the detection of the affected sites, not only in the axial but in the longitudinal direction. Correspondence between the affected sites on 3-D and the neurophysiological examinations (ABR, SSEP) confirms that our 3-D method is adequate for use in the anatomical diagnosis of affected sites in any small structure in the brainstem.
Most cases of spinal epidural abscesses occur in a midthoracic or lower lumbar location. Cervical spinal epidural abscess is distinctly rare, and its prognosis is not favorable due to respiratory problems. We report a case of cervical spinal epidural abscess. A 77-year-old male was admitted because of tetraparesis and dyspnea. Two months before admission, he had been treated by femoro-femoral bypass for arteriosclerosis obliterans , and he had suffered from postoperative wound infection one month later. He had noticed neck pain two days before admission, followed by a numbness and motor weakness in both hands. Neurological examination showed flaccid tetraplegy with an absence of DTRs, paralysis of intercostal muscles, loss of sensation below the C4 dermatome, and bladder dysfunction. A spinal CT scan revealed a mass lesion in the anterior epidural space from C2 to C6, which displaced the spinal cord posteriorly. A myelogram showed complete blockage of contrast medium at the level of C7-T1. He was treated by emergency laminectomy of C3 to C6 with evacuation of the epidural abscess. Culture showed staphylococcus aureus, for which appropriate antibiotics were administered. In spite of such an intensive treatment, the patient showed poor neurological improvement and died 42 days after operation.
Histochemical changes in peptidergic and catecholaminergic neurons during ischemia were investigated in the cerebral neocortex of the gerbil. Catecholaminergic fibers were observed by catecholamine histofluorescence with glyoxylic acid solution, and peptidergic neuron systems such as vasoactive intestinal polypeptide (VIP), somatostatin (SOM), and neuropeptide Y (NPY) were observed by immunohistochemistry. Two hours after unilateral occlusion of the internal carotid artery, catecholaminergic fibers disappeared in the neocortex on the occlusion side, while peptidergic nerve fibers except for NPY fibers were intact after 2 hours of ischemia. NPY fibers had decreased in number on the occlusion side 2 hours after ischemia. VIP-, SOM-, and NPY-immunoreactive neurons showed a decrease of 60% six hours after ischemia, and these neurons completely disappeared in the cerebral neocortex 24 hours after ischemia. These results suggest that catecholaminergic neuron system is more vulnerable than the peptidergic one in ischemic event.
