Elizabeth C. Crosby

Vascular insufficiency of brain stem and spinal cord in spinal trauma

IN THE STUDY of the relationship of spinal trauma to the resultant acute and chronic damage to the brain stem and spinal cord, some clinical and pathologic features cannot be explained readily on the basis of the initial traumatic lesion. A remote or secondary clinical or pathologic effect often is present which requires further explanation. Evidence accumulating in the literature suggests that these facts may be related to the peculiarities of the vascular supply to the brain stem and spinal cord. The task of describing briefly the normal circulation of these areas is almost impossible when one reviews the immense volume of literature on the subject. A group of references will be cited without too great amplification of the subject matter, so that the reader does not become so lost in anatomic details that correlation with the clinical aspects of the problem is forgotten. Adamkiewicz,l Kadyk20 and Ross31 contributed the outstanding fundamental work on the vascular supply of the spinal cord during the last twenty years of the nineteenth century. With the exception of the paper written by Stopford42 and a few other scattered articles, more than thirty-five years elapsed before interest in the subject was rekindled by Alexander and Suh,2 Bolton,7 Herren and Alexander,16 Klaue,22 Sahs,33 Suh and Alexander,43 Tureen,46 Y o s s , ~ ~ and Zulch.49 The culmination and condensation of much of their extensive investigations are ably presented in two texts, Mettle97 and Bing.6

Korsakoff's syndrome associated with surgical lesions involving the mammillary bodies

THE MENTAL MANIFESTATIONS of Korsakoff‘s syndrome-amnesia, confabulation, and disorientation-are familiar to most physicians. Delay1 in 1942 and Barbizet’ in 1963 coilsidered them to be defects in memorizing with possible involvement of the hippocampi and mammillary bodies. It had been thought earlier that lesions were invariably present in the mammilhry bodies. A comprehensive monograph on the subject was published by Delay and Brion3 in 1969. There has been considerable confusion about the syndromes of Korsakoff and Wernicke. Wernicke’s syndrome is almost always due to alcoholism or at least to a thiamine deficiency and usually has an apoplectic onset, hemorrhages being found in the mamillary bodies and midbrain. The mental symptoms of Korsakoffs syndrome are present but to these are added ophthalmoplegias. Gamper,4 in 1928, showed the similarity of the pathological processes in the two syndromes. In a detailed study of the brains of 16 alcoholics, there were lesions extending from the thalamus and hypothalamus to the brainstem, and the mammillary bodies were involved in all the cases. There were no consistent changes in the cerebral cortex. I t is well known that Korsakoffs syndrome can have etiologies other than chronic alcoholism. The syndrome has been described with lesions in the hippocampi5.6 and the septa1 area718 and with tumors pressing upon the mammillary bodies.o--12 We are describing 5 cases which showed the syndrome of Korsakoff as a result of retrochiasmal craniopharyngiomas iiivolving the mammillary bodies. In 4 cases the symptoms disappeared soon after removal of the tumor. The anatomical bases for the development of Korsakoffs symptoms will be discussed in the light of clinical cases.

Evidence for some of the Trends in the Phylogenetic Development of the Vertebrate Telencephalon

In this brief account of the shifts in position and changes in size and in differentiation of certain structures in the medial and lateral walls of the vertebrate telencephalon, it is understood that one is not dealing with a direct line of evolution of these structures. The brains considered are those of representative forms which occupy positions on side branches and in some cases on almost terminal branchlets of the phylogenetic tree. Of these forms, the lungnsh is probably the nearest and the higher teleosts and higher birds the farthest away from the main trunk. Nuclear patterns and relations and fiber tracts appearing in many divergent forms are supposed to be common characteristics of the brains of animals no longer known to exist, which held positions along the main trunk of this phylogenetic tree.

Temporal or occipital lobe hallucinations triggered from frontal lobe lesions

DIAGKOSIS of a temporal lobe lesion is usually made when the patient has a single or several of the following symptoms: auditory, olfactory, or visual hallucinations, experiential illusions, macropsia, micropsia, dbjd uu phenomena, or automatic movements. T h e question a t once arises i i s to whether this group of symptoms occurs only with temporal lobe involvement or whether it may be obtained from lesions in m y other portion of the cerebral hemisphere and, if so, what the relationship of this second area may be to the temporal lobe. T h e patients whose case histories are reported below, although exhibiting the symptoms risrially regarded as diagnostic of a temporal lobe syndrome, were found a t operation to have frontal lobe involvements.

Stimulation of “Second” Motor Areas in the Macaque Temporal Lobe

CONTRACTION F THE MUSCLES of the face on the side of stimulation and ipsilateral or bilateral movements of the upper and, occasionally, of the lower extremities have been elicited repeatedly on stimulation of the tip of the temporal lobe, the anterior portion of the superior temporal gyrus, and the lateral and basal portions of the inferior temporal gyrus. This is a preliminary report of the movements elicited. The interesting responses which were demonstrated suggest that considerably more attention must be devoted to discovering the pathways involved in the reactions. The results obtained from ablation studies in these animals and further stimulation experiments will be reported at a later date. Ipsilateral movements on stimulation of regions of the cerebral cortex other than area 4 have been reported in various animals by numerous observers, including Wertheimer and Lepage,13 Hering,’ Rothmann,” Vogt,12 Bucy,l Bucy and Fulton,2 Wyss,“ Lemmer~,~ and Lauer.s The ipsilateral representation of the extremities has also been demonstrated or suggested in human subjects by F ~ e r s t e r , ~ Gardner? Dandy: and Penfield.lo Penfield and his associates regarded the regions from which these movements are obtained as “additional” motor areas. None of these reported ipsilateral responses upon stimulation of the temporal cortex of animals or man. For an excellent discussion of ipsilateral movements, the reader is referred to the paper by Bucy and Fulton.2 They were able to produce ipsilateral movements in monkeys by stimulating a restricted region about the superior precentral sulcus, predominately in area 6 but also including the anterior portion of area 4. They found that the responses were independent of the contralateral movements with which they were frequently associated and seemed to be carried by an ipsilateral tract through the central nervous system, although a double decussation within the brainstem could not be excluded.

LIV Experimental and Clinical Studies of the Central Connections and Central Relations of the Facial Nerve

The peripheral distribution of the facial nerve, given in beautiful detail by Dr. Anson, demonstrates its various components. Obviously, in this nerve there are motor fibers to striated muscle with accompanying afferent fibers serving proprioceptive functions. The nerve also carries preganglionic fibers and, in the nervus intermedius, general visceral afferent, gustatory, and cutaneous components.

The supranuclear control of voluntary lateral gaze: Clinical and anatomic correlation in a case of ventral pontine infarction

EARLY STUDIES relevant to the voluntary control of lateral gaze were summarized by Dejerine,lS2 who described the aberrant corticobulbar (or aberrant pyramidal) fibers in the medial lemniscus, in addition to fascicles descending to brainstem motor nuclei in the cerebral peduncle, base of pons, and medullary pyramid along with the corticospinal components of the pyramidal system. These were studied by the Marchi technique in a human case of recent frontal cortical ischemic infarctiom2 Recent workers have extirpated frontal cortical eye fields for lateral gaze in monkeys and, with the Marchi technique, followed the corticobulbar fibers to the reticular gray in the neighborhood of the contralateral abducens nucleus and directly or through intercalated neurons to the abducens nucleus itself. These studies indicated not quite complete decussation of these fibers near or at abducens All of the evidence presently available indicates that for voluntary lateral gaze there is no direct cortical connection with the oculomotor nucleus. For conjugate deviation of the eyes in the horizontal plane, all connections to the oculomotor nucleus are by way of the reticular gray in the region of the abducens nucleus and the contralateral medial longitudinal fasciculus. Fibers from the frontal eyefields related to voluntary deviation of the eyes in vertical or obliquely upward or downward planes depend upon corticobulbar fibers which relay directly to the oculomotor and trochlear nuclei. Consequently, voluntary vertical gaze is preserved after a transection of the midpons, which would abolish voluntary lateral gaze. The relevant literature has been summarized

Certain Afferent Cortical Connections of the Rhinencephalon

Publisher Summary Afferent connections from various cortical areas to the hippocampal gyrus and the hippocampus are traced in Marchi preparations following suitable lesions. The projection of the cingulate gyrus to the inferior temporal gyrus and the hippocampal gyrus and, in less amount, directly to the hippocampus and the amygdala are demonstrated. The connections of the orbital surface of the frontal lobe with the hippocampal gyrus and the hippocampus, as well as with the inferior temporal cortex, are described from a clinical case in which there was a lesion in the orbital cortex. The results exhibit that the anterior temporal lobe syndrome (involving the rostral end of the temporal lobe, the rostral end of the hippocampus, and the hippocampal gyrus and the amygdala of the anatomists) may be equally well obtained from irritating lesions in frontal cortex or cingulate cortex without any direct inclusion of the rostral temporal or rhinencephalic fields in the lesion. The typical anterior temporal lobe syndrome includes deja vu phenomena, olfactory aura, micropsia and macropsia, and sometimes auditory hallucinations.

Motor effects of stimulation and ablation of the caudate nucleus of the monkey

Electric stimulation of the caudate nucleus of the lightly anesthetized monkey was undertaken to demonstrate contralateral extremity movement. Contralateral forelimb flexion was observed in 75 percent of stimulations. The caudate nuclei were subsequently ablated, and 40 percent showed abnormal movements, mainly ipsilateral torticollis and ipsilateral eye deviation. The findings are consistent with previous studies using the caudate nucleus of the cat.

Torsional and somersaulting movements in the macaque secondary to irritative foci in or near the vestibular cortex

The study was carried out on 7 adult Macaca mulatta monkeys. Only 3 of these animals developed the compulsive behavior, and their protocols will be presented in detail. Two of the 7 had preoperative and all had postoperative electroencephalograms. Several monkeys had 1 postoperatively and another had 8. All had left anterior temporal implants of alumina hydroxide cream1 through a left frontal or temporal craniectomy. In addition, 5 of these monkeys had left frontal lobectomies, 3 had right anterior temporal implants, and 1 had a right frontal lobectomy. In all operations, light, open-drop ether anesthesia was used. All were performed under sterile precautions, with the animal’s head in a holder. Craniectomies were clone, the dura was reflected, and the cortex was exposed widely enough to identify the temporal lobe. In the first monkey, the alumina hydroxide cream was inserted subcortically according to the techniqiie of Kopeloff and associates.2 However, the consistency of the cream left some doubt as to the amount retained in the specific area. After working with the cream (and drying it out in the autoclave), a solution with the consistency of heavy cold cream was obtained. This was packed into a smoothed-off Grass silver disk electrode and inserted between the cortex and the dura. Absorbable gelatin sponge (Gelfoam@) was used to absorb the excess fluid, and the dura was closed, as far as possible, to keep the disk in place. The animals received penicillin and were carefully observed postoperatively. Since 5 of the animals had more than one surgical procedure, they were kept as long as thirteen months, and their behavior was noted. When the animals were sacrificed, the brains were perfused, photographed, sectioned and prepared by the Weil and thionin staining techniques and studied to verify lesions. There were no wound infections. An &channel model 3 Grass electroencephalograph was used. Recording was not possible during hyperactivity, since electrodes had not been implanted before operation. All tracings were done under light ether anesthesia with the animal supported in a head holder. Electrodes were small solder disks applied with bentonite in frontal, central, occipital, anterior, and midtemporal areas. Two earclips