G. Sieben

Pathogenesis of Binswanger chronic progressive subcortical encephalopathy

We studied the clinicopathologic findings in four hypertensive patients with multiple leukomalacia, demyelinated lesions, and lacunar state. Only one patient had clinical evidence of dementia. The periventricular watershed infarcts were attributed to transient episodes of cardiac failure in brains with a compromised circulation in the territory of the deep perforating branches. These observations suggest that Binswanger encephalopathy does not differ from multi-infarct dementia.

Granulomatous angiitis of the nervous system: a clinicopathological study of one case.

SummaryThe clinical history is presented of a 69-year-old man with a disease starting with a herpes zoster infection and an acute ascending myelopathy, and ending with an intracerebral hemorrhage. The postmortem examination revealed multiple angiitis lesions, restricted to the central nervous system. In review of the 31 previously described cases there were four other patients in whom the granulomatous angiitis of the nervous system (GANS) was associated with a herpes zoster infection. The relation between both disorders is discussed.ZusammenfassungBei einem 69jährigen Manne setzte nach einer Herpes-Zoster-Infektion akut eine aufsteigende Myelitis ein. Es erfolgte schließlich eine intracerebrale Massenblutung. Autoptisch stellte man Arteriitiden fest, die auf das Zentralnervensystem beschränkt waren. Eine Analyse von 31 früher in der Literatur beschriebenen Fällen ergab, daß bei vier weiteren Patienten eine granulomatöse Arteriitis des zentralen Nervensystemes mit einem Herpes Zoster einherging. Die Beziehung zwischen beiden Affektionen wird diskutiert.

Dementia and Confusional State in Patients with Cerebral Infarcts

In a series of 302 postmortem brains with cerebral infarcts, a history of dementia was obtained in 21 and of confusional state in 13 patients in whom the occurrence of strokes was the only responsible

Epilepsy in patients with cerebral infarcts

SummaryOut of series of 240 patients, with proved cerebral infarcts at necropsy, 14 with a clinical history of epilepsy were selected. The possible etiology of seizures was analyzed by comparing the clinical and pathological data. It appeared from this series that epileptic spells, preceding for years the occurrence of a stroke, were due to other causes than to cerebrovascular insufficiency. It was also difficult to separate apoplectic seizures from those occurring due to scar formation after a cerebral infarct, as postapoplectic epilepsy was induced either by the occurrence of a new stroke or by hemodynamic disturbances. Severe generalized or local hemodynamic and metabolic disturbances were also noted in cases of convulsions resulting from a cerebral infarct.ZusammenfassungVierzehn Patienten mit der klinischen Vorgeschichte einer Epilepsie gehörten einer Gruppe von 240 Fällen an, bei denen zerebrale Infarkte bei Autopsie nachgewiesen wurden. Die klinischen und pathologischen Ergebnisse wurden verglichen, um die mögliche Ätiologie der Krampfanfälle analysieren zu können. Es zeigte sich, daß die epileptischen Anfälle, die dem Auftreten eines Ictus um Jahre vorausgingen, andere Ursachen als eine zerebrovaskuläre Insuffizienz hatten. Außerdem schien es schwierig, apoplektische Konvulsionen zu trennen von jenen Epilepsien, welche nach Narbenbildung infolge eines zerebralen Infarktes auftraten, da eine post-apoplektische Epilepsie entweder durch das Auftreten eines neuen Ictus oder durch hemodynamische Störungen induziert wird. Auch in Fällen von Konvulsionen, die mit dem Auftreten eines zerebralen Infarktes verbunden sind, wurden ernsthafte allgemeine oder lokale haemodynamische oder metabole Störungen festgestellt.

Stroke Pattern and Topography of Cerebral Infarcts

In a series of 312 postmortem confirmed cerebral infarcts the clinical history was reviewed and the pattern of the strokes compared to the involved vascular territory. A high incidence of silent strok

Parkinsonism in patients with cerebral infarcts

From 220 necropsies of patients with cerebral infarcts, 5 were selected, in which the clinical history revealed typical parkinsonian symptoms with a progressive course of the extrapyramidal disorder. No correlation could be found between the location and the size of the infarcts on the one hand and the signs of parkinsonism on the other hand. In the 5 cases presented, the substantia nigra showed patchy areas of neuronal degeneration without any Lewy bodies nor neurofibrillary changes, around a pronounced status cribrosus in areas irrigated by paramedian branches of the mesencephalic arteries. Similar neuropathologic findings were present, but to a minor degree, in 2 of 5 cases of pseudo-bulbar palsy. Some extrapyramidal features were also present. It is proposed that is some rare instances, status cribrosus may be responsible for nigral degeneration and for the occurrence of parkinsonism.

Dumb-Bell Sarcoma of the Foramen Jugulare with Syringomyelia. A Radio-Induced Tumour?

SummaryThe clinicopathological findings of a 58-year-old man, who developed cervicothoracic syringomyelia at the age of 25 are presented. He was given radiation therapy at the age of 33. At the age of 57 he developed a foramen jugulare syndrome on the left, caused by a low grade leiomyosarcoma. Etiologically, the most attractive hypothesis appears to be that the tumour was induced by radiation therapy administered 24 years previously.ZusammenfassungEs werden die klinischen sowie pathologisch-anatomischen Befunde bei einem 58jährigen Patienten beschrieben, der im Alter von 25 Jahren die ersten Symptome einer zervikothorakalen Syringomyelie entwickelte und im Alter von 33 Jahren röntgenbestrahlt wurde. Mit 57 Jahren trat ein Foramen-jugulare-Syndrome links in Erscheinung, welches auf ein sanduhrförmiges Leiomyosarkom zurückzuführen war. Es scheint am wahrscheinlichsten, daß dieser Tumor durch die 24 Jahre früher durchgeführte Bestrahlung der Nackenregion induziert wurde.

Prospective neuropathologic study on the occurrence of Wernicke's encephalopathy in patients with tumours of the lymphoid-hemopoietic systems.

In this prospective neuropathologic study, Wernickes encephalopathy appears to be the most frequent intracranial complication of treated patients with tumours of the lymphoid-hemopoietic systems. The highest incidence of this encephalopathy is found in elderly and in patients with a prolonged survival. The chronic form of Wernickes encephalopathy is most commonly observed.

Cytophotometric DNA determination in human oligodendroglial tumours

Cytophotometric DNA determination was performed on 11 surgically resected oligodendroglial tumours and on oligodendroglial cells in two normal brains. The results are compared with the histological findings, the mitotic index and the degree of clinical malignancy. In this type of glioma there is no correlation between the DNA pattern and the histological appearances and the mitotic index. It is concluded that an aneuploid DNA distribution curve corresponds to a bad prognosis, whilst a diploid DNA curve does not allow prediction of the degree of clinical malignancy.

Cranial subdural metastases: A clinicopathological study

During a period of 10 years, 2782 brains were examined at post-mortem and in 17 cases metastases were attached to the dura mater, 8 presenting as multiple nodules 6 as a single nodule and 3 as diffuse dural thickening. The primary growths were, in equal proportions sarcomas, epitheliomas and lymphoid tumours. In contrast to the frequent location of metastases in the axial skeleton (9 cases), brain involvement was rarely observed (2 cases). The clinical findings were non-specific. The difference in biological behaviour between subdural and intracerebral metastases is stressed.