Masayuki Fujioka

Magnetic resonance imaging shows delayed ischemic striatal neurodegeneration.

Brief focal ischemia leading to temporary neurological deficits induces delayed hyperintensity on T1‐weighted magnetic resonance imaging (MRI) in the striatum of humans and rats. The T1 hyperintensity may stem from biochemical alterations including manganese (Mn) accumulation after ischemia. To clarify the significance of this MRI modification, we investigated the changes in the dorsolateral striatum of rats from 4 hours through 16 weeks after a 15‐minute period of middle cerebral artery occlusion (MCAO), for MRI changes, Mn concentration, neuronal number, reactivities of astrocytes and microglia/macrophages, mitochondrial Mn‐superoxide dismutase (Mn‐SOD), glutamine synthetase (GS), and amyloid precursor protein. The cognitive and behavioral studies were performed in patients and rats and compared with striatal T1 hyperintensity to show whether alteration in brain function correlated with MRI and histological changes. The T1‐weighted MRI signal intensity of the dorsolateral striatum increased from 5 days to 4 weeks after 15‐minute MCAO, and subsequently decreased until 16 weeks. The Mn concentration of the dorsolateral striatum increased after ischemia in concert with induction of Mn‐SOD and GS in reactive astrocytes. The neuronal survival ratio in the dorsolateral striatum decreased significantly from 4 hours through 16 weeks, accompanied by extracellular amyloid precursor protein accumulation and chronic glial/inflammatory responses. The patients and rats with neuroradiological striatal degeneration had late‐onset cognitive and/or behavioral declines after brief focal ischemia. This study suggests that (1) the hyperintensity on T1‐weighted MRI after mild ischemia may involve tissue Mn accumulation accompanied by Mn‐SOD and GS induction in reactive astrocytes, (2) the MRI changes correspond to striatal neurodegeneration with a chronic inflammatory response and signs of oxidative stress, and (3) the subjects with these MRI changes are at risk for showing a late impairment of brain function even though the transient ischemia is followed by total neurological recovery. Ann Neurol 2003;54:732–747

Fulminant cerebral infarctions caused by nonbacterial thrombotic endocarditis due to gallbladder cancer

A 41-year-old woman was admitted on September 9, 1995 to our hospital because of acute left hemiparesis. On admission, the patient was alert, but she presented motor weakness in her face and upper extremity. Initial CT scans on admission failed to demonstrate any abnormality, but follow-up CT scans on the next day revealed an infarcted area in the right frontal cortex and white matter (Fig. 1). Cerebral angiography was performed on the same day, and demonstrated occlusion of the right cortical branches of the middle cerebral artery (MCA). We suspected embolism from the heart. Transthoracic echocardiography did not show any abnormality in the heart except for mild mitral regurgitation. Intravenous heparin and low molecular dextran were started. She developed generalized convulsions on September 11. CT scans immediately after the ictus revealed new ischaemic lesions in both hemispheres (Fig. 1). Diffuse ischaemic cerebral oedema caused by continuous multiple embolisms resulted in a neurological picture of brain death on September 13. The patient died on the sixth hospital day. An autopsy was performed which revealed an adenocarcinoma filling the cavity of the gallbladder. Both the mitral and aortic valves were thickened with many vegetations, which were loosely adherent. A large vegetation on the mitral valves caused incomplete closure of the leaflets. On pathological examination, the vegetations consisted of fibrin and the underlying valvular leaflet showed no evidence of destruction and no bacterial infiltration.

ADAMTS13 may be neuroprotective against brain ischaemia-reperfusion injury by improving post-ischaemic microcirculation and inflammation

The abstracts have been reviewed by: F. Antonaci, Z. Argov, I. Arnulf, A. Arzimanoglou, T. Back, O. Bajenaru, E. Bartels, P.-D. Berlit, K. Bhatia, P. Boon, T. Brandt, B. Brochet, M.J. Brodie, A. Bronstein, H. Cock, G. Comi, J. de Keyser, M. de Visser, L. Deecke, R. Dengler, S. Di Donato, H.C. Diener, M. Dieterich, V. Dietz, M. Donaghy, M. Eraksoy, T. Ettlin, F. Fazekas, L. Ferini-Strambi, J. Ferro, M. Filippi, D. Galimberti, A. Grau, W. Grisold, O. Hardiman, H.P. Hartung, W. Heide, C. Helmchen, D.M. Hermann, G. Ickenstein, L. Kappos, R. Khatami, B. Kieseier, T. Klopstock, C. Krarup, G. Lammers, G. Lauria, A. Luft, P. Lyrer, Z. Martinovic, G. Mayer, S.I. Mellgren, G. Meola, R. Milo, I. Milonas, C. Möller, X. Montalban, G. Moonen, M. Mumenthaler, N. Nardocci, O. Nascimento, E. Nobile-Orazio, W.H. Oertel, M. Onofrj, D. Pareyson, Y. Parman, H.W. Pfister, D. Pohl, P. Portegies, J. Rees, H. Reichmann, P.F. Reyes, A. Rossetti, M. Rousseaux, E. Ruzicka, G. Said, J. Santamaria, E. Scarpini, N. Schaeren-Wiemers, B. Schalke, P. Schestatsky, E. Schmutzhard, J. Schoenen, M. Seeck, A. Sena, S. Sergay, V. Silani, M. Sinnreich, A. Siva, R. Soffietti, C. Sommer, A. Steck, G. Stoll, D. Straumann, E. Tolosa, A. Toscano, K.V. Toyka, H. Tumani, J. Valls-Solé, J. van Gijn, P. Vermersch, M.J. Vidailhet, R.D. Voltz, J. Wokke