Naohito Kuroda

An autopsy case of early (“minimal change”) olivopontocerebellar atrophy (multiple system atrophy-cerebellar)

We report a 57-year-old woman with multiple system atrophy (MSA) of 15-month duration. The patient developed dysarthria, followed by impaired balance of gait, mild limb ataxia, and saccadic eye movement. A postmortem examination performed after she was found dead in a bathtub revealed neuronal loss restricted to the olivopontocerebellar system, being more severe in the pontine nucleus. Mild neuronal loss was also found in the anterior vermis and inferior olivary nucleus. α-Synuclein immunohistochemistry demonstrated widespread occurrence of glial cytoplasmic inclusions in the central nervous system, which were more numerous in the pontine base and cerebellar white matter. In contrast, neuronal α-synuclein accumulation was confined to the pontine and inferior olivary nuclei. The number of neuronal intranuclear inclusions was much higher than that of neuronal cytoplasmic inclusions. Moreover, α-synuclein accumulation was more severe in the neurites than in the cytoplasm or nucleus. This case demonstrates the early pattern of brain pathology in MSA-cerebellar (olivopontocerebellar atrophy).

Colchicine poisoning resulting from accidental ingestion of meadow saffron (Colchicum autumnale).

A rare case of colchicine poisoning resulting from accidental ingestion of meadow saffron (Colchicun Autumnale) is reported. The plant can frequently be found in the woods of the Northern Hemisphere (1), also in Japan. A 48-year-old male was admitted to hospital complaining of vomiting, nausea and diarrhea following ingestion of the plant and died in four days. The most striking histological findings were metaphasic mitotic figures in the mucosa of the large intestine and the liver. Colchicine was detected in the bile with high-performance liquid chromatography/sonicspray ionization mass spectrometry (HPLC/SSI-MS).

Expression of paraoxonase isoform did not confer protection from acute sarin poisoning in the Tokyo subway terrorist attack

Abstract We previously reported the polymorphism of the high density lipoprotein-associated enzyme paraoxonase (PON1), in the 10 sarin poisoning victims in the Tokyo subway terrorist attack. Arg192 PON1, which has low sarin hydrolysing activity, was found to be more common in the Japanese population than in people of other races. However, from our analyses seven of the victims expressed the PON1 phenotype with high sarin hydrolysing activity and three with low sarin hydrolysing activity. These results indicate that the main factor contributing to the tragedy of the Tokyo subway terrorist attack was the high toxicity of sarin rather than the race-dependent genetic difference in the Arg192 PON1 polymorphism.

Multinucleated astrocytes in old demyelinated plaques in a patient with multiple sclerosis

A 51‐year‐old woman with MS of 26 years duration is reported. The patients MS history began at the age of 25 years with an initial relapsing‐remitting course, followed by slow progression without distinct relapses. She became bed‐ridden at the age of 40 years. A post‐mortem examination revealed numerous demyelinated plaques that exhibited fibrillary gliosis with Rosenthal fibers, but without lymphocytic cuffing or foamy macrophages. Activated microglia were found mainly in the marginal portion of the plaques. These plaques were consistent with so‐called ‘slowly expanding plaques’. Interestingly, multinucleated astrocytes were observed within the plaques, being more numerous in the area where microglial infiltration had occurred. These findings suggest that mild persistent inflammatory processes are present even in old plaques and that certain inflammatory stimuli cause multinucleation of astrocytes. This might explain the gradual deterioration without definite relapses observed in the late stage of MS.

Acute coronary syndrome as a cause of sudden death in patients with old myocardial infarction: a pathological analysis

Old myocardial infarction (OMI) is one of the most important pathological manifestations in sudden cardiac death. Fatal arrhythmia arising from a fibrotic scar has been determined as the cause of death in most cases with old myocardial infarction. However, the significance of acute plaque disruption/thrombosis of the coronary arteries in those patients has not been investigated. We examined a series of 33 hearts from individuals with OMI who died suddenly during the period from 1998 to 2001. Detailed coronary pathological findings on these hearts indicated fresh or recent rupture of the coronary plaque with thrombosis in 18 cases (55%). As a result of comprehensive analysis, the sudden deaths were explained by acute coronary syndrome in 18 cases (55%), fatal arrhythmia in eight (24%), cardiac pump failure in five (14%), and other causes in two (6%) cases. Our findings revealed that a new coronary plaque rupture independent of the old infarct was a major cause of sudden cardiac death with OMI.

Hydranencephaly with extensive periventricular necrosis and numerous ectopic glioneuronal nests

The case reported here relates to a male infant with hydranencephaly who was born at 37 weeks of gestation and died immediately after birth. Post‐mortem examination revealed that the cerebral hemispheres had been replaced by fluid‐filled cavities within a normal‐sized cranium. The membranous hemispheric wall was composed of gliosed tissue with multiple foci of necrosis and hemosiderin‐laden macrophages. The ependyma was absent. Many necrotic foci containing hemosiderin were also found around the aqueduct and fourth ventricle. These findings suggest that hemorrhagic necrosis had occurred throughout the periventricular region, and more severely in the cerebral hemispheres. Moreover, numerous glioneuronal nests were found throughout the subarachnoid space and ventricles. Glioneuronal nests, if present, are usually minimal in hydranencephaly, whereas it is one of the pathological features of multicystic encephalopathy. The transition of multicystic encephalopathy to hydranencephaly has been demonstrated repeatedly. The former is a condition resulting from a severe circulatory disturbance, most often at the end of gestation or in the perinatal period. These lesions date later than hydranencephaly. Considering that numerous glioneuronal nests were found in the present case, it is likely that the encephaloclastic process developed toward the end of gestation.

Traumatic dissection of extracranial vertebral artery with massive subtentorial cerebral infarction: Report of an autopsy case

We present an extremely rare autopsy case with traumatic dissection of the extracranial vertebral artery due to blunt injury caused by a traffic accident. The patient complained of nausea and numbness of the hands at the scene of the accident. His consciousness deteriorated and he fell into a coma within 12h, then died 4 days after the collision. Brain CT/MRI disclosed massive infratentorial cerebral infarction while MRA imaged neither of the vertebral arteries. Autopsy revealed a seatbelt mark on the right side of the lower neck, with fracture of the right transverse process of the sixth cervical vertebra. The right extracranial vertebral artery (V2) showed massive medial dissection from the portion adjacent to the fracture throughout the upper end of the extracranial part of the artery and was occluded by a thrombus. An intimal tear was confirmed near the starting point of the dissection. The brain disclosed massive infarction of posterior circulation territories with changes to the so-called respirator brain. The victims left vertebral artery was considerably hypoplastic. We concluded that a massive infratentorial infarction was caused by dissection of the right extracranial vertebral artery and consecutive thrombus formation brought about by impact with the seatbelt at the time of the collision.

Subependymal injuries in anterior horns of lateral ventricles

The authors histopathologically surveyed 12 autopsy cases with fatal head traumata, especially regarding neural tissue injuries at the anterior horns of the lateral ventricles, compared with 32 control cases with no head traumata. Traumatic injuries, including axonal injuries as well as hemorrhages, tearing of white matter and neurofilament- containing hypertrophic astrocytes were observed in the neural tissue adjacent to the anterior horn of the lateral ventricle in 8 cases which were killed by rotational mechanism when wounded, while other 4 cases without those traumatic lesions had linear or direct injury to the head. It is suggested that traumatic changes in the subependymal zone around the anterior horn might suggest saggital rotational acceleration to the head. The simplicity of this examination method is also emphasized. here have been few descriptions concerning neural tissue injuries in the subependymal zones (SEZ) at anterior horns (AH) of the lateral ventricles (LV) in major textbooks of neuropathology (1, 2), forensic neuropathology (3-5) and accessible English articles, apart from Makinos report (6). The authors of the present paper microscopically examined the neural tissue of SEZ around AH of LV in cases with or without fatal head injuries. Neural tissue injuries in these regions were seen in some of the cases with fatal head injuries, while no traumatic lesion is observed in any of the cases without fatal head injuries. It appears there is a tendency that cases with neural injuries in SEZ at AH of LV have common mode of injury; the force to the head has an element of rotational acceleration in the saggital direction. Eight and 4 cases with and without neural tissue injuries in SEZ at AH, respectively, were analyzed in the present study, in comparison with 32 cases without fatal head injuries as control cases. Materials and methods

Significance of fatal head injuries associated with subependymal hemorrhage at the anterior horns of lateral ventricles

We hypothesize the following items based on 41 autopsy cases with or without head injuries especially on subependymal injuries at the anterior horns of the lateral cerebral ventricles. The subependymal injuries at the regions (1) are not seen in fatal cases that did not have intracranial injuries, (2) have nothing to do with technical procedures for removal of the whole brain at autopsy, (3) are frequently associated with axonal injuries, (4) are presumed to be formed by rotating head injuries in a sagittal direction.