Richard H. Schmidt

Functional reinnervation of the neostriatum in the adult rat by use of intraparenchymal grafting of dissociated cell suspensions from the substantia nigra

SummaryDissociated cell suspensions were prepared from the substantia nigra of 15–17 day-old rat embryos and grafted via an intraparenchymal injection into the depth of the neostriatum of adult recipient rats. The survival and fibre outgrowth of the dopamine-containing neurones in the implants were studied by fluorescence histochemistry, and the functional capacity of the grafts was monitored by repeated testing of the amphetamine-induced turning behaviour of the implanted rats.Before transplantation the target neostriatum of the recipient rats was denervated of its normal dopaminergic innervation by an injection of 6-hydroxydopamine into the ipsilateral nigrostriatal dopamine pathway. The completeness of the denervation was ascertained by measurement of the intensity of the amphetamine-induced turning response. After injection of the dissociated cells large numbers of dopamine-containing neurones were found in clusters at the site of injection as well as scattered in the apparently intact neostriatal tissue up to a distance of about 0.5 mm from the site of injection. Extensive dopamine-containing fibre networks had developed around the implant. These newly formed fibres, which were most abundant around the cell clusters at the injection site, extended in a loose network into large areas of the initially denervated caudate-putamen. In all animals with surviving dopamine neurones the amphetamine-induced turning response was reduced, and in the most extensively reinnervated cases even reversed, within 3–5 weeks after transplantation. This strongly suggests that the implanted dopamine neurones are capable of restoring dopaminergic neurotransmission in the denervated neostriatum, probably via reinnervation of the denervated neostriatal tissue.The use of dissociated brain tissue preparations thus permits reliable intraparenchymal grafting of neurones to plausibly any desired site within the central nervous system, and should open entirely new possibilities for investigation of neuronal growth dynamics and functional reconstruction of damaged brain circuits, perhaps even in brains of larger mammals.

Functional Activity of Substantia Nigra Grafts Reinnervating the Striatum: Neurotransmitter Metabolism and [14C]2-Deoxy-d-glucose Autoradiography

Abstract: Dopaminergic innervation of the caudate nucleus in adult rats can be partially restored by the grafting of embryonic substantia nigra into the overlying parietal cortex with concomitant compensation of certain behavioral abnormalities. In this study the function of such grafts was investigated neurochemically by quantification of transmitter metabolism and glucose utilization in the reinnervated target. Rats with unilateral 6‐hydroxydopamine lesions of the nigrostriatal bundle received a single graft to the dorsal caudateputamen and were screened for rotational behavior following 5 mg/kg methamphetamine. The grafts restored dopamine concentrations in the caudateputamen from initially less than 0.5% to an average of 13.6% of normal in rats with behavioral compensation. The ratio of 3,4‐dihydroxyphenylacetic acid to dopamine, which is a measure of the rate of transmitter turnover, were equivalent in transplanted and normal control rats. Moreover, measurements of DOPA accumulation for a 30‐min period after DOPA decarboxylase inhibition indicated similar fractional dopamine turnover rates in normal and transplantreinnervated tissues. Correlations between rotational behavior and dopamine concentrations showed that reinnervation to only 3% of normal was sufficient to counterbalance the motor asymmetry. Measurements of glucose utilization by [14C]deoxyglucose autoradiography indicated equivalent metabolic rates for the grafted tissue and the intact substantia nigra. 6‐Hydroxydopamine denervation of the caudate‐putamen had no significant effect on neuronal metabolism in that region, nor did subsequent reinnervation from a graft. Grafts, however, were associated with a 16% reduction of glucose uptake in the ipsilateral globus pallidus, indicating a significant transsynaptic influence of the nigral transplants on neuronal metabolism in the host brain. Overall the results indicate that behaviorally functional neuronal grafts spontaneously metabolize dopamine and utilize glucose at rates characteristic of the intact nigrostriatal system. This provides further evidence that ectopic intracortical nigral trans‐plants can reinstate dopaminergic neurotransmission in regions of the host brain initially denervated by the 6‐hydroxydopamine lesion.

Origin and termination of the diencephalo-spinal dopamine system in the rat

Using a combination of neonatal 6-hydroxydopamine and adult 5,7-dihydroxytryptamine treatment we have been able to achieve a 94-99% depletion of noradrenaline in the spinal cord. In such animals the dopamine levels are only marginally affected in the dorsal horn (at all levels) and in the intermediate zone at thoraco-lumbar levels. This combined treatment thus offers new possibilities for selective studies of the spinal dopamine projection. In agreement with the biochemical data the fluorescence histochemistry shows that the spinal dopamine innervation is mainly confined to the dorsal horn, the intermediolateral cell column and associated parts of the intermediate and central gray. Injections of fluorescent retrograde tracer combined with monoamine fluorescence histochemistry reveal that the diencephalic A11 cell group is the principal, and perhaps exclusive, source of this innervation. The area of termination, as well as the organizational similarities with certain diencephalic peptide-containing projections to the spinal cord, suggest that the diencephalo-spinal dopamine system may be importantly involved in autonomic regulatory processes.

Intracerebral grafting of dissociated CNS tissue suspensions: a new approach for neuronal transplantation to deep brain sites

Suspensions of central nervous tissue, prepared by dissociation of selected embryonic brain regions, may be viably transplanted by intraparenchymal injection into a variety of sites in the depth of adult rat host brains. Such grafted neurons can mediate considerable reinnervation of a previously denervated brain region, and they can replace neurons intrinsic to a particular target, such as the caudate-putamen, previously damaged by the neurotoxin kainic acid. The present technique should open entirely new possibilities for experiments on neuronal reconstruction following brain lesions.

Primate neostriatal neurons containing tyrosine hydroxylase: Immunohistochemical evidence

We have detected, in monkey caudate nucleus and putamen, neuronal cell bodies containing tyrosine hydroxylase-like immunoreactivity, as revealed by peroxidase-antiperoxidase immunohistochemistry. Many of these cells are distributed in an outer rim of 1-2 mm throughout the anterior-posterior extent of the neostriatum near its borders with the corona radiata; others are embedded in the adjacent white matter, especially near the ventral putamen and nucleus accumbens. Light and electron microscopy indicate that they are small (8-12 micron), bipolar cells with large nuclei. Such neostriatal neurons, containing tyrosine hydroxylase-like immunoreactivity, number in the tens of thousands.

Extensive experience with dural sinus thrombosis

OBJECTIVEDural sinus thrombosis (DST) is an uncommon cause of stroke. The safest and most effective therapy for DST has not been conclusively identified. METHODSA retrospective chart review of data for 31 patients who were treated for DST at our institution between 1992 and 2001 was performed. Four treatment strategies were identified, i.e., 1) medical observation only, 2) systemic anticoagulation (AC) therapy with heparin, 3) endovascular chemical thrombolysis with urokinase or tissue plasminogen activator and concurrent systemic AC therapy, and 4) mechanical endovascular clot thrombolysis with concurrent systemic AC therapy. Complications and clinical outcomes were assessed for each group. RESULTSPatients treated solely with medical observation fared the worst; four of five patients experienced intracranial hemorrhagic complications, and only two of five exhibited clinical improvement. Patients who received systemic AC therapy experienced no hemorrhagic complications, even when pretreatment hemorrhage was present; 75% (six of eight patients) exhibited improvement with AC therapy alone. Chemical thrombolysis was very effective in restoring sinus patency (90% of patients); however, 30% of patients (3 of 10 patients) experienced hemorrhagic complications. Sixty percent of patients (6 of 10 patients) who underwent chemical thrombolysis exhibited clinical improvement. Patients who underwent mechanical thrombectomies demonstrated a low hemorrhagic complication rate, and most (88%) made good recoveries. CONCLUSIONTherapy directed at the underlying clot in DST must begin without delay. Our results suggest that supportive medical management of DST, without therapy directed at the clot or clotting process, is not effective. Systemic AC therapy, even in the presence of intracerebral hemorrhage, seems to be safe. Heparin can be safely titrated to yield partial thromboplastin times of 60 to 70 seconds. Chemical clot thrombolysis is efficacious in opening occluded sinuses but may cause intracranial hemorrhage. We currently recommend either systemic AC therapy or systemic AC therapy in conjunction with mechanical clot thrombectomy as a safe effective treatment for DST.

Neurosurgical complications of direct thrombin inhibitors—catastrophic hemorrhage after mild traumatic brain injury in a patient receiving dabigatran

Dabigatran etexilate is an oral anticoagulant that acts as a direct, competitive thrombin inhibitor. Large randomized clinical trials have shown higher doses of dabigatran (150 mg taken twice daily) to be superior to warfarin in terms of stroke and systemic embolism rates in patients with nonvalvular atrial fibrillation. As a result, in 2010 the US FDA approved the use of dabigatran for the prevention of stroke and systemic embolism in patients with atrial fibrillation. Dabigatran is especially attractive in the outpatient setting because patients do not require routine monitoring with prothrombin times or international normalized ratios. To date, no effective reversal agent for dabigatran in the event of catastrophic hemorrhage has been identified. The authors report a case of an elderly patient, being treated with dabigatran for atrial fibrillation, who presented with a rapidly expanding intracranial hemorrhage after a ground-level fall. This case highlights an impending neurosurgical quandary of complications secondary to this new anticoagulation agent and suggests potential options for management.

Ruptured intracranial dermoid cysts: clinical, radiographic, and surgical features.

OBJECTIVE Intracranial dermoid cysts are pathologically characterized by a thick, stratified squamous epithelium cyst wall containing dermal elements. Rupture into the subarachnoid spaces and ventricles is extremely rare. We review the clinical, radiographic, and surgical features of eight ruptured dermoid cysts. METHODS We retrospectively evaluated five surgically treated patients with pathologically proven ruptured dermoid cysts. Clinic notes, operative reports, and neuroimaging, including initial computed tomographic and magnetic resonance imaging scans, were reviewed. Imaging was also available on three outside patients reviewed by members of our radiology department. RESULTS The most common presentations were headaches (57%) and seizures (42%), followed by hydrocephalus (29%) from intraventricular rupture. These lesions were consistently hypodense on computed tomographic scans and hyperintense on T1-weighted images with minimal to no enhancement after gadolinium administration. Disseminated fat droplets were present in the subarachnoid space in both cerebral hemispheres in all patients, and five patients had intraventricular rupture with fat-fluid levels in the ventricles. Gross to near-total resection of the primary lesion was achieved in all five surgically treated patients treated at our institution. Four patients had remnant tumor capsules adherent to neurovascular structures that were unresectable. Repeat resection was performed for one recurrence; there were no further recurrences during a follow-up period of 2 to 134 months (mean, 65.6 mo). Two patients with preoperative hydrocephalus eventually required ventriculoperitoneal shunting. CONCLUSION Ruptured intracranial dermoid cysts represent 0.18% of all central nervous system tumors surgically treated in our institution during a 12-year period. The presence of disseminated fat droplets in the subarachnoid space or ventricles on neuroimaging is diagnostic for a ruptured dermoid cyst. Gross total removal is achievable; however, residual tumor capsules adherent to neurovascular structures should be left behind to minimize complications.

Assessment of the effects of neonatal subcutaneous 6-hydroxydopamine on noradrenergic and dopaminergic innervation of the cerebral cortex.

Female rats, treated at birth with 6-hydroxydopamine (3 x 100 mg/kg s.c. at 24 h intervals) or vehicle, were subjected at 112 days of age to unilateral electrolytic lesions of the locus coeruleus. Two weeks later regions of the telencephalon, both ipsi- and contralateral to the lesion, were simultaneously assayed for norepinephrine (NE) and dopamine (DA) content, and for tyrosine hydroxylase (TOH) and dopamine-beta-hydroxylase (DBH) activities. In the vehicle-treated rats the lesion resulted in at least an 80% reduction of NE and DBH on the ipsilateral side, relative to the contralateral side. TOH was reduced to a similar extent only in the parietal cortex and hippocampus. In the prefrontal cortex and cingulate gyrus TOH was decreased by only 31% and 64% respectively; the remainder was interpreted to be associated with projections of the mesocortical dopamine system. From this data it was possible to calculate that the ratio of TOH to DA in dopaminergic terminals is about 10-fold greater than the ratio of TOH to NE in noradrenergic terminals. Neonatal 6-hydroxydopamine treatment resulted in practically total elimination of noradrenergic terminals throughout the telencephalon, and the locus coeruleus lesion had no additional effect. The drug treatment produced no significant change in DA content or in the TOH to DA ratio in the prefrontal cortex and cingulate gyrus, indicating complete sparing of the mesocortical DA projections.

Prefrontal cortex: dense dopaminergic input in the newborn rat

Using a recently introduced modification of the aluminum-formaldehyde histofluorescence method, in combination with exogeneous administration of alpha-methylnoradrenaline and biochemical analyses, a remarkably advanced development of the dopaminergic and noradrenergic afferent to the frontal lobe has been demonstrated in neonatal rat. At birth, the density and general distributional pattern of the catecholamine innervation was similar to that found in the fully developed prefrontal cortex. The previously not recognized, early and extensive maturation of the mesocortical dopamine projection suggests a functional role of dopamine already in the early postnatal period.