Vira Kasantikul

Derangement of Serotonin System in Migrainous Patients With Analgesic Abuse Headache: Clues From Platelets

Accumulating evidence indicates that serotonin (5‐HT) may be involved in the process of analgesic‐induced headache transformation. In order to clarify this hypothesis, we investigated the 5‐HT system in migraine patients with analgesic abuse headache by using platelets as a neuronal model. Our results revealed a significant decrease in platelet 5‐HT content in these patients compared to migraine patients and nonheadache controls (179.24 ± 10.18, 451.22 ± 14.35, and 480.22 ± 13.98 ng/109 platelets, respectively; P<0.001). This biochemical result was well correlated with a significant decrease (P

Intraspinal melanotic arachnoid cyst and lipoma in neurocutaneous melanosis.

A 22-year-old woman with neurocutaneous melanosis is reported in whom an intraspinal melanotic congenital arachnoid cyst and melanotic lipoma occurred at the same thoracic location. Such combined occurrence of lesions of the central nervous system, producing compression of the spinal cord, has not been noted in any previously reported case of neurocutaneous melanosis. The pathogenesis of these two unusual melanotic lesions is discussed in relation to the ectomesenchymal properties of the neural crest. The concurrent melanotic arachnoid cyst and lipoma, in juxtaposition, were demonstrated by a computed tomography scan in which the preoperative diagnosis of lipoma was possible through the density of the lesion.

Cerebellar medulloblastomas: A study of 35 cases with particular reference to cellular differentiation ☆

A series of 35 cerebellar medulloblastomas was studied using light microscopy and immunohistochemistry for localization of glial fibrillary acidic protein, an antigen specific for neuroglia. Most medulloblastomas occurred in children less than 15 years of age (77.1%), especially in the first decade of life (65.7%), with the peak incidence (40.0%) between 6 and 10 years. The rest were found in adults beyond 15 years of age (22.9%). The male to female ratio was 4:3. Ependymal differentiation was observed in 100% of medulloblastomas, astrocytic differentiation in 88.6%, oligodendroglial differentiation in 34.3%, glioblastomatous differentiation in 8.9%, and neuronal differentiation in 8.9%. These data suggest that medulloblastoma is a primitive (stem cell) neuroepithelial neoplasm with the capacity of differentiating along both neuroglial and neuronal directions. Excessive mucin production was encountered in one medulloblastoma. Leptomeningeal invasion occurred in 34.3% of medulloblastomas and endothelial hyperplasia in 28.6%. One medulloblastoma (2.9%) spread postoperatively to several bones.

Hyposerotonin-induced nitric oxide supersensitivity in the cerebral microcirculation.

Objective.–To investigate the relationship between hyposerotonin and cranial microvascular responses to nitric oxide (NO).

Intracanalicular Neurilemmomas Clinicopathologic Study

Twenty-five patients with intracanalicular neurilemmomas were studied, the largest series yet reported. The tumors were most frequent in men by a ratio of 2:1, occurred more often on the left acoustic nerve, were generally associated with long duration of symptoms, and were equally distributed in the third to fifth decades, but the prevalence slightly increased in the sixth and seventh decades. A shorter length of illness occurred in younger persons as well as most patients with von Recklinghausens disease. The length of illness ranged from six months to 35 years. Symptoms generally were limited to the auditory nerve except in three instances of involvement of the facial nerve. These three cases were the only ones with preoperative facial palsy. Posterior fossa myelogram was the most useful diagnostic aid. The rate of growth in one patient was estimated to be 1 to 2 mm per year by serial study of myelograms, but the growth rate is probably variable. CT scans were not useful in detecting small tumors. Histologically, most tumors less than 1 cm in diameter were primarily composed of Antoni type A tissue. Vascular malformations were found within the tumor in three cases. Altered blood vessels are the mechanism whereby characteristic changes occur in the cerebrospinal fluid (CSF). Small tumors generally lack blood vessels, hence are less often associated with abnormal CSF.

Primary phycomycosis of the brain in heroin addicts

Two heroin addicts had fatal primary phycomycosis of the brain. The first case is unique. A 28-year-old man displayed unusual symptoms of unilateral hydrocephalus confirmed by both computed tomography (CT) scanning of the brain and craniotomy. The nature of the fungal granuloma was verified histopathologically. The second case, a 40-year-old man, possessed bilateral basal ganglionic lesions in which the CT scanning suggested abscesses. Postmortem examination confirmed the presence of phycomycotic abscesses. There was no evidence of systemic mycoses in both cases. Review of the clinical features of this fatal complication in drug abusers and narcotic addicts disclosed that hemiparesis and facial weakness are common. Brain or CT scan along with brain biopsy are necessary for rapid diagnosis and prompt treatment.

Combined angioma and glioma (angioglioma)

Ten patients in whom tissue proliferation akin to angioglioma occurred within the brain are described; seven of the lesions were supratentorial and three infratentorial. Only 31 accepted instances of such neoplasms have been found in the literature. The combined lesions usually become symptomatic in the second and third decades. In all 10 cases, the angiomatous part of the combined tumors showed characteristic vascular malformation such as severe hyalinization, tortuosity, and some were even calcified. The number of abnormal blood vessels were excessive in all examples. The glial portion consisted of either astrocytoma, oligodendroglioma, or mixtures of these gliomas. Dedifferentiation of the neuroglia combined with neoplastic endothelial proliferation indicates the true neoplastic nature rather than reactive gliosis associated with a vascular anomaly.

Magnetic resonance images of brain stem infarct in periarteritis nodosa

A 35-year-old woman displayed unusual symptoms of progressive bulbar dysfunction. At necropsy, systemic necrotizing vasculitis and small pontine infarcts were demonstrated. The angiographic and magnetic resonance imaging findings are described. The latter investigation is a sensitive method for detecting such pontine lesions. To our knowledge, this case is the first report of magnetic resonance imaging findings of brain stem infarct in a patient with periarteritis nodosa.

Extramedullary subdural meningioma after trauma.

A 61-year-old man had an extramedullary subdural meningioma occurring close to the site of an old vertebral traumatic fracture and spinal cord injury. The tumor was discovered 3 years after the spinal trauma. This finding supports the existence of a causal relationship between trauma and subsequent tumor development. A review of the literature disclosed only one other case of intraspinal meningioma after the traumatic fracture of the spine with spinal cord compression.

Primary chromoblastomycosis of the medulla oblongata: Complication of heroin addiction

A 20-year-old male heroin addict had a sudden onset of progressive medullary dysfunction and died within 12 days. Postmortem examination disclosed mycotic granulomas due to primary chromoblastomycosis strictly limited to the medulla oblongata and adjacent leptomeninges. Similar lesions were absent outside the central nervous system. Such pathologic lesions related to narcotic addiction have not been reported previously.