Vascular pathology of the brain stem due to experimentally increased intracranial pressure: changes noted in the micro- and macrocirculation

1973 ◽  
Vol 39 (5) ◽  
pp. 601-609 ◽  
Author(s):  
Stanley J. Goodman ◽  
Donald P. Becker
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Brain Stem ◽  
Neurological Status ◽  
Vascular Pathology ◽  
Vascular Lesions ◽  
Vascular Abnormality ◽  
Content Type ◽  
The Brain ◽  
Supratentorial Mass

✓ The neurological status and supra- and infratentorial intracranial pressures were studied in awake unsedated cats during expansion of a supratentorial mass. The pontomesencephalic portion of the brain stem was removed, serially sectioned, stained with sodium nitroprusside benzidine, and microscopically examined. Three types of vascular abnormality were seen: macrocirculation hemorrhages, microcirculation hemorrhages, and vascular stasis. As the supratentorial mass expanded and the intracranial pressure rose, there was a progression of vascular lesions from stasis to microcirculation hemorrhages, and finally to macrocirculation hemorrhages. The microcirculation hemorrhages occurred in stuporous animals, and the macrocirculation hemorrhages in comatose animals. Microcirculation hemorrhages were distributed primarily in the tectum, and macrocirculation hemorrhages were mainly in the tegmentum. Microcirculation hemorrhages first appeared in association with moderate to severe intracranial hypertension; macrocirculation hemorrhages were seen mainly with extreme intracranial hypertension. The clinical implications of these brain-stem vascular lesions are discussed.

Cerebral cysticercosis with aqueductal obstruction

1980 ◽  
Vol 53 (2) ◽  
pp. 252-255 ◽  
Author(s):  
Tung Pui Poon ◽  
Edward J. Arida ◽  
Wolodymyr P. Tyschenko
Keyword(s):  
Intracranial Hypertension ◽  
Brain Stem ◽  
Normal Pressure Hydrocephalus ◽  
Signs And Symptoms ◽  
Normal Pressure ◽  
Content Type ◽  
Neurological Signs ◽  
Cerebral Cysticercosis ◽  
The Brain ◽  
Fine Print

✓ The authors report a case of cerebral cysticercosis which presented with generalized nonspecific neurological signs and symptoms attributed to acute aqueductal obstruction, with concomitant intracranial hypertension. These were characteristic intracranial calcifications along with angiographically demonstrated signs of hydrocephalus. Contrast encephalography clearly demonstrated aqueductal obstruction. Pathologically, the aqueductal obstruction was shown to be due to parasitic invasion of the brain stem with compression of the aqueduct. The presence of typical intracranial calcification in conjunction with either obstructive or normal-pressure hydrocephalus should alert the observer to the possibility of cerebral cysticercosis.

Catecholamine response to a gradual increase of intracranial pressure

1993 ◽  
Vol 79 (5) ◽  
pp. 705-709 ◽  
Author(s):  
Johan van Loon ◽  
Bharati Shivalkar ◽  
Chris Plets ◽  
Jan Goffin ◽  
T. Budya Tjandra-Maga ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Perfusion Pressure ◽  
Gradual Increase ◽  
Hemodynamic Changes ◽  
Content Type ◽  
Catecholamine Response ◽  
Cushing Response ◽  
The Mean ◽  
The Brain

✓ To determine the catecholamine response to progressive intracranial hypertension, intracranial pressure (ICP) was raised gradually by continuous expansion of an epidural balloon in seven dogs. Hemodynamic parameters, ICP, and cerebral perfusion pressure (CPP) were monitored continuously and serum catecholamine levels began to rise when CPP was in the low-positive range (20 to 30 mm Hg), reaching a peak just after brain death (CPP ≤ 0 mm Hg). There was no correlation between ICP and the catecholamine peak. Compared to control values, the mean increase was 286-fold for epinephrine and 78-fold for norepinephrine. Temporally, the catecholamine peak corresponded well with the observed hemodynamic changes. These results suggest that ischemia in certain parts of the brain stem is responsible for the hemodynamic changes observed in intracranial hypertension (such as the Cushing response), and they show that catecholamines play an important role in these hemodynamic changes.

Acute intracranial hypertension and auditory brain-stem responses

1979 ◽  
Vol 51 (5) ◽  
pp. 669-676 ◽  
Author(s):  
Seigo Nagao ◽  
Peter Roccaforte ◽  
Robert A. Moody
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Brain Stem ◽  
Neural Activity ◽  
Neurological Dysfunction ◽  
Auditory Pathways ◽  
Content Type ◽  
Transtentorial Herniation ◽  
Auditory Brain Stem Responses ◽  
Auditory Brain Stem

✓ Changes in auditory brain-stem responses (BER's) and somatosensory evoked responses (SER's) were investigated to correlate mass volume, intracranial pressure, and neurological dysfunction in mass-induced intracranial hypertension in cats. As the intracranial pressure was raised by expansion of a supratentorial balloon, the late components of the SER's were suppressed first, followed by the early components of the SER's, then Wave V and Wave IV of the BER's, in that order. This suggests that the nonspecific reticular projections are most vulnerable to compression ischemia, and the specific somatosensory pathways are the next most vulnerable. Neural activity of the auditory pathways in the upper brain stem was also gradually suppressed, but less so than that of the somatosensory pathways. After complete transtentorial herniation, in spite of immediate mass evacuation, the function of the somatosensory pathways was greatly impaired, often irreversibly. The neural activity of the auditory pathways in the upper brain stem revealed progressive recovery during a 3-hour period. The measurements of BER Wave V is thought to be useful in predicting transtentorial herniation.

Surgical treatment of vascular lesions in the brain stem

1975 ◽  
Vol 42 (1) ◽  
pp. 23-31 ◽  
Author(s):  
Shelley N. Chou ◽  
Donald L. Erickson ◽  
Humberto J. Ortiz-Suarez
Keyword(s):  
Surgical Treatment ◽  
Brain Stem ◽  
Arteriovenous Malformations ◽  
Vascular Lesions ◽  
Surgical Removal ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ The authors report the total surgical removal of five vascular lesions of the brain stem, three hemangioblastomas and two arteriovenous malformations. One patient died; among the others, the quality of survival is excellent. Factors favoring surgical removal of such lesions are discussed.

Cavernous malformations of the brain stem

1991 ◽  
Vol 75 (1) ◽  
pp. 32-39 ◽  
Author(s):  
Richard S. Zimmerman ◽  
Robert F. Spetzler ◽  
K. Stuart Lee ◽  
Joseph M. Zabramski ◽  
Ronald W. Hargraves
Keyword(s):  
Brain Stem ◽  
Cavernous Malformation ◽  
Venous Malformation ◽  
Neurological Status ◽  
Shunt Infection ◽  
Neurological Deficits ◽  
Cavernous Malformations ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ Once they become symptomatic, cavernous malformations of the brain stem appear to cause progressive morbidity from repetitive hemorrhage, and can even be fatal. Twenty-four patients with long-tract and/or cranial nerve findings from their cavernous malformations of the brain stem were seen for initial evaluation or surgical consultation and thereafter received either surgical or continued conservative treatment. The decision to operate was based on the proximity of the cavernous malformation to the pial surface of the brain stem, the patient's neurological status, and the number of symptomatic episodes. Sixteen patients were treated by definitive surgery directed at excision of their malformation. In four patients, associated venous malformations influenced the surgical approach and their recognition avoided the risk of inappropriate excision of the venous malformation. Although some of the 16 patients had transient, immediate, postoperative worsening of their neurological deficits, the outcome of all except one was the same or improved. Only one patient developed recurrent symptoms: a new deficit 2½ years after surgery required reoperation after regrowth of the cavernous malformation. She has been neurologically stable since the second surgery. One patient died 6 months postoperatively from a shunt infection and sepsis. The eight conservatively treated patients are followed with annual magnetic resonance imaging studies. One has a dramatic associated venous malformation. Seven patients have either minor intermittent or no symptoms, and the eighth died from a hemorrhage 1 year after his initial presentation. Based on these results, surgical extirpation of symptomatic cavernous malformations of the brain stem appears to be the treatment of choice when a patient is symptomatic, the lesion is located superficially, and an operative approach can spare eloquent tissue. When cavernous malformations of the brain stem are completely excised, cure appears permanent.

Barbiturate-augmented hypothermia for reduction of persistent intracranial hypertension

1974 ◽  
Vol 40 (1) ◽  
pp. 90-100 ◽  
Author(s):  
Harvey M. Shapiro ◽  
Stephen R. Wyte ◽  
John Loeser
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Combined Therapy ◽  
Pressure Reduction ◽  
Content Type ◽  
Cardiovascular Instability ◽  
Previously Treated ◽  
The Brain

✓ Thiopental and pentobarbital caused further reductions in intracranial pressure (ICP) in five patients with persistent intracranial hypertension who had been previously treated with diuretics, steroids, and hyperventilation therapy. The ICP reduction obtained with these patients at normothermia was rapid. Abrupt increases in ICP could be quickly checked by barbiturate treatment. Frequently, the ICP reduction was accompanied by an improvement in the cerebral perfusion pressure. Reduction of ICP by thiopental was brief while that due to pentobarbital was more prolonged. Sustained intracranial pressure reduction could be maintained for up to 5 days by combining pentobarbital (serum concentration 3 mg%) and hypothermia (30°C) without cardiovascular instability or other untoward side-effects. The cerebral metabolic depression due to this combined therapy may be additive and therefore offer a greater protection to the brain during periods of elevated ICP.

Arteriovenous malformations in the posterior fossa

1977 ◽  
Vol 47 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Hiroshi Matsumura ◽  
Yasumasa Makita ◽  
Kuniyuki Someda ◽  
Akinori Kondo
Keyword(s):  
Arteriovenous Malformation ◽  
Brain Stem ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Cerebellopontine Angle ◽  
Anterior Part ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ We have operated on 12 of 14 cases of arteriovenous malformation (AVM) in the posterior fossa since 1968, with one death. The lesions were in the cerebellum in 10 cases (three anteromedial, one central, three lateral, and three posteromedial), and in the cerebellopontine angle in two; in two cases the lesions were directly related to the brain stem. The AVM's in the anterior part of the cerebellum were operated on through a transtentorial occipital approach.

The effects of mass-induced intracranial pressures on arterial hypertension and survival in awake cats

1972 ◽  
Vol 37 (5) ◽  
pp. 514-527 ◽  
Author(s):  
Stanley J. Goodman ◽  
Donald P. Becker ◽  
John Seelig
Keyword(s):  
Intracranial Pressure ◽  
Systemic Hypertension ◽  
Content Type ◽  
Arterial Blood ◽  
Mass Size ◽  
Intracranial Pressures ◽  
Relationship Of ◽  
The Relationship ◽  
Awake Cats ◽  
Supratentorial Mass

✓ Intracranial pressures above and below the tentorium, arterial blood pressure, heart rate, and respiratory rate were recorded continuously before, during, and after expansion of a supratentorial mass in awake unsedated cats. In general, as the mass enlarged, the intracranial pressure rose; however, considerable variation was observed among animals with respect to specific mass size and associated intracranial pressures. There was considerable variation in the relationship of supratentorial pressure to infratentorial pressure. No animal survived that had sustained a mass-induced pressure exceeding 1100 mm H2O, and survival was shorter with greater pressures. Systemic hypertension occurred always and only when the infratentorial pressure exceeded 600 mm H2O, regardless of the magnitude of the associated supratentorial intracranial pressure. The methodological limitations of previous studies of mass-induced intracranial hypertension appear to have been substantially reduced by the technique described.

Cervical spinal cord in experimental hydrocephalus

1972 ◽  
Vol 37 (5) ◽  
pp. 538-542 ◽  
Author(s):  
George J. Dohrmann
Keyword(s):  
Spinal Cord ◽  
Brain Stem ◽  
Cervical Spinal Cord ◽  
Central Canal ◽  
Content Type ◽  
Experimental Hydrocephalus ◽  
Physiological Pressure ◽  
The Brain ◽  
Shunting Procedure ◽  
Fine Print

✓ Adult dogs were rendered hydrocephalic by the injection of kaolin into the cisterna magna. One group of dogs was sacrificed 1 month after kaolin administration, and ventriculojugular shunts were performed on the other group. Hydrocephalic dogs with shunts were sacrificed 1 day or 1 week after the shunting procedure. All dogs were perfused with formalin at physiological pressure, and the brain stem and cervical spinal cord were examined by light microscopy. Subarachnoid granulomata encompassed the superior cervical spinal cord and dependent surface of the brain stem. Rarefaction of the posterior white columns and clefts or cavities involving the gray matter posterior to the central canal and/or posterior white columns were present in the spinal cords of both hydrocephalic and shunted hydrocephalic dogs. Predominantly in the dogs with shunts, hemorrhages were noted in the spinal cord in association with the clefts or cavities. A mechanism of ischemia followed by reflow of blood is postulated to explain the hemorrhages in the spinal cords of hydrocephalic dogs with shunts.

Meningioangiomatosis of the brain stem

1994 ◽  
Vol 80 (4) ◽  
pp. 732-735 ◽  
Author(s):  
Spyros S. Kollias ◽  
Kerry R. Crone ◽  
William S. Ball ◽  
Erin C. Prenger ◽  
Edgar T. Ballard
Keyword(s):  
Brain Stem ◽  
Low Grade ◽  
Facial Weakness ◽  
Content Type ◽  
Weighted Image ◽  
Small Vessels ◽  
Body Magnetic Resonance Imaging ◽  
The Brain ◽  
Firm Mass

✓ The case is reported of meningioangiomatosis of the brain stem in a 3½-year-old girl who suffered from vomiting, left facial weakness, difficulty in swallowing, and ataxia. This is believed to be the first reported case of meningioangiomatosis in the brain stem. Computerized tomography showed an intensely enhancing hyperdense mass in the left restiform body. Magnetic resonance imaging revealed that the lesion was isointense to gray matter on the T1-weighted image and hypointense on the T2-weighted image, with a surrounding zone of high T2 signal and intense enhancement. Angiography was normal. Surgical exploration demonstrated an intramedullary firm mass that was partially resected. Histologically, the mass consisted of a low-grade lesion of meningeal origin with spindle cells in a whorling pattern that were occasionally focused around small vessels. On 2-year follow-up imaging, the lesion remains unchanged in size. Certain particularities of this lesion are discussed in the context of the literature.

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