Granulomatous angiitis of the nervous system first seen as relapsing myelopathy.

A previously healthy 19-year-old man with a painful, relapsing myelopathy died of a cerebral hemorrhage. At autopsy he was found to have granulomatous angiitis of the nervous system (GANS). This particular case of GANS is distinctive and has been reported on two previous occasions.

Hypoxic-ischemic brain injury and the vegetative state: clinical and neuropathologic correlation.

We studied 10 patients who survived for 2 to 8 weeks in a vegetative state, including 8 with cardiopulmonary failure and 2 with subarachnoid hemorrhage. Within days of onset, they regained brainstem function and awoke, but none had evidence of cognitive awareness. All patients opened their eyes within 2 weeks, and eight had roving conjugate eye movements. Pupillary and corneal responses were intact within 1 week, and seven patients had tonic oculovestibular responses (OVR) within 24 hours. By the end of 1 day, only three patients failed to move limbs in response to noxious stimuli. At postmortem, all patients had widespread ischemic neuronal damage in the cerebral hemispheres. The brainstems lacked morphologic abnormality, except that one patient had a single microinfarct in the superior colliculus.

Experimental cerebral ischemia produced by extracranial vascular injury: protection with indomethacin and prostacyclin.

To determine whether the production of brain ischemia is modified by antiplatelet agents administered at the time of extracranial endothelial injury, we modified a four-vessel occlusion rat model so that an electrogenic platelet thrombus in one carotid artery produced cerebral ischemia. DC current was passed through an anode around the left carotid artery of 11 rats with preoccluded vertebral and contralateral carotid arteries. Five of six untreated rats became unresponsive because of carotid occlusion and resultant cerebral ischemia; none of five animals pretreated with indomethacin and infused with prostacyclin (PGI2) were clinically affected. Light- and electronmicroscopic studies showed arterial platelet-fibrin thrombi and ischemic brain damage in untreated rats. All rats had received radiolabeled platelets; radioactivity was increased in the electrogenically injured left carotid arteries from treated and untreated rats, but counts were reduced by more than 80% in indomethacin/PGI2-treated rats (p less than 0.01).

The cytodiagnosis of malignant lymphomas and Hodgkin's disease in cerebrospinal, pleural and ascitic fluids.

One hundred twenty-six fluids from 98 patients with malignant lymphomas have been examined cytologically. The overall accuracy was 88 per cent with only one false positive in 126 fluids. False negatives were highest in the cerebrospinal fluid, which may reflect poor exfoliation of malignant lymphoma cells when the leptomeninges are involved. We have found exfoliative cytology to be an accurate method of diagnosing lymphomatous involvement of the leptomeninges, pleura and peritoneum and when a cytologic diagnosis of involvement by lymphoma is made it is almost as accurate as a histologic diagnosis. Nuclear characteristics and selected histochemical methods will allow classification of many types of lymphoma in bytologic preparations.

Cytology of the cerebrospinal fluid in patients with Hodgkin's disease or malignant lymphoma.

The cerebrospinal fluids (CSF) of 18 patients with Hodgkin's disease and 33 patients with malignant lymphoma were evaluated for the presence of malignant cells. The CSF cytology was correlated with the neuropathologic findings at surgery or autopsy. In the 51 patients included in the study there were seven false-negative CSF cytodiagnoses. Methods to improve detection in the false-negatives will be discussed. There were two false-positives. Explanations for the two false-positive cytodiagnoses will be presented. It is concluded that cytological examination of the CSF in patients with Hodgkin's disease and malignant lymphoma is a useful and reliable diagnostic tool.

Selective immunodeficiency and malignant lymphoma of the central nervous system. Possible relationship to the Epstein-Barr virus.

This report presents the findings of a study of a 17-year-old male with a selective immunodeficiency to the Epstein-Barr virus, who died of a malignant lymphoma following clinical infectious mononucleosis. Autopsy findings and immunohistochemical techniques demonstrated a malignant lymphoma with B-lymphocyte characteristics which primarily involved the central nervous system (CNS). The relationship of the Epstein-Barr virus to lymphoproliferation is discussed.