Medullary and Hypothalamic Functional Magnetic Imaging During Acute Hypoxia in Tracing Human Peripheral Chemoreflex Responses.

[Figure: see text].

Orthodontic tooth separation activates the hypothalamic area in the human brain.

OBJECTIVES: An animal experiment clarified that insertion of an orthodontic apparatus activated the trigeminal neurons of the medulla oblongata. Orthodontic tooth movement is known to be associated with the sympathetic nervous system and controlled by the nucleus of the hypothalamus. However, the transmission of both has not been demonstrated in humans. The purpose of this study were to examine the activated cerebral areas using brain functional magnetic resonance imaging (MRI), when orthodontic tooth separators were inserted, and to confirm the possibility of the transmission route from the medulla oblongata to the hypothalamus. METHODS: Two types of alternative orthodontic tooth separators (brass contact gauge and floss) were inserted into the right upper premolars of 10 healthy volunteers. Brain functional T2*-weighted images and anatomical T1-weighted images were taken. RESULTS: The blood oxygenation level dependent (BOLD) signals following insertion of a brass contact gauge and floss significantly increased in the somatosensory association cortex and hypothalamic area. CONCLUSION: Our findings suggest the possibility of a transmission route from the medulla oblongata to the hypothalamus.

Decreased regional cerebral blood flow in the bilateral thalami and medulla oblongata determined by an easy Z-score (eZIS) analysis of (99m)Tc-ECD-SPECT images in a case of MM2-thalamic-type sporadic Creutzfeldt-Jakob disease.

We report a case of autopsy-verified MM2-thalamic-type sporadic Creutzfeldt-Jakob disease (sCJD) in a 46-year-old patient with a 16-month history of abnormal behavior, progressive dementia, insomnia, and speech disturbances without family history. Neurological examination revealed progressive dementia, frontal signs, insomnia, speech disturbance, gait disturbance and bilaterally exaggerated tendon reflexes. Both brain MRI and cerebrospinal fluid examinations, including 14-3-3 protein, yielded normal results. An easy Z-score (eZIS) analysis for (99m)Tc-ethyl cysteinate dimer-single photon emission computed tomography ((99m)Tc-ECD-SPECT) revealed decreased regional cerebral blood flow in the bilateral thalami and medulla oblongata. PRNP gene analysis revealed methionine homozygosity at codon 129 without mutation. Neuropathological examinations revealed severe neuronal loss, gliosis, and hypertrophic astrocytosis in the medial thalamus and inferior olivary nucleus. A slight depletion of Purkinje cells was observed. PrP immunostaining showed no obvious PrP deposits in the basal ganglia, thalamus, cerebellum, or brainstem; however, mild synaptic-type PrP deposits with some smaller plaque-like structures were only partially observed in the localized region of the frontal lobe with the spongiform change. Western blot analyses of protease-resistant PrP showed a type 2 pattern. In conclusion, eZIS analysis of (99m)Tc-ECD-SPECT images is useful for detecting both thalamic and medullary lesions. This is the first case of medullary lesions detected in a live patient with MM2-thalamic-type sCJD using SPECT.

Risks and causes of cervical cord and medulla oblongata injuries due to acupuncture.

BACKGROUND: Acupuncture has become one of the most popular alternative medicines in the world today. Some acupuncturists still intentionally embed entire needles deep in the tissue for treatments, and some patients stick needles into their own bodies on their own. CASE DESCRIPTION: Surgical removal of an accidentally broken acupuncture needle due to self-acupuncture that was embedded in the medulla oblongata and cerebellum was performed. The broken needle migrated further into the brain in a few days. Contrary to expectation, it was extremely laborious to find the needle, which turned out to be completely embedded in the brain. No postoperative complications developed. The patient denied any symptoms and was subsequently discharged. RESULTS: Previously reported cases of 25 patients, in addition to our patient, who suffered from cervical or brain injuries due to acupuncture needles, were retrospectively studied. Embedded needles were the most frequent cause of the injuries and comprised 15 patients (57.7%). Accidentally broken needles came in second, comprising 11 patients (42.3%). Five cases (19.2%) were attributed to self-acupuncture. Sixteen (61.5%) patients developed symptoms more than 30 days after the accident. Twenty-three (88.5%) patients complained of sensory deficits, whereas 11 (42.3%) presented with motor weakness. Surgical removals were performed in 21 patients (80.8%), and 10 patients showed signs of recovery. On the other hand, no patients showed improvements in conservatively treated cases. CONCLUSIONS: Embedded needles in the brain should be urgently removed if possible. Both embedded needle acupuncture and self-acupuncture are extremely dangerous and hazardous to health.

Migration of an acupuncture needle into the medulla oblongata.

A case of a delayed lesion of the medulla oblongata caused by migration of an acupuncture needle is presented. The patient was a 60-year-old woman who had undergone embedded-type acupuncture needle treatment around 1975. In 1993 she was admitted to our hospital with a 3-week history of progressive motor and sensory disturbance of her right upper extremity. CT demonstrated that one needle had penetrated the medulla oblongata transversely at the level of the foramen magnum. The needle was removed surgically without any complications. This is the first report of an acupuncture needle migrating in the medulla oblongata.

Glucose metabolism in the brain of patients with essential tremor.

Using positron emission tomography with [18F]fluoro-2-deoxyglucose, we determined the regional cerebral metabolic rate of glucose utilization at rest in 8 medication-free patients with essential tremor and in 10 normal subjects. Taking the metabolic values of regions of interest as ratios to the mean hemispheric metabolism, the patients showed significant glucose hypermetabolism of the medulla and thalami, but not of the cerebellar cortex. This study lends support to earlier suggestions that circuits involving the inferior olivary nuclei in the medulla and the thalmus are involved in the generation of essential tremor.

Computerized axial tomography in syringomyelia.

The ACTA-scanner, a device for computerized axial tomography, permits cross-sectional radiographic study of the entire human body, including the spine. In the ACTA-scan, the spinal cord appears as a roundish formation surrounded by the less dense subarachnoidal cerebrospinal fluid. The spines of 18 patients with verified (nine cases) or suspected (nine cases) syringomyelia were studied by ACTA-scanning. In seven of the verified and in four of the nonverified cases, some evidence of cord cavitation was shown. The cystic part of a cervical-cord ependymoma was also demonstrated. ACTA-scanning is an easily performed, noninvasive, innocuous procedure. This technic, which complements other radiographic methods of evaluating the spinal cord, is particularly suitable for screening and follow-up study of patients with syringomyelia. The easily accomplished recognition of a possible associated hydrocephalus is an added advantage of ACTA-scanning.