Patterns of lesions of corpus callosum in inner cerebral trauma visualized by computed tomography.

Computed tomographic analysis of lesions of the corpus callosum in 13 patients with "inner cerebral trauma" showed significant congruence of linear translation of acceleration and the topographic distribution of such lesions. This congruence permits computed tomography to be used to reconstruct the course of linear translation and the site of the main blow, which can be important for forensic use. The findings of even a small lesion in the corpus callosum indicates the need for further investigation of other structures which are usually involved in inner cerebral trauma, such as the hippocampus and brain stem.

Distribution of traumatic lesions of corpus callosum in "inner cerebral trauma".

This study deals with the topographic distribution of traumatic lesions in the corpus callosum within the pattern of "inner cerebral trauma". Material for neuropathological investigations consisted of 49 brains of patients who suffered closed head injury of the acceleration type with linear translation of acceleration acting along the longer axis of the head. As a control, 5 brains were investigated in which the direction of linear translation was latero-lateral. The patients were divided into 4 groups according to reconstruction of the traumatic event and ascertaining of the direction of the linear translation of acceleration: (1) Medial blow (antero-posterior and postero-anterior), (2) Semioblique left blow (frontal left-occipital right and occipital right-frontal left), (3) Semioblique right blow (frontal right-occipital left and occipital left-frontal right), (4) Vertex-base direction. Fornix and septum pellucidum, as anatomically adjacent structures were also investigated. The results showed that the lesions in the corpus callosum were related to the pattern of "inner cerebral trauma" (ICT) (Grcevic 1982), and the biomechanical conditions originally proposed by Lindenberg. These investigations, carried out on a representative material of 54 brains and by subserial histological analysis of the entire corpus callosum, produced a new evidence for our previous preliminary observations about the correlation of the shape and distribution of the periaxial lesions of the pattern of "inner cerebral trauma" and direction of the linear translation of accelerating forces. Our present investigations showed a striking congruence between the pattern of lesions within the corpus callosum in such type of cerebral trauma and the course of linear translation of acceleration. Furthermore, this study proved the importance of topographic interpretation of lesions in the corpus callosum in vivo i.e. by the CT and MRI examinations, because they may serve as a significant information for reconstruction of the biomechanical conditions of the injury which can be of importance for early therapeutical strategy and forensic interpretations of the accident. By using silver impregnation-techniques for histopathological study of the corpus callosum, we could confirm our previously expressed concept on "focalized" and not "diffuse" axonal injures in ICT (Grcevic 1988). In this study corpus callosum served as a representative anatomical structure for axonal studies showing that axonal lesions strictly follow the pattern of tissue lesions with definite focal principle.

Sex steroid receptors in intracranial tumors.

Estrogen (ER), progestin (PGR), and androgen (AR) receptors were assayed in cytosols prepared from 38 various intracranial tumors. The receptors were in the following proportions (number of receptor-positive/number of tumors examined): meningiomas were positive for PGR (4/6) and AR (2/5); glioblastomas were also positive for PGR (3/21) and AR (7/21); astrocytomas were positive only for PGR (4/5); and oligodendrogliomas only for AR. In two hamartomas AR was present, while in one chordoma both PGR and AR were present. In this latter tumor ER were not assayed due to insufficient material. The receptors were present in concentrations between 10 and 20 fmol/mg protein. Exceptions were two meningiomas and a chordoma with a high concentration of PGR and AR. Our results support the notion that a proportion of intracranial tumors contains sex steroid receptors, and some of these tumors might be hormonally dependent.

The concept of inner cerebral trauma.

The pattern of "inner cerebral trauma" is a morphological and functional-pathological correlate of biomechanical conditions at the event of severe closed craniocerebral injury of acceleration-type, if the traumatizing forces act in the direction of the longest diameter of the skull. The lesions are characteristically localized in the "centro-axial" regions of the brain involving most frequently: corpus callosum, septum pellucidum, fornix, tela chorioidea, peri- and para-ventricular zone, infundibulobasal region and cingulum; this pattern also includes lesions of the hippocampal area, upper brainstem, pontocerebellar complex, and parasagittal areas of the cerebrum. This pattern includes lesions, which are from the onset "primary irreversible" as well as "primary reversible" lesions, which spread apart from the "epicentres" of the primary irreversible damage and are in principle more diffuse but still within the basic pattern of the main predilection. This is the basis of the process of "traumatic cerebral disease". The final size and scope of the pathological process of the "traumatic cerebral disease" depend on a number of secondary factors, which may allow the normal process of healing to keep the tissue changes within the initial scope of "primary irreversible damage", or may enhance a progressive process of turning the "reversible" traumatic damage into the irreversible lesions.

Traumatic tears of the tela chorioidea: a hitherto unrecognized cause of post-traumatic hydrocephalus.

A new and hitherto unrecognized phenomenon of rupture of the tela chorioidea in closed head injury of acceleration-deceleration type is described. It occurs very frequently, especially in association with blows in the centro-axial plane even if the acceleration forces are relatively mild. These tears are regularly followed by intraventricular bleeding which follows the flow of the CSF into the subarachnoid space producing a leptomeningeal reaction with impairment of absorption of CSF and consequent communicating hydrocephalus.

Centronuclear myopathy with type I fibre hypotrophy and "fingerprint" inclusions associated with Marfan's syndrome.

The authors present results of histological and electron-microscopical investigations of muscular tissue obtained by biopsy from a 20-year-old man, who showed typical features of Marfan's syndrome associated with slowly progressive muscular weakness. The muscle showed a peculiar combination of centronuclear myopathy with hypotrophy of type I fibres and the so called "fingerprint myopathy". The combination of such myopathic phenomena with Marfan's syndrome presents a unique and hitherto undescribed condition.

"L'acropathie ulcéro-mutilante familiale" with involvement of the distal mixed nereves and long bones fractures.

Two siblings are described with mutilating lesions of the feet and hands, with sensory disturbances and muscle amyotrophy. The motor and afferent nerve conduction velocities were at the lower limit of normal. The nerve action potentials disappeared, first with percutaneous stimulation of the fingers and later with more proximal direct nerve stimulation. Early in the course of the illness indolent fracture of different long bones appeared in both cases. Histology revealed severe loss of nerve fibres, especially of the thin nonmyelinated ones. Excessive proliferation of Schwann sheaths and endoneurium exceeded the amount of the usual reparation for loss of nerve fibres and could be considered as a specific feature. Obliterative vasculopathy also belongs to the picture of changes in the nerves, skin, and bones.