[Traumatic late apoplexy]. / Die traumatische Spätapoplexie.

"Traumatic late apoplexy" is a sudden cerebrovascular attack subsequent to traumatic cerebral lesion. According to Bollinger's concept, on which the term "traumatic late apoplexy" is based, this process was always a cerebral haemorrhage following trauma and appearing several days or weeks after the accident. In the discussions which followed after Bollinger had introduced this concept, the time sequence of this incident was fixed and the interval between trauma and apoplexy defined as occurring between the 6th day and the 8th week after the injury. However, cerebrovascular disease would have to be excluded; if this condition could not be verified with reasonable certainty, the patient would have to be at least less than 40 years of age. However, the pathological process always had to be "established" morphologically. This concept and this definition were extended a few decades later on the basis of progress made in the knowledge and treatment of cerebrovascular lesions. It was found that the pathological process need not be confined to haemorrhages only; every other traumatic cerebral lesion could be included which resulted in "apoplexy" in the clinical sense of the term with some delay after the trauma. Therefore, this article includes all modern concepts on such processes and discusses the various types of traumatic cerebral lesions which can occur in our present technological age. Reports published in literature are scrutinised and analysed more closely, and guidelines and hints are given which can be helpful in expertising work. The list of references is very extensive.

A morphologic classification of brain tumors found in several strains of mice.

Brain tumors were found in 42 mice from a total study population of 77,410 mice, which included several strains (BALB/c, C3H, C57BL/6, and hybrids of these strains). The brain tumors were classified on the basis of the new World Health Organization classification of human brain tumors. Tumors originated from neuroepithelial and meningeal tissues, blood vessels, and germ cells. The youngest animal with a tumor was 111 days of age. The tumor incidence was low, being 0.054% of the total study population, with 0.067% in controls and 0.052% in treated mice. Lipomas were the most common type of tumor diagnosed, and they were considered to represent hamartomas rather than true neoplasms. There were 27 brain tumors other than lipomas, the majority (16) of which occurred in BALB/c mice, whereas meningeal tumors (6) were confined to C3H and hybrid strains of mice. The morphologic characteristics of each tumor type are presented.

[Postoperative radiotherapy of astrocytomas grade 3 and 4 with the radiosensitizer misonidazole. -End results of a multicentric controlled German study]. / Die postoperative Strahlenbehandlung von Astrozytomen Grad 3 und 4 mit dem Strahlensensibilisator Misonidazol. Endergebnis einer multizentrischen und kontrollierten deutschen Studie.

102 patients entered a multicentric randomized study from May 1978 till December 1980. After an operative removal of a supratentorial astrocytoma grade 3 or 4 all patients were treated by radiotherapy of the whole brain with 40 Gy, and after a rest of 1 to 2 weeks with a boost dose of 20 Gy to the tumor region. By randomization the patients got misonidazole (400 mg/m2) to each of the 30 fractions or a placebo. The overall tolerance was good. A mild transient peripheral neuropathy was seen only in 2 patients. The median of survival time was not significantly different for both groups with 16 months (grade 3) and 10 months (grade 4). Thus a radiosensitizing effect of misonidazole was not proven.

Are there still unclassified cerebral tumours?

The case of a stillborn full-term child is presented, which showed a fistsized supratentorial tumour. The origin of the anaplastic tumour from the ependymal surface is discussed. However, the mass remains an "Unclassified Tumour".

[Pathology and natural history of mass-lesion in the spinal cord, its covers and in the neighbouring vertebral column (author's transl)]. / Pathologie und Biologie der raumfordernden Prozesse von Rückenmark und Wirbelsäule.

Space-occupying lesions occurring in the spinal cord, its covers and in the neighbouring vertebral column are reviewed with consideration to their favourite site and the patients age and sex. The main tumor types are described with special reference to the literature and a comparison is made to the findings of specific tumors when occurring intracranially.

The effect of mild microembolic injury on the energy metabolism of the cat brain.

Moderate unilateral cerebral ischemia was produced by microembolism in 24 adult cats. Two million plastic microspheres with a diameter of 15 +/- 5 microns were injected into the left common carotid artery via the lingual artery. The physiological and metabolic responses to embolism were accessed by electrocorticography and by determining the cerebral energy state. Embolism caused an immediate slowing and voltage reduction of the ipsilateral electrocorticogram with a gradual recovery after 30 to 60 min. Some animals also had an immediate and short depression of the contralateral electrocorticogram. In spite of the market functional suppression, metabolites of the cerebral energy-producing metabolism in most of the animals changed only slightly. In the embolized hemisphere pyruvate increased from 0.06 to 0.10 mumol/g and lactate from 1.9 to 4.6 mumol/g within 5 min after embolization and remained at this level during the 4 h observation period. Phosphocreatine, adenosine triphosphate and the energy charge of the adenylate pool remained uncharged during this period. However, there was a slight increase of ATP in the non-embolized hemisphere during the early postembolic period. In two animals, the initial slowing of the electrocorticogram recurred and spread to the contralateral hemisphere, followed by bilateral flattening after a few hours. This delayed functional deterioration was accomplished by complete loss of energy-rich phosphates. These animals also had a progressive increase of cerebrospinal fluid (CSF) pressure and considerable brain swelling with cerebellar herniation after 4 h. It is concluded that unilateral cerebral embolism in the above concentration leads only to a slight increase of anerobic glycolysis without significant perturbation of the cerebral energy state, unless progressive brain swelling with cerebrellat herniation supervenes. This supports previous findings, that brain edema and not initial ischemia is the main pathogenetic factor for tissue damage in cerebral microembolism.

Hyperperfusion and enhancement in dynamic computed tomography of ischemic stroke patients.

The passage of contrast medium was observed using serial computed tomography (CT) in 24 stroke patients. Density--time profiles of various brain regions were plotted. In normal brain tissue, X-ray attenuation showed a maximum increase during the arterial phase (16.4 +/- 11.0%) and was 2.8 +/- 2.2% above control during stable distribution. In hypoperfusion, increase in attenuation was always below 10% in the arterial phase, while hyperperfusion was characterized by an attenuation increase of 25 to 70%. Enhancement was defined by a density increase of 16.8 +/- 14.8% and a tissue/blood ratio between 7 and 60%. An attempt was made to establish a relationship between the serial CT pattern and the prognosis. Enhancement tended to indicate severe morphological changes followed by permanent neurological deficit, whereas hyperperfusion was generally an indicator of probably recovery.

Brain tumor chemotherapy using a rat glioma model.

The antitumor agent chloroethylcyclohexyl-nitrosourea (CCNU) was examined using a rat glioma model. A i.p. administration of three times 40 mg/kg CCNU was highly effective and increased the life-span of tumor-bearing rats from 53 to 86%. A total quantity of CCNU amounting to less than 30 mg/kg was not effective. On the other hand, large dosages exceeding LD10 proved to be toxic. The depression of platelets and white blood cells was mild after a single dosage of 40 mg/kg CCNU which recovered on about the 6th day. In the CCNU-treated animals there was an increase of the extent of necrobiosis. Ballooning of tumor cells with nuclear pyknoses and a lack of mitotic features occurred. Microcystic changes appeared sometimes to be more frequent than in control groups.