The pathophysiology of intracerebral haemorrhage.

Spontaneous intracerebral haemorrhage carries a high mortality rate and treatment of the disease raises more questions then answers. Mass effect, ischaemia and toxicity of blood components are responsible for brain tissue damage. Initially occurring disturbances of cerebral blood flow have a temporary character and do not play a key role in the pathology of intracerebral haematoma. Oedema formatting in the 24-48 hours after intracerebral bleeding is the result of multidirectional processes. The pathological mechanism that underlines it is the function of activation of systemic complement and cascade of coagulation. In the light of these findings, further clinical and experimental investigations should be focused on these factors.

The technique of inhalation anaethesia in experimental investigation in the rat.

The rat is the most frequently used animal in scientific inquiry conducted for the purpose of advancing basic knowledge that may lead to an improvement in the results of treatment. Understanding of the pharmacological properties of inhalation anaesthetics, in combination with monitoring of their concentration in the inspired and end-tidal gas, together provide safe and precise control of the depth of the anaesthesia. However, accurate application of the inhalation method of anaesthesia requires special equipment for the delivery and effective scavenging of inhalation anaesthetics.

The influence of sevoflurane on the reactivity of astrocytes in the course of the experimental intracerebral haemorrhage in rat.

40 adult Wistar rats were divided into two groups depending on the applied anaesthesia. In both groups animals were generally anaesthetized with fentanyl, dehydrobenzperidol administered intraperitoneally and midazolam given intramuscularly. In the second group (SEVO) animals received sevoflurane of 2.2 vol% end-tidal concentration. Intracerebral haematoma was produced through infusion of 100 microl of autologous blood into the striatum. Each group was divided into five subgroups depending on the length of survival period: 1, 3, 7, 14, 21 days. The astrocytic population was studied by means of anti-GFAP staining. Stereological analysis was applied to estimate the numerical density of immunoreactive cells and the distribution of their types. On 7th day of observation the density of GFAP-immunoreactive astrocytes in SEVO was lower (p<0,05) than that in the control group. In the control group, the increase (p<0.05) of per cent of activated astrocytes between the 1st and 3rd survival day was noted, which remained at this level till the end of observation. In SEVO group, the increase (p<0.05) of per cent of activated astrocytes between the 3rd and 7th day and the decrease (p<0.05) between the 14th and 21st survival day were observed. During days of observation the per cent of activated astrocytes was lower (p<0.05) in the SEVO group than that in the control group. Administration of sevoflurane during anaesthesia to animals with intracerebral haemorrhage has evoked not only the delay of the activation of astrocytes but also decrease in its level.

Apoptosis in the course of experimetal intracerebral haemorrhage in the rat.

Intracerebral haematoma was produced in 25 adult rats by infusion of 100 microl of autologous blood into the striatum. The animals' brains were removed at 1, 3, 7, 14 and 21 days after production of the haematoma. The TUNEL method was used to detect DNA fragmentation and TUNEL-positive cells were qualified. TUNEL-positive cells were already found on the first day of observation and were present for three weeks after haematoma production. These results provide evidence that programmed cell death is associated with intracerebral haemorrhage.

The cortico-related zones of the rabbit claustrum-study of the claustrocortical connections based on the retrograde axonal transport of fluorescent tracers.

The claustrocortical connections in the rabbit were assessed for the first time by the method of axonal retrograde transport of two fluorescent tracers (Fast Blue and Diamidino Yellow). The material consisted of 23 adult New Zealand rabbits. Projection zones of spindle-like form, connected with the precentral, postcentral, temporal and occipital cortices have been delineated. They are organized topographically both in the anteroposterior and ventrodorsal direction. The precentral (motor) projection zone is localized in the anterodorsal part of the claustrum. It may be divided into two separate parts that project to the medial and lateral part of the precentral cortex. The large postcentral (somatosensory) zone occupies mainly the central part, whereas the temporal (auditory) and occipital (visual) zones are situated in the posteroventral part of the claustrum. The overlap of various claustral projection zones is differentiated, the largest being that of the somatosensory zones. In comparison to the results of study of claustral projection zones performed on other species, presumably on the rat and cat, its seems plausible to conclude that the extension of claustral projection zones and degree of their overlap in the rabbit represent an intermediate character.

The limbic zone of the rabbit and rat claustrum: a study of the claustrocingulate connections based on the retrograde axonal transport of fluorescent tracers.

The claustrum is a subcortical structure lying under the insular and piriform cortices, whose function is still not clear. Although data exist on connections of the claustrum and the limbic cortex, the topography of the limbic zone in the rabbit and rat claustrum has not been studied extensively. The study was performed on 17 adult Wistar rats and 12 New Zealand rabbits. Two percent water solutions of fluorescent retrograde tracers fast blue and nuclear yellow were injected into the various regions of the limbic cortex. The limbic zone is localized throughout the whole rostrocaudal extent of the claustrum, mainly in its ventromedial portion lying close to the external capsule. Although this zone of the claustrum is localized similarly in both rat and rabbit, some differences between these two species exist. In the rat, neurons projecting to all limbic areas are localized mainly in the anterior and central parts of the claustrum, whereas in the rabbit, the majority of the neurons projecting to the cingulate cortex are present in the anterior and central parts of this structure, while neurons sending axons to the retrosplenial cortex are localized in the central and posterior parts. In both species, double-labeling study showed that neurons projecting to various limbic regions are intermingled and that neurons sending axons into two different limbic regions are seen only occasionally. Our findings give support to the role of the claustrum in integrating information between different areas of the cerebral cortex and the limbic system.

Visual zone of the claustrum shows localizational and organizational differences among rat, guinea pig, rabbit and cat.

The retrograde axonal transport method was used to compare the topography and organization of the visual zone of the claustrum in rat, guinea pig, rabbit and cat. First, massive Fluoro-Gold injections were placed into the primary visual cortex and the secondary areas. Experiments showed differences in the location of the visual zone among the animals under study. In rat, the visual zone occupied the posteroventral part of the claustrum and spread to its anterior pole. In guinea pig, neurons projecting to the visual cortex were located dorsally in the posterior half of the claustrum. In rabbit, similarly to the rat, they were localized in the posteroventral part; however, they did not reach the anterior pole. In cat, neurons that project to the visual cortex were concentrated dorsally in the posterior fourth of the claustrum. In double-injection experiments, Fast Blue and Diamidino Yellow were placed into the primary and secondary visual areas in various combinations. The experiments showed that in the rat and the rabbit claustral neurons project to primary visual cortex (area 17) as well as to both secondary visual areas (areas 18a and b). Populations of neurons sending axons to the primary and secondary areas showed full overlap. The presence of double-labeled neurons indicates that some claustral neurons project both to the primary and secondary fields. In cat, neurons that project to the primary visual cortex appear to be clearly separated from those connected with the secondary visual area, as no double-labeled neurons were found. In all studied species, the double injections placed into the visual and primary somatosensory cortex did not result in any double-labeling neurons. Our results indicate that the location of the visual zone in the posterior part of the claustrum is a phylogenetically stable feature, whereas its dorsoventral shift as well as the extent toward the anterior pole is related to the particular species. The overlap of neurons projecting to the primary and secondary visual areas in the rat and rabbit as well as the separation of both projections in cat appear to reflect the higher degree of complexity of the visual system in the latter.

The influence of the intraventricular hemorrhage on the intracranial pressure and hemodynamic changes in the experimental intracerebral hemorrhage in the rabbits.

The experimental model of the intracerebral hematoma in the rabbit was used for the investigation of the changes of the intracranial pressure and selected hemodynamic parameters. The study was performed on 13 adult rabbits, divided into two groups receiving 1 ml (group I--6 animals) and 2 ml (group II--7 animals) of fresh arterial blood, respectively. The monitoring of the intracranial pressure (ICP), the mean arterial blood pressure (MABP), the heart rate (HR), the end-tidal CO2 concentration (ETCO2) and the body temperature was measured every minute in the hematoma production phase and every 5 minutes for the consecutive three hours. The volume of the hematoma was calculated according to Cavalieri formula, with the use of the system for the automatic picture analysis. The mean volume of the intraparenchymal part of the hematoma in group I was higher than in the group II. However, in all the representatives of the second group the evidence of the intraventricular hemorrhage was present. The dynamics of the ICP, MABP and HR changes differed significantly in both groups during the period of the observation. On the basis of the physiological and morphological observations we conclude that the changes of ICP remain the most sensitive and valuable parameter during the early course of the intracerebral hemorrhage. Coexistence of the rapid ICP, MABP and HR changes must be always regarded as the possible sign of the intraventricular hemorrhage.

The combined retrograde transport and unbiased stereological study of the claustrocortical connections in the rabbit.

The quantitative analysis of the claustrocortical connections in the rabbit, labeled with the fluorescent retrograde tracer Fluoro-Gold (FG), was conducted by means of unbiased stereology. The FG was injected into selected regions of the motor, somatosensory, auditory and visual cortices and then a comparison of the various claustrocortical projections was carried out. This was achieved by comparing (1) the numerical densities of projecting neurones for each claustral projection zone and (2) the distribution of the labeled neurones throughout the rostro-caudal extent of the claustrum. No significant differences between the numerical densities of labeled neurones in the various projection zones are reported. The motor and primary somatosensory projections dominated in the anterior and central parts of the claustrum, whereas the secondary somatosensory, auditory and visual projections--in the posterior part. The difference in the distributions was significant (p < 0.001). Summarizing, the cortical projections in the claustrum, although varying topographically, do not reveal a quantitative differentiation. This may speak in favour of the integrative and modulating function of this structure in relationship to the neocortex.

General anaesthesia in rats undergoing experiments on the central nervous system.

The rat is one of the species most commonly used in laboratory practice. Numerous publications concerning various aspects of morphology and physiology are based on the results obtained in this species. It make these results comparable and under some precautions enables to transpose into the relationships observed in humans. Each experimental project must obtain the permission of the Local Ethical Committee, as well as comply with the regulations of the European Communities Council, outlined in the "European Convention for the protection of vertebrate animals used for experimental and other scientific purposes". Adequate pre-operative care can eliminate or reduce the incidence of many complications, which may occur during anaesthesia. General anaesthesia in experimental practice can be achieved using a variety of drugs and ways of administration, among others inhalational or intravenous. The side effects of anaesthetic agents can be reduced in this way. Knowledge of the effect of anaesthetics on the cerebral circulation, metabolism and intracranial pressure in both normal and pathological conditions is crucial for neurobiological purposes. Many anaesthetic agents depress respiration, which can result in hypoxia, hypercapnia and acidosis. To maintain blood carbon dioxide and oxygen concentration in the physiological range, it is necessary to apply tracheal intubation and artificial ventilation. However, even when using sophisticated equipment, the role of basic clinical observation, such as the colour of the blood shed in the operation field, breathing depth and frequency, cannot be overestimated. The importance of monitoring mean arterial blood pressure and intracranial pressure in experiments on the central nervous system is fundamental. Special attention should be paid to controlling the temperature and monitoring the fluid balance. Appropriate postoperative care can have a decisive influence on the final results of the research.

The different patterns of maturation of the claustrocortical connections in a rabbit.

The quantitative analysis of the claustrocortical connections labeled with the fluorescent retrograde tracer Fluoro-Gold (FG) was conducted on 90 rabbits subdivided into the following age groups (P2, P7, P14, P21, P30, P60, P90, P120, P180). The equal volumes of retrograde fluorescent tracer FluoroGold (FG) were injected into the selected regions of the motor or somatosensory cortices. The volume of the dorsal part of the claustrum, total number of projecting neurons, numerical density and percentage distribution of projecting neurons were estimated by means of the unbiased stereological methods. The claustrocortical connections both with the motor and somatosensory areas in a rabbit are established in the postnatal life. The parts of the claustrum occupied by the motor and somatosensory projection zones as well as the morphology of the cortically projecting neurons do not reveal characteristic changes during the studied period. The significant decrease of the total number and numerical density of cortically projecting neurons as well as the increase of the claustral volume may reflect the process of adjustment of the claustrum to its modulatory function upon corresponding cortical areas. The intensity of the claustral connections with the motor and somatosensory cortices reveals significant difference during the studied period, being higher for the motor projection. It may be assumed that the claustrocortical connections established before birth undergo significant quantitative changes during postnatal development.

Claustrocingulate connections in the rabbit and rat--a stereological study.

Unbiased stereological methods were used for estimating the numerical density and the total number of claustral neurones projecting to the cingulate cortex in rabbit and rat. In rat the numerical density of neurones projecting to the retrosplenial granular cortex (RSG) differed significantly from those projecting to the retrosplenial agranular (RSA) and cingulate (Cg) cortices while in rabbit the numerical densities of retrogradely labelled neurones in the claustrum following injections into various areas of the cerebral cortex did not differ significantly. The total number of retrogradely labelled neurones in the claustral limbic zones did not differ significantly in both species. The quantitative analysis of claustral zones projecting to a different cingulate cortex area, both in rabbit and rat, reveals that each of these zones is rather homogeneous.

[Use of somatosensory evoked potentials for prognostic evaluation of patients with intracerebral hematoma]. / Próba zastosowania somatosensorycznych potencjalów wywolanych do oceny rokowniczej chorych z krwiakami sródmózgowymi.

Evoked somatosensory potential (SEP) was studied in 15 patients with intracerebral haematomas comparing the obtained results with those in healthy subjects. In all studied patients the diagnosis was based on clinical picture and on computerized tomography. In 6 patients normal symmetrical records of SEP or records with slight differences of latency, amplitude or symmetry of various components between the ipsilateral and contralateral side in relation to the pathological focus were obtained. The postoperative course in this group was good. In 9 patients SEP on the ipsilateral or contralateral side (in relation to the pathological focus) was absent or deformed. The postoperative course in this group was unfavourable, and all patients died despite intensive treatment.

[Epidural gas aggregation in the course of gaseous degeneration of lumbar intervertebral disk as a cause of foot paresis]. / Obecnosc zewnatrzoponowego gazu sródkanalowo w przebiegu gazowego zwyrodnienia jadra miazdzystego w odcinku ledzwiowym jako domniemana przyczyna niedowladu prostowników stopy.

The finding of gas within the vertebral disc space ("vacuum phenomenon") is relatively common. Degenerative spine disease, gaseous degeneration of the intervertebral disc, and epidural gas were disclosed on imaging study. The epidural gas could be attributed to gaseous disc degeneration. The nerve root in presented patient was compressed by epidural gas. Following surgery the clinical syndrome including foot drop has thoroughly resolved.

[Multiple venous air embolism during cerebellar tumor surgery. Case report]. / Wielokrotny zylny zator powietrzny podczas operacji guza mózdzku.

A case of successfully treated multiple venous air embolism occurred in a man aged 41 operated on for cerebellar tumour. Postoperatively exceptionally serious complication developed in the form of neurogenic pulmonary oedema. Attention is called to a number of aetiological factors in this case. The anaesthesiological management in such cases should include careful monitoring of end-tidal CO2 concentration and insertion of catheter into right atrium.

[MRI of traumatic superficial temporal artery aneurysm. Case report]. / Obraz MRI urazowego tetniaka powierzchownej tetnicy skroniowej. Opis przypadku.

A case of 14-years-old girl with superficial temporal artery aneurysm is presented. She sustained head injury six weeks before the first symptom. Presence of the recent blunt trauma in confrontation with MRI lead to establishing of the final diagnosis. It must be considered in the differential diagnosis of masses located in the temporal fossa. Surgical resection of the involved segment of the vessel is indicated in the cases without the need of reconstruction. The result of treatment in our case was excellent and all symptoms have resolved. The aneurysmal character of the lesion was confirmed by histopathological examination.

Quantitative analysis of influence of sevoflurane on the reactivity of microglial cells in the course of the experimental model of intracerebral haemorrhage.

BACKGROUND: Microglial cells play an important role in the pathophysiology of intracerebral haemorrhage. We have examined the possible influence of sevoflurane on the reactivity of microglial cells during intracranial haemorrhage. METHODS: Forty adult male rats were divided into two groups. All animals were anaesthetized with fentanyl, dehydrobenzperidol and midazolam. In the experimental group animals additionally received sevoflurane 2.2 vol% end-tidal concentration. Intracranial haemorrhage was produced through infusion of blood into the striatum. The microglial cell population (numerical density of immunoreactive cells and their distribution) was assessed on days 1, 3, 7, 14 and 21 after producing a haematoma using antibodies OX42 and OX6. RESULTS: In the control group significant differences in the density of OX42-ir cells between 3rd and 7th (81.86 vs. 129.99) (95% CI: -77.99 to -18.25, P = 0.0035) and between 14th and 21st (105.36 vs. 63.81) (95% CI: 13.21 to 69.89, P = 0.006) survival days were observed. However, significant increase of percentage of amoeboid OX42-ir cells between 3rd and 7th (0.98 vs. 48.71) (95% CI: -52.17 to -43.30, P = 0.0001) and between 7th and 14th (48.71 vs. 58.47) (95% CI: -13.96 to -5.55, P = 0.0002) and then their decrease - between 14th and 21st (58.47 vs. 31.74) (95% CI: 22.52 to 30.93, P = 0.0001) days of observation were noted. In the sevoflurane groups OX42-ir cells were not found. On the 3rd day the density of OX6-ir cells in the sevoflurane group was significantly lower than that in the control group (12.39 vs. 34.57) (95% CI: -49.78 to -2.96, P = 0.02). The percentage of an amoeboid form of OX6-ir cells was significantly lower in the sevoflurane group than that in the control group (27.31 vs. 82.03) (95% CI: -72.52 to -36.92, P = 0.0001) (58.76 vs. 82.37) (95% CI: -38.81 to -8.41, P = 0.003) (42.87 vs. 81.55) (95% CI: -53.23 to -24.10, P = 0.0001) respectively for 3rd, 7th and 14th days of survival. CONCLUSION: Administration of sevoflurane during anaesthesia in animals with intracerebral haemorrhage evoked a decrease of activation of the microglial cells.

Effect of sevoflurane on intracranial pressure and cardiovascular function in rabbits with experimental intracerebral haematoma.

BACKGROUND: Sevoflurane is one of the newest volatile anaesthetic agents. The effect of sevoflurane on ICP in conditions of intracranial pathology is essential from the clinical point of view but still not sufficiently clear. The aim of the study was to examine the effects of 1 MAC, 2 MAC, 3 MAC sevoflurane on intracranial pressure (ICP), mean arterial blood pressure (MABP) and heart rate (HR) in rabbits with experimental intracerebral haematoma (ICH). MATERIAL AND METHODS: The experiments were performed in 13 adult rabbits, 3.5-4.0 kg weight. The rabbits were randomly allocated to two different groups. In group I, (n = 7), sevoflurane was administered in stepwise increasing concentrations of 2.2 vol%, 4.4 vol% and 6.6 vol%, each for a period of 15 minutes. In group II (n = 6), intracerebral haematoma was produced and subsequently sevoflurane was administered in the same manner as in group I. Ventilation parameters, inspiratory and end-tidal sevoflurane concentration, end-tidal CO2 concentration (ETCO2), HR, MABP, ICP and body temperature, measured in the nasopharynx, were monitored throughout the experiment. RESULTS: Mean values of ETCO2 and temperature in the nasopharynx were not significantly different in both groups and remained stable in the whole observation period. In group II in all cases the evidence of intraventricular haematoma was observed. In this group mean values of ICP, MABP and HR after haematoma production were significantly higher than those in group I. Statistically significant increase of ICP was observed in 30th minute in group I, while in 35th minute in group II. In both groups a statistically significant decrease in MABP was observed from 20th minute of observation. A significant decrease in HR in both groups from 25th minute of experiment was also observed. CONCLUSION: In conclusion it should be stressed that sevoflurane, in doses not exceeding 1 MAC, shows no significant effect on ICP and cardiovascular function in the course of intracranial haematoma.