Acute encephalopathy with thalamotegmental involvement is characterized by the rapid evolution of stupor and coma, associated with generalized seizures and decorticate or decerebrate rigidity without focal neurologic or meningeal irritation signs. The magnetic resonance findings in a 6-year-old patient with neurologic abnormalities demonstrate bilateral symmetrical high signal intensity lesions involving both the thalami and the tectum in axial T2-weighted image. We report a case of acute encephalopathy with thalamotegmental involvement.
Child ; Coma ; Decerebrate State ; Humans ; Seizures ; Stupor

Acute encephalitis with thalamotegmental involvement in infants and children was reported in Japan, 1995. This encephalitis was preceded for several days by fever and symptoms of upper respiratory infection. These symptoms were followed by the rapid evolution of stupor and coma, associated with generalized seizures and decorticated and decerebrate rigidity without focal neurologic or meningeal signs. The prognosis was generally poor. We have experienced a case of acute encephalitis; the child had three days of fever before the hospitalization and convulsion and deteriorated mental change into a semicomatous state had developed. The patient was diagnosed as acute encephalitis with thalamotegmental involvement by magnetic resonance imaging.
Child ; Coma ; Decerebrate State ; Encephalitis* ; Fever ; Hospitalization ; Humans ; Infant ; Japan ; Magnetic Resonance Imaging ; Prognosis ; Seizures ; Stupor

Acute encephalopathy with thalamotegmental involvement occurs in infants and young children and is thought to be a postviral or postinfectious brain disease. This disease is preceded for several days by fever and symptoms of upper respiratory infection. The symptoms are followed by the rapid evolution of stupor and coma, associated with generalized seizures and decerebrate rigidity. In this disease, the computed tomography (CT) or brain magnetic resonance imaging demonstrate symmetrical focal lesions in the thalami and brainstem tegmentum. We report two cases of acute encephalopathy with thalamotegmental involvement and remaining motor dysfunction in infants.
Brain ; Brain Diseases ; Brain Stem ; Child ; Coma ; Decerebrate State ; Fever ; Humans ; Infant* ; Magnetic Resonance Imaging ; Seizures ; Stupor

BACKGROUND: Body temperature is usually regulated by opposing controls of heat production and heat loss. However, systemic administration of capsaicin, the pungent ingredient of hot peppers, facilitated heat production and heat loss simultaneously in rats. We recently found that the capsaicin-induced heat loss and heat production occur simultaneously and that the biphasic change in body temperature is a sum of transient heat loss and long-lasting heat production. Moreover, suppression of the heat loss response did not affect capsaicin-induced heat production and suppression of heat production did not affect capsaicin-induced heat loss. These observations suggest the independent peripheral mechanisms of capsaicin-induced thermal responses. Thus, the capsaicin-induced thermal responses apparently lack an integrated control. METHODS: Male Wistar rats were maintained at an ambient temperature of 24 1 degrees C on a 12 h on-off lighting schedule at least for two weeks before the experiments. They were anesthetized with urethane (1.5 g/kg, i.p.) and placed on a heating pad, which was kept between 29 and 30 degrees C. Skin temperature(Ts) was measured with a small thermistor, which was taped to the dorsal surface of the rat's tail, to assess vasoactive changes indirectly. Colonic temperature(Tc) was measured with another thermistor inserted about 60 mm into the anus. O2 consumption was measured by the open-circuit method, and values were corrected for metabolic body size (kg0.75). Capsaicin (Sigma) was dissolved in a solution comprising 80+ACU- saline, 10+ACU- Tween 80, and 10+ACU- ethanol, and injected subcutaneously at a dose of 5 mg/kg. Each rat received a single injection of capsaicin because repeated administration of capsaicin renders an animal insensitive to the subsequent administration of capsaicin. Laminectomy was performed at the level of the first and second cervical vertebrae to expose the cervical spinal cord for sectioning. The brain was transected at 4-mm rostral from the interaural line with an L-shaped knife. RESULTS: After administration of capsaicin, O2 consumption increased from 13.5 0.4 mL/min/kg0.75 at 0 min to a peak of 15.9 0.4 mL/min/kg0.75 at 71 min and gradually declined but remained higher than the basal value until the end of the 4-h observation period. Ts also immediately increased from 27.7 0.2 degrees C to 31.9 0.3 degrees C at 39 min, and it returned to the baseline level within 90 min after the capsaicin administration. Tc initially decreased from 37.1 0.1 degrees C to 36.8 0.2 degrees C at 43 min and then gradually increased over the baseline level and remained at 37.6 0.2 degrees C until the end of the experiment. In spinalized rats, the capsaicin-induced increases in O2 consumption was largely attenuated, while the basal O2 consumption was similar to that of control rats. The basal Ts of spinalized rats was 32.4 0.3 degrees C, which was higher than that of control rats. Capsaicin increased Ts by less than 1 degree C, and Tc did not change after the capsaicin administration. O2 consumption of decerebrated rats was statistically higher than that of control rats after the injection of capsaicin. However, capsaicin did not increase Ts, showing a lack of a vasodilatory response. Decerebration between the hypothalamus and midbrain prevented the capsaicin-induced heat loss but not the heat production response. CONCLUSION: These results show that the capsaicin-induced heat production and heat loss are controlled separately by the brainstem and by the forebrain, respectively, and suggest that the body temperature regulation is performed without an integrative center.
Animal ; Body Temperature Regulation/drug effects+ACo- ; Brain/physiology ; Brain/drug effects ; Capsaicin/pharmacology+ACo- ; Decerebrate State ; Male ; Oxygen Consumption/drug effects ; Rats ; Rats, Wistar

Recently, the detection of traumatic intracerebral hematoma has been greatly expedited by the advent of computed tomography. However, traumatic basal ganglia hemorrhage(TBGH) in child have remained rare. The authors obtained following results with analysis of clinical features and outcome in 8 cases of child's TBGH who had been treated at the department of neurosurgery, chonnam university hospital from January 1984 to December 1986. 1) Age distribution was ranged from 3 to 9 years with an average age 5.1 years and 5 were males and 3 were females. 2) Blow of site of the head were right frontal 3, left frontal 3, right parietal 1 and right temporal 1. However, hematoma in the basal ganglia occurred 6 in the left and 2 in the right. 3) On admission, the consciousness level appeared 2 cases in drowsy state(GCS 13), 3 cases in stuporous state(GCS 8,9) and 3 cases in semicomcatose state(GCS 5,7). 4) CT findings of TBGH were classified into 3 types; Type I; spotty type, Type II; moderate type and Type III : massive type. The number of patients was 4 in type I, 2 in type II and 2 in type III. 5) Neurological examination revealed contralateral hemiparesis to the hematoma in all cases(8), facial nerve palsy in 3 cases, motor aphasia in 4 cases and decerebrate rigidity in 2 cases. 6) Of all cases (8), conservative treatment were done in 5 and surgical treatment in 3. As regards the outcome of all cases (8), showed good recovery in 3, moderate disabilety in 2 and death in 3. It was concluded that the first regimen to be chosen in the management of TBGH in child was medical treatment. The patient of moderately disturbed conseionsness would be successfully managed by conservative treatment. The indication for surgery should be restricted to such cases in which the consciouness status were getting worse in spite of active conservative treatment.
Age Distribution ; Aphasia, Broca ; Basal Ganglia* ; Child ; Consciousness ; Decerebrate State ; Facial Nerve ; Female ; Head ; Hematoma ; Hemorrhage* ; Humans ; Jeollanam-do ; Male ; Neurologic Examination ; Neurosurgery ; Paralysis ; Paresis ; Rabeprazole ; Stupor

Spontaneous intracranial epidural hematoma (EDH) due to dural metastasis of hepatocellular carcinoma is very rare. A 53-year-old male patient with hepatocellular carcinoma, who was admitted to the department of oncology, was referred to department of neurosurgery because of sudden mental deterioration to semicoma with papillary anisocoria and decerebrate rigidity after transarterial chemoembolization for hepatoma. Brain computed tomography (CT) revealed large amount of acute EDH with severe midline shifting. An emergent craniotomy and evacuation of EDH was performed. Active bleeding from middle cranial fossa floor was identified. There showed osteolytic change on the middle fossa floor with friable mass-like lesion spreading on the overlying dura suggesting metastasis. Pathological examination revealed anaplastic cells with sinusoidal arrangement which probably led to spontaneous hemorrhage and formation of EDH. As a rare cause of spontaneous EDH, dural metastasis from malignancy should be considered.
Anisocoria ; Brain ; Carcinoma, Hepatocellular ; Cranial Fossa, Middle ; Craniotomy ; Decerebrate State ; Floors and Floorcoverings ; Hematoma, Epidural, Cranial ; Hemorrhage ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis ; Neurosurgery

Decerebrate rigidity, in which there is an exaggereted posture with continuous spasm of muscles, especially the extensors, was first produced in 1898 by Sherrington in animals by transection of the brain at a prepontine level. Since it was shown that intact vestibular nuclei were necessary for decerebrate ridigity to persist, the disorder was believed to be caused by release of vestibular nuclei from higher extrapyramidal control. We have experienced 42 cases of the presence of decerebrate ridigity following head injury who were admitted to the Chosun University Hospital from March 1972 to February 1976. Although no one doubts the prognostic gravity of the decerebrate state following cranial trauma, a surpring number of patients in this study survived in a reasonably functional state. The particular factors we have evaluated are the duration of decerebration, the presence or absence of an intracranial hematoma of surgical proportions, the time of surgical intervention in relation to onset of decerebration and the use of corticosteroids. 42 consecutive parients with traumatic decerebration were studied to determine factors that influence the recovery from the decerebrate state. All these cases were diagnosed by clinical findings and cerebral angiography and assessed the prognostic factors on the result of treatment. Although the data did not lend themselves to precise statistical analysis, it is our option that the following conclusions be inferred ; 1. Intracranial hematoma was found in 25 patients (about 60%) from 42 patients who were presence of decerebrate rigidity, among these the sites of intracranial hematoma were as follows ; a) Epidural hematoma was found in 8 patients(32%). b) Subdural hematoma was found in 13 patients(52%). c) Intracerebral hematoma was found in 4 patients(16%). 2. The mortality of decerebrate patients(65%) with direct damage to the brain stem was greater than that of those supratentorial hematoma(52%). However the quality of survival was better in the latter group, indicating the likehood that brain stem compression is often reversible after evacuation of the hematoma even though with residual neurological deflicit. 3. The mortality and morbidity were greater with traumatic intracerebral and subdural hematoma than with epidural hematoma. This correlation was probably related to the amount of associated diffuse brain damage. 4. A progressive increase in the mortality rate in the surgical group could be correlated with the duration of decerebrate rigidity prior to surgical intervention. 5. Patients who recovered from the decerebrate state usually survived even though with residual sequelae. 6. There was an increase in the mortality rate when decerebration persisted for more than on weeks, but there was one survivor after even 35 days of decerebrate state. 7. The mortality rate was highest over 40 years old and was on the contrary under 20 years old. 8. There was no specific effectiveness in the patients with the presence of decerebrate state with the use of parenteral corticosteroid therapy.
Adrenal Cortex Hormones ; Adult ; Animals ; Brain ; Brain Stem ; Cerebral Angiography ; Craniocerebral Trauma ; Decerebrate State ; Gravitation ; Hematoma ; Hematoma, Subdural ; Humans ; Mortality ; Muscles ; Posture ; Spasm ; Survivors ; Vestibular Nuclei ; Young Adult

A clinical study was done on 29 cases of spontaneous pontine hemorrhage which were confirmed by brain CT scan at Keimyung university Dongsan hospital from Jan. 1981 to Feb. 1986. The results are summarized as follows. 1. The incidence of pontine hemorrhage was 7.4% of all spontaneous intracranial parenchymal hemorrhage. 2. The most prevalent age group were 40th and 50th decades and male to female ratio was 2.2:1. 3. The most common precipitating factor was hypertension and most of pontine hemorrhage occurred during daily routine or increased activities. 4. Symptoms on onset were headache, altered consciousness, vomiting, dizziness, motor weakness, dysarthria, sensory disturbance and generalized convulsion, in order of frequency. 5. Cardinal neurologic signs on admission were loss of consciousness, ocular signs e.g. Pinpoint or miotic pupil absent horizontal doll's eye movement ocular bobbing skew deviation MLF syndrome, motor weakness e.g. quadriparesis hemiparesis decerebrate rigidity, positive Babinski sign. 6. Mean size of hematoma on CT was 6.8cc and 44% was under 5cc. Hematoma of 4th ventricle was seen in 36% of pontine hemorrhage. 7. 25 cases of pontine hemorrhage were divided into 3 groups according to the location of hematoma on CT-basilar (2 cases), tegmental (15 cases), diffuse (8 cases). 8. All 29 cases of pontine hemorrhage were treated medically, 21% were improved, and 79% hopeless discharge or death. 9. Mild disturbance of consciousness on admission, small size (under 5cc) of hematoma and absence of hematoma in the 4th ventricle seem to be good prognostic indicators.
Brain ; Consciousness ; Decerebrate State ; Dizziness ; Dysarthria ; Eye Movements ; Female ; Headache ; Hematoma ; Hemorrhage* ; Humans ; Hypertension ; Incidence ; Male ; Neurologic Manifestations ; Ocular Motility Disorders ; Paresis ; Precipitating Factors ; Pupil ; Quadriplegia ; Reflex, Babinski ; Seizures ; Tomography, X-Ray Computed ; Unconsciousness ; Vomiting

Twenty seven cases(1.7%) of traumatic intracerebral hematoma among in-patients of head injury had been operated in the Department of Neurosurgery, Chonnam University Hospital from June, 1973 to May, 1978. We attempted to analyse these cases clinically and discussed with the review of the literature. The results were summarized as follows: In the age and sex distribution, the common incidence of age was between third and fifth decade and 25 cases were male and 2 female. 2) The most common cause of trauma was traffic accident(13 cases:48.2%) and others were pedestrian(7 cases:25.9%), fall(5 cases:18.5%) and direct blow(2 cases:7.4%). 3) 3 types of the course of consciousness from accident to admission were unconscious to lucid to unconscious(13 cases), unconscious throughout(13 cases) and lucid throughout(1 case). There were no relationship between the course of consciousness and the site of the lesion. 4) The site of impact of the original blow on the head were almost the lateral blows(23 cases), while axial ones were only 4 cases(include one unknown case). The intracerebral hematoma tended to be caused more often by contre-coup injuries(21 cases) rather than by coup one(6 cases). 5) There were 14 hematomas in the temporal lobe(51.9%), 11 in the frontal lobe(40.7%) and 2 in the fronto-temporal lobe(7.4%). Among the 27 cases, only 6 cases were simple intracerebral hematomas, 16 cases were associated with subdural hematomas and 5 cases with epidural hematomas. 6) On the neurological findings, anisocoria was noted in 22 cases(81.5%), hemiparesis in 21 cases(78.0%), aphasia in 5 cases(15.0%) and decerebrate rigidity in 7 cases(26.0%). 7) Cerebral angiography disclosed specific findings due to the location and pathogenesis of hematoma;The angiographic evidence of intracerebral hematoma in the frontal lobe was quite same with the tumor in this site. The intracerebral hematoma in the temporal lobe showed displacement of middle cerebral artery with or without shifting of anterior cerebral artery to opposite side. 8) In all of cases, the osteoplastic craniotomy had been performed and the hematoma contents were evacuated through the puncture or the cortical incision. The mortality rate was 29.6%.
Anisocoria ; Anterior Cerebral Artery ; Aphasia ; Cerebral Angiography ; Consciousness ; Craniocerebral Trauma ; Craniotomy ; Decerebrate State ; Female ; Frontal Lobe ; Head ; Hematoma* ; Hematoma, Subdural ; Humans ; Incidence ; Jeollanam-do ; Male ; Middle Cerebral Artery ; Mortality ; Neurosurgery ; Paresis ; Punctures ; Sex Distribution ; Temporal Lobe

Volatile anesthetics alter the arterial baroreflex (BRX) but its mechanisms are poorly understood. This study was designed to determine the effect of 1 and 2 minimal alveolar concentrations (MAC) of enflurane on the BRX parameters in unanesthetized brain stem-intact and decerebrate rats. Under enflurane anesthesia, the femoral artery and both femoral vein were catheterized for pressor (phenylephrine) and depressor (nitroprusside) drug delivery and continuous blood pressure measurements. Decerebration was performed at midcollicular level. BRX tests were performed in 3 time periods; before enflurane (conscious brain-intact), during 1 or 2 MAC enflurane exposure 1 hour after a sham operation or a decerebration operation, and 2 hours after the termination of enflurane (zero enflurane). Mean arterial pressure (MAP) and heart rate (HR) were fitted to a sigmoid logistic equation, the Boltzman equation. The curve of best fit was obtained with a computer program. 1 MAC and 2 MAC of enflurane shifted MAP-HR baroreflex curves to the left in the all groups and significantly attenuated the baroreflex range. The slope of conscious intact period and zero enflurane period of each group did not change significantly, but during the enflurane period the slope was significantly lowered. Enflurane depressed the baroreflex sensitivity (slope) and the HR range in a similar dose-dependant manner in both brain stem-intact and decerebrate rats. Such results draw into question whether the suprapontine sites contribute to enflurane's actions on cardiovascular autonomic regulation.
Anesthetics, Inhalation/*pharmacology ; Animals ; Baroreflex/*drug effects ; Blood Pressure/drug effects ; Carbon Dioxide/blood ; Decerebrate State ; Enflurane/*pharmacology ; Heart Rate/*drug effects ; Hydrogen-Ion Concentration ; Male ; Oxygen/blood ; Rats ; Rats, Sprague-Dawley ; Support, Non-U.S. Gov't