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Histologic Studies of the Brain Following Head Trauma

IV. Late Changes: Atrophic Sclerosis of the White Matter

Joseph P. Evans and I. Mark Scheinker

Observations . The dorsal surface of the brain was flattened, and the leptomeninges were slightly thickened. The undersurface of the brain appeared normal. The blood vessels at the base were soft save for scattered areas of mild sclerosis. On coronal section there were found multiple scattered areas of petechial hemorrhage, chiefly in the white substance. No areas of massive hemorrhage or grossly visible softening were present. Microscopic Observations . Blocks were taken from various areas of the cerebral cortex, from the basal ganglia, and the hypothalamus. There were

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R. A. Groat, W. F. Windle and H. W. Magoun

of the hydraulic apparatus was increased in diameter and the falling weight was made heavier. In this way, a force of sufficient magnitude to produce concussion in a monkey could be transmitted to its brain. During the concussion experiment, the state of respiration, corneal reflex, spontaneous motor activity and threshold of stimulus required to elicit appropriate responses of the motor cortex, hypothalamus or facial nucleus were followed and recorded. Adequate recovery intervals were allowed between blows in the same animal. Placement and fixation of electrodes

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Unusual Size and Extension of a Pituitary Adenoma

Case Report of a Chromophobe Tumour with Unusually Extensive Compression of the Base of the Brain, and Review of the Literature on the Pathways of Extension of These Tumours

James C. White and Shields Warren

* : This is caused by projection of the tumour directly upwards into the third ventricle behind a prefixed chiasm, as is so frequently the case with craniopharyngiomas. Here the usual symptoms, apart from visual disturbances, are headache and drowsiness, with possible evidence of injury to the autonomic centres. Jefferson points out that temperature variations and cardiac or respiratory alterations are not common with tumours that merely indent the hypothalamus without actually invading its walls, but polydipsia and polyuria may be produced by involvement of the

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Histologic Studies of the Brain Following Head Trauma

I. Post-traumatic Cerebral Swelling and Edema

Joseph P. Evans and I. Mark Scheinker

matter of the right hemisphere showed a moderate degree of congestion with occasional perivascular extravasations of lymphocytes. The cerebellum and medulla appeared grossly normal. The blood vessels at the base were normally distributed and were of normal appearance. Microscopic Observations . Survey sections from the white and gray substance of both hemispheres, from the hypothalamus, and the midbrain were stained with hematoxylin and eosin and with cresyl violet, and were also prepared by the Loyez and Bodian methods. The white matter of the right hemisphere

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Walter G. Haynes

, exerted through the incisura of the tentorium, upon the brain stem. On the whole, however, extensive occipital damage carried a poor prognosis. The neurologic defect exhibited by such a patient, if he survived, was only that of a homonymous hemianopsia, unless the diffuse brain damage interfered with other functional areas. The prognosis of parietal and temporal lobe wounds seemed to be dependent upon further penetration of the missile into the diencephalon, hypothalamus or ventricle. The neurologic deficit after such wounds was lamentable; paralysis, aphasia

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Walter G. Haynes

small. The patient was usually, therefore, conscious, alert and oriented, and demonstrated only minimal neurologic signs. A persistent, abnormally high temperature was a consistent finding in ventricular wounds. The temperature usually ascended as the patient's general condition declined. A temperature of 106°–107° was not uncommon and vigorous means to combat this were necessary. Hyperthermia may be attributed to the leakage of blood into the 3rd ventricle and stimulation of the paraventricular nuclei of the hypothalamus. The important clinical aspect of such a

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John T. B. Carmody

influence on the hypothalamus. In Dandy's large series there was no case that in any way gave evidence of derangement of the functional activities of this center. 3 CASE REPORT A white 53-year-old veteran was admitted to the hospital on March 13, 1944. He complained of “severe headache over the right eye, trouble with his eyes, and fainting spells.” The onset occurred 25 years previously in 1919 while serving with the armed forces in France. At that time he received a minor injury to his head, and, although dazed, was not knocked unconscious. He was able to recall a

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George Ehni

relationship to teratoma. J. Path. Bact. , 1944, 56: 145–150. 21. Van Wagenen , W. P. A surgical approach for the removal of certain pineal tumors. Report of a case. Surg., Gynec. Obstet. , 1931 , 53 : 216 – 220 . Van Wagenen , W. P. A surgical approach for the removal of certain pineal tumors. Report of a case. Surg., Gynec. Obstet. , 1931, 53: 216–220. 22. Weinberger , L. M. , and Grant , F. C. Precocious puberty and tumors of the hypothalamus. Report of a case and review of the literature, with a

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Histologic Studies of the Brain Following Head Trauma

II. Post-traumatic Petechial and Massive Intracerebral Hemorrhage

Joseph P. Evans and I. Mark Scheinker

. There were massive subdural hemorrhages and extensive subarachnoid bleeding. Coronal sections showed, in addition to the superficial tearing of cerebral substance, petechial hemorrhages scattered throughout the gray and white matter, chiefly in the inferior half of the brain. Survey sections for histologic study taken from the basal ganglia, the cornu Ammonis, and the hypothalamus showed congestion of the veins and capillaries, vessel wall degeneration, maximal distention and some disruption by red blood cells of the perivascular spaces, coalescence in some areas

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Franc D. Ingraham and Orville T. Bailey

caused by the presence of the tumor in the neighborhood of the third ventricle and pressing upon the hypothalamus. The surgery necessary for the removal of the neoplasm would probably have been impossible without the use of adrenal cortical extract. When this was given in amounts sufficiently large to restore the patient's physiology to somewhere near normal, the operative procedure could be carried out safely. The remarkably small number of successful operations on tumors of the pineal region serves to emphasize the gravity of surgery in this location when the