Document o98RM2OJyrgey5Le635D7OQ3w

IIS 61N 689100 an  *' AGSs SO N P-43-39 K-43-44 AOIGFSf DATES HOSES POST s d s t s ii* OST* i/W m " 2/10/43 ; . S ^: T .0F -ffij03lt 12S0 grssaa ebnilGAL DlACSiGSIS H y p erten siv e encephalopathy? p o s s ib le le a d p o iso n in g . ANATOMICAL DIAGNOSIS* C on flu en t l o b u l a r pneumonia. R3P0BT OF THS LA30HAT0RT OF IUSBOPATROLOO? (MiSS DBSORXPTIOiij T h t d u r a l cap h a s n o t been p re s e rv e d . The r ig h t f r o n ta l p o le has been removed f o r le a d s tu d ie s . . Viewed from above th e r i g h t p o s te r io r p a r i e t a l reg io n . appears, a l i t t l e , f u l l e r th a n th e corr spending region on th e l e f t , and th e g y ri a re somewhat f la tte n e d . 2 s th e rig h t p a rie ta l o c c ip ita l region there i s a l i t t l e g re y ly d isco lo ratio n o f th e su lc i, suggestive o f a lo calized . oeningeal re a c tio n . The s a s ia ! p o rtio n o f th e lob# ju s t anterior to the p arietal o ccip ital fissure is soft to touch. This region i s broadened sad th e su lsa l oaskhsgs are le s s prominent. The lep to aen iag es a re n o t othersftse rem arkable. The v ascu lar p a tte rn i s normal, th e d is trib u tio n o f veins not being re m arkable. _ In sp e ctio n o f th e median c l e f t shows nothing rem arkable, except fo r a d e fin ite fu lln ess o f th e m esial portion o f th e p a r ie ta l lobe running: backward t o th e o c c ip ita l p a r ie ta l ju n c tio n . The o c c ip ita l lo b es a re n o t rem arkable. The cerebellum h a s a su g g estio n o f a p re ssu re eon. The b ra in ste a has been c a t very sh o rt, but what th e re is lo f t i s . not rem arkable i n appesraas. The pons i s n o t notew orthy. The leptom eninges a t th e base are s lig h tly thickened. There i s no uncai h e rn ia tio n . . The v e s s e ls t th e base a re o f la rg e c a lib r e , th e w a lls a re m oderately th ic k e n ed , b u t th e r e a re no fra n k p laq u es. The d istrib u tio n of the vessels o f th e c irc le is noraal. V e rtic a l co ro n al se c tio n s were mads through th e b ra in a t 1 .5 cm. th ic k n e s s e s . The l e f t hem isphere th ro u g h o u t ap p ears normal, and th e le f t la te r a l v e n tric le i s o f about noraal s i z e , p erhaps somewhat sm a ll. Throughout a l l th e sectio n s o f th e rig h t hemisphere, th e A it m a tte r sppe&rs b ro ad er th a n th e corresponding w hite m atter o n ' 2 > HP-43-33 S --43--4 4 th e l e f t s a d th e w h ite s e t t e r i s s o f t t o to u ch , o n t h i s s id e * Tkm d em a rca tio n , betw een, g ra y an d w h ite i s s h a rp , e x c e p t l a t h e p o s t e r i o r " -.2a B lo c k s 2, 3 * ' s a d "4 th e* :!i s , s u p e r f i c i a l f "JS :ss& .iiit t $ * I s g 4 Bamd. b lo c k ti 3 $ -,1 4 The r ig h t In te r& l w en triel i s MICRO8G0PKU I n B lock ? 1 tfc jr sp k o a o id d fis s u re i s th e im m ediate on th e le f t la a s trik in g d isap p earan ce o f th e u p p er Li n th m e s ia l p o r tio a o f th e te m p o ra l lob o f th e o b lite ra te d fissu re th e re i s a |;-gdp ^ re s p o n d r o u g h ly t o a s i m i l a r s o b -' M a ltip l c o ro n a l s e c tio n s 'sers sad th ro u g h t h e d is a r tic u la te d c e re b e llu m end b r a in ste . T h ese show th p ressas o f e sassiw hao3*r3 'th re g io n o f th a l e f t : d sa ta t n u c le i s a d spyai th s a ld lin e * T hs 'g r e a te s t m sasu reiassts are S e c tio n s T akeat S u rrey fro a th r ig h t hem isphere o f ? - l and rm th e s o b s o f hem orrhage i n th # r e b e lla s Photographic Indications* C oronal se c tio n s from th e e re b e llu s t o show t h e g e s s r a l n a tu re o f t h e d-sss o f t h e r i g h t hem isphere and th e extent; o f th hemorrhage ia- th e cerebellum . S tate o f Fixations- F a ir ' B rain sav ed . ' G ro ss K europstkolegis& L B ia g o o siss M a s s if l e f t , ia tr& e e re b s lla F h sB o rrh ag o ; dees. o f th r ig h t h s& isp h sre , a s s o c ia te d is ith s o f te n in g in . th e r ig h t p a r ie ta l reg io n * - ' S urvey s e c tio n s w ore ta k e n f ro a th e fro n to -te m o o ra l re g io n o f th e co rtex * fro th e cen tra s e a io v a lo , b a s a l g a n g lia , p o n s, sa d c a re b e H u sj. A ll s e c t i o n s w ere s ta i n e d w ith c r e s y l v i o l e t an d II* & 3 . a t m icro sco p ic x sa ia a tio n rev ealed - th e fo llo w in g changes* ( l ) h e p to se n ia se s* T h p is. sra e k a o id vast th ic k e n e d sa d h y p o rp lsg feic in sos a re a s* The tM s k s n ia g s d u s t o d is te n tio n , o f th e m eshes, i n i i l t r a t i o a w ith a v a rie ty o f c e lls and h y p e rp la sia o f co n n ectiv e t is s u e . The d iste n d e d n o sh e s c o n ta in e d many s c a tte r e d c e l l u l a r e lm e a x ts , m ost o f them f ib r o b la s t ic i n n a tu re * 2 a sou a re a s th e r e T ore la r g e acctrsu X atio n s o f m acrophages. T he la r g e r b lo o d v e s s e ls a p p e a re d th i k e B e d .and :a o d e ra te ly a c le ro s e d * The s m a lle r v e in s d is c lo se d a m arked p r o lif e r a tio n o f th e e n d o th e lia l and a d v e n titia l c e lls (g ) Parenchym a* The ch an g es i n th e parenchym a c o n s is te d o f s c a tte re d ' a r e a s o f s o f te n in g , .and h s s o rr a g e s j. T he fo rm e r w e re l o c a l i s e d c h i e f l y w ith in th e su b c o rte x and w ere in d iff e re n t s ta g e s o f o rg a n is a tio n . Some o f th e n d is c lo s e d t h e c h a r a c t e r i s t i c f e a tu r e o f a c u te anem ic in f a r c tio n ; o th e r s m ore ad vanced o r g a n iz a tio n and g l i a l r e p a ir . B P-43-33 1-43-44. In ad dition th e re wss t o be seen a d iffu s# Ischem ic degeneration o f th e n a r r e c e lls ? son o f them e s p e c ia ll y i n th e deeper' la y e r ; w ere ^ surrounded <*& p a r t l y invaded by g l i a c e l l s {s a t e l l i t e s ! .and: Sauren- nhagia) i n spn# a re a s -fh^ g a a g lio ^ ' ' lin d is sjo a e d . ip&9so^>& iaa:i p ;:i :^1 ^^ i i s s ^ - . t ' ji';i4'': ;: ^ ppi*? i _ rresniv chonres o f -he- g i l t , a j c l l i n ; ; o f he a t tilo i a s s o c ia te d v i m a 5bv::.'c.c.*!o Z f chro-rctfr, *ad cy-opln- :--4 p r o s e r s - s - I t h a ten d en cy t o l i A r a t i o n cad v jc 1rz C a tio n i n r / ,r o r a l u r t c r ? . ( 3) Vc-i'cul&r e f r ,om T e r / s tr ih ir .'; chs-ugos - c r o e ia c lo s e d w ith in th e c a r d llw ie s . Ibey afcrrcd ntxed -r o Iifo rr* iv e end progressiv phmofoett a s e v td -s c e d by e n d r tb c lia l e r r of--`S t i t i c l p r o l i f r a t i o n and new fo -= '-t o a r.f C '-jU :.0T ic r, The ~= o r : . - / c f t v - a . I l l c r l e s w ere end* up o f Ed r e l i f c r n t o d n d o th c lie l c o ll? m ic h co n tain ed c h ro n a tin - rirl ,, r r l r ; . \l* h :n a rc r'-o io b l? :r ru n t n" ep icp ico n ? t h e i r polos T h e / -cro lr" " ji'_ ^ 3 y f i l l e d ui r h p r e - r ic h j r ovule at r r c -*cre sometimes currourdr-rl I: r fc - I '. o r ^ 'hrj-jon. Xr. con- e r r a t - ore wer t o be s e a T e r r a c-- i J . o i l e r w ith b r l h M '- rJ.*-:-rr-r L'.jr'-r'; r e p lie d e n d o th e lia l i i f l c v f- h d o n rV-.i v -B . b o c ic j. H--*" r f th cr. d is c lo s e d n u ssro u s b--Y ln g B r ' i i c r . . I n .-r.# . . - r 'r -...ti'". fio7.d appeared to be o -i'c rc o V y- t n -.hw nJ'to" o f - r - l i f . r a te d c m i l l . l i r e c o n ta in in g h y p s r- p'j c r t i o o - ' cod o t o . - i ' - i r l Oi.13:- 1 1 .' rf.Ie o f t h e l a r g e r ,-r.r;.ri / r 7'f ro :.p- *v. f i 'i:;r--fr-d, j|| ^ - p in -- ;ir<r' o f - l^w j-+'2*.L.. .c..c. .2J...S..?.*..... ;!' :c;r'.s*id in. _i.:.o -f >'id m t r .ifSSl ; "ro d . n i : r or tiv .ch sa g e s. c ' th e I r .r rer* Hoot* v c o o rlc c is s lc c c C a --ode r o ii d eg ree o f a r t e r i o -- r e V r o e i c . ^ f e r c f th e s r e l l c r v e in s or: re d c e l i c i t f&broa&a and ,-pp j-y -- io n o f t i v vecKi'f. "d?*,. Lj.hi -joe c c p i- lf r i o s t h e l a r g e r Doel-" d id "! '- iio r lc o ^ p^i'iva.icola:.' i n f i l t j v b i c n v i t h honotogonons olenento. sm skffXi The changes in d iffe re n t a re a s o f th e b ra in tis s u e a re both parenchjsateus and in te r s titia l The forcier d iffu s e degenerative cheages o f th e serv e c e l l throufm o' a s s o c ia te d w ith o ire n a s o rib e d a re a s o f s o f tis n s g sad t i s s u e n e c ro s is * a re e s s e n t i s l l y re g re ssiv o r d e g e n e ra tiv e . Thus i n t e r s t i t i a l changes are d e fin ite ly progressive and p ro life ra tiv e in ch aracter, (h y p e rp la s tic end p r o lif e r a tiv e phenomena i n th e e n d o th e lia l and adven t i t i a l * c e l l s , new fo rm a tio n o f e a p i l l c r i e s , h y p e r p la s tic changes o f th e le p to a e n ia g e s). COWBOSt Whk& th e oarern h y ao to u s changes a r e n o t s p e c i f i c i n t h e i r c h a r a c te r s a d nay resemble th o se to be found i n any type o f s tru c tu ra l v a sc u la r le s io n s , (a r te r io s c le r o s is , h y p erten siv e encephalopathy) th e mesodermal changes o f th e c a o illa r le s and leptom euinges are more c h a r a c te r is tic and s i g n i f ic a a t end are compatible* w ith lead encephalopathy. The l a t t e r i a c h srae te rised .ch iefly by prevalence o f productive and p ro life ra tiv e phenomena i n th e e n d o th e lia l sad a d v e n titia l v a sc u la r ti s s u e and i n th e leptom sningos. DIA0SIS* Load encephalopathy. X . M art: S c h e in k e r , M .D.