ATROPHY OF THE THALAMUS IN A CASE OF ACQUIRED HEMIPLEGIA ASSOCIATED WITH DIFFUSE PORENCEPHALY AND SCLEROSIS OF THE LEFT CEREBRAL HEMISPHERE

Women Neuroscientist Disciples of Pío del Río-Hortega: the Cajal School Spreads in Europe and South America

Pio del Rio-Hortega was not only the discoverer of the microglia and oligodendroglia but also possibly the most prolific mentor of all Santiago Ramon y Cajal’s disciples (Nobel awardee in Physiology or Medicine 1906 and considered as the father of modern Neuroscience). Among Río-Hortega’s mentees, three exceptional women are frequently forgotten, chronologically: Pio’s niece Asunción Amo del Río who worked with Río-Hortega at Madrid, Paris, and Oxford; the distinguished British neuropathologist Dorothy Russell who also worked with Don Pío at Oxford; and Amanda Pellegrino de Iraldi, the last mentee in his career. Our present work analyzes the figures of these three women who were in contact and collaborated with Don Pío del Río-Hortega, describing the influences received and the impact on their careers and the History of Neuroscience. The present work completes the contribution of women neuroscientists who worked with Cajal and his main disciples of the Spanish Neurological School both in Spain (previous work) and in other countries (present work).

Prefrontal Leucotomy

The operation of prefrontal leucotomy or, as some call it, prefrontal lobotomy, is one of the most startling of modern therapeutic procedures. It was introduced in Portugal by Moniz (1936)—the actual operation being performed by Lima—and was subsequently developed in Italy and in America. In this country it was first carried out at the Burden Neurological Institute in Bristol on December 11, 1940. At the time of writing (May, 1943) some 350 leucotomies have been performed in Great Britain. In 1942 Freeman published his book, Psychosurgery, dealing with the work done up to the end of 1941. Most of the work dealt with in the present review has been published since then, although for the sake of completeness Freeman's book will be referred to.

Neuropathological Problems Arising from Prefrontal Leucotomy

The neuropathological problems which arise from prefrontal leucotomy may be conveniently divided into three groups.

The first group is concerned with the analysis of the anatomical and possible other factors which may influence the prospect of recovery. This group is naturally of the greatest practical interest to the psychiatrist and, for this reason, will require our foremost attention.

The Anatomy of the Nervous System

Owing to the difficulties of investigating the sensory organization of the nervous system experimentally, for many years experimental neurologists tended to direct their attention rather to the motor mechanisms, for these can easily be studied and recorded objectively. During the last few years, however, research investigations have been more concentrated on the anatomical basis of sensation and, accordingly, this review will be mainly concerned with this aspect.

Neuropathology

This review is based on neuropathological contributions which have either a direct or indirect relation to mental disease or are of major general interest. Notwithstanding these restrictions the field which had to be covered remains vast, and no claim can be made that the survey of the literature is complete, although it is hoped that it is, to some extent, representative. In order to counteract this defect, recent reviews or comprehensive papers on special problems have been recommended, whenever they were available. They will enable the reader to trace references which for lack of space had to be suppressed. For the same reason of economy, a number of quotations have been made from reviews. This does not mean that the original papers have not been consulted.

Whisker stimulation metabolically activates thalamus following cortical transplantation but not following cortical ablation

Local cerebral glucose utilization was assessed during whisker stimulation by 2-deoxyglucose autoradiography. Whisker stimulation increased local cerebral glucose utilization in brainstem, thalamus and whisker sensory cortex in normal rats. Whereas whisker stimulation increased glucose metabolism in brainstem, whisker stimulation failed to increase glucose metabolism in thalamus of rats that had whisker sensory cortex ablated 5 h to five weeks previously. The failure of whisker stimulation to activate thalamus after cortical ablations was probably not due to decreased cortical input to thalamus because whisker stimulation activated thalamus after large cortical tetrodotoxin injections. Failure of whisker stimulation to activate thalamus at early times (5 h and one day) after cortical ablations was not due to thalamic neuronal death, since it takes days to weeks for axotomized thalamic neurons to die. The failure of whisker stimulation to activate thalamus at early times after cortical ablations was likely due to the failure of trigeminal brainstem neurons that project to thalamus to activate axotomized thalamic neurons. This might occur because of synaptic retraction, glial stripping or inhibition of trigeminal brainstem synapses onto thalamic neurons. The thalamic neuronal death that occurs over the days and weeks following cortical ablations was associated with thalamic hypometabolism. This is consistent with the idea that the thalamic neurons die because of the absence of a cortically derived trophic factor, since the excitotoxic thalamic cell death that occurs following cortical kainate injections is associated with thalamic hypermetabolism. The glucose metabolism of parts of the host thalamus was higher and the glucose metabolism in surrounding nuclei lower than the normal side of thalamus in rats that sat quietly and had fetal cortex transplants placed into cavities in whisker sensory cortex five to 16 weeks previously. Whisker stimulation in these subjects activated the contralateral host thalamus and fetal cortical transplants. This was accomplished using a double-label 2-deoxyglucose method to assess brain glucose metabolism in the same rat while it was resting and during whisker stimulation. The high glucose metabolism of parts of host thalamus ipsilateral to the fetal cortical transplants is consistent with prolonged survival of some axotomized thalamic neurons. The finding that whisker stimulation activates portions of host thalamus further suggests that the cortical transplants maintained survival of the host thalamic neurons and that synaptic connections between whisker brainstem and thalamic neurons were functional.

Thalamic retrograde degeneration following cortical injury: an excitotoxic process?

Traumatic or stroke-like injuries of the cerebral cortex result in the rapid retrograde degeneration of thalamic relay neurons that project to the damaged area. Although this phenomenon has been well documented, neither the basis for the relay neuron's extreme sensitivity to axotomy nor the mechanisms involved in the degenerative process have been clearly identified. Physiological and biochemical studies of the thalamic response to cortical ablation indicate that pathological overexcitation might contribute to the degenerative process. The responses of thalamic projection neurons, protoplasmic astrocytes, and inhibitory thalamic reticular neurons in adult mice were examined from one to 120 days following ablation of the somatosensory cortex as part of an investigation of the role of excitotoxicity in thalamic retrograde degeneration. The responses of thalamic neurons to cortical ablation were compared with those produced by intracortical injection of the convulsant excitotoxin kainic acid, since the degeneration of neurons in connected brain structures distant to the site of kainic acid injection is also thought to occur via an excitotoxic mechanism. Within two days after either type of cortical injury, protoplasmic astrocytes in affected regions of the thalamic ventrobasal complex and the medial division of the posterior thalamic nuclei became reactive and expressed increased levels of immunohistochemically detectable glial fibrillary acidic protein. Within the affected regions of the ventrobasal complex an increased intensity of puncta positive for glutamate decarboxylase immunoreactivity, presumably due to an increase in its content within the terminals of the reciprocally interconnected thalamic reticular neurons, was also evident. These immunohistochemically detectable alterations in the milieu of the damaged thalamic neurons preceded the disappearance of the affected relay neurons by at least two days following cortical ablation and by seven to 10 days following intracortical kainic acid injection. Regions of the thalamus containing reactive astrocytes corresponded very closely to the regions undergoing retrograde degeneration. Protoplasmic astrocytes in these areas remained intensely reactive up to 60 days after cortical injury. Levels of glutamate decarboxylase were only transiently elevated in the degenerating regions of the ventrobasal complex following cortical ablation and returned to normal by 14 days. Increased glutamate decarboxylase immunoreactivity was transiently seen through the entire ventrobasal complex following intracortical kainic acid injection but was markedly more intense in degenerating regions. These patterns of labeling did not return to normal until 50 days after intracortical kainic acid injection, well after the death of the relay neurons. Cortical ablation and intracortical kainic acid injection produce similar alterations in thalamic neuronal and glial populations.(ABSTRACT TRUNCATED AT 400 WORDS)

Nucleus dorsalis superficialis (lateralis dorsalis) of the thalamus and the limbic system in man

Although the earlier supposition was that the n. dorsalils superficialis (n. lateralis dorsalis) of the thalamus projected to the parietal region, more recent evidence has linked it to the posterior cingulate gyrus and possibly adjacent regions near the splenium of the corpus callosum. An afferent supply from lower levels was in more doubt, although some report had been made of cell and fibre degeneration in the n. dorsalis superficialis after extensive temporal resections and section of the fornix in lower primates. The five human hemispheres of the present study all had lesions of long duration below the level of the splenium of the corpus callosum in the posteromedial temporal region. All showed marked degeneration in the fornix and n. dorsalis superficialis. In favourably stained cases, gliotic fascicles could be followed from the descending column of the fornix to the n. dorsalis superficialis via the region lateral to the stria medullaris thalami. The cell loss in the nucleus thus appeared to be an instance of anterograde transynptic degeneration. These cases provided an interesting instance in which human infarctions provided natural lesions that would have been hard to duplicate in experimental animals.

The late sequelae of pneumococcal meningitis

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