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Morphological changes in children with cerebral palsy With symptomatic epilepsy
Artykova Mavlyuda Abdurahmanovna, Chief physician of Bukhara Regional Children's Mental Hospital of the Republic of Uzbekistan E-mail: evovision@bk.ru
Morphological changes in children with cerebral palsy With symptomatic epilepsy
Abstract: Mikropoligirii is the most common defect in brain development of children with cerebral palsy, morphologically manifested in the form of small, for-rounding meanders with deep furrows, in the presence of symptomatic epilepsy marked thinning of the gray matter, the expansion of the ventricles and the emergence of foci of haemorrhage. Keywords: Cerebral Palsy, mikropoligirii, morphological changes.
It is known that cerebral palsy polietiologic nevrologic disease often starts as a result of intrauterine damage to the central nervous system, continued in the first years ofpostnatal life, uniting all forms of spastic paralysis with similar clinical features (). In the structure of the causes of cerebral palsy recovered prenatal, natal and postnatal factors. These include infectious diseases of mother during pregnancy, mental, physical, and mechanical trauma during delivery, asphyxia and others. The impact of these factors leads to ischemic injury periventricular areas of the brain, and atrophic changes in different parts of the cortex. There are more than 20 forms of cerebral palsy, but most often meets double hemiplegia is characterized by a pronounced atrophy of the cerebral cortex in the form of microcephaly and increased ventricular volume; mental development of de children with this form of cerebral palsy, and corresponds to the minimum oligophrenic degree in imbecility or idiocy. At the same time, especially patomorfologic changes in different parts of the brain during cerebral palsy accession seizures have not been studied, revealing them can reveal the essence of the pathogenesis, morphogenesis and morphology of the severe pathology of nerve tissue.
The aim of the work was to identify features in the comparative aspect patho-morphological changes in children with cerebral palsy in the form of microcephaly with symptomatic epilepsy without it.
Material and methods. The object of the study were 5 brains taken at autopsy of children died from cerebral palsy, ofwhich 3 cases on the clinical data from the disorder syndrome. First studied the anatomical parameters of the brain: the state of hemispheres, their symmetry, surface condition and convolutions, their symmetry, sphericity, and the number, state and subcortical regions of the ventricles, a condition of cerebellum and the medulla oblongata. Then brain was cut by Shore from each hemisphere, subcortical sections taken size pieces 1.5x1.5 cm. After fixation in 10% neutral solution of formalin and dehydrated in alcohols embedded in paraffin. Histologic sections 5-6 microns thick were stained with hematoxylin-eosin, Nissl method for acid mucopolysaccharides impregnation and glial cells and
Results and its discussion. Results of morphological studies have shown that when microcephaly all parts of the brain are reduced symmetrically due to the backlog and the violation of its growth. Mass brain compared with normal reduced on average by 24%. Hemispheres of the brain, particularly the frontal lobes atrophic, reduced in size, are asymmetrical. Sometimes the presence of mikrogirii detected lesions makrogirii, gonadal agenesis, and even nuclear structures, expansion of the ventricles and subarachnoid spaces.
Microscopic examination revealed secondary changes caused by brain scars: Smart narrow, irregularly shaped, deep-bo-breather.
Sometimes deep in the brain revealed a cystic cavity is divided into several compartments or pores. It's time represents a scar lesions caused by vascular changes in the brain occurred during fetal life. Microscopically, there is a lack of nerve cells in the superficial layers of the cortex (Figure 1a), but the nerve cells are available in the state-of atrophic and distrait cal changes observed around glial cell proliferation and thickening of the vessel walls. Pia considerably thickened and tortuous due to the increase of fibrous connective tissue structures.
Under the brain tissue of the brain shell some what loosened, diluted and swollen. When histochemical study by Nissl in the cerebral cortex observed asymmetry and deformation of sulci and gyri. Blood vessels somewhat widened and thickened wall significantly due to proliferation of endothelial cells and connective fibers, which apparently leads to ischemia of brain tissue with subsequent atrophy of nerve cells. The cerebral sulci nerve cells randomly arranged, formed a with out cells fields in the outer part of the cerebral cortex (Fig. 1b). The surviving nerve cells of different shapes and conducted, most of them shriveled, in some neurons tiger substance densely Skopje as dark purple inclusion inclusions, while in others a little concentrated and colored Bazophilic, indicating that there are significant metabolic disorders in the cytoplasma nerve cells characteristic of seizures. Between the grooves in the neural tissue observed sprouting tufts of fibrous connective tissue.
Microscopic examination of microcephaly with seizures noted the presence of a massive outbreak of hemorrhage into the deep layers of the cerebral cortex. The peripheral of the hemorrhage observed resorption of blood cells, turning gemoglobin pigments, thinning the surrounding brain tissue, Koto-rye demonstrate the newly developed chamber hemorrhage, clinically coincides with the development of seizures, and apparently is the direct cause of death of the patient. In the center of hematoma erythrocytes and nerve tissue in a state of decay, circumferentially marked gliosis small that also speak of weakness glial cell regenerative activity due to atrophic changes in general. The circumference of hemorrhage in the brain activation is determined by a small nerve cells in the form of hypertrophy and hyperplasia of glial cells (Fig. 1C). Blood vessels slept with wall thickening and development of perivascular edema.
Mikropoligiriya according to the literature and our research were the most frequent defect in brain development of children with cerebral palsy. Morphologically it is characterized by the presence of small, rounded meanders with deep furrows. In the presence of seizures marked atrophy of the temporal lobe of the cerebral cortex with the thinned of the gray matter and a significant expansion of the lumen of the ventricles of the brain. Microscopically when the number of seizures of nerve cells is limited, and most of them underdeveloped, retain some signs of neuroblasts. Other nerve cells represent
Section 7. Medical science
an intermediate pattern between neuroblastoma and mature nerve cell. The processes of cells in a small amount and short. The number of nerve cells in the ITS, III is reduced cortical layers are arranged irregularly. The distribution of pyramidal cells marked anomie layers heterotopia, in all layers of the cortex are arranged randomly and uneven layers. Microscopic studies of individual areas of the cerebral cortex was noted that in the frontal area of the cerebral hemispheres of the cerebral cortex sulcus asymmetrical, deformed. Where meninges are thickened especially from the grooves atrophied due to the proliferation of connective tissue cells and thickening of the vessel walls. When histochemical study by Nissl cases with seizures showed that nerve cells are actually arranged randomly in the cortex, they are of different sizes and forms, most of them shriveled and deformed with uneven content of tiger substance (Fig. 1d). Processes of nerve cells due to lack of tiger substances are not determined. Glial cells are few in number, are also deformed and atrophic. The periventricular part of the cerebral cortex and subcortical areas of the brain is determined by polymorphic pathological changes. Vessels hyperplastic, sometimes with the development of angiomatosis, a wall of irregularly thickened by proliferation of connective tissue cells and fibers. Some of them extended congested, while others slept with perivascular edema. The brain tissue is determined by the pronounced swelling in the form of different formation of the vacu-
a) cortical atrophy, thickening of soft brain-ing shell extension bezkletochnogo layer of the cerebral cortex. Colouring: hematoxylin and eosin. Magnification: ok.10, ob.20.
ole. Nerve cells are few in number and are able to wrinkling and atrophy. Glial cells in large amounts by hypertrophy and hyperplasia, in particular in the perivascular areas of brain tissue.
Conclusions:
1. ICP in the form of microcephaly seen a decrease in brain mass, atrophy and deformation of the cerebral hemispheres, the presence of foci mikrogirii, makrogirii, agenesis of individual furrows and nuclei, the expansion of the ventricles, and the accession of symptomatic epilepsy appear foci of hemorrhage and degenerative changes in the nerve cells.
2. The microscopic features of microcephaly were lagging behind in the development and differentiation of nerve cells, the appearance with out cells fields, chaotic arrangement of nerve cells with uneven content of the tiger compound.
3. Mikropoligirii is the most common defect in brain development of children with cerebral palsy, morphologically manifested in the form of small, rounded meanders with deep furrows, in the presence of symptomatic epilepsy marked thinning of the gray matter, the expansion of the ventricles and the emergence of foci of hemispheres.
4. Mikropoligirii microscopically observed hypoplasia of the nerve cells, the preservation of evidence of neuroblasts and their disorderly arrangement of the prevalence of diffuse gliosis.
b) The asymmetry of cortical thickening of the vessel wall, a disorderly arrangement of nerve cells. Colour: hematoxylin and eosin. Magnification: ok.10 about. 20
в) Massive bleeding in the thickness of the cerebral cortex with g) The random arrangement of atrophy, reduced substance tiger gliosis in his circle. Colouring: hematoxylin and eosin. Magnifica- in nerve cells. Colouring: hematoxylin and eosin. Magnification: tion: ok.10, ob.20. ok.10, ob.20.
Figure 1. The child of 2.7 years. Hemiplegic cerebral palsy double form with symptomatic epilepsy
Morphological and morphometric features of the brain in children with cerebral palsy complicated by epilepsy
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Artykova Mavlyuda Abdurahmanovna Senior Researcher of Tashkent Institute of Postgraduate Medical Education, Uzbekistan, Chief physician of Bukhara Regional Children's Mental Hospital of the Republic of Uzbekistan E-mail: evovision@bk.ru
Morphological and morphometric features of the brain in children with cerebral palsy complicated by epilepsy
Abstract: Cerebral palsy (CP) is one of the most severe pediatric neurological diseases. Numerous studies are devoted to the diagnosis and treatment of this disease, but the morphological status of the brain in children with CP complicated by epilepsy has not been studied. The aim of this study is to investigate the morphological and morphometric features of the brain of deceased children with CP associated with epilepsy. The morphometric studies were performed in 32 cases with hyperkinetic, double hemiplegia and hemiplegic forms of CP in the central gyrus of the frontal lobe and the hypothalamus of the affected hemisphere. Morphological findings revealed a greater degree of immaturity of the brain of children with CP and seizures that may underlie the defect of brake mechanisms of the brain, which causes the occurrence of epileptic foci.
Key words: cerebral palsy, epilepsy, brain morphology, histological and morphometric studies.
Cerebral disorders in children is one of the urgent topics of modern neurology. The rate of congenital abnormalities of the central nervous system in newborn infants ranges from 0.74 to 1.89 cases per 1000 births, while in the general structure of all congenital defects of the nervous system accounts 10-20% [1, 2, 9].
Cerebral palsy (CP) is one of the most severe neurological diseases of pediatric age [3, 6, 10]. Numerous studies address mainly the issues of diagnosis and treatment of this pathology [4, 5, 7, 8]. However, the morphological status of the brain in children with cerebral palsy complicated by epilepsy has not been studied.
The purpose of this study is to investigate morphological and morphometric features of the brain in children with epilepsy.
Materials and Methods
Morphometric studies were performed in 32 patients with hyperkinetic form of CP, double hemiplegia and hemiplegic form in the central gyrus of the frontal lobe of the affected hemisphere and hypothalamus.
Brain tissue for histological study was processed according to standard methods. The sections were stained with hematoxylin and eosin, as well as with 0.5% solution of cresyl-violet by Nissle method, the dignity of which is stability of the results and the possibility of directional electoral identification ofspecific nerve cells with all their processes. In the preparations were determined morphological and morphometric characteristics of the cortex of the temporal lobe of both hemispheres and nuclear structures ofhypothalamic region of the brain: the thickness of the layers of the cortex, the length (height) and width of neurons in layers, the density of neurons and neuroglia in square cut in 1 mm 2.
The thickness of the layers of the cortex, the dimensions of the bodies of pyramidal neurons in layers I, II, III, IV, V VI of the cor-
tex were measured by using ocular ruler (7x eyepiece, 20x objective, microscope Leica). There were used methods of S. M. Blinkov and I. I. Glezer (1984). The volume of bodies ofpyramidal neurons was calculated according to the formula of I. N. Bogolepov, (1978). The data were processed by methods of variation statistics.
Results of the study
The thickness of all layers of the affected areas of the cortex of the central gyrus of frontal lobe in double hemiplegic form of CP without epilepsy was significantly less, in comparison with mor-phometric parameters of the same areas of the brain in children who died because of other causes. In this case, there was significant thinning of the thickness of V large pyramidal layer by 2 times, III external pyramidal layer by 1.8 times, I, II, IV layers on average by 1.5 times. VI internal polymorphic cell layer thickens by 50%, compared to control (Table 1).
In case of double hemiplegic form of CP with epilepsy morphometric changes differed somewhat from the above data. It was noted some thickening of the external three layers of the cortex, while the thickness of IV-V layers was more thin (Photo 1). Morphometric changes of the thickness of layers of cortex of frontal lobe of brain affected hemisphere in double hemiplegia were undoubtedly associated with atrophic changes of cerebral cortex as a manifestation of CP. Thickening of the external layers in epilepsy seems to be associated with the development of secondary changes in the form of edema and blood filling of vessels (Table 1).
The study of astrocytes density in the cortex in double hemiplegia showed its slight increase in II, III, and IV layers of the cortex on average by 30-40%, as compared to the control. In epilepsy was observed more increase in astrocytes density in the same layers of
