UMMARY
Results of the intracarotid and intravertebral injection of metrazol and sodium amytal in patients with generalized seizures associated with generalized bilaterally synchronous spike and wave discharges, suggest that cortical mechanisms are very important for the physiopathogenesis of these seizures. It seems, however, unjustified to exclude reticular brain stem and thalamic mechanisms entirely, since the animal experimental evidence supporting their role in the mechanism of the generalized bilaterally synchronous spike and wave discharges is very strong.

It is proposed that this type of generalized seizures results from an abnormal interaction of cortical and subcortical grey matter and that the mechanism of discharge cannot be satisfactorily explained by evoking only cortical or only subcortical mechanisms. For this reason the term of “generalized cortico-reticular epilepsies” is proposed. Three main subvarieties of these epilepsies seem to exist: (1) genetic form (classical “centrencephalic” epilepsy); (2) metabolic forms and (3) organic forms. The latter show diffuse pathological lesions of cortical and subcortical grey matter. “Secondary bilateral synchrony” is thought to be a subvariety of the latter resulting from the fact that generalized discharges are under the control of a focal cortical pacemaker.

RESUME
Les resultats d'une injection intracarotidienne ou intravertebrale de cardiazol ou d'amytal sodique chez des sujets presentant des crises generalisees associees a des decharges generalisees de pointes-ondes bilaterales et synchrones, suggerent que des mecanismes corticaux jouent un role tres important dans la physiopathogenie de ces crises. Cela n'empeche qu'il semble injustifie d'exclure entierement un mecanisme impliquant le tronc cerebral et le thalamus dans la genese des pointes-ondes bilaterales et synchrones, puisqu'il existe chez l'animal des preuves experimentales tres con-vaincantes du role joue par un tel mecanisme.

Nous proposons d'admettre que ce type de crises generalisees resulte d'une interaction anormale de la substance grise corticale et sous-corticale et que le mecanisme des decharges bilaterales et synchrones ne saurait dependre d'un mecanisme ex-clusivement cortical ou sous-cortical. C'est pour cette raison que nous proposons le teime d‘epilepsie generalisee cortico-reticulaire. U semble exister 3 varietes de cette epilepsie: (1) la variete genetique (epilepsie “centrencephalique” classique); (2) la variete metabolique; (3) la variete organique. La derniere variete repond a des lesions diffuses de; la substance grise corticale et sous-coiticale. La “synchronic bilaterale secondairt ’ raracteriserait une sous-variete d‘epilepsie generalisee cortico-reticulaire organique dans laquelle les decharges generalisees seraient sous le controle d'un foyer cortical jouant le role de ”centre entraineun“.

Generalized cortico-reticular epilepsies. Some considerations on the pathophysiology of generalized bilaterally synchronous spike and wave discharge.

Publisher Summary The hippocampus, among those vulnerable regions, is the area where anatomic, physiologic, and behavioral can be studied. For understanding the basic mechanism of ischemic neuronal damage, the hippocampus has proven to be one of the most suitable systems for experimental study. There is ample time to examine the CAI neurons before these cells totally lose their viability. Most of the population of nerve cells in the particular location in the hippocampus behaves almost synchronously and therefore it is easier to focus the attention than in a system where the neuronal change is scattered more sparsely. The chapter discusses the “vascular theory” that seems to be unsatisfactory to explain the cell damage in a circumscribed region of the hippocampus. In contrast, there is increasing evidence that the ischemic damage to hippocampal neurons is related to the chemical characteristics and interconnection of individual neurons in the complex circuitry of the brain.

Selective vulnerability of the hippocampus to ischemia - reversible and irreversible types of ischemic cell damage

Traumatically induced subtotal hippocampal neuronal loss traditionally has been considered a consequence of intracranial hypertension and impaired cerebral perfusion. We have examined the frequency and distribution of hippocampal lesions in an acceleration model of brain injury in 54 anesthetized nonhuman primates undergoing physiologic monitoring and subjected postinjury to comprehensive neuropathologic examination. Hippocampal lesions occurred in 32/54 animals (59%). These lesions always involved the CA-1 hippocampal subfield and were bilateral in 24 animals. Hippocampal involvement was not associated with marked elevation of intracranial pressure or depression of cerebral perfusion pressure. These lesions occurred in the absence of involvement of other brain regions considered selectively vulnerable to hypoxic insults. Hippocampal damage occurred in 46% of animals with mild injury characterized by brief periods of unconsciousness and no residual neurologic deficit. Ninety-four percent of animals with severe injuries and prolonged posttraumatic coma had hippocampal involvement. Traumatically induced selective neuronal necrosis of the hippocampus is a specific lesion not explained by the conventional mechanistic theories of head injury. An alternative hypothesis, such as excitotoxicity involving glutamate or other neurotransmitters, may account for the lesions demonstrated in this study.

Selective vulnerability of hippocampal neurons in acceleration-induced experimental head injury.

Neurofibrillary degeneration and neuronal loss in alzheimer's disease

Generalized penicillin epilepsy in the cat: Effects of intracarotid and intravertebral pentylenetetrazol and amobarbital injections ☆

The distribution of the internal carotid circulation of the macaque brain was studied by using a method of intracarotid dye injections which produced no appreciable disturbance of the dynamics of the cerebral circulation. The areas in cortical and diencephalic structures supplied by the carotid circulation are described and displayed semidiagrammatically in a set of figures. The carotid artery supplies most of the lateral and mesial surfaces of the cerebral hemisphere, whereas the hemispherical portion supplied by the posterior cerebral artery is confined to the occipital and inferior temporal region. Left and right internal carotid territories overlap widely across the midline in cortical areas due to the existence of a single pericallosal arterial trunk formed by the junction of both anterior cerebral arteries. In the diencephalon the segregation of the territories of the left and right internal carotid arteries is sharp, except in its anterior-most portion. The pattern of internal carotid supply to the thalamus is somewhat variable, the most lateral structures are most consistently supplied by this vessel, whereas the more medial structures, even those lying far rostral within the thalamus, are supplied by the posterior cerebral artery. The territories of the two vessels overlap considerably within the thalamus. In a certain number of animals, the posterior cerebral artery is part of the internal carotid, rather than of the vertebral-basilar system.

The distribution of the internal carotid circulation in the brain of the macaque monkey (Macaca mulatta)

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The distribution of the internal carotid circulation in the brain of the macaque monkey (Macaca mulatta)