Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 48, Issue 5
Displaying 1-11 of 11 articles from this issue
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Original Articles
  • Prevalence of Idiopathic Normal-Pressure Hydrocephalus in the Elderly Population of a Japanese Rural Community
    Kotaro HIRAOKA, Kenichi MEGURO, Etsuro MORI
    2008 Volume 48 Issue 5 Pages 197-200
    Published: 2008
    Released on J-STAGE: May 23, 2008
    DOIhttps://doi.org/10.2176/nmc.48.197
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    The prevalence of idiopathic normal-pressure hydrocephalus (NPH) in a community was investigated by retrospective analysis of data from a previous community-based study of 170 randomly selected elderly residents aged 65 years or older. Magnetic resonance (MR) images of the subjects were reviewed for the specific structural features of idiopathic NPH, i.e. ventricular enlargement and narrow cerebrospinal fluid (CSF) space at high convexity and high midline areas. The clinical features of idiopathic NPH, gait disturbance, urinary incontinence, and cognitive impairment, were evaluated on the basis of records of the subjects’ neurological examinations, a health questionnaire, the Mini-Mental State Examination, and Clinical Dementia Rating. Thirteen of the 170 subjects showed lateral ventricular enlargement greater than 0.3 on Evans’ index. Five subjects (2.9%) demonstrated both ventricular enlargement and narrow CSF space at the high convexity/midline. All five subjects with these MR imaging signs had cognitive impairment, one had gait disturbance, and one had urinary incontinence. The present study found 2.9% of community-dwelling elderly subjects showed radiological and clinical features consistent with idiopathic NPH.
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  • Prediction of Postoperative Alignment in Patients Undergoing Anterior Cervical Fusion Using Autologous Vertebral Bone Grafting
    Kyongsong KIM, Toyohiko ISU, Atsushi SUGAWARA, Ryoji MATSUMOTO, Masano ...
    2008 Volume 48 Issue 5 Pages 201-207
    Published: 2008
    Released on J-STAGE: May 23, 2008
    DOIhttps://doi.org/10.2176/nmc.48.201
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    Cervical anterior fusion is useful for the treatment of patients with cervical disease, but carries the risk of postoperative worsening of the cervical spine alignment and kyphosis. Preoperative prediction of the risk for kyphosis could help to avoid such postoperative complications. We attempted to predict the postoperative development of kyphosis in 59 patients scheduled for cervical anterior fusion using autologous vertebral bone grafting. Of these, 36 underwent single and 23 two level fusion with median follow up of 58.2 months. Whole spine alignment, fused segment alignment, and mobility of the intervertebral disc were compared using pre- and postoperative radiographs. Alignment of the whole spine changed from 13.7° to 11.1°, and the angle of the fused segment changed from 3.6° to -3.2°. Postoperative alignment was not worse than the preoperative flexion posture in any of the 59 patients. Forty-nine patients with preoperative lordotic alignment did not develop postoperative kyphosis. Nine patients with preoperative straight alignment had several types of postoperative alignment, including kyphosis. Two patients with postoperative kyphosis showed marked loss in the angle of the fused segment, which affected mobility to flexion of the fused segment. One patient with preoperative kyphotic alignment manifested postoperative kyphosis. The postoperative alignment was influenced by the preoperative alignment. Kyphosis may develop in patients with preoperative straight alignment and large mobility to flexion of the fused segment. This information is useful for surgical planning of anterior cervical fusion using autologous vertebral bone grafting.
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Case Reports
  • Endovascular Treatment for Traumatic Ear Bleeding Associated With Acute Epidural Hematoma
    —Case Report—
    Kouichi MISAKI, Naoki MURAMATSU, Hisashi NITTA
    2008 Volume 48 Issue 5 Pages 208-210
    Published: 2008
    Released on J-STAGE: May 23, 2008
    DOIhttps://doi.org/10.2176/nmc.48.208
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    A 44-year-old woman presented with intractable ear bleeding after head trauma. Computed tomography showed a longitudinal petrosal bone fracture and a mastoid air cell hematoma with a small acute epidural hematoma. Conservative therapy for more than 12 hours failed to stop the bleeding, so we planned endovascular treatment rather than open surgery. Angiography of the external carotid artery demonstrated continuous extravasation of contrast material from the middle meningeal artery near the fracture line in the temporal bone. Intravascular embolization was performed using polyvinyl alcohol particles and gelatin sponge pieces, resulting in immediate successful hemostasis. Endovascular management should be considered for the treatment of intractable traumatic ear bleeding.
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  • Endarterectomy for Mild Cervical Carotid Artery Stenosis in Patients With Ischemic Stroke Events Refractory to Medical Treatment
    —Two Case Reports—
    Masakazu KOBAYASHI, Kuniaki OGASAWARA, Takashi INOUE, Hideo SAITO, Yas ...
    2008 Volume 48 Issue 5 Pages 211-215
    Published: 2008
    Released on J-STAGE: May 23, 2008
    DOIhttps://doi.org/10.2176/nmc.48.211
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    A 62-year-old man and a 44-year-old man with unilateral cervical carotid artery stenosis (less than 50% with echolucent plaque and ulceration) suffered recurrent ischemic stroke events despite treatment with antiplatelet and anticoagulation drugs. Carotid endarterectomy (CEA) was performed under transcranial Doppler monitoring for the detection of micro-emboli using a microscope inserted through a skin incision to minimize pressure on the carotid arteries. The atheroma plaque included an ulcer with fresh thrombi in both patients. Both patients awoke from anesthesia without new neurological deficits, and no ischemic stroke events have recurred since CEA. Endarterectomy is an effective method for preventing stroke in patients with severe carotid stenosis (>70%), but the efficacy of this procedure for mild carotid stenosis (<50%) remains uncertain, regardless of carotid plaque characteristics. The present cases suggest that even mild stenosis of the cervical carotid artery may result in ischemic stroke events that are refractory to medical treatment if the stenosis is associated with echolucent plaque with ulceration. Endarterectomy is recommended to prevent further stroke in such patients.
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  • Unusual Angiographic Changes in an Internal Carotid Artery Pseudoaneurysm After Infection in the Deep Neck Space
    —Case Report—
    Yasuhiko HAYASHI, Hiroshi SHIMA, Katsuyoshi MIYASHITA, Masashi KINOSHI ...
    2008 Volume 48 Issue 5 Pages 216-219
    Published: 2008
    Released on J-STAGE: May 23, 2008
    DOIhttps://doi.org/10.2176/nmc.48.216
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    A 48-year-old man presented with a pseudoaneurysm at the cervical portion of the left internal carotid artery (ICA) secondary to infection in the deep neck space. Magnetic resonance (MR) imaging demonstrated enhancement of the wall of the ICA and a pseudoaneurysm, considered to be sequelae of infection spread. ICA occlusion occurred on the next day resulting in sudden onset of right hemiparesis and motor aphasia. The ICA pseudoaneurysm shrank gradually and his neurological deficits improved with conservative therapy. One month later, he presented with aneurysm regrowth. The common carotid artery was occluded with Guglielmi detachable coils to block arterial flow into the pseudoaneurysm. There were no neurological complications. Marked enhancement of the ICA wall on computed tomography and MR imaging may indicate the possibility of vascular complications such as rupture, pseudoaneurysm development, or ICA occlusion, and consequent neurological deficits. ICA occlusion caused by spread of infection in the deep neck space may cause accelerated coagulopathy due to ICA wall inflammation.
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  • Intracystic Hematoma of Middle Fossa Arachnoid Cyst Caused by Rupture of Internal Carotid-Posterior Communicating Artery Aneurysm
    —Case Report—
    Ikki KAJIWARA, Toshihide TANAKA, Issei KAN, Toshihiro OHTSUKA, Satoshi ...
    2008 Volume 48 Issue 5 Pages 220-222
    Published: 2008
    Released on J-STAGE: May 23, 2008
    DOIhttps://doi.org/10.2176/nmc.48.220
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    A 46-year-old woman was admitted with generalized convulsion and deep coma which occurred 3 weeks after sudden onset of severe headache and pyrexia. Initial computed tomography did not reveal any abnormal findings except for an arachnoid cyst in the right middle fossa. Three weeks later repeat computed tomography showed intracystic hematoma in the arachnoid cyst with uncal herniation. Angiography revealed a right internal carotid-posterior communicating artery aneurysm. The neck of the aneurysm was clipped successfully, but hemiparesis was persistent postoperatively. Angiography is required for investigation of intracystic hematoma of an arachnoid cyst, especially in the absence of head injury, to avoid delayed diagnosis of any ruptured aneurysm.
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  • Intrasacral Extradural Arachnoid Cysts
    —Three Case Reports—
    Mustafa Kemal HAMAMCIOGLU, Tufan HICDONMEZ, Cumhur KILINCER, Sebahatti ...
    2008 Volume 48 Issue 5 Pages 223-226
    Published: 2008
    Released on J-STAGE: May 23, 2008
    DOIhttps://doi.org/10.2176/nmc.48.223
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    Three patients presented with rare intrasacral extradural arachnoid cysts manifesting as sensory deficiencies and pain in the lower extremities. Magnetic resonance imaging with various sequences identified the cysts. Two patients underwent surgery via laminectomy of the sacrum for cyst exploration and disconnection of the cyst with the dural theca. Postoperative outcome was favorable in these two patients. Intrasacral extradural arachnoid cyst should be considered in the differential diagnosis of low back pain.
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  • Spontaneous Regression of an Asymptomatic Meningioma Associated With Discontinuation of Progesterone Agonist Administration
    —Case Report—
    Jun SHIMIZU, Masayoshi MATSUMOTO, Etsuo YAMAZAKI, Masaharu YASUE
    2008 Volume 48 Issue 5 Pages 227-230
    Published: 2008
    Released on J-STAGE: May 23, 2008
    DOIhttps://doi.org/10.2176/nmc.48.227
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    An 80-year-old male visited the hospital as an outpatient with a head injury sustained in a traffic accident. Brain computed tomography incidentally revealed a left frontal lobe tumor measuring 5 cm in a diameter. The patient had a history of taking chlormadinone acetate (a progesterone agonist) prescribed several years previously as treatment for benign prostatic hypertrophy. The tumor was seen as an isointense lesion on T1-weighted magnetic resonance (MR) images with enhancement by gadolinium, and as a heterogeneously hyperintense mass on T2-weighted MR images. The tentative diagnosis was left frontal meningioma attached to the sphenoid ridge or sphenoid plane. The patient was managed conservatively because of his advanced age and no symptoms or progression were observed during a 9-month follow-up period. The medication for benign prostatic hypertrophy was changed from chlormadinone acetate to naftopidil (an alpha-2-blocker) about 9 months after his first presentation. The patient presented again 2 years later complaining of dizziness. Computed tomography and MR imaging performed at this time revealed remarkable regression of the tumor. The signal intensity change with regression of the tumor on T2-weighted images was observed as a hypointense lesion. Thus, we wish to emphasize that treatment of meningiomas, especially those diagnosed incidentally, must be based on a thorough consideration of any history of hormonal therapy with prostate disease.
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  • Rapid Spontaneous Remission of a Spontaneous Spinal Chronic Subdural Hematoma in a Child
    —Case Report—
    Dong-Hyuk PARK, Tai-Hyoung CHO, Jang-Bo LEE, Jung-Yul PARK, Youn-Kwan ...
    2008 Volume 48 Issue 5 Pages 231-234
    Published: 2008
    Released on J-STAGE: May 23, 2008
    DOIhttps://doi.org/10.2176/nmc.48.231
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    A 13-year-old boy presented with a rare spontaneous spinal chronic subdural hematoma (SCSDH) with no associated trauma or medical problems manifesting as back and bilateral lower extremity pain persisting for 10 days. Neurological examination revealed mild weakness and paresthesia in both lower extremities. Magnetic resonance (MR) imaging performed 1 week after the appearance of symptoms revealed a chronic subdural hematoma at the thoracolumbosacral region. Follow-up MR imaging performed 1 week later showed significant resolution of the hematoma without the need for surgery. The patient was discharged with only conservative management. This case of spontaneous SCSDH with rapid spontaneous remission in a child not associated with coagulopathy indicates that aggressive surgical treatment should be delayed as long as possible in pediatric patients because the spinal structure is still developing.
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Technical Note
  • Cutting Balloon Angioplasty for Carotid Artery In-stent Stenosis Supported by Three-dimensional Rotational Angiography With Automated Vessel Analysis Software
    —Technical Note—
    Yasuhiko AKIYAMA, Kouzo MORITAKE, Takeshi MIYAZAKI, Kentaro KOWARI, Hi ...
    2008 Volume 48 Issue 5 Pages 235-238
    Published: 2008
    Released on J-STAGE: May 23, 2008
    DOIhttps://doi.org/10.2176/nmc.48.235
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    In-stent stenosis is a possible long-term complication of carotid artery stenting. A simple and safe technique of cutting balloon angioplasty is described for carotid in-stent stenosis. The stented vessel is imaged by three-dimensional (3D) rotational angiography, the acquired projection images are transferred to a workstation, and the stenotic lesion and implanted stent are reconstructed. The diameter of the implanted stent in the stenotic region is measured by automated analysis software. Cutting balloon angioplasty carries the risk of vessel injury by the cutting balloon microblades, but the implanted stent acts as a barrier to protect the vessel. Therefore, cutting balloon inflation up to the stent diameter is safe and results in maximal vessel dilation. The key to success is precise measurement of the stent diameter and choice of a cutting balloon catheter of the appropriate size. 3D rotational angiography provides high-quality images of the vasculature of a stented vessel and a reference for intervention based on absolute measurements. Cutting balloon angioplasty supported by 3D rotational angiography with automated vessel analysis software should be considered as a treatment strategy for high-grade carotid artery in-stent stenosis.
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Editorial Committee
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