Neurologia medico-chirurgica

Original Articles

Experimental Petit Mal-Like Seizure Induced by Microinjection of Kainic Acid Into the Unilateral Mediodorsal Nucleus of the Thalamus

Koichi KATO, Tomoyuki URINO, Tomokatsu HORI, Hiroshige TSUDA, Katsunar ...

2008 Volume 48 Issue 7 Pages 285-291
Published: 2008
Released on J-STAGE: July 24, 2008

DOIhttps://doi.org/10.2176/nmc.48.285

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The mediodorsal nucleus (MD) of the thalamus has reciprocal projections with the frontal cortex and limbic system, and may be involved in absence seizures. Kainic acid was injected into the left MD of Wistar rats, and behavior and electroencephalography were monitored for 24 hours, then continued intermittently for 8 weeks. The rat brains were then examined histologically. Brain metabolic changes were also investigated by intravenous injection of 100 μCi/kg of [¹⁴C]2-deoxyglucose to measure local cerebral glucose metabolism. Bilateral synchronous spike and wave complexes appeared almost 2 hours after kainic acid injection, and the waveforms continued for about 5-7 hours in the bilateral MDs, ipsilateral sensorimotor cortex, and basolateral nucleus of the amygdala. The associated behavioral changes were mainly those of behavioral arrest and staring, associated with occasional limbic seizures. Clear metabolic increases were found in the ipsilateral frontal cortex, hippocampus, and amygdala. The present results suggest that the MD was involved in both the mechanism of spike and wave complexes in the bilateral frontal cortices, and in seizure propagation to the limbic system. Consequently, kainic acid-induced MD seizure is associated with significant cognitive impairment and may explain the mechanism of petit mal seizure.

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Administration of Free Radical Scavenger Edaravone Associated With Higher Frequency of Hemorrhagic Transformation in Patients With Cardiogenic Embolism

Masahiro MISHINA, Yuichi KOMABA, Shiro KOBAYASHI, Shushi KOMINAMI, Tak ...

2008 Volume 48 Issue 7 Pages 292-297
Published: 2008
Released on J-STAGE: July 24, 2008

DOIhttps://doi.org/10.2176/nmc.48.292

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Free radicals are known to activate coagulation and inhibit fibrinolysis. Edaravone, a free radical scavenger, protects vascular endothelial cells and neurons during acute brain ischemia in in vitro models. Hemorrhagic transformation and treatment outcomes were retrospectively examined in 76 patients with acute cardiogenic embolism treated with edaravone in addition to routine treatment within 24 hours of the onset of symptoms. Hemorrhagic transformation was categorized according to European Cooperative Acute Stroke Study-II. Patient characteristics were also evaluated, including evidence of hypertension, diabetes mellitus, hyperlipidemia, coronary heart disease, history of smoking, National Institutes of Health Stroke Scale on arrival, and modified Rankin scale at 3 months post-onset. Edaravone administration was one of the factors that contributed to increased frequency of hemorrhagic transformation, but had showed no significant relationship with the outcome. The present study showed that edaravone administration increased the frequency of hemorrhagic transformation with heparin in patients with cardiogenic embolism. Free radical scavenging may have promoted the coagulating conditions. Edaravone administration may allow reduction of the dose of heparin and tissue plasminogen activator in patients with acute ischemic stroke.

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Lumbar Synovial Cysts: Experience With Nine Cases

Gıyas AYBERK, Faik ÖZVEREN, Beril GÖK, Aylin YAZGAN, H ...

2008 Volume 48 Issue 7 Pages 298-303
Published: 2008
Released on J-STAGE: July 24, 2008

DOIhttps://doi.org/10.2176/nmc.48.298

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Nine patients treated surgically for lumbar spinal synovial cyst were reviewed. Four patients had synovial, two had ganglion, one had posterior longitudinal ligament, and two had ligamentum flavum cyst. Synovial cysts had a single layer of epithelial cells in the inner layer of the cyst with continuity with the facet joint. Ganglion cyst had no continuity with the facet joint and epithelial lining was present in one and absent in one case. Posterior longitudinal ligament and ligamentum flavum cysts had no continuity with the facet joint and no epithelial lining. Magnetic resonance imaging showed the cysts better than computed tomography. All patients treated for nerve root compression or lumbar spinal canal narrowing. One patient suffered recurrence 1 year later and was reoperated. Operative results were excellent in six and good in three patients. Lumbar spinal synovial cysts should be considered in differential diagnosis of lumbar radiculopathy/neurogenic claudication and is surgically treatable.

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Case Reports

Pupil-Sparing Oculomotor Nerve Paresis as an Early Symptom of Unruptured Internal Carotid-Posterior Communicating Artery Aneurysms

—Three Case Reports—

Ryuta SAITO, Takayuki SUGAWARA, Sigeki MIKAWA, Takeshi FUKUDA, Misaki ...

2008 Volume 48 Issue 7 Pages 304-306
Published: 2008
Released on J-STAGE: July 24, 2008

DOIhttps://doi.org/10.2176/nmc.48.304

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Oculomotor nerve paresis caused by internal carotid-posterior communicating artery (IC-PC) aneurysm usually manifests with pupillary dysfunction. Recently, we treated three patients with unruptured IC-PC aneurysms initially manifesting as pupil-sparing oculomotor nerve paresis, which resolved after clipping of the aneurysms. Review of the 56 patients admitted to our hospital with unruptured IC-PC aneurysms between January 2000 and December 2006 identified 6 patients with oculomotor nerve disturbances, and the 3 present cases with pupil sparing. The incidence of IC-PC aneurysms manifesting as pupil-sparing oculomotor nerve paresis may be increasing with improved accessibility to medical services and wider awareness of oculomotor nerve paresis as a symptom of cerebral aneurysms. Cerebral angiography should be performed in patients with pupil-sparing oculomotor nerve paresis.

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Pathological Laughter Caused by Frontal Glioblastoma

—Case Report—

Satoshi TSUTSUMI, Yukimasa YASUMOTO, Masanori ITO

2008 Volume 48 Issue 7 Pages 307-310
Published: 2008
Released on J-STAGE: July 24, 2008

DOIhttps://doi.org/10.2176/nmc.48.307

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A 60-year-old, right-handed female presented with episodes of pathological laughter and left hemiparesis. She had no history of traumatic brain injury, or neurological or psychiatric disease, and showed no signs of drug or alcohol abuse. Neurological examination found moderate left hemiparesis. Her face was symmetrical with intact emotional expression. The episodes of pathological laughter had become more frequent during the 3 months since the onset of hemiparesis, were elicited by non-specific, trivial stimuli, and lasted for a few minutes until she gained some control. Her personal and social behavior was entirely appropriate except for the outbursts of laughter. Cerebral magnetic resonance (MR) imaging revealed a 2.5 × 2.5 × 3 cm ring-enhanced mass in the subcortical area of the right frontal lobe associated with extensive perifocal brain edema. The hypothalamus, thalamus, internal capsule, brainstem, and cerebellum were unaffected. Functional MR imaging showed the tumor located mainly in the prefrontal area with the posterior limit involving the premotor cortex. She underwent total tumor resection. The histological diagnosis was glioblastoma multiforme. The pathological laughter and hemiparesis resolved within 2 weeks after surgery. Invasive tumor in the frontal lobe involving the prefrontal cortex and subcortical structure may cause pathological laughter, and can be cured by surgery.

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Biochemical Cure of Acromegaly After Transsphenoidal Surgery Despite Residual Tumor on Magnetic Resonance Imaging

—Case Report—

Hiroshi NISHIOKA, Jo HARAOKA

2008 Volume 48 Issue 7 Pages 311-313
Published: 2008
Released on J-STAGE: July 24, 2008

DOIhttps://doi.org/10.2176/nmc.48.311

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A 52-year-old acromegalic woman underwent transsphenoidal removal of a pituitary macroadenoma. The tumor was totally removed apart from the part invading the right cavernous sinus. Postoperative magnetic resonance (MR) imaging demonstrated small residual tumor, but her acromegaly was “cured” using current strict criteria. The histological diagnosis was somatotroph cell adenoma with fibrous bodies. This biochemical cure persisted with no change in the residual tumor on MR imaging for 9 years without further treatment. Biochemical cure may not reflect total removal of the tumor, particularly if the growth hormone secretory activity of the residual tumor is low. Careful evaluation of postoperative MR imaging is always necessary to interpret surgical outcome, even if biochemical cure in acromegaly has been achieved.

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Neurosarcoidosis Manifesting as Tremor of the Extremities and Severe Hypopituitarism

—Case Report—

Yoshikazu OGAWA, Teiji TOMINAGA, Hidetoshi IKEDA

2008 Volume 48 Issue 7 Pages 314-317
Published: 2008
Released on J-STAGE: July 24, 2008

DOIhttps://doi.org/10.2176/nmc.48.314

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A 48-year-old woman initially presented with significant tremor of the extremities and subsequent severe hypopituitarism. Magnetic resonance imaging showed hyperintense areas in bilateral caudate heads and putamina, and a pituitary mass. L-dopa and corticosteroid were given and the tremor was reduced. Serum markers including autoimmune diseases were negative. Computed tomography and positron emission tomography detected no abnormalities except for pituitary lesion. Transsphenoidal biopsy revealed a noncaseating granuloma including giant cells with destroyed pituitary gland. The diagnosis was sarcoidosis. Diagnosis of isolated neurosarcoidosis is definitely difficult. Biopsy may be essential to establish the diagnosis in such a case. Corticosteroid administration is strongly recommended to avoid irreversible damage to the normal tissues even if histological confirmation was not achieved.

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Electroencephalography-Guided Resection of Dysembryoplastic Neuroepithelial Tumor

—Case Report—

George IMATAKA, Masahiro OGINO, Eiji NAKAGAWA, Hideo YAMANOUCHI, Osamu ...

2008 Volume 48 Issue 7 Pages 318-321
Published: 2008
Released on J-STAGE: July 24, 2008

DOIhttps://doi.org/10.2176/nmc.48.318

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A 3-year-old girl presented with a dysembryoplastic neuroepithelial tumor in the right cingulate gyrus manifesting as epilepsy refractory to anticonvulsant medication. Computed tomography and magnetic resonance imaging revealed a cystic tumor in the right cingulate gyrus. The tumor was removed under intraoperative electrocorticography guidance. Abnormal spikes recorded adjacent to the tumor disappeared immediately after total removal. Histological examination showed a multinodular, multicystic structure, satisfying the criteria for the diagnosis of dysembryoplastic neuroepithelial tumor. She has remained seizure-free for more than 4 years without complications. In this case, intraoperative electrocorticography was very useful to identify the possible focus and prevent unnecessary resection of the adjacent tissue. Total removal of the tumor resulted in a dramatic reduction of seizure activity.

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Rapid Growth of Congenital Diffuse Brain Tumor Considered to Be Teratoma

—Case Report—

Satoshi TSUTSUMI, Akihide KONDO, Yukimasa YASUMOTO, Masanori ITO

2008 Volume 48 Issue 7 Pages 322-325
Published: 2008
Released on J-STAGE: July 24, 2008

DOIhttps://doi.org/10.2176/nmc.48.322

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Prenatal ultrasonography of a 17-year-old pregnant female detected ventriculomegaly of the fetus at 31 weeks of gestation. Her medical and family histories were unremarkable. Fetal magnetic resonance imaging taken at 33 weeks of gestation showed a tumorous lesion with ventriculomegaly. A male baby was delivered by cesarean section at 36 weeks of gestation. The Apgar scores were 9 and 9 at 1 and 5 minutes after the delivery, respectively. The head circumference at birth was 41.5 cm with bulging anterior fontanel, but no other congenital anomaly. He showed relatively good activity with satisfactory feeding. Computed tomography performed on postnatal day 5 revealed a massive brain tumor of mixed density, with multiple lobulation and cystic and calcified components. The tumor had rapidly grown with diffuse appearance. The patient underwent endoscopic biopsy with installation of an Ommaya reservoir to control the hydrocephalus on postnatal day 6. The tumor appeared hypervascular and bled profusely on resection maneuver, so the endoscopic procedure for histological verification was abandoned. Cerebrospinal fluid taken intraoperatively revealed marked elevation of the alpha-fetoprotein level and mild increase of the human chorionic gonadotropin level, strongly suggestive of teratoma. Neuroimaging performed on postnatal day 11 indicated significant additional tumor growth which occupied nearly the whole cranial cavity. His activity began to deteriorate on postnatal day 13 and he died of respiratory distress on the 15th day of life.

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Cortical Laminar Necrosis Caused by Critically Increased Intracranial Pressure in an Infant

—Case Report—

Masahiko AKIYAMA, Satoshi TATESHIMA, Yuzuru HASEGAWA, Sadataka KAWACHI ...

2008 Volume 48 Issue 7 Pages 326-329
Published: 2008
Released on J-STAGE: July 24, 2008

DOIhttps://doi.org/10.2176/nmc.48.326

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A 3-month-old boy presented with critically elevated intracranial pressure (ICP) due to bilateral subdural hematomas, which resulted in diffuse cortical laminar necrosis, manifesting as a 1-week history of appetite loss, fever, and intermittent seizure. Initial computed tomography revealed bilateral subdural fluid collections. Burr hole drainage was carried out to control the ICP. T₁-weighted magnetic resonance imaging on day 26 revealed diffuse linear hyperintense lesions, which suggested cortical laminar necrosis. This is an extremely unusual case of cortical laminar necrosis caused by elevated ICP due to subdural hematoma in an infant.

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Supplementary Comment on “Importance of Fixation Angle in Posterior Instrumented Occipitocervical Fusion —Technical Note—”

David ROJAS-ZALAZAR, Jorge MURA, Evandro de OLIVEIRA

2008 Volume 48 Issue 7 Pages 329
Published: 2008
Released on J-STAGE: July 24, 2008

DOIhttps://doi.org/10.2176/nmc.48.329

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Editorial Committee

Editorial Committee

2008 Volume 48 Issue 7 Pages EC13-EC14
Published: 2008
Released on J-STAGE: March 25, 2013

DOIhttps://doi.org/10.2176/nmc.48.EC13

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