Traumatic intracerebral hematomas were classified by initial CT scan performed within 4 to 6 hours after injury and by repeated CT scan follow-up to establish correct treatment methods by the findings obtained.
Traumatic hematomas were classified into the following three types : primary hematoma resulting from traumatic vascular lesion; hematoma within contusion resulting from hemorrhagic contusion; and contusional hematoma formed by an entirely different mechanism which is not yet clear. Both contusional hematoma and hematoma within contusion are delayed traumatic intracerebral hematomas.
Of the 34 cases (31 patients), primary hematoma produced by traumatic damage of the intracerebral vessels could be diagnosed by oval or round high density areas with regular low density zone on initial CT scan in 20%.
Hematoma within contusion, produced by fusion of the hemorrhagic contusion on the second to 7th day after trauma, showing low density areas or several hemorrhagic spots in the low density area on initial CT scan was noted in 30%. The mechanism may be similar to the Scheinker theory.
Contusional hematoma, produced on the second to 7th day after injury or after removal of subdural or epidural hematoma by compressive craniectomy, showing normal density of the brain on the initial CT scan was noted in 50%. The mechanism is quite different from the Scheinker theory and may be related to hyperoxydation caused by local disturbance of cerebral circulation.
Classification of traumatic intracerebral hematoma into these three types by repeated CT scan is thus thought to be useful clinically to establish correct diagnosis and to obtain good results by enabling adequate treatment.

抄録全体を表示

Intracranial pressure (ICP) was recorded continuously in 24 pre-operative patients with angiographic evidence of diffuse cerebral vasospasm due to rupture of an intracranial aneurysm. Increased ICP in the range of 20-40 mmHg was observed in the acute stage after subarachnoid hemorrhage (SAH) in 12 out of 24 patients with no signs of angiographic evidence of diffuse vasospasm. While awaiting clinical improvement, the mean ICP began to decrease gradually to a level below 15 mmHg within a few days. Bilateral carotid angiography at this time showed diffuse vasospasm. Depressed and low ICP was observed in 10 of the patients with angiographic evidence of diffuse vasospasm, in whom the ICP recording was started between 6-11 days after SAH. Thus, 22 out of 24 patients showed low and depressed ICP in early phases of diffuse vasospasm.
On continuing the recording, however, a secondary increase of ICP followed in 14 patients always associated with serious neurological deterioration. The pressure curve of this group was characterized by a biphasic pattern, i. e., depressed ICP followed by increased ICP. We refer to this pressure pattern as “Diffuse Vasospasm Type I”.On the other hand, the remaining 8 patients had no increase of ICP throughout the course of diffuse vasospasm. The term “Diffuse Vasospasm Type II” has been used for this type of ICP tracing.
Of the 16 patients of Diffuse Vasospasm Type I, 7 patients were found to show enlargement of the ventricular system and 11 patients to have widespread low density on CT scan. On the other hand, 2 out of 8 patients of the Diffuse Vasospasm Type II were found to show a circumscribed low density on CT scan.
The changes in cerebral blood flow (CBF) were analyzed. Mean value of CBF of 47.6 ml/100 gr/min has been obtained in patients with no cerebral vasospasm. Type I and II patients of low ICP phase showed flows of 35.4 and 36.2 ml/100 gr/min, respectively. Marked reduction in CBF of 25.2 ml/100 gr/min was found in Type I patients of high ICP phase. It is suggested that a level of below 25 ml/100 gr/min may lead to major neurological deterioration.

抄録全体を表示

To make an experimental cerebral infarction in the dog, a proximal clipping of the middle cerebral artery (MCA) was performed and the collateral blood supply was compromised by subjecting the animal hemorrhagic hypotension involving reduction of blood pressure to 50 mmHg for 1 hour. Then, the systemic blood pressure was restored by infusion of the shed blood. The clip was removed at different times—immediately, 0.5 hours, 3 hours, 6 hours, 12 hours and 24 hours after restoration. The no-reflow area was investigated by fluorescein angiography (FAG) and carbon perfusion method (CP). There were other groups in which the clip had been taken off at 0.5 or 4 hours after restoration and circulation was maintained 24 hours. Then the no-reflow area was also investigated.
There was no evidence of the no-reflow phenomenon on the surface vessels after cerebral ischemia in any of the experimental conditions. Arteriovenous shunt or perivascular infiltration of fluorescein dye were only observed in the reflow area in animals which received temporary occlusion of the MCA for 6 hrs or more.
On the other hand, the no-reflow phenomenon was observed by CP in intraparenchymal vessels which had been exposed to focal cerebral ischemia. The longer the duration of ischemia, the more extensive were the areas of non-filling. In animals with recirculation of 24 hrs duration after 4 hrs of temporary occlusion, large perfusion defects were also observed.
In continuous occlusion of the MCA for 24 hrs without removing the clip, extravasation of carbon particles were localized only in the boundary zone between the deep cortical layer and the subcortical white matter. To the contrary, animals with temporary occlusion for 24 hrs or animals with 4 hrs occlusion followed by recirculation for 24 hrs frequently caused wide exudation of carbon particles which extended into the gray matter of the MCA territory. These animals showed more severe hemorrhagic infarction than those with the permanent occlusion.

抄録全体を表示

For the purpose of treatment of brain tumors with ACNU [1-(4-amino-2-methyl-5-pyrimidinyl) methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride], inhibitory effects on tumor cell proliferation in vitro, pharmacokinetics, clinical responses and side effects of the drug were investigated.
ED₅₀ of ACNU for KS-1 cells was 25 μg/ml. Generally, glioblastoma cells were more sensitive to ACNU than meningioma cells.
After intravenous injection of ACNU 100-150 mg/boby, in 14 patients with brain tumors, transition of the drug into cerebrospinal fluid was noticed at 5 minutes in all cases with the maximum value of 0.59±0.13 μg/ml at 30 minutes.
The therapeutic effects of the drug were evaluated in 31 patients with brain tumors by neurological and CT-scan examinations. Combined chemo-radiotherapy with ACNU, FT207 and Tele-cobalt was more effective than ACNU therapy alone; 36% of the patients were “improved” in our criteria, although hematologic toxicity of ACNU was observed in 55%.

抄録全体を表示

The authors experienced 3lpatients with meningioma since CT scans had become available. There were various extents of low density areas surrounding the tumors on CT scans. These diminished density areas were thought to be related to tissue necrosis, demyelination, widening of the subarachnoid spaces, or cerebral edema. A finger-shaped extension within the white matter is generally regarded as cerebral edema. On the other hand, meningiomas were thought to be associated with different degrees of brain edema in their neighborhood, and the reason for the difference of edema extent in each case was unknown. So a comparative study between the CT findings of meningiomas and the angiograms was performed to clarify the mechanism of expansion of cerebral edema around these tumors. The conclusions are as follows: 1) there is no definite relationship between the perifocal low density and the size of tumors or the pathological findings; 2) tumors that exhibit high vascularity or block the venous drainage in angiograms tend to show greater perifocal low density areas; 3) intraventricular or parasellar meningiomas tend to show smaller low density areas; and 4) it is reasonable to assume that the degree of edema surrounding a meningioma is defined by a factor in which the arterial, venous, and CSF systems are correlated to each other.

抄録全体を表示

Ultrastructure of 34 cases of human pituitary adenomas were studied. Ferritin-labeled and horseradish peroxidase-labeled lectin binding sites were also analyzed electronmicroscopically. The 34 cases were divided into three groups; the first was 13 cases of prolactin producing adenomas, the second was 9 cases of human growth hormone (HGH)-producing adenomas and the third group was 12 cases of hormonally non-functioning adenomas. Attention was paid to secretory granules in the adenoma cell and in each group generally admitted features were observed. There were some exceptional cases. Measuring the size of the secretory granules was important not only to differentiate each adenoma cell, but also to detect some unusual cases in each group.
Study of ferritin-labeled lectin binding sites of the adenoma cell plasma membrane revealed significant differences between the prolactin or HGH-producing adenoma group and the hormonally non-functioning group. Ferritinlabeled Ricinus communis agglutinin (which binds to galactose) binding sites were significantly reduced in number in the non-functioning adenoma group when compared to those of HGH or prolactin producing groups.
In the study of horseradish peroxidase (HRP)-labeled lectin binding sites, general features were as follows: 1) HRP-labeled concanavalin A (which binds to mannose) bound to the plasma membrane, nuclear envelope, rough ER and Golgi membrane, and HRP-labeled RCA bound to the plasma membrane and Golgi membrane. 2) The typical secretory granules of the prolactin producing adenoma and HGH-producing adenoma had no lectin binding sites. 3) On the other hand, in an atypical case of HGH-producing adenoma, small secretory granules (mean diameter, 130 nm) had Con A and RCA binding sites in the form of electron dense reaction products. 4) In the non-functioning group, there existed no consistent results concerning the lectin binding sites of the granules (mean diameter, 100-150 nm).
Influence of the trypsinization on the adenoma cell secretory activity was checked by the control study and the result was that the trypsinized adenoma cells had the same secretory activity with the non-trypsinized cells and responded to thyrotropin releasing hormone (0.1 μg/ml).

抄録全体を表示

Lateral ventricle size on CT film and lumbar pressure change due to CSF drainage were measured in 15 patients with hydrocephalus to determine indications for shunt operation.
Changes of ventricular size were classified into the following two patterns: Pattern A showing decrease in size; and Pattern B showing no change. The degree of decrease in Pattern A was 9.9%, 14.2%, and 16.3% in accordance with CSF drainages of 10, 15, and 20 ml, respectively.
Lumbar pressure changes were also classified into the following two patterns: Pattern C showing rapid decrease to an extent of 22% of the initial pressure after 5-10 ml of CSF drainage; and Pattern D also showing rapid decrease up to a pressure ranging between 100-150 mmH₂O, and continuous slow decrease with drainage thereafter.
Ventriculo-peritoneal and lumbar subarachnoid peritoneal shunt were effective in cases with Pattern A and D combination, but shunt operation was noneffective for Pattern B and C combination cases. In cases of Pattern B and D combination, shunt operation seemed unnecessary.

抄録全体を表示

Dural arteriovenous malformations (AVM) in the region of the transverse-sigmoid sinus are common, although they have been reported infrequently. Various questions concerning their etiology, pathophysiology and treatment remain unanswered and surgical treatments are not always successful.
Six Dural AVM patients ranging in age from 28-74 years were studied. There was no significant difference in sex. Clinical symptoms and signs were pulsatile tinnitus, convulsion, headache, sudden loss of consciousness, papilledema, and subarachnoid hemorrhage. Angiography revealed the dural lesion fed by one or more of the meningeal branches supplying the dura mater of the posterior fossa: the occipital artery, the posterior branches of the middle meningeal artery, the ascending pharyngeal artery, the meningohypophyseal trunk of the internal carotid artery and the meningeal branches of the vertebral artery. In all 6 patients, venous drainage was entirely via the transverse sinus which was irregular in all and occluded in 3 cases. In these cases, there was retrograde venous outflow through the cortical veins and Labbe's vein. In the venous phase of the angiogram, the transverse sinus at the involved side was not opacified in 4 of 5 cases, while the contralateral transverse sinus was filled from the superior sagittal sinus densely. This indicated that the involved transverse sinus drained venous flow from the Dural AVM alone and had no significant role in the outflow from the intracranial venous system.
Various surgical procedures were performed. Ligation or occlusion of the occipital artery or the external carotid artery (Cases 1, 2, 4, ) was insufficient. Isolation of the transverse sinus from all dural attachments (Case 4) resulted in disappearance of the pulsatile tinnitus, but postoperative angiography revealed that the tentorial artery continued to contribute to the dural lesion. Excision of the bilateral transverse sinuses, including the torcular, resulted in complete cure in Case 5. Cases 3 and 6 received no surgical interventions and were asymptomatic for 3 and less than 2 years after the diagnosis, respectively.
The most effective treatment was total removal of the involved dural sinus and the adjacent dura mater. Angiographical findings of the involved dural sinus in the arterial or venous phase suggested that the lesion, including the dural sinus, could be excised successfully.

抄録全体を表示

The authors report a case of cerebral paragonimiasis in an 8-year-old boy who was admitted to the hospital due to epileptic fits and left hemiparesis. The patient had eaten raw wild boar meat, which is said to play a role of paratenic host of Paragonimus westermani, 3 months prior to the symptoms.
Skull X-ray, carotid angiography, and electroencephalography did not suggest cerebral paragonimiasis. CT scan and the use of intravenous contrast medium showed multiple round and/or oval rings with “soap bubble” appearances in the right parietal area. The band specific to Paragonimus westermani was identified in immunoelectrophoresis and skin test was also positive. There was remarkable eosinophilia in the circulating blood. Thus, the diagnosis of cerebral paragonimiasis was rendered and one course of Bithionol was started. This, however, failed to improve clinical symptoms and signs. A right parietal craniotomy was then performed and multiple encapsulated masses were removed from the right parietal lobe. Surgical specimen contained eggs of Paragonimus westermani and a great number of Charcot-Leyden crystals. Postoperatively another course of Bithionol was provided. Clinical symptoms and signs improved remarkably and the patient was discharged at the 47th postoperative day. It is emphasized that the combination of CT scan and immunological examinations was quite valuable in the diagnosis. This may be the first case of cerebral paragonimiasis diagnosed in such a relatively early stage by CT scan.

抄録全体を表示