Neurologia medico-chirurgica

Protective Effects of Barbiturate, Mannitol and Glycerol on Experimental Global Cerebral Ischemia (Part I)

Shizuo HATASHITA

1982 Volume 22 Issue 12 Pages 963-971
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.963

JOURNAL FREE ACCESS

Show abstractHide abstract

Protective effects of thiopental, mannitol, and glycerol on global cerebral ischemia were neurophysiologically investigated.
Global cerebral ischemia was produced for 20 or 30 minutes in cats by temporary intrathoracic clamping of the innominate and left subclavian arteries following previous ligation of the mammary arteries and simultaneous lowering of the systemic arterial blood pressure. Thiopental, mannitol, or glycerol was rapidly given by intravenous infusion over 20 minutes; two thirds of the total dosage prior to ischemia and the remaining one third during ischemia. The measurement of recovery of neuronal functions after ischemia was assessed by electroencephalograms (EEG), somatosensory evoked potentials (SEP), and neurologic conditions. All 6 animals which received no treatment and were subjected to ischemia for 20 or 30 minutes did not show any recovery of neurologic condition after cerebral ischemia, showed no reappearance of EEG activity or discernible response of SEP, and died within 2 hours following cerebral ischemia. In contrast, about half of the 28 animals which were treated with these agents and subjected to ischemia for 20 (n = 12) or 30 (n = 1) minutes significantly recovered all parameters of neuronal functions monitored, which was Grade 3 or better. There was little difference in neuronal recovery among these agents, and neuronal functions recovered better with thiopental-mannitol or thiopental-glycerol combinations than with thiopental alone. Thiopental, mannitol, and glycerol had neurophysiologically significant protective effects on cerebral ischemia.

View full abstract

Download PDF (612K)
Protective Effects of Barbiturate, Mannitol and Glycerol on Experimental Global Cerebral Ischemia (Part II)

Shizuo HATASHITA

1982 Volume 22 Issue 12 Pages 972-981
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.972

JOURNAL FREE ACCESS

Show abstractHide abstract

Protective effects of thiopental, mannitol, and glycerol on global cerebral ischemia were histopathologically investigated.
Global cerebral ischemia was produced as reported previously (Part I). They were divided into four groups: no treatment; thiopental; mannitol; and glycerol-treated groups. Morphological change after ischemia was evaluated by electron microscopy of red blood cells, the luminal surface of the internal carotid artery, and of the cerebral cortex. In animals receiving no treatment, many erythrocytes underwent a shape change from discocytes to echinocytes or sphero-stomatocytes. The luminal surface revealed various “crater-like” defects. Neurones were shrunken with extremely dense cytoplasm containing swollen mitochondria or endoplasmic reticulum and capillary lumina were reduced to a slit. In contrast, in animals treated with thiopental, ischemic change of neurones and luminal surface of the internal carotid artery were minimal. In animals treated with mannitol or glycerol, deformed erythrocytes were less frequent. Capillary lumina remained patent and the swelling of perivascular glial processes was strikingly decreased. Moreover, in animals treated with glycerol, neurones underwent little ischemic change.
It is confirmed that thiopental can protect neurones and can also improve cerebral circulation, and that mannitol or glycerol can improve post-ischemic microcirculatory disturbance.

View full abstract

Download PDF (1241K)
Surgical Treatment of Myelomeningocele

With Special Reference to Therapeutic Policy

Yuh TANAKA, Hiroshi YAMADA, Shigetoshi NAKAMURA, Masataka TAJIMA, Naok ...

1982 Volume 22 Issue 12 Pages 983-988
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.983

JOURNAL FREE ACCESS

Show abstractHide abstract

With the spread of a policy that the infant with myelomeningocele should receive surgery as early as possible after birth, the survival rate of the infant with this serious malformation has greatly improved. However, this early operation for myelomeningocele has also increased the number of severely handicapped survivors. Such a dilemma in treatment of myelomeningocele forced some clinicians to select the patients for surgical treatment. Lorber advocated a policy of strict selection in which the infant with severe paraplegia, severe hydrocephalus, kyphoscoliosis, or other gross malformations should be managed conservatively without any surgical intervention.
During 1969-80, 77 unselected infants with myelomeningocele received early operations almost within 48 hours after birth. There were 25 infants who had one or more of Lorber's adverse criteria on admission, out of which 13 patients (52%) are still alive. All of these survivors, however, have severe multiple handicaps especially in locomotion and bladder control. By contrast, of the remaining 52 infants who did not have any of Lorber's criteria, 45 (86.5%) are alive and 33 have no or only moderate handicaps. Severe mental retardation occurred in 6 survivors, 4 of which were those with Lorber's criteria, but this extreme handicap could be considered the result of diffuse ventriculitis caused by infection at the myelomeningocele site.
It is true that the future status in locomotion may be predicted by assessment of the leg movement of the neonate, but intellectual potential cannot be determined even when complicated with hydrocephalus. The most decisive factor influencing the functional prognosis of an infant with myelomeningocele should be its intellectual quality. Until an appropriate evaluation method for the intellectual potential at birth is established, all infants with myelomeningocele should be treated surgically regardless of the neurological status at the neonatal period.

View full abstract

Download PDF (435K)
Clinicopathological Study and Clinical Significance of ‘Silent’ Hemorrhage in Arteriovenous Malformations of the Brain

Yoshio MIYASAKA, Kenji NAKAYAMA, Kuniaki MATSUMORI, Toshio BEPPU, Taka ...

1982 Volume 22 Issue 12 Pages 989-994
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.989

JOURNAL FREE ACCESS

Show abstractHide abstract

Operative procedures for cerebral arteriovenous malformations (AVMs) and histological study of the specimens may reveal old hemorrhage in some cases of AVMs with no clinical history of hemorrhage. Such asymptomatic hemorrhage has been reported as ‘silent’ hemorrhage.
The authors analysed the incidence of silent hemorrhage of cerebral AVMs and its correlation with: patient's age, sex, location and size of AVMs, type of symptoms, number of attacks, interval from the onset to operation, CSF protein content, and CT scan findings. The clinical material consisted of 16 cases of supratentorial AVMs without evidence of a clinical history of hemorrhage. They had histories of either epilepsy or transient hemiparesis. All AVMs were totally excised microsurgically and the specimens were examined histologically for detection of iron containing granule cells. Silent hemorrhage was confirmed either surgically or histologically in 5 cases (31%). Presence or absence of silent hemorrhage had a tendency to be correlated with the location, size of AVMs, interval from clinical onset to operation, CSF protein content, and CT scan findings. However, statistical significance was not seen except in CSF protein content. Therefore, preoperative prediction of the presence of silent hemorrhage was not possible.
This investigation indicated that the incidence of silent hemorrhage of cerebral AVMs was unexpectedly high. Since it was not possible to diagnose preoperatively, the possibility of silent hemorrhage should be kept in mind in determining the indication of surgical management for unruptured AVMs. Surgical management of unruptured AVMs should be justified in patients who have small or mediumsized AVMs mainly situated in silent areas.

View full abstract

Download PDF (515K)
Membrane Formation in Epidural and Subperiosteal Hematomas

Relationship with the Neomembrane of Chronic Subdural Hematomas

Hideaki MASUZAWA, Jinichi SATO, Hiroshi KAMITANI, Hiroyuki MIYAKE, Tos ...

1982 Volume 22 Issue 12 Pages 995-1001
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.995

JOURNAL FREE ACCESS

Show abstractHide abstract

Granulation tissues in four cases of chronic epidural hematoma, two of depressed fracture and two of ossified caput succenadeum were pathologically studied and compared with the neomembranes of subacute and chronic subdural hematomas. Five males and 3 females, ranging between 1 month and 51 years of age were examined. The elapsed time from trauma varied from 9 days to 3 months.
Nine to fourteen day old epidural clots showed early granulation over the dural side. A zone of macrocapillaries and infiltration of the solid clots by endothelial cells and fibroblasts were seen microscopically. Three week old clots showed liquefaction and encapsulation. Microscopically, the sinusoidal channel layer and a zone of hemorrhage with widespread invasion of fibrovascular cells were noted. Next to the dura mater lay a layer of ossification. Small-sized brown-colored granulation tissues were found beneath the depressed bone fragments 13 to 21 days after trauma. Fibrous strands and residual clots with macrocapillaries were also seen. Ossified caput succenadeum contained bloody fluid with whitish and elastic capsules. Fibrous tissues intermingled with areas of macrocapillaries were microscopically noted. Thus, six cases of epidural clots, both large and small, induced a granulation reaction of the dura mater, similar to that found in subdural hematomas. Two cases of subperiosteal hematomas which had no contact with the dura showed a similar granulation reaction.
Neomembrane formations in epidural hematoma as well as in subdural hematomas might be the result of the dura mater granulation reaction to blood clots, either solid or liquefied. Persistence of the subperiosteal hematoma would be analogous to Labadie's subcutaneously induced chronic subdural hematoma model in rats. Breakdown products of blood corpuscules such as hydroperoxides of prostaglandins were thought to induce these inflammatory reactions in the dura mater, as well as in other mesenchymal tissues.

View full abstract

Download PDF (594K)
Seasonal Variation of Birth Incidence of Children with Cerebellar Medulloblastoma

A Study in Fukuoka-Ohita Area and in All Japan

Yuzo YAMAKAWA, Masashi FUKUI, Kazuo KINOSHITA, Eizo KANO

1982 Volume 22 Issue 12 Pages 1002-1008
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.1002

JOURNAL FREE ACCESS

Show abstractHide abstract

To explore the possibility that environmental factors may affect the incidence of childhood cancers, the monthly incidence of birth among cerebellar medulloblastoma patients was investigated. The data were collected from two series of investigations. One was the birth and residence data from the north-west district of Kyushu (Fukuoka-Ohita area, Japan) and the other was that of all Japan (from “Brain Tumor Registry in Japan”, 1981). Subjects in this study were children with verified cerebellar medulloblastoma who were at the age of five or under on admission. Twenty-one subjects residing in the Fukuoka-Ohita area were compared with 107 subjects from all Japan. The former group had been born during the period from 1955 to 1976; the latter was from 1969-1971 and 1974-1976. Control numbers of live births were calculated from the “Vital Statistics” of each area.
A tendency of seasonal accumulation of medulloblastoma patient births was seen in both groups in July, August, September, and October, with a peak value in September. The average number of medulloblastoma patient births per month and a monthly incidence rate per 100, 000-births were evaluated. It was evident that the births were significantly accumulated in August, September, and October (p < 0. 10). The monthly incidence rates of medulloblastoma patient births during these three months were twice as many as those in April, May, and June. The incidences of total live births revealed a high peak in January in both the Fukuoka-Ohita area and in all of Japan. The number of live births in June and November showed a dip in both groups.
In conclusion, the monthly incidence of cerebellar medulloblastoma patient births was higher in summer and autumn, especially in the months around September. Season-specific and concurrent etiological factors for cerebellar medulloblastoma and CNS anomalies may be present in and around the month of September.

View full abstract

Download PDF (478K)
Sex Hormone Receptor in Meningioma

Jun-ichi KURATSU, Yasuhiko MATSUKADO

1982 Volume 22 Issue 12 Pages 1009-1013
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.1009

JOURNAL FREE ACCESS

Show abstractHide abstract

Meningiomas have often been described as being hormone dependent because of their preponderant incidence in females with clinical manifestation during or after pregnancy. The authors have experienced three cases of meningioma which became symptomatic during pregnancy, after delivery, or during menses. Estrogen receptor protein and progesterone receptor protein of the meningioma tissue were examined in 11 cases (8 females and 3 males) including these three cases to confirm the relation between sex hormones and neoplastic proliferation. Progesterone receptor protein was found in six female cases and estrogen receptor protein was obtained from one male case. Meningioma cells of the female patients showed no estrogen receptor protein unlike previously reported. There was no case where the meningioma cells held both progesterone and estrogen receptor proteins.
To explain the rapid growth of a meningioma after delivery, it was presumed that the sudden change in serum sex hormone concentration after delivery would cause a feed-back mechanism of the meningioma sex hormone receptor with subsequent cellular proliferation.

View full abstract

Download PDF (337K)
Giant Cell Tumors of the Skull

Report of Three Cases

Taisuke OTSUKI, Teruaki MORI, Satoru FUJIWARA, Jiro SUZUKI

1982 Volume 22 Issue 12 Pages 1015-1021
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.1015

JOURNAL FREE ACCESS

Show abstractHide abstract

Two primary and one secondary case of giant cell tumor of the skull were presented.
Case 1 was a 34-year-old male with a benign giant cell tumor of the left temporal bone. He had complained of progressive tinnitus and difficulty in hearing in the left ear for six years. Disturbance of the fifth, and the seventh to the eleventh cranial nerves on the left were observed on admission. Craniograms showed bony destruction of the left temporal bone and of the pterygoid process of the sphenoid bone. The tumor was subtotally removed and no signs of recurrence were observed 8 years postoperatively. Case 2 was a 20-year-old female with a malignant giant cell tumor of the sphenoid bone. She complained of double vision and decreased visual acuity. Left oculomotor palsy, decreased right visual acuity, visual field defects, and a slight papilledema were noticed on admission. Pituitary functions were normal. Bony destruction of the sella and of the anterior half of the clivus were shown on craniograms. CT scan revealed an enhanced mass in the sphenoid sinus extending upwards to the suprachiasmatic cistern. Partial removal of the extradural tumor, 6, 000 rads of radiation, and chemotherapy were performed. However, the patient progressively deteriorated and the bilateral internal carotid arteries became obliterated by tumor encroachment 2 months after the operation. Case 3 was a 65-year-old female with a metastatic malignant giant cell tumor of the left parietal bone. She noticed a subcutaneous tumor in the left parietal region when the third recurrence of giant cell tumor of the left knee joint occurred. The skull tumor was totally removed. Histological examination showed that the tumor had invaded the dura mater.

View full abstract

Download PDF (697K)
Malignant Meningioma with Multiple Extracranial Metastases

Case Report

Kikuo KYOI, Shozaburo UTSUMI, Kazuhiro YOKOYAMA, Tatsuo TANIKAKE, Yoic ...

1982 Volume 22 Issue 12 Pages 1022-1028
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.1022

JOURNAL FREE ACCESS

Show abstractHide abstract

A rare case of intracranial malignant meningioma with repeated local recurrences and widespread extracranial metastases is reported.
A 53-year-old man developed convulsive seizure of the right upper limb and the right side of the face in December 1969 and was diagnosed as having convexity meningioma in the left parietal region. The tumor was totaly removed in May 1970. In February 1974 he noticed right hemiparesis. The recurrent tumor was totally removed. It was a cystic meningioma with histological features of angioblastic type. Subsequently he underwent seven more operations in his clinical course, all of which were subtotal or total extirpations. At the fifth surgery tumors were recognized in the left frontal, anterior-temporal and parieto-occipital regions (multiple meningioma). In March 1980, a large recurrent intracranial tumor was detected by computerized tomography. Chest X-ray revealed a massive tumor shadow in the left lung and multiple nodules of varying sizes throughout both lungs. The patient died in July 1980, 11 years after the first diagnosis. Autopsy showed an extensive residual intracranial tumor in the left temporo-occipital region and multiple metastatic tumors in both lungs, pleura, pericardium and diaphragma. The metastatic tumors were similar to the intracranial meningioma in histological features.

View full abstract

Download PDF (782K)
Kinking of Cervical Internal Carotid Artery Causing Acute Infantile Hemiplegia

Case Report

Kenji OHATA, Akira HAKUBA, Nobuyuki SHIRAHATA, Shuro NISHIMURA

1982 Volume 22 Issue 12 Pages 1029-1034
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.1029

JOURNAL FREE ACCESS

Show abstractHide abstract

A 4-year-old right handed boy was admitted with the left hemiparesis of sudden onset. Angiographic studies demonstrated kinking of the bilateral internal carotid arteries and right vertebral artery in the neck portion. On rotating the neck to the right, the kinked segment of the right carotid artery was rendered more stenotic. Computerized tomography and electroencephalography were normal. Reconstructive surgery of the right internal carotid artery including an end to side anastomosis between the internal carotid artery and the common carotid artery was performed to prevent cerebral atrophy or stroke. Eleven months postoperatively, the left hemiparesis had disappeared and he remained free of symptoms. Various methods of surgical correction for carotid coiling, tortuosity, kinking or stenosis have been reported for adults. In four children, Suzuki et al. did not amputate the internal carotid artery, but fixed its coiled portion to the external carotid artery. In the present case, mannitol was used to overcome the risk during the reconstructive operation of the internal carotid artery at its bifurcation.
Reconstructive surgery may be possible even in children and is safe and effective in selective cases.

View full abstract

Download PDF (443K)
Primary Demyelinating Disease Simulating Infiltrating Glioma on CT

Yoko NAKASU, Kinya SUDA, Jyoji HANDA, Fumitada HAZAMA

1982 Volume 22 Issue 12 Pages 1035-1038
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.1035

JOURNAL FREE ACCESS

Show abstractHide abstract

Demyelinating diseases of the brain may show mass effects and/or contrast enhancement on CT scans, simulating the appearance of infiltrating glioma.
A 36-year-old male, had suffered from gait disturbance and convulsive attacks involving the right lower limb since the age of 30. He had gradually developed character changes and urine incontinence. Six months prior to admission he experienced several attacks of generalized convulsions. On admission, he showed a mild hemiparesis, bilateral Babinski signs, and ataxic gait. He was disoriented and had memory disturbance and moria. CT scan showed low density areas in the bilateral frontal lobes and corpus callosum associated with a mild mass effect. Contrast study revealed irregular enhancement along the edge of the low density area and another small enhancing lesion in the left temporal lobe. This CT finding was interpreted as that of “butterfly” glioma. Craniotomy and right frontal lobectomy were performed. Histological study, however, demonstrated demyelination in the white matter associated with perivascular proliferation of lymphocytes. The final diagnosis was the ‘transitional sclerosis’ of Poser.

View full abstract

Download PDF (338K)