Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 22, Issue 8
Displaying 1-11 of 11 articles from this issue
  • Takashi SHIMIZU, Kenichi KITO, Taeko HOSHI, Naomi YAMAZAKI, Kenji TAKA ...
    1982 Volume 22 Issue 8 Pages 613-619
    Published: 1982
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Using immunological studies, it was investigated whether any vasoactive substances were produced in the subarachnoid space and whether these substances effected delayed cerebral vasospasm after subarachnoid hemorrhage.
    Cerebrospinal fluid (CSF) was aseptically mixed with autologous arterial whole blood or its fractions; red blood cells, serum, inactivated serum, platelet-rich lymphocytes, aggregated immunoglobulin G, or dried pepsin-treated human immunoglobulins G. Each mixture was incubated at 37°C for 7 days. Instead of CSF saline was used for controls. White sediments were observed in the mixtures of CSF plus serum and of CSF plus inactivated serum after two days of incubation. Immunoelectrophoresis showed that immunoglobulin G decreased in the supernate of these mixtures compared with the corresponding controls. Immunofluorescence microscopy of the sediments revealed marked granular deposits of immunoglobulin G and β1C/1A globulin. These results suggested that the mixtures of CSF plus serum and CSF plus inactivated serum might contain C1q binding immunoglobulin. C1q solid-phase enzyme immunoassay was then performed to measure the C1q binding immunoglobulin in the supernate and sediment of the CSF plus serum mixture. C1q binding immunoglobulin was not demonstrated in either CSF alone or serum alone. In the CSF plus serum mixture, however, C1q binding immunoglobulin was detected.
    It was then investigated whether the sediments and supernates containing C1q binding immunoglobulin were biologically active. Filter paper, soaked in the sediment and supernate of each mixture, was applied to the mesenteric artery of rats. Microscopic observations were made for vasoconstriction. The mesenteric artery was constricted by three mixtures only; CSF plus whole blood, CSF plus serum, and CSF plus inactivated serum. These findings suggest that C1q binding immunoglobulin may be formed when CSF is contaminated by serum, and that this protein will activate the complement system. As a result, vasoconstrictive substances such as C3a and C5a (anaphylatoxin) may be produced, which constrict the cerebral artery in the subarachnoid space.
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  • Experimental and Clinical Study
    Toshisuke SAKAKI, Tetsuya MORIMOTO, Kazuhiro YOKOYAMA, Kazuhiko KINUGA ...
    1982 Volume 22 Issue 8 Pages 620-625
    Published: 1982
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Electric action potentials accompanying cerebral vasoconstriction and vasodilatation were observed in the exposed basilar artery of the cat. Spontaneous discharges were recognized at the beginning of either constriction or dilatation of blood vessels with a frequency of once every 5 to 10 seconds.
    Spontaneous discharges from the smooth muscle of the parent artery near a ruptured aneurysm were clinically observed in 21 patients after aneurysm neck clipping. These patients were operated on from 3 to 30 days after the attack. Cerebral angiography was done either on the day of operation or on the day before. In cases where vasospasm was not seen with angiography, spontaneous discharges ranging from 30 to 100 μV were encountered once every 3 to 15 seconds. When stimulation with either cold or warm water was given to the blood vessel, action potentials were observed at a frequency of 5 to 6 discharges every 10 seconds. In cases with late vasospasm however, both spontaneous discharges and action potentials caused by water stimulation decreased. In cases where vasospasm was reduced at the time of an intentionally delayed operation, a remarkable reduction of action potentials was noted.
    Late vasospasm may be concerned not only with smooth muscle constriction, but also with some quite different mechanism.
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  • Fluosol-DA, 20% and Improvement of Cerebral Ischemia
    Shiro NAGASAWA, Yoshito NARUO, Yasuhiro YONEKAWA, Minoru HOSHIMARU, Yo ...
    1982 Volume 22 Issue 8 Pages 626-632
    Published: 1982
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Fluosol-DA, 20% is a newly developed synthetic perfluorochemical emulsion experimentally known to be biologically inert, non-toxic and to have a high oxygen carrying capacity. On this basis, the effect of its administration was evaluated in cases of cerebral ischemia.
    A total of 51 administrations was performed in 24 patients suffering from symptomatic cerebral vasospasm due to ruptured aneurysms. Their neurological conditions were evaluated before and after intravenous infusion at a dose of 10 ml/kg in 60 minutes. Regional cerebral blood flow and power spectrum displayed EEG were recorded in 2 and 6 patients, respectively. Fifteen cases (62%) out of twenty four (28/51 times of administration) showed improvement of disturbed consciousness and/or motor weakness which continued for about 24 hours after the administration. The solution was not effective in 9 cases (38%). No aggravation was observed. Cases with anterior communicating artery aneurysms had a better improvement ratio (10/11 cases, 18/24 times) than those with aneurysms located in other regions (5/13 cases, 10/27 times). The solution more effectively improved motor weakness (14/27 times) than disturbed consciousness (18/49 times). Mild consciousness disturbance was found to improve better (16/39 times) than severe disturbance. Marked increase of regional cerebral blood flow (Case 7) or the appearance of α wave on EEG (Case 24) were observed in accordance with the improvement of the conditions.
    From these clinical data, Fluosol-DA, 20% is considered to be an effective treatment for the improvement of cerebral ischemia due to vasospasm.
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  • Hideo TAKIZAWA, Kazuaki SUGIURA, Motoki BABA, Takayuki TACHIZAWA, Eiic ...
    1982 Volume 22 Issue 8 Pages 633-639
    Published: 1982
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Detailed monitoring of the intracranial pressure and other parameters of patients with intracranial lesions is essential for the recognition of its pathophysiology and for determination of adequate treatment. Recent advances in microcomputer technology has made it possible to assemble a compact intelligent system for bedside use. A new computerized system was developed for the numerical analysis of intracranial pressure (ICP), systemic blood pressure (BP), and heart rate (HR).
    ICP and BP were detected by pressure transducers and HR by ECG equipment. The systolic, mean, and diastolic pressures of ICP and BP were electrically measured. These seven kinds of data were converted to binary code by an analog-to-digital converter and were put into the microcomputer. The data were displayed on a TV monitor and refurnished every two seconds. They were recorded on paper tape and stored in the memory of the microcomputer.
    Data analysis was divided into the on-line and off-line modes. On-line processing was performed during data acquisition. It made a table of the average and standard deviations of each type of data during the previous hour, and a graph of the mean hourly ICP for the six hours prior with the formula of its regression line. The regression coefficient showed the tendency of the course of the ICP; that is, either increasing, decreasing, or stationary. Off-line processing was performed from the data recorded on the paper tape and included seven kinds of analysis. It coulds: 1) list all seven kinds of data; 2) list the ηHB (the ratio of the ICP pulse pressure to the BP); 3) list the cerebral perfusion pressure; 4) graph the ICP and BP; 5) graph the ICP and BP after smoothing by a moving average; 6) classify the data and; 7) make an ICP histogram.
    For an accurate analysis of ICP, quantitative analysis is essential. This system is capable of processing a variety of parameters, such as ICP, BP, and H R into digital form, and could also perform multiple data analysis. The program was designed to automatically perform many kinds of processing within a short time. It was also possible to select the most appropriate type of analysis for a given case.
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  • Eiichiro HONDA, Takashi HAYASHI, Takao MASAJIMA, Shigetaka ANEGAWA, Sh ...
    1982 Volume 22 Issue 8 Pages 640-648
    Published: 1982
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Intracranial pressure (ICP) is one of the most important parameters in evaluating intracranial pathology. The skulls of the newborn and the infant, unlike the tightly sutured skull of the adult, provide non-invasive access to ICP via the anterior fontanelle.
    The authors have developed a new transducer which is convenient for non-invasive, continuous measurement of the intracranial pressure through the anterior fontanelle. The new transducer is thinner and lighter than the APT-16 type transducer (Hewlett-Packard).
    The authors described the principles of measurement with this new transducer via the anterior fontanelle, the results of basic experiments, and some clinical results obtained through its numerous clinical applications.
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  • Clinical Study
    Hideo HIRATSUKA, Shin TSURUOKA, Hitoshi TABATA, Seiji MONMA, Tohru FUK ...
    1982 Volume 22 Issue 8 Pages 649-653
    Published: 1982
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Clinical experience on xenon-enhanced cranial computed tomography was reported. Sixteen patients (10 with cerebral vascular diseases, 4 with brain tumors, and two with normal pressure hydrocephalus or brain atrophy) were studied with CT before and during xenon inhalation. In two cases, serial CT scans were done to obtain the clearance rate of xenon from the brain tissue. The results obtained would not have been possible with conventional plain or intravenously enhanced CT scans. Both the static and dynamic xenon-enhanced CT should prove useful for observation of the pathophysiology of the brain. Caution must be exercised, however, against its anesthetic effects.
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  • Evaluation of CT Findings
    Norio ISHIYAMA, Kazuhiro KATADA, Youichi SHINOMIYA, Hirotoshi SANO, Te ...
    1982 Volume 22 Issue 8 Pages 654-660
    Published: 1982
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Computed tomography performed in 27 cases in the vegetative state was analyzed concerning the possibility of escape from the vegetative state. All patients had been in the vegetative state for 3 months or longer at the time of entry to this study. Of the 27, 23 cases did not escape from the vegetative state, while 4 cases could. Characteristic CT findings for each group were sought and the results were as follows. If diffuse low density was noted in the cerebral cortex, the case did not escape from the vegetative state. If diffuse low density was noted in the cerebral white matter, the case did not improve. A low density area in the bilateral basal ganglia was a poor finding. A low density area in the brain stem indicated poor results.
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  • Report of Five Cases and Review of Literature
    Yoshio MIYASAKA, Kenji NAKAYAMA, Kuniaki MATSUMORI, Toshio BEPPU, Akir ...
    1982 Volume 22 Issue 8 Pages 661-667
    Published: 1982
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Five (9.6%) of 52 cases of supretentorial hypertensive intracerebral hemorrhage which suffered rehemorrhage in the contralateral regions were analyzed in the present study, and the 28 cases reported since 1950 were reviewed.
    The literature suggests that the time between the first hemorrhage and the second was quite long. However, the present series showed that re-hemorrhage in the contralateral side developed within one month in three out of five cases. In case 1, hemorrhages developed almost simultaneously in the left thalamus and in the right putamen.
    Three characteristics were observed: The symptoms including hemiparesis and/or hemispheric signs related to the first hemorrhage had a tendency to exacerbate after the second attack in other the contralateral region in the second attack, symptoms excessively severe for the size of the hematoma developed. Finally, the clinical course after the second hemorrhage was poor.
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  • Case Report
    Masaru TAMURA, Minoru MURATA, Jun-ichi KAWAFUCHI, Takao NAGAYA, Keiji ...
    1982 Volume 22 Issue 8 Pages 668-672
    Published: 1982
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    A 16-month-old boy was admitted with right exophthalmos and disturbance of ocular movement. CT scan disclosed a tumor occupying the supra and para-sellar regions. The tumor was partially removed. Whole brain irradiation was given at doses of 4, 600 rads. One month later, the right cervical lymph nodes became swollen. CSF cytology and bone marrow smear showed tumor cells. The patient expired 6 months after the onset of the initial symptoms. Urinary catecholamine, homovanillic acid, vanylmandelic acid, and metanephrine were within normal limits after surgery and thereafter. Autopsy excluded neuroblastoma of the adrenal glands and of the sympathetic chains. Microscopically, the primary tumor of the sellar region showed fibrous tissue intermingled with a small amount of coagulative tumor cell necrosis. Meningeal tumor cell dissemination of the spinal cord and metastases to cervical lymph nodes were observed. Microscopic tumor deposits were also found in the costal and vertebral bone marrow. Histological findings of the surgical specimen and of the metastatic tumor at autopsy were almost the same. The tumor cells had oval or slightly fusiform, hyperchromatic nuclei and small, scanty or illdefined cytoplasm. Several incomplete Homer Wright rosettes were seen. Electron microscopy disclosed a few dense core vesicles of 80-200 nm in diameter in the tumor cell processes.
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  • Case Report
    Yoshifumi KONISHI, Teruaki TAMAGAWA, Mitsuhiro HARA, Kazuo TAKEUCHI, H ...
    1982 Volume 22 Issue 8 Pages 673-676
    Published: 1982
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Cirsoid aneurysm of the scalp is rare. The authors report a case of cirsoid aneurysm which was supplied by the right occipital artery. The patient was a 44-year-old male with a tumor in the right occipital region for the past ten years which had begun to enlarge five years previously after he suffered a head injury. Investigation at the time of admission revealed a pulsatile, soft and compressive mass with thrill and pulsating murmur in the right occipital region. The continuous murmur disappeared when the right occipital artery was compressed. Enhanced CT revealed the mass to be in the extracranial right occipital region with no connection to the intracranial space. Selective external carotid angiography and right brachial angiography demonstrated an enlarged tortuous mass.
    The tumor was removed by surgery and measured 4×5 cm, and the feeding artery and the dilated draining veins were identified. Pathological findings showed the muscular arteries and veins twisted and dilated in parallel. The arterial wall demonstrated proliferation of the inner coat, the internal elastic membrane and of the elastic fiber, and a thickening of the venous valves. The authors diagnosed this tumor as the cirsoid aneurysm of Brescht. This was the third case reported in Japan of a cirsoid aneurysm with a history of more than 10 years.
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  • Case Report
    Takashi FUJII, Shuzoh MISUMI, Kimio ONODA, Ryoichi KIMURA, Hirofumi NA ...
    1982 Volume 22 Issue 8 Pages 677-681
    Published: 1982
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    A 39-year-old woman with long-standing untreated primary hypothyroidism had suffered amenorrhea-galactorrhea syndrome and myxoedema. She also had pituitary enlargement with supraseller extention which was found on CT. Her serum T3 and T4 were unmeasurably low, and her serum TSH and prolactin were abnormally high. A microsome test gave an abnormally high value. Because she had no visual disturbance, thyroid replacement therapy and follow-up by CT were performed without resort to surgery. Within 2 months after the therapy, pituitary regression was seen on CT. Her serum T3 and T4 were normalized. TSH and prolactin levels reduced during the thyroid replacement therapy. Jawadi et al. and Pita et al. reported radiological evidence of pituitary regression or diminution of pituitary tumor by thyroid replacement therapy. These masses might not be a pituitary tumor, but a pituitary hyperplasia caused by the long-standing untreated primary hypothyroidism. A long-standing pituitary hyperplasia may be transformed into a pituitary tumor. The first choice of treatment for this type of pituitary tumor is thyroid replacement therapy unless the patient has a severe visual disturbance. However, if this replacement therapy is not effective for dimination of the tumor, surgical removal of the tumor should be considered.
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