Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 23, Issue 4
Displaying 1-11 of 11 articles from this issue
  • Hiroshi YAMADA, Shigetoshi NAKAMURA, Yuh TANAKA, Masataka TAJIMA, Naok ...
    1983 Volume 23 Issue 4 Pages 255-261
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Eighteen infants and children with typical congenital hydranencephaly were studied by pneumoencephalography, water-soluble contrast ventriculography, and cisternography (radioisotope or metrizamide). Pneumoencephalography and ventriculography suggested that the aqueduct was obstructed or markedly stenotic in all cases. Cisternography demonstrated blocks at the aqueduct and at the level of the basal-ambient cisterns in most cases. These findings support the concept that aqueduct stenosis is an important factor in the hydrocephalic process of hydranencephaly.
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  • Clinical Study
    Ryoji ISHII, Mizuo KUROKI, Ryuichi TANAKA, Masao WATANABE, Makoto TOYA ...
    1983 Volume 23 Issue 4 Pages 262-266
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Spontaneous subarachnoid hemorrhage (SAH) of unknown cause is not rare even though modern neuroradiological technique has greatly reduced its incidence. Between March 1976 and October 1981, 55 patients were admitted for treatment of SAH whose underlying source could not be found. Each patient had severe headache of sudden onset, a characteristic manifestation of SAH, and SAH was confirmed by the presence of blood-stained or xanthochromic lumbar CSF. Panangiography (three- or four-vessel study) was negative, and computed tomography (CT) disclosed no presence of intracerebral hematoma, recent infarction, or tumor. Hemorrhagic diathesis was excluded. Repeat panangiography was performed in 24 cases and was negative.
    The average age at the time of onset was 48.3 years in the males (n = 30) and 54.0 years in the females (n = 25). The symptoms were usually relatively mild; three-fourths of the patients presented no focal neurological findings. Subarachnoid clot on CT was less than that noted in patients with ruptured aneurysms; subarachnoid clot was found in only 14 patients (25%) on admission. In no case was there a further episode of SAH during the average admission period of 4 weeks. The follow-up period ranged from 6 months to 5 years and 11 months. Forty-seven patients (85%) returned to their former employment. No patient experienced a second SAH, except for one female who suddenly died 3 years after discharge, possibly because of SAH.
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  • Use of Dynamic Computerized Tomography Scan and Digital Subtraction Angiography for Follow-up Study
    Kazuo KATAOKA, Kazuo YAMADA, Toru HAYAKAWA, Kentaro KOSHINO, Takuya IK ...
    1983 Volume 23 Issue 4 Pages 267-272
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Four patients with large or giant carotid aneurysms treated by carotid ligation and extracranialintracranial (EC-IC) arterial bypass, and one patient with giant vertebral aneurysm treated by intracranial clipping of the vertebral artery were studied. Dynamic CT scan was employed to analyze the hemodynamic changes of the aneurysmal domes before and after surgery.
    Preoperative dynamic CT scan revealed rapid transit of the contrast material in the aneurysmal dome which slowed within a few days after proximal artery ligation. The time-density curve of the aneurysmal dome remained flat up to 29 months after indicating that the aneurysmal lumen had become thrombosed. CT scan of a case showed ring enhancement of the aneurysmal wall 13 months after surgery. Dynamic CT scan in this case revealed slow transit of the contrast material, indicating that the ring enhancement was due to the presence of capillary vessels.
    Patency of EC-IC bypass, completeness of proximal ligation, and lack of opacification of aneurysms were clearly demonstrated by digital subtraction angiography in all patients after surgery. Dynamic CT scan and digital subtraction angiography were useful for long-term follow-up after proximal artery ligation and EC-IC bypass for unclippable large intracranial aneurysms.
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  • Yukio IKEDA, Shozo NAKAZAWA, Hiroshi HIGUCHI, Kazuyoshi HONDA
    1983 Volume 23 Issue 4 Pages 273-277
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Transcatheter embolization of an extracranial arteriovenous malformations (AVM) was successfully performed using a stainless steel coil.
    The case was a 26-year-old male admitted with a tender, pulsatile mass involving the left occipital region. Enhanced CT revealed an extracranial mass in the left occipital region. Selective angiography revealed a large scalp AVM supplied by the left superficial temporal artery, the auricular artery, and the occipital artery. The AVM was embolized with stainless steel coils (Cook, Inc.) and small pieces of Gelfoam. The stainless steel coil was useful for permanent intravascular occlusion of the proximal portion of the artery feeding the AVM. Postembolization angiography demonstrated no opacification of the malformation.
    There was still no clinical evidence of recurrence after a three month follow-up period.
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  • Takashi UEDA, Tomokazu GOYA, Kazuo KINOSHITA
    1983 Volume 23 Issue 4 Pages 278-281
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    A case of fenestration of the middle cerebral artery (MCA) associated with an aneurysm arising from the distal bifurcation was reported.
    A 65-year-old male was suddenly seized with severe headache followed by left hemiparesis. CT scan demonstrated a right temporal intracerebral hematoma and right carotid angiography showed an aneurysm arising from the bifurcation of the right MCA and a fenestration of the same artery proximal to the aneurysm. Neurological examination on admission revealed somnolence, nuchal stiffness, left spastic hemiparesis, and bilateral papilledema. At surgery the afferent and efferent arteries of the aneurysm showed marked arteriosclerosis. Eight cases with fenestration of the MCA confirmed by angiography or operation have been reported in the Japanese literature and concomitant aneurysms were detected in five of them. Fenestration might be a remnant of the primitive MCA from the fetal stage. The coexistence of fenestration and aneurysm in the present case seemed to indicate that congenital factors played a role in the pathogenesis of the aneurysm.
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  • Report of a Case and Review of Literature
    Masao MOTOMOCHI, Yasumasa MAKITA, Sachio NABESHIMA, Tetsuya ITAGAKI, T ...
    1983 Volume 23 Issue 4 Pages 282-288
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Cystic meningiomas are rare. The authors presented a case of cystic meningioma in the right frontal convexity of a 36-year-old female. The patient was admitted because of progressive headache, foggy sight, diplopia, and left-sided motor weakness of two months' duration. The preoperative diagnosis of cystic meningioma was made by plain skull X-rays, CT scans, and cerebral arteriograms. At surgery, a tumor was found adherent to the dura in the right frontal convexity with multiloculated intratumoral cysts containing xanthochromic fluid. Histologically, the tumor was a transitional meningioma with intratumoral infarction in the vicinity of the cysts. The pathogenesis of the intratumoral cysts in this particular case were considered intratumoral infarction resulting in microcysts and then finally macrocysts.
    Ninety-six cases of cystic meningiomas reported in the literature were reviewed and the pathogenesis of cyst formation was discussed. Nauta's classification of four types of cystic meningiomas is important when considering the different pathogenesis of cyst formation in meningiomas. Adding to the four types of cystic meningiomas classified by Nauta et al., the authors suggested another type, namely, the subdural cyst mainly seen in infant meningiomas.
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  • Case Report
    Nobuhisa YAMADA, Motoharu YOKOYAMA, Kentaro SEKIGUCHI, Hiroshi SATOH, ...
    1983 Volume 23 Issue 4 Pages 289-294
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    A case of pituitary apoplexy was reported.
    A 17-year-old patient was admitted with a 3-day history of headache, vomiting, high fever, neck stiffness, consciousness disturbance, visual disturbance, ophthalmoplegia, and left hemiparesis. He appeared to be acromegalic. The cerebrospinal fluid contained numerous polymorphonuclear cells. CT showed a large, high-density suprasellar mass. Meningitis due to rupture of an abscess in a pituitary adenoma was suspected, but conservative chemotherapy was not effective. On the 5th hospital day he became comatose, and CT showed an extensive hypodense lesion with mass effect in the right cerebral hemisphere. Although decompressive craniectomy was performed, he died 13 days after the onset. Postmortem examination revealed that a large suprasellar pituitary adenoma with massive intratumoral hemorrhage had compressed the right intracranial internal carotid artery and had caused extensive infarction of the ipsilateral cerebral hemisphere. The tumor was a mixed adenoma consisting of chromophobe and eosinophilic cells, and immunohistochemical study showed the presence of growth hormone-producing adenoma cells. There was no evidence of intracranial infection.
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  • Case Report
    Shigeki OHARA, Terumasa TAKAGI, Taichiro SHIBATA, Hajime NAGAI
    1983 Volume 23 Issue 4 Pages 295-300
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    The authors discussed the developing process of delayed radiation necrosis of the brain from the case of a 42-year-old female who developed intracranial hypertension and left hemiparesis 5 and a half years after radiotherapy for pituitary adenoma.
    The initial sign of radiation necrosis was from a CT scan taken 3 and a half years after radiotherapy showing an irregular low density lesion in the right temporal lobe. CT scan 2 years later demonstrated displacement of the midline structures to the left and a larger low density lesion with partially high density in the right MCA territory that was enhanced with intravenous contrast medium. Recovery after a right temporal lobectomy and administration of steroid hormone were uneventful. Eight months later there were no signs of raised intracranial pressure nor of neurological deficits. Tissues obtained from the right temporal lobe at lobectomy revealed the characteristic changes of delayed radiation necrosis; a mixture of fresh, recent, and old vascular lesions in the same specimen. From these findings, it was speculated that delayed radiation necrosis might initially occur within several years after radiotherapy and might gradually take a progressive and extended course, even in cases whose clinical symptoms develop much later.
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  • Case Report
    Fumoto NAKAJIMA, Takeo KUWABARA, Saburo YAGISHITA
    1983 Volume 23 Issue 4 Pages 301-304
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    A case of primary cerebral ganglioneuroblastoma was reported.
    One month prior to admission, the patient, a 36-year-old female, suffered from generalized convulsions. Neurological examination showed no pathological findings, but CT scan revealed a calcification surrounded by an enhanced area in the left frontal lobe. A left frontotemporal craniotomy was performed and the brain tumor was totally removed. The tumor was greyish white, soft, poorly vascularized and cleary margined. Postoperative neurological deficit was mild expressive aphasia. Since Linac therapy with whole brain dosage of 1, 090 rads induced leukopenia, further irradiation and chemotherapy was discontinued and only OK-432 was given. More than three years after the operation CT scans have not revealed any sign of recurrence. Histologically, the tumor was composed of two cell types, small and large. The small cells or neuroblasts were poorly differentiated and had positive silver impregnation of fibers. The large cells or ganglion cells had round vesicular nuclei, deeply staining nucleoli, and Nissl granules in their cytoplasm.
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  • Report of a Successfully Treated Case
    Toshihiko KUROIWA, Tsukasa FUJIMOTO, Masaki AOYAGI, Yutaka INABA
    1983 Volume 23 Issue 4 Pages 305-310
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    The authors presented a surgically treated case of cavernous hemangioma on the fourth ventricle floor.
    The patient was a 44-year-old female who complained of double vision. Neurological examination revealed left facial nerve palsy, bilateral internuclear ophthalmoplegia, and hypesthesia of the right trigeminal area. Vertebral angiography did not show any sign of space taking lesion or of vascular abnormality. CT scan 1 week after onset of symptoms showed a round, high density area on the fourth ventricle floor and a perifocal low density area. The patient was followed and a CT scan was performed every 5 months. Although the neurological signs disappeared within 6 months, a CT scan after 15 months revealed a persistent high density area with minimal contrast enhancement. A pneumoencephalotomogram clearly visualized a semi globular filling defect 1 cm in diameter protruding into the fourth ventricle. At surgery, a red mulberry-like tumor was found in the middle of the fourth ventricle floor. Gliosis and hemosiderosis were seen at the base of the tumor. The tumor was totally resected. Microscopic examination showed closely packed, thin-walled vascular channels lined by a single layer of endothelial cells. The histological diagnosis was cavernous hemangioma. Three such previously reported cases are summarized.
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  • Case Report
    Sadayasu TANI, Keiji KAWAMOTO, Yasuo YAMANOUCHI, Takayuki NAKAJIMA, Ya ...
    1983 Volume 23 Issue 4 Pages 311-316
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Few reports of metastatic Ewing's sarcoma encroaching on the central nervous system have been available, and two types of CNS involvement have been described; one is invasion of the skull and/or dura forming an extracerebral mass, and the other is intraparenchymal infiltration causing focal symptoms.
    A 12-year-old male received a ventriculo-peritoneal shunt operation because of non-communicating hydrocephalus brought about by a metastatic bony tumor on the occipital squama two years after the amputation of the right humerus as an initial treatment for the primary Ewing's sarcoma. After an eight month interval of remission, he underwent a revision of the shunt but still neurological condition worsened. The associated soft tissue mass around his nuchal region exhibited a tremendously rapid growth. Three months later, he died of compression of the brain stem by the metastatic bony tumor occupying the cisterna magna. Though the post-mortem examination showed the cerebellum apparently demarcated from the mass, histological survey verified some invasion at the cerebellar surface which had had direct contact with the mass.
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