Neurologia medico-chirurgica

Effects of Hypercapnia and Papaverine on Cerebrospinal Fluid Formation and Choroid Plexus Blood Flow

Kenichiro HIGASHI, Sanao KATAYAMA

1985 Volume 25 Issue 1 Pages 1-8
Published: 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.1

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Changes in the cerebrospinal fluid (CSF) formation rate (Vf) with hypercapnia and papaverine infusion were measured by the ventriculocisternal perfusion technique in anesthetized dogs. In addition, local blood flow in the choroid plexus and cerebral cortex was measured by the hydrogen clearance method. When PaCO₂ increased with 10% CO₂ inhalation, Vf increased transiently and gradually decreased to the control level within an hour. This transient increase in Vf is considered to be due to mobilizing unequilibrated pools of CSF, caused by sudden changes of the craniospinal blood volume. Excluding such an apparent increase caused by an artifact, neither hypercapnia nor papaverine affected Vf.
Local blood flow of the choroid plexus of 12 normal dogs was 72.8±13.1 ml100 gmin in average which was higher than that of the cerebral cortex; 57.8±12.4 ml 100 gmin. Although cortical blood flow increased to 225% of the control under hypercapnia with 10% CO2 inhalation, the choroid plexus blood flow did not increase significantly. Papaverine infusion also raised the cortical blood flow up to 143% of the control, while the choroid plexus blood flow did not increase significantly. From the above results, the choroid plexus, a major source of CSF, is demonstrated to be less reactive to vasodilatation induced by either hypercapnia or a vasoactive agent. This phenomenon favorably explanes, at least partially, the unchanged Vf under the effect of hypercapnia or papaverine.

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Effects of Bromocriptine and Radiation on the Size and Activity of Estrogen-induced Rat Prolactinomas

Tomokatsu HORI, Hideharu NUMATA, Yasuo HOKAMA, Kiyoaki MURAOKA, Yoshik ...

1985 Volume 25 Issue 1 Pages 9-14
Published: 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.9

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Estrogen-induced rat prolactinomas were produced after seven weekly injections of 2.5 mg of estradiol valerate. The rats were treated with various combinations of therapeutic agents. They were divided into four groups including the bromocriptine (CB) treated group, irradiated group, combined CB and radiation treated group, and finally the control group. Serum concentrations of prolactin and weights of tumors containing pituitary tissues were measured and statistically compared.
The suppressing effect of CB against prolactinomas was well demonstrated in their hormonal activities. But it alone was not effective in reducing the size of prolactinomas. Concerning irradiation, on the 17th day it alone was not effective in reducing hormonal activities of rat prolactinomas. In the chronic stage, on the 30th day radiation alone was effective in reducing hormonal activity. Throughout the experiment CB was more potent than radiation in reducing hormonal activity. Concerning the size reducing effect, combined use of CB with radiation was significantly effective. If CB is not sufficient in reducing the size and hormonal activity of human prolactinoma, its combined use with radiation may be suggested.

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Chronological and Volumetric Changes in Structures of the Human Brain in Hemorrhagic Cerebral Infarction

Noboru GOTO, Mitsuo KANEKO, Keisei TANAKA

1985 Volume 25 Issue 1 Pages 15-22
Published: 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.15

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Chronological and volumetric changes of the brain were studied with the help of an electronic optical planimeter in five autopsies from patients with left-sided embolism extending from the distal internal carotid artery to the proximal middle cerebral artery. Four brains had hemorrhagic infarctions. The survival periods were 2, 3, 4 and 11 days after the stroke. Characteristic diphasic abnormalities indicative of ischemic cerebral edema were noticeable not only in the ischemic hemisphere—especially when compared with the non-diseased side—but also in the non-ischemic hemisphere (although they were milder and started later in the latter case). The fifth non-hemorrhagic brain had only ischemic cerebral edema. There were no corticomedullary differences in volume between hemispheres. The patient survived two days.
The concept of corticomedullary volume ratio was introduced to evaluate quantitative gradings of ischemic volume changes between the cerebral cortex and white matter.

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Increased Risk of Cerebral Thrombo-embolic Complication during Gradual Carotid Artery Occlusion Combined with Extra- and Intracranial Bypass Surgery in the Treatment of an Inaccessible Carotid Aneurysm

Toru HAYAKAWA, Yoshikazu IWATA, Kazuo YAMADA, Norio ARITA, Shintaro MO ...

1985 Volume 25 Issue 1 Pages 23-26
Published: 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.23

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We report a 31-year-old woman with an intracavernous carotid aneurysm who experienced a cerebral embolic complication during the gradual occlusion of an internal carotid artery (ICA) following superficial temporal to middle cerebral artery anastomosis. The cerebral angiogram revealed an embolus lodged in the stem of the middle cerebral artery. Based on our findings we suggest that in the presence of a sufficient collateral blood supply after extra and intracranial bypass surgery, abrupt ICA ligation may reduce the risk for thrombo-embolic complications. If, on the other hand, the collateral blood flow is insufficient, gradual ICA occlusion should be considered and anticoagulant therapy should be used.

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The Value of Contrast-enhanced Computed Tomography for the Diagnosis of Intracranial Aneurysms

Masakazu TAKAYASU, Akira SHINTANI, Makoto NEGORO, Takahiko ASAI

1985 Volume 25 Issue 1 Pages 27-31
Published: 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.27

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Plain and contrast-enhanced computed tomography (CE-CT) was evaluated in 48 patients with 55 angiographically confirmed cerebral aneurysms by a method simulating the prospective study to show the real value. The detection rate by CE-CT was 44%. The CE-CT was a helpful diagnostic method, when there was no localizing sign in plain CT. Seven aneurysms out of fifteen (47%) without subarachnoid hemorrhage or other lacalizing signs in plain CT were detected by CE-CT. The CE-CT gave a more specific diagnosis and may be useful, when angiography is deferred. Though other less invasive techniques, like intravenous digital subtraction angiography, provides an alternative method at present, the detection rate of this study would represent one of the standards of less invasive tech niques for the diagnosis of intracranial aneurysms.

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Extravasation of Contrast Medium into Blood Clot in Acute Traumatic Intraventricular Hemorrhage

Shiro KOBAYASHI, Shozo NAKAZAWA, Masami YANO, Toshibumi OTSUKA

1985 Volume 25 Issue 1 Pages 32-35
Published: 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.32

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Two patients are reported who showed evident extravasation of contrast medium into a blood clot in an intraventricular hemorrhage during contrast-enhanced computerized tomography. Both patients had a poor prognosis despite ventricular drainage. The findings may suggest an association with severe brain damage.

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Chondrosarcoma in the Optic Canal

—A Case Report with Ultrastructural Study—

Toshihiko KUBOTA, Shinjiro YAMAMOTO, Asoa HIRANO, Hideaki MURATA

1985 Volume 25 Issue 1 Pages 36-41
Published: 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.36

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A rare case of primary low grade chondrosarcoma in the optic canal is presented. The fine structure of the tumor is generally that of a differentiated cartilage. The neoplastic cell cytoplasm has abundant glycogen granules, rough endoplasmic reticuli, Golgi apparatus and mitochondria. In the Golgi zone, secretory vacuoles frequently contain fine dense particles, associated with fine filamentous material, resembling the reticulated structure of extracellullar proteoglycans. Abundant mitochondria exist in the degenerated cells. Membrane invested matrix vesicles are frequently encountered in the amorphous material of disintegrated cells and in the vicinity of necrotic cells. Some of them may represent remnants of mitochondria. Intact neoplastic cells may secrete proteoglycans to make the chondroid matrix, while the degenerated tumor cells provide extracellular matrix vesicles for initial calcification.

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Acquired Intracerebral Toxoplasmosis Presented as Calcified Mass Lesions

Jun-ichi KURATSU, Yasuhiko MATSUKADO, Nobuhito NONAKA, Yoichi ITOYAMA, ...

1985 Volume 25 Issue 1 Pages 42-44
Published: 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.42

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A case of cerebral toxoplasmosis in a 57-year-old female is reported, considered to be an acquired form of the disease, although no obvious immunosuppressive illness preceded the history. Clinical findings showed other interesting features with this patient, who developed convulsive disorders and had calcified round lesions in the basal ganglia and cerebral hemisphere. Toxoplasmosis antibody test was strongly positive and histological examination revealed intracellular protozoan toxoplasma.

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Intracranial Osteogenic Sarcoma Complicating Paget's Disease of Bone

—Case Report—

Masamichi SHINONAGA, Gakuji GONDO, Kazuhiko FUJITSU, Takeo KUWABARA

1985 Volume 25 Issue 1 Pages 45-49
Published: 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.45

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A rare case of Paget's disease of bone accompanied by osteogenic sarcoma which invaded into the intracranial cavity is reported. A 60-year-old woman was admitted complaining of disturbed consciousness, aphasia, right hemiparesis, and severe intermittent headaches. Skull X-ray films showed thick calvaria with “cotton wool appearance.” A CT scan revealed an intracranial enhanced mass lesion in the left occipital area. Elevated serum alkaline phosphatase was noted. Biopsy of the left occipital bone demonstrated osteogenic sarcoma complicating Paget's disease of bone. The tumor grew progressively, showing no response to irradiation, and the patient died. Paget's sarcoma is rare in Japan, where only one case of intracranial Paget's sarcoma has previously been reported.

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Neonatal Orbital Teratoma with Intracranial Extension

—Case Report—

Hiromi SATO, Noriko SATO, Mineo GAKIYA, Chin-Ying LO, Norihiko TAMAKI, ...

1985 Volume 25 Issue 1 Pages 50-54
Published: 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.50

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Congenital teratoma of the orbit is a rare tumor, which usually manifests unilateral proptosis in an otherwise normal newborn infant. It rarely extends intracranially. A rare case of congenital orbital teratoma with intracranial extension, which presented microphthalmia from birth, is reported. Intracranial approach with orbital unroofing enabled total removal of this rare tumor during the neonatal period through combined efforts of neurosurgery and ophthalmology.

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Traumatic Arteriovenous Fistula of the Scalp

—Report of Two Cases and Review of the Literature in Japan—

Jun SHINODA, Tomohiko IWAI, Toshihiro MORITA, Yoshiaki MIWA, Mitsuaki ...

1985 Volume 25 Issue 1 Pages 55-60
Published: 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.55

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Two cases with traumatic arteriovenous fistula (AVF) arising from the superficial temporal vessels are reported. In both cases, AVF was diagnosed by angiography and then, removed totally with feeding arteries and draining veins. The postoperative course of both cases was uneventful and the preoperative symptoms disappeared.
Traumatic AVF of the scalp is rare, and only 18 cases have previously been reported in Japan. Out of the total of 20 reported cases with AVF of the scalp, including our two cases, the authors are presenting a review of their sexes, ages, locations, symptoms, diagnoses, and treatments.

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Successful Treatment of Dwarfism and Hypogonadism after Total Removal of Craniopharyngioma

Tatsuya KOBAYASHI, Jun YOSHIDA, Naoki KAGEYAMA, Osamu MORI, Masamichi ...

1985 Volume 25 Issue 1 Pages 61-65
Published: 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.61

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A case of successful treatment of child craniopharyngioma is reported. The tumor was totally removed seven years ago and the patient's height became normalized by human growth hormone (HGH) therapy lasting for 2 12 years. Completed development of his sexual characteristics and induction of spermatogenesis resulted from a combination therapy with human chorionic gonadotropin (HCG) and human menopausal gonadotropin (HMG).

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