Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 25, Issue 2
Displaying 1-12 of 12 articles from this issue
  • Sadao KANEKO, Hiroshi ABE, Kouichi TOKUDA, Shinji SUGIMOTO, Mitsuo TSU ...
    1985 Volume 25 Issue 2 Pages 75-80
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The in vitro and in vivo antitumor effects of photoradiation with hematoporphyrin derivative (HPD) on malignant glioma were evaluated.
    Ethylnitrosourea induced rat glioma (KEG-1) cells, following incubation at various concentrations of HPD, were irradiated with 8×5 W fluorescent white cool lamps. Using photoradiation, it was possible to destroy glioma cells in a culture incubated for 2 hours at 5 μgml and 50 μgml of HPD in less than 35 minutes and less than 15 minutes, respectively. Glioma cells incubated for 6 hours at 5 μgml of HPD could destroy in less than 25 minutes. Photoradiation with HPD proved to be dose-dependently lethal in a culture of glioma cells.
    The brain tumor model was produced in Wistar King Aptekman (WKA) male rats by stereotaxic inoculation of KEG-1 glioma cells. The rats with brain tumors were given an injection of 10 mgkg of HPD intravenously 24 hours before photoradiation. For the photoradiation, light of a wave length of 514.5 nm was produced by an argon laser and was delivered through an optical fiber 400 μm in diameter. The optical fiber was inserted into the brain, through a burr hole made in the rat's skull. The tip of the optical fiber was placed on the tumor. The duration of the photoradiation was 20 minutes at 100 mW (120 joules). The median survival time of the controls was 24.0 days. That of HPD alone was 24.0 days and that of photoradiation alone 23.0 days. The median survival time of the treatment with photoradiation following HPD was 28.0 days with 16.6% increased life span and this was significantly longer than that of the controls (P=0.0048).
    In conclusion, photoradiation therapy with HPD may prove useful in the management of malignant brain tumors that are resistant to current methods of treatment.
    Download PDF (393K)
  • Electron Microscopical Examination
    Takao WATANABE, Michiyasu SUZUKI, Takashi YOSHIMOTO, Jiro SUZUKI
    1985 Volume 25 Issue 2 Pages 81-88
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Histological changes in the ischemic focus after recirculation were examined by electron microscopy, using a thalamic infarction model in the dog. In this model, the regional blood flow in the ischemic focus decreased to 10 ml100 gmin, about 13 of the pre-occlusion value, after occlusion of the intracranial arteries.
    Mild swelling of the endoplasmic reticulum and mitochondria and dispersion of polysomal rosettes were found after a 30 minute occlusion. Recovery from these changes occurred after 12 or 24 hours of recirculation. Spongiosis of neuropil and slight swelling of the perivascular glial endfeet also recovered. On the other hand, severe swelling of the endoplasmic reticulum and mitochondria, with destroyed crista and severe shrinkage of the cytoplasm of the nerve cells were found after 1 or 2 hour occlusions. After recirculation, disruption of nerve cells and glial cells are frequently found in the ischemic focus. In this thalamic infarction model, therefore recirculation after 30 minutes was effective for recovery, but recirculation after 1 or 2 hour occlusions was not effective, on the contrary, tissue damage was aggravated.
    Download PDF (1158K)
  • Tomoaki TERADA, Haruhiko KIKUCHI, Jun KARASAWA, Yoshihiro KURIYAMA
    1985 Volume 25 Issue 2 Pages 89-94
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Sequential changes in the autoregulation of cerebral blood flow (CBF) were studied in 12 pa. tients having subarachnoid hemorrhages (SAH) with symptomatic vasospasms. These patients underwent aneurysmal clipping in the acute stage. An autoregulation curve was prepared from %CBF calculated from the arteriovenous oxygen difference and the mean arterial blood pressure. Dopamine was infused to increase blood pressure, while trimethaphan was used to decrease blooc pressure. Autoregulation curves in the patients with vasospasms were classified into four stages. Stage I : Autoregulation of CBF completely disappeared and the relationship between CBF anc blood pressure was linear. This stage was noted about 6 days after the SAH. Stage II : This patterr was noticed 11 days or so after the SAH. The increase in CBF due to the rise of blood pressure steep ly declined at hypertensive levels. Stage III: Constant CBF appeared at hypertensive levels about 11 days after the SAH. Stage IV: Normalization of autoregulation was noted more than 26 days after the SAH. From these results, induced hypertensive and hypervolemic therapy through the use of plasma expander and dopamine was thought to be effective in stage I and stage II. In stage III hypervolemic therapy and a decrease of intracranial pressure were thought to be the most suitable. In stage IV, hypertensive therapy was thought to be contraindicated. The reason for disturbec autoregulation was unknown, but changes in the vascular wall, denervation around the cerebra: vessels and increased intracranial pressure due to ischemia were all suspected as causes.
    Download PDF (378K)
  • Yasuji YOSHIDA, Fusahiro IKUTA, Ryoji ISHII, Ryuichi TANAKA
    1985 Volume 25 Issue 2 Pages 95-102
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Histopathological studies on the cerebral aneurysm in cerebrovascular moyamoya disease have been limited to only a few cases and the pathological details still remain obscure. Six moyamoya disease autopsy cases that satisfied the criteria of this disease proposed by Nishimoto in 1976 are studied. In addition to the routine neuropathological examination of the brains, detailed observation of the circle of Willis and its branches was carried out under a dissecting microscope and all of the bulged areas or locally thin portions of the vessel wall were histologically examined. All the patients had cerebral aneurysms. Seventeen aneurysms in total were discovered and their diameter ranged from 450 to 1, 300 μm (mean diameter of 860 μm) . The principal histology of these aneurysms was of the saccular type in which the dome was composed of endothelial and adventitial layers, accompanied by the disappearance of the internal elastic lamina and the media. These small saccular aneurysms of the cerebral arteries in moyamoya disease were revealed to have the following characteristic features: 1) They were located at the bifurcating sites of arteries, and were distributed predominantly on the posterior communicating and posterior cerebral arteries, and on the abnormal vascular networks branching from these arteries. 2) They were usually small, about 1 mm in diameter in size, and were multiple. 3) The lumen of the aneurysms was often occluded by fibrous thickening of the intima, which is believed to be the most characteristic disease process in moyamoya disease, and is commonly noticed in various cerebral arteries, most significantly at the terminal portion of bilateral internal carotid arteries. Based on these results, the pathogenesis of these small saccular aneurysms in moyamoya disease, and a possible mechanism in cerebral aneurysm formation were discussed.
    Download PDF (750K)
  • Tetsuo KOIKE, Osamu SASAKI, Ryoji ISHII, Ryuichi TANAKA, Jusuke ITO, K ...
    1985 Volume 25 Issue 2 Pages 103-109
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Experiences of preoperative embolization using Ivalon (polyvinyl alcohol foam) particles in 12 cases of intracranial meningiomas are reported. Preoperative embolization was carried out for the purpose of decreasing bleeding from the tumor during operation.
    Catheterization was performed through the femoral artery in 8 cases and through the common carotid artery in 4 cases. Ivalon particles, with a mean size of 0.5×0.5×0.5 mm, were instilled, half-and-half with normal saline and contrast material. The emboli were injected as gently as possible under the image intensifier.
    In 9 cases a computed tomography scan was done after the embolization and all the cases showed a decrease in the contrast enhancement of the tumor. The operations were performed from 1 to 22 days after the embolization. Total removal was performed in 11 cases. The pathological specimens showed fragments of Ivalon within the tumor in 7 cases. In all the cases but one, the primary purpose of minimizing bleeding during operation, was achieved. No major side effects were encountered in this series. However, attention should be paid to vascular anomalies, such as the ophthalmic artery arising from the middle meningeal artery and the vertebral artery visualized through the collateral from the occipital artery, before embolization so as to prevent possible catastrophes.
    Download PDF (722K)
  • Case Report
    Mitsunori MATSUMAE, Tatsuya KONDO, Masumi YOSHIOKA, Mitsuru SHINOHARA, ...
    1985 Volume 25 Issue 2 Pages 110-114
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A case of metastatic intracranial germ cell tumor from the testis is reported. A 27-year-old man underwent orchidectomy in January, 1982, and received systemic chemotherapy from January to September, 1982. In October, 1982, the patient was readmitted because of an episode of generalized seizure. Enhanced computerized tomography (CT) revealed round high density areas in the left frontal and right occipital lobes, which suggested metastatic intracranial tumors. Whole brain irradiation therapy was started. Upon completion of 8 Grey (Gy) irradiation, the patient developed right hemiparesis and motor aphasia. CT revealed an increased irregular high density area which was indicative of bleeding from the left frontal lesion. In October, craniotomy and removal of the hematoma and the tumor were performed. Two days later the patient complained of a headache. CT showed another bleeding from the right occipital lesion. Evacuation of the hematoma and removal of the tumor were again performed. In November, CT disclosed additional new bleeding in the left occipital lesion and the patient eventually died in November, because of respiratory failure.
    The surgical indication, follow-up of human chorionic gonadotropin and alpha fetoprotein, immunohistochemical results of metastatic intracranial germ cell tumors from testis are discussed with a review of the literature.
    Download PDF (626K)
  • Case Report
    Yasuaki HOSAKA, Shizuo HATASHITA, Nobunori KOGA, Jun SUGIMURA, Kouzou ...
    1985 Volume 25 Issue 2 Pages 115-118
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A case of ventricular meningioma associated with intracerebral and intraventricular hemorrhages was reported.
    The patient was a 69-year-old male who had been showing mild dementia for 6 months. He was transferred because of a sudden onset of headaches, right hemiparesis, total aphasia and disturbances in consciousness. A computerized tomography scan disclosed a well enhanced left lateral ventricular mass. A left parietotemporal intracerebral and intraventricular hemorrhages was also noted. A left carotid angiography showed dilatation of the choroidal artery and tumor stain in the left trigone, especially in the venous phase. Extravasation from the outer margin of the tumor was noted. Left parietotemporal craniotomy and total removal of the tumor and intracerebral hematoma were performed. The tumor was encapsulated and associated with a clot. The histological diagnosis was fibroblastic meningioma with whorl formation. In the peripheral area of the tumor, many thin-walled angiomatous vessels were observed. The post-operative course was uneventful, and the patient was transferred to another hospital because of aphasia and disorientation. The authors reviewed the literature and discussed the mechanism of intracerebral hemorrhage from lateral ventricular meningioma.
    Download PDF (531K)
  • Case Report
    Yoshikazu OKADA, Takuhiro HOTTA, Kiyoshi HARADA, Tohru UOZUMI, Masashi ...
    1985 Volume 25 Issue 2 Pages 119-124
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The authors reported a case of chondromyxoma, which was a subentity of intracranial chondroma. A 63-year-old man was admitted with double vision and sensory disturbance of the face. Neurological examination revealed left abducens and trigeminal nerve palsies. A computerized tomography (CT) scan revealed a round-shaped mass lesion with contrast enhancement in the left middle cranial fossa. The carotid angiogram showed no tumor stain. Narrowing of the osseous portion of the internal carotid artery, medial shift of the intracranial carotid artery and elevation of the trunk of the middle cerebral artery were seen. Operation revealed an extraaxial mass made up of almost myxomatous grayish white material and small cartilagenous tumor. The ground substance of the tumor was strongly positive for Alcian blue stain, denoting an acid mucopolysaccharide material, and the cartilagenous cells were positive for periodic acid-Schiff stain, indicating glucoprotein. These macroscopic and microscopic investigations confirmed the diagnosis of chondromyxoma.
    The histological characteristics and CT findings of the intracranial chondroma were discussed.
    Download PDF (832K)
  • Case Report
    Seiichi KOBAYASHI, Nobuto KOJO, Masafumi YOSHIDA, Masahiko KATAYAMA, K ...
    1985 Volume 25 Issue 2 Pages 125-130
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A 54-year-old male was admitted in April, 1983, because of progressive neurological symptoms. On neurological examination, the patient was stuporous, had right hemiparesis, expressive aphasia, bilateral papilledema and right sixth cranial nerve paresis. A computerized tomography (CT) scan demonstrated a mass in the left thalamus with a marked enhancement after contrast administration. Left carotid angiography showed a vascular stain in the same region. Prednisolone was given intramuscularly, at a dose of 20 mgday. Ten days later, an improvement of neurological findings were observed. A CT scan at this time revealed the mass lesion was markedly decreased in size. In June, a stereotaxic biopsy of the mass in the thalamus showed a malignant lymphoma. After this procedure, whole brain irradiation at a total dose of 4, 000 rad and a local dose of 2, 000 rad was given. Prednisolone therapy was continued. A CT scan taken after irradiation demonstrated disappearance of the tumor mass and also, improved neurological symptoms.
    Seven cases of primary malignant lymphoma of the brain which showed remission in conjunction with the administration of glucocorticoids have been previously reported. It is thought that glucocorticoids may have a direct cytotoxic effect on the lymphoma cell or that glucocorticoids may favorably alter the biologic activity of tumor tissue in some cases.
    Download PDF (714K)
  • Case Report
    Ichiro SHIMOYAMA, Kaoru HINOKUMA, Toshiaki NINCHOJI, Kenichi UEMURA, I ...
    1985 Volume 25 Issue 2 Pages 131-135
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The radiosensitivity of meningiomas is controversial. Meningiomas are generally benign tumors. However, there are some malignant subtypes, and even for these, total removal alone is considered the best therapy. Radiotherapy is considered only when the former cannot be accomplished.
    The patient was a 49-year-old, right-handed man, admitted for progressive headache, visual field disturbances, right leg motor weakness and difficulty in comprehending. Computerized tomography (CT) scans showed a multilobular isodense mass in the left occipital lobe, with marked homogeneous enhancement. Angiograms showed a large highly vascular lesion in the same area, fed from the left posterior cerebral, left superior cerebellar, and bilateral occipital arteries. The first attempt to remove the mass was unsuccessful, because of profuse bleeding from the tumor. The histology of the surgical specimen showed hemangiopericytic meningioma and so 60Co-irradiation of 5, 500 rad was given over 6 weeks. On repeated follow-up CT scans, the enhancing mass became progressively smaller. Four months after the irradiation, the tumor was totally removed with little bleeding. It showed markedly decreased cellularity and fewer capillaries. One year after the second operation, the patient is doing well with no neurological deficits.
    Download PDF (666K)
  • Case Report
    Yasuo YAMANOUCHI, Nobuhiko TAKAHARA, Yasuo KAWAMURA, Hiroshi MATSUMURA
    1985 Volume 25 Issue 2 Pages 136-142
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A 69-year-old male was admitted complaining of gait disturbances and diplopia, 2.5 years after an episode of serous meningitis. Neurological examination on admission disclosed Parinaud's sign, unsteady gait and dysdiadochokinesis on the left side. A striking finding on the computerized tomography (CT) was the left to right shift of the posterior portion of the third ventricle without visualization of the quadrigeminal and ambient cisterns, which were almost completely occupied by an isodense mass accompanied by high dense flecks and a low dense part. Enhanced CT showed positive enhancement in the vicinity of the pineal calcification. By the suboccipital supracerebellar approach, an encapsulated mass containing brownish yellow fluid was subtotally removed and a histological examination of it revealed epidermoid tissue and hemosiderin deposits in the solid portion. Few reports of isodense epidermoid cysts have so far been found in the literature giving a full explanation for this unusual CT attenuation value. Based on the clinical course and histology of this case, the pathogenesis of the unusual density is discussed along the following lines: The mixture of the low dense factor due to cholesterin and the high dense factor due to prior bleeding is believed to result in the isodense attenuation value in the liquid portion. Also, in the solid part, a microscopically mixed texture of deposited hemosiderin and cholesterin clefts in the inflammatory granulomatous tissue could explain its density on the CT scan.
    Download PDF (801K)
  • Case Report
    Takashi UEDA, Tomokazu GOYA, Kazuo KINOSHITA
    1985 Volume 25 Issue 2 Pages 143-148
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A case of radiculo-myelopathy due to ossifications of multi-vertebral ligaments is reported. A 50year-old female had vague symptoms, such as radiating pain in the right back, sudden onset of muscle weakness and spasticity in both legs. She had been known to be hypertensive and diabetic for years. Neurological examination revealed moderate myelopathy from the cervical level down, with marked radiculopathy in the lower thoracic level and sphincter impairment. Routine laboratory examination results were within normal limits, except for 50 g oral glucose tolerance test. Vertebral plain roentgenograms and tomograms demonstrated ossifications of the posterior longitudinal ligament (OPLL) of C2-6, Th2-4, Th5-10, Th12-L1 and L2-3, and ossification of the yellow ligament (OYL) of Th8-9 and Th9-10 interspaces. Myelography demonstrated an incomplete block at the level of Th8-10. Spinal plain and metrizamide computerized tomography scans clearly demonstrated these ossifications, especially at the lower thoracic level where the spinal cord was markedly strangled by the OPLL and OYL. Total laminectomy of Th8 and Th9 was performed and OYLs were subtotally removed. Foraminotomy at the level of right Th7-8 and Th8-9 was added. Histological examination showed this to be OYL. Postoperatively, the radiculopathy of the lower thoracic level and urinary disturbances improved.
    The authors discuss the problems of the ossification of multi-vertebral ligaments.
    Download PDF (843K)
feedback
Top