Neurologia medico-chirurgica

Active Neural Processes within the Brain Stem in Production of Coma

—Araki's Coma-puncture Revisited—

Takashi TSUBOKAWA, Yoichi KATAYAMA

1985 Volume 25 Issue 7 Pages 503-514
Published: July 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.503

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During a series of studies of neural processes underlying coma following concussive head injury, we recognized processes similar to those originally termed coma-puncture by Araki et al. In this paper we will review the pioneer work by Araki and his colleagues in light of current information. The data from their studies and our own observations suggest that sudden, disorganized excitation of extensive areas in the pontomesencephalic region may be associated with neural sequences resulting in activation of neural systems that actively inhibit responsiveness to external stimuli and thereby produce coma.

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Comparative Study of Chemotherapy and/or Immunotherapy of Established Experimental Brain Tumors

Yoshihisa KIDA, Humberto CRAVIOTO

1985 Volume 25 Issue 7 Pages 515-521
Published: July 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.515

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Intracerebral injection of 5×10⁵ nitrosourea-induced glioma cells (T₉ tissue culture line) consistently produced brain tumors in syngenic Cesarean Derived Fisher rats. The tumors were 1 mm in diameter within 7 days and caused death within 23 days (mean results). The effects of therapy with ACNU and/or Corynebacterium parvum (C. parvum) were evaluated. C. parvum alone was apparently ineffective. ACNU (10 mg/kg body weight) given on days 7 and 14 prolonged the mean survival time to 33.4 days. Combined treatment with ACNU and intradermal immunization with T₉ cells and C. parvum on days 7 and 14, or on days 0 and 7, prolonged the mean survival time to 35.3 and 39.6 days, respectively. Eleven rats that survived following this treatment showed specific immunity against T₉ cells, as demonstrated by subsequent challenge with T₉ cells. The Winn's test procedure showed that spleen lymphocytes from immune rats were effective against T₉ cells. The results suggest that immunochemotherapy may be an effective treatment for rats with established brain tumors.

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Immunohistochemical Evidence for the Presence of S-100 Protein in Stromal Cells of Cerebellar Hemangioblastomas

Kazuo TABUCHI, Rinkichi OHNISHI, Akira NISHIMOTO

1985 Volume 25 Issue 7 Pages 522-527
Published: July 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.522

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The histogenesis of the stromal cells in cerebellar hemangioblastomas is still a subject of controversy.
In this study, 13 cerebellar hemangioblastomas were examined immunohistochemically for S-100 protein, glial fibrillary acidic protein (GFAP), and human factor VIII-related antigen in an attempt to elucidate the histogenesis of the stromal cells in these tumors. An unequivocally positive immunoperoxidase reaction for S-100 protein was observed in most of the stromal cells in 10 of the 13 cerebellar hemangioblastomas examined, whereas GFAP and human factor VIII-related antigen assays were essentially negative. The positive GFAP reaction occurred sporadically, in what we thought to be astrocytes trapped within the tumor. Human factor VIII-related antigen was positive exclusively in the capillary endothelial cells of the tumor. Thus, our results suggest that the stromal cells are derived from either vestigial cells of the neural crest or histiocytic cells of the reticuloendothelial system, which potentially produce S-100 protein.
Our results, considered in light of certain previous observations, imply that the stromal cells are the principal neoplastic cells of hemangioblastoma and are associated with the proliferation of vascular channels, possibly as a secondary effect of this tumor.

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Post-irradiation Brain Tumors

Shinichiro OKAMOTO, Hajime HANDA, Junkoh YAMASHITA, Yasuhiko TOKURIKI, ...

1985 Volume 25 Issue 7 Pages 528-533
Published: July 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.528

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Four cases of brain tumor—three meningiomas and one glioblastoma—that developed after radiation therapy are reported. The location and course of each tumor were highly suggestive of a pathogenetic role of the preceding irradiation in the development of the tumor. A review of the literature revealed that there is evidence for a causative role of irradiation in the development of brain tumors, although there has been no definitive epidemiological study.

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Clinical Significance of Short-term Cerebral Aneurysmal Enlargement

Nobuo ONO, Shuji IMAI, Akira ZAMA, Tsutomu HOSAKA, Kimio ONODA, Tetsuo ...

1985 Volume 25 Issue 7 Pages 534-540
Published: July 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.534

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We attempted to determine whether or not there is a relationship between the rate of aneurysmal growth during the waiting period in cases of delayed surgery and the incidence of fatal rebleeding. Angiographic studies were repeated in 53 patients with ruptured aneurysms, with the interval between angiograms ranging from 4 to 60 days. Aneurysmal enlargement over a longer period than 2 months was not evaluated in this study because the prognostic significance of long-term aneurysmal growth is different from that of short-term growth. Of 53 patients, 40 showed no change in the size of the aneurysm, four showed a decrease, and nine showed an increase. Patients with aneurysmal enlargement were classified into two groups: 1) the aneurysmal dome increased in size (4 cases), and 2) only the bleb enlarged (5 cases). All patients in group I suffered from fatal rebleeding during hospitalization, one patient during angiography and one just before craniotomy. Among the patients in group 2, all of the aneurysms were successfully clipped before fatal rebleeding. Short-term growth of aneurysms, as evidenced by angiograms, appears to be extremely hazardous and of significant value in predicting acute, fatal rebleeding. Selected case histories are presented.

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Follow-up Study of Intracranial Aneurysms with Special Reference to Long-term Social Rehabilitation

Hiroshi ISE, Akira YAMAURA, Katsumi ISOBE, Nobuo OKA, Hiroyasu MAKINO

1985 Volume 25 Issue 7 Pages 541-550
Published: July 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.541

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192 patients with aneurysms of anterior circulation were evaluated with respect to social rehabilitation. All underwent definitive surgery and were followed for more than 6 months. 168 patients (87.5%) returned to full or partial employment. Factors such as age, preoperative level of consciousness, preoperative Hunt and Hess' grading, requirement of shunts, the presence or absence of an intraventricular hematoma, and evidence of ventricular dilatation on computerized tomograms were the most important in predicting social recovery. The prophylaxis and treatment of epilepsy following subarachnoid hemorrhage are also discussed.

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Glossopharyngeal Neuralgia Treated by Micro vascular Decompression

—Case Report—

Akira MURASAWA, Kazuo YAMADA, Toru HAYAKAWA, Yasuo ARAGAKI, Toshiki YO ...

1985 Volume 25 Issue 7 Pages 551-553
Published: July 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.551

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In a patient with glossopharyngeal neuralgia caused by neurovascular compression of the 9th cranial nerve, microvascular decompression of the glossopharyngeal and vagal nerves led to complete pain relief. Operative findings are described and selection of treatment for this type of neuralgia is discussed.

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Intracranial Embryonal Carcinoma mixed with Endodermal Sinus Tumor and Teratomatous Elements in the Anterior Third Ventricle

—Case Report—

Isao IWASAKI, Hiroshi HORIE, Ten Jun YU, Naobumi ARIGA, Tetsuo OHWADA, ...

1985 Volume 25 Issue 7 Pages 554-558
Published: July 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.554

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A 16-year-old male patient was diagnosed as having an intracranial germ cell tumor in the anterior third ventricle. Surgery revealed that the tumor was composed of embryonal carcinoma, endodermal sinus tumor, and teratomatous elements, such as cartilage, myogenic tissue, and keratinizing squamous epithelium. Alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) were elevated in the serum preoperatively and demonstrated also in the excised tumor tissue by the immunohistochemical method. After postoperative radiation therapy, the serum AFP and HCG returned to normal limits. About 1 year after the first operation, a recurrence of the tumor, with marked elevation of serum AFP, was detected. A second operation was performed, and the histological examination showed mostly endodermal sinus tumor with irradiation effect and teratomatous elements. The embryonal carcinoma portion had almost disappeared as a result of the earlier radiation therapy. Changes in the tumor composition correlated with changes in serum tumor markers. The patient is being followed closely.

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Surgical Intervention in Ruptured Venous Angioma

—Case Report—

Tetsuji INAGAWA, Haruyoshi TAGUCHI, Tohru YAMADA

1985 Volume 25 Issue 7 Pages 559-563
Published: July 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.559

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A patient with a venous angioma of the temporal lobe, which was discovered as a result of intracranial hemorrhage, underwent a two-stage surgical procedure. First, the hematoma was removed and the medullary veins that converge at the draining vein were partially coagulated. Next, the majority of the remaining medullary veins were coagulated. A postoperative angiogram showed a reduction in the size of the venous angioma and good opacification of the venous system surrounding the angioma. Various other operative procedures for venous angioma are also discussed.

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Myxofibroxanthoma of the Fourth Ventricle

—Case Report—

Mau Nan CHEN, Show NAKAZAWA, Toshiro SHIMURA, Kouzo YAJIMA

1985 Volume 25 Issue 7 Pages 564-567
Published: July 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.564

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Intracranial fibrous xanthomas are extremely rare. Only 10 cases have so far been reported. A fourth ventricular tumor in an elderly female, identified histopathologically as a myxofibroxanthoma, is described here. After total excision of the tumor, she recovered uneventfully. The histological features and diagnosis of intracranial fibrous xanthomas are discussed.

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Spontaneous Subdural Hematoma in Patients with Advanced Cancer

—Report of Two Cases—

Junya HANAKITA, Akinori KONDO, Kiyoshi NISHIHARA, Yoshisuke YAMAMOTO, ...

1985 Volume 25 Issue 7 Pages 568-570
Published: July 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.568

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Two cases of spontaneous subdural hematoma in patients with advanced cancer are presented, and the mechanisms involved in the formation of such spontaneous subdural hematomas are discussed. We believe that disseminated intravascular coagulation (DIC) played the most important role in inducing the spontaneous subdural hematomas in the two patients presented here.

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Total Removal of Embryonal Carcinoma in the Pineal Region

—Case Report and Review of the Literature—

Shin MASAKI, Hiroshi TAKIMOTO, Norio ARITA, Yukitaka USHIO, Heitaro MO ...

1985 Volume 25 Issue 7 Pages 571-577
Published: July 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.571

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An 8-year-old boy was admitted to our hospital with an embryonal carcinoma of the pineal region, which increased in size (to 5.0×5.5 cm) after a ventriculoperitoneal shunt. The tumor was totally removed by the infratentorial supracerebellar approach, and the patient was given radiation therapy and chemotherapy. The tumor was diagnosed histologically as embryonal carcinoma with endodermal sinus tumor elements. The patient died 1 year after the onset of symptoms.
Embryonal carcinoma (including endodermal sinus tumors) of the pineal region has been reported in 38 patients (26 articles). We analyzed the reported cases, with particular reference to treatment and survival. The survival was nearly the same when partial excision plus radiation therapy was compared with radiation therapy alone. Longer survival periods can be expected if subtotal or total removal is combined with radiation therapy.

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