Neurologia medico-chirurgica

5'-deoxy-5-fluorouridine and 5-fluorouracil Concentrations and Thymidine Phosphorylase Activity in Brain Tumors following Intravenous Administration of 5'-deoxy-5 fluorouridine

Masafumi YAMASHITA, Takahisa HASHIMOTO, Toshihiko HIRAKAWA, Takeo FUKU ...

1985 Volume 25 Issue 8 Pages 613-619
Published: August 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.613

JOURNAL FREE ACCESS

Show abstractHide abstract

To evaluate the usefulness of 5'-deoxy-5-fluorouridine (5'-DFUR) therapy for brain tumor, the pharmacokinetics of 5'-DFUR and 5-fluorouracil (5-FU) in the tumor, in the white matter surrounding the tumor and in the serum were investigated, and the thymidine phosphorylase, the main activating enzyme of 5'-DFUR in human tissues, was also studied. Materials were obtained from 24 cases of primary brain tumors and from 4 cases of metastatic carcinoma. During the operation 500 or 1, 000 mg of 5'-DFUR was administrated intravenously, and blood, tumor tissue and white matter were taken mainly within 60 minutes and partly within 180 minutes after intravenous administration of 5'-DFUR. In some cases samplings were performed serially. Concentrations of 5'-DFUR and 5-FU were measured by high performance liquid chromatography, and thymidine phosphorylase activity in tissue extracts was obtained against d-thymidine and/or 5'-DFUR as substrates. The concentrations of 5'-DFUR and 5-FU in serum decreased immediately in an exponential mode after intravenous administration of 1, 000 or 500 mg of 5'-DFUR. High concentrations of 5'-DFUR and 5-FU in the tumor tissues were noticed in malignant tumors, such as glioblastoma, ependymoma and chondrosarcoma, and 5-FU concentrations in the tumor in two cases of glioblastoma and one of ependymoma were higher than that in their sera. An important characteristic of 5'-DFUR was that it was converted to 5-FU in various tissues predominantly in malignant neoplasms. Thymidine phosphorylase activity was more prominent in glioblastoma, metastatic carcinoma and chordoma. Although the 5'-DFUR concentration in white matter was considerable, the 5-FU concentration was negligible suggesting low enzyme activity. An effect of 5'-DFUR therapy on malignant brain tumor should be expected from the high concentration of 5' DFUR and 5-FU in the tumor tissue. However, these high concentrations rapidly decreased, therefore, the appropriate mode of prescription of 5'-DFUR should be considered in clinical practice.

View full abstract

Download PDF (432K)
Cerebral Hemorrhage from Unsuspected Intracranial Tumors

Masaru TAMURA, Hiroshi INOUE, Masaru NAKAMURA, Hiromichi YAMASAKI, Hid ...

1985 Volume 25 Issue 8 Pages 620-625
Published: August 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.620

JOURNAL FREE ACCESS

Show abstractHide abstract

Six patients with unsuspected brain tumors presented symptoms of intracerebral hemorrhage. The initial symptoms were a sudden onset of headache and vomiting, sometimes followed by disturbance of consciousness and focal symptoms. The patients had no history of hypertension, evidence of bleeding disorders, or prior anticoagulant therapy. The medical history was important in patients with primary malignancy outside the central nervous system. Massive cerebral hemorrhage from metastatic chorioepithelioma was suspected in women of childbearing age with a recent history of pregnancy, abnormal vaginal bleeding, and/or amenorrhea. The intracranial lesions were demonstrated by computerized tomography (CT) scans. The characteristic CT findings included round and heterogeneous or lobulated, high-density areas of coagulation, perifocal low-density areas, and lesions of contrast enhancement. Three cases were operated on immediately. Two cases were operated 9 and 16 months after hemorrhage, when signs of brain tumor appeared. Histological examination revealed 1 undifferentiated sarcoma of the leptomeninges, 1 anaplastic astrocytoma, and 3 metastatic tumors (including 1 melanoma and 2 chorioepitheliomas). One was an unverified thalamic tumor.

View full abstract

Download PDF (466K)
Anterior Pituitary Function in Cerebrovascular Disease

Cerebral Arteriovenous Malformation Cases and Unruptured Giant Cerebral Aneurysm Cases

Hisanori YOSHIMOTO, Tohru UOZUMI

1985 Volume 25 Issue 8 Pages 626-632
Published: August 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.626

JOURNAL FREE ACCESS

Show abstractHide abstract

Systematic anterior pituitary function tests were performed in 12 patients with cerebral arteriovenous malformation and 7 patients with unruptured giant cerebral aneurysm, and the results were assessed for correlation with clinical factors. In the radio-immunoassay, growth hormone and cortisol were determined during the insulin tolerance test (regular insulin, 0.15-0.20 U/kg), luteinizing hormone and follicle stimulating hormone under luteinizing hormone-releasing hormone (100 μg), thyroid stimulating hormone and prolactin under thyrotropin-releasing hormone (500 μg). The results were as follows. 1) In the cerebral arteriovenous malformation group, growth hormone and cortisol secretions were impaired in 33% and 17% of the cases, respectively. The case incidence of impaired anterior pituitary hormonal secretion was 33%, and it was lower than in other groups. 2) In the unruptured giant cerebral aneurysm group, growth hormone, cortisol, follicle stimulating hormone, luteinizing hormone, thyroid stimulating hormone, and prolactin secretions were impaired in 71%, 29%, 14%, 14%, 14%, and 14% of the cases, respectively. The case incidence of impaired anterior pituitary hormonal secretion was 86%, but the intensity was mild in most patients. Hypothalamic panhypopituitarism was noted in one patient with a giant aneurysm at the right internal carotid-ophthalmic artery junction. 3) The effects of stress, age, drugs, and hormonal diseases must be considered in an exact evaluation of the anterior pituitary function in patients with cerebrovascular disease.

View full abstract

Download PDF (490K)
Postoperative Course of Involved Cranial Nerves due to Intracranial Aneurysms

Especially about the Oculomotor Nerve Palsy

Akira WATANABE, Ryoji ISHII, Ryuichi TANAKA

1985 Volume 25 Issue 8 Pages 633-639
Published: August 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.633

JOURNAL FREE ACCESS

Show abstractHide abstract

The postoperative course of cranial nerve involvement caused by 62 cerebral aneurysms (oculomotor nerve palsy: 52, visual disturbance: 4 and multiple cranial nerve involvement: 6) was analyzed. Statistical analysis was respectively applied to 27 unruptured and 20 ruptured internal carotid artery aneurysms on the correlation between the outcome of oculomotor nerve palsy one year after clipping surgery, and the interval between the onset of the palsy and clipping (less than 2 weeks or not), the degree of the preoperative palsy (incomplete or complete palsy) and the beginning of the recovery after clipping (within 2 weeks or not). In the unruptured group, the outcome was more influenced by the duration of the palsy (P=0.09) than the degree of the preoperative palsy (P=0.25). In the ruptured group, however, the outcome was more influenced by the degree of the preoperative palsy (P=0.004) than the duration of the palsy (P=0.20). The prognosis was better in cases where recovery had started within 2 weeks than in cases, where recovery had started 2 weeks or more after clipping surgery, independent of subarachnoid hemorrhage (unruptured group: P=0.002, ruptured group: P=0.02). There was no statistically significant difference between the unruptured group and the ruptured group on the outcome, so that the subarachnoid hemorrhage itself was not the factor causing a poor outcome. The size and direction of the aneurysm in carotid angiograms did not seem to affect the degree of recovery in the ruptured group, but in the unruptured group the posterolateral inferior direction of aneurysms was more common in the incomplete recovery cases (74%) than in the complete recovery cases (26%). Visual disturbance due to ruptured anterior communicating artery aneurysms in 3 cases and unruptured internal carotid-ophthalmic artery aneurysm in 1 case was immediately improved by clipping surgery, even though the duration of the visual disturbance was long, i.e., between 24 days and 3 years. Multiple cranial nerve involvement (I-VI) due to ruptured (2 cases) and unruptured (4 cases) internal carotid artery aneurysms was also improved by carotid ligation.

View full abstract

Download PDF (431K)
Intracranial Hemorrhage during Pregnancy

Motoo KUBOTA, Akira YAMAURA, Hirotaka NISHIYAMA, Hiroyasu MAKINO

1985 Volume 25 Issue 8 Pages 640-644
Published: August 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.640

JOURNAL FREE ACCESS

Show abstractHide abstract

Intracranial bleeding—especially subarachnoid hemorrhage (SAH)—is one of the commonest cerebrovascular complications encountered during pregnancy.
Eight patients with intracranial bleeding during pregnancy are reported in this paper: 2 patients with intracranial hematoma following eclampsia, and the other 6 patients with SAH in otherwise normal pregnancies. A ruptured intracranial aneurysm or aneurysms were the cause of SAH in 3 cases and an arteriovenous malformation (AVM) in 2 cases. The source of bleeding was undetermined in one case. All of these aneurysms were successfully clipped. Two newborn babies were delivered by cesarean section, one under local anesthesia, and the other under spinal anesthesia just prior to the intracranial operation.
The authors discuss the differences in clinical course and treatment between aneurysm and AVM during pregnancy. They emphasized that the incidence of aneurysmal rupture parallels the hemodynamic changes during pregnancy. Aneurysms should be treated surgically before delivery, irrespective of the stage of pregnancy. By contrast, AVM can be treated surgically after delivery. The delivery of untreated cases with SAH (either aneurysm or AVM) should be done by cesarean section under spinal or lumbar epidural anesthesia. If near the full term, newborn babies can be delivered by cesarean section, just prior to intracranial operation, as in the present cases.

View full abstract

Download PDF (374K)
Nonsurgical Treatment of Chronic Subdural Hematoma

Sequential Changes of Computed Tomography Findings

Toshihiko KINJO, Yoshiharu SAKURAI, Akira OGAWA, Shinro KOMATSU, Jiro ...

1985 Volume 25 Issue 8 Pages 645-653
Published: August 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.645

JOURNAL FREE ACCESS

Show abstractHide abstract

Sequential changes of clinical symptoms and computed tomography (CT) scans were investigated in 20 patients of chronic subdural hematoma treated by osmotherapy utilizing intravenous 20% mannitol 1, 000 ml daily for 2 weeks. Plain, contrast enhancement, and 4-hour-delayed contrast enhancement CT scans were taken once every week for 4 weeks from the start of the treatment and then once every month until hematoma disappeared. Though the clinical symptoms aggravated slightly in 4 cases during the first or second week, all the cases became asymptomatic at the end of the treatment and showed no recurrence thereafter. Sequential changes in CT scans are summarized as follows. 1) Plain CT scans showed that the hematoma started to reduce in size rapidly after termination of the treatment. Density of hematoma decreased sequentially, although it increased transiently in 9 cases. After treatment, the hematoma disappeared after 3 months in 18 cases, after 4 months in one case, and 5 months in one case. 2) In contrast enhancement CT, two types of contrast enhancement were observed: ribbon-like cortical enhancement and linear enhancement beneath the hematoma. These enhancement effects were seen in 80% of cases (cortical enhancement in 70%, linear enhancement in 10%) before the treatment. The cortical enhancement decreased through the treatment and disappeared in 2 months after the treatment. 3) The contrast enhancement effects within the hematoma cavity (evaluated as the relative increase of the CT numbers in the 4-hour-delayed contrast enhancement CT scans) were closely related to the hematoma reduction rate; the more marked and lasting the enhancement effects, the more delayed was the hematoma to be reduced by osmotherapy. These results may support the authors' previous view, based on an elect ronmicroscopic study, that the permeability in the sinusoidal channel layers of the outer membrane of the hematoma increases in the active and growing stage and gradually normalizes in the healing stage. The delayed contrast enhancement study is thought to be useful in evaluating the activity of chronic subdural hematoma.

View full abstract

Download PDF (749K)
Diagnosis of Adult Communicating Hydrocephalus by Simultaneous Radioisotope and Computed Tomography Cisternographies

Yoshihisa KIDA, Masakazu BANNO

1985 Volume 25 Issue 8 Pages 654-661
Published: August 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.654

JOURNAL FREE ACCESS

Show abstractHide abstract

Simultaneous radioisotope (RI) and metrizamide computed tomography (CT) cisternographies were studied and compared to obtain a precise diagnosis of normal pressure hydrocephalus (NPH). RI cisternography demonstrated more prolonged visualization of the cerebrospinal fluid (CSF) dynamics including persistent ventricular reflux. However, these two methods are apparently comparable and complement each other when they are performed simultaneously.
Twenty-six cases presenting dementia and hydrocephalus were included in this study, 12 cases of which were operated and the other 14 were observed conservatively. Eight of the 12 cases operated showed an excellent result, but the other 4 did not. Retrospective analysis of the findings obtained from the cisternograms demonstrated in NPH patients that a block at the convexity, more prolonged ventricular reflux and faster RI clearance were noted. These findings apparently indicate an accelerated absorption from the collateral pathway of CSF in NPH. By contrast, cisternograms of non-NPH patients demonstrated delayed RI clearance and RI accumulation over the cortex, indicating moderate congestion or slowing of CSF dynamics. Therefore, RI clearance seems to be the most valuable method for differentiating NPH from non-NPH.

View full abstract

Download PDF (556K)
Dural Arteriovenous Fistulas associated with Superior Sagittal Sinus Occlusion

Report of Two Cases

Masaji MURAKAMI, Hajime TOKUDA, Akira YOKOTA, Shigeaki MATSUOKA, Yoshi ...

1985 Volume 25 Issue 8 Pages 662-667
Published: August 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.662

JOURNAL FREE ACCESS

Show abstractHide abstract

Two cases of dural arteriovenous fistula (AVF) with sinus occlusion in the superior sagittal sinus are reported. Case 1 was a 47-year-old male, who was admitted because of several episodes of convulsions, followed by a progressive motor weakness in the right lower limb. He had an old history of a severe head injury. Case 2 was a 52-year-old male, who was admitted because of a sudden speech disturbance and left hemiparesis. He never experienced any head injury. Cerebral angiogram taken 2.5 years before showed no definite evidence of dural AVF except for occlusion of the superior sagittal sinus. Sequential computed tomography scans revealed hemorrhagic infarctions of moderate sizes in the bilateral frontal lobes, one of which was followed by a massive hemorrhagic infarction.
Clinical features of dural AVF in this region were characterized by convulsions and motor weakness in addition to bruit and headache, which seemed to depend on the location and blood flow. It was confirmed that the dural AVF in this area are acquired lesions evolving from the organization and revascularization of a previously thrombosed sinus. Every attempt should be made to excise the malformation, including the affected dural sinus, as completely as possible in the initial procedure.

View full abstract

Download PDF (494K)
Intracranial Penetrating Injuries caused by Glass Splinters

Report of Three Cases

Kazuyo KAMIYAMA, Shunro ENDO, Eiji TSUKAMOTO, Yutaka HIRASHIMA, Akira ...

1985 Volume 25 Issue 8 Pages 668-671
Published: August 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.668

JOURNAL FREE ACCESS

Show abstractHide abstract

Three cases of penetrating craniocerebral injuries caused by glass splinters are presented. One was caused by a plate glass splinter, the others by a tempered windshield. In one case, the glass splinters appeared to have broken into two or three fragments on the X-ray film. However, when operated it was found that they had broken into more than 20 pieces. Attention should therefore be paid when using radiological examination, not to leave fragments behind in the operation.
Ten cases including the present ones have been reported. Nine out of the 10 were transorbital intracranial penetrating injuries. The possibility of intracranial penetration should be raised when periorbital wounds caused by glass splinters are encountered.

View full abstract

Download PDF (382K)
Giant Brain-stem Arteriovenous Malformation in Infant

Seigo NAGAO, Takeo OOHASHI, Kenji SUZUKI, Akira NISHIMOTO, Masahiro KA ...

1985 Volume 25 Issue 8 Pages 672-679
Published: August 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.672

JOURNAL FREE ACCESS

Show abstractHide abstract

A case of huge arteriovenous malformation (AVM) with aneurysmal dilatation in the brain stem and thalamus in a 1 3/4-year-old girl is presented. Initial symptoms were Parinaud's syndrome and right hemiparesis, presumably due to mass effect of the AVM on the midbrain. Computed tomography scan disclosed a high density mass in the upper brain stem and thalamus. Cerebral angiography demonstrated a huge aneurysmal AVM (4×4.5×4.5 cm) which was fed by the elongated and dilated posterior thalamoperforators and right superior cerebellar artery, and drained by the superior petrosal, superior cerebellar veins and the great vein of Galen. The patient gradually deteriorated. Craniotomy was carried out through right parieto-occipital interhemispheric approach in order to occlude the feeders. The operative procedure did not disclose the AVM. The feeding artery of the right superior cerebellar artery was coagulated. The patient expired 30 days postoperatively secondary to ventricular hemorrhage and hemorrhage around the AVM. Autopsy specimen showed that the main feeder to the AVM was a large arterial shunt from the left posterior cerebral artery which was not proven preoperatively. It was suggested that definite preoperative clarification of the feeding artery and anatomical correlation between the AVM and the brain stem was essential to distinguish this case from “true” vein of Galen aneurysm. Surgical indications for such a huge AVM in the brain stem and the mechanism of the postoperative hemorrhage are also discussed.

View full abstract

Download PDF (776K)
Simultaneous Occurrence of a Pituitary Adenoma and a Falcotentorial Junction Meningioma

Case Report

Kenji OHATA

1985 Volume 25 Issue 8 Pages 680-686
Published: August 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.680

JOURNAL FREE ACCESS

Show abstractHide abstract

A case of pituitary adenoma associated with a falcotentorial junction meningioma is presented. A 50-year-old female having a 12-year history of acromegalic features and a 3-year history of visual disturbance was admitted because of headache, vomiting, and a floating sensation. On admission acromegalic appearance, bitemporal hemianopsia, and truncal ataxia were noted. Computed tomography scan showed two mass lesions on the midline, one in the suprasellar region and the other in the retropineal region. With angiographical and endocrinological examinations, coexistence of a pituitary adenoma and a falcotentorial junction meningioma was diagnosed. Two operations were performed and the preoperative diagnosis was confirmed histologically.
Regarding the simultaneous occurrence of pituitary adenomas and meningiomas, only 7 cases were reported previously. A falcotentorial junction meningioma itself is also rare. Only 21 such cases were found in the literature. The clinical manifestation and the management of falcotentorial junction meningiomas are discussed.

View full abstract

Download PDF (792K)
Spinal Subdural Hematoma following Lumbar Puncture

Case Report

Hiroshi HASEGAWA, Shoji BITOH, Jiro OBASHI, Hideo OHTSUKI, Tomio YAMAM ...

1985 Volume 25 Issue 8 Pages 687-690
Published: August 15, 1985
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.25.687

JOURNAL FREE ACCESS

Show abstractHide abstract

A case of acute spinal subdural hematoma following lumbar puncture is reported. A 52-year-old male was admitted for evaluation of persistent headache after head injury. Computed tomography (CT) scan showed dilated ventricles and a ventriculo-peritoneal shunt was placed. Preoperative coagulation studies were normal and no difficulty of hemostasis was encountered during the surgery. Three weeks following the surgery, lumbar puncture was performed for CT cisternography. A few hours after the lumbar puncture, he complained of low back pain. The pain persisted the next day and radiated down to the lower extremities. Examination revealed positive straight leg raising test on the left side. The following morning he became paraplegic with urinary retention. An emergency myelography by lateral C 1/2 puncture revealed complete blockage at the level of Th10. Laminectomy disclosed a large subdural clot extending from the sacrum to the mid-thoracic region. No specific bleeding point was identified. Postoperatively he remained paraplegic.

View full abstract

Download PDF (328K)

Register with J-STAGE for free!