Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 26, Issue 4
Displaying 1-12 of 12 articles from this issue
  • A Comparative CT Study of Skull Base using Dried Human Skull
    Shigetaka ANEGAWA, Yasuhiro FURUKAWA, Hironori NAKASHIMA, Toru SHIROUZ ...
    1986 Volume 26 Issue 4 Pages 271-276
    Published: April 15, 1986
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    High resolution computed tomography (CT) scans reveal delicate anatomical structures in the brain. However, observation of bony structures by CT has been infrequently performed because the spatial resolution has not been suitable for that purpose.
    Using “Close-up Scan, ” which is a program loaded in the Toshiba TCT-60A, 35 observation of bony structure has been performed on all of the patients with pathological lesions. However, without detailed anatomical knowledge, it is quite difficult to evaluate the CT findings. Hence, using dried human skulls, CTs were taken in 2 and 5 mm slices and a comparative anatomical study was performed. The results were as follows: 1) “Close-up Scan” was performed on 7 dried human skulls with two sections, parallel to the orbito-meatal line (OM-line), and at right angles to the OM-line. 2) A 2 mm slice is more suitable for the observation of delicate anatomical structures or discrimination of two objects which are close to each other. A 5 mm slice is useful for the observation of a structure which is parallel to the OM-line or to reveal the total image of small canals. 3) In slices parallel to the OM-line, small canals and sutures can be revealed dramatically, except for structures which are parallel to the OM-line. 4) Coronal slices are suitable for the observation of the paranasal sinus, orbita, and petrous part of the temporal bone. Furthermore, the entire path of the facial nerve within the petrous bone can be observed with axial slices.
    As described above, results of these comparative anatomical studies will be useful for the evaluation of bony structures in clinical cases.
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  • Masamichi SHINONAGA, Satoshi FUJII, Kazuhiko TOKORO, Shigeo INOMORI, K ...
    1986 Volume 26 Issue 4 Pages 277-283
    Published: April 15, 1986
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Vasospasm following subarachnoid hemorrhage is a serious problem. In spite of extensive clinical and experimental research, the pathogenesis of cerebral vasospasm is still obscure. Recent advances in prostaglandin (PG) research has contributed to the study of stroke and cerebral vasospasm. It is indicated that PG is concerned in the pathogenesis of cerebral vasospasm. Thromboxane B2 (TxB2) and 6-keto prostaglandin F (6-keto PGF) in cerebrospinal fluid (CSF) and serum in patients suffering from subarachnoid hemorrhage with or without subsequent cerebral vasospasm were measured by radioimmunoassay. The mean value of CSF TxB2 in cases with vasospasm was 610 pg/ml, and in cases without vasospasm was 78 pg/ml. The mean value of CSF 6-keto PGF in cases with vasospasm was 1, 152 pg/ml, and in cases without vasospasm was 65 pg/ml. As for serum, the mean value of TxB2 in cases with vasospasm was 1, 672 pg/ml, and in cases without vasospasm was 346 pg/ml. The mean value of 6-keto PGF in cases with vasospasm was 312 pg/ml, and in cases without vasospasm was 117 pg/ml. Sequential measurements were performed in 5 cases with vasospasm and 5 cases without vasospasm. Values of TxB2 and 6-keto PGF in the CSF were elevated at the early stage of subarachnoid hemorrhage in cases with subsequent vasospasm, and the levels of TxB2 and 6-keto PGF in the CSF decreased gradually. The value of TxB2 in serum was elevated for 5 or 6 days after subarachnoid hemorrhage. In cases without vasospasm, TxB2 and 6-keto PGF in the CSF were constantly at low levels. In one case with vasospasm, TxB2 and 6-keto PGF levels in cisternal and ventricular CSF were compared. Cisternal CSF had higher TxB2 and 6-keto PGF values than ventricular CSF. Comparison of TxB2/6-keto PGF ratio in cases with or without vasospasm revealed no definite tendency. This study indicates that PG is closely related to cerebral vasospasm. Measurement of TxB2 and 6-keto PGF in CSF at the early stages of subarachnoid hemorrhage might be useful for the anticipation of vasospasm.
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  • Yoshio MIYASAKA, Kaichi TOKIWA, Kenji NAKAYAMA, Toshio BEPPU, Kuniaki ...
    1986 Volume 26 Issue 4 Pages 284-290
    Published: April 15, 1986
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    One hundred and five patients with hypertensive cerebral hemorrhage or cerebral infarction were reviewed with regard to the incidence of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). SIADH occurred in 8 (7.6%) out of 105 patients. The mean interval between the onset of cerebrovascular accidents (CVA) and the development of SIADH was 13.9 days (ranging from 7 to 23 days). All the cases with SIADH showed moderate to severe disturbance of consciousness levels. In 2 of these 8 cases, preexisting impaired consciousness was aggravated with severe hyponatremia. The incidence of SIADH varied significantly according to the type of CVA, being lower in cases with cerebral infarction [one out of 51 (1.9%)], than in cases with cerebral hemorrhage [7 out of 54 (12.9%)]. The incidence of SIADH in patients with thalamic hemorrhage (26.7%) was much higher than in patients with putaminal hemorrhage (7.7%). Plasma antidiuretic hormone (ADH) levels measured in 2 cases with SIADH were 8.1 and 6.5 pg/ml, inappropriately elevated for the corresponding serum osmolarities. Even though the mean values of serum sodium and osmolarity were not significantly different from the controls, the mean (±SD) plasma level of ADH in cases with cerebral hemorrhage measured within 14 days after the onset was 7.3±1.6 pg/ml, significantly higher than the controls (p<0.001). Hematological and urinary studies showed that the excessive release of ADH recognized in cases with cerebral hemorrhage was a non-physiological (inappropriate) release of ADH, caused by non-osmotic factors, except blood volume depletion.
    From the present study, it is suggested that patients with impaired consciousness, especially in an acute stage following cerebral hemorrhage, are unable to suppress ADH release properly to excrete the water load normally, and are susceptible to SIADH even if they are under normoosmotic conditions.
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  • New Method for Fixation of the Measuring Apparatus
    Shigetaka ANEGAWA, Takashi HAYASHI, Eiichiro HONDA, Kazuhiko MORITAKA, ...
    1986 Volume 26 Issue 4 Pages 291-295
    Published: April 15, 1986
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    In pediatric neurosurgical practice, it is often beneficial to measure intracranial pressure (ICP) in deciding the operative indication, observation of the postoperative course, or assessing the prognosis. Honda et al. developed a transducer (F.P. sensor), which is easy to use, sensitive, and highly accurate in measurement of ICP from the anterior fontanelle. The authors have developed a new method for fixation of this measuring device on the scalp.
    The apparatus comprises two main parts, the guide ring, which has three notches for fixation, and flanged springs, which are connected to the transducer on the scalp by means of adhesive. Each part of the apparatus can be easily connected or disconnected in one action. For adhesive, alphacyanoacrylate appeared to be most suitable because of its strength of adhesion, negligible reaction on the skin, and the rapidity of reaction. However, it is quite difficult to remove the device from the skin after the measurement. To overcome this problem, acetone, which is a solvent of alpha-cyanoacrylate, is applied to the guide ring. Alpha-cyanoacrylate exerts a considerable holding strength on the skin, but repeat application of acetone will allow painless guide ring removal.
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  • With Special Reference to the Correlation between Clinical and Computed Tomographical Findings and Outcome
    Akihito SAITO, Nobumasa KUWANA, Yasuhiko MOCHIMATSU, Naoki TANAKA, Tos ...
    1986 Volume 26 Issue 4 Pages 296-303
    Published: April 15, 1986
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Twenty-two cases of diffuse cerebral swelling (DCS) following head injuries, rated 14 or less on the Glasgow Coma Scale (GCS) at the time of admission, were investigated. In nine cases the GCS was greater than 8, and in the remaining cases the GCS was 8 or less. This study focused on clinical features, computed tomography (CT) findings and the patient outcomes.
    The patients studied were classified into three age groups: the child group; aged 15 or under (9 cases), the adolescent group; aged 16 to 19 (7 cases), and the adult group; aged 20 or older (6 cases). The frequency of skull fracture was significantly higher in the adult group compared to the other two groups. Regarding the site of the impact, frontal impact was most common in the child and adolescent groups, but this tendency was not evident in the adult group. Diagnosis of DCS on CT was made within 6 hours following the injury in all cases. Initial CT findings of DCS were classified into 3 types: Type I; slightly compressed ventricular system without narrowing of the perimesencephalic (PMC) cistern (12 cases), Type II; moderately compressed ventricular system with narrowing of the PMC cistern (4 cases), and Type III; markedly compressed ventricular system with obliteration of the PMC cistern (6 cases). The average age of the cases belonging to Types I, II, and III was 11.0, 18.0, and 34.5, respectively. There were no deaths among Type I cases. On the other hand, all Type III cases died. As other CT findings associated with DCS, subarachnoid hemorrhage in the basal cisterns and intraventricular hemorrhage were critical findings which always signified primary brain stem injury.
    This study indicates that the degree of DCS on CT in children was far less than that in adults, and also the prognosis for children was obviously better than that for adults. It is the authors' impression that the differences between the two groups are based on two factors, i.e., strength and direction of impact.
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  • A Combined Chemoradiotherapy with Intra-arterial Neocarzinostatin Perfusion and Irradiation
    Shozaburo UEMURA, Yasuhiko MATSUKADO, Hiroshi SONODA, Jun-ichi KURATSU ...
    1986 Volume 26 Issue 4 Pages 304-310
    Published: April 15, 1986
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The authors evaluated the results of a combined chemoradiotherapy with intracarotid administration of neocarzinostatin (NCS) and radiation in a follow-up study of 26 patients with cerebral malignant glioma. The survival rate was 84.6% at 1 year, and 52.4% at 2 years. Computed tomography scans within 3 months after complete application of the protocols showed complete remission, partial response, minor response, no change, and progressive disease in 11.5%, 38.5%, 19.2%, 23.1%, and 7.7% of patients, respectively. Thus, it was effective in 69.2% of patients. Six (33.3%) out of the 18 patients treated more than 3 years before were alive at full scale (100%) of Karnofsky performance status. Intra-arterial NCS administration was especially appropriate to the malignant glioma, which was fed by unilateral internal carotid artery, and showed marked hypervascularity. Since a preliminary experimental study revealed a synergic effect in cytotoxicity of NCS with radiation, NCS was clinically administered through a slow infusion pump during radiation therapy. The most untoward effect of this method was ocular retinopathy. One third of the cases suffered visual impairment during or after the treatment, when the selective catheterization of the internal carotid artery failed to pass the origin of the ophthalmic artery.
    NCS seems to be a suitable chemotherapeutic agent for intra-arterial administration, because of the short half-life in the blood (12 seconds), selective cytotoxicity for glioma cells, and increase of the radiation effect. The total dose of NCS should be over 5 mg in order to attain sufficient therapeutic effect.
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  • Report of 14 Cases
    Toshihiro YASUI, Akira HAKUBA, Junsuke KATSUYAMA, Shuro NISHIMURA
    1986 Volume 26 Issue 4 Pages 311-317
    Published: April 15, 1986
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The authors have treated 14 cases of intramedullary spinal cord tumors (5 astrocytomas, 2 ependymomas, 5 hemangioblastomas, 1 dermoid, and 1 lipoma) during the past 12 years. They have analyzed their early and late results of surgical treatment, with follow-up periods ranging from 3 months to 10 years and 3 months. These tumors were treated according to the principle of radical resection using microsurgical techniques. Of the 14 patients, total removal of tumors was performed in 9 patients, subtotal removal in 4 patients, and only biopsy removal in 1 patient. Guidetti's criteria was adopted for assessing the results of surgery. Long-term results in the cases were as follows: 6 were very good, 2 were good, 3 were fair, and 2 were poor. One patient had a glioblastoma multiforme and died 1 month following decompressive surgery with biopsy and postoperative radiotherapy. Gross total removal of intramedullary tumors is technically feasible and compatible with neurological recovery. Since the majority of intramedullary tumors are benign and these disease processes may span not only years but decades, long-term follow-up is inevitable.
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  • Report of Two Cases
    Mitsuru SEIDA, Umeo ITO, Kiyohiro KITO, Shuichi TOMIDA, Yutaka INABA
    1986 Volume 26 Issue 4 Pages 318-322
    Published: April 15, 1986
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Only a few traumatic cerebellar hematomas have been reported. Two young patients who had traumatic cerebellar hematomas with different outcomes are reported. Case 1 was an 11-year-old schoolboy who was hit in the occiput by his friend's fist. He complained of headache, nausea, and vomiting for 3 days after the head injury. A computed tomography (CT) scan revealed a walnutsized hematoma in the left cerebellar hemisphere and vermis. After observation for about a month, he was discharged without neurological signs. Case 2 was a 9-year-old schoolgirl who was struck in the occiput in a traffic accident. On admission, she was alert and no neurological findings were observed. A craniogram showed a linear fracture in the left occiput, but the CT was not remarkable. Her consciousness level abruptly deteriorated 4 hours after the accident. CT revealed a walnut-sized hematoma involving the left cerebellar hemisphere and vermis. The hematoma was completely removed by an emergency operation. However, she expired 19 hours after the accident with atrioventricular block. Traumatic cerebellar hematoma can be roughly divided into two groups. One is a slowly enlarging hematoma with good prognosis, and the other is a rapidly growing hematoma with poor prognosis.
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  • Case Report
    Akatsuki WAKAYAMA, Keiji SHIMIZU, Yutaka OKAMOTO, Yasuyoshi MIYAO, Sus ...
    1986 Volume 26 Issue 4 Pages 323-327
    Published: April 15, 1986
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A 52-year-old male was brought to Wakakusa Daiichi Hospital by ambulance because he had fallen unconscious. On admission he was stuporous. Neurological examination revealed left-sided facial palsy, left-sided ptosis, right-sided hemiplegia, and marked impairment of horizontal eye movement except for convergence. Computed tomography (CT) revealed a small high density area in the paramedian tegmentum. Cerebral angiography showed no abnormal vessels. Three hours after admission he became alert. One month after admission the right-sided hemiplegia improved, but he could not walk by himself. CT performed 45 days after admission showed a low density area in the pontine tegmentum with the fourth ventricle compressed persistently. Fifty days after admission, suboccipital craniectomy and evacuation of the hematoma was performed. The postoperative course was uneventful. One week after surgery the bulbar palsy improved and the tracheotomy could be closed. One month later, facial palsy and hemiplegia had so improved that he could close his eyes and walk without aids. Half a year after evacuation of the hematoma, the patient recovered to partially assisted daily life.
    Cases of primary pontine hemorrhage successfully evacuated have been reported, but the majority of primary pontine hemorrhages are treated conservatively. The importance of evacuation of primary pontine hemorrhage in the chronic stage was recognized.
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  • Report of Two Cases
    Masahiko YODONAWA, Kazuyuki KOHNO, Sohkichi TANAKA
    1986 Volume 26 Issue 4 Pages 328-332
    Published: April 15, 1986
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Two cases of hyperosmolar nonketotic coma with neurological disorders are presented.
    One was a 49-year-old male, who was admitted because of a brain contusion and a traumatic subarachnoid hemorrhage. At the time of admission, the patient was semicomatose with a mild right hemiparesis; his Glasgow Coma Scale rating was 6. He was treated with glycerol, steroids, and diphenylhydantoin, and his Glasgow Coma Scale rating improved to 10. On the fifth hospital day, he suffered from pneumonia and gastrointestinal bleeding, and was given intravenous hyperalimentation. On the tenth hospital day, he became semicomatose again and his Glasgow Coma Scale rating was 6. The laboratory findings were as follows: blood sugar 675 mg/dl, serum sodium 160 mEq/l, serum blood urea nitrogen 59 mg/dl, plasma osmolarity 404 mOsm/l, and negative keton bodies in the urine. Immediately, he was treated with large amounts of intravenous drip infusion and insulin, and he recovered fully from the syndrome. The other case was a 73-year-old female, who had suffered from a hypertensive intracerebral hematoma.
    A close monitoring of fluid, blood sugar, and electrolytes seems to be important for comatose patients. This is particularly true of patients who are dehydrated and given steroids, diuretics, diphenylhydantoin, and intravenous hyperalimentation.
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  • Case Report
    Ichiro SUNADA, Toshihisa SUZUKI, Akira HAKUBA, Takehisa INOUE, Meijun ...
    1986 Volume 26 Issue 4 Pages 333-338
    Published: April 15, 1986
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A case of spinal cord compression from an intradural arachnoid cyst in the thoracic region is reported. The patient was a 59-year-old female. She had noted thoracic girdle pain and urinary trouble for 2 years. Neurologically, she showed muscle atrophy and weakness of the right leg, and loss of all sensory modalities below the 7th thoracic cord (Th7) level bilaterally. Metrizamide myelography showed no abnormal findings, but computed tomography (CT) following the metrizamide myelography demonstrated marked enlargement of the subarachnoid space and remarkable rightward and ventral displacement of the spinal cord. During surgery it was noted that the spinal cord was severely compressed by an arachnoid cyst from Th4 through Th6. After this operation, neurological deficits disappeared completely.
    Most spinal intradural arachnoid cysts arise in the region of the septum posticum in the thoracic portion. Various etiologies have been postulated. Although conventional myelogram has been the most important form of examination, intradural arachnoid cysts may be filled incompletely or not at all in the myelography performed in a prone position, because they mostly locate on the dorsal aspect of the spinal cord. There are some reported cases in which intradural arachnoid cysts were found a few hours after myelography. Therefore it is not so easy to diagnose intradural arachnoid cysts with conventional myelography. With metrizamide CT myelography, intradural arachnoid cysts can be visualized more easily.
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  • Case Report
    Eiji MORIYAMA, Shohei TSUCHIDA, Hiroichi BECK, Toshihiko MIYAMOTO, Tsu ...
    1986 Volume 26 Issue 4 Pages 339-343
    Published: April 15, 1986
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The patient was a 28-year-old woman, para 0, who complained of headache and visual disturbance during the 5th month of her pregnancy. Ophthalmological tests showed impaired visual acuity on the right and irregular bitemporal hemianopsia with normal fundi. A computed tomography (CT) scan disclosed a round sellar mass extending into the suprasellar cistern. Laboratory examinations revealed mild hypopituitarism. After uneventful natural labor, a transsphenoidal hypophysectomy was carried out with diagnosis of non-functioning pituitary adenoma. The mass was firm, orange-yellow tissue which was indistinguishable from the normal pituitary gland. About two thirds of the tissue was resected. Histological examination showed a marked infiltration of lymphocytes with many folliculoid patterns. This finding was the same as in previous reports. The postoperative course was uneventful.
    Lymphocytic adenohypophysitis is an apparently rare condition which occurs exclusively in pregnant or postpartum women. At present, it is believed to be an autoimmune disorder triggered by pregnancy. Because its symptoms and CT findings resemble those of pituitary adenoma, this disease should be kept in mind when evaluating any women with an intrasellar mass lesion during pregnancy or the postpartum period.
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