Neurologia medico-chirurgica

Interaction of Human Fibroblast Interferon with Chemotherapeutic Agents and Radiation against Human Gliomas in Nude Mice

Osamu NAKAMURA, Koji MARUO, Yoshito UEYAMA, Kazuhiro NOMURA, Kintomo T ...

1986 Volume 26 Issue 9 Pages 671-676
Published: September 15, 1986
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.26.671

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Growth inhibitory effects of the combination of β-interferon (β-IFN) and conventional anticancer drugs such as adriamycin (ADM) and 1-(4-amino-2-methyl pyrimidine-5-yl)-methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU) were evaluated in nude mice receiving subcutaneous transplants of human glioblastoma. Next, the anticancer and radiation sensitizing effects of β-IFN on human glioblastoma were also evaluated in the nude mouse model. Tumor reduction rates (treated/control values of the tumor volume) were evaluated by Battelle's method after 3 weeks of the combination treatment. The tumor reduction rates of each treatment group were as follows: β-IFN alone, 63%; ADM (8 mg/kg) alone, 48%; β-IFN plus ADM, 36%; ACNU (20 mg/kg) alone, 44%; β-IFN plus ACNU, 36%; radiation (390 rad) alone, 61%; β-IFN plus radiation (390 rad), 35%; radiation (650 rad) alone, 51%; and β-IFN plus radiation (650 rad), 26%. The growth inhibitory effect of β-IFN was most enhanced when β-IFN was administered following radiotherapy. Furthermore, the combination effect was enhanced in proportion to the dose of radiation.

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Magnetic Resonance Imaging in Acute Stage of Cerebral Ischemia

Experimental Study

Sen YAMAGATA, Haruhiko KIKUCHI, Ikuo IHARA, Izumi NAGATA, Yoshito NARU ...

1986 Volume 26 Issue 9 Pages 677-682
Published: September 15, 1986
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.26.677

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The value of the nuclear magnetic resonance image (MRI) was investigated in the acute stage of experimental cerebral ischemia. The MRI system employed was designed for clinical use, and the superconducting magnet was operated at a field strength of 1.5 tesla. Ischemic insult was made by transorbital occlusion of the middle cerebral artery (MCA) permanently in 4 cats and temporarily in 2 cats. After MCA occlusion the regional cerebral blood flow (rCBF) was measured on the affected cortex, and 5 cats with rCBF below 10 ml/100 g/min and one with rCBF over 15 ml/100 g/ min were studied. In the permanent occlusion group, MRI was performed every 2 hours from 4 to 12 hours after MCA occlusion and another MRI was carried out 20 min after gadoliniumdiethylenetriamine-pent aacetic acid (Gd-DTPA) intravenous administration. The earliest changes were found 6 to 8 hours after MCA occlusion on the spin echo image (repetition time=1.4 sec, echo time=70 msec) in 3 cats with severe ischemia. It was postulated that the ischemic lesion could be depicted less than 6 hours on more T₂-weighted images. The increased intensity area was markedly enhanced with Gd-DTPA 12 hours after occlusion. In the recirculation group, the increased intensity area was observed on enhanced MRI in a cat with recirculation as early as one hour after MCA occlusion, although it was not found on the plain MRI. In the other cat with recirculation after 2 hours' occlusion, definite lesion was found in all parameter images without enhancement. The results suggest that changes in cerebral ischemia can be obtained on the MRI earlier than X-ray computed tomography, and that it may be possible to determine the severity of the ischemic brain injury by the MRI findings.

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Metabolic Response to Hypertensive Intracerebral Hemorrhage and Ruptured Intracranial Aneurysm

Hajime TOHO, Tohru SAWADA, Jun KARASAWA, Haruhiko KIKUCHI, Shigeki OHG ...

1986 Volume 26 Issue 9 Pages 683-688
Published: September 15, 1986
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.26.683

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Oxygen consumption, carbon dioxide production, respiratory quotients, and resting metabolic expenditure were measured in 25 patients with hypertensive intracerebral hemorrhage or with ruptured intracranial aneurysm in their acute stage. Metabolic measurements were carried out with the indirect calorimetry technique on admission within 72 hours from the onset. At the same time, urine was collected for 24 hours to measure the urinary catecholamines excretion. The mean value of resting metabolic expenditure was 130.0% and this positively correlated with urinary catecholamines, especially noradrenalin excretion. Oxygen consumption and carbon dioxide production correlated also positively to urinary catecholamines excretion. Maximum value of resting metabolic expenditure was up to 186.0% of that expected for an uninjured resting person of the same age, sex, and body surface area. On the other hand, respiratory quotients did not have any significant correlation with oxygen consumption, carbon dioxide production, resting metabolic expenditure, or urinary catecholamines excretion.
From these facts, it is implied that there is an overactivity of sympathetic nervous system in the acute stage of hemorrhagic cerebrovascular diseases, that the over-flow might directly influence oxygen consumption, carbon dioxide production, and resting metabolic expenditure, and that, moreover, the hypermetabolic state should be taken into consideration to manage patients with hemorrhagic cerebrovascular diseases, as malnutrition might cause weight loss and immune incompetence.

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Prognosis of Ruptured Cerebral Aneurysms with Retinal Hemorrhage

Kengo KASHIHARA, Tetsumori YAMASHIMA, Hisashi NITTA, Hideo HAYASE, Har ...

1986 Volume 26 Issue 9 Pages 689-694
Published: September 15, 1986
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.26.689

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564 patients with subarachnoid hemorrhage caused by ruptured cerebral aneurysm were studied statistically with a correlation between retinal hemorrhage (RH) and outcome. Of these, 142 patients (or 25%) exhibited RH. No correlation was demonstrated between the frequency of RH and age or sex. Unilateral RH was seen in 34 patients with middle cerebral artery or internal carotid artery aneurysm and out of them, 25 patients (or 74%) had RH in the aneurysm side. The mortality rate of the patients with RH was 35% which is higher than that of patients without RH (13%). Of the 93 survivors with RH, 68 patients (or 73%) required daily-care. In contrast, out of 367 survivors without RH, 124 patients (or 34%) required daily-care. There was a significant correlation between the severity of RH and survival rate or activities of daily living, although there was no difference in the outcome between the patients with unilateral and bilateral RH. There were 15 cases (or 2.7%) with Terson's syndrome (TS). The mortality rate of patients with TS was 20% and all of the 12 survivors required daily-care. It is concluded that ruptured cerebral aneurysms with RH show a poorer prognosis than those without RH.

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Cerebral Hemodynamics in Moyamoya Disease

Significance of Cerebral Blood Flow in Relation with the Changes in Arterial CO₂ Tension

Jun KARASAWA, Haruhiko KIKUCHI, Izumi NAGATA, Yoshito NARUO, Ikuo IHAR ...

1986 Volume 26 Issue 9 Pages 695-700
Published: September 15, 1986
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.26.695

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Cerebrovascular CO₂ reactivity was studied in 93 children and 33 adults with moyamoya disease. In 58 children and 3 adults, cerebral ischemic symptoms were induced by hyperventilatory movements. Functional angiography under changing arterial CO₂ tension, revealed a decreased filling of the intracranial vasculature and delayed circulation time in the hypocapnic state. These findings were demonstrated mainly in the mildly involved cases. In the severely involved cases, cerebral vasculature showed variable CO₂ reactivity without any tendencies. The relationship between cerebral blood flow and arterial CO₂ tension was evaluated using the argon desaturation method. Cerebrovascular CO₂ reactivity was mostly normal in cases with transient ischemic attack, and disturbed in cases with minor stroke. It was disturbed in the cerebral surface especially in the hypercapnic state. In the deep regions of the brain, it was disturbed only mildly. After external carotidinternal carotid bypass surgery, it was improved. The improvement was sufficient in cases with transient ischemic attack, but limited in those with minor stroke.

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Chemodectoma of the Glomus Jugulare with Multiple Metastases

Case Report

Tadashi SAKAKURA, Yasumasa MAKITA, Sachio NABESHIMA, Taikyoku TEI, Shi ...

1986 Volume 26 Issue 9 Pages 701-705
Published: September 15, 1986
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.26.701

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A relatively rare case of chemodectoma of the glomus jugulare with multiple metastases is reported. Ten years ago, a 37-year-old male was seen because of dysphagia and a mass in the right retro-auricular region. The mass in the right jugular foramen was partially resected and irradiated. Histological examination revealed a chemodectoma. Five years thereafter the patient was readmitted with an epidural mass involving the left eighth cervical nerve root. One year later he developed a chest pain and lumbago. A bone scan revealed multiple skeletal metastases. Histologically, specimens from the right parietal bone and the right 10th rib showed a chemodectoma. He was again irradiated. He was again admitted with paraplegia, 9 years after the first admission. With repeated irradiation with a total dose of 16, 700 rads in 10 years, he died with cachexia and aspiration pneumonia at the age of 47. The autopsy revealed multiple metastases of chemodectoma to bone, spinal epidural space, lung, and pancreas. Although chemodectoma of the glomus jugulare is generally considered to be a rare benign tumor, slow metastatic spread to various organs is not uncommon. A careful search for metastatic lesions, possibly for years is essential when following up the patient.

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CT Scan Findings of Malignant Epidermoid Cyst

Case Report

Takamichi KUBOKURA, Toshihiko NISHIMURA, Kyouji TSUBONE

1986 Volume 26 Issue 9 Pages 706-711
Published: September 15, 1986
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.26.706

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The authors report a case of malignant epidermoid cyst (MEC) and discuss the characteristic findings on computed tomography (CT) scan, the differential diagnosis and the difference from the atypical findings of benign epidermoid cyst (BEC) with a review of the literature.
A 60-year-old female complained of right oculomotor palsy and syncopal attacks. Plain CT scan revealed an irregularly low-density lesion with a ring-like and nodular high-density area mainly in the suprasellar cistern and midbrain, and another iso- to a slightly high-density area in the medial aspect of the right temporal lobe. On enhanced CT scan, a faint and inhomogeneous enhancement was observed in the lesion of the right temporal lobe. Surgical treatment was performed, and pathological examination of the specimen from the medial aspect of the right temporal lobe showed malignant change in the BEC.
As a common and characteristic feature of CT scan findings of the present and the five previously reported cases, MEC shows homogeneous or inhomogeneous enhancement in the iso- to a slightly high-density lesion or the low-density lesion found in a typical BEC.

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An Autopsy Study about the Origin of Craniopharyngioma confined in the Third Ventricle

Case Report

Katsuzo KUNISHIO, Norio SUNAMI, Yuji YAMAMOTO, Shoji ASARI, Tadaatsu A ...

1986 Volume 26 Issue 9 Pages 712-717
Published: September 15, 1986
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.26.712

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A case of craniopharyngioma confined to the third ventricle is reported. A 49-year-old male was admitted because of progressive memory defects. No abnormal neurological findings were present. Post-contrast axial computed tomography (CT) scan showed a large, homogeneously enhanced mass in the third ventricle. Coronal CT showed this mass separated from the sella turcica and confined in the third ventricle. The tumor was partially removed by a transcallosal approach under an operating microscope. Histologically, this tumor was a squamous cell type craniopharyngioma. The patient died of the tumor recurrence 5 months after surgery. Autopsy demonstrated that the tumor did not become exposed on the basal surface of the brain, and that no tumor was found around the hypophyseal stalk. A stalk-like structure in this tumor was found at the base of the third ventricle wall, which was considered to be the origin of the tumor. It was disclosed that this tumor was a craniopharyngioma, originating from the remnant of Rathke's pouch in the tuber cinereum, and proliferating exclusively in the third ventricle.

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Lipoma of the Sylvian Fissure

Case Report

Tetsuya SHIRAISHI, Shoji TSUCHIMOTO, Kohgo KINOSHITA

1986 Volume 26 Issue 9 Pages 718-721
Published: September 15, 1986
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.26.718

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A case of lipomas of the right sylvian fissure and cisterna velum interpositum in a 22-year-old man is reported. The patient's chief complaint was generalized clonic convulsions. The neurological examination was normal. Computed tomography scan demonstrated low density masses in the right sylvian fissure and cisterna velum interpositum. Right carotid angiogram showed the dilated pre-central artery penetrating into the tumor and hypervascularity in the sylvian fissure. These masses were thought to be lipomas and no operation was performed.
The authors review previously reported cases and discuss the neuroradiological findings and surgical indications of intracranial lipomas.

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Cerebral Venous Angioma associated with a Cerebral Aneurysm

Report of Two Cases

Nobuhiro INOUE, Toru MARUBAYASHI, Toru NISHI, Yasuhiko MATSUKADO

1986 Volume 26 Issue 9 Pages 722-727
Published: September 15, 1986
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.26.722

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Two cases of cerebral venous angiomas associated with saccular aneurysms are reported. The incidence of such cases is very rare and only two cases have so far been reported in the literature. The first case was a 65-year-old female, who was admitted because of convulsive seizures. Neurological examination revealed right-sided cerebellar signs. Post-contrast computed tomography (CT) scan showed an irregularly shaped high-density area in the right cerebellar hemisphere. Cerebral angiography revealed a characteristic venous angioma in the right cerebellar hemisphere, and a saccular aneurysm of the right internal carotid artery. This patient was treated conservatively. The second case was a 44-year-old female, who was admitted because of severe headache and vomiting. Neurological examination revealed neck stiffness and right oculomotor palsy. CT scan showed a linearly enhanced lesion in the right frontal paraventricular region. Carotid angiography revealed a venous angioma in the right frontal lobe, and a right internal carotid-posterior communicating aneurysm. The aneurysm was clipped, but the venous angioma was treated conservatively. A review of the literature suggests the possibility of coincidental association of cerebral aneurysm with cerebral venous angioma as congenital vascular anomalies. The incidence of venous angioma associated with aneurysm should be higher than previously reported, if the angiogram of subarachnoid hemorrhage is carefully reviewed with serial venograms.

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Thoracolumbar Spinal Cord Astrocytoma with Intense Calcification

Case Report

Tokutaro TANAKA, Ichiro SHIMOYAMA, Mitsutoshi ENDOH, Kaoru HINOKUMA, T ...

1986 Volume 26 Issue 9 Pages 728-733
Published: September 15, 1986
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.26.728

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A case of thoracolumbar spinal cord astrocytoma (grade 2) with intense calcification detected by computed tomography (CT) scan is reported with its radiological and pathological findings.
A 28-year-old female with a 6-year history of very mild weakness of bilateral lower extremities was admitted a day after a sudden onset of severe headache associated with nausea and vomiting. CT scans for the head revealed subarachnoid hemorrhage and hydrocephalus. Cerebral angiograms showed no intracranial vascular lesions. Neurological findings suggested a spinal cord lesion and CT scans for the spine showed marked calcification in the spinal canal from the 9th to the 12th thoracic vertebral levels. A myelogram showed swelling of the spinal cord and partial block at the level of 9th thoracic vertebra with filling defects, suggesting the presence of abnormal vessels. A selective spinal angiography showed a tumor blush and draining veins corresponding to the filling defects in the myelogram. An intramedullary spinal cord tumor was diagnosed. The patient underwent laminectomy and biopsy alone because the tumor showed no plane of cleavage even with the aid of the operative microscope. The histology of the tumor was astrocytoma grade 2 with numerous psammoma bodies. Radiological and histological findings of the spinal cord astrocytoma and the therapy are discussed with a review of the literature.

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Neurinoma of the Trigeminal Root with Intratumoral Recurrent Hemorrhages

Case Report

Shuso ISHIGURO, Masahiro KITABAYASHI, Shigeru MUNEMOTO, Masato IKEDA, ...

1986 Volume 26 Issue 9 Pages 734-737
Published: September 15, 1986
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.26.734

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A rare case of neurinoma of the trigeminal root associated with recurrent hemorrhages is reported. The patient was a 77-year-old male. The tumor was composed of a large cyst which was demonstrated as a low density area on a plain computed tomography (CT). Contrast enhancement CT revealed a so-called “rim enhancement” of the tumor. Only partial removal of the cyst wall was performed because of the high age and a medical complication. The postoperative course was uneventful, but intratumoral hemorrhage was observed with abrupt appearance of various symptoms 3 months later. An Ommaya reservoir was used to evacuate the contents of the cyst and it relieved the symptoms. A cyst-peritoneal shunt was then used because of recurrent intratumoral hemorrhages. Favorable result has been attained for one year. The cyst-peritoneal shunt may be selected as a surgical procedure for a neurinoma associated with a large cyst when the total removal is judged to be inadvisable.

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