Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 27, Issue 4
Displaying 1-15 of 15 articles from this issue
  • Haruhide ITO, Osami SHIMADA, Hisajiro TSUCHIYA, Masahiro KITABAYASHI, ...
    1987 Volume 27 Issue 4 Pages 265-270
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Effects of hemoglobin derivatives in the subarachnoid space on the cerebral cells were studied. Cultured cells were used for a model of subarachnoid hemorrhage excluding any effects of circulation, respiration, or intracranial pressure. The brain was taken from chick embryos from 12 to 14 days after conception; it was cultured using single layer methods for 7-14 days. After bilirubin was added to the cultured medium, the macrophages turned brown in 1 hour. Bilirubin contracted the processes of the cultured cells over 0.85×10-4 mol. The cultured cells showed vacuole degeneration 24 hours after the administration of bilirubin. The enzymes relating to glycolysis were stained by tetrazolium methods. Lactate dehydrogenase increased its activity under the influence of bilirubin. The activities of succinate dehydrogenase, reduced nicotinamide adenine dinucleotide diaphorase, and cytochrome were decreased by bilirubin. Glucose utilization and production of lactate and pyruvate increased, while oxygen consumption and production of carbon dioxide decreased. The pH of the medium changed little for 8 hours. When the pH of the cultured medium was less than 7.4, glycolysis was greatly impaired by bilirubin. Albumin prevents the impairment of glycolysis by bilirubin.
    Bilirubin, a derivative of hemoglobin, promotes the Embden-Meyerhof pathway and anaerobic glycolysis, while it inhibits tricarboxylic acid cycle and aerobic glycolysis of cerebral cells.
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  • Hideaki IWASA, Fumiaki SATO, Naoshi YAMADA, Hiroshi SHIMABUKURO, Nobor ...
    1987 Volume 27 Issue 4 Pages 271-275
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    In order to evaluate long-term postoperative human growth hormone (HGH) and prolactin (PRL) levels by intraoperative or immediately postoperative measurement of both hormones, 17 surgically-treated cases of pituitary adenomas were analyzed. There were seven and 10 cases of HGH and PRL-producing tumors, respectively. Serum levels of HGH and PRL were measured sequentially, from the preoperative period to 1 month after surgery. Rates of decrease of hormone levels and the statistical correlation among those rates were calculated. For PRL-producing tumors (PT), significant correlation was found between short-term decreasing rate (ΔS) and 1 week decreasing rate (ΔW) (p<0.01), between ΔS and long-term decreasing rate (ΔL) (p<0.02), and between ΔW and ΔL (p<0.02). As for HGH-producing tumors (GT), there were no such correlations. In both GT and PT, no correlation was found between intraoperative decreasing rate (ΔOp) and ΔS or between ΔOp and ΔL. It is concluded that (1) intraoperative measurement of HGH and PRL cannot predict postoperative HGH and PRL levels; (2) there are remarkable differences between GT and PT in their remnant tumor reactivity and regrowth mechanisms. (3) In PT, measurement of immediate postoperative PRL levels can predict long-term postoperative PRL levels.
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  • Giant Cell and Gemistocytic Cell Formation
    Motohide OGASHIWA, Masahiro NAKADAI, Yuji ASOH, Tatsuhiro MAEDA, Haruh ...
    1987 Volume 27 Issue 4 Pages 276-282
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Morphological features and microscopic characteristics of the autopsied specimens of 14 adult cadavers with supratentorial recurrent gliomas were studied. One of the specific findings in the morphological change of the tumor cells was giant cell formation. These giant cells were subdivided into 3 types: 1) monstrous cell, 2) giant cell, and 3) gemistocytic cell. 1) Monstrous cells were found in 12 cases, 4 grade 3 astrocytomas and 8 glioblastomas out of 14 recurrent gliomas. These cells were defined as those larger than 150μm in diameter and having bizarre, irregular and hyperchromatic multinuclei. The glial fibrillary acidic protein (GFAP) stain of monstrous cells was negative. These cells were scattered in the periphery of the tumor or necrosis. 2) Giant cells were demonstrated in 3 glioblastoma cases. They were 100-150μm in diameter and had single or multiple nuclei. These cells were scattered in the periphery of both the tumor and necrosis, and contributed major cells of the tumor in two cases. The GFAP stain was negative in two cases and positive in one. 3) Gemistocytic cells were noted in 8 cases, 5 grade 3 astrocytomas and 3 glioblastomas, and were about 100μm in diameter. They had a single distinct nucleus. The distribution of the cells was in the marginal zone of the tumor or necrosis, or grouped around vessels in the tumor. The GFAP stain was positive. These results suggest that the specific cells indicated herein may be degenerative changes of the tumor cells exposed while withstanding such adverse conditions as hypoxia, irradiation, and chemotherapy.
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  • Akira WATANABE, Ryuichi TANAKA, Norio TAKEDA, Yasuo SUZUKI, Tetsuro TA ...
    1987 Volume 27 Issue 4 Pages 283-288
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The radiosensitivity of 9 cerebellar medulloblastomas (6 cases of preoperative irradiation, 2 cases of postoperative irradiation, 1 case of non-operation) was evaluated by serial computerized tomography (CT). Six patients were males and 3 were females, and their ages ranged from 2 weeks to 18 years. A reduction ratio of 45 to 90% of the enhanced lesion was observed after irradiation with a total dose of about 20 Gy in 8 cases, excluding 1 case which was histologically diagnosed as “medulloblastoma with marked astrocytic differentiation.” The enhanced lesion had completely disappeared by the completion of initial radiotherapy in 2 cases and within 1 year in 4 cases (average: 6.6±3.1 months). In 1 case, the enhanced lesion which did not disappear at the completion of initial radiotherapy of 56 Gy was reduced by the delayed effect of radiotherapy. The results show that most primary lesions of typical medulloblastoma might be radiocurable, and that irradiation might be useful in the differential diagnosis of cerebellar tumors in younger patients. The site of recurrence after the initial radiotherapy was studied in 5 cases experienced in CT era. In all 5 cases, the site of recurrence was leptomeningeal dissemination, and no recurrence was found in the primary region except in 1 case. Therefore, prevention or treatment of leptomeningeal dissemination is very important in the therapy schedule for medulloblastoma.
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  • Amplitude Changes of Pulse Wave Components and Their Clinical Significance
    Minoru SHIGEMORI, Tomoyuki KAWABA, Takashi TOKUTOMI, Hironori NAKASHIM ...
    1987 Volume 27 Issue 4 Pages 289-294
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The changes in the two consistent components of epidural pressure (EDP) pulse waves, designated as P1 and P2 waves, and mean velocity of common carotid blood flow (CBFV) were studied in 21 patients with acute intracranial hypertension, to determine the origin of an amplitude change in these components. The dynamics of the intracranial compartment were altered by head elevation, jugular vein compression, hyperventilation, or mannitol administration. The amplitudes of the P2 wave, synchronous with the tidal wave of the blood pressure pulse wave, increased progressively with the rise of EDP. But those of the P1 wave, synchronous with the percussion wave of the blood pressure pulse wave, remained nearly invariable at EDPs more than 20-30 mmHg. This is compatible with the changes of the CBFV during the diastole. Jugular vein compression induced a rapid rise of EDP and a proportionate increase in the magnitudes of both waves. Hyperventilation and mannitol administration caused a disproportionate reduction in the amplitudes of P2 wave with a fall of EDP. But mannitol administration at high EDP (more than 40 mmHg) caused a mild fall of EDP and some increase in the amplitudes of the P2 wave.
    These results indicate that the variations in the amplitudes of the P1 wave reflect the changes in vascular resistance of the large intracranial conductive arteries, while those of the P2 wave result from the changes in the volume of the cerebral bulk. The increase of the amplitudes of the P2 wave induced by mannitol at high EDP suggests a defective autoregulation of the cerebral vessels.
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  • Kiyohiro HOUKIN, Kazuyoshi UENO, Mitsuhiro TADA, Hiroshi IBARA
    1987 Volume 27 Issue 4 Pages 295-301
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    It is well-known that recanalization of the occluded arteries in a cerebral infarction is a common phenomenon observed in about 40% of cerebral infarctions caused by an occlusion of angiographically visible arteries. The precise process and clinical significance of the recanalization is, however, not always analyzed satisfactorily.
    The authors performed a follow-up angiography in 41 patients with a cerebral infarction which had an arterial occlusion in an initial angiography, and disclosed a recanalization of the occluded artery in 18 patients. The clinical and neuroradiological findings in the 18 patients are reviewed. Recanalization occurred within 7 days after a stroke. In well-documented cases, the recanalization seemed to occur around 4 days after the stroke. However, the precise process were not always uniform and there seemed to be several variations such as partial recanalization caused by migration of an embolus and incomplete recanalization due to gradual spontaneous clot lysis. In thrombotic occlusions the recanalization occurred later than in embolic occlusions, and, moreover, it had a tendency to result in incomplete recanalization which showed a residual stenosis in post-recanalized angiography. Computed tomography (CT) disclosed a hemorrhagic infarction in half of the recanalized cerebral infarctions and enhancement effects by an intravenously injected contrast medium were seen in almost all cases. These CT findings tended to appear later than the arterial recanalization itself.
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  • Report of Two Cases with Review of the Literature
    Youichi ITOYAMA, Akinobu FUKUMURA, Yoshihiro ITOH, Seishi TAKAMURA, Ya ...
    1987 Volume 27 Issue 4 Pages 302-307
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Case 1: A 26-year-old man was admitted with multiple injuries. A computed tomography (CT) scan revealed severe fractures of the cranial base and a faint subarachnoid hemorrhage. On day 14 the patient began complaining of left motor weakness. Angiography revealed remarkable angiospasm not only in the C1, A1, and M1 portions bilaterally, but also in the basilar artery. The left hemiparesis recovered well and follow-up angiography after about 1 month showed that the angiospasm had disappeared completely. Case 2: A 48-year-old man was admitted with head trauma. A CT scan revealed a distinct subarachnoid hemorrhage in the right sylvian fissure and a small intracerebral hematoma in the left temporal lobe. Right carotid angiography on day 12 revealed segmental angiospasm in the right C1 portion and a few branches of the middle cerebral artery. The patient recovered well neurologically without showing any local signs. Follow-up angiography after about 2 weeks showed that the spasm had disappeared completely. The pathogenesis of traumatic arterial spasm is not yet well understood. The following three factors, however, have been postulated: 1) subarachnoid hemorrhage, 2) mechanical injury to the arterial wall, and 3) dysfunction of the hypothalamus. The cases reported here indicate that besides subarachnoid hemorrhage, mechanical injury to the arterial wall could be an important factor.
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  • Report of a Fatal Case
    Kunihiko EBINA, Seiichi MIYAMOTO
    1987 Volume 27 Issue 4 Pages 308-312
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A boy aged 11 years sustained a small laceration on the left ear after being struck with a ski-pole. Three hours later, he suffered progressive nausea, vomiting, right hemiparesis, aphasia, and disturbance of consciousness resulting from thrombosis of the left internal carotid artery at the upper cervical level. He was examined extensively by computed tomography, but at the early stage of the clinical course, head computed tomography revealed minimal low density area and little mass effect except in the cavum Vergae and cavum septi pellucidi. He died 62 hours after the trauma. A correct diagnosis has rarely been made at an initial stage of the clinical course of this type of trauma. The clinical and diagnostic pitfalls of this complication are discussed and the literature is reviewed. This complication should be considered whenever a patient who has suffered cervical trauma exhibits progressive neurological deterioration without intracranial hematoma, and retains a relatively good level of consciousness. Magnetic resonance image and digital subtraction angiography may be a choice in future to verify the diagnosis at an early stage because they are safe and reliable non-invasive methods.
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  • Report of Two Cases
    Norio MISU, Toshiyuki HIROTA, Kiyonori TOHYAMA
    1987 Volume 27 Issue 4 Pages 313-318
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The authors report two cases of successfully removed meningioma of the free margin of the tentorium which had developed into the quadrigemino-pineal region. Case 1: A 45-year-old woman presented symptoms of headache, mental deterioration, urinary incontinence, and gait disturbance of 6 months' duration. Computed tomography (CT) demonstrated a round, homogeneously enhanced mass lesion in the pineal region associated with hydrocephalus. Magnetic resonance imaging (MRI) showed the tumor mostly extending down into the infratentorial space. A ventriculoperitoneal shunt operation was performed. The tumor was totally removed through the infratentorial supracerebellar approach (Stein's approach) with the Nd-YAG laser and an ultrasonic surgical aspirator. Case 2: A 59-year-old woman was admitted with headache, unsteady gait, hoarseness, and swallowing disturbance of 6 months' duration. CT revealed a round-shaped highdensity mass in the pineal region with homogeneous contrast enhancement. MRI showed the tumor occupying the posterior third ventricle and extending above and below the tentorium cerebelli. The tumor was totally resected through the occipital transtentorial approach (Jamieson's approach). The postoperative courses of these cases were uneventful and the patients were discharged with no neurological deficits. Similar cases reported in the literature are reviewed and the clinical features, diagnostic aspects, and surgical management are discussed.
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  • Case Report
    Hirotaka SEO, Susumu ISHIKAWA, Satoshi KUWABARA, Akihiro NAGASE
    1987 Volume 27 Issue 4 Pages 319-324
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A 56-year-old female was admitted because of repeated focal fits, weakness, and sensory disturbance of the left foot and leg. Computed tomography (CT) scan showed a high density mass in the right frontoparietal parasagittal region, and perifocal edema. Right internal carotid angiography revealed an unusual middle meningeal artery, which originated from the ophthalmic artery and supplied the vascular tumor. A saccular aneurysm was noted at the internal carotid-posterior communicating artery junction. Right external carotid angiography showed no conventional middle meningeal artery. Plain skull roentgenogram and bone window CT scan verified the presence of the right meningoorbital foramen (Hyrtl's canal) and the absence of the right foramen spinosum. The tumor was almost totally removed. The histological diagnosis was meningioma. Six weeks later the aneurysm was clipped. The ophthalmic artery occasionally provides most or part of the blood supply of the middle meningeal artery through anastomosis between the recurrent meningeal branch of the ophthalmic artery and the orbital branch of the middle meningeal artery. Twenty-nine such cases are analysed and the clinical significance of this vascular channel is discussed.
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  • Case Report
    Shinsuke SUZUKI, Ryuichi KATAKURA, Seiya KATO, Jiro SUZUKI
    1987 Volume 27 Issue 4 Pages 325-328
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A case of coincidental meningioma and astrocytoma is described. The patient, a 75-year-old female, suffered from motor aphasia, right hemiparesis, vomiting, and urinary incontinence for about 1 month prior to hospitalization. Plain computed tomography scan demonstrated a round isoor high density area in the medial frontal lesion and a large low density area in the left frontal lobe adjacent to the medial round tumor. After injection of contrast medium, the medial round tumor was enhanced homogeneously, and the left frontal low density area was enhanced irregularly, with low density in its central portion. Bilateral frontal osteoplastic craniotomy was performed, followed by left frontal lobectomy and extirpation of the falx meningioma. Histologically the two tumors were diagnosed as a transitional meningioma and an anaplastic astrocytoma. After surgery, postoperative irradiation combined with chemotherapy was administered. Three months after the operation, the patient was discharged with slight hemiparesis and motor aphasia. The authors have found 38 cases in the literature of meningioma and glioma combined in the same patient, but cannot find any case in which both meningioma and glioma were diagnosed preoperatively and were surgically treated successfully.
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  • Case Report and Review of the Literature
    Kazunori ARITA, Tohru UOZUMI, Katsuaki SAKODA, Hirofumi OKAMOTO, Masas ...
    1987 Volume 27 Issue 4 Pages 329-335
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A case of hemangiopericytic meningioma with both intra and extra-cranial metastases is reported and the biological features of the tumor are discussed. A 57-year-old male underwent total excision of a left suboccipital meningioma in 1973. This tumor was histologically confirmed to be a hemangiopericytic meningioma. Seven years later multiple intracranial meningiomas with metastasis to the sacral bone were found. A two-step operation and biopsy revealed that these tumors were metastases of the tumor which was excised in the first operation. Following irradiation the residual tumors were reduced in size dramatically and the patient's symptoms improved satisfactorily. However, metastatic lesions spread to the left humerus, the right scapula, the left ilium and the ribs. Furthermore, intracranial tumors began to regrow 2 years after the irradiation. The patient's general condition gradually deteriorated and he finally died 11 years after the first operation. Autopsy revealed additional metastatic tumors in the spinal cord, the pancreas and the left kidney. Review of the literature indicates that this patient appears to be the first reported case of hemangiopericytic meningioma with both intra and extra-cranial metastases.
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  • Case Report
    Amei WANG, Yoko NAKASU, Masaharu ICHIKAWA, Satoshi NAKASU, Jyoji HANDA ...
    1987 Volume 27 Issue 4 Pages 336-340
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A hypothalamic hamartoma associated with true precocious puberty in a 2-year-old girl is reported. Following subtotal removal of the tumor, endocrinological abnormalities as well as clinical manifestations of precocious puberty were restored to normal. Although the immunofluorescence study of the specimen was negative, ultrastructural studies revealed dense core vesicles of approximately 100 nm in size in the neurons. The mechanisms of precocious puberty in patients with a hypothalamic hamartoma are briefly discussed.
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  • Case Report
    Hideyuki KUYAMA, Seigo NAGAO, Takashi TAMIYA, Akira NISHIMOTO, Takeo O ...
    1987 Volume 27 Issue 4 Pages 341-346
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A 4-month-old girl was hospitalized in 1975 because of vomiting. The anterior fontanelle was tense and bulging. She showed no abnormal neurological signs. Ventriculography showed the right lateral ventricle larger than the left. No mass was seen within the ventricles. A ventriculo-peritoneal (V-P) shunt was performed. After the operation the patient showed no signs of increased intracranial pressure for six years. The child was admitted with severe headache and vomiting in 1981. Roentgenograms disclosed disruption of the Holter valve. She showed normal physical and mental development. Computed tomography (CT) scan revealed enlarged ventricles with a contrast enhanced mass within the trigone of the right lateral ventricle. A right parietotemporal craniotomy was performed, the tumor was totally removed, and the shunt system was disposed of. The pathological diagnosis was benign choroid plexus papilloma. The child made an uneventful and rapid recovery. A neurological examination 4 years after the operation gave normal findings, and a CT scan showed a normal ventricular system. The tumor did not directly obstruct the flow of the cerebrospinal fluid; tumor removal alone was sufficient to stop the progression of hydrocephalus, and no shunt was necessary. This case supports the concept that hyperproduction of cerebrospinal fluid is sufficient to cause communicating hydrocephalus in patients with choroid plexus papilloma of the lateral ventricle.
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  • Case Report
    Isao FUWA, Yasuhiko MATSUKADO, Akira TAKADA, Susumu YOSHIOKA
    1987 Volume 27 Issue 4 Pages 347-350
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A case of an 8-year-old boy with slit-ventricle syndrome (SVS) is reported. The child received a ventriculo-peritoneal shunt operation for postmeningitic hydrocephalus at 9 months of age. From 4 years of age, he frequently showed intermittent spells of severe headache, vomiting, respiratory disturbance, and drowsiness. The peritoneal catheter was changed to a high pressure one. However, similar symptoms recurred 2 years after this procedure. On readmission the patient showed normal development and was neurologically free of symptoms in the intervals between attacks. A computed tomography (CT) scan taken during an attack showed collapsed ventricles. Epidural pressure monitoring demonstrated significant elevation of the intracranial pressure. The symptoms became unmanageable in spite of mannitol infusion. Another CT scan demonstrated slightly enlarged lateral ventricles compared with the previous scan. Emergent revision of the shunt system was performed. The ventricular catheter was obstructed by a piece of connective tissue, and thus was replaced with a new ventricular catheter with an anti-siphon valve. The postoperative course was uneventful and the symptoms completely disappeared. In many reported cases of SVS, intermittent headache and vomiting are the main symptoms. This case is unusual because of the accompanying respiratory disturbance and remarkable elevation of the intracranial pressure. The reason for the intermittent occurrence of the symptoms is discussed, with a review of the literature in regard to the etiology of SVS.
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