Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 27, Issue 6
Displaying 1-15 of 15 articles from this issue
  • Ryoichi OTSUKA
    1987 Volume 27 Issue 6 Pages 475-481
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Experimental prolactinomas were produced in Wistar rats by weekly injections of 2.5 mg estradiol dipropionate, and the effects of bromocriptine on these prolactinomas were studied by light microscopy, immunohistochemistry, and electron microscopy. Serum concentrations of prolactin and weight of the pituitary gland were markedly increased, more prominently in female rats, even after 6 weeks of weekly injections of estrogen. The prolactin productive cells were diffusely distributed and their population was high. The cytoplasm was mostly chromophobe. Immunohistochemical study of the prolactin showed diffuse staining. Electron microscope study showed that the nuclei were enlarged, containing one or two prominent nucleoli, and the Golgi apparatus and endoplasmic reticulum were strongly developed, while secretory granules were decreased. These morphological findings suggest that estrogen-induced rat prolactinoma simulate human prolactinomas. Discontinuation of estrogen administration for 3 weeks after six weekly injections resulted in a significant lowering of the serum prolactin level, with a tendency to decreased weight of the pituitary gland. Therefore, the effects of 1 mg/kg/day bromocriptine administered intramuscularly for 3 weeks were studied in female rats, without discontinuing estrogen administrations. The weight of the pituitary gland and serum concentration of prolactin were markedly decreased. Light microscopy showed an increase of eosinophilic cells. Immunohistochemical staining of prolactin showed little change. Electron microscope study showed that the Golgi apparatus and endoplasmic reticulum were markedly reduced and secretory granules were fully increased in the cytoplasm. The mechanism of inhibition of prolactin secretion by bromocriptine is discussed from the viewpoint of the morphological alterations.
    Download PDF (836K)
  • Yoshihiko YOSHII, Yutaka MAKI, Takayuki MATSUKI, Yoji KOMATSU, Hideo T ...
    1987 Volume 27 Issue 6 Pages 482-490
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The growth fraction (GF) of brain tumors in 26 patients was estimated by counting the nuclei that incorporated fractionated doses of 200 mg/sq m of bromodeoxyuridine (BrdU) injected every 8 hours for 3 days prior to surgery. Each tumor section embedded in paraffin was reacted with monoclonal antibodies against BrdU and visualized by means of immunoperoxidase. To estimate the GF of each tumor, the areas containing histologically viable tumor cells were selected. The BrdUlabeled cells were scored in 3 to 6 microscopic fields for totals of 1, 000 to 2, 000 tumor cell populations. GF was expressed by a ratio of the BrdU-labeled cells divided by total cells counted. GFs were 9.1 to 46.5% in malignant gliomas, 2.0 to 24.8% in benign gliomas, 11.2 to 43.2% in central nervous system metastasis, 6.2 to 8.2% in meningioma, 3.9 to 4.6% in acoustic neurinoma, 0.8 to 1.9% in pituitary adenoma, and 6.1 % in cerebellar hemangioblastoma. Average GFs of glioblastoma multiforme, giant cell glioblastoma, and astrocytoma grade IV were approximately 32%, whereas those of low grade astrocytoma and oligodendroglioma were 5%. In addition, the average intervals between onset of initial neurological signs and surgery, or relapse and surgery, were 3 months in malignant glioma and central nervous system metastasis, and were over 12 months in benign brain tumors including low grade glioma, meningioma, and acoustic neurinoma. Therefore, GFs estimated by this method appear to correlate with the biologically malignant nature of each human brain tumor in situ.
    Download PDF (807K)
  • Teizo OKUMURA, Junkoh YAMASHITA, Yasuhiko TOKURIKI, Hajime HANDA, Seig ...
    1987 Volume 27 Issue 6 Pages 491-497
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The intra-arterial administration of 3-[4 (amino-2-methyl-5-pyrimidinyl) methyl]-1 (2-chloroethyl)-1-nitrosourea hydrochloride (ACNU) was carried out in an attempt to achieve more effective delivery of ACNU to tumor cells with fewer systemic side effects. The concentration of ACNU in the blood, tumor tissue, and cerebrospinal fluid in 20 cases of malignant brain tumor was measured by high-performance liquid chromatography and the pharmacokinetics of ACNU were compared between intravenous and intra-arterial administration of the same dose of ACNU, using parameters of the mean concentration (MC) and area under the curve (AUC), and analyzed by the two compartment model. In three cases, intra-arterial administration of ACNU was carried out following blood-brain barrier (BBB) disruption. (1) The MC and AUC in the blood were not significantly different between the intravenous and intra-arterial administration groups. (2) On the other hand, both MC and AUC in the brain tumor tissue were significantly higher in the intraarterial administration group than in the intravenous administration group. (3) The concentration of ACNU in the cerebrospinal fluid remained below 1 ng/ml in both groups. (4) Analysis using the two compartment model also revealed that the concentration of ACNU in tumor tissue was consistently higher in the intra-arterial administration group than in the intravenous administration group. (5) In the hyperosmolar BBB disruption group, MC and AUC in tumor tissue tended to be higher but varied among the cases. (6) No marked side effects due to the intra-arterial administration of ACNU were observed. This study indicates the superiority of intra-arterial ACNU administration to intravenous administration.
    Download PDF (441K)
  • Kuniaki MATSUMORI, Michiko YOSHIOKA
    1987 Volume 27 Issue 6 Pages 498-504
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The kinetics of prostaglandin (PG) in hematomas and circulating blood plasma was explored in 29 cases of chronic subdural hematoma (31 hematomas), divided into four groups according to the density of hematoma on computed tomography scanning, i.e., low density V, isodensity (1), high density (H), and combined density (C). The study disclosed the following: 1) PG E levels of hematoma fluid were high in Groups H and I and low in Group L. The plasma level of PG E was found elevated in Groups C and I1 and generally was less variable. 2) The 6-keto-PG F content of hematoma fluid was slightly increased in Groups H and I, but showed no variation in Groups L and C. 3) Thromboxane B2 (TX B2) was noted to be increased in both hematoma fluid and circulating plasma in all groups. 4) Hematomas of Group L showed high values of TX B2/6-keto-PG F ratio. Plasma values of this parameter were heightened in all groups. 5) The plasma level of PG F showed no noticeable variation, while the hematoma fluid content of PG F was increased in all groups, especially markedly in Group I. 6) Elevated serum estrogen levels, notably of estrone, were observed in all groups. In Groups C, I, and H, serum estrogens rose in parallel with the hematoma fluid level of PG F. 7) The leukocyte fraction from hematoma fluid in Groups I, C, and H was found to contain a high percentage of eosinophils.
    These facts suggest that in chronic subdural hematoma there occurs generalized activation of the blood clotting system with increased local vasoconstrictive capacity at the site of hematoma formation. These biological responses were heightened in Groups I, C, and H, while less pronounced in Group L. The study also revealed that there was hyperactivity of the platelet aggregation-inhibiting system at the site of hematoma in Groups I and H. PG was thus demonstrated to play a role in the antagonism between the systemically increased capacity of platelet aggregation and the enhanced platelet aggregation-inhibiting activity at the affected locality, and thereby to participate in the formation and healing of a hematoma.
    Download PDF (534K)
  • Akifumi SUZUKI, Nobuyuki YASUI
    1987 Volume 27 Issue 6 Pages 505-510
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Until now, investigations have indicated that small cerebellar hematomas should be treated conservatively. But the treatment for medium-sized hematoma is still controversial, and the outcome of surgical treatment of large hematomas is not always good. The authors therefore studied the clinical results of hypertensive cerebellar hematomas, especially for medium-sized and large hematomas, and the surgical indication based on preoperative computed tomography (CT) findings and clinical findings was considered.
    Thirty-seven patients with hypertensive cerebellar hematomas were treated after the introduction of CT scan. In nineteen patients, hematoma evacuations were carried out under suboccipital craniectomy with or without ventricular drainage. In three patients only ventricular drainage or ventriculo-peritoneal shunt was carried out. The other eighteen patients were treated conservatively. In studying the series, the size of hematoma was classified as follows: the maximum diameter of a small hematoma was 2 cm or less, and that of a large hematoma was 3.5 cm or more. The clinical results were evaluated by the activities of daily living on discharge. From the results, the surgical indication of hypertensive cerebellar hematoma was considered as follows: 1) In patients with medium-sized hematoma (more than 2 cm, less than 3.5 cm), alert or somnolent patients should be treated conservatively. Hematoma evacuation is indicated in stuporous patients. 2) In patients with large hematoma (3.5 cm or more), hematoma should be evacuated within 24 hours after onset. Comatose patients, however, cannot achieve an independent daily life.
    Download PDF (403K)
  • Osamu SASAKI, Tetsuo KOIKE, Shigeaki OHSUGI, Shigekazu TAKEUCHI, Ryuic ...
    1987 Volume 27 Issue 6 Pages 511-518
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Regional cerebral blood flow (rCBF) was measured by the Xe-133 inhalation method in sixty patients before and after superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis, which was performed in the chronic stage. The aim of this study was to assess the effect of the surgery on rCBF and to obtain objective criteria for the surgery. The results were as follows: 1) A close relationship was found between the postoperative changes in mean hemispheric CBF (mCBF) and the preoperative states such as the site of lesion, the degree of occlusion, the size and location of infarction, and the degree of ischemia. 2) In patients with major artery occlusion, mCBF increased in those with no or a smaller infarction in the cortex, and the degree of improvement was more pronounced in those with internal carotid artery occlusion than in those with middle cerebral artery occlusion. 3) In patients with major artery stenosis, mCBF decreased slightly but significantly within one month after the surgery, and it returned gradually to near the previous levels. 4) An increase in mCBF occurred in patients with a severely reduced flow before surgery, and a slight decrease occurred in those with a nearly normal level. 5) The degree of intracranial filling via the anastomosis was good in patients with major artery occlusion with no or a smaller infarction, and was more correlated with the improvement of laterality, which was the difference of mCBF compared between the hemispheres, than improvement of the mCBF in an affected hemisphere.
    In conclusion, anastomosis seems to be useful for patients with major artery occlusion, a relatively small infarction and a severely reduced flow, and the indication in patients with major artery stenosis needs further investigation.
    Download PDF (595K)
  • Yutaka TSUTSUMI, Yukihiko ANDOH, Yoshiaki MAYANAGI, Makoto NOGUCHI, Yu ...
    1987 Volume 27 Issue 6 Pages 519-525
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The authors studied the hemodynamics in small aneurysms from the viewpoint of the Doppler effect with continuous waves, using an in vitro test model and in vivo experiments during brain surgery. A significant difference in pattern was confirmed between the hemodynamics in small aneurysms and the normal intra-arterial hemodynamics. The results of these studies were clinically applied in two patients, one with a giant aneurysm and one with a large aneurysm, using a transcranial pulsed-wave Doppler unit. The intra-aneurysmal and the parent artery signals were monitored through the skull. Comparison of these sonagrams revealed a significant difference. The difference in sonagraphic patterns between the intra-aneurysmal blood flow and the intra-arterial flow is discussed, and the possibility that this method would provide a completely noninvasive screening test for intracranial aneurysms is mentioned.
    Download PDF (541K)
  • A Clinical Study
    Hiroji KUCHIWAKI, Masato NAGASAKA, Jyunki ITOH, Sohshun TAKADA, Hitosh ...
    1987 Volume 27 Issue 6 Pages 526-532
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Quantitative evaluation of radioisotope (RI) cisternography was performed by single photon emission computed tomography (SPECT) in eight patients suspected of chronic hydrocephalus or malfunction of a shunt system, showing symptoms for two to 24 months, and one control patient with cerebrospinal fluid (CSF) leakage ten years after head trauma. Criteria of ventricular dilation by CT scan were satisfied in seven of the eight patients. The patients were given an injection of 1 ml of 1 mCi indium-111 diethylene triamine pentaacetic acid (In-Ill DTPA) via the lumbar route (seven cases) or ventricular catheter (two cases). Regular evaluations were scheduled (4, 7, 10-12, 24, 48 and 72 hours after injection). The region of interest, about 1.3 cm in radius and 0.8 cm in height, was placed in cisterna magna, sylvian cistern, basal cistern, and interhemispheric cistern as well as in the ventricle using a reconstructed image of a horizontal section by SPECT. Clearance curves were calculated with estimated decreasing count of RI each time by the method of exponential regression coefficients. Discrimination of the disease was attempted using the values of constant K of clearance curve and biological half-life time (BHT). Diagnosis of hydrocephalus was satisfactorily made in five patients demonstrating K values lower than 0.04 in all the cisterns expect for the cisterna magna, as well as BHT longer than 18-20 hours. Three of the five patients were treated with ventriculo-peritoneal (VP) shunt (two reconstructions of shunt systems and one VP shunt), and all of the improved. Although the remaining two patients were diagnosed as having hydrocephalus from the study, surgery was not performed, because of complicating psychiatric and malignant gastrointestinal diseases. Each patient diagnosed as Parkinson's disease or Alzheimer's disease showed a higher K value and shorter BHT than those in hydrocephalic patients. This tendency became clearer in the control patient with CSF leakage. Thus quantitative RI cisternography was highly valuable in the discrimination of chronic hydrocephalic from non-hydrocephalic patients with definitive dilation of the ventricles or symptoms similar to normal pressure hydrocephalus. This study may also be useful for estimation of the degree of impairment of CSF circulation.
    Download PDF (422K)
  • Report of Two Cases occurring after Suboccipital Craniectomy
    Kuniaki BANDOH, Takeyoshi SHIMOJI, Minoru MAEDA, Taizo NITTA, Shozo IS ...
    1987 Volume 27 Issue 6 Pages 533-537
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    An isolated fourth ventricle or “disproportionately large communicating fourth ventricle” (DLCFV) is a clinical entity characterized by marked dilatation of the fourth ventricle isolated from other cerebrospinal fluid pathways, producing various brain stem and/or cerebellar symptoms. In some cases, the aqueduct is reported patent. Two patients with a DLCFV developed after suboccipital craniectomy are reported. Both cases had previously undergone a ventriculo-peritoneal shunting procedure (V-P shunt) for hydrocephalus secondary to suboccipital craniectomy. Following the malfunction of the V-P shunt, the entire ventricular system was found to be markedly dilated, the fourth ventricle being disproportionately large. The aqueduct was found to be patent. Both cases have had several revisions of the V-P shunt, but they failed to reduce the size of the fourth ventricle and worsened neurological symptoms. Therefore, a fourth ventriculo-peritoneal shunt (IVth-P shunt) was performed. At the time of shunting in one case, pressure monitoring of the fourth ventricle was performed, and revealed large compliance. It is speculated that one of the mechanisms producing the DLCFV is altered cerebellar compliance due to suboccipital craniectomy. IVth-P shunt is proposed as treatment of DLCFV, if it is not relieved by revision of the V-P shunt.
    Download PDF (444K)
  • Report of Three Cases
    Yasuo KATOH, Hisashi ONOUE, Yoshinobu MANOME, Satoshi TANI, Hiroaki SE ...
    1987 Volume 27 Issue 6 Pages 538-544
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Three cases of extracerebral cavernous hemangioma in the middle cranial fossa are reported. Case 1 was a 25-year-old man who had complaints of left orbital pain and decreased visual acuity. An extradural tumor with a highly hemorrhagic tendency was biopsied. Case 2 was a 51-year-old man who had a complaint of decreased visual acuity in the right eye. He was diagnosed as having an extradural cavernous hemangioma fed by the right meningohypophyseal trunk. The tumor was totally removed with the aid of a CO2 laser. Case 3 was a 44-year-old woman who had amenorrhea, bilateral decreased visual acuity, left temporal hemianopsia, and left oculomotor nerve palsy. The neuroradiological diagnosis was cavernous hemangioma fed by the middle meningeal artery and meningohypophyseal trunk, and the tumor was partially removed. The residual tumor was significantly decreased in size by radiation therapy.
    35 reported cases of extracerebral cavernous hemangioma in the middle cranial fossa are summarized. There is female preponderance and racial dominancy by Orientals. The neurological deficits are very closely related to the tumor locations. The bony erosion of the sella turcica and the tumor stain of the cerebral angiogram as well as computerized tomography scan with contrast material in terms of the neuroradiological diagnosis are stressed. Preoperative irradiation is recommended in order to reduce the tumor size and avoid unexpected intraoperative bleeding.
    Download PDF (623K)
  • Case Report
    Hiroyuki FUJII, Sotaro HIGASHI, Masaaki HASHIMOTO, Katsuo SHOUIN, Hide ...
    1987 Volume 27 Issue 6 Pages 545-549
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A 70-year-old woman was admitted with a diagnosis of subarachnoid hemorrhage. She had complaints of sudden severe occipital headache and vomiting. Examination showed right blepharoptosis, mild right mydriasis, depression of the right corneal reflex, dysphagia, and left sensory disturbance. Computerized tomography revealed a high density area in the fourth and third ventricles. External ventricular drainage was performed, but the patient took a downhill course and died 6 months later. Necropsy revealed tumor tissue arising from the posterior aspect of the pontomedullary junction growing exclusively in the fourth ventricle. Histological examination showed a hemangioblastoma with endothelial proliferation, foam cells, swollen and lipid-filled endothelial cells, and varying sizes of dilated veins. It seems quite reasonable to assume that the hemorrhage in this case was due to rupture of the abnormally dilated veins around the tumor.
    Download PDF (483K)
  • Case Report
    Manabu TAKASE, Takahiro SANADA, Osamu WATANABE, Yoshinobu SUGITA
    1987 Volume 27 Issue 6 Pages 550-553
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A case of adult aqueductal stenosis presenting with cerebrospinal fluid (CSF) otorrhea is reported. The patient, a 56-year-old female, was admitted because of CSF otorrhea which had appeared spontaneously for the previous 2 months. Neurological examination on admission revealed bilateral optic atrophy and left conductive deafness. CSF leakage from the left Eustachian tube was confirmed by nasopharyngeal fiberscopy. The skull X-ray and computed tomography (CT) scan were consistent with aqueductal stenosis. Metrizamide CT cisternography showed clouding of the left mastoid air cells and middle ear cavity, presumably due to overflowing of CSF. The patient was gradually relieved of CSF otorrhea after shunt insertion. Spontaneous CSF otorrhea is an uncommon phenomenon and has seldom been described in association with aqueductal stenosis. The authors review the literature and discuss the possible routes of CSF leakage and the treatment for this rare complication.
    Download PDF (339K)
  • Report of an Adult Case with an Unusual Clinical Course
    Junichi ONO, Katsumi ISOBE, Iwao YAMAKAMI, Hiroshi ISE
    1987 Volume 27 Issue 6 Pages 554-558
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    An adult case of isolated fourth ventricle with an unusual clinical course is reported. A 62-yearold female had undergone lateral ventriculo-peritoneal (V-P) shunting for communicating hydrocephalus which was related to subarachnoid hemorrhage (SAH). Approximately three months later, following surgery for acute traumatic subdural hematoma (ATSDH) the symptoms of posterior fossa mass lesion developed. Computed tomography scan revealed disproportionate enlargement of the fourth ventricle, which was treated by fourth V-P shunting. Ultimately, the patient recovered well and returned to normal life. A possible mechanism for the isolated fourth ventricle in this case might be that the aqueduct was occluded by a midline shift due to ATSDH, in addition to the communicating hydrocephalus caused by SAH. The authors stress that the recognition of this entity is, indeed, important and that early diagnosis and adequate surgical intervention are indispensable.
    Download PDF (367K)
  • Report of Two Cases
    Hiroshi OKUDERA, Jouji KOIKE, Yasuyuki TOBA, Takayuki KUROYANAGI, Kazu ...
    1987 Volume 27 Issue 6 Pages 559-563
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Two cases of angiographically demonstrated fenestration of the middle cerebral artery associated with cerebral infarction are presented. The clinical significance of the coexistence of the fenestration and infarction in the territory of the lenticulostriate artery originating from the fenestration is discussed.
    Case 1. A 69-year-old male with a history of arterial fibrillation was suddenly seized with left hemiparesis. Right carotid angiography demonstrated a fenestration of the middle cerebral artery from which the lateral lenticulostriate artery originated. Follow-up computerized tomography (CT) scan showed an infarction in the right putaminal area. Case 2. A 75-year-old male was admitted after an attack of right hemiparesis and motor aphasia. Left carotid angiography showed a fenestration of the left middle cerebral artery from which the intermediate lenticulostriate artery was branching. The wall of the cervical-internal carotid artery was irregular. Follow-up CT scan showed an infarction in the left internal capsule.
    From these cases, it is suggested that fenestration of the sphenoidal portion of the middle cerebral artery may play a role in producing an infarct in the region of the basal ganglia, probably due to hemodynamic changes caused by the anatomical abnormality.
    Download PDF (374K)
  • Case Report
    Yoshihiro ITOH, Youichi ITOYAMA, Akinobu FUKUMURA, Yasuhiko MATSUKADO, ...
    1987 Volume 27 Issue 6 Pages 564-568
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    On lifting a heavy case, a 51-year-old male experienced a sudden onset of headache with giddiness and clouded vision. A week later, vertigo and right hand numbness were added to his symptoms. The next day anisocoria (right>left) and dilation of the left retinal veins were noted. Cranial computed tomography (CT) scan appeared normal and there were no other remarkable neurological findings. The patient was treated conservatively for cerebral infarction, however, the headache worsened and diplopia occurred. Neurological examination on admission revealed nothing unusual except for left Horner's syndrome. Physical examination showed a palpable sausage-like painless tumor on the left side of the neck. Angiography showed a narrowing of the internal carotid artery in the cervical region with a small dissecting aneurysm at the C3 level. Cervical CT scan at the upper C3 level showed a low density lunar defect in the high density section of the enlarged left internal carotid artery. The patient was operated on by superficial temporal artery-middle cerebral artery anastomosis to increase the intracranial blood flow. Postoperatively the symptoms were quickly relieved. Angiography 1 month later showed less narrowing of the carotid artery, though the dissecting aneurysm still remained. Postoperative cervical CT scan showed the left internal carotid artery to be of normal size. The patient returned to his work in normal condition 2 months later. It is emphasized that cervical CT scan may be useful in the diagnosis of this unusual type of cervical dissecting aneurysm.
    Download PDF (400K)
feedback
Top