Neurologia medico-chirurgica

Effect of the Intracellular Calcium Antagonist HA1004 on Cerebral Blood Flow in Rats

Tomohisa OKADA, Masato SHIBUYA, Yoshio SUZUKI, Ichiro IKEGAKI, Naoki K ...

1988 Volume 28 Issue 7 Pages 625-630
Published: 1988
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.28.625

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The effect of a novel intracellular calcium antagonist, HA1004, on local cerebral blood flow (LCBF) was examined in rats. LCBF was measured in the striatum by the hydrogen clearance method. In the control rats, HA1004 (10 mg/kg, intravenously: IV) increased striatal LCBF by a maximum of 26% despite a transient drop in mean arterial blood pressure (MABP). The LCBF increased for a period of over 100 minutes after the infusion of HA1004. Nicardipine, a calcium entry blocker (0.1 mg/kg, IV), caused a decrease in MABP similar to that induced by HA1004 and increased LCBF by a maximum of 13% for up to 90 minutes after injection. In a second group of rats, the middle cerebral artery (MCA) was occluded by direct ligature of its proximal portion. After MCA occlusion, the LCBF rapidly dropped to 30% of the control value and gradually recovered to the control level during the next 60 minutes. However, in rats prophylactically treated with a small dose of HA1004 (1 mg/kg, IV), LCBF recovered more quickly than in untreated rats. The results of this study suggest that HA1004 increases LCBF by enhancing collateral blood flow to ischemic regions and may be useful for the treatment of ischemia.

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Immunological Study of Interleukin-2 in the Patients with Malignant Brain Tumors

Seiichi YOSHIDA, Ryuichi TANAKA, Nobuyuki TAKAI

1988 Volume 28 Issue 7 Pages 631-634
Published: 1988
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.28.631

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The authors studied the capacity of peripheral blood lymphocytes from patients with malignant brain tumors to produce, and to respond to, interleukin-2 (IL-2). The role of IL-2 in generation of T cells cytotoxic to tumor cells was also studied. Lymphocytes from the patients with malignant brain tumors produced less IL-2 than did those of normal controls. However, phytohemagglutinin-activated peripheral blood lymphocytes from normal controls and the patients responded equally well to IL-2. This indicates that IL-2 receptors are abundant in the patients' lymphocytes, although IL-2 production may be depressed. Furthermore, after incubation with IL-2, lymphocytes from patients with malignant glioma exhibited higher natural killer activity and strong cytotoxicity to glioma cells. Its tumor cell cytotoxicity makes IL-2 a likely candidate for use in adoptive immunotherapy.

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Local Administration of Human Fibroblast Interferon (Hu IFN-β) for Metastatic Brain Tumor

Yasuto KAWAKAMI, Masanori CHIKAMA, Takashi TAMIYA, Yoichi WATANABE, Yu ...

1988 Volume 28 Issue 7 Pages 635-641
Published: 1988
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.28.635

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Twelve patients with intracranial metastatic tumors were given local treatment with human fibroblast interferon (Hu IFN-β). Following tumor removal, the IFN was injected into the tumor removed cavity through an Ommaya's reservoir. When serial computed tomographic scans suggested recurrence, whole brain irradiation was started. The results demonstrated that local administration of Hu IFN-β was an important addition to surgical excision and whole brain irradiation when there were no extracranial metastases from the primary lesion and T lymphocyte transformation to phytohemagglutinin and concanavalin A was relatively normal. However, IFN was not effective in preventing the appearance of other intracranial metastases beyond the site of injection.

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Chemical Shift Misregistration Effect in Spinal Magnetic Resonance Imaging

Masaki KOMIYAMA, Toshihiro YASUI, Hisatsugu YAGURA, Yoshihiko FU, Haji ...

1988 Volume 28 Issue 7 Pages 642-644
Published: 1988
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.28.642

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The purpose of this study was to identify the manifestations of the chemical shift misregistration effect in spinal magnetic resonance (MR) images. With the use of a 0.5-T superconducting MR scanner, axial images of a normal lumbar spine were obtained with T₁-weighted spin echo sequences in which the frequency- and phase-encoding gradients were interchanged. A low intensity meniscus (band) was demonstrated around the thecal sac in the direction of the lower frequency-encoding gradient. Awareness of this phenomenon is crucial to the correct interpretation of spinal MR images, especially in cases of lipoma or other fatty tumors.

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Changes in Glutathione Peroxidase and Lipid Peroxides in Cerebrospinal Fluid and Serum after Subarachnoid Hemorrhage

—With Special Reference to the Occurrence of Cerebral Vasospasm—

Takashi WATANABE, Tomio SASAKI, Takao ASANO, Kintomo TAKAKURA, Keiji S ...

1988 Volume 28 Issue 7 Pages 645-649
Published: 1988
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.28.645

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To clarify the pathogenesis of delayed cerebral vasospasm after subarachnoid hemorrhage (SAH), the authors studied changes in lipid peroxides (measured as thiobarbituric acid reactive substances, TRS) and their scavenging enzyme, glutathione peroxidase (GPx), in the cerebrospinal fluid (CSF) and the serum of SAH patients and normal subjects. The CSF of the normal subjects was almost devoid of both TRS and GPx. A sudden increase in GPx activity in the CSF of SAH patients appeared to be due to the efflux of serum GPx to the subarachnoid space. GPx in the CSF decreased within 2-4 days after SAH, and in some cases the TRS content then became elevated and delayed vasospasm ensued. Following SAH, serum TRS increased, reaching a plateau 4-5 days after onset. GPx also increased 1 or 2 days later. The increase in serum TRS appeared to be a consequence of blood clotting within the subarachnoid space and may have stimulated GPx activity. The findings suggest that lipid peroxides present in the CSF and the serum of SAH patients may be responsible for development of delayed vasospasm and that serum GPx might play an important role in controlling it.

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Colloidal Osmotic Pressure in Chronic Subdural Hematoma

Haruhide ITO, Takashi SHIMOJI, Shinjiro YAMAMOTO, Kenichi SAITO, Satos ...

1988 Volume 28 Issue 7 Pages 650-653
Published: 1988
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.28.650

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The colloidal osmotic and hydrostatic pressure of chronic subdural hematomas were measured with a manometer in 35 patients. Manometric measurement showed an increase in the hematoma fluid corresponding to 5% of the total hematoma volume. The maximum colloidal osmotic pressure of the hematoma fluid, as measured with a transducer, was 23 ± 12 mmHg (mean ± standard deviation). Hemorrhage occurs continuously or intermittently within a subdural hematoma, accompanied by red cell hemolysis and hemoglobin degradation. The colloidal osmotic pressure within a subdural hematoma is higher than that in plasma or cerebrospinal fluid, so that the hematoma is able to absorb water through semipermeable membranes or capillaries. However, since the absorption force can transport only 5% of the hematoma volume, the colloidal osmotic pressure is a contributory process rather than a primary etiologic factor.

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Prognosis of Chronic Subdural Hematoma using Noninvasive Skull Impedance Plethysmography

Totaro TAKEUCHI, Takashi TSUBOKAWA, Nariyuki HAYASHI, Hidehiko KUSHI, ...

1988 Volume 28 Issue 7 Pages 654-660
Published: 1988
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.28.654

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Postoperative resolution of neurological symptoms was assessed in eight patients with chronic subdural hematoma by means of noninvasive skull impedance plethysmography. A control population comprising 20 normal adults was also studied. Preoperatively, in comparison with the control subjects, the patients with chronic subdural hematoma had much higher intracranial pressure, considerably reduced mean cerebral blood flow, greater cerebrovascular resistance, a longer cerebrovascular conduction time, and somewhat lower cerebrovascular compliance and cerebral perfusion pressure. The differences in the last five parameters reflect pathophysiological changes due to elevated intracranial pressure in the hematoma patients. Among those who showed neurological improvement after surgery, the most dramatic changes, as demonstrated by a 5-minute 3% CO₂ inhalation test, were mean increases in mean cerebral blood flow of 106.7% and in cerebrovascular compliance of 101.5%. Among the patients who responded poorly to surgery, the corresponding mean increases were only 44.5% and 46.5%, respectively.

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Intracranial and Cerebral Perfusion Pressures in Relation to Auditory Brainstem Responses and Initiation of Secondary Brainstem Damage

Nobutaka KAWAHARA, Haruhiko TSUTSUMI, Koji MII, Tetsuya SAKAMOTO, Hiro ...

1988 Volume 28 Issue 7 Pages 661-666
Published: 1988
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.28.661

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The authors investigated the relationship between supratentorial intracranial pressure (ICP) and serial changes in auditory evoked brainstem responses (ABR). Of 122 cases of brain death evaluated over a 5-year period, serial ABRs were observed in 28, excluding patients with posterior fossa lesions. When an increase of ICP to 35-40 mmHg was sustained for an average of 10.1 hours, wave V was prolonged. Wave V was lost when the ICP exceeded 40 mmHg. Waves I and III were undetectable above an ICP of 60 mmHg and below a cerebral perfusion pressure (CPP) of 30 mmHg.
The results indicate that evaluation of secondary brainstem damage by ABR should be initiated when an increase in ICP to within the critical zone of 35-40 mmHg lasts for more than 10 hours and that vigorous efforts should be made to decrease the ICP below this level. Both low CPP and high ICP were involved in the loss of wave I, indicating that both ischemia and displacement of the brainstem were important pathophysiological factors.

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Low-grade Gliomas associated with Epilepsy: Long-term Follow-up with Computed Tomography

—Report of Four Cases—

Hirokazu KAWANO, Minoru HAYASHI, Hidenori KOBAYASHI, Yuji HANDA, Masan ...

1988 Volume 28 Issue 7 Pages 667-672
Published: 1988
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.28.667

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Four epileptic patients with low-grade gliomas were followed with computed tomography (CT) from the onset of epilepsy. In each case, focal epilepsy was the initial symptom. All four patients had left frontal lobe lesions, which manifested on CT scans as low-density areas (three patients) and calcification (one patient) without mass effect. In each case, little change was evidenced by follow-up CT scans obtained over a considerable period of time, and then tumor growth was noted, as indicated by the appearance of mass effect and/or contrast enhancement on CT scans. These findings underscore the necessity of following patients whose CT scans demonstrate low-density areas or calcification without mass effect for more than 2 years. In addition, when the diagnosis is uncertain, early biopsy and histological confirmation of gliomas should significantly improve the prognosis for these patients.

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Postpartum Regression of a Spontaneous Carotid-cavernous Fistula

—Case Report—

Yoshifumi HIRATA, Yasuhiko MATSUKADO, Hideo TAKESHIMA, Hiroshi SETO

1988 Volume 28 Issue 7 Pages 673-676
Published: 1988
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.28.673

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A spontaneous carotid-cavernous fistula in a 32-year-old female improved without treatment a few days after a normal pregnancy and delivery. The mechanism of spontaneous resolution of the fistula in the postpartum stage may have involved thrombosis of the cavernous sinus due to a change in blood coagulability or a direct effect of estrogen on the vascular wall. The relevant literature is reviewed.

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Magnetic Resonance Imaging of Traumatic Pneumocephalus

—Case Report—

Masaki KOMIYAMA, Toshihiro YASUI, Hisatsugu YAGURA, Yoshihiko FU, Haji ...

1988 Volume 28 Issue 7 Pages 677-680
Published: 1988
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.28.677

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Computed tomographic scans and magnetic resonance (MR) images in a case of traumatic pneumocephalus are presented and discussed. MR images clearly demonstrated not only the accumulation of air but also the herniation of brain tissue through the fracture into a paranasal sinus. A fistulous tract for cerebrospinal fluid leakage was strongly suggested on the images of brain herniation. The clinical usefulness of MR images is compared with that of conventional diagnostic modalities.

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Precocious Puberty due to an Ectopic Pituitary Gland

—Case Report—

Shuji NIIKAWA, Hiroaki NOKURA, Toshiro UNO, Akio OHKUMA, Jun SHINODA, ...

1988 Volume 28 Issue 7 Pages 681-684
Published: 1988
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.28.681

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A 35-month-old female exhibiting precocious puberty of cerebral origin was found to have a suprasellar mass. The provisional diagnosis was hypothalamic hamartoma, and the mass was totally removed through a right frontotemporal pterional craniotomy. The mass, which was situated in the suprasellar and prechiasmal region, was isolated, adhering to and compressing the pituitary stalk and diaphragma sellae. Histological examination showed it to contain normal pituitary gland cells without evidence of neoplastic differentiation. The final diagnosis was precocious puberty due to a suprasellar ectopic pituitary gland. This is believed to be the first such case reported.

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Bilateral Absence of the Internal Carotid Artery

—Case Report—

Kazuo OKUCHI, Kitaro KAMADA, Shoji INUI, Toku TAKAHASHI, Ken-ichiroh H ...

1988 Volume 28 Issue 7 Pages 685-689
Published: 1988
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.28.685

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To date, there have been only 15 reported cases of bilateral absence of the internal carotid artery. The authors describe a 70-year-old male with bilateral absence of the internal carotid artery and cerebral infarction. He was hospitalized because of a right sensory disturbance. Bilateral retrograde brachial angiography demonstrated filling of the right and left anterior and middle cerebral arteries by the dilated posterior communicating arteries. Neither bony carotid canal could be demonstrated by conventional computed tomography, including scanning of the petrous portion of the temporal bone. These neuroradiological findings confirmed the absence of the carotid arteries.

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Giant Epicranial Neurofibroma

—Case Report—

Yukio WAKUTA, Tetsumi MITANI

1988 Volume 28 Issue 7 Pages 690-694
Published: 1988
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.28.690

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The authors describe a case of giant epicranial neurofibroma unassociated with von Recklinghausen's neurofibromatosis. The tumor, which was situated in the occipital region, gradually enlarged over a 14-year period, while the two skull defects beneath it increased in size over a period of 3 years. On angiography the tumor exhibited marked hypervascularity. It was fed mainly by the bilateral occipital arteries and drained into the transverse sinus. After its embolization and total excision the pathological diagnosis was plexiform neurofibroma. This and two similar reported cases have features in common with those of von Recklinghausen's neurofibromatosis.

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Loss of Vision due to Cryptococcal Optochiasmatic Arachnoiditis and Optocurative Surgical Exploration

—Case Report—

Chikashi MARUKI, Hideki NAKANO, Takeyoshi SHIMOJI, Minoru MAEDA, Shozo ...

1988 Volume 28 Issue 7 Pages 695-697
Published: 1988
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.28.695

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A female patient became blind as a complication of cryptococcal optochiasmatic arachnoiditis. The diagnosis of optochiasmatic arachnoiditis was made by metrizamide CT cisternography. Surgical lysis of the adhesion restored her vision. The diagnosis and surgical treatment of optochiasmatic arachnoiditis in cryptococcal meningitis are discussed.

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