Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 28, Issue 9
Displaying 1-14 of 14 articles from this issue
  • Experimental Study in Kaolin-induced Hydrocephalic Dogs with Normal Intracranial Pressure
    Yukihiko UEDA, Takashi MATSUMOTO, Mitsuhito MASE, Hajime NAGAI
    1988 Volume 28 Issue 9 Pages 857-863
    Published: 1988
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Plateau waves are often observed in patients with “normal pressure hydrocephalus” during continuous monitoring of intracranial pressure (ICP). The authors attempted to determine whether or not hypoventilation is responsible for the plateau waves in such patients. Sixteen adult mongrel dogs were immobilized and mechanically ventilated. Hypoventilation was induced for 10 minutes by means of a 50% decrease in both tidal volume and respiratory rate, after which normal ventilation was resumed. Arterial blood gas, heart rate, mean systemic arterial pressure, mean ICP, and cerebral perfusion pressure (CPP) were monitored throughout the study. The dogs were divided into three groups: Group C (controls; n=6); Group K (dogs with kaolin-induced hydrocephalus in whom the ICP had returned to normal in the chronic stage; n=6); and Group B (animals in whom, for the purpose of comparison with Group K, a balloon was extradurally inserted and inflated and whose ICP was within the normal range; n=4) . During hypoventilation, ICP increased more and CPP in turn decreased significantly more in Groups K and B than in Group C. The increase in ICP persisted during hypoventilation, as did plateau waves. None of the parameters monitored was significantly different between Groups K and B. Thus, it appears that in these two groups ICP responded similarly to specific respiratory changes.
    These results suggest that the spatial compensatory capacity in kaolin-induced hydrocephalus is lowered even if ICP is within the normal range. In such circumstances, alteration of cerebral blood volume as a result of hypoventilation can lead to elevation of ICP, which is expressed as plateau waves. It is hoped that further study will disclose whether or not hypoventilation is also a factor in the development of plateau waves in humans with normal pressure hydrocephalus.
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  • Masakazu SUGA, Seigo NAGAO, Takenobu MUROTA, Hideyuki KUYAMA, Akira NI ...
    1988 Volume 28 Issue 9 Pages 864-870
    Published: 1988
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    The effects of an expanding supratentorial mass on neural function and local cerebral blood flow (LCBF) in the brainstem were investigated in 32 cats. A balloon was inserted into the supratentorial epidural space and was inflated at a constant rate of 0.0197 ml/minute. The auditory brainstem response (ABR) and short-latency somatosensory evoked response (SSER) were measured for evaluation of electrical conduction through the auditory and lemniscal pathways, respectively (n=18) . The blink reflex was monitored to investigate neural function of the brainstem reticular formation (n=8). LCBF was measured by the hydrogen clearance method in four regions, including the inferior colliculus (IC), medial lemniscus (ML), pontine reticular formation (PRF), and reticular formation of the medulla oblongata (MORF). When ICP was raised to 40 to 60 mmHg, blood flow in the IC and PRF was markedly decreased relative to that in the ML and MORF. The R2 blink reflex disappeared at 40 to 70 mmHg of ICP, prior to the disappearance of ABR wave V, SSER II components, and the R1 blink reflex. Upon the appearance of anisocoria, the ABR wave V disappeared in all cases, while the SSER II components were preserved in 4 of 18 cases. When both ABR wave V and SSER II components had nearly disappeared, LCBF in the IC and ML decreased to less than 50% of control values. The balloon was deflated within 15 minutes of the appearance of anisocoria. One hour after the deflation, the R2 blink reflex remained lost in all cases. SSER II components and ABR wave V recovered in 10 of 14 cases and 5 of 18 cases, respectively. Brainstem LCBF improved in the majority of cases in which neural function of the corresponding region recovered. These results suggest that blood flow and neural function are more vulnerable to intracranial hypertension in the PRF and IC than in the ML and, if there is evidence of tentorial herniation, do not recover well following decompression.
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  • Takayuki SHIBATA, Akio ITO, Shigeru MIYAJI, Yasukazu KAJITA, Yoshimasa ...
    1988 Volume 28 Issue 9 Pages 871-874
    Published: 1988
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Cerebral angiography is the most important diagnostic procedure for aneurysms. However, it is often necessary to obtain several oblique views in order to confirm the location, shape, and origin of an aneurysm. Recently, the development of a rotational stereoscopic cerebral angiography (RS-CAG) system, consisting of a Diagnost N unit, an image intensifier, and a camera, was reported. Subsequently a similar unit was devised, in which the image intensifier was replaced by a film changer CXC-U1. The X-ray tube and film changer are rotated around the head, which is positioned at the isocentrum of the tube/film changer unit. During the rotation procedure, sequential 3-persecond X-ray exposures at angles differing by about 5° yield stereoscopic images. The total exposure is 60°.
    Six patients with aneurysms underwent both conventional angiography and RS-CAG. Another 20 patients were studied by RS-CAG alone. RS-CAG more clearly depicted the location, size, and shape of aneurysms. Overlapping arteries and arterial loops were also better visualized with RS-CAG, and the time required for examination was shorter than that of conventional angiography. In most cases, one RS-CAG examination was sufficient for evaluation of unilateral lesions within the territory of the internal cerebral artery.
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  • Positional Angiography and Surgical Management
    Hiroyoshi SHIMIZU, Shintaro MORI, Kazuyoshi MORIMOTO, Takuya IKEDA, Fu ...
    1988 Volume 28 Issue 9 Pages 875-879
    Published: 1988
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    The thoracic outlet syndrome involves neurovascular compression at the site where the brachial plexus and subclavian vessels pass through the isthmus of the root of the neck. This disorder, which may be overlooked by neurosurgeons, is diagnosed mainly on the basis of subjective symptoms and objective findings. Such objective manifestations as supraclavicular tenderness and radial pulse obliteration may be elicited by the Morley and Allen tests, respectively. Positional angiography offers the most precise means of localizing the compression. The aim of surgery is to create an adequate passage for the neurovascular bundle. The authors prefer the supraclavicular approach to thoracic outlet decompression and emphasize complete decompression, i.e., scalenotomy and resection of the first rib. The importance of this disorder and its surgical management are discussed.
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  • Measurement of Bradykinin, Fibrinopeptide A, and Thromboxane B2 in Cerebrospinal Fluid
    Hidetoshi KASUYA, Takashi SHIMIZU, Takaharu OKADA, Kenji TAKAHASHI, Ta ...
    1988 Volume 28 Issue 9 Pages 880-885
    Published: 1988
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Cerebrospinal fluid (CSF) fibrinopeptide A (FPA) levels were measured serially by radioimmunoassay (RIA) in 25 patients with subarachnoid hemorrhage (SAH). The FPA levels, which reflect the amount of thrombin, were extremely high on days 0 to 1 (1, 012±334 ng/ml, mean±SE) and decreased rapidly. Bradykinin (BK) levels in the CSF of 27 patients with SAH, which were also measured serially by RIA, were 122.7±22.7 pg/ml on day 0, 38.6±6.9 pg/ml on day 1, and 22.7±6.3 pg/ml on day 2, and decreased slowly. Thromboxane B2 (TXB2), which is produced by the activation of platelets, was measured by RIA in the CSF of 25 patients with SAH. TXB2 levels were 771±280 pg/ml on days 0 to 1, 169±30.9 pg/ml on days 2 through 4, 259±45.2 pg/ml on days 5 through 7, and 167±12.9 pg/ml on days 8 through 14. The control values of FPA, BK, and TXB2 were 1.2±0.9 ng/ml, 8.0±3.3 pg/ml, and 93.0±14.6 pg/ml (mean±SD), respectively. BK is produced through the activation of Hageman factor, which is believed to be activated by trabeculae arranged in collagen bundles in the subarachnoid space. In the case of SAH, the coagulation process might be initiated by Hageman factor (intrinsic system). Platelets are also thought to be activated by trabeculae, as well as by thrombin. Trabeculae can thus be assumed to play a major role in the initiation of coagulation in SAH.
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  • Hiroyuki YOKOTA, Takayuki MIZUNARI, Masaaki KUZUHARA, Shiro KOBAYASHI, ...
    1988 Volume 28 Issue 9 Pages 886-890
    Published: 1988
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    The authors evaluated six cases of delayed traumatic intracerebellar hematoma (DTIClH) that occurred between April, 1977 and December, 1985. The patients' ages ranged from 1 to 65 years; four were under 10 years of age. The site of impact was the occipital region in five of the six cases. DTIClH was diagnosed on the basis of initial as well as serial computed tomography (CT) scans. In five cases, serial CT disclosed supratentorial lesions. Regarding the pathogenesis of DTIClH, it is possible that vasoparalysis associated with cerebellar contusion is contributory. Patients with DTIClH had somewhat better outcomes than did those with acute traumatic intracerebellar hematoma.
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  • Masami YANO, Shiro KOBAYASHI, Takayuki KITAMURA, Takuro OKADA, Toshibu ...
    1988 Volume 28 Issue 9 Pages 891-897
    Published: 1988
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    The authors compared the clinical outcome in cases of isolated, severe, blunt head injury (IHI) and those involving multiple trauma that included head injury (HMI). There were 204 patients in the IHI group (mean age, 38.5 years) and 192 in the HMI group (mean age, 35.3 years). The overall mortality rate was 53.9% following IHI and 50.0% following HMI. The incidence of shock was significantly lower with IHI (6.9%) than with HMI (34.9%), although the mortality rate for patients in shock was over 70% in both groups. Among HMI patients with both chest and abdominal injuries, those in shock had a higher mortality rate. Among patients who did not go into shock, mortality was significantly lower in the HMI group (37.6%) than in the IHI group (50.5%). Glasgow Coma Scale and Outcome Scale scores did not differ significantly between IHI and HMI patients. Among patients with the same Trauma Scores, the mortality rate tended to be lower with HMI than with IHI. The results of this study suggest that head injury alone is more severe than head injury accompanied by other trauma, despite the similarity between the two groups of patients in Glasgow Coma Scale scores. In addition, the trauma scale should be applied to patients with multiple injuries, since it evaluates respiratory and cardiovascular function.
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  • Case Report
    Kazumi MATSUDA, Kouichi UETSUHARA, Masaki NIIRO, Tetsuhiko ASAKURA
    1988 Volume 28 Issue 9 Pages 898-903
    Published: 1988
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Cerebral angiograms of a 48-year-old woman with subarachnoid hemorrhage revealed an aneurysm on the anterior communicating artery. The aneurysm was clipped 38 days after onset via the pterional approach, with the patient in the supine position. During surgery, 900 ml of mannitol was administered and her blood pressure and body temperature were normal. However, 1 hour postoperatively, disturbance of consciousness and right hemiparesis were noted. Computed tomographic scans obtained 30 minutes later showed a large epidural hematoma in the left frontoparietal region, contralateral to the craniotomy site. Emergency evacuation of the hematoma was performed. The patient's postoperative course was uneventful and she had fully recovered at the time of discharge.
    Postoperative epidural hematomas distant to the operative site are often seen after ventricular drainage, shunting, and suboccipital craniectomy and are attributed to intensive internal decompression. However, a review of the literature yielded only four other cases of contralateral epidural hematoma following aneurysmal clipping. Among the five reported cases (the authors' case included), surgery was performed within 16 to 47 days of the onset of subarachnoid hemorrhage. The interval between surgery and detection of the hematoma ranged from 1.5 to 4 hours in four cases. In three cases the hematoma was in the contralateral frontal region.
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  • Case Report
    Tatsuo TAKAHASHI, Koji NAKAMURA, Kazuhiko ANDOH, Masataka TAJIMA
    1988 Volume 28 Issue 9 Pages 904-909
    Published: 1988
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    A 68-year-old woman who suddenly developed severe, recurrent epistaxis was found to have bilateral, nontraumatic intracavernous aneurysms. On the right side, a giant aneurysm protruded medially, enlarging the sella turcica. Following emergency ligation of the cervical internal carotid artery under local anesthesia, the bleeding stopped. Subsequently, a right superficial temporal to middle cerebral artery anastomosis was created and the aneurysm was trapped at the C3 portion proximal to the ophthalmic artery.
    There have been only eight other reports of ruptured nontraumatic intracavernous aneurysms presenting with massive epistaxis. These cases are reviewed and compared with similar cases in which the aneurysms were traumatic in origin. Diagnostic procedures are also discussed.
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  • Case Report
    Shingo TAKANO, Tadao NOSE, Tetsuo OOWADA, Shizuo SHIRAI, Yutaka MAKI
    1988 Volume 28 Issue 9 Pages 910-914
    Published: 1988
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    A case of duplication of the middle cerebral artery and an aneurysm at its origin is described. The patient, a 74-year-old male, was hospitalized following a head injury. A computed tomography scan showed intraventricular and subarachnoid hemorrhages. Carotid and vertebral angiograms revealed no vascular abnormalities causative of the hemorrhages. However, duplication of the middle cerebral artery and a saccular aneurysm at its origin were coincidentally observed on the right side. Craniotomy was performed 3 weeks later, and the duplication was confirmed. The neck of the unruptured aneurysm was clipped. Of the 55 reported cases of duplication of the middle cerebral artery, only six were associated with an aneurysm at the origin. The possible etiologies of such aneurysms are discussed.
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  • Case Report
    Yoji NODE, Yukihide TSUJI, Shozo NAKAZAWA
    1988 Volume 28 Issue 9 Pages 915-918
    Published: 1988
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    A 30-year-old hypertensive male was hospitalized because of left motor weakness. A computed tomography (CT) scan showed high density in the right putaminal region. Right carotid angiography revealed no vascular abnormality but indicated mild mass effect on the right lenticulostriate arteries. Following emergency surgery, the left hemiparesis improved. A CT scan obtained on the 8th day after surgery demonstrated no high density in the right putaminal region. However, on the 16th day the patient complained of mild headache. His blood pressure was 170/106 mmHg, but he showed no neurological deterioration. A CT scan taken on the following day showed a small highdensity area in the right putaminal region. The diagnosis was recurrent hypertensive intracerebral hemorrhage in the same region. With medical treatment the left hemiparesis improved. Although the etiology of recurrent hypertensive intracerebral hemorrhage is not known, control of diastolic blood pressure may be very important in its prevention.
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  • Case Report
    Masanori KURIMOTO, Kazuyo KAMIYAMA, Nobuo OKA, Yutaka HIRASHIMA, Akira ...
    1988 Volume 28 Issue 9 Pages 919-924
    Published: 1988
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    A 10-year-old boy was hospitalized with post-traumatic nausea, vomiting, and ataxia. A cervical X-ray showed atlantoaxial dislocation with os odontoideum, and a computed tomography scan revealed multiple cerebellar infarctions. Cerebral angiography disclosed right vertebral artery occlusion at the craniovertebral junction and basilar artery occlusion distal to the origin of the anterior inferior cerebellar artery. An intra-arterial thrombus was present in the left vertebral artery just above the transverse foramen of os axis. Sequential cerebral angiography showed persistent occlusion of the right vertebral and basilar arteries. However, within 1 month of the injury, the thrombus in the vertebral artery had disappeared and an aneurysmal dilatation had appeared at the same site. The patient underwent posterior fusion of the atlas and axis, and his recovery was uneventful. Aneurysmal dilatation disappeared spontaneously 4 months after the trauma. In this case, atlantoaxial dislocation might have caused the left vertebral artery thrombosis and resulted in the basilar artery occlusion. The authors discuss 38 previously reported cases of vertebrobasilar arterial occlusion in children and emphasize that, in children, the vertebral artery is vulnerable at the atlantoaxial level.
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  • Case Report
    Mikiro MATSUMOTO, Kenji SANPEI, Hitoshi OHISHI, Yoshikatsu SEIKI, Hide ...
    1988 Volume 28 Issue 9 Pages 925-929
    Published: 1988
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    A 46-year-old woman was hospitalized in October, 1982 because of double vision and hypesthesia in the left forehead. Computed tomography (CT) and angiography demonstrated a round, well demarcated, vascular tumor in Meckel's cave. A left temporal craniotomy was performed, but complete removal of the tumor was not feasible because of its tight adherence to the cavernous sinus. The histological diagnosis was angioblastic meningioma. The patient was discharged with left facial hypesthesia and abducens palsy. She was readmitted in July of 1983 because of oculomotor palsy, headache, nausea, and progressive worsening of persisting deficits. CT and angiography revealed an notable increase in the tumor's size. After the administration of steroids, all of her symptoms except oculomotor palsy and facial hypesthesia disappeared. Left abducens palsy recurred in August of 1984, and CT scans and angiograms confirmed that the tumor had enlarged. Steroid administration resulted in complete resolution of the abducens palsy. For 3 years thereafter, the patient's neurological status was unchanged. In April, 1987, CT and angiography demonstrated complete disappearance of the tumor, and the patient is now well, with only facial hypesthesia. The most reasonable explanation for this unusual occurrence is thrombotic occlusion of the vessels supplying the tumor.
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  • Case Report
    Tsutomu KATO, Toshimitsu AIDA, Hiroshi ABE, Keikichi MIYAMACHI, Kazuto ...
    1988 Volume 28 Issue 9 Pages 930-933
    Published: 1988
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    An ectopic salivary gland was discovered within the pituitary gland of an 11-year-old boy who had been diagnosed as a pituitary dwarf at the age of 9. On admission his height was 129.5 cm and his weight 31 kg. Pituitary function studies revealed only hyposecretion of growth hormone. There was no neurologic deficit. Plain computed tomography showed a well-defined, high-density mass extending from the sella into the suprasellar cistern. Magnetic resonance imaging demonstrated a cystic lesion, with reduction of the spin-lattice relaxation time (T1) and spin-spin relaxation time (T2). The cyst was totally removed through the trans-sphenoidal approach. Histopathologic examination disclosed that the cyst, which was situated in the posterior lobe of the pituitary gland, contained acid to neutral mucopolysaccharides and acinar tissue formed from simple epithelium. The cells were cuboidal or columnar, with distinct walls. The diagnosis was typical salivary gland. Other cases of extracranial ectopic salivary glands have been reported. However, symptomatic ectopic salivary glands having a pituitary origin are very rare. Nonetheless, ectopic salivary gland should be included in the differential diagnosis of sellar and parasellar lesions. The authors describe this case in detail and review the pertinent literature.
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