Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 29, Issue 12
Displaying 1-14 of 14 articles from this issue
  • Takafumi JINNOUCHI, Shobu SHIBATA, Masaaki FUKUSHIMA, Kazuo MORI
    1989 Volume 29 Issue 12 Pages 1065-1069
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    The microvasculature of ethylnitrosourea (ENU) -induced brain tumors and transplanted 9L cell brain tumors were studied in ultrathin sections and by the freeze fracture replica method. The vessels in ENU-induced tumors were similar to human glioma vessels in that they had endothelial tight junctions and increased pinocytotic vesicles. In the 9L cell tumors, the vessels lacked endothelial tight junctions and had fenestrated endothelium. Macroscopically, Evans blue dye penetrated the 9L cell tumors but not the ENU-induced tumors. Judging from the ultrastructure of the microvessels, the ENU-induced tumor appears more suitable as a human glioma model.
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  • Shoji MASHIYAMA, Ryuichi KATAKURA, Kou TAKAHASHI, Masakazu KITAHARA, J ...
    1989 Volume 29 Issue 12 Pages 1070-1077
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Human glioblastoma A-7 (GB A-7) cells can apparently recover from potentially lethal X-irradiation. The authors, using a colony-forming assay, studied the influence of pretreatment with 1-(4amino-2-methyl-5-pyrimidinyl) methyl-3 (2-chloroethyl) -3-nitrosourea hydrochloride (ACNU) on the effectiveness of X-irradiation against GB A-7 cells grown in monolayers and as multicellular spheroids. Pre-exposure to ACNU inhibited the recovery of irradiated GB A-7 cells. In monolayer cells, the combination treatment was most effective when ACNU was applied 2 to 8 hours prior to irradiation, and the larger the X-ray dose, the more potent the effect. ACNU pretreatment was more effective against large spheroids (enhancement ratio 1.86) than against small ones (1.34). Large spheroids showed necrosis, whereas small ones did not. Isobolographic analysis disclosed that the effect of combining X-irradiation and ACNU is within an additive envelope at the surviving fraction of 10-2, while supra-additive at the surviving fraction of 10-3. These results suggest that the potency of X-irradiation is augmented by ACNU pretreatment through an interactive mechanism. Further, suppression of recovery from X-ray induced potentially lethal damage was influenced by the presence of necrosis.
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  • Naoya KUWAYAMA, Osamu FUKUDA, Keiji KOSHU, Shunro ENDO, Tateo SAITO, A ...
    1989 Volume 29 Issue 12 Pages 1078-1084
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    The Peltier stack, which allows quantitative measurement of cerebral blood flow (CBF) by means of thermal diffusion, has a probe too large for use in small animals. However, it is difficult to measure CBF by a thermal diffusion method involving the use of a constantan heating wire, because of heat conduction between the two gold plates. The authors developed a new thermal diffusion flow probe, using a constantan wire as a heat source rather than the Peltier stack. With the new probe, separation of the gold plates and attachment of a pair of long thermocouples minimize heat conduction between the two plates. Moreover, the probe itself is considerably smaller than that of the Peltier stack.
    The new probe was inserted to the subdural space of rabbits and the voltage (V; mV) was measured with an amplifier by the circuit of constant current method. CBF (F; ml/100 g/min) was measured simultaneously by the hydrogen clearance method in the adjacent cortex. A regression equation of F=29, 111(1/V-1/226) was obtained between 35 pairs of F and V (r=0.92, p<0.001), which verified that CBF can be accurately measured with the new probe.
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  • Hiroshi TENJIN, Yoshio IMAHORI, Norihiko MIZUKAWA, Kimiyoshi HIRAKAWA, ...
    1989 Volume 29 Issue 12 Pages 1085-1095
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Chronological changes in regional cerebral blood flow (rCBF) and in the regional cerebral metabolic rate for glucose (rCMRGIu) were studied by a double tracer autoradiographic method in regions of local ischemia in rabbit brains. Local ischemia was produced by cautery of the bilateral vertebral artery, followed several days later by cautery of the left middle cerebral artery through a transorbital approach and ligation of the left common carotid artery. Autoradiography was performed, 2 hours, 6 hours, and 4 days after occlusion, by a double tracer method involving the use of 14Ciodo-antipyrine and 18F-fluoro-deoxyglucose. Absolute rCBF values were estimated by Sakurada's method and rCMRGIu values by Hutchins' formula. Histological examination was performed concurrently with the rCBF and rCMRGIu study. Mildly ischemic lesions (rCBF of 25 to 40 ml/100 g/ min) were detected in the superior portion of the left frontal lobe, the left parietal lobe, and the left occipital lobe. Severely ischemic lesions (rCBF below 25 ml/100 g/min) were found in the lateral part of the left frontal lobe, the left temporal lobe, and the left caudate nucleus. In the mildly ischemic regions, rCMRGIu decreased in proportion to the decrease in rCBF. That is, matched low perfusion was observed, but there were no histological abnormalities. In severe ischemia the situation was quite different. Two hours after occlusion, most areas showed a decrease in rCMRGIu in proportion to the decrease in rCBF. However, 6 hours after occlusion, rCMRGIu decreased nonuniformly: in some places the decrease was dramatic and in others, rCMRGIu residue was found. Four days after occlusion, the reduction in rCMRGIu was again proportional to the rCBF decrease. In severely ischemic regions, necrosis was observed 4 days after occlusion. Thus, disturbance of glucose metabolism and eventual tissue necrosis occurred in severely ischemic regions. Moreover, the results suggest that nonuniformity of the decrease in rCMRGIu may have prognostic significance in cases of severe ischemic brain insult.
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  • Mechanism of Delayed Postischemic Hypoperfusion
    Chikashi MARUKI
    1989 Volume 29 Issue 12 Pages 1093-1100
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    During the period of recirculation following transient global ischemia, an initial hyperemia is succeeded by a secondary decrease in cerebral blood flow, termed “delayed postischemic hypoperfusion.” It has been suggested that this phenomenon can lead to additional brain damage after the initial ischemic insult. One proposed mechanism of delayed postischemic hypoperfusion is increased cerebrovascular smooth muscle tone. Release of vasoactive amines, formation of vasoactive products of arachidonic acid metabolism, and disturbance of calcium ion homeostasis in cerebrovascular smooth muscle may contribute to postischemic vasoconstriction. In this study, monoamine metabolism following transient global ischemia was investigated. Mongolian gerbils subjected to 15 minutes of temporal bilateral common carotid artery occlusion and up to 6 hours of recirculation were employed as a model of transient global ischemia. In this model, secondary energy failure reportedly occurs after 6 hours of recirculation. Regional cerebral concentrations of monoamines and their metabolites were determined by high-performance liquid chromatography with electrochemical detection. After 4 to 6 hours of recirculation, accumulation of vasoactive amine, 5-hydroxytryptamine, its major metabolite, 5-hydroxyindole acetic acid, and its precursor amino acid, tryptophan were detected. This finding strongly suggests a postischemic increase in both synthesis and release of this amine, which may explain postischemic vasoconstriction. Moreover, increased dopamine synthesis and release after 1 hour of recirculation was suggested. As dopamine release is reported to increase cerebral glucose utilization, its elevation may contribute to an increase in cerebral energy demand after ischemia. Thus, the brain becomes relatively ischemic and secondary ischemic cell damage occurs.
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  • Report of Four Cases
    Akira SAITO, Takuya NAKAZAWA, Masayuki MATSUDA, Jyoji HANDA
    1989 Volume 29 Issue 12 Pages 1101-1106
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Four cases of trigeminal schwannoma with different clinical presentations are reported. Two patients had root-type tumors and two ganglion-type tumors. Computed tomography demonstrated the mass in each case, but extension of the tumor into Meckel's cave, displaced but uninvolved seventh and eighth cranial nerves, extension of the tumor into the orbit or into the infratemporal fossa, and other anatomical details were far more clearly shown by magnetic resonance imaging, which provided confirmation of the mass lesions in the base of the brain and within the posterior fossa.
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  • Ken ASAKURA, Makoto MIZUNO, Nobuyuki YASUI
    1989 Volume 29 Issue 12 Pages 1107-1112
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Twenty-four patients with caudate hemorrhage, in whom such definite organic lesions as arteriovenous malformations or ruptured cerebral aneurysms could not be proved, were analyzed. These cases comprise 2.0% of 1202 cases of hypertensive intracerebral hemorrhage diagnosed by computed tomography and experienced from 1976 through 1987. Thirteen patients were male and 11 were female. Their average age was 61 years. Headache (67%) and nausea and vomiting (50%), which were often the initial symptoms, were similar to those of subarachnoid hemorrhage. The main clinical symptoms were signs of meningeal irritation. Ten patients (42%) had transient disturbance of consciousness, and nine (38%) of these were somnolent; only one patient, who had a massive hematoma, was stuporous. When the hematoma extended to the internal capsule, the patient showed motor disturbance (38%). Two patients (8%) had Horner's sign, five (21%) exhibited diminished activity, and one (4%) suffered anosognosia.
    The volume of the intracerebral hematoma averaged 4.7 ml and was less than 5 ml in 17 patients (71%). In 20 patients (83%), the hematoma was confined to the head of the caudate nucleus. The hemorrhage tended to rupture into the anterior horn of the lateral ventricle, and in nearly all cases (96%), intraventricular hematoma was observed. Seventeen patients (71%) underwent cerebral angiography. There were no instances of dilation of the recurrent artery of Heubner. Twenty patients (83%) were treated conservatively. Continuous ventricular drainage was employed in four patients (17%), and ventriculoperitoneal shunting in three (13%). However, it was judged retrospectively that continuous ventricular drainage had been necessary in only two cases in which disturbance of consciousness was progressed due to acute hydrocephalus. Good recovery was achieved with conservative treatment. In summary, 21 (88%) of 24 patients became independent in terms of activities of daily living.
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  • Kenji WAKIYA, Takanori FUKUSHIMA, Shinichiro MIYAZAKI
    1989 Volume 29 Issue 12 Pages 1113-1118
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Seven males and nine females with glossopharyngeal neuralgia were treated by microvascular decompression (MVD) over a 4-year period. Their ages ranged from 40 to 72 years (average, 54.7 years). The duration of pain ranged from 2 months to 13 years, and all except one patient had brief attacks of lancinating pain in the throat and/or ear. One patient reported dull, paroxysmal throat pain. At surgery, vascular compression of the 9th and 10th nerves at the root entry-exit zone was observed in all cases. The offending vessels were the posterior inferior cerebellar artery (PICA) in 11 cases, the PICA and the anterior inferior cerebellar artery (AICA) in two, the PICA and vertebral artery (VA), and AICA and VA in one case each. The patient with atypical pain had compression by a large vein. In 15 cases of arterial compression, the pain completely disappeared after MVD, and there was no recurrence during the follow-up period, which ranged from 1 month to 4 years. One patient with venous compression had significant pain relief, although mild throat pain persists. In one case, postoperative complications included transient 6th, 7th, and 10th nerve palsies and sensory disturbance, which were assumed to be due to disturbance of the circulation in the perforating branches from the compressing artery. The experience with these 16 patients indicates that vascular compression is the etiology of glossopharyngeal neuralgia and that MVD provides excellent results.
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  • Makoto MIZUNO, Tadashi KURIMOTO, Yasuo KAWAMURA, Hiroshi MATSUMURA
    1989 Volume 29 Issue 12 Pages 1119-1124
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Sixty-two cases of acute subdural hematoma were clinically analyzed with special reference to such prognostic factors as age, Glasgow Coma Scale (GCS) score on admission, pupillary signs, decerebration, and initial computed tomography (CT) findings. Intraparenchymal lesions demonstrated by CT were evaluated according to Yamaura's classification. In 19 cases, serum fibrin and fibrinogen degradation products (FDP) were measured at the time of admission. Emergency surgery was performed in 46 cases, and the remaining 16 patients were treated conservatively. The final outcome was judged according to the Glasgow Outcome Scale, and patients were divided into a “good outcome” group (good recovery or moderate disability) and a “poor outcome” group (severe disability, vegetative state, or death).
    In general, the outcomes proved to be unsatisfactory. Forty-four patients (71%) had a poor outcome, with 32/62 (52%) mortality, and only 18 (29%) had a good outcome. The clinical factors associated with a poor outcome were age over 64 years, a GCS score on admission of less than 7, decerebration, and absence of pupillary reaction to light. Initial CT scans showed brain damage in 46 patients (74%), 39 (85%) of whom had a poor outcome. This indicates that the outcome was significantly related to brain injury complicating the acute subdural hematoma. A high serum FDP level was similarly related to a poor outcome, which suggests that the serum FDP level reflects the degree of both primary and secondary brain injury. Thus, measurement of serum FDP may be valuable both in assessing clinical status and in evaluating the extent of brain injury in acute subdural hematoma.
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  • Gakuji GONDO, Kazuhiko FUJITSU, Takeo KUWABARA, Yasuhiko MOCHIMATSU, Y ...
    1989 Volume 29 Issue 12 Pages 1125-1131
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    In neurosurgical patients with renal failure, dialysis entails specific problems, chief of which is increased intracranial pressure and progressive brain edema as a result of rapid lowering of the serum osmolality. Another major problem is a tendency to hemorrhage, in response to either systemic heparinization or insufficient dialysis. The authors describe the results obtained with hemodialysis (HD), continuous arteriovenous hemofiltration (CAVH), continuous ambulatory peritoneal dialysis (CAPD), continuous peritoneal dialysis (CPD), and intermittent peritoneal dialysis (IPD) . Nine patients were treated with HD, one with CAVH, five with CAPD or CPD, and two with IPD. Three of the six patients treated with continuous dialysis (CAVH, CAPD, and CPD) died, whereas intermittent dialysis (HD and IPD) carried an 82% mortality rate (nine of 11 patients). The causes of death were progressive brain edema in three cases, intracranial hemorrhage in three, gastrointestinal bleeding in three, overhydration due to insufficient dialysis in one, septicemia in one, and rupture of a cerebral aneurysm in one. Continuous dialysis appeared to be superior to intermittent dialysis in these neurosurgical patients in that it produced less brain edema and was less often associated with hemorrhage due to insufficient dialysis. In HD and CAVH, systemic heparinization was also thought to account for the high incidence of hemorrhage. However, CAVH with short half-life anticoagulants may be useful in patients who have abdominal complications and are therefore not suitable candidates for peritoneal dialysis.
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  • Report of Three Cases
    Junya HANAKITA, Hideyuki SUWA, Shinji NAGAYASU, Shogo NISHI, Fumito OH ...
    1989 Volume 29 Issue 12 Pages 1132-1136
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Cervical spondylotic myelopathy usually arises in patients in their late 40s or early 50s, most frequently at the C5/6 and C6/7 levels. Recently, excellent results have been attained with microsurgery in cases of cervical spondylosis. On the other hand, treatment of cervical spondylotic myelopathy in patients with athetoid dystonic cerebral palsy entails several problems. The authors report three cases of such troublesome myelopathy. A 34-year-old male with severe athetoid movement showed cervical spondylotic myelopathy. Myelography and magnetic resonance (MR) imaging demonstrated compression of the spinal cord through the C3-C5 levels. A 47-year-old female with athetoid dystonic cerebral palsy presented myelopathy. Myelography and MR imaging showed instability and spinal cord compression at the C5/6 level. A 34-year-old male with spasmodic torticollis showed C6 radiculopathy due to cervical disc hernia at the C5/6 level. Cervical anterior decompression with interbody fusion brought temporary improvement in all the three patients. However, such problems as slippage of Halo-vest, difficulty in eating during Halo-vest fixation, relapse of neurological deficit, were experienced. Due to postoperative cervical instability, cervical laminectomy is considered to be contraindicated in such patients. Anterior decompression with bone fusion has been reported effective, but, if athetoid dystonia continues, there is a potential for myelopathic deterioration due to spondylotic changes adjacent to the fused vertebrae.
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  • Case Report
    Yoshihiro YAMAMOTO, Katsuzo KUNISHIO, Masakazu SUGA, Norio SUNAMI, Yuj ...
    1989 Volume 29 Issue 12 Pages 1137-1143
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    A 13-month-old boy admitted with lethargy and hydrocephalus was found to have a right thalamic mass. Ventricular drainage was instituted, and the tumor mass was reduced by partial resection and local irradiation. A ventriculoperitoneal shunt was then placed. However, the tumor recurred 16 months later, with extensive ventricular seeding and peritoneal metastasis through the shunt tube. The child died 22 months after onset. Histological study of surgical specimens of the primary tumor and autopsy specimens of the brain and peritoneal metastatic tumors revealed poorly differentiated, small, round cells with numerous mitotic figures. In addition, autopsy specimens of the brain tumor contained areas of ependymal, oligodendroblastic, and spongioblastic differentiation. On immunohistochemical study, the tumor cells of each specimen were positive for antineuron specific enolase and anti-neurofilament antibodies, but negative for anti-glial fibrillary acidic protein antibodies. Electron microscopy revealed some zonulae adherens. These findings strongly suggest that the tumor originated from primitive multipotential cells capable of differentiating into ependymal, glial, and neuronal lines.
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  • Report of Two Cases
    Ikuya YAMAURA, Atsuhiko SUKENAGA, Tsuyoshi MATSUMOTO, Yukio MAEDA
    1989 Volume 29 Issue 12 Pages 1144-1147
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Two cases of tapered occlusion of the unilateral internal carotid artery after head and facial injury are reported. The first was a 42-year-old male admitted because of left hemiparesis 3 hours after receiving blows to the face. Computed tomography (CT) scan obtained 10 hours after injury showed an area of slight low density in the right frontotemporal region. Carotid angiography demonstrated tapered occlusion of the right cervical internal carotid artery. A large cerebral infarction had developed in the right hemisphere and the patient died 10 days after the traumatic incident. The second case involved a 45-year-old male hospitalized with aphasia and right hemiparesis about 1 month after incurring a depressed fracture of the left temporal bone. CT revealed two small lowdensity areas in the left corona radiata, and carotid angiography disclosed tapered occlusion of the left cervical internal carotid artery. The neurological signs gradually improved after anticoagulant therapy. Early diagnosis of traumatic cervical carotid artery occlusion may be difficult in the absence of apparent cervical trauma with focal cerebral symptoms appearing after a lucid interval. No definitive management has been established and the prognosis is poor. It is emphasized that unusual neurological symptoms following head or cervical trauma should provoke suspicion of carotid artery injury, which, on diagnosis, should be promptly treated.
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  • Case Report
    Masaru MIYATA, Haruo YAMASHITA, Seiya SHIRAKATA, Zenju TAKEDA
    1989 Volume 29 Issue 12 Pages 1148-1152
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    A 24-year-old female was hospitalized for progressive headache and nausea. Computed tomography showed a mass lesion in the left lateral ventricle near the foramen of Monro. On light microscopy, this tumor morphologically resembled an oligodendroglioma. However, ultrastructural examination disclosed synapses and neuronal differentiation. Review of the literature revealed 21 cases of intraventricular neuronal tumors in adults that were diagnosed as central neurocytoma or differentiated neuroblastoma. Fourteen of the 21 patients were males and seven were females. Their ages ranged from 16 to 52 years and averaged 30.7 years. All of the tumors were located near the foramen of Monro and the clinical symptoms were primarily headache and nausea. The outcome was generally good. Surgical removal was the most effective treatment, whereas the effect of radiation therapy was unclear. The diagnosis requires demonstration of neuronal differentiation. Generally, the diagnosis is neurocytoma if the neuronal tissue is mature, with complete synapses, and neuroblastoma if it is immature. However, the criteria for differentiation between these two tumors are still controversial.
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