Neurologia medico-chirurgica

An Experimental Model of Cerebral Venous Hypertension in the Rat

Yasutaka KUROKAWA, Kazuo HASHI, Tohru OKUYAMA, Satoshi SASAKI

1989 Volume 29 Issue 3 Pages 175-180
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.175

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Several means of establishing a useful experimental model of cerebral venous hypertension were examined in rats. Retrograde embolization with an autologous blood clot passed through a catheter inserted in an external jugular vein, combined with ligation of the contralateral external jugular vein, was found to produce consistent, sustained cerebral venous hypertension. This model has the advantages of being technically easy to prepare, well tolerated by the animals, and suitable for autoradiographic and/or histochemical assessment of regional circulation and metabolism.

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Regional Disparity in the Vascular Response to Subarachnoid Hemorrhage

—Relationship between Alteration of the Concentration of Eicosanoids and Electron Microscopic Findings—

Saburo NAKAMURA, Kenshi YOSHIDA, Takashi TSUBOKAWA

1989 Volume 29 Issue 3 Pages 181-186
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.181

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In an attempt to document the apparent regional disparity of the vascular response to subarachnoid hemorrhage (SAH), the authors measured the concentrations of eicosanoids in various arterial segments corresponding to alterations observed on electron microscopy, using cats with experimentally produced SAH. The level of thromboxane B₂ was elevated in both the arterial walls and cerebral cortices, particularly in the latter, on day 7 after SAH production. The 6-keto-prostaglandin F_1α (6-keto-PGF_1α) levels in the SAH group were decreased in the basilar and pial arteries after the production of SAH. The mean concentration of 6-keto-PGF, a in the cerebral cortices showed only slight, erratic changes. Ultrastructural observations revealed that the vessels of smaller diameter, such as the pial vessels, underwent more marked spastic changes than did those of larger diameter. These results suggest that the ischemic events following SAH may have been induced by vasospasm and increased coagulability caused by changes in the concentrations of arachidonic acid metabolites in arteries of relatively small diameter.

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Neurotransmitter Amines in Brain Edema of a Rat Glioma Model

Chia-Cheng CHANG

1989 Volume 29 Issue 3 Pages 187-191
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.187

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The effect of vasogenic brain edema on amine neurotransmitter concentrations as studied in rats bearing transplanted glioma C6 brain tumors. In comparison with sham-operated and nonoperated controls, the tumor-implanted animals showed significant decreases in both dopamine (DA) and norepinephrine (NE) in the hypothalamus, cortex, and striatum. Treatment with dexamethasone (DEX) tended to restore these monoamines to the levels measured in sham-operated controls. In the nonoperated controls, DEX significantly increased NE but not DA. In tumor-bearing rats there was no increase in hypothalamic or striatal water content, and DEX had no effect on the water content of these structures. However, there was a significant increase in the cortical water content, which was reduced by DEX to the control levels. The water content within the tumor was also significantly decreased by DEX. In the nonoperated controls, there was no difference in water content between DEX-treated and nontreated animals. These findings suggest that tumor-induced brain edema reduces noradrenergic and dopaminergic activities. DEX administration resulted in normalization of the water content in edematous regions and of the DA and NE concentrations, and brought about marked symptomatic improvement.

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Biochemical Markers in the Acute Stage of Head Injury

—Aldosterone and CK-BB—

Hideaki TAKAHASHI, Hiroshi SATO, Yukihide TSUJI

1989 Volume 29 Issue 3 Pages 192-195
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.192

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In the acute stage of head injury biochemical markers are valuable in the assessment of tissue damage and outcome. In this study, in addition to evaluating computed tomographic (CT) scans, we measured plasma aldosterone and brain type of serum creatine kinase isozyme (CK-BB) to determine whether or not the values obtained reflect the degree of morphological brain changes caused by injury. All 152 patients studied were diagnosed with CT and blood samples were taken on admission. On the basis of clinical and CT findings they were classified into seven groups according to the nature and severity of the insult. Slightly over one half had severe brain injury. Aldosterone was measured by radioimmunoassay and CK-BB by electrophoresis. Aldosterone and CK-BB levels were high in patients with severe cerebral contusion and in those whose CT scans showed a marked midline shift and disappearance of the perimesencephalic cistern. Aldosterone, but not CK-BB, was markedly elevated in patients with epidural hematoma and was only moderately increased in those with a slight midline shift. The results of this study indicate that aldosterone and CK-BB may be useful as biochemical markers in the acute stage of head injury.

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Late Infection after Cranioplasty

—Review of 14 Cases—

Kazuhiko TOKORO, Yasuhiro CHIBA, Kyoji TSUBONE

1989 Volume 29 Issue 3 Pages 196-201
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.196

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The incidence of late infection after cranioplasty was studied in 130 patients with 133 cranioplasties. The materials used were prefabricated resin in 62 cases, autogenic bone in 38, intraoperatively fashioned resin in 25, and vitallium in eight. Six infections were documented, for an infection rate of 4.5%. In addition to these six cases, we studied eight patients with infections who had undergone cranioplasty elsewhere but had the infected plates removed in our hospitals. Among the 14 cases of infection, the intervals between cranioplasty and plate removal were 3 to 43 months (average, 10.5 months). The eight patients referred from other hospitals had a significantly shorter average interval between external decompression and cranioplasty than did patients who did not develop infection (2.6 versus 6.7 months; p < 0.005). Systemic signs were mild despite obvious local signs of infection. Of the 11 first infections, nine (82%) were associated with discharge of pus from a fistula; in these cases a galeal suture had become infected apparently through scratching by the patients. In contrast, in the three patients who had had a previous infection, the second infection manifested as subgaleal and epidural empyema or meningitis without a fistula or pus discharge. Nine infections (69%) were due to Staphylococcus. All but two patients required removal of the infected plates. One recovered with conservative therapy and one died of meningitis, giving a mortality rate of 0.8%. No matter how mild the systemic signs, late infection warrants surgical debridement and plate removal. The risk factors for late infection of cranioplasty are discussed.

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The Role of Serial Angiography in the Management of Bacterial and Fungal Intracranial Aneurysms

—Report of Two Cases and Review of the Literature—

Yasuhiro KOJIMA, Akihito SAITO, Ilu KIM

1989 Volume 29 Issue 3 Pages 202-216
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.202

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The authors review 149 cases of bacterial and mycotic intracranial aneurysms reported since 1957 and describe two cases of bacterial aneurysms managed in their institution. The overall mortality rate was 39%. Bacterial aneurysms accounted for 0.49-4.3% of all intracranial aneurysms. Among the reported cases, the mortality rate for patients treated with antibiotics alone was high, whereas it was low among those who underwent elective surgery. The authors conclude the following: 1) Distal aneurysms should be treated with high-dose antibiotics and followed with serial cerebral angiography at 7 days, 14 days, 1 month, 3 months, and 1 year after the initiation of therapy; 2) proximal aneurysms should be treated with high-dose antibiotics, and surgery is rarely indicated; 3) any significant associated hematoma should be evacuated and the aneurysm resected, if possible; and 4) if serial angiography shows enlargement of an aneurysm, surgery should be considered. The clinical features and management of mycotic and bacterial aneurysms are discussed in detail.

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Effects of Human Recombinant Interferon-gamma on Immunological Parameters in Brain Tumor Patients

—Report of Two Cases—

Kazufumi KAMIKASEDA, Iwao TAKESHITA, Masashi FUKUI, Kikuo NOMOTO

1989 Volume 29 Issue 3 Pages 217-222
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.217

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Two patients with brain tumors were treated with human recombinant interferon-gamma (ReIFNgamma) in a clinical phase II study, and its effects on their white blood cell counts, T cell subsets, natural killer (NK) cell activity, and tuberculin skin reactions were investigated. Leukopenia developed shortly after the start of therapy and persisted until its discontinuation, after which the white blood cell counts recovered. T cell subsets were dramatically altered, with an increase in OKT4⁺ cells and a decrease in OKT8⁺ cells, within 4 hours after the administration of ReIFN-gamma. NK cell activity was suppressed at 4 hours after administration but was slightly enhanced at 12 hours after administration. The tuberculin skin reaction was also enhanced during the therapy. ReIFN-gamma may be effective in augmenting host defenses against brain tumor.

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Cerebellar Malignant Glioma after Radiation Therapy for Suprasellar Germinoma

—Case Report—

Tohru TAMURA, Saburo NAKAMURA, Kanji SHIRATA, Kohten SATO, Takashi TSU ...

1989 Volume 29 Issue 3 Pages 223-229
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.223

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A 39-year-old male was discovered to have a malignant glioma in the right cerebellar hemisphere 8 years after surgical excision of a suprasellar germinoma and postoperative irradiation (4250 cGy). The clinical and pathological details are presented, and the literature on radiation-induced gliomas is reviewed.

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Congenital Arteriovenous Malformation of the Scalp

—Case Report—

Yoji KOMATSU, Kiyoshi NARUSHIMA, Eiki KOBAYASHI, Tadao NOSE, Yutaka MA ...

1989 Volume 29 Issue 3 Pages 230-234
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.230

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A case of congenital arteriovenous malformation (AVM) of the scalp containing a complex vascular network is described. The AVM was totally removed, together with its feeding artery and draining veins. Congenital AVM of the scalp is rare; only 21 other cases have been reported since 1973. All involved complex vascular networks, and about one half of the patients had red or purple birthmarks. These clinical features clearly differ from those of traumatic arteriovenous fistulae of the scalp. Although many treatment approaches have been tried, total excision appears to be the most appropriate.

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Klippel Trenaunay Weber Syndrome with Spinal Arteriovenous Malformation

—Case Report—

Yasuhiro KOJIMA, Nobumasa KUWANA, Masazumi SATO, Yoshihiro IKEDA

1989 Volume 29 Issue 3 Pages 235-240
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.235

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A 28-year-old female with Klippel-Trenaunay-Weber syndrome associated with an arteriovenous malformation (AVM) of the spinal cord is reported. She was admitted to our hospital with a 4month history of steadily progressive weakness and dysesthesia of the legs. A nevus flammeus, varices, hypertrophy and elongation of the left leg had been present since her infancy. These symptoms progressed and she became unable to walk and pass water by herself. Myelography disclosed a spinal AVM extending from Thll to L2. Angiography confirmed the presence of stretched and tortuous vessels as well as an arteriovenous shunt in the left leg. Magnetic resonance imaging showed a highintensity area extending from Th l0 to L2. Following laminectomy from Th l0 to L2 and resection of the AVM, her motor and bladder functions worsened. However, 6 months later, her motor function improved to the preoperative state and the bladder dysfunction disappeared. The coexistence of Klippel-Trenaunay-Weber syndrome with spinal AVM, considered to be rare, is discussed, and the pertinent literature is reviewed. The case presented here is the first to have been surgically treated in Japan.

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Intracerebral Hemorrhage from a Peripheral Aneurysm associated with an Astrocytoma

—Case Report—

Yoshiaki KADOTA, Shizuo HATASHITA, Tokiwa SAKAKIBARA, Suguru TAKAGI

1989 Volume 29 Issue 3 Pages 241-244
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.241

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A 23-year-old female developed a massive hemorrhage in the left frontal lobe from a ruptured aneurysm on a distal branch of the left anterior cerebral artery. The aneurysm was associated with an astrocytoma. The histopathological findings suggested that the aneurysm may have been due to the destruction of the arterial wall by tumor cells.

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Multiple Saccular Cerebral Aneurysms associated with Systemic Lupus Erythematosus

—Case Report—

Akio ASAI, Masao MATSUTANI, Takeshi KOHNO, Takamitsu FUJIMAKI, Kintomo ...

1989 Volume 29 Issue 3 Pages 245-247
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.245

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A rare case of multiple saccular cerebral aneurysms in a patient with systemic lupus erythematosus (SLE) is presented. The aneurysms were located at the junction of the left internal carotid artery (ICA) and the posterior communicating artery (PComA), at the anterior communicating artery, at the middle cerebral artery, at the junction of the right ICA and the PComA, and at the top of the basilar artery. All the aneurysms, except for the one on the basilar artery, which was unruptured, were successfully clipped. Histopathological examination of one resected aneurysmal dome confirmed the diagnosis of transmural arteritis secondary to SLE. Postoperatively, she died of a massive hemorrhage from a rectal ulcer. The etiology and prognosis of cerebral aneurysms in SLE are discussed.

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Monostotic Fibrous Dysplasia of the Left Parietal Bone

—Case Report—

Shin-ichi OTSUKA, Shoji NAKATSU, Shigeo MATSUMOTO, Shin-ichi SATO, Tak ...

1989 Volume 29 Issue 3 Pages 248-250
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.248

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A 14-year-old female presented with a hard, painless mass, 5 × 5 cm, in the left parietal region. Skull x-rays showed a radiolucent skull tumor with a sclerotic margin in the parietal region. Computed tomography revealed an intradiploic multilocular mass separated by bony trabeculae. The outer table had thinned and protruded outward. The inner table was also thin and protruded inward slightly. External carotid angiography revealed a faint tumor stain and feeding from the middle meningeal artery. Bone scintigraphy revealed abnormal uptake in the lesion. Total removal of the skull tumor and cranioplasty were performed. The histological diagnosis was fibrous dysplasia. Fibrous dysplasia within the cranial vault is often expressed as painless bulging without neurological symptoms. Surgery is recommended when neurological symptoms and/or cosmetic problems are present. Histological confirmation of the diagnosis is also important.

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Intraventricular Cryptococcal Granulomas

—Case Report—

Nobuhiko AOKI

1989 Volume 29 Issue 3 Pages 251-254
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.251

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A 54-year-old, previously healthy female with chronic meningoencephalitis is presented. Computed tomography (CT) revealed hydrocephalus and mass lesions in both the lateral and fourth ventricles. A culture of cerebrospinal fluid obtained from the lateral ventricle on admission was negative, but 2 years later, when the meningoencephalitis recurred, Cryptococcus neoformans was cultured. The diagnostic difficulties and CT features of intracranial cryptococcal granulomas are discussed.

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Elevation of Plasma A trial Natriuretic Peptide in a Neurosurgical Patient with the Syndrome of Inappropriate Secretion of Antidiuretic Hormone

—Case Report—

Naohito YAMAMOTO, Akio KUWAYAMA, Norihiro MIYAMOTO, Hisao SEO, Nobuo M ...

1989 Volume 29 Issue 3 Pages 255-258
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.255

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The authors describe a case of subarachnoid hemorrhage with hyponatremia accompanied by elevation of plasma atrial natriuretic peptide (ANP). The early phase of hyponatremia was classified as the syndrome of inappropriate secretion of antidiuretic hormone (ADH) due to subarachnoid hemorrhage. However, in the later phase, hyponatremia and natriuresis were accompanied by suppression of ADH while plasma ANP remained elevated. The patient was effectively treated with demeclocycline and hypertonic saline. The significance of ANP in the pathophysiology of increased natriuresis is discussed.

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