Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 29, Issue 4
Displaying 1-15 of 15 articles from this issue
  • Takamitsu UCHIZAWA
    1989 Volume 29 Issue 4 Pages 273-279
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Intracerebral serum proteins were measured in rats with altered blood-brain barrier (BBB) function. The rats were divided into seven groups of five to 10 each and subjected to the following procedures: controls (NOR) ; bilateral common carotid artery ligation (BLCL), evaluated after 6 hours; three-vessel occlusion (bilateral common carotid and right vertebral arteries) (TVO), evaluated after 6 hours; cold injury (BE6 and BE24), evaluated after 6 and 24 hours; and intracarotid injection of a hypertonic solution (BBB6 and BBB24), evaluated after 6 and 24 hours. The protein components of concentrated, water-soluble extracts of each rat's brain were analyzed by cellulose acetate membrane electrophoresis. Serum proteins of each rat were also analyzed. The intracerebral albumin fraction was increased in groups BE24, BBB6, and some TVO rats. The intracerebral α-1 fraction was increased in group BBB24. No difference was found in the lectrophoretographic patterns of groups NOR and BLCL. These findings demonstrate that serum albumin is increased in TVO, and suggest that the BBB is damaged as in cold injury, which is thought to cause edema. The predominant intracerebral serum protein appeared to change from the α-1 fraction to the albumin fraction in cold-injured animals, which suggests that under this circumstance the BBB becomes progressively permeable to larger molecules. However, following injection of the hypertonic solution, the predominant intracerebral serum protein pattern changed from albumin to α-1, indicating recovery of BBB function. These differences in the intracerebral protein profiles may reflect differences between BBB disruption without edema and vasogenic brain edema. Disruption of the BBB may play as important a role in ischemic brain edema as it does in vasogenic edema.
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  • Takehiko SASAKI, Rihei TAKEDA, Toshikazu OGASAWARA, Toshio HYOGO, Yosh ...
    1989 Volume 29 Issue 4 Pages 280-284
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Intraoperative somatosensory evoked potentials (SEPs) were measured in 17 patients during 21 extracranial revascularization and related procedures. The operations included 13 carotid endarterectomies (CEAs), two cervical internal carotid ligations, one vertebral artery (VA) clipping, one VA-common carotid artery (CCA) transposition, and four temporary balloon occlusion tests (TBOTs). Three of the 13 CEAs (23%) showed reduced amplitude and delayed latency of primary cortical SEPs during clamping of the carotid artery, followed by their recovery after emplacement of the internal shunt. Flattening of SEPs during clamping of the CCA was observed in the case of VA-CCA transposition; however, SEPs returned to normal immediately after insertion of a biballoon indwelling shunt into the CCA. One of the four TBOTs showed alteration of SEPs during balloon occlusion of the subclavian artery proximal to the origin of the VA. In the others, SEPs remained stable during the entire procedure. Only one transient intraoperative ischemic complication was encountered among the cases of CEA. It was detected through flattening of SEPs, which led to the discovery of an internal shunt obstruction. Carotid stump pressure was also measured in 12 CEAs and two TBOTs, and seven of these 14 had pressure ≤50 mmHg. Four of the seven had carotid stump pressure ≤30 mmHg, and three of these four also showed altered SEPs. SEPs remained stable if the collateral flow was sufficient during vascular occlusion and showed obvious alteration when the blood flow was reduced to below the threshold. The authors conclude that monitoring of SEPs during extracranial revascularization is very useful.
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  • Kazuyoshi KOROSUE, Takeshi KONDOH, Akihiro ISHIKAWA, Hisahiko SUZUKI, ...
    1989 Volume 29 Issue 4 Pages 285-291
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Delayed neurologic deterioration from vasospasm remains the greatest cause of morbidity and mortality following subarachnoid hemorrhage. The authors performed superficial temporal arterymiddle cerebral artery bypass in three patients with symptomatic vasospasm and studied its effects on cerebral hemodynamics. All three patients responded neurologically to the bypass procedure within 24 hours. The average cerebral blood flow in the region supplied by the spastic middle cerebral artery increased from 40 ml/100 g/min to 49 ml/100 g/min after bypass. Angiography disclosed dilatation of donor vessels during the peak of spasm, followed by their decrease in caliber coincident with alleviation of vasospasm. The authors conclude that superficial temporal arterymiddle cerebral artery anastomosis for the management of symptomatic vasospasm can increase blood flow in the ischemic region supplied by the spastic artery. This management strategy may lower the incidence of death and disability from vasospasm after subarachnoid hemorrhage.
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  • Reconstruction of the Vertebral Artery in the Distal First Portion
    Shunichiro FUJIMOTO, Yoshinori TERAI, Takahiko ITOH, Masamitsu KAWAUCH ...
    1989 Volume 29 Issue 4 Pages 292-296
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Fourteen patients with symptoms of vertebrobasilar insufficiency caused by vertebral artery stenosis in the distal first portion underwent surgical reconstruction. They ranged in age between 42 and 73 years, with a median age of 57 years. Their symptoms included vertigo, dysarthria, syncope, hemiparesis, and homonymous quadrant anopsia. The etiologies of the stenoses involved kinking in 12 cases and mechanical compression due to cervical sympathetic nerve, osteophyte, or fibrous bands in two cases. Digital subtraction angiography revealed that stenosis was maximal at systole and minimal at diastole in six of eight cases. In two of the 14 cases, stenosis was not demonstrated in the neutral position, but stenosis of the left vertebral artery appeared when the head was rotated to the right. Surgical procedures involved 13 decompressions of the vertebral artery and one subclavian artery-vertebral artery bypass using the saphenous vein. Postoperatively, 12 cases of miosis and one of asymptomatic phrenic nerve palsy were observed, but there were no serious complications. All but two patients had complete resolution of their symptoms. Stenosis due to kinking and/or mechanical compression disappeared in all cases after decompression of the vertebral artery. The effects of arterial pulse and neck rotation on vertebral artery stenosis in the distal first portion are discussed.
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  • Relationship with Severity of Injury and Age
    Jun-ichi IKEDA, Jun-ichi KURATSU, Nobuhito NONAKA, Yasuhiko MATSUKADO, ...
    1989 Volume 29 Issue 4 Pages 297-301
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    The immunological function of 29 head-injured patients was investigated, with special reference to the relationships between changes in immunity and both severity of head injury and age. The patients were classified according to Glasgow Coma Scale scores (15, 9 to 14, and 3 to 8) and age (under 35, 35 to 65, and over 65 years). T cell subsets (OKT4 and OKT8) and Leu-11 a cells were studied by flow cytometry with the use of monoclonal antibody. Lymphocyte stimulation indices were also evaluated. The percentage of OKT4 cells was significantly decreased in the young patients with severe head injury, whereas the percentage of OKT8 cells remained almost within the normal range. Thus, the ratio of OKT4 to OKT8 cells was decreased. The percentage of Leu-1 la cells showed no correlation with severity of injury or age. Lymphocyte stimulation indices were reduced in cases of severe head injury. In this study, patients with severe head injury were immunosuppressed, particularly those under age 35.
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  • Report of Four Cases
    Izumi KOYANAGI, Yoshinobu IWASAKI, Toyohiko ISU, Minoru AKINO, Hiroshi ...
    1989 Volume 29 Issue 4 Pages 302-306
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Four cases of acute cervical cord injury treated by posterior midline myelotomy are described. The initial neurological examinations of these four patients indicated complete cord lesions. On plain neck X-rays, two exhibited anterior dislocation and two showed no bony injury other than ossification of the posterior longitudinal ligament. Myelography via C1/2 lateral puncture showed complete block of the subarachnoid space in two cases, and incomplete block in the other two. Computed tomographic myelography revealed cord swelling in all cases. Posterior midline myelotomy was performed after administration of a steroid and mannitol, or reduction of spinal dislocation. The time from injury to myelotomy ranged from 5 to 21 hours. No patient developed new deficits postoperatively. During long-term follow-up, which ranged from 10 to 19 months, all patients showed improvement in motor function of the upper extremities. Sensory disturbances also diminished to some degree. However, in one patient, who underwent myelotomy 18 hours after injury and had shown progressive neurological deterioration before surgery, the improvement in motor function was only slight. In this case, earlier myelotomy may have been more beneficial. These results support the indication for myelotomy in cases of acute cervical cord injury with cord swelling. Particularly if performed early, this procedure is effective in preventing secondary neurological damage.
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  • Report of Three Cases
    Hideaki IIZUKA, Tsutomu NAKAMURA, Masaru KATO
    1989 Volume 29 Issue 4 Pages 307-311
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Three patients with non-Hodgkin's lymphoma involving the spinal epidural space are reported. All three patients, a 3-year-old boy (Case 1), a 63-year-old female (Case 2), and a 64-year-old male (Case 3), manifested signs and symptoms of neurological involvement before the diagnosis of malignant lymphoma was established by tissue examination. The tumors were located in the thoracic (Case 3) and thoracolumbar regions (Cases 1 and 2). The initial signs and symptoms of all cases were low back pain and progressing myelopathies. Bony abnormalities of the vertebrae, seen on both plain X-rays and computed tomographic scans, were unremarkable except for bilateral L 1 pedicle erosion observed in Case 2. Total or subtotal tumor removal was followed by radiation therapy with or without chemotherapy in all cases. The primary lesion in Case 1 was a paravertebral lymphoma that had invaded the adjacent thoracolumbar epidural space through the intervertebral foramina. In Case 2, the primary lesion, documented by post-mortem examination, was a submucosal lymphoma of the stomach. In Case 3, the site of primary lesion could not be determined, although splenic and retroperitoneal nodal involvement was found at autopsy. The authors take a skeptical view of the existence of “primary” spinal epidural lymphoma, which has been reported a few times. Each of the three patients reported here presented with an epidural mass as the initial clinical manifestation of malignant lymphoma.
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  • Noboru SAKAI, Hiromu YAMADA, Takashi ANDOH, Mitsuaki TAKADA, Toshifumi ...
    1989 Volume 29 Issue 4 Pages 312-318
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Intraoperative radiation therapy (IOR) is an ideal means of exterminating residual tumor after surgical resection. In this study, the clinical results of IOR using a Scanditronix Microtron MM-22 were evaluated in 14 patients with malignant glioma, five of whom had recurrent tumors. Between July, 1985 and October, 1986, 11 patients with glioblastoma multiforme (GB) were irradiated 18 times (mean, 1.6 times/case), and three with astrocytoma (Kernohan grade III) underwent IOR once each. The target-absorbed dose at 1 to 2 cm deeper than the tumor resection surface was 15 to 50 Gy. During irradiation, a cotton bolus was placed in the dead space after over 91 % of the tumor had been resected. As a rule, external irradiation therapy was also given postoperatively at a dose of 30 to 52 Gy. One patient died of pneumonia and disseminated intravascular coagulation syndrome 1 month postoperatively. The 1 and 2-year survival rates of the remaining 13 patients were 84.6% and 61.5%, respectively; among the 10 with GB, they were 80% and 50%. Generally, the smaller the tumor size, the better the results. There were no adverse effects, despite the dose 15 to 50 Gy applied temporally to the tumor bed. IOR was especially effective against small, localized tumors, but was not always beneficial in cases of large tumors, particularly those with a contralateral focus. The improved survival rate in this series demonstrates that IOR is significantly effective in the “induction of remission” following surgical excision of malignant gliomas.
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  • Case Report
    Yasutaka MAEDA, Toshiaki FUJITA, Satoshi YAMAMOTO, Mitsumasa KANOH
    1989 Volume 29 Issue 4 Pages 319-323
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    A case of recurrent cerebral aneurysm after complete neck clipping is described. A 47-year-old male who presented with headache and nausea underwent neck clipping of a berry aneurysm of the left middle cerebral artery. Ten days later, angiographic findings suggested the presence of a second, large aneurysm adjacent to the first, which suggested misplaced clipping. Reoperation confirmed that a new aneurysm had formed next to the original aneurysm. A possible explanation of the recurrence is as follows. The M1 flowed into the M2 at a right angle. The aneurysmal neck was situated on the distal end of the M1 and the dome protruded anteroinferiorly at an angle of nearly 90' to the long axis of the M1 opposite the origin of the M2-. The parent artery bulged slightly, and its wall was thin and reddish, just distal to the aneurysmal neck. Proximal to the neck there was another small bulge, but the wall here was normal. These bulges were coated with Oxycel(R) and Biobond(R) at the time of aneurysmal neck clipping. After clipping, blood flow into the dome was interrupted, and the consequent hemodynamic stress caused the bulges to expand dramatically and form a new aneurysm. The authors conclude that there is a likelihood of early recurrence after neck clipping if the parent artery exhibits such morphological features as observed in this case.
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  • Case Report
    Ken SUGIYAMA, Hidetoshi MOCHIDA, Hideharu KARASAWA, Hiroshi KIN, Tetsu ...
    1989 Volume 29 Issue 4 Pages 324-327
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Palinopsia is defined as persistence or recurrence of a visual image when the stimulus is no longer present. The authors describe a female patient with a left tentorial meningioma who experienced recurrent visual images. Computed tomography revealed a well demarcated, high-density mass above the left side of the tentorium, but formal field testing revealed no visual field defect. The findings in this case suggest that the palinopsia may have been the result of disordered temporal synthesis of visual experiences.
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  • Case Report
    Akira KURATA, Takeshi SAITO, Masaya AKATSUKA, Shinichi KANN, Hiroshi T ...
    1989 Volume 29 Issue 4 Pages 328-332
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    A case of acoustic neurinoma with multiple intratumoral hemorrhages is reported. A 56-year-old male noted sudden hearing reduction in his left ear in October of 1985. The diagnosis of a local physician was sudden deafness. About 10 months later, he had two episodes of severe headache without nausea or vomiting. The patient was hospitalized in October of 1986. Neurological examination on admission revealed left V and VII-X cranial nerve palsies and left cerebellar ataxia. Plain and enhanced computed tomography revealed only an unremarkable low-density area at the left cerebellopontine angle. In contrast, magnetic resonance imaging (MRI) clearly demonstrated a large (3 × 4 × 5 cm), multicystic tumor in this site. On exposure of the tumor at surgery, most of the cysts were found to be filled with a dark red or xanthochromic fluid. The tumor was completely removed following numerous cyst punctures to decrease its volume. There was no evidence of subarachnoid hemorrhage. Histological examination showed a typical acoustic neurinoma. The cyst wall contained numerous telangiectasia-like lesions. The initial symptom of this patient was sudden hearing loss, which is an atypical manifestation of acoustic neurinoma. The massive intratumoral hemorrhage was thought to be caused by telangiectatic lesions in the cyst wall. MRI clearly demonstrated the hemorrhagic cysts within the tumor, especially in the posterior fossa.
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  • Case Report
    Masashi NAKATSUKASA, Shigeo TOYA, Mitsuhiro OTANI, Kazunari YOSHIDA, Y ...
    1989 Volume 29 Issue 4 Pages 333-337
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    A case of pineocytoma associated with intraventricular and meningeal metastasis is reported. The patient, a 25-year-old female, was admitted complaining of headache. Computed tomography revealed an irregular-shaped pineal lesion enhanced by contrast medium and accompanied by a cyst. An intraventricular cystic metastatic lesion and meningeal metastasis were also suggested. Biopsy of the pineal region proved the lesion to be a pineocytoma without neuronal or filial differentiation. Ventriculoperitoneal shunting was performed, and radiation therapy combined with chemotherapy (ACNU and vincristine) was administered. This treatment apparently destroyed both the primary and metastatic lesions, and the patient returned to her normal life. In 4 years of follow-up there has been no recurrence of the tumor. Pineocytoma with meningeal metastasis usually has a poor prognosis, but in this case combined radiation therapy and chemotherapy was curative. Although pineocytoma is rarely accompanied by a cyst, in cases of a pineal lesion coexistent with a cyst, a diagnosis of pineocytoma should be considered.
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  • Case Report
    Katsunari TAKIFUJI, Toru ITAKURA, Fuminori OZAKI, Katsumi ITATANI, Tak ...
    1989 Volume 29 Issue 4 Pages 338-341
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    The authors present the fifth reported case of arteriovenous malformation (AVM) associated with cyst formation. Among these five cases, computed tomography has demonstrated two types of cyst: round, and slit-like with low density. The three patients with slit-like cysts experienced sudden, severe headache, probably due to hemorrhage. The two patients with round cystic lesions did not have sudden headache, and at surgery the cysts were found to contain a mural nodule. These facts suggest that there may be two different mechanisms of cyst formation in the vicinity of an AVM: hemorrhage (slit-like cysts) and exudation (round cysts).
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  • Case Report
    Kohsuke YAMASHITA, Hiroshi ABE, Toshio IKOTA, Takashi TASHIRO, Hiroyas ...
    1989 Volume 29 Issue 4 Pages 342-346
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    A 61-year-old male was hospitalized for subarachnoid hemorrhage. Cerebral angiography revealed a small left vertebral-posterior inferior cerebellar artery aneurysm, 5 mm to the right of the midline and in the lower third level of the clivus—the so-called “no man's land.” It was felt that surgery through the lateral suboccipital approach would likely result in neurological deficits, since the aneurysm would be obscured by the tortuous parent artery or the basilar artery. Therefore, the transoral transclival approach was undertaken and the aneurysm was successfully obliterated. Postoperatively, the patient developed transient right hemiparesis and mild meningitis without evidence of liquorrhea, but fully recovered with conservative management.
    Certain specific sites of aneurysms, as well as excessive tortuosity of the parent artery, are considered to be indications for the transoral transclival approach. Meningitis is the most worrisome complication of this approach, and mortality is high. Effective preventative measures, which were taken in this case, include tight closure of the dura mater and the pharyngeal mucous membrane, use of the smallest possible clip, and continuous cerebrospinal fluid drainage.
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  • Case Report
    Mitsunori MATSUMAE, Masumi YOSHIOKA, Isao MURAOKA, Akio MORITA, Toru M ...
    1989 Volume 29 Issue 4 Pages 347-351
    Published: 1989
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    A case of porencephaly in a 33-year-old male is presented. The patient exhibited right hemiparesis and generalized seizures. Computed tomography and, subsequently, craniotomy revealed a cerebral defect in the left parietal lobe, which communicated with the lateral ventricle. On angiography and at surgery, the cortical branches of the middle cerebral artery were found to be stretched over the surface of the cyst. Histopathological examination showed the outer membrane of the cyst to consist of arachnoid, subarachnoid space, vessels, pia mater, and a layer of degenerative brain tissue on histology. The diagnosis of porencephaly and its differentiation from arachnoid cyst are discussed.
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