Neurologia medico-chirurgica

Analysis of the Water-soluble Protein Fraction of Glioma Cells by Two-dimensional Electrophoresis

Chiho HONDA, Kazuo TABUCHI, Akira NISHIMOTO

1989 Volume 29 Issue 6 Pages 465-470
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.465

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The authors analyzed water-soluble proteins of cultured human and rat glioma cells by twodimensional polyacrylamide gel electrophoresis methods. Glioma cells were suspended in distilled water and then destroyed by freezing and thawing to obtain the water-soluble protein fractions. A modification of O'Farrell's non-equilibrium pH gradient (NEPHGE) method was used to analyze differences in protein mapping. Manabe's microscale two-dimensional electrophoresis without denaturing agents was used to detect proliferating cell nuclear antigen (PCNA/cyclin) by Western blotting. With O'Farrell's NEPHGE method and silver staining, at least 200 different polypeptides were clearly identified in each cell line. Cytoskeletal proteins, such as actin, were consistently separated in all cell lines. Marked differences in the protein map were observed between human and rat glioma cell lines, and even within the same species. Presumably, these differences are attributable to cell-biological difference in the glioma cell lines. Some proteins that were prominent in proliferating cells were scant in the protein maps of cells cultured for 24 hours in medium not containing calf serum, which suppresses cell growth. PCNA, an acidic nuclear protein that appears only in the late G₁-S phase and is believed to be involved in cell proliferation, was detected by Western blotting and indirect immunostaining. Quantitative analysis of PCNA spots on the protein map appears useful in assessment of glioma cell proliferation. These results indicate that twodimensional polyacrylamide gel electrophoresis can contribute to the understanding of the biological features of glioma cells.

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Pharmacokinetics of Neocarzinostatin in Patients with Malignant Glioma

Quantitative Analysis of Tissue Concentration

Tadahiro OTSUKA, Yasuhiko MATSUKADO, Shozaburo UEMURA, Jun-ichi KURATS ...

1989 Volume 29 Issue 6 Pages 471-475
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.471

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Because of technical difficulties, the pharmacokinetics of neocarzinostatin (NCS) have not been thoroughly evaluated in patients with malignant glioma. The authors produced anti-NCS antibody by immunizing rabbits with NCS and established a means of quantifying tissue levels of NCS with enzyme-linked immunosorbent assay. In one patient given a bolus injection of 1 mg of NCS intraarterially, the concentration of drug in neoplastic tissue at 25 minutes (0.1136μg/g) was higher than that in blood at 20 minutes and was retained for a longer period. Rapid entry of NCS into the tumor cavity was observed at 5 minutes. In two postoperative cases, NCS applied topically to the tumor site (50 and 100μg) was retained at high levels (0.2941 and 3.33 μg/ml) even after 48 hours, although no NCS was detected in blood after 60 minutes. NCS concentrations as low as 1 μg/ml demonstrated cytocidal effects, and a delay in tumor growth was observed even at an NCS level of 0.1 μg/ml, despite the fact that the half-life of NCS is extremely short (3 seconds in serum). Because its cytotoxic effect seems to be very rapid, it appears more important to obtain a high initial NCS concentration than to maintain a constant blood level.

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Monitoring of Intracranial Pressure in Patients with Brain Tumors

Clinical Study of the A Wave Mechanism

Jun KAGAWA

1989 Volume 29 Issue 6 Pages 476-483
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.476

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Intracranial pressure (ICP) was continuously monitored in 70 patients with brain tumors. Simultaneous recording of respiration and systemic blood pressure was carried out in 20 and 13 cases, respectively. In 13 of the former 20 cases, blood gases were analyzed during typical A waves (Lundberg's A wave). In addition, in four cases cerebral blood flow (CBF) was measured during typical A waves. The A wave appeared when the baseline ICP exceeded 20 mmHg, and the higher the baseline pressure was, the more frequently the A wave was recorded. Three respiratory patterns occurred during typical A waves: hyperventilation, hypoventilation, and normal respiration. However, these respiratory patterns were not always clear-cut, and the three often were mixed. Systemic blood pressure during the typical A wave phase was either elevated (Cushing's response) or normal. All patients who showed Cushing's response had high baseline ICP and, with the frequently appearance of the A wave, had such symptoms of increased ICP as headache, nausea, and disturbance of consciousness. In all four cases studied, CBF decreased during typical A waves. These results, indicate that the A wave is associated with elevation of ICP and intracranial tightness. A particular region in the brainstem reportedly participates in the generation of the A wave. However, the mechanism of its development appears complex and involves such secondary factors as respiration and systemic blood pressure.

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The Usefulness of Lumbar Epidural Pressure as an Index of Intracranial Pressure

Shodo FUJIOKA, Motoyuki KAKU, Jun-ichiro HAMADA, Akira YOKOTA, Yukitak ...

1989 Volume 29 Issue 6 Pages 484-489
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.484

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The reliability of lumbar intraspinal epidural pressure (ISEDP) as an index of intracranial pressure was investigated in seven patients with high intracranial pressure following neurosurgery. ISEDP and intracranial epidural pressure (ICEDP) were measured simultaneously, the latter by the conventional method. ISEDP was measured with a Gaeltec catheter-tip pressure transducer placed percutaneously in the lumbar epidural space via Touhy's needle. In five of seven patients, the ISEDP value was consistently 70 to 100% of the ICEDP value. In all patients, ISEDP always fluctuated in parallel with ICEDP, and the time courses of both were quite similar in response not only to normal cardiac pulsation but also to various manipulations, such as neck compression, coughing, breath holding, mannitol administration, and compression at the cranial defect. In one patient with communicating hydrocephalus following subarachnoid hemorrhage, the relationship between ISEDP and cerebrospinal fluid (CSF) pressure was studied. Upon gradual withdrawal of CSF, ISEDP decreased in parallel with CSF pressure until the latter reached 8 mmHg. Below 8 mmHg CSF pressure, ISEDP did not correlate with CSF pressure. This phenomenon was attributed to slackness of the dural sac due to lowering of CSF pressure, which severed contact between the spinal dural theca and the sensor. Although the discrepancy between ISEDP and ICEDP was prominent in some patients, especially those with low intracranial pressure or blockage of the subarachnoid space, in this study ISEDP reliably reflected ICEDP. The results suggest that ISEDP measurement is useful in monitoring intracranial pressure in patients with increased intracranial pressure. Also, the procedure is simple and relatively noninvasive.

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Anterior Pituitary Function in the Vegetative State

Hisanori YOSHIMOTO, Tohru UOZUMI

1989 Volume 29 Issue 6 Pages 490-495
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.490

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Anterior pituitary function tests were performed in 33 patients in the vegetative state, and the results were assessed for correlation with various clinical factors. Radioimmunoassays were employed to measure the secretion of growth hormone and cortisol during insulin tolerance testing (regular insulin, 0.15 to 0.20 U/kg), luteinizing hormone and follicle stimulating hormone under administration of luteinizing hormone-releasing hormone (100 μg), and thyroid stimulating hormone and prolactin under administration of thyroid-releasing hormone (500 μg) . Impairment rate, defined as number of abnormal hormone secretions divided by number of hormones examined, was calculated for each patient. The data were statistically assessed by analysis of variance in terms of disease, sex, age, site of lesion, etiology of vegetative state, duration of illness, brain atrophy as demonstrated by computed tomography, and Hockaday's electroencephalographic (EEG) grade. The results were as follows. 1) The levels of growth hormone, luteinizing hormone, follicle stimulating hormone, cortisol, thyroid stimulating hormone, and prolactin were abnormal in 70%, 67%, 45%, 39%, 36%, and 15% of cases, respectively. 2) Anterior pituitary hormone secretion was impaired in all 33 patients, severely in 52%. 3) The impairement rate was significantly increased in patients with ruptured cerebral aneurysms, primary coma, severe brain atrophy, and abnormal EEGs. 4) The impairment rate tended to be higher in long-term vegetative patients. These results suggest that, in the vegetative state, impairment of anterior pituitary function frequently occurs at the onset of disease and worsens over time.

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Measurement of Cerebral Blood Flow by Single Photon Emission Computed Tomography in Cases of Internal Carotid Artery Occlusion

Ichiro SUNADA

1989 Volume 29 Issue 6 Pages 496-502
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.496

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Cerebral blood flow (CBF) was measured with ¹³³xenon inhalation and single photon emission computed tomography in 33 cases of internal carotid artery occlusion, in the resting state and 25 minutes after acetazolamide (Diamox®) administration. The patient population consisted of 24 males and nine females with a mean age of 57 years, who presented with transient ischemic attacks or stroke. Acetazolamide inhibits carbonic anhydrase, and CBF increases as a result of dilatation of cerebral arteries due to CO₂ accumulation. The mean CBF was 46 ml/100 g/min on the affected hemisphere and 56 ml/100 g/min on the unaffected hemisphere. The mean CBF value obtained by the same method in 10 normal volunteers was 55 ml/100 g/min. Thus, in the patients, CBF decreased on the affected side. The average increase in CBF after acetazolamide administration was 9% on the affected side and 17% on the unaffected side. The average increase in 10 normal volunteers was 32%. The reduced cerebral arterial reactivity to acetazolamide administration was bilateral in the patient group, which suggests that the cerebral arteries were dilated in order to maintain normal CBF. Extra-intracranial (EC-IC) bypass surgery was performed in nine patients. Preoperatively, the mean CBF was 48 ml/100 g/min on the affected side and 57 ml/100 g/min on the unaffected side; the postoperative CBF was 48 ml/100 g/min on the affected side and 56 ml/100 g/min on the unaffected side. Thus, there was no notable change in CBF on either side after surgery. However, with postoperative acetazolamide administration, the percent increase in CBF rose from 13% to 22% on the affected side and from 17 Yo to 23% on the unaffected side. These changes were statistically significant on the affected side. The bilateral change toward normal in cerebral arterial reactivity to acetazolamide indicates that the dilated cerebral arteries returned to normal after ECIC bypass surgery. This suggests that bypass surgery is effective in patients with internal carotid artery occlusion in whom ischemia is caused only by hemodynamic factors, and that measurement of CBF via acetazolamide loading is useful in identifying appropriate candidates for bypass surgery.

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Predicting Recovery of Ambulatory Function after Hypertensive Putaminal Hemorrhage by Multivariate Analysis of Acute phase Clinical Data

Yasutoshi FUKIISHI, Seizaburo ARITA, Toshihisa SUZUKI

1989 Volume 29 Issue 6 Pages 503-509
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.503

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In 66 patients with hypertensive putaminal hemorrhage, several acute-phase clinical parameters were subjected to multivariate analysis and the usefulness of such analysis in predicting the eventual recovery of ambulatory function was evaluated. Seven items were studied: age, laterality of the lesion, computed tomography classification, hematoma volume, level of consciousness on admission, severity of motor impairment of the affected leg on admission, and the treatment employed. A numerical prediction of ambulatory function was derived from an equation in which each item was scored and weighted. This value was compared with that of the actual ambulatory ability several months after onset, as rated on a 5-point scale. In these 66 cases, the predicted and actual outcomes were well correlated (r=0.871). The results indicate that an accurate prognosis can be made on the basis of clinical data obtained in the acute phase of putaminal hemorrhage.

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Recurrent Germinoma Successfully Treated with Cisplatin

Case Report

Kazutoshi HIDA, Toshimitsu AIDA, Hiroshi ABE

1989 Volume 29 Issue 6 Pages 510-514
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.510

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A 23-year-old male with a suprasellar germinoma was initially treated with local irradiation, and the tumor completely disappeared. Three months later, he complained of pain in the left thigh. Myelography revealed multiple spinal metastases at the Th5 to Th8 and Th11 to L5 levels. The tumors were removed through a laminectomy, and the histopathological diagnosis was typical germinoma. Whole spinal irradiation was administered postoperatively. Neurological examination on discharge revealed no abnormality other than hypalgesia over the left L5 segment. Six years later, tumor was found in the lateral ventricles. The human chorionic gonadotropin (HCG) and HCG β subunit levels were markedly elevated in both serum and cerebrospinal fluid (CSF). Irradiation considerably decreased the size of the tumor but did not completely eradicate it. Subsequent chemotherapy with cisplatin resulted in complete disappearance of the intraventricular tumor, as evidenced by computed tomography (CT). The serum and CSF levels of HCG and HCG β subunit were well correlated with the tumor size, as shown by CT. The authors emphasize the curative potential of cisplatin in the treatment of recurrent germinoma.

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Multiple Myeloma presenting as a Mass Lesion in the Frontal Bone

Case Report

Kazuhiko SUYAMA, Minoru NAKAMURA, Hiroaki YOKOYAMA, Masahiko SHIMADA, ...

1989 Volume 29 Issue 6 Pages 515-519
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.515

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The patient, a 51-year-old male, was hospitalized for evaluation of a frontal subcutaneous mass. There were no signs of intracranial hypertension and no neurological deficit. His general medical status was normal, but he had been diagnosed as having immunoglobulin G (IgG) lambda type multiple myeloma by bone marrow aspiration and immunoelectrophoresis. A plain skull X-ray showed a large bony defect and multiple punched-out lesions in the frontal bone. Computed tomography showed an epidural high-density mass with marked homogeneous enhancement. Carotid angiography showed a hypervascular tumor fed by the bilateral external carotid arteries. At surgery, a reddish tumor was detached from the dura mater and totally resected. The pathological diagnosis was IgG lambda type plasmacytoma. After 40-Gy radiation and chemotherapy, the postoperative course over the following year was uneventful. Although the prognosis of multiple myeloma is poor, that of solitary intracranial plasmacytoma is reportedly good. However, since there is a high incidence of transition from solitary plasmacytoma to multiple myeloma, patients with intracranial plasmacytoma should be followed for a long period.

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Cerebral Cysticercosis presenting as a Solitary Cyst

Diagnosis and Treatment with CT-guided Stereotactic Biopsy —Case Report—

Takahiro HASHIMOTO, Tsuneo TAKASHIMA, Keiichi IWABUCHI, Kanji SUEYOSHI

1989 Volume 29 Issue 6 Pages 520-524
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.520

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The patient, a 52-year-old male, experienced a generalized convulsive seizure. Computed tomography (CT) revealed a solitary, noncalcified cyst, 1 × 2 cm in diameter, in the left occipital lobe, without contrast enhancement. No other lesions were found in systemic soft tissues, skeletal muscles, or the eyes. A CT-guided stereotactic biopsy was performed through an occipital burr hole, and the diagnosis was cerebral cysticercosis. Although cysticercosis is still common in Mexico, Chile, and India, its occurrence has rarely been reported in Japan, especially since World War II. Intraparenchymal calcification and cystic lesions are common CT findings. However, in this case, a non-enhancing solitary cyst was the only CT finding. The authors review the literature and discuss the CT features and the usefulness of CT-guided stereotactic biopsy in the diagnosis and treatment of cysticercosis.

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Diffuse Axonal Injury manifested as Corpus Callosum Damage on Magnetic Resonance Imaging

Case Report

Hiroshi TOMITA, Norihiko TAMAKI, Naoya TAKEDA, Shizuo OI, Satoshi MATS ...

1989 Volume 29 Issue 6 Pages 525-527
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.525

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A 26-year-old male was injured in a motorcycle accident and arrived unconscious at a local general hospital. Lack of improvement despite intensive care prompted his referral to the neurosurgical department, approximately 10 hours after the accident. On neurological examination his Glasgow Coma Scale score was 8, and mild right hemiparesis and right radial nerve palsy were noted. There was no skull fracture. Computed tomography disclosed intraventricular hemorrhage and small hemorrhagic foci in the prepontine area and the border between the gray and white matter. No hemorrhage was demonstrated in the corpus callosum. Magnetic resonance imaging (MRI) was performed 3 weeks after admission with a 0.5-tesla resistive Vista magnetic resonance scanner. The inversion recovery technique was used, with a repetition time (TR) of 2100 msec, an inversion time of 500 msec, and an echo time (TE) of 40 msec, for T₁-weighted images. The spinecho technique was used, with a TR of 2000 msec and a TE of 80 msec, for T₂-weighted images. In the body and splenium of the corpus callosum, T₁-weighted images showed a spotty area of low signal intensity with an irregular margin; this area was of high signal intensity on T₂-weighted images. On repeat MRI performed 4 months after injury, T₁-weighted images showed, in the same region, granular low signal intensity, while T₂-weighted images showed high signal intensity. The MRI findings in the subacute and chronic stages of diffuse axonal injury are discussed.

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Moyamoya Disease with Persistent Primitive Hypoglossal Artery

Case Report

Kikuo KUROSE, Hiroshige KISHI, Tsuyoshi SADATOH

1989 Volume 29 Issue 6 Pages 528-532
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.528

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A 44-year-old female developed aphasia and visual disturbance of the left eye. Four-vessel angiography showed occlusion of the extra and intracranial portions of the right internal carotid artery, severe stenosis of the left internal carotid fork, bilateral moyamoya vessels, and a persistent primitive hypoglossal artery on the left side. Measurement of cerebral blood flow by ¹³³Xe inhalation revealed decreased flow and no response to acetazolamide loading in the left cerebral hemisphere. The patient underwent superficial temporal artery-middle cerebral artery anastomosis, first on the left and then on the right side. There have been no other reported cases of moyamoya disease associated with a persistent primitive hypoglossal artery. Although the cause of moyamoya disease remains to be established, it is generally believed that stenotic changes of the carotid fork cause the development of moyamoya vessels as collateral pathways. According to this theory, there is no significant etiological relationship between moyamoya disease and persistent primitive hypoglossal artery. However, persistent primitive hypoglossal artery is compatible with moyamoya disease in terms of providing a collateral pathway via the vertebrobasilar system.

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Peripheral Superior Cerebellar Artery Aneurysm

Case Report

Mitsuru HIDAKA, Masami SHIMODA, Naoki SHIBUYA, Isao YAMAMOTO, Osamu SA ...

1989 Volume 29 Issue 6 Pages 533-537
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.533

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The patient, a 37-year-old female, was hospitalized with a severe headache. Neurological examination on admission revealed no deficits except for neck stiffness and somnolence. Computed tomography showed a subarachnoid hemorrhage, which was especially prominent in the supracerebellar and quadrigeminal cisterns, but demonstrated no ventriculomegaly. Cerebral angiography on admission revealed no apparent abnormalities, but repeat angiography 8 days later disclosed a saccular aneurysm (2 × 3 mm) arising from the hemispheric branch of the left superior cerebellar artery (SCA). Three days after admission, the patient developed cerebellar dysarthria, which was assumed to be due to vasospasm. On the 24th day after admission, the aneurysm was successfully clipped through the infratentorial-supracerebellar approach. The postoperative course was uneventful and the patient was discharged with no neurological deficit. Nineteen other cases of peripheral SCA aneurysm have been reported in the literature. The presence of this type of aneurysm should be considered in patients who are fairly young and have focal neurological signs, such as third or fourth nerve palsy and/or cerebellar dysfunction. The prognosis for such patients is good, except in cases in which the neurological status is poor at the onset.

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Spinal Epidural Cavernous Hemangioma

Case Report

Kikuo KUROSE, Hiroshige KISHI, Tsuyoshi SADATOH

1989 Volume 29 Issue 6 Pages 538-542
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.538

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Spinal epidural cavernous hemangiomas are very rare; only 18 cases have been reported in the literature. The authors describe the case of a 38-year-old male whose first symptom was numbness of the foot, which, after 2 years, spread to the abdomen. On admission, he had no weakness but exhibited hyper-reflexia of the lower limbs and hypalgesia below the 7th thoracic dermatome. Magnetic resonance imaging (MRI) revealed an extradural tumor at the level of the 7th thoracic vertebra, with erosion of the 7th vertebral body. T₁-weighted images were obtained by inversion recovery with a repetition time (TR) of 2100 msec, an inversion time of 600 msec, and an echo time (TE) of 40 msec. T₂-weighted images were obtained by a spin echo pulse sequence with a TR of 2000 msec and a TE of 120 msec. Compared with the spinal cord, the tumor showed low intensity on T₁-weighted images and high intensity on T₂-weighted images. The tumor was removed through a laminectomy. The histological diagnosis was cavernous hemangioma. After surgery, the patient's symptoms and signs improved. This is the first report of a spinal epidural cavernous hemangioma that includes MRI findings. It appears difficult to differentiate cavernous angiomas from neurinomas by MRI.

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