Neurologia medico-chirurgica

Uptake and Localization of Neocarzinostatin in Malignant Glioma

Experimental Study by Immunofluorescent Staining Method

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

1989 Volume 29 Issue 8 Pages 689-695
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.689

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The authors studied the localization of neocarzinostatin (NCS) in cultured cells and in tumorbearing rats by means of immunofluorescent staining. Anti-NCS antibody was obtained through immunization of rabbits with NCS. Cellular uptake of NCS was dose-dependent (1.0 to 1000 μg/ml) in 9L rat gliosarcoma cells in monolayer. In monolayer cells of 9L, KMG-4 (derived from human glioblastoma), and KMS II (human ependymoma) treated with 1 mg/ml of NCS, drug uptake occurred within a few seconds. Accumulation was much higher in the cytoplasm than in the nucleus and, although nuclear uptake increased slightly over time, there appeared to be no increase in total cellular uptake. Mitotic cells, which were spherical in culture, showed greater intracellular accumulation than other cells. There was no significant difference in uptake among non-mitotic cells. Cells surviving 20 hours of treatment retained accumulation as high as that in killed cells. In KMG-4 monolayers, cytoplasmic and nuclear NCS distribution still differed, whereas 9L monolayers exhibited more even intracellular distribution. In 9L spheroid models treated with 1 mg/ml of NCS, the drug permeated almost all layers within 10 minutes, and at 120 minutes had heavily accumulated in the central necrotic areas. In rats with transplanted brain tumors, NCS selectively accumulated in neoplastic tissues following intra-arterial administration. However, NCS uptake by arterial endothelium was also seen, which suggests the potential for vascular toxicity. The therapeutic value of NCS is discussed in terms of its pharmacokinetic characteristics.

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Ultrastructural Study of Capillary Permeability of Liposome-encapsulated Cisplatin in an Experimental Rat Brain Tumor Model

Shobu SHIBATA, Takafumi JINNOUCHI, Kazuo MORI

1989 Volume 29 Issue 8 Pages 696-700
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.696

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The anticancer chemotherapeutic agent cisplatin (cis-diamminedichloroplatinum) has several disadvantages, including extreme nephrotoxity, rapid binding to plasma proteins, and poor penetration into the central nervous system. Liposomes would seem to be suitable as carriers of cisplatin to brain tumors. This ultrastructural study was undertaken to identify the capillary permeability of liposome-encapsulated cisplatin in a rat brain tumor model. Brain tumors were induced transplacentally with a single intravenous dose of 50 mg/kg of ethylnitrosourea (ENU). One ml of liposomeencapsulated cisplatin and ferritin prepared from phosphatidylcholine and cholesterol (molar ratio 7:2) was administered via the carotid artery to rats with ENU-induced brain tumors. The tumor platinum content and that of the contralateral hemisphere were assayed by flameless atomic absorption spectrometry. The presence of ferritin-bearing liposomes was demonstrated by electron microscopy of brain capillary endothelium as well as tumor cells. Thirty minutes after drug administration, the average dry-weight platinum concentrations were 3.98±0.50μg/g within the intracerebral tumors and 0.72±0.24 μg/g in the contralateral hemispheres. Electron microscopic ultrastructural study, which can distinguish ferritin-bearing liposomes from cell materials, demonstrated the presence of liposomes containing ferritin in both cell surface folds and capillary endothelial cells and also within tumor cells. An enlarged electron micrograph of a liposome with a diameter of approximately 0.2 μm suggested the presence of ferritin molecules in the lamellar structure. Liposome-encapsulated cisplatin is apparently able to pass the blood-brain barrier and should be useful in the chemotherapy of glioma.

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Artifacts in Magnetic Resonance Imaging of the Head

Toru IWAMA, Takashi ANDOH, Noboru SAKAI, Hiromu YAMADA, Takashi FUNAKO ...

1989 Volume 29 Issue 8 Pages 701-706
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.701

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The results of 505 magnetic resonance (MR) imaging examinations of the head disclosed several different types of artifact. Various artifacts observed with two-dimentional Fourier transformation are described and illustrated. All images were obtained with a 0.5 Tesla superconducting MR imager. About 70% of all images contained artifacts. Phase encoding artifacts due to motion or flow were most frequently observed. Center, “zipper, ” truncation, radiofrequency, and ferromagnetic artifacts and contrast error on inversion recovery (IR) images were noted less frequently. Phase encoding artifacts and contrast errors on IR images totally degraded the images, and “zipper” artifacts were regional. Center artifacts resembled small infarctions, and ferromagnetic artifacts sometimes mimicked hematomas. It is important to recognize these artifacts and to devise methods to avoid their influence on the region of interest.

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Magnetic Resonance Imaging in 38 Cases of Acoustic Tumors

Masafumi UCHINO, Takashi OHTSUKA, Yoshikatsu SEIKI, Mikiro MATSUMOTO, ...

1989 Volume 29 Issue 8 Pages 707-714
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.707

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The value of magnetic resonance imaging (MRI) in the diagnosis of acoustic tumors was retrospectively assessed in 38 cases. A 0.15 Tesla permanent magnet and a 1.5 Tesla superconducting magnet were employed in 24 and 14 cases, respectively. Gadolinium diethylene triamine pentaacetic acid (Gd-DTPA), a paramagnetic contrast agent, was used in 10 cases. Acoustic tumors were identified in all cases. Small, medium, and large tumors were depicted with equal clarity by MRI and computed tomography (CT). However, tumor contour and extension, accompanying cysts, and brainstem displacement were more clearly visualized on MRI. The use of Gd-DTPA improved the quality of the MR images by markedly enhancing the acoustic tumors in all cases. In particular, detection of small acoustic tumors and intra or paratumoral cysts was facilitated by the use of Gd-DTPA. The possibility of a correlation between acoustic tumor histology and MRI features was studied by calculation of the contrast to noise (C/N) ratio in 10 cases of acoustic tumor and 7 cases of meningioma. No definite correlation was demonstrated, but there appeared to be some difference in the C/N ratio between acoustic tumors and meningiomas. In three volunteers, MRI demonstrated intracanalicular nerves, separately. Because of its higher resolution, MRI can be expected to replace CT and air CT in the diagnosis of acoustic tumors.

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Percutaneous Transluminal Angioplasty for Experimental Carotid Artery Stenosis

Mechanism and Long-term Results

Eiji MAEMURA

1989 Volume 29 Issue 8 Pages 715-723
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.715

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Percutaneous transluminal angioplasty (PTA) is not commonly applied to the carotid artery because of the risk of cerebral embolization and the uncertainty concerning the long-term results. To test its effectiveness and safety, the author performed PTA in dogs with experimentally induced carotid artery stenosis. Under general anesthesia, one carotid artery was exposed by midline incision. Two vascular tourniquets were applied to the artery, 2 to 5 cm apart, and the blood between them was replaced with pentobarbital sodium for 5 minutes. The drug was then removed and the tourniquets released. Angiography revealed the formation of stenotic lesions within 1 to 6 weeks. Histological examination showed the source of stenosis to be thrombi adhering to the vessel wall. PTA was performed 1 week or 3 to 6 weeks after induction of stenosis using either Grüntzig or Dotter catheters. Immediately after PTA, considerable enlargement of stenotic areas was angiographically observed, and no emboli were detected in distal arteries. Histological findings included depressions in the intima, thrombi, and stretching of the internal elastic membrane and tunica media. Angiograms obtained 3 and 6 months after PTA disclosed persistence of dilatation of the carotid lumen and diminution of the inner surface irregularities. Six months after PTA, the histological features included intimal proliferation and rarefaction of the tunica media. On the other hand, stenotic arteries not subjected to PTA were totally occluded by thrombi and intimal proliferation 6 months after induction of stenosis. It is apparent that PTA was effective not only in bringing about dilatation of the carotid artery but also in arresting the progression of stenosis. These results suggest that PTA would be effective in the treatment of carotid artery stenosis in humans.

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Hypoxemia in the Acute Stage of Hypertensive Intracerebral Hemorrhage, with Special Reference to Increased Extravascular Lung Water

Hajime TOUHO, Jun KARASAWA, Hisashi SHISHIDO, Keisuke YAMADA, Yoshinor ...

1989 Volume 29 Issue 8 Pages 724-727
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.724

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Respiratory responses to acute brain damage have been well documented. Severe hypoxemia of unknown origin has often been seen in the acute stage of intracerebral and subarachnoid hemorrhage. Neurogenic pulmonary edema is a particular concern in the neurosurgical intensive care setting. In this study, the extravascular lung water volume (EVLW), alveolar-arterial oxygen difference (AaDO₂), and intrapulmonary shunt (QS/QT) were measured in 17 patients with hypertensive intracerebral hemorrhage in the acute stage. The mean AaDO₂, QS/QT, and EVLW values were 19.1 mmHg, 7.7%, and 5.49 ml/kg, respectively. The mean pulmonary arterial, central venous, and pulmonary capillary wedge pressures were all within the normal ranges. Eight patients with an AaDO₂ of 20 mmHg or more manifested abnormal increases in QS/QT and EVLW, the mean values of which were 10.3% and 6.52 ml/kg, respectively. Nine patients with an AaDO₂ of less than 20 mmHg exhibited normal QS/QT and EVLW, with mean values of 5.4% and 4.57 ml/kg, respectively. There was a significant, direct correlation between AaDO₂ and EVLW. AaDO₂ and EVLW in 11 measured cases either stayed normal or normalized within 4 weeks. These results suggest that acute congestive heart failure and/or pulmonary hypertension were not the main causes of the increase in AaDO₂ and EVLW; the increase in EVLW might be explained by increased permeability of pulmonary vessels. The results of this study suggest that an increase in EVLW is causally related to hypoxemia. Further studies of lung water are necessary if we are to better understand respiratory abnormalities associated with acute-stage hypertensive intracerebral hemorrhage.

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Surgical Treatment of Syringomyelia

Selection of Surgical Procedures

Toyohiko Isu, Yoshinobu IWASAKI, Minoru AKINO, Hiroshi ABE

1989 Volume 29 Issue 8 Pages 728-734
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.728

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The surgical approach to syringomyelia is controversial. In this study, the authors evaluated the results of various operative procedures applied in 31 patients with syringomyelia. Syringomyelia was associated with Chiari malformation in 17 cases, with spinal adhesive arachnoiditis in nine, with trauma in three, and with epidural arachnoid cyst in one. One case was idiopathic. A total of 38 operations were performed. Syringosubarachnoid shunting was applied in 17 patients, syringoperitoneal shunting in 11, terminal syringostomy in three, ventriculoperitoneal shunting in three, lumboperitoneal shunting in two, foramen magnum decompression (suboccipital craniectomy plus upper cervical laminectomy) and terminal syringostomy in one, and foramen magnum decompression with syringosubarachnoid shunting in one. The postoperative follow-up period ranged from 2 to 55 months (average, 26 months). Of the 31 patients, 23 showed neurological improvement, five were unchanged, and three deteriorated. Among the last three, one patient with Chiari malformation developed shunt malfunction due to arachnoiditis after syringosubarachnoid shunting. In two patients with syringomyelia secondary to adhesive arachnoiditis, the spinal cord was damaged by extensive separation of the arachnoid membrane at surgery. On the basis of the results in these 31 cases, the authors conclude that syringosubarachnoid shunting is effective for syringomyelia associated with Chiari malformation if syringomyelia is responsible for the clinical symptoms. Post-traumatic syringomyelia and syringomyelia secondary to adhesive arachnoiditis should be treated by syringoperitoneal shunting. If hydrocephalus is present, ventriculoperitoneal shunting is indicated. Finally, terminal syringostomy is no more effective than syringosubarachnoid or syringoperitoneal shunting.

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Effect of External Decompression on the Development of Delayed Ischemic Neurological Deficits after Subarachnoid Hemorrhage

Ichirou MIYATA, Kazuyuki TSUNO, Tetsuya MASAOKA, Tsukasa NISHIURA, Yas ...

1989 Volume 29 Issue 8 Pages 735-739
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.735

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The protective effect of a large decompressive craniectomy against delayed ischemic neurological deficits (DIND) was evaluated in patients operated on after subarachnoid hemorrhage due to a ruptured aneurysm. In 54 cases, a large decompressive craniectomy was performed (Group D), and 41 patients underwent conventional craniotomy (Group ND). Transient DIND appeared in three (17%) of the 18 Group D patients of Hunt and Kosnik grade I or II, but permanent deficits were not observed in this group. In Group ND, permanent DIND developed in seven (21%) of the 33 grade I or II patients, despite their having received the same medical care. This difference was statistically significant. However, there were no differences in outcome among patients of grades III, IV, and V. These results suggest that, at least in patients of grade I or II, a large decompressive craniectomy, performed early, will prevent DIND after subarachnoid hemorrhage. The procedure may prevent the increase in intracranial pressure and decrease in perfusion pressure brought on by vasospasm and the development of brain edema.

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Clinical Value of Bedside Ultrasonography in Craniectomized Patients

Shiro KOBAYASHI, Takayuki KITAMURA, Kazuo ISAYAMA, Hiroyuki YOKOTA, Sh ...

1989 Volume 29 Issue 8 Pages 740-745
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.740

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Twenty-five patients underwent bedside ultrasonographic examination through a postoperative skull defect, and the images were compared with axial computed tomography (CT) scans. The patients included 12 with cerebrovascular disease, two with brain tumor, one with a brain abscess, and 10 with head injury. Clear ultrasonographic images were obtained in all patients except one who had undergone a suboccipital craniectomy. Ultrasound was most useful when hydrocephalus was present, in which cases, regardless of the cause, hypo-echoic dilated third and lateral ventricles were demonstrated. In one case, it was decided to emplace a ventriculoperitoneal shunt on the basis of the results of serial sonography, which documented ventricular enlargement. Intracerebral hematomas also were identified by ultrasonography. Acute hematomas, such as subarachnoid blood clots persisting after clipping of an aneurysm, appeared as hyper-echoic images, whereas, late hematomas were depicted as hypo-echoic images. In one case, a recurrent brain tumor was depicted as a hyper-echoic mass. In multiple-trauma patients with head injury who were too unstable to be moved for CT scanning, ultrasound was extremely useful. So-called “delayed traumatic intracerebral hematoma” was identified in two cases subsequent to removal of an acute subdural hematoma.
These results indicate that serial ultrasonographic examination of the lateral ventricles through a craniectomy can supplement CT scanning in the evaluation of hydrocephalus and is also useful in evaluating cerebrovascular disease, brain tumors, infection, and head injury.

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Cloverleaf Skull Syndrome with Occipital Bone Cristae

Report of Two Cases

Shingo TAKANO, Takao ENOMOTO, Hiroko ONIZUKA, Tadao NOSE

1989 Volume 29 Issue 8 Pages 746-752
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.746

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Two cases of cloverleaf skull syndrome are reported. The patients were born with trilobed deformity of the skull associated with synostosis of the lambdoidal, coronal, and sagittal sutures in Case 1 and of the lambdoidal suture in Case 2. Both patients had hydrocephalus, low-set ears, and ocular hypertelorism. Ventriculoperitoneal shunting had been performed for hydrocephalus in both cases in early infancy. Thereafter, the skull anomaly caused mental and physical retardation and elevated intracranial pressure. In both cases, surgery was successful in terms of cosmetic and neurological improvement. Both cases involved prominent midline crista formation of the skull over the posterior fossa, which steadily progressed during the first year of life and produced hydrocephalus, apparently by compressing or obstructing the aqueduct and/or the ostia of the fourth ventricle. Twenty-four cases of surgery for cloverleaf skull syndrome have been reported to date. Only Partington's types II and III were treated surgically, and patients with type III had more favorable outcomes than those with type II. However, these reports provide no clear-cut data that surgery significantly influences the outcome. The experience with the two cases reported here suggests the benefits of early shunting followed later by radical surgery.

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Anterior Sacral Meningocele

Case Report

Kazufumi SATO, Minoru HAYASHI, Hirokazu KAWANO, Toshihiko KUBOTA, Masa ...

1989 Volume 29 Issue 8 Pages 753-757
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.753

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A 53-year-old male presented with an abdominal mass and urinary disturbance. Plain pelvic Xrays revealed a scimitar deformity of the sacrum. Computed tomography (CT) of the abdomen and lumbosacral spine showed a 13×17×17 cm, hypodense, cystic mass. Metrizamide myelography disclosed a bony defect at the S2 level through which contrast material entered the pelvic cyst, confirming the diagnosis of anterior sacral meningocele. Magnetic resonance imaging demonstrated the extent of the abdominal mass and its communication with the thecal sac through the anterior sacral defect. The patient underwent surgery via the transabdominal approach. The mass was extremely adherent to the intestine and it was difficult to reach the stalk of the sac. The wall of the meningocele was resected to the extent possible, and was tightly sutured following a meningoceleperitoneal shunting procedure. Postoperatively, the patient was neurologically normal, but 4 months later he was readmitted because of headaches and clouding of consciousness. CT showed bilateral chronic subdural hematomas. Following their evacuation, the patient recovered uneventfully. The clinical and neuroradiological features and the surgical approaches to anterior sacral meningoceles are discussed.

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Incidental Meningioma

Case Report

Shin-ichiro TAKAHASHI, Yoshinori ITOH

1989 Volume 29 Issue 8 Pages 758-761
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.758

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The authors report the incidental discovery of a meningioma during surgery for an acute infratentorial subdural hematoma. The patient was a 46-year-old female admitted for severe head trauma. A plain skull X-ray showed a sharp linear fracture in the left posterior region, extending from the parietal area to the foramen magnum. An initial computed tomographic scan demonstrated a highdensity intracranial mass in the left posterior fossa. Three hours after onset, the patient underwent emergency craniectomy and a subdural hematoma weighing 30 g was aspirated. During this procedure, an infratentorial tumor 30 mm in diameter was found to be attached to the dura and was totally removed. The tumor was a fibroblastic meningioma. The patient's postoperative course was uneventful. Most incidentally discovered meningiomas have been found in patients with ruptured aneurysms or chronic subdural hematomas. This is the first reported case in which the tumor was found in association with an acute infratentorial subdural hematoma.

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Metastatic Malignant Lymphoma of the Skull with Extradural and Extracranial Extension

Case Report

Kiyoshi YUKI, Yasunori KODAMA, Jun ONDA, Katsuya EMOTO, Kouji KIRIMOTO ...

1989 Volume 29 Issue 8 Pages 762-766
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.762

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A 72-year-old male was hospitalized because of a steadily growing mass (4×4×2 cm) in the frontal region, noticed following head injury. Six months earlier, he had declined treatment for malignant lymphoma (small non-cleaved cell type), discovered upon evaluation of a subcutaneous mass in his forearm. Neurological examination on admission was negative. Plain skull films revealed a large, osteolytic lesion with an irregular margin. Bone scintigraphy disclosed no uptake other than in the frontal bone. Computed tomography (CT) showed a large, homogeneously enhanced mass with both extradural and extracranial extension, which had destroyed the left frontal bone. The skull tumor was totally resected, and the diagnosis was malignant lymphoma, large cell, immunoblastic and plasmacytoid type. Postoperative combined chemotherapy with vincristine, cyclophosphamide, prednisolone, and adriamycin resulted in the complete disappearance of liver metastases. The patient was readmitted 2 months later, however, because of headache and gradually progressive impairment of consciousness. A CT scan disclosed brain metastasis in the paraventricular region. Radiation therapy (20 Gy) was administered but no further treatment was given. Skull metastasis is not uncommon in cases of malignant lymphoma, but a large mass with both extradural and extracranial extension is rare. Although aggressive chemotherapy was effective, prophylactic irradiation of the brain should have been considered in this case.

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A Variant of Persistent Trigeminal Artery associated with a Petroclival Meningioma

Case Report

Kiyohiro MINOKURA, Akira HAKUBA, Kikuo KUROSE, Shuro NISHIMURA

1989 Volume 29 Issue 8 Pages 767-771
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.767

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A 52-year-old female was admitted with a chief complaint of progressive gait disturbance over the previous 16 months. Neurological examination revealed impairment of the Vth and VIIIth cranial nerve functions and cerebellar ataxia on the left side. Computed tomography showed a petroclival tumor of 5×5×4.5 cm. Left carotid angiography disclosed tumor staining fed by branches of the tentorial artery. Also, an anomalous artery branched from the internal carotid artery between the C5 and C6 portions and supplied the region usually fed by the anterior inferior cerebellar artery. The tumor was removed via a combination of transpetrosal-transtentorial and transzygomatic approaches. The anomalous artery was confirmed to course along the Vth cranial nerve, replacing the anterior inferior cerebellar artery. Twenty-seven cases of variant persistent trigeminal artery have been reported in the world literature, including this case. The embryological and clinical features of this anomaly are discussed.

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Unilateral Nerve Deafness due to Rupture of a Right Vertebral Artery Aneurysm

Case Report

Shigeru NISHIZAWA, Tetsuo YOKOYAMA, Kenichi UEMURA, Hiroshi RYU, Toshi ...

1989 Volume 29 Issue 8 Pages 772-776
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.772

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A 49-year-old female with no history of hearing disturbance developed sudden onset of headache and was admitted with no neurological deficits other than mild nuchal rigidity. Computed tomography (CT) showed subarachnoid hemorrhage. Four-vessel cerebral angiography disclosed no aneurysm. A second angiogram obtained on the 14th day showed vasospasm of the bilateral posterior cerebral arteries and right anterior inferior cerebellar artery, but still failed to demonstrate an aneurysm. Following the second angiography, she developed mild disturbance of consciousness and cerebellar ataxia of the right limbs, and repeat CT showed an infarct in the right cerebellar hemisphere. When she regained consciousness a few days later, she was completely deaf on the right side. The third angiography revealed a right vertebral artery dissecting aneurysm. Following clipping of the proximal portion of the right vertebral artery, she did well and was discharged, although right cerebellar ataxia and deafness persisted. Neuro-otological evaluation, including pure-tone audiography, auditory brainstem responses, electrocochleography, and caloric testing, indicated that her deafness resulted from ischemia in the territory of the right internal auditory artery due to vasospasm.

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Hemiplegia Cruciata caused by a Stab Wound of the Spinal Cord

Case Report

Shigetaka ANEGAWA, Hironori NAKASHIMA, Ryuichiro TORIGOE, Yasuhiro FUR ...

1989 Volume 29 Issue 8 Pages 777-781
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.777

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A 56-year-old female sustained a neck laceration by a piece of glass, which broke when she fell backward. She immediately became quadriplegic and was transported to a local hospital, then deteriorated and was referred to the authors' hospital. Neurological examination revealed quadriplegia that was particularly pronounced in the right arm and left leg. Pain sensation was decreased in the right upper and lower extremities below the C3 level. Cervical spine films showed glass fragments in the gap between the occipital bone and the C1 arch. Computed tomography dramatically demonstrated glass fragments that had become fixed in the spinal cord at the spinomedullary transition. A suboccipital craniectomy and C1 laminectomy allowed visualization of the dural laceration. Opening of the dura exposed a glass fragment penetrating the upper cervical spine just caudal to the left tonsil. It was successfully removed with a hemostat clamp. Postoperatively, the patient was soon able to walk without assistance. To the authors' knowledge, upper cervical spinal cord injury caused by glass has previously been reported only twice, although broken glass is a common cause of wounds. Also, this patient exhibited signs of “hemiplegia cruciata, ” which is thought to be due to damage to the pyramidal decussation.

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