Neurologia medico-chirurgica

Ultrastructural Investigation of Nerve Regeneration in Vivo

—;Comparison with in Vitro Neurite Formation—

Hiroshi K. INOUE, Lars OLSON

1989 Volume 29 Issue 9 Pages 799-805
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.799

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The process of regeneration of rat dorsal root ganglion cells was investigated by scanning and transmission electron microscopy and compared with the process of in vitro neurite formation. After disruption of the granular reticulum, numerous microtubules appeared in the perinuclear cytoplasm. Many thin, regenerating nerve fibers were found at the suture line adjacent to collagen fibers. Subsequently, the number of cytoplasmic neurofilament bundles increased and many of the regenerated nerves attached to the suture line. By the eighth week after experimental injury, the granular reticulum had reconstituted in the cytoplasm and the regenerated nerves resembled those of control animals, although the fiber arrangement was somewhat irregular. The process was almost identical to that of in vitro neurite formation, although the time course was much slower. Structural proteins, such as actin, tubulin, and neurofilament triplet, appeared to form similarly in neuronal regeneration and in vitro neurite formation. The results also suggest that microtubules are essential for nerve regeneration as well as neurite formation and that components of the neuronal microenvironment, such as collagen fibers and migrating cells, play crucial roles in nerve regeneration.

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Influence of Vasopressin Level on Osmotic Pressure and Sodium Concentration in Plasma and Cerebrospinal Fluid in Patients with Intracranial Lesions

Masaki MIURA, Shuichi TAKAGI, Yasuhiko MATSUKADO, Yukitaka USHIO

1989 Volume 29 Issue 9 Pages 806-810
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.806

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To study the influence of the vasopressin level on osmotic pressure and sodium concentration in plasma and cerebrospinal fluid (CSF), plasma and CSF were sampled simultaneously in 27 patients with central nervous system lesions. A significant elevation of arginine vasopressin (AVP) levels in plasma and CSF and a significant increase in the osmotic pressure gradients of plasma and CSF were observed in hyponatremic patients. The significant increases in the osmotic pressure gradients may be attributable to hemodilution and CSF concentration resulting from the elevated AVP level, because the sodium concentration gradients of plasma and CSF did not significantly increase. The elevated AVP levels in plasma and CSF and the increased osmotic pressure gradients of plasma and CSF normalized in parallel with improvement of consciousness. These findings suggest that the increased osmotic pressure gradients of plasma and CSF, derived from increased AVP secretion into blood and CSF, exacerbates brain edema induced by the primary lesion and may contribute to the clinical deterioration of some patients with intracranial lesions.

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Clinical Features and Outcome in 68 Cases of Aneurysmal Subarachnoid Hemorrhage without Aneurysm Repair

—A Community Hospital Study—

Jun SHINODA, Takafumi KIMURA, Takashi FUNAKOSHI

1989 Volume 29 Issue 9 Pages 811-815
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.811

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The authors studied the clinical features and outcome at 6 months in 191 patients with subarachnoid hemorrhage (SAH) from ruptured aneurysms. Aneurysm repair (AR) was undertaken in 123 cases (64.4%). In the non-AR group (n = 68), 48.5% of the patients were 70 years of age or older, compared with 12.2% in the AR group. The duration from onset to admission was less than 3 hours in 48 non-AR cases (70.6%) and in 42 AR cases (34.1 %). Among non-AR patients, 63.2% were Hunt and Hess grade IV or V, whereas the figure for AR patients was only 14.7%. By 6 months after SAH, 94.1% of non-AR patients had died, and the remainder were vegetative or severely disabled. In contrast, only 15.4% in the AR group died, and over 50% showed good recovery. The large majority of non-AR patients were treated conservatively because they were judged to be poor surgical risks and, among these patients, nearly one half were elderly. In the 10 elderly patients considered good surgical candidates, vasospasm was the most common reason (70%) for not performing AR.

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The Outcome of Head Injury: The Saudi Experience

Abdel Wahab M. IBRAHIM, Upendra M. CHOWDHARY, Ahmed AMMAR, Ezzeldine M ...

1989 Volume 29 Issue 9 Pages 816-819
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.816

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The outcome in 159 cases of head injury was evaluated in terms of the Glasgow Coma Scale (GCS) score, age, and computed tomographic (CT) findings. Children below the age of 10 accounted for 30% of the head-injured patients, and 69% were Saudis. 81% of the patients had a GCS score of 8 or higher, and in this group the outcomes were favorable. In contrast, 19% had an initial GCS score of 7 or less, tended to be older, and had worse outcomes, with a mortality rate of 68%. The initial GCS score, age, presence or absence of associated injuries, and the degree of midline shift according to CT were useful prognostic indices in patients with head injury.

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Rapid Resolution of Acute Subdural Hematoma

—Report of Four Cases—

Shuji NIIKAWA, Shingo SUGIMOTO, Tatsuaki HATTORI, Akio OHKUMA, Takafum ...

1989 Volume 29 Issue 9 Pages 820-824
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.820

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We report four cases of acute subdural hematoma (ASDH) in which the hematoma rapidly resolved. Three of the four hematomas were traumatic. The outcome was good in three cases and fair in one. Spontaneous resolution of ASDH is rare.

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Responses of Pineocytoma to Radiation Therapy and Chemotherapy

—Report of Two Cases—

Katsuaki SAKODA, Tohru UOZUMI, Keiichi KAWAMOTO, Yoshimi FUJIOKA, Jun ...

1989 Volume 29 Issue 9 Pages 825-829
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.825

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Pineal parenchymal tumors are so rare that their responses to radiation and/or chemotherapy are not well known. Two cases of pineocytoma, which responded well to radiation therapy and chemotherapy, respectively, are reported. A 45-year-old female received radiation therapy in a total dose of 5000 rads to the tumor. Three months after the completion of therapy, computed tomography (CT) showed complete disappearance of the tumor, and she remains well as of 1 year after treatment. The second patient, a 6-year-old girl, underwent four cycles of intravenous infusion of ACNU (25 mg) over 10 months. CT demonstrated complete disappearance of the tumor and, 18 months postoperatively, there was no evidence of tumor recurrence. The results in these two cases indicate that postoperative radiation therapy and/or chemotherapy should be strongly considered for patients with pineal parenchymal tumors.

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Cystic Acoustic Neurinomas

—Report of Two Cases—

Shozo YAMADA, Tadashi AIBA

1989 Volume 29 Issue 9 Pages 830-833
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.830

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Two cases of large, cystic acoustic neurinoma are described. On computed tomographic scans, cystic acoustic neurinomas resemble, and may be confused with, other tumors of the cerebellopontine angle. A cystic acoustic neurinoma should be considered in the event of a large, cystic cerebellopontine angle tumor, especially if there is no significant hearing loss and no destruction of the internal auditory canal.

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Multiple Meningiomas of the Spinal Canal and Posterior Fossa

—Case Report—

Katsuhiro YAMASHITA, Tatsuo AKIMURA, Katsunori KAWANO, Naoto ADACHI, T ...

1989 Volume 29 Issue 9 Pages 834-837
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.834

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The majority of multiple meningiomas are associated with von Recklinghausen's disease, and those that are not, i.e., true multiple meningiomas, particularly with simultaneous development in the posterior fossa and spinal canal, are very rare. We recently encountered a case of true multiple meningiomas in which the lesions were found simultaneously in the left posterior fossa and the upper thoracic spinal canal. The spinal meningioma consisted mainly of meningotheliomatous components, and that in the posterior fossa of fibroblastic components. Both tumors were surgically removed. The cause of the multiplicity in cases of true multiple meningiomas is unknown. Incidental multiplicity is a consideration when the number of tumors is relatively small. Spinal meningiomas are often undetected in the absence of neurological symptoms. However, even if von Recklinghausen's disease is not present, and particularly when more than two meningiomas have been discovered, the patient must be carefully examined for other tumors.

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Intramedullary Ganglioglioma of Spinal Cord

—Case Report—

Kazufumi KAMIKASEDA, Tosuke TAKAKI, Takashi HIKITA

1989 Volume 29 Issue 9 Pages 838-841
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.838

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Gangliogliomas occur least commonly in the spinal cord. A case of ganglioglioma of C8-Th1 spinal cord in a 24-year-old male is reported. Magnetic resonance imagings are an important element of diagnosis and treatment.

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Intratemporal Facial Nerve Neurinoma

—Case Report—

Masayuki MATSUDA, Hiroyuki KITANO, Kazuyoshi WATANABE, Jyoji HANDA

1989 Volume 29 Issue 9 Pages 842-845
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.842

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A 59-year-old female had episodes of vertigo for 13 years, right tinnitus for 6 years, and right hearing difficulty for 2 years. She had no facial nerve dysfunction or other neurological deficits. Postcontrast computed tomography (CT) did not show abnormalities, but a wide, high-window CT scan revealed erosion of the petrous pyramid on the right side. Magnetic resonance imaging clearly delineated the entirety of a small tumor transecting the petrous bone. At operation a neurinoma was found to originate from the facial nerve proximal to the geniculate ganglion; it was totally removed. This case is unique in that she had a long history of signs and symptoms of acoustic nerve disturbance, but no facial nerve dysfunction whatsoever.

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Postoperative Subarachnoid Hemorrhage from an Intracranial Aneurysm after Craniotomy for Astrocytoma

—Case Report—

Hiroshi YAMADA, Katsushi TAOMOTO

1989 Volume 29 Issue 9 Pages 846-849
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.846

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The authors present the first reported case of a glioma associated with a right posterior cerebral artery (PCA) aneurysm. A 37-year-old male underwent craniotomy and total removal of the glioma, which appeared, according to encephalographic findings, to be responsible for the initial symptom of loss of consciousness. The risk of craniotomy-induced bleeding from the aneurysm was thought to be low, since it was unruptured and was packed with coagulum. However, subarachnoid hemorrhage due to rupture of the PCA aneurysm occurred just after craniotomy, and clipping was performed 15 days after the first operation.

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Bilateral Aseptic Femoral Head Necrosis associated with Steroid Therapy for Prolactinoma

—Case Report—

Patrick O. EGHWRUDJAKPOR, Masahiro KURISAKA, Masanori MORIMOTO, Koreak ...

1989 Volume 29 Issue 9 Pages 850-853
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.850

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The authors report a recent case of prolactin-secreting pituitary adenoma in a young male who had earlier received treatment for infertility. Following partial adenomectomy, he was placed on postoperative steroid substitution among other treatments, but developed femoral head necrosis several months later. Hormone studies at the time showed significant findings, including an elevated serum cortisol level. The authors conclude that this complication resulted from prolonged steroid therapy and offer suggestions as to how a similar situation may be avoided.

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Spontaneous Epidural Hematoma Secondary to Dural Metastasis from an Ovarian Carcinoma

—Case Report—

Shigetaka ANEGAWA, Suguru HIROHATA, Takashi TOKUTOMI, Shinken KURAMOTO

1989 Volume 29 Issue 9 Pages 854-856
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.854

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We report a case of spontaneous epidural hematoma secondary to dural metastasis of an undifferentiated ovarian carcinoma. The hemorrhage occurred 2 days after oophorectomy. The hematoma was evacuated, and histological examination of the galea and dura mater revealed metastatic ovarian carcinoma. The absence of other pathology in the vicinity of the hematoma indicates that the hemorrhage was caused by the dural metastasis. Although subdural hematoma secondary to dural metastasis has been reported, this is believed to be the first reported case of epidural hematoma attributable to dural metastasis.

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Medullary Venous Malformation with an Arterial Component associated with a Ruptured Aneurysm

—Case Report—

Yoshihiko TASHIRO, Yoshiaki TAKENO, Tsuyomi MIZOGUCHI, Fumiaki MAEHARA

1989 Volume 29 Issue 9 Pages 857-860
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.857

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We report the rare occurrence of a medullary venous malformation (MVM) with an arterial component associated with a saccular aneurysm on the opposite side. This 49-year-old male patient was admitted with headache and vomiting. He was diagnosed as having a subarachnoid hemorrhage on the basis of bloody cerebrospinal fluid. Angiography revealed a saccular aneurysm at the junction of the internal carotid and posterior communicating arteries on the left side. A MVM with an arterial component was also seen in the right basal frontal lobe. On the seventh hospital day, the aneurysm was clipped via a left frontotemporal craniotomy. The postoperative course was uneventful.
There are many hypotheses concerning cerebral aneurysms; some are thought to derive from persistent primitive arteries in the early fetal period. On the other hand, MVM is thought to be intimately related to arteriovenous malformation, which is believed to develop from the premordial vascular plexus, also in early fetal life.

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Neonatal Brain Abscess with Intracystic Hemorrhage

—Case Report—

Yoshinobu NAKAGAWA, Kiyohito SHINNO, Yuji AKAIKE, Naomi FUJIMOTO, Kazu ...

1989 Volume 29 Issue 9 Pages 861-863
Published: 1989
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.29.861

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The authors describe the case of an 11-day-old boy with high fever and signs of meningeal irritation in whom computed tomography demonstrated a large brain abscess with intracystic hemorrhage in the right temporal lobe. Cerebrospinal fluid analysis indicated purulent meningitis caused by Escherichia coli. After aspiration of the abscess contents, the entire ventricular system gradually enlarged. Despite repeated ventricular drainage and ventriculoperitoneal shunting, the lateral horn of the left lateral ventricle remained dilated. The isolation of the lateral ventricle may have resulted from septation due to the inflammatory reaction. This fluid was also shunted to the peritoneal cavity.

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