Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 30, Issue 1
Displaying 1-15 of 15 articles from this issue
  • Tatsuya NAGASHIMA, Takayuki SHIRAKUNI, Stanley I. RAPOPORT
    1990 Volume 30 Issue 1 Pages 1-9
    Published: 1990
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
    The authors constructed a two-dimensional model of vasogenic brain edema, using the finite element method (FEM). The model incorporates the following physical parameters: cerebrovascular hydraulic conductivity, metabolic water production, tissue hydraulic conductivity and compliance, tissue and plasma osmotic and hydrostatic pressures, cerebrospinal fluid hydrostatic pressure and absorption, intracerebral stress, and shift of brain tissue. These parameters, related by partial differential equations, were approximated numerically in time and space by the FEM. The results of computer simulation of brain edema by the FEM were compared with experimental data obtained in a feline cold injury brain edema model. Computer simulation predicted the changes observed in interstitial pressure, extent of edema, intracerebral stress distribution, and shift of brain tissue. The results indicate that the FEM, applied to a model of vasogenic brain edema, can be used to predict the time course and regional distribution of fluid accumulation and the accompanying regional stress and deformation of brain tissue.
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  • Kazuhiko NOZAKI, Shinichiro OKAMOTO, Hiroji YANAMOTO, Haruhiko KIKUCHI
    1990 Volume 30 Issue 1 Pages 10-15
    Published: 1990
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
    The in vivo spasmogenic activity of various blood components was examined in dogs. Each blood fraction was injected into the cisterna magna at 0.5 or 1.0 ml/kg body weight, after the removal of 0.5 ml/kg body weight of cerebrospinal fluid, and vertebral angiography was then performed. Whole blood induced both early and late arterial spasm. Platelet-rich and platelet-poor plasma produced only early spasm, and no arterial narrowing was observed on days 1, 3, and 7 after injection. On the contrary, intracisternal injection of washed red blood cells (0.5 ml/kg body weight) produced no arterial narrowing for 6 hours after injection and induced moderate arterial narrowing on days 1, 3, and 7 after injection. Hemolysate (a 10-gm/dl concentration of hemoglobin) produced prolonged monophasic arterial narrowing after injection. These results imply that red blood cells are required for late, prolonged arterial narrowing after experimental subarachnoid hemorrhage.
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  • Hidenori OHTA
    1990 Volume 30 Issue 1 Pages 16-23
    Published: 1990
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
    Cerebral blood flow (CBF) was measured in 90 patients who underwent early aneurysmal clipping after subarachnoid hemorrhage (SAH). Measurements were made by a noninvasive, two-dimensional method involving intravenous injection of 133Xe. Patients of Hunt and Hess grades I and II exhibited normal to slightly subnormal CBF, without significant changes, during the study period. Grades III-V patients had almost normal CBF in the early postoperative period, but their CBF gradually decreased, becoming significantly low after day 31. It is noteworthy that in grades IV and V patients, CBF was abnormally high in the acute stage, relative to their poor neurological condition; these patients were considered to have the “global luxury perfusion syndrome.” The syndrome was not uncommon in patients with severe SAH. Possible causative or contributory factors are attempts to surgically reduce intracranial pressure, which leads to increased cerebral perfusion pressure, and concomitant global dysautoregulation. In patients with this syndrome, maneuvers intended to increase CBF should be avoided, as they may aggravate brain swelling or cause hemorrhagic events. Positron emission tomographic studies will provide more accurate and useful information concerning the management of SAH patients.
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  • —Clinical Features and Indications for Operation—
    Shin-ichi OTSUKA, Shoji NAKATSU, Shigeo MATSUMOTO, Shin-ichi SATO, Tak ...
    1990 Volume 30 Issue 1 Pages 24-28
    Published: 1990
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
    In this retrospective study, 11 cases of posterior fossa epidural hematoma were analyzed in terms of clinical and radiological features, treatment, and outcome. Posterior fossa epidural hematomas accounted for 11.8% of all epidural hematomas encountered during the 7-year period studied. There were eight males and three females ranging in age from 2 to 53 years (mean, 20.7 years). Glasgow Coma Scale scores on admission were relatively good in many cases. Headache and/or vomiting were common symptoms on admission, whereas cerebellar signs were rare. As all 11 cases involved trauma, occipital fractures were present in eight (72.7%). Six patients underwent surgery. The indications for surgery, in terms of computed tomography findings, were: 1) the maximum thickness of the epidural hematoma was more than 15 mm; 2) the posterior fossa cisterns (e.g., the quadrigeminal and ambient cisterns) were poorly visualized; 3) there was marked deformity and/or displacement of the fourth ventricle; and 4) the hematoma extended to the supratentorial region and severely compressed the brain. At discharge, eight patients showed good recovery and one was moderately disabled. Two patients died. The prognosis for posterior fossa epidural hematoma appears relatively good, if it is not accompanied by severe primary brainstem injury and is diagnosed early, and appropriately and promptly treated.
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  • Kazuhito HASHIMOTO, Hiroshi SHIBASAKI, Kazuo TABUCHI
    1990 Volume 30 Issue 1 Pages 29-35
    Published: 1990
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
    Auditory brainstem responses (ABRs) were studied in 15 adults with suspected normal pressure hydrocephalus (NPH) before and after shunting. The patients were divided into Groups A (shunt-ineffective) and B (shunt-effective). The pre and postoperative ABRs of each patient were compared with those of 20 normal volunteers, and the relationships between ABRs and certain clinical findings were investigated. Preoperatively, nine patients (60%) showed prolonged central conduction time (CCT) (interpeak latency of wave I-V or neural-axonal conduction time) relative to the mean control value plus 2 SD. There was no significant difference between Groups A and B in the percentage of patients with abnormal CCT, and no specific ABR abnormalities that were predictive of the efficacy of shunting. However, a significantly higher percentage of Group B patients (p < 0.05) showed a postoperative reduction in the CCT of more than 1 SD of the mean control value. In Group A, the CCT was positively correlated with preoperative clinical disability. These results suggest that brainstem dysfunction may be reversed by shunting, but is not correlated with clinical disability in patients in whom shunting is effective, that is, in those with NPH. It appears that measurement of ABRs is a useful technique for the clinical monitoring of shunted patients.
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  • —Histological Analysis of Sequential Tissue Changes in 34 Autopsy Cases—
    Shizuo OI, Takashi KOKUNAI, Akihiro IJICHI, Satoshi MATSUMOTO, Anthony ...
    1990 Volume 30 Issue 1 Pages 36-42
    Published: 1990
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
    The nature and sequence of the radiation-induced changes in the brain were studied postmortem in 34 children with glioma, 22 of whom underwent central nervous system radiation therapy. Twenty received whole-brain or whole-neuroaxis radiation at a total mean dosage of 4063 cGy. Brain tissue alterations were analyzed histologically by means of various staining methods, including immunohistochemical techniques. The histological features of irradiated brains were compared with those of non-irradiated brains. Microscopic findings included demyelination (seven cases), focal necrosis (six cases), cortical atrophy (four cases), endothelial proliferation (four cases), and telangiectatic vascular proliferation with vascular thickening and oozing of a thick fluid (one case). Such findings were rare in non-irradiated patients. Demyelination was observed earliest in a patient who died 5 months after radiation therapy and was more common after 9 months. Focal necrosis was first observed 9 months post-irradiation but was more advanced and extensive after 1 year. Calcified foci were found only after 60 months. Various vascular changes such as vascular thickening and thrombosis suggested ischemic insult to the brain as a late effect of radiation injury. The results of this study suggest that the immature brain may be more sensitive to radiation than is the adult brain, and that the manifestations of radiation-induced injury depend on the time elapsed after irradiation.
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  • —eport of Two Cases—
    Akira IKEDA, Ikuzo IGUCHI, Makoto HARA, Isao YAMAMOTO, Osamu SATO
    1990 Volume 30 Issue 1 Pages 43-46
    Published: 1990
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
    The authors report an instance of familial moyamoya disease involving a 47-year-old female and her 18-year-old daughter, both of whom initially presented, within a 1-year period, with intracranial hemorrhage. Cerebral angiography showed the typical features of moyamoya disease. The mother, whose disease was more advanced, underwent superficial temporal-middle cerebral artery bypass, with satisfactory results. Human leukocyte antigen typing was performed in both cases. The pertinent literature is reviewed.
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  • —Case Report—
    Toshiaki YAMAKI, Masayuki TAKEDA, Hiroshi TAKAYAMA, Yoichi NAKAGAKI
    1990 Volume 30 Issue 1 Pages 47-50
    Published: 1990
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
    A 69-year-old female underwent surgery for subarachnoid hemorrhage due to a ruptured intracranial aneurysm. Nine additional aneurysms were found. Four of the latter nine aneurysms were clipped in a second operation, and two were wrapped.
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  • —Case Repor—
    Tatsuaki HATTORI, Hiroyasu YAMAKAWA, Hiroshi KOBAYASHI, Shuji NIIKAWA, ...
    1990 Volume 30 Issue 1 Pages 51-53
    Published: 1990
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
    Computed tomographic (CT) features of central descending transtentorial herniation (DTH) were identified in a patient who presented with subarachnoid hemorrhage. The main features were symmetrical deformity of the brainstem and downward displacement of the third ventricle. The authors believe these findings will contribute significantly to the establishment of CT diagnostic criteria for central DTH.
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  • —Case Report—
    Tokutaro TANAKA, Kenichi UEMURA, Masashi SUGIURA, Haruyuki OHISHI, Mam ...
    1990 Volume 30 Issue 1 Pages 54-58
    Published: 1990
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
    A case of acute aortic dissection (AAD) presenting as sudden, transient paraplegia and severe back pain is reported. The patient was a 66-year-old male with a 10-year-history of hypertension. The pain characteristically migrated from the back to the neck and then returned to the back. He showed complete transverse myelopathy at the level of the 9th thoracic cord. Computed tomography disclosed internal displacement of aortic intimal calcifications, without abnormalities in the spinal canal, and myelography showed no spinal canal block or stenosis. Electrocardiography and chest x-ray indicated nonspecific changes of high amplitudes and mild cardiomegaly, respectively. Together, these findings suggested acute aortic dissection with spinal cord ischemia. The initial systolic blood pressure of 220 mmHg was lowered with medication, and the pain was controlled with morphine. He recovered fully and was discharged 80 days after the onset of symptoms, with no neurological deficits. AAD carries a very poor prognosis unless treated immediately. Therefore, it is very important to promptly differentiate this disorder from spinal vascular conditions that also produce back pain and paraparesis.
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  • —Case Report—
    Yasutaka MAEDA, Toshiaki FUJITA, Eiichiroh MABUCHI, Mitsumasa KANOH, T ...
    1990 Volume 30 Issue 1 Pages 59-62
    Published: 1990
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
    The authors report a case of an epidermoid in the quadrigeminal cistern in a 40-year-old female who presented with headache and nausea. According to the literature, epidermoids are rarely found in the quadrigeminal cistern. Additional unusual features in this case were the absence of a capsule and T1-weighted magnetic resonance images suggestive of both solid (less intense) and fluid (more intense) comnonents.
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  • —Case Report—
    Takeo FUKUSHIMA, Masamichi TOMONAGA, Toshio SAWADA, Hiroshi IWASAKI
    1990 Volume 30 Issue 1 Pages 63-68
    Published: 1990
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
    The authors describe a case of pineocytoma studied by light and electron microscopy and the immunoperoxidase method. The tumor consisted of two types of cells bearing either chromatin-rich or pale nuclei. These cells were arranged in rosettes and contained pale, eosinophilic material at the center, or in lobular patterns with thin connective tissue and a few blood vessels. Bodian silver staining disclosed a delicate tangle of argyrophilic fibers and processes with small, club-like terminations. These findings are characteristic of pineocytoma. On ultrastructural examination, the tumor cells were found to be closely packed, in clumps separated by numerous fine or expanded, interlacing processes, some of which contained microtubules. A few dense core vesicles and clusters of clear vesicles similar to synaptic vesicles were seen, the latter being aggregated around desmosome-like thickenings in the cellular membrane, suggestive of a synaptic complex. Some tumor cells were positive for neuronspecific enolase and S-100 protein. Only a few cells positive for glial fibrillary acidic protein were distributed in the tumor tissue, but it was not ascertained if they were tumor cells or normal, pre-existing astrocytes. The tumor was diagnosed as a pineocytoma with neuronal differentiation.
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  • —Case Report—
    Tatsuhito YAMAGAMI, Haruhiko KIKUCHI, Kenichiro HIGASHI, Yasunobu GOTO ...
    1990 Volume 30 Issue 1 Pages 69-73
    Published: 1990
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
    The authors report a case of cerebral metastasis from a spinal cord astrocytoma. The first metastatic tumor was controlled by radiation therapy. A second metastatic brain tumor was detected 2 years later, but attempts to control it through subtotal removal and chemotherapy failed. Metastasis from a spinal cord tumor to the brain is a rare event.
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  • —Case Report—
    Masakazu MIYAJIMA, Shizuo HATASHITA, Akira OHNUKI, Suguru TAKAGI
    1990 Volume 30 Issue 1 Pages 74-76
    Published: 1990
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
    A 25-year-old female presented with a 1-month history of headache and vomiting. Computed tomography revealed several enhanced nodules with surrounding edema in the right cerebellum. A T2-weighted magnetic resonance image showed heterogeneous high signal intensity throughout the right cerebellar hemisphere. A tuberculin skin test was positive and the erythrocyte sedimentation rate was slightly high, but there was no other clinical evidence of a tuberculous process. The histological diagnosis of the surgical specimen was tuberculoma. The combination of surgery and antituberculosis chemotherapy eradicated the cerebellar lesions.
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  • —Technical Note—
    Kazunari OKA, Tatsuhiko OHTA, Michihiro KIBE, Masamichi TOMONAGA
    1990 Volume 30 Issue 1 Pages 77-79
    Published: 1990
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
    A new, flexible fiberoptic ventriculoscope for observation of the ventricles and major cisterns is reported. This device has been safely used to examine patients with obstructive hydrocephalus due to lesions within the lateral and third ventricles or to congenital aqueductal stenosis. With this instrument, a pineal tumor protruding into the third ventricle was successfully observed and photographed in situ.
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