Neurologia medico-chirurgica

Early Surgery in Elderly Patients with Ruptured Intracranial Aneurysms

—Preoperative Clinical Evaluation and Prognosis—

Akifumi SUZUKI, Nobuyuki YASUI, Hiromu HADEISHI, Makoto MIZUNO, Takeo ...

1990 Volume 30 Issue 2 Pages 95-99
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.95

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Numerous clinical classification systems have been developed for patients with ruptured intracranial aneurysms. However, most systems do not take age into account and are less reliable in elderly than in younger patients in terms of indications for early surgery and predicting the clinical outcome. The authors have studied this problem using our clinical classification system and, present here the results of 38 elderly patients (≥65 years of age) who underwent neck clipping and implementation of continuous ventricular drainage within 3 days of aneurysm rupture. The clinical outcome at 1 year after onset was considered “good” if the patient was able to function independently and “poor” if he or she was partially or fully dependent or had died. The preoperative level of consciousness was not significantly correlated with the outcome according to Spearman's nonparametric statistical analysis. Age, however, was a significant factor: the incidence of poor outcome was significantly higher in patients over age of 70 years than in those between 65 and 70 (p < 0.05). Postoperative complications, which were previously found to be significantly related to the outcome in elderly patients, were significantly more common in patients who had a history of cardiac, pulmonary, hepatic, and/or renal disease than in those without such a history (p < 0.005). The authors found that the prognostic accuracy of clinical classification systems, based on preoperative level of consciousness, is improved in geriatric cases if one point is added for patients over age of 70 years or those with a history of systemic diseases. Additional relevant factors included computed tomographic findings and pre-existing cerebral dysfunction.

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Distal Posterior Inferior Cerebellar Aneurysms

—Report of 12 Cases—

Tatsuya ISHIKAWA, Akifumi SUZUKI, Nobuyuki YASUI

1990 Volume 30 Issue 2 Pages 100-108
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.100

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The authors review 12 cases of distal posterior inferior cerebellar artery (PICA) aneurysm. Nine of the aneurysms were discovered after their rupture and three were incidentally detected. Seven (78%) of the nine ruptured aneurysms rebled, leading in four cases to coma and respiratory arrest. Computed tomography revealed intraventricular hematomas, mainly in the fourth ventricle, and a subarachnoid clot at the cisterna magna. In five of the nine cases involving aneurysm rupture, radical surgery was performed. The remaining four, whose clinical status was poor, were treated conservatively and subsequently died. Two patients were rendered partially dependent as a result of perioperative complications. A high incidence of rebleeding is characteristic of ruptured distal PICA aneurysms, and for this reason the prognosis for these patients is rather poor.

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Effects of Naloxone on Prolactin-secreting Pituitary A denomas

Katsuji SHIMA, Hiroo CHIGASAKI, Katsuyoshi SEKI

1990 Volume 30 Issue 2 Pages 109-112
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.109

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The investigators assessed the effects of the opioid antagonist naloxone on anterior pituitary hormone release in hyperprolactinemic females with pituitary microadenoma (n = 6) and macroadenoma (n = 7). In those with microadenoma, intravenous bolus injection of naloxone significantly increased serum luteinizing hormone (LH) concentrations but had no significant effect on serum prolactin (PRL), follicle-stimulating hormone, and thyroid-stimulating hormone concentrations. In patients with macroadenoma, naloxone significantly decreased serum LH and serum PRL concentrations. The response of LH to naloxone differed considerably between the two groups of patients. The results suggest that LH and PRL secretion is influenced by changes in endogenous opiates and in gonadotropinreleasing hormone and PRL inhibitory factor due to hypothalamic dysfunction.

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Measurement of Cerebral Blood Flow, Cerebral Blood Volume, and Cerebral Capillary Permeability in Glioma-bearing Rats

Shizuka AIZAWA, Kazuhiro SAKO, Yukichi YONEMASU

1990 Volume 30 Issue 2 Pages 113-118
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.113

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Effective chemotherapy and radiation therapy of brain tumors require knowledge of the cerebral circulatory dynamics involved. In this study, regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), and regional cerebral capillary permeability (rCP) were measured in Wistar King Aptekman rats bearing experimental KEG-1 gliomas. These parameters were assessed by autoradiography with ¹⁴C-iodoantipyrine, ¹⁴C-deoxyglucose-labeled red blood cells, and ¹⁴C-aminoisobutyric acid, respectively. rCBF within the tumor was approximately one third that in the contralateral cortex and was consistently higher in the periphery than in the center of the tumor. In the periphery of the tumor, rCBV was approximately twice that in the contralateral cortex, but it was very low in the center of the tumor. Throughout the tumor, rCP was sharply increased relative to that measured in the contralateral cortex, and the increase was especially pronounced in the central portion. Thus, rCBF, rCBV, and rCP each appeared to vary within the tumor, implying that the combined use of lipid and water-soluble chemotherapeutic agents is reasonable. Measurement of these parameters may also provide indices of radiation sensitivity.

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Fusiform Superior Cerebellar Artery Aneurysm Presenting with Contralateral Abducens Nerve Paresis

—Case Report—

Yuichi HIROSE, Tsuneo NAKAMURA, Yoshiaki TAKAMIYA, Norihisa KINOSHITA, ...

1990 Volume 30 Issue 2 Pages 119-122
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.119

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A 25-year-old female suddenly developed headache and diplopia. On admission, neurological examination revealed neck stiffness and left abducens nerve paresis. A computed tomographic scan suggested subarachnoid hemorrhage. Left vertebral angiogram showed an aneurysm on the anterior pontine segment of the right superior cerebellar artery (SCA) and marked flexion and meandering of the basilar artery to the left. At surgery, an atherosclerotic, fusiform aneurysm was found through the right subtemporal transtentorial approach, and the right SCA was clipped just proximal to the aneurysm. Thirteen cases of SCA aneurysm have been described in the literature, but none was a fusiform aneurysm.

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Germ Cell Tumor Arising in the Basal Ganglia in a Female

—Case Report—

Hiroshi KOBAYASHI, Hiromu YAMADA, Noboru SAKAI, Takashi ANDOH, Jun SHI ...

1990 Volume 30 Issue 2 Pages 123-126
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.123

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Germ cell tumors in the basal ganglia are very rare in females. The authors report the case of a 12-yearold girl with such a tumor in the left basal ganglia. The tumor was subtotally removed and responded well to irradiation.

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Multiple Oligodendroglioma

—Case Report—

Hidenori OGASAWARA, Katsuzo KIYA, Tohru UOZUMI, Kazuhiko SUGIYAMA, Kei ...

1990 Volume 30 Issue 2 Pages 127-131
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.127

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A 32-year-old male was hospitalized with headache and disturbance of consciousness. Computed tomography (CT) revealed a tumor and an intracranial hematoma in the right frontal lobe. The tumor was totally removed, and postoperative radiation therapy was administrated locally at 50 Gy. Five years later, he experienced sudden onset of headache and vertigo. CT demonstrated a mass lesion with a hematoma in the cerebellar vermis. The tumor was subtotally removed and he underwent postoperative local irradiation at 50 Gy as well as ventriculoperitoneal shunting. Four years later, he complained of visual and gait disturbances, and CT disclosed a tumor in the suprasellar region. Following partial removal of the tumor, local brain irradiation was given at 40 Gy. Histological examination proved all three tumors to 0be oligodendrogliomas with no evidence of malignant change.

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Neurinoma of the Oculomotor Nerve

—Case Report—

Shoji TAKANO, Masataka ENDO, Yoshio MIYASAKA, Kenzoh YADA, Takashi OHW ...

1990 Volume 30 Issue 2 Pages 132-136
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.132

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Only 10 cases of oculomotor nerve neurinoma have been reported previously. The authors report the rarity of a neurinoma originating from Schwann cells of the oculomotor nerve. The diagnosis was based on the initial sign of oculomotor nerve paresis without involvement of other cranial nerves, neuroradiological and surgical findings, and histological features of the specimen obtained at surgery.

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Lipoma in the Cerebellopontine Angle

—Case Report—

Shigeru NISHIZAWA, Tetsuo YOKOYAMA, Seiji OHTA, Hiroshi RYU, Toshiaki ...

1990 Volume 30 Issue 2 Pages 137-142
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.137

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The authors report a case of a cerebellopontine (CP) angle lipoma with a very unusual histological appearance. The 38-year-old male patient suffered vertigo, left tinnitus, and left hearing disturbance. Computed tomography and magnetic resonance imaging showed a nonenhanced low-density area and a high-intensity region in the left CP angle, respectively. The tumor, which was only partially removed because of its tight adhesion to the VIIIth nerve and brainstem, consisted of mature lipocytes and contained a piece of cartilage, which is highly unusual.

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Computed Tomography and Magnetic Resonance Imaging of Nonhemorrhagic, Metastatic Melanoma of the Brain

—Case Report—

Akimasa UOZUMI, Takashi SAEGUSA, Katsunobu OHSATO, Akira YAMAURA

1990 Volume 30 Issue 2 Pages 143-146
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.143

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Malignant melanoma frequently metastasizes to the central nervous system. Characteristic features of such lesions are increased density on computed tomography (CT) and shortening of the T₁ and T₂ on magnetic resonance (MR) imaging. Intratumoral hemorrhage, rather than melanin, is considered to be mainly responsible for these unique radiological features. The authors report a case involving a nonhemorrhagic, metastatic intracerebral melanoma. CT revealed a high-density mass, and MR imaging demonstrated a hyperintense mass both on T₁-and T₂-weighted images. These observations suggest that melanin is in fact a major determinant of the increased density on CT scans and the high signal intensity on T₁-weighted MR images. On T₂-weighted images, the paramagnetic effect appears to vary according to the melanin content.

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