Neurologia medico-chirurgica

Effects of X-irradiation Alone and in Combination with ACNU on Human Glioblastoma Cells in Vitro

Shoji MASHIYAMA, Ryuichi KATAKURA, Kou TAKAHASHI, Masakazu KITAHARA, J ...

1990 Volume 30 Issue 5 Pages 295-300
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.295

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The combined effects of x-irradiation and 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea (ACNU) on multicellular glioblastoma A-7 spheroids were analyzed by means of cell survival and dose-response curves. The actual dose-response curve for small spheroids was almost identical to that estimated from the cell survival curve. It was strongly suggested that a small number of radiation-resistant cells, which were not detected in the cell survival curve, were present in large spheroids with central necrosis. The enhancing effect of ACNU was greater with large spheroids than with monolayer cells or small spheroids. A possible explanation for this is that ACNU is higher effective against the few radiation-resistant cells that may be present in larger spheroids.

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The Effect of Increased Intracranial Pressure during the Appearance of Pressure Waves on the Brainstem

Yuji HANDA, Minoru HAYASHI, Satoshi HIROSE, Yoshiyuki NOGUCHI, Hidenor ...

1990 Volume 30 Issue 5 Pages 301-308
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.301

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The effects of increased intracranial pressure (ICP) during the appearance of plateau waves or Bwaves to the brainstem functions were investigated by evaluation of evoked potentials. The ICP and systemic blood pressure were continuously recorded in nine cases of intracranial hypertension. In the four cases demonstrating plateau waves in ICP recording, the latencies of the auditory brainstem evoked potentials (ABEP) measured during the appearance of plateau waves showed no significant differences compared to those measured during the interval phase between two plateau waves. In the five cases demonstrating B-waves in ICP recording, four cases showed significant (p < 0.05) prolongation of the V wave of ABEP and three showed significant (p <0.05) prolongation of the P₁₅ of somatosensory evoked potentials during the phase of increased ICP level with B-waves compared to those measured during the phase of decreased ICP level without B-waves, produced by external drainage of the cerebrospinal fluid or mannitol administration. The results indicated that during the appearance of plateau waves there were no significant changes of electrical activity in the brainstem, even though there was a significant reduction in cerebral perfusion pressure. It is suggested that in cases with the appearance of B-waves, an increase in ICP frequently affects the electrical activity in the brainstem.

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Cerebral Microthrombosis in Symptomatic Cerebral Vasospasm

—A Quantitative Histological Study in Autopsy Cases—

Shigeharu SUZUKI, Masahide KIMURA, Masashi SOUMA, Hiroki OHKIMA, Toshi ...

1990 Volume 30 Issue 5 Pages 309-316
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.309

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A comparative investigation of the pathogenetic factor in symptomatic cerebral vasospasm was made by quantitative histological and clinical studies in four patients who died immediately of symptomatic cerebral vasospasm (Cases 1-4) and in two who died without fatal cerebral vasospasm (Cases 5 and 6). Histological examination of the brain from Cases 1 and 2 found many white and fibrin microthrombi together with ischemic and infarctic changes in the territories of spastic arteries, which corresponded to the low-density areas (LDAs) observed on computed tomographic (CT) scans and the typical neurological symptoms. In Case 3, who had suffered severe vasospasms in bilateral anterior cerebral and middle cerebral arteries, bilateral LDAs were observed on CT scans and multiple fibrin thrombi were seen diffusely throughout the brain. In Case 4, extensive bilateral LDAs (It > rt) were observed on CT scans, and multiple microthrombi were seen diffusely but predominantly in the left cerebral hemisphere. Only in Case 3 the possible complication of disseminated intravascular coagulation could not be ruled out. Only negligible thrombi were observed in Cases 5 and 6, whose immediate cause of death was considered to be acute hydrocephalus and aneurysmal rerupture, respectively. Distributions of microthrombi were significantly greater in the regions clinically identified to have been ischemic or infarctic.

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Hyperdynamic Therapy for Cerebral Vasospasm

Hiromu HADEISHI, Makoto MIZUNO, Akifumi SUZUKI, Nobuyuki YASUI

1990 Volume 30 Issue 5 Pages 317-323
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.317

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The effects of hyperdynamic therapy on patients with cerebral vasospasm following subarachnoid hemorrhage (SAH), under normal blood pressure (BP) and normal blood volume conditions, are reported. Forty-four patients, who underwent surgery for aneurysms in acute stage, received hydroxyethyl starch (500 ml/day) postoperatively to prevent dehydration. Twenty-four of the 44 patients with prominent SAH on the computed tomographic (CT) scan, anticipating to develop cerebral ischemia due to vasospasm, were given dobutamine (DOB). The BP was maintained within the normal range, and the heart rate was kept below 130/min. In the 24 patients treated with DOB, cerebral blood flow (CBF) was measured repeatedly by the ¹³³Xe intravenous injection method. In 8 of these 24 patients, the cardiovascular function was monitored with Swan-Ganz (S-G) catheters. Twelve of the 44 patients (27%) developed delayed neurological deficits associated with cerebral vasospasm. The neurological deficits were reversed by the administration of DOB, at a dose of 8-25 (average 12.4), ug/ kg/min. In 43 patients, the ischemic lesions associated with vasospasm did not appear on CT scan and the patients were of normal condition at discharge. However, one patient showed multiple low-density lesions on CT scan. This was because of the failure of hyperdynamic therapy due to pulmonary complications. No case of pulmonary edema or heart failure due to volume overload was noted. In the 24 patients with prominent SAH, CBF increased significantly by up to 20% following DOB administration, although the BP stayed in the normal range. In the 8 patients monitored with S-G catheter, the cardiac index increased markedly after treatment with DOB, but the pulmonary wedge pressure was remained below 10 mmHg. There were no significant changes in either the stroke volume index (SI) or the stroke-CBF (CBF/heart rate).
Hyperdynamic therapy with DOB is effective for the postoperative management of cerebral vasospasm, and neither induced hypertension nor hypervolemia was necessary. DOB had positive inotropic effects, but did not decrease the SI or stroke-CBF, so that hyperdynamic therapy with DOB increased the CBF in patients with vasospasm, and caused no side effects.

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Is Chiari I Malformation in the Aged Initiated by Mechanical Factors?

—Report of Three Cases—

Toshisuke SAKAKI, Shigeru TSUNODA, Tetsuya MORIMOTO, Shozaburo UTSUMI

1990 Volume 30 Issue 5 Pages 324-328
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.324

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Three cases in which the signs and symptoms of Chiari I malformation were induced and worsened after the occurrence of supratentorial mass lesions are reported. The symptoms improved markedly after removal of the supratentorial lesions in these cases. In the first case, a meningioma in the right parietal region coexisted with Chiari I malformation. Although the cerebellar ataxia and nystagmus disappeared after tumor removal, decompressive surgery for the malformation was performed because of upper cervical nerve symptoms and the patient recovered completely. In the second case, the symptoms first occurred after a car accident, and a computed tomographic scan revealed not only a subdural hematoma, but also tonsillar herniation due to Chiari I malformation. After evacuation of the hematoma and decompressive surgery on the craniospinal junction, the symptoms disappeared. In the third case, the symptoms of malformation developed gradually with depression and gait disturbance. A meningioma in the left frontal region coexisted with Chiari I malformation. Although the symptoms improved remarkably after tumor removal, decompressive surgery on the craniospinal junction was performed because of upper cervical nerve symptoms, and the patient recovered completely. These clinical findings indicate that a supratentorial mass lesion may provoke the symptoms of Chiari I malformation in the aged.

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Treatment of Intraventricular Hemorrhage Using Urokinase

Ping-Hui SHEN, Yoshimi MATSUOKA, Katsuhisa KAWAJIRI, Makoto KANAI, Kat ...

1990 Volume 30 Issue 5 Pages 329-333
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.329

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Four patients with severe intraventricular hemorrhage (IVH) were treated using urokinase administered into the lateral ventricles via a ventricular drainage catheter. All patients were female and of ages ranging from 24 to 53 years. The primary diseases were hemorrhagic infarction, moyamoya disease, sinus thrombosis, and thalamic bleeding. Urokinase administration was initiated at 1.3 days average after occurrence of IVH and continued for 3.3 days average in doses of 12, 000-96, 000 IU per day. Average clot lysis times from IVH, as assessed by computed tomography, were 5.0 ± 0.8, 5.0 ± 1.4, and 6.0 ± 0.8 days for the fourth, the third, and the lateral ventricles, respectively. All patients suffered from meningitis which was probably caused by urokinase administration through a ventricular catheter. However, this was successfully treated by changing the antibiotics. There was no general bleeding tendency or intraventricular rebleeding due to urokinase administration, and none of the ventricular catheters were obstructed by clots throughout the course. The final outcome was good recovery in two patients, severe disability in one, and persistent vegetative state in one. These results correlated well with the consciousness level seen before ventricular drainage in each patient. Consequently, we are convinced that urokinase administration can prevent the harmful effects of IVH and that urokinase is useful not only for lysing ventricular clots but also for maintaining the patency of the ventricular catheter, which is important for control of intracranial pressure in the acute stage of severe IVH.

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Multicentric Glioblastoma Multiforme Occurring in the Supra and the Infratentorial Regions

—Case Report—

Hiroshi KUDO, Makoto TANAKA, Seishirou URUI, Hisahiko SUZUKI, Norihiko ...

1990 Volume 30 Issue 5 Pages 334-338
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.334

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A 74-year-old male was admitted because of severe headache, vertigo, and vomiting. A computed tomographic scan showed heterogeneously enhanced tumors in the supra and the infratentorial regions, apparently attached to the cerebellar tentorium. He died 2 months after the onset despite external decompression and a ventriculo-peritoneal shunt. The autopsy showed both tumors were intraaxial and not attached to the dura mater including the cerebellar tentorium. The histological diagnosis of either tumor was glioblastoma multiforme. This case could be classified as multicentric gliomas. In the 23 reported cases, including our case, most died soon after the onset of symptoms. Some, however, with low grade tumors had a comparatively long life span after the onset. It is, therefore, important to investigate the histology of these tumors for correct prognosis.

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Extracranial Metastases of Malignant Ependymoma

—Case Report—

Junki ITOH, Kazuo Usui, Masafumi ITOH, Yoshio HASHIZUME

1990 Volume 30 Issue 5 Pages 339-345
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.339

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A case of malignant ependymoma with extracranial metastases is reported. A 59-year-old male was admitted to our hospital with vomiting and ataxia. Following computed tomographic (CT) scanning indicating a ring-like enhanced mass in the cerebellum, the tumor was subtotally removed in December, 1985. Histological diagnosis was malignant ependymoma. A second operation was performed in February, 1987, due to recurrence of the tumor in the fourth ventricle. Postoperative radiation therapy at a total dose of 7780 rads was given over 2 years. Eleven months after radiation therapy was completed, he reported cough and multiple skin metastases. Chest x-rays showed metastases at the right hilus. Repeated CT scans revealed separate frontal cerebral metastatic tumors. He died of respiratory insufficiency. Extracranial metastases of infratentorial ependymoma to the skin and lung are rare pathological entities.

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Lymphocytic Adenohypophysitis Accompanying Occlusion of Bilateral Internal Carotid Arteries

—Case Report—

Jun-ichi IKEDA, Jun-ichi KURATSU, Masaki MIURA, Yutaka KAI, Yukitaka U ...

1990 Volume 30 Issue 5 Pages 346-349
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.346

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A 45-year-old female presented with blurred vision, headache, and abnormal thirstiness. She was not pregnant nor postpartum. She had diabetes insipidus and bitemporal hemianopsia. Radiological evidence suggested a mass arising in the sella turcica with extension into the parasellar and suprasellar regions. Carotid angiography showed occlusions of bilateral internal carotid arteries at the cavernous portions. The mass was subtotally removed by the trans-sphenoidal approach and was histologically diagnosed as an adenohypophysitis. Laboratory data showed the patient to be in an active state of autoimmune disorder and hypopituitarism. When a patient presents with pituitary insufficiency and an enhanced intrasellar mass lesion on computed tomographic scan, lymphocytic adenohypophysitis must be included in the differential diagnosis.

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Intracranial Arterial Vasospasm Associated with Pituitary Apoplexy after Head Trauma

—Case Report—

Youichi ITOYAMA, Satoshi GOTO, Masatake MIURA, Jun-ichi KURATSU, Yukit ...

1990 Volume 30 Issue 5 Pages 350-353
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.350

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A case of intracranial arterial vasospasm caused by pituitary apoplexy after head trauma is reported. In this case, pituitary apoplexy was secondary to head trauma, and the vasospasm was thought to be due to subarachnoid hemorrhage from a pituitary tumor. No such case has previously been reported in the literature.

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