Neurologia medico-chirurgica

Development of GFAP positive Cells and Reactive Changes Associated with Cystic Lesions in HTX Rat Brain

Yasuji YOSHIDA, Goyo KOYA, Kouki TAMAYAMA, Toshiro KUMANISHI, Satoshi ...

1990 Volume 30 Issue 7 Pages 445-450
Published: 1990
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.30.445

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HTX rat, a congenital hydrocephalic strain, develops ventricular dilatation and cystic cavities in the cerebral white matter after birth. To investigate the reactive changes in glial cells around these cavities, immunohistochemical staining for glial fibrillary acidic protein (GFAP), a specific marker protein of astrocytes, and bromodeoxyuridine (BrdU), a thymidine analogue, was carried out on 107 Wistar and HTX rat brains from birth to postnatal day (P) 26. Animals were divided into three groups: Group A, Wistar rats as normal controls; Group B, HTX rats with a normal structure or only mild ventricular dilatation without any lesion in the white matter; and Group C, HTX rats with severe ventricular dilatation and cyst formation in the white matter. Group B rats showed similar development of GFAPpositive (GFAP⁺) cells to that in Group A rats, both morphologically and quantitatively. On the other hand, Group C rats showed definite structural changes in GFAP⁺ cells around the cystic cavities from P5. These included enriched cytoplasm and thickened cell processes with increased GFAP expression, and enveloped most cyst walls from P10. However, quantitative examination of the percentage of GFAP⁺ cells in Group C rats showed a similar developmental profile to those in Group A and B rats. Furthermore, the labeling index of BrdU-positive cells, indicating S-phase cells, in the white matter in Group C rats showed a similar decreasing pattern to that in Group A and B rats from P1 to P26. These results indicate that the GFAP⁺ cells in HTX rats develop in a similar manner to those in Wistar rats, and that the reactive changes in the cyst walls occur immediately after the beginning of GFAP production and have similar structural and functional features of lesion repair to those in adult brain pathology. However, the reactive changes do not involve new cell proliferation.

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Measurement of Energy Expenditure in Acute Stage of Cerebrovascular Diseases

Hajime TOUHO, Jun KARASAWA, Hisashi SHISHIDO, Toshitaka MORISAKO, Shin ...

1990 Volume 30 Issue 7 Pages 451-455
Published: 1990
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.30.451

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Oxygen consumption (VO₂), carbon dioxide production, respiratory quotient, urinary nitrogen excretion (UN), resting energy expenditure (REE), REE rate (%REE) and consumption rates of carbohydrate (%C), fat (%F) and protein (%P) were pre and postoperatively measured in the acute stage of 17 patients with cerebrovascular diseases. They included six of ruptured intracranial aneurysms, six of cerebrovascular occlusion, and five of hypertensive intracerebral hemorrhage. Preoperative VO₂, UN, REE, and %REE were 185.1 ml/min, 7.1 gm/day, 1280 cal/day, and 132.6, respectively. %C, %F, and %P were 40.9, 38.5, and 20.6, respectively. Especially the preoperative %P had markedly increased. Postoperatively, %C significantly decreased to 28.3, and %P showed a significant increase up to 30.3. Patients with ruptured intracranial aneurysms manifested a significant increase of %P and %F and a decrease of %C, postoperatively. In summary, the catabolism of fat and protein increases in the acute stage, especially postoperatively, and this hypermetabolic state should be considered when caring for patients with cerebrovascular diseases as malnutrition might prevent wound healing and cause weight loss and a decrease in immunity.

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Factors Affecting Prognosis of Intrauterine Hydrocephalus Diagnosed in the Third Trimester

—Computerized Data Analysis on Controversies in Fetal Surgery—

Shizuo OI, Hiroshi YAMADA, Mitsuru KIMURA, Kazuo EHARA, Satoshi MATSUM ...

1990 Volume 30 Issue 7 Pages 456-461
Published: 1990
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.30.456

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Twenty hydrocephalic patients diagnosed in the third trimester of fetal life were evaluated and followed during a 7-year period. The factors affecting the prognosis, including the type of hydrocephalus, underlying conditions, associated anomalies, time of diagnosis and delivery, fetal period after diagnosis, head circumference and degree of ventriculomegaly at birth, and age at treatment, were comprehensively analyzed. The difference between final outcomes as assessed by developmental quotient (DQ) or intelligence quotient (IQ) were statistically tested with computation by means of STAX packages in an NEC 9801 VX. Hydrocephalus as an isolated defect occurred in six cases (30%), was associated with other central nervous system anomalies in nine (45%), and was secondary to intrauterine intraventricular hemorrhage or brain tumor in five (25%). The average age at the time of diagnosis was 33.9 weeks of gestation (range, 27-40 weeks). One fetus was treated by transabdominal cephalocentesis, but the majority of patients underwent ventriculoperitoneal shunt postnatally. The final IQ or DQ scores ranged from 20 to 120 (mean score, 50.6). The data analyses revealed that the only significant factor affecting outcome was the fetal period after diagnosis of hydrocephalus (r = -0.5076, p < 0.01). Our data supports the fact that the results of an on-going hydrocephalic state may become irreversible during fetal life. It is emphasized that establishment of a more precise pathophysiological evaluation, and a less invasive but more reliable decompressive technique for fetal hydrocephalus, is urgent.

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Microvascular Decompression for Trigeminal Neuralgia with Special Reference to Delayed Recurrence

Tomokazu GOYA, Shinichiro WAKISAKA, Kazuo KINOSHITA

1990 Volume 30 Issue 7 Pages 462-467
Published: 1990
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.30.462

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Thirty-five patients with trigeminal neuralgia underwent microvascular decompression. Complete remission was obtained in 33 patients, while one was fair and another unchanged postoperatively. The clinical and operative findings were reviewed, analyzing the direction of vascular compression of the trigeminal nerve and the distribution of pain in the peripheral regions. There were some weak correlations between the direction of vascular compression and the distribution of pain. Neuralgia in the region of second branch of the trigeminal nerve (V2) or in the regions of V2 and third branch of the nerve (V3) was caused by compression from the ventral or ventro-rostral direction, in the region of first branch of the nerve from the ventro-caudal direction, and in the V3 region from the ventral, rostral, and dorsal directions of the nerve in general. In two patients who had had complete remission after first operation, trigeminal neuralgia recurred. They had typical intermittent painful attacks with a background of continuous dull pain or painful dysesthesia caused by Ivalon® sponges inserted between the nerve and the offending vessel. Complete remission was again obtained after removal of these sponge pieces. We would like to stress continuous dull pain or painful dysesthesia in cases of delayed recurrence as indicators for re-exploration.

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Clinical Experience of Intraorbital Optic Nerve Sheath Meningioma

—Report of Eight Cases—

Ryotaro KURODA, Jiro NAKATANI, Akira YORIMAE, Yuzo NAKAO, Toshifumi OH ...

1990 Volume 30 Issue 7 Pages 468-475
Published: 1990
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.30.468

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Eight cases of primary optic nerve sheath meningioma were treated between 1980 and 1988. Five were females aged 37-61 years. The other three were two boys, one with neurofibromatosis, and an old male aged 71 years. They were first seen by the ophthalmologist with complaints of unilateral progressive visual loss or proptosis. Although blindness of the affected eye mainly occurred between 1 month and 3 years after the initial symptoms, the diagnosis tended to be made late in the adult cases. Intracranial extension was demonstrated in four of the six adult cases when contralateral visual loss or disturbance of consciousness presented. Larger intraorbital meningiomas were easily diagnosed by a combination of computed tomographic (CT) scanning, magnetic resonance (MR) imaging, and carotid angiography. MR imaging provided clear delineation of the optic nerve and its course through the tumor, and perioptic meningioma could be diagnosed. However, it was difficult to make a diagnosis without biopsy at the early stage, for example, when just the enlargement of the optic nerve was demonstrated by CT or MR imaging. Tumor removal was performed when blindness developed after definitive diagnosis by biopsy, intracranial extension was demonstrated, and advanced proptosis presented. The transcranial supraorbital approach or transcranial transorbital approach with resection of the supraorbital rim was used for these large intraorbital meningiomas. From our clinical experience, early diagnosis and early treatment should be emphasized.

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Brain and Skull Metastases of Hepatic or Pancreatic Cancer

—Report of Six Cases—

Jun-ichi KURATSU, Masaji MURAKAMI, Shozaburo UEMURA, Yukitaka USHIO

1990 Volume 30 Issue 7 Pages 476-482
Published: 1990
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.30.476

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Brain and skull metastases from primary hepatic or pancreatic cancer are very rare. The authors describe six cases of metastatic tumors. These are skull (three cases) and brain (one) metastasis of hepatic cancer and brain metastasis (two) of pancreatic cancer. In three hepatic cancer patients, the metastatic lesions were diagnosed before the diagnosis of primary cancer. In these patients, plain skull x-ray showed osteolytic lesions and vascular enlargement. A postcontrast computed tomographic (CT) scan showed an enhanced high-density epidural mass. Angiograms showed a tumor stain fed by abnormal vessels from the external carotid artery. In one patient with a metastatic brain tumor from hepatic cancer, a CT scan showed a high-density mass with hematoma. In one of the brain metastases from pancreatic cancer, a CT scan revealed a cystic, ring-like enhanced lesion in the thalamus. In the other case, a CT scan showed an isodensity mass in the vermis and hydrocephalus. Metastatic tumors from primary hepatic cancer were soft and hemorrhagic, but they were clearly demarcated from the surrounding tissue. In the case of thalamic metastasis, the cyst content was aspirated and an anticancer agent was administered into the cystic cavity. In the other cases, the tumors were totally removed. The outcome was very poor in all cases.

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Intracranial and Intraspinal Dissemination from Pineal Yolk Sac Tumor Treated by PVB Therapy

—Case Report—

Noboru ASANO, Hirofumi OKA, Kensaku TAKASE, Hideki HONDO, Shin UEDA, K ...

1990 Volume 30 Issue 7 Pages 483-488
Published: 1990
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.30.483

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A 15-year-old male was admitted because of diplopia and persistent headache. Postcontrast computed tomography (CT) revealed a homogeneously enhanced large mass, 3 × 4 cm in size, in the pineal region and moderate obstructive hydrocephalus. A right ventriculoperitoneal shunt was installed. At that time, the serum a-fetoprotein (AFP) level increased to 23, 036 ng/ml, but the level of serum β-subunit of human chorionic gonadotropin was less than 0.2 ng/ml. These data indicated the tumor to be a pure yolk sac tumor. Following cisplatin-vinblast ine-bleomycin (PVB) therapy and whole-brain irradiation (50 Gy), the tumor disappeared on CT, although the AFP level did not return to normal. Eight months after the completion of initial therapy, he had lumbago. Spinal magnetic resonance imaging revealed a metastatic mass at the L5-S2 levels, which was subtotally removed and histologically diagnosed as yolk sac tumor. Postoperative local irradiation (30 Gy) was performed. Seven months after the operation, spinal dissemination at the Th7 level occurred and, 1 month later, intracranial dissemination in the left cerebellopontine angle was detected. He died 25 months after the first admission. PVB therapy did not prevent spinal dissemination in this case.

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Spinal Cord Glioblastoma Multiforme with Intracranial Dissemination

—Case Report—

Noboru ASANO, Katsushi KITAMURA, Yoshinobu SEO, Kanji MUKAI, Tetsuro S ...

1990 Volume 30 Issue 7 Pages 489-494
Published: 1990
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.30.489

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A case of spinal cord glioblastoma multiforme with intracranial dissemination is reported. A 23-year-old female was admitted to a local hospital complaining of lumbago. Myelography revealed an intramedullary thoracic tumor. The tumor was partially removed through a laminectomy at Th 11-L1. The histological diagnosis was glioblastoma multiforme, and focal irradiation (total 50 Gy) was given. Eight months after the operation, symptoms of increased intracranial pressure appeared. Computed tomographic (CT) scans showed marked hydrocephalus, and multiple tumors at anterior horns of bilateral lateral ventricles. A ventriculoperitoneal shunt and an Ommaya reservoir into the left lateral ventricle were emplaced. Three months later, she was transferred to our hospital. CT scans showed enhanced lesions in the fourth ventricle, anterior horn of the left lateral ventricle, septum pellucidum, and pituitary gland. Suboccipital craniectomy was performed, and the mass around the fourth ventricle was partially removed. Histological examination of the tumor specimens showed glioblastoma multiforme. Postoperatively, she received whole brain irradiation (total 50 Gy), and intrathecal injection of β-interferon via the Ommaya reservoir. However, she died of respiratory insufficiency. It is considered that the spinal cord glioblastoma multiforme disseminated into the intracranial space.

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Huge Calcified Epidural Abscess

—Case Report—

Kazuko KAMIYA, Tetsuji INAGAWA

1990 Volume 30 Issue 7 Pages 495-497
Published: 1990
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.30.495

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A 76-year-old female with an intracranial epidural abscess having a long history of about 30 years is presented. Craniogram, carotid angiogram, and computed tomographic scan showed a huge calcified lesion with hyperostosis at the right parietal region. The abscess appeared to have granulated and calcified due to long-lasting stagnation of the pus.

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Saccular Aneurysm of the Distal Anterior Choroidal Artery

—Case Report—

Tetsuji INAGAWA, Yasuhiro MATSUDA, Kazuko KAMIYA, Hideyuki AOYAMA, Ren ...

1990 Volume 30 Issue 7 Pages 498-502
Published: 1990
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.30.498

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The authors report a case of a distal anterior choroidal artery aneurysm in a 75-year-old female who presented with nausea, vomiting, and severe headache. Computed tomographic (CT) scans revealed a hematoma in the right lateral ventricle and a subarachnoid hemorrhage in the right parasellar-Sylvian cistern. Cerebral angiography showed a saccular aneurysm at the right distal anterior choroidal artery. The authors intended to operate at the chronic stage, and carried out conservative management. After 1 month her condition suddenly worsened and she died, although a CT scan showed no remarkable changes. At autopsy, a pulmonary artery thrombosis was considered the cause of death. The aneurysm was identified in the temporal horn of the right lateral ventricle, and was a true aneurysm.

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