Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
30 巻, 8 号
選択された号の論文の10件中1~10を表示しています
  • Hajime TOUHO, Jun KARASAWA, Hisashi SHISHIDO, Keisuke YAMADA
    1990 年 30 巻 8 号 p. 569-574
    発行日: 1990年
    公開日: 2006/09/05
    ジャーナル フリー
    Noninvasive and simplified methods for estimating regional cerebral blood flow (CBF) and regional partition coefficient (λ) using the inhalation of stable xenon (Xes) and computed tomographic (CT) scanning are described. Thirty percent Xes in 70% oxygen was inhaled for 240 seconds and exhaled for 160 seconds during serial CT scanning without denitrogenation in 26 patients with cerebrovascular diseases and four volunteer controls. During the investigation, the end-tidal Xes concentration was continuously monitored with a thermoconductivity analyzer to determine the build-up range (A value) and build-up rate constant (K value) of the artery by the curve fitting method. Calculated A and K values were corrected by the following formulae reported previously: for patients aged 0-20 years, Ae = 0.75Aa + 2.15, Ke = 0.67Ka + 0.69; 21-40 years, Ae = 0.56Aa + 3.24, Ke = 0.38Ka + 1.12; 41-60 years, Ae = 0.91Aa + 1.95, Ke = 0.38Ka + 1.32; over 61 years, Ae = 0.52Aa + 3.81, Ke = 0.3lKa + 1.55 (Ae and Ke were calculated with end-tidal Xes concentration, Aaand Ka were calculated by direct sampling of arterial blood). A CBF map (f map) and λ map made with corrected A and K values demonstrated reliable distribution. The CBF was high in the gray matter, low in the white matter, and much lower in the infarcted area. λ was high in the white matter, low in the gray matter, and much lower in the infarcted area. Eight patients were examined with and without denitrogenation. Both the f map and λ map with denitrogenation were compatible with those without denitrogenation. Xes CT-CBF studies without denitrogenation are useful in clinical neurosurgery and outpatients for estimating regional cerebral circulation.
  • —Combination of an Expert System and DSA Examination—
    Hirotsugu SAMEJIMA, Yukio USHIKUBO, Toru MIZOKAMI, Kazuya AOKI, Satosh ...
    1990 年 30 巻 8 号 p. 575-581
    発行日: 1990年
    公開日: 2006/09/05
    ジャーナル フリー
    We have designed a screening system to diagnose unruptured aneurysms, including the use of digital subtraction angiography (DSA). We surveyed 115 patients who had undergone clipping procedures after subarachnoid hemorrhage (SAH) and questioned them with regard to the subjective symptoms. Sixty-eight of 92 patients who returned the questionnaire reported, prior to rupture, headache, eye pain, and neck pain most frequently, and also impairment of extraocular movements, ptosis, visual field defects, and motor and sensory disturbances. Nineteen (47.5%) of 40 patients who had complete pain relief after surgery complained of headache from 1 week to 1 month before SAH. In addition, nine patients (22.5%) complained of headache for several years, and were also pain-free after surgery. For the indication of DSA, we employed an expert system based on fuzzy set theory. Seven groups of parameters are: Group 1, a basic questionnaire concerning age, sex, and past and family histories; Group 2, 15 warning signs selected on the basis of retrospective study; and Groups 3-7, detailed questions concerning each sign. Scoring weights assigned to each condition based on the results of the retrospective study, and threshold values were determined by several neurosurgeons. The certainty factors for intermediate hypotheses were calculated from these weights and threshold values and summed up, from which the conclusion was obtained. Twelve new cases of unruptured cerebral aneurysm were diagnosed using this screening system. This system may improve the ability to diagnose cerebral aneurysms before rupture.
  • Mitsusuke MIYAGAMI, Takashi TSUBOKAWA, Makoto TAZOE, Yukihide KAGAWA
    1990 年 30 巻 8 号 p. 582-590
    発行日: 1990年
    公開日: 2006/09/05
    ジャーナル フリー
    The clinical effects and problems of intra-arterial water-soluble antitumor nitrosourea (ACNU) therapy following osmotic blood-brain barrier modification are discussed. Twenty-one patients with malignant brain tumors were divided into two groups. Group 1 consisted of 16 patients treated by operation, irradiation, and two or more courses of intracarotid infusion of ACNU 100 mg/body (1.72.2 mg/kg) following 20% mannitol 200 ml (1.3-1.6 ml/sec) (7 grade 4 astrocytomas, 5 grade 3 astrocytomas, and 4 others). Group 2 consisted of five patients treated by operation, irradiation, and repeated intracarotid infusion of ACNU 100 mg/body alone (grade 4 astrocytoma). The 2-year survival rate in Group 1 was 79% (11 of 14 cases followed up for longer than 2 years) and the 3-year survival rate was 67%. Five of seven grade 4 astrocytoma patients (71%) in Group 1 survived for more than 1 year 6 months, whereas four of five grade 4 astrocytoma in Group 2 died within 1 year 6 months. The measurement of the ACNU concentration in tumor tissues and blood in 11 brain tumors, after intracarotid infusion of ACNU with blood-brain barrier disruption, showed peak values in the tumor tissues of 3.02-32.53 μg/gm (mean, 9.67 μg/gm), about three to five times as high as that in blood in most cases. This method used in Group I appears to be relatively safe without permanent neurological deficits and offers a potential therapeutic effect when used in combination with appropriate premedication in suitable patients.
  • —Characteristic Problems of Surgical Treatment—
    Kenichi KITAOKA, Hiroshi ABE, Toshimitsu AIDA, Masaharu SATOH, Terufum ...
    1990 年 30 巻 8 号 p. 591-598
    発行日: 1990年
    公開日: 2006/09/05
    ジャーナル フリー
    Recently, the incidence of metastatic cerebellar tumors has increased. The authors operated on 12 cases of metastatic cerebellar tumors, with total or subtotal removal of nodules in brain metastases. Surgical complications observed as a result of postoperative investigation are presented. 1) Some cases developed carcinomatous meningitis within a short period. During removal of a tumor on the superior cerebellar surface attention should be paid to the prevention of dissemination to the cerebral cisterns adjacent to the tumor. 2) Some cases demonstrated peritoneal metastasis probably due to dissemination via the ventriculoperitoneal shunt tube, suggesting that great care should be taken during a shunt operation after removal. 3) Both carcinomatous meningitis occurring after removal and remote metastasis via the shunt tube were related to recurrence after removal of the cerebellar metastatic lesion, raising the issue of whether or not total macroscopic removal should be included in the indications for surgical treatment of cerebellar metastasis. Those cases in which surgery is indicated should also be routinely treated by postoperative irradiation.
  • Masanori HASHIMOTO, Akira YOKOTA, Hidehiko KAJIWARA, Shigeaki MATSUOKA ...
    1990 年 30 巻 8 号 p. 599-603
    発行日: 1990年
    公開日: 2006/09/05
    ジャーナル フリー
    Ten patients with cerebral venous angioma (VA) were followed up for 12 to 106 months. Seven VAs were found as a result of intracerebral hemorrhage and the others were found incidentally. Among three VAs cauterized or partially excised, one disappeared but two were unchanged on follow-up angiography. Another VA, treated by irradiation following evacuation of the hematoma, gradually reduced in size on angiography. In the remaining six VAs treated conservatively, follow-up angiography demonstrated no visible change. During the follow-up period, bleeding from VA was encountered in one patient who had previously suffered from intracerebral hemorrhage. Prevention of bleeding from VA is considered important; however, complete extirpation of VA is difficult since the resectable area of normal brain parenchyma including the VA is very limited. From our experience, radiation therapy is believed to be useful when VA is considered to carry the risk of hemorrhage.
  • —Report of Three Cases—
    Tsutomu KATO, Toshimitsu AIDA, Hiroshi ABE, Akihiko OGATA, Nishio NAKA ...
    1990 年 30 巻 8 号 p. 604-609
    発行日: 1990年
    公開日: 2006/09/05
    ジャーナル フリー
    Three cases of multiple gliomas with postmortem findings including a rare case of multicentric glioma are presented. A 59-year-old female was hospitalized with decreased mental activity and gait disturbance. Computed tomographic (CT) scans and magnetic resonance (MR) images showed two independent mass lesions in the left frontal and the right temporal lobes, shown by postmortem to have no communication. Histologically, they were a gemistocytic astrocytoma and an anaplastic astrocytoma, respectively. Therefore, multicentric glioma was diagnosed. A 66-year-old male was admitted with slow mentation and gait disturbance. CT scans and MR images demonstrated two mass lesions; one overriding the bilateral frontal lobes through the corpus callosum and the other in the left temporal lobe. Postmortem examination showed that both lesions were glioblastoma and the left temporal tumor was accompanied by subarachnoid dissemination. A 29-year-old male was hospitalized with gustatory hallucination and convulsions of the right upper extremity. CT scans revealed two mass lesions in the right frontal and the left temporal lobes. MR images demonstrated communication between the two lesions through the corpus callosum. The left temporal tumor developed into the occipital lobe and another new lesion appeared in the right temporal lobe despite chemotherapy and irradiation. Postmortem examination revealed communication between the three masses through the corpus callosum. Histologically, all three tumors were glioblastoma.
     Multicentric gliomas have been reported at various incidences from 2.3 to 9.1 %. However, multicentric gliomas with multiple tumors of different histologies are very rare and only 16 cases have been reported. MR imaging is more valuable than CT scanning to detect communication between two or more lesions.
  • —Report of Four Cases—
    Yasuto KAWAKAMI, Kobun UEKI, Masanori CHIKAMA, Yutaka SHIMAMURA, Tokuo ...
    1990 年 30 巻 8 号 p. 610-617
    発行日: 1990年
    公開日: 2006/09/05
    ジャーナル フリー
    The authors report four cases of intracranial hemorrhage associated with nontraumatic disseminated intravascular coagulation (DIC). Two cases demonstrated a sudden onset of intracerebral hemorrhage. The other two showed chronic subdural hematoma initially, followed by acute multiple intracranial hemorrhages or general hemorrhagic diathesis. The underlying disorders were glioblastoma multiforme, thoracoabdominal aortic aneurysm, acute promyelocytic leukemia, and stomach cancer associated with disseminated carcinomatosis of the bone marrow. All patients died eventually. When the underlying disorder has a rare incidence of DIC as in glioblastoma multiforme or thoracoabdominal aortic aneurysm, the possibility of DIC and the need for immediate initiation of replacement therapy should be recognized, although the mortality is very high because the underlying disorder cannot be eliminated quickly. When the underlying disorder has a high incidence of DIC as in acute promyelocytic leukemia or disseminated carcinomatosis of the bone marrow, it is mandatory to start replacement therapy and treatment for the underlying disorder simultaneously. DIC can be controlled when the treatment for the underlying disorder is effective.
  • —Case Report—
    Koji IIHARA, Yasumasa MAKITA, Sachio NABESHIMA, Taikyoku TEI, Atsushi ...
    1990 年 30 巻 8 号 p. 618-623
    発行日: 1990年
    公開日: 2006/09/05
    ジャーナル フリー
    The authors present an extremely rare case of aspergillosis of the central nervous system (CNS) causing subarachnoid hemorrhage (SAH). A 78-year-old female developed facial pain, progressive deterioration in left visual acuity, and left total ophthalmoplegia. Computed tomography demonstrated a heterogeneously enhanced mass extending from the sphenoid sinus to the left cavernous sinus and left orbit, and angiography showed luminal narrowing and irregularity of the left internal carotid artery at its siphon. Biopsy of the left orbital and sphenoid sinus mass resulted in the diagnosis of Aspergillus granuloma. Despite combined administration of amphotericin-B and 5-FC, she became comatose from brainstem infarction and finally, suddenly died. Postmortem examination revealed massive SAH due to a ruptured mycotic aneurysm of the basilar artery. Aspergillosis of the CNS is a growing problem with the wider use of immunosuppressants and antibiotics. To the authors' knowledge, however, only 13 cases of CNS aspergillosis causing SAH have been reported. The prognosis is absolutely bad, with all patients dying from rupture of major intracranial arteries such as the internal carotid artery and basilar artery. Early diagnosis and vigorous chemotherapy are important.
  • —Case Report—
    Eiji KOHMURA, Takuyu TAKI, Tsuneo TANIOKA
    1990 年 30 巻 8 号 p. 624-627
    発行日: 1990年
    公開日: 2006/09/05
    ジャーナル フリー
    The authors describe a case of multiple intracerebral arteriovenous malformations (AVMs) in a 23-year-old male with two distinct, deep-seated AVMs. One was located in the left basal ganglia, which had bled twice, and the other in the splenium. They were removed separately. He recovered satisfactorily with only a mild dysphasia. The authors emphasize that the therapeutic principle for multiple AVMs is the same as that for a solitary AVM. Multiplicity alone does not dictate the operability. Dissection just adjacent to the nidus and direct coagulation of an AVM are the indicated techniques, especially in cases of deep-seated AVMs in order to reduce postoperative neurological deficit.
  • —Case Report—
    Hideo ASADA, Mitsuhiro OTANI, Shigeru FURUHATA, Hiroshi INOUE, Shigeo ...
    1990 年 30 巻 8 号 p. 628-632
    発行日: 1990年
    公開日: 2006/09/05
    ジャーナル フリー
    A gangliocytoma in the sellar region is very rare. We report a case of an intrasellar gangliocytoma complicated by pituitary adenoma presenting with acromegaly. A 52-year-old female was admitted to our hospital with headache, mild acromegaly, and bitemporal hemianopsia, and endocrinological study found a high serum level of growth hormone (GH). A computed tomographic scan revealed a tumor in the sellar region, which was almost totally removed by trans-sphenoidal surgery. Histological examination of the resected specimen showed diffuse, chromophobe-type pituitary adenoma, partially containing cholesterin clefts. Areas of clusters of dysmorphic neurons, adjacent to or mixed with pituitary adenoma, were diagnosed as gangliocytoma. The immunohistochemical examination showed GH-releasing hormone (GRH)-positive dysmorphic neurons and GH-positive pituitary adenoma. We consider that the trophic effect of GRH secreted by the neurons of GRH-producing intrasellar gangliocytoma probably caused the GH-producing pituitary adenoma.
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