Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 31, Issue 1
Displaying 1-10 of 10 articles from this issue
  • —Clinical and Experimental Study—
    Isao YAMAMOTO, Shinya YAMADA, Osamu SATO
    1991 Volume 31 Issue 1 Pages 1-6
    Published: 1991
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Balloon compression of the left IXth and Xth cranial nerves and ventrolateral medulla oblongata in dogs resulted in statistically significant increases in blood pressure without obvious changes in cardiac output. Five of 21 hypertensive patients with trigeminal neuralgia or hemifacial spasm demonstrated normalized blood pressure following microvascular decompression for arterial compression of the brainstem in the area of the IXth and Xth cranial nerves on the left. Our experimental and clinical results suggest that neurogenic hypertension caused by the vascular compression of the medulla oblongata can be relieved by microvascular decompression.
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  • —Selection of Candidates for Extracranial-intracranial Bypass—
    Satoshi KURODA, Hiroyasu KAMIYAMA, Hiroshi ABE, Shugo TAKIGAWA, Kenji ...
    1991 Volume 31 Issue 1 Pages 7-12
    Published: 1991
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    The correlation between the drug-induced hypotension somatosensory evoked potential (SEP) test and regional cerebral blood flow changes after acetazolamide administration was studied. Fourteen patients presenting with transient ischemic attack, reversible ischemic neurological deficits, or minor completed stroke were evaluated. All patients had no or only localized low-density areas on computed tomographic scans, and unilateral occlusion or severe stenosis of the internal carotid or middle cerebral artery on cerebral angiograms. The Diamox® asymmetry enhancement (DAE) was studied to detect reduced cerebral perfusion reserve in the affected hemispheres. The DAE was 7.9 ± 5.8% in seven patients positive in the SEP test, significantly higher than -1.5 ± 2.9% in patients negative in the SEP test. Postoperative SEP tests were negative in all five patients who underwent extracranialintracranial (EC-IC) bypass surgery, suggesting that the EC-IC bypass improved the cerebral perfusion reserve in the affected hemispheres. The DAE decreased significantly in four of these patients. This study disclosed a significant correlation between the drug-induced hypotension SEP test and DAE. These parameters are considered important for evaluating patients with hemodynamic compromise and/or suitable candidates for EC-IC bypass.
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  • —Correlation Between Central Conduction Time and Postoperative Neurological Status—
    Masayuki MATSUDA, Minoru KIDOOKA, Takuya NAKAZAWA, Kazumitsu KYOSHIMA, ...
    1991 Volume 31 Issue 1 Pages 13-17
    Published: 1991
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Somatosensory evoked potentials (SEPs) were monitored during 55 aneurysm procedures in 49 patients to investigate the relationship between central conduction time (CCT) and neurological status in the immediate postoperative period. Significant CCT prolongation was observed in 15 cases. The postoperative neurological status deteriorated in nine of the 15 cases, compared with three of 40 cases without appreciable CCT changes. This difference was significant at p < 0.05. The CCT prolongation was ascribable to temporary vascular occlusion in half of the cases. Intraoperative SEP monitoring is useful in predicting neurological morbidities in the immediate postoperative period in patients with cerebral aneurysm.
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  • —Prognostic Factors—
    Yutaka IDE, Kazunari OKA, Hirohito TSUCHIMOCHI, Tsuyomi MIZOGUCHI, Tak ...
    1991 Volume 31 Issue 1 Pages 18-23
    Published: 1991
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Twenty-five patients receiving surgical treatment for brain metastasis from lung cancer were retrospectively studied to evaluate the prognostic factors for survival time. Twenty-two patients had died of respiratory distress by April, 1989. Favorable prognostic factors derived from the median survival time (MST) in these patients included; 1) resection of primary tumor (MST 10 months); 2) total or subtotal removal of metastatic tumor (MST 6.5 months); 3) adenocarcinoma (MST 13 months); 4) metachronous onset of brain metastasis (MST 12 months); 5) single metastasis (MST 8 months). These results suggest that therapy for the primary lung cancer is important before surgery for metastatic brain tumor.
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  • Kenta YAMAKAWA, Tomio SASAKI, Shinichi TSUBAKI, Tadayoshi NAKAGOMI, Is ...
    1991 Volume 31 Issue 1 Pages 24-31
    Published: 1991
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    The effects of high-dose methylprednisolone (MP) on vasospasm following subarachnoid hemorrhage (SAH) were investigated. In a double hemorrhage canine model, administration of high-dose MP (10 mg/kg, every 12 hours) reduced angiographic narrowing of the basilar artery and prevented morphological changes in the arterial wall. In addition, increased platelet aggregation observed from days 4 to 7 in untreated SAH dogs was inhibited by the MP treatment. An in vitro experiment showed that MP inhibited platelet aggregation dose-dependently. High-dose MP had a nonspecific vasodilatory effect on the smooth muscle of the basilar artery. In another SAH model with dysautoregulation of cerebral blood flow (CBF), intravenous MP administration markedly attenuated the decrease in both blood pressure and CBF caused by exsanguination. These results indicate that MP has beneficial effects in normalizing CBF dysautoregulation following SAH. High-dose MP has several advantages for preventing and improving the multiple pathological status in cerebral vasospasm following SAH.
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  • Yasuto KAWAKAMI, Takaho TANIMOTO, Yutaka SHIMAMURA
    1991 Volume 31 Issue 1 Pages 32-36
    Published: 1991
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Coagulation factors were studied in 30 fluids aspirated from 25 patients with chronic subdural hematoma. Compared with the normal range for plasma, the hematoma fluids demonstrated a marked reduction in factors II, V, VII, VIII, and X, moderate reduction of factors IX and XI, and slight reduction of XII. Factor VIII and IX inhibitors were not present or negligible. Activated protein C and antithrombin III were decreased and fibrinopeptide A was markedly increased. No case had a basic disorder causing these abnormal data spontaneously. The decrease in activated protein C possibly caused the marked reduction of factor VIII, therefore the intrinsic and extrinsic clotting pathways were affected differently. The results show excessive activation of coagulation, predominantly via the extrinsic clotting pathway in hematoma, suggesting its importance in the growth of chronic subdural hematoma.
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  • —Case Report—
    Masao SUGITA, Hideo SASAKI, Toshiyuki KAKIZAWA, Ryoichi KIMURA, Akira ...
    1991 Volume 31 Issue 1 Pages 37-40
    Published: 1991
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    A 54-year-old female was admitted with consciousness disturbance and right hemiparesis. Computed tomographic (CT) scans and angiograms revealed diffuse subarachnoid hemorrhage, a partially thrombosed, giant middle cerebral artery aneurysm (5 × 5 × 4 cm), and occlusion of the parent artery at the aneurysm site. Despite conservative treatment, a generalized convulsion occurred. Emergency CT scans revealed irregular enlargement of the left temporal high-density mass and severe mass effect due to cerebral infarction. Barbiturate coma therapy was administered, but she did not recover and died 9 days after admission.
     Only two cases of ruptured aneurysm with simultaneous occlusion of the major cerebral vessels have been reported, both with poor outcome. In this case, the mechanism of parent artery occlusion is unclear, but thrombus protrusion from the giant aneurysm into the parent artery may have been involved.
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  • —Case Report—
    Toshihiro MINETA, Kouzou FUKUYAMA, Hisao KOGA, Shun-ichi MATSUMOTO, Ta ...
    1991 Volume 31 Issue 1 Pages 41-44
    Published: 1991
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    The authors report a rare case of dural arteriovenous malformation (AVM) associated with occlusion of the superior sagittal sinus. A 78-year-old female developed transient aphasia, followed by generalized convulsion. Common carotid angiography showed a dural AVM fed by the bilateral middle meningeal arteries, draining to the superior sagittal sinus, and sinus occlusion. 123I-single photon emission computed tomography demonstrated decreased blood flow in the bifrontal-parasagittal regions. Transcatheter embolization via the feeding arteries improved the cerebral blood flow around the lesion, and the symptoms disappeared.
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  • —Case Report—
    Hidemitsu NAKAGAWA, Shin NAKAJIMA, Yoshikazu NAKAJIMA, Yoshihiro FURUT ...
    1991 Volume 31 Issue 1 Pages 45-48
    Published: 1991
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    A 59-year-old male developed peripheral oculomotor nerve paresis due to compression by the left posterior cerebral artery (PCA), which was successfully treated by microvascular decompression. Two months later, a similar oculomotor nerve paralysis due to the same mechanism occurred contralaterally and was also treated by microvascular decompression. The previous condition was probably caused by arteriosclerotic changes in the PCA, and the following condition by postsurgical adhesion of the arachnoid membrane. The possibility of vascular compression should be considered when oculomotor nerve palsy rapidly develops, although not proven by angiography.
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  • —An Autopsy Case—
    Shobu SHIBATA, Kazuo MORI, Ichiro SEKINE, Hirofumi SUYAMA
    1991 Volume 31 Issue 1 Pages 49-52
    Published: 1991
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    The authors report an autopsy case of methamphetamine-related intracranial hemorrhage and vasculitis. A 22-year-old female was comatose after an intravenous injection of an unknown dose of methamphetamine. Computed tomographic scans demonstrated massive subarachnoid hemorrhage and hematoma in the corpus callosum. Cerebral angiography revealed nonfilling of bilateral intracranial carotid arteries and extravasation of contrast medium from the right pericallosal artery which was visualized retrogradely via the vertebral artery. Postmortem studies found cerebral edema, subarachnoid, intraventricular, and intracerebral hemorrhage, and intracranial vasculitis, but no aneurysm or arteriovenous malformation. Necrosis of vessel walls with destruction of the smooth muscle layer, but no leukocytotic infiltration of the vessel walls were observed in all major cerebral arteries. The hemorrhage probably resulted from medial necrosis in the large intracerebral vessels, and a sudden drug-induced rise in blood pressure.
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