Neurologia medico-chirurgica

Lectin Cytochemistry Combined with Silver Colloid Staining of Argyrophilic Nucleolar Organizer Regions in Human Gliomas

Shuji NIIKAWA, Akira HARA, Takashi ANDO, Noboru SAKAI, Hiromu YAMADA, ...

1992 Volume 32 Issue 9 Pages 653-658
Published: 1992
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.32.653

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Investigation of lectin cytochemical staining of inflammatory cells in human gliomas showed that Allomyrina dichotoma (Allo-A) cytochemistry can reliably distinguish inflammatory from neoplastic cells. Allo-A cytochemistry combined with silver colloid staining of argyrophilic nucleolar organizer regions (Ag-NORs) was performed in human gliomas. Inflammatory cells possessed usually one but sometimes two Ag-NORs and macrophages often possessed several Ag-NORs. The mean Ag-NOR number per nucleus of inflammatory cells ranged from 1.81 to 2.34, and that of neoplastic cells ranged from 2.57 to 3.53 and from 2.84 to 4.46 in low and high-grade gliomas, respectively. The mean Ag-NOR number per nucleus of inflammatory cells was significantly smaller than that of neoplastic cells (p < 0.001). Combined Allo-A cytochemical and silver colloid Ag-NOR staining can provide a reliable Ag-NOR number in human gliomas by distinguishing inflammatory cells.

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Indications for Surgery and Prognosis in Patients with Cerebral Cavernous Angiomas

Helmut BERTALANFFY, Gryta KÜHN, Rudolf SCHEREMET, Wolfgang SEEGER

1992 Volume 32 Issue 9 Pages 659-666
Published: 1992
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.32.659

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Seventy-three cerebral cavernous angiomas were removed microsurgically from a series of 71 patients between August, 1983 and December, 1989. This retrospective investigation assessed the current indications for surgery and determined the prognosis for patients with cerebral cavernous angioma. There were 38 males and 33 females with a mean age of 37 years. Analysis included clinical presentation and history, neuroradiological findings, indications for surgery, and postoperative course. After an average follow-up period of 15 months, 35 patients were symptom-free, 16 had improved preoperative complaints, six were unchanged, and eight had deteriorated. Microsurgical extirpation of the malformation is indicated in all symptomatic patients where neuroimaging demonstrates the presence of a readily accessible cerebral cavernoma. Surgery is recommended in cases with deep-seated lesions causing massive hemorrhage, repetitive minor bleeding, or significant long-standing and progressive neurological disabilities. Clinically silent cavernomas located in eloquent regions of the brain contraindicate surgery, but should be closely monitored. Patients presenting with convulsions or neurological deficits caused by easily accessible cavernomas of the hemispheres have the best prognosis and a negligible risk for surgical complications. Those with deep-seated lesions of eloquent regions of the brain that have bled or caused sustained neurological disorders face the highest risk for morbidity owing to the surgical intervention, requiring careful preoperative evaluation.

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Risk Factors for Brain Abscess in Patients with Congenital Cyanotic Heart Disease

Mikihiko TAKESHITA, Mizuo KAGAWA, Hiroshi YONETANI, Masahiro IZAWA, Se ...

1992 Volume 32 Issue 9 Pages 667-670
Published: 1992
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.32.667

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Brain abscess is a serious complication of congenital cyanotic heart disease. We retrospectively evaluated the risk factors for brain abscess in 21 such patients treated between 1975 and 1990 in comparison with a control group. The mean arterial oxygen saturation, arterial partial pressure of O₂, arterial blood oxygen content, and base excess in patients with brain abscess were significantly lower than in the control patients. The mean arterial partial pressure of CO₂, pH, hematocrit, hemoglobin, and red blood cell content in patients with brain abscess were not significantly different. Patients with congenital cyanotic heart disease may develop minute encephalomalacia due to severe hypoxemia and increased blood viscosity resulting from compensatory polycythemia. The increased blood viscosity and reduced blood flow in the microcirculation may induce cerebral thrombosis or exaggerate minute encephalomalacia during dehydration or cardiac dysfunction, and shunted blood containing infectious organisms at such sites may be followed by focal cerebritis.

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Evaluation of Therapeutically Induced Hypertension in Patients with Delayed Cerebral Vasospasm by Xenon-enhanced Computed Tomography

Hajime TOUHO, Jun KARASAWA, Hideyuki OHNISHI, Hisashi SHISHIDO, Keisuk ...

1992 Volume 32 Issue 9 Pages 671-678
Published: 1992
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.32.671

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Serial cerebral blood flow (CBF) measurements were made with stable xenon-enhanced computed tomography in 20 patients with angiographically confirmed ruptured intracranial aneurysms, before and during induced hypertension with continuous infusion of dopamine. All patients showed angiographic vasospasm during their course. Twelve patients without symptomatic vasospasm (Group 1) had the lowest hemispheric CBF on the craniotomy side of 31.6 ± 6.8 ml/100 gm/min on days 4-9 (control value, 40.1 ± 2.0 ml/100 gm/min), while the other eight patients with symptomatic vasospasm (Group 2) had the lowest hemispheric CBF on the craniotomy side of 25.0 ± 7.6 ml/100 gm⁄min on days 10-14. The critical hemispheric CBF inducing neurological deficits was about 20 ml/ 100 gm/min in Group 2. Dysautoregulation was usually present in Groups 1 and 2, but therapeutically induced hypertension could reverse the delayed neurological deficits, if begun early at the stage of delayed vasospasm.

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Treatment of Unclippable Giant Posterior Cerebral Artery Aneurysms with Detachable Balloons —Report of Three Cases—

Kohsuke YAMASHITA, Waro TAKI, Shogo NISHI, Akiyo SADATO, Haruhiko KIKU ...

1992 Volume 32 Issue 9 Pages 679-683
Published: 1992
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.32.679

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Three patients presented with rare giant posterior cerebral artery aneurysms, clinically manifesting as cerebral ischemia, mass effect, and subarachnoid hemorrhage. All aneurysms were partially thrombosed, originated at the P₂ segment, and possessed broad necks. Surgical neck clipping was difficult but proximal occlusion of the parent artery was feasible. Aneurysm occlusion sparing the parent artery was attempted in all cases, but failed because the detachable balloon did not successfully block the aneurysmal neck. All patients tolerated test occlusion at the P₂ segment, so the parent artery was occluded proximally with detachable balloons, leaving the important perforating arteries unaffected. Two transient ischemic attacks were associated with the procedure. Where surgical treatment is unusually difficult, and proximal ligation or trapping just feasible, embolization with detachable balloons is an acceptable substitute.

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Chronic Subdural Hematoma Following Bypass Surgery —Report of Three Cases—

Takashi ANDOH, Noboru SAKAI, Hiromu YAMADA, Hirohito YANO, Hiroshi HIR ...

1992 Volume 32 Issue 9 Pages 684-689
Published: 1992
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.32.684

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Bypass surgery is a safe procedure with low mortality and morbidity, and few reported surgical complications. Three patients developed postoperative chronic subdural hematoma (CSDH): two with stroke after superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis and one with moyamoya disease after STA-MCA anastomosis combined with encephalomyosynangiosis. The factors inducing CSDH after revascularization in the seven reported and present cases included postoperative subdural effusion associated with brain atrophy, and postoperative anticoagulant therapy such as aspirin. CSDH may occur in patients with pre-existing brain atrophy and postoperative subdural effusion. Anticoagulant therapy should be avoided at the early postoperative stage after bypass surgery.

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Bilateral Posterior Fossa Epidural Hematoma —Report of Two Cases—

Savas CEYLAN, Kayhan KUZEYLI, Süleyman BAYKAL, Fadil AKTURK

1992 Volume 32 Issue 9 Pages 690-692
Published: 1992
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.32.690

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Two cases of posttraumatic bilateral posterior fossa epidural hematoma are presented. Such hematomas are extremely rare, but can be surgically cured. Computed tomography helps to establish the diagnosis and determine the neurosurgical treatment.

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Giant Aneurysm of the Azygos Anterior Cerebral Artery Associated with Acute Subdural Hematoma —Case Report—

Kazuhiro HASHIZUME, Hideaki NUKUI, Tohru HORIKOSHI, Masami KANEKO, Aki ...

1992 Volume 32 Issue 9 Pages 693-697
Published: 1992
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.32.693

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A ruptured giant aneurysm of the azygos anterior cerebral artery (ACA) associated with an acute subdural hematoma (SDH) occurred in a 67-year-old male with two episodes of sudden severe headache and transient loss of consciousness. Neurologically, he had mild weakness of the left lower extremity. Computed tomography showed an elliptical heterogeneous hyperdense mass in the interhemispheric fissure in front of the corpus callosum and an acute SDH on the right. Angiography disclosed a giant aneurysm (2.8 × 2.0 cm) at the distal end of the azygos ACA. Removal of the SDH and aneurysmal neck clipping achieved a good outcome. Successive small bleedings may allow the aneurysmal dome to develop adhesions to the arachnoid membrane, and the final rupture will occur into the subdural space, resulting in a SDH.

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Dynamic Magnetic Resonance Appearance of the Vertebral Dissecting Aneurysm —Case Report—

Jun-ichiro HAMADA, Kyoichi SATO, Shinji NAGAHIRO, Yukitaka USHIO

1992 Volume 32 Issue 9 Pages 698-700
Published: 1992
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.32.698

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A dissecting aneurysm of the vertebral artery occurred in a 38-year-old male presenting with ischemic attacks. Vertebral angiography revealed irregular narrowing and dilatation of the right vertebral artery, and retention of the contrast medium. Routine T₁-weighted magnetic resonance (MR) imaging demonstrated signal voids compatible with a patent but narrowed vertebral lumen surrounded by three intensity components at the abnormality location identified on the vertebral angiograms. Dynamic MR imaging demonstrated strong enhancement of these components on the early images. These findings were consistent with the false lumen of the dissecting aneurysm. The different signal intensities were thought to reflect the blood flow rate.

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Suprasellar Malignant Teratoma with 11-year Survival —Case Report—

Noboru SAKAI, Hiromu YAMADA, Yasuaki NISHIMURA, Shin-ichi YOSHIMURA, T ...

1992 Volume 32 Issue 9 Pages 701-705
Published: 1992
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.32.701

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Long-term survival of malignant teratoma is rare. A 16-year-old female with a suprasellar malignant teratoma survived for 11 years before succumbing to embryonal carcinoma. A suprasellar immature teratoma with increased serum alpha fetoprotein level was verified histologically. Radiation therapy and combined chemotherapy were given after partial removal. Eleven years later, the primary lesion recurred as embryonal carcinoma.

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