Neurologia medico-chirurgica

Evaluation of Masked Neurological Disorders in the Chronic Stage after Middle Cerebral Artery Occlusion in Rats

—Methamphetamine-induced Rotation and Regional Glucose Metabolism in Basal Ganglia—

Akatsuki WAKAYAMA, Kazuo KATAOKA, Mamoru TANEDA, Kazuo YAMADA, Toru HA ...

1993 Volume 33 Issue 12 Pages 801-808
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.801

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Neurofunctional changes in rats in the chronic stage of focal cerebral ischemia induced by left middle cerebral artery (MCA) occlusion were examined. Neurological disorders and behavioral changes were observed with or without methamphetamine administration. Metabolic changes in the basal ganglia following methamphetamine intraperitoneal injection were evaluated by [¹⁴C]deoxyglucose autoradiography 30 days after occlusion. Neurological examination revealed persistent spontaneous rotation to the lesioned side in two of 18 rats, and forelimb flexion to the lesioned side in nine of 18 rats during a 28-day observation period after occlusion. Intraperitoneal administration of methamphetamine (4 mg/kg) induced full 360° rotation toward the lesion side in 14 of 17 rats. The number of rotations was inversely correlated with the size of the intact striatum on the lesion side, especially in rats with cerebral infarct located only in the striatum. Rats with extensive cortical lesion in addition to striatal lesion did not demonstrate this relationship. Deoxyglucose autoradiography in methamphetamine-untreated rats showed symmetrical local cerebral glucose utilization in the basal ganglia except for the subthalamic nucleus, striatum and sensorimotor cortex. Autoradiography in methamphetamine-treated and MCA-occluded rats showed a remarkable increase in glucose utilization in the anterior striatum, entopeduncular nucleus, substantia nigra pars reticulata, and sensorimotor cortex contralateral to the occlusion side, but not on the lesioned side. Rotational movements observed in methamphetamine-treated rats are related to lack of stimulation of the basal ganglia system on the ischemic side. The methamphetamine test may be useful for quantifying masked neuronal dysfunction in the chronic stage of experimental focal cerebral infarct in rats.

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Theoretical and Experimental Assessment of the Kinetic Properties of N-isopropyl-p-[¹²³I]iodoamphetamine in the Human Brain

Kentaro MORI, Keiji NAKAJIMA, Minoru MAEDA

1993 Volume 33 Issue 12 Pages 809-814
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.809

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The effect of the loss of radioactivity from the human brain on the measurement of regional cerebral blood flow (rCBF) using N-isopropyl-p-[¹²³I]iodoamphetamine (IMP) was evaluated by measuring rCBF in 10 normal male volunteers from 0.5 to 30 minutes after intravenous administration. rCBF was calculated by the operational equation, which assumes no product loss. Brain tissue and arterial blood concentration data were plotted according to a multiple-time/graphic evaluation technique. Data were fitted to the kinetic three-compartment model to estimate four kinetic rate constants to evaluate activity loss from the brain. These studies showed that loss of activity from the brain is negligible during the first 5 minutes, but after 7.5 minutes the loss becomes significantly higher with time. The present study corroborates the necessity for using single photon emission computed tomographic images measured within 5 minutes of IMP injection to quantify rCBF.

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Clinical Application of Angioscopy During Carotid Endarterectomy for Patients with Internal Carotid Artery Stenosis

Satoshi KURODA, Hiroyasu KAMIYAMA, Akihiro TAKAHASHI, Kiyohiro HOUKIN, ...

1993 Volume 33 Issue 12 Pages 815-819
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.815

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The accuracy of angioscopy in detecting atherosclerotic changes, such as plaque, ulcer, and mural thrombus, in the extracranial cerebral arteries was evaluated during carotid endarterectomy by comparison with angiographic and operative findings. Ten patients with internal carotid artery stenosis underwent intraoperative angioscopy during surgery. After clamping the carotid bifurcation, intraarterial atherosclerotic lesions were observed with an angioscope (0.8 or 1.4 mm outer diameter) inserted through a small incision in the common carotid artery. Angioscopic findings correlated well with both angiographic and operative findings in six patients, and provided additional information in two patients, such as organized thrombi within the ulcer and mural thrombi. Angioscopic findings were quite different to those from angiograms in two patients. In one, an ulcer on angiograms was false positive, and in the other, false negative. These findings were confirmed intraoperatively. Our results suggest that preoperative carotid angioscopy is of great value in detecting ulcers more accurately than angiography, and in selecting candidates for carotid endarterectomy, although further development of equipment is needed.

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Efficacy of Superficial Temporal to Middle Cerebral Artery Anastomosis against Hemodynamic Stroke

Shoichiro KAWAGUCHI, Toshisuke SAKAKI, Hideyuki OHNISHI

1993 Volume 33 Issue 12 Pages 820-823
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.820

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The effect of superficial temporal artery-middle cerebral artery anastomosis on regional cerebral blood flow (rCBF) was measured on 31 patients with ischemic cerebrovascular diseases. rCBF was measured on the precentral and superior temporal gyri during surgery using the thermal diffusion technique. The mean rCBF was significantly lower than controls before anastomosis, but increased significantly after. Severer clinical symptoms were associated with lower rCBF. The rCBF increased significantly in patients with transient ischemic attack, reversible ischemic neurological deficit, and minor and major completed stroke. All 31 patients demonstrated dysautoregulation, both before and after anastomosis. However, the rCBF had increased above the ischemic threshold during hypotension, achieving a reserve capacity to prevent hemodynamic stroke.

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Neuropsychological Outcome and Social Recovery of Head-injured Patients

Katsuzo KUNISHIO, Yuzo MATSUMOTO, Sanami KAWADA, Yoshiyuki MIYOSHI, Ta ...

1993 Volume 33 Issue 12 Pages 824-829
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.824

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The Wechsler Adult Intelligence Scale and Yatabe-Guilford personality test were administered to 123 patients hospitalized for head injury who had made a relatively good recovery. Intelligence quotient (IQ) was correlated with clinical condition based on the Glasgow Coma Scale and duration of coma. More severely injured patients tended to show a greater decline in IQ. The type of lesion, as described by computed tomography, was also an important factor in predicting the outcome of intellectual function. The mean IQ of patients with diffuse injury, such as diffuse axonal injury and diffuse brain swelling, and intracerebral hematoma, was significantly lower than that of the control subjects, especially performance IQ (PIQ). Several patients demonstrated improved IQ level during the initial year. In particular, PIQ improved more than verbal IQ. The difference between the IQ of patients achieving social recovery and not was significant (p < 0.001). Causes of difficulty in returning to previous work were decreased IQ and personality change, such as lack of cooperativeness. Neuropsychological evaluation is important in predicting social recovery and selecting necessary neuropsychological rehabilitation.

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Treatment of Severe Localized Cerebral Vasospasm Following Recurrent Hemorrhage from Middle Cerebral Artery Aneurysm —Case Report—

Kazuo KATAOKA, Kazuhide NIIYAMA, Toshifumi UEJIMA, Ryotaro KURODA, Mas ...

1993 Volume 33 Issue 12 Pages 830-832
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.830

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A 52-year-old female presented with localized but severe cerebral vasospasm induced by recurrent aneurysmal subarachnoid hemorrhage. The middle cerebral artery (MCA) aneurysm was clipped and the subarachnoid hematoma evacuated 1 day after recurrent hemorrhage. The cerebral vasospasm, localized in a region near the MCA aneurysm, was reduced by papaverine and nicardipine vasodilating agents delivered via an Ommaya cerebrospinal fluid reservoir placed at craniotomy.

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Asymptomatic Syringomyelia Associated with Cerebellopontine Angle Meningioma —Case Report—

Kazuhiro FUKUI, Akira KITO, Ikuzo IGUCHI

1993 Volume 33 Issue 12 Pages 833-835
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.833

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A 66-year-old female with a 3-year history of left trigeminal neuralgia presented with an unusual left cerebellopontine angle meningioma associated with asymptomatic syringomyelia at the C2 to C4 levels diagnosed by magnetic resonance (MR) imaging. Two months after total tumor removal, the syringomyelia had diminished without shunting. MR images are useful as a basis for early diagnosis of syringomyelia.

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Pineocytoma with Intratumoral Hemorrhage Following Ventriculoperitoneal Shunt —Case Report—

Katsuhiko HARADA, Takashi HAYASHI, Shigetaka ANEGAWA, Ryuichiroh TORIG ...

1993 Volume 33 Issue 12 Pages 836-838
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.836

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A 58-year-old female with pineocytoma developed intratumoral hemorrhage after ventriculoperitoneal shunting for hydrocephalus. Neurological examination revealed Parinaud''s sign and papilledema. Computed tomography and magnetic resonance (MR) imaging revealed a pineal neoplasm and obstructive hydrocephalus. Serum and cerebrospinal fluid levels of human chorionic gonadotropin, alpha-fetoprotein, carcinoembryonic antigen, and placental alkaline phosphatase were negative or within normal limits. MR images after the ventriculoperitoneal shunting disclosed intratumoral hemorrhage and markedly smaller ventricles. The tumor was totally removed via the occipital transtentorial approach and was diagnosed histologically as a pineocytoma with astrocytic differentiation. The tumor probably shifted away from the surrounding structures following the marked reduction in ventricular size after ventriculoperitoneal shunting, resulting in changed venous circulation in the tumor and the formation of intratumoral hematoma.

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Cranial Metastasis of Hepatocellular Carcinoma in a Female —Case Report—

Daizo YOSHIDA, Mau Nan CHEN, Sakae AWAYA, Shozo NAKAZAWA

1993 Volume 33 Issue 12 Pages 839-844
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.839

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A 78-year-old female presented with swelling and severe pain in the left forehead secondary to a simple head injury received 1 month previously. On admission, neurological examination was normal. Plain skull x-ray films and computed tomography showed an osteolytic and well-defined mass in the left frontal bone. Bone scintigraphy showed high-uptake areas in the right lower ribs and fifth lumbar vertebra. Blood tests showed slight liver dysfunction and a high alpha-fetoprotein level. Abdominal computed tomography showed a huge mass within the liver. Left common carotid angiography disclosed the enlargement of several feeding arteries arising from the external carotid artery with tumor staining. The bone tumor was removed for histological diagnosis and to reduce the localized pain. The histological diagnosis was a cranial metastasis from hepatocellular carcinoma. She died of ruptured varicose veins of the esophagus approximately 8 months after surgery. Surgery for cranial metastasis from hepatic cancer is only indicated when localized pain or hemorrhage threaten the quality of life.

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Dandy Walker Syndrome Forming a Giant Occipital Meningocele —Case Report—

Tomoki TODO, Masaaki USUI, Fumio ARAKI

1993 Volume 33 Issue 12 Pages 845-850
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.845

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A boy was born with Dandy-Walker syndrome associated with a giant occipital meningocele, cleft lip, and cleft palate. The meningocele was actually a component of the giant posterior fossa cyst which communicated with the fourth ventricle. A cyst-peritoneal shunt achieved a considerable decrease in the size of the meningocele, but decubital ulcers developed due to restricted head movement caused by the occipital lesion. Cranioplasty removed a wide area of the inferior occipital bone, and the boundary between the superior occipital and parietal bones was thinned to allow free bending of the bone flap. The meningocele was removed totally in the third operation, but infection of the wound and pneumonia developed, causing death. The coexistence of Dandy-Walker syndrome and occipital meningocele, together with midline facial anomalies, may suggest a later pathogenesis of Dandy-Walker syndrome than previously believed.

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