Neurologia medico-chirurgica

Potential Protection by a Specific Kappa-opiate Agonist U-50488H Against Membrane Failure in Acute Ischemic Brain

Tomoo FURUI

1993 Volume 33 Issue 3 Pages 133-138
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.133

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The effects of a novel opioid κ-receptor agonist U-50488H on Na⁺-K⁺-adenosine triphosphatase (AT-Pase) activity and regional cerebral blood flow (rCBF) were studied in the acute ischemic brain of rats after middle cerebral artery (MCA) occlusion. Administration of U-50488H 15 minutes prior to MCA occlusion attenuated ischemic reduction in Na⁺-K⁺-ATPase activity 15 minutes after MCA occlusion. The effect was statistically significant at a dosage of 30 mg/kg, but not at lower doses (0.3 an/ 3 mg/ kg). There was no effect on rCBF before MCA occlusion, and the decreased flow after occlusion was enhanced with a significant fall in systemic blood pressure at a dosage of 30 mg/kg. These results indicate that U-50488H has therapeutic potential in cerebral ischemia by mechanisms other than improvement in CBF.

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Local Cerebral Blood Flow and Glucose Metabolism in Hydrostatic Brain Edema

Hitoshi UMEZAWA, Katsuji SHIMA, Hiroo CHIGASAKI, Shozo ISHII

1993 Volume 33 Issue 3 Pages 139-145
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.139

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This study investigated the effect of hydrostatic pressure gradient on the cerebrovascular dynamics and metabolism during the development of brain edema. Hydrostatic brain edema was induced by bolus injection of autologous blood through the common carotid artery in Sprague-Dawley rats. Rats were divided into two groups, with craniectomy (Cr⁺ group) and without (Cr^- group). Animals were sacrificed 0, 24, and 48 hours after hypertensive insult. Brain water content was determined by the gravimetric method. Regional cerebral blood flow and local cerebral glucose utilization were measured by the quantitative autoradiographic method using [¹⁴C]iodoantipyrine and [¹⁴C]deoxyglucose, respectively. Hypertensive insult produced multifocal lesions stained by Evans blue. Brains from the Cr^-group showed a transient increase in water content and no significant change in cerebrovascular dynamics and metabolism. Brains from the Cr⁺ group showed a pronounced increase in water content which persisted 48 hours later. Misery perfusion was also observed 24 hours after the insult and the cerebrovascular dynamics and metabolism were significantly decreased after 48 hours. These results indicate that an increased hydrostatic pressure gradient enhances tissue damage and causes reopening of the blood-brain barrier.

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Influence of Regional Cerebral Blood Flow on Event-related Potential (P300)

Toshikazu KUWATA, Kazuyoshi FUNAHASHI, Shinichiro MAESHIMA, Mitsuhiro ...

1993 Volume 33 Issue 3 Pages 146-151
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.146

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The relationships between event-related potential (P300), higher brain functions, and regional cerebral blood flow (rCBF) were examined in 31 neurosurgical patients. The P300 latency, evaluated by an acoustic “odd-ball” paradigm, was normal in 14 and prolonged in 17 patients. Fourteen of 17 prolonged P300 patients had reduced rCBF in the right cerebral hemisphere, especially the frontal lobe and/or thalamus. There was a significant inverse relationship between P300 latency and laterality index (rt rCBF/lt rCBF) in the frontal lobe. Prolonged P300 patients revealed significant abnormalities in psychological tests compared to normal P300 patients. There were significant inverse relationships between the P300 latency and “orientation” and “memory” test scores. Decreased rCBF in the right cerebral hemisphere, especially the frontal lobe and/or thalamus, is associated with prolonged P300 latency, suggesting that the right cerebral hemisphere is important in human cognitive processes.

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Endocrine Functions in Children with Suprasellar Germinoma

Toshimitsu AIDA, Hiroshi ABE, Kenji FUJIEDA, Nobuo MATSUURA

1993 Volume 33 Issue 3 Pages 152-157
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.152

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Clinical manifestations and endocrine functions were evaluated in 17 children with suprasellar germinoma. Polyuria and growth retardation were the most common initial symptoms. Physical and neurological examinations revealed diabetes insipidus in 17, growth retardation in five, and visual disturbance in three of the patients. Assessment of hypothalamic-pituitary function before treatment revealed pituitary deficits in all patients involving growth hormone, thyroid-stimulating hormone, luteinizing hormone, follicle-stimulating hormone, and adrenocorticotropic hormone. These pituitary dysfunctions persisted after tumor remission due to radiation therapy. These results indicate that children with suprasellar germinoma need long-term hormone replacement therapy to prevent growth retardation, thyroid dysfunction, and delayed secondary sexual development.

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Two-step Procedure for Early Neonatal Surgery of Fetal Hydrocephalus

Kazuyoshi MORIMOTO, Toru HAYAKAWA, Toshiki YOSHIMINE, Akatsuki WAKAYAM ...

1993 Volume 33 Issue 3 Pages 158-165
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.158

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This retrospective study analyzed the diagnosis and treatment of 36 infants with central nervous system anomalies diagnosed antenatally by ultrasonographic studies between December, 1987 and December, 1990. Magnetic resonance imaging of the fetuses without maternal or fetal sedation/ anesthesia was very useful, as the fetal ventricular system was depicted clearly. Twenty-three infants with hydrocephalus underwent early postnatal surgical emplacement of a miniature Ommaya''s reservoir. Continuous cerebrospinal fluid aspiration was combined with intracranial pressure monitoring. Observation of the ventricular size used ultrasonography through the anterior fontanelle. This technique controlled the intracranial pressure during the early neonatal period without serious complications. A ventriculoperitoneal shunt was emplaced 1 month later as the second, more permanent treatment. This two-step procedure achieves brain reconstitution and prevents irreversible neurological damages. Clinical and radiographic findings are presented to illustrate the effectiveness of this approach.

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Intracerebral Arteriovenous Malformation Supplied by Ethmoidal Arteries —Case Report—

Shinzo YOSHIDA, Toyoshiro YAMAMOTO

1993 Volume 33 Issue 3 Pages 166-169
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.166

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An intracerebral arteriovenous malformation supplied by bilateral ethmoidal arteries in a 51-year-old male is described. Operation revealed a vascular conglomerate on the cerebral surface which formed an arteriovenous shunt. The feeding artery and draining vein were clipped and incised, and the malformation was removed en bloc. An intra- or extracerebral vascular anomaly supplied by the ethmoidal artery is thought to be derived from a similar developmental fault, in which an arteriovenous shunt becomes trapped in an extradural location, the dura mater, the subdural space, or the cerebral parenchyma, during later fetal development.

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Intramedullary Spinal Cord Arteriovenous Malformation with Hematomyelia without Subarachnoid Hemorrhage —Case Report—

Susumu OHARA, Takashiro OHYAMA, Atsufumi MOTO, Fumiyuki MOMMA

1993 Volume 33 Issue 3 Pages 170-172
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.170

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A 36-year-old male presented with an intramedullary spinal cord arteriovenous malformation with hematomyelia but without subarachnoid hemorrhage, manifesting as lower body sensory impairments and leg weakness. Magnetic resonance imaging was used to localize the lesion. Myelotomy allowed excision of the lesion and his sensory impairments improved.

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Proton Radiation Therapy for Clivus Chordoma —Case Report—

Yoshihiko YOSHII, Takashi TSUNODA, Akio HYODO, Tadao NOSE, Hirohiko TS ...

1993 Volume 33 Issue 3 Pages 173-176
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.173

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A 57-year-old male with clival chordoma developed severe hoarseness, dysphagia, and dysphonia 1 month after a second removal of the tumor. Magnetic resonance imaging demonstrated a mass 10 cm in diameter in the region of the middle clivus enhanced inhomogeneously by gadoliniumdiethylenetriaminepenta-acetic acid, and a defect in the skull base. There was evidence of compression of the anterior surface of the pons. He received proton irradiation employing a pair of parallel opposed lateral proton beams. The dose aimed at the tumor mass was 75.5 Gy, to the pharyngeal wall less than 38 Gy, and to the anterior portion of the pons less than 30 Gy. Time dose and fractionation factor was calculated at 148. Thirty-one months following treatment, he was free of clinical neurological sequelae. Proton therapy should be considered in treatment planning following initial surgical removal or for inoperable clivus chordoma.

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Desmoplastic Infantile Ganglioglioma with Extraparenchymatous Cyst —Case Report—

Yoshio TAGUCHI, Takashi SAKURAI, Isao TAKAMORI, Hiroaki SEKINO, Mamoru ...

1993 Volume 33 Issue 3 Pages 177-180
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.177

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A large supratentorial tumor associated with an extraparenchymatous cyst and multiloculated intraparenchymatous cysts occurred in a 14-month-old infant. This case had all the characteristic features of desmoplastic infantile ganglioglioma both clinically and histologically. The notable difference was the extraparenchymatous cyst. The extraparenchymatous cyst was probably caused by entrapment of cerebrospinal fluid in the subarachnoid space by some check-valve mechanism because the leptomeninges were commonly involved in the tumor. A similar mechanism may explain the etiology of the intraparenchymatous, disproportionately large cyst in desmoplastic infantile gangliogliomas.

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Carotid and Vertebral Rete Mirabile in Man —Case Report—

Youichi ITOYAMA, Ikuo KITANO, Yukitaka USHIO

1993 Volume 33 Issue 3 Pages 181-184
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.181

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Rete mirabile is a normal vascular network in the carotid artery distribution of some vertebrates, but is an abnormal and extremely rare finding in humans. We describe a 40-year-old male with a carotid and vertebral rete mirabile manifesting as cerebrovascular disorder. This was the second case of carotid and vertebral rete mirabile in man.

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