Neurologia medico-chirurgica

Serial Changes in Metabolism and Histology in the Cold—injury Trauma Rat Brain Model —Proton Magnetic Resonance Imaging and Spectroscopy Study—

Kyousuke KAMADA, Kiyohiro HOUKIN, Kazutoshi HIDA, Yoshinobu IWASAKI, H ...

1995 Volume 35 Issue 1 Pages 1-7
Published: 1995
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.35.1

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The serial changes in metabolism and histology during the first 24 hours in the cold-injury trauma rat brain model were investigated by proton magnetic resonance (MR) imaging and high-resolution proton MR spectroscopy. Edema developed extensively via the corpus callosum in the ipsi- and contralateral hemispheres during observation as shown by gradually increased signal intensity on proton MR images. Proton MR spectroscopy showed increased levels of acetate (Ace), lactate (Lac), and glutamine (Glmi) 1 hour after lesion formation. The elevated Glmi level slightly decreased, the level of alanine (Ala) increased substantially, and that of N-acetyl-aspartate (NAA) decreased markedly after 24 hours. Increased Lac, Ace, and Ala might reflect anaerobic glycolysis associated with mitochondrial dysfunction, while decreased Glmi and NAA reveal brain tissue breakdown. The relationship between brain edema and tissue viability can be analyzed in detail using this simple traumatic model and MR techniques which will be useful in the development of therapeutic agents for brain injury.

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Cytosolic Free Calcium Elevation in Vascular Smooth Muscle Cells Induced by Cerebrospinal Fluid from Patients with Subarachnoid Hemorrhage

—Biochemical Nature of the Calcium-mobilizing Factor—

Toshihiko NAKASHIMA, Katsunobu TAKENAKA, Seiji FUKAZAWA, Koh YANO, Yas ...

1995 Volume 35 Issue 1 Pages 8-12
Published: 1995
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.35.8

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The present study was undertaken to characterize the biochemical nature of the factor in cerebrospinal fluid (CSF) from patients with subarachnoid hemorrhage (SAH) that induces a transient elevation of cytosolic free calcium in cultured vascular smooth muscle cells. Cell-free CSF collected from patients on days 7-10 after SAH was treated in three different ways: heating, ultrafiltration, and salting out with ammonium sulfate. The effects of the resultant solutions on the level of cytosolic free calcium in cultured vascular smooth muscle cells were then examined. Heated CSF and ultrafiltrated solution containing substances with molecular weights of less than 10, 000 caused no significant elevation of cytosolic free calcium. Proteins precipitated by 50-75% saturated ammonium sulfate caused an increase in the level of cytosolic free calcium and also produced a rapid accumulation of inositol 1, 4, 5-trisphosphate in vascular smooth muscle cells. The results indicate that the factor responsible for the increase in cytosolic free calcium in cultured vascular smooth muscle cells is a protein with a molecular weight of more than 10, 000, and the factor stimulates receptor-mediated phosphoinositide breakdown.

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Osteomas of the Skull: Comparison of Magnetic Resonance Imaging and Histological Findings

Yasushi SHIBATA, Akira MATSUMURA, Yoshihiko YOSHII, Tadao NOSE

1995 Volume 35 Issue 1 Pages 13-16
Published: 1995
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.35.13

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Magnetic resonance (MR) images of five patients with osteomas of the skull and six patients with other primary skull tumors were reviewed. All osteomas appeared as low-intensity areas on T₁-weighted images. T₂-weighted images showed homogeneous low-intensity areas in two dense osteomas, a high-intensity area in one spongy osteoma, and mixed intensity areas in two mixed spongy and dense osteomas, respectively. The signal intensities of osteomas on T₂-weighted MR images correlated well with the histological findings. Other skull tumors showed no specific MR imaging appearance.

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Cavernous Sinus Invasion by Pituitary Adenomas

—Relationship between Magnetic Resonance Imaging Findings and Histologically Verified Dural Invasion—

Go DAITA, Yukichi YONEMASU, Hirofumi NAKAI, Hidetoshi TAKEI, Katsuhiro ...

1995 Volume 35 Issue 1 Pages 17-21
Published: 1995
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.35.17

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The relationship between magnetic resonance (MR) imaging findings and histologically verified invasion of the cavernous sinus by tumor cells was studied in 26 patients treated surgically for pituitary adenoma. Dural invasion of the sellar floor by tumor cells was found in 10 cases (38%). All patients were classified according to MR imaging findings into three types. Type I showed a gadolinium-enhanced stripe medial to the carotid artery (5 patients), none of which showed dural invasion. Type II showed no enhanced stripe (17 patients), six of which showed dural invasion. Within this type, tumor size and dural invasion showed no correlation. Type III showed displacement or encasement of the carotid artery by the tumor with or without extracranial extension (4 patients), all of which showed massive infiltration of the tumor cells into the dura mater. This study shows that preoperative MR imaging can provide information for assessment of invasion into the cavernous sinus in patients with pituitary adenoma.

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Effect of Lymphokine—activated Killer Cells with or without Radiation Therapy against Malignant Brain Tumors

Kunio NAKAGAWA, Takao KAMEZAKI, Yasushi SHIBATA, Takashi TSUNODA, Koto ...

1995 Volume 35 Issue 1 Pages 22-27
Published: 1995
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.35.22

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The use of autologous lymphokine-activated killer (LAK) cells to treat malignant brain tumors was evaluated in 10 patients, one with metastatic malignant melanoma and nine with malignant glioma. LAK cells were obtained by culturing autologous peripheral blood lymphocytes with human recombinant interleukin-2 (rIL-2) for 7-28 days. All patients underwent surgery to remove as much tumor as possible and an Ommaya reservoir was implaced in the tumor cavity. Two of the 10 patients had received radiotherapy elsewhere, so were treated with LAK cells alone. Eight patients were treated with a combination of LAK cells and radiotherapy, using 1.8-2.0 Gy fractions given five times a week with a total dosage between 54 and 65 Gy. LAK cells and rIL-2 were injected to the tumor cavity (I)via(I/) the Ommaya reservoir once a week for inpatients and once a month for outpatients. The duration of the LAK therapy ranged from 3 to 23 months (mean 13.7 mos). Neuroimaging evaluation revealed two complete responses, three partial responses, four no changes, and one progressive disease. In one patient with pontine glioma, the Karnofsky performance score was raised from 20 to 60. There were no side effects after the injection of LAK cells and rIL-2. The results suggest low-dose LAK therapy is a useful and safe treatment modality for malignant brain tumors.

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Tolosa—Hunt Syndrome with Unusual Clinical Courses

—Two Case Reports—

Fumihiro IMAI, Nobuo KIYA, Yuko OGURA, Masayo NOMURA, Kunjuraman GIREE ...

1995 Volume 35 Issue 1 Pages 28-31
Published: 1995
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.35.28

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Two cases of Tolosa-Hunt syndrome with unusual clinical courses are described. The clinical onset of the first patient was typical, but was unresponsive to steroid hormone treatment. The symptoms resolved spontaneously after 1 year. Computed tomography (CT) and magnetic resonance (MR) imaging revealed enlargement of the affected cavernous sinus, which did not change after the symptoms resolved. The clinical presentation in the second patient included marked pupillary dilatation, a sign which is absent in the classical criteria. CT showed no abnormal findings, but MR imaging revealed a mass located in the medial side of the cavernous sinus extending to the lateral wall, which might have caused the pupillary dilatation. After steroid therapy the symptoms disappeared and MR imaging showed remarkable reduction of the mass in the cavernous sinus. Tolosa-Hunt syndrome usually responds promptly to steroid therapy and rarely manifests marked pupillary dilatation. Such variation in presentation adds to the difficulties in diagnosis and treatment of this disease of unknown etiology.

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Neural Differentiation and Maturation in Metastatic Medulloblastoma

—Case Report—

Yoshiaki KADOTA, Hajime ARAI, Kiyoshi SATO

1995 Volume 35 Issue 1 Pages 32-35
Published: 1995
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.35.32

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A 6-year-old boy presented with a cerebellar medulloblastoma. Radical removal of the tumor and postoperative irradiation achieved complete remission. However, a metastatic tumor in the frontal lobe developed 2 years later. Radical removal and postoperative chemotherapy achieved partial remission, but he died of multiple intracranial and intraspinal dissemination of the tumor 2 years later. Comparison of the light microscopy, immunohistochemical staining, and electron microscopy findings from specimens of the tumors showed that the mainly undifferentiated primary tumor demonstrated both glial and neural differentiation, while the more mature metastatic tumor showed only neural differentiation. This suggests that differentiation and maturation of immature tumors such as medulloblastoma may proceed independently of metastatic potential.

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Primary Spinal Chondrosarcoma Localized in the Cervical Spinal Canal and Intervertebral Foramen

—Case Report—

Shiro OHUE, Saburo SAKAKI, Kanehisa KOHNO, Kou NAKAGAWA, Katsusuke KUS ...

1995 Volume 35 Issue 1 Pages 36-39
Published: 1995
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.35.36

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A 48-year-old male presented with a very rare case of spinal chondrosarcoma localized in the cervical spinal canal and intervertebral foramen, but without marked destruction of the vertebral column. Spinal chondrosarcoma is characterized by radiological evidence of destruction of the surrounding bone structure and mottled calcification. Magnetic resonance imaging was useful in the diagnosis and determination of the extent of this spinal chondrosarcoma. However, preoperative differential diagnosis of the tumor was not possible based on neuroimagina evidence.

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Enterogenous Cyst in the Fourth Ventricle —Case Report—

Shinichi OKABE, Kenichi KAMATA, Takuji KOHNO, Yoichi HARADA

1995 Volume 35 Issue 1 Pages 40-44
Published: 1995
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.35.40

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A 53-year-old male presented with a rare enterogenous cyst in the fourth ventricle associated with repeated ventriculoperitoneal shunt malfunction. Surgical excision of the cyst resolved the shunt problems. Electron microscopy findings of the surgical sample were microvilli covered with electrondense coating materials, basement membrane, and several intercellular junctional devices, suggesting the cyst was derived from the endodermal structure. The viscous and gelatinous contents of the cyst might be responsible for the shunt malfunction.

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Spontaneous Intraorbital Hematoma Mimicking Orbital Neoplasm

—Case Report—

Hiroshi MATSUURA, Motoki BABA, Motoshige KUDO, Tsutomu NAKAOKA

1995 Volume 35 Issue 1 Pages 45-47
Published: 1995
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.35.45

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A 66-year-old female presented with spontaneous intraorbital hematoma manifesting as left exophthalmos after left eye discomfort persisting for 5 months. She had no history of head injury. Computed tomography revealed a round mass in her left orbit which was slightly high density with no postcontrast enhancement. A blood cyst was extirpated through frontotemporal craniotomy. Histological findings showed no tumor or vascular anomaly. Spontaneous intraorbital hematoma with insidious symptoms is extremely rare and should be considered in the differential diagnosis of orbital mass lesions.

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