Neurologia medico-chirurgica

Immunohistochemical Study of Glutathione S-Transferase-π in Meningiomas

Mitsutoshi NAKAMURA, Shigeru TSUNODA, Toshisuke SAKAKI, Noboru KONISHI ...

1995 Volume 35 Issue 11 Pages 787-790
Published: 1995
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.35.787

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Immunostaining for glutathione S-transferase-π was investigated in various subtypes of meningioma for the purpose of biological characterization. Specimens included five normal meninges and 25 meningiomas (10 meningothelial type, 6 fibrous type, 5 transitional type, 3 microcystic type, and 1 secretory type). In the meningothelial type, most cells showed strongly positive staining. In the fibrous type, all cells were negative. In the transitional type, only the meningothelial components were positive. In the microcystic type, meningothelial cell clusters and arachnoid trabecular cells were positive. In the secretory type, the meningothelial components and the pseudopsammoma-body-producing cells were positive. These results suggest that the meningothelial type and the fibrous type have a different basis of development and biological features. The results also suggest that arachnoid trabecular cells and meningothelial cells share the same origin, and that the arachnoid trabecular cells serve as supportive cells and as cells which detoxify harmful substances in the subarachnoid space. The pseudopsammoma-body-producing cells in the secretory type represent the outcome of epithelial differentiation of meningothelial cells with their biological character being preserved.

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Mammosomatotroph Adenoma Cells Secrete Both Growth Hormone and Prolactin

Yasuhiro KOJIMA, Jun ARITA, Nobumasa KUWANA

1995 Volume 35 Issue 11 Pages 791-796
Published: 1995
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.35.791

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Pituitary adenoma cells from a mammosomatotroph adenoma obtained from a 21-year-old female presenting with acromegaly and amenorrhea were investigated by sandwich cell immunoblot assay, immunohistochemistry, and electron microscopy. The new, simple technique of sandwich cell immunoblot assay could detect two hormones secreted in the same one cell, and found that 89% of mammosomatotrophs secreted both growth hormone (GH) and prolactin (PRL). Immunohistochemistry showed that the tumor cells were positive for both GH and PRL. Electron microscopy showed cells contained granules ranging in size from 150 to 500 nm. This is the first demonstration of both GH and PRL in the same mammosomatotroph cell. Sandwich cell immunoblot assay can measure the amount of secreted hormone, allowing a new approach to the investigation of mammosomatotroph adenomas.

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Effects of Cervical Spinal Cord Stimulation on Glucose Consumption in Patients with Posttraumatic Prolonged Unconsciousness

Narihito YAMAGUCHI, Hiroyasu SEKI, Kiyonobu IKEDA, Junkoh YAMASHITA

1995 Volume 35 Issue 11 Pages 797-803
Published: 1995
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.35.797

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The effects of cervical spinal cord stimulation (CSCS) on glucose consumption were examined in two patients with prolonged disturbance of consciousness due to head injuries. Several clinical parameters, including glucose consumption using positron emission tomography (PET) with [¹⁸F]2-fluoro-2-deoxyD-glucose (FDG), were compared before and after CSCS. After a 4-month period of stimulation, one patient (Case 1) regained consciousness and began to speak, but the other patient (Case 2) showed no improvement in consciousness level. Computed tomography and magnetic resonance imaging showed Case 1 had no abnormalities in the thalamus and brainstem and no diffuse brain atrophy. Case 2 had a low density area in the left thalamus and enlargement of the aqueduct with diffuse atrophy of the left cerebral hemisphere. Cerebral blood flow studies and electrophysiological examinations revealed no remarkable change after CSCS. The PET study showed an increase in FDG uptake in the hypothalamus and thalamus in both patients, but an increase in FDG uptake in the left cingulate gyrus and left frontal lobe was observed only in Case 1. These observations suggest that activation of the ascending reticular activating system, hypothalamus, thalamus, cingulate gyrus, and frontal cortex, and the preservation of the fiber connections between the limbic system and the thalamus and hypothalamus are important for CSCS treatment to improve the level of consciousness.

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Cranioplasty with Split-thickness Calvarial Bone

Akira INOUE, Susumu SATOH, Kentarou SEKIGUCHI, Yasuo IBUCHI, Shunichi ...

1995 Volume 35 Issue 11 Pages 804-807
Published: 1995
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.35.804

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Cranioplasty with autogenous split-thickness calvarial bone was performed in 10 patients. Follow-up for a mean of 19 months (range 2-43 mos) showed satisfactory protection of the brain and cosmetic reconstruction. No serious complication was seen except in one patient with postoperative epidural abscess. Split-thickness calvarial bone graft is recommended in patients with previous infection or high risk of infection, in poorly vascularized recipient sites resulting from multiple operations or irradiation, and in younger patients aged more than 7 years.

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Serial Positron Emission Tomography Imaging of Changes in Amino Acid Metabolism in Low Grade Astrocytoma After Radio and Chemotherapy

—Case Report—

Kiyotaka SATO, Motonobu KAMEYAMA, Takamasa KAYAMA, Takashi YOSHIMOTO, ...

1995 Volume 35 Issue 11 Pages 808-812
Published: 1995
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.35.808

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A 37-year-old male with mixed glioma was treated with combined radio and chemotherapy. The amino acid metabolism of the tumor site and normal brain was followed by positron emission tomography using [¹¹C]methionine ([¹¹C]Met). The accumulation of [¹¹C]Met in the tumor decreased during therapy and slightly increased 7 months after completion of the therapy, but then decreased markedly. However, computed tomography revealed no notable changes. The contralateral gray matter also showed a gradual decrease of [¹¹C]Met accumulation. These findings indicate that reduction of amino acid metabolism in the tumor continues after radiochemotherapy although neuroimaging reveals no further morphological changes. Such therapy also has long-term effects on normal brain tissue.

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Cerebral Gumma Showing Linear Dural Enhancement on Magnetic Resonance Imaging

—Case Report—

Ryo INOUE, Seiji KATAYAMA, Takanori KUSAKABE, Teruaki MORI, Shigeaki H ...

1995 Volume 35 Issue 11 Pages 813-817
Published: 1995
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.35.813

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A 51-year-old male presented with a rare cerebral gumma accompanied by abducens nerve paresis and cerebellar infarction. Magnetic resonance (MR) imaging demonstrated a homogeneous enhanced mass lesion and adjacent linearly enhanced dura mater. Histological examination of the mass revealed a caseating granuloma. Serological studies were positive for active syphilis. Although linear dural enhancement adjacent to the mass lesion on MR imaging is characteristic of meningioma, this finding is also demonstrated in cerebral gumma. Therefore, cerebral gummas should also be included in the differential diagnosis. Immunological tests for syphilis (serum, cerebrospinal fluid) can confirm the diagnosis.

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Eighth Cranial Nerve Lipoma Manifesting as Intractable Vertigo

—Case Report—

Shoichiro KAWAGUCHI, Toshisuke SAKAKI, Hidehiro HIRABAYASHI, Hiroshi H ...

1995 Volume 35 Issue 11 Pages 818-821
Published: 1995
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.35.818

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A 49-year-old female presented with an extremely rare lipoma of the cerebellopontine angle (CPA) manifesting as intractable vertigo and tinnitus. Subtotal removal of the lipoma was performed to debulk the tumor and decompress the cranial nerve VIII. Her complaints were resolved without new neurological deficit. We recommend surgery in patients with symptomatic CPA lipomas for diagnosis, debulking, and decompression of cranial nerves to relieve the symptoms.

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Dolichoectasia of the Middle Cerebral Artery

—Case Report—

Ichiro NAKAHARA, Waro TAKI, Masato TANAKA, Kouji MATSUMOTO, Haruhiko K ...

1995 Volume 35 Issue 11 Pages 822-824
Published: 1995
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.35.822

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A 59-year-old female with a previous history of head injury presented with mild occipitalgia due to dolichoectasia of the middle cerebral artery (MCA). Initial examination by computed tomography and angiography using the usual projections suggested a terminal internal carotid artery saccular aneurysm. However, angiography by the reverse Waters view excluded a saccular aneurysm. Superselective angiography using a microcatheter revealed the complex tortuous course of the MCA due to dolichoectasia. She was discharged and has remained asymptomatic. Superselective angiography is extremely useful for the diagnosis of dolichoectasia localized in the MCA.

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Posterior Cerebral Artery Aneurysm Associated with Unilateral Internal Carotid Artery Agenesis

—Case Report—

Mitsunobu IDE, Minoru JIMBO, Masaaki YAMAMOTO, Shinji HAGIWARA

1995 Volume 35 Issue 11 Pages 825-829
Published: 1995
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.35.825

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A 38-year-old housewife presented with a ruptured aneurysm associated with unilateral internal carotid artery agenesis. She had been in good health until May 31, 1994, when she was admitted to our facility immediately after sudden onset of headache and nausea. She was alert and exhibited no focal neurological deficit on admission. Cerebral angiography demonstrated an aneurysm arising from the junction of the horizontal segment of the right posterior cerebral artery and posterior communicating artery. The right internal carotid artery was totally absent. High resolution computed tomography demonstrated absence of the right carotid canal in the skull base. Neck clipping of the aneurysm was carried out through the right pterional approach on June 2. She returned home 52 days after the surgery with mild paresis of the left upper extremity and has since resumed household activities. Early surgery may be recommended in a patient with a ruptured aneurysm associated with agenesis of the internal carotid artery to prevent catastrophic rebleeding, if the initial insult is mild and subsequent vasospasm is unlikely to occur.

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Hypertrophic Anterior Falx Artery Associated with Interhemispheric Subdural Empyema

—Case Report—

Hideyuki MITSUOKA, Akira TSUNODA, Kentaro MORI, Atsushi TAJIMA, Minoru ...

1995 Volume 35 Issue 11 Pages 830-832
Published: 1995
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.35.830

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A 14-year-old boy presented with interhemispheric subdural empyema. Angiography demonstrated a hypertrophic anterior falx artery. He was treated with antibiotics and craniotomy to evacuate the lesion. The postoperative course was uneventful with no signs of neurological deficit. The abnormal artery was no longer visualized angiographically after the resolution of the empyema. Reactive appearance of the anterior falx artery is a pathognomonic sign of interhemispheric subdural empyema.

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