Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 35, Issue 5
Displaying 1-10 of 10 articles from this issue
  • Masahiro SASAHIRA, Tetsuhiko ASAKURA, Masaki NIIRO, Akihiro HARUZONO, ...
    1995 Volume 35 Issue 5 Pages 277-284
    Published: 1995
    Released on J-STAGE: March 30, 2006
    JOURNAL FREE ACCESS
    Functional magnetic resonance (MR) imaging of the brain was performed during motor task activation in five normal subjects and a patient with meningioma using conventional fast low-angle shot sequences and a 2.0 T system. A high intensity area in the motor cortex was observed in all normal subjects. Single-slice studies showed the right-sided finger task produced an increase of 1.9-23.5% (6.67 ± 4.36%) in the signal intensity of the left motor cortex, while the left-sided finger task increased the signal by 1.5-18.2% (6.09 ± 3.34%) in the right motor cortex. There was no significant difference between the sides. Multiple-slice studies also showed the activated motor cortex as a high intensity area. The maximum signal intensity increase in the activated motor area was 11.0% for the left motor cortex and 8.8% for the right motor cortex. There was no significant difference between the sides. Preoperative mapping of the patient with meningioma showed that the motor cortex was displaced posteriorly by the tumor. Functional MR imaging is possible with a standard MR imaging system and conventional gradient echo sequences. Useful clinical information can be obtained by preoperative mapping of the motor cortex.
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  • Yukio KITAHARA, Hideo IIDA, Shigekuni TACHIBANA
    1995 Volume 35 Issue 5 Pages 285-288
    Published: 1995
    Released on J-STAGE: March 30, 2006
    JOURNAL FREE ACCESS
    The effect of the longitudinal stretching force of the spinal cord on intramedullary pressure was investigated using our method for measuring intramedullary pressure of the spinal cord with implanted balloons. The transverse compressive force against the posterior wall of the spinal column was excluded by measuring the intramedullary pressure during flexion of the head with the middle and lower cervical spine in the neutral position. The intramedullary pressure of the cervical spinal cord was measured simultaneously at the C-2, C-4, and C-6 levels in 10 mongrel dogs, in three head positions: neutral, and head extension and flexion. Head flexion caused significant increases in the intramedullary pressure at C-2, C-4, and C-6. The pressure increase in the middle to lower cervical cord must have been due to the transmission of the longitudinal stretching force of the cord itself, and may be a factor in the development of intramedullary disorders such as syringomyelia and intramedullary neoplasms.
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  • Mitsunobu IDE, Minoru JIMBO, Masaaki YAMAMOTO, Yutaka UMEBARA, Shinji ...
    1995 Volume 35 Issue 5 Pages 289-293
    Published: 1995
    Released on J-STAGE: March 30, 2006
    JOURNAL FREE ACCESS
    The relationship between tumor doubling time, estimated by serial computed tomography (CT), and the proliferating cell nuclear antigen (PCNA) staining index of the tumor specimen was analyzed in 12 patients with nine partially or subtotally resected meningiomas and three meningiomas which recurred after gross total removal. There were nine meningothelial and three fibrous meningiomas. Malignant meningiomas and hemangiopericytomas were excluded. Serial CT was performed at various intervals ranging from 354 to 2007 days. Formalin-fixed, paraffin-embedded archival tissues were immunohistochemically stained using the avidin-biotin complex method with monoclonal antibody against PCNA. Percentages of PCNA-positive cells were calculated in 10 microscopic fields to determine the mean PCNA staining index. PCNA staining indexes varied from 0.13% to 7.46%. The tumor doubling time ranged from 197 to 7943 days and demonstrated a significant inverse rank correlation with the PCNA staining index (r = -0.89, p = 0.003). Meningiomas with PCNA staining indexes higher than 1 % have comparatively short tumor doubling times of less than 5 years. PCNA immunostaining is a useful method for evaluating the proliferative activity of meningiomas.
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  • Kazuya NAGATA, Yousuke SEYAMA, Takao SHIMIZU
    1995 Volume 35 Issue 5 Pages 294-297
    Published: 1995
    Released on J-STAGE: March 30, 2006
    JOURNAL FREE ACCESS
    A high concentration of a type of cholic acid, 7α-hydroxy-3-oxo-4-cholestenoic acid, is observed in the content of chronic subdural hematoma. To investigate the possible causes, the level of this compound was measured in the cerebrospinal fluid of patients who underwent surgery for aneurysmal subarachnoid hemorrhage or non-hemorrhagic diseases. The maximum level was significantly higher in the aneurysmal subarachnoid hemorrhage patients, indicating that surgical intervention did not cause the postoperative increase in the level of this compound in the cerebrospinal fluid. Monitoring of plasma levels showed no postoperative increase. In vitro culture of a mixture of arterial blood and cerebrospinal fluid failed to show the de novo production of this compound. These results strongly suggest extrahepatic intracranial production of this cholic acid occurs in subarachnoid hemorrhage. The high concentration of this compound in both chronic subdural hematoma and subarachnoid hemorrhage suggests a possible role for 7α-hydroxy-3-oxo-4-cholestenoic acid in intracranial hemorrhagic disorders.
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  • —A Preliminary Study—
    Tohru HORIKOSHI, Akira FUKAMACHI, Hideo NISHI, Shin-ichi YAGI, Isao FU ...
    1995 Volume 35 Issue 5 Pages 298-304
    Published: 1995
    Released on J-STAGE: March 30, 2006
    JOURNAL FREE ACCESS
    Serial evaluation of cerebral vasospasm following subarachnoid hemorrhage was attempted in 11 patients using magnetic resonance (MR) angiography. MR angiography demonstrated vasospasm with angiographic confirmation in three patients as a segmental narrowing or loss of flow signal, usually accompanied by decreased distal flow signal. MR angiography also showed decreased flow signal suggestive of vasospasm in another patient with clinical evidence of vasospasm but no angiographic confirmation was possible because of poor condition. MR angiography showed no vasospasm in five patients without clinical evidence of vasospasm, except in one patient with disappearance of the unilateral anterior cerebral artery signal, shown to be involvement of the clipped artery. MR angiography is a potential method for detection of vasospasm with further improvement of the technique.
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  • —Three Case Reports—
    Yasushi KUROKAWA, Seisho ABIKO, Tomomi OKAMURA, Yukihide IKEYAMA, Tats ...
    1995 Volume 35 Issue 5 Pages 305-309
    Published: 1995
    Released on J-STAGE: March 30, 2006
    JOURNAL FREE ACCESS
    Three patients developed acute pulmonary embolism after cerebral angiography. The diagnoses were based on the clinical symptoms and echocardiography, chest roentgenography, blood gas analysis, and pulmonary perfusion scans after intravenous injection of 5 mCi of technetium-99m-labeled human albumin macroaggregates. Two of the three patients achieved clinical improvement, but one patient with severe embolization and circulatory deterioration died in spite of anticoagulation therapy. Recognition of the potential risk of pulmonary embolism after angiography and active prophylaxis are most important in preventing this complication.
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  • —Case Report—
    Kiyoshi NAGATA, Yuji NIKAIDO, Takashi YUASA, Masayuki FUJIOKA, Yuhki I ...
    1995 Volume 35 Issue 5 Pages 310-313
    Published: 1995
    Released on J-STAGE: March 30, 2006
    JOURNAL FREE ACCESS
    A 35-year-old male presented with trigeminal neuralgia associated with venous angioma at the root entry zone. Magnetic resonance imaging and angiography demonstrated a venous angioma with a dilated petrosal draining vein, and displacement of the anterior inferior cerebellar artery (AICA). The AICA and dilated petrosal vein were both decompressed, resulting in complete relief from symptoms of trigeminal neuralgia for 30 months. Microvascular decompression rather than resection of venous angioma is recommended for treatment of such cases. The possibility of a venous anomaly should be considered in younger patients with trigeminal neuralgia.
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  • —Case Report—
    Kazuya UEMURA, Makoto SONOBE, Takuya AKAI, Katsunobu OYAMA, Kyoichi SU ...
    1995 Volume 35 Issue 5 Pages 314-316
    Published: 1995
    Released on J-STAGE: March 30, 2006
    JOURNAL FREE ACCESS
    A 69-year-old male presented with sudden onset of headache. Computed tomography of the head demonstrated diffuse subarachnoid hemorrhage. Angiography showed a saccular basilar bifurcation aneurysm. Endovascular coil occlusion of the aneurysm on the same day enabled complete obliteration of the aneurysm. He did not develop vasospasm and returned home 4 months later. Early endovascular occlusion of the aneurysmal sac is an alternative method for the management of ruptured basilar bifurcation aneurysms.
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  • —Case Report—
    Hideo KIMURA, Yoshiaki TAKENO, Takeo FUKUSHIMA
    1995 Volume 35 Issue 5 Pages 317-320
    Published: 1995
    Released on J-STAGE: March 30, 2006
    JOURNAL FREE ACCESS
    A 63-year-old female presented with recurrent glioblastoma at the site of a right parietal glioblastoma which was diagnosed 1 year before. She was treated at that time by total removal of the tumor, irradiation, and chemotherapy. Four months after the initial treatment, serial thallium-201 single photon emission computed tomography (201T1 SPECT) showed increased uptake at the edge of the original tumor site. The index, the ratio of 201T1 uptake in the lesion to the normal brain, was 2.9 which suggested a recurrent tumor. Magnetic resonance images with gadolinium over the next 7 months demonstrated an enhanced mass lesion at the site of primary tumor resection and a new enhanced mass in the right temporal lobe. The lesion in the right parietal lobe had a 201T1 uptake index of 2.5, while the lesion in the right temporal lobe had an index of 1.5. Re-craniotomy and total resection of the tumors in the right parietal and temporal lobes were performed. The histological diagnosis of both tumors was glioblastoma. The proposed use of 201T1 SPECT for the differential diagnosis of recurrent glioma and radiation necrosis should be carefully considered because the 201T1 uptake index can vary in tumor with the same malignancy grade.
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  • —Case Report—
    Hiroshi DOI, Izumi TOYODA, Kiyoshi MATSUMOTO, Satoshi IMAI, Masayuki S ...
    1995 Volume 35 Issue 5 Pages 321-324
    Published: 1995
    Released on J-STAGE: March 30, 2006
    JOURNAL FREE ACCESS
    A 32-year-old female presented with a history of intermittent, severe lower back pain, exacerbated by pregnancy and persisting for several years. Magnetic resonance (MR) imaging showed a sacral mass as a low signal intensity area on the T1-weighted image and a high signal intensity area on the T2-weighted image, consistent with a cystic structure containing cerebrospinal fluid. A tethered cord attached to the thecal sac was also confirmed. Sacral laminectomy revealed thinned sacral vertebral laminae, but no neuronal elements existed within the cyst. The cyst was attached to the distal thecal sac by a small fistula. The thecal sac was explored, revealing a thick filum terminale, which was transected. The severe pain resolved postoperatively. This type of meningeal cyst, often called“occult intrasacral meningocele, ”is best diagnosed by MR imaging. Surgery to obliterate the fistulous tract is the optimum treatment. Total removal of the cyst is unnecessary, but evaluation of other associated congenial abnormalities is important.
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