Neurologia medico-chirurgica

Neuronal and Glial Processes in Neuropathology

Asao HIRANO

1997 Volume 37 Issue 1 Pages 1-5
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.1

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Effects of Intrathecal Nonnarcotic Analgesics on Chronic Tactile Allodynia in Rats: α₂-Agonists versus Somatostatin Analog

Nobuo ONO, Jeffrey S. KROIN, Richard D. PENN, Judith A. PAICE

1997 Volume 37 Issue 1 Pages 6-11
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.6

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The effects of the intrathecal α₂-agonists tizanidine and clonidine and the somatostatin analog octreotide on an experimental rat model of tactile allodynia were investigated to determine the therapeutic potential for treating chronic neuropathic pain. Allodynia was induced by ligating the rat sciatic nerve. The mechanical threshold for paw withdrawal was assessed by applying von Frey hairs to quantify analgesic actions. Mean 50% paw withdrawal thresholds were converted to the percentage of maximum possible effect (%MPE) where %MPE = (postdrug threshold − predrug threshold) ÷ (15 g − predrug threshold) × 100. Dose-response curves were plotted for suppression of paw withdrawal 30 minutes after intrathecal injection of various doses of tizanidine, clonidine, and octreotide. Thresholds on the nonlesioned side were greater than 15 g. The lesioned side had baseline thresholds of less than 4.5 g. Doseresponse curves were established for the antiallodynia effects of each drug. Tizanidine and clonidine at a 25-μg dose increased the threshold to greater than 97% of the MPE, but caused transient hindpaw weakness or sedation. No side effect was observed at a 10-μg dose, at which the threshold was 88-96% of MPE. Intrathecal octreotide modestly increased the threshold to only 49-67% of MPE, showing a lesser analgesic effect, although no side effect was observed at a 4-μg dose. The antiallodynic effects of intrathecal tizanidine and clonidine were more potent than that of octreotide.

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Measurement of Cell Kinetic Parameters in Meningiomas

Yoshio NAKAGAWA, Noriaki SUGAWA, Satoshi UEDA, Kenzo SUZUKI, Alessandr ...

1997 Volume 37 Issue 1 Pages 12-17
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.12

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Cell kinetic parameters were measured in four cases of meningioma showing regrowth. The cell cycle time (T_c) and tumor doubling time (T_d) were established by histological evaluation of the biopsy specimens and calculation of the growth curve based on computed tomography (CT)/magnetic resonance (MR) images. MIB-1 mouse monoclonal antibody, which recognizes an epitope of the Ki-67 antigen, was used to establish the MIB-1 staining index (SI) (MIB-1-positive nuclei⁄5000 tumor cells) for each tumor. The changes in tumor volume were calculated from CT/MR images, and the T_d was estimated from the growth curve. The T_c was calculated using Steel''s formula from the MIB-1 SI and tumor volume. MIB-1 SI varied from 0.0055 to 0.0468, T_d from 270 to 1429 days, and T_c from 10.4 to 15.9 days. Furthermore, the potential doubling time (T_p) was calculated using the corresponding T_c and MIB-1 SI (growth fraction) for the four cases; these values varied from 197 to 1645 days and were very close to the T_d values. This method of evaluation of tumor T_c and calculation of T_p may be useful for predicting the postoperative course in meningiomas.

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Survival Probability, Delayed Mortality, and Relationship Between Short-term Outcome and Long-term Survival After Aneurysmal Subarachnoid Hemorrhage

Takahisa MORI, Koreaki MORI, Masahiro KURISAKA, Masanori MORIMOTO

1997 Volume 37 Issue 1 Pages 18-24
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.18

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The long-term survival probability, causes of delayed mortality, and relationship between short-term outcome and long-term survival after aneurysmal subarachnoid hemorrhage were retrospectively studied in 106 patients followed up for longer than 5 years. The Kaplan-Meier cumulative survival probabilities at 1 month, 6 months, and 5 years were 85.9%, 79.2%, and 66.8%, respectively. Six months after the onset, 41 patients made a good recovery (GR) and 34 were moderately disabled (MD). On the last follow-up day, 64 had good outcome (GR or MD) and eight had died. In contrast, there were nine patients with poor 6-month outcome (severe disability or vegetative state), seven of whom died within 5 years. Five of these seven patients had experienced intraventricular hemorrhage (IVH) on admission. A total of 15 patients died beyond 6 months, five died of complications related to shunts. Sixmonth outcome is a predictor of long-term survival and delayed mortality. Improved long-term survival requires the development of better management for IVH, improved 6-month outcome, and careful follow-up of patients who undergo shunting.

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Early Effects of Gamma Knife Radiosurgery on Brain Metastases: Assessment by ²⁰¹TlCl SPECT and ^99mTc-DTPA-Human Serum Albumin SPECT

Yoshinobu SEO, Seiji FUKUOKA, Jyoji NAKAGAWARA, Masami TAKANASHI, Kats ...

1997 Volume 37 Issue 1 Pages 25-31
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.25

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Thallium-201 chloride (²⁰¹TlCl) single photon emission computed tomography (SPECT) was used to determine tumor viability, and the early and delayed images of technetium-99m-diethylenetriaminepentaacetic acid-human serum albumin (^99mTc-HSA-D) SPECT were used to assess tumor vascularity and permeability, respectively, in 17 patients with 18 brain metastases. SPECT was performed before, 1 week after, and 1 month after radiosurgery. The ratios of ²⁰¹Tl and ^99mTc-HSA-D uptake in a tumor were expressed as a ratio to uptake in the corresponding normal contralateral areas (uptake index). Magnetic resonance imaging with gadolinium was used to determine tumor volume. ²⁰¹Tl index decreased significantly 1 week (p < 0.05) and 1 month (p < 0.005) after radiosurgery. In contrast, ^99mTc-HSA-D indices of early and delayed images obtained at 1 week after radiosurgery were not significantly different from the pretreatment values. However, both were significantly low (p < 0.05) 1 month after radiosurgery. No change in tumor volume was detected 1 week following radiosurgery, but there was a significant decrease (p < 0.005) after 1 month. The reduction in tumor viability that occurs before the appearance of evidence of tumor shrinkage represents the early effect of radiosurgery on brain metastases. Reduction in tumor size, vascularity, and permeability occur subsequently.

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Magnetic Resonance Imaging of Sequelae of Temporal Lobe Herniation Secondary to Traumatic Acute Subdural Hematoma: Kernohan''s Notch and Posterior Cerebral Artery Territory Infarctions Contralateral to the Supratentorial Lesion —Case Report—

Shobu NAMURA, Yoo KANG, Isao MATSUDA, Yoshinari KAMIJYO

1997 Volume 37 Issue 1 Pages 32-35
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.32

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A 16-year-old girl presented with left hemiparesis and right oculomotor nerve paresis due to temporal lobe herniation resulting from a traumatic acute subdural hematoma secondary to a head injury. Computed tomography revealed a subdural hematoma in the right frontotemporal regions and midline structures shifted to the left. She became comatose and underwent an emergency operation. The hemiparesis and newly manifested homonymous hemianopsia on the right side persisted after surgery. Postoperative magnetic resonance imaging showed Kernohan''s notch in the cerebral peduncle and infarctions in the occipital lobe and posterolateral part of the thalamus on the left side, contralateral to the supratentorial lesion.

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Magnetic Resonance Imaging and Angiographic Appearance of Meningioma of the Fourth Ventricle —Two Case Reports—

Tsutomu ISEDA, Tomokazu GOYA, Shinichi NAKANO, Shinichiro WAKISAKA

1997 Volume 37 Issue 1 Pages 36-40
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.36

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A 47-year-old female presented with a transitional type meningioma entirely confined to the fourth ventricle. The tumor was totally resected. A 67-year-old female had undergone resection of an intraventricular transitional type meningioma of the fourth ventricle 9 years previously. She presented with a new meningioma of an obviously different origin at the posterior rim of the foramen magnum. The new meningioma was totally resected and the histological diagnosis was atypical meningioma. The magnetic resonance (MR) imaging characteristics of these two intraventricular meningiomas of the fourth ventricle were isointense and slightly hypointense to gray matter on the T₁-weighted images, and hyperintense to gray matter on the T₂-weighted images, with intense and homogeneous enhancement with gadolinium. Angiography showed the two intraventricular meningiomas fed by branches of the posterior inferior cerebellar arteries or superior cerebellar arteries. The second meningioma with dural attachment was fed by the right occipital artery. Intraventricular meningiomas of the fourth ventricle are not supplied by meningeal branches from vertebral and external cerebral arteries. MR imaging is the most useful tool in preoperative diagnosis, but cerebral angiography should also be performed to confirm the feeding vessels and the correct diagnosis.

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Abnormal Cerebral Blood Flow Associated with Antiphospholipid Antibody Syndrome —Four Case Reports—

Hirofumi OYAMA, Hidetsugu KOJIMA, Yoshihiro OHTA, Masanori IWAI, Kazuy ...

1997 Volume 37 Issue 1 Pages 41-48
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.41

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Patients with antiphospholipid antibody syndrome manifesting as neurological symptoms (one patient with twice repeated cerebral ischemic symptoms in the left parietal and frontal lobes, and the other patient with cerebral infarction of the right temporal lobe) and non-neurological symptoms (one patient with occlusion of the superior mesenteric artery and the other patient with thrombophlebitis) underwent cerebral blood flow (CBF) studies using xenon-enhanced computed tomography. The patients with neurological symptoms had decreased CBF at the affected sites. The patients with non-neurological symptoms had decreased CBF in the left parietal and temporal lobes and/or corona radiata. Subtle preclinical thrombosis may cause chronic cerebral hypoperfusion in patients with antiphospholipid antibody syndrome.

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Effect of Cisternal Papaverine on Cerebral Blood Flow in Patients with Subarachnoid Hemorrhage —Three Case Reports—

Hirofumi OYAMA, Masahiro NIWA, Yoshihisa KIDA, Takayuki TANAKA, Kazuo ...

1997 Volume 37 Issue 1 Pages 49-54
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.49

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Three patients presenting with subarachnoid hemorrhage due to aneurysmal rupture underwent cerebral blood flow (CBF) measurements before and after cisternal injection of papaverine hydrochloride. One patient showed prominent increases in CBF in the frontal lobe and basal ganglia after injection of papaverine, but paradoxical decreases in the parietal lobe and corona radiata. The other two patients had poor CBF response. Dense clotting in the basal cisterns may have prevented diffusion of the agent so that only the proximal trunks of the internal carotid, anterior cerebral, and middle cerebral arteries were dilated in the former case. The dilation of proximal trunks of cerebral arteries might steal blood flow from the parietal lobe and corona radiata, where the intraparenchymal arteries were maximally dilated and cerebrovascular reserve capacity was poor.

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Intraparenchymal Metastatic Tumor with Periventricular Dissemination —Case Report—

Liu RONG-YAO, Kengo MATSUMOTO, Yusuke YOSHIMOTO, Takashi OHMOTO

1997 Volume 37 Issue 1 Pages 55-58
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.55

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A 50-year-old male presented with a rare intraparenchymal metastatic tumor spreading through the periventricular tissue. Magnetic resonance (MR) imaging demonstrated the tumor as a heterogeneous low-intensity area on T₁-weighted images with enhancement by gadolinium-diethylenetriaminepentaacetic acid, and as a heterogeneous high or isointensity area on T₂-weighted images. Histological examination of a biopsy sample showed adenocarcinoma. This MR imaging appearance is typical of malignant glioma. The differential diagnosis of tumor in the cerebral parenchyma with ventricular dissemination should include both primary and secondary intracranial malignant tumors. MR imaging is useful in the diagnosis of such tumors, but the final diagnosis should be based on either tissue biopsy or cytological examination of the cerebrospinal fluid.

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Splitting of Temporalis Muscle for Basal Exposure —Technical Note—

Atul GOEL

1997 Volume 37 Issue 1 Pages 59-62
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.59

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Splitting of the temporalis muscle to increase the basal exposure in subtemporal approaches is discussed. The temporalis muscle is split vertically in the direction of its insertion at the coronoid process of the mandible up to the zygomatic arch and the split components of the muscle are retracted apart. This simple procedure significantly reduces the obstruction caused by the temporalis muscle during subtemporal surgery. The procedure was employed in six patients with tumors located in the basal temporal, posterior cavernous sinus, and petrous apex region. Zygomatic osteotomy could be avoided in selected patients and the exposure of the infratemporal fossa region could be widened by employing this technique. The function and bulk of the temporalis muscle were effectively preserved.

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