Neurologia medico-chirurgica

Changes in Regional Cortical Temperature and Cerebral Blood Flow after Cortical Spreading Depression

Morikazu UEDA, Noriaki WATANABE, Yukio USHIKUBO, Takashi TSUZUKI, Kazu ...

1997 Volume 37 Issue 6 Pages 441-446
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.441

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Regional cerebral blood flow (rCBF) measurement by laser Doppler flowmetry and cortical temperature measurement using thermoencephaloscopy (TES) were performed to investigate the relationship between the changes in rCBF and cortical temperature after induced cortical spreading depression (CSD) in rats. TES showed a gradually expanding thermoresponse like an extending circular wave after CSD induced by application of KCl. Similarly, a transient increase in rCBF spread from the site of stimulation with a velocity of propagation of 2.5 mm/min. Simultaneous monitoring of rCBF and cortical temperature showed that the transient increase in rCBF was associated with an initial decrease in cortical temperature, followed by an increase in cortical temperature. We suggest that the cortical temperature is regulated mainly by neurogenic control of the pial microvascular blood supply that is precisely adjusted to the metabolic needs of the cerebral cortex. Non-injured cortex with the fine vascular architecture must be preserved during neurosurgery to allow heat transfer from deep areas of the cortex.

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Effects of Repeated Short versus Single Long Episodes of Focal Ischemia on Somatosensory Evoked Potentials and Development of Cerebral Infarction in Cats

Kyu Chang LEE, Jin Yang JOO, Seung Kon HUH, Tai Seung KIM

1997 Volume 37 Issue 6 Pages 447-452
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.447

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The effects of repeated short episodes of focal ischemia at 30-minute intervals or a single equivalent long episode of focal ischemia on neuronal function and development of cerebral infarction were compared using somatosensory evoked potential (SEP) recording and 2, 3, 5-triphenyltetrazolium chloride staining in a cat model. Seventeen cats underwent transorbital occlusion of the middle cerebral artery (MCA), using one of three procedures: sham-operation; single 1-hour occlusion of the MCA, followed by 3 hours of recirculation; or three 20-minute occlusions of the MCA at 30-minute intervals, followed by 3 hours of recirculation. Two of six cats in the single long-term occlusion group showed recovery of SEP, whereas all six cats in the repeated short-term occlusion group showed recovery of SEP at 3 hours after recirculation. All six cats in the single long-term occlusion group had cerebral infarction of various sizes, but only one cat in the repeated short-term occlusion group developed infarction. Repeated short episodes of focal ischemia are relatively less damaging than a single equivalent long episode of focal ischemia, even if the reperfusion interval is extended to 30 minutes.

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Sonic Analysis for Detection of Cervical and Intracranial Vascular Disease

Yasunari OTAWARA, Naohiko KUBO, Miyuki ABE, Nobuhiko TOMITSUKA, Akira ...

1997 Volume 37 Issue 6 Pages 453-458
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.453

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A sonic analysis system was developed for the detection of cervical and intracranial vascular disease. The system analyzes recorded sound signals converted to digital data, and plots the frequency, time interval after the QRS wave of the electrocardiogram, and amplitude on the graph using contour lines. Sonic analysis of 22 patients with and 23 patients without cerebrovascular disease identified a characteristic pattern of disease called the “circular pattern.” Five of 10 patients with internal carotid artery stenosis, four of seven with cerebral aneurysms, three of three with cerebral arteriovenous malformation, and two of two with dural arteriovenous malformation showed the circular pattern. Only one of 23 control patients showed the circular pattern. This system is a promising method for cost-effective mass screening for the early detection of cerebrovascular disease.

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Choroidal Detachment and Dural Carotid-Cavernous Sinus Fistula —Case Report—

Masaki KOMIYAMA, Misao NISHIKAWA, Toshihiro YASUI

1997 Volume 37 Issue 6 Pages 459-463
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.459

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A 71-year-old female presented with the rare complication of choroidal detachment after endovascular treatment of a dural carotid-cavernous sinus fistula. Since the residual arteriovenous shunt flow was minimal and intraocular pressure was normal, the choroidal detachment was treated conservatively and disappeared within one month. The possibility of choroidal detachment during the clinical course of a dural carotid-cavernous sinus fistula should be recognized.

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Sinus Pericranii Associated with a Cerebellar Venous Angioma —Case Report—

Kyoji SAKAI, Katsunari NAMBA, Toshinari MEGURO, Shinya MANDAI, Yuji GO ...

1997 Volume 37 Issue 6 Pages 464-467
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.464

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A 64-year-old male presented with sinus pericranii associated with a venous angioma draining through a large venous lake. Increased venous pressure and flow in the dural venous lake in contact with the venous sinus may have developed the sinus pericranii. Three-dimensional computed tomography was very useful in determining the sites of the transcranial venous anastomotic channels, and magnetic resonance imaging was also very useful in detecting the intracranial vascular anomalies.

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Hypothalamic Hamartoma Associated with Dural Arteriovenous Fistula of the Transverse-Sigmoid Sinus —Case Report—

Takeshi MATSUYAMA, Hiroshi NOGUCHI, Toshio KAKIZAKI, Toshisuke SAKAKI

1997 Volume 37 Issue 6 Pages 468-471
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.468

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A 32-year-old female presented with a hypothalamic hamartoma associated with a dural arteriovenous fistula (DAVF) of the left transverse-sigmoid sinus. She complained of pulsatile tinnitus in the left retroauricular region and infertility. Endocrinological examination revealed that the luteinizing hormone reaction to luteinizing hormone-releasing hormone was exceedingly high. Magnetic resonance imaging demonstrated a distinct mass occupying the suprasellar cistern and protruding into the third ventricle. Left carotid angiography demonstrated a DAVF of the left transverse-sigmoid sinus, which was treated by embolization. Histological examination of a biopsy specimen of the tumor revealed a hamartoma. She was free from pulsatile tinnitus after treatment for the DAVF.

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Petrous Bone Meningioma Originating from the Jugular Foramen —Case Report—

Seiji OHTA, Tetsuo YOKOYAMA, Kenichi UEMURA, Shigeru NISHIZAWA, Seiji ...

1997 Volume 37 Issue 6 Pages 472-474
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.472

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A 49-year-old female presented with a rare meningioma in the petrous bone. High resolution computed tomography and magnetic resonance imaging demonstrated that the tumor had developed in the jugular foramen and extended into the infralabyrinthine area of the petrous bone and intracranially into the cerebellopontine angle. The operative findings confirmed these observations. Meningiomas of the petrous bone may originate from the jugular foramen.

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Intracranial Tuberculoma Mimicking Metastasis from Renal Tumor —Case Report—

Faik ÖZVEREN, Hasan ÇETIN, Alev GÜNER, Baran KANDEMIR

1997 Volume 37 Issue 6 Pages 475-478
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.475

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A 63-year-old female presented with intracranial tuberculoma manifesting as severe headache. Systemic examination found a mass in the left kidney. The histological diagnosis was tuberculoma after kidney biopsy. Cranial computed tomography found two lesions, in the right frontal and occipital lobes. The intracranial lesions were considered to be tuberculomas. Tuberculosis chemotherapy was continued for 15 months. Her neurological deficit was resolved. Cranial computed tomography showed the lesion in the frontal lobe had disappeared and the lesion in the occipital lobe was reduced in size.

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Immunohistochemical Detection of Tumor Marker in Recurrent Clivus Enterogenous Cyst —Case Report—

Toshiya FUJITA, Takamasa KAYAMA, Shinjiro SAITO, Mitsunori YAMAKAWA, O ...

1997 Volume 37 Issue 6 Pages 479-482
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.479

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A 26-year-old male presented with recurrence of an enterogenous cyst in the intracranial region 10 years after the first operation. The cyst was drained and the cyst wall partially resected at both operations with good outcome. Histological examination showed a change from one layer epithelium in the first specimen to glandular structures in the second. Alcian blue, periodic acid-Schiff, and immunohistochemical staining for epithelial membrane antigen, S-100 protein antigen, keratin, and carcinoembryonic antigen were used to confirm the accurate diagnosis. Immunohistochemical staining showed CA19-9 antigen was positive in both specimens. The CA19-9 level in the cerebrospinal fluid was extremely high (621.5 U/ml) at the second operation. Patients with enterogenous cyst should be monitored to detect possible recurrence.

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Global Health Care and Neurosurgeons

Susumu WAKAI

1997 Volume 37 Issue 6 Pages 483-490
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.483

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The contributions that neurosurgeons can make to global health are discussed in the context of the author''s clinical and research experience, his views on priorities and equity in research and economic development, and the state of health care in developed and developing countries. Ideas for establishing a new paradigm of health care for all are proposed, as well as more general interventions on behalf of human rights and peace. Neurosurgeons, other medical professionals, and those who are concerned about these global issues are urged to work in concert to remove inequalities in health care both locally and globally.

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