Neurologia medico-chirurgica

Preoperative Detection of the Composition of Atherosclerotic Plaque in the Carotid Artery Using Ultrasonography and Magnetic Resonance Imaging

Hiroshi TENJIN, Kiyoshi YASUKOCHI, Yoshikazu NAKAHARA, Toshihiro HIGUC ...

1997 Volume 37 Issue 7 Pages 505-511
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.505

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Preoperative identification of the components of atherosclerotic plaque was attempted using ultrasonography in five patients and magnetic resonance (MR) imaging in three patients before carotid endarterectomy. The correlation between surgical and histological findings, and preoperative ultrasonography and MR imaging was evaluated. Plaque consisting predominantly of calcification appeared as bright echo on ultrasonography and was tough. Plaque consisting predominantly of hemorrhage was echolucent, appeared as low intensity on T₂-weighted MR images and was fragile. Such preoperative assessment of plaque composition using ultrasonography and MR imaging is useful for manipulation of atherosclerotic plaque during carotid endarterectomy.

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Moyamoya Disease in Yugoslavia: Angiographic Study

Ljubisa BOROTA, Slobodan MARINKOVIC, Radoslav BAJIC, Branko PRSTOJEVIC ...

1997 Volume 37 Issue 7 Pages 512-524
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.512

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The angiographic findings in 31 Yugoslav moyamoya patients, 16 males and 15 females, including four children, were studied by conventional or digital subtraction angiography. The angiographic findings were reviewed for stenoocclusive lesions, form of the main cerebral arteries, transdural anastomoses, and basal vascular networks. There were 27 patients with bilaterally symmetrical or asymmetrical lesions and four with unilateral lesions. In two of these latter four patients, follow-up studies showed progression of the disease to the opposite side. Of 58 sides investigated, stenoocclusive lesions were localized above the origin of the anterior choroidal artery in 33 internal carotid arteries. Occlusions of the anterior and middle cerebral arteries were noted more frequently than stenoses: 89 vs. 27. The majority of the nests of abnormally dilated vessels (73 of 102) were localized in the ethmoidal region and basal ganglia. Analysis of distribution of the transdural collateral pathways to the brain discovered predominant participation of the middle meningeal and occipital arteries (43 of 55). Moyamoya disease in Yugoslavia predominantly affects the adult population, males and females equally, with the slowly progressive course typical for adults, and is mainly confined to the carotid fork and rarely extends to the posterior circulation.

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Short-latency Somatosensory Evoked Potentials in Patients with Brain Stem Tumor: Study of N₂₀ and N₁₈ Potentials

Masafumi FUKUDA, Shigeki KAMEYAMA, Yoshiho HONDA, Hidetoshi YAMAZAKI, ...

1997 Volume 37 Issue 7 Pages 525-532
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.525

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Short-latency somatosensory evoked potentials (SSEPs) elicited by median nerve stimulation were studied in 17 patients with brain stem tumor. A total of 35 SSEP records were obtained and classified into five groups: 13 in Group I, central conduction time (CCT) < 7.56 msec (within the normal limits); eight in Group II, CCT ≥ 7.56 msec; nine in Group III, N₂₀ potential was abolished; four in Group IV, N20 and N18 potentials were abolished; and one in Group V, N₂₀, N₁₈, and P₁₄ potentials were abolished. These SSEP groups were correlated with the size and location of the brain stem tumor on magnetic resonance images. N20 potentials were unchanged in latency in patients with small localized gadolinium (Gd)-enhanced lesions. In contrast, the N20 potentials were abolished in patients with tumors extending to the dorsal pons and the upper medulla oblongata. The extent of nonenhanced low-intensity lesion did not correlate with the changes of the N₂₀ potentials. The degree of the impairment of the N₂₀ potentials reflected the severity of the clinical symptoms. The N₂₀ potential can evaluate brain stem dysfunction caused by brain stem tumor. The N₁₈ potentials were abolished in four patients, in whom the tumor extension (one Gd-enhanced lesion, three low-intensity lesions) involved not only the pons but also the medulla oblongata. Therefore, the N₁₈ potentials are probably generated from the medulla oblongata.

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Acute Subdural Hematoma Without Subarachnoid Hemorrhage Due to Ruptured Intracranial Aneurysm —Case Report—

Akira ISHIBASHI, Yoshitake YOKOKURA, Manabu SAKAMOTO

1997 Volume 37 Issue 7 Pages 533-537
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.533

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A 54-year-old female presented with acute subdural hematoma secondary to rupture of an intracranial aneurysm. She was admitted with acute onset of severe headache, nausea, and vomiting. There was no past history of head trauma. Computed tomography demonstrated a left subdural hematoma with extension along the tentorium in the absence of subarachnoid or intraparenchymal hemorrhage. Angiography revealed an aneurysm of the internal carotid-posterior communicating artery which was oriented posterolaterally. Uneventful clipping was performed and the patient was discharged from hospital without neurological deficits. The possibility of aneurysmal subdural hematoma should be considered in the absence of trauma.

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Cerebellar Infarction with Hydrocephalus Caused by Spontaneous Extracranial Vertebral Artery Dissection —Case Report—

Masachika SAGOH, Yuichi HIROSE, Hideki MURAKAMI, Masateru KATAYAMA, Ka ...

1997 Volume 37 Issue 7 Pages 538-541
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.538

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A 38-year-old male suffered sudden onset of rotational vertigo without headache. Consciousness disturbance developed on the 3rd day after the onset. Computed tomography showed cerebellar infarction with obstructive hydrocephalus. External ventricular drainage was performed. Angiography showed bilateral extracranial vertebral artery dissection. Antiplatelet therapy was given. Repeat angiography showed improvement of the dissection. His neurological deficits completely resolved. Vertebral artery dissections may cause both lateral medullary or cerebellar infarction and hydrocephalus due to the cerebellar infarction manifesting as various symptoms, so careful evaluation and treatment are required.

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Childhood Ischemic Stroke Caused by Fibromuscular Dysplasia of the Intracranial Artery —Case Report—

Adnan Abd Rahman ZURIN, Kiyohiro HOUKIN, Tsuyoshi ASANO, Tatsuya ISHIK ...

1997 Volume 37 Issue 7 Pages 542-545
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.542

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An 8-year-old girl presented with fibromuscular dysplasia of the intracranial vessels manifesting as ischemic stroke. Neuroimaging showed infarction of the right putamen and ipsilateral frontal white matter. Angiography revealed “string of beads” sign involving the terminal portion of the right internal carotid artery and the horizontal segment of the ipsilateral middle cerebral artery. She was treated conservatively. Magnetic resonance angiography at 2 months post ictus showed similar findings in the middle cerebral artery but improvement of the stenosis of the internal carotid artery. Her neurological deficits had almost resolved. Fibromuscular dysplasia should be part of the differential diagnosis of ischemia in children.

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Carcinomatous Change in the Cranial Metastasis from a Metastasizing Mixed Tumor of the Salivary Gland —Case Report—

Miki FUJIMURA, Takayuki SUGAWARA, Hirobumi SEKI, Yasunari OTAWARA, Tsu ...

1997 Volume 37 Issue 7 Pages 546-550
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.546

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A 57-year-old female who had had a mixed tumor of the submandibular gland for 30 years presented with a cranial metastasis in the ipsilateral occipital region. Detailed histological examinations of the primary tumor failed to detect any carcinomatous component. In contrast, the metastasis contained a carcinomatous component. This histological discrepancy was confirmed by assessment of the expression of Ki-67 antigen in these tumor specimens and comparison with five typical benign mixed tumors. Cranial metastasis of a histologically benign mixed tumor is extremely rare, and a carcinomatous change in the metastatic tumor is apparently unique.

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Intracerebral Schwannoma —Case Report—

Yasushi HAGA, Hiroko SHOJI, Keiji OGURO, Shigeo MORI, Toshiro KAWAI, S ...

1997 Volume 37 Issue 7 Pages 551-555
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.551

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A 15-year-old girl presented with a rare intracerebral schwannoma manifesting as epileptic seizure. Computed tomography, magnetic resonance imaging, and cerebral angiography showed a right parietooccipital lobe tumor. The preoperative diagnosis was malignant glioma, but immunohistochemical and ultrastructural examinations showed the tumor was indistinguishable from peripheral schwannoma. Only 29 cases of schwannomas not related to the cranial nerve have been reported, mostly in children and young adults. The origin appears to be ectopic or perivascular elements in the brain. Such intracerebral schwannomas can be classified according to origins into intra-axial, periventricular, dural attachment, and other types.

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Pure Amnesia Caused by Bilateral Temporal Lobe Astrocytoma —Case Report—

Atsushi UMEMURA, Kazuo YAMADA, Atsuo MASAGO, Motoki TANIGAWA, Shutaro ...

1997 Volume 37 Issue 7 Pages 556-559
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.556

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A 32-year-old male presented with progressive pure amnesia caused by astrocytoma invading the bilateral medial temporal lobes. Methionine positron emission tomography demonstrated the extent of tumor invasion well. His memory impairment was partially improved by treatment for the astrocytoma. Lesion of the bilateral hippocampus causes memory impairment, but pure memory loss without other associated neurological sign or deterioration of consciousness is rare in a case of cerebral neoplasm.

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Adult Respiratory Distress Syndrome in Patients with Malignant Astrocytoma —Three Case Reports—

Toshihiro KUMABE, Teiji TOMINAGA, Takashi YOSHIMOTO, Takamasa KAYAMA

1997 Volume 37 Issue 7 Pages 560-565
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.560

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Three patients treated for intracranial malignant astrocytomas developed adult respiratory distress syndrome (ARDS). All three patients had a Karnofsky performance status score of at least 80% and similar clinical characteristics. All demonstrated hypersensitivity to phenytoin. ARDS occurred in two patients during radiotherapy and in one with radiation-induced brain damage following initial radiochemotherapy. ARDS occurred shortly after tapering the long-term administration of betamethasone. The initial symptoms were dry cough, fever, and generalized toxic eruption. Serum lactic acid dehydrogenase (LDH) concentrations were increased up to 2500 IU/l. Several days later, the patients suddenly complained of dyspnea. All patients fulfilled the diagnostic criteria for ARDS. Two patients recovered, but a young woman died. Clinical symptoms such as fever of unknown origin, dry cough, and skin eruptions, accompanied by abnormally increased serum LDH concentrations during or following the tapering of long-term administration of corticosteroids, are warning signs of ARDS in patients being treated for malignant gliomas.

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