Neurologia medico-chirurgica

Angiotensin-converting Enzyme Inhibitor Cilazapril Suppresses Expression of Basic Fibroblast Growth Factor Messenger Ribonucleic Acid and Protein in Endothelial and Intimal Smooth Muscle Cells in a Vascular Injury Model of Spontaneous Hypertensive Rats

Akira IWATA, Atsuo MASAGO, Kazuo YAMADA

1998 Volume 38 Issue 5 Pages 257-265
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.257

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The relationship between the expression of basic fibroblast growth factor (bFGF) messenger ribonucleic acid (mRNA) and protein, a potent mitogen for vascular smooth muscle cells in vivo, and administration of the angiotensin-converting enzyme inhibitor cilazapril, which suppresses smooth muscle cells proliferation in denuded arteries, was studied in spontaneously hypertensive rats using the in situ hybridization technique and immunohistochemical study. The effect of cilazapril on neointimal formation through modification of bFGF expression was evaluated using the increased tissue expression of the renin-angiotensin system in spontaneously hypertensive rats. Arterial injury was produced by using balloon catheter denudation in the left carotid artery of rats. The effects were evaluated 2 weeks later. bFGF mRNA and protein were observed only in the endothelial cells of sham-operated rats. bFGF mRNA and protein were observed in both endothelial cells and intimal smooth muscle cells in operated rats receiving only vehicle. Expression of bFGF mRNA and protein was suppressed in both endothelial cells and intimal smooth muscle cells of operated rats receiving cilazapril. These data suggest that cilazapril suppresses smooth muscle cell proliferation through modification of the expression of bFGF mRNA and bFGF protein in addition to other genes.

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Microsurgical Treatment of Intramedullary Spinal Cord Tumors

Nedal HEJAZI, Werner HASSLER

1998 Volume 38 Issue 5 Pages 266-273
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.266

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Eighty patients with intramedullary spinal cord tumors were treated by microsurgical methods between 1988 and 1996. Twenty-nine patients were diagnosed with astrocytoma, 36 with ependymoma, five with metastasis, four with lipoma, three with dermoid or epidermoid tumor, two with neurofibroma, and one with neuroma. Vascular and infectious lesions (such as abscesses and hemangioblastomas) were excluded. After laminectomy, total removal of the lesion was achieved in 68 of 80 patients and subtotal removal in 12. Postoperative radiation therapy was performed in 13 of 80 patients. The follow-up period ranged from 12 to 92 months (mean 42.2 months). All patients underwent preoperative and postoperative magnetic resonance imaging at intervals ranging from 3 months to 5 years postoperatively. Four patients showed clinical and radiological evidence of local tumor recurrence during the follow-up period. Four patients died 5 months to 15 months postoperatively from the re-expansion of their primary metastatic disease. The operative results at long term (after the 6th postoperative month) were better than the results at short term (before the 6th postoperative month) and revealed clinical improvement in 63, no change in 10, and deterioration in seven patients. We recommend early radical surgery, whenever possible, to be performed when the patient''s neurological status is still good. Subtotal removal and irradiation are better for malignant or metastatic tumors. Partial decompressive removal is best for large intramedullary lipomas. Plastic laminotomy with preservation of the intervertebral joints is especially recommended in young or middle-aged patients.

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Extensive Edema in the Thalamus Caused by Thrombosed Basilar Artery Aneurysm —Case Report—

Yoshiya NAKAYAMA, Akira TANAKA, Shinya OHSHIRO, Shinya YOSHINAGA

1998 Volume 38 Issue 5 Pages 274-277
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.274

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A 69-year-old female presented with sudden onset of truncal ataxia, urinary incontinence, mental confusion, and Parinaud''s sign. With conservative treatment, her ataxia and urinary incontinence resolved. Magnetic resonance (MR) imaging disclosed a round mass with laminated intramural hemorrhage in the third ventricle. Right vertebral angiography demonstrated a giant aneurysm in the distal basilar artery. Xenon-enhanced computed tomography showed that cerebral blood flow (CBF) was reduced in the thalamus bilaterally and was paradoxically decreased by acetazolamide. Two months later, MR imaging showed that the intramural hemorrhage had shrunk, and the edema in the thalamus was resolving. The CBF reduction and vascular response to acetazolamide had reversed to some extent. A partially thrombosed giant aneurysm can grow acutely as the result of fresh intramural hemorrhage. The edema is secondary to ischemia and loss of vasoresponsivity.

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Central Neurocytoma Presenting with Intratumoral Hemorrhage 15 Years after Initial Treatment by Partial Removal and Irradiation —Case Report—

Jun NAMIKI, Masashi NAKATSUKASA, Ikuro MURASE, Kazuto YAMAZAKI

1998 Volume 38 Issue 5 Pages 278-282
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.278

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A 50-year-old male presented with a central neurocytoma with intratumoral homorrhage. He had undergone partial removal of the tumor and postoperative radiation therapy 15 years previously. He was followed as an outpatient after the initial treatment, and there was no evidence of regrowth of the residual tumor. Removal of the hematoma and biopsy of the tumor were performed. Abnormally developed blood, capillaries in the tumor may have undergone disturbances of circulation caused by irradiation which resulted in bleeding. Patients with partially resected central neurocytomas which have low proliferative potential may not require radiation therapy, due to the benign nature and the risk of delayed complications of irradiation including intratumoral hemorrhage.

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Pilocytic Astrocytoma of the Velum Interpositum —Case Report—

Makoto IDEGUCHI, Takafumi NISHIZAKI, Katsumi HARADA, Taisyoku KWAK, To ...

1998 Volume 38 Issue 5 Pages 283-286
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.283

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A 72-year-old male presented with a pilocytic astrocytoma in the velum interpositum manifesting as a 5-day history of dizziness attacks and unstable gait. Computed tomography and T₁-weighted magnetic resonance imaging with gadolinium enhancement demonstrated a small, homogeneously enhanced mass in the velum interpositum. The tumor was removed subtotally, and the structure of the splenium was intact. The histological diagnosis was pilocytic astrocytoma. The MIB-1 growth fraction was 5%. The tumor may have originated from the splenium or the thalamus. The aggressive histology indicates the need for close neuroimaging follow-up.

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Glioblastoma Following Radiotherapy in a Patient with Tuberous Sclerosis —Case Report—

Hirotaka MATSUMURA, Hiroshi TAKIMOTO, Nobumitsu SHIMADA, Masayuki HIRA ...

1998 Volume 38 Issue 5 Pages 287-291
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.287

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A 26-year-old male with tuberous sclerosis developed a glioblastoma in the right temporal lobe 8 years after surgical excision and irradiation of a subependymal giant cell astrocytoma. The glioblastoma was probably an irradiation-induced tumor. Irradiation should not be given routinely for subependymal giant cell astrocytoma.

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Plasma Cell Granuloma Extending from the Extracranial to the Intracranial Space Associated with Epstein-Barr Virus Infection —Case Report—

Atsushi FUKUNAGA, Kazunari YOSHIDA, Mitsuhiro OTANI, Yoshihiro OGAWA, ...

1998 Volume 38 Issue 5 Pages 292-296
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.292

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A 70-year-old male presented with a plasma cell granuloma extending from the extracranial to the intracranial space. Findings of preoperative magnetic resonance imaging and intraoperative observation indicated that the lesion extended from the temporal muscle to the subarachnoid space, penetrating the frontal bone. The subarachnoid lesion was composed of neutrophils indicating the presence of acute or subacute inflammation. The final diagnosis of the resected tumor was plasma cell granuloma. High levels of antibodies against Epstein-Barr (EB) virus in the cerebrospinal fluid and the immunohistochemical demonstration of EB nuclear antigens in the plasma cell granuloma suggested that EB virus infection was associated with the development of plasma cell granuloma in this patient.

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Pineal Dermoid Cyst Developing 18 Years after Gross Total Removal of a Pineal Mature Teratoma —Case Report—

Tatsuo MORIMURA, Hiroaki KUBO, Juji TAKEUCHI, Ba JII

1998 Volume 38 Issue 5 Pages 297-300
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.297

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A 21-year-old male presented with a pineal dermoid cyst manifesting as headache and diplopia. He had undergone gross total removal of a pineal mature teratoma 18 years before and had done well until recently. Diffusion-weighted magnetic resonance imaging showed a region of high signal intensity due to a round mass in the pineal region and extending into the trigone of the right lateral ventricle. Subtotal excision of the tumor was achieved. Histological examination showed an epidermoid cyst consisting of keratinized stratified squamous epithelium and connective tissue. Intraoperative observation had detected black hairs, so the diagnosis was dermoid cyst. The dermoid cyst may have arisen from a microscopic remnant of the cyst wall of the original pineal mature teratoma. The regrowth of a dermoid cyst 18 years after gross total removal of a mature cystic teratoma in the pineal region is exceptional. However, careful follow-up of patients who undergo gross total removal of a pineal teratoma is recommended for a period more than that of the patient''s age at surgery plus 9 months.

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[title in Japanese]

[in Japanese]

1998 Volume 38 Issue 5 Pages 305-308
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.305

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