Neurologia medico-chirurgica

Co-localization of Human Growth Hormone and Human Prolactin in Hormonally Pure Human Growth Hormone-producing Pituitary Adenomas

Masamichi KUROSAKI, Takashi WATANABE, Tomokatsu HORI, Kazumitsu HIRAI, ...

1998 Volume 38 Issue 6 Pages 335-341
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.335

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Co-localization of human growth hormone (hGH) and human prolactin (hPRL) in hGH-producing pituitary adenomas was examined by electron microscopy with immunoblot analysis. At the electron microscopic level using anti-hGH or anti-hPRL polyclonal antibody, hGH and hPRL were found to be co-localized within each of the secretory granules in one of five cases. Double-labeling electron immunocytochemistry using colloidal gold particles of different sizes was effective in demonstrating this co-localization. As an additional step, we performed immunoblot analysis of hGH-producing pituitary adenomas using monoclonal antibodies. Four hGH-producing adenomatous tissue samples contained several hPRL-immunoreactive bands. In Case 2, the main 23K hPRL band was stained especially strongly. The immunoblotting analysis of purified hGH using both anti-hPRL polyclonal antibody and monoclonal antibody to assess cross-reaction of the polyclonal anti-hPRL antisera with hGH revealed that both monoclonal and polyclonal antibodies were suitable for determining the co-localization. Double-labeling techniques using anti-hGH and anti-hPRL monoclonal antibodies demonstrated that only a few secretory granules were positive for co-localization of both hGH and hPRL (Case 2). The present study, which used not only polyclonal but also monoclonal antibodies, suggests that some hGH-producing pituitary adenomas contained both hPRL and hGH in the same secretory granules of tumor cells.

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Clinical Usefulness of ¹¹C-MET PET and ²⁰¹Tl SPECT for Differentiation of Recurrent Glioma from Radiation Necrosis

Yukihiko SONODA, Toshihiro KUMABE, Toshiei TAKAHASHI, Reizo SHIRANE, T ...

1998 Volume 38 Issue 6 Pages 342-348
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.342

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The clinical usefulness of L-methyl-¹¹C-methionine positron emission tomography (¹¹C-MET PET) and thallium-201 single photon emission computed tomography (²⁰¹Tl SPECT) for distinguishing glioma recurrence from radiation-induced changes was evaluated. Ten patients with lesions highly suggestive of recurrent glioma on magnetic resonance imaging underwent ¹¹C-MET PET and ²⁰¹Tl SPECT studies. Two patients were examined twice, so a total of 12 studies were performed. The clinical diagnoses were five recurrent gliomas and seven radiation necrosis. The five recurrent gliomas appeared as increased uptakes on both ¹¹C-MET PET and ²⁰¹Tl SPECT scans. Four of the seven radiation necrosis lesions also appeared as increased uptakes on the ²⁰¹Tl SPECT scans. In contrast, only one radiation necrosis appeared as increased uptake on the ¹¹C-MET PET scans. There was no significant difference in ²⁰¹Tl SPECT indices between radiation necrosis and tumor recurrence, but the ratio of the differential absorption ratio of tumor tissue to that of the homologous contralateral gray matter in PET of recurrent glioma was significantly higher than that of radiation necrosis. ¹¹C-MET PET is superior to ²⁰¹Tl SPECT for the differentiation of tumor recurrence from radiation necrosis and delineation of the extent of the tumor.

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Familial Occurrence of Moyamoya Disease in the Mother and Four Daughters Including Identical Twins —Case Report—

Yoichi KANEKO, Naoyuki IMAMOTO, Hiromichi MANNOJI, Masashi FUKUI

1998 Volume 38 Issue 6 Pages 349-354
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.349

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Familial occurrence of moyamoya disease is described in the mother and four daughters, including identical twins. Physical examination findings on admission were all normal and no mental retardation was observed. The third daughter had suffered from a ventricular septal defect when aged 6 years, but the others all had unremarkable past histories. Four of the five patients presented with transient ischemic attack as the initial symptoms, but one patient remains asymptomatic. Two patients had had repeated transient ischemic attacks. Cerebral angiography revealed either stenosis or occlusion of the intracranial portion of the bilateral internal carotid arteries associated with moyamoya vessels in all patients. The findings of moyamoya disease in a parent and four siblings including identical twins suggest that genetic factors are important in the pathogenesis of moyamoya disease.

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Spinal Cord Hemangioblastoma Presenting with Subarachnoid Hemorrhage —Case Report—

Keiko IRIE, Hideyuki KUYAMA, Seigo NAGAO

1998 Volume 38 Issue 6 Pages 355-358
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.355

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A 41-year-old male presented with subarachnoid hemorrhage (SAH) caused by a cervical spinal cord hemangioblastoma. There were no features to distinguish the SAH from that due to an intracranial lesion. The diagnosis was established by cerebral angiography, computed tomography, and magnetic resonance imaging. The tumor was located in the right dorsolateral aspect of the cervical spinal cord. Hemilaminectomy was performed, and the tumor was completely removed. No postoperative neurological deficit was observed. The possibility of a spinal origin for SAH should be considered if no cranial origin can be detected.

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Malignant Fibrous Histiocytoma in the Parietal Bone —Case Report—

Daizo YOSHIDA, Katsuyuki HARASHIMA, Yoji NODE, Toyoyuki KOJIMA, Toshir ...

1998 Volume 38 Issue 6 Pages 359-362
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.359

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Malignant fibrous histiocytomas (MFHs) are mesenchymal tumors, usually arising in soft tissue of the extremities and are remarkably resistant to radiation and chemotherapy. A 45-year-old female presented with a rare case of MFH originating in the cranial bone manifesting as a lump in the left parietal region with no neurological abnormality. Neuroimaging revealed the presence of an osteolytic tumor in the left parietal bone invading into muscle and subdural region, penetrating through the dura. Selective external carotid angiography disclosed a marked tumor stain. Examination of the whole body excluded neoplastic disease elsewhere. The patient was treated by surgical excision, radiation, and two courses of multi-drug chemotherapy using cyclophosphamide, doxorubicin, vincristine, and prednisolone. Since there is no established treatment against this malignancy, a longer follow-up is necessary to determine whether cure has been achieved.

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Abducens Nerve Palsy Caused by Basilar Impression Associated with Atlanto-occipital Assimilation —Case Report—

Yuichi HIROSE, Masachika SAGOH, Keita MAYANAGI, Hideki MURAKAMI

1998 Volume 38 Issue 6 Pages 363-366
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.363

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A 47-year-old male presented with abducens nerve palsy due to basilar impression associated with atlanto-occipital assimilation manifesting as slowly progressive bilateral trigeminal neuralgia and diplopia in the right lateral gaze. X-ray and computed tomography of the skull confirmed the diagnosis of basilar impression and atlanto-occipital assimilation, and magnetic resonance imaging disclosed tightness of the posterior cranial fossa. Surgical suboccipital decompression resulted in gradual resolution of the patient''s complaints, and no additional symptoms were recognized. Impairment of the sixth cranial nerve is a rare symptom compared to those of the fifth or the eighth cranial nerve in a patient with a craniocervical malformation. However, the present case shows the possibility of cranial nerve dysfunction due to tightness of the posterior cranial fossa, and suggests that surgical treatment for basilar impression with atlanto-occipital assimilation should be considered in patients with uncommon and unusual symptoms.

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Trigeminal Neuralgia Caused by the Vertebral Artery Associated with Primitive Trigeminal Artery and Agenesis of the Internal Carotid Artery —Case Report—

Masafumi FUKUDA, Shigeki KAMEYAMA, Hideaki TAKAHASHI, Ryuichi TANAKA

1998 Volume 38 Issue 6 Pages 367-370
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.367

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A 69-year-old female presented with trigeminal neuralgia caused by tortuous vertebrobasilar artery associated with primitive trigeminal artery (PTA) and agenesis of the ipsilateral internal carotid artery (ICA). Left vertebral angiography showed marked elongation of the left vertebral artery and filling of the left ICA via the PTA. Bone window computed tomography suggested agenesis of the left ICA. Intraoperative findings showed that the vertebrobasilar junction had compressed the root entry zone of the trigeminal nerve. The neuralgia improved immediately after microvascular decompression. There has been no recurrence for 20 months. Trigeminal neuralgia may be caused by a tortuous vertebrobasilar system due to hemodynamic stress associated with PTA and agenesis of the ICA.

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Pseudo-cerebrospinal Fluid Rhinorrhea After Skull Base Surgery —Case Report—

Hideo HAMADA, Shunro ENDO, Takuya AKAI, Masayoshi OHI, Masanori KURIMO ...

1998 Volume 38 Issue 6 Pages 371-373
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.371

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A 41-year-old female underwent complete resection of a left petroclival meningioma via an anterior transpetrosal approach, during which the greater superficial petrosal nerve was divided. On the 14th day after the operation, she first noticed leakage of clear fluid from her right nostril whenever the ambient room temperature rose. This pseudo-cerebrospinal fluid rhinorrhea may have developed because of parasympathetic hypersensitivity due to division of the greater superficial petrosal nerve.

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Nontraumatic Convexity Intradiploic Arachnoid Cyst —Case Report—

Takashi ASAHI, Shunro ENDO, Takuya AKAI, Michiyasu TAKABA, Akira TAKAK ...

1998 Volume 38 Issue 6 Pages 374-376
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.374

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A 63-year-old male presented with an unusual case of nontraumatic intradiploic arachnoid cyst in the frontotemporal convexity area. Skull radiography showed a circular osteolytic lesion of the right parietal bone. Computed tomography revealed a defect of the inner table, widened diploic space, and thinned outer table. Magnetic resonance imaging showed a cyst containing cerebrospinal fluid. Bone scintigraphy showed no abnormal uptakes. Intraoperative observation confirmed the neuroimaging findings. Histological examination found no abnormal findings in specimens of skull bone or arachnoid membrane. Intradiploic arachnoid cyst is characterized by parasagittal, multiple, welldemarcated osteolytic lesions on radiographs in the elderly. However, the clinical features of this disease remain unclear and diagnosis without an exploratory surgical procedure may not be possible.

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Idiopathic Hypertrophic Cranial Pachymeningitis of the Cavernous Sinus Mimicking Lymphocytic Hypophysitis —Case Report—

Hiroshi NISHIOKA, Hiroshi ITO, Jo HARAOKA, Megumi TAKAHASHI, Fujio SHI ...

1998 Volume 38 Issue 6 Pages 377-382
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.377

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A 56-year-old female presented with idiopathic hypertrophic cranial pachymeningitis manifesting as headache, hypopituitarism, and diabetes insipidus, mimicking lymphocytic hypophysitis. Five months later, she complained of double vision and unusual right facial sensation. The diagnosis was based on magnetic resonance imaging, angiography, and meningeal biopsy via transsphenoidal surgery, and exclusion of other known causes of pachymeningitis. Despite initial response to steroid treatment, her symptoms recurred repeatedly and she became steroid-dependent. Repetition of short-term steroid pulse therapy restrained the deterioration of her condition. The clinical presentation of idiopathic hypertrophic cranial pachymeningitis is variable, and it may develop with signs of adjacent tissue involvement. Resultant secondary hypophysitis must be differentiated from lymphocytic hypophysitis. Initial steroid therapy is effective in improving symptoms, but should be carefully considered since the natural course of this disease seems to be self-limited.

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