Neurologia medico-chirurgica

Ultrastructure of Obstructive Tissue in Malfunctioning Ventricular Catheters Without Infection

Yoshihiko TAKAHASHI, Akira OHKURA, Masaru HIROHATA, Takashi TOKUTOMI, ...

1998 Volume 38 Issue 7 Pages 399-404
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.399

JOURNAL FREE ACCESS

Show abstractHide abstract

The obstructive tissue in eight malfunctioning ventricular catheters without infection was studied using scanning and transmission electron microscopy. Shunt obstruction was due to debris from ventricular structures such as the choroid plexus and ependymal tissue. There was a preponderance of collagen fibers, and many fibroblasts were present within these tissues. The cytoplasm of the fibroblasts contained extended endoplasmic reticulum. The tissues filled the lumen of the catheters in radially arranged layers. Peeling of the silicone was seen on the surface of the ventricular catheters but was not present in normal silicone catheters. Finger-like microvilli were observed on the free surface of the tissue. Many vessels were seen in thtie transverse section of the tissue. Activated fibroblasts and vascularization may be important in tissue growth in ventricular catheters.

View full abstract

Download PDF (713K)
Multiple Scalp Aneurysms Caused by Atypical Temporal Arteritis —Case Report—

Tetsuyuki YOSHIMOTO, Hiroyuki KOBAYASHI, Hiroshi MURAI, Kouhei ECHIZEN ...

1998 Volume 38 Issue 7 Pages 405-408
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.405

JOURNAL FREE ACCESS

Show abstractHide abstract

A 55-year-old male suffered sudden onset of dysarthria and mild left hemiparesis due to a right intracerebral small hemorrhage. On admission, six subcutaneous elastic hard lumps were found on the scalp with painless and regular pulsation. The lumps were located along the course of the bilateral superficial temporal arteries (5 locations) and the occipital artery. The patient did not have symptoms of headache or blurred vision associated with temporal arteritis. The largest lump was removed for cosmetic reasons and definitive diagnosis. Histological examination demonstrated many infiltrating inflammatory cells along the entire vascular wall but without giant cells or fibrinoid necrosis. These multiple scalp aneurysms were probably caused by atypical temporal arteritis.

View full abstract

Download PDF (440K)
Fenestration of the Proximal Anterior Cerebral Artery (A₁) with Aneurysm Manifesting as Subarachnoid Hemorrhage —Case Report—

Rajneesh KACHHARA, Suresh NAIR, Arun Kumar GUPTA

1998 Volume 38 Issue 7 Pages 409-412
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.409

JOURNAL FREE ACCESS

Show abstractHide abstract

A 50-year-old female presented with a rare fenestration of the proximal anterior cerebral artery (A₁ segment). This rare congenital anomaly was associated with an aneurysm at the proximal end of A₁ fenestration causing subarachnoid hemorrhage, and aplasia of the contralateral A₁ segment. Surgical treatment to clip the aneurysm resolved her symptoms. Hemodynamic stress at the arterial fenestration probably caused the aneurysm, possibly induced by aplasia of the contralateral A₁ segment.

View full abstract

Download PDF (318K)
Temporal Lobe Epilepsy Associated with Cerebral Venous Angioma —Case Report—

Masami FUJII, Tetsuhiro KITAHARA, Junta MOROI, Shoichi KATO, Haruhide ...

1998 Volume 38 Issue 7 Pages 413-416
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.413

JOURNAL FREE ACCESS

Show abstractHide abstract

A 21-year-old male presented with temporal lobe epilepsy associated with a venous angioma in the ipsilateral frontal lobe, presenting as intractable complex partial seizures. Neuroimaging showed a cerebral venous angioma in the right dorsolateral and opercular frontal lobe, and atrophy of the right hippocampus. As the ictal electroencephalogram (EEG) obtained with subdural electrodes indicated spike discharges initiating from the right mesial temporal lobe, temporal lobectomy was performed. The patient was seizure-free after the operation. Patients with epilepsy who have a cerebral venous angioma require precise analysis of the seizure pattern and an ictal EEG because a cerebral venous angioma may be associated with an another epileptogenic lesion which is surgically treatable.

View full abstract

Download PDF (353K)
Embolic Stroke in the Territory of a Cerebellar Arteriovenous Malformation —Case Report—

Masaki KOMIYAMA, Hideki NAKAJIMA, Misao NISHIKAWA, Toshihiro YASUI

1998 Volume 38 Issue 7 Pages 417-419
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.417

JOURNAL FREE ACCESS

Show abstractHide abstract

A 63-year-old male presented with an embolic stroke in the right medial inferior cerebellum. Angiography at 2 and 8 months after the stroke revealed arteriovenous shunts from the vermian branch of the right posterior inferior cerebellar artery to the right inferior vermian vein. The shunts mimicked the arteriovenous shunts of post-recanalization in acute ischemic stroke, but were finally diagnosed as a pre-existing congenital arteriovenous malformation based on their persistence. Arteriovenous shunts that persist more than 2 weeks after ictus should be differentiated from the post-recanalization arteriovenous shunts of ischemic stroke, as the different etiology may affect the ultimate prognosis and course of treatment.

View full abstract

Download PDF (307K)
Hyperperfusion Syndrome after Extra cranial-Intracranial Bypass in a Patient with Moyamoya Disease —Case Report—

Masaaki UNO, Norio NAKAJIMA, Kyoko NISHI, Kiyohito SHINNO, Shinji NAGA ...

1998 Volume 38 Issue 7 Pages 420-424
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.420

JOURNAL FREE ACCESS

Show abstractHide abstract

A 47-year-old female developed hyperperfusion syndrome after superficial temporal artery-middle cerebral artery (STA-MCA) bypass for moyamoya disease. She presented with right hemiparesis and motor aphasia due to left cerebral infarction. She underwent left STA-MCA bypass. One day after surgery, she manifested neurological deterioration. Magnetic resonance (MR) imaging 4 days after the operation indicated regional brain edema in the territory supplied by the bypass, and single photon emission computed tomography 17 days after the operation demonstrated hyperperfusion in that area. Symptoms improved within 1 week after surgery, and MR imaging showed disappearance of edema and return to the preoperative appearance. Such events are rare, but hyperperfusion syndrome may occur after STA-MCA bypass for moyamoya disease.

View full abstract

Download PDF (554K)
Ossification of Transverse Ligament of the Atlas Associated with Atlanto-axial Dislocation —Case Report—

Takuro HAYASHI, Yuichi HIROSE, Masachika SAGOH, Hideki MURAKAMI

1998 Volume 38 Issue 7 Pages 425-428
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.425

JOURNAL FREE ACCESS

Show abstractHide abstract

A 68-year-old male presented with progressive spastic quadriparesis. Twelve years previously he had undergone anterior decompression with bone grafting for cervical ossification of the posterior longitudinal ligament associated with spinal trauma. Radiological examination showed ossification of the transverse ligament of the atlas (TLA) and severe stenosis of the upper cervical canal. Anterior dislocation of the atlas was also present, but the occiput/atlas/axis unit was perfectly stable due to the prior anterior fusion. Suboccipital decompression and laminectomy of the atlas were performed, and his symptoms improved. Based on the atlanto-axial dislocation, the TLA might have been damaged at the time of the primary trauma and became the trigger for the ossification of the TLA, showing that marked ossification of a vertebral ligament can occur after injury.

View full abstract

Download PDF (368K)
Acute Cauda Equina Syndrome Secondary to Lumbar Disc Herniation Mimicking Pure Conus Medullaris Syndrome —Case Report—

Hironori FUJISAWA, Seishi IGARASHI, Tsunemaro KOYAMA

1998 Volume 38 Issue 7 Pages 429-431
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.429

JOURNAL FREE ACCESS

Show abstractHide abstract

A 49-year-old male presented with a rare case of acute cauda equina syndrome secondary to a sequestrated lumbar disc mimicking pure conus medullaris syndrome. He consulted the emergency room of Otsu Municipal Hospital because of saddle anesthesia and complete urinary retention which had started 2 days before admission. Additionally, he complained of constipation and impotence. Abnormality of the deep tendon reflexes, sciatica, and leg weakness were not recognized. Emergent myelography and subsequent computed tomography revealed a sequestrated disc in the sacrum compressing the lower cauda equina, but not the conus medullaris. Emergent surgical decompression was performed about 60 hours after the onset. The patient almost fully recovered from sphincter dysfunction, impotence, and saddle anesthesia 3 months after the operation. When a syndrome like conus medullaris compression is encountered, the lower cauda equina should be examined as well as the conus level. Such cases require urgent diagnosis and treatment.

View full abstract

Download PDF (258K)
Subarachnoid Hemorrhage Caused by Aspergillus Aneurysm as a Complication of Transcranial Biopsy of an Orbital Apex Lesion —Case Report—

Yoshikazu OKADA, Takeshi SHIMA, Masahiro NISHIDA, Kanji YAMANE, Akira ...

1998 Volume 38 Issue 7 Pages 432-437
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.432

JOURNAL FREE ACCESS

Show abstractHide abstract

A 62-year-old male complaining of unilateral visual disturbance and pain in the involved eye had a small mass at the right orbital apex which was identified as an Aspergillus granuloma by transcranial biopsy. One month later, the patient became comatose because of fatal subarachnoid hemorrhage due to a newly developed aneurysm. Autopsy showed a ruptured aneurysm on the right internal carotidposterior communicating artery. Histological examination demonstrated prominent Aspergillus invasion of the arterial wall. Aspergillus infection must be taken into consideration in patients with orbital apex syndrome, which may lead to serious cerebrovascular consequences. If sino-orbital lesions are detected by neuroimaging techniques, biopsy using an extradural approach should be performed to obtain a definitive diagnosis.

View full abstract

Download PDF (630K)
Treatment of the Survivors from the Nagoya Air Crash

Hirofumi OYAMA, Yoshihisa KIDA, Hiroyuki SUENAGA, Masatada KUMAGAI

1998 Volume 38 Issue 7 Pages 438-443
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.438

JOURNAL FREE ACCESS

Show abstractHide abstract

Six patients were taken to our hospital alive just after the air crash at Nagoya Airport in 1994. On admission, all patients suffered from profound shock which rapidly progressed. Serum albumin and hemoglobin levels, and platelet count decreased on admission or soon after. The four patients who died could not recover from the shock and associated rapid deterioration of neurological signs. However, two patients were successfully treated with massive transfusion of packed red blood cells, fresh frozen plasma, fresh blood, and/or platelet concentrate and survived to discharge. We recommend addition of albumin to the transfusate in such cases.

View full abstract

Download PDF (722K)

Register with J-STAGE for free!