Neurologia medico-chirurgica

Computed Tomography Characteristics Suggestive of Spontaneous Resolution of Chronic Subdural Hematoma

Toru HORIKOSHI, Hirofumi NAGANUMA, Isao FUKASAWA, Mikito UCHIDA, Hidea ...

1998 Volume 38 Issue 9 Pages 527-533
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.527

JOURNAL FREE ACCESS

Show abstractHide abstract

The clinical and radiological characteristics of self-resolving hematoma were assessed retrospectively in a series of patients with chronic subdural hematomas (SDHs) treated over a recent 6-year period in a local hospital. Spontaneous resolution was observed in five of 27 hematomas occurring in four of 23 patients. Clinical and radiological findings of the four cases were compared to those of the remaining 19 cases. All spontaneously resolving SDHs were asymptomatic or only caused mild transient headache, and disappeared within 4 to 9 months after head injury. All spontaneously resolving SDHs were located in the frontal region, and maximum thickness and midline displacement were less than those in the other 19 patients who were symptomatic and underwent surgery. Computed tomography demonstrated a low density line between the hematoma and the cerebral cortex, indicative of remaining cerebrospinal fluid space in four of five hematomas. Spontaneously resolving SDH is more frequent than formerly expected. Asymptomatic SDHs localized in the frontal region with small mass signs can be expected to disappear spontaneously without deterioration.

View full abstract

Download PDF (647K)
Prospective Analysis of Complications of Catheter Cerebral Angiography in the Digital Subtraction Angiography and Magnetic Resonance Era

Masaki KOMIYAMA, Kazuhiro YAMANAKA, Misao NISHIKAWA, Toru IZUMI

1998 Volume 38 Issue 9 Pages 534-540
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.534

JOURNAL FREE ACCESS

Show abstractHide abstract

Permanent and temporary neurological complications of catheter cerebral angiography were prospectively evaluated in 500 consecutive diagnostic cerebral angiographic procedures, 268 performed on 213 males and 232 on 175 females. Complications were divided into permanent (> 1 week), reversible (≤ 1 week, > 24 hours), and temporary (≤ 24 hours). There were four permanent (0.8%), one reversible (0.2%), and nine temporary neurological complications (1.8%). There was no death. With the correct selection of patients, catheter cerebral angiography is considered to be safe with acceptable rates of complications.

View full abstract

Download PDF (493K)
Clinical and Neuroimaging Features of Chiari Type I Malformations With and Without Associated Syringomyelia

Yoshinori YAMAZAKI, Shigekuni TACHIBANA, Makoto TAKANO, Kiyotaka FUJII

1998 Volume 38 Issue 9 Pages 541-547
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.541

JOURNAL FREE ACCESS

Show abstractHide abstract

The clinical and neuroimaging characteristics of 22 consecutive patients with Chiari type I malformations were evaluated to investigate the pathogenesis of syrinx formation. All patients underwent magnetic resonance imaging and x-ray tomography before surgery. The electric manometric Queckenstedt test was performed on 16 patients pre- and postoperatively. Syringomyelia was present in 17 patients and absent in five patients. All patients without syringomyelia suffered from foramen magnum compression syndrome, with a wider basal angle, more acute clivo-axial angle, shorter clivus, and more prominent tonsillar ectopia than patients with syringomyelia. Low brain stem position, basilar impression, and beaking of the cervicomedullary junction were also more prominent in patients without syringomyelia. Marked to complete block with the neck in flexed position by Queckenstedt test was present in all patients except one. Patients with Chiari malformation not associated with syringomyelia have more pronounced compression of the brain stem at the foramen magnum. Therefore, despite a block of the cerebrospinal fluid pathway at the foramen magnum, syrinx formation may be prevented by severe compression.

View full abstract

Download PDF (558K)
Hemodynamic Evaluation of the Effect of Percutaneous Transluminal Angioplasty for Atherosclerotic Disease of the Vertebrobasilar Arterial System

Hajime TOUHO, Jun KARASAWA

1998 Volume 38 Issue 9 Pages 548-556
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.548

JOURNAL FREE ACCESS

Show abstractHide abstract

The relationship between clinical improvement after percutaneous transluminal angioplasty (PTA) and hemodynamic condition in vertebrobasilar insufficiency was evaluated in 43 patients between 45 and 86 years of age with clinically symptomatic atherosclerotic stenotic lesions in the posterior circulation. The 43 patients had a total of 51 stenotic lesions, including 17 in the first segment of the vertebral artery, 32 in the fourth segment of the vertebral artery, and two in the basilar artery. Angiography was performed and cerebral perfusion was measured with technetium-99m-hexamethylpropyleneamine oxime single photon emission computed tomography before and after administration of 10 mg/kg acetazolamide prior to and more than 7 months after PTA. Mean stenosis was 81.3 ± 7.4% before PTA, but only 41.5 ± 17.4% at follow-up. Eighteen of the 24 patients with improved neurological condition after PTA had subnormal (<mean - 2 SDs) cerebral perfusion before PTA. Twenty of these 24 patients had subnormal vasodilatory response to administration of acetazolamide before PTA. Clinical improvement following PTA was noted in only one of the 12 patients with a single stenotic lesion of the first segment, but in 23 of the 31 patients with intracranial stenotic or multiple stenotic lesions. PTA in the posterior circulation is indicated for patients with atherosclerotic stenotic intracranial lesion or multiple stenotic lesions who have subnormal cerebral perfusion and low vasodilatory response to administration of acetazolamide.

View full abstract

Download PDF (746K)
Hyperperfusion Syndrome Following Carotid Endarterectomy: Evaluation Using Diffusion-weighted Magnetic Resonance Imaging —Case Report—

Kiyohito SHINNO, Shin UEDA, Masaaki UNO, Kazutoshi NISHITANI, Shinji N ...

1998 Volume 38 Issue 9 Pages 557-561
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.557

JOURNAL FREE ACCESS

Show abstractHide abstract

A 65-year-old female developed hyperperfusion syndrome following carotid endarterectomy for severe stenosis of the left internal carotid artery. Transcranial Doppler monitoring showed a sharp increase in flow velocity in the middle cerebral artery (MCA). Diffusion-weighted magnetic resonance (MR) imaging demonstrated diffuse hyperintensity in the region of the left MCA, which diminished markedly 9 days later. The abnormal hyperintensity decreased as the patient''s symptoms improved, suggesting that diffusion-weighted MR imaging can be used for evaluating the course of hyperperfusion syndrome.

View full abstract

Download PDF (629K)
Serial Magnetic Resonance Imaging of Acute Spontaneous Thrombosis of a Giant Intracranial Aneurysm —Case Report—

Kenji KANSAKU, Shinji HIRAI, Eiichi KOBAYASHI, Jun-ichi ONO, Akira YAM ...

1998 Volume 38 Issue 9 Pages 562-565
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.562

JOURNAL FREE ACCESS

Show abstractHide abstract

A 46-year-old female presented with decreased bilateral visual acuity due to an unruptured non-thrombosed giant aneurysm arising from the left internal carotid artery. After admission, acute thrombosis of the aneurysm occurred spontaneously. Her consciousness and visual acuity temporarily worsened. Serial T₂-weighted magnetic resonance (MR) imaging showed the size of the low intensity area near the orifice increased, and the aneurysm ruptured thereafter. Trapping of the aneurysm with a high-flow bypass was performed. Serial MR imaging findings clearly demonstrated the intraluminal structure of the thrombosed giant aneurysm. The aneurysm grew in size after thrombosis. The enlarging signal-void area on T₂-weighted MR images were indicative of aneurysmal rupture. MR imaging is quite helpful to evaluate the changes of intraluminal thrombosis and size in giant aneurysms.

View full abstract

Download PDF (445K)
Moyamoya Disease Associated With Pulmonary Sarcoidosis —Case Report—

Katsunobu TAKENAKA, Masafumi ITO, Morio KUMAGAI, Haruki YAMAKAWA, Yuka ...

1998 Volume 38 Issue 9 Pages 566-568
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.566

JOURNAL FREE ACCESS

Show abstractHide abstract

A 61-year-old female presented with a unique case of moyamoya disease associated with pulmonary sarcoidosis. She was admitted for sudden onset of left temporalgia with episode of numbness on face, tongue, and upper extremity on the right side. The next morning, she had symptoms of Gerstmann syndrome and her ability to speak was disturbed. Her medical history included radical resection of lung cancer on the right side. She had no symptoms of pulmonary sarcoidosis. Neuroimaging showed an infarction in the left occipital lobe. Angiography showed occlusions of the bilateral internal carotid arteries at the supraclinoid portions. Subsequently, a left superficial temporal artery-middle cerebral artery anastomosis with encephalo-myo-synangiosis was performed. Ninety-three days after admission, she suddenly developed dyspnea which resulted in death 3 hours later. Autopsy findings showed typical epithelioid granulomas of sarcoid type in the lymphnodes of the peribronchus, lung, and liver. Thrombotic emboli were found in the bilateral pulmonary arteries, and marked fibrous intimal thickening in the bilateral internal carotid arteries. Immunological reaction with inflammatory events may cause pathological changes in patients with moyamoya disease or sarcoidosis. The co-incidence in this case suggests that some common inflammatory events may be involved in the pathogenesis of these diseases.

View full abstract

Download PDF (317K)
Cerebellar Mutism after Basilar Artery Occlusion —Case Report—

Misao NISHIKAWA, Masaki KOMIYAMA, Hiroaki SAKAMOTO, Toshihiro YASUI, H ...

1998 Volume 38 Issue 9 Pages 569-573
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.569

JOURNAL FREE ACCESS

Show abstractHide abstract

A 30-year-old female became comatose due to embolic occlusion of the basilar artery, caused by surgical injury to the origin of the vertebral artery during removal of a neurinoma in the upper thoracic paravertebral region. The basilar artery occlusion was treated by local fibrinolysis through a microcatheter. Two weeks later she recovered her consciousness but suffered mutism. Her speech disturbance was characterized by severe ataxic dysarthria known as “cerebellar mutism” but without cranial nerve paresis. The mutism gradually improved during the following 3 months. This is case of cerebellar mutism was apparently due to ischemic stroke. Disturbance by hypoperfusion of the cerebellum and brain stem may have been involved in the pathogenesis of cerebellar mutism.

View full abstract

Download PDF (529K)
Extraneural Metastasis of Intracranial Germinoma with Syncytiotrophoblastic Giant Cells —Case Report—

Takuya AKAI, Hideaki IIZUKA, Satoru KADOYA, Takayuki NOJIMA

1998 Volume 38 Issue 9 Pages 574-577
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.574

JOURNAL FREE ACCESS

Show abstractHide abstract

A 14-year-old boy presented with an extraneural metastasis of germinoma with syncytiotrophoblastic giant cells (STGC). The tumor was located in the pineal area, suprasellar cistern, and frontal base, and associated with the slight elevation of the beta-human chorionic gonadotropin (HCG) serum level. Following radiation therapy, the tumor completely disappeared, and the beta-HCG level decreased to normal. Two years after the initial treatment, metastasis of the tumor to the left femur was observed without recurrence of the primary lesion. The biopsy specimen revealed germinoma, the diagnosis was germinoma with STGC because of the associated elevation of HCG level. The metastatic tumor was treated by chemotherapy with cisplatin and etoposide, and the tumor completely disappeared. With adjuvant chemotherapy, he has been recurrence-free for 3 years. Extraneural metastasis occurs more frequently from germinoma with STGC than germinoma. Aggressive chemotherapy combined with radiation therapy in the initial treatment might have to be tried to avoid metastasis from germinoma with STGC.

View full abstract

Download PDF (335K)
Juvenile Symptomatic Rathke''s Cleft Cyst —Case Report—

Tomoko TANAKA, Hidehiro OKA, Nobuyuki KAWANO, Ikuo KOBAYASHI, Hirotada ...

1998 Volume 38 Issue 9 Pages 578-581
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.578

JOURNAL FREE ACCESS

Show abstractHide abstract

A 14-year-old girl presented with a rare symptomatic Rathke''s cleft cyst manifesting as diabetes insipidus and growth retardation. Neuroimaging demonstrated the suprasellar cyst. Computed tomography showed the cyst as an isodense area with enhancement, and magnetic resonance imaging showed an hyperintense area on both T₁- and T₂-weighted images. Histological examination showed the cyst was consistent with Rathke''s cleft cyst. Symptomatic Rathke''s cleft cysts usually occur in middle-aged adults. Juvenile cases tend to present with diabetes insipidus, and the cyst content may include more mucopolysaccharides or hemosiderin degradation products.

View full abstract

Download PDF (296K)

Register with J-STAGE for free!