Neurologia medico-chirurgica

Coronary Artery Stenosis Evaluated by Combined Carotid and Coronary Angiography in Patients Undergoing Carotid Endarterectomy

Masaaki UNO, Shin UEDA, Kiyohito SHINNO, Kyoko NISHI, Kazutoshi NISHIT ...

1999 Volume 39 Issue 8 Pages 567-574
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.567

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The relationship between coronary artery stenosis and the postoperative outcome was investigated in patients who underwent carotid endarterectomy (CEA). The benefit of combined carotid and coronary angiography was also evaluated. Combined carotid and coronary angiography was performed in 72 patients treated with CEA (mean age 64.0 years). Fourteen patients with a history of ischemic heart disease (IHD) had a higher Gensini score for coronary artery stenosis than patients with no history of IHD (37.9 ± 36.8 vs. 7.9 ± 12.5, p < 0.0001). However, 39.7% of patients with no history of IHD had a Gensini score exceeding 6. Patients with diabetes mellitus had a significantly higher Gensini score than nondiabetic patients. Eleven patients (15.3%) underwent percutaneous transluminal coronary angioplasty and three (4.2%) underwent coronary artery bypass grafting during the CEA perioperative period. None of the patients who underwent combined angiography showed signs of IHD during or after CEA (mean follow-up period 30 months). Combined angiography was not performed in 189 previous patients. Of these, two died of acute myocardial infarction in the postoperative period, 11 manifested nonfatal IHD, and 18 succumbed to IHD (mean follow-up period 8 years). Although patients with a history of IHD manifested more severe coronary artery stenosis than patients without such a history, the possibility of coronary artery stenosis must be considered in patients with no history of IHD, especially those with diabetes mellitus. Combined carotid and coronary angiography and careful management of coronary artery stenosis can be expected to decrease the mortality and morbidity in patients treated with CEA.

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Temporal and Spatial Profile of Apoptotic Cells after Focal Cerebral Ischemia in Rats

Akira YAMADA, Mitsuo ISONO, Shigeaki HORI, Tsuyoshi SHIMOMURA, Toshihi ...

1999 Volume 39 Issue 8 Pages 575-584
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.575

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The significance of apoptosis in focal ischemia was investigated in the spatial and temporal profiles of apoptotic cells caused by permanent and transient focal ischemia induced in male Wistar rats by intraluminal vascular occlusion. Animals were sacrificed at various times and coronal sections of the brain at the level of the optic chiasm were examined histologically by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling. Animals in both groups showed apoptotic cells in the infarcted area, particularly in the border zone. Animals with permanent ischemia showed more extensive infarct and more rapid appearance of apoptotic cells. Activation of apoptosis might depend on the severity of the ischemic insult. Apoptotic cells were observed at 7 days after the ischemic insult in animals with transient ischemia, suggesting apoptosis is involved in the developments of delayed infarct.

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Relationship Between Aneurysmal Subarachnoid Hemorrhage and Climatic Conditions in the Subtropical Region, Amami-Oshima, in Japan

Tatsuki OYOSHI, Masaki NAKAYAMA, Jun-ichi KURATSU

1999 Volume 39 Issue 8 Pages 585-591
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.585

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Epidemiological studies of the relationship between climate and the onset of aneurysmal subarachnoid hemorrhage (SAH) have been reported in the temperate and subarctic latitudes. However, the relationship between the incidence of aneurysmal SAH and the climatic variations in the subtropical region remains uncertain. Epidemiological analysis requires study of an extremely isolated area. This study analyzed the relationship between the onset of aneurysmal SAH and climatic conditions in the isolated subtropical island of Amami-Oshima in Japan. During an 11-year period from 1986 to 1996, 210 patients with a primary diagnosis of aneurysmal SAH were identified by computed tomography and angiography. The mean annual age-adjusted incidence of aneurysmal SAH was 15.5 per 100, 000 population (10.4 for males and 20.6 for females). No significant seasonal variations in the incidence of aneurysmal SAH and admission clustering were observed in males (p > 0.05) or females (p > 0.05). Furthermore, temperature, atmospheric pressure, and relative humidity were not significantly correlated with the monthly incidence of aneurysmal SAH. However, the occurrence of aneurysmal SAH tended to be higher in both females and the elderly during the winter and spring seasons and not during other seasons. This study indicates that seasonal and climatic conditions do not strongly contribute to the incidence of aneurysmal SAH in subtropical regions. However, elderly people are affected more by climatic conditions than young people.

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Long-term Magnetic Resonance Imaging Follow-up of Asymptomatic Sellar Tumors —Their Natural History and Surgical Indications—

Takuji IGARASHI, Naokatsu SAEKI, Akira YAMAURA

1999 Volume 39 Issue 8 Pages 592-599
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.592

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Serial magnetic resonance (MR) images and clinical symptoms were analyzed in 23 patients with sellar lesions, who were followed up without initial therapy for mass reduction to evaluate their natural history and surgical indication for these lesions. The patients were aged 17 to 78 years (mean 47.3 years) and the follow-up period was 1.5 to 11.6 years (mean 5.1 years). Lesions were divided into two types based on the MR imaging findings, regardless of their histological types. Type C was cystic with or without enhancement of the smooth and thin wall. Type S had enhanced solid components. Ten patients had Type C tumors. Three patients presented with sudden onset of headache. The tumor size spontaneously decreased with intensity change, indicating pituitary apoplexy as the trigger of the onset and intensity change. Four patients presented with the visual disturbance which improved with the reduction of tumor size, but three patients deteriorated and required surgery. The operation revealed Rathke''s cleft cyst. The remaining three patients were found incidentally and have been asymptomatic without MR imaging changes. Thirteen patients had Type S tumors. Six patients of nine with 14 mm or larger tumors developed symptomatic tumor enlargement over the follow-up period of 1.2 to 8.6 years (mean 4.9 years) and required treatment. The remainder showed no change. Type C tumors frequently shrink or even disappear spontaneously. We can justify conservative follow-up of Type C tumors in patients with no or only transient symptoms. Type S tumors, larger than 14 mm in size, need closer observation or treatment because they often enlarge and become symptomatic.

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External Carotid Endarterectomy with Patch Angioplasty Using Internal Jugular Vein —Two Case Reports—

Kiyoyuki YANAKA, Shozo NOGUCHI, Hiroko MARUNO, Kotoo MEGURO, Tadao NOS ...

1999 Volume 39 Issue 8 Pages 600-605
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.600

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A 59-year-old male and a 74-year-old male presented with occlusion of the right internal carotid artery and stenosis at the origin of the ipsilateral external carotid artery manifesting as cerebral ischemia. External carotid endarterectomy with patch angioplasty using the internal jugular vein was performed. Special care was taken to obliterate the stump of the carotid artery using a Weck clip in one case and plication with non-absorbable sutures in the other. Cerebral blood flow in the affected hemisphere was increased after surgery and the patients remained asymptomatic. External carotid endarterectomy has several special aspects such as patch angioplasty and elimination of the stump which must be understood.

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Cystic Lesion at the Foramen Magnum Disseminated from a Pituitary Adenoma —Case Report—

Katsuyoshi SHIMIZU, Yoshiaki TAKAMIYA, Shigeru FURUHATA, Heiji NARITAK ...

1999 Volume 39 Issue 8 Pages 606-611
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.606

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A 38-year-old male presented with a cystic lesion at the foramen magnum due to intracranial dissemination from a pituitary adenoma. The primary tumor had required reoperation for regrowth twice. The tumor at the foramen magnum was removed surgically. Two smaller solid tumors were located in the left parietal convexity and the right temporal lobe. The former tumor was also removed surgically and the latter was observed. Histological examination showed the typical characteristics of pituitary adenoma in both surgical specimens. Immunohistochemical staining with MIB-1 and p53 antibodies showed low (< 1%) and negative reaction. Patients with pituitary adenoma, even benign tumors, must be carefully followed up for signs of metastasis.

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Pineoblastoma Showing Unusual Ventricular Extension in a Young Adult —Case Report—

Atsushi FUJITA, Masahiro ASADA, Minoru SAITOH, Hidemi NAKAMURA, Shuji ...

1999 Volume 39 Issue 8 Pages 612-616
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.612

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A 19-year-old male presented with a 4-week history of headache. Neurological examination showed bilateral papilledema. Computed tomography revealed a pineal region mass with remarkable obstructive hydrocephalus. Magnetic resonance imaging showed a pineal region tumor continuously invading through the tectum into the cerebral aqueduct and the fourth ventricle with the preservation of the adjacent structures. The tumor appeared an iso to hypointense mass on T₁-weighted images, a heterogeneous iso to hyperintense mass on T₂-weighted images, and a heterogeneously enhanced mass after administration of contrast medium. Histological examination after endoscopic biopsy confirmed that the tumor was a pineoblastoma. Radiotherapy was given to the whole brain and the spinal cord, and magnetic resonance imaging showed complete remission of the tumor. Pineoblastomas are highly malignant tumors with seeding potential through the neighboring ventricle or along the meninges, and this type of tumor becomes larger with local extension. We found no previous reports of the continuous extension into the fourth ventricle. The present case showed ventricular extension with minimal mass effect to adjacent structures, and did not disturb ventricular configuration. According to the unusual finding of ventricular extension, this rare case of pineoblastoma requires adjuvant chemotherapy.

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Cavernous Angioma of the Optic Chiasm —Case Report—

Yoshiyasu IWAI, Kazuhiro YAMANAKA, Hideki NAKAJIMA, Taku MIYAURA

1999 Volume 39 Issue 8 Pages 617-620
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.617

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A 31-year-old female presented with cavernous angioma originating from the optic chiasm manifesting as sudden onset of right retroorbital pain and right visual disturbance. She had had a psychomotor seizure 10 years ago. Cavernous angioma at the right basal ganglia had been partially removed at that time. After the operation, the patient had left hemiparesis, but gradually improved. Neurological examination revealed decreased right visual acuity, left homonymous hemianopsia, and left hemiparesis. Magnetic resonance imaging revealed a mixed signal intensity mass at the right optic nerve to the optic chiasm with a low signal intensity rim on T₂-weighted imaging, situated at the right basal ganglia where the cavernous angioma had been partially resected. Right frontotemporal craniotomy was performed by the pterional approach. A subpial hematoma was situated at the right optic nerve to the optic chiasm. The hematoma with an angiomatous component was completely resected from the surrounding structure. Histological examination of the specimens confirmed cavernous angioma. Postoperatively, her right visual acuity was slightly improved, but the visual field defect was unchanged. We emphasize the importance of correct diagnosis by magnetic resonance imaging and subsequent resection for preserving and improving the visual function of patients with cavernous angiomas of the optic chiasm.

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Neuroimaging Findings of the Development and Resolution of Solitary Brainstem Abscess: Characteristics of Neuroimagings in the Early Stage of Brainstem Abscess and Importance of Surgical Management for Brainstem Abscess —Case Report—

Reiko KAGAWA, Yoshikazu OKADA, Takeshi SHIMA, Masahiro NISHIDA, Kanji ...

1999 Volume 39 Issue 8 Pages 621-624
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.621

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A 64-year-old female presented with a solitary brainstem abscess. Magnetic resonance imaging and computed tomography demonstrated the development and resolution of the brainstem abscess with an unusual and fluctuating clinical course over several months. Serial neuroimaging examinations are required to detect a brainstem abscess in the early stage to establish the optimum treatment.

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Attachment Device for Side-biting Cannula in Stereotactic Biopsy —Technical Note—

Toru KOYAMA, Sumio KOBAYASHI, Chiharu OBINATA, Takehiro YAKO, Shigeaki ...

1999 Volume 39 Issue 8 Pages 625-628
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.625

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An attachment device to fix a Sedan side-biting biopsy cannula to a stereotactic frame is described. The disadvantages of the biopsy cup forceps are resolved, and a relatively large amount of multiple specimens can be obtained along a single biopsy trajectory. This attachment device enables the side-biting cannula to follow a straight trajectory biopsy in various stereotactic frames.

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