Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 40, Issue 1
Displaying 1-11 of 11 articles from this issue
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Review Article
  • Magnetic Resonance Imaging in Temporal Lobe Epilepsy: Usefulness for the Etiological Diagnosis of Temporal Lobe Epilepsy
    Armin MOHAMED, Hans O. LÜDERS
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 1 Pages 1-15
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.1
    JOURNAL OPEN ACCESS
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    With improvement in magnetic resonance (MR) imaging techniques, the ability to identify lesions responsible for temporal lobe epilepsy has increased. MR imaging has also enabled the in vivo diagnosis of hippocampal sclerosis. Brain tumors are responsible for 2-4% of epilepsies in adult population and 10-20% of medically intractable epilepsy. The sensitivity of MR imaging in the diagnosis of tumors and other lesions of the temporal lobe (vascular malformations, etc.) is around 90%. Both hippocampal sclerosis and other temporal lobe lesions are amenable to surgical therapy with excellent postsurgical seizure outcome. In this article, we characterize and underline distinguishing features of the different pathological entities. We also suggest an approach to reviewing the MR images of an epileptic patient.
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Original Articles
  • Changes in Local Cerebral Blood Flow, Glucose Utilization, and Mitochondrial Function Following Traumatic Brain Injury in Rats
    Xiao Bin JIANG, Kikuo OHNO, Liang QIAN, Ben TOMINAGA, Toshihiko KUROIW ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 1 Pages 16-29
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.16
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    The pathophysiology of secondary brain damage following experimental traumatic brain injury was investigated by measuring local cerebral blood flow (lCBF), local cerebral glucose utilization (lCGU), and activity of succinate dehydrogenase (SDH), which is a mitochondrial enzyme of the tricarboxylic acid cycle, in the rat brain after moderate lateral fluid percussion injury. Measurements used autoradiography for lCBF and lCGU with [14C]iodoantipyrine and [14C]2-deoxyglucose, respectively. Regional SDH activity was determined using quantitative imaging of formazan produced from 2, 3, 5-triphenyl tetrazolium chloride by SDH. lCBF decreased at 1 hour after injury and was significantly lower than the preinjury level in almost all regions of both hemispheres at 6 and 24 hours, and remained low at 2 weeks. lCGU increased 1 hour after injury but was significantly decreased at 6 and 24 hours, and at 2 weeks in most regions of both hemispheres. The ipsilateral hemisphere showed a significant decrease in the activity of SDH in the cortices, hippocampus, thalamus, and caudate/putamen, most conspicuously 72 hours after injury, whereas no significant decrease was observed in the contralateral hemisphere at any time. Necrosis in the injured cortex and reduction of the number of neurons in the ipsilateral hippocampus were observed 2 weeks after injury. The present study showed that a decrease in lCBF and mitochondrial dysfunction occur with glucose hypermetabolism around 1 hour after lateral fluid percussion injury, and that lCBF, lCGU, and mitochondrial function all deteriorate after 6 hours. This suggests that lCBF and cellular metabolism may change dynamically during the several hours following traumatic brain injury, and afterwards neuronal damage may result in an irreversible change in the areas with depressed glucose hypermetabolism in the early period after injury in combination with mitochondrial dysfunction.
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  • Use of Microvascular Doppler Sonography in Aneurysm Surgery on the Anterior Choroidal Artery
    Yuuji SHIBATA, Shigekiyo FUJITA, Tetsuro KAWAGUCHI, Kohkichi HOSODA, H ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 1 Pages 30-37
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.30
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    Anterior choroidal artery (AChA) syndrome is still one of the most serious complications of the clipping of internal carotid artery aneurysms. No monitoring method can detect ischemia in the area of the AChA during surgery. This artery may be obstructed when a clip is applied to the neck of the aneurysm, and patency is sometimes difficult to confirm by microscopy because of the artery’s small size and site of origin (usually behind the internal carotid artery as viewed surgically). However, microvascular Doppler sonography (MVDS) can detect flow instantaneously even in such a small vessel. In our series, AChA syndrome occurred in three of 19 patients treated for AChA aneurysm before the introduction of MVDS, but only one of 19 patients treated with the aid of this device. In that patient, one of the two AChA branches was intentionally sacrificed by applying a clip to the prematurely ruptured aneurysm. MVDS detected hypoperfusion of the AChA after clipping in five other patients, and so the clip was readjusted to preserve AChA flow. Use of MVDS is very effective to prevent inadvertent injury to the AChA during aneurysm surgery on this artery.
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  • Indications for Shunting in Patients with Idiopathic Normal Pressure Hydrocephalus Presenting with Dementia and Brain Atrophy (Atypical Idiopathic Normal Pressure Hydrocephalus)
    Totaro TAKEUCHI, Eishi KASAHARA, Mitsuyoshi IWASAKI, Tatsuo MIMA, Kore ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 1 Pages 38-47
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.38
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    The indications for shunt operation in patients with idiopathic normal pressure hydrocephalus accompanied by brain atrophy (atypical idiopathic normal pressure hydrocephalus: AINPH) were investigated in 25 patients who satisfied the diagnostic criteria and underwent ventriculoperitoneal (VP) shunting. All patients had no apparent history of intra- or extracranial disease; dementia and gait disturbance as the main complaints; moderate to severe cerebral atrophy and ventricular dilatation and at least periventricular low density around the anterior horn on computed tomography; normal cerebrospinal fluid (CSF) pressure and filling of ventricles or cortical surface space with contrast medium at 24 hours on cisternography. The 15 male and 10 female patients were aged 47-83 years (mean 60.4 years). VP shunting was effective in 12 improved patients and not effective in 13 unimproved patients according to NPH grading.
    Pathological pressure wave on epidural pressure monitoring was observed in eight of 12 improved patients, but none of 13 unimproved patients. CSF outflow resistance was 35.33 ± 11.16 mmHg/ml/min in improved patients and 9.12 ± 3.51 mmHg/ml/min in unimproved patients. Preoperative serum alpha-1-antichymotrypsin value (alpha-1-ACT) was 42.02 ± 8.64 mg/dl in improved patients and 61.72 ± 11.03 mg/dl in unimproved patients. Alpha-1-ACT over 55 mg/dl occurred only in unimproved patients. Cerebral arteriovenous difference of oxygen content value (c-AVDO2) before and after surgery was 6.34 ± 0.9 ml% and 5.91 ± 0.78 ml% in improved patients and 4.75 ± 1.85 ml% and 4.81 ± 1.73 ml% in unimproved patients, respectively. The two cases with preoperative c-AVDO2 value over 8.5 ml% were both unimproved. Mean cerebral blood flow value before and after surgery was 23.51 ± 4.20 ml/100 g/min and 45.22 ± 8.11 ml/100 g/min in improved patients and 21.77 ± 5.12 ml/100 g/min and 24.82 ± 4.97 ml/100 g/min in unimproved patients, respectively.
    Cerebral atrophy in improved patients is caused by a cerebral circulation disturbance defined as a cerebral blood flow of penumbra or more due to cerebral arteriosclerosis, etc. A flow-chart of indications of shunt surgery for AINPH was prepared based on the results of the present study.
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  • Far Lateral Approach for Foramen Magnum Lesions
    Sunil K. GUPTA, Bhawani S. SHARMA, Virender K. KHOSLA, Suresh N. MATHU ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 1 Pages 48-54
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.48
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    Twelve patients with lesions in the anterior or anterolateral regions of foramen magnum were treated through the far lateral approach. The patients presented with neck pain, dysesthesia, quadriparesis, numbness, respiratory distress, and spastic contractures. Most lesions were meningiomas and neurofibromas, with one patient each with a posterior inferior cerebellar artery aneurysm, neurenteric cyst, and chordoma. All mass lesions were excised totally and the aneurysm was clipped. Three patients had severe respiratory problems preoperatively and two of them died. The other patients made a satisfactory neurological recovery. It was not found necessary to resect the condyle or mobilize the vertebral artery in any of the patients.
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Case Reports
  • Intraventricular Aneurysms
    —Three Case Reports—
    Hiroji MIYAKE, Tomio OHTA, Yoshinaga KAJIMOTO, Ryusuke OGAWA, Jun DEGU ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 1 Pages 55-60
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.55
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    Three rare cases of purely intraventricular aneurysms are described, including a unique aneurysm in the fourth ventricle. A 30-year-old female, a 47-year-old male, and an 11-year-old girl presented with disturbance of consciousness due to massive intraventricular hemorrhage. Digital subtraction angiography revealed an idiopathic peripheral aneurysm in the fourth ventricle in the first patient, and aneurysms in the lateral ventricle associated with moyamoya disease in the latter two patients. The former two aneurysms were treated surgically and histologically confirmed to be pseudoaneurysms. The latter aneurysm disappeared spontaneously within 2 months after onset. The aneurysm in the lateral ventricle was resected via a parietal corticotomy with stereotactic insertion of an 8-Fr silicone tube to guide the approach route. This method was very useful because computerized neuronavigation was not available. The aneurysm in the fourth ventricle was resected via a midline suboccipital approach with C-1 laminectomy. Conservative treatment is usually recommended initially for patients with intraventricular aneurysm because spontaneous cure often occurs. We recommend direct surgery if the size of the aneurysm remains unchanged, because the risk of surgery has decreased recently owing to new techniques for neuronavigation.
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  • Transvenous Embolization of Carotid-Cavernous Sinus Fistula Associated with a Primitive Trigeminal Artery
    —Case Report—
    Yoshihisa OKA, Kazuhiko SADAMOTO, Masahiko TAGAWA, Yoshiaki KUMON, Sab ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 1 Pages 61-64
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.61
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    A 58-year-old female presented with right conjunctival chemosis and right abducens nerve paresis. Cerebral angiography demonstrated a right carotid-cavernous sinus fistula associated with persistent primitive trigeminal artery. The fistula was treated by introducing detachable coils through the transvenous approach, as the detachable balloon was not available. Follow-up angiography performed 14 days after the embolization revealed complete disappearance of the carotid-cavernous sinus fistula due to thrombosis, which was presumably accelerated by the coils. Transvenous coil embolization should be considered as an alternative treatment for high-flow carotid-cavernous sinus fistula, but only if transarterial balloon embolization is not successful or unavailable.
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  • Crossed Cerebellar Hyperperfusion in Symptomatic Epilepsy
    —Two Case Reports—
    Atsushi UMEMURA, Tomonao SUZUKA
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 1 Pages 65-68
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.65
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    A 74-year-old female with cerebral infarction and a 78-year-old female with cerebral glioblastoma suffered complex partial seizure. Ictal perfusion single photon emission computed tomography in these patients showed the interesting phenomenon of ‘crossed cerebellar hyperperfusion, ’ a reversed crossed cerebellar diaschisis. The mechanism is probably spread of electrical seizure through efferent projections, and may be related to the cerebellar atrophy seen in patients with long-standing partial epilepsy.
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  • Hemangioblastomas with Blood Supply from the Dural Arteries
    —Two Case Reports—
    Shoko M. YAMADA, Yukio IKEDA, Hiroshi TAKAHASHI, Akira TERAMOTO, Shoke ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 1 Pages 69-73
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.69
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    Hemangioblastomas are benign vascular tumors that often occur in the cerebellum, and are located near the pia mater. The blood supply is usually received through the pia mater, and rarely through the external carotid artery. The present cases of hemangioblastoma received blood supply from the external carotid artery (occipital artery) and a branch of the internal carotid artery (carotico-tympanic artery or artery of Bernasconi Cassinari) through the dural branches. The dural arteries were not the main feeders in either case, but preoperative embolization of the occipital artery contributed to minimum bleeding during the operation in one case. Incomplete resection of hemangioblastoma is related to multicentricity of the tumors, small mural nodules, or brain stem involvement. Angiography is valuable for demonstrating arterial supply to small or multiple mural nodules. Conventional angiography is necessary for investigation of the external carotid artery branches.
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  • Epidermoid Tumor Within Meckel’s Cave
    —Case Report—
    Trimurti NADKARNI, Kaustubh DINDORKAR, Dattatraya MUZUMDAR, Atul GOEL
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 1 Pages 74-76
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.74
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    A rare case of an epidermoid tumor lying within Meckel’s cave is reported. A 27-year-old housewife presented with complaints of right facial hypesthesia for two and a half years. On examination she had partial loss of touch sensation in the right trigeminal nerve distribution. Magnetic resonance imaging revealed a tumor located at the right petrous apex and cavernous sinus. The epidermoid tumor was excised through a lateral basal subtemporal approach. The symptoms resolved following surgery.
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Technical Note
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