Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 40, Issue 10
Displaying 1-10 of 10 articles from this issue
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Original Articles
  • Radiation-induced Diffuse Brain Injury in the Neonatal Rat Model
    —Radiation-induced Apoptosis of Oligodendrocytes—
    Katsuhiro SANO, Ken MORII, Mitsuya SATO, Hiroshi MORI, Ryuichi TANAKA
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 10 Pages 495-500
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.495
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    The mechanism of radiation-induced diffuse brain injury was investigated using a model of delayed myelination in the irradiated neonatal rat brain in which the number of oligodendrocytes decreases without associated necrosis of the cerebral white matter. Immunohistochemical analysis using antibody against the large myelin-associated glycoprotein, a specific marker of oligodendrocytes at an early stage of development, showed that the number of the oligodendrocytes associated with myelination decreased in the irradiated hemisphere 1 day after irradiation and remained low until 5 days after irradiation. In situ terminal deoxynucleotidyl transferase-mediated nick end-labeling assay revealed that apoptosis mainly occurred in the cerebral white matter of the irradiated hemisphere. Three hours after irradiation, apoptotic cells were found in the subcortical white matter and the periventricular white matter. Six hours after irradiation, apoptotic cells were found in the internal capsule, and the numbers of apoptotic cells in the periventricular white matter and subcortical white matter increased. One day after irradiation, the number of apoptotic cells in the periventricular white matter decreased. Three days after irradiation, apoptotic cells were not observed in the cerebral white matter. These results suggest that the oligodendrocytes associated with myelination may be damaged via radiation-induced apoptosis, and depletion of the oligodendrocytes may cause delay of myelination.
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  • Can Continuous Intraoperative Facial Electromyography Predict Facial Nerve Function Following Cerebellopontine Angle Surgery?
    Theodoros KOMBOS, Olaf SUESS, Bodo-Christian KERN, Thomas FUNK, Tertu ...
    2000 Volume 40 Issue 10 Pages 501-507
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.501
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    Intraoperative cranial nerve monitoring has significantly improved the preservation of facial nerve function following surgery in the cerebellopontine angle (CPA). Facial electromyography (EMG) was performed in 60 patients during CPA surgery. Pairs of needle electrodes were placed subdermally in the orbicularis oris and orbicularis oculi muscles. The duration of facial EMG activity was noted. Facial EMG potentials occurring in response to mechanical or metabolic irritation of the corresponding nerve were made audible by a loudspeaker. Immediate (4-7 days after tumor excision) and late (6 months after surgery) facial nerve function was assessed on a modified House-Brackmann scale. Late facial nerve function was good (House-Brackmann 1-2) in 29 of 60 patients, fair (House-Brackmann 3-4) in 14, and poor (House-Brackmann 5-6) in 17. Postmanipulation facial EMG activity exceeding 5 minutes in 15 patients was associated with poor late function in five, fair function in six, and good function in four cases. Postmanipulation facial EMG activity of 2-5 minutes in 30 patients was associated with good late facial nerve function in 20, fair in eight, and poor in two. The loss of facial EMG activity observed in 10 patients was always followed by poor function. Facial nerve function was preserved postoperatively in all five patients in whom facial EMG activity lasted less than 2 minutes. Facial EMG is a sensitive method for identifying the facial nerve during surgery in the CPA. EMG bursts are a very reliable indicator of intraoperative facial nerve manipulation, but the duration of these bursts do not necessarily correlate with short- or long-term facial nerve function despite the fact that burst duration reflects the severity of mechanical aggression to the facial nerve.
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Case Reports
  • Recovery From Duret Hemorrhage: A Rare Complication After Craniotomy
    —Case Report—
    Yasunori FUJIMOTO, Paulo Henrique AGUIAR, Alexandre Bruno Raul FREITAS ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 10 Pages 508-510
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.508
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    A 44-year-old female presented with Duret hemorrhage due to transtentorial herniation by extradural hematoma as a complication after craniotomy for treatment of spontaneous middle cranial fossa cerebrospinal fluid leakage through the oval window. Brain computed tomography revealed linear hemorrhage in the midbrain and the rostral pons. She awoke after 2 weeks in a coma, despite showing ocular bobbing and bilateral intranuclear ophthalmoplegia. She was discharged from the hospital with minimal neurological defects. Duret hemorrhage is usually fatal, but this case shows that early surgical decompression is the most important factor to avoid the worst sequelae.
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  • Ruptured Aneurysm at the Origin of the Median Artery of the Corpus Callosum Associated With Accessory Middle Cerebral Artery
    —Case Report—
    Kiyoyuki YANAKA, Shizuo SHIRAI, Yasushi SHIBATA, Tadao NOSE
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 10 Pages 511-514
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.511
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    A 62-year-old male presented with ruptured anterior communicating artery (ACoA) aneurysm manifesting as severe headache associated with the rare combination of median artery of the corpus callosum (MACC) and accessory middle cerebral artery (MCA). Computed tomography demonstrated diffuse subarachnoid hemorrhage. Left carotid angiography demonstrated an anomalous vessel originating from the ACoA complex and passing forward in the interhemispheric fissure between the two companion A2 segments. This vessel was identified as the MACC. Another anomalous vessel originated from the left A1-A2 segment and passed into the sylvian fissure. This vessel was identified as the accessory MCA. Left frontotemporal craniotomy was performed to clip the neck of the aneurysm. After identifying both A1 and A2 segments, accessory MCA, and the MACC, the aneurysm neck was occluded successfully. The ACoA complex is one of the most frequent sites of vascular anomalies. Preoperative and intraoperative care is required to identify the presence of anomalies of the ACoA complex prior to clip placement, to avoid accidental damage or clipping, which may result in severe neurological deficits.
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  • Endovascular Treatment of Basilar Tip Aneurysm Associated With Moyamoya Disease
    —Case Report—
    Keiko IRIE, Masahiko KAWANISHI, Seigo NAGAO
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 10 Pages 515-518
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.515
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    A 58-year-old female was admitted unconscious to a local hospital. Computed tomography demonstrated subarachnoid hemorrhage. Cerebral angiography revealed evidence of moyamoya disease and a saccular aneurysm at the tip of the basilar artery. The patient was transferred to our hospital for embolization of the basilar tip aneurysm. Endovascular embolization was performed using Guglielmi detachable coils (GDCs), and the aneurysm was completely occluded with preservation of the parent artery. No change in the patient’s neurological status was seen during and after the procedure. Endovascular treatment using GDCs appears to be particularly suitable for ruptured cerebral saccular aneurysms in patients with moyamoya disease.
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  • Correlation of Magnetic Resonance Imaging and Histological Findings in a Large Basilar Tip Aneurysm After Coil Embolization
    —Case Report—
    Jun-ichirou ASAI, Ryuta SUZUKI, Tsukasa FUJIMOTO, Takayasu MIYO, Goro ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 10 Pages 519-523
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.519
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    A 73-year-old female with a large basilar tip aneurysm underwent endovascular coil embolization with interlocking detachable coils (IDCs). The patient subsequently died of pneumonia 25 days after the embolization, and the aneurysm specimen was obtained at autopsy. Histological examination showed that the intraaneurysmal structure consisted of three layers. The outer layer was mildly organized thrombus surrounding the coils, the middle layer was disorganized clot, and the inner layer consisted of fresh blood clot. Gradient-echo magnetic resonance (MR) imaging taken before death had demonstrated a central region of high intensity and a peripheral low intensity region corresponding to the inner and middle-outer layers of the aneurysm, respectively. Intraaneurysmal placement of IDCs leads to the formation of a clot surrounding the coils. However, clot formation may be inadequate where the packing of the IDCs is incomplete. Comparison of the MR imaging and histological findings in this case show that gradient-echo MR imaging can assess thrombus and residual blood flow within the aneurysm.
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  • Restoration of Hearing with an Auditory Brainstem Implant in a Patient with Neurofibromatosis Type 2
    —Case Report—
    Yojiro SEKI, Hiromichi UMEZU, Masaaki USUI, Kozo KUMAKAWA, Fumiai KUMA ...
    2000 Volume 40 Issue 10 Pages 524-527
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.524
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    A 25-year-old male with neurofibromatosis type 2 had hearing restored with an auditory brainstem implant (ABI) after removal of an acoustic schwannoma. The ABI allows the patient to discern many different environment sounds and is a significant adjunct to lip-reading, enabling conversation with people who have clear pronunciation without the necessity for writing.
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  • Huge Facial Schwannoma Extending Into the Middle Cranial Fossa and Cerebellopontine Angle Without Facial Nerve Palsy
    —Case Report—
    Shigeru FURUTA, Takao HATAKEYAMA, Kiichiro ZENKE, Shigeyuki NAGATO
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 10 Pages 528-531
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.528
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    A 46-year-old male presented with a huge facial schwannoma extending into both the middle cranial fossa and the cerebellopontine angle but without manifesting facial nerve palsy. Neurological examination on admission revealed no deficits except for speech disturbance. Computed tomography showed a multicystic tumor extending into the middle cranial fossa and the cerebellopontine angle, with destruction of the petrous bone. The tumor was totally grossly removed. Histological examination identified schwannoma. Total facial nerve palsy appeared postoperatively, but hearing acuity was preserved at a useful level. Facial nerve palsy is one of the most typical symptoms in patients with facial schwannoma, but is not always manifested even if the tumor extends into both the middle cranial fossa and the cerebellopontine angle.
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  • Langerhans Cell Histiocytosis Limited to the Pituitary-Hypothalamic Axis
    —Two Case Reports—
    Ayako ISOO, Keisuke UEKI, Tsuyoshi ISHIDA, Tetsushi YOSHIKAWA, Takamit ...
    2000 Volume 40 Issue 10 Pages 532-535
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.532
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    Langerhans cell histiocytosis rarely presents as a solitary lesion in the pituitary-hypothalamic region, and is indistinguishable from germinoma, which occurs much more frequently, especially in Japanese. A 14-year-old girl and a 9-year-old girl presented with polydipsia and polyuria as the initial symptoms. Magnetic resonance (MR) imaging demonstrated a round mass at the pituitary stalk appearing as isointense on T1-weighted imaging and hyperintense on T2-weighted imaging. Endocrinological examination revealed mild hypopituitarism with central diabetes insipidus. Both patients underwent open craniotomy. Histological examination revealed granulomatous tissue with eosinophil infiltration and frequent Langerhans histiocyte clustering, compatible with the diagnosis of Langerhans cell histiocytosis. Low-dose local irradiation of 20 Gy was administered. First patient was followed up for 8 years, and her hypopituitarism gradually improved to a minimal level with only amenorrhea as the residual symptom. Recent MR imaging showed no residual mass at the region. Second patient was followed up for 15 months, and her diabetes insipidus is stable. MR imaging performed 5 months after the treatment showed marked reduction of the mass. These cases reemphasize the importance of histological diagnosis for lesions with similar neuroimaging appearances. Biopsy and low-dose irradiation are an effective treatment for this rare and essentially benign lesion, as opposed to attempting total removal of the mass.
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  • Interhemispheric Glioependymal Cyst Associated With Agenesis of the Corpus Callosum
    —Case Report—
    Yuichi TANGE, Aya AOKI, Kentaro MORI, Shinichi NIIJIMA, Minoru MAEDA
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 10 Pages 536-542
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.536
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    A male neonate was admitted because prenatal ultrasonography indicated central nervous system abnormalities. Neurological examination showed no abnormality except for electroencephalographic spike activities. Magnetic resonance imaging revealed a cystic lesion in the left interhemispheric fissure, agenesis of the corpus callosum, and microgyria in the left frontotemporal lobes. Cerebral blood flow (CBF) was diffusely reduced. The cyst wall was partially removed and a cyst-peritoneal shunt procedure was performed. The histological diagnosis was glioependymal cyst. The spike activity disappeared and CBF dramatically improved after the operation.
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