Neurologia medico-chirurgica

Original Articles

Neuropsychological Changes After Surgery for Anterior Communicating Artery Aneurysm

Hiroyuki JIMBO, Kazuo HANAKAWA, Hiroshi OZAWA, Kenji DOHI, Yoshiharu S ...

2000 Volume 40 Issue 2 Pages 83-87
Published: 2000
Released on J-STAGE: September 02, 2005

DOIhttps://doi.org/10.2176/nmc.40.83

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Neuropsychological disturbances following surgery for anterior communicating artery aneurysms were analyzed in 26 patients (11 males, 15 females) using the Hasegawa dementia scale-revised (HDS-R) over a 3-year period. The patients were aged from 34 to 76 years (mean 54.1 years). Lesions in the frontal lobe were evaluated using computed tomography (CT). Twenty-three patients had symptoms over the course. Four patients had basal forebrain lesion, five had ventral frontal lesion, and 12 had no lesion. Patients with basal forebrain lesion and no lesion tended to show disorientation. The mean HDS-R score was 10.2 points in the patients with ventral frontal lesion, and 13.5 points in the patients with no lesion. These scores are within the range for dementia. The mean HDS-R score in patients with basal forebrain and striate lesions was over 25 points and beyond the range for dementia. Significant differences were observed in the HDS-R score between patients with ventral frontal lesion and basal forebrain lesion, and between patients with no lesion and basal forebrain lesion (p < 0.05). Recovery from neuropsychological disturbances was poorer in patients with ventral frontal lesion and no lesion compared to those with basal forebrain and striate lesions, and their symptoms tended to persist.

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Long-term Follow-up Study of Patients with Cavernous Sinus Aneurysm Treated by Proximal Occlusion

Masaki NIIRO, Tetsuro SHIMOZURU, Katsumi NAKAMURA, Koki KADOTA, Jun-ic ...

2000 Volume 40 Issue 2 Pages 88-97
Published: 2000
Released on J-STAGE: September 02, 2005

DOIhttps://doi.org/10.2176/nmc.40.88

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Proximal occlusion of the internal carotid artery (ICA) is still the treatment of choice for a large cavernous sinus aneurysm. Endovascular occlusion or trapping of the ICA with or without an extracranial-intracranial bypass is sometimes performed. We analyzed the results of the long-term follow up of 11 patients with a giant or large cavernous sinus aneurysm treated by only proximal occlusion between 1975 and 1989. Proximal occlusion of the carotid artery was performed by Selverstone clamping. The follow-up period ranged from 6 to 21 years (mean 13.9 years). Eight of the 11 patients showed improvement of cranial nerves paresis or headache, and four became asymptomatic. None of the original aneurysms ruptured. The final outcomes were nine good recovery, one moderately disabled, and one severely disabled by the Glasgow Outcome Scale. The causes of morbidity were early ischemia and subarachnoid hemorrhage from a newly formed aneurysm. Late complications included ischemia in two patients, and new formation and enlargement of aneurysms at a site other than the original aneurysm in two patients, 13 and 17 years later. Therapeutic carotid artery occlusion requires strict test ICA occlusion. In addition, long-term follow up by periodical cerebral angiography using magnetic resonance, computed tomography, or digital subtraction angiography is necessary, and postoperative medical treatment is important to reduce the risk of late complications.

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Treatment of Bacterial Brain Abscess by Repeated Aspiration

—Follow up by Serial Computed Tomography—

Masaaki YAMAMOTO, Takeo FUKUSHIMA, Katsuyuki HIRAKAWA, Hideo KIMURA, M ...

2000 Volume 40 Issue 2 Pages 98-105
Published: 2000
Released on J-STAGE: September 02, 2005

DOIhttps://doi.org/10.2176/nmc.40.98

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Bacterial brain abscess often requires repeated aspiration before the abscess finally resolves. However, there are no guidelines for treatment by aspiration; for example, when should the abscess be tapped again, or when can an abscess be treated by antibiotics alone without further aspiration. Eleven patients with bacterial brain abscess treated by aspiration were evaluated to establish treatment guidelines for brain abscess, in particular the abscess size on serial computed tomography (CT) after aspiration. CT was performed about 24 hours after aspiration to evaluate the size of the abscess, and almost weekly during follow up. The diameter of the brain abscess before and after the initial and last aspirations were reviewed. In eight of the 11 patients, abscesses were aspirated repeatedly: two to three times in most patients. The diameter of the abscesses was 2.5-4.5 cm (mean 3.5 cm) before the last aspiration, and 1.4-3.4 cm (mean 2.3 cm) after the last aspiration, or when continuous drainage was discontinued. Perifocal edema was moderately decreased within 3 weeks after the last aspiration by medical treatment alone, with a concomitant decrease in the volume of the abscess. There were no deaths, and most patients had a favorable outcome. These results suggest that after the diameter of the abscess becomes less than 2 to 3 cm and does not increase anymore on serial CT, medical treatment alone can be anticipated to give satisfactory results without further aspiration.

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Case Reports

Chronic, Traumatic Intraconal Hematic Cyst of the Orbit Removed Through the Fronto-orbital Approach

—Case Report—

Akira IWATA, Takashi MATSUMOTO, Mitsuhito MASE, Kazuo YAMADA

2000 Volume 40 Issue 2 Pages 106-109
Published: 2000
Released on J-STAGE: September 02, 2005

DOIhttps://doi.org/10.2176/nmc.40.106

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A 22-year-old male presented with a chronic encapsulated intraorbital hematoma 3 months after blunt trauma to his left eyeball. Ophthalmological examination found the best corrected visual acuity was 4/20 in the left eye, and 20/20 in the right eye. The orbit exhibited exophthalmus and inability of the eye to move above the horizontal level. Orbital magnetic resonance imaging showed a fairly well-demarcated area in the medial aspect of the orbit appearing as hyperintense on T₁-weighted images and isoto hyperintense on T₂-weighted images. This area was believed to be hemorrhage. No other abnormalities were found. The diagnosis was hematic cyst. The cyst was approached through a left fronto-orbital route and its location identified within the periorbita and orbital fat. The cyst was removed partially. Histological examination demonstrated cystic accumulation of blood and breakdown products in a non-epithelium-lined fibrous capsule, compatible with hematic cyst. The presence of hemosiderin in the cyst wall suggested that the cyst was a chronically enlarging lesion. Hematic cysts of the orbit usually present as subperiosteal mass months to years after trauma. Surgical removal of the cyst wall rather than needle aspiration is recommended to prevent recurrence.

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Magnetic Resonance Imaging of Calvarial Eosinophilic Granuloma with Pericranial Soft Tissue Reaction

—Case Report—

Atsushi KEYAKI, Sachio NABESHIMA, Takeshi SATO, Masanori MORIMOTO, Kor ...

Article type: Others
Subject area: Others
2000 Volume 40 Issue 2 Pages 110-111
Published: 2000
Released on J-STAGE: September 02, 2005

DOIhttps://doi.org/10.2176/nmc.40.110

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A 4-year-old girl presented with an eosinophilic granuloma in the cranial vault. Magnetic resonance (MR) imaging showed the mass as slightly low intensity on T₁- and high intensity on T₂-weighted images. The pericranial soft tissue was densely enhanced after gadolinium-diethylenetriaminepentaacetic acid infusion. The mass was soft and successfully removed. Histological examination disclosed Langerhans’ cell histiocytosis. MR imaging is useful for the diagnosis of calvarial eosinophilic granuloma with soft tissue involvement.

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Complications Associated with Intraarterial Administration of Papaverine for Vasospasm Following Subarachnoid Hemorrhage

—Two Case Reports—

Hideo TSURUSHIMA, Takao KAMEZAKI, Yasushi NAGATOMO, Akio HYODO, Tadao ...

2000 Volume 40 Issue 2 Pages 112-115
Published: 2000
Released on J-STAGE: September 02, 2005

DOIhttps://doi.org/10.2176/nmc.40.112

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Complications associated with intraarterial papaverine infusion occurred in two patients treated for vasospasm due to subarachnoid hemorrhage (SAH). A 42-year-old male with an anterior communicating artery aneurysm underwent craniotomy and aneurysm clipping. Five days after the SAH occurred, angiography demonstrated moderate vasospasm in spite of hypervolemic-hypertensive therapy. During papaverine infusion into the carotid artery, he suffered loss of consciousness due to a seizure for a few minutes. A 61-year-old female with a right internal carotid-posterior communicating artery aneurysm underwent clipping. Six days after the SAH occurred, angiography demonstrated severe vasospasm in spite of hypervolemic-hypertensive therapy. Angiography performed immediately after papaverine infusion into the carotid artery revealed exacerbation of the vasospasm. Finally she suffered cerebral infarction and died. Complications of intraarterial papaverine infusion are potentially dangerous. We recommend trial administration of papaverine with angiography and neurological examination before full dose infusion to avoid complications.

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Malignant Schwannoma Metastasizing to the Parenchyma of the Brain

—Case Report—

Hidenori OISHI, Kazunori ISHII, Kuniaki BANDOU, Hiroshi ASHIDA, Mitsub ...

Article type: Others
Subject area: Others
2000 Volume 40 Issue 2 Pages 116-119
Published: 2000
Released on J-STAGE: September 02, 2005

DOIhttps://doi.org/10.2176/nmc.40.116

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A 48-year-old male presented with a very rare case of malignant schwannoma metastasizing to the parenchyma of the brain. He had undergone previous radical surgical resection of an abdominal wall tumor that was histologically confirmed as a malignant schwannoma. Five years later, the patient presented with metastases to the parenchyma of the brain and lung. A large mass at the left frontoparietal region was totally resected immediately after intratumoral hemorrhage. He recovered well and the lung metastasis was also removed, but he later developed further multiple metastases in the lung and brain.

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Toxoplasmic Encephalitis in Patients with Acquired Immunodeficiency Syndrome

—Four Case Reports—

Susumu NAKAZAKI, Naokatsu SAEKI, Seiro ITOH, Katsunobu OSATO, Osamu WA ...

Article type: Others
Subject area: Others
2000 Volume 40 Issue 2 Pages 120-123
Published: 2000
Released on J-STAGE: September 02, 2005

DOIhttps://doi.org/10.2176/nmc.40.120

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Four patients, all males aged 40-64 years, presented with toxoplasmic encephalitis associated with human immunodeficiency virus (HIV) infection manifesting as nonspecific neurological deficits such as epilepsy or hemiparesis. Magnetic resonance imaging showed single or multiple lesions with ring enhancement, mimicking metastatic brain tumor or brain abscess. Marked eosinophilia was noted in three patients. Two patients who received anti-toxoplasma chemotherapy in the early stage had a good outcome. However, the other two patients suffered rapid neurological deterioration and needed decompressive surgery, resulting in a poor outcome. Toxoplasma diffusely infects the whole central nervous system from the early stage. The outcome for patients who needed emergency surgery was poor. Therefore, this rare but increasingly common infectious disease must be considered in the differential diagnosis of a patient with neuroimaging findings similar to those of metastatic tumor or brain abscess. Appropriate chemotherapy should be started immediately after HIV-positive reaction is identified in patients with single or multiple mass lesions with ring enhancement.

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Trigeminal Neuralgia Associated with Tentorial Agenesis and Temporal Lobe Herniation

—Case Report—

Toshihide TANAKA, Hiromichi NAKAZAKI, Toshirou HIDA, Masato NAKAJIMA, ...

Article type: Others
Subject area: Others
2000 Volume 40 Issue 2 Pages 124-127
Published: 2000
Released on J-STAGE: September 02, 2005

DOIhttps://doi.org/10.2176/nmc.40.124

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A 22-year-old female presented with an extremely rare case of trigeminal neuralgia associated with tentorial agenesis. The pulsating pain in her left maxillary region persisted for an abnormally long time and had no trigger zone. The pain later spread to the periorbital region. Coronal magnetic resonance imaging revealed left medial temporal lobe herniation caused by tentorial agenesis. The herniated temporal lobe, which had distorted the superior cerebellar artery, was causing compression of the trigeminal nerve. Her condition improved following microvascular decompression surgery. Tentorial agenesis should be considered as a cause of atypical pulsating facial pain, especially in younger patients.

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Technical Note

Revised New Brain Retractor: Characteristics and New Indications

—Technical Note—

Hiroji MIYAKE, Tomio OHTA

Article type: Others
Subject area: Others
2000 Volume 40 Issue 2 Pages 128-130
Published: 2000
Released on J-STAGE: September 02, 2005

DOIhttps://doi.org/10.2176/nmc.40.128

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Revisions were made to our new brain retractor with respect as follows. A knob was added to each shaft of the new brain retractor to facilitate handling. The angle between the shaft and the blade can now be adjusted from 60 to 135 degrees, which is useful in deep, narrow operative fields. Three blade lengths (20, 30, and 40 mm) are now available. The new retractor is entirely made from titanium. This revised brain retractor is very useful for the dissection of sylvian and interhemispheric arachnoid membranes, as well as in the extirpation of intracerebral masses via corticotomy.

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