Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 40, Issue 3
Displaying 1-10 of 10 articles from this issue
Original Articles
  • Youichi YANAGAWA, Toshihisa SAKAMOTO, Daizoh SAITOH, Chikanori TERAI, ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 3 Pages 133-139
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    The clinical differences between patients with skull base and convexity fractures were retrospectively investigated in 324 patients, of whom 110 had suffered head injury resulting in skull fracture. These 110 patients were divided into the skull base and convexity groups. There were no significant differences between the groups with respect to sex, age, Glasgow Coma Scales, injury severity scores, pupil abnormalities, and outcomes. Automobile collisions were the most common causes in the skull base group, and falls in the convexity group. Traumatic Coma Data Bank diffuse 1 type injuries were more frequent in the skull base group and evacuated masses were more frequent in the convexity group. Multiple injuries, shock on admission, lower hemoglobin concentrations, and increased transfusion requirements were evident in the skull base group. Controlling for shock, the outcomes in the skull base group were favorable. Convexity fractures were usually associated with isolated severe head injuries and require brain protection therapy. Skull base fractures were caused by a significant force distributed over a large area of the body with a tendency to induce shock, and require a multidisciplinary approach to treatment.
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  • Masanori HASHIMOTO, Akira YOKOTA, Haruyuki YAMADA, Toshio OKUDERA
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 3 Pages 140-150
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    The development and morphological structure of the lateral sellar compartment (LSC), an interdural space containing the cavernous sinus (CS), cranial nerves, and internal carotid artery (ICA), was investigated by histological examination of sections of the LSC and cerebral venograms from human fetal specimens. Twenty-eight LSC coronal sections were obtained from 14 fetuses of 13-32 weeks’ gestation. Venograms of 11 other fetuses of 13-32 weeks’ gestation were studied to observe changes in venous drainage. The CS appeared as a collection of small venous canals with an endothelial layer. These venous canals gradually became much larger through expansion and unification. The CS and basilar venous plexus were demonstrated as a faint cluster of small vessels on venograms obtained after 13 weeks’ gestation. The dura mater increased in thickness and collagen fiber networks developed around all the components in the LSC after 23 weeks’ gestation. The LSC lateral wall could not be histologically differentiated as separate multiple layers. Branching and joining of the cranial nerve fascicles were completed with the envelopment of collagen fibers after 23 weeks’ gestation. The ICA at 13-15 weeks’ gestation ran straight within the LSC, becoming tortuous before birth. CS formation occurs through the development of venous canals without smooth muscle layers, followed by web-formation by collagen fibers in the mesenchymal interstices. LSC formation, including the dense dura mater and an internal structure like that seen in the adult, is largely completed before birth.
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  • Hideyuki SUWA, Junya HANAKITA, Noboru OHSHITA, Kazuo GOTOH, Norihiro M ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 3 Pages 151-155
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    Damage to the paraspinal muscle after various lumbar back surgery procedures was evaluated by measuring the paraspinal muscle thickness preoperatively and postoperatively in 89 patients, 61 males and 28 females. There were 42 single interlaminar level procedures (SL group), 13 multiple interlaminar level procedures (ML group), and 34 posterolateral fusion procedures (PLF group). Changes in paraspinal muscle thickness were evaluated at more than 10 months after surgery, because muscle swelling continued as long as 10 months after surgery, and then reduced as the edema subsided. Postoperative serum creatine phosphokinase (CPK) level on postoperative day 2 was also measured. The decrease of paraspinal muscle thickness was significantly larger in the PLF group than in the SL group (−12.9% and −2.7%, respectively, p < 0.02). There was no significant correlation between postoperative serum CPK level and decrease of paraspinal muscle thickness. However, the postoperative elevation of serum CPK level was significantly higher in the PLF group than in the SL and ML groups (979 ± 114 vs. 292 ± 45 and 410 ± 44 IU/l, respectively, p < 0.001). In conclusion, posterolateral fusion is the most invasive procedure of the paraspinal muscles in various lumbar back surgery procedures. Paraspinal muscle damage during lumbar back surgery may be one of the most important factors that causes atrophy of the muscles.
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Case Reports
  • —Case Report—
    Kazuhiko KIBAYASHI, Paul M. NG’WALALI, Kisei HAMADA, Kohji HONJY ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 3 Pages 156-159
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    A 20-year-old male presented with traumatic basal subarachnoid hemorrhage after being involved in a fight. Antemortem clinical examinations could not exclude the possibility of rupture of abnormal blood vessels because of the absence of external injuries. Careful postmortem examination of the head and neck regions and histological examination of the intracranial arteries demonstrated traumatic rupture of the left posterior inferior cerebellar artery due to a fist blow to the jaw. This case indicates the need for careful autopsy examination for the differentiation of traumatic and non-traumatic basal subarachnoid hemorrhages.
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  • —Case Report—
    Hiroshi KUDO, Yoshio SAKAGAMI, Atsufumi KAWAMURA, Norihiko TAMAKI
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 3 Pages 160-163
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    A 51-year-old female had undergone transsphenoidal surgery for pituitary adenoma producing growth hormone. Cerebrospinal fluid (CSF) leakage occurred during surgery. The sella turcica and sphenoid sinus were packed with abdominal fat and fibrin glue, buttressing the closure with a fragment of sphenoid bone. No CSF rhinorrhea occurred postoperatively. Severe meningitis developed 7 months later. CSF rhinorrhea occurred 10 days after readmission. Exploration through the transsphenoidal approach identified a small hole at the floor of the sella and CSF leaking into the sphenoid sinus through the hole. The CSF leakage stopped after the second surgery. Delayed CSF rhinorrhea without bromocriptine administration is very rare. The cause of delayed CSF rhinorrhea remains unclear. CSF rhinorrhea should be suspected if meningitis develops even months after transsphenoidal surgery.
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  • —Case Report—
    Takuro HAYASHI, Yuichi HIROSE, Masachika SAGOH, Hideki MURAKAMI
    2000 Volume 40 Issue 3 Pages 164-168
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    A 69-year-old female suffered from sudden onset of severe headache. Computed tomography showed subarachnoid hemorrhage primarily located in the posterior fossa. Initial angiography demonstrated a fenestration of the vertebral artery and an extracranial origin of the posterior inferior cerebellar artery. However, no bleeding points could be clearly detected. The operative findings revealed a massive clot in subarachnoid space, but no bleeding point. Serial angiography demonstrated dissection in one of the limbs of the fenestrated vertebral artery on the 25th day after the onset. On the 100th day, the lesion was spontaneously occluded. The patient is presently doing well at 8 years after surgery.
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  • —Case Report—
    Kazuhiro OHTAKARA, Yoshihiro KUGA, Kenichi MURAO, Tadashi KOJIMA, Waro ...
    2000 Volume 40 Issue 3 Pages 169-172
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    A 21-year-old female presented with an unusual case of posterior fossa arteriovenous malformation (AVM) associated with ipsilateral persistent primitive trigeminal artery (PPTA), manifesting as intraparenchymal hemorrhage involving both the brain stem and the left cerebellar hemisphere. The presenting symptoms were compatible with Wallenberg’s syndrome and Foville’s syndrome on the left side. She was initially treated conservatively, and subsequently with transarterial embolization followed by stereotactic radiosurgery. This case combined the rare association of posterior fossa AVM and PPTA, with the clinical presentation of intraparenchymal hemorrhage causing both Wallenberg’s syndrome and Foville’s syndrome.
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  • —Case Report—
    Andreas SCHOEGGL, Marion REDDY, Christian MATULA, Andreas CHOTT, Wolfg ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 3 Pages 173-175
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    Myelosarcomas are rare, solid extramedullary tumors composed of granulocyte precursors in most cases associated with leukemia. A 38-year-old nonleukemic female presented with a myelosarcoma of the cavernous sinus. After surgical removal of the cavernous sinus tumor she was treated by chemotherapy and whole brain radiation therapy. Despite this aggressive therapy, she died 4 months after surgical intervention.
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  • —Case Report—
    Yoshinobu IWASAKI, Kazutoshi HIDA, Kousuke ONISHI, Rina NANBA
    2000 Volume 40 Issue 3 Pages 176-178
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    A 26-year-old female, the elder of monozygotic twins, presented with slow progressive numbness and pain in her left arm. Magnetic resonance (MR) imaging showed syringomyelia with Chiari malformation. The patient’s birth had been difficult with prolonged delivery time, breech delivery, and neonatal asphyxia. MR imaging of the patient’s twin sister showed mild tonsillar ectopia, but absence of syringomyelia. This younger sister was born without problems. The patient underwent syringosubarachnoid shunt at the C5-6 level. The syrinx was collapsed promptly, and her symptoms disappeared. This case of syringomyelia with Chiari malformation in one of twins suggests that birth injury is likely to be a cause of the pathogenesis of syringomyelia.
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  • —Four Case Reports—
    Hiroji MIYAKE, Tomio OHTA, Shizuo OI, Yoshinaga KAJIMOTO, Daiji OGAWA
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 3 Pages 179-185
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    Four patients presented with isolated dilation of the trigono-inferior horn associated with either mass lesion at the trigone of the lateral ventricle or with shunt over-drainage. We investigated clinical symptoms, course, and neuroradiological findings of these cases. The pressure of the isolated ventricle was measured or estimated at surgery in all cases. The common symptoms were recent memory disturbance and contralateral homonymous hemianopia. Contralateral hemiparesis was observed occasionally. Rapid deterioration of the isolation caused uncal herniation in one case. Comma-shaped dilation of the inferior horn was observed in all cases. Midline shift was not conspicuous except in one case. Intraventricular pressure at surgery was 18 cmH2O, 35 cmH2O, 3 cmH2O, and within normal range. These cases had very similar clinical symptoms and neuroradiological findings. The pathophysiology of isolation suggested three types of isolation (high-, normal-, and low-pressure isolation), depending on the pressure of the isolated ventricle. The isolation of trigono-inferior horn is an important clinical entity as it may cause uncal herniation in patients with high-pressure lesions.
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