Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 40, Issue 4
Displaying 1-11 of 11 articles from this issue
Review Article
  • Takeshi MATSUYAMA, Margot MACKAY, Rajiv MIDHA
    2000 Volume 40 Issue 4 Pages 187-199
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    In this review, various conventional nerve repair techniques including direct epineurial repair, grouped fascicular repair, fascicular repair, and nerve grafting are described. The indications for use, as well as the relative advantage and disadvantage, of each technique are discussed. The experimental and clinical evidence from a review of the pertinent literature does not demonstrate a significant difference in outcome of one method over the others. Surgical decisions should be made by a thorough evaluation of all aspects of the nerve injury and surgical methods. All nerve injuries cannot be repaired using only one type of nerve repair method. The surgeon should be familiar with all the techniques described and be prepared to use them under appropriate circumstances.
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Original Articles
  • —With Special Reference to Prediction of Patient Outcome—
    Shigeru ADACHI, Nobuo HIRANO, Michiharu TANABE, Takashi WATANABE, Hiro ...
    2000 Volume 40 Issue 4 Pages 200-205
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    Quantification theory type II was used to predict the outcome of 63 patients with head injury. Age, sex, two factors based on neurological examination, and seven factors based on findings of skull radiography and computed tomography of the head were selected as predictors. Patient outcome was evaluated 6 months after injury and assigned to good recovery, severe disability, or death. Discriminant analysis of patient outcomes was performed using the 11 factors. Two category scores were obtained for each category, since the highest correlation ratios were 0.869 and 0.252, and others were less than 10-15. For each patient, a pair of sample scores was then obtained by simple summation of the 11 category scores. Pairs of sample scores were plotted, and the three groups of patient outcomes were clearly distinguishable without exception. These findings show that the outcome of patients with head injury can be accurately discriminated by quantitative analysis of qualitative data.
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  • Toshiro KATSUTA, Toshio MATSUSHIMA, Hung T. WEN, Albert L. RHOTON, Jr.
    2000 Volume 40 Issue 4 Pages 206-210
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    A microanatomical study of the hypoglossal canal and its surrounding area was carried out using dry skulls and cadaveric heads to determine the course of the hypoglossal nerve in the hypoglossal canal, especially the significance for the transcondylar approach. The hypoglossal nerve enters the superomedial part of the hypoglossal canal as two bundles, which then change course abruptly to an anterosuperior direction, and unite as one trunk before exiting the canal. The hypoglossal nerve has an oblique course in the canal rather than being located in the center, and exits through the inferolateral part of the canal. A venous plexus surrounds the entire length of the nerve bundles in the canal. The present results suggest that during drilling the occipital condyle toward the hypoglossal canal from behind, the surgeon does not need to be overly concerned even if some bleeding occurs from the posterolateral edge of the hypoglossal canal.
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Case Reports
  • —Case Report—
    Shinzo YOSHIDA, Kazutomo NAKAZAWA, Yoshifumi ODA
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 4 Pages 211-215
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    A 57-year-old male presented with a rare case of spontaneous vertebral arteriovenous fistula manifesting as radiculopathy of the right arm, subsequently associated with pulsating tinnitus and vascular bruit in the nape. He had a past history of chiropractic-induced vertebrobasilar infarction. Angiography showed a simple and direct fistula between the third segment of the right vertebral artery and the epidural veins at the C-1 level, where the artery runs backward above the arch of the C-1 just proximal to the penetration of the dura. The fistula was successfully obliterated by coil embolization, resulting in rapid improvement of the signs and symptoms. Mechanical compression to the nerve roots by the engorged epidural veins with arterial pressure was considered to be the major cause of radiculopathy. Vertebral artery dissection induced by chiropractic manipulation is most likely responsible for the development of the fistula.
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  • —Case Report—
    Tetsuro SAMESHIMA, Yoshihiro MORITA, Mitsuro YANAGITA, Shinichi NAKANO ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 4 Pages 216-219
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    A 29-year-old male with Down’s syndrome presented with severe headache and vomiting. Computed tomography demonstrated subarachnoid hemorrhage. Left carotid angiography showed severe stenosis of the middle cerebral artery 2 cm distal to its origin, as well as abnormal hypervascularization near the stenosis site similar to that seen in moyamoya disease. Right carotid angiography showed no abnormalities. However, slight stenosis of the distal part of the bilateral vertebral arteries was noted. There was no aneurysm. We judged that the subarachnoid hemorrhage had been caused by rupture of the moyamoya-like vessel. Some patients with Down’s syndrome have anatomical vascular abnormality and vascular fragility. The cerebral vascular abnormality found in this case may be part of the systemic vascular abnormalities associated with Down’s syndrome. The vascular changes in some adult patients with Down’s syndrome may be a sign of premature aging, and long-term studies with periodic vascular examination of patients with Down’s syndrome need to be performed.
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  • —Case Report—
    Shu HASEGAWA, Jun-ichiro HAMADA, Motohiro MORIOKA, Yutaka KAI, Akihito ...
    2000 Volume 40 Issue 4 Pages 220-223
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    A 15-year-old girl underwent partial removal of a pituitary adenoma followed by local irradiation of the brain with a total of 70 Gy through two lateral opposing ports. Twenty years later, she experienced frequent transient ischemic attacks with left sensory disturbance. Cerebral angiography revealed stenoses of the right distal middle cerebral artery (MCA) and the right distal posterior cerebral artery without net-like vessels. There was a severe decrease of vasoreactivity in the right hemisphere. Right superficial temporal artery (STA)-MCA anastomosis was performed. Her neurological deficits were resolved and perfusion reserve capacity had markedly improved 6 months later. We recomment STA-MCA anastomosis in such cases.
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  • —Two Case Reports—
    Takatomo YOSHIDA, Nobuyuki KAWANO, Hidehiro OKA, Kiyotaka FUJII, Yoich ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 4 Pages 224-229
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    We report two cases of “decade survivor” of glioblastoma. Case 1 is a 34-year-old female who developed a tumor in the left frontal pole, and Case 2 is a 46-year-old male with a left frontal tumor. Both tumors were surgically excised and the patients received postoperative chemo-radiotherapy. Histological re-evaluation of the resected tumor tissue confirmed the most malignant type of glioma-glioblastoma. We speculate that the entire extent of tumors had been extirpated by surgery in both cases.
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  • —Case Report—
    Dattatraya P. MUZUMDAR, Aadil S. CHAGLA, Atul GOEL
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 4 Pages 230-233
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    A 50-year-old female presented with a right acoustic schwannoma colocated with a cerebellopontine angle arachnoid cyst. The arachnoid cyst was distinct from the arachnoid cap surrounding the acoustic schwannoma. Initial excision of the arachnoid cyst created the space required to excise the schwannoma. The acoustic schwannoma had surprisingly dense adhesions to the brainstem, probably due to the constant pressure exerted by the cyst displacing the tumor towards the brainstem. The acoustic schwannoma was excised by meticulous dissection. Such a coexisting lesion should be suspected when a large cystic collection surrounds an acoustic schwannoma. Initial excision of the arachnoid cyst will prevent excessive cerebellar retraction.
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  • —Case Report—
    Tatsuhito YAMAGAMI, Nobuyuki KAWANO, Hiromi NAKANO
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 4 Pages 234-238
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    A 52-year-old male presented with calcification of the cervical ligamentum flavum manifesting as hypesthesia of the bilateral middle, ring, and little fingers and ulnar halves of both forearms, as well as motor weakness in the bilateral upper extremities and gait disturbance. Cervical x-ray tomography detected a round calcified mass on the posterior wall of the cervical canal at the C-5 level. Computed tomography showed the round, nodular calcified mass more clearly. Magnetic resonance imaging showed an epidural low intensity mass compressing and distorting the cervical cord at the C-5 level on both T1- and T2-weighted images. Administration of gadolinium-diethylenetriaminepenta-acetic acid caused marginal enhancement of the mass. The lesion was eventually removed by posterior laminectomy. The mass was composed of a very hard crystal-like calcified deposition in the ligamentum flavum. X-ray diffraction analysis of the histological specimen showed calcium pyrophosphate dihydrate (CPPD) and hydroxyapatite in the crystal-like substance, confirming that CPPD is responsible for calcification of the cervical ligamentum flavum.
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  • —Case Report—
    Hiromichi NAKAZAKI, Toshihide TANAKA, Akira ISOSHIMA, Toshiro HIDA, Ma ...
    2000 Volume 40 Issue 4 Pages 239-243
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    A 51-year-old female presented with an extremely rare case of idiopathic hypertrophic cranial pachymeningitis manifesting as markedly thickened frontotemporal meninges with expanding perifocal edema. Magnetic resonance imaging with gadolinium revealed enhancement of the thickened dura mater protruding into the brain parenchyma accompanied by focal edema causing a mass effect. Histological examination of a biopsy specimen revealed thickened dura with infiltrating lymphocytes. Serological and immunological tests were normal. No inflammatory response or evidence of malignant tumors was observed. The patient was treated with predonisolone, resulting in marked improvement of the mass effect. High-dose steroid therapy appears to be effective for intracranial pachymeningitis associated with expanding perifocal brain edema.
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