Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 40, Issue 5
Displaying 1-10 of 10 articles from this issue
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Original Articles
  • Preoperative Hyponatremia as a Clinical Characteristic in Elderly Patients With Large Pituitary Tumor
    Shigeru NISHIZAWA, Tetsuo YOKOYAMA, Naoki YOKOTA, Seiji OHTA
    2000 Volume 40 Issue 5 Pages 249-255
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.249
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    This study investigated the pathophysiology of preoperative hyponatremia in elderly patients with a large pituitary tumor. The tumor size, initial symptoms, and preoperative pituitary hormonal function were analyzed in 96 patients, consisting of 82 younger than 70 years old (mean age 49.7 years) and 14 older than 70 years old (mean age 72.0 years). There was no difference in tumor size between the two age groups. The initial symptom of all younger patients was visual disturbance. Preoperative hormonal evaluations revealed subclinical panhypopituitarism in four patients (4.9%). Five of the 14 older patients had severe hyponatremia (107-117 mEq/l) based on panhypopituitarism, and four of these five patients showed consciousness disturbance as the initial symptom, initiated by physical and/or psychological stress, or occurrence of intratumoral hemorrhage. Preoperative subclinical panhypopituitarism was found in another patient. The overall occurrence rate of preoperative panhypopituitarism in the older patients was 42.9%. The difference in the frequency of preoperative panhypopituitarism was statistically significant between the two groups. Preoperative severe hyponatremia associated with a large pituitary tumor is characteristic of elderly patients. The number of receptors for adrenocorticotropic hormone in the adrenal cortex decreases during the aging process. Additional physical and/or psychological stress prompts pituitary dysfunction in such patients, causing the manifestation of acute symptoms of adrenal insufficiency based on panhypopituitarism. Primary care using high dose hydrocortisone and electrolyte fluid is critical.
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  • Transduction Efficiency of Adenoviral Vectors into Human Glioma Cells Increased by Association with Cationic Liposomes
    Yasushi RYUKE, Masaaki MIZUNO, Atsushi NATSUME, Jun YOSHIDA
    2000 Volume 40 Issue 5 Pages 256-260
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.256
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    Replication-deficient adenoviral vectors are promising agents for human gene therapy of the greater transduction efficiency than other vectors. However, there are distinct disadvantages, including high immunogenicity, which limits the administration to human organs, particularly the brain. Injection of adenoviral vectors into the human brain causes inflammatory responses and induces cerebral edema. The combined effect of adenoviral vectors and cationic liposomes in vitro was investigated in an effort to reduce the immune reaction against the antigens of adenoviral vectors. No toxicity of adenoviral vector-associated liposomes was observed within optimal lipid concentration. The transduction efficiency of the adenoviral vectors containing the β-galactosidase gene increased almost 10-fold when associated with the cationic liposomes. Furthermore, greater cytotoxicity was induced when the adenoviral vector containing herpes simplex virus-thymidine kinase gene was combined with cationic liposomes than with only the adenoviral vector. These results suggest that the combination of adenoviral vectors and cationic liposomes allows the doses of adenoviral vectors to be reduced while maintaining transduction efficiency.
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Case Reports
  • Pseudoaneurysm of the Superficial Temporal Artery Following Craniotomy
    —Case Report—
    Masanori TSUTSUMI, Teruaki KAWANO, Tsutomu KAWAGUCHI, Yoshirou KANEKO, ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 5 Pages 261-263
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.261
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    A 48-year-old male without marked blood coagulation disorder developed a pseudoaneurysm of the superficial temporal artery (STA) following craniotomy. Cerebral angiography revealed a pseudoaneurysm on the parietal branch of the STA. Total extirpation was performed, and the postoperative course was uneventful. Most pseudoaneurysms of the STA develop after trauma. Lesions rarely develop after craniotomy. However, pseudoaneurysm of the STA should be considered as a possible surgical complication.
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  • Pulmonary Arteriovenous Fistula Manifesting as Amaurosis Fugax
    —Case Report—
    Munekazu YAMAKUCHI, Shigeya TANAKA, Tetsuzo TOMOSUGI, Koichi MOROKI, M ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 5 Pages 264-267
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.264
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    Pulmonary arteriovenous fistula (PAVF) is a rare condition which occasionally causes neurological complications. A 43-year-old female with multiple PAVFs presented with several episodes of amaurosis fugax and transient right hemiparesis. She had no other vascular abnormality, and her human leukocyte antigen haplotype did not coincide with previous patients with hereditary hemorrhagic telangiectasia. She underwent PAVF embolization to prevent further neurological complications, and had an uneventful subsequent clinical course. Amaurosis fugax is a slight neurological symptom and may be an early important sign of PAVF. We stress that PAVFs should be considered in the differential diagnosis of patients with amaurosis fugax who complain of exertional dyspnea or demonstrate cyanosis.
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  • Giant Aneurysm of the Pericallosal Artery Causing Acute Subdural Hematoma
    —Case Report—
    Seigo KOYAMA
    2000 Volume 40 Issue 5 Pages 268-271
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.268
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    A 66-year-old female presented with a very rare giant aneurysm of the distal pericallosal artery. She lost consciousness and was admitted. Computed tomography demonstrated a subdural hematoma over the left cerebral convexity and a mass in the frontal lobe. Cerebral angiography disclosed a giant aneurysm located on the distal segment of the right pericallosal artery. The subdural hematoma was removed and the aneurysmal neck was clipped, but she died 15 days after the operation. Autopsy found the giant aneurysm (33 × 30 × 27 mm) on the distal segment of the right pericallosal artery. Highly atheromatous changes were recognized in part of the aneurysmal wall, the arteries near the circle of Willis, and the distal anterior cerebral artery (ACA) adjacent to the aneurysm. There were no anomalous vessels such as azygos ACA. Giant aneurysms situated beyond the genu of the corpus callosum are extremely rare. Atherosclerosis was probably a major etiological factor in this case.
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  • Tentorial Meningioma Associated with Pathological Laughter
    —Case Report—
    Satoshi TSUTSUMI, Shizuo HATASHITA, Yoshiaki KADOTA, Kazuhiro ABE, Hid ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 5 Pages 272-274
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.272
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    A 33-year-old male presented with involuntary and inappropriate laughter. Neuroimaging revealed a meningioma ventrolateral to the pons and midbrain, attached to the medial middle tentorium on the left side. The pathological laughter ceased immediately after subtotal removal of the tumor. Pathological laughter may be an early focal sign of a mass compressing ventrolateral brainstem.
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  • Primary Malignant Lymphoma of the Cavernous Sinus
    —Case Report—
    Hirohiko ARIMOTO, Toshiki SHIROTANI, Hiroya NAKAU, Keizo HASHIZUME, Yu ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 5 Pages 275-279
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.275
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    A 59-year-old female presented with a very rare case of primary malignant lymphoma of the cavernous sinus manifesting as diplopia and right facial hypesthesia. Magnetic resonance (MR) imaging showed the tumor located in the right cavernous sinus as low intensity with marked enhancement by gadolinium. The tumor was partially removed by the transzygomatic extradural approach. The histological diagnosis was malignant lymphoma. Chest and abdominal computed tomography and gallium-67 scintigraphy revealed no other lesions in the body. The patient received conventional radiotherapy and her diplopia and right facial hypesthesia gradually improved. At 1 month after radiotherapy, MR imaging showed no evidence of residual tumor. Primary cavernous sinus malignant lymphoma is extremely rare, but should be considered in the differential diagnosis of cavernous sinus lesions. Histological confirmation of tumors in this region is essential for choosing the most appropriate treatment to achieve a better outcome.
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  • Unusual Massive Neurinoma in the Suboccipital Region
    —Case Report—
    Dattatraya MUZUMDAR, Ketan DESAI, Atul GOEL, Asha SHENOY
    2000 Volume 40 Issue 5 Pages 280-282
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.280
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    An 8-year-old boy with no evidence of von Recklinghausen’s disease presented with an unusual neurinoma manifesting as a gradually progressive swelling in the suboccipital region over 2 years. The lesion was massive and had widely eroded the posterior aspects of the atlas, axis, and suboccipital bone. The tumor had involved the dura of the sigmoid and transverse sinuses, was highly vascular, and had encased the ipsilateral vertebral artery. The tumor was almost completely resected although with considerable loss of blood through a large rent in the right sigmoid sinus. This unusual benign neurinoma most probably arose from the second cervical ganglion.
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  • Pineal Region Metastasis Appearing as Hypointensity on T2-Weighted Magnetic Resonance Imaging
    —Case Report—
    Hideki KANAI, Kazuo YAMADA, Noritaka AIHARA, Kenichi WATANABE
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 5 Pages 283-286
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.283
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    A 48-year-old female presented with headache and limitation of upward gaze. She had a history of total gastrectomy for gastric adenocarcinoma 2 years previously. Computed tomography with contrast medium and T1-weighted magnetic resonance (MR) imaging with gadolinium showed ring-like enhancement of a solitary mass in the pineal region with obstructive hydrocephalus. T2-weighted MR imaging showed the tumor as hypointense. This MR imaging finding complicated the preoperative diagnosis, but malignancy was suspected from the medical history. The tumor was subtotally resected via the occipital transtentorial approach with a rigid endoscope. Histological examination of the surgical specimen revealed adenocarcinoma cells with extensive coagulation necrosis, which might have contributed to the hypointensity on T2-weighted MR imaging. Correct diagnosis of metastatic adenocarcinoma based only on MR imaging may be difficult in such cases, but metastatic adenocarcinoma of the pineal region must be considered in the differential diagnosis of pineal tumors.
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  • Cerebral Blood Flow During Plateau Waves in a Patient With Benign Intracranial Hypertension
    —Case Report—
    Ryusuke KABEYA, Suguru INAO, Masanori TADOKORO, Masanari NISHINO, Jun ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 5 Pages 287-292
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.287
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    A 50-year-old male presented with benign intracranial hypertension (BIH). He was admitted to our hospital for headache and papilledema. The diagnosis was BIH as continuous monitoring of lumbar cerebrospinal fluid pressure (CSFP) showed high basal pressure with intermittent plateau waves. Ten months after successful ventriculoperitoneal shunting, he presented with headache again due to shunt malfunction. CSFP monitoring showed the same findings as before. Regional cerebral blood flow (rCBF) was measured by positron emission tomography (PET) using the 15O-labeled water autoradiographic method with simultaneous recording of lumbar CSFP. The rCBF values of the cerebral cortex, white matter, thalamus, cerebellar cortex, and pons were evaluated during both the plateau waves and the intervals. In spite of severely reduced cerebral perfusion pressure, rCBF during the plateau waves was not reduced when compared with the rCBF of normal volunteers in all regions. This result might explain why patients with BIH show no impairment of consciousness or focal signs during the plateau waves.
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