Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 41, Issue 3
Displaying 1-11 of 11 articles from this issue
Original Articles
  • Yoshihiro TAKANASHI, Tatsuhiro ISHIDA, Marc J. KIRCHMEIER, Ashfaq SHUA ...
    2001 Volume 41 Issue 3 Pages 107-114
    Published: 2001
    Released on J-STAGE: July 02, 2005
    JOURNAL OPEN ACCESS
    Pharmacological treatment for cerebral ischemia cannot attain sufficiently high concentrations of the drugs in the cerebrospinal fluid (CSF) without precipitating systemic side effects. The objective of this study is the development of a liposomal drug delivery system that maintains effective concentrations of protein kinase inhibitors fasudil in the CSF, resulting in neuroprotection against cerebral ischemia. Focal cerebral ischemia in rats was induced by middle cerebral artery occlusion using an intraluminal suture technique. Treated rats received 0.25 mg liposome-entrapped fasudil via the cisterna magna 2 hours after ischemic insult. Control rats received drug-free liposomes. Neurological condition and the infarct size were assessed at 24 and 72 hours after ischemia. The concentration of liposome-entrapped fasudil in the CSF was measured before sacrifice. Treated animals showed significantly improved neurological outcomes after the 24-hour observation period compared to the control group (p < 0.001). Treatment with 0.25 mg liposomal fasudil resulted in a reduction in the infarct area (24 hours: 29.0 ± 4.4%, 72 hours: 28.1 ± 3.9% of total brain slices) compared to controls (49.6 ± 4.6%, p < 0.001), but there was no statistical difference between 24 and 72 hours. At 24 hours post-administration, CSF concentrations of liposome-entrapped fasudil were 45.4 ± 31.5 μg/ml (20% of the injected dose). A single intrathecal injection of liposomal fasudil can maintain a therapeutic drug concentration in the CSF over a period of time, significantly decreasing infarct size in a rat model of acute ischemia.
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  • Toshihiko WAKABAYASHI, Yasukazu KAJITA, Masaaki MIZUNO, Tetsurou NAGAS ...
    2001 Volume 41 Issue 3 Pages 115-120
    Published: 2001
    Released on J-STAGE: July 02, 2005
    JOURNAL OPEN ACCESS
    An adjuvant chemotherapy regimen consisting of procarbazine, MCNU, and vincristine (PMV) was evaluated for the treatment of malignant oligodendroglial tumors. Ten patients with histologically proven oligodendroglial tumors were treated with PMV therapy and the effectiveness was assessed using magnetic resonance imaging. Four patients with primary tumors underwent PMV after radiation therapy, and six patients with recurrent tumors were treated using PMV only. Tumor response was defined as radiological evidence of mass size change after completion of three courses of PMV. Complete or partial responses (more than 50% reduction in tumor mass) were noted in six patients, and tumor growth stabilized in four patients. In particular, inhibition of tumor growth using PMV was achieved in three patients with recurrent oligodendroglial tumors, despite the initial response after chemoradiation therapy (interferon-β, MCNU, radiation) or nitrosourea chemotherapy (ACNU, MCNU). This PMV regimen (a modified PCV regimen using drugs available in Japan) is effective for treating malignant oligodendroglial tumors despite recurrence after other initial treatment procedures.
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  • Osamu KADOTA, Kanehisa KOHNO, Shiro OHUE, Yoshiaki KUMON, Saburo SAKAK ...
    2001 Volume 41 Issue 3 Pages 121-126
    Published: 2001
    Released on J-STAGE: July 02, 2005
    JOURNAL OPEN ACCESS
    Proton magnetic resonance (MR) spectroscopy was evaluated for the differentiation of brain abscesses and cystic brain tumors. Proton MR spectroscopy was performed in vivo in two patients with brain abscess and eight patients with various cystic brain tumors (anaplastic astrocytoma, glioblastoma, and metastatic brain tumor). MR imaging with contrast medium demonstrated ring-like enhanced mass lesions in all patients. The various resonance peaks in proton MR spectra were assigned to metabolites according to chemical shifts. Treatment of the cystic brain lesions was based on the information from proton MR spectroscopy. Aspirated pus from one patient with brain abscess was examined using ex vivo proton MR spectroscopy. The in vivo spectra of brain abscess contained resonance peaks attributed to acetate, lactate, alanine, amino acids, and lipids in both cases, and an additional peak of succinate in one case. In vivo spectra of the neoplasms contained resonance peaks corresponding to lactate, lipids, choline, creatine, and N-acetyl aspartate. Proton MR spectroscopy is useful for discriminating brain abscess from cystic tumors with similar neuroimaging appearance, which is very important for determining the treatment strategy.
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Case Reports
  • —Case Report—
    Ketan DESAI, Trimurti NADKARNI, Dattatraya MUZUMDAR, Atul GOEL
    2001 Volume 41 Issue 3 Pages 127-130
    Published: 2001
    Released on J-STAGE: July 02, 2005
    JOURNAL OPEN ACCESS
    A 4-month-old female child presented with a huge posterior fossa mass lesion and severe hydrocephalus. Six hours after a ventriculoperitoneal shunt procedure, her condition worsened and she died. Autopsy showed extensive intracranial hemorrhage due to rupture of a posterior inferior cerebellar artery aneurysm. The probable causes of the rupture of the aneurysm were mechanical effects or changes in cerebral blood flow.
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  • —Case Report—
    Masaru OHTA, Haruo MATSUNO
    2001 Volume 41 Issue 3 Pages 131-134
    Published: 2001
    Released on J-STAGE: July 02, 2005
    JOURNAL OPEN ACCESS
    A 72-year-old male presented with a post-traumatic false aneurysm of the right proximal M2 artery with massive subarachnoid hemorrhage after closed head injury. Serial computed tomography (CT) and angiography showed the development of the aneurysm which was verified at autopsy. He was admitted in a drowsy state just after a motorcycle accident. Initial brain CT showed subarachnoid hemorrhage without skull fracture. Follow-up brain CT showed a huge hematoma in the right temporal lobe. He died 47 hours after the accident. Histological examination of the aneurysm showed a false aneurysm. Delayed diagnosis of traumatic aneurysms leads to high mortality, so early surgical treatment is essential to save such patients.
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  • —Two Case Reports—
    Miki FUJIMURA, Michiharu NISHIJIMA, Kunihiko UMEZAWA, Hiroyuki KON, Te ...
    2001 Volume 41 Issue 3 Pages 135-139
    Published: 2001
    Released on J-STAGE: July 02, 2005
    JOURNAL OPEN ACCESS
    A 48-year-old male and a 39-year-old female presented with subarachnoid hemorrhage (SAH) due to ruptured anterior communicating artery aneurysms. Both patients were comatose on admission. Chest radiography disclosed pulmonary edema. They were conservatively treated under controlled ventilation, but cardiopulmonary dysfunction persisted over 2 days. The patients were then treated by intra-aneurysmal embolization with Guglielmi detachable coils (GDCs) 2 days after the onset. The postoperative courses were uneventful, and the patients showed full recovery from pulmonary edema and were discharged without neurological deficits. Neurogenic pulmonary edema is one of the serious complications of SAH, and is a leading cause of poor clinical outcome. The favorable outcomes of the present cases suggest that intra-aneurysmal embolization with GDCs is an excellent choice for the patients with severe aneurysmal SAH complicated with pulmonary edema, in whom conventional surgical treatment under general anesthesia is difficult to perform in the acute stage.
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  • —Two Case Reports—
    Noriyuki KATO, Takashi TSUNODA, Akira MATSUMURA, Kiyoyuki YANAKA, Tada ...
    2001 Volume 41 Issue 3 Pages 140-143
    Published: 2001
    Released on J-STAGE: July 02, 2005
    JOURNAL OPEN ACCESS
    Coronal magnetic resonance imaging provided evidence of redistribution during the rapid spontaneous resolution of acute subdural hematoma (ASDH) in two patients. A 79-year-old female was transferred to our hospital after a traffic accident. Computed tomography (CT) on admission demonstrated an ASDH in the right frontal cerebral cortex. CT 12 hours after the accident revealed spontaneous resolution of the ASDH. Coronal magnetic resonance (MR) imaging 3 days after the accident clearly detected a very thin, sharply demarcated layer diffusely covering the cerebral convexity and the middle cranial fossa. A 41-year-old female fell and sustained head trauma with the loss of consciousness. CT on admission demonstrated an ASDH in the left frontal cerebral cortex. CT 12 hours after the accident revealed spontaneous resolution of the ASDH. Coronal MR imaging 3 days after the insult clearly demonstrated the redistribution and dispersal of the hematoma. Although CT showed the disappearance of the hematoma, MR imaging demonstrated redistribution rather than disappearance of the blood in both cases. These cases indicate that spontaneous resolution of ASDH occurs by redistribution and dispersal of the hematoma.
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  • —Case Report—
    Kimiaki HASHIGUCHI, Takanori INAMURA, Kazuo IRITA, Michie ABE, Eiichir ...
    2001 Volume 41 Issue 3 Pages 144-148
    Published: 2001
    Released on J-STAGE: July 02, 2005
    JOURNAL OPEN ACCESS
    Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome can occur at any time in the course of pregnancy and is associated with many complications including fatal stroke. A 37-year-old female presented with HELLP syndrome causing an intracerebral hematoma, which was treated by evacuation and mild hypothermia. Unexpected diffuse cerebral swelling occurred on the 15th day of the initially favorable postoperative course. Considerable impairment of consciousness persisted despite conservative therapy. Serial computed tomographic findings indicated delayed cerebral vasospasm as the cause of the swelling. Particularly careful management is required even beyond the first 2 weeks for patients with stroke as a complication of HELLP syndrome.
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  • —Case Report—
    Tomosato YAMAZAKI, Atsurou TSUKADA, Kazuya UEMURA, Hiroaki SATOU, Kouj ...
    2001 Volume 41 Issue 3 Pages 149-153
    Published: 2001
    Released on J-STAGE: July 02, 2005
    JOURNAL OPEN ACCESS
    A 62-year-old male presented with a rare intraosseous meningioma with intradural extension manifesting as frequent vomiting and floating sensation that had persisted for 3 months. Neuroimaging detected a mass lesion that was mainly located extradurally in the right posterior fossa with a daughter lesion inside the dura. He underwent surgical excision of the mass lesion. Craniectomy exposed the main lesion of the tumor just beneath the thinned outer table of the skull, and in the extradural space, with the daughter lesion penetrating the dura. Both portions of the tumor were resected. There was no attachment to the adjacent dura mater. Histological examination showed meningotheliomatous meningioma containing scattered bony tissue. This intraosseous meningioma probably originated from the occipital bone with a small intradural extension caused by mechanical compression.
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  • —Two Case Reports—
    Koji YOSHIMOTO, Iwao TAKESHITA, Takuya INOUE, Tatsumi YAMAGUCHI, Masar ...
    2001 Volume 41 Issue 3 Pages 154-159
    Published: 2001
    Released on J-STAGE: July 02, 2005
    JOURNAL OPEN ACCESS
    A 37-year-old male and an 18-year-old male presented with spontaneous spinal cerebrospinal fluid (CSF) leakage from multiple nerve root sleeves. Both patients suffered abrupt onset of intense headache followed by nausea, dizziness, and one patient with and one without positional headache. Radioisotope spinal cisternography of both patients revealed that the CSF leaks were not localized in a special zone but distributed to multiple spinal nerve root sleeves. Magnetic resonance (MR) myelography suggested that the spinal CSF column was fully expanded to the root sleeves. The extraspinal nerve bundles demonstrated numerous high intensity spots. Both patients were treated conservatively, and their symptoms resolved within one month. Repeat radioisotope cisternography and MR myelography confirmed the spine was normal after recovery. We suggest that spreading disruption of the arachnoid membrane occurs at the nerve root sleeves due to CSF overflow into the spinal canal.
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  • —Case Report—
    Eiichirou URASAKI, Hideoki YASUKOUCHI, Akira YOKOTA
    2001 Volume 41 Issue 3 Pages 160-162
    Published: 2001
    Released on J-STAGE: July 02, 2005
    JOURNAL OPEN ACCESS
    A 14-year-old Japanese boy presented with myelopathy due to atlas hypoplasia with complete posterior arch. Decompressive laminectomy of the atlas produced good neurological recovery, and follow-up T2-weighted magnetic resonance imaging showed disappearance of spinal cord edema. Congenital atlas stenosis may be symptomatic even in children, with no accompanying cervical spondylotic change. Such cases have previously occurred only in Asian adults. A radiological study of the patient's brother showed median cleft formation of the posterior arch of atlas, indicative of a wide spectrum of atlas anomalies and a possible genetic relationship between these anomalies.
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